Measuring the Benefits of Healthcare: DALYs and QALYs – Does the Choice of Measure Matter? A Case Study of Two Preventive Interventions

Abstract Background: The measurement of health benefits is a key issue in health economic evaluations. There is very scarce empirical literature exploring the differences of using quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) as benefit metrics and their potential impact in decision-making. Methods: Two previously published models delivering outputs in QALYs, were adapted to estimate DALYs: a Markov model for human papilloma virus (HPV) vaccination, and a pneumococcal vaccination deterministic model (PNEUMO). Argentina, Chile, and the United Kingdom studies were used, where local EQ-5D social value weights were available to provide local QALY weights. A primary study with descriptive vignettes was done (n=73) to obtain EQ-5D data for all health states included in both models. Several scenario analyses were carried-out to evaluate the relative importance of using different metrics (DALYS or QALYs) to estimate health benefits on these economic evaluations. Results: QALY gains were larger than DALYs avoided in all countries for HPV, leading to more favorable decisions using the former. With discounting and age-weighting –scenario with greatest differences in all countries– incremental DALYs avoided represented the 75%, 68%, and 43% of the QALYs gained in Argentina, Chile, and United Kingdom respectively. Differences using QALYs or DALYs were less consistent and sometimes in the opposite direction for PNEUMO. These differences, similar to other widely used assumptions, could directly influence decision-making using usual gross domestic products (GDPs) per capita per DALY or QALY thresholds. Conclusion: We did not find evidence that contradicts current practice of many researchers and decision-makers of using QALYs or DALYs interchangeably. Differences attributed to the choice of metric could influence final decisions, but similarly to other frequently used assumptions

Assistência institucionalizada a indivíduos portadores de deficiência mental: dimensões esquecidas Institutionalized assistence to the mental deficiency's patients: forgetables dimensions

O estudo foi realizado em uma instituição que existe indivíduos portadores de deficiência mental. Aqui denominada CASA GRANDE, a instituição abriga cerca de 900 internos. O cuidado direto aos internos é prestado por aproximadamente 400 pajens, formalmente subordinadas ao Serviço de Enfermagem. O propósito desse estudo foi conhecer e compreender como se dá o trabalho das pajens nesse contexto. Para tanto, partiu-se das representações que estas tem à respeito desse cuidar. A análise dessas representações propiciou a compreensão da dimensão simbólica desse trabalho, bem como da psicodinâmica aí compreendida, tanto ao nível da mulher trabalhadora, grupo e instituição.<br>This study was carried out in en institution which assists mentally impaired individuals, and are kept as inters. The institution, herein denominated CASA GRANDE, houses approximately 900 interns. The direct care of the is providad by, on average, 400 nursing assistants. The purpose of this study was to gain knowlwdge of, and comprehend, to work of the nursing assistants in this context, through the representations they have regarding their daily chores. The analysis of these representations provided the compreension of the symbolic dimension of the work, having demonstrated its movements in the psyco-social (individual), social-dynamic (group), institutional (institution) and societal (community) levels