Global Patterns of QALY and DALY Use in Surgical Cost-Utility Analyses: A Systematic Review.
<h4>Background</h4>Surgical interventions are being increasingly recognized as cost-effective global priorities, the utility of which are frequently measured using either quality-adjusted (QALY) or disability-adjusted (DALY) life years. The objectives of this study were to: (1) identify...
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2016-01-01
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| author | Arturo J Rios-Diaz Jimmy Lam Margarita S Ramos Andrea V Moscoso Patrick Vaughn Cheryl K Zogg Edward J Caterson |
| author_facet | Arturo J Rios-Diaz Jimmy Lam Margarita S Ramos Andrea V Moscoso Patrick Vaughn Cheryl K Zogg Edward J Caterson |
| author_sort | Arturo J Rios-Diaz |
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| description | <h4>Background</h4>Surgical interventions are being increasingly recognized as cost-effective global priorities, the utility of which are frequently measured using either quality-adjusted (QALY) or disability-adjusted (DALY) life years. The objectives of this study were to: (1) identify surgical cost-effectiveness studies that utilized a formulation of the QALY or DALY as a summary measure, (2) report on global patterns of QALY and DALY use in surgery and the income characteristics of the countries and/or regions involved, and (3) assess for possible associations between national/regional-income levels and the relative prominence of either measure.<h4>Study design</h4>PRISMA-guided systematic review of surgical cost-effectiveness studies indexed in PubMed or EMBASE prior to December 15, 2014, that used the DALY and/or QALY as a summary measure. National locations were used to classify publications based on the 2014 World Bank income stratification scheme into: low-, lower-middle-, upper-middle-, or high-income countries. Differences in QALY/DALY use were considered by income level as well as for differences in geographic location and year using descriptive statistics (two-sided Chi-squared tests, Fischer's exact tests in cell counts <5).<h4>Results</h4>A total of 540 publications from 128 countries met inclusion criteria, representing 825 "national studies" (regional publications included data from multiple countries). Data for 69.0% (569/825) were reported using QALYs (2.1% low-, 1.2% lower-middle-, 4.4% upper-middle-, and 92.3% high-income countries), compared to 31.0% (256/825) reported using DALYs (46.9% low-, 31.6% lower-middle-, 16.8% upper-middle-, and 4.7% high-income countries) (p<0.001). Studies from the US and the UK dominated the total number of QALY studies (49.9%) and were themselves almost exclusively QALY-based. DALY use, in contrast, was the most common in Africa and Asia. While prominent published use of QALYs (1990s) in surgical cost-effectiveness studies began approximately 10 years earlier than DALYs (2000s), the use of both measures continues to increase.<h4>Conclusion</h4>As global prioritization of surgical interventions gains prominence, it will be important to consider the comparative implications of summary measure use. The results of this study demonstrate significant income- and geographic-based differences in the preferential utilization of the QALY and DALY for surgical cost-effectiveness studies. Such regional variation holds important implications for efforts to interpret and utilize global health policy research. PROSPERO registration number: CRD42015015991. |
| format | Article |
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| spelling | doaj-art-c2fbc8ec8b1348cf8b86d81ad3594d702025-08-20T03:27:33ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-01112e014830410.1371/journal.pone.0148304Global Patterns of QALY and DALY Use in Surgical Cost-Utility Analyses: A Systematic Review.Arturo J Rios-DiazJimmy LamMargarita S RamosAndrea V MoscosoPatrick VaughnCheryl K ZoggEdward J Caterson<h4>Background</h4>Surgical interventions are being increasingly recognized as cost-effective global priorities, the utility of which are frequently measured using either quality-adjusted (QALY) or disability-adjusted (DALY) life years. The objectives of this study were to: (1) identify surgical cost-effectiveness studies that utilized a formulation of the QALY or DALY as a summary measure, (2) report on global patterns of QALY and DALY use in surgery and the income characteristics of the countries and/or regions involved, and (3) assess for possible associations between national/regional-income levels and the relative prominence of either measure.<h4>Study design</h4>PRISMA-guided systematic review of surgical cost-effectiveness studies indexed in PubMed or EMBASE prior to December 15, 2014, that used the DALY and/or QALY as a summary measure. National locations were used to classify publications based on the 2014 World Bank income stratification scheme into: low-, lower-middle-, upper-middle-, or high-income countries. Differences in QALY/DALY use were considered by income level as well as for differences in geographic location and year using descriptive statistics (two-sided Chi-squared tests, Fischer's exact tests in cell counts <5).<h4>Results</h4>A total of 540 publications from 128 countries met inclusion criteria, representing 825 "national studies" (regional publications included data from multiple countries). Data for 69.0% (569/825) were reported using QALYs (2.1% low-, 1.2% lower-middle-, 4.4% upper-middle-, and 92.3% high-income countries), compared to 31.0% (256/825) reported using DALYs (46.9% low-, 31.6% lower-middle-, 16.8% upper-middle-, and 4.7% high-income countries) (p<0.001). Studies from the US and the UK dominated the total number of QALY studies (49.9%) and were themselves almost exclusively QALY-based. DALY use, in contrast, was the most common in Africa and Asia. While prominent published use of QALYs (1990s) in surgical cost-effectiveness studies began approximately 10 years earlier than DALYs (2000s), the use of both measures continues to increase.<h4>Conclusion</h4>As global prioritization of surgical interventions gains prominence, it will be important to consider the comparative implications of summary measure use. The results of this study demonstrate significant income- and geographic-based differences in the preferential utilization of the QALY and DALY for surgical cost-effectiveness studies. Such regional variation holds important implications for efforts to interpret and utilize global health policy research. PROSPERO registration number: CRD42015015991.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0148304&type=printable |
| spellingShingle | Arturo J Rios-Diaz Jimmy Lam Margarita S Ramos Andrea V Moscoso Patrick Vaughn Cheryl K Zogg Edward J Caterson Global Patterns of QALY and DALY Use in Surgical Cost-Utility Analyses: A Systematic Review. PLoS ONE |
| title | Global Patterns of QALY and DALY Use in Surgical Cost-Utility Analyses: A Systematic Review. |
| title_full | Global Patterns of QALY and DALY Use in Surgical Cost-Utility Analyses: A Systematic Review. |
| title_fullStr | Global Patterns of QALY and DALY Use in Surgical Cost-Utility Analyses: A Systematic Review. |
| title_full_unstemmed | Global Patterns of QALY and DALY Use in Surgical Cost-Utility Analyses: A Systematic Review. |
| title_short | Global Patterns of QALY and DALY Use in Surgical Cost-Utility Analyses: A Systematic Review. |
| title_sort | global patterns of qaly and daly use in surgical cost utility analyses a systematic review |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0148304&type=printable |
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