Measure-dependent variation in burden of disease estimates: Implications for policy

BACKGROUND. Health adjusted life years (HALYs) are used for estimating burden of disease and as outcomes in cost-effectiveness analyses of medical care and public health interventions. OBJECTIVES. The impact of use of health-related quality of life (HRQL) scores associated with the disability-adjusted life year (DALY), the quality-adjusted life year (QALY), and the years of healthy life (YHL) measure on burden of disease estimates by income and race for five illnesses was studied. RESEARCH DESIGN. Abridged life tables were constructed using 1997 death certificate data from the National Center for Health Statistics. These tables were then quality-adjusted using prevalence data from the National Health Interview Survey and HRQL scores obtained using the Quality of Well-Being scale, the DALY, and the YHL measure to estimate burden of disease for five common diseases. Separate estimates were made for low and higher income families as well as black persons and white persons. RESULTS. Measure-related burden of disease estimates differed substantially from one an-other. Rank order of disease burden was not maintained across measures. Discrepancies in the rank order of disease were greater when different sociodemographic groups were examined. CONCLUSIONS. Diseases and demographic groups will receive differing priorities for intervention or research depending on which measurement system is used to inform decision-making. Refinement and standardization of measures is necessary to enhance their utility for medical care and public health policy applications.