Leprosy Mailing List – July 8, 2015
Ref.: (LML) Disability Adjusted Life Years (DALYs)
From: Joel Almeida, Kochaikanal, India
Dear Pieter,
Getting DALY estimates right could be the important first step in rebuilding the political will to fight leprosy. Otherwise our aspirations for better health among our beloved patients and populations could be empty: like a wonderful car which has maps, satellite navigations, steering wheel, tyres, 4 wheel drive engine, headlights, and everything except fuel.
As I wrote to an interested colleague:
GBD (global burden of disease) 2013 from the IHME (Institute for Health Metrics & Evaluation), as published in the Lancet 2015, states:
"YLD (years lost to disability) estimates for leprosy increased by 560% (from 6,046 to 37,922 YLDs) from the GBD 2010 to the GBD 2013."*
Previous errors in estimation are being corrected. However, the correction still appears inadequate. That's what needs to be written up.
* Supplement to: Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; published online June 8. http://dx.doi.org/10.1016/S0140-6736(15)60692-4.
What can leprosy projects do to help correct the DALY underestimates for leprosy? Do sample surveys of populations to enumerate and describe:
1) How many leprosy-affected people are found in a defined geographical area? (prevalence of leprosy-affected persons)
2) What are the sequelae of leprosy (physical or emotional or both) in each such person?
That will enable authoritative calculation of YLD (years lost to disability) for leprosy, which are given by:
Prevalence of sequelae x average disability weight of these sequelae
We could go one step further and determine the disability weight of these sequelae independently; by following the methods of the GBD study (ask a panel of ordinary people which of 2 sequelae they would rather suffer from, repeating this until we arrive at a disability weight for the sequelae of leprosy).
The projected (marginal) cost-effectiveness of interventions can then be calculated as:
(increased financial outlay required for a given intervention) / (projected YLDs averted by the intervention)
That tells us the projected marginal cost per DALY loss averted.
This is the game that decision-makers play, a game which allocates and re-allocates resources (or even raises new finance) by the billions of dollars each year. We need to learn the game and play it well, on behalf of our beloved patients and populations at risk. They trust us to do our best. Let's do it, let's transform the prospects for them.
Regards,
Joel Almeida
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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