PubMed · 10568610
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R Coleman. 1999-11-13. Disability in developing countries.. https://doi.org/10.1016/s0140-6736(05)76730-1
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PURPOSE: The Disability Adjusted Life Year (DALY) is a unit that was developed for use in cost-effectiveness analysis and epidemiology studies. It is a combined measure of both death and disability, and has been extensively utilized in several countries and across various conditions. The purpose of this paper is to examine the implications for rehabilitation of the widespread use of this measure. METHOD: The premises upon which the disability weight were developed are examined in the light of existing literature. CONCLUSION: It is concluded that, whereas the incorporation of the impact of disability on disease burden is to be lauded, the DALY is insensitive to changes in disability status. Consequently, resource allocation to rehabilitation activities based on cost-effectiveness analysis using DALYs may be diminished. There is also a dearth of epidemiological information relating to disability and it is incumbent on rehabilitation professionals to address this lack. The DALY protocol is under revision and those concerned with rehabilitation issues should contribute to the debates surrounding cost-effectiveness analysis and the units that are used to determine the effectiveness component.
Before the introduction of screening for type 2 diabetes, it is necessary to evaluate not only the technology, but also the patient perspective, the economical consequences, and the organising aspects. A review of the relevant literature shows that type 2 diabetes is a rapidly increasing, serious disease. However, there is no documentation that systematic screening will have a positive effect on morbidity and mortality, owing to the lack of randomised clinical trials. The methods for screening could be optimised, and there is a lack of literature on patient perspective. Economical models indicate that opportunistic screening is more cost-effective than is systematic screening, but the lack of randomised trials makes the conclusion dubious. A decision to introduce systematic screening for type 2 diabetes should await the results of ongoing randomised clinical trials. In the meantime, efforts should be spent on improving the level of care for those already diagnosed with diabetes.
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