Adjusting life for quality or disability: stylistic difference or substantial dispute?

This paper focuses on the contrast between describing the benefit of a healthcare intervention as gain in health (QALY-type ideas) or a disability reduction (DALY-type ideas). The background is an apparent convergence in practice of the work conducted under both traditions. In the light of these methodological developments, we contrast a health planner who wants to maximise health and one who wants to minimise disability. To isolate the effect of framing the problem from a health or a disability perspective, we do not use age-weighting in calculating DALY and employ a common discounting methodology and the same set of quality of life weights. We find that interventions will be ranked in a systematically different way. The difference, however, is not determined by the use of a health or a disability perspective but by the use of life expectancy tables to determine the years of life lost. We show that this feature of the DALY method is problematic and we suggest its dismissal in favour of a fixed reference age rendering the use of a health or a disability perspective merely stylistic. Copyright © 2008 John Wiley & Sons, Ltd.