GRAP 2017 – Need for Common Discount Rate in Economic Evaluation (01-Larson)
GRAP Project:
A common discount rate should be used when estimating costs and disability-adjusted life years (DALYs) for priority setting and economic evaluation
Faculty / Researcher Mentor: Bruce Larson
Description Statement:
Disability-adjusted life years (DALYs) lost are used for two main purposes: (1) for assessing the global burden of disease; and (2) as an effectiveness measure for cost-effectiveness analyses. DALYs lost from a death today (e.g., road accident) is simply the present value of the expected years of life lost. When estimating this present value, the question of discounting arises. Should DALYs be based on a 0% or positive discount rate?
Beginning with the 2010 global burden of disease study, country-specific and global estimates of the burden disease have assumed a 0% social discount rate for estimating DALYs [1]. While burden-of- disease type studies may decide to use a 0% social discount rate, for actual evaluations of interventions and policies to improve public health, where both effectiveness and costs of interventions must be assessed, DALYs used as an effectiveness measure should use the same discount rate as used for estimating costs.
The purpose of this GRAP project is to work with Larson to write a short paper that reviews the literature using DALYs (the burden of disease literature and cost-effectiveness analyses) to highlight this inconsistency and explain why a positive discount rate should be used.
The initial target journal is Health Policy and Planning (see: https://academic.oup.com/heapol/pages/General_Instructions#HOW%20TO%20DO…OR%20NOT%20TO%20DO )
Scope of Work:
- Learn and or refresh understanding of how to calculate DALYs.[2][3]
- Complete short literature review of the main global burden of disease reports (e.g., beginning with reference 1) and write up a short synthesis of the literature confirming a 0% discount is used.
- Complete a short literature review identifying 10-15 articles since 2012 that use DALYs as an effectiveness measure as part of a cost-effectiveness analysis that highlights the discount rate used for cost and DALYs estimates.
- Collaborate with Larson to write a short paper for submission to a journal (target HPP).
Minimum skills desired:
- Conduct literature search mainly used PubMed
- Use Mendeley as a reference manager
- Some prior, basic knowledge of DALYs and cost-effectiveness analysis would preferred but not required
- Ability to write clearly
Time / Date Expectations:
4 hours per week for approximately 10 weeks (start date and be flexible)
Number of Positions: One
Logistics & Support: It is expected that the candidate will have access to a computer.
References
- Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380: 2197–2223. doi:10.1016/S0140-6736(12)61689-4
- Larson BA. Calculating disability-adjusted-life-years lost (DALYs) in discrete-time. Cost Eff Resour Alloc. England; 2013;11: 18. doi:10.1186/1478-7547-11-18
- Fox-Rushby J a, Hanson K. Calculating and presenting disability adjusted life years (DALYs) in cost-effectiveness analysis. Health Policy Plan. 2001;16: 326–331. doi:10.1093/heapol/16.3.326
