Putting Health Metrics Into Practice:
Using the Disability-Adjusted Life Year
(DALY) for Strategic Decision Making
Kim Longfield
Brian Smith
Rob Gray
Lek Ngamkitpaiboon
Nadja Vielot
9th World Congress on Health Economics
Sydney, Australia
July 8, 2013
Background
 66 developing countries
 More than 60 products
and services
What is a DALY?
A year of healthy life lost to death or illness
Disability-Adjusted Life Year
page 3
Methods
PSI’s health impact calculated over 10-year period (2001-2011)
Models developed to estimate impact of
products and services
Outputs from models are coefficients
Coefficients multiplied by country-level
sales, distribution, and service utilization
figures
DALYs averted routinely reported by program area,
geographic region, and country
Case studies used most up-to-date country-level
coefficients (2011)
page 4
Results: PSI Impact by Health Area, Global
79.7
DALYs averted,
Actions million
Taken:
2007-2011
Recognized
in by
health
impact through
free
Doubled
healthgains
impact
2011,
Malaria
58%
distribution
averted 22.8 million DALYs
HIV/AIDS
Expanded “relevance” to target new health
conditions: 24%
acute respiratory infections (pneumonia), TB, nutrition
Scaled up successful interventions
page 5
Family Planning
15%
Results: PSI Impact by Region, Asia/EE
Actions Taken:
Just 7% of PSI’s overall
Greater
examination of burdenhealth
of disease
impact
averted,
2007-2011
5.3 million DALYs
Included Burden
“relevance”of
metric
in regional
strategic plan
Disease
(BOD)
Started identifying new funding sources
Pilots in TB diagnosis and treatment, hypertension,
tobacco control, cervical cancer screening and treatment
Integrated high BOD interventions into existing programs
Largest
Child Survival 24%
Expanded facility-based
interventions
increases
in
21%
DALYs averted: Malaria
page 6
Results: PSI Impact, Laos
Actions Taken:
Burden
of Disease
Shifted strategic
direction
Secured
funding
to launch projects in FP (IUD), maternal
Between 1999
and 2006,
focus
health
(Miso),
was primarily
on HIV
and nutrition (Micronutrient Sprinkles), WASH,
and TB
malaria prevention
Increased capacity of staff in new health conditions
BOD actually concentrated in
pneumonia,Developed
unmet need
for
capacity
of private sector for new interventions
family planning (FP), nutritional
Better
deficiencies,
TB targeted HIV and malaria interventions
Continue to seek funding for pneumonia and other high
BOD areas
page 7
Results: PSI Impact, Laos
Performance:
PSI/Laos hovered at bottom of
list of DALYs-averting countries
Lower condom distribution
reduced health impact for
HIV/AIDS and FP
Condom distribution dropped for general population; condom
use among key populations rose
DALYs averted in 2011 started to increase due to new FP and
TB interventions
Growth expected to continue with new interventions in FP,
nutrition, WASH, and TB
page 8
Limitations of Using DALYs Averted
Change management required for adoption of metric and
updates to estimates
Building and maintaining tailored models is resource
intensive
Current models do not consider combined effects,
competing risks, or trade-offs between different
intervention options
Capturing health impact for behavior change
communication (BCC) requires population-based surveys
Data for model development sometimes limited
page 9
Conclusions
PSI’s adoption of DALYs Averted shifted the organizational
focus from product sales to BOD and helped the organization
double its health impact
More targeted strategy – decisions
now based on scale and relevance
Greater diversification in interventions
and country programs, but securing
funding can be difficult
More responsive to potential funding
sources and alternative distribution
strategies
page 10
DALYs Averted are just one of
several factors for decision making
Policy environment
Strategic advantage
Logistical feasibility
Funding
Thank You
Kim Longfield
Director, Research & Metrics
Brian Smith
Vice President and Senior Regional Director,
Asia and Eastern Europe
[email protected]
Nadja Vielot
Senior Research Assistant
Lek Ngamkitpaiboon
Data Analyst
Rob Gray
Country Representative, Laos