5.3 Quantifying health outcomes in economics

A key issue in health economics is how to most productively deploy limited healthcare resources. These decisions necessarily involve weighing the health impacts of distinct interventions against each other. For example, decision-makers have to decide whether intervention to reduce AMR is more important to implement than an intervention for tuberculosis or the hepatitis C virus.

As such, universal measures were developed in an attempt to quantify impacts on all health conditions in a fair and consistent way. To do so, these measures need to consider that health burdens can be realised in two ways:

• mortality (i.e. health conditions that can cause premature death)
• morbidity (i.e. health conditions that can have symptoms or contribute to poor health whilst alive).

The two most commonly used measures of this type are disability-adjusted life years (DALYs) and quality-adjusted life years (QALYs). DALYs are more commonly used in low- and middle-income contexts and, as such, are what you are focusing on in this course, but more information about QALYs can be found elsewhere (De Silva et al., 2023). Alternatively, some economic analyses use other natural units to quantify the health outcomes, such as number of deaths, number of new disease cases or number of antibiotics prescribed.

There have also been recent efforts to develop additional outcome metrics that reflect the One Health nature of AMR. For example, researchers developed a modified DALY metric for zoonotic diseases, known as the zDALY, that considers both human health and the impact of poor animal health on its owner in terms of the time that might be required to replace that animal. Further information on the zDALY can be found online (Torgerson et al., 2018).