Disability-adjusted life years: a critical review

J Health Econ. 1997 Dec;16(6):685-702. doi: 10.1016/s0167-6296(97)00005-2.


The disability-adjusted life year (DALY) has emerged in the international health policy lexicon as a new measure of the 'burden of disease'. We argue that the conceptual and technical basis for DALYs is flawed, and its assumptions and value judgements are open to serious question. In particular, the implications of age-weighting and discounting are found to be unacceptable. Moreover, the proponents of DALYs do not distinguish between the exercises of measuring the burden of disease and of allocating resources. But the appropriate information sets for the two exercises are quite different. Allocating resources by aggregate DALY-minimization is shown to be inequitable.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Cost of Illness*
  • Cost-Benefit Analysis / methods
  • Disabled Persons*
  • Evaluation Studies as Topic
  • Health Care Rationing / economics
  • Health Care Rationing / methods
  • Health Services Research / methods
  • Health Status Indicators*
  • Humans
  • Life Expectancy
  • Models, Economic*
  • Public Sector
  • Social Justice
  • Treatment Outcome
  • Value of Life*