Burden of disease calculation, cost of illness analysis and demand for death: a theoretical review

Abstract

The works of Murray and co-workers on calculating Burden of Disease (BoD), and even the analysis of Cost of Illness (CoI), to fully understand the priority areas for public health intervention, have sparked controversies in health economics. This paper joins in these controversies. It brings together the methodologies for BoD calculation; Disability Adjusted Life Years (DALY), which is Years of Life Lost (YLL) + Years of LifeLived in Disability (YLD), as well as analyzes the CoI; Direct Health Care Cost (DHC), Direct Non Health Cost (DNHC), Indirect Non Health Care Cost (INHC), Indirect Health Care Cost (IHC). Added to the criticisms found in literature, the paper posits reasons why BoD calculation and CoI analysis may even prove to be more difficult with diseases of the tropic regions in developing countries. There are data unavailable and unlike the diseases of the temperate regions, which are less prevalent and thus easy to quarantine, diseases of the tropic regions are usually of high prevalence, making quarantine impossible and making the exercise very expensive. The paper introduces the demand for death for Activities of Daily Living (ADL) measured disability as being pioneered by Igberaese and co-workers, as a way of eliminating the BoD and CoI once and for all. It makes DALY only equal to YLL, as YLD approaches zero. DALY will simply be the number of years of life lost due to mortality. It has removed the entire burden that he and the relatives, including that of his caregiver would have suffered if he had not died, but continued to live in the state of ADL disability. Demand for death also enlarges IHC, which is the future savings on health care cost as a result of premature death. DHC approaches zero, DNHC also approaches zero while INHC remains constant. This is also a great gain, as the individual‘s relatives and the society can channel such resources and energy to other uses that would benefit the household and the economy.

Keywords: Burden of disease calculation, Cost of illness, Demand for death, Disability adjustment life