1. MEASURING HEALTH
Abdur Razzaque Sarker
MHE (Health Economics), MSS (Economics)
Health Economics and Financing Research, icddrb
and
PhD Fellow in Strathclyde University, UK
Email: razzaque.sarker@gmail.com

2. Why measuring health?
 For estimating health status of
individual and population
 For assessing the impact of any health
intervention
 For assessing equity in health across
socioeconomic groups (based on
income, education etc.), across
countries etc.
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3. Who should put “value” in health
 The individual?
 The society?
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4. Kind of measurements
 Natural measurement:
Healthy days, blood pressure level,
healthy years, days without illness
 Quality adjusted measurement:
Quality-adjusted life years (QALYs)
and Disability-adjusted life years (DALYs)
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5. Concept and measurement of QALYs
The QALY as a composite measure of health status covering
both
dimensions – “quality” and “quantity”.
QALYs
1.0
Time
Weight
0
Dead 10 year
0.8
QALYs = 10 × 1.0 = 10
QALYs = 10 × 0.8 = 8
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6. QALYs without treatment: 0.5 year at 0.9 + 1 year at 0.7 = 1.15
QALYs with treatment: 0.25 year at 0.8 + 1 year at 0.9 + 0.5 year at 0.7 =
1.45
QALYs gained: 1.45-1.15=0.3
Application of QALYs
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7. Some methods for estimating weight
 Rating scale
 Time trade-off
 Standard Gambling
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8. Rating scale (Visual Analogue Scale – VAS)
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9. Respondent is presented with a choice between living the rest of their
life (t) in a given health state i (for example, on dialysis) or a shorter
period of time (x) living in perfect health. Time x is varied until the
respondent is indifferent between the two alternatives, at which point
the required preference score for state i is x/t.
Time-trade off (TTO)
1.0
Time
Weight
State i
x
Time (years)
t
If x = 6 years and t = 10 years
Score for state i = 6/10=0.6
Dead
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10. Respondent is given with two alternatives to choose
Between.
Alternative 1: Living at a health status (i), which is less than full
health for t years
Alternative 2: Having an intervention which can give the
respondent full health with a certain probability
or
death.
The probability where the respondent is indifferent
between alternatives is the value of his or her health.
Standard gambling
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11. Full health
Death
Health i, years t
Example:
Selim is currently living (alternative 2) with disability and expected to have
this
condition 10 years before his death. He can have a surgical intervention
(alternative 1) with a probability (p) of 75% that he will be fully cured and
live rest of his life (10 years) at full health. At the same time there is a
probability of (1-p) 25% that he can die during surgery.
If Selim is indifferent in his choice between the two alternative, then his
value of health is 0.75.
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12. Instrument for measuring quality
adjusted health
 EQ-5D
 SF-36/ SF-12
 Health Utility Index
 Quality of well-being
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13. EQ-5D Instrument (EuroQol group)
Total number of health states “245” (35 = 243 plus “unconscious” and “dead”)
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14. Co-efficient for TTO tariffs
Dimension Coefficient
Constant 0.081
Mobility
Level 2 0.069
Level 3 0.314
Self-care
Level 2 0.104
Level 3 0.214
Usual activity
Level 2 0.036
Level 3 0.094
Pain/discomfort
Level 2 0.123
Level 3 0.386
Anxiety/depression
Level 2 0.071
Level 3 0.236
N3 0.269 14

15. Example: Elma responded to his health as “11223”
Mobility = No problem [1]
Self-care = No problem [1]
Usual activities = Some problems [2]
Pain/discomfort = Moderate pain [2]
Anxiety/depression = Extreme [3]
EQ-5D weights
Health Weight
Full health 1.000
Constant - 0.081
Mobility - 0.000
Self-care - 0.000
Usual activities - 0.036
Pain/discomfort - 0.123
Anxiety/depression - 0.236
Constant (level 3/ N3) - 0.269
QALY-weight 0.255
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16. THANKS
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Email:
razzaque.sarker@gmail.com