Measurement of variance in health state valuations in Phnom Penh, Cambodia

Introduction Initiated in 1992, the Global Burden of Disease (GBD) Study was conducted at the request of the World Bank and in collaboration with the World Health Organization (WHO) to develop a set of consistent estimates of disease and injury rates for 1990, as well as to develop a comparative index of the burden of each disease or injury, either from premature mortality or time lived with less than perfect health. This comparative index is the summary measure of population health, the disability adjusted life year three volumes of the GBD Study's method-ologies and final results were published on behalf of the World Health Organization and the World Bank (Murray and Lopez 1996a; 1996b; 1998), among other publications highlighting key findings or methods (Murray and Lopez 1996c; 1997a–d). The GBD Study's methods and findings have generated considerable discussion in the literature and international forums, as well as within the organizations collaborating on The potential normative use of the GBD study's findings by WHO, the World Bank and national governments has raised concerns on the comparability and interpretation of findings across regions, cultures and socioeconomic groups, as well as on the policy relevance and implications for resource allocation in different health system contexts. Much of the debate centres on the construction of DALY as a summary measure of population health, in particular the explicit social values incorporated within DALY. These include social values for severity weights for disability (e.g. disability weights for over 400 different health states partially based on valuations of 22 indicator health states), the discount rate for future health, age-weights across the life cycle, and target expectancy of life. This chapter reports on an empirical investigation of (i) 594 Summary Measures of Population Health whether the DALY protocol to elicit valuations for indicator health states may be replicated among non-health professionals in a developing country ; (ii) whether differences exist between valuations of health states obtained from individuals with different demographic characteristics or health experiences; and (iii) whether differences exist between health and non-health professionals' valuations.