Common currency in health assessments

This page is a method. The page identifier is Op_en4692
Moderator:Nobody (see all) Click here to sign up.
Give your opinion to the peer rating of the content of this page. {{ #opasnet_rater: }}
Upload data

op_en:Plantlibra

Scope

This page reviews identifying a common metric to be used in benefit-risk assessments. The options are adapted from several sources (see references), and the conclusions are drawn from the options.

Definition

In 2006 EFSA suggested that the assessments with both risk and benefit ideally should be performed under the same criteria for weighing the evidence and identifying the uncertainties. The presentation of the results of the risk-benefit assessment must fit the predefined purpose of the request and make clear where the certainties and uncertainties are in order to compare the relative confidence on the benefits with the risks. The following possible common scale measures were mentioned:

• Incidences.
• Disability Adjusted Life Years (DALYs).
• Quality Adjusted Life Years (QALYs).
• Days of work lost.
• Costs in money.

Further EFSA 2006 concluded that QALYs are still based on a number of assumptions, and are more difficult to quantify than DALYs. The difficulty in expressing results from toxicological studies in experimental animals as DALYs needs to be overcome. Using costs requires equal cost structures across countries/world and is difficult to communicate. It was agreed that more research and experience with different approaches are needed.

Scientific committee, appointed by the EFSA 2010, recommended a stepwise approach for assessing the benefits and risks of food. --# : Mieluiten viitataan käyttäen <ref>-tägiä. --Jouni 09:18, 2 November 2010 (UTC) The last of the three steps utilizes common currency approach to combine two or more of the following elements: increases or decreases in morbidity, mortality, disease burden, and quality of life. The choice of composite metrics should be made on a case by case basis, based on the specific risk-benefit question, identified hazards and positive health effects. Whilst composite metrics, such as DALYs or QALYs, can be used for direct comparison of effects, it is important to recognize that not all relevant dimensions are captured in these metrics, for example, whether the effect is in children or adults. This is because these metrics combine incidence with life years to obtain an estimate of years saved or lost respectively, so that a few young people with many years of potential life can give an equivalent value as a larger number of elderly people with far fewer years of potential life. In addition some of the DALY or QALY weightings are open for discussion.

BRAFO project tried to develop a framework that allows quantitative comparison of human health risks and benefits of foods and food compounds based on a common scale of measurement. It will be based on the evaluation of changes in the quality/duration of life using a system that allows weighting of data quality and severity of effect, with quantification by QALY or DALY-like methodology. QALIBRA project developed a tool for the higher (quantitative) tiers of tiered approaches to risk-benefit assessment, such as those being considered by the EFSA and the related EU project BRAFO. QALIBRA chose to use DALY or QALY as a common currency. Also, BEPRARIBEAN project found that the most used integrated health measures in food-related benefit-risk analysis are the DALY and the QALY. QALY’s are traditionally mostly used to measure health gains at micro scale, for example to compare two interventions. For many diseases, disability weights, which are currently being revised in the Global Burden of Disease 2010 study, are available at the WHO website. Further, often the choice for DALY or QALY is a pragmatic one, based on data availability or experience of use rather than on a fundamental choice.

Tarjolla olevista (tai kuviteltavissa olevista) lopputuloksista päättäjän mielestä (tässä katsotaan aina jonkun päättäjän näkökulmasta) huonoimman lopputuloksen utiliteettia merkitään arvolla 0 ja parasta arvolla 1. Muiden lopputulosten utiliteetti määräytyy seuraavasti: jos päättäjä on indifferentti (ei osaa valita parempaa) vaihtoehdoista a) paras toteutuu todenäköisyydellä p ja b) tarkasteltava vaihtoehto toteutuu todennäköisyydellä 1, silloin tarkasteltavan vaihtoehdon utiliteetti on p.|--Jouni 09:18, 2 November 2010 (UTC)}}

Conclusions

We identified DALYs, QALYs and utility as potential measures for common currency. DALY is the most widely used measure.

References

Guidance on human health risk-benefit assessment of foods. 2010 EFSA Scientific Committee. European Food Safety Authority (EFSA), Parma, Italy

Summary Report EFSA Scientific Colloquium 6, 13-14 July 2006 - Tabiano (Province of Parma), Italy

BRAFO: A Specific Support Action to Investigate the Risk Benefit Analysis of Foods. 2009 Publishable Executive Summary

QALIBRA: Quality of Life – Integrated Benefit and Risk Analysis. Web-based tool for assessing food safety and health benefit

BEBPRARIBEAN manuscripts: State of the art in food benefits-risk assessments