Health-adjusted life expectancy

Although the QALY is the most commonly used health outcome summary measure, it is not the only one. Other conceptually equivalentoutcomes include years of healthy lifeiYHl), well years (WYs), health-adjusted person-years (HAPYs), and health-adjusted life expectancy (HALE). An alternative concept called healthy year equivalents (HYEs) has been proposed as theoretically superior to QALYs, but its practi-cai significance has been iimited. 

In addition, there are several extensions of QALY, for example, DALYs, health-adjusted life expectancy (HALE) (Weinstein et al. 2009), and the Q-TWiST (Gelber et al. 1995) in cancer epidemiology. 

Interestingly, if we chart the pesticide usage in various countries for the past 70 years alongside life expectancy, they rise in parallel. At the same time, age-adjusted cancer risks for nonsmokers have been declining. The use of chemistry in medicines and public health interventions has had more direct human health impact, but pesticides help reduce the real cost of fruits and vegetables. That s vital, because the 25% of people who eat the most produce have only half the total cancer risks of the 25% who eat the least ... 

Everyone is familiar with the measurement of the benefit of treatment in saving or extending life, i.e. life expectancy the measure is the quantity of life (in years). But it is evident that life may be extended and yet have a low quality, even to the point that it is not worth having at all. It is therefore useful to have a unit of health measurement that combines the quality of life with its quality to allow individual and sodal decisions to be made on a sounder basis than mere intuition. To meet this need economists have developed the quality-adjusted-life-year (QALY) estimations of years of life expectancy are modified according to estimations of quality of life. 

The CUA is a form of cost-effectiveness analysis in which the health outcomes are measured in terms of quality-adjusted life-years (QALYs) gained. The QALY is a measure that associates quantity of life (for example survival data and life expectancy) with quality of life, by amalgamating them into a single index. One QALY is equal to a year of full life quality. Because of its universal denominator which allows comparisons across divergent areas, CUA is a tool that can (in theory) be used by policy makers... 

In this chapter, we have highlighted the basic principles of managing the discharge home of the patient who requires prolonged mechanical ventilation. Although this may present major challenges to all concerned, the benefits in health-related quality of life and life expectancy may be substantial. Although some patients do find that the burden of HMV to be very difficult, most adjust with the help of home supports and many go on to achieve the unexpected (16). 

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