Using DALYs in TreeAge Markov Models
Occasionallly (and recently), I received a question about how to use DALYs in a Markov model within TreeAge Pro. People nearly always use QALYs rather than DALYs in their models, so I have limited experience using DALYs.
I understand DALYs to be a measurement of mortality and morbidity on patients, representing the overall disease burden. This is a little trickier to use in TreeAge Pro than QALYs.
With QALYs, you can simply enter the utility for each state and that amount will be accumulated as the cohort passes among the health states in the model.
With DALYs, it is unclear exactly what to do. I believe it would make sense to enter a kind of disutility related to DALYs at all health states other than dead and fully healthy. Please comment if you have thoughts on this.
This brings us to the dead state. We need to add DALYs for the dead state to account for a portion of the cohort being dead from this point in time into the future. However, I'm unclear on the details.
- Should we accumulate 1 DALY for every cycle until the end of the time horizon?
- Should we accumulate 1 DALY for every cycle until the end of expected end of life?
- Is there a better approach?
I welcome all comments on this post. Thank you for your input.