Using disability adjusted life years to value the treatment of thirty chronic conditions in the U.S. from 1987 to 2010: a proof of concept

Health care spending in the U.S. grew two trillion dollars from 1987 to 2010, a 400% increase, but our understanding of the value of that increase is limited. In this paper we estimate the net value of spending for thirty chronic diseases between 1987 and 2010 by assigning a monetary value to changes in health outcomes and relating it to the costs of treating each disease. Changes in health outcomes are measured using a newly-available time series of disability adjusted life years (DALYs) data from the Institute for Health Metrics and Evaluation. Spending on treatments are determined using health care expenditure data from nationally representative surveys. We find the net value of treatment has grown substantially for several diseases. Overall, 20 of the 30 chronic conditions studied experienced an increase in health outcomes over the period, with 8 of those 20 showing a decrease in per-patient spending. Our estimates of net value of health spending using DALYs data are simple to apply and results are generally consistent with previous estimates which usually involve onerous data collection methods to study a single disease. The DALYs data have potential to be a useful, low-cost way to measure changes in health outcomes. However, challenges remain in using DALYs data to accurately measure the changing value of health care spending on the treatment of disease.