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The case against annual profiles

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Figure 1

Duration-specific Dutch disability weights (95% confidence interval) for three selected chronic conditions and annual profiles of conditions of short duration

Condition – duration

Severe hearing loss – chronic Severe vision loss – chronic Paraplegia – chronic

Pneumonia – 2 weeks Influenza – 2 weeks Constitutional eczema – 2 x 6 weeks Acute cystitis – 1 week Acute urethritis – 1 week Acute pyelitis – 2 weeks Peptic ulcer disease – 4 weeks Acute bronchitis – 2 weeks Acute tonsillitis – 2 weeks Acute sinusitis – 2 weeks Acute nasypharyngitis – 1 week Symptomatic acute gonorrhoea or chlamydia – 1 week Digestive tract infection (complicated) – 3 weeks Digestive tract infection (mild) – 2 weeks

2.69 4.97

2.03 1.20

0.00

0.25

0.50

0.75

1.00

weights appear to be considerably overvalued. Their use in burden of disease assessments would give undue weight to short duration conditions.

Essink-Bot and Bonsel (chapter 9.1) state that the annual profile ap- proach worked reasonably well. This may be the case for the valuation procedure. It is indeed a bit uncomfortable for panel members to imagine living a full year with pneumonia. However my experience as a member of a valuation panel in the past is that it is feasible to imagine living for a year in a state as severe as during a bout of pneumonia and to compare it with a year with a chronic condition.

A reason for the high values given to the annual profiles may be that valuation procedures have problems in determining accurate weights for low-severity conditions. Specifically, in the PTO1 and PTO2 methods the Dutch study replicated from the GBD protocol, the numbers of people to trade off against 1 000 healthy persons for a low-severity condition is close to 1 000 for the PTO1 method and a very high number in the PTO2 method. For example, the equivalent for a condition with a disability weight of 0.01 in the PTO1 trade-off is 1 010 and in the PTO2 trade-off is 100 000 (Table 1). What probably happens is that most people find it hard to make a distinction between one large and another even larger number in the PTO2 trade-off and similarly consider the difference trivial between trading off 1 010 or 1 005 people with a minor disease against 1 000 healthy people in the PTO1 version. Unfortunately, at the lower end of the severity spectrum these seemingly trivial differences in PTO values trans- late into a doubling of the corresponding disability weight. As a conse-

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