Beyond QALYs and DALYs: factoring in the well-being effects of dietary supplementation with omega-3 fatty acids in dry eye syndrome

Abstract

PurposeThis study aims to explore the use and relevance of WALYs (well-being-adjusted life years) in light of the utilitarian premises of neoclassical economics that continue to dominate health outcomes evaluation. QALYs (quality-adjusted life years) and DALYs (disability-adjusted life years) measure longevity and quality of life in terms of purely health-related aspects and outcomes of medical interventions. However, evaluative questions of subjective well-being may be equally important in comparing outcomes and cost-effectiveness of these interventions.Design/methodology/approachA two-phase online search strategy for refereed research on dry eye treatment with omega-3 fatty acids (omega-3s) was adopted. Phase I aimed to identify and contrast clinical parameters of efficacy in omega-3 dietary supplementation. Phase II aimed to find a preference-based, multi-attribute utility instrument specific and sensitive enough to dry eye and its consequences on patients’ subjective well-being. We then illustrate how WALYs can be conceptualized and calculated based on the search results.FindingsEmpiric therapies like omega-3s can be assessed in terms of reducing or relieving symptomatic discomfort and pain, and enabling the patient to enjoy life and derive satisfaction from daily activities. We find in VisQoL (Vision and Quality of Life Index) a viable alternative to conventional multi-attribute utility instruments, including those typically used in QALY and DALY calculations. Clinical efficacy indices of dry eye can be linked to VisQoL’s quality of life dimensions. Differently weighted outcomes can be aggregated. And WALYs per patient per year can be computed by scaling aggregated outcomes to match the WALY rating scale. The implications of subjective well-being for both patient and society can thus be approached from a broader and richer perspective.Originality/valueTo the best of our knowledge, this is the first study of its kind in pharmaceutical outcomes valuation and marketing. It offers a framework for analyzing life satisfaction and well-being among dry eye patients under treatment. It is also the first to use and adapt a multi-attribute utility measure to treatment outcomes of omega-3s in ocular diseases, from which this study suggests WALYs may be computed. However, it does not suggest that WALYs should supplant QALYs and DALYs in evaluating health outcomes. Medical economics is enriched if alternative methods of outcomes evaluations can help fill in the gaps in existing paradigms and do so by accounting for other effects of condition-specific interventions. Costs and benefits of interventions to the individual and society can then be valued not just more effectively, but also more equitably.