Quality adjusted life years (QALYs) and dose–response models in environmental health policy analysis — methodological considerations

Abstract

Analyses of competing risks are currently limited by the lack of empirically well-founded and generalizable quantitative methods. Specifically, quantitative methods for comparative risk analysis require the consideration of the population impacted, the duration of impact, the health endpoints at risk, and the impact on individual quality of life. Whereas risk analysis can be used to provide quantitative estimates of disease incidence, environmental health policy analyses do not often account for differences in health impact from alternative disease states. We discuss the methodological issues related to the use of quality adjusted life years (QALY) as a metric for normalizing expected disease incidence to account for health impact. Through a case study of the risks and benefits of fish consumption, we demonstrate the use of QALY weights with dose–response models for environmental health policy decision making. We suggest that, although this approach can be generalized for use in comparative risk and health policy analysis, it is informationally intensive and requires additional assumptions to those used in traditional safety/risk assessment.