ABSTRACT
Resources to improve health are and always have been scarce, in the sense that health must compete with other desirable social goals like education and personal security for resources. Cost effectiveness analysis comparing alternative health interventions in the quality-adjusted life years (QALYs) produced from a given level of resources constitutes a quantitative method for prioritising different interventions to improve health. There are many unresolved technical and methodological issues in QALYs and CEA, none of which will be the concern here. In the World Bank Study, World Development Report 1993; Investing in Health, the alternative DALY measure was developed to measure the burden of disease in reducing life expectancy and quality of life. Future benefits are appropriately discounted when they are more uncertain than proximate benefits. Cost effectiveness and utilitarian standards require minimising the aggregate burden of disease and maximising the aggregate health of a population without regard to the resulting distribution of disease and health, or who gets what benefits.
