INTEGRATING THE DALY METRIC INTO HEALTH STATISTICS AND PRIORITY-SETTING IN UZBEKISTAN: A FOUR-STAGE ROADMAP
Abstract
The DALY proved methodologically mature, internationally recognised and applied in routine national practice. Following the York school (Ochalek, Lomas, Claxton), a realistic cost-effectiveness threshold for low- and middle-income countries lies near 0.5 of gross domestic product per capita - approximately US$1,430 per DALY for Uzbekistan. No peer-reviewed DALY-based national burden-of-disease study has so far been published in Central Asia, the Kazakh analysis of acute myocardial infarction being the closest analogue. Three parallel reform streams – state medical insurance from 2026, the IT-Med digitalisation programme and the Primary Care 2030 strategy – form a historically favourable window of opportunity. A four-stage integration model is proposed, with a horizon from 6–12 months to 3–5 years: (1) a pilot burden-of-disease calculation; (2) a DALY module for selected diseases; (3) inclusion of a “burden of disease” block in official statistics; (4) regional and national dynamic monitoring. Four financing proposals are formulated: funding prevention in proportion to measured burden; scaling rehabilitation capacity to the volume of years lived with disability; adopting cost per DALY as the official methodology of health technology assessment; and an equalisation fund based on territorial burden.
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