Measurement of QALY, DALY and utility measures MCQs With Answer

Measurement of QALY, DALY and utility measures MCQs With Answer

This quiz bundle is designed for M.Pharm students studying pharmacoepidemiology and pharmacoeconomics. It focuses on measurement and interpretation of QALY (Quality-Adjusted Life Year), DALY (Disability-Adjusted Life Year) and common utility elicitation methods (TTO, SG, VAS), plus instruments (EQ-5D, SF-6D), calculations, and limitations. Questions range from core definitions and formulas to applied calculation problems, policy implications, discounting and ethical considerations in health technology assessment. The aim is to deepen conceptual understanding and strengthen computation skills used in cost-effectiveness and burden-of-disease studies, preparing students for exam-style MCQs and real-world pharmacoeconomic evaluations.

Q1. What is the standard definition of a QALY?

• One year of life lived in perfect health weighted by cost
• One year of life adjusted by a health-related quality weight where 1 equals perfect health and 0 equals death
• The number of years lost due to premature mortality in a population
• The sum of years lived with disability in a population

Correct Answer: One year of life adjusted by a health-related quality weight where 1 equals perfect health and 0 equals death

Q2. DALY is composed of which two components?

• Quality of life and utility
• Years of life lived in perfect health and years lived with morbidity
• Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability (YLD)
• Health-adjusted life expectancy and health state preference values

Correct Answer: Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability (YLD)

Q3. Which formula correctly defines YLL for DALY calculation?

• YLL = Number of deaths × Standard life expectancy at age of death
• YLL = Incidence × Disability weight × Duration
• YLL = Prevalence × Disability weight
• YLL = QALY gained per intervention

Correct Answer: YLL = Number of deaths × Standard life expectancy at age of death

Q4. Which formula correctly defines YLD under the incidence-based approach?

• YLD = Number of deaths × Standard life expectancy
• YLD = Incidence × Disability weight × Average duration of condition
• YLD = Prevalence × Utility weight
• YLD = QALY loss per person

Correct Answer: YLD = Incidence × Disability weight × Average duration of condition

Q5. A patient experiences 2 years with a health state utility of 0.6 and then dies. How many QALYs were experienced?

• 0.6 QALYs
• 1.2 QALYs
• 2.6 QALYs
• 3.0 QALYs

Correct Answer: 1.2 QALYs

Q6. Which utility elicitation method involves asking how many years in perfect health a person would trade for a longer time in a given impaired health state?

• Standard Gamble (SG)
• Visual Analogue Scale (VAS)
• Time Trade-Off (TTO)
• EQ-5D questionnaire

Correct Answer: Time Trade-Off (TTO)

Q7. Which method uses a probability choice between certain impaired health and a gamble with possible perfect health or immediate death?

• Time Trade-Off (TTO)
• Standard Gamble (SG)
• Visual Analogue Scale (VAS)
• SF-6D mapping

Correct Answer: Standard Gamble (SG)

Q8. Which instrument is widely used to derive utility values for QALY calculation and has five dimensions?

• SF-36
• EQ-5D
• HADS
• Karnofsky Performance Scale

Correct Answer: EQ-5D

Q9. Which statement about the Visual Analogue Scale (VAS) is true?

• VAS elicits utilities via gambles against death
• VAS places a respondent-marked value on a line anchored at 0 (worst) and 100 (best) and is not choice-based
• VAS always yields the same values as TTO and SG
• VAS requires complex probability questions

Correct Answer: VAS places a respondent-marked value on a line anchored at 0 (worst) and 100 (best) and is not choice-based

Q10. In cost-effectiveness analysis, the incremental cost-effectiveness ratio (ICER) is most commonly expressed as:

• Cost per DALY averted
• Number needed to treat
• Cost per QALY gained
• Average cost per patient

Correct Answer: Cost per QALY gained

Q11. Which of the following is a major limitation of QALYs?

• They capture societal preferences for all non-health aspects of life
• They may undervalue treatments for elderly or disabled people due to weighting by life expectancy and quality
• They are purely objective without need for preference elicitation
• They cannot be used in economic evaluation

Correct Answer: They may undervalue treatments for elderly or disabled people due to weighting by life expectancy and quality

Q12. Which approach to YLD calculation uses current cases at a point in time multiplied by disability weight to estimate burden?

• Incidence-based YLD
• Prevalence-based YLD
• Life-table based YLL
• QALY decrement method

Correct Answer: Prevalence-based YLD

Q13. Disability weights used in DALY calculations are scaled between which values?

• -1 to +1
• 0 to 10
• 0 (full health) to 1 (equivalent to death)
• 0 (death) to 1 (full health)

Correct Answer: 0 (death) to 1 (full health)

Q14. True or false: Negative utility values (less than 0) are possible in some utility elicitation scales meaning states worse than death.

• True
• False
• Only for VAS
• Only for EQ-5D-3L but not EQ-5D-5L

Correct Answer: True

Q15. A prevention program averts 100 deaths at age 40; standard life expectancy at 40 is 40 additional years. What are the YLLs averted (no discounting)?

• 100 YLLs
• 4,000 YLLs
• 400 YLLs
• 40 YLLs

Correct Answer: 4,000 YLLs

Q16. Which practice in DALY calculations was used in early Global Burden of Disease studies but is controversial due to equity concerns?

• Using only prevalence-based YLD
• Applying age-weighting and time discounting to future life years
• Excluding non-fatal health states
• Using QALY weights instead of disability weights

Correct Answer: Applying age-weighting and time discounting to future life years

Q17. When converting EQ-5D health profiles to a utility value, what is needed?

• A set of disability weights from DALY studies
• An established value set (tariff) derived from population preferences for that country or region
• A clinical severity score only
• No additional information; profile equals utility directly

Correct Answer: An established value set (tariff) derived from population preferences for that country or region

Q18. In a cost-utility analysis, an intervention costs $10,000 and yields 0.5 QALYs more than comparator. What is the ICER?

• $20,000 per QALY gained
• $5,000 per QALY gained
• $10,000 per QALY gained
• $2,000 per QALY gained

Correct Answer: $20,000 per QALY gained

Q19. Mapping algorithms in pharmacoepidemiology are used to:

• Estimate DALYs directly from mortality data
• Convert disease incidence into life expectancy
• Predict utility values (e.g., EQ-5D) from disease-specific health-related quality-of-life questionnaires when direct utility data are unavailable
• Translate QALYs into monetary values using willingness-to-pay

Correct Answer: Predict utility values (e.g., EQ-5D) from disease-specific health-related quality-of-life questionnaires when direct utility data are unavailable

Q20. Sensitivity analysis in QALY/DALY-based economic evaluations is important because:

• Utilities and disability weights are measured without uncertainty
• Parameter uncertainty (utilities, durations, discount rates) can substantially change cost-effectiveness and burden estimates
• It eliminates the need for preference elicitation
• DALYs do not depend on model assumptions

Correct Answer: Parameter uncertainty (utilities, durations, discount rates) can substantially change cost-effectiveness and burden estimates

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