1. Using QALYs to Evaluate Chronic Sequelae: The Case of Reactive Arthritis David Zorn CFSAN-FDADavid.Zorn@fda.hhs.gov

2. Background on Valuing Chronic Sequelae Buzby, Roberts, Lin, and MacDonald, 1996 Buzby, Roberts, Lin, and MacDonald, 1996 Hemolitic Uremic Syndrome (HUS) Hemolitic Uremic Syndrome (HUS) Listeriosis Listeriosis Zorn and Klontz, 1998 Zorn and Klontz, 1998 Reactive Arthritis (ReA) Reactive Arthritis (ReA) Scharff and Jessup, 2007 Scharff and Jessup, 2007 ReA ReA Apologies to others Apologies to others

3. Regulatory Analyses including Valuations of Chronic Sequelae Food Safety & Inspection Service Meat & Poultry HACCP Rule (unpublished 1996) Food Safety & Inspection Service Meat & Poultry HACCP Rule (unpublished 1996) FDA Juice Labeling and HACCP Rules (1998, 2001) FDA Juice Labeling and HACCP Rules (1998, 2001) FDA Egg Refrigeration & Labeling Rule (1999, 2000) FDA Egg Refrigeration & Labeling Rule (1999, 2000) FDA Egg Production Rule (2004) FDA Egg Production Rule (2004)

4. Secondary Complications of Campylobacteriosis Health Loss SymptomMobilityPhysicalSocialWell-being QALDs Lost Guillain Barre Syndrome -0.333-0.09-0.077 - 0.106 0.390.61 GBS perm disability -0.299-0.062-0.06 - 0.061 0.520.48 ReA-0.1440.000-0.060.0000.800.20 Previous Illustration

5. Simple Method for Valuation of Chronic Sequelae Adaptation of FDA’s method for acute illness Adaptation of FDA’s method for acute illness Monetized QALYs + Medical Costs Monetized QALYs + Medical Costs Duration of symptoms is lengthened Duration of symptoms is lengthened (QALD loss/symptom) x (days) x ($ of QALD) + Medical Costs

6. QALY Valuation of Reactive Arthritis Days QALDs Lost Value of QALDs Lost (QALD = $630) Medical Costs Total Valuation per Case ReA Short- term ReA 2510.8$6,800$100$7,000 Long- term ReA 18,2505,223.2$970,000$5,860$976,000