ArticleCost effectiveness and resource allocation : C/E2014
Making use of equity sensitive QALYs: a case study on identifying the worse off across diseases.
Article in Cost effectiveness and resource allocation : C/E, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- A Decision-Analytic Model to Evaluate Cost-Effectiveness of Regional Implementation of a Mobile Stroke Unit.Neurology · 2025Article
- Achieving health equity in immune disease: leveraging big data and artificial intelligence in an evolving health system landscape.Frontiers in big data · 2025Review
- Appraising Drugs Based on Cost-effectiveness and Severity of Disease in Norwegian Drug Coverage Decisions.JAMA network open · 2022Article
- Attitudes towards priority setting in the norwegian health care system: a general population survey.BMC health services research · 2022Article
- Article
- A flexible formula for incorporating distributive concerns into cost-effectiveness analyses: Priority weights.PloS one · 2019Article
- Distribution-Weighted Cost-Effectiveness Analysis Using Lifetime Health Loss.PharmacoEconomics · 2017Article
- Using Cost-Effectiveness Analysis to Address Health Equity Concerns.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2017Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundResource allocation decisions currently lack standard quantitative methods for incorporating concerns about the worse off when analysing the cost-effectiveness of medical interventions.
objectiveTo explore and demonstrate how to identify who are the worse off without a new intervention by measuring lifetime Quality-Adjusted Life Years (QALYs) for patients across different conditions, and compare the results to using proportional shortfall of QALYs.
methodsCase study of eight condition-intervention pairs that are relevant to priority setting in Norway; childhood deafness (unilateral cochlear implant), unruptured cerebral aneurysm (coiling), morbid obesity (RY gastric bypass), adult deafness (unilateral cochlear implant), atrial fibrillation (catheter ablation), hip osteoarthritis (hip replacement), rheumatoid arthritis (TNF inhibitor) and acute stroke (stroke unit). We extracted prospective QALYs without and with new interventions from published health technology assessments and economic evaluations.
resultsAmong the eight cases, the lifetime QALY method and the proportional shortfall method yielded conflicting worse-off rank orders. Particularly two conditions had a substantial shift in ranking across the applications of the two methods: childhood deafness and acute stroke. Deaf children had the lowest expected lifetime QALYs (38.5 without a cochlear implant) and were worst off according to the lifetime approach, while patients with acute stroke had the second-highest lifetime QALYs (76.4 without stroke units). According to proportional shortfall of QALYs, patients with acute stroke were ranked as worse off than deaf children, which seems counterintuitive.
conclusionThis study shows that it is feasible to identify who are the worse off empirically by the application of lifetime QALYs and proportional shortfalls. These methods ease further examination of whether there is a true conflict between maximization and equity or whether these two concerns actually coincide in real world cases. It is yet to be solved whether proportional prospective health losses are more important than absolute shortfalls in expected lifetime health in judgements about who are worse off.
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