Table 1 Condition-intervention pairs ranked in order of gain in QALYs

Childhood deafness

8

30.5

10.7

(3.9)

High-cost, low-volume health care intervention. To date, relatively few patients have been considered eligible for a cochlear implant. Cochlear implantation has become an established routine treatment option for profoundly deaf adults and children who do not benefit from acoustic hearing aids both in Norway and around the world.

HTA

Bond 2009 [25]

(unilateral cochlear implant vs hearing aid and waiting list for implant)

Unruptured cerebral aneurysm

50

23.9

6.4

(3.6)

High-risk patient with symptomatic aneurysm produces subarachnoid haemorrhage (SAH) with substantial rate of mortality (30-60%) and permanent disability (15-30%). Over the years, there has been debate about which unruptured aneurysm to treat.

CUA

Johnston 1999 [26]

(Coiling vs. no treatment)

Morbid obesity

48

28.2

5.2

(2.3)

Increasing public health problem in Norway and elsewhere. Increased risk of premature death and reduced quality of life due to obesity-related co-morbidities. Potential demand for bariatric surgery is greater than availability.

HTA

Klarenbach 2010 [27]

(RY gastric bypass vs. lifestyle modification: diet and exercise medical counselling)

Adult deafness

50

14.0

4.2

(2.4)

See childhood deafness

HTA

Bond 2009 [25]

(Unilateral cochlear implant implant for adult)

Atrial fibrillation

52

17.3

2.3

(1.4)

Uncertainty about the intervention‘s long-term effects on stroke risk, mortality and QoL, but already established as an attractive alternative to drug-refractory AF in symptomatic patients with recurrent AF. Waiting list 0.5-1 year in Norway. Causes patients to pursue treatment abroad, some at their own cost.

CUA

McKenna 2009 [28]

(Catheter ablation vs. antiarrhythmic drug therapy

Hip osteoarthritis

63

19.8

1.3

(0.9)

High-volume, relatively high-cost intervention. Five thousand hip arthroplasties per year. Half of the adult population at risk.

CUA

Rasanen 2007 [29]

(Hip replacement vs. nonoperative approach)

Rheumatoid arthritis

55

6.1

1.3

(1.0)

20 000–30 000 patients in Norway. Lifelong burden of pain, discomfort and physical impairment; the years of life lost are estimated to be 5–7 years. In Norway, at least one DMARD has to be tried before prescribing biological agents such as TNF inhibitors on the grounds of the higher cost of biological agents, although combination therapy with a TNF inhibitor is more effective in treating rheumatoid arthritis.

HTA

Chen 2006 [30]

(TNF inhibition + methotrexate vs. Methotrexate)

Acute stroke

70

6.4

0.5

(0.3)

Approximately 15 000 cases annually in Norway and is the third most common cause of death; it is a major cause of severe disability and accounts for a significant proportion of healthcare spending. Over the past years, there has been a focus on developing stroke units at hospitals around the country.

HTA

Hamidi 2010 [31]

(Stroke unit vs. general ward)