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

From: Making use of equity sensitive QALYs: a case study on identifying the worse off across diseases

Patient group Age* QALE std QALY gain Priority relevance Source References
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)        
  1. *Average age (years) at the time of intervention.
  2. †Expected remaining quality-adjusted life years given a certain disease with standard care. Undiscounted data. Utilities expressing the current severity can be found in Additional file 2.
  3. ‡Undiscounted data. The discounted gain in QALYs is shown in brackets. Note that the annual discount rates vary between the source studies [see Additional file 2]. Ranking according to the discounted gains in QALYs would yield a different order.
  4. Abbreviations: AF atrial fibrillation, CUA cost-utility analysis, DMARD disease-modifying antirheumatic drug, QoL quality of life, HTA health technology assessment, QALY quality-adjusted life year, RY roux-en-y, TNF tumour necrosis factor.