Absolute shortfall of QALYs yields similar results.
We define absolute shortfall of QALYs as the expected future loss of QALYs from a condition, i.e. the absolute difference between the QALY expectancy in absence of illness (QALEN) and the remaining QALYs with standard care at the time of intervention.
Absolute shortfall of future health (QALY loss) is a measure suggested by the UK Department of Health and National Institute for Health and Care Excellence to be used in weighting the societal wider impact of conditions, while using proportional shortfall in weighting the burden of illness, in value-based assessment of interventions [ 36].
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.
The absolute shortage is greatest in Asia, where there is a shortfall of 1.16 million doctors, nurses and midwives and perhaps 2.1 million of all types of health workers, dominated by the shortages in Bangladesh, India and Indonesia.
To further highlight the inequality equivalence criteria we draw three lines, each representing any population with the same level of attainment-relative, absolute, or shortfall-relative inequality as Russia.
To further illustrate the relation among the attainment-relative, absolute, and shortfall-relative inequality measures, and how the choice of index may influence the conclusions, we present an epidemiologic and a health economic example.
For variables with two bounds, however, to avoid the risk, or suspicion, that a perspective shortfalls or attainment is chosen because the results are more favorable (in some dimension), we suggest that researchers present all three; attainment-relative, absolute, and shortfall-relative measures.
Whether we use attainments or shortfalls, absolute and relative inequality measures both give us the right result (i.e., a zero change in inequality) when changes occur that leave inequality unaffected.
Table reports attainment-relative, absolute, and a shortfall-relative inequality measures for age-standardized mortality rates per 1,000 person-years, demonstrating that the choice of measure influences the comparison: Russia is the most unequal according to the attainment-relative and absolute measure, while it is the least unequal according to the shortfall-relative measure.
Whether we work in attainments or shortfalls, absolute inequality measures like the generalized concentration index will correctly record a zero change in inequality following equal increments, and relative inequality measures like the concentration index will correctly record a zero change in inequality following equiproportionate changes.
