Over a career of 52 years, that gap translates into a lifetime earnings shortfall of £298,064 for female employees, according to the analysis by the recruitment company Robert Half.
When we compare the rankings of conditions according to lifetime QALYs and proportional shortfall, we find that the proportional shortfall measure hardly discriminates between childhood deafness, adult deafness, and acute stroke, despite the fact that the number of healthy life years for these patient groups differs considerably: the lifetime QALYs were 38.5, 64.0, and 76.4, respectively.
To determine the lifetime QALYs and proportional shortfall of QALYs for patients with a given condition without the new intervention, we need three variables (see Figure 1).
These cases were chosen because they 1) are relevant to priority setting in Norway, and 2) illustrate properties of the measures of lifetime QALYs and proportional shortfall of QALYs.
According to both lifetime QALYs and proportional shortfall of QALYs, A is worse off than B, whereas the gain in QALYs is higher for B than for A. Below, we discuss why this is ethically relevant.
In this article, we identify the worse off by measuring lifetime QALYs and proportional shortfall of QALYs for a realistic set of eight condition-intervention pairs with data from published health economic evaluations, and we illustrate how these measures offer ethically relevant supplementary information to the effectiveness and costs of interventions.
This study shows that it is feasible to identify who are the worse off empirically by the application of lifetime QALYs and proportional shortfalls.
We report and compare lifetime QALYs, QALY loss, proportional shortfall of QALYs, and QALYgain for all example cases.
Whether people actually are less averse to QALY attainments than equivalent QALY shortfalls over a lifetime remains unclear.
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.
