Does the use of the proportional shortfall help align the prioritisation of health services with public preferences?
It has been proposed that equity may be included in the economic evaluation of health services using the ‘proportional shortfall’ (PS)—the proportion of a person’s QALY expectation that they would lose because of an illness. The present paper reports the results of a population survey designed to test whether PS helped to explain people’s preferences for health services and whether it did this better than the absolute shortfall or the equity related variables that PS seeks to replace. Survey respondents were asked to allocate 100 votes between 13 scenarios and a standard scenario. Variation in the allocation of votes was explained by health gain and different combinations of the equity variables. Differences in votes for the comparisons were significantly related to differences in PS but the relationship was weaker than between votes and the age related variables. Cases were identified where PS suggested a priority ordering of services which was strongly rejected by respondents. It is concluded that the use of PS is unlikely to improve the alignment of priorities with public preferences.
KeywordsProportional shortfall Fair innings Severity Equity-efficiency Economic evaluation Cost utility analysis
Financial support for this study was provided entirely by a grant from the National Health and Medical Research Council (NH&MRC) project Grant ID 1069241 Measuring health related social preferences and their inclusion in an alternative formula for prioritising health services.
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest.
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