Proportional Shortfall
A method used to measure how severely a disease affects a person's remaining quality-adjusted life years, and to adjust cost-effectiveness thresholds based on that severity.
At a glance
Use when
Assessing equity implications of health interventions; setting context-sensitive cost-effectiveness thresholds in HTA
Avoid when
When equity weighting based on disease severity is not a policy priority; when reliable life expectancy or utility data are unavailable
Inputs
Disease severity, remaining life expectancy, baseline health state utility
Outputs
Severity-adjusted willingness-to-pay threshold, equity-weighted QALY valuation
How it works
Proportional Shortfall quantifies disease severity as the proportional loss of remaining QALYs due to a health condition. It is used to inform equity-weighted willingness-to-pay thresholds in health technology assessment, particularly in Dutch HTA appraisals by Zorginstituut Nederland.
- HTA domains
- Clinical Effectiveness, Costs & Economic Evaluation, Patient and Social Aspects
- Assumptions
- The proportional impact of a disease on remaining QALYs reflects its severity; individuals with shorter remaining life expectancy experience greater proportional impact from a given health loss
- Strengths
- Incorporates equity by prioritizing patients with greater proportional health loss; aligns with societal values on fairness in resource allocation
- Limitations
- Dependent on accurate estimation of remaining life expectancy and utility values; may disadvantage older populations or those with comorbidities
- Also known as
- PS
Questions this answers
- › How is disease severity quantified in terms of QALY loss?
- › How does disease severity influence cost-effectiveness thresholds?
- › What equity considerations are integrated into Dutch HTA appraisals?
- › How does Proportional Shortfall differ from absolute QALY loss?
- › In what way does Proportional Shortfall support fair resource allocation?
- › How is remaining life expectancy factored into severity assessment?
References & sources
Similar by meaning
Beta record. Based on the original catalogue summary; primary-source enrichment pending.