Table 3 Investigative issues associated with the chosen health care practices
| Health Care Technology/Practice | Setting | Interest from methodological and policy perspectives* | Key Issues |
|---|---|---|---|
| ART ≥ 42 years of age | Clinic or Hospital |
Harmful x Clinically Effective x Cost Effective ? Appropriate ? Socially Valued √ Universally Accessible ?/x Ethical ? |
- Marginal clinical and cost-effectiveness (on population basis) but limiting its use poses problems: it is highly beneficial from perspective of concerned individuals - Therapy has equivocal purpose - Highly valued by recipients and potentially by society broadly - Ability to pay: user vs society - Equity of access - Medical vs social infertility - Opportunity cost |
| Upper airway surgery for adult OSA | Surgical Theatre |
Harmful ? Clinically Effective ?/x Effective Alternative √ Cost Effective x Appropriate ? Necessary ? Socially Valued ?/√ Ethical ? |
- Limiting its use should not, in theory, pose any problems, but pressures are strong from clinical interest groups - Complex practice paradigms/incentives - Small, homogeneous craft group - Equipoise/clinical uncertainty - Perspectives of patients who value the potential of a surgical 'fix' - Is this preference based on sound evidence or supplier induced demand? - Opportunity cost |