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Table 3 Investigative issues associated with the chosen health care practices

From: Challenges in Australian policy processes for disinvestment from existing, ineffective 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

  1. *Key: ? = Unsure or in question; x = Limited or evidence in the negative; √ = Evidence in the positive