J Med Ethics 39:175-180 doi:10.1136/medethics-2012-100740
  • Justice
  • Paper

Lifetime QALY prioritarianism in priority setting

  1. Trygve Ottersen
  1. Correspondence to Trygve Ottersen, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Bergen 5018, Norway; trygve.ottersen{at}
  • Received 18 April 2012
  • Revised 4 October 2012
  • Accepted 17 October 2012
  • Published Online First 30 November 2012


Two principles form the basis for much priority setting in health. According to the greater benefit principle, resources should be directed toward the intervention with the greater health benefit. According to the worse off principle, resources should be directed toward the intervention benefiting those initially worse off. Jointly, these principles accord with so-called prioritarianism. Crucial for its operationalisation is the specification of the worse off. In this paper, we examine how the worse off can be defined as those with the fewer lifetime Quality-Adjusted Life Years (QALYs). We contrast this proposal with several alternative specifications.

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