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Rare and common diseases should be treated equally and why the article by de Magalhaes somewhat misses its’ mark
  1. Lars Sandman
  1. Correspondence to Professor Lars Sandman, National Centre for Priorities in Health, Department of Health, Medicine and Caring Sciences, Linköpinfg university, Linköping, Sweden; lars.sandman{at}

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In the article Should rare diseases get special treatment? by Monica Q F de Magalhaes,1 it is argued that rarity is not a morally relevant feature to consider in prioritising treatment in healthcare, but severity is. A central conclusion in the article is that severity rather than prevalence should guide different cost-effectiveness thresholds. Hence, I take it, she answers no to the question in her own heading. I agree with all of this—and with most of her other arguments and conclusions in the article—except for the clause ‘rather than prevalence’. For this reason, I find the article misses its’ mark (even if not by much). Let me explain by taking Sweden as an example.

Sweden has a legally established ethics framework for priority setting in healthcare since 1997, comprising three principles: human-dignity principle, needs-solidarity principle and cost-effectiveness principle. The implication of these principles in practice is that the higher the severity—the higher the cost-effectiveness threshold acceptable.2 During the last 10 years or so, the highest accepted cost-effectiveness threshold for the most severe conditions have been in the order of €100 000/QALY. Until a few years ago rarity or prevalence was …

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  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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