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

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