These could be the socioeconomically deprived, the young, those who are severely ill or those having a very low life expectancy.For example, the a QALY is a QALY assumption rules out the possibility that society might prefer to deliver an improvement of 0.1 in the quality of life state to a patient who is severely ill over someone who is in near perfect health. Any divergence away from the strict a QALY is a QALY assumption, in order to value more equitable outcomes, will be associated with some loss in total health outcomes. This is an example of the equity-efficiency trade-off