Comparative analysis of decision maker preferences for equity/efficiency attributes in reimbursement decisions in three European countries

Abstract

2 AbstractBackground: In addition to cost-effectiveness, national guidelines often include other factors in reimbursement decisions. However, weights attached to these are rarely quantified, thus decisions may strongly depend on decision-maker preferences.Objective: To explore the preferences of policymakers and healthcare professionals involved in the decision-making process for different efficiency and equity attributes of interventions and analyse crosscountry differences.Method: Discrete choice experiments (DCEs) were carried out in Austria, Hungary, and Norway with policymakers and other professionals working in the health industry (N=153 respondents). Interventions were described in terms of different efficiency and equity attributes (severity of disease, target age of the population and willingness to subsidize others, potential number of beneficiaries, individual health benefit, and cost-effectiveness). Parameter estimates from the DCE are used to calculate the probability of choosing a healthcare intervention with different characteristics, and to rank different equity and efficiency attributes according to their importance.Results: In all three countries, cost-effectiveness, individual health benefit and severity of the disease are significant and equally important determinants of decisions. All countries show preferences for interventions targeting young and middle age population compared to those targeting population over 60. However, decision-makers in Austria and Hungary show preferences more oriented to efficiency than equity, while those in Norway show equal preferences for equity and efficiency attributes.Conclusion: We find that factors other than cost-effectiveness seem to play an equally important role in decision-making. We also find evidence of cross-country differences in the weight of efficiency and equity attributes.

Equity and efficiency priorities within the Spanish health system: A discrete choice experiment eliciting stakeholders preferences

“…The preference for severity of disease aligns with the findings of similar studies conducted in Norway, Israel, Austria and Hungary, Brazil and Uganda (10,26,27). A review of popular preferences also listed the severity of illness as a criterion for health resource allocation (28).…”

Balancing Between Efficiency and Equity in Publicly Funded Health Systems

“…Discrete choice methods have proved in recent empirical research (e.g. Baji, García-Goñi, Gulácsi, Mentzakis, E., & Paolucci, F., 2016;Mirelman et al, 2012) to be very useful in eliciting population's preferences (Dukić, 2012). Thus, it can be argued that aligning supply (through evaluation of health-care interventions) and demand (through evaluating patients' preferences) is the key of resources allocation in publicly funded health systems (Dukić, Tomas Žiković, & Žiković, 2015).…”

Value Judgment of Health Interventions From Different Perspectives: Arguments and Criteria

“…In that sense, effectiveness captures several of the distinct criteria that are classified here as 'clinical' . Individual health benefits strongly influence policy decisions in various countries [28]. The number of patients in 'need of treatment' adds information to the decision about the likelihood that a population will benefit from a medication or intervention [29,30].…”