Health Literacy and Self-Reported Health Status Using the Eq-5d-5l: An Exploratory Analysis

Abstract

Objectives: In publicly funded health systems such as the United Kingdom (UK) National Health Service (NHS), patients do not normally face the full economic cost of treatment decisions, nor are they aware of the potential cost to the system. We investigated whether patient awareness of treatment costs, either to the system or to themselves, would affect treatment choices. MethOds: 344 representative members of the UK public were recruited via an online survey panel. Respondents were required to make treatment decisions in three different health conditions (sore throat, psoriasis and sciatica). Respondents were presented with condition-specific patient decision aids (Option Grids™), each supported by: 1) no cost information, 2) cost to the NHS (drug/ procedure tariff), 3) cost to patient (drug/ procedure tariff), and 4) access cost to patient (flat cost for all options). Differences in treatment choices were explored using ANOVA. Significant differences within each health condition were subsequently explored using t-tests. Results: A significant number of respondents switched choice to the cheapest intervention when tariff costs to either the system (p< 0.05) or themselves (p< 0.01) were considered versus no cost information when choosing between treatments for psoriasis. For all three health conditions, presenting flat access costs increased the likelihood (p< 0.01) of respondents choosing the treatment option known to have the highest tariff price. cOnclusiOns: Cost information influences treatment decisions. We observed that awareness of cost to the system or to oneself encouraged the choice of lower priced treatment options, whereas flat access charges encouraged the choice of treatment known to be more expensive. Provision of cost information may therefore be important for informed decision making, and could also be a policy tool to generate cost savings for the health system.