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

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

Background
In addition to cost-effectiveness, national guidelines often include other factors in reimbursement decisions. However, weights attached to these are rarely quantified, thus decisions can depend strongly 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 to analyse cross-country 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 subsidise others, potential number of beneficiaries, individual health benefit, and cost-effectiveness). Parameter estimates from the DCE were 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 were significant and equally important determinants of decisions. All countries show preferences for interventions targeting young and middle aged populations compared to those targeting populations 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
priority setting, equity-efficiency trade-off, discrete choice experiment, reimbursement
1618-7598
1-9
Baji, Petra
cd57d2a5-167d-418f-94bc-27e5d334fee5
García-Goñi, Manuel
9a0c4235-d845-44cc-b7f5-e9cccf567f17
Gulácsi, László
9cafd2c6-a60c-4018-8840-f2c73347f023
Mentzakis, Emmanouil
c0922185-18c7-49c2-a659-8ee6d89b5d74
Paolucci, Francesco
073b630d-7adc-41ee-b198-6b33bcacce6c
Baji, Petra
cd57d2a5-167d-418f-94bc-27e5d334fee5
García-Goñi, Manuel
9a0c4235-d845-44cc-b7f5-e9cccf567f17
Gulácsi, László
9cafd2c6-a60c-4018-8840-f2c73347f023
Mentzakis, Emmanouil
c0922185-18c7-49c2-a659-8ee6d89b5d74
Paolucci, Francesco
073b630d-7adc-41ee-b198-6b33bcacce6c

Baji, Petra, García-Goñi, Manuel, Gulácsi, László, Mentzakis, Emmanouil and Paolucci, Francesco (2015) Comparative analysis of decision maker preferences for equity/efficiency attributes in reimbursement decisions in three European countries. The European Journal of Health Economics, 1-9. (doi:10.1007/s10198-015-0721-x).

Record type: Article

Abstract


Background
In addition to cost-effectiveness, national guidelines often include other factors in reimbursement decisions. However, weights attached to these are rarely quantified, thus decisions can depend strongly 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 to analyse cross-country 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 subsidise others, potential number of beneficiaries, individual health benefit, and cost-effectiveness). Parameter estimates from the DCE were 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 were significant and equally important determinants of decisions. All countries show preferences for interventions targeting young and middle aged populations compared to those targeting populations 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

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Baji_etal_DCE.pdf - Accepted Manuscript
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More information

Accepted/In Press date: 5 April 2015
e-pub ahead of print date: 22 August 2015
Keywords: priority setting, equity-efficiency trade-off, discrete choice experiment, reimbursement
Organisations: Economics

Identifiers

Local EPrints ID: 382649
URI: http://eprints.soton.ac.uk/id/eprint/382649
ISSN: 1618-7598
PURE UUID: 1fd93100-94f8-4314-92c2-65443e921683
ORCID for Emmanouil Mentzakis: ORCID iD orcid.org/0000-0003-1761-209X

Catalogue record

Date deposited: 03 Nov 2015 12:44
Last modified: 17 Dec 2019 01:38

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