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.
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.
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.
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.
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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The Main Association of Austrian Social Security Institutions) based on the recommendations of the Pharmaceutical Evaluation Board classify the drugs into three different reimbursement categories: red, green and yellow boxes.
(1) Priorities of the health care system, (2) severity of the disease, (3) equity (size of the target population, accessibility), (4) cost-effectiveness and quality of life (ICER, health gain per patient), (5) budget impact, and (6) opinions from Hungary and abroad.
e.g. National Health Insurance Fund, Ministry of Human Resources, National Institute for Quality and Organisational Development in Healthcare and Medicines.
Purely equitable and purely efficient interventions are those where all equity attributes are set to 1 (with all efficiency attributes to 0) and those where all efficiency attributes are set to 1 (with all equity attributes to 0), respectively.
Results are available from the authors upon request.
Results are available from the authors upon request.
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The authors are grateful for Georg Rubiko, University of Innsbruck, Austria, Prof. Terje P. Hagen, Department of Health Management and Health Economics, University of Oslo, Norway, Dr. Márta Péntek, Department of Health Economics, Corvinus University of Budapest, Hungary, Dr. Valentin Brodszky, Department of Health Economics, Corvinus University of Budapest, Hungary for their assistance in the data collection. Petra Baji was supported by the Hungarian Scientific Research Fund OTKA (PD 112499). Manuel García-Goñi’s research was supported by the research project Evaluating Preferences for Equity and Efficiency among National/Regional Health Policy Makers” financed by the Spanish Instituto de Estudios Fiscales.
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Baji, P., García-Goñi, M., Gulácsi, L. et al. Comparative analysis of decision maker preferences for equity/efficiency attributes in reimbursement decisions in three European countries. Eur J Health Econ 17, 791–799 (2016). https://doi.org/10.1007/s10198-015-0721-x
- Priority setting
- Equity-efficiency trade-off
- Discrete choice experiment