Public preferences for prioritizing preventive and curative health care interventions : a discrete choice experiment
Faculty of Applied Economics
Faculty of Medicine and Health Sciences
Value in health. - Oxford
, p. 224-233
University of Antwerp
Background: Setting fair health care priorities counts among the most difficult ethical challenges our societies are facing. Objective To elicit through a discrete choice experiment the Belgian adult populations (1875 years; N = 750) preferences for prioritizing health care and investigate whether these preferences are different for prevention versus cure. Methods: We used a Bayesian D-efficient design with partial profiles, which enables considering a large number of attributes and interaction effects. We included the following attributes: 1) type of intervention (cure vs. prevention), 2) effectiveness, 3) risk of adverse effects, 4) severity of illness, 5) link between the illness and patients health-related lifestyle, 6) time span between intervention and effect, and 7) patients age group. Results: All attributes were statistically significant contributors to the social value of a health care program, with patients lifestyle and age being the most influential ones. Interaction effects were found, showing that prevention was preferred to cure for disease in young adults, as well as for severe and lethal disease in people of any age. However, substantial differences were found in the preferences of respondents from different age groups, with different lifestyles and different health states. Conclusions: Our study suggests that according to the Belgian public, contextual factors of health gains such as patients age and health-related lifestyle should be considered in priority setting decisions. The studies, however, revealed substantial disagreement in opinion between different population subgroups.