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Are societal perspectives on resource allocation in health care reflected in recommendations and decisions about funding of costly end of life technologies?

Projectomschrijving

Omdat de Nederlandse bevolking vergrijst, de vraag naar zorg alsmaar toeneemt en er steeds meer behandelmogelijkheden zijn, dreigt de gezondheidszorg onbetaalbaar te worden. Daarom zullen we als maatschappij moeten bepalen wat we willen blijven vergoeden. Met behulp van interviews, discussiebijeenkomsten en vragenlijsten zijn de voorkeuren van de Nederlandse bevolking voor de verdeling van het budget voor gezondheidszorg onderzocht.

Resultaten

Er zijn drie visies gevonden. In de visie ‘Gelijk recht op zorg’ (61% van de bevolking) heeft iedereen recht op zorg en mag er geen voorkeur uitgaan naar bepaalde patiënten boven anderen. In de visie ‘Grenzen aan de zorg’ (26%) zijn er grenzen aan wat de zorg kan doen voor patiënten en zijn preventie en kwaliteit van leven belangrijk. In de visie ‘Effectieve en efficiënte zorg’ (7%) staat het behalen van de hoogste gezondheid in de bevolking centraal. Zes procent had geen duidelijke voorkeur. Geen van de visies gaf prioriteit aan behandelingen aan het einde van het leven.

Producten

Titel: Priority to End of Life Treatments? Views of the Public in the Netherlands
Auteur: Wouters, Sofie, van Exel, Job, Baker, Rachel, B.F. Brouwer, Werner
Magazine: Value in Health
Link: https://doi.org/10.1016/j.jval.2016.09.544

Verslagen


Eindverslag

The ageing of our population, the persistently rising demand for care and the continuously increasing possibilities for treatment threaten the affordability of our health care system. In order to be able to continue providing good care to all, society needs to determine which treatments should remain being reimbursed (and which not). This study has used interviews, focus group sessions and surveys to investigate which criteria the public in the Netherlands considers important for decisions about how to spend the health care budget optimally. A majority of the population considers healthcare as a right, appears to negate that there are limits to healthcare, and therefore does not want to make choices. Everything that is medically possible and desired by patients should be possible. Another part of the population seems to accept that choices need to be made, and appear to prefer quality to length of life, children to adults, and as much health as possible from the available budget. There appears to be no support among the public for making a special case for certain patient groups, as for instance expensive treatments for cancer.

Samenvatting van de aanvraag

While the Dutch guidelines for pharmacoeconomic evaluations state explicitly that studies should take a societal perspective and contemporary pharmacoeconomic evaluation studies in the Dutch context often adhere to this guideline and provide such information, there is a lack of transparency about how the results of such evaluation studies are weighed against other aspects in following recommendations and decisions about the funding of technologies. Furthermore, against accumulating evidence that the general public may be of a different opinion, (internationally) pharmacoeconomic evaluation studies tend to treat all costs and all effects equally, no matter where the money comes from and how it is spent, who the beneficiaries are of the health gains, and what the origin is of their health problem. Consequently, it is not clear whether recommendations and decisions about the funding of technologies actually reflect the societal perspective. While in the Netherlands some weighting (through varying the threshold for costs per QALY estimates for varying proportional shortfall percentages) does take place, it is unclear whether this weighting reflects societal preferences adequately. This project will use a combination of qualitative and quantitative methods to explore the diversity of views in the Dutch population about the relative value of gains from treatment and their possible implications for decisions about the funding of technologies, with a particular focus on costly end-of-life technologies. First, it develops and tests an approach to elicit societal views about complex matters such as the relative value of health gains. Second, a panel of stakeholders (decision makers, industry, patient representation) will evaluate how the approach could complement current procedures to optimize decisions about funding of (costly end-of-life) technologies/pharmaceuticals, and drivers and obstacles for wider implementation of this approach in decision making.

Onderwerpen

Kenmerken

Projectnummer:
152002049
Looptijd: 100%
Looptijd: 100 %
2012
2017
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
Prof. dr. N.J.A. van Exel
Verantwoordelijke organisatie:
Erasmus Universiteit Rotterdam