Presentation on theme: "Policies on how to allocate resources in health care are typically based on two kinds of information: (a) the factual benefits and costs of different treatments;"— Presentation transcript:
Policies on how to allocate resources in health care are typically based on two kinds of information: (a) the factual benefits and costs of different treatments; and (b) social value judgements. The latter comes from views of the general public about how limited health care resources should be used – should the health care system improve average population health, or should it give higher priority to the severely ill even if their health cannot be improved as much? In order to establish such public views, surveys of the general public are used. A question might describe two patients A and B, suffering from different diseases, and the amount of health improvement that is possible with treatment. Then the respondent would be asked which of the two patients they think society should treat. Since the objective is to elicit the relative values of the two different health care interventions, the respondent should assume the two patients are already ill and consider which of the two changes would be of larger value for society: for patient A to get better and for patient B to be left untreated, or for patient A to be left untreated and for patient B to get better – i.e. the ‘ex post societal’ perspective. Background Online surveys of societal preferences – do we know what respondents are doing? A literature review Donna Rowen, Mandy Ryan, Aki Tsuchiya, Verity Watson, Universities of Sheffield and Aberdeen Corresponding author: Donna Rowen www.sheffield.ac.uk/heds; @sharrheds; www.abdn.ac.uk/heru; @HERU_Abdn Contact us The use of online surveys to elicit societal preferences is on the rise. Given its speed and cost of data collection, it is an attractive approach to an important research topic. However, there are concerns that perspective error may be present in the data. This poster reports on the findings of a literature review where we examined the information on the wording of the surveys that were available from the published journal articles. We find that, while none of the papers were found to use ambiguous wording between ex ante and ex post preferences, 5 out of 12 papers used wording that we regard as susceptible to perspective error, since a respondent may use a personal perspective to answer a question intended to elicit societal preferences. Conclusion Only 1 paper explicitly indicated whether their survey is aimed to elicit ex ante or ex post preferences. 1 paper did not give enough detail. The remaining papers can be interpreted to have elicited ex post preferences, with baseline health clearly indicated in the scenarios. This includes 3 studies with questions that involved preventive interventions, which we interpreted as ex post (because the choice is down to the size of the health gain; and because choosing A means the illness for B will happen). However, 1 of these explicitly referred to the perspective used as ex ante, (presumably) because at the time of the decision, it is not known who will become ill. Ex post perspective? Key word Search -“social values” -“resource allocation” -“on-line survey” -“health” Database: Medline 1946 onwards in English Hits: 207 Included: Societal values in health using online survey: 13 papers, covering 14 studies Year of publication: 2002-2013, and 9 of the 13 published 2010 or later Journals: 9 different journals including British Medical Journal ; Health Economics ; and Value in Health  Countries: Australia ; Europe ; US; other Topics covered: patient age, baseline health (QOL, survival), health gain (QOL, survival), unmet need, end of life, dependents, sex, ethnicity, income, smoking (responsibility), rarity Recruitment: self selected open access ; convenience sample ; online panel  Sample size: 127-4118; median 800; mean 1198 Method: DCE ; PTO/budget pie ; other Search and hits School Of Health And Related Research Online surveys offer many advantages compared to ‘traditional’ survey modes such as face to face interviews – they are cheaper and quicker. However, online surveys are typically used for market research, asking respondents to indicate which type of product or service they prefer for themselves. So the respondent may think: “whom would I prefer to have treated?”, or even, “which patient would I rather be?” Answering this way would involve the personal perspective instead of the societal. Furthermore, instead of comparing the effects of change, or treatments, this comparison could be between two overall outcomes: getting one disease and being treated for it, or getting the other disease and being treated for that. This would involve an ‘ex ante’ perspective instead of the ‘ex post’. Given this, how susceptible are online surveys to perspective error – where respondents answer from the ‘wrong’ perspective? What can we learn from examining the publications in peer reviewed journals? The question Desser, A.S., Gyrd-Hansen, D., Olsen, J.A., Grepperud, S., Kristiansen, I.S., 2010. Societal views on orphan drugs: cross sectional survey of Norwegians aged 40 to 67. BMJ 341, c4715. Eisenberg, D., Freed, G.L., Davis, M.M., Singer, D., Prosser, L.A., 2011. Valuing health at different ages: evidence from a nationally representative survey in the US. Applied Health Economics & Health Policy 9, 149-156. Lim, M.K., Bae, E.Y., Choi, S.E., Lee, E.K., Lee, T.J., 2012. Eliciting public preference for health-care resource allocation in South Korea. Value in Health 15, Suppl-4. Linley, W.G., Hughes, D.A., 2013. Societal views on NICE, cancer drugs fund and value-based pricing criteria for prioritising medicines: a cross-sectional survey of 4118 adults in Great Britain. Health Economics 22, 948-964. Norman, R., Hall, J., Street, D., Viney, R., 2013. Efficiency and equity: a stated preference approach. Health Economics 22, 568-581. Richardson, J., Sinha, K., Iezzi, A., Maxwell, A., 2012. Maximising health versus sharing: measuring preferences for the allocation of the health budget. Social Science & Medicine 75, 1351-1361. Schwappach, D.L., 2002. The equivalence of numbers: the social value of avoiding health decline: an experimental Web-based study. BMC Medical Informatics & Decision Making 2, 3. Schwappach, D.L., 2003. Does it matter who you are or what you gain? An experimental study of preferences for resource allocation. Health Economics 12, 255-267. Schwappach, D.L., 2005. Are preferences for equality a matter of perspective? Medical Decision Making 25, 449-459. Schwappach, D.L., Strasmann, T.J., 2006. "Quick and dirty numbers"? The reliability of a stated- preference technique for the measurement of preferences for resource allocation. Journal of Health Economics 25, 432-448. Singh, J., Lord, J., Longworth, L., Orr, S., McGarry, T., Sheldon, R., Buxton, M., 2012. Does responsibility affect the public's valuation of health care interventions? A relative valuation approach to health care safety. Value in Health 15, 690-698. van der Wulp I. van den Hout WB. de Vries M. Stiggelbout AM. van den Akker-van Marle EM., 2012. Societal preferences for standard health insurance coverage in the Netherlands: a cross- sectional study. BMJ Open 2, e001021. Werntoft, E., Edberg, A.K., 2009. The views of physicians and politicians concerning age-related prioritisation in healthcare. Journal of Health Organization & Management 23, 38-52. The papers reviewed Although the terms “social values” “societal views” and “societal preferences” were used in all 13 papers, only 4 papers gave any explanation on what was meant by these terms – the 4 papers indicated that these are values/preferences that were not personal or private. None gave a definition. However, 1 paper indicated that societal preferences will be captured by a simple majority in a survey of “individual preferences”. Of the 13 papers, 1 did not give enough detail on the survey so we cannot say what perspective was used. Of the remaining 12 papers, 5 used wording that could potentially be answered from a personal perspective. For example: “indicate your preferred way for the NHS to spend money” “Which of the following two services would you choose or is there no difference?” “If you were asked to choose one of the following two programs, each of which would impact on the health of 100 people, which would you select? A respondent may answer such questions on the basis of the alternative that would benefit them most, personally. Of these, 3 papers referred to choices across health care insurance policies, which would concern personal utility. On the other hand, 7 papers used wording that was clearly consistent with a societal perspective. For example: “Please imagine now, that you work as a health authority. Your responsibility is to decide how the available financial resources should be spent.” “"Please imagine now, that you are the health minister. […] Please consider that you have responsibility for society as a whole." Such wording is less likely to lead to perspective error. Societal perspective? Ex ante Ex post Clearly societal07 Potentially personal05 This poster was prepared for HESG / GCU June 2014, with thanks to Anna Cantrell for conducting the literature search. Acknowledgements
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