Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands.
Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands; Erasmus University Rotterdam, Erasmus School of Economics, Rotterdam, The Netherlands.
Value Health. 2019 Dec;22(12):1441-1449. doi: 10.1016/j.jval.2019.07.012. Epub 2019 Sep 7.
Priority setting in healthcare can be guided by both efficiency and equity principles. The latter principle is often explicated in terms of disease severity and, for example, defined as absolute or proportional shortfall. These severity operationalizations do not explicitly consider patients' age, even though age may be inextricably related to severity and an equity-relevant characteristic.
This study examines the relative strength of societal preferences for severity and age for informing allocation decisions in healthcare.
We elicited preferences for severity and age in a representative sample of the public in The Netherlands (N = 1025) by applying choice tasks and person-trade-off tasks in a design in which severity levels and ages varied both separately and simultaneously between patient groups. We calculated person trade-off ratios and, in addition, applied ordinary least squares regression models to aid interpretation of the ratios when both severity and age varied.
Respondents attached a higher weight (median of ratios: 2.46-3.50) to reimbursing treatment for relatively more severely ill and younger patients when preferences for both were elicited separately. When preferences were elicited simultaneously, respondents attached a higher weight (median of ratios: 1.98 and 2.42) to reimbursing treatment for relatively younger patients, irrespective of patients' severity levels. Ratios varied depending on severity level and age and were generally higher when the difference in severity and age was larger between groups.
Our results suggest that severity operationalizations and equity weights based on severity alone may not align with societal preferences. Adjusting decision-making frameworks to reflect age-related societal preferences should be considered.
医疗保健中的优先事项设定可以同时遵循效率和公平原则。后者原则通常以疾病严重程度来解释，例如，定义为绝对或相对不足。这些严重程度的操作化定义并没有明确考虑到患者的年龄，尽管年龄可能与严重程度和与公平相关的特征密切相关。
本研究旨在检验社会对严重程度和年龄的偏好在医疗保健中的分配决策中的相对重要性。
我们通过在荷兰的代表性公众样本中应用选择任务和个人权衡任务来引出对严重程度和年龄的偏好，该设计中，严重程度水平和年龄在患者群体之间分别和同时变化。我们计算了个人权衡比，并应用普通最小二乘回归模型来帮助解释当严重程度和年龄同时变化时的比值。
当分别引出对两者的偏好时，受访者更倾向于为相对更严重和更年轻的患者报销治疗费用（中位数比值：2.46-3.50）。当同时引出偏好时，受访者更倾向于为相对更年轻的患者报销治疗费用，而不考虑患者的严重程度水平（中位数比值：1.98 和 2.42）。比值因严重程度水平和年龄而异，并且在组间严重程度和年龄差异较大时通常较高。
我们的结果表明，基于严重程度的操作化定义和公平权重可能与社会偏好不一致。应考虑调整决策框架以反映与年龄相关的社会偏好。
