Potential Modifiers of Cost-Effectiveness Thresholds: Public Perspectives on Prioritization in Healthcare Spending
Author(s)
Tom Belleman, MSc1, Jorien Veldwijk, BSc, MSc, PhD2, Maureen Rutten-van Mölken, Sr., PhD2, Carin A. Uyl-De Groot, Sr., PhD3.
1PhD-candidate, Erasmus School of Health Policy and Management, Amsterdam, Netherlands, 2Erasmus University, Rotterdam, Netherlands, 3ESHPM/iMTA Erasmus University Rotterdam, Rotterdam, Netherlands.
1PhD-candidate, Erasmus School of Health Policy and Management, Amsterdam, Netherlands, 2Erasmus University, Rotterdam, Netherlands, 3ESHPM/iMTA Erasmus University Rotterdam, Rotterdam, Netherlands.
OBJECTIVES: Governments use modifiers - specific characteristics that adjust the cost-effectiveness threshold - to prioritize healthcare spending. This study explores public views on such modifiers to assess which could justify potential higher spending on new treatments in Europe.
METHODS: A literature review identified currently used and potential modifiers, including ISPOR value flower elements, resulting in 14 possible modifiers: purpose of treatment, degree of effectiveness, uncertainty, budget impact, age, severity of disease, rarity of disease, unmet need, equity, additional healthcare benefits, staff workload, environmental impact, value of hope, and value of knowing. Three focus groups were held in the Netherlands to explore public perspectives on national healthcare spending and to prioritize the 14 possible modifiers. Additionally, a questionnaire was conducted in five European countries (Bulgaria, Netherlands, Norway, Slovakia, Spain), where participants (n=100 per country) prioritized these modifiers to assess and compare perspectives across Europe.
RESULTS: Focus group participants (N=23) found trade-offs in healthcare spending complex, involving ethical, financial, and fairness considerations. Participants ranked degree of effectiveness, purpose of treatment, and severity of disease highest, while unmet need, value of hope, and environmental impact were ranked lowest. The questionnaire (N=529) confirmed severity of disease, degree of effectiveness, and purpose of treatment as the top three factors. While severity of disease was consistently ranked highest across European countries, environmental impact was consistently ranked lowest. The greatest cross-country variation was observed for additional healthcare benefits and unmet need.
CONCLUSIONS: Our study shows that public views on the prioritization of new treatments are largely consistent with existing policies, particularly related to the use of disease severity as a modifier. Although environmental impact is becoming more prominent in policy discussions, the public seems to consider it less relevant in healthcare spending decisions. Further research is planned to examine public preferences regarding the independent impact of each modifier on healthcare spending.
METHODS: A literature review identified currently used and potential modifiers, including ISPOR value flower elements, resulting in 14 possible modifiers: purpose of treatment, degree of effectiveness, uncertainty, budget impact, age, severity of disease, rarity of disease, unmet need, equity, additional healthcare benefits, staff workload, environmental impact, value of hope, and value of knowing. Three focus groups were held in the Netherlands to explore public perspectives on national healthcare spending and to prioritize the 14 possible modifiers. Additionally, a questionnaire was conducted in five European countries (Bulgaria, Netherlands, Norway, Slovakia, Spain), where participants (n=100 per country) prioritized these modifiers to assess and compare perspectives across Europe.
RESULTS: Focus group participants (N=23) found trade-offs in healthcare spending complex, involving ethical, financial, and fairness considerations. Participants ranked degree of effectiveness, purpose of treatment, and severity of disease highest, while unmet need, value of hope, and environmental impact were ranked lowest. The questionnaire (N=529) confirmed severity of disease, degree of effectiveness, and purpose of treatment as the top three factors. While severity of disease was consistently ranked highest across European countries, environmental impact was consistently ranked lowest. The greatest cross-country variation was observed for additional healthcare benefits and unmet need.
CONCLUSIONS: Our study shows that public views on the prioritization of new treatments are largely consistent with existing policies, particularly related to the use of disease severity as a modifier. Although environmental impact is becoming more prominent in policy discussions, the public seems to consider it less relevant in healthcare spending decisions. Further research is planned to examine public preferences regarding the independent impact of each modifier on healthcare spending.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
P6
Topic
Health Policy & Regulatory
Topic Subcategory
Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas