Balancing Cost-Effectiveness With Societal Values: A Representative Survey of Norwegian Attitudes Toward Healthcare Resource Allocation
Author(s)
Francisco Oteiza, PhD1, Susanne Gerda Værnø, M.Sc.1, Christoffer Bugge, PhD1, Thomas Hansen, M.Sc.2, Navneet Kaur Bhuller, M.Sc.2.
1Oslo Economics, Oslo, Norway, 2Value & Access, Sanofi, Oslo, Norway.
1Oslo Economics, Oslo, Norway, 2Value & Access, Sanofi, Oslo, Norway.
OBJECTIVES: Public resources are scarce and public healthcare systems must prioritise. In Norway, an explicit set of prioritisation criteria has been established, in which cost-effectiveness and disease severity play a key role. However, few studies have been conducted to understand the general public’s view on these, or other, prioritisation criteria. The aim of the study was thus to assess the attitudes of the Norwegian general population towards a range of priority setting criteria relevant to the Norwegian public health care system.
METHODS: An electronic survey was conducted among a representative sample of Norwegian adults in April 2024 (N= 1,010). Respondents were asked to express agreement with prioritisation principles and to allocate hypothetical healthcare funds across treatment alternatives in specific trade-off scenarios. These scenarios varied by disease characteristics (severity, rarity) as well as treatment impacts (enabling patients or caregivers to return to work). Sampling weights were applied to each individual respondent to further match the distribution of these traits among the general adult Norwegian population. This survey is among the first of its kind including multiple criteria conducted in Norway.
RESULTS: While 94% supported prioritising treatments that maximise health gains, substantial shares of respondents deviated from strict cost-effectiveness when faced with concrete trade-off scenarios. Notably, 78% opted to prioritise more costly treatment because it enabled patients to return to work. Similarly, 66%, 58%, and 38% prioritised more expensive treatments when they benefited caregivers, addressed a severe or a rare disease, respectively.
CONCLUSIONS: Norwegian societal preferences favour a more comprehensive prioritization framework than what is currently applied. Respondents were consistently willing to trade off efficiency for other ethical or societal considerations—most strongly in favour of productivity gains. These insights underscore the need for constant revision of prioritization criteria used in healthcare decisions, to reflect public preferences.
METHODS: An electronic survey was conducted among a representative sample of Norwegian adults in April 2024 (N= 1,010). Respondents were asked to express agreement with prioritisation principles and to allocate hypothetical healthcare funds across treatment alternatives in specific trade-off scenarios. These scenarios varied by disease characteristics (severity, rarity) as well as treatment impacts (enabling patients or caregivers to return to work). Sampling weights were applied to each individual respondent to further match the distribution of these traits among the general adult Norwegian population. This survey is among the first of its kind including multiple criteria conducted in Norway.
RESULTS: While 94% supported prioritising treatments that maximise health gains, substantial shares of respondents deviated from strict cost-effectiveness when faced with concrete trade-off scenarios. Notably, 78% opted to prioritise more costly treatment because it enabled patients to return to work. Similarly, 66%, 58%, and 38% prioritised more expensive treatments when they benefited caregivers, addressed a severe or a rare disease, respectively.
CONCLUSIONS: Norwegian societal preferences favour a more comprehensive prioritization framework than what is currently applied. Respondents were consistently willing to trade off efficiency for other ethical or societal considerations—most strongly in favour of productivity gains. These insights underscore the need for constant revision of prioritization criteria used in healthcare decisions, to reflect public preferences.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR32
Topic
Health Policy & Regulatory, Health Technology Assessment, Patient-Centered Research
Topic Subcategory
Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Rare & Orphan Diseases