EUROPEAN PUBLIC PREFERENCES FOR HEALTHCARE REIMBURSEMENT DECISION CRITERIA: RESULTS FROM AN EIGHT-COUNTRY DISCRETE CHOICE EXPERIMENT
Author(s)
Tom Belleman, MSc1, Jorien Veldwijk, BSc, MSc, PhD2, Maureen Rutten-van Mölken, Sr., PhD2, Carin 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: Healthcare systems face increasing pressure from costly health technologies, yet evidence remains limited on how citizens value reimbursement decision criteria. This study aimed to quantify European public preferences for healthcare reimbursement decision criteria using a discrete choice experiment (DCE).
METHODS: A DCE-survey was developed within the ASCERTAIN project, informed by a literature review, focus groups, and a ranking survey. The DCE used a labelled design with three severity-based alternatives and seven attributes: disease rarity, patient age, unmet need, treatment effectiveness, uncertainty about effectiveness, budget impact, and environmental impact. Respondents were asked to make a reimbursement decision between two alternatives and a ‘neither’ option, while posing as decision-makers. The DCE was administered to the general public in eight European countries: Austria, Bulgaria, France, Lithuania, the Netherlands, Norway, Slovakia, and Spain (n=800/country). Preferences were analysed using MXL models, adjusting for preference heterogeneity across countries and respondent characteristics.
RESULTS: Analyses indicate that all seven attributes were statistically significant independent predictors of reimbursement choices (p<0.05). Treatment effectiveness was most important across Europe, accounting for 25.2% of relative attribute importance, with respondents preferring larger gains in life expectancy and quality of life. Respondents also preferred treatments for newborns and children over adults, and severity-labelled alternatives representing more severe conditions. Lower uncertainty, lower budget impact, and lower environmental impact were associated with higher preference, but had smaller effects than treatment effectiveness. Disease rarity and unmet medical need showed weaker effects. Country-specific analyses indicated variation in the relative importance and direction of several criteria, particularly unmet medical need, disease rarity, budget impact, and environmental impact.
CONCLUSIONS: This study shows how the European public values and trades off healthcare reimbursement decision criteria. Cross-country differences highlight the importance of national priority-setting contexts. These results may inform discussions on threshold modifiers, broader HTA-frameworks, and the alignment of reimbursement policy with societal values.
METHODS: A DCE-survey was developed within the ASCERTAIN project, informed by a literature review, focus groups, and a ranking survey. The DCE used a labelled design with three severity-based alternatives and seven attributes: disease rarity, patient age, unmet need, treatment effectiveness, uncertainty about effectiveness, budget impact, and environmental impact. Respondents were asked to make a reimbursement decision between two alternatives and a ‘neither’ option, while posing as decision-makers. The DCE was administered to the general public in eight European countries: Austria, Bulgaria, France, Lithuania, the Netherlands, Norway, Slovakia, and Spain (n=800/country). Preferences were analysed using MXL models, adjusting for preference heterogeneity across countries and respondent characteristics.
RESULTS: Analyses indicate that all seven attributes were statistically significant independent predictors of reimbursement choices (p<0.05). Treatment effectiveness was most important across Europe, accounting for 25.2% of relative attribute importance, with respondents preferring larger gains in life expectancy and quality of life. Respondents also preferred treatments for newborns and children over adults, and severity-labelled alternatives representing more severe conditions. Lower uncertainty, lower budget impact, and lower environmental impact were associated with higher preference, but had smaller effects than treatment effectiveness. Disease rarity and unmet medical need showed weaker effects. Country-specific analyses indicated variation in the relative importance and direction of several criteria, particularly unmet medical need, disease rarity, budget impact, and environmental impact.
CONCLUSIONS: This study shows how the European public values and trades off healthcare reimbursement decision criteria. Cross-country differences highlight the importance of national priority-setting contexts. These results may inform discussions on threshold modifiers, broader HTA-frameworks, and the alignment of reimbursement policy with societal values.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR52
Topic
Health Policy & Regulatory
Topic Subcategory
Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas