OBJECTIVES: Active disinvestment of healthcare interventions (i.e. stopping reimbursement by means of a policy decision) may be inevitable to curb the growth in healthcare expenditure. This study aims to quantify the criteria the general public takes into account when choosing between candidate healthcare interventions for active disinvestment. Furthermore, the usefulness and feasibility of the participatory value evaluation (PVE) approach, a novel preference elicitation approach, was assessed.

METHODS: Data were collected in April and May 2020 through a web-based environment, in which the participants (N=1335) were presented with a list of eight unlabeled healthcare interventions, described with attributes and levels. From this list, participants were asked to select healthcare interventions for disinvestment in order to save at least a €100 million. Attributes were: quality of life, life expectancy, availability of alternative treatment, and age. After the PVE task, participants were asked to reflect on their choices and provide feedback on the PVE task. PVE data was analyzed using the portfolio and the MDCEV model.

RESULTS: In general, participants understood and enjoyed conducting the PVE task. However, there were some difficulties in including individuals with a low education level. Respondents preferred disinvesting treatments where a (less-effective) alternative was available, that resulted in a smaller gain in life expectancy and quality of life, and which were targeted at older patient groups. Respondents gained the same amount of utility from availability of an alternative treatment as from a gain in life expectancy of 3.6 years.

CONCLUSIONS: PVE is a novel method within the portfolio of preference elicitation methods, which combines the paradigm of consumer sovereignty with citizen sovereignty to determine the social welfare effect of public policies. This study provides researchers insight in the potential merit of this novel method in healthcare. Furthermore, it provides insight in relevant considerations in the disinvestment context.