Medical treatments and who pays for them-and how much they pay for them-are obviously widely divergent depending on the country's healthcare system. But whether a nation has universal coverage or a third-party payer system such as the one in the US, all systems try to draw some correlation between the cost and benefit of a given procedure or prescription therapy.
Medical treatments and who pays for them—and how much they pay for them—are obviously widely divergent depending on the country’s healthcare system. But whether a nation has universal coverage or a third-party payer system such as the one in the US, all systems try to draw some correlation between the cost and benefit of a given procedure or prescription therapy.
Measurements such as the cost per quality-adjusted life year (QALY), which is calculated by multiplying the length of time spent in a health state by the value of that health state, are useful but limited. Such measures may underestimate the benefits of a treatment that patients experience and that society might value. The cost-benefit analysis is of particular interest for rheumatoid arthritis (RA), given that spontaneous drug-free remission is rare. Thus, RA patients typically need long-term care from a specialist.
An article in a recent issue of Rheumatology looked at the value society places on treatment for RA. The article describes a discrete choice experiment that was given to a representative sample of the Canadian general population. The experiment, developed using focus groups, had seven attributes (route and frequency of treatment administration, chance of benefit, possibility of serious and minor side effects, and confidence in evidence and life expectancy).
“Values are better quantified by what people do rather than what they say they will do,”says study co-author Nick Bansback, MD, Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, Canada. “But it’s really difficult to get actual data on this, so asking [about] hypothetical trade-offs is the best we can do. Policymakers use similar methods for decision-making based on values for health-related quality of life.”
Responses from more than 700 respondents were analyzed. Six attribute levels within four attributes significantly influenced preferences for treatments: a willingness to trade a year of life expectancy over a 10-year period to increase the probability of benefiting from treatment, or two-thirds of a year to reduce minor or serious side effects to the lowest level or improve the confidence in benefit/side-effect estimates.
The results suggest that society values the degree of confidence in the estimates of risks and benefits of RA treatments and the route of administration, as well as benefits and side effects. Bansback says that while the results of the survey were not unexpected, he was surprised by how much people valued precise estimates of risks and benefits. “The results suggest that people are willing to take treatment with a higher point estimate of risk…for example, 10% risk versus 8% risk, as longs as they are more confident in the estimated value.”
As a next step, Bansback would like to look into other factors related to the RA treatment process “Does the rheumatologist listen to the patient’s preferences? Do they inform [other physicians on the treatment team] about the patient’s options?”