title: Who prefers the 'cost-effectiveness ratio' prioritization approach in health-care decisions? Results of an empirical analysis.
abstract: BACKGROUND
  The problem of resource scarcity has led to an on-going debate about priority setting in the health-care system. Prioritization via the economic-based cost-effectiveness ratio (CER), for example, is controversial and has many advocates as well as opponents. Hence, the aim of our research is to analyse the fairness consideration of the CER approach in comparison with other prioritization approaches and to investigate whether these preferences depend on the field of study.
  
  
  METHODS
  We developed and tested a unique questionnaire. Between October 2011 and January 2012, freshmen and advanced university students of medicine, law, economics, philosophy and religion in Germany were asked to choose among four prioritization approaches (CER, minimum health, random selection and age) using a dichotomous choice technique. The data were analysed by descriptive and microeconometric regression techniques.
  
  
  RESULTS
  Data on 913 students were included in the study. A majority of the students prioritized cost-effectiveness second after minimum health. Advanced economics students preferred the CER approach significantly more than did incoming economics students. The attitudes of the advanced philosophy/religion students towards the CER were significantly more negative compared with the respective freshmen. Further, gender had a strong, significant impact on attitudes: women chose the CER less often than men did (P < 0.01).
  
  
  CONCLUSIONS
  The results of this study indicate that attitudes presented by opinion leaders in the investigated fields of study seem to be in line with the perceptions of the respective fields' advanced students. Because of these differences, the debate on how to deal with scarce resources may remain complicated.
authors.affiliation: Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Damm
authors.affiliation: Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Prenzler
authors.affiliation: Leibniz University Hannover, Center for Risk and Insurance, Hannover, Germany.
authors.forename: Andy
authors.initials: A
authors.lastname: Zuchandke
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003659:Decision Making, Organizational; D003695:Delivery of Health Care; D005260:Female; D005858:Germany; D015276:Health Care Rationing / Q000379:methods*; D006801:Humans; D008297:Male; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Germany; attitude; empirical analysis; health care; priority setting