title: Public preferences for prioritizing preventive and curative health care interventions: a discrete choice experiment.
abstract: BACKGROUND
  Setting fair health care priorities counts among the most difficult ethical challenges our societies are facing.
  
  
  OBJECTIVE
  To elicit through a discrete choice experiment the Belgian adult population's (18-75 years; N = 750) preferences for prioritizing health care and investigate whether these preferences are different for prevention versus cure.
  
  
  METHODS
  We used a Bayesian D-efficient design with partial profiles, which enables considering a large number of attributes and interaction effects. We included the following attributes: 1) type of intervention (cure vs. prevention), 2) effectiveness, 3) risk of adverse effects, 4) severity of illness, 5) link between the illness and patient's health-related lifestyle, 6) time span between intervention and effect, and 7) patient's age group.
  
  
  RESULTS
  All attributes were statistically significant contributors to the social value of a health care program, with patient's lifestyle and age being the most influential ones. Interaction effects were found, showing that prevention was preferred to cure for disease in young adults, as well as for severe and lethal disease in people of any age. However, substantial differences were found in the preferences of respondents from different age groups, with different lifestyles and different health states.
  
  
  CONCLUSIONS
  Our study suggests that according to the Belgian public, contextual factors of health gains such as patient's age and health-related lifestyle should be considered in priority setting decisions. The studies, however, revealed substantial disagreement in opinion between different population subgroups.
authors.affiliation: Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerpen, Belgium; Centre for Economics and Ethics, Institute of Philosophy, University of Leuven, Leuven, Belgium; Department of Social Policy, London School of Economics and Political Science, London, UK. Electronic address: jeroen.luyten@uantwerpen.be.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Luyten
authors.affiliation: Faculty of Applied Economics, Department of Economics, University of Antwerp, Antwerpen, Belgium; StatUa Center for Statistics, University of Antwerp, Antwerpen, Belgium.
authors.forename: Roselinde
authors.initials: R
authors.lastname: Kessels
authors.affiliation: Faculty of Applied Economics, Department of Economics, University of Antwerp, Antwerpen, Belgium; StatUa Center for Statistics, University of Antwerp, Antwerpen, Belgium; Department of Econometrics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands; Faculty of Bioscience Engineering, Department of Biosystems, University of Leuven, Leuven, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Goos
authors.affiliation: Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerpen, Belgium; School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia.
authors.forename: Philippe
authors.initials: P
authors.lastname: Beutels
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001499:Bayes Theorem; D001530:Belgium / Q000453:epidemiology; D002755:Choice Behavior; D003258:Consumer Behavior / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006292:Health Priorities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: QALY; distribution; efficiency; equity; prevention; treatment