title: Comparative analysis of decision maker preferences for equity/efficiency attributes in reimbursement decisions in three European countries.
abstract: BACKGROUND
  In addition to cost-effectiveness, national guidelines often include other factors in reimbursement decisions. However, weights attached to these are rarely quantified, thus decisions can depend strongly on decision-maker preferences.
  
  
  OBJECTIVE
  To explore the preferences of policymakers and healthcare professionals involved in the decision-making process for different efficiency and equity attributes of interventions and to analyse cross-country differences.
  
  
  METHODS
  Discrete choice experiments (DCEs) were carried out in Austria, Hungary, and Norway with policymakers and other professionals working in the health industry (N = 153 respondents). Interventions were described in terms of different efficiency and equity attributes (severity of disease, target age of the population and willingness to subsidise others, potential number of beneficiaries, individual health benefit, and cost-effectiveness). Parameter estimates from the DCE were used to calculate the probability of choosing a healthcare intervention with different characteristics, and to rank different equity and efficiency attributes according to their importance.
  
  
  RESULTS
  In all three countries, cost-effectiveness, individual health benefit and severity of the disease were significant and equally important determinants of decisions. All countries show preferences for interventions targeting young and middle aged populations compared to those targeting populations over 60. However, decision-makers in Austria and Hungary show preferences more oriented to efficiency than equity, while those in Norway show equal preferences for equity and efficiency attributes.
  
  
  CONCLUSIONS
  We find that factors other than cost-effectiveness seem to play an equally important role in decision-making. We also find evidence of cross-country differences in the weight of efficiency and equity attributes.
authors: Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary. petra.baji@uni-corvinus.hu.|CERGE-EI, Prague, Czech Republic. petra.baji@uni-corvinus.hu.
authors: Petra
authors: P
authors: Baji
authors: Departamento de Economía Aplicada II, Universidad Complutense de Madrid, Madrid, Spain.
authors: Manuel
authors: M
authors: García-Goñi
authors: Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary.
authors: László
authors: L
authors: Gulácsi
authors: Economics Department, School of Social Sciences, University of Southampton, Southampton, UK.
authors: Emmanouil
authors: E
authors: Mentzakis
authors: University of Bologna, Bologna, Italy.|Murdoch University, Murdoch, Australia.
authors: Francesco
authors: F
authors: Paolucci
mesh_terms: D000367:Age Factors; D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D003657:Decision Making; D017598:Efficiency, Organizational; D005060:Europe; D017408:Guidelines as Topic; D015276:Health Care Rationing / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D012720:Severity of Illness Index
keywords: Discrete choice experiment; Equity-efficiency trade-off; Priority setting; Reimbursement