title: Priority to End of Life Treatments? Views of the Public in the Netherlands.
abstract: Recent debates in the Netherlands on health care priority setting have focused on the relative value of gains generated by life-extending medicines for people with a terminal illness, mostly new cancer drugs. These treatments are generally expensive, provide relatively small health gains, and therefore usually do not meet common cost per QALY thresholds. Nevertheless, these drugs may be provided under the assumption that there is public support for making a special case for treatments for people with a terminal illness. This study investigated the views of the public in the Netherlands on a range of equity and efficiency considerations relevant to priority setting and examines whether there is public support for making such a special case.
  
  
  
  Using Q methodology, three viewpoints on important principles for priority setting were identified. Data were collected through ranking exercises conducted by 46 members of the general public in the Netherlands, including 11 respondents with personal experience with cancer.
  
  
  
  Viewpoint 1 emphasized that people have equal rights to healthcare and opposed priority setting on any ground. Viewpoint 2 emphasized that the care for terminal patients should at all times respect the patients' quality of life, which sometimes means refraining from invasive treatments. Viewpoint 3 had a strong focus on effective and efficient care and had no moral objection against priority setting under certain circumstances.
  
  
  
  Overall, we found little public support for the assumption that health gains in terminally ill patients are more valuable than those in other patients. This implies that the assumption that society is prepared to pay more for health gains in people who have only a short period of lifetime left does not correspond with societal preferences in the Netherlands.
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Sofie
authors.initials: S
authors.lastname: Wouters
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands. Electronic address: vanexel@bmg.eur.nl.
authors.forename: Job
authors.initials: J
authors.lastname: van Exel
authors.affiliation: Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Baker
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Werner
authors.initials: W
authors.lastname: B F Brouwer
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D002755:Choice Behavior; D003661:Decision Support Techniques; D005260:Female; D015276:Health Care Rationing / Q000191:economics*; D006292:Health Priorities / Q000191:economics*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000191:economics; D009426:Netherlands; D011639:Public Opinion; D011788:Quality of Life; D013727:Terminal Care / Q000191:economics*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents