To discern how the public in four countries, each with unique health systems and cultures, feels about efforts to restrain healthcare costs by limiting the use of high-cost prescription drugs and medical/surgical treatments.
Adult populations in Germany, Italy, the UK and the USA.
2517 adults in the four countries. A questionnaire survey conducted by telephone (landline and cell) with randomly selected adults in each of the four countries.
Main outcome measures
Support for different rationales for not providing/paying for high-cost prescription drugs/medical or surgical treatments, measured in the aggregate and using four case examples derived from actual decisions. Measures of public attitudes about specific policies involving comparative effectiveness and cost-benefit decision making.
The survey finds support among publics in four countries for decisions that limit the use of high-cost prescription drugs/treatments when some other drug/treatment is available that works equally well but costs less. The survey finds little public support, either in individual case examples or when asked in the aggregate, for decisions in which prescription drugs/treatments are denied on the basis of cost or various definitions of benefits. The main results are based on majorities of the public in each country supporting or opposing each measure.
The survey findings indicate that the public distinguishes in practice between the concepts of comparative effectiveness and cost-effectiveness analysis. This suggests that public authorities engaged in decision-making activities will find much more public support if they are dealing with the first type of decision than with the second.
Despite increasing concerns among government officials about high healthcare spending, a survey of the public in four countries finds little support for decisions that limit use of high-cost prescription drugs and treatments.
The results provide insights for policy-makers, indicating that the public distinguishes in practice between the concepts of comparative effectiveness and cost-benefit analysis. They will generally support decisions related to the first but not the second.
Government agencies dealing with cost-control issues should highlight those decisions not to pay for or provide the more expensive drug or treatment when two prescription drugs or treatments have the same outcome but one is more expensive than the other.
Policy-makers need to be aware that when they discuss limiting the availability of high-cost prescription drugs or treatments based on the assessment of broader benefits, they may face considerable public controversy.
Strengths and limitations of this study
This is the only multi-country study of attitudes on this subject. It is unique in that it includes responses for four actual cases where governments made decisions about what should be paid for or provided.
For general public respondents, these are complex issues that may be difficult to understand, and some responses might differ if respondents were aware of other factors.