Understanding Social Preferences Regarding the Prioritisation of Treatments Addressing Unmet Need and Severity

Background: The UK Government is proposing to include “burden of illness” in its proposed scheme for the value-based pricing (VBP) of branded medicines. The VBP consultation document suggests that medicines that tackle diseases associated with high levels of burden of illness will be rewarded more highly than those that do not. It includes a definition of burden of illness that incorporates consideration of severity (in terms of either length or quality of life) and unmet need (the degree to which treatments exist). However, there is a dearth of empirical evidence on societal preferences regarding this particular definition of unmet need. Objective: The aim of this exploratory study is to design and pilot an approach to eliciting public preferences regarding the prioritisation of health care resources according to unmet need and severity. Methodology: In face-to-face interviews, respondents answered 11 questions. Some of these involved the consideration of hypothetical priority setting scenarios; others involved consideration of pairs of statement about NHS priorities and required choosing the statement with which they most agreed. The various questions were designed to examine the extent to which respondents were willing to make trade-offs between health gains, treating the severely ill, and addressing areas of unmet need. Results: Sixty members of the general public in southeast England were interviewed in May 2012. We find that maximising health gain is considered by most respondents to be more important than the competing objectives of giving priority to the severely ill and giving priority to treating conditions for which no alternative treatments exist. According to the interviewers, most of the respondents showed a good understanding of the survey tasks. Discussion and Conclusions: Some of our findings run counter to those of empirical studies elsewhere in the literature that examine social preferences regarding unmet need and severity. However, framing effects clearly are at play, since the level of support for an implied policy of giving priority according to unmet need varies greatly from question to question. A key finding is that people’s responses to stated preference questions appear to be influenced heavily by the ways in which the questions are framed