Priority to end of life treatments? Views of the public in the Netherlands

Sofie Wouters, Job van Exel, Rachel Baker, Werner B.F. Brouwer

Research output: Contribution to journalArticle

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Abstract

Objectives
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.

Methods
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.

Results
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.

Conclusions
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.
Original languageEnglish
Pages (from-to)107-117
Number of pages11
JournalValue in Health
Volume20
Issue number1
Early online date5 Jan 2017
DOIs
Publication statusPublished - Jan 2017

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Netherlands
Health
Delivery of Health Care
Health Priorities
Terminally Ill
Terminal Care
Quality-Adjusted Life Years
Therapeutics
Pharmaceutical Preparations
Neoplasms
Patient Care
Quality of Life
Exercise
Costs and Cost Analysis

Keywords

  • end of life treatments
  • health economics
  • Q methodology
  • social values
  • Netherlands

Cite this

Wouters, S., van Exel, J., Baker, R., & Brouwer, W. B. F. (2017). Priority to end of life treatments? Views of the public in the Netherlands. Value in Health, 20(1), 107-117. https://doi.org/10.1016/j.jval.2016.09.544
Wouters, Sofie ; van Exel, Job ; Baker, Rachel ; Brouwer, Werner B.F. / Priority to end of life treatments? Views of the public in the Netherlands. In: Value in Health. 2017 ; Vol. 20, No. 1. pp. 107-117.
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Wouters, S, van Exel, J, Baker, R & Brouwer, WBF 2017, 'Priority to end of life treatments? Views of the public in the Netherlands', Value in Health, vol. 20, no. 1, pp. 107-117. https://doi.org/10.1016/j.jval.2016.09.544

Priority to end of life treatments? Views of the public in the Netherlands. / Wouters, Sofie; van Exel, Job; Baker, Rachel; Brouwer, Werner B.F.

In: Value in Health, Vol. 20, No. 1, 01.2017, p. 107-117.

Research output: Contribution to journalArticle

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AU - Wouters, Sofie

AU - van Exel, Job

AU - Baker, Rachel

AU - Brouwer, Werner B.F.

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PY - 2017/1

Y1 - 2017/1

N2 - ObjectivesRecent 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.MethodsUsing 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.ResultsViewpoint 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.ConclusionsOverall, 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.

AB - ObjectivesRecent 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.MethodsUsing 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.ResultsViewpoint 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.ConclusionsOverall, 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.

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