Abstract
BackgroundThis paper presents qualitative findings from an assessment of the acceptability of using economic evaluation among policy actors in Thailand. Using cost-utility data from two economic analyses a hypothetical case scenario was created in which policy actors had to choose between two competing interventions to include in a public health benefit package. The two competing interventions, laparoscopic cholecystectomy (LC) for gallbladder disease versus renal dialysis for chronic renal disease, were selected because they highlighted conflicting criteria influencing the allocation of healthcare resources.MethodsSemi-structured interviews were conducted with 36 policy actors who play a major role in resource allocation decisions within the Thai healthcare system. These included 14 policy makers at the national level, five hospital directors, ten health professionals and seven academics.ResultsTwenty six out of 36 (72%) respondents were not convinced by the presentation of economic evaluation findings and chose not to support the inclusion of a proven cost-effective intervention (LC) in the benefit package due to ethical, institutional and political considerations. There were only six respondents, including three policy makers at national level, one hospital director, one health professional and one academic, (6/36, 17%) whose decisions were influenced by economic evaluation evidence.ConclusionThis paper illustrates limitations of using economic evaluation information in decision making priorities of health care, perceived by different policy actors. It demonstrates that the concept of maximising health utility fails to recognise other important societal values in making health resource allocation decisions.
Highlights
This paper presents qualitative findings from an assessment of the acceptability of using economic evaluation among policy actors in Thailand
Given the first information set about disease severity and treatment, 58% of respondents, including eight decision makers at national level, three hospital directors, seven health professionals and three academics opted to support the life-saving intervention, dialysis for chronic renal disease, rather than laparoscopic cholecystectomy (LC) for gallbladder disease
One academic respondent supported dialysis on the grounds that including it in the Universal Health Insurance Coverage (UC) benefit package would reduce an inequality of access in the Thai health care system:
Summary
Using cost-utility data from two economic analyses a hypothetical case scenario was created in which policy actors had to choose between two competing interventions to include in a public health benefit package. Health economic evaluation is a method used to analyse the costs and benefits of different health care interventions, and has often been quoted as the most promising tool to assist decision-makers in health care rationing[2,3]. To allow comparisons across a broad spectrum of intervention or programme areas, a common health benefit composite indicator, such as the Quality Adjusted Life Year (QALY), has been created and applied to numerous interventions to enable decision makers to decide which health investments maximise health (QALYs)[8,9]. A QALY measures both the quantity of life generated by an intervention (in years) and the change to quality of life in each of those years
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