We can't always get what we need : A methodological study on the trade-off between disease severity and treatment effect in Swedish healthcare prioritization using a discrete choice experiment

Abstract: In Sweden, three principles prescribed by law compose the ethical platform aiming to ensure a fair distribution of healthcare resources. The goals of each of the three principles are to 1: ensure equal care, regardless of personal characteristics or social function; 2: give priority to patients of bad health; 3: base priority decisions on cost-effectiveness. The weights given to the last two principles yield different implications on which pharmaceuticals and medical procedures to subsidize and can be seen as an equity-efficiency trade-off. Knowledge of the Swedish public's views on this balance has been stated to be of large value to decision-makers, to be used as a basis for priority decisions. However, no such information exists to date. A large share of studies from other countries has moreover provided counter-intuitive estimates, possibly indicating a need for methodological development. In this thesis, I provide a suggestion on a discrete choice approach to quantify opinions on how to weight disease severity and cost-effectiveness in healthcare prioritization. In addition, I present a novel method to use the estimates to rank treatments. The design is furthermore tested in a pilot study, being the first to investigate this question in a Swedish setting. The results indicate that the population values both the amount and distribution of health created, favoring individuals suffering from severe conditions, which is seen as in line with a priori expectations. The thesis contributes to the literature aiming to quantify opinions on healthcare prioritization.