Views of the UK General Public on Important Aspects of Health Not Captured by EQ-5D.

INTRODUCTION: The EQ-5D is a standardised instrument designed for use as a generic measure of health outcome. It was (and is) intended to provide information about a 'common core' of dimensions known to be relevant across a range of conditions; however, the five dimensions may not fully capture the health-related impacts of certain conditions. This study analyses the views of the UK general public about important aspects of health considered to be missing from the instrument. METHODS: Survey respondents were asked whether there are any aspects of health they consider to be important but are not captured by the EQ-5D, and, if so, what these aspects are. The responses (text comments) were analysed using content analysis with analyst triangulation. Data were collected from a broadly representative sample of the general public via a paper questionnaire administered as part of face-to-face interviews. RESULTS: Data are available for 436 respondents, 179 of whom suggested aspects of health they considered important but not captured by the five EQ-5D dimensions. These were organised into 22 themes. Sensory deprivation and mental health were the health aspects most commonly mentioned by respondents. CONCLUSIONS: Respondents identified several important aspects of health that are not covered by the EQ-5D descriptive system. This study can provide the basis for more detailed qualitative and quantitative research-in particular to examine the views of different patient groups-to inform further review of the EQ-5D descriptive system. The results also have implications for the sensitivity of other generic measures.

Government and charity funding of cancer research: public preferences and choices.

BACKGROUND: It is unclear how the public would respond to changes in government decisions about how much to spend on medical research in total and specifically on major disease areas such as cancer. Our aim was to elicit the views of the general public in the United Kingdom about how a change in government spending on cancer research might affect their willingness to donate, or to hypothecate a portion of their income tax payments, to cancer research charities. METHODS: A web-based stated preference survey was conducted in 2013. Respondents considered hypothetical scenarios regarding changes in the levels of government funding for medical research. In each scenario, respondents were asked to imagine that they could allocate £100 of the income tax they paid this year to one or more medical research charities. They were asked how they wished to allocate the £100 between cancer research charities and medical research charities concerned with diseases other than cancer. After having been given the opportunity to allocate £100 in this way, respondents were then asked if they would want to reduce or increase any personal out-of-pocket donations that they already make to cancer research and non-cancer medical research charities. Descriptive analyses and random effects modelling were used to examine patterns in the response data. RESULTS: The general tendency of respondents was to act to offset hypothetical changes in government spending. When asked to imagine that the government had reduced (or increased) its spending on cancer research, the general tendency of respondents was to state that they would give a larger (or smaller) allocation of their income tax to cancer research charities, and to increase (or reduce) their personal out-of-pocket donations to cancer research charities. However, most respondents' preferred allocation splits and changes in personal donations did not vary much from scenario to scenario. Many of the differences between scenarios were small and non-significant. CONCLUSIONS: The public's decisions about how much to donate to cancer research or other medical research charities are not greatly affected by (hypothetical) changes to government plans about the amount of public funding of cancer or other medical research.

IS THE LINK BETWEEN HEALTH AND WEALTH CONSIDERED IN DECISION MAKING? RESULTS FROM A QUALITATIVE STUDY.

OBJECTIVES: The aim of this study was to explore whether wealth effects of health interventions, including productivity gains and savings in other sectors, are considered in resource allocations by health technology assessment (HTA) agencies and government departments. To analyze reasons for including, or not including, wealth effects. METHODS: Semi-structured interviews with decision makers and academic experts in eight countries (Australia, France, Germany, Italy, Poland, South Korea, Sweden, and the United Kingdom). RESULTS: There is evidence suggesting that health interventions can produce economic gains for patients and national economies. However, we found that the link between health and wealth does not influence decision making in any country with the exception of Sweden. This is due to a combination of factors, including system fragmentation, methodological issues, and the economic recession forcing national governments to focus on short-term measures. CONCLUSIONS: In countries with established HTA processes and methods allowing, in principle, the inclusion of wider effects in exceptional cases or secondary analyses, it might be possible to overcome the methodological and practical barriers and see a more systematic consideration of wealth effect in decision making. This would be consistent with principles of efficient priority setting. Barriers for the consideration of wealth effects in government decision making are more fundamental, due to an enduring separation of budgets within the public sector and current financial pressures. However, governments should consider all relevant effects from public investments, including healthcare, even when benefits can only be captured in the medium- and long-term. This will ensure that resources are allocated where they bring the best returns.