Otago Daily Times, 23 October 2010
By Elspeth McLean
If you had to rank 14 health treatments ranging from hip replacements to drugs for erectile dysfunction according to their benefit or value to society, how would you do it?
That task was given to six focus groups by researcher Trudy Sullivan of the University of Otago's economics department as part of her PhD study.
She is trying to find out the importance New Zealanders place on some of the factors that could be considered when setting priorities for health spending where demands exceed a limited budget.
The focus groups - nurses, health policy makers, over-65-year-olds, public health researchers, GPs and Maori health service providers - were given some information about 14 different treatments (see fact box) and asked to rank them without considering the cost.
The information included prevalence of the condition or illness and the side-effects from the treatment.
Ms Sullivan said the groups eventually ranked the treatments by majority consensus with four out of the six putting oral drugs for erectile dysfunction at the bottom and the same number ranking statins for patients at high risk of cardiovascular disease at the top.
Ms Sullivan said while there was reasonable agreement about the top and bottom priorities, people were divided over ranking of such things as hand sanitiser in schools.
Treatment for illnesses considered to have a lifestyle element, and late-stage treatment for leukaemia and kidney disease were lowly ranked.
Ms Sullivan said it was not the ranking that mattered, but getting people to talk about how they made their choices.
From that she gleaned six factors which those in the groups thought should be included in a prioritisation process - age; benefit to patient (length and/or quality of life); benefit to others (family or society); whether there were alternative treatments; how sick patients were before the treatment; and whether the illness or injury had been caused mainly by lifestyle choices.
What weight people give to these factors is now being tested by Ms Sullivan in an online survey in which people are given a series of scenarios where they must choose between two hypothetical patients.
Ms Sullivan hopes her thesis, which she hopes to have completed in 15 months, may be used by policy makers to aid decision making and that it might lead to further research in the area.
Her survey, which takes 10 to 20 minutes to complete, is open for anyone to complete until November 15.
Later, Ms Sullivan will also be randomly selecting 1500 people from electoral rolls and inviting them to complete the survey, something she expects may yield 200 to 300 participants.
She will be comparing the results of the random group with the self-selected groups.
About 200 people from the latter group had completed the survey so far.
How would you rank these treatments according to their benefit to society?
• Service for postnatal depression.
• Providing hand sanitiser in primary schools.
• Statins for patients at high risk of cardiovascular disease.
• Methadone for opioid addiction.
• Vaccine to prevent cervical cancer.
• Growth hormone for the rare Prader-Willi syndrome.
• Oral drugs for erectile dysfunction.
• Antiretroviral drugs for HIV.
• Invitro fertilisation treatment.
• Abatacept for last-line treatment of rheumatoid arthritis.
• Dialysis for end-stage kidney disease.
• Imatinib mesylate for chronic myeloid leukaemia.
• Hip replacements.
• Positron emission tomography (PET scan).
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