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Into the Far West? Investigating Health Policy-Makers' Willingness to Adopt Decrementally Cost-Effective Innovations Using a DCE Approach

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  • Ivan Tzintzun

    (PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement)

  • Jonathan Sicsic

    (LIRAES (URP_ 4470) - Laboratoire Interdisciplinaire de Recherche Appliquée en Economie de la Santé - UPCité - Université Paris Cité)

  • Lise Rochaix

    (PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, UP1 - Université Paris 1 Panthéon-Sorbonne)

Abstract

In a context of increasingly limited resources, a number of strategies, such as the adoption of decrementally cost-effective interventions (d-CEIs), which are both less clinically effective and less costly, could offer potential levers at enhancing both efficiency and equity in healthcare systems. These interventions are located in the SouthWest (S-W) quadrant of the cost-effectiveness plane, and have yet received little attention from researchers or HTA agencies as they are often perceived as per se "unethical" or "unacceptable", hence the reference sometimes made to the S-W quadrant as the 'Far West'. The purpose of our paper is to investigate policy-makers' willingness to adopt d-CEIs using a choice experiment. We use a two-stage pairwise DCE survey to elicit (i) preferences for d-CEIs' attributes in forced choices and (ii) adoption preferences, i.e. the determinants of d-CEIs' adoption (unforced choices). We investigate the effect (and trade-offs) between three attributes: health loss (very small to significant), reversibility defined as the possibility to switch back to usual care (from possible to hardly possible) and cost-savings (from 5% to 15% of a fixed budget). Such trade-offs are contextualized by using two sensitivity attributes: disease severity (low and moderate) and savings uncertainty (low and high). Our final sample consists of 180 respondents with 46.7% originating from France and the remaining respondents from other EU countries. All attributes' levels have a significant effect in the two decision stages. The "health loss" attribute dominates in the first stage followed by "reversibility": we calculate that decision-makers would require 28.3% increase of budget savings to be indifferent between a scenario of small versus significant health losses and 14.5% budget savings to be indifferent between a scenario of possible and hardly possible reversibility. In contrast, the "reversibility" attribute dominates in the second stage suggesting that anticipated regret may play a role in adoption decisions.

Suggested Citation

  • Ivan Tzintzun & Jonathan Sicsic & Lise Rochaix, 2023. "Into the Far West? Investigating Health Policy-Makers' Willingness to Adopt Decrementally Cost-Effective Innovations Using a DCE Approach," PSE Working Papers halshs-04154933, HAL.
    • Handle: RePEc:hal:psewpa:halshs-04154933
    Note: View the original document on HAL open archive server: https://shs.hal.science/halshs-04154933
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    References listed on IDEAS

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    Keywords

    Health policy-makers choices; Discrete Choice Experiment; Decrementally Cost-Effective Interventions; Disinvestment;
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