Does productivity influence priority setting? A case study from the field of CVD prevention

Lars Lindholm¹ , Emil Löfroth¹^,2 and Måns Rosén³

¹Umeå International School of Public Health and Centre for Populations Studies: Ageing and Living Conditions Programme, Umeå University, Sweden

²Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden

³The Swedish Council on Technology Assessment in Health Care, Stockholm, Sweden

author email corresponding author email

Cost Effectiveness and Resource Allocation 2008, 6:6doi:10.1186/1478-7547-6-6


Published:	17 March 2008

Abstract

In this case study, different measures aimed at preventing cardiovascular diseases (CVD) in different target groups have been ranked based on cost per QALY from a health care sector perspective and from a societal perspective, respectively. The innovation in this study is to introduce a budget constraint and thereby show exactly which groups would be included or excluded in treatment or intervention programs based on the two perspectives. Approximately 90% of the groups are included in both perspectives. Mainly elderly women are excluded when the societal perspective is used and mainly middle-aged men are excluded when the health care sector perspective is used. Elderly women have a higher risk of CVD and generally lower income than middle-aged men. Thus the exclusion of older women in the societal perspective is not a trivial consequence since it is in conflict with the general interpretation of the "treatment according to need" rule, as well as societal goals regarding gender equality and fairness. On the other hand, the exclusion of working individuals in the health care perspective undermines a growth of public resources for future health care for the elderly. The extent and consequences of this conflict are unclear and empirical studies of this problem are rare.