More than health : the role and value of meta-health effects in health care decisions

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One of the most visible functions of government is to make decisions about funding health care treatments. This thesis investigates the role and value of meta-health effects in such decisions. Meta-health effects are effects other than health that result from the consumption of health care, and have value in their own right regardless of health status. The research in this thesis is facilitated via four inter-related case studies. The first examines the available information on decisions made by the Pharmaceutical Benefits Advisory Committee (PBAC) in Australia for evidence of the use of meta-health effects in drug reimbursement decisions. This is supplemented in that same case study by a systematic review of the methods used to value meta-health effects for use in economic evaluations. Three empirical case studies are subsequently presented which focus on the role of meta-health effects in individuals’ decisions regarding health care as a means of informing what might be considered in public decision making. All three case studies use survey-based methods: a general community survey on experiences and attitudes on general practitioner use, and two discrete choice experiment (DCE) surveys (one on ongoing therapy for rheumatoid arthritis, the other for the management of breast cancer recurrence risk). Together these three case studies explore how differences in the decision-making context, and methods of elicitation (such as attitudes or preferences) influence the role and value of meta-health effects. Within the DCEs those values are explored using willingness to pay, investigating how they are affected by framing. The results show that meta-health effects do influence choice. The review of PBAC decisions and the systematic review show that gains in convenience (e.g. gains in mode of administration) are investigated most often, but that differences in study methods influence the values derived. An important finding of the results of the empirical case studies is that meta-health effects do influence individual choices and the extent of that influence declines the greater the health implications of that decision. Similarly, they find that the amount and type of information presented influences the values derived in studies eliciting values for meta-health effects. This is not only a contribution to the literature, but highlights the importance to government decision makers of understanding how values for meta-health effects have been derived; careful attention needs to be paid to the manner in which such values have been derived lest they misrepresent the resulting value to society.
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