Master of Science
Epidemiology and Biostatistics
Background: Resource allocation decisions are made based on the principle of maximizing population health (efficiency). However, in practice, much higher willingness-to-pay thresholds are used for cancer therapies, with limited supportive evidence.
Objective: To quantify Canadian public preferences on trade-offs between cancer and non-cancer health outcomes.
Methods: Our systematic review identified 7 studies, but none evaluated cancer trade-offs. We conducted a survey using a sample of 300 respondents, with three resource allocation scenarios: (1) cancer versus non-cancer; (2) lung cancer versus heart failure; and (3) lung cancer prevention versus diabetes prevention.
Results: The median respondent preferred health maximization, irrespective of the health condition. Across scenarios 1/2/3, only 29%, 10%, and 26%, respectively, were willing to trade-off efficiency to prioritize cancer outcomes. Regression analysis did not find any significant associations.
Conclusion: We did not find evidence to support a higher preference for sacrificing total health to improve cancer outcomes over non-cancer outcomes.
Summary for Lay Audience
Resource allocation decisions made by our health system focus on the principle of maximizing total population health for the available resources. Policy makers determine whether a health intervention is worth funding if it is at what they consider an “acceptable threshold” of cost-effectiveness. However, in many countries, including Canada, cancer drug reimbursements are evaluated using higher cost-effectiveness thresholds than other interventions; this implies that cancer outcomes are valued higher than non-cancer outcomes. There is limited evidence that society supports this threshold and is willing to sacrifice a portion of the total population health in favour of certain health conditions.
The objective of this thesis was first to conduct a systematic review to identify Canadian studies eliciting trade-offs between population groups. As we did not identify any studies evaluating cancer conditions, our second objective was to determine Canadians' relative preference on health gains associated with cancer versus non-cancer conditions - this was achieved through our survey. We invited participants to allocate additional treatment funds to patients with non-cancer health problems (option A) or patients with cancer (option B); however, option B became more and more inefficient with each subsequent comparison. This framework was used for three allocation scenarios: (1) cancer versus non-cancer; (2) lung cancer versus heart failure; and (3) lung cancer prevention versus diabetes prevention. The degree of preference was estimated by observing the point at which a respondent is indifferent between the two options or “switches” from option B (supports cancer patients) to option A (supports non-cancer patients). Responses were also categorized based on when the respondent makes the “switch” or becomes indifferent.
We found that the median respondent preferred health maximization, irrespective of the health condition (60%-75%). Across scenarios 1/2/3, only 29%, 10%, and 26%, respectively, were willing to trade-off efficiency to prioritize cancer outcomes.
We did not find evidence to support sacrificing a portion of the total population health to improve cancer outcomes. As societal preferences are crucial to healthcare priority-setting and can be used to inform decision-making processes, future research should focus on gaining a deeper understanding of Canadians’ preferences on trade-offs involved in resource allocation decisions.
Garaszczuk, Roxanne, "Societal Preferences for Trade-offs between Cancer and Non-Cancer Health Outcomes: A Choice Experiment" (2021). Electronic Thesis and Dissertation Repository. 8270.