Exception Is When Something Else is Found to Work Equally Well but Cost Less
For immediate release: December 22, 2011
Washington (DC) – A new survey by the Harvard School of Public Health and the Alliance for Aging Research finds that a majority (62%) of Americans oppose decisions by the government or health insurance plans where prescription drugs or medical or surgical treatments are not paid for because the payors determine that the benefits do not justify the cost. The exception is if there’s evidence that something else works equally well but costs less. A majority (64%) of Americans believe the government or health insurance plans should not pay for a more expensive prescription drug or medical or surgical treatment if it has not been shown to work better than less expensive ones. Majorities in Italy and Germany share both of these beliefs with the U.S. public. In the United Kingdom, at least a plurality shares these beliefs.
“Despite a common presumption that public resistance to placing limits on the use of expensive drugs and treatments is an American phenomenon, similar attitudes also exist in other countries,” said Robert J. Blendon, professor of Health Policy and Political Analysis at the Harvard School of Public Health.
“The results of the survey underscore the need for balance between measures to control health care costs and ensuring that Americans receive high quality health care at all stages of life, particularly for the growing aging population,” said Daniel Perry, President & CEO, Alliance for Aging Research.
New efforts to slow the growth of health care costs may be hampered by the belief of two-thirds (67%) of Americans that government or health insurance plans already often withhold high-cost prescription drugs and medical or surgical treatments from some people who might benefit from them in order to save money. Majorities in Italy and Germany, but not the U.K., also believe this to be the case in their own countries.
The survey included four case examples of actual decisions where the high cost of a prescription drug or diagnostic test was not thought by payors to be justified by its overall benefits. People were read a description of the decision without mentioning in what country it was made or the name of the prescription drug or test involved, and then asked whether they would favor or oppose the decision if it were made in their own country.
In the following case example, describing a decision in the U.K. involving Avastin and bowel cancer, a majority (59%) of Americans said they would oppose such a decision if it were made in their country. This decision was also opposed by the majorities in the other three countries.
- In one country, the national government decided against paying for a new drug for treating an advanced form of cancer. On average, the drug costs ($35,000/£21,000/€25,000) per patient. The drug does not cure the disease, but studies suggest that using the drug can, on average, add about six months to a patient’s life. Some patients would gain only a short period, while others could gain a lot more time.
In the following case, which describes a decision made in Germany involving PET scans for head and neck tumors, a majority (63%) of Americans said they would oppose such a decision if it were made in their country. This decision was also opposed by majorities in Germany and the U.K., but not in Italy.
- In one country, the national government decided against paying for the use of an imaging technology for diagnosing certain types of cancers. The technology is more expensive than alternative methods, costing over ($2,000/£1,200/€1,400) per use. After conducting an evaluation, a government organization concluded there was not enough scientific evidence to recommend using the technology for these other types of cancer. Other countries, however, actively use this technology for multiple types of cancer, because many doctors believe it provides the best, most detailed view of these other types of tumors. The evaluation organization argued that existing studies have not conclusively proven that the technology has advantages over alternative methods and therefore should not be paid for.
In the other two case examples, majorities in all four countries opposed the decision.
The survey found that Americans differ from the public in the other countries on one important matter. A majority of Americans do not support having a government decision-making body that recommends whether government programs should pay for or provide prescription drugs and medical or surgical treatments if they think they cost too much (43% favor, 54% oppose), while majorities in Italy and Germany do support having such a decision-making body and the public in the U.K. is about evenly divided.
When it comes to governmental decision-making in health care, the survey also found that compared with the public in the other three countries, Americans have the lowest level of trust (34%) in the national government to make the right health care decisions.
The Four-Country Comparative Effectiveness Decision-making and Patient Access Survey was designed and analyzed by researchers at the Harvard School of Public Health and the Alliance for Aging Research. The project director is Robert J. Blendon of the Harvard School of Public Health. The research team also includes John M. Benson, Michael Botta, and Kathleen J. Weldon of the Harvard School of Public Health, and Deborah Zeldow of the Alliance for Aging Research.
Fieldwork was conducted via telephone (landline and cell) with nationally representative random samples of adults age 18 and over in the U.S., the U.K., Italy, and Germany by SSRS/ICR, an independent research company.
|Interviewdates||Total interviews||Margin of error|
|U.S.||June 28 – July 24, 2011||1017||+/-3.9|
|U.K.||June 30 – July 19, 2011||500||+/-5.4|
|Italy||June 30 – July 19, 2011||500||+/-5.4|
|Germany||June 30 – July 19, 2011||500||+/-5.4|
Possible sources of non-sampling error include non-response bias, as well as question wording and ordering effects. Non-response in telephone surveys produces some known biases in survey-derived estimates because participation tends to vary for different subgroups of the population. To compensate for these known biases, sample data are weighted to represent each country’s adult population. Weighting targets included telephone status (landline, cell) and various individual demographic: race/ethnicity (U.S. only), age, gender, education, and region.
Many of the questions were asked of split samples, where one half was asked about prescription drugs, the other half about medical or surgical treatments. Because the responses of the half-samples were similar, the data for the two forms were combined in this release. In the U.S. and Germany, questions were asked about “the government or health insurance plans paying for….” In the U.K. and Italy, questions were asked about “national national health service providing….”
The survey was supported by a grant to the Alliance for Aging Research from Bayer AG. Bayer was not involved in the design of the survey or the analysis of the findings.
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Harvard School of Public Health ( https://www.hsph.harvard.edu ) is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: https://www.hsph.harvard.edu
Founded in 1986, the Alliance for Aging Research is a nonprofit, independent organization dedicated to improving the health and independence of aging Americans through public and private funding of medical research and geriatric education. The Alliance combines the interest of top scientists, public officials, business executives, and foundation leaders to promote a greater national investment in research and new technologies that will prepare our nation for the coming senior boom, and improve the quality of life for today’s older generation. Please visit www.agingresearch.org.