Bias in valuation of health care benefits in metastatic prostate cancer: A contingent valuation of willingness to pay.

6616 Background: Willingness to pay (WTP) studies assess societal valuation of healthcare interventions. Prostate cancer (PC) is the most common cancer diagnosis in men. We explore factors that may bias valuation of health care benefits through contingent valuation of WTP for therapeutic innovation in metastatic castration-resistant PC. Methods: Cross-sectional study of Portuguese Society (SOC) and Healthcare Providers (HCP). Monthly WTP assessed through biding and open-ended questions by standardized survey with 2 baseline scenarios: ScA 12-month median survival, ScB 30-month median survival. Respondents considered own financial resources and expenses and for each therapeutic scenario reported WTP, out-of-pocket, and expected National Healthcare System (NHCS) WTP. Impact of demographic, personal medical history and household income assessed by tweedie generalized linear model. Results: 1000 subjects on societal cohort and 100 physicians provided valid responses. Subjects reported higher WTP values when NHCS was to provide treatment compared to out-of-pocket cost. For NHCS perspective median WTP for ScA was 2,133€ for HCP vs 5,510€ for SOC and ScB 1 963€ for HCP vs 5,479€ for SOC. Overall, societal cohort’s NHCS mean WTP was 2.6 (ScA) and 2.8 (ScB) times higher (p < .001) than healthcare providers, but with no difference for out-of-pocket WTP. This difference remained significant when adjusted for all other factors. Additionally, subjects with prior personal or familial history of cancer and subjects with higher household income provided higher WTP estimates. In HCP cohort, urologists reported higher WTP compared to Medical Oncologists. Conclusions: This study provides critical insight into differing valuation of cancer treatments between physicians and society and potential biases in individual valuation of healthcare benefits. Improvement of societal’s perception and understanding of cost-benefit assessments is critical to designing an equitable healthcare system.

Procedura kontraktowania świadczeń przez Narodowy Fundusz Zdrowia. Próba analizy SWOT

Contracting of health care benefits is a very important tool that allows a payer to create desired structure, considering the needs notified by the patients, the cost-effectiveness and the quality of the benefits. Contracting is aimed at attaining a number of important tasks such as the implementation of the existing rules of access to health care and the development of supply and demand in a way that facilitates the implementation of the adopted health policy. Contracting of health care benefits is thus an important tool enabling to introduce the regulated market and regulated competition. Therefore, a correct model for contracting of benefits is essential for correct exchanges of the limited (and specific) resources on the healthcare market. The purpose of this article is to assess the contracting of health care benefits by the National Health Fund. The following areas impacting on contracting of benefits were analysed: sources of financing, benefits purchase planning, valuation of benefits and the procedures for the award of contracts. A SWOT analysis was used to perform the analysis. At present the contracting of health care benefits in Poland is regulated by the Act of 27 August 2004 on health care benefits financed from public funds (consolidated text: Journal of Laws 2015, item 581, as amended). The article describes the legal situation on 31 March 2016. The conclusions from the analysis confirm the need for change, in particular by improving the cost efficiency and the implementation of activities promoting comprehensive care of a patient.