Priority for Self or Others? Incorporating Equity Considerations in a Preference-Based Health Value Assessment

To investigate patient preferences for health insurance plans covering newer type 2 diabetes treatments when equity is considered.

A discrete choice experiment with 701 patients with type 2 diabetes tested 2 experimental conditions: (1) personal health outcomes only (experiment 1) and (2) equal health outcomes for self and other patients with poorer health (experiment 2). Preferences were estimated using latent-class logit models in willingness-to-pay (WTP) space.

Two distinct classes emerged under each experimental condition. In experiment 1, a "Risk-Averse" class (68.6%) displayed high WTP for a 1-percentage-point improvement in efficacy ($26.06, P < .01) and required large compensation for a 1-percentage-point increase in risk of side effects (-$28.39, P < .01), with low price sensitivity and a low likelihood of opting out. In contrast, a "Cost-Sensitive" class (31.4%) valued efficacy at $6.89 (P < .01), showed weaker risk aversion (-$5.15, P < .01), greater price sensitivity (-0.39, P < .01), and a higher tendency to opt-out. In experiment 2, an "Equity-Concerned" class (71.6%) showed a high WTP for efficacy ($20.84, P < .01), lower risk aversion (-$14.33, P < .01), and relatively lower price sensitivity (-0.10, P < .01). The "Cost-Sensitive" class (28.4%) valued efficacy at $7.28 (P < .01) and was insensitive to risk ($0.03, P = .98). Older respondents tended to align with cost-sensitive classes, whereas those with childcare responsibilities were more likely to belong to risk averse/equity-concerned classes.

Patients exhibited strong preferences for treatment efficacy, risk aversion, and varying levels of cost sensitivity. However, risk tolerance increased when equity was considered.