Do medical professionals value cost-effectiveness or equity higher in clinical decision making? A recent paper in BMJ investigated this question. The following hypothetical decision-making scenario was sent to medical students, residents-in-training, and practicing physicians, to select between two colon cancer screening tests for a population.
‘A group of doctors was formed to help the government decide which of two tests to offer low-risk people. Test 1 [the more equitable option] is inexpensive but does not always detect cancers in their early stages. Test 2 [the more cost-effective option] is more expensive but is better at detecting early cancers. The decision is complicated by budget limitations: the government has only a certain amount of money available to pay for the screening tests. After evaluating the costs and benefits of each test, the doctors have reached the following conclu- sions. The budget is just large enough to offer Test 1 [the equitable option] to all the low-risk people. With this approach, everyone can receive the test, and 1000 deaths from colon cancer will be prevented. The budget is just large enough to offer Test 2 [the cost-effective option] to half of the low-risk people. With this approach, half of the people can receive the test and half cannot, and 1100 deaths from colon cancer will be prevented.’
The researchers found that practicing physicians appeared to be more egalitarian than residents-in-training, while medical students appeared to be most utilitarian and cost-effective. Female respondents favored the more equitable option.
In an era where health care equity is under attack, my opinion is that we need a renewed focus on ensuring that everyone has access to high quality health care.