Table 1 Hypothetical decision-making scenarios used in the survey

Scenario 1

Clinical Treatment

A new drug has the potential to heal a chronic infectious disease (prevalence 3%) for which no cure has been available to date. The drug is extremely expensive (US$ 84,000 per course of treatment, approximately US$ 50,000 per quality-adjusted life year gained), and it does not work for all genotypes of the infectious agent. Furthermore, it can lead to serious side effects in rare cases.

Scenario 2

Public Health Intervention

A new vaccination has the potential to prevent a particular type of cancer (incidence 9.9/100,000 per year), but no long-term studies showing the effectiveness are available to date. Preliminary data on the reduction of infection rates of the cancer-causing virus are promising. Interest groups are pushing heavily for health officials to recommend the vaccine and for insurance plans to cover the costs. The costs of a population-wide vaccination campaign would be substantial (US$ 43,600 per quality-adjusted life year gained).

Scenario 3

Clinical Prevention

A drug class has been widely prescribed for the primary and secondary prevention of cardiovascular disease. The number needed to treat to prevent one cardiovascular event is 71 (over 10 years at a cost of € 35,000 per quality-adjusted life year gained). Several new drugs within this class have been approved recently. They are heavily marketed by the industry but, despite higher costs, whether they have any therapeutic benefit compared with that from older drugs remains unclear.