Incorporating cost considerations into shared decision-making: A cross-country comparison among Hungary, France, and Bulgaria

This study aims to compare the patients’ and healthcare professionals’ (HCPs) opinions about the necessity and acceptance of discussing the cost of treatment as part of shared decision-making (SDM) in three healthcare jurisdictions – Bulgaria, Hungary, and France. The applied methodology was qualitative and non-interventional, in the form of a focus group series performed in all three countries. The focus group guideline contained a set of preliminarily formulated questions, consistent across countries, about the potential importance of discussing effectiveness, safety, and cost with physicians. The study found that information about the cost of therapy is considered important, especially for diseases with co-payments for medicines, such as diabetes. Despite the importance of costs, patients and physicians reported avoiding discussions and decision-making that consider the cost of therapies. Patients in France are more open to such discussions but often state that after authorities decide price and reimbursement on behalf of the community, patients should not be involved, whereas in the other two countries, they are more reluctant. In all groups, it was suggested that there is a need for more properly trained healthcare professionals who can guide conversations with expertise in shared decision-making, a method that is still not widely applied. In conclusion, shared decision-making, including cost consideration, is not widely applied in the observed countries. HCPs and patients recognize its importance but lack experience and training to properly include it in discussions.