1
|
Boxebeld S, Geijsen T, Tuit C, Exel JV, Makady A, Maes L, van Agthoven M, Mouter N. Public preferences for the allocation of societal resources over different healthcare purposes. Soc Sci Med 2024; 341:116536. [PMID: 38176245 DOI: 10.1016/j.socscimed.2023.116536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Increasing healthcare expenditures require governments to make difficult prioritization decisions. Considering public preferences can help raise citizens' support. Previous research has predominantly elicited preferences for the allocation of public resources towards specific treatments or patient groups and principles for resource allocation. This study contributes by examining public preferences for budget allocation over various healthcare purposes in the Netherlands. METHODS We conducted a Participatory Value Evaluation (PVE) choice experiment in which 1408 respondents were asked to allocate a hypothetical budget over eight healthcare purposes: general practice and other easily accessible healthcare, hospital care, elderly care, disability care, mental healthcare, preventive care by encouragement, preventive care by discouragement, and new and better medicines. A default expenditure was set for each healthcare purpose, based on current expenditures. Respondents could adjust these default expenditures using sliders and were presented with the implications of their adjustments on health and well-being outcomes, the economy, and the healthcare premium. As a constraint, the maximum increase in the mandatory healthcare premium for adult citizens was €600 per year. The data were analysed using descriptive statistics and a Latent Class Cluster Analysis (LCCA). RESULTS On average, respondents preferred to increase total expenditures on all healthcare purposes, but especially on elderly care, new and better medicines, and mental healthcare. Three preference clusters were identified. The largest cluster preferred modest increases in expenditures, the second a much higher increase of expenditures, and the smallest favouring a substantial reduction of the healthcare premium by decreasing the expenditure on all healthcare purposes. The analyses also demonstrated substantial preference heterogeneity between clusters for budget allocation over different healthcare purposes. CONCLUSIONS The results of this choice experiment show that most citizens in the Netherlands support increasing healthcare expenditures. However, substantial heterogeneity was identified in preferences for healthcare purposes to prioritize. Considering these preferences may increase public support for prioritization decisions.
Collapse
Affiliation(s)
- Sander Boxebeld
- Department of Health Economics, Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, the Netherlands; Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, the Netherlands.
| | | | | | - Job van Exel
- Department of Health Economics, Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, the Netherlands; Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, the Netherlands
| | - Amr Makady
- Janssen-Cilag B.V., Breda, the Netherlands
| | | | | | - Niek Mouter
- Populytics, Leiden, the Netherlands; Transport and Logistics Group, Faculty of Technology, Policy & Management (TPM), Delft University of Technology, the Netherlands
| |
Collapse
|
2
|
Gupta P, Rouffy-Ly B, Rohrer-Herold K, Koch K, Rao N, Poulussen C, Brearley L, Abou-Taleb H, Rajan D. Assessing the interactions of people and policy-makers in social participation for health: an inventory of participatory governance measures from a rapid systematic literature review. Int J Equity Health 2023; 22:240. [PMID: 37978389 PMCID: PMC10657134 DOI: 10.1186/s12939-023-01918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/18/2023] [Indexed: 11/19/2023] Open
Abstract
Social participation, also termed stakeholder voice, is an important component of health system governance. Increased interactions between the community and policy makers could facilitate a more responsive health system that targets the needs of the community better. Recently, the World Health Organization (WHO) published a handbook on social participation that identified five key themes for ministries of health to consider when engaging the input of the community. In this rapid systematic literature review, we aimed to identify quantitative and qualitative measures that have been used to assess aspects of social participation involving people and policy makers. We identified 172 measures from 48 studies from countries in all six WHO regions. These measures were categorized by all five themes from the handbook on social participation and these measures are linked to 27 concepts. This rapid review found that the focus of measures is largely on the existence of participation-be it by the general population or specific vulnerable groups-rather than on the quality of their participation. The measures in this inventory may be useful for ministries of health and other key stakeholders to use when developing methods to assess and encourage social participation in their context.
Collapse
Affiliation(s)
- Prateek Gupta
- Special Programme On Primary Health Care, World Health Organization, Av. Appia 20, 1211, Geneva, Switzerland.
- Universal Health Coverage/Health Systems Department, World Health Organization, Magless El Shaab, PO Box No. 146, Cairo, 11516, Egypt.
| | - Benjamin Rouffy-Ly
- Special Programme On Primary Health Care, World Health Organization, Av. Appia 20, 1211, Geneva, Switzerland
| | - Katja Rohrer-Herold
- Special Programme On Primary Health Care, World Health Organization, Av. Appia 20, 1211, Geneva, Switzerland
| | - Kira Koch
- Special Programme On Primary Health Care, World Health Organization, Av. Appia 20, 1211, Geneva, Switzerland
| | - Neethi Rao
- Special Programme On Primary Health Care, World Health Organization, Av. Appia 20, 1211, Geneva, Switzerland
| | - Charlotte Poulussen
- Special Programme On Primary Health Care, World Health Organization, Av. Appia 20, 1211, Geneva, Switzerland
| | - Lara Brearley
- Special Programme On Primary Health Care, World Health Organization, Av. Appia 20, 1211, Geneva, Switzerland
| | - Hala Abou-Taleb
- Universal Health Coverage/Health Systems Department, World Health Organization, Magless El Shaab, PO Box No. 146, Cairo, 11516, Egypt
| | - Dheepa Rajan
- European Observatory On Health Systems and Policies, Place Victor Horta/Victor Hortaplein, 40/10, 1060, Brussels, Brussels, Belgium
| |
Collapse
|
3
|
Pollard S, Dunne J, Costa S, Regier DA. Stakeholder Perspectives on Navigating Evidentiary and Decision Uncertainty in Precision Oncology. J Pers Med 2022; 12:22. [PMID: 35055337 PMCID: PMC8778253 DOI: 10.3390/jpm12010022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022] Open
Abstract
(1) Background: Precision oncology has the potential to improve patient health and wellbeing through targeted prevention and treatment. Owing to uncertain clinical and economic outcomes, reimbursement has been limited. The objective of this pan-Canadian qualitative study was to investigate barriers to precision oncology implementation from the perspectives of health system stakeholders. (2) Methods: We conducted 32 semi-structured interviews with health technology decision makers (n = 14) and clinicians (n = 18) experienced with precision oncology. Participants were recruited using a purposive sampling technique. Interviews were analyzed using thematic analysis. Recruitment continued until two qualitative analysts reached agreement that thematic saturation was reached. (3) Results: While cautiously optimistic about the potential for enhanced therapeutic alignment, participants identified multiple decisional challenges under conditions of evidentiary uncertainty. Decision makers voiced concern over resource requirements alongside small benefitting patient populations and limited evidence supporting patient and health system impacts. Clinicians were comparatively tolerant of evidentiary uncertainty guiding clinical decision-making practices. Clinicians applied a broader definition of patient benefit, focusing on the ability to assist patients making informed clinical decisions. (4) Conclusions: Sustainable precision oncology must balance demand with evidence demonstrating benefit. We show that clinicians and decision makers vary in their tolerance for evolving knowledge, suggesting a need to establish evidentiary standards supporting precision oncology reimbursement decisions.
Collapse
Affiliation(s)
- Samantha Pollard
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 4C2, Canada; (S.P.); (J.D.); (S.C.)
| | - Jessica Dunne
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 4C2, Canada; (S.P.); (J.D.); (S.C.)
| | - Sarah Costa
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 4C2, Canada; (S.P.); (J.D.); (S.C.)
| | - Dean A. Regier
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 4C2, Canada; (S.P.); (J.D.); (S.C.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| |
Collapse
|
4
|
Leopold C, Lu CY, Wagner AK. Integrating public preferences into national reimbursement decisions: a descriptive comparison of approaches in Belgium and New Zealand. BMC Health Serv Res 2020; 20:351. [PMID: 32334579 PMCID: PMC7183657 DOI: 10.1186/s12913-020-05152-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 03/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background Public health care payer organizations face increasing pressures to make transparent and sustainable coverage decisions about ever more expensive prescription drugs, suggesting a need for public engagement in coverage decisions. However, little is known about countries’ approaches to integrating public preferences in existing funding decisions. The aim of this study was to describe how Belgium and New Zealand used deliberative processes to engage the public and to identify lessons learned from these countries’ approaches. Methods To describe two countries’ deliberative processes, we first reviewed key country policy documents and then conducted semi-structured interviews with five leaders of the processes from Belgium and New Zealand. We assessed each country’s rationales for and approaches to engaging the public in pharmaceutical coverage decisions and identified lessons learned. We used qualitative content analysis of the interviews to describe key themes and subthemes. Results In both countries, the national public payer organization initiated and led the process of integrating public preferences into national coverage decision making. Reimbursement criteria considered outdated and changing societal expectations prompted the change. Both countries chose a deliberative process of public engagement with a multi-year commitment of many stakeholders to develop new reimbursement processes. Both countries’ new reimbursement processes put a stronger emphasis on quality of life, the separation of individual versus societal perspectives, and the importance of final reimbursement decisions being taken in context rather than based largely on cost-effectiveness thresholds. Conclusions To face the growing financial pressure of sustainable funding of medicines, Belgium’s and New Zealand’s public payers have developed processes to engage the public in defining the reimbursement system’s priorities. Although these countries differ in context and geographic location, they came up with overlapping lessons learnt which include the need for 1) political commitment to initiate change, 2) broad involvement of all stakeholders, and 3) commitment of all to engage in a long-term process. To evaluate these changes, further research is required to understand how coverage decisions in systems with and without public engagement differ.
Collapse
Affiliation(s)
- Christine Leopold
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive Suite 401, Boston, MA, 02215, USA.
| | - Christine Y Lu
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive Suite 401, Boston, MA, 02215, USA
| | - Anita K Wagner
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive Suite 401, Boston, MA, 02215, USA
| |
Collapse
|
5
|
Razavi SD, Kapiriri L, Abelson J, Wilson M. Who is in and who is out? A qualitative analysis of stakeholder participation in priority setting for health in three districts in Uganda. Health Policy Plan 2020; 34:358-369. [PMID: 31180489 DOI: 10.1093/heapol/czz049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 11/12/2022] Open
Abstract
Stakeholder participation is relevant in strengthening priority setting processes for health worldwide, since it allows for inclusion of alternative perspectives and values that can enhance the fairness, legitimacy and acceptability of decisions. Low-income countries operating within decentralized systems recognize the role played by sub-national administrative levels (such as districts) in healthcare priority setting. In Uganda, decentralization is a vehicle for facilitating stakeholder participation. Our objective was to examine district-level decision-makers' perspectives on the participation of different stakeholders, including challenges related to their participation. We further sought to understand the leverages that allow these stakeholders to influence priority setting processes. We used an interpretive description methodology involving qualitative interviews. A total of 27 district-level decision-makers from three districts in Uganda were interviewed. Respondents identified the following stakeholder groups: politicians, technical experts, donors, non-governmental organizations (NGO)/civil society organizations (CSO), cultural and traditional leaders, and the public. Politicians, technical experts and donors are the principal contributors to district-level priority setting and the public is largely excluded. The main leverages for politicians were control over the district budget and support of their electorate. Expertise was a cross-cutting leverage for technical experts, donors and NGO/CSOs, while financial and technical resources were leverages for donors and NGO/CSOs. Cultural and traditional leaders' leverages were cultural knowledge and influence over their followers. The public's leverage was indirect and exerted through electoral power. Respondents made no mention of participation for vulnerable groups. The public, particularly vulnerable groups, are left out of the priority setting process for health at the district. Conflicting priorities, interests and values are the main challenges facing stakeholders engaged in district-level priority setting. Our findings have important implications for understanding how different stakeholder groups shape the prioritization process and whether representation can be an effective mechanism for participation in health-system priority setting.
Collapse
Affiliation(s)
- S Donya Razavi
- Department of Health Research Methods, Evidence, and Impact (HEI), Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence, and Impact (HEI), Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| | - Michael Wilson
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster Health Forum, Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| |
Collapse
|
6
|
Ezeife DA, Dionne F, Fares AF, Cusano ELR, Fazelzad R, Ng W, Husereau D, Ali F, Sit C, Stein B, Law JH, Le L, Ellis PM, Berry S, Peacock S, Mitton C, Earle CC, Chan KKW, Leighl NB. Value assessment of oncology drugs using a weighted criterion-based approach. Cancer 2019; 126:1530-1540. [PMID: 31860138 DOI: 10.1002/cncr.32639] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/09/2019] [Accepted: 10/24/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Globally, the rising cost of anticancer therapy has motivated efforts to quantify the overall value of new cancer treatments. Multicriteria decision analysis offers a novel approach to incorporate multiple criteria and perspectives into value assessment. METHODS The authors recruited a diverse, multistakeholder group who identified and weighted key criteria to establish the drug assessment framework (DAF). Construct validity assessed the degree to which DAF scores were associated with past pan-Canadian Oncology Drug Review (pCODR) funding recommendations and European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS; version 1.1) scores. RESULTS The final DAF included 10 criteria: overall survival, progression-free survival, response rate, quality of life, toxicity, unmet need, equity, feasibility, disease severity, and caregiver well-being. The first 5 clinical benefit criteria represent approximately 64% of the total weight. DAF scores ranged from 0 to 300, reflecting both the expected impact of the drug and the quality of supporting evidence. When the DAF was applied to the last 60 drugs (with reviewers blinded) reviewed by pCODR (2015-2018), those drugs with positive pCODR funding recommendations were found to have higher DAF scores compared with drugs not recommended (103 vs 63; Student t test P = .0007). DAF clinical benefit criteria mildly correlated with ESMO-MCBS scores (correlation coefficient, 0.33; 95% CI, 0.009-0.59). Sensitivity analyses that varied the criteria scores did not change the results. CONCLUSIONS Using a structured and explicit approach, a criterion-based valuation framework was designed to provide a transparent and consistent method with which to value and prioritize cancer drugs to facilitate the delivery of affordable cancer care.
Collapse
Affiliation(s)
- Doreen A Ezeife
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Francois Dionne
- Prioritize Consulting Ltd, Vancouver, British Columbia, Canada
| | - Aline Fusco Fares
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Rouhi Fazelzad
- Department of Medical Oncology and Hematology, Library and Information Services, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Wenzie Ng
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Barry Stein
- Colorectal Cancer Canada, Montreal, Quebec, Canada
| | - Jennifer H Law
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lisa Le
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Scott Berry
- Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada
| | - Stuart Peacock
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Craig Mitton
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Craig C Earle
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | | | - Natasha B Leighl
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Peacock SJ, Regier DA, Raymakers AJN, Chan KKW. Evidence, values, and funding decisions in Canadian cancer systems. Healthc Manage Forum 2019; 32:293-298. [PMID: 31645144 DOI: 10.1177/0840470419870831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Expenditure on cancer therapies is rising rapidly in many countries, particularly for cancer drugs. In recent years, this has stimulated a global debate among the public, patients, clinicians, decision-makers, and the pharmaceutical industry on value, affordability, and sustainability propositions relating to cancer therapies. In this article, we discuss some recent developments in evidence-based approaches to priority setting and resource allocation in Canadian cancer systems. These developments include new methods for deliberative public engagement, generating and using real-world evidence, multi-criteria decision analysis, and handling uncertainty with evidence for gene therapies.
Collapse
Affiliation(s)
- Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam J N Raymakers
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Kelvin K W Chan
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Care Ontario, Toronto, Ontario, Canada
- Sunnybrook Hospital Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Huls SPI, Whichello CL, van Exel J, Uyl-de Groot CA, de Bekker-Grob EW. What Is Next for Patient Preferences in Health Technology Assessment? A Systematic Review of the Challenges. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1318-1328. [PMID: 31708070 DOI: 10.1016/j.jval.2019.04.1930] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Integrating patient preferences in Health Technology Assessment (HTA) is argued to improve uptake, adherence, and patient satisfaction. However, how to elicit and incorporate these preferences in HTA in a systematic and scientifically valid manner is subject to debate. OBJECTIVE This article provides a systematic review of the challenges to integrating patient preferences in HTA that have been raised in the literature about patient preferences in HTA. METHODS A systematic review of articles published between 2013 and 2017 addressing challenges to the integration of patient preferences in HTA was conducted in 7 databases. All issues with respect to the integration of patient preferences in HTA were extracted and divided into 5 categories: conceptual, normative, procedural, methodological, and practical issues. The issues were ranked according to how often they were mentioned. RESULTS Of 2147 retrieved articles, 67 were included in the analysis. Thirty-seven unique research issues were identified. In the majority of the articles, methodological issues were posed (82%), followed by procedural (73%), normative (51%), practical (24%), and conceptual (9%) issues. Frequently posed methodological issues concerned preference heterogeneity and choice of method. Common procedural issues concerned how to evaluate the impact of preference studies and their degree of being evidence based. CONCLUSIONS This article provides an overview of issues with respect to the integration of patient preferences in HTA procedures. Most issues were of a methodological or procedural nature; yet, the large number of different issues points to the overall importance of further researching the different aspects concerned with patient preferences in HTA. Through its ranking of how many articles mention particular issues, this article proposes an implicit research agenda.
Collapse
Affiliation(s)
- Samare P I Huls
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Chiara L Whichello
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
9
|
Mitton C, Seixas BV, Peacock S, Burgess M, Bryan S. Health Technology Assessment as Part of a Broader Process for Priority Setting and Resource Allocation. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:573-576. [PMID: 31161365 DOI: 10.1007/s40258-019-00488-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Over the last two decades, economic evaluation of health technologies has developed enormously, affirming its importance within the pursuit of efficiency in the management of health care systems. One concern that has been raised with health technology assessment (HTA) has been its operationalization within the realm of decision making. Here, we suggest a mechanism by which HTA can be understood as an input into a broader framework for priority setting and resource allocation. When HTA is seen in this light, topics that at times have had some lack of clarity, such as public engagement and disinvestment, simply become steps in the overall decision-making process.
Collapse
Affiliation(s)
- Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Brayan V Seixas
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | - Stuart Peacock
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, BC, Canada
| | - Michael Burgess
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- W. Maurice Young Centre for Applied Ethics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| |
Collapse
|
10
|
Public perspectives on disinvestments in drug funding: results from a Canadian deliberative public engagement event on cancer drugs. BMC Public Health 2019; 19:977. [PMID: 31331312 PMCID: PMC6647147 DOI: 10.1186/s12889-019-7303-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 07/10/2019] [Indexed: 11/16/2022] Open
Abstract
Background Decisions relating to the funding of new drugs are becoming increasingly challenging due to a combination of aging populations, rapidly increasing list prices, and greater numbers of drug-indication pairs being brought to market. This is especially true in cancer, where rapid list price inflation is coupled with steeply rising numbers of incident cancer cases. Within a publicly funded health care system, there is increasing recognition that resource allocation decisions should consider the reassessment of, and potential disinvestment from, currently funded interventions alongside new investments. Public input into the decision-making process can help legitimize the outcomes and ensure priority-setting processes are aligned with public priorities. Methods In September 2014, a public deliberation event was held in Vancouver, Canada, to obtain public input on the topic of cancer drug funding. Twenty-four members of the general public were tasked with making collective recommendations for policy-makers about the principles that should guide funding decisions for cancer drugs in the province of British Columbia. Deliberative questions and decision aids were used to elicit individuals’ willingness to make trade-offs between expenditures and health outcomes. Results Participants discussed the implications of disinvestment decisions from cancer drugs in terms of its impact on patient choice, fairness and quality of life. Their discussions indicate that in order for a decision to disinvest from currently-funded cancer drugs to be acceptable, it must align with three main principles: the decision must be accompanied by significant gains, described both in terms of cost savings and opportunities to re-invest elsewhere in the health care system; those who are currently prescribed a cancer drug should be allowed to continue their course of treatment (referred to as a continuance clause, or “grandfathering” approach); and it must consider how access to care for specialized populations is impacted. Conclusions The results from this deliberation event provide insight into what is acceptable to British Columbians with respect to disinvestment decisions for cancer drugs. These recommendations can be considered within wider health system decision-making frameworks for funding decisions relating to all drugs, as well as for cancer drugs.
Collapse
|
11
|
Bentley C, Peacock S, Abelson J, Burgess MM, Demers-Payette O, Longstaff H, Tripp L, Lavis JN, Wilson MG. Addressing the affordability of cancer drugs: using deliberative public engagement to inform health policy. Health Res Policy Syst 2019; 17:17. [PMID: 30732616 PMCID: PMC6367823 DOI: 10.1186/s12961-019-0411-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health system expenditure on cancer drugs is rising rapidly in many OECD countries given the costly new treatments and increased rates of use due to a growing and ageing population. These factors put considerable strain on the sustainability of health systems worldwide, sparking public debate among clinicians, pharmaceutical companies, policy-makers and citizens on issues of affordability and equity. We engaged Canadians through a series of deliberative public engagement events to determine their priorities for making cancer drug funding decisions fair and sustainable in Canada's publicly financed health system. METHODS An approach to deliberation was developed based on the McMaster Health Forum's citizen panels and the established Burgess and O'Doherty model of deliberative public engagement. Six deliberations were held across Canada in 2016. Transcripts were coded in NVivo and analysed to determine where participants' views converged and diverged. Recommendations were grouped thematically. RESULTS A total of 115 Canadians participated in the deliberative events and developed 86 recommendations. Recommendations included the review and regular re-review of approved drugs using 'real-world' evidence on effectiveness and cost-effectiveness; prioritisation of treatments that restore patients' independence, mental health and general well-being; ensuring that decision processes, results and their rationales are transparent; and commitment to people with similar needs receiving the same care regardless of where in Canada they live. CONCLUSIONS The next steps for policy-makers should be to develop mechanisms for (1) re-reviewing effectiveness and cost-effectiveness data for all cancer drugs; (2) making disinvestments in cancer drugs that satisfy requirements relating to grandfathering and compassionate access; (3) ensuring fair and equitable access to cancer drugs for all Canadians; and (4) fostering a pan-Canadian approach to cancer drug funding decisions.
Collapse
Affiliation(s)
- Colene Bentley
- Canadian Centre for Applied Research in Cancer Control (ARCC), 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, Canada.
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West (CRL 203), Hamilton, Ontario, L8S 4K1, Canada
| | - Michael M Burgess
- School of Population and Public Health, University of British Columbia, 239 RHS, 1088 Discovery Avenue, Kelowna, British Columbia, V1V 1V7, Canada
| | - Olivier Demers-Payette
- Institute National d'Excellence en Santé et en Services Sociaux (INESSS), 2021 avenue Union, 12th Floor, bureau 1200, Montreal, Quebec, H3A 2S9, Canada
| | - Holly Longstaff
- Engage Associates Consulting Firm, Vancouver, British Columbia, Canada
| | - Laura Tripp
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West (CRL 203), Hamilton, Ontario, L8S 4K1, Canada
| | - John N Lavis
- McMaster Health Forum, 1280 Main Street West, MML-417, Ontario, Hamilton, L8S 4L6, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main Street West, MML-417, Ontario, Hamilton, L8S 4L6, Canada
| |
Collapse
|
12
|
Breault LJ, Rittenbach K, Hartle K, Babins-Wagner R, de Beaudrap C, Jasaui Y, Ardell E, Purdon SE, Michael A, Sullivan G, Unger ASR, Vandall-Walker L, Necyk B, Krawec K, Manafò E, Mason-Lai P. People with lived experience (PWLE) of depression: describing and reflecting on an explicit patient engagement process within depression research priority setting in Alberta, Canada. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:37. [PMID: 30349739 PMCID: PMC6190547 DOI: 10.1186/s40900-018-0115-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/28/2018] [Indexed: 05/04/2023]
Abstract
PLAIN ENGLISH SUMMARY The Alberta Depression Research Priority Setting Project aimed to meaningfully involve patients, families and clinicians in determining a research agenda aligned to the needs of Albertans who have experienced depression. The project was modeled after a process developed in the UK by the James Lind Alliance and adapted to fit the Alberta, Canada context. This study describes the processes used to ensure the voices of people with lived experience of depression were integrated throughout the project stages. The year long project culminated with a facilitated session to identify the top essential areas of depression research focus. People with lived experience were engaged as part of the project's Steering Committee, as survey participants and as workshop participants. It is hoped this process will guide future priority setting opportunities and advance depression research in Alberta. ABSTRACT Background The Depression Research Priority Setting (DRPS) project has the clear aim of describing the patient engagement process used to identify depression research priorities and to reflect on the successes of this engagement approach, positive impacts and opportunities for improvement. To help support patient-oriented depression research priority setting in Alberta, the Patient Engagement (PE) Platform of the Alberta Strategy for Patient Oriented Research Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit designed, along with the support of their partners in addictions and mental health, an explit process to engage patients in the design and execution of the DRPS. Methods The UK's James Lind Alliance (JLA) Priority Setting Partnership (PSP) method was adapted into a six step process to ensure voices of "people with lived experience" (PWLE) with depression were included throughout the project stages. This study uses an explicit and parallel patient engagement process throughout each estage of the PSP designed by the PE Platform. Patient engagement was divided into a five step process: i) Awareness and relationship building; ii) Co-designing and co-developing a shared decision making process; iii) Collaborative communication; iv) Collective sensemaking; and v) Acknowledgement, celebration and recognition. A formative evaluation of the six PE processes was undertaken to explore the success of the parallel patient engagement process. Results This project was successful in engaging people with lived depression experience as partners in research priority setting, incorporating their voices into the discussions and decisions that led to the top 25 depression research questions. Conclusions The DRPS project has positively contributed to depression research in Canada by identifying the priorities of Albertans who have experienced depression for depression research. Dissemination activities to promote further knowledge exchange of prioritized research questions, with emphasis on the importance of process in engaging the voices of PWLE of depression are planned.
Collapse
Affiliation(s)
- Lorraine J. Breault
- Department of Psychiatry Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- DRPS Steering Committee, Edmonton, Canada
| | - Katherine Rittenbach
- Department of Psychiatry Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- DRPS Steering Committee, Edmonton, Canada
| | - Kelly Hartle
- Department of Psychiatry Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- DRPS Steering Committee, Edmonton, Canada
| | | | | | | | | | | | | | | | | | | | - Brad Necyk
- DRPS Steering Committee, Edmonton, Canada
| | - Kiara Krawec
- Patient Engagement Platform, Alberta SPOR SUPPORT Unit, Edmonton, Canada
| | - Elizabeth Manafò
- Patient Engagement Platform, Alberta SPOR SUPPORT Unit, Edmonton, Canada
| | - Ping Mason-Lai
- Patient Engagement Platform, Alberta SPOR SUPPORT Unit, Edmonton, Canada
| |
Collapse
|
13
|
Breault LJ, Rittenbach K, Hartle K, Babins-Wagner R, de Beaudrap C, Jasaui Y, Ardell E, Purdon SE, Michael A, Sullivan G, Unger ASR, Vandall-Walker L, Necyk B, Krawec K, Manafò E, Mason-Lai P. The top research questions asked by people with lived depression experience in Alberta: a survey. CMAJ Open 2018; 6:E398-E405. [PMID: 30266777 PMCID: PMC6182109 DOI: 10.9778/cmajo.20180034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To support patient-oriented setting of priorities for depression research in Alberta, the Patient Engagement Platform of the Alberta Strategy for Patient Oriented Research's Support for People and Patient-Oriented Research and Trials Unit and Alberta Health Services' Addiction and Mental Health Strategic Clinical Network, along with partners in addictions and mental health, designed the Alberta Depression Research Priority Setting Project. The aim of the project was to survey patients, caregivers and clinicians/researchers in Alberta about what they considered to be the most important unanswered questions about depression. METHODS The project adapted the James Lind Alliance Priority Setting Partnership method into a 6-step process to gather and prioritize questions about depression posed by people with lived depression experience, which included patients, caregivers, clinicians and health care practitioners. RESULTS Implementation of the project, from initial data collection to final priority setting, took 10 months (August 2016 to June 2017). A total of 445 Albertans with lived experience of depression participated, ultimately identifying 11 priority depression research questions spanning the health continuum, life stages, and treatment and prevention opportunities. INTERPRETATION This project is a fundamental step that has the potential to positively influence depression research. Including the voices of Albertans with lived experience will create advantages for depression research for Albertans, researchers and research funders, and for patient engagement in the research enterprise overall.
Collapse
Affiliation(s)
- Lorraine J Breault
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Katherine Rittenbach
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Kelly Hartle
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Robbie Babins-Wagner
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Catherine de Beaudrap
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Yamile Jasaui
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Emily Ardell
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Scot E Purdon
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Ashton Michael
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Ginger Sullivan
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Aakai'naimsskai'piiaakii Sharon Ryder Unger
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Lorin Vandall-Walker
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Brad Necyk
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Kiara Krawec
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Elizabeth Manafò
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| | - Ping Mason-Lai
- Department of Psychiatry (Breault, Rittenbach, Hartle, Sullivan), Faculty of Medicine & Dentistry, University of Alberta; Faculty of Pharmacy and Pharmaceutical Sciences (Necyk), University of Alberta, Edmonton, Alta.; Calgary Counselling (Babins-Wagner); Hotchkiss Brain Institute (Jasaui), University of Calgary; The Alex Community Health Centre (Ardell); Explorror (Michael), Calgary, Alta.; Parkland School Division (de Beaudrap), Spruce Grove, Alta.; Shinah House Foundation (Ryder Unger), Lethbridge, Alta.; Alberta Health Services (Purdon), Edmonton, Alta.; Athabasca University (Krawec, Manafò, Mason-Lai), Athabasca Alta.; Edmonton, Alta. (Vandall-Walker)
| |
Collapse
|
14
|
Bentley C, Costa S, Burgess MM, Regier D, McTaggart-Cowan H, Peacock SJ. Trade-offs, fairness, and funding for cancer drugs: key findings from a deliberative public engagement event in British Columbia, Canada. BMC Health Serv Res 2018; 18:339. [PMID: 29739463 PMCID: PMC5941483 DOI: 10.1186/s12913-018-3117-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 04/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Spending on cancer drugs has risen dramatically in recent years compared to other areas of health care, due in part to higher prices associated with newly approved drugs and increased demand for these drugs. Addressing this situation requires making difficult trade-offs between cost, harms, and ability to benefit when using public resources, making it important for policy makers to have input from many people affected by the issue, including citizens. METHODS In September 2014, a deliberative public engagement event was conducted in Vancouver, British Columbia (BC), on the topic of priority setting and costly cancer drugs. The aim of the study was to gain citizens' input on the topic and have them generate recommendations that could inform cancer drug funding decisions in BC. A market research company was engaged to recruit members of the BC general public to deliberate over two weekends (four days) on how best to allocate resources for expensive cancer treatments. Participants were stratified based on the 2006 census data for BC. Participants were asked to discuss disinvestment, intravenous versus oral chemotherapy delivery, and decision governance. All sessions were audio recorded and transcribed. Transcripts were analyzed using NVivo 11 software. RESULTS Twenty-four individuals participated in the event and generated 30 recommendations. Participants accepted the principle of resource scarcity and the need of governments to make difficult trade-offs when allocating health-care resources. They supported the view that cost-benefit thresholds must be set for high-cost drugs. They also expected reasonable health benefits in return for large expenditures, and supported the view that some drugs do not merit funding. Participants also wanted drug funding decisions to be made in a non-partisan and transparent way. CONCLUSION The recommendations from the Vancouver deliberation can provide guidance to policy makers in BC and may be useful in challenging pricing by pharmaceutical companies.
Collapse
Affiliation(s)
- Colene Bentley
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - Sarah Costa
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Michael M Burgess
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, Medical Genetics, Southern Medical Program, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Dean Regier
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Helen McTaggart-Cowan
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Faculty of Health Science, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Faculty of Health Science, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| |
Collapse
|
15
|
Seixas BV. The No-Destination Ship of Priority-Setting in Healthcare: A Call for More Democracy. Int J Health Policy Manag 2018; 7:345-348. [PMID: 29626402 PMCID: PMC5949225 DOI: 10.15171/ijhpm.2017.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/02/2017] [Indexed: 11/18/2022] Open
Abstract
In dealing with scarcity of resources within healthcare systems, decision-makers inevitably have to make choices about which services to fund. Setting priorities represents a challenging task that requires systematic, explicit and transparent methodologies with focus on economic efficiency. In addition, the engagement of the general public in the process of decision-making has been regarded as one of the most important aspects of the management of publicly-funded health systems in liberal democracies. In the current essay, we aim to discuss the problematics of public engagement in the process of resource allocation and priority-setting within the context of publiclyfunded health systems. Our central argument is that although there may be a conflict between democratic mechanisms of citizen participation and economic efficiency, in the extra-welfarist sense, expected for/from the system, the solution for this tension does not seem to rely on more or novel authoritative technocratic approaches, but rather on the deepening and betterment of democratic participation.
Collapse
Affiliation(s)
- Brayan V Seixas
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
16
|
Costa S, Regier DA, Meissner B, Cromwell I, Ben-Neriah S, Chavez E, Hung S, Steidl C, Scott DW, Marra MA, Peacock SJ, Connors JM. A time-and-motion approach to micro-costing of high-throughput genomic assays. ACTA ACUST UNITED AC 2016; 23:304-313. [PMID: 27803594 DOI: 10.3747/co.23.2987] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Genomic technologies are increasingly used to guide clinical decision-making in cancer control. Economic evidence about the cost-effectiveness of genomic technologies is limited, in part because of a lack of published comprehensive cost estimates. In the present micro-costing study, we used a time-and-motion approach to derive cost estimates for 3 genomic assays and processes-digital gene expression profiling (gep), fluorescence in situ hybridization (fish), and targeted capture sequencing, including bioinformatics analysis-in the context of lymphoma patient management. METHODS The setting for the study was the Department of Lymphoid Cancer Research laboratory at the BC Cancer Agency in Vancouver, British Columbia. Mean per-case hands-on time and resource measurements were determined from a series of direct observations of each assay. Per-case cost estimates were calculated using a bottom-up costing approach, with labour, capital and equipment, supplies and reagents, and overhead costs included. RESULTS The most labour-intensive assay was found to be fish at 258.2 minutes per case, followed by targeted capture sequencing (124.1 minutes per case) and digital gep (14.9 minutes per case). Based on a historical case throughput of 180 cases annually, the mean per-case cost (2014 Canadian dollars) was estimated to be $1,029.16 for targeted capture sequencing and bioinformatics analysis, $596.60 for fish, and $898.35 for digital gep with an 807-gene code set. CONCLUSIONS With the growing emphasis on personalized approaches to cancer management, the need for economic evaluations of high-throughput genomic assays is increasing. Through economic modelling and budget-impact analyses, the cost estimates presented here can be used to inform priority-setting decisions about the implementation of such assays in clinical practice.
Collapse
Affiliation(s)
- S Costa
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - D A Regier
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - B Meissner
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - I Cromwell
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - S Ben-Neriah
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - E Chavez
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - S Hung
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - C Steidl
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC
| | - D W Scott
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Medicine, University of British Columbia, Vancouver, BC
| | - M A Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Medical Genetics, University of British Columbia, Vancouver, BC
| | - S J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - J M Connors
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Medicine, University of British Columbia, Vancouver, BC
| |
Collapse
|
17
|
John-Baptiste A, Schapira MM, Cravens C, Chambers JD, Neumann PJ, Siegel J, Lawrence W. The Role of Decision Models in Health Care Policy: A Case Study. Med Decis Making 2016; 36:666-79. [PMID: 27225487 DOI: 10.1177/0272989x16646732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 03/26/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND In 2009, the Centers for Medicare and Medicaid Services (CMS) underwent a National Coverage Determination on computed tomography colonography (CTC) to screen for colorectal cancer. The Cancer Intervention & Surveillance Network developed decision models to inform this decision. The purpose of our study was to investigate the role of models in this decision. METHODS We performed a descriptive case study. We conducted semistructured telephone interviews with members of the CMS coverage and analysis group (CAG) and Medicare Coverage and Analysis Advisory Committee (MEDCAC) panelists. Informed by previously published literature, we developed a coding scheme to analyze interview transcripts, MEDCAC meeting transcripts, and the final CMS decision memo. RESULTS Four members of the CAG and 8 MEDCAC panelists were interviewed. The total number of codes across all study documents was 772. We found evidence that decision makers believed in the adequacy of models to inform decision making. In interview transcripts, the code Models Are Adequate to Inform was more frequent than the code Models Are Inadequate to Inform (47 times v. 5). Discussion of model conceptualization dominated the MEDCAC meeting (Model Conceptualization assigned 113 times) and was frequently discussed during interviews (Model Conceptualization assigned 84 times). We also found evidence that the models helped to focus the policy discussion. Across study documents, the codes Focus on Cost, Focus on Clinical-Health Impact, and Focus on Inadequacy of Evidence Base were assigned 99, 98, and 97 times, respectively. CONCLUSIONS Decision makers involved in the CTC decision believed in the adequacy of models to inform coverage decisions. The model played a role in focusing the CTC coverage policy discussion.
Collapse
Affiliation(s)
- Ava John-Baptiste
- Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD, USA (AJ-B, CC, JS, WL),Departments of Anesthesia & Perioperative Medicine, Epidemiology & Biostatistics, Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada (AJ-B),Centre for Medical Evidence, Decision Integrity, Clinical Impact (MEDICI), London, Ontario, Canada (AJ-B),Lawson Health Research Institute, London, Ontario, Canada (AJ-B),Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA (AJ-B, JDC, PJN)
| | - Marilyn M Schapira
- Perelman School of Medicine, University of Pennsylvania, PA, USA (MMS),Center for Health Equity & Research Program, Philadelphia VA Medical Center, PA, USA (MMS)
| | - Catherine Cravens
- Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD, USA (AJ-B, CC, JS, WL)
| | - James D Chambers
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA (AJ-B, JDC, PJN)
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA (AJ-B, JDC, PJN)
| | - Joanna Siegel
- Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD, USA (AJ-B, CC, JS, WL)
| | - William Lawrence
- Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD, USA (AJ-B, CC, JS, WL)
| |
Collapse
|
18
|
Rooshenas L, Owen-Smith A, Hollingworth W, Badrinath P, Beynon C, Donovan JL. “I won't call it rationing…”: An ethnographic study of healthcare disinvestment in theory and practice. Soc Sci Med 2015; 128:273-81. [DOI: 10.1016/j.socscimed.2015.01.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|