Priority-setting decisions for new cancer drugs: a qualitative case study

被引:81
作者
Martin, DK
Pater, JL
Singer, PA [1 ]
机构
[1] Univ Toronto, Joint Ctr Bioeth, Toronto, ON M5G 1L4, Canada
[2] Univ Toronto, Dept Hlth Policy Management & Evaluat, Toronto, ON M5G 1L4, Canada
[3] Univ Toronto, Dept Publ Hlth Sci, Toronto, ON M5G 1L4, Canada
[4] Queens Univ, Dept Epidemiol & Community Hlth, Kingston, ON, Canada
基金
英国医学研究理事会; 加拿大健康研究院;
关键词
D O I
10.1016/S0140-6736(01)06714-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Frameworks for legitimate and fair priority setting emphasise the importance of the rationales for priority setting decisions. However, priority setting rationales, in particular for new cancer drugs, are not well described. We describe the rationales used by a committee making funding decisions for new cancer drugs. Methods We did a qualitative case study of a priority setting committee (Cancer Care Ontario Policy Advisory Committee for the New Drug Funding Program) by analysing documents, interviewing committee members, and observing committee meetings. Findings We identified and described decisions and rationales related to 14 drugs in eight disease conditions over 3 years. Our main findings were that: priority setting existed in relation to resource mobilisation; clinical benefit was the primary factor in decisions; in the context of an expanding budget, rationales changed; rationales could change as costs for individual treatments increased; when all options were reasonable, groups funded a range of options and let patients decide; and priority setting rationales involve clusters of factors, not simple trade-offs. Interpretation Observing priority-setting decisions and their rationales in actual practice reveals lessons not contained in theoretical accounts.
引用
收藏
页码:1676 / 1681
页数:6
相关论文
共 28 条
[11]   Perspectives of commissioners and cancer specialists in prioritising new cancer drugs: impact of the evidence threshold [J].
Foy, R ;
So, J ;
Rous, E ;
Scarffe, JH .
BRITISH MEDICAL JOURNAL, 1999, 318 (7181) :456-459
[12]  
GARLAND A, 1997, COMMUNICATION 0730
[13]  
Giacomini MK, 1999, J HEALTH POLIT POLIC, V24, P715
[14]   SETTING HEALTH-CARE PRIORITIES IN OREGON - COST-EFFECTIVENESS MEETS THE RULE OF RESCUE [J].
HADORN, DC .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1991, 265 (17) :2218-2225
[15]   RATIONING IN ACTION - PRIORITY SETTING IN THE NHS - REPORTS FROM 6 DISTRICTS [J].
HAM, C .
BMJ-BRITISH MEDICAL JOURNAL, 1993, 307 (6901) :435-438
[16]   Goodbye to the simple solutions: the second phase of priority setting in health care [J].
Holm, S .
BRITISH MEDICAL JOURNAL, 1998, 317 (7164) :1000-1002
[17]  
Hope T, 1998, BRIT MED J, V317, P1067
[18]   NICE: a step forward in the quality of NHS care [J].
Horton, R .
LANCET, 1999, 353 (9158) :1028-1029
[19]  
Jonsen Albert, 1988, ABUSE CASUISTRY HIST
[20]  
NAYLOR CD, 1996, ACP J CLUB, V124, pA12