Evaluating Canadians’ Values for Drug Coverage Decision Making

• Published in: Value in health Vol. 22; no. 3; pp. 362 - 369
• Main Authors: Rizzardo, Shirin, Bansback, Nick, Dragojlovic, Nick, Douglas, Conor, Li, Kathy H., Mitton, Craig, Marra, Carlo, Blanis, Litsa, Lynd, Larry D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2019; Elsevier Science Ltd
• Subjects: Cost analysis; coverage; Decision makers; Decision making; Drug prices; Drugs; drugs for rare diseases; Efficacy; Financing; Health care expenditures; Health status; health technology assessment; Insurance coverage; Lifestyles; orphan drugs; policy; Prioritizing; Quality of life; Reimbursement; Severity; Socioeconomic status; Values; Canada; coverage; health technology assessment; orphan drugs; decision making; values; drugs for rare diseases; reimbursement; policy
• ISSN: 1098-3015; 1524-4733; 1524-4733
• DOI: 10.1016/j.jval.2018.08.008

Decision makers are facing growing challenges in prioritizing drugs for reimbursement because of soaring drug costs and increasing pressures on financial resources. In addition to cost and effectiveness, payers are using other values to dictate which drugs are prioritized for funding, yet there are limited data on the Canadian public’s priorities. To measure the relative societal importance of values considered most relevant in informing drug reimbursement decisions in a representative sample of Canadians. An online survey of 2539 Canadians aged 19 years and older was performed in which 13 values used in drug funding prioritization were ranked and then weighted using an analytic hierarchy process. Canadians value safe and efficacious drugs that have certainty of evidence. The values ranked in the top 5 by most of our subjects were potential effect on quality of life (65.4%), severity of the disease (62.6%), ability of drug to work (61.1%), safety (60.5%), and potential to extend life (49.4%). Values related to patient or disease characteristics such as rarity, socioeconomic status, and health and lifestyle choices held the lowest rankings and weights. Canadians value, above all, treatment-related factors (eg, efficacy and safety) and disease-related factors (eg, severity and equity). Decision makers are currently using additional justifications to prioritize drugs for reimbursement, such as rarity and unmet need, which were not found to be highly valued by Canadians. Decision makers should integrate the public’s values into a Canadian reimbursement framework for prioritization of drugs competing for limited funds. •Faced with growing challenges in prioritizing drugs for reimbursement because of soaring drug costs, public payers are increasingly using considerations other than cost effectiveness to inform prioritization, and although there is a body of evidence indicating that citizens generally do not support decision making based specifically on attributes such as the rarity of a disease, knowledge regarding how citizens trade off different values is limited.•Using a national survey of 2539 Canadians in which respondents ranked 13 potential values for drug reimbursement decision making, we find that Canadians favor the prioritization of potential health gains and drug safety over alternative considerations such as patient characteristics and disease rarity in pharmaceutical reimbursement decisions.