EVIDENCE USE IN THE ALLOCATION OF HEALTH CARE BUDGETS:
A COMPARATIVE STUDY OF DRUG REIMBURSEMENT IN POLAND, CANADA AND GERMANY.
This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement number 665778. The funding was awarded through the POLONEZ 3 competition, grant number UMO-2016/23/P/hs5/04134.
The financing of drug reimbursement is a substantive problem for many health care systems. In many countries, the selection of medications and technologies to be placed on a reimbursement list (formulary) is conducted by multidisciplinary committees and supported by multiple types of evidence (e.g. clinical, economic, ethical and patient values). Examples include the pan Canadian Oncology Drug Review (pCODR) in Canada, the the Agency for Health Technology Assessment (AOTMiT) in Poland, and the Federal Joint Committee in Germany.
The broader goal of this study is to develop a framework and tools for the optimization of processes used to place drugs on reimbursement lists in a variety of health systems. To support this goal, the study focuses on how individual members of committees use, reconcile and weigh multiple types of evidence when an explicit framework is not provided, in the context of oncology drugs. Specific objectives of the research are:
- To characterize the behaviours of the formulary committee members
- Describe the information sought in the review processes;
- Describe the processes of reconciling clinical, economic and other information;
- Measure weights placed on information types;
- To assess how economic information provided by economists is used in the processes;
- Describe the characteristics of economic reports used;
- Describe the role of economists in the processes;
- Describe the gaps between information provided and sought;
- To assess how patient and public preferences contribute to the processes;
- Describe the information used to describe patient and public preferences;
- Describe the role of patient advocacy groups/ public consultations in the process;
- Describe the gaps between information provided and sought.
The project follows a mixed methods approach, where qualitative and quantitative data are used to support the research objectives. Three groups of participants are to be involved in the study: the first are members of committees mentioned above, the second are members of a patient advocacy group in Poland, and the third are individuals in the general public whose lives have been affected by cancer.
Quantitative data to measure weights assigned to decision criteria will be collected via a preference elicitation experiment with committee members, patients and the public. To characterize perceptions of committee members and patient advocates about challenges experienced and importance ascribed to various types of information, qualitative data will be collected by way of semi-structured qualitative interviews, as well as a research roundtable.
The results of the study will contribute to the development of rigorous, transparent and consistent formulary processes in a variety of health system contexts. The results will also contribute to our broader understanding of how individuals behave in situations, where multiple and at times conflicting information must be used to arrive at a binary decision.