Priority setting for high cost medications (HCMs) in public hospitals in Australia: a case study.
ABSTRACT Health care providers (HCPs) are increasingly aware of pressures on funding for health care services, including high cost medicines (HCMs). Allocating resources to innovative and expensive medications is particularly challenging and the decision-making processes and criteria used to allocate resources to HCMs have not been widely described in the literature. This case study aimed to describe the operations of the first reported High Cost Drug Sub-Committee (HCD-SC) in a public hospital in Australia. In addition the study also evaluated the decision-making process using Daniel and Sabin's ethical framework of "accountability for reasonableness". Some lessons emerged from the description of the operations of the HCD-SC. Decisions were not solely based on effectiveness and cost. Additional factors such as "clinical need" and the lack of an alternative treatment were involved in decisions about access to HCMs. Members of the HCD-SC also considered it was important to have consistency in the way decisions were being made. The findings from this study provide an evidence base for developing strategies to improve this hospital's decision-making process regarding access to HCMs.
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ABSTRACT: Objective: To identify the viewpoints and perceptions of different stakeholders regarding high cost medicines (HCMs). Methods: Asystematic review of the literature was performed to identify original research articles. Using predefined categories, data related to the viewpoints of different stakeholders was systematically extracted and analyzed. Results: Thirty seven original research articles matched the criteria. The main stakeholders identified include physicians, patients, public and health funding authorities. The influence of media and other economic and ethical issues were also identified in the literature. A large number of stakeholders were concerned about lack of access to HCMs. Physicians have difficulty balancing the the rational use of expensive drugs while at the same time acting as "patients' advocate". Patients would like to know about all treatment options, even if they may not be able to afford them. The process and criteria for reimbursement should be transparent and access has to be equitable across patient groups. Conclusion: Access to HCMs could be improved through transparency and involvement of all stakeholders, especially patients and the public. Moral issues and the "rule of rescue" could influence decision-making process significantly. At system level, objectivity is important to ensure that the system is equitable and transparent. © Versita Sp. z o.o. 1. Background and rationale Accesses to HCMs, and the issues surrounding this top-ic, have both economic and social implications. It would seem that public dialogue relating to access to HCMs is dominated by affected patient groups. The views of patient groups are likely to be more emotive in nature . Pharmaceutical companies develop and market high cost medicines (HCMs) and desire relatively unhindered market access and a price that returns investments . The public health care system is the monopsony for buy-ing these medicines; the physicians are the provider of the drug; and the patient is the consumer in this scenario. Despite the likelihood of tensions between different stakeholder views, there is little consensus about where the funding threshold should lie with respect to indi-vidual HCM and which parameters should be used to determine this. The often cited standard for cost-effec-tiveness is a threshold of $50,000. The British National Institute for Clinical Excellence (NICE) has set a limit of £30,000 per QALY to recommend individual HCM for reimbursement. Fojo and Grady suggest a threshold of $120,090 which equates to the QALY per year costs of renal dialysis , which is supported by others . The objective of this review is to inform this dis-cussion on the basis of the analysis of the available evidence. The issues associated with access to HCMs suggest a complex picture with multiple interested par-ties and the examination of one or two studies is unlikely to provide a comprehensive understanding of what has been published . Additionally, it is not easy to defini-tively state what constitutes a HCM and the literature is scarce in this regard. A definition is required in-order to place boundaries around this systematic review and to provide context for the synthesis of issues as the pri-mary output of this paper .Central European Journal of Medicine 06/2014; 9(3). · 0.21 Impact Factor
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ABSTRACT: Insight into local health service provision in rural communities is limited in the literature. The dominant workforce focus in the rural health literature, while revealing issues of shortage of maldistribution, does not describe service provision in rural towns. Similarly aggregation of data tends to render local health service provision virtually invisible. This paper describes a methodology to explore specific aspects of rural health service provision with an initial focus on understanding rurality as it pertains to rural physiotherapy service provision.BMC Medical Research Methodology 07/2014; 14(1):94. · 2.17 Impact Factor
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ABSTRACT: Priority setting research has focused on the macro (national) and micro (bedside) level, leaving the meso (institutional, hospital) level relatively neglected. This is surprising given the key role that hospitals play in the delivery of healthcare services and the large proportion of health systems resources that they absorb. To explore the factors that impact upon priority setting at the hospital level, we conducted a thematic review of empirical studies. A systematic search of PubMed, EBSCOHOST, Econlit databases and Google scholar was supplemented by a search of key websites and a manual search of relevant papers' reference lists. A total of 24 papers were identified from developed and developing countries. We applied a policy analysis framework to examine and synthesize the findings of the selected papers. Findings suggest that priority setting practice in hospitals was influenced by (1) contextual factors such as decision space, resource availability, financing arrangements, availability and use of information, organizational culture and leadership, (2) priority setting processes that depend on the type of priority setting activity, (3) content factors such as priority setting criteria and (4) actors, their interests and power relations. We observe that there is need for studies to examine these issues and the interplay between them in greater depth and propose a conceptual framework that might be useful in examining priority setting practices in hospitals.Health Policy and Planning 03/2014; · 2.65 Impact Factor