Skip to main content
SpringerLink
Log in

To Fund or Not to Fund

Development of a Decision-Making Framework for the Coverage of New Health Technologies

  • Original Research Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Background: Attempts to improve the acceptability of resource allocation decisions around new health technologies have spanned many years, fields and disciplines. Various theories of decision making have been tested and methods piloted, but, despite their availability, evidence of sustained uptake is limited. Since the challenge of determining which of many technologies to fund is one that healthcare systems have faced since their inception, an analysis of actual processes, criticisms confronted and approaches used to manage them may serve to guide the development of an ‘evidence-informed’ decisionmaking framework for improving the acceptability of decisions.

Objective: The purpose of this study was to develop a technology funding decision-making framework informed by the experiences of multiple healthcare systems and the views of senior-level decision makers in Canada.

Methods: A 1-day, facilitated workshop was held with 16 senior-level healthcare decision makers in Canada. International examples of actual technology funding decision-making processes were presented. Participants discussed key elements of these processes, debated strengths and weaknesses and highlighted unresolved challenges. The findings were used to construct a technology decision-making framework on which participant feedback was then sought. Its relevance, content, structure and feasibility were further assessed through key informant interviews with ten additional senior-level decision makers.

Results: Six main issues surrounding current processes were raised: (i) timeliness; (ii) methodological considerations; (iii) interpretations of value for money; (iv) explication of social values; (v) stakeholder engagement; and (vi) accountability for reasonableness. While no attempt was made to force consensus on what should constitute each of these, there was widespread agreement on questions that must be addressed through a robust process. These questions, grouped and ordered into three phases, became the final framework.

Conclusions: A decision-making framework informed by processes in other jurisdictions and the views of local decision makers was developed. Pilot testing underway in one Canadian jurisdiction will identify any further refinements needed to optimize its usefulness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hauck K, Smith PC, Goddard M. The economics of priority setting for health care: a literature review [Health, Nutrition and Population (HNP) discussion paper]. Washington, DC: The International Bank for Reconstruction andDevelopment/The World Bank, 2004 [online]. Available from URL: http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/Chapter3Final.pdf [Accessed 2010 Jun 6]

    Google Scholar 

  2. Daniels N, Sabin J. The ethics of accountability in managed care reform. Health Aff (Millwood) 1998; 17 (5): 50–64

    Article  CAS  Google Scholar 

  3. Zhu K, Weyant JP. Strategic decisions of new technology adoption under asymmetric information: a game-theoretic model. Decis Sci 2003; 34 (4): 643–75

    Article  Google Scholar 

  4. Robbins SP, Judge TA. Organizational behavior. 12th ed. Upper Saddle River (NJ): Pearson Prentice Hall, 2007

    Google Scholar 

  5. Cohen MD, March JG, Olsen JP. A garbage can model of organizational choice. Admin Sci Q 1972; 17 (1): 1–25

    Article  Google Scholar 

  6. Lindblom CE. The science of ‘muddling through’. Public Adm Rev 1959; 19 (2): 79–88 [online]. Available from URL: http://www.polsci.chula.ac.th/pitch/planningtheory2009/lindblom.pdf [Accessed 2010 Feb 4]

    Article  Google Scholar 

  7. O’Brien BJ, Goeree R, Gafni A, et al. Assessing the value of a new pharmaceutical: a feasibility study of contingent valuation in managed care. Med Care 1998; 36 (3): 370–84

    Article  PubMed  Google Scholar 

  8. Nord E. Towards cost-value analysis in health care? Health Care Anal 1999; 7 (2): 167–75

    Article  PubMed  CAS  Google Scholar 

  9. Mitton C, Peacock S, Donaldson C, et al. Using PBMA in health care priority setting: description, challenges and experience. Appl Health Econ Health Policy 2003; 2 (3): 121–7

    PubMed  Google Scholar 

  10. Farrar S, Ryan M, Ross D, et al. Using discrete choice modelling in priority setting: an application to clinical service developments. Soc Sci Med 2000; 50 (1): 63–75

    Article  PubMed  CAS  Google Scholar 

  11. Stafinski T, Menon D, Philippon DJ, et al. Health technology funding decision-making processes around the world: the same yet different. Pharmacoeconomics 2011; 29 (6): 475–95

    Article  PubMed  Google Scholar 

  12. Simon H. Rational decision making in business organizations. Am Econ Rev 1979; 69 (4): 493–513

    Google Scholar 

  13. Wilking N, Jönsson B. A pan-European comparison regarding patient access to cancer drugs. Stockholm: Karolinska Institutet, 2006 [online]. Available from URL: http://ki.se/cotent/1/c4/33/52/Cancer_Report.pdf [Accessed 2010 Mar 11]

    Google Scholar 

  14. Simon H. Bounded rationality and organizational learning. Organization Sci 1991; 2 (1): 125–34

    Article  Google Scholar 

  15. Etzioni A. Mixed-scanning: a ‘third’ approach to decisionmaking. Public Adm Rev 1967; 27 (5): 385–92

    Article  Google Scholar 

  16. Eddama O, Coast J. A systematic review of the use of economic evaluation in local decision-making. Health Policy 2008; 86 (2-3): 129–41

    Article  PubMed  Google Scholar 

  17. Rocchi A, Menon D, Verma S, et al. The role of economic evidence in Canadian oncology reimbursement decision-making: to lambda and beyond. Value Health 2008; 11 (4): 771–83

    Article  PubMed  Google Scholar 

  18. Milewa T. Health technology adoption and the politics of governance in the UK. Soc Sci Med 2006; 63 (12): 3102–12

    Article  PubMed  Google Scholar 

  19. Patten S, Mitton C, Donaldson C. From the trenches: views from decision-makers on health services priority setting. Health Serv Manage Res 2005; 18 (2): 100–8

    Article  PubMed  Google Scholar 

  20. Sinclair S, Hagen NA, Chambers C, et al. Accounting for reasonableness: exploring the personal internal framework affecting decisions about cancer drug funding. Health Policy 2008; 86 (2-3): 381–90

    Article  PubMed  Google Scholar 

  21. Maynard A, Bloor K, Freemantle N. Challenges for the National Institute for Clinical Excellence. BMJ 2004; 329 (7459): 227–9

    Article  PubMed  Google Scholar 

  22. Williams I, Bryan S. Understanding the limited impact of economic evaluation in health care resource allocation: a conceptual framework. Health Policy 2007; 80 (1): 135–43

    Article  PubMed  Google Scholar 

  23. Dolan P, Green C. Using the person trade-off approach to examine differences between individual and social values. Health Econ 1998; 7 (4): 307–12

    Article  PubMed  CAS  Google Scholar 

  24. Sabik LM, Lie RK. Principles versus procedures in making health care coverage decisions: addressing inevitable conflicts. Theor Med Bioeth 2008; 29 (2): 73–85

    Article  PubMed  Google Scholar 

  25. Menon D, Stafinski T. Engaging the public in prioritysetting for health technology assessment: findings from a citizens’ jury. Health Expect 2008; 11 (3): 282–93

    Article  PubMed  Google Scholar 

  26. Friedman A. Beyond accountability for reasonableness. Bioethics 2008; 22 (2): 101–12

    Article  PubMed  Google Scholar 

  27. Crabtree BF, Miller WL, editors. Doing qualitative research. 2nd ed. Thousand Oaks (CA): Sage Publications, 1999

    Google Scholar 

  28. Menon D, Stafinski T, Stuart G. Access to drugs for cancer: does where you live matter? Can J Public Health 2005; 96 (6): 454–8

    PubMed  Google Scholar 

  29. Dault M, Lomas J, Barer M. Listening for direction II: a national consultation on health services and policy. Final report. Ottawa (ON): Canadian Health Services Research Foundation, 2004 [online]. Available from URL: http://www.chsrf.ca/Libraries/Listening_for_Direction/LfD_II_Final_Report_e.sflb.ashx [Accessed 2010 Apr 23]

    Google Scholar 

  30. The health of Canadians: the federal role. Final report. Volume six: recommendations for reform. The Standing Senate Committee on Social Affairs, Science and Technology. Ottawa (ON): Government of Canada, 2002 [online]. Available from URL: http://www.parl.gc.ca/37/2/parlbus/commbus/senate/Com-e/soci-e/rep-e/repoct02vol6-e.htm [Accessed 2010 Apr 23]

    Google Scholar 

  31. Ekos Research Associates Inc. Evaluation of the first year of operation for the Common Drug Review. Final report. Ottawa (ON): Canadian Coordinating Office for Health Technology Assessment, 2005 [online]. Available from URL: http://cadth.ca/media/cdr/cdr_evaluation_firstyear_oct2005.pdf [Accessed 2010 Mar 11]

    Google Scholar 

  32. Helmer O. Analysis of the future: the Delphi method [RAND Paper]. Santa Monica (CA): RAND Corporation, 1967 [online]. Available from URL: http://www.rand.org/pubs/papers/2008/P3558.pdf [Accessed 2009 Dec 6]

    Google Scholar 

  33. Daniels N, Sabin J. Limits to health care: fair procedures, democratic deliberation, and the legitimacy problem for insurers. Philos Public Aff 1997; 26 (4): 303–50

    Article  PubMed  Google Scholar 

  34. Daniels N. Accountability for reasonableness. BMJ 2000; 321 (7272): 1300–1

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank Leigh-Ann Topfer for her invaluable help with the literature search. This study was funded through a New Emerging Team Grant on Cancer Technology Decision Making awarded by the Canadian Institutes of Health Research. The authors have no conflicts of interest that are directly relevant to the content of this study.

Author information

Authors and Affiliations

  1. Health Technology and Policy Unit, School of Public Health, University of Alberta, Research Transition Facility (RTF), 8308-114 Street, Edmonton, AB, Canada

    Tania Stafinski, Devidas Menon & Donald J. Philippon

  2. Academic Unit of Health Economics, University of Leeds, Leeds, UK

    Christopher McCabe

Authors
  1. Tania Stafinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Devidas Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher McCabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donald J. Philippon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tania Stafinski.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stafinski, T., Menon, D., McCabe, C. et al. To Fund or Not to Fund. Pharmacoeconomics 29, 771–780 (2011). https://doi.org/10.2165/11539840-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11539840-000000000-00000

Keywords

Search

Navigation