Gallego Gisselle, Taylor Susan Joyce, Brien Jo-Anne Elizabeth
Centre for Health Economics Research and Evaluation (CHERE), University of Technology, Sydney, PO Box 123, Broadway, NSW 2007, Australia.
Health Policy. 2007 Nov;84(1):58-66. doi: 10.1016/j.healthpol.2007.05.008. Epub 2007 Jul 6.
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.
医疗服务提供者（HCPs）越来越意识到医疗服务资金面临的压力，包括高成本药物（HCMs）。将资源分配给创新且昂贵的药物尤其具有挑战性，而用于将资源分配给高成本药物的决策过程和标准在文献中尚未得到广泛描述。本案例研究旨在描述澳大利亚一家公立医院首个报告的高成本药物小组委员会（HCD-SC）的运作情况。此外，该研究还使用丹尼尔和萨宾的“合理问责”伦理框架对决策过程进行了评估。从对HCD-SC运作情况的描述中得出了一些经验教训。决策并非仅基于有效性和成本。关于高成本药物获取的决策还涉及“临床需求”和缺乏替代治疗等其他因素。HCD-SC的成员还认为决策方式保持一致很重要。本研究的结果为制定改善该医院关于高成本药物获取决策过程的策略提供了证据基础。
