Canadian Centre for Applied Research in Cancer Control (ARCC), 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West (CRL 203), Hamilton, Ontario, L8S 4K1, Canada.
Health Res Policy Syst. 2019 Feb 7;17(1):17. doi: 10.1186/s12961-019-0411-8.
Health system expenditure on cancer drugs is rising rapidly in many OECD countries given the costly new treatments and increased rates of use due to a growing and ageing population. These factors put considerable strain on the sustainability of health systems worldwide, sparking public debate among clinicians, pharmaceutical companies, policy-makers and citizens on issues of affordability and equity. We engaged Canadians through a series of deliberative public engagement events to determine their priorities for making cancer drug funding decisions fair and sustainable in Canada's publicly financed health system.
An approach to deliberation was developed based on the McMaster Health Forum's citizen panels and the established Burgess and O'Doherty model of deliberative public engagement. Six deliberations were held across Canada in 2016. Transcripts were coded in NVivo and analysed to determine where participants' views converged and diverged. Recommendations were grouped thematically.
A total of 115 Canadians participated in the deliberative events and developed 86 recommendations. Recommendations included the review and regular re-review of approved drugs using 'real-world' evidence on effectiveness and cost-effectiveness; prioritisation of treatments that restore patients' independence, mental health and general well-being; ensuring that decision processes, results and their rationales are transparent; and commitment to people with similar needs receiving the same care regardless of where in Canada they live.
The next steps for policy-makers should be to develop mechanisms for (1) re-reviewing effectiveness and cost-effectiveness data for all cancer drugs; (2) making disinvestments in cancer drugs that satisfy requirements relating to grandfathering and compassionate access; (3) ensuring fair and equitable access to cancer drugs for all Canadians; and (4) fostering a pan-Canadian approach to cancer drug funding decisions.
由于新的昂贵治疗方法的出现以及人口的增长和老龄化导致使用量的增加，许多经合组织国家的癌症药物卫生系统支出迅速增长。这些因素对全球卫生系统的可持续性造成了相当大的压力，在临床医生、制药公司、政策制定者和公民之间引发了关于可负担性和公平性问题的公开辩论。我们通过一系列的公众参与协商活动让加拿大人参与其中，以确定在加拿大公共资助的卫生系统中做出癌症药物资金决策的公平和可持续性的优先事项。
根据麦克马斯特健康论坛的公民小组和已建立的伯吉斯和奥多赫蒂审议式公众参与模式，制定了一种审议方法。2016 年在加拿大各地举行了六次审议。使用 NVivo 对转录本进行编码并进行分析，以确定参与者的观点趋同和分歧的地方。建议按主题分组。
共有 115 名加拿大人参加了审议活动，并提出了 86 项建议。建议包括使用有关有效性和成本效益的“真实世界”证据审查和定期重新审查已批准的药物；优先考虑能够恢复患者独立性、心理健康和整体健康的治疗方法；确保决策过程、结果及其理由是透明的；并承诺无论患者居住在加拿大何处，具有相似需求的人都能获得相同的护理。
政策制定者的下一步应该是制定机制：（1）重新审查所有癌症药物的有效性和成本效益数据；（2）对满足祖父条款和同情准入要求的癌症药物进行撤资；（3）确保所有加拿大人都能公平、平等地获得癌症药物；（4）促进加拿大癌症药物资金决策的全加方式。
