Canadian Centre for Applied Research in Cancer Control, 675 West 10th Avenue, Vancouver, British, Columbia, V5Z 1L3, Canada.
Cancer Control Research, BC Cancer, 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, Canada.
BMC Public Health. 2019 Jul 22;19(1):977. doi: 10.1186/s12889-019-7303-2.
Decisions relating to the funding of new drugs are becoming increasingly challenging due to a combination of aging populations, rapidly increasing list prices, and greater numbers of drug-indication pairs being brought to market. This is especially true in cancer, where rapid list price inflation is coupled with steeply rising numbers of incident cancer cases. Within a publicly funded health care system, there is increasing recognition that resource allocation decisions should consider the reassessment of, and potential disinvestment from, currently funded interventions alongside new investments. Public input into the decision-making process can help legitimize the outcomes and ensure priority-setting processes are aligned with public priorities.
In September 2014, a public deliberation event was held in Vancouver, Canada, to obtain public input on the topic of cancer drug funding. Twenty-four members of the general public were tasked with making collective recommendations for policy-makers about the principles that should guide funding decisions for cancer drugs in the province of British Columbia. Deliberative questions and decision aids were used to elicit individuals' willingness to make trade-offs between expenditures and health outcomes.
Participants discussed the implications of disinvestment decisions from cancer drugs in terms of its impact on patient choice, fairness and quality of life. Their discussions indicate that in order for a decision to disinvest from currently-funded cancer drugs to be acceptable, it must align with three main principles: the decision must be accompanied by significant gains, described both in terms of cost savings and opportunities to re-invest elsewhere in the health care system; those who are currently prescribed a cancer drug should be allowed to continue their course of treatment (referred to as a continuance clause, or "grandfathering" approach); and it must consider how access to care for specialized populations is impacted.
The results from this deliberation event provide insight into what is acceptable to British Columbians with respect to disinvestment decisions for cancer drugs. These recommendations can be considered within wider health system decision-making frameworks for funding decisions relating to all drugs, as well as for cancer drugs.
由于人口老龄化、药品定价迅速上涨以及更多的药物适应证组合推向市场等多种因素的综合影响，新药品的资金决策变得越来越具有挑战性。在癌症领域，这种情况尤其明显，因为药品定价迅速上涨，同时癌症新发病例数量也在急剧上升。在一个公共资助的医疗体系中，人们越来越认识到，资源配置决策应考虑重新评估和潜在地放弃当前资助的干预措施，同时进行新的投资。公众参与决策过程有助于使结果合法化，并确保优先事项设定过程与公众的优先事项保持一致。
2014 年 9 月，在加拿大温哥华举行了一次公众审议活动，就癌症药物资金问题征求公众意见。24 名普通公众被要求就不列颠哥伦比亚省癌症药物资金决策应遵循的原则向政策制定者提出集体建议。使用审议性问题和决策辅助工具来了解个人在支出和健康结果之间进行权衡的意愿。
参与者根据其对患者选择、公平性和生活质量的影响，讨论了从癌症药物投资中撤出的决定所带来的影响。他们的讨论表明，为了使从当前资助的癌症药物中撤出的决定是可以接受的，它必须符合三个主要原则：该决定必须伴随着重大收益，既要从成本节约的角度，也要从重新投资于医疗体系其他领域的机会方面来描述；应该允许目前正在服用癌症药物的人继续他们的治疗过程（称为继续治疗条款或“祖父”方法）；并且必须考虑到专门人群获得医疗服务的机会受到了怎样的影响。
这次审议活动的结果为不列颠哥伦比亚省的人们在癌症药物投资撤出方面提供了可以接受的观点。这些建议可以在更广泛的卫生系统决策框架内用于与所有药物以及癌症药物相关的资金决策。
