Access to High‐Cost Drugs: Decision Makers' Perspectives

Abstract

ABSTRACTAimTo explore the attitudes, perceptions and concerns among decision makers about equity of access to high‐cost drugs in public hospitals.Method25 in‐depth, semi‐structured interviews were conducted with senior hospital administrators, directors of pharmacy and senior medical doctors. Topics included the decision‐making process and associated problems, and solutions to issues of access to high‐cost drugs. Interviews were audiotaped, transcribed verbatim and thematically analysed.ResultsHealthcare funding models were perceived as obstacles to equity of access to high‐cost drugs. Participants were concerned that there were inequities in decisions for individual patients according to public or private sector status. Tertiary public hospitals were seen to be at the ‘cutting edge’ and therefore were required to fund new and expensive drugs. This meant prioritising between patient groups and individuals. Participants had difficulty in identifying solutions. They suggested that ethical principles should be considered in addition to safety, efficacy and cost. Most wanted a transparent, accountable, evidence‐based decision‐making process.ConclusionDecision makers were concerned about equity of access to high‐cost drugs in public hospitals. They were also concerned about processes for decision making and the outcomes of these decisions.