Prioritization of chemotherapy drugs in the Catalan hospital system: a qualitative case study

Abstract

OBJECTIVES To analyze the prioritization process for chemotherapy drugs in the Drug-Therapeutic Committees (DTCs) in Catalan hospitals and assess their impact on patients' access to these drugs. METHODS A case qualitative study of the DTCs of tertiary hospitals in Catalonia was performed, based on semi-structured interviews and a review of the scientific literature. Key professionals were interviewed with technical and institutional involvement in the DTCs assessment process, including pharmacists, oncologists, clinical pharmacologists and other physicians with different medical specialties. The conceptual framework accountability for reasonableness, by Daniels and Sabin, which analyzes prioritization processes from a fair and legitimate perspective, was used. RESULTS The current regulatory framework for the introduction of drugs is characterized by a fragmented hospital system and lacks coordination strategies. These weaknesses fail to allow the prioritization and optimization of resources in the Catalan health service. CONCLUSION We propose the implementation of a decision-making coordination strategy for all public sector hospitals. This strategy would allow an increasingly innovative environment to be exploited, in which inequalities in access to drugs at the hospital level should be avoided.