PSY59 - Values Of The Canadian Public Towards Pharmaceutical Reimbursement Decisions

Abstract

Traditional health technology assessment is based on cost-effectiveness, and is the foremost method used by decision-making bodies to inform funding decisions. This method is insufficient for expensive rare disease treatment decisions as it is premised on efficiency. Other factors guide the decision to fund rare disease treatments, including decision-maker values. With Canada’s drug costs being borne by the public, it is essential that societal values be understood by health ministries, particularly for rare diseases where large resources serve a small population. Identify the value-based criteria society feels are most important in decision making, the relative weight of these values, and whether rarity is strongly valued. A literature review revealed 13 values other than cost which have been used for value-based funding decisions. 2211 Canadians were surveyed online and asked to rank the values, and then perform an analytic hierarchy process of pairwise comparisons in order to attain both their rank and weight. The factors selected in the top 5 for the majority of our subjects were: The ability of the drug to improve quality of life (66%) and quantity of life (50%), ability of drug to work (61%), severity of disease (60%) and safety (65%).These values were weighted 4-5 fold more important than those ranked lowest: unmet need, socioeconomic status, rarity, and adherence. Rarity had a relative weight of 0.02, the second least important value. Factors related to rare diseases such as severity of disease (0.12), Equity (0.07) and unmet need (0.04), were ranked higher. We have determined the most important factors Canadians feel should be used in value-based funding as well as their relative weight. These results have broad applications not limited to rare diseases. If rare diseases are to undergo value-based funding, our results indicate rarity alone may not be sufficient justification.