Abstract
BackgroundHealth care system decision makers face challenges in allocating resources for screening, diagnosis and treatment of hepatitis C. Approximately 240,000 individuals are infected with the hepatitis C virus (HCV) in Canada. Populations most affected by HCV include Indigenous people, people who inject drugs, immigrants and homeless or incarcerated populations as well as those born between 1946 and 1965. Curative but expensive drug regimens of novel direct acting antivirals (DAAs) are available. We aim to identify social values from academic literature for inclusion in health technology assessments.MethodsWe conducted a scoping review of academic literature to identify and analyze the social values and evidence-based recommendations for screening, diagnosis and treatment of HCV in Canada. After applying inclusion/exclusion criteria, we abstracted: type of intervention(s), population(s) affected, study location, screening methods, diagnostics and treatments. We then abstracted and applied qualitative codes for social values. We extracted social value statements and clustered them into one of 4 categories: (1) equity and justice, (2) duty to provide care, (3) maximization of population benefit, and (4) individual versus community interests.ResultsOne hundred and eighteen articles met our inclusion criteria on screening, diagnosis and treatment of HCV in Canada. Of these, 54 (45.8%) discussed screening, 4 (3.4%) discussed diagnosis and 60 (50.8%) discussed treatment options. Most articles discussed the general population and other non-vulnerable populations. Articles that discussed vulnerable populations focused on people who inject drugs. We coded 1243 statements, most of which fell into the social value categories of equity and justice, duty to provide care and maximization of population benefit.ConclusionThe academic literature identified an expanded set of social values to be taken into account by resource allocation decision makers in financially constrained environments. In the context of hepatitis C, authors called for greater consideration of equity and justice and the duty to provide care in making evidence-based recommendations for screening, diagnosis and treatment for different populations and in different settings that also account for individual and community interests.
Highlights
Health care system decision makers face challenges in allocating resources for screening, diagnosis and treatment of hepatitis C
Our study suggests that the academic literature may be used to identify an expanded set of social values to be taken into account by resource allocation decision makers in financially constrained environments
Our analysis of hepatitis C screening, diagnosis and treatment in the context of curative, but high cost and large budget impact treatment options highlighted social values specific to vulnerable populations, which may augment the predominantly utilitarian calculus applied in most Health Technology Assessment (HTA)
Summary
Health care system decision makers face challenges in allocating resources for screening, diagnosis and treatment of hepatitis C. HTA is often characterized as considering efficiency, defined as the balance that maximizes population health outcomes for given resources [1] As such, it has been criticized as being overly utilitarian in approach. Decisions premised in utilitarianism maximize wellbeing and limit the loss of wellbeing for individuals; the most successful outcomes increase wellbeing with minimal corresponding loss [1, 2] Such approaches may fail to consider other measures for an acceptable amount of loss and benefit, including consideration of a broader set of social values [1,2,3]. We aim to identify the social values from the academic literature that could be included in HTA decision making for the screening, diagnosis and treatment of an exemplar infectious disease – hepatitis C
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