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Canadian Journal of Public Health

, Volume 93, Issue 6, pp 421–425 | Cite as

“Cost-effectiveness” Estimates Result in Flawed Decisionmaking in Listing Drugs for Reimbursement

  • Roy West
  • E. Keith Borden
  • Jean-Paul Collet
  • Nigel S. B. Rawson
  • Robert S. Tonks
Article

Abstract

Background: Facing financial pressures, the provinces and territories have chosen to use “costeffectiveness” for making decisions about drug listings. This study examines the scientific basis for the procedures used to determine cost-effectiveness in 5 Canadian provinces.

Methods: Questionnaires were mailed to key provincial informants asking about the respondent’s expertise and role, the administrative and scientific basis for decision-making, organizational structures and other factors in the scientific evaluation and decision-making process, and the transparency of the process. There were also questions about the data required and received and their importance, the place of cost-effectiveness and other economic impact evaluations, the data sources for them, and the use of follow-up monitoring to evaluate the decisions made.

Results: Information required by the provinces for decision-making about cost-effectiveness is not available to them at the time of their decisions about listing new medications. The primary sources of data on both efficacy and cost-effectiveness are pharmaceutical companies. Efficacy information is generated in a scientifically rigorous manner, whereas the effectiveness and cost data are estimates potentially subject to biases and evaluated by judgement (expert opinion) alone. Moreover, there is no collaboration in the assessment process between provinces. The outcomes are large differences between provinces in the decisions made and, hence, in the pharmaceuticals accessible to residents.

Conclusions: Current methods for making decisions about provincial drug listings are based on inadequate data, and the lack of consistency in the provinces’ decisions suggest they may be scientifically flawed. We recommend establishing a single national scientific review committee, with re-evaluation of each drug’s cost-effectiveness after a suitable period of monitored use.

Résumé

Contexte: Face aux pressions financières, les provinces et territoires ont choisi de se servir des études ª coût-efficacité « pour prendre les décisions concernant l’admission des nouveaux médicaments sur les formulaires provinciaux. Cette étude examine la base scientifique du processus d’évaluation coût-efficacité dans cinq provinces.

Méthodes: Un questionnaire a été envoyé aux personnes responsables dans chaque province pour obtenir des renseignements sur leur rôle et expertise, les bases administratives et scientifiques entourant la prise de décision ainsi que la structure organisationnelle et tout autre facteur pouvant affecter le processus de décision et sa transparence. D’autres questions portaient sur les données utilisées pour la prise de décision afin de déterminer leur importance dans le processus décisionnel et leur disponibilité au moment de la prise de décision. Le questionnaire s’attachait, enfin à déterminer l’importance des études coût-efficacité pour la prise de décision, la source des données économiques et les modalités de suivi une fois la décision prise.

Résultats: De nombreuses données sur le coût et l’efficacité considérées comme importantes par les provinces pour la prise de décision ne sont pas disponibles quand la décision est prise. Les compagnies pharmaceutiques constituent la principale source d’information concernant l’efficacité réelle (dans la vie habituelle) et le ratio coût-efficacité. Alors que les renseignements sur l’efficacité expérimentale proviennent d’une approche scientifique et rigoureuse, les données sur l’efficacité dans la vie habituelle et celles concernant les coûts sont issues d’estimations (opinions d’experts) avec possibilité de biais et risque de subjectivité. L’enquète révèle également qu’il n’y a pas de collaboration entre les provinces, ce qui explique de grandes différences entre les provinces quant aux décisions prises; ce dernier point soulève la question de l’équité des populations vis à vis de l’accessibilité aux médicaments.

Conclusions: Le processus actuel de revue des médicaments par les provinces repose sur des données inadéquates et scientifiquement défectueuses; ce qui explique de grandes différences entre les provinces quant aux décisions prises. Dans ces conditions, nous recommandons l’établissement d’un comité national de revue scientifique des médicaments après leur mise sur le marché pour réévaluer après quelques années leur ratio coût-efficacité.

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Copyright information

© The Canadian Public Health Association 2002

Authors and Affiliations

  • Roy West
    • 1
  • E. Keith Borden
    • 2
  • Jean-Paul Collet
    • 3
  • Nigel S. B. Rawson
    • 4
  • Robert S. Tonks
    • 5
  1. 1.Division of Community HealthMemorial University of Newfoundland, Health Sciences CentreSt. John’sCanada
  2. 2.TorontoCanada
  3. 3.McGill UniversityMontrealCanada
  4. 4.Center for Health Care Policy and EvaluationUnitedHealth GroupMinneapolisUSA
  5. 5.Dalhousie UniversityHalifaxCanada

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