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Evaluating New Zealanders’ Values for Drug Coverage Decision Making: Trade-Offs between Treatments for Rare and Common Conditions



New Zealand’s near static healthcare budget limits access to expensive medications including those for rare conditions. As such, it is necessary to know the public’s priority for values in the drug funding decision-making process.


The objectives of this study were to measure the relative societal importance of values of New Zealanders in informing drug funding decisions and to determine how New Zealanders trade off funding in various scenarios between common and rare diseases.


An online survey was conducted between 17 April and 17 May, 2019 on a sample of 500 New Zealanders aged ≥ 18 years. Participants ranked 13 values using an analytical hierarchy process. Participants were then presented with different trade-off scenarios to measure their attitudes towards funding drugs for common and rare diseases.


The values ranked in the top five by most were potential effect on quality of life (71.8%), ability of the drug to work (57.6%), severity (57.6%), safety (57%), and potential to extend life (56%). Adherence and rarity held the lowest and second lowest ranking. Most believe that resources should be allocated towards drugs that have been proven to work and have the greatest health benefits. In trade-offs between access to an expensive drug therapy for a rare disease with uncertain benefits or receive a fixed cash payment, the overwhelming consensus was to receive the cash payment.


New Zealanders ultimately value drug-related factors (e.g. quality of life and efficacy) and disease-related factors (e.g. severity of disease and equity) the most but did not value disease rarity.

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Authors and Affiliations


Corresponding author

Correspondence to Carlo A. Marra.

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This research was funded by the University of Otago.

Conflicts of Interest/Competing Interests

Linda Yamoah, Nick Dragojlovic, Alesha Smith, Larry D. Lynd and Carlo A. Marra have no conflicts of interest that are directly relevant to the content of this study.

Ethics Approval

This study was approved by the University of Otago Human Ethics Committee (D19/048).

Consent to Participate

Informed consent was sought prior to completion of the online survey.

Consent for Publication

Informed consent for publication was sought.

Availability of Data and Material

As consent was not sought for sharing the data, we are unable to share the data from the survey.

Code Availability

We can share the R code for the analytic hierarchy process upon request.

Authors’ Contributions

Linda Yamoah was a BPharm(Hons) student and adapted the survey from the Canadian study, analysed the data and drafted the manuscript. This manuscript is an adaptation of her dissertation. Nick Dragojlovic was an investigator on the Canadian survey and helped with the data analysis, reviewed the manuscript for publication and helped respond to reviewers’ comments. Alesha Smith was a co-supervisor of Linda Yamoah and reviewed the manuscript. Larry Lynd was the primary investigator of the Canadian study and reviewed the manuscript and helped with reviewers’ comments. Carlo Marra was the primary investigator of the study, supervised Linda Yamoah, helped analyse the data, reviewed the manuscript and responded to the reviewers’ comments.

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Yamoah, L., Dragojlovic, N., Smith, A. et al. Evaluating New Zealanders’ Values for Drug Coverage Decision Making: Trade-Offs between Treatments for Rare and Common Conditions. PharmacoEconomics 39, 109–119 (2021).

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