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Stated and Revealed Preferences for Funding New High-Cost Cancer Drugs: A Critical Review of the Evidence from Patients, the Public and Payers

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Abstract

Background

The growing focus on patient-centred care has encouraged the inclusion of patient and public input into payer drug reimbursement decisions. Yet, little is known about patient/public priorities for funding high-cost medicines, and how they compare to payer priorities applied in public funding decisions for new cancer drugs.

Objectives

The aim was to identify and compare the funding preferences of cancer patients and the general public against the criteria used by payers making cancer drug funding decisions.

Methods

A thorough review of the empirical, peer-reviewed English literature was conducted. Information sources were PubMed, EMBASE, MEDLINE, Web of Science, Business Source Complete, and EconLit. Eligible studies (1) assessed the cancer drug funding preferences of patients, the general public or payers, (2) had pre-defined measures of funding preference, and (3) had outcomes with attributes or measures of ‘value’. The quality of included studies was evaluated using a health technology assessment-based assessment tool, followed by extraction of general study characteristics and funding preferences, which were categorized using an established WHO-based framework.

Results

Twenty-five preference studies were retrieved (11 quantitative, seven qualitative, seven mixed-methods). Most studies were published from 2005 onward, with the oldest dating back to 1997. Two studies evaluated both patient and public perspectives, giving 27 total funding perspectives (41 % payer, 33 % public, 26 % patients). Of 41 identified funding criteria, payers consider the most (35), the general public considers fewer (23), and patients consider the fewest (12). We identify four unique patient criteria: financial protection, access to medical information, autonomy in treatment decision making, and the ‘value of hope’. Sixteen countries/jurisdictions were represented.

Conclusions

Our results suggest that (1) payers prioritize efficiency (health gains per dollar), while citizens (patients and the general public) prioritize equity (equal access to cancer medicines independent of cost or effectiveness), (2) citizens prioritize few criteria relevant to payers, and (3) citizens prioritize several criteria not considered by payers. This can explain why payer and citizen priorities clash when new cancer medicines are denied public funding.

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Acknowledgments

The authors wish to acknowledge Duncan Mortimer for assistance with the development of the initial search strategy.

Authorship

This review was undertaken as a component of a doctoral study. TM conducted the literature search, analysed results and drafted the manuscript. TM and AH evaluated studies for inclusion. AH and AM provided edits and knowledgeable guidance.

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Authors and Affiliations

  1. Centre for Health Economics, Level 2, Building 75, Monash University, Clayton, VIC, 3800, Australia

    Tatjana E. MacLeod & Anthony H. Harris

  2. The Finkel Chair of Global Health, School of Public Health and Preventive Medicine, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia

    Ajay Mahal

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  1. Tatjana E. MacLeod
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Correspondence to Tatjana E. MacLeod.

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No funding was received. TM, AH and AM have no conflicts of interest regarding this paper.

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MacLeod, T.E., Harris, A.H. & Mahal, A. Stated and Revealed Preferences for Funding New High-Cost Cancer Drugs: A Critical Review of the Evidence from Patients, the Public and Payers. Patient 9, 201–222 (2016). https://doi.org/10.1007/s40271-015-0139-7

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