Drug attributes associated with the selection of drugs for reimbursement: a pilot stated preferences experiment with Canadian stakeholders

ABSTRACT

Introduction: Health Technologies Assessment requires that evidence about clinical, economic, social, and organizational aspects be considered and weighted in the selection of drugs for reimbursement. We investigate how evidence is balanced by committee members in Canada, where neither explicit weighing schemes nor thresholds are provided.

Methods: Thirty-six past and present members of cancer drug appraisal committees participated in an online stated preferences experiment. The experiment included a ranking of drug attributes, a discrete choice experiment asking to vote in favor or against the funding of drugs described using five attributes, and a best–worst scaling experiment using the same drug descriptions.

Results: Respondents focused on the clinical attributes of drugs, particularly on the survival benefit relative to a comparator. As a second criterion, respondents either consider economic attributes or they consider patient relevant attributes, depending on how questions are framed. The small sample size is a limitation to generalizability.

Conclusion: Understanding how individuals involved in HTA weigh evidence is important to the development of policy guidelines for the drug selection process. Our pilot results suggest that non-clinical criteria can become marginalized in the appraisal process in the absence of clear guidelines to their use. Avenues for further research are discussed.

KEYWORDS:

• Health technologies assessment
• drug reimbursement
• discrete choice experiment
• stated preferences analysis
• pan Canadian oncology drug review

Author contribution statement

Wiesława Dominika Wranik led the study. She obtained funding for the project, worked on project design, questionnaire design, supervision of data management, data analysis, and interpretation. She acted as the liaison between the research team and the knowledge users advisory group. She was responsible for the drafting and full preparation of the manuscript. Christopher Skedgel co-led the study with focus on the technical aspects of experimental design and data analysis, as well as interpretation. He contributed to the preparation and revisions of the manuscript. Min Hu was responsible for the management of data from the experiment and all statistical analysis. He contributed to the interpretation of the results and the preparation of the manuscript. All authors jointly discussed the manuscript, all provided critical thought and revisions to its intellectual content, and all agree with the contents of the final version.

Data Availability Statement

The data for this study were collected by the authors and are currently not openly available to other researchers. The authors continue to work with the data in further studies.

Declaration of Interest

Wiesława Dominika Wranik is affiliated with the pan Canadian Oncology Drug Review as an expert reviewer for the appraisal process. Christopher Skedgel is senior consultant at IQVIA; employment began after data were collected and initial analysis had taken place. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Ethical Standards Declaration

This study protocol was approved by the Dalhousie University Research Ethics Board, REB # 2013-3162.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the Canadian Institutes for Health Research (CIHR) as a part of the Partnerships in Health Systems Improvement program, under Grant Number PHE 129912.