CoChat
Sign Up
Cited by 22Health Systems, Economic Evaluations, Quality of LifePharmaceutical Economics and PolicyEconomic and Financial Impacts of Cancer

Public perspectives on disinvestments in drug funding: results from a Canadian deliberative public engagement event on cancer drugs

Open access
Costa, Sarah, Bentley, Colene, Regier, Dean A., McTaggart-Cowan, Helen, Mitton, Craig, Burgess, Michael M., Peacock, Stuart J.·2019·BMC Public Health
DOI 10.1186/s12889-019-7303-2PMC PMC6647147
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Decisions relating to the funding of new drugs are becoming increasingly challenging due to a combination of aging populations, rapidly increasing list prices, and greater numbers of drug-indication pairs being brought to market. This is especially true in cancer, where rapid list price inflation is coupled with steeply rising numbers of incident cancer cases. Within a publicly funded health care system, there is increasing recognition that resource allocation decisions should consider the reassessment of, and potential disinvestment from, currently funded interventions alongside new investments. Public input into the decision-making process can help legitimize the outcomes and ensure priority-setting processes are aligned with public priorities. METHODS: In September 2014, a public deliberation event was held in Vancouver, Canada, to obtain public input on the topic of cancer drug funding. Twenty-four members of the general public were tasked with making collective recommendations for policy-makers about the principles that should guide funding decisions for cancer drugs in the province of British Columbia. Deliberative questions and decision aids were used to elicit individuals' willingness to make trade-offs between expenditures and health outcomes. RESULTS: Participants discussed the implications of disinvestment decisions from cancer drugs in terms of its impact on patient choice, fairness and quality of life. Their discussions indicate that in order for a decision to disinvest from currently-funded cancer drugs to be acceptable, it must align with three main principles: the decision must be accompanied by significant gains, described both in terms of cost savings and opportunities to re-invest elsewhere in the health care system; those who are currently prescribed a cancer drug should be allowed to continue their course of treatment (referred to as a continuance clause, or "grandfathering" approach); and it must consider how access to care for specialized populations is impacted. CONCLUSIONS: The results from this deliberation event provide insight into what is acceptable to British Columbians with respect to disinvestment decisions for cancer drugs. These recommendations can be considered within wider health system decision-making frameworks for funding decisions relating to all drugs, as well as for cancer drugs.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/s12889-019-7303-2

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 36

  1. [1]Bach P Limits on medicare's ability to control rising spending on cancer drugs N Engl J Med 2009 360 6 626 633 10.1056/NEJMhpr0807774 19176475 · DOI
  2. [2]Davis C Naci H Gurpinar E Poplavska E Pinto A Aggarwal A Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European medicines agency: retrospective cohort study of drug approvals 2009-13 BMJ (Clinical research ed) 2017 359 j4530 10.1136/bmj.j4530 PMC5627352 28978555 · DOI
  3. [3]Cressman S Browman G Hoch J Kovacic L Peacock S A time-trend economic analysis of cancer drug trials Oncologist 2015 20 729 736 10.1634/theoncologist.2014-0437 26032135 PMC4492232 · DOI
  4. [6]Schrag D The Price tag on Progress — chemotherapy for colorectal cancer N Engl J Med 2004 351 4 317 319 10.1056/NEJMp048143 15269308 · DOI
  5. [7]O'Brien SG Guilhot F Larson RA Gathmann I Baccarani M Cervantes F Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia N Engl J Med 2003 348 11 994 1004 10.1056/NEJMoa022457 12637609 · DOI
  6. [8]Motzer RJ Hutson TE Tomczak P Michaelson MD Bukowski RM Rixe O Sunitinib versus interferon alfa in metastatic renal-cell carcinoma N Engl J Med 2007 356 2 115 124 10.1056/NEJMoa065044 17215529 · DOI
  7. [9]Parkinson B Sermet C Clement F Crausaz S Godman B Garner S Disinvestment and value-based purchasing strategies for pharmaceuticals: an international review PharmacoEconomics 2015 33 905 924 10.1007/s40273-015-0293-8 26048353 · DOI · Paper page
  8. [10]Mitton C Patten S Donaldson C Listening to the decision makers: sustainability of PBMA in Alberta Appl Health Econ Health Policy 2004 3 3 143 151 10.2165/00148365-200403030-00005 15740170 · DOI
  9. [11]Harris C Ko H Waller C Sloss P Williams P Sustainability in health care by allocating resources effectively (SHARE) 4: exploring opportunities and methods for consumer engagement in resource allocation in a local healthcare setting BMC Health Serv Res 2017 17 329 10.1186/s12913-017-2212-5 28476155 PMC5420096 · DOI
  10. [12]Canadian Agency for Drugs and Technology in Health (CADTH) Procedure for the CADTH common drug review Canadian Agency for Drugs and Technology in health (CADTH) 2014
  11. [14]Elshaug A Hiller J Tunis S Moss J Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices Aust New Zealand Health Pol 2007 4 23 10.1186/1743-8462-4-23 PMC2174492 17973993 · DOI
  12. [16]Canadian Agency for Drugs and Technology in Health (CADTH) Health technology expert review panel - process for developing recommendations Canadian Agency for Drugs and Technology in health (CADTH) 2015 1 5
  13. [17]Elshaug A Moss J Littlejohns P Karnon J Merlin T Jiller J Identifying existing health care services that do not provide value for money Med J Aust 2009 190 5 269 273 19296794
  14. [18]Leggett L Noseworthy T Zarrabi M Lorenzetti D Sutherland L Clement F Health technology reassessment of non-drug technologies: current practices Int J Technol Assess Health Care 2012 28 3 220 227 10.1017/S0266462312000438 22980697 · DOI
  15. [20]Robinson S Glasby J Allen K It ain't what you do it's the way that you do it': lessons for health care from decommissioning of older people's services Health Soc Care Community 2013 21 6 614 622 23647622
  16. [22]Watt AM Hiller JE Braunack-Mayer AJ Moss JR Buchan H Wale J The ASTUTE health study protocol: deliberative stakeholder engagements to inform implementation approaches to healthcare disinvestment Implement Sci 2012 7 1 101 10.1186/1748-5908-7-101 23088222 PMC3520863 · DOI
  17. [24]Calabrò GE La Torre G de Waure C Villari P Federici A Ricciardi W Disinvestment in healthcare: an overview of HTA agencies and organizations activities at European level BMC Health Serv Res 2018 18 1 148 10.1186/s12913-018-2941-0 29490647 PMC5831213 · DOI
  18. [27]Street J Callaghan P Braunack-Mayer A Hiller JE Citizens’ perspectives on disinvestment from publicly funded pathology tests: a deliberative forum, vol. 18 2015 26686790
  19. [28]LLPd L Guerra Júnior AA Santos M Magliano C Diniz I Souza K The assessment for disinvestment of intramuscular interferon Beta for relapsing-remitting multiple sclerosis in Brazil PharmacoEconomics 2018 36 2 161 173 10.1007/s40273-017-0579-0 29139001 PMC5805817 · DOI
  20. [29]Hodgetts K Hiller J Street J Carter D Braunack-Mayer A Watt A Disinvestment policy and the public funding of assisted reproductive technologies: outcomes of deliverative engagements with three key stakeholder groups BMC Health Serv Res 2014 14 204 1 13 24885716 PMC4016640
  21. [30]Lindstrom H Waldau S Ethically acceptable prioritisation of childless couples and treatment rationing: “accountability for reasonableness” Eur J Obstet Gynecol 2008 139 176 186 10.1016/j.ejogrb.2008.02.018 18417271 · DOI
  22. [31]Regier D Bentley C Mitton C Bryan S Burgess M Chesney E Public engagement in priority-setting: results from a pan-Canadian survey of decision-makers in cancer control Soc Sci Med 2014 122 130 139 10.1016/j.socscimed.2014.10.038 25441325 · DOI
  23. [33]Mitton C Smith N Peacock S Evoy B Abelson J Public participation in health care priority setting: a scoping review Health Policy 2009 91 219 228 10.1016/j.healthpol.2009.01.005 19261347 · DOI
  24. [34]Peacock S Public attitudes and values in priority setting Isr J Health Policy Res 2015 4 29 1 3 26097679 PMC4474577
  25. [35]Solomon S Abelson J Why and when should we use public deliberation? Hast Cent Rep 2012 42 2 17 20 10.1002/hast.27 PMC3645483 22733325 · DOI
  26. [36]Haas M Hall J Viney R Gallego G Breaking up is hard to do: why disinvestment in medical technology is harder than investment Aust Health Rev 2012 36 2 148 152 10.1071/AH11032 22624634 · DOI · Paper page
  27. [37]Chafe R Levinson W Hébert PC The need for public engagement in choosing health priorities CMAJ 2011 183 2 1 10.1503/cmaj.101517 PMC3033917 21098064 · DOI
  28. [38]Bentley C Costa S Burgess MM Regier D McTaggart-Cowan H Peacock SJ Trade-offs, fairness, and funding for cancer drugs: key findings from a deliberative public engagement event in British Columbia, Canada BMC Health Serv Res 2018 18 1 339 10.1186/s12913-018-3117-7 29739463 PMC5941483 · DOI
  29. [39]O'Doherty K Burgess M Engaging the public on biobanks: outcomes of the BC biobank deliberation Public Health Genomi 2009 12 203 215 10.1159/000167801 19367089 · DOI
  30. [40]Burgess M From ‘trust us’ to participatory governance: deliberative publics and science policy Public Underst Sci 2014 23 1 48 52 10.1177/0963662512472160 24434712 · DOI
  31. [41]Hislop J Societal preferences for health technology disinvestment policy: views of Scottish taxpayers - a qualitative study Value Health 2011 14 7 A356 A357 10.1016/j.jval.2011.08.680 · DOI
  32. [42]Renwick M Smolina K Gladstone E Weymann D Morgan S Postmarket policy considerations for biosimilar oncology drugs Lancet Oncol 2016 17 e31 e38 10.1016/S1470-2045(15)00381-2 26758759 · DOI
  33. [45]Waller J Sullivan E Piercy J Black CM Kachroo S Assessing physician and patient acceptance of infliximab biosimilars in rheumatoid arthritis, ankylosing spondyloarthritis and psoriatic arthritis across Germany Patient Prefer Adherence 2017 11 519 530 10.2147/PPA.S129333 28331299 PMC5356924 · DOI
  34. [46]Casey D Key strategic factors for stakeholders in the current global biosimilar market, vol. 21 2015 26375407
  35. [50]Daniels T Williams I Bryan S Mitton C Robinson S Involving citizens in disinvestment decisions: what do health professionals think? Findings from a multi-method study in the English NHS Health Econ Policy Law 2018 13 2 162 188 10.1017/S1744133117000330 29284547 · DOI
  36. [51]Maloney MA Schwartz L O'Reilly D Levine M Drug disinvestment frameworks: components, challenges and solutions Int J Technol Assess Health Care 2017 33 2 261 269 10.1017/S0266462317000277 28703087 · DOI · Paper page

Cited by

Sorted by citations

Authors
Costa, S., Bentley, C., Regier, D. A., McTaggart-Cowan, H., Mitton, C., Burgess, M. M., & Peacock, S. J.
Affiliations
  • BC Cancer Agency (CA)
  • University of British Columbia (CA)
Corresponding author
Costa, Sarah
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2019-07-22
Volume
19
Issue
1
Pages
977-977
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-019-7303-2
PMC
PMC6647147
OpenAlex
W2964045988
Cited by
22
References
0
Citations by year
2026: 3 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 7 · 2020: 1
FWCI
3.25
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • cIRcle (University of British Columbia) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Open Collections
Funders
  • Canadian Institutes of Health Research (FRN-114107)
  • Michael Smith Foundation for Health Research (-)
  • Canadian Centre for Applied Research in Cancer Control (-)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
Keywords
anticancer agents, public deliberation, citizen participation, healthcare resource allocation, priority setting, grandfathering, health equity
MeSH terms
Adolescent, Adult, Aged, Antineoplastic Agents, British Columbia, Community Participation, Decision Making, Female, Financing, Government, Humans, Male, Middle Aged, Policy Making, Public Opinion, Health Care Rationing, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review