The prioritization preferences of pan-Canadian Oncology Drug Review members and the Canadian public: a stated-preferences comparison

Abstract

The pan-Canadian Oncology Drug Review (pcodr) is responsible for making coverage recommendations to provincial and territorial drug plans about cancer drugs. Within the pcodr process, small groups of experts (including public representatives) consider the characteristics of each drug and make a funding recommendation. It is important to understand how the values and preferences of those decision-makers compare with the values and preferences of the citizens on whose behalf they are acting. In the present study, stated preference methods were used to elicit prioritization preferences from a representative sample of the Canadian public and a small convenience sample of pcodr committee members. The results suggested that neither group sought strictly to maximize quality-adjusted life year (qaly) gains and that they were willing to sacrifice some efficiency to prioritize particular patient characteristics. Both groups had a significant aversion to prioritizing older patients, patients in good pre-treatment health, and patients in poor post-treatment health. Those results are reassuring, in that they suggest that pcodr decision-maker preferences are consistent with those of the Canadian public, but they also imply that, like the larger public, decision-makers might value health gains to some patients more or less highly than the same gains to others. The implicit nature of pcodr decision criteria means that the acceptability or limits of such differential valuations are unclear. Likewise, there is no guidance as to which potential equity factors-for example, age, initial severity, and so on-are legitimate and which are not. More explicit guidance could improve the consistency and transparency of pcodr recommendations.

Keywords: Priority-setting; pcodr; stated preferences.

FIGURE 1

Distribution of quality-adjusted life-year (QALY)–maximizing choices per respondent, by group. The proportion of respondents in each group by the number of QALY-maximizing choices they made over the 11 tasks in each questionnaire.

FIGURE 2

Preferences of the public and of pan-Canadian Oncology Drug Review members, by attribute level. The graphs show compensating variations (CVs) associated with an upward and downward change in the level of each attribute, relative to a baseline state with all attributes at their middle level, by respondent group. The y axis is reversed to show more-preferred differences above zero and less-preferred differences below zero.