Trade-offs, fairness, and funding for cancer drugs: key findings from a deliberative public engagement event in British Columbia, Canada

Abstract

Background: Spending on cancer drugs has risen dramatically in recent years compared to other areas of health care, due in part to higher prices associated with newly approved drugs and increased demand for these drugs. Addressing this situation requires making difficult trade-offs between cost, harms, and ability to benefit when using public resources, making it important for policy makers to have input from many people affected by the issue, including citizens.

Methods: In September 2014, a deliberative public engagement event was conducted in Vancouver, British Columbia (BC), on the topic of priority setting and costly cancer drugs. The aim of the study was to gain citizens' input on the topic and have them generate recommendations that could inform cancer drug funding decisions in BC. A market research company was engaged to recruit members of the BC general public to deliberate over two weekends (four days) on how best to allocate resources for expensive cancer treatments. Participants were stratified based on the 2006 census data for BC. Participants were asked to discuss disinvestment, intravenous versus oral chemotherapy delivery, and decision governance. All sessions were audio recorded and transcribed. Transcripts were analyzed using NVivo 11 software.

Results: Twenty-four individuals participated in the event and generated 30 recommendations. Participants accepted the principle of resource scarcity and the need of governments to make difficult trade-offs when allocating health-care resources. They supported the view that cost-benefit thresholds must be set for high-cost drugs. They also expected reasonable health benefits in return for large expenditures, and supported the view that some drugs do not merit funding. Participants also wanted drug funding decisions to be made in a non-partisan and transparent way.

Conclusion: The recommendations from the Vancouver deliberation can provide guidance to policy makers in BC and may be useful in challenging pricing by pharmaceutical companies.

Keywords: Canada; Cancer drugs; Priority setting; Public engagement.

Fig. 1

Decision scenarios. Participants were given the following instructions and decision scenarios on Day 3 of the deliberation: Imagine you are decision-makers, responsible for the cancer budget. The decision you make will affect the people in your province only. A fixed budget has been set aside to fund one treatment. The budget is not large enough to fund both of the treatments. The budget will only fund healthcare and cannot be used for research that may improve a patient’s condition in the future. The total cost of the treatment includes all costs that are relevant to the decision. (Decision scenario 1): Trade-off between cost and additional length of life. (Decision scenario 2): Trade-off between cost and increased quality of life

Fig. 2

Quality of Life Scale. Note: Usual activities means things like work, study, family, and leisure activities