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. 2019 Feb 7;17(1):17.
doi: 10.1186/s12961-019-0411-8.

Addressing the affordability of cancer drugs: using deliberative public engagement to inform health policy

Colene Bentley  1 , Stuart Peacock  2 , Julia Abelson  3 , Michael M Burgess  4 , Olivier Demers-Payette  5 , Holly Longstaff  6 , Laura Tripp  3 , John N Lavis  7 , Michael G Wilson  7
Affiliations

Addressing the affordability of cancer drugs: using deliberative public engagement to inform health policy

Colene Bentley et al. Health Res Policy Syst. .

Abstract

Background: Health system expenditure on cancer drugs is rising rapidly in many OECD countries given the costly new treatments and increased rates of use due to a growing and ageing population. These factors put considerable strain on the sustainability of health systems worldwide, sparking public debate among clinicians, pharmaceutical companies, policy-makers and citizens on issues of affordability and equity. We engaged Canadians through a series of deliberative public engagement events to determine their priorities for making cancer drug funding decisions fair and sustainable in Canada's publicly financed health system.

Methods: An approach to deliberation was developed based on the McMaster Health Forum's citizen panels and the established Burgess and O'Doherty model of deliberative public engagement. Six deliberations were held across Canada in 2016. Transcripts were coded in NVivo and analysed to determine where participants' views converged and diverged. Recommendations were grouped thematically.

Results: A total of 115 Canadians participated in the deliberative events and developed 86 recommendations. Recommendations included the review and regular re-review of approved drugs using 'real-world' evidence on effectiveness and cost-effectiveness; prioritisation of treatments that restore patients' independence, mental health and general well-being; ensuring that decision processes, results and their rationales are transparent; and commitment to people with similar needs receiving the same care regardless of where in Canada they live.

Conclusions: The next steps for policy-makers should be to develop mechanisms for (1) re-reviewing effectiveness and cost-effectiveness data for all cancer drugs; (2) making disinvestments in cancer drugs that satisfy requirements relating to grandfathering and compassionate access; (3) ensuring fair and equitable access to cancer drugs for all Canadians; and (4) fostering a pan-Canadian approach to cancer drug funding decisions.

Keywords: Canada; Public engagement; cancer; priority-setting.

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Conflict of interest statement

Ethics approval and consent to participate

The project was approved by the Hamilton Integrated Research Ethics Board (#13-369) and the University of British Columbia-British Columbia Cancer Research Ethics Board (#H16-00623). All participants signed a written informed consent form in advance of the event and, before the event commenced, were provided with an in-person explanation of the project and its goals, a description of any risks involved for participants, and an opportunity to ask questions.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

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Fig. 1
Decision scenarios
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References

    1. Vogler S, Vitry A, Babar ZU. Cancer drugs in 16 European countries, Australia, and New Zealand: a cross-country price comparison study. Lancet Oncol. 2016;17(1):39–47. doi: 10.1016/S1470-2045(15)00449-0. - DOI - PubMed
    1. OECD . Pharmaceutical Spending (indicator) 2018.
    1. Cressman S, et al. A time-trend economic analysis of cancer drug trials. Oncologist. 2015;20(7):729–736. doi: 10.1634/theoncologist.2014-0437. - DOI - PMC - PubMed
    1. Howard DH, et al. Pricing in the market for anticancer drugs. J Econ Perspect. 2015;29(1):139–162. doi: 10.1257/jep.29.1.139. - DOI - PubMed
    1. de Oliveira C, et al. Trends in use and cost of initial cancer treatment in Ontario: a population-based descriptive study. CMAJ Open. 2013;1(4):E151–E158. doi: 10.9778/cmajo.20130041. - DOI - PMC - PubMed

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