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| Research article summary (published 30 Oct 2002): |
"Cost-effectiveness" estimates result in flawed decision-making in listing drugs for reimbursement.
Full Abstract
BACKGROUND:
Facing financial pressures, the provinces and territories have chosen to use "cost-effectiveness" for making decisions about drug listings. This study examines the scientific basis for the procedures used to determine cost-effectiveness in 5 Canadian provinces.
METHODS:
Questionnaires were mailed to key provincial informants asking about the respondent's expertise and role, the administrative and scientific basis for decision-making, organizational structures and other factors in the scientific evaluation and decision-making process, and the transparency of the process. There were also questions about the data required and received and their importance, the place of cost-effectiveness and other economic impact evaluations, the data sources for them, and the use of follow-up monitoring to evaluate the decisions made.
RESULTS:
Information required by the provinces for decision-making about cost-effectiveness is not available to them at the time of their decisions about listing new medications. The primary sources of data on both efficacy and cost-effectiveness are pharmaceutical companies. Efficacy information is generated in a scientifically rigorous manner, whereas the effectiveness and cost data are estimates potentially subject to biases and evaluated by judgement (expert opinion) alone. Moreover, there is no collaboration in the assessment process between provinces. The outcomes are large differences between provinces in the decisions made and, hence, in the pharmaceuticals accessible to residents.
CONCLUSIONS:
Current methods for making decisions about provincial drug listings are based on inadequate data, and the lack of consistency in the provinces' decisions suggest they may be scientifically flawed. We recommend establishing a single national scientific review committee, with re-evaluation of each drug's cost-effectiveness after a suitable period of monitored use.
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Author information
Author/s: West, Roy (R); Borden, E Keith (EK); Collet, Jean-Paul (JP); Rawson, Nigel S B (NS); Tonks, Robert S (RS);
Affiliation: Division of Community Health, Memorial University of Newfoundland, Health Sciences Centre, St. John's, NF A1B 3V6. roywest(-atsign-)mun.ca
Journal and publication information
Publication Type: Journal Article; Research Support, Non-U.S. Gov't
Journal: Canadian journal of public health. Revue canadienne de santé publique (Can J Public Health), published in Canada. (Language: eng)
Reference: -2002 Nov-Dec; vol 93 (issue 6) : pp 421-5
Dates: Created 2002/11/25; Completed 2002/12/20; Revised 2008/02/13;
PMID: 12448863, status: MEDLINE (last retrieval date: 11/6/2008)
Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.
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