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

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

 The elicitations were administered over the Internet. Respondents were asked to imagine themselves as a decision-maker responsible for allocating a fixed budget between two competing health care programs. They were told that both programs had the same cost and that the budget was not large enough to fund both of them. To provide a uniform context, respondents were told that the groups each had some form of cancer; however, specific diagnoses were not mentioned, and the alternatives were presented simply as program A and program B. Although labelled alternatives have the advantage of making hypothetical choice tasks more realistic and concrete, respondents can also use such labels to infer information that was not presented or intended as part of the task. At the extreme, respondents might ignore trade-offs between attributes and make their choices based on their perceptions of the labels alone29.....

For example, the results implied that both groups would be willing to pay more for health gains accruing to younger patients than for the same gains accruing to patients 70 years of age. The acceptability and limits of such differential valuations are not addressed in the pcodr guidelines. More explicit guidance could improve the consistency and transparency of pcodr recommendations, and in turn, public trust in the pcodr decision-making process6,37. Such transparency could also stimulate constructive debate about societal values pertaining to the allocation of public health care resources.

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.