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Priority setting for high cost medications (HCMs) in public hospitals in Australia: A case study

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  • Gallego, Gisselle
  • Taylor, Susan Joyce
  • Brien, Jo-anne Elizabeth

Abstract

Health care providers (HCPs) are increasingly aware of pressures on funding for health care services, including high cost medicines (HCMs). Allocating resources to innovative and expensive medications is particularly challenging and the decision-making processes and criteria used to allocate resources to HCMs have not been widely described in the literature. This case study aimed to describe the operations of the first reported High Cost Drug Sub-Committee (HCD-SC) in a public hospital in Australia. In addition the study also evaluated the decision-making process using Daniel and Sabin's ethical framework of "accountability for reasonableness". Some lessons emerged from the description of the operations of the HCD-SC. Decisions were not solely based on effectiveness and cost. Additional factors such as "clinical need" and the lack of an alternative treatment were involved in decisions about access to HCMs. Members of the HCD-SC also considered it was important to have consistency in the way decisions were being made. The findings from this study provide an evidence base for developing strategies to improve this hospital's decision-making process regarding access to HCMs.

Suggested Citation

  • Gallego, Gisselle & Taylor, Susan Joyce & Brien, Jo-anne Elizabeth, 2007. "Priority setting for high cost medications (HCMs) in public hospitals in Australia: A case study," Health Policy, Elsevier, vol. 84(1), pages 58-66, November.
    • Handle: RePEc:eee:hepoli:v:84:y:2007:i:1:p:58-66
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    1. Martin, Douglas K. & Giacomini, Mita & Singer, Peter A., 2002. "Fairness, accountability for reasonableness, and the views of priority setting decision-makers," Health Policy, Elsevier, vol. 61(3), pages 279-290, September.
    2. Daniels, Norman & Sabin, James E., 2002. "Setting Limits Fairly: Can we learn to share medical resources?," OUP Catalogue, Oxford University Press, number 9780195149364.
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    2. Jeannette Winkelhage & Adele Diederich, 2012. "The Relevance of Personal Characteristics in Allocating Health Care Resources—Controversial Preferences of Laypersons with Different Educational Backgrounds," IJERPH, MDPI, vol. 9(1), pages 1-21, January.
    3. Kapiriri, Lydia & Razavi, Donya, 2017. "How have systematic priority setting approaches influenced policy making? A synthesis of the current literature," Health Policy, Elsevier, vol. 121(9), pages 937-946.
    4. Jana Rogge & Bernhard Kittel, 2016. "Who Shall Not Be Treated: Public Attitudes on Setting Health Care Priorities by Person-Based Criteria in 28 Nations," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-15, June.
    5. Jennifer Whitty & Sharyn Rundle-Thiele & Paul Scuffham, 2012. "Insights from triangulation of two purchase choice elicitation methods to predict social decision making in healthcare," Applied Health Economics and Health Policy, Springer, vol. 10(2), pages 113-126, March.
    6. Gallagher, Siun & Little, Miles, 2019. "Procedural justice and the individual participant in priority setting: Doctors' experiences," Social Science & Medicine, Elsevier, vol. 228(C), pages 75-84.
    7. Rosenberg-Yunger, Zahava R.S. & Daar, Abdallah S. & Thorsteinsdóttir, Halla & Martin, Douglas K., 2011. "Priority setting for orphan drugs: An international comparison," Health Policy, Elsevier, vol. 100(1), pages 25-34, April.
    8. Lesley Chim & Glenn Salkeld & Patrick Kelly & Wendy Lipworth & Dyfrig A Hughes & Martin R Stockler, 2017. "Societal perspective on access to publicly subsidised medicines: A cross sectional survey of 3080 adults in Australia," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-24, March.
    9. Adele Diederich & Jeannette Winkelhage & Norman Wirsik, 2011. "Age as a Criterion for Setting Priorities in Health Care? A Survey of the German Public View," PLOS ONE, Public Library of Science, vol. 6(8), pages 1-10, August.
    10. Douglas, Conor M.W. & Wilcox, Elizabeth & Burgess, Michael & Lynd, Larry D., 2015. "Why orphan drug coverage reimbursement decision-making needs patient and public involvement," Health Policy, Elsevier, vol. 119(5), pages 588-596.
    11. Rosenberg-Yunger, Zahava R.S. & Thorsteinsdóttir, Halla & Daar, Abdallah S. & Martin, Douglas K., 2012. "Stakeholder involvement in expensive drug recommendation decisions: An international perspective," Health Policy, Elsevier, vol. 105(2), pages 226-235.
    12. Brayan V. Seixas & François Dionne & Craig Mitton, 2021. "Practices of decision making in priority setting and resource allocation: a scoping review and narrative synthesis of existing frameworks," Health Economics Review, Springer, vol. 11(1), pages 1-11, December.

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