The selection and reimbursement of new anti-cancer drugs in Australia: The nature of oncologist and public preferences for decision-making purposes

Abstract

The studies that form the major part of this thesis examine the views and attitudes of the Pharmaceutical Benefits Advisory Committee (PBAC), Australian oncologists and the general public to gather information on the value perceptions of these stakeholders in order to inform the adequacy of the current evaluative framework for the assessment and valuation of anti-cancer drugs. The decision criteria used for the selection and reimbursement of anti-cancer drugs by the PBAC, pan-Canadian Oncology Drug Review (pCODR) and National Institute of Health and Care Excellence (NICE) were reviewed. A systematic literature review was conducted on the preferences/priorities of patients, the general public and payers for anti-cancer drugs. A literature review on the oncologists’ views and preferences on the benefits, harms, costs and value of anti-cancer drugs was also conducted. An analysis of the PBAC recommendations revealed that the PBAC appears to apply decision criteria equally to anti-cancer and non-cancer drugs in that anti-cancer drugs are neither favoured nor disadvantaged. A web-based survey was conducted to elicit Australian oncologists’ preferences for different treatment attributes of two anti-cancer drugs (bevacizumab and everolimus). A cross sectional survey was conducted to explore societal preferences for government spending on medicines and views on distributional preferences based on 12 allocation criteria relevant to the Australian PBS. Findings arising from the studies presented in this thesis show that the general public are willing and capable of giving opinions on distributional preferences, sharing their views on what constitute an equitable allocation of the government’s drug budget, and that the perceived value of anti-cancer drugs can be influenced by oncologists’ preferences for different treatment attributes. To enable integration of public and patient preferences into health technology assessment (HTA) decisions, further research should focus on defining a strategy to incorporate public perspectives (patients and the general public) into funding decisions of anti-cancer drugs with a view to reconciling the different value perceptions among stakeholders to ensure that the general public/patient values and preferences are reflected in HTA assessment and recommendations.