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Does the public think it is reasonable to wait for more evidence before funding innovative health technologies? The case of PET scanning in Ontario

  • Roger Chafe (a1), Farhan Merali (a2), Andreas Laupacis (a3), Wendy Levinson (a4) and Doug Martin (a5)...

Abstract

Objectives: Many innovative health technologies do not have a sufficient evidence-base to allow for adequate assessment of their benefits. Funders in several countries have been exploring arrangements that allow for temporary or partial coverage of these technologies, but only as part of a further evaluation. The public's support of arrangements that restrict access to innovative technology until sufficient evidence is available is crucial if these arrangements are going to remain viable. The project's other objective is to examine the lay public's views on a case in which patients’ publicly funded access to an innovative health technology is being delayed until there is sufficient evidence to justify a coverage decision. The case considered is the Ontario (Canada) government's decision to restrict access to positron emission tomography (PET) scans until further evidence becomes available.

Methods: The case was deliberated on by twenty-six members of the Toronto Health Policy Citizens' Council, with a follow-up survey administered to individual council members.

Results: The majority of council members agreed that the approach taken by the government was reasonable and in the best interests of its citizens. The council did express concerns regarding certain aspects of the case, including about the length of time it is taking to obtain further evidence.

Conclusions: Public support for arrangements that limit access to new technologies will likely vary depending on the details of the specific arrangement being proposed. Deliberative public dialogue can be effectively used to identify cases the general public is most likely to support.

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References

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1. Carino, T, Sheingold, T, Tunis, S. Using clinical trials as a condition of coverage: Lessons from the National Emphysema Treatment Trial. Clin Trials. 2004;1:108121.
2. Chafe, R. Allocating health care resources in Canada: A comparison of nine case studies. Saarbrücken, Germany: Verlag Dr. Müller; 2009.
3. Chalkidou, K, Hoy, A, Littlejohns, P. Making a decision to wait for more evidence: When the National Institute for Health and Clinical Excellence recommends a technology only in the context of research. J R Soc Med. 2007;100:453460.
4. CHSRF Insights and Actions. Public engagement (Part II): How do deliberative processes achieve meaningful public engagement? February, Issue 49. www.chsrf.ca/other_documents/insight_action/html/ia49_e.php (accessed August 18, 2009).
5. Council of Medical Imaging [Ontario]. Positron emission tomography. Oakville, Ontario: Council of Medical Imaging; 1999.
6. Davies, C, Wetherell, M, Barnett, E. Citizens at the centre: Deliberative participation in healthcare decisions. Clifton, Bristol: Policy Press; 2006.
7. Dhalla, I, Garner, S, Chalkidou, K, Littlejohns, P. Perspectives on National Institute for Health and Clinical Excellence's recommendations to use health technologies only in research. Int J Technol Assess Health Care. 2009;23:272280.
8. Government of Ontario. Field evaluations. 2007 www.health.gov.on.ca/english/providers/program/mas/field/field_cffe.html (accessed August 18, 2009).
9. Gregoire, J, MacNeil, P, Skilton, K, et al. Inter-provincial variation in government drug formularies. Can J Public Health. 2001;92:307312.
10. Hutton, J, Trueman, P, Henshall, C. Coverage with evidence development: An examination of conceptual and policy issues. Int J Technol Assess Health Care. 2007;23:425435.
11. Laupacis, A, Alter, D, Mamdani, M, et al. Health technology assessment of Positron Emission Tomograghy (PET): A systematic review. ICES Investigative Report 2001. www.ices.on.ca/file/Health_Technology_Assessment-PET_May-2001.pdf (accessed August 18, 2009).
12. Martin, DK, Abelson, J, Singer, PA. Participation in health care priority setting through the eyes of the participants. J Health Serv Res Policy. 2002;7:222229.
13. Maziak, DE, Darling, GE, Inculet, RI, et al. Positron emission tomography in staging early lung cancer: A randomized trial. Ann Intern Med. 2009;151:221228.
14. Merali, F, Laupacis, A, Levinson, W, et al. ; the University of Toronto Citizen's Council. PET scanning in Ontario: Deliberations, recommendations and lessons learned. http://www.canadianprioritysetting.ca/html/documents/cc_PET_report.pdf (accessed August 18, 2009).
15. Miller, F, Pearson, S. 2008. Coverage with evidence development: Ethical issues and policy implications. Med Care. 2008;746751.
16. Morgan, S, McMahon, M, Mitton, C, et al. Centralized drug review processes in Australia, Canada, New Zealand, and the United Kingdom. Health Aff (Millwood). 2006;25:337347.
17. NICE Citizens Council. 2007. Only in research. www.nice.org.uk/media/129/29/OIRReport300407.pdf (accessed August 18, 2009).
18. Sontag, S. Illness as metaphor and aids and its metaphors. New York: Doubleday; 1990.
19. The Toronto Health Policy Citizens' Council. Website. http://www.canadianprioritysetting.ca/html/citizenscouncil.html (accessed August 18, 2009).
20. Tunis, S, Pearson, S. Coverage options for promising technologies: Medicare's ‘coverage with evidence development.’ Health Aff (Millwood). 2006;25:12181230.
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International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
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