Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-23T18:50:34.868Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  15 April 2010

Roger Chafe
Affiliation:
Cancer Care Ontario and University of Toronto
Farhan Merali
Affiliation:
Harvard Medical School
Andreas Laupacis
Affiliation:
Li Ka Shing Knowledge Institute of St. Michael's Hospital and University of Toronto
Wendy Levinson
Affiliation:
University of Toronto and Sunnybrook Health Science Centre
Doug Martin
Affiliation:
University of Toronto

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.

Type
POLICIES
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

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.CrossRefGoogle ScholarPubMed
2. Chafe, R. Allocating health care resources in Canada: A comparison of nine case studies. Saarbrücken, Germany: Verlag Dr. Müller; 2009.Google Scholar
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.CrossRefGoogle ScholarPubMed
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).Google Scholar
5. Council of Medical Imaging [Ontario]. Positron emission tomography. Oakville, Ontario: Council of Medical Imaging; 1999.Google Scholar
6. Davies, C, Wetherell, M, Barnett, E. Citizens at the centre: Deliberative participation in healthcare decisions. Clifton, Bristol: Policy Press; 2006.Google Scholar
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.CrossRefGoogle Scholar
8. Government of Ontario. Field evaluations. 2007 www.health.gov.on.ca/english/providers/program/mas/field/field_cffe.html (accessed August 18, 2009).Google Scholar
9. Gregoire, J, MacNeil, P, Skilton, K, et al. Inter-provincial variation in government drug formularies. Can J Public Health. 2001;92:307312.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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).Google Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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).Google Scholar
15. Miller, F, Pearson, S. 2008. Coverage with evidence development: Ethical issues and policy implications. Med Care. 2008;746751.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
17. NICE Citizens Council. 2007. Only in research. www.nice.org.uk/media/129/29/OIRReport300407.pdf (accessed August 18, 2009).Google Scholar
18. Sontag, S. Illness as metaphor and aids and its metaphors. New York: Doubleday; 1990.Google Scholar
19. The Toronto Health Policy Citizens' Council. Website. http://www.canadianprioritysetting.ca/html/citizenscouncil.html (accessed August 18, 2009).Google Scholar
20. Tunis, S, Pearson, S. Coverage options for promising technologies: Medicare's ‘coverage with evidence development.’ Health Aff (Millwood). 2006;25:12181230.CrossRefGoogle ScholarPubMed