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

• Published in: Health policy (Amsterdam) 2007-11, Vol.84 (1), p.58-66
• Main Authors: Gallego, Gisselle, Taylor, Susan Joyce, Brien, Jo-anne Elizabeth
• Format: Article
• Language: English
• Subjects: Australia; Case study; Costs; Decision Making; Health administration; Health care; Health costs; Health Priorities; Hospitals; Hospitals, Public; Humans; Internal Medicine; Interviews as Topic; National Health Programs - economics; New South Wales; Organizational Case Studies; Patients; Pharmaceutical Preparations - economics; Pharmaceuticals; Pharmaceuticals Decision-making Case study Australia; Prescriptions; Public health care; Resource allocation
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2007.05.008

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.