Canadian Public Places High Priority on Drugs’ Safety, Effectiveness, and Certainty of Evidence

Survey Reveals Top Values for Drug Coverage Decision Making

Lawrenceville, NJ, USA—March 25, 2019—Value in Health, the official journal of ISPOR—the professional society for health economics and outcomes research, announced today the publication of new research showing that Canadians believe drug coverage decision makers should prioritize safety, effectiveness, and strong evidence. The report, “Evaluating Canadians’ Values for Drug Coverage Decision Making,” was published in the March 2019 issue of Value in Health.

Researchers conducted an online survey of 2539 Canadian adults, asking respondents to rank the relative importance that 13 factors should have in informing drug reimbursement decisions. The values ranked in the top 5 by most of the subjects were potential effect on quality of life (65.4%), severity of the disease (62.6%), ability of drug to work (61.1%), safety (60.5%), and potential to extend life (49.4%). These factors were 5 to 7 times more important than those values ranked the lowest (disease rarity, adherence, unmet need, age, and lifestyle), and support the traditional methods used in Canada to review common drugs, which stress the drugs’ effectiveness and the certainty of the evidence for effectiveness and safety.

The public did not appear to value several factors included in the prioritization rationales recently employed by decision-making bodies—including unmet need and disease rarity—as strongly as decision makers. In particular, the Canadian public recognized that the ability of a drug to work (certainty of evidence) was a highly important factor that decision makers need to consider more prominently in their decisions.

“There is growing consensus that decision makers’ criteria of ‘value’ must be expanded beyond cost-effectiveness and efficiency,” said author Larry D. Lynd, PhD, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada. “Because decision makers in a democratic system are expected to reflect the public’s (ie, taxpayers’) priorities, informing value-laden decisions with an evidence-based understanding of societal values is imperative. The funding of expensive drugs for rare disease can be deemed to be a highly value-laden and preference-sensitive decision. On the basis of the results of our study, the considerations that should form the basis for funding any drug should be safety, the ability of the drug to work, and improvement in quality and quantity of life, even for drugs for rare diseases, or where there is an unmet need.”

Priority setting in healthcare is complex, and addressing equity concerns for the allocation of resources is a difficult task. Decision makers are currently using additional justifications to prioritize drugs for reimbursement that were not found to be highly valued by Canadians. Decision makers should integrate the public’s values into a Canadian reimbursement framework for prioritization of drugs competing for limited funds.



ISPOR, the professional society for health economics and outcomes research (HEOR), is an international, multistakeholder, nonprofit dedicated to advancing HEOR excellence to improve decision making for health globally. The Society is the leading source for scientific conferences, peer-reviewed and MEDLINE®-indexed publications, good practices guidance, education, collaboration, and tools/resources in the field.
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Value in Health (ISSN 1098-3015) is an international, indexed journal that publishes original research and health policy articles that advance the field of health economics and outcomes research to help healthcare leaders make evidence-based decisions. The journal’s 2017 impact factor score is 5.494. Value in Health is ranked 3rd among 94 journals in healthcare sciences and services, 3rd among 79 journals in health policy and services, and 6th among 353 journals in economics. Value in Health is a monthly publication that circulates to more than 10,000 readers around the world.
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