Introduction
Reimbursement decisions are influenced by quantitative (e.g. health gain, cost-effectiveness, financial implications) and qualitative factors (e.g. clinical need, equity, patient impact). There is an increased focus on patient input into health technology assessment (HTA) decision making especially in oncology (ONC). This study sets out to examine the level of input from consumers into the Australian HTA process.
Methods
Public summary documents (PSDs) specific to drugs considered by the Pharmaceutical Benefits Advisory Committee across 2015-17 were PBACreviewed. The prevalence of consumer submissions (patients, HCOs, HCPs) was identified and compared across ONC and non-oncology (nonONC) applications. The relationship between consumer submissions and positive outcomes was investigated along with other explanatory variables (1st time submission, type of submission, type of economic evaluation). Relative risks (RR) and 95% confidence intervals (95% CI) were calculated with logistic regression used to correct for variables.
Results
516 PSDs were reviewed. Of these, 27.5% were specific to ONC medicines. Significant more consumer submissions (dominated by patients) were observed for ONC when compared to nonONC applications (69.7% vs 40.4%, p<0.001). Positive PBAC outcomes were reported in 44.6% of ONC submissions and 63.4% of nonONC submissions. Only type of economic evaluation had a statistically significant influence on recommendation (p<0.001), with the risk ratio of consumer input leading to a positive recommendation being 1.55 [95% CI: 1.09; 2.23] i.e. more likely that a positive recommendation did not have patient input.
Conclusion
Consumer input is a recent yet integral component of the HTA process in Australia. As evidenced by the disproportionate number of consumer submissions for ONC applications, cancer patients and others affected by cancer have a strong desire to have their voice be part of the decision making process. While this analysis did not demonstrate a direct relationship between consumer input and PBAC positive outcome, the indirect benefits of such input is acknowledged by all stakeholders. Further research into how the patient voice can further enhance HTA decision making in Australia is required.