BACKGROUND & OBJECTIVES
Overarching and decision-making frameworks may be used to facilitate the evaluation of prescription drug technologies to enable Health Technology Assessment (HTA) agency’s reassessment recommendations. The objectives of this thesis were to; 1) identify overarching and qualitative decision-making reassessment framework challenges and methodological gaps and; 2) develop and/or modify a framework to address challenges/gaps. The focus was on Canadian public prescription drug reimbursement with the hope that the findings may inform other jurisdictions.
METHODS
The first paper systematically identified drug disinvestment frameworks to describe framework components, challenges and solutions. A qualitative descriptive study was conducted in the second paper to explore whether a qualitative benefit-risk framework (Universal Methodology for Benefit-Risk Assessment (UMBRA)) could be used or modified to further enable Health Technology Reassessment (HTR) recommendations. The last research paper assessed the Canadian Agency for Drugs and Technologies in Health’s (CADTH’s) Therapeutic Review Process. Enhancements to this process were developed based on previous research and published frameworks.
RESULTS
Qualitative framework components were identified, disinvestment terms captured and challenges and solutions to drug disinvestment were compiled in Chapter 2. The participants interviewed in chapter 3 recognized that the Therapeutic Review assessment process did not include a qualitative deliberative framework. However, participants did not consider that all steps of the UMBRA framework were transferable to the assessment phase of HTR. Assessment of CADTH’s Therapeutic Review process, conducted in Chapter 4, found three areas for process enhancement: Therapeutic Review topic prioritization criteria; a qualitative assessment framework, and; publically accessible mechanisms for decision monitoring and performance measurement.
CONCLUSION
This thesis has identified reassessment framework enhancements that are hypothesized to address HTR challenges and specific solutions to enhance CADTH’s Therapeutic Review Framework. Next steps include further evaluation and pilot testing of these proposed enhancements to enable additional Canadian stakeholder feedback. / Thesis / Doctor of Philosophy (PhD) / This thesis focuses on overarching and decision-making assessment frameworks whose purpose is to aid policy-makers in recommending which prescription drugs should continue to be government-funded and/or if modifications to funding should occur. The goal of this work is to; 1) identify challenges and gaps in these frameworks and 2) develop or modify a framework to address findings. This thesis focuses on the Canadian public prescription drug reimbursement environment. Results identified Canadian reassessment framework enhancements which could address challenges to ultimately aid in maintaining financial and institutional stability of public health care systems.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/23843 |
| Date | January 2019 |
| Creators | Maloney, Mary Alison |
| Contributors | Schwartz, Lisa, Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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