Priority-setting decisions for new cancer drugs: a qualitative case study

Background Frameworks for legitimate and fair priority setting emphasise th e importance of the rationales for priority setting decisions. However, pri ority setting rationales, in particular for new cancer drugs, are not well described. We describe the rationales used by a committee making funding de cisions for new cancer drugs. Methods We did a qualitative case study of a priority setting committee (Ca ncer Care Ontario Policy Advisory Committee for the New Drug Funding Progra m) by analysing documents, interviewing committee members, and observing co mmittee meetings. Findings We identified and described decisions and rationales related to 14 drugs in eight disease conditions over 3 years. Our main findings were tha t: priority setting existed in relation to resource mobilisation; clinical benefit was the primary factor in decisions; in the context of an expanding budget, rationales changed; rationales could change as costs for individua l treatments increased; when all options were reasonable, groups funded a r ange of options and let patients decide; and priority setting rationales in volve clusters of factors, not simple trade-offs. Interpretation Observing priority-setting decisions and their rationales in actual practice reveals lessons not contained in theoretical accounts.