To fund or not to fund: development of a decision-making framework for the coverage of new health technologies

Attempts to improve the acceptability of resource allocation decisions around new health technologies have spanned many years, fields and disciplines. Various theories of decision making have been tested and methods piloted, but, despite their availability, evidence of sustained uptake is limited. Since the challenge of determining which of many technologies to fund is one that healthcare systems have faced since their inception, an analysis of actual processes, criticisms confronted and approaches used to manage them may serve to guide the development of an 'evidence-informed' decision-making framework for improving the acceptability of decisions.

The purpose of this study was to develop a technology funding decision-making framework informed by the experiences of multiple healthcare systems and the views of senior-level decision makers in Canada.

A 1-day, facilitated workshop was held with 16 senior-level healthcare decision makers in Canada. International examples of actual technology funding decision-making processes were presented. Participants discussed key elements of these processes, debated strengths and weaknesses and highlighted unresolved challenges. The findings were used to construct a technology decision-making framework on which participant feedback was then sought. Its relevance, content, structure and feasibility were further assessed through key informant interviews with ten additional senior-level decision makers.

Six main issues surrounding current processes were raised: (i) timeliness; (ii) methodological considerations; (iii) interpretations of 'value for money'; (iv) explication of social values; (v) stakeholder engagement; and (vi) 'accountability for reasonableness'. While no attempt was made to force consensus on what should constitute each of these, there was widespread agreement on questions that must be addressed through a 'robust' process. These questions, grouped and ordered into three phases, became the final framework.

A decision-making framework informed by processes in other jurisdictions and the views of local decision makers was developed. Pilot testing underway in one Canadian jurisdiction will identify any further refinements needed to optimize its usefulness.