Priority-Setting and Values: A Qualitative Study of the Danish Medicines Council

As priority setting committees become commonplace in contemporary welfare states, it becomes increasingly important to understand how they operate. This article contributes to our understanding of contemporary priority setting by examining how the Danish Medicines Council (DMC) makes and justifies its decisions, as well as the role of different (and perhaps conflicting) concerns and values in these decisions. We conducted seventeen interviews with DMC members and observed three DMC meetings spanning five days. Firstly, we find that health-related effect is the most crucial factor in DMC members' recommendations of newly proposed medicines and that discussions of effects take precedence over other considerations in council deliberations. Secondly, we find that the ability of DMC members to adequately assess the effect of newly proposed medicines is often significantly limited by poor data quality and a lack of sufficient documentation, which shifts the DMC's task from making recommendations on an informed basis to providing estimated assessments of the expected effect. In these circumstances of uncertainty about effect, recommendations are influenced by considerations such as the age of patients and the rarity of the disease. This raises significant moral issues in which the DMC has no particular expertise.