6-STEPPPs: A Modular Tool to Facilitate Clinician Participation in Fair Decisions for Funding New Cancer Drugs

Abstract

Purpose: To design a tool to assist clinician participation with cancer drug funding decisions. Public policy-makers and insurers are struggling with funding decisions regarding increasingly expensive new cancer drugs. Increasingly, oncologists are contributing to the process of review that leads to such decisions. We were asked to design a system for ranking new cancer drugs for priority-based funding decisions. Methods:The "Accountability for Reasonableness" framework informed the design of a six-module multistakeholder decision process blending evidence-based traditional technology assessment methods with individual and cultural values elicitation. The tool was piloted in three settings: (1) videotaped simulated multistakeholder deliberation sessions; (2) clinical oncology leaders; and (3) a regional (Canadian provincial) pharmacy and therapeutics committee making formulary decisions. The modules involve: decision clarification, drug eligibility screening (filtering), clinical performance scoring index, cost modeling, data integration and values clarification, and process evaluation. Results:The tool was feasible to use, acceptable to participants, and able to rank candidate drugs. The pharmacy and therapeutics committee with whom it was tested used the tool as a part of their deliberations, and the tumor group leaders requested its incorporation into organization-based decision making. Conclusion:The decision tool can facilitate priority-based cancer drug funding decisions that meet the conditions of fairness as perceived by participants, including oncologists.

Análise de Decisão Multicritérios (MCDA): uma revisão rápida sobre os critérios utilizados na Avaliação de Tecnologias em Saúde

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“…*32 Dionne et al, 2009;Golan & Hansen, 2010;Johnson et al, 2009;Kirby et al, 2008;Mullen, 2004. *33 Marsh et al, 2013;Menon et al, 2010;Venhorst et al, 2014. *34 Browman et al, 2008;Diaby & Goeree, 2014;Dolan, 2010;Le Gales & Moatti, 1990;Goetghebeur et al, 2008;Goetghebeur et al, 2010;Goetghebeur et al, 2012;Golan & Hansen, 2010;Golan & Hansen, 2012;Gurtner, 2014;Kolasa et al, 2016;Menon et al, 2010;Miot et Alguns critérios e atributos encontrados eram muito específicos de determinadas tecnologias e foram excluídos da síntese. Por exemplo, os atributos "mortalidade materna" e "qualidade dos serviços de cuidado materno" eram específicos para programa de segurança materna (Youngkong et al, 2009).…”

Accounting for reasonableness: Exploring the personal internal framework affecting decisions about cancer drug funding

“…In this paper, we describe the qualitative evaluation of a decision tool developed for priority-based decision-making about cancer drug funding based on these criteria. The '6-STEPPPs Tool' (Systematic Tool for Evaluating Pharmaceutical Products for Public Funding Decisions) [5], is intended to provide decision-makers with a robust, external framework to support multistakeholder and multi-disciplinary transparent decisions that meet the conditions of A4R about funding new cancer drug therapies. The tool facilitates decision-making by navigating panels systematically through a datarich framework, to help elicit and resolve different interpretations of data, and the values that inform decisions about thresholds and outcomes that cannot be imposed using formulaic approaches.…”

Can Quality-Adjusted Life Year Avoidance Help in Oncology Drug Reimbursement Decisions?

“…In this issue of JOP, Browman et al 2 propose an imaginative example of what might be called a non-QALY component in reimbursement decisions. Inspired by the "Accounting for Reasonableness" approach advocated by Norman Daniels and others, 3,4 Browman et al wish to integrate the experience and intuition of clinical oncologists into reimbursement decisions.…”