Using evidence to set priorities in health: an analysis of decisions of the Pharmaceutical Benefits Advisory Committee

澳大利亚率先使用严格的临床和经济证据来评估药物，然后再为我们的国家补贴药品福利计划提供资金。自实行药品在给予补贴之前必须证明成本效益的要求以来的十年里，一直没有对该制度进行正式的独立评估，以评估其绩效。该项目将审查药品福利咨询委员会在过去十年中的建议，并考虑解释这些决定的因素。有时有人断言，这些决定是武断的，或基于不适当的考虑，如政府或当时政治的财政成本，而不是所涉药物的物有所值。我们将审查这些决定背后的原因，这些决定违背了以具有成本效益的方式提供提高生命的药物的目标。我们将研究一种药物是否被推荐列入PBS或被拒绝的关键决定因素是什么。一个关键的重点将是，就这些决定因素与该计划的目标的一致性而言，这些决定因素是否可以被描述为合法。例如，拒绝的主要原因是缺乏关于效力-成本效益的高质量证据，还是仅仅因为诸如政府的高财政成本等因素。该项目将建立一个数据库，记录1992-2004年提交给建设和平委员会的所有材料，使我们能够探讨一些关于决策过程在更广泛地利用关于卫生有效性和费用的证据方面的有效性的问题，以及公共部门所特有的那些问题。在强调证据及其解释方面的一些问题时，总的目的是提高今后决策过程的质量。

Australia has pioneered the use of rigorous clinical and economic evidence in the evaluation of drugs prior to funding on our nationally subsidised Pharmaceutical Benefits Scheme. In the ten years since the introduction of the requirement that drugs demonstrate cost effectiveness prior to subsidy being granted there has been no formal independent evaluation of the system to assess its performance. This project will examine the recommendations of the Pharmaceutical Benefits Advisory Committee in the last decade and consider the factors that explain those decisions. At times it has been asserted that those decisions have been arbitrary or based on inappropriate considerations such as the financial cost to government or politics of the day rather than the value for money of the drug in question. We will examine the reasons behind the decisions against the objectives of providing access to life enhancing medicines in a cost effective manner. We will look at what are the key determinants of whether a drug is recommended for listing on the PBS or is rejected. A key focus will be on whether those determinants could be described as legitimate in terms of their consistency with the objectives of the scheme. For example whether the main cause of rejection is a lack of high quality evidence on effectiveness- cost effectiveness or simply because of factors such as the high financial cost to government. The project will create a database of all submissions to the PBAC 1992-2004 that will allow us to explore a number of questions about the effectiveness of the decision making process in using evidence on effectiveness and costs in health more broadly as well as those specific to the PBS. In highlighting some of the problems with the evidence and its interpretation the overall aim is to improve the quality of the decision making process in the future.