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Mechanisms for Managing Uncertainty in Decisions on the Introduction of New and Innovative Technologies into Healthcare Systems

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Abstract

As tensions between payers, responsible for ensuring prudent and principled use of scarce resources, and both providers and patients, who legitimately want access to technologies from which they could benefit, continue to mount, interest in approaches to managing the uncertainty surrounding the introduction of new health technologies has heightened.

The purpose of this project was to compile an inventory of various types of ‘access with evidence development’ (AED) schemes, examining characteristics of the technologies to which they have been applied, the uncertainty they sought to address, the terms of arrangements of each scheme, and the policy outcomes. It also aimed to identify issues related to such schemes, including advantages and disadvantages from the perspectives of various stakeholder groups.

A comprehensive search, review and appraisal of peer-reviewed and ‘grey’ literature were performed, followed by a facilitated workshop of academics and decision makers with expertise in AED schemes. Information was extracted and compiled in tabular form to identify patterns or trends. To enhance the validity of interpretations made, member checking was performed.

Although the concept of AED is not new, evaluative data are sparse. Despite varying opinions on the ‘right’ answers to some of the questions raised, there appears to be consensus on a ‘way forward’ — development of methodological guidelines.

All stakeholders seemed to share the view that AEDs offer the potential to facilitate patient access to promising new technologies and encourage innovation while ensuring effective use of scarce healthcare resources. There is no agreement on what constitutes ‘sufficient evidence’, and it depends on the specific uncertainty in question. There is agreement on the need for ‘best practice’ guidelines around the implementation and evaluation of AED schemes.

This is the first attempt at a comprehensive analysis of methods that have been used to address uncertainty concerning a new drug or other technology. The analysis reveals that, although various approaches have been experimented with, many of them have not achieved the ostensible goal of the approach. This article outlines challenges related to AED schemes and issues that remain unresolved.

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Acknowledgements

The authors wish to acknowledge Leigh-Ann Topfer and Judy Wright for their assistance with the literature searches, and Mohamed El-Shayeb for research assistance in the preliminary stages of this research.

The authors declare that there are no conflicts of interest.

This project was supported by a team grant from the Canadian Institutes of Health Research and an unrestricted capacity-building grant from the Alberta Ministry of Health & Wellness.

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Authors and Affiliations

  1. Department of Public Health Sciences, University of Alberta, 3021, 114 Street, Edmonton, T6G 2V2, Alberta, Canada

    Tania Stafinski & Devidas Menon

  2. Academic Unit of Health Economics, Leeds Institute of Health Sciences, Leeds, UK

    Christopher J. McCabe

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  1. Tania Stafinski
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  2. Christopher J. McCabe
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  3. Devidas Menon
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Correspondence to Tania Stafinski.

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Stafinski, T., McCabe, C.J. & Menon, D. Funding the Unfundable. Pharmacoeconomics 28, 113–142 (2010). https://doi.org/10.2165/11530820-000000000-00000

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