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Nakada H, Watanabe S, Takashima K, Suzuki S, Kawamura Y, Takai Y, Matsui K, Yamamoto K. General public's understanding of rare diseases and their opinions on medical resource allocation in Japan: a cross-sectional study. Orphanet J Rare Dis 2023; 18:143. [PMID: 37291571 DOI: 10.1186/s13023-023-02762-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 06/04/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Rare diseases (RDs) may impose a considerable financial burden on patients and their families. Public acceptance is essential to ensure sustainable public systems supporting RDs, especially in countries with universal healthcare coverage, such as Japan. This study aimed to explore the public's understanding of RDs and identify crucial factors associated with the public acceptance of prioritizing financial support for RDs in Japan. METHODS An online questionnaire was sent to 131,220 Japanese residents aged 20-69 years. The items included in the questionnaire were general interest in medical science and medical care, general knowledge regarding RDs and health care systems, opinions on the cost of medical care, opinions on the research and development of RDs and common diseases, and individual characteristics. RESULTS The responses of 11,019 respondents were analyzed. Several respondents agreed to partially cover the medication cost of adult and pediatric RDs (59.5% and 66.8%, respectively) with public funding. The major reasons for agreeing were the huge financial burden imposed on patients and their families, limited available treatment options, effects of RDs on the life planning of patients, and difficulties caused by RDs in the patient's social life. Furthermore, the respondents ranked RDs (56.0%) higher than common diseases (44.0%) for government funding for research and development. The reasons for supporting government-funded research and development for RDs included the lack of treatment options for numerous RDs (34.9%) and difficulty of studying RDs owing to the small number of researchers (25.9%). The chief reasons for supporting government-funded research and development for common diseases were the large number of affected patients (59.7%) and the possibility of more treatment options becoming available through the promotion of research and development (22.1%). CONCLUSIONS The general public considers burdens associated with daily living or finance more than the epidemiological characteristics of RD while making funding decisions, demonstrating that rarity was less prioritized. A gap appears to exist between the general public and RD experts regarding the understanding of the epidemiological characteristics of RD and its thresholds. This gap should be bridged to ensure that prioritization of financial support for RDs is accepted by the society.
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Affiliation(s)
- Haruka Nakada
- Division of Bioethics and Healthcare Law, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
| | - Saori Watanabe
- Department of Public Policy, The Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Kyoko Takashima
- Bioethics Section, Center for Clinical Sciences, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shohei Suzuki
- Bioethics Section, Center for Clinical Sciences, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuki Kawamura
- Graduate School of Social Sciences, Hitotsubashi University, Kunitachi, Tokyo, Japan
| | - Yutori Takai
- Faculty of Informatics, Gunma University, Maebashi, Gunma, Japan
| | - Kenji Matsui
- Division of Bioethics and Healthcare Law, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Keiichiro Yamamoto
- Bioethics Section, Center for Clinical Sciences, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
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Valuation of Treatments for Rare Diseases: A Systematic Literature Review of Societal Preference Studies. Adv Ther 2023; 40:393-424. [PMID: 36451072 PMCID: PMC9898379 DOI: 10.1007/s12325-022-02359-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION We sought to synthesize published empirical studies that elicited and characterized societal valuations of orphan drugs and the attributes that may drive different valuations for orphan drugs versus other treatments. METHODS We conducted a systematic literature review (SLR) in MEDLINE and EMBASE databases up to November 2, 2020. Search terms covered societal preferences and attributes of orphan drugs (e.g., disease prevalence, severity, burden, unmet needs, and benefits). RESULTS We identified 38 eligible publications: 33 societal preference studies and 5 reviews discussing societal valuations and attributes of orphan drugs. Most publications suggested that a majority of respondents favored allocating funds to more prevalent diseases. However, trade-off studies and discrete-choice experiments found that survey participants chose to allocate resources to orphan drugs even when the cost per unit of health benefit was greater than for therapies for more prevalent diseases. Overall, 19 of 27 studies assessing severity in treatment valuation revealed that respondents prioritized patients with severe diseases over those with milder ones for equal health benefits. Members of the general public tended to prefer treatments for diseases with no alternative or when existing alternatives had limited efficacy over diseases with clear therapeutic alternatives. There was evidence that individuals preferred sharing resources, so no patient was left without treatment. CONCLUSIONS Our SLR indicates the general public typically attaches greater value to orphan drugs than to other treatments for common diseases. This is not because of rarity per se, but primarily because of disease severity and lack of therapeutic alternatives typically associated with rare diseases.
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Stafinski T, Street J, Young A, Menon D. Moving beyond the Court of Public Opinion: A Citizens' Jury Exploring the Public's Values around Funding Decisions for Ultra-Orphan Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:633. [PMID: 36612953 PMCID: PMC9819519 DOI: 10.3390/ijerph20010633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Health system decision-makers need to understand the value of new technology to make "value for money" decisions. Typically, narrow definitions of value are used. This paper reports on a Canadian Citizens' Jury which was convened to elicit those aspects of value that are important to the public. The criteria used by the public to determine value included those related to the patient, those directly related to caregivers and those directly created for society. Their choices were not binary (e.g., cost vs. health gained), but rather involved multiple factors (e.g., with respect to patient factors: disease severity, health gained with the drug, existence of alternatives, life expectancy, patient age and affordability). Overall, Jurors prioritized funding treatments for ultra-rare disease populations when the treatment offered significant improvements in health and quality of life, and when the pre-treatment health state was considered extremely poor. The prevalence of the disease by itself was not a factor in the choices. Some of the findings differ from previous work, which use survey methods. In our Citizens' Jury, Jurors were able to become more familiar with the question at hand and were exposed to a broad and balanced collection of viewpoints before and throughout engaging in the exercises. This deliberative approach allows for a more nuanced approach to understanding value.
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Affiliation(s)
- Tania Stafinski
- Health Technology & Policy Unit, School of Public Health, 4-343, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada
| | - Jacqueline Street
- Australian Centre for Engagement, Evidence and Values, University of Wollongong, Northfields Ave, Wollongong 2522, Australia
| | - Andrea Young
- Health Technology & Policy Unit, School of Public Health, 4-343, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada
| | - Devidas Menon
- Health Technology & Policy Unit, School of Public Health, 4-343, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada
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Delpasand M, Olyaaeemanesh A, Jaafaripooyan E, Abdollahiasl A, Davari M, Kazemi Karyani A. Eliciting the public preferences for pharmaceutical subsidy in Iran: a discrete choice experiment study. J Pharm Policy Pract 2021; 14:59. [PMID: 34256875 PMCID: PMC8278681 DOI: 10.1186/s40545-021-00345-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Deciding on pharmaceutical subsidy is regarded as a challenging issue for healthcare policymakers in Iran in most times. Public preferences, rarely attended in Iran, could be invaluable for including a particular drug in the list of subsidized medications. OBJECTIVES The current study aims to elicit the public preferences to develop an evidence-based decision-making framework for entering a drug into the list of subsidies in Iran. METHODS Discrete Choice Experiment (DCE) was employed to elicit the public preferences. Around 34 attributes were identified based on the systematic review and interview with 51 experts. By holding an expert panel, 7 attributes were finalized, namely: the survival after treatment, quality of life after treatment (QoL), alternative treatment, age group of the target population, cost burden for the government, disease severity, and drug manufacturer country. Next, 1224 households were selected for the survey in the city of Tehran, using random cluster sampling. Data were analyzed using conditional logit model. RESULTS The survival after treatment (β = 1.245; SE = 0.053) and disease severity (β =- 0.143; SE = 0.043) had the highest and lowest priority, respectively, in the preferences for allocating subsidy to a drug. In developed region, unlike the other two regions, the level of domestic drug production (β =- 0.302; SE = 0.073) was inversely associated with preferences toward allocating subsidy to a drug. In contrast to other districts, those living in district number one (β = 2.053; SE = 0.138) gave the highest value to promoting the QoL after treatment. CONCLUSIONS It is suggested that policymakers pay more attention to attributes such as effectiveness and alternative treatment when developing an evidence-based framework for entering a drug into the list of subsidies. This study highlighted the public belief in the government's subsidy for medicines, provided that, this results in an increased survival and QoL.
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Affiliation(s)
- Mansoor Delpasand
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaaeemanesh
- Health Equity Research Center & National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Jaafaripooyan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Abdollahiasl
- Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Davari
- Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kazemi Karyani
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Zimmermann BM, Eichinger J, Baumgartner MR. A systematic review of moral reasons on orphan drug reimbursement. Orphanet J Rare Dis 2021; 16:292. [PMID: 34193232 PMCID: PMC8247078 DOI: 10.1186/s13023-021-01925-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/20/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The number of market approvals of orphan medicinal products (OMPs) has been increasing steadily in the last 3 decades. While OMPs can offer a unique chance for patients suffering from rare diseases, they are usually very expensive. The growing number of approved OMPs increases their budget impact despite their low prevalence, making it pressing to find solutions to ethical challenges on how to fairly allocate scarce healthcare resources under this context. One potential solution could be to grant OMPs special status when considering them for reimbursement, meaning that they are subject to different, and less stringent criteria than other drugs. This study aims to provide a systematic analysis of moral reasons for and against such a special status for the reimbursement of OMPs in publicly funded healthcare systems from a multidisciplinary perspective. RESULTS With a systematic review of reasons, we identified 39 reasons represented in 243 articles (scientific and grey literature) for and against special status for the reimbursement of OMPs, then categorized them into nine topics. Taking a multidisciplinary perspective, we found that most articles came from health policy (n = 103) and health economics (n = 49). More articles took the position for a special status of OMPs (n = 97) than those against it (n = 31) and there was a larger number of reasons identified in favour (29 reasons) than against (10 reasons) this special status. CONCLUSION Results suggest that OMP reimbursement issues should be assessed and analysed from a multidisciplinary perspective. Despite the higher occurrence of reasons and articles in favour of a special status, there is no clear-cut solution for this ethical challenge. The binary perspective of whether or not OMPs should be granted special status oversimplifies the issue: both OMPs and rare diseases are too heterogeneous in their characteristics for such a binary perspective. Thus, the scientific debate should focus less on the question of disease prevalence but rather on how the important variability of different OMPs concerning e.g. target population, cost-effectiveness, level of evidence or mechanism of action could be meaningfully addressed and implemented in Health Technology Assessments.
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Affiliation(s)
- Bettina M Zimmermann
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
- Institute for History and Ethics in Medicine, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany.
| | - Johanna Eichinger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Institute for History and Ethics in Medicine, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias R Baumgartner
- Division of Metabolism and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
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Hartman AL, Hechtelt Jonker A, Parisi MA, Julkowska D, Lockhart N, Isasi R. Ethical, legal, and social issues (ELSI) in rare diseases: a landscape analysis from funders. Eur J Hum Genet 2019; 28:174-181. [PMID: 31537898 DOI: 10.1038/s41431-019-0513-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/01/2019] [Accepted: 08/29/2019] [Indexed: 12/20/2022] Open
Abstract
Recent interest in personalized medicine has highlighted the importance of research in ethical, legal, and social issues (ELSI). Issues in ELSI research may be magnified in the rare diseases population (i.e., small numbers of affected individuals, challenges in maintaining confidentiality, and paucity of treatments for diseases where natural history information may be limited). More than other areas of research, potential barriers include the lack of funding opportunities and appropriate review processes for applications to funding agencies. The ELSI Working Group of the International Rare Diseases Research Consortium (IRDiRC) performed an informal survey on ELSI funding initiatives to learn more about different funding mechanisms and to identify potential gaps in funding opportunities. The Working Group discusses these challenges and highlights the role of funding agencies and partners such as patient advocacy groups, specialists in social sciences and humanities, and clinicians to advance ELSI research in rare diseases.
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Affiliation(s)
- Adam L Hartman
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, NIH, Rockville, MD, 20852, USA.
| | | | - Melissa A Parisi
- Intellectual & Developmental Disabilities Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, 20892, USA
| | - Daria Julkowska
- European Joint Programme on Rare Diseases, Institut Thématique Génétique, Génomique et Bioinformatique, INSERM, 75013, Paris, France
| | - Nicole Lockhart
- Division of Genomics and Society, National Human Genome Research Institute, NIH, Bethesda, MD, 20892, USA
| | - Rosario Isasi
- Institute for Bioethics and Health Policy, Department of Human Genetics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
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Vukovic S, McAdam L, Zlotnik-Shaul R, Amin R. Putting our best foot forward: Clinical, treatment-based and ethical considerations of nusinersen therapy in Canada for spinal muscular atrophy. J Paediatr Child Health 2019; 55:18-24. [PMID: 30246272 DOI: 10.1111/jpc.14226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/13/2018] [Accepted: 08/24/2018] [Indexed: 11/30/2022]
Abstract
Spinal muscular atrophy (SMA) is the most common genetic cause of infant mortality. SMA is a spectral disorder and is categorised based on symptom onset and severity. The median life expectancy for infants with SMA presenting before 6 months of age is less than 2 years without respiratory support. To date, there is no cure for SMA. In June 2017, nusinersen was approved in Canada as the first disease-modifying drug for SMA because of its demonstrated benefits on motor function and survival in clinical trials. However, with a price tag of almost 1 million dollars for the first year of therapy, careful clinical, treatment-based and ethical consideration of the principles of (i) best interests; (ii) universality; (iii) portability; (iv) public administration; (v) accessibility; and (vi) comprehensiveness are important guideposts to ensure transparent and equitable allocation of health-care resources for nusinersen and all other future orphan drugs.
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Affiliation(s)
- Sonya Vukovic
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura McAdam
- Division of Developmental Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Bloorview Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Randi Zlotnik-Shaul
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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