title: Decision-making in priority setting for medicines--a review of empirical studies.
abstract: Rising pharmaceutical expenditure leads to an increased need for priority setting in medicinal care. The objective of this paper is to review studies that empirically analyse a macro- and meso-level decision-making process for including drugs in and/or excluding drugs from reimbursement lists and drug formularies in industrialized countries. We identified six separate studies analysing a decision-making process as a whole. According to them, the most important groups in decision-making were experts and administrative persons. The decision-makers had an explicitly or implicitly defined set of criteria that were considered in decision-making, with clinical evidence on the benefit and the costs being the main criteria used. However, formal pharmacoeconomic analyses were given a rather small role. The criteria used varied between studies, and also between decisions. The decisions seemed inevitably to be partly value-based in their nature, as the scientific or other exact evidence did not give a firm foundation on which the decisions could be solely based. The majority of the studies concentrated on descriptive analysis on how things are rather than on explicitly analysing how decision-making processes perform against defined principles or goals. To facilitate decision-making by clearly defined principles and methods, more analytic studies on decision-making are especially needed.
authors.affiliation: STAKES (the National Research Centre for Welfare and Health), Finland. lauri.vuorenkoski@stakes.fi
authors.forename: Lauri
authors.initials: L
authors.lastname: Vuorenkoski
authors.forename: Hanna
authors.initials: H
authors.lastname: Toiviainen
authors.forename: Elina
authors.initials: E
authors.lastname: Hemminki
mesh_terms: D003657:Decision Making; D036262:Empirical Research; D005569:Formularies as Topic; D006292:Health Priorities; D004364:Pharmaceutical Preparations
chemical_list: D004364:Pharmaceutical Preparations