title: Challenges in measuring the societal value of orphan drugs: insights from a canadian stated preference survey.
abstract: BACKGROUND
  Expensive drugs for rare diseases (i.e. orphan drugs) often do not meet traditional cost-effectiveness criteria and thus put further strain on limited healthcare budgets. Failing to provide medically necessary care to patients, however, violates one of the underlying tenets of most public health insurance systems-equity. This has led payers to consider the value that society places on the treatment of rare diseases, given the opportunity cost, when deciding on whether to fund specific treatments.
  
  
  OBJECTIVE
  In this article we aim to illustrate two factors that make the measurement of societal value in this area particularly difficult: the low level of public awareness of, and engagement with, the orphan-drug issue, and the 'zero-sum' framing commonly used to describe the policy challenge posed by orphan drugs.
  
  
  METHODS
  We illustrate these challenges using data from an original survey of 2,005 Canadian adults. Respondents completed two tasks in which they were asked to choose between funding the treatment of patients suffering from either rare or common diseases.
  
  
  RESULTS
  Respondents were more likely to display choice aversion and unstable preferences if they had not completed a university degree and when a 'zero-sum' frame was used to introduce the choice sets.
  
  
  CONCLUSIONS
  The results suggest that studies in which the stated opportunity costs of funding orphan drugs focus exclusively on reductions in funding for other drugs or treatments may only provide a limited understanding of citizens' policy preferences in the area of rare diseases.
authors.affiliation: Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 4th Floor, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada, nick.dragojlovic@ubc.ca.
authors.forename: Nick
authors.initials: N
authors.lastname: Dragojlovic
authors.forename: Shirin
authors.initials: S
authors.lastname: Rizzardo
authors.forename: Nick
authors.initials: N
authors.lastname: Bansback
authors.forename: Craig
authors.initials: C
authors.lastname: Mitton
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Marra
authors.forename: Larry D
authors.initials: LD
authors.lastname: Lynd
mesh_terms: D000328:Adult; D002170:Canada; D002755:Choice Behavior; D016527:Drug Costs; D005260:Female; D005380:Financing, Government; D006291:Health Policy; D006801:Humans; D008297:Male; D009965:Orphan Drug Production / Q000191:economics*; D057240:Patient Preference; D035583:Rare Diseases / Q000188:drug therapy; D012945:Social Values; D011795:Surveys and Questionnaires