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Transparency vs. closed-door policy: Do process characteristics have an impact on the outcomes of coverage decisions? A statistical analysis.

Health Policy 112, 187-196 (2013)
Open Access Green as soon as Postprint is submitted to ZB.
The aim of this study was to analyze influences of process- and technology-related characteristics on the outcomes of coverage decisions. Using survey data on 77 decisions from 13 countries, we examined whether outcomes differ by 14 variables that describe components of decision-making processes and the technology. We analyzed the likelihood of committees covering a technology, i.e. positive (including partial coverage) vs. negative coverage decisions. We performed non-parametric univariate tests and binomial logistic regression with a stepwise variable selection procedure. We identified a negative association between a positive decision and whether the technology is a prescribed medicine (p=0.0097). Other significant influences on a positive decision outcome included one disease area (p=0.0311) and whether a technology was judged to be (cost-)effective (p<0.0001). The first estimation of the logistic regression yielded a quasi-complete separation for technologies that were clearly judged (cost-)effective. In uncertain decisions, a higher number of stakeholders involved in voting (odds ratio=2.52; p=0.03) increased the likelihood of a positive outcome. The results suggest that decisions followed the lines of evidence-based decision-making. Despite claims for transparent and participative decision-making, the phase of evidence generation seemed most critical as decision-makers usually adopted the assessment recommendations. We identified little impact of process configurations.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Fourth hurdle; Drug reimbursement; Coverage decision-making; Logistic regression; Industrialized countries; Public drug formularies; Market access; Participation; Health Technology-assessment ; Cost-effectiveness ; 4th Hurdle ; Logistic-regression ; Nice ; Australia ; Canada ; Framework ; Drugs ; World
ISSN (print) / ISBN 0168-8510
e-ISSN 1872-6054
Journal Health Policy
Quellenangaben Volume: 112, Issue: 3, Pages: 187-196 Article Number: , Supplement: ,
Publisher Elsevier
Reviewing status Peer reviewed