Aims: This thesis explores the preferences of different stakeholders, particularly national level decision-makers and the public, to determine the relevance of current and proposed criteria and processes for medicines reimbursement in the UK National Health Service.
Methods and Results: Based on a systematic literature review of health-related conjoint analyses (Chapter 2), process-related aspects of health care are demonstrated to be important to stakeholders, albeit less so than health outcomes. Using revealed preference methods (Chapter 3) and a stated preference discrete choice experiment (Chapter 4), members of a medicines appraisal committee are prepared to trade-off cost effectiveness and health gains against other factors when making national decisions on new medicines.
The first comprehensive empirical analysis of public preferences towards UK medicines prioritisation criteria (Chapter 5), demonstrates that several current criteria (e.g. the end-of-life premium, the special funding status for treatments of rare diseases, the Cancer Drugs Fund in England) do not reflect public preferences for resource allocation, but support is evident for the proposed criteria for rewarding new medicines with higher prices under the value-based pricing system commencing in 2014. From a comparative review of its reports, there is a degree of alignment between the views of the Citizens Council of
the National Institute for Health and Clinical Excellence (NICE) and the wider public (Chapter 6), but evidence that it has influenced NICE decision-making processes is lacking.
Conclusions: Using a range of methods, this thesis confirms that current medicines reimbursement processes are inadequate, and moves towards value-based pricing of medicines are supported. Non-health, process-related aspects of health care should be explicitly considered in decision-making. The involvement of patients and public as stakeholders in medicines decision-making at all levels is supported. Efforts to demonstrate fair decision-making processes do not obviate the need for incorporation of relevant social value judgements in decision-making.