New treatments for rare and severe diseases are becoming available, but their high costs are creating challenges for the Norwegian public health system. A recent thesis examines how these expensive drugs impact the way Norway sets priorities in healthcare.
The research looks at both national policy and the interactions between doctors and patients. One part of the study analyzes media discussions about Norwegian health priorities before and after the creation of the Decision Forum and Nye Metoder, a national system for introducing new health technologies. The analysis focuses on debates over three costly treatments for cancer and rare diseases from 2013 to 2019. It finds that many different commentators took part in these discussions, and that after Nye Metoder was established, debates about specific treatments became less tied to party politics.
Another part of the thesis investigates what criteria people use when asked to make choices between hypothetical patient groups. The results show that societal factors, such as reducing informal caregiving needs or improving a patient's ability to work, often lead to higher priority being given to those patients. Health-related factors like gaining more quality-adjusted life years or having more severe conditions also increase priority. Whether respondents themselves were employed influenced their views on prioritizing work ability.
A third sub-study is based on interviews with 18 physicians about a new high-cost treatment for cystic fibrosis introduced in 2022. The findings indicate that doctors negotiate clinical guidelines with patients and interpret treatment costs in ways that allow them to continue offering therapy even if its effects are uncertain.
The thesis highlights how difficult it can be for doctors to apply broad principles of priority-setting in everyday practice, especially when both costs and consequences for other patient groups are unclear. According to the findings: "Greater transparency in price agreements and clearer, evidence-based criteria in clinical guidelines for high-cost medicines can provide better support to clinicians when navigating uncertain treatment effects, while also contributing to fairer and more transparent priority-setting in the health service."
These insights may help inform future development of tools used by Norway’s healthcare system when deciding how resources should be allocated.
