Supporting information for the Factors for Consideration

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The need dimension

Need is about the disease, condition or illness. The Factors in this dimension describe the current health state, and does not consider the efficacy or impact of a proposed funding decision. Within the Need dimension we consider the impact of the disease, condition or illness on the person, their family or whānau, wider society, and the broader New Zealand health system.

We consider some the Factors within this dimension when evaluating the cost-effectiveness of a medicine or medical device.  For more information on how we determine cost-effectiveness see Appendix 1(external link) .

The health need of the person

  • How unwell is a person with the health condition compared with an individual in perfect health?

One major way in which we consider this is by comparing life expectancy and quality of life (QoL) at full health to life expectancy and QoL with the disease, condition or illness. In circumstances where an individual’s circumstances are unique (such as some applications considered under the Named Patient Pharmaceutical Assessment (NPPA) Policy) we will consider the health need of that individual person in isolation. Below is an example of a health need graph, which further describes this severity concept using a fictional example. Analyses of this type help us to consider the health need of the person.

Explanation in text below.
Example of quality-adjusted life years

The availability and suitability of existing medicines, medical devices and treatments

This Factor considers two important aspects:

  • What options are currently publicly funded to treat the population with this condition?
  • How well do the current options work?

A medicine is generally considered to be ‘available’ if it is listed on the Pharmaceutical Schedule. Medical devices and other treatments (for example, physiotherapy, nutrition advice, counselling) will generally be considered ‘available’ if they are used as part of standard practice within DHB hospitals or the community.

When thinking about the 'suitability' of available pharmaceuticals and treatments, we consider the practicality, effectiveness or appropriatness in the patient population group.

Relevant things that could determine the suitability of currently available treatments may include, for example, ease of use, required clinician skill and training, and the overall impact of change on the person using the device - insofar as these considerations may impact on health outcomes. The suitability of a pharmaceutical being proposed is noted in the Suitability dimension.

 The health need of others

  • What are the health needs for the family or whānau of the person with the disease, condition or illness? And the health needs for wider society?

As well as the needs of people with the health condition, there are also the effects of that person’s illness on the people around them – caregivers, family, whanau and wider society. Illness or disability may impact directly on these people too.

For example, those living with, or caring for, a person with an infectious disease are at risk of being infected and hence risk having a health loss. And there can be health needs for wider New Zealand society, for example, microbes that become resistant to antibiotics (‘superbugs’) eventually risk the health of the whole New Zealand population.

 The impact on the Māori health areas of focus and Māori health outcomes

  • Has the disease, condition or illness been identified as a Māori health area of focus?
  • What is the impact of the disease, condition or illness on Māori health outcomes?

The intent of this Factor is to specifically consider Māori health need, in doing so representing PHARMAC's commitment to being a good Te Tiriti o Waitangi partner. 

There are two important considerations to this Factor. The first consideration is whether the disease, condition or illness itself has been identified as a health area of focus by Māori (as outlined in Te Whaioranga PHARMAC’s Māori responsiveness strategy). Te Whaioranga was developed in partnership with Māori. The strategy will be updated regularly to ensure we address the health needs of Māori as identified by Māori.

Hauora Arotahi Māori health areas of focus

  • Hauora hinengaro Mental health

  • Matehuka Diabetes

  • Manawa Ora Heart health-high