The public funding of expensive cancer therapies: synthesizing the "3Es"--evidence, economics, and ethics.

The cost of new cancer therapies and drugs has risen sharply and somewhat alarmingly in the last five years. In those developed countries where healthcare systems are (primarily) publicly funded, this has caused legitimate concern among government administrators and politicians who must make decisions regarding funding. In the Canadian context, provincial Departments of Health are mandated to provide comprehensive healthcare services to all citizens out of a "fixed pot" of financial resources, which is determined annually as part of the provincial government's overall budget process. In recent years there has been increasing recognition among healthcare decision makers that the approval of funding for multiple new expensive cancer treatments is creating an "opportunity cost" for meeting the other legitimate healthcare needs of provincial citizens. In response to this reality, the Department of Health of the Canadian province of Nova Scotia created a Cancer Systemic Therapy Policy Committee (CSTPC) in 2005. The mandate of this committee is to make recommendations to the Nova Scotia Deputy Minister of Health regarding the public funding of new cancer therapies. In collaboration with consultants from the Dalhousie University Department of Bioethics, the committee developed a comprehensive and inclusive decision-making framework to promote and facilitate decision making that is explicitly informed by evidence, economics, and ethics--the "3Es"--in reaching and making recommendations.