Rationalising rationing: economic and other considerations in the debate about funding of Viagra
Section snippets
Viagra: an exceptional case in debates on rationing
In September 1998, Viagra was introduced on the European market, where it was an immediate success: the sales figures in the first months after introduction were extraordinarily high, especially given the fact that Viagra was a new, non-funded medicine. The question then became whether or not governments should fund Viagra in a public health care system. After all, the budgetary impact of funding of Viagra could be substantial, given this high demand.
In such funding decisions, economic
Main arguments against funding Viagra
In the Viagra discussion, two main arguments are put forward, both in the political and in the public discussion, that object to funding the new drug [7], [8], [9]. First, erectile dysfunction is often accepted as normal part of ageing. Consequentially, treatment can be viewed as an unnecessary luxury, which should not interfere with providing necessary medical interventions (e.g. lifesaving interventions). Second, it is argued that funding of treatment of erectile dysfunction may be denied on
Operationalisation of other arguments
In spite of their poor current operationalisation, the here discussed arguments of necessity and individual responsibility have intuitive appeal and seem to be based on widely shared underlying moral principles.
Implications for decision making
The arguments regarding necessary care and individual responsibility, in combination with information about cost-effectiveness, seem to outline a decision-making framework in which QALY maximisation is not the only goal. Necessity and individual responsibility also play a role. Below we explore how these findings can change the Dutch model for choices in health care.
The criteria necessary care and individual responsibility have been discussed before. For example, they were put forward, together
Conclusions
It becomes apparent from the Viagra funding discussion, that cost-effectiveness information alone cannot provide sufficient information to guide reimbursement decisions. Economic considerations need to be supplemented with the criteria necessary care and individual responsibility. The way these criteria are used in the Viagra debate may suggest that QALY gains are valued differently, depending on the place on the QALY scale where they occur compared to some societal reference point for health.
Acknowledgements
We would like to thank an anonymous referee for his valuable comments on an earlier version of this paper.
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