Confident, Cautious, Opposed… Using Legitimacy to Connect Disparate Stakeholder Views of Accelerated Access to Medicines

Jessica Pace1

1Sydney Health Ethics, University Of Sydney, Sydney, Australia

Numerous policy approaches aim to address concerns regarding timely access to medicines. These may provide patients with a wider range of treatment options and earlier access to cancer medicines but can also increase uncertainty surrounding safety, efficacy and cost-effectiveness. Stakeholder engagement is essential to determine the appropriate risk-benefit balance of such initiatives and therefore optimal policy approaches. Here, I report the results of an empirical study exploring physician and consumer attitudes towards accelerated access initiatives. This involved semi-structured interviews with 18 Australian physicians and 13 patients and patient advocates and two focus groups with patients. These were transcribed verbatim and analysed thematically.

There is significant diversity in stakeholder opinion. We identified three “types” of attitudes amongst physicians—Confident Accelerators, Cautious Accelerators and Opposed to Acceleration. Although all acknowledged potential risks and benefits, they disagreed on their magnitude and extent and how these should be balanced in both policy formation and clinical practice. Consumers both recognised the potential benefits of accelerated access and noted risks such as increased uncertainty surrounding the safety and effectiveness of and limited resources to pay for medicines made available via these schemes. All participants emphasised procedural factors—such as transparency, relevant expertise and thorough consideration of evidence—needed for appropriate decision-making processes. As not all substantive positions can be accommodated in policy processes simultaneously, I argue for an emphasis on implementing fair procedures to increase legitimacy in order to increase the acceptability of decisions about accelerated access to medicines.


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