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Journal of Bioethical Inquiry
Published in: Journal of Bioethical Inquiry 3/2023

Open Access 21-09-2023 | Original Research

Principles for Just Prioritization of Expensive Biological Therapies in the Danish Healthcare System

Authors: Tara Bladt, Thomas Vorup-Jensen, Mette Ebbesen

Published in: Journal of Bioethical Inquiry | Issue 3/2023

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Abstract

The Danish healthcare system must meet the need for easy and equal access to healthcare for every citizen. However, investigations have shown unfair prioritization of cancer patients and unfair prioritization of resources for expensive medicines over care. What is needed are principles for proper prioritization. This article investigates whether American ethicists Tom Beauchamp and James Childress’s principle of justice may be helpful as a conceptual framework for reflections on prioritization of expensive biological therapies in the Danish healthcare system. We present an empirical study exploring the principles for prioritizing new expensive biological therapies. This study includes qualitative interviews with key Danish stakeholders experienced in antibody therapy and prioritizing resources for expensive medicines. Beauchamp and Childress’s model only covers government-funded primary and acute healthcare. Based on the interviews, this study indicates that to be helpful in a Danish context this model should include equal access for citizens to government-funded primary and acute healthcare, costly medicine, and other scarce treatments. We conclude that slightly modified, Beauchamp and Childress’s principle of justice might be useful as a conceptual framework for reflections on the prioritization of expensive biological therapies in the Danish healthcare system.
Footnotes
1
Since resources of societies are limited, priorities need to be set for healthcare. Beauchamp and Childress therefore consider the right to a decent minimum of health care an attractive goal “… and, realistically, probably the only goal that can be achieved in most societies seeking to implement a right to health care” (Beauchamp and Childress 2019, 292–293).
 
2
In this article, our purpose is to explore principles for just prioritization of expensive biological therapies in the Danish healthcare system. This aim includes exploring the use of data gained from analytic techniques in general in the light of distributive justice (Beauchamp and Childress 2019, 253). These analytic techniques are briefly exemplified by cost-effective and cost-benefit analyses. Strictly speaking, however, cost-effective analyses and cost-benefit analyses are two different approaches (Ubel 2000; Lippert-Rasmussen and Lauridsen 2010).
 
3
Cost-benefit analysis (CBA) (Beauchamp and Childress 2019, 253).
 
4
In this article, MS patients are considered a minor patient group suffering from a rare disease. In Denmark approximately 17,200 patients, or approx. 3:1000, suffer from MS (Danish Sclerosis Association 2022), which would not qualify MS as a rare disease according to the European Union definition with a threshold at 1:2000 (European Commission 2021). However, in the public debate, the concept of rare disease seems to follow a more relational understanding, where it is noted that the prevalence of MS is dwarfed by cancer, type II diabetes, and heart diseases. This is also evident from our interviews and discussed in the present paper with this understanding.
 
5
The issue of what equal access requires in the context of rare diseases is thoroughly discussed in the literature (Albertsen 2022; Juth 2017; Juth et al. 2021; Magalhaes 2022; Sandman and Gustavsson 2017).
 
6
Inserted by the authors.
 
7
Hermeneutics is the study of the interpretation of texts. The aim of hermeneutics is to gain a valid and common understanding of a text (Kvale 1983).
 
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Metadata
Title
Principles for Just Prioritization of Expensive Biological Therapies in the Danish Healthcare System
Authors
Tara Bladt
Thomas Vorup-Jensen
Mette Ebbesen
Publication date
21-09-2023
Publisher
Springer Nature Singapore
Published in
Journal of Bioethical Inquiry / Issue 3/2023
Print ISSN: 1176-7529
Electronic ISSN: 1872-4353
DOI
https://doi.org/10.1007/s11673-023-10283-2

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