Table 6.

Framework results—issues discussed by committee members

Level issue	MACRO	MESO	MICRO
Value of using economics	• Economic information is generally important, as there is a need to carefully allocate resources. Not all committee members shared this opinion.	• The consideration of economic evidence is key to the committee's decision process. • Concerns about other committee members not using economics. • Concerns that economics is sometimes used to support Provincial political interests.	• Individual committee members felt it important that the economic evidence be considered, but felt ill equipped to meaningfully use it themselves.
Challenges with economics	• Practical challenges include the funders of economic reports and subsequent lack of trust in the results, and lack of regulation of the production of economic reports. • Methodology was seen as speculative rather than definitive.	• Concerns that studies were not applicable to local context, because of geography, and because of population differences from those used in the utility valuation. • Concern about the lack of consistency between economic studies, and a lack of clarity.	• Individual committee members found it challenging to understand economic terminology and methods, particularly that of cost‐utility. Terminology and concepts were conflated.
Multi‐criteria decision context	• The initial question of what an economic report should include was interpreted more broadly. Important to include clinical evidence, economic evidence, ethical aspects, patient care perspective, alternatives, feasibility, total impact on the budget, and the overall budget.	• A clear distinction was not made between a general and a NS committee specific evidence package. • The lack of a consistent framework, and the lack of important information, and specifically budgetary information were identified.	• Status quo not questioned. Discussion of the pieces of economic evidence focused on what was presented to the committee. • The lack of budget information was mentioned by several committee members.
Composition of the committee	• In principle, committees should be composed of multiple disciplines to create a balance of perspectives, as the importance assigned to various pieces of evidence varies between disciplines.	• The composition of the particular NS committee was not questioned. There was little discussion of needing more or fewer representatives from any particular discipline.	• Some concerns were raised about being able to have a voice in the presence of a number of clinicians or economists. • Some committee members felt unheard.
The decision process	• The importance of education of stakeholders was highlighted, particularly in economics. • The literature had highlighted the need for regulation of the production of economic reports. • Committee members would have liked long‐term follow‐up to understand the broader implications of their decisions.	• The need for a framework was highlighted. • The opportunity for multidisciplinary discussion prior to voting was appreciated. • Committee members stressed their reliance on the economic expert to interpret economic studies for them.	• There was a desire to have more time to discuss each drug, and more time to review the summary of evidence. • Some experienced a sustained confusion. Not sure how to vote after the meeting and discussion. Took mental shortcuts.