Table A1.

The value of economics in decision making

Level	Quotations
Macro	“There is a fixed pool of resources out there. We have to allocate it is some way that hopefully has the most benefit to society. And economic evaluation is […] the tool that we use to allocate those resources between competing programs”
	“… have to use the funds that we have […] in the best possible way to benefit the greater good…”
	“…looking at the economics […] is one piece of the equation in terms of looking at the total picture on whether or not something should be recommended for funding.”
	“The economic factor, without a doubt, has to be one of the biggest things given today's environment …”
	“Economics is […] probably the least important thing. It's the thing we wrestle with the most, but it's the least relevant in so many ways.”
Meso	“Most of them (committee members) are oncologists or pharmacologists […] don't think with the dollar sigh hat on …”
	“ … in the finance world (this respondent self‐identified as belonging to this world) they really look at budget numbers […] in terms of the public purse and trying to make good decisions […] that's the thing we need to look at …”
	“… because I am a bureaucrat […] unlike some other folks on this committee, I think the budget means a lot more to me […] have to be able to explain, using pharmacoeconomic information, why I would support spending $10 million on a very few number of people …”
	“… we have to have a really good defendable process that incorporates the economics in it that can be understood by some politicians […] and the public”
	“People generally aren't angry when you approve a program, they're more angry when you don't approve the program.”
Micro	“My experience has been that it's generally secondary to clinical evidence. If there is strong clinical evidence that this drug extends life, it would have to be a pretty awful CE ratio on the other side to get them not to fund that drug.”
	“I am purely simply a clinician, so I mean it really goes back to […] the clinical benefit of a particular treatment.”
	“… there's been a few things that have been winners […] then you worry about what the economics is going to look like […] everything is basically hinged on the economics.”
	“My faith in the cost‐effectiveness analysis is really on a very low level, you know, I've always tended to put my interest in the clinical data.”
	“… it's useful to have somebody like [the health economist] and there is one other member of our panel who has a fair amount of economic background … because left on your own, without having an economics background, it's complex to understand …”
	“I don't go back and actually read the studies myself, so I take that information […] based on her [the health economist's] expertise …”