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Public participation in decision-making on the coverage of new antivirals for hepatitis C

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Katharina Kieslich, Jeonghoon Ahn, Gabriele Badano, Kalipso Chalkidou, Leonardo Cubillos, Renata Curi Hauegen, Chris Henshall, Carleigh B. Krubiner, Peter Littlejohns, Lanting Lu, Steven D. Pearson, Annette Rid, Jennifer A. Whitty, James Wilson

Original languageEnglish
Pages (from-to)769-785
Number of pages17
JournalJournal of Health Organization & Management
Issue number5
Early online date15 Aug 2016
Accepted/In press28 May 2016
E-pub ahead of print15 Aug 2016


King's Authors


New hepatitis C medicines such as sofosbuvir underline the need to balance considerations of innovation, clinical evidence, budget impact and equity in health priority-setting. The purpose of this paper is to examine the role of public participation in addressing these considerations.

The paper employs a comparative case study approach. It explores the experience of four countries – Brazil, England, South Korea and the USA – in making coverage decisions about the antiviral sofosbuvir and involving the public and patients in these decision-making processes.

Issues emerging from public participation activities include the role of the universal right to health in Brazil, the balance between innovation and budget impact in England, the effect of unethical medical practices on public perception in South Korea and the legitimacy of priority-setting processes in the USA. Providing policymakers are receptive to these issues, public participation activities may be re-conceptualized as processes that illuminate policy problems relevant to a particular context, thereby promoting an agenda-setting role for the public.

The paper offers an empirical analysis of public involvement in the case of sofosbuvir, where the relevant considerations that bear on priority-setting decisions have been particularly stark. The perspectives that emerge suggest that public participation contributes to raising attention to issues that need to be addressed by policymakers. Public participation activities can thus contribute to setting policy agendas, even if that is not their explicit purpose. However, the actualization of this contribution is contingent on the receptiveness of policymakers.

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