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Title: Paradigms in operation : pharmaceutical benefit assessments in England and Germany
Author: Kieslich, K.
ISNI:       0000 0004 5365 1149
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2015
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The assessment of the benefits of pharmaceutical products through health technology assessments (HTAs) has become a feature of health care decision-making in numerous OECD countries, including England and Germany. Assessment outcomes vary between countries but, to date, there is a lack of research on the factors that affect those assessments. This thesis addresses this shortcoming by examining what determines the outcome of pharmaceutical benefit assessments in two countries that employ formalised HTA procedures. It takes a novel theoretical approach by employing a framework of policy paradigms to explain an empirical phenomenon other than policy change. The study presents a qualitative analysis that compares the reasoning processes that led to assessment outcomes in ten of the same cases of pharmaceuticals in England and Germany. It finds that benefit assessment outcomes are determined by how a similar set of themes around evidence gets interpreted and framed by a HTA body, e.g. the National Institute for Health and Care Excellence (NICE) in England and the Federal Joint Committee (FJC) in Germany. The study explains the differences in addressing a similar set of themes around evidence by reference to different HTA paradigms that are applied, namely a cost effectiveness paradigm in England and a patient relevance paradigm in Germany. The thesis makes a significant theoretical contribution because it demonstrates that policy paradigms can be used to explain empirical phenomena other than policy change. This requires an analysis of how paradigms are articulated in ‘normal decision-making’, much akin to Kuhn’s analysis on the connection between ‘normal science’ and paradigms. The study calls for an expansion of the current use of policy paradigms to include how they are operationalised in practice as this leads to a better understanding of the crucial elements of a paradigm.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available