Rationalising rationing: economic and other considerations in the debate about funding of Viagra.

Although the cost-effectiveness of Viagra for the treatment of patients with erectile dysfunction is favourable, both public and political opinions seem to be inclined not to fund, or merely to partially fund (i.e. by reimbursing only specific patient groups) this medicine. This shows that in funding discussions, cost-effectiveness information is not solely decisive. In a theoretical framework for choices in health care that was developed in The Netherlands (the Dunning report, 1991), two other criteria besides cost-effectiveness were put forward as being important for rationing decisions: "necessary care" and "individual responsibility". Overlooking the Viagra discussion, many of the arguments put forward seemed to be related to these two criteria. However, a clear operationalisation of the criteria necessary care and individual responsibility is lacking, which makes it difficult to use the arguments in funding decisions. In this paper, we try to demonstrate how these criteria were presented in the Viagra discussion and we will indicate how these criteria can be operationalised in relation to the outcomes of a cost-effectiveness analysis.