New Zealand engages in the same sorts of processes that we engage with here in Canada. You do a form of health technology appraisal of the technology, essentially to try to determine what health benefits this product is likely to give relative to how much you need to spend on it. The “relative to how much you need to spend on it” is really important, only from the point of view of knowing how much you can spend within a given budget. More importantly, once you rank all of these options it tells you which one is the most valuable down to which one is the least valuable within the budget that you have available.
The usefulness of doing these sorts of analyses is in understanding which one provides the most benefit and which one provides the least. That what's we refer to in trying to provide incentives to minimize the opportunity costs of these decisions.
That process is no different from the way it's done here; it's just that the results are used differently. One goes through the same use of technical expertise to try to arrive at an understanding of the product's benefits and the product's costs, and ultimately the budget impact of that. Those options are then compared with other options that are on the table and various recommendations are made, in the case of New Zealand, to a board of directors of the Pharmaceutical Management Agency to list a product or not list a product.
It evolves over time through the addition...and, as I mentioned, you have the substitutability of products. As opportunities come up to substitute from one product to another, those opportunities are taken and patients are asked to switch. Essentially doctors are asked to manage that process of switching the patients from one product to another product.