ABSTRACT
BACKGROUND: The argument about funding criteria poses challenges for health decision-makers in all countries. This study aimed to investigate the public and decision-maker preferences for pharmaceutical subsidy decisions in Iran. METHODS: A discrete choice experiment (DCE) was used for eliciting the preferences of the public and decision-makers. Four attributes including health gain after treatment, the severity of the disease, prevalence of the disease, and monthly out of pocket and relevant levels were designed in the form of hypothetical scenarios. The analysis was done by using conditional logit analysis. RESULTS: The results show all of four attributes are important for pharmaceutical subsidy decisions. But a medicine that improves health gain after treatment is more likely to be a choice in subsidy decisions (by relative importance of 28% for public and 42% for decision-makers). Out of pocket, severity, and prevalence of disease subsequently influence the preferences of the public and decision-makers, respectively. The greatest difference is observed in changing the health gain after treatment and out of pocket levels, between public and decision-makers. CONCLUSION: This research reveals that the public is willing and able to provide preferences to inform policymakers for pharmaceutical decision-making; it also sets grounds for further studies.
ABSTRACT
BACKGROUND: Rapid increasing pharmaceutical spending on the one hand and limited budgets on the other hand are problems confronting health expenditure. Policymakers have realized that without the negative effect on quality of care, they can control pharmaceutical spending. METHODS: The study methodology involved a targeted review of the literature on cost containment policies, their implementation issues, advantages, and disadvantages. Then, all proposed strategies were investigated through interviewing insurance experts. Finally, these policies were prioritized with respect to their adherence to the main issues of performance. RESULTS: Considering implementation costs, durability, and feasibility, six policy options have been proposed as follows: stopping non-prescription medicine reimbursement, using a tiered-coinsurance mechanism, establishing prescription-guidelines, implementing cost-effectiveness-studies, employing scientific bargaining methods, and using different levels of reference pricing. CONCLUSIONS: Despite the possibility of some physicians' resistance, preparing prescription guidelines and their gradual enforcement is considered as the first choice. Next, it seems that reference pricing is the most feasible policy. It is in spite of some confusion and dissatisfaction, which might arise due to lack of knowledge and an increase in out-of-pocket expenses. Then, all pricing methods, including cost-effectiveness studies and internal and external reference pricing, should be used as negotiation leverage with pharmaceutical companies. Afterward, stopping non-prescription medicine reimbursement should be implemented by good media communication in view of its effects on a wide range of population. Finally, implementation of tiered-coinsurance mechanism should be considered with special attention to some inherent technical complexity.
Subject(s)
Drug Costs , Pharmaceutical Preparations , Cost Control , Health Policy , Insurance, Health , Insurance, Health, Reimbursement , Iran , PolicyABSTRACT
Discrete choice experiments (DCES) as a stated preference method have used increasingly to determine preferences attached to some attributes associated to health. Although, the validity of this type of studies comprehensively depends on the appropriate determination of attributes and attribute-levels for DCES, there is little rigorous evidence regarding which factors or attributes and attribute- levels should be counted for eliciting public preferences in health resource allocation. This paper responds to such question by carefully doing a qualitative study. A qualitative study used semi-structured interviews, which were audio recorded, transcribed and subject to thematic analysis. Sixteen participants had been key informants and decision makers of pharmaceutical and health system. Initially, by conducting a meticulous literature review, an inclusive list of attributes associated with intended policy was identified. Qualitative data for the development of attributes and their levels were collected using 16 key informant interviews and were analyzed by software MAXQDA followed by a focus group discussion (FGD) with 7 people, well-familiar with the notion pharmaceutical policy and Pharmacoeconomics. The 311 codes in four main dimensions were initially identified by conducting interviews. However, for being manageable within a DCE, they were classified and limited to four attributes, including severity of disease without treatment, health gain after treatment, frequency of patients, and cost of treatment per patient. This qualitative study provides enough evidence for designing and doing a precise discrete choice experiment answering the question about public preferences in pharmaceutical subsidization and contributes empirical evidence to the limited methodological literature on attributes development for DCE, specifically within low and middle-income countries.
