Economic Evaluation Methods and Pharmacoeconomics, University of Montreal, QC, Canada.
Appl Health Econ Health Policy. 2011 Nov 1;9(6):389-402. doi: 10.2165/11595220-000000000-00000.
The General Mutual Benefit Fund for Civil Servants and State Employees of Côte d'Ivoire (MUGEFCI; Mutuelle Générale des Fonctionnaires et Agents de l'État de Côte d'Ivoire) is a health mutual fund providing coverage (medical consultations, laboratory tests and treatment) for its enrolees (government officials and agents). This organization aims to improve its current drug reimbursement process because of budgetary constraints. One method of achieving this is to implement a formulary-listing framework specifically developed for low-income countries.
The aim of this study was to evaluate the feasibility of developing a new formulary for the MUGEFCI in Côte d'Ivoire, by implementing a formulary-listing framework specifically designed for under-researched settings.
The application of this formulary-listing framework (based on multi-criteria decision analysis [MCDA]) consisted of four steps. First, relevant formulary-listing criteria and their levels of variation were identified and weighted according to their importance in the decision making around drug reimbursement. Second, a set of priority treatments to be assessed was determined. Once the treatments eligible for reimbursement were determined, scores were assigned to these treatments according to their performance on the formulary-listing criteria levels. Finally, a composite league table (weighted matrix) was constructed to rank the set of treatments by priority order of reimbursement. A budget-impact analysis (BIA) was also conducted to appraise the economic implications of the new composite drugs league table. The extent to which the new priority list of reimbursable drugs was affordable for the MUGEFCI was then measured.
Policy makers in Côte d'Ivoire considered severity of disease and cost effectiveness of treatment to be the most significant criteria for priority reimbursement of drugs. This translated into a general preference for antimalarials, treatments for asthma and antibacterials for urinary tract infection. Moreover, the results of the BIA suggest that the new priority list of reimbursable drugs would be affordable if the real economic impact of drugs per member is less than $US66. Over this threshold, the MUGEFCI would have to select reimbursable drugs according to their rank in the priority list and their respective budget impact per patient (cost per patient). This selection would start from the first treatment, going down the list until the $US66 per patient is exhausted.
It was possible to use MCDA to simultaneously consider different decision criteria for drug reimbursement in Côte d'Ivoire; therefore, it is feasible to use MCDA to establish a formulary for low-income countries. The application of this method is a step towards transparency in policy making.
科特迪瓦公务员和国家雇员共同福利基金（MUGEFCI；Mutuelle Générale des Fonctionnaires et Agents de l'État de Côte d'Ivoire）是一个为参保人（政府官员和代理人）提供医疗咨询、实验室检查和治疗的健康互助基金。由于预算限制，该组织旨在改进其当前的药品报销流程。实现这一目标的一种方法是实施专为低收入国家制定的处方清单框架。
本研究旨在通过实施专为研究不足的环境设计的处方清单框架，评估为科特迪瓦 MUGEFCI 制定新处方的可行性。
该处方清单框架（基于多准则决策分析 [MCDA]）的应用包括四个步骤。首先，根据药物报销决策中的重要性，确定并加权相关的处方清单标准及其变化水平。其次，确定一套需要评估的优先治疗方案。一旦确定了有资格报销的治疗方案，就根据其在处方清单标准水平上的表现为这些治疗方案分配分数。最后，构建一个综合联赛表（加权矩阵），根据报销优先级对治疗方案进行排名。还进行了预算影响分析（BIA），以评估新复合药物联赛表的经济影响。然后衡量 MUGEFCI 能够承担新的可报销药物优先清单的程度。
科特迪瓦的政策制定者认为疾病的严重程度和治疗的成本效益是优先报销药物的最重要标准。这转化为对抗疟药、哮喘治疗和尿路感染抗菌药物的普遍偏好。此外，BIA 的结果表明，如果每个成员的药物实际经济影响低于 66 美元，新的可报销药物优先清单是可以承受的。超过这个阈值，MUGEFCI 将不得不根据其在优先清单中的排名及其每位患者的预算影响（每位患者的成本）选择可报销的药物。这种选择将从第一个治疗方案开始，沿着清单向下，直到每个患者的 66 美元用尽。
使用 MCDA 可以同时考虑科特迪瓦药物报销的不同决策标准；因此，使用 MCDA 为低收入国家建立处方是可行的。该方法的应用是实现政策制定透明化的一步。
