探究伊朗民众对药品补贴的偏好：一项离散选择实验研究。
Eliciting the public preferences for pharmaceutical subsidy in Iran: a discrete choice experiment study.
作者信息
Delpasand Mansoor, Olyaaeemanesh Alireza, Jaafaripooyan Ebrahim, Abdollahiasl Akbar, Davari Majid, Kazemi Karyani Ali
机构信息
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Health Equity Research Center & National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
J Pharm Policy Pract. 2021 Jul 13;14(1):59. doi: 10.1186/s40545-021-00345-4.
BACKGROUND
Deciding on pharmaceutical subsidy is regarded as a challenging issue for healthcare policymakers in Iran in most times. Public preferences, rarely attended in Iran, could be invaluable for including a particular drug in the list of subsidized medications.
OBJECTIVES
The current study aims to elicit the public preferences to develop an evidence-based decision-making framework for entering a drug into the list of subsidies in Iran.
METHODS
Discrete Choice Experiment (DCE) was employed to elicit the public preferences. Around 34 attributes were identified based on the systematic review and interview with 51 experts. By holding an expert panel, 7 attributes were finalized, namely: the survival after treatment, quality of life after treatment (QoL), alternative treatment, age group of the target population, cost burden for the government, disease severity, and drug manufacturer country. Next, 1224 households were selected for the survey in the city of Tehran, using random cluster sampling. Data were analyzed using conditional logit model.
RESULTS
The survival after treatment (β = 1.245; SE = 0.053) and disease severity (β =- 0.143; SE = 0.043) had the highest and lowest priority, respectively, in the preferences for allocating subsidy to a drug. In developed region, unlike the other two regions, the level of domestic drug production (β =- 0.302; SE = 0.073) was inversely associated with preferences toward allocating subsidy to a drug. In contrast to other districts, those living in district number one (β = 2.053; SE = 0.138) gave the highest value to promoting the QoL after treatment.
CONCLUSIONS
It is suggested that policymakers pay more attention to attributes such as effectiveness and alternative treatment when developing an evidence-based framework for entering a drug into the list of subsidies. This study highlighted the public belief in the government's subsidy for medicines, provided that, this results in an increased survival and QoL.
背景
在大多数情况下，药品补贴决策被视为伊朗医疗政策制定者面临的一个具有挑战性的问题。在伊朗很少受到关注的公众偏好，对于将特定药物纳入补贴药物清单可能具有重要价值。
目的
本研究旨在引出公众偏好，以建立一个基于证据的决策框架，用于将一种药物纳入伊朗的补贴清单。
方法
采用离散选择实验（DCE）来引出公众偏好。基于对51位专家的系统综述和访谈，确定了约34个属性。通过召开专家小组会议，最终确定了7个属性，即：治疗后的生存率、治疗后的生活质量（QoL）、替代治疗、目标人群的年龄组、政府的成本负担、疾病严重程度和药品生产国。接下来，采用随机整群抽样的方法，在德黑兰市选择了1224户家庭进行调查。使用条件逻辑模型对数据进行分析。
结果
在将补贴分配给一种药物的偏好中，治疗后的生存率（β = 1.245；标准误 = 0.053）和疾病严重程度（β = -0.143；标准误 = 0.043）分别具有最高和最低优先级。在发达地区，与其他两个地区不同，国内药品生产水平（β = -0.302；标准误 = 0.073）与对一种药物分配补贴的偏好呈负相关。与其他地区相比，居住在第一区的人（β = 2.053；标准误 = 0.138）对提高治疗后的生活质量给予了最高评价。
结论
建议政策制定者在建立基于证据的框架以将一种药物纳入补贴清单时，更多地关注有效性和替代治疗等属性。本研究强调了公众对政府药品补贴的信任，前提是这会提高生存率和生活质量。
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