Darvishi Ali, Akbari Sari Ali, Yaseri Mehdi, Mobinizadeh Mohammadreza, Daroudi Rajabali
Department of Health Policy and Management, School of Public Health and Safety, https://ror.org/034m2b326Shahid Beheshti University of Medical Sciences, Tehran, Iran.
National Center for Health Insurance Research, Tehran, Iran.
Int J Technol Assess Health Care. 2025 Jul 21;41(1):e50. doi: 10.1017/S0266462325100263.
Prioritization of health technologies for insurance coverage is usually based on explicit and implicit criteria. This study presents the development of the multi-criteria decision analysis (MCDA) model, the Iranian Health Insurance Benefit Optimization Model (IR-HIBOM), to inform the design of basic health insurance benefit packages.
An initial set of twenty-nine potential allocation criteria was identified through a review of available evidence and other relevant literature. Review of this set by three specialized panels yielded a final set of thirteen criteria. A cross-sectional survey using the best-worst scaling method was then fielded to 163 health system experts to evaluate their preferences regarding the relative importance of the allocation criteria. The mixed logit method was employed to determine the weight of the relative importance of each criterion. Subsequently, a multilevel criteria scoring framework was defined based on a review of similar models and input from a panel of five expert members of the study team. Finally, model's appraisal was conducted.
Thirteen criteria, including relative safety, efficacy, disease severity, access to alternative health technologies, budget impacts, cost-effectiveness, quality of evidence, population size, age, job absenteeism, economic status, daily care needs, and ease-of-use/acceptance were selected. Cost-effectiveness and ease-of-use criteria had the highest and lowest relative importance weights, with 30.5 percent and 1 percent, respectively. Furthermore, scores were determined for the several levels of each criterion, and decision rules were defined for the cost-effectiveness and budget impact criteria. The final model's appraisal, based on weighted scores of thirteen selected technologies, indicated that it was valid and applicable.
The IR-HIBOM demonstrated its potential utility in the health resource allocation.
医保覆盖范围内卫生技术的优先排序通常基于明确和隐含的标准。本研究介绍了多标准决策分析（MCDA）模型——伊朗健康保险福利优化模型（IR-HIBOM）的开发过程，以指导基本健康保险福利包的设计。
通过回顾现有证据和其他相关文献，确定了一组初步的29个潜在分配标准。由三个专业小组对这组标准进行审查后，得出了最终的13个标准。然后，采用最佳-最差尺度法对163名卫生系统专家进行横断面调查，以评估他们对分配标准相对重要性的偏好。采用混合逻辑回归方法确定每个标准相对重要性的权重。随后，在回顾类似模型并参考研究团队五名专家成员小组的意见后，定义了一个多层次标准评分框架。最后对模型进行了评估。
选择了13个标准，包括相对安全性、有效性、疾病严重程度、获得替代卫生技术的机会、预算影响、成本效益、证据质量、人口规模、年龄、旷工、经济状况、日常护理需求以及易用性/可接受性。成本效益标准和易用性标准分别具有最高和最低的相对重要性权重，分别为30.5%和1%。此外，还确定了每个标准几个级别的得分，并为成本效益和预算影响标准定义了决策规则。基于13种选定技术的加权得分对最终模型进行评估，结果表明该模型有效且适用。
IR-HIBOM在卫生资源分配中显示出其潜在效用。
