Abstract
Background. Economic evaluation evidence can improve policies and decision-making processes in medicine and health system, prevent wastage of resources caused by trial and error, and facilitate the patients' access to medications. Therefore, the present study aimed to explore the feasibility of using economic evaluation evidence in the Iranian pharmaceutical sector.
Methods. In this qualitative study, 29 stakeholders selected by purposeful sampling were interviewed using semi-structured interviews. The statistical population consisted of 29 experts in the fields of pharmacology, management, policymaking, and health economics. The inclusion criteria for participants included being employed in decision-making fields, having a minimum of a master's degree, as well as possessing sufficient and comprehensive knowledge of the subject matter. The interviews were analyzed adopting content analysis method, and the data were coded using the MAXQDA 11 software.
Results. In order to identify the obstacles and facilitators of the application of economic evaluation evidence in medicine and health system, the study findings were extracted from three main sections (i.e., characteristics of production and extraction of evidence and information, mechanisms and requirements of using evidence, opportunities and benefits of using evidence) and 11 sub-sections of the identification.
Conclusion. In sum, implementing all identified facilitators and mechanisms needed to establish a robust foundation was found extremely important for correcting an economic evaluation and evidence-based management. Removing the obstacles to an evidence-based management was also found crucial for creating an enabling environment required to implement the evidence-based practices effectively and for facilitating the production and utilization of evidence sources.
Extended Abstract
Background
An evidence-based management and the application of appropriate evidence are essential for decision-making and policy formulation. Based on the importance of management and policymaking in determining the effectiveness of healthcare interventions, evidence-based management and the use of appropriate evidence are essential for decision-making and policy formulation. Given the numerous challenges arising from resource scarcity which negatively affects the provision of equitable healthcare services in different healthcare systems, the prioritization and optimal allocation of available resources are more crucial than ever. Using economic evaluation evidence can improve policies and decision-making processes in the pharmaceutical sector of the healthcare system, prevent resource wastage caused by trial and error, and facilitate the patients' access to pharmaceuticals. The present study, therefore, aimed to explore the feasibility of utilizing economic evaluation evidence in the pharmaceutical domain of Iran's healthcare system.
Methods
This qualitative study was conducted in 2022 to identify stakeholders' perspectives regarding the feasibility of using economic evaluation evidence in the pharmaceutical domain of Iran's healthcare system. The study population included key individuals and experts in the fields of management, policymaking, and health economics in the context of economic evaluation and pharmaceutical domain.
Purposive sampling along with the snowball technique was employed and , then, a semi-structured interview was conducted to identify the opportunities and threats of using economic evaluation evidence in the pharmaceutical domain of Iran's healthcare system. A total of 29 participants were interviewed using an interview guide, and the data collection was continued until the data saturation was reached. MAXQDA software was used for data coding and categorization. After implementing the interviews, the data files were entered into the software in DOC format. Initially, a conceptual framework was developed for the main dimensions of the research topic and the data coding and categorization were performed based on these dimensions and, then, the study findings were placed in the established framework. After creating the initial codes, they were compared conceptually and the codes with common concepts were classified into sub-categories. This process was repeated in other interviews to form a set of sub-categories. After classifying the sub-categories, they were carefully examined and arranged based on their conceptual and thematic similarities and, subsequently, the sub-categories were placed under broader categories. Validity and reliability criteria, including acceptability, transparency, triangulation, repeatability, and trustworthiness were employed to ensure the accuracy and precision of the study.
Results
Our comparative study findings revealed that the production and extraction of evidence were mandatory in Canada, England, and Australia, while they were optional in Iran and Germany. Furthermore, evidence was not used for adding drugs to the drug list in other countries except for Australia and Canada. The qualitative data analysis of the interviews also resulted in the extraction of codes and their integration into the sub-categories and main categories. Four main categories identified were: characteristics of the evidence production and extraction, mechanisms and requirements for evidence utilization, opportunities and benefits of using evidence, and challenges and threats of the evidence utilization. According to the final extracted codes, the main category of characteristics of the evidence production and extraction consisted of two sub-categories: evidence extraction/production and economic challenges.
The second main category related to the mechanisms and requirements for evidence utilization consisted of seven sub-categories: utilization and application of the evidence, infrastructure enhancement and structural reforms, policymakers' engagement with the evidence producers, human resources and establishment of the expert committees, conflict of interest prevention, standardization and framework development, and effective adjustments in evidence utilization.
The third main category, focused on opportunities and benefits of evidence utilization, comprised of two sub-categories: an improvement of the policy outcomes/impacts as well as the economic benefits and reform of the drug policies.
The fourth and final main category associated with the challenges and threats of evidence utilization included nine sub-categories: structural and access problems, lack of transparency and conflicts of interest, commitment and expertise in evidence production and utilization, lack of communication with evidence producers, participation in policymaking, weak oversight and control of evidence, inadequate training of specialized personnel and human resources, social and political factors, and economic challenges. Moreover, studies have shown that a managerial expertise and a specialized training in management sciences are among those effective factors contributing to the evidence-based management utilization.
Conclusion
In conclusion, the mechanisms and requirements were identified and analyzed as facilitators for establishing an evidence-based management infrastructure and an economic evaluation in the pharmaceutical sector of the healthcare system. Providing the given facilitators and requirements was essential for establishing a proper economic evaluation and an evidence-based management. The policymakers' decisions and the type of economic evaluations in the pharmaceutical domain had a significant effect on the success or failure of the drug policies. Identifying the necessary mechanisms and facilitating factors, as well as removing the barriers to evidence-based management and economic evaluation formed the basis of an evidence-based management model and may also have facilitated the generation of evidence resources. Neglecting the context of an evidence-based management was to disregard a significant portion of the influential factors affecting the economic evaluation of pharmaceuticals, leading to an ineffective implementation of this approach.