Journal of Medical Council of Iran
Volume 43, Issue 4 (2025)
jmciri 2025, 43(4): 45-54 |
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Ethics code: IR.IAU.PS.REC.1402.572
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Chalaki V, Sobhanian S A, Khoshdel A, Radmanesh R, Hashemian F. Evaluation of Factors Influencing Insurance Organizations’ Reimbursement for Effective Medications in Relapsing-Remitting Multiple Sclerosis within a Novel Dynamic Model. jmciri 2025; 43 (4) :45-54
URL: http://jmciri.ir/article-1-3386-en.html
URL: http://jmciri.ir/article-1-3386-en.html
Department of Clinical Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
Abstract: (12 Views)
Abstract
Background: The high cost of disease-modifying drugs (DMDs) for patients with relapsing-remitting multiple sclerosis (RRMS) poses a significant challenge to healthcare systems, especially in resource-constrained settings. To ensure fair access and optimal allocation of insurance resources, it is essential to develop structured and evidence-based frameworks for reimbursement decisions. This study aimed to quantify the relative importance of various factors influencing insurance reimbursement decisions for DMDs in RRMS and to evaluate the conceptual interrelations among corresponding domains.
Methods: Across-sectional, quantitative study was conducted using a structured and previously validated questionnaire comprising 38 items across 7 domains. The questionnaire was distributed among 91 health experts, including 46 neurologists and 45 pharmacists, all with more than five years of experience in health insurance or MS treatment. Respondents rated the importance of each factor using a 10-point Likert scale. Data analysis involved standardizing factor weights, ranking them based on relative importance, and conducting inter-domain correlation analysis using SPSS version 26.
Results: The domains of Safety and Side Effects and Drug Efficacy received the highest average weights (0.922 and 0.863, respectively), highlighting their central role in reimbursement decisions. Key factors included “Preventing the recurrence of MS attacks based on the annual relapse rate” (weight = 1.000), “Improving survival in RRMS” (0.957), and “Safety and tolerability level of the drug in patients” (0.924). In contrast, “Presence of traditional medicine interventions as alternatives to standard drug therapy.” (0.423) and “Presence of ethical considerations related to prescribing and using the drug” (0.514) had the lowest impact. The strongest inter-domain correlation was observed between financial and accessibility domains (0.745), indicating their interconnected influence on access to DMDs.
Conclusion: The findings of this study could contribute to the development of a novel dynamic model in the future, which may serve as a decision-support tool in the insurance reimbursement process for RRMS-related medications. By focusing on high-weighted factors and reducing the influence of less significant ones in various decision-making contexts, the model has the potential to enhance transparency and fairness in pharmaceutical policy-making.
Background: The high cost of disease-modifying drugs (DMDs) for patients with relapsing-remitting multiple sclerosis (RRMS) poses a significant challenge to healthcare systems, especially in resource-constrained settings. To ensure fair access and optimal allocation of insurance resources, it is essential to develop structured and evidence-based frameworks for reimbursement decisions. This study aimed to quantify the relative importance of various factors influencing insurance reimbursement decisions for DMDs in RRMS and to evaluate the conceptual interrelations among corresponding domains.
Methods: Across-sectional, quantitative study was conducted using a structured and previously validated questionnaire comprising 38 items across 7 domains. The questionnaire was distributed among 91 health experts, including 46 neurologists and 45 pharmacists, all with more than five years of experience in health insurance or MS treatment. Respondents rated the importance of each factor using a 10-point Likert scale. Data analysis involved standardizing factor weights, ranking them based on relative importance, and conducting inter-domain correlation analysis using SPSS version 26.
Results: The domains of Safety and Side Effects and Drug Efficacy received the highest average weights (0.922 and 0.863, respectively), highlighting their central role in reimbursement decisions. Key factors included “Preventing the recurrence of MS attacks based on the annual relapse rate” (weight = 1.000), “Improving survival in RRMS” (0.957), and “Safety and tolerability level of the drug in patients” (0.924). In contrast, “Presence of traditional medicine interventions as alternatives to standard drug therapy.” (0.423) and “Presence of ethical considerations related to prescribing and using the drug” (0.514) had the lowest impact. The strongest inter-domain correlation was observed between financial and accessibility domains (0.745), indicating their interconnected influence on access to DMDs.
Conclusion: The findings of this study could contribute to the development of a novel dynamic model in the future, which may serve as a decision-support tool in the insurance reimbursement process for RRMS-related medications. By focusing on high-weighted factors and reducing the influence of less significant ones in various decision-making contexts, the model has the potential to enhance transparency and fairness in pharmaceutical policy-making.
Keywords: Key Words: Multiple Sclerosis, Insurance Reimbursement, Decision Making, Cost-Effectiveness, Health Policy
Type of Study: Research |
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