Public value judgments about the criteria for reimbursement of medicines in South Korea

ABSTRACT

Objectives

Although reimbursement decisions for new drugs involve value judgment, the value judgment of laypersons has not been thoroughly investigated. This study quantified the public value (PV) of the criteria and sub-criteria in the current drug reimbursement systems in South Korea and examined sociodemographic factors that associated with PV.

Methods

The Analytic Hierarchy Process (AHP) was used to quantify the PVs of criteria and sub-criteria. We developed a questionnaire to generate pairwise comparison matrices among criteria and sub-criteria. From 27 March to 1 April 2023, we recruited 1,000 study participants using a quota sampling method stratified by age, sex, and region based on Korean census data. We used eigenvalue methods to calculate the PV of the criteria and sub-criteria. The effects of sociodemographic factors on the PVs were analyzed using linear regression methods.

Results

The PVs for the criteria were highest for clinical usefulness (28.5%), followed by cost-effectiveness (27.1%), budget impact (24.3%), and reimbursement in other countries (20.1%). The sociodemographic characteristics of the participants had a significant impact on the PVs of the criteria. Willingness to pay additional premiums for national health insurance was negatively associated with PV for clinical usefulness and cost-effectiveness and positively associated with PV for reimbursement in other countries.

Conclusions

The public prioritized clinical usefulness and cost-effectiveness as the main criteria. However, the PVs of the criteria were divergent and associated with sociodemographic factors. Divergent public interests require an evidence-informed deliberative process for reimbursement decisions.

KEYWORDS:

• Value judgments
• reimbursement decisions
• health technology assessment
• evidence-informed deliberative process

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Declaration of Interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Authors’ contribution

K-B Son developed the concept of the manuscript, performed the analysis, and wrote the manuscript.

Data availability statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was funded by the Ministry of Education of South Korea and by the National Research Foundation of South Korea (NRF-2023S1A5A8075569).