선택실험법을 이용한 의약품 급여결정기준에 대한 선호분석

The purpose of this study is to elicit preference for drug listing decision criteria and to estimate the ICER threshold in South Korea using the discrete choice experiment (DCE) method. To collect the data, a DCE survey was administered to a subject sample either educated in the principle concepts of pharmacoeconomics or were decision makers within that field. Subjects chose between alternative drug profiles differing in four attributes: ICER, uncertainty, budget impact and severity of disease. The orthogonal and balanced designs were determined through computer algorithm to take the optimal set of drug profiles. The survey employed 15 hypothetical choice sets. A random effect probit model was used to analyze the relative importance of attributes and the probabilities of a recommendation response. Parameter estimates from the models indicated that three attributes (ICER, Impact, Severity of disease) influenced respondents' choice significantly(p<0.001). In addition, each parameter displayed an expected sign. The Lower the ICER, the higher the probability of choosing that alternative. Respondents also preferred low levels of uncertainty and smaller impact on health service budget. They were also more likely to choose drugs for serious diseases rather than mild or moderate ones. Uncertainty however is not statistically significant. The ICER threshold, at which the probability of a recommendation was 0.5, was 29,000,000 KW/QALY in expert group and 46,500,000 KW/QALY in industry group. We also found that those in our sample were willing to accept high ICER to get medication for severe diseases. This study demonstrates that the cost-effectiveness, budget impact and severity of disease are the main reimbursement decision criteria in South Korea, and that DCE can be a useful tool in analyzing the decision making process where a variety of factors are considered and prioritized.