Attributes Development for Pharmaceutical Subsidization: A Qualitative Study.

Discrete choice experiments (DCES) as a stated preference method have used increasingly to determine preferences attached to some attributes associated to health. Although, the validity of this type of studies comprehensively depends on the appropriate determination of attributes and attribute-levels for DCES, there is little rigorous evidence regarding which factors or attributes and attribute- levels should be counted for eliciting public preferences in health resource allocation. This paper responds to such question by carefully doing a qualitative study. A qualitative study used semi-structured interviews, which were audio recorded, transcribed and subject to thematic analysis. Sixteen participants had been key informants and decision makers of pharmaceutical and health system. Initially, by conducting a meticulous literature review, an inclusive list of attributes associated with intended policy was identified. Qualitative data for the development of attributes and their levels were collected using 16 key informant interviews and were analyzed by software MAXQDA followed by a focus group discussion (FGD) with 7 people, well-familiar with the notion pharmaceutical policy and Pharmacoeconomics. The 311 codes in four main dimensions were initially identified by conducting interviews. However, for being manageable within a DCE, they were classified and limited to four attributes, including severity of disease without treatment, health gain after treatment, frequency of patients, and cost of treatment per patient. This qualitative study provides enough evidence for designing and doing a precise discrete choice experiment answering the question about public preferences in pharmaceutical subsidization and contributes empirical evidence to the limited methodological literature on attributes development for DCE, specifically within low and middle-income countries.