Attributes Development for Pharmaceutical Subsidization: A Qualitative Study

Discrete choice experiments (DCES) as a stated preference method have used increasingly todetermine preferences attached to some attributes associated to health. Although, the validity ofthis type of studies comprehensively depends on the appropriate determination of attributes andattribute-levels for DCES, there is little rigorous evidence regarding which factors or attributes andattribute- 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 studyused semi-structured interviews, which were audio recorded, transcribed and subject to thematicanalysis. Sixteen participants had been key informants and decision makers of pharmaceutical andhealth system. Initially, by conducting a meticulous literature review, an inclusive list of attributesassociated with intended policy was identified. Qualitative data for the development of attributesand their levels were collected using 16 key informant interviews and were analyzed by softwareMAXQDA followed by a focus group discussion (FGD) with 7 people, well-familiar with thenotion pharmaceutical policy and Pharmacoeconomics. The 311 codes in four main dimensionswere initially identified by conducting interviews. However, for being manageable within aDCE, they were classified and limited to four attributes, including severity of disease withouttreatment, 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 choiceexperiment answering the question about public preferences in pharmaceutical subsidization andcontributes empirical evidence to the limited methodological literature on attributes developmentfor DCE, specifically within low and middle-income countries.