Improving decision-making for drug reimbursement in Iran

Reimbursement decision making in any healthcare system is an important process to ensure patient access to various healthcare services in an affordable manner. A proper reimbursement decision making happens when it can concurrently pursue three main goals including quality of care, population of health, and affordability. However, achieving the goals requires enough knowledge and proper healthcare governance. In middle-income countries (MICs) improving the three main goals is likely to be difficult due to weakness in the knowledge production infrastructure and healthcare governance. To investigate possible solutions for improving the drug reimbursement decision-making system in MICs, this thesis focuses on the drug reimbursement decision-making system in Iran. Subsequently, we focus on use of a monoclonal antibody in breast cancer. Trastuzumab (Herceptin) is widely used in the treatment of overexpressed human epidermal growth factor receptor 2 (HER2-positive) breast cancer. Trastuzumab, as an expensive drug, has continued to be a topic of conversation in many healthcare systems since its launch into the pharmaceutical markets.
The overall aim of this thesis is to investigate how an MIC (in this case, focusing on Iran) can improve its drug reimbursement decision-making system. Therefore, this thesis provided important information on how an MIC can improve the drug reimbursement decision-making system in three parts. Firstly, we discussed the current situation and subsequent consequences of the drug reimbursement decision-making system in Iran. Secondly, we provided some solutions to improve limited health economics-related evidence in Iran. And finally, some recommendations are provided to improve the system.
This thesis includes three parts and each of these provides an answer to one or more research questions. In the first part (chapters 2 and 3), the current situation and subsequent consequences of the drug reimbursement decision-making system in Iran are discussed. The second part focuses on knowledge production in MICs. As already mentioned, obtaining information is not an easy task in MICs and researchers have to find solutions to overcome this shortage of information. Therefore, this part provides some solutions for this problem. In addition, it describes some economic evaluations and a scenario analysis for efficient and affordable treatment. This part has three chapters (4−6). The third part provides recommendations to improve the system. It describes how MICs can benefit from HTA studies and knowledge production in order to achieve the overall goals of a reimbursement decision-making system. This part has two chapters, which are chapter 7 and 8.