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Link between process and appraisal in coverage decisions: an analysis with structural equation modeling.

Katharina E Fischer^1,2, Björn Stollenwerk¹, Wolf H Rogowski^1,3

¹Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, München, Germany (KEF, BS, WHR).

Medical Decision Making : an International Journal of the Society for Medical Decision Making

|June 18, 2013

Summary

Rigorous assessment and stakeholder participation enhance fair coverage decisions. Scientific evidence is key, while transparency

Keywords:

formulary decision making pharmaceuticals pharmacist statistical methods survey methods

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Area of Science:

Health Policy and Services Research
Decision Science
Health Economics

Background:

Fair coverage decision-making involves material and procedural justice criteria.
The interplay between these criteria remains unclear.

Purpose of the Study:

To investigate the impact of assessment, transparency, and participation on the reasonableness of coverage decisions.
To analyze the underlying hypotheses of these process components.

Main Methods:

Structural equation modeling with observable indicators for latent constructs.
Internet survey of experts on third-party payer coverage decisions (2006-2011).
Partial least squares path modeling (PLS-PM) with 97 decisions from 15 countries.

Main Results:

Stakeholder participation (RC=0.289, P=0.005) and scientific rigor (RC=0.485, P<0.001) significantly influenced reasonableness.
Transparency did not significantly impact reasonableness (RC=0.289, P=0.358).
The model explained a considerable variance in reasonableness (R²=0.44).

Conclusions:

Rigorous assessment and stakeholder participation promote reasonable coverage decisions.
Scientific rigor of assessment had the strongest positive effect.
Transparency's influence on reasonableness was not statistically significant.