A comprehensive value evaluation index system for provincial medical insurance access to traditional Chinese medicine preparations in medical institutions

Abstract

Background

This study established a comprehensive value evaluation index system for provincial medical insurance access to traditional Chinese medicine (TCM) preparations in medical institutions from the insurance viewpoint. The system aims to provide a reference for insurance access applications and decision-making.

Methods

The index system was first established through systematic evaluation and expert consultation. The Delphi method and analytic hierarchy process were employed to reveal the index system and calculate each indicator’s weight. The indicator selection thresholds were based on the importance score thresholds and the coefficient of variation thresholds. Indicators with importance scores higher than the threshold and coefficient of variation less than the threshold were included in the index system.

Results

The researchers retrieved 6201 articles in total, 68 of which were retained following a review of the titles and full text. The initially established index system had six dimensions (i.e., basic information and TCM theory of the preparation, safety, effectiveness, economy, innovation, and fairness), 25 primary indicators, and 55 secondary indicators. Two expert consultation rounds were employed to collect the opinions of 13 and 11 experts. The final index system considered the index system’s aforementioned six dimensions, including safety (30.44 %), effectiveness (43.18 %), economy (14.72 %), innovation (6.48 %), and fairness (5.17 %), along with 22 primary indicators, and 26 secondary indicators. Moreover, the top three weight indicators were the prescription source (secondary indicator), effectiveness evaluation based on real-world evidence (primary indicator), and direct costs (secondary indicator).

Conclusion

The proposed index system elucidates the scope of evidence and basic research design for TCM preparations from the insurance viewpoint. It also integrates cost evaluation and value evaluation indicators and improves the definition of reference drugs, thus providing a reference for achieving rational clinical drug usage and a pricing policy for TCM preparations.