Table 1.
Views towards guideline concerning IFNβ use
| Actor | Judgement of solutiona | Problem definition | Background theories | Normative values |
|---|---|---|---|---|
| Ministry of health (1996) | + Clear criteria for reimbursement IFNβ needed |
IFNβ is an expensive medicine; uncertainty on meaning of effects Possibly inappropriate use because high expectations |
Only if evidence of effectiveness is available, a medicine can be at the expense of the community | Cost control Efficiency |
| PAM staff | + A central pre-utilisation approval for IFNβ use A clear treatment protocol on IFNβ should be available |
Health insurance companies judged reimbursement requests differently Individual health insurer lack expertise to judge reimbursement requests |
Differences in judgement result in differences in care Situation IFNβ resembles situation growth hormones, for which a central pre-utilisation approval in combination with central registration was set up Central pre-utilisation approval prevents inappropriate use |
Cost control; efficiency Equal accessibility |
| PAM staff (2003) | − Central pre-utilisation approval no longer needed |
Situation concerning IFNβ was relatively stable; no longer problems concerning reimbursement requests Costs committee higher than possible savings IFNβ use |
Criteria for central pre-utilisation approval: – medicine is expensive – inappropriate use expected – decisions on treatment are complex |
Cost control Efficiency |
| Medical advisor health insurance company | + Guidelines on IFNβ needed for decisions reimbursement |
Unclear when IFNβ is (still) meaningful | Pharmaceutical companies benefit from extending criteria Expensive drugs are financed from public funds, on a solidarity base |
Cost control |
| Neurologist | + Not guideline on IFNβ solely but guideline on diagnosis & treatment MS |
Increase possibilities for diagnosis and therapy; variance in MS care | As in other fields increasing attention to evidence based medicine | Provide clarity for neurologists on how to care patients |
| Patient | + National guideline might be useful |
Differences between hospitals care (IFNβ not offered in every hospital; contradictory advises on lifestyle) | No common knowledge on MS Prognosis differs between individuals |
Improve or maintain quality of life |
a‘+’ actor defines the intervention meaningful; ‘−’ intervention is not meaningful