Table 2.

Views towards a national registry of MS patients or IFNβ users

Actor	Judgement of solutiona	Problem definition	Background theories	Normative values
Ministry of health (1996)	+ For evaluation long-term effects	Uncertainty on (meaning of) effects of IFNβ	Only medicines of which evidence of effectiveness is available at the expense of the community If no evidence on effectiveness, use is inappropriate	Efficiency
PAM Staff	+ Database with only limited patient data to take samples for research or Database with all relevant data for research	For each new medicine a study on effectiveness is inefficient Health insurance companies judged reimbursement requests differently, leading to difference in health care	Aim of national database to optimise IFNβ prescription: to monitor use of IFNβ in practice (which patients (indications), volume, costs) and to evaluate effectiveness IFNβ	Efficiency
PAM Staff (2003)	− Registration without central judgement committee difficult	Central committee no longer relevant No problems perceived	Central pre-utilisation judgement provides a minimal registration of patient data	Efficiency
Medical advisor of health insurance company	+ Prospective database only way to assess long-term effectiveness	Judgement of relative value as compared to alternative interventions not systematically but only in the neurologists head	Expensive drugs are financed from public funds Pharmaceutical industry’s power is underestimated	Clear vision from the ministry of health on pharmacy Quality of care
Neurologist	+ Meaningful for evaluating effectiveness of medicines and knowledge on MS National coverage might be difficult	Clinical trials have limited follow up period Distrust amongst neurologists	MS is a chronic disease, invalidating on long term MS neurologists have their own “kingdoms”	Quality of care Increase knowledge on disease and treatment

^a‘+’ actor defines intervention as meaningful; ‘−’ intervention is not meaningful