1
|
Sharda S, Gupta A, Jyani G, Prinja S, Goyal A. Modeling the cost-effectiveness of school-based supervised toothbrushing program in reducing the dental caries burden in India. Int J Paediatr Dent 2024. [PMID: 38807269 DOI: 10.1111/ipd.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Supervised toothbrushing (STB) significantly reduces the incidence and progression of dental caries. School years present a favorable age for introducing such healthy habits for a lifetime. AIM To estimate the cost-effectiveness of implementing a STB program in India in preventing dental caries incidence. DESIGN An operational framework of a national STB program was devised. A mathematical model was then developed to evaluate this program's clinical effectiveness and economic impact in the Indian scenario. This study considered a hypothetical cohort of the Indian population aged from 6 to 75 years. Two groups were compared: no intervention and STB in government schools. The health outcomes assessed were a number of tooth caries incidences averted and quality-adjusted life years gained. RESULTS The STB program in the government schools of India would prevent at least one tooth from developing caries in an individual's lifetime. Considering the current treatment-seeking behavior, the STB program saves INR 153 (US$ 1.95) per carious tooth incidence averted and INR 22 202 (US$ 283) per QALY gained. CONCLUSION In India, the school-based STB program is expected to be a cost-effective strategy for reducing the dental caries burden and its associated treatment costs.
Collapse
Affiliation(s)
- Shweta Sharda
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Arpit Gupta
- Unit of Public Health & Preventive Dentistry, Oral Health Sciences CentreI National Resource Centre for Oral Healthcare of Children & Elderly, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashima Goyal
- Head, Oral Health Sciences Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
2
|
Sharma A, Prinja S, Thakur R, Gupta D, Kaur R, Sharma S, Munjal S, Panda N. Healthcare Cost of Cochlear Implantation in India. Indian J Otolaryngol Head Neck Surg 2024; 76:1716-1723. [PMID: 38566707 PMCID: PMC10982277 DOI: 10.1007/s12070-023-04389-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/18/2023] [Indexed: 04/04/2024] Open
Abstract
Making evidence-based policy decisions is challenging when there is a lack of information, especially when deciding provider payment rates for publicly funded health insurance plans. Therefore, the goal of this study was to estimate the cost of a cochlear implant operation in a tertiary care setting in India. We also looked at the patients' out-of-pocket (OOP) expenses for the cochlear implant surgery. From the perspectives of the patients and the healthcare systems, we assessed the financial costs of the cochlear implantation procedure. A bottom-up pricing model was used to assess the cost that the healthcare system would bear for a cochlear implant procedure. Information on all the resources (both capital and ongoing) required to offer cochlear implantation services for hearing loss was gathered over the course of a year. 120 individuals with hearing loss who had cochlear implantation surgery disclosed their out-of-pocket (OOP) costs, which included both direct medical and non-medical expenses. All costs for the budgetary year 2018-2019 were anticipated. The unit health system spent ₹ 151($2), ₹ 578($7.34) and ₹ 37,449($478) on ear exams, audiological evaluations, and cochlear implant surgeries, respectively. Per bed-day in the otolaryngology ward, hospitalization cost ₹ 202($2.6), or ₹ 1211($15.5). The estimated average out-of-pocket cost for a cochlear implant operation was ₹ 682,230($8710). Our research can be used to establish package rates for publicly funded insurance plans in India, plan the growth of public sector hearing care services, and do cost-effectiveness assessments on various hearing care models. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04389-7.
Collapse
Affiliation(s)
- Anuradha Sharma
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Shankar Prinja
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravinder Thakur
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Dharna Gupta
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajwinder Kaur
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Sameer Sharma
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Munjal
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Naresh Panda
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| |
Collapse
|
3
|
Shafi M, Jan R, Gani KM. Selection of priority emerging contaminants in surface waters of India, Pakistan, Bangladesh, and Sri Lanka. CHEMOSPHERE 2023; 341:139976. [PMID: 37657704 DOI: 10.1016/j.chemosphere.2023.139976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023]
Abstract
The challenge of emerging contaminants (ECs) in global surface water bodies and particularly in low- and middle-income countries such as India, Pakistan, Bangladesh, and Sri Lanka, is evident from the literature. The complexity arises from the high costs involved in EC analysis and the extensive list of ECs, which complicates the selection of essential compounds for scientific and regulatory investigations. Consequently, monitoring programs often include ECs that may have minimal significance within a region and do not pose known or suspected ecological or human health risks. This study aims to address this issue by employing a multi-risk assessment approach to identify priority ECs in the surface waters of the aforementioned countries. Through an analysis of occurrence levels and frequency data gathered from published literature, an optimized risk quotient (RQ) was derived. The findings reveal a priority list of 38 compounds that exhibit potential environmental risks and merit consideration in future water quality monitoring programs. Furthermore, the majority of antibiotics in India (12 out of 17) and Pakistan (7 out of 17) exhibit a risk quotient for antimicrobial resistance selection (RQAMR) greater than 1, highlighting the need for devising effective strategies to mitigate the escalation of antibiotic resistance in the environment.
Collapse
Affiliation(s)
- Mozim Shafi
- Department of Civil Engineering, National Institute of Technology, Srinagar, Jammu, and Kashmir, 190006, India; Environmental Engineering and Management, Department of Civil Engineering, Indian Institute of Technology Kharagpur, Kharagpur, 721302, West Bengal, India
| | - Ruby Jan
- Department of Civil Engineering, National Institute of Technology, Srinagar, Jammu, and Kashmir, 190006, India
| | - Khalid Muzamil Gani
- Department of Civil Engineering, National Institute of Technology, Srinagar, Jammu, and Kashmir, 190006, India.
| |
Collapse
|
4
|
Sharma D, Prinja S, Aggarwal AK, Rajsekar K, Bahuguna P. Development of the Indian Reference Case for undertaking economic evaluation for health technology assessment. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 16:100241. [PMID: 37694178 PMCID: PMC10485782 DOI: 10.1016/j.lansea.2023.100241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/24/2023] [Accepted: 06/02/2023] [Indexed: 09/12/2023]
Abstract
Background Health technology assessment (HTA) is globally recognised as an important tool to guide evidence-based decision-making. However, heterogeneity in methods limits the use of any such evidence. The current research was undertaken to develop a set of standards for conduct of economic evaluations for HTA in India, referred to as the Indian Reference Case. Methods Development of the reference case comprised of a four-step process: (i) review of existing international HTA guidelines; (ii) systematic review of economic evaluations for three countries to assess adherence with pre-existing country-specific HTA guidelines; (iii) empirical analysis to assess the impact of alternate assumptions for key principles of economic evaluation on the results of cost-effectiveness analysis; (iv) stakeholder consultations to assess appropriateness of the recommendations. Based on the inferences drawn from the first three processes, a preliminary draft of the reference case was developed, which was finalised based on stakeholder consultations. Findings The Indian Reference Case provides twelve recommendations on eleven key principles of economic evaluation: decision problem, comparator, perspective, source of effectiveness evidence, measure of costs, health outcomes, time-horizon, discounting, heterogeneity, uncertainty analysis and equity analysis, and for presentation of results. The recommendations are user-friendly and have scope to allow for context-specific flexibility. Interpretation The Indian Reference Case is expected to provide guidance in planning, conducting, and reporting of economic evaluations. It is anticipated that adherence to the Reference Case would increase the quality and policy utilisation of future evaluations. However, with advancement in the field of health economics efforts aimed at refining the Indian Reference Case would be needed. Funding This research received no specific grant from any funding agency, commercial, or not-for-profit sectors. The research was undertaken as part of doctoral thesis of Sharma D, who received scholarship from the Indian Council of Medical Research (ICMR), New Delhi, India.
Collapse
Affiliation(s)
- Deepshikha Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun K. Aggarwal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
5
|
Rojas-Roque C, Palacios A. A Systematic Review of Health Economic Evaluations and Budget Impact Analyses to Inform Healthcare Decision-Making in Central America. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:419-440. [PMID: 36720754 DOI: 10.1007/s40258-023-00791-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Little is known about the quality, quantity and disease areas analysed by health economic research that inform healthcare decision-making in Central America. This study aimed to review the existing health economic evaluations (HEEs) and budget impact analyses (BIAs) evidence in Central America based on scope and reporting quality. METHODS HEEs and BIAs published from 2000 to April 2021 were searched in five electronic databases: PubMed, Embase, LILACS (Latin American and Caribbean Health Science Literature), EconLIT and OVID Global Health. Two reviewers assessed titles, abstracts and full texts of studies for eligibility. The quality appraisal for the reporting was based on La Torre and colleagues' version of the Drummond checklist and the ISPOR good practices for BIA. For each country, we correlated the number of studies by disease area with their respective burden of disease to identify under-researched health areas. RESULTS 102 publications were eligible for this review. Ninety-four publications reported a HEE, six publications reported a BIA, and two studies reported both a HEE and a BIA. Costa Rica had the highest number of publications (n = 28, 27.5%), followed by Guatemala (n = 25, 24.5%). Cancer and respiratory infections were the most common types of disease studied. Diabetes mellitus, chronic kidney diseases, and mental disorders were under-researched relative to their disease burden in most of the countries. The overall mean quality reporting score for HEE and BIA studies were 71/119 points (60%) and 7/10 points (70%), respectively; however, these assessments were made on different scales. CONCLUSION In Central America, health economic research is sparse and is considered as suboptimal quality for reporting. The findings reported information useful to other low- and middle-income countries with similar advances in the application of economics to promote health policy decision-making.
Collapse
Affiliation(s)
- Carlos Rojas-Roque
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina.
| | - Alfredo Palacios
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Facultad de Ciencias Económicas, Universidad de Buenos Aires, Buenos Aires, Argentina
- Centre for Health Economics (CHE), University of York, York, UK
| |
Collapse
|
6
|
Chugh Y, Bahuguna P, Sohail A, Rajsekar K, Muraleedharan VR, Prinja S. Development of a Health Technology Assessment Quality Appraisal Checklist (HTA-QAC) for India. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:11-22. [PMID: 36260276 PMCID: PMC9579659 DOI: 10.1007/s40258-022-00766-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We aim to develop a comprehensive checklist for evaluating Health Technology Assessment (HTA) studies commissioned in India. The primary objective of this work is to capture all vital aspects of an HTA study in terms of conduct, reporting and quality. METHODOLOGY The development of a quality appraisal checklist included 3 steps. First, a targeted review of the literature was done to gather information on existing HTA checklists. After reviewing these checklists, an initial draft of the HTA quality appraisal checklist (HTA-QAC) for India was prepared with discussion amongst the authors. Second, the draft checklist was reviewed by the members of the Technical Appraisal Committee (TAC) and their feedback was incorporated. Subsequently, the revised checklist was presented at a virtual meeting of the TAC. Finally, a pilot phase was undertaken to apply HTA-QAC for the approved HTA study reports. Three rounds of virtual discussions were held with the researchers who were involved in the conduct of these HTA studies to resolve any discordance in opinion or develop solutions for the problems in the use of the HTA-QAC followed by a further revision of the checklist. RESULTS The HTA-QAC is divided into two parts: a self-reporting section to be completed by the author, and the other to be completed by the reviewer. The reviewer checklist has two sections: one to review the report and the other to review the model. The author section is in a self-reporting format, which includes details of basic study information, the rationale for the study, policy relevance, study description, study methods, reporting of model parameters, and results. The reviewer section of the checklist focuses on the quality aspect of the conducted study. The domains included in the report review include details on study methodology, results, discussion, and conclusion. The second part of the reviewer section of HTA-QAC constitutes a review of the model in terms of model assumptions, functionality, model inputs, calculations, uncertainty analysis, model output, and model validation. CONCLUSION We recommend a standardised process of quality appraisal to ensure the high quality of HTA evidence for policy use in the Indian context. The proposed HTA-QAC will help authors to ensure standardised reporting, as well as allow reviewers to assess the quality of analysis.
Collapse
Affiliation(s)
- Yashika Chugh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Aamir Sohail
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - V R Muraleedharan
- Centre for Technology and Policy, Indian Institute of Technology, Chennai, Tamil Nadu, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
- Government of India, National Health Authority, New Delhi, India.
| |
Collapse
|
7
|
Prinja S, Sharma A, Nadipally S, Rana SK, Bahuguna P, Rao N, Chakraborty G, Shankar M, Rai V. Impact and cost-effectiveness evaluation of nutritional supplementation and complementary interventions for tuberculosis treatment outcomes under mukti pay-for-performance model in Madhya Pradesh, India: A study protocol. Int J Mycobacteriol 2023; 12:82-91. [PMID: 36926768 DOI: 10.4103/2212-5531.307071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background A. "pay-for-performance" (P4P) intervention model for improved tuberculosis (TB) outcomes, called "Mukti," has been implemented in an underdeveloped tribal area of central India. The target of this project is to improve nutritional status, quality of life (QoL), and treatment outcomes of 1000 TB patients through four interventions: food baskets, personal counseling, peer-to-peer learning and facilitation for linkage to government schemes. The current study aims to assess the success of this model by evaluating its impact and cost-effectiveness using a quasi-experimental approach. Methods Data for impact assessment have been collected from 1000 intervention and control patients. Study outcomes such as treatment completion, sputum negativity, weight gain, and health-related QoL will be compared between matched samples. Micro costing approach will be used for assessing the cost of routine TB services provision under the national program and the incremental cost of implementing our interventions. A decision and Markov hybrid model will estimate long-term costs and health outcomes associated with the use of study interventions. Measures of health outcomes will be mortality, morbidity, and disability. Cost-effectiveness will be assessed in terms of incremental cost per quality-adjusted life-years gained and cost per unit increase in patient weight in intervention versus control groups. Results The evidence generated from the present study in terms of impact and cost-effectiveness estimates will thus help to identify not only the effectiveness of these interventions but also the optimal mode of financing such measures. Our estimates on scale-up costs for these interventions will also help the state and the national government to consider scale-up of such interventions in the entire state or country. Discussion The study will generate important evidence on the impact of nutritional supplementation and other complementary interventions for TB treatment outcomes delivered through P4P financing models and on the cost of scaling up these to the state and national level in India.
Collapse
Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer Nadipally
- Partnership for Affordable Healthcare, Access and Longevity, IPE Global Pvt. Ltd, New Delhi, India
| | - Saroj Kumar Rana
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India; School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Neeta Rao
- US Agency for International Development, New Delhi, India
| | | | - Manjunath Shankar
- Partnership for Affordable Healthcare, Access and Longevity, IPE Global Pvt. Ltd, New Delhi, India
| | - Varsha Rai
- State TB Office, National Tuberculosis Elimination Program, Government of Madhya Pradesh, India
| |
Collapse
|
8
|
Shah K, Singh M, Kotwani P, Tyagi K, Pandya A, Saha S, Saxena D, Rajshekar K. Comprehensive league table of cost-utility ratios: A systematic review of cost-effectiveness evidence for health policy decisions in India. Front Public Health 2022; 10:831254. [PMID: 36311623 PMCID: PMC9606776 DOI: 10.3389/fpubh.2022.831254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/22/2022] [Indexed: 01/21/2023] Open
Abstract
Background and objectives Although a relatively recent concept for developing countries, the developed world has been using League Tables as a policy guiding tool for a comprehensive assessment of health expenditures; country-specific "League tables" can be a very useful tool for national healthcare planning and budgeting. Presented herewith is a comprehensive league table of cost per Quality Adjusted Life Years (QALY) or Disability Adjusted Life Years (DALY) ratios derived from Health Technology Assessment (HTA) or economic evaluation studies reported from India through a systematic review. Methods Economic evaluations and HTAs published from January 2003 to October 2019 were searched from various databases. We only included the studies reporting common outcomes (QALY/DALY) and methodology to increase the generalizability of league table findings. To opt for a uniform criterion, a reference case approach developed by Health Technology Assessment in India (HTAIn) was used for the reporting of the incremental cost-effectiveness ratio. However, as, most of the articles expressed the outcome as DALY, both (QALY and DALY) were used as outcome indicators for this review. Results After the initial screening of 9,823 articles, 79 articles meeting the inclusion criteria were selected for the League table preparation. The spectrum of intervention was dominated by innovations for infectious diseases (33%), closely followed by maternal and child health (29%), and non-communicable diseases (20%). The remaining 18% of the interventions were on other groups of health issues, such as injuries, snake bites, and epilepsy. Most of the interventions (70%) reported DALY as an outcome indicator, and the rest (30%) reported QALY. Outcome and cost were discounted at the rate of 3 by 73% of the studies, at 5 by 4% of the studies, whereas 23% of the studies did not discount it. Budget impact and sensitivity analysis were reported by 18 and 73% of the studies, respectively. Interpretation and conclusions The present review offers a reasonably coherent league table that reflects ICER values of a range of health conditions in India. It presents an update for decision-makers for making decisions about resource allocation.
Collapse
Affiliation(s)
- Komal Shah
- Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, India,*Correspondence: Komal Shah
| | - Malkeet Singh
- HTAIn Secretariat-Department of Health Research, New Delhi, India
| | | | - Kirti Tyagi
- HTAIn Secretariat-Department of Health Research, New Delhi, India
| | - Apurvakumar Pandya
- Faculty of Medicine, Parul Institute of Public Health, Parul University, Vadodara, India
| | - Somen Saha
- Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, India
| | - Deepak Saxena
- Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, India
| | | |
Collapse
|
9
|
Jiang X, Jackson LJ, Syed MA, Avşar TS, Abdali Z. Economic evaluations of tobacco control interventions in low- and middle-income countries: a systematic review. Addiction 2022; 117:2374-2392. [PMID: 35257422 DOI: 10.1111/add.15821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Tobacco consumption and its associated adverse outcomes remain major public health issues, particularly in low- and middle-income countries. This systematic review aimed to identify and critically assess full economic evaluations for tobacco control interventions in low- and middle-income countries. METHODS Electronic databases, including EMBASE, MEDLINE and PsycINFO and the grey literature, were searched using terms such as 'tobacco', 'economic evaluation' and 'smoking' from 1994 to 2020. Study quality was assessed using the Consensus Health Economic Criteria and the Philips checklist. Studies were included which were full economic evaluations of tobacco control interventions in low- and middle-income settings. Reviews, commentaries, conference proceedings and abstracts were excluded. Study selection and quality assessment were conducted by two reviewers independently. A narrative synthesis was conducted to synthesize the findings of the studies. RESULTS This review identified 20 studies for inclusion. The studies evaluated a wide range of interventions, including tax increase, nicotine replacement therapy (nicotine patch/gum) and financial incentives. Overall, 12 interventions were reported to be cost-effective, especially tax increases for tobacco consumption and cessation counselling. There were considerable limitations regarding data sources (e.g. using cost data from other countries or assumptions due to the lack of local data) and the model structure; sensitivity analyses were inadequately described in many studies; and there were issues around the transferability of results to other settings. Additionally, the affordability of the interventions was only discussed in two studies. CONCLUSIONS There are few high-quality studies of the cost-effectiveness of tobacco use control interventions in low- and middle-income countries. The methodological limitations of the existing literatures could affect the generalizability of the findings.
Collapse
Affiliation(s)
- Xiaobin Jiang
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Muslim Abbas Syed
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tuba Saygın Avşar
- Department of Applied Health Research, University College London, London, UK
| | - Zainab Abdali
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
10
|
Jyani G, Sharma A, Prinja S, Kar SS, Trivedi M, Patro BK, Goyal A, Purba FD, Finch AP, Rajsekar K, Raman S, Stolk E, Kaur M. Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study: The Indian 5-Level Version EQ-5D Value Set. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1218-1226. [PMID: 35779943 DOI: 10.1016/j.jval.2021.11.1370] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 05/19/2023]
Abstract
OBJECTIVES This study aimed to develop the Indian 5-level version EQ-5D (EQ-5D-5L) value set, which is a key input in health technology assessment for resource allocation in healthcare. METHODS A cross-sectional survey using the EuroQol Group's Valuation Technology was undertaken in a representative sample of 3548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. The participants were interviewed using a computer-assisted personal interviewing technique. This study adopted a novel extended EuroQol Group's Valuation Technology design that included 18 blocks of 10 composite time trade-off (c-TTO) tasks, comprising 150 unique health states, and 36 blocks of 7 discrete choice experiment (DCE) tasks, comprising 252 DCE pairs. Different models were explored for their predictive performance. Hybrid modeling approach using both c-TTO and DCE data was used to estimate the value set. RESULTS A total of 2409 interviews were included in the analysis. The hybrid heteroscedastic model with censoring at -1 combining c-TTO and DCE data yielded the most consistent results and was used for the generation of the value set. The predicted values for all 3125 health states ranged from -0.923 to 1. The preference values were most affected by the pain/discomfort dimension. CONCLUSIONS This is the largest EQ-5D-5L valuation study conducted so far in the world. The Indian EQ-5D-5L value set will promote the effective conduct of health technology assessment studies in India, thereby generating credible evidence for efficient resource use in healthcare.
Collapse
Affiliation(s)
- Gaurav Jyani
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sitanshu Sekhar Kar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Mayur Trivedi
- Indian Institute of Public Health, Gandhinagar, India
| | | | - Aarti Goyal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Fredrick Dermawan Purba
- Department of Developmental Psychology, Faculty of Psychology, Universitas Padjadjaran, Indonesia
| | | | - Kavitha Rajsekar
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Swati Raman
- Academy of Management Studies, Lucknow, India
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
11
|
Cost-Utility Analysis of Dabigatran and Warfarin for Stroke Prevention Among Patients With Nonvalvular Atrial Fibrillation in India. Value Health Reg Issues 2022; 31:119-126. [PMID: 35667196 DOI: 10.1016/j.vhri.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/11/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Dabigatran has a better safety profile and requires less monitoring, but is costlier than warfarin. This study evaluated the cost-utility of dabigatran relative to warfarin for preventing stroke in nonvalvular atrial fibrillation (NVAF) in India. METHODS A Markov decision analysis model was developed to compare dabigatran (110 or 150 mg twice a day) to warfarin titrated to target prothrombin time in patients with NVAF at high risk of stroke. Model utilities and transition probabilities were based on literature and costs on market prices. Data on out-of-pocket expenses and income lost were taken from a nationally representative survey. We adopted a societal perspective and discounted both costs and outcomes at 3%. Ischemic stroke, intracranial bleed, other major bleeds, and death were outcomes of NVAF. The model projected the costs, life-years, and quality-adjusted life-years (QALYs) for each intervention over a lifetime. We used gross domestic product per capita of India (US dollars [US$]1889) as the cost-effectiveness threshold. Sensitivity analyses were conducted. RESULTS Treatment with either dose of dabigatran was associated with gain in life-years and QALYs compared with warfarin. The discounted incremental cost-effectiveness ratios/QALYs for both doses of dabigatran (110 mg US$7519; 150 mg US$6634) were above the cost-effectiveness threshold, and the probability of being cost-effective at this threshold was low. Cost of dabigatran was an important factor in determining incremental cost-effectiveness ratio. Price reduction of 150 mg dose by 49% will make it cost-effective. CONCLUSIONS Dabigatran is not cost-effective in the Indian societal context. Reducing the price of dabigatran 150 mg by half will make it cost-effective.
Collapse
|
12
|
Bhatia H, Dharmagadda S. Health Technology Assessment in India: Necessity, Progress and Future Plans. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221087787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The implementation of a universal healthcare coverage by the Indian government has forced a relook into the existing systems of healthcare decision-making. Health technology assessment (HTA) is being looked at to provide efficient decision-making and helping in priority setting for the policymakers. The Ministry of Health and Family Welfare has, therefore established a Medical Technology Assessment Board as a way of institutionalising the HTA framework and methodology in India. Despite some challenges, the future looks bright for HTA in India.
Collapse
Affiliation(s)
- Hardik Bhatia
- Department of Pharmacy Management, Manipal College of Pharmaceutical Sciences, MAHE, Manipal, Karnataka, India
| | - Sreedhar Dharmagadda
- Department of Pharmacy Management, Manipal College of Pharmaceutical Sciences, MAHE, Manipal, Karnataka, India
| |
Collapse
|
13
|
Erku D, Mersha AG, Ali EE, Gebretekle GB, Wubshet BL, Kassie GM, Mulugeta A, Mekonnen AB, Eshetie TC, Scuffham P. A Systematic Review of Scope and Quality of Health Economic Evaluations Conducted in Ethiopia. Health Policy Plan 2022; 37:514-522. [PMID: 35266523 PMCID: PMC9128743 DOI: 10.1093/heapol/czac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/16/2021] [Accepted: 02/20/2022] [Indexed: 11/13/2022] Open
Abstract
There has been an increased interest in health technology assessment and economic evaluations for health policy in Ethiopia over the last few years. In this systematic review, we examined the scope and quality of healthcare economic evaluation studies in Ethiopia. We searched seven electronic databases (PubMed/MEDLINE, EMBASE, PsycINFO, CINHAL, Econlit, York CRD databases and CEA Tufts) from inception to May 2021 to identify published full health economic evaluations of a health-related intervention or programme in Ethiopia. This was supplemented with forward and backward citation searches of included articles, manual search of key government websites, the Disease Control Priorities-Ethiopia project and WHO-CHOICE programme. The quality of reporting of economic evaluations was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. The extracted data were grouped into subcategories based on the subject of the economic evaluation, organized into tables and reported narratively. This review identified 34 full economic evaluations conducted between 2009 and 2021. Around 14 (41%) of studies focussed on health service delivery, 8 (24%) on pharmaceuticals, vaccines and devices, and 4 (12%) on public-health programmes. The interventions were mostly preventive in nature and focussed on communicable diseases (n = 19; 56%) and maternal and child health (n = 6; 18%). Cost-effectiveness ratios varied widely from cost-saving to more than US $37 313 per life saved depending on the setting, perspectives, types of interventions and disease conditions. While the overall quality of included studies was judged as moderate (meeting 69% of CHEERS checklist), only four out of 27 cost-effectiveness studies characterized heterogeneity. There is a need for building local technical capacity to enhance the design, conduct and reporting of health economic evaluations in Ethiopia.
Collapse
Affiliation(s)
- Daniel Erku
- Centre for Applied Health Economics, Griffith University, Nathan, QLD
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
- Addis Consortium for Health Economics and Outcomes Research (AnCHOR)
| | - Amanual G Mersha
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Eskindir Eshetu Ali
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University
| | - Gebremedhin B Gebretekle
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Befikadu L Wubshet
- Health Services Research Centre Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Gizat Molla Kassie
- University of South Australia: Clinical & Health Sciences, Quality Use of Medicines and Pharmacy Research Centre
| | - Anwar Mulugeta
- Australian Centre for Precision Health, Unit of Clinical and Health Sciences, University of South Australia, Adelaide, Australia, SA 5000, Australia
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa 1000, Ethiopia
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Alemayehu B Mekonnen
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, VIC, Australia
| | - Tesfahun C Eshetie
- Plein Center for Geriatric Pharmacy Research, Education and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Paul Scuffham
- Centre for Applied Health Economics, Griffith University, Nathan, QLD
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
| |
Collapse
|
14
|
Khurana T, Gupta A, Rathi H. The state of cost-utility analysis in India: A systematic review. Perspect Clin Res 2021; 12:179-183. [PMID: 34760643 PMCID: PMC8525785 DOI: 10.4103/picr.picr_256_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022] Open
Abstract
Aims: Cost-utility studies are crucial tools that help policy-makers promote appropriate resource allocation. The objective of this study was to evaluate the extent and quality of cost-utility analysis (CUA) in India through a systematic literature review. Methods: Comprehensive database search was conducted to identify the relevant literature published from November 2009 to November 2019. Gray literature and hand searches were also performed. Two researchers independently reviewed and assessed study quality using Consolidated Health Economic Evaluation Reporting Standards checklist. Results: Thirty-five studies were included in the final review. Thirteen studies used Markov model, five used decision tree model, four used a combination of decision tree and Markov model and one each used microsimulation and dynamic compartmental model. The primary therapeutic areas targeted in CUA were infectious diseases (n = 12), ophthalmology (n = 5), and endocrine disorders (n = 4). Five studies were carried out in Tamil Nadu, four in Goa, three in Punjab, two each in Delhi, Maharashtra, and Uttar Pradesh, and one each in West Bengal and Karnataka. Twenty-three, eight, and four studies were found to be of excellent, very good, and good quality, respectively. The average quality score of the studies was 19.21 out of 24. Conclusions: This systematic literature review identified the published CUA studies in India. The overall quality of the included studies was good; however, features such as subgroup analyses and explicit study perspective were missing in several evaluations.
Collapse
Affiliation(s)
- Tanu Khurana
- Health Economics and Outcomes Research, Skyward Analytics Private Limited, Gurgaon, Haryana, India
| | - Amit Gupta
- Health Economics and Outcomes Research, Skyward Analytics Private Limited, Gurgaon, Haryana, India
| | - Hemant Rathi
- Health Economics and Outcomes Research, Skyward Analytics Private Limited, Gurgaon, Haryana, India.,Health Economics and Outcomes Research, Skyward Analytics Pte. Limited Singapore, Singapore
| |
Collapse
|
15
|
Economic impact And SafetY of Same-Day Discharge following percutaneous coronary intervention: A tertiary care centre experience from northern India (EASY-SDD). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:71-77. [PMID: 34776354 DOI: 10.1016/j.carrev.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The literature about the safety and feasibility of same-day discharge (SDD) following complex percutaneous coronary intervention (PCI) and in acute coronary syndrome (ACS) is scarce. The economic impact of SDD has not been evaluated in this geographical region. We in the present study evaluated the safety, feasibility, and economic impact of SDD following PCI at a tertiary care centre of north India. METHODS It was a single-centre, non-randomized, prospective study, in which all consecutive PCI patients during the study period of 15 months were evaluated for SDD using a "patient-centred" approach. The patients who were discharged on the next calendar day were included in the next day discharge (NDD) group. The baseline demographic data including coronary risk factors, clinical presentation, and management details were noted for all patients. All patients were followed up for 6 weeks. The Indian health system is only partially insured, hence most of the expendable costs are borne by patients. In the present study, we computed the total societal expenditure of each PCI which includes both the health system costs and the expenditure borne by the patients. A standardized tool and bottoms up costing method were used for recording out-of-pocket expenditure (OOPE) by the patients and health care expenditure respectively. RESULTS Out of a total of 675 PCI patients, 617 patients were enrolled in the study, and 132/617 (21.39%) patients were discharged the same day. Sixty-five % of patients (86/132) in the SDD cohort and 70% of patients (337/485) in the NDD cohort presented with ACS. Baseline characteristics in the two cohorts were identical. A higher syntax score, greater number of stents, and longer stented segment predicted the NDD. The mean length of stay after PCI in patients with SDD and NDD was 8.71 ± 2.48 and 21.76 ± 2.42 h, respectively. In the SDD group, there were no readmissions or adverse events after discharge till 6 weeks of follow-up. The total mean cost of PCI (health care system and OOPE) for SDD and NDD was Indian Rupees (INR) 129,322.14 [United States dollar (US$) 1810.51] and INR 165500.71 [US$ 2317.01] respectively. An amount of INR 36178.57 (health system cost: INR 10242.76 and OOPE: INR 25935.71 was saved for each SDD. Besides 100 cardiac unit bed days including 85 intensive cardiac care bed days were saved with 21% SDD in the present cohort. CONCLUSION Post PCI SDD is safe and feasible in selected ACS/chronic stable angina patients using the "patient-centred" approach. Besides, decreasing OOPE for the patients, SDD also helps in the efficient use of scarce health system resources.
Collapse
|
16
|
Butani D, Gupta N, Jyani G, Bahuguna P, Kapoor R, Prinja S. Cost-effectiveness of Tamoxifen, Aromatase Inhibitor, and Switch Therapy (Adjuvant Endocrine Therapy) for Breast Cancer in Hormone Receptor Positive Postmenopausal Women in India. BREAST CANCER: TARGETS AND THERAPY 2021; 13:625-640. [PMID: 34866937 PMCID: PMC8636459 DOI: 10.2147/bctt.s331831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022]
Abstract
Background Breast cancer is the leading cause of cancer among women in India. Treatment with hormone therapy reduces recurrence. We undertook this cost-effectiveness study to ascertain the treatment option offering the best value for money. Methods The lifetime costs and health outcomes of using tamoxifen, AI and switch therapy were measured in a cohort of 50-year-old women with HR-positive early stage breast cancer. A Markov model of disease was developed using a societal perspective with a lifetime study horizon. Local, contralateral, and distant recurrence were modelled along with treatment related adverse effects. Primary data collected to obtain estimates of out-of-pocket expenditure (OOPE) and utility weights. Both health system cost and OOPE were included. The future costs and consequences were discounted at 3%. A probabilistic sensitivity analysis was used. Results The lifetime cost of hormone therapy with tamoxifen, AI and switch therapy was to be ₹1,472,037 (I$ 68,947), ₹1,306,794 (I$ 61,208) and ₹1,281,811 (I$ 60,038). The QALYs lived per patient receiving tamoxifen, AI and switch were 13.12, 13.42 and 13.32. tamoxifen was found to be more expensive and less effective. As compared to switch therapy, AI for five years incurred an incremental cost of ₹259,792 (I$12,168) per QALY gained. At the willingness to pay equals to per capita GDP of India, there is 55% probability of AI therapy to be cost-effective compared to switch therapy. Conclusion In postmenopausal women with HR-positive early-stage breast cancer, switch therapy is recommended for use on the basis of cost-effectiveness.
Collapse
Affiliation(s)
- Dimple Butani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiation Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Correspondence: Shankar Prinja Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaTel +91 9872871978 Email
| |
Collapse
|
17
|
Baek Y, Ademi Z, Paudel S, Fisher J, Tran T, Romero L, Owen A. Economic Evaluations of Child Nutrition Interventions in Low- and Middle-Income Countries: Systematic Review and Quality Appraisal. Adv Nutr 2021; 13:282-317. [PMID: 34510178 PMCID: PMC8803532 DOI: 10.1093/advances/nmab097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/24/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Abstract
Economic evaluation is crucial for cost-effective resource allocation to improve child nutrition in low and middle-income countries (LMICs). However, the quality of published economic evaluations in these settings is not well understood. This systematic review aimed to assess the quality of existing economic evaluations of child nutrition interventions in LMICs and synthesize the study characteristics and economic evidence. We searched 9 electronic databases, including MEDLINE, with the following concepts: economic evaluation, children, nutrition, and LMICs. All types of interventions addressing malnutrition, including stunting, wasting, micronutrient deficiency, and overweight, were identified. We included economic evaluations that examined both costs and effects published in English peer-reviewed journals and used the Drummond checklist for quality appraisal. We present findings through a narrative synthesis. Sixty-nine studies with diverse settings, perspectives, time horizons, and outcome measures were included. Most studies used data from sub-Saharan Africa and South Asia and addressed undernutrition. The mortality rate, intervention effect, intervention coverage, cost, and discount rate were reported as predictors among studies that performed sensitivity analyses. Despite the heterogeneity of included studies and the possibility of publication bias, 81% of included studies concluded that nutrition interventions were cost-effective or cost-beneficial, mostly based on a country's cost-effectiveness thresholds. Regarding quality assessment, the studies published after 2016 met more criteria than studies published before 2016. Most studies had well-stated research questions, forms of economic evaluation, interventions, and conclusions. However, reporting the perspective of the analyses, justification of discount rates, and describing the role of funders and ethics approval were identified as areas needing improvement. The gaps in the quality of reporting could be improved by consolidated guidance on the publication of economic evaluations and the use of appropriate quality appraisal checklists. Strengthening the evidence base for child malnutrition across different regions is necessary to inform cost-effective investment in LMICs. Trial registration: PROSPERO CRD42020194445.
Collapse
Affiliation(s)
- Yeji Baek
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan Paudel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | | |
Collapse
|
18
|
Sharma D, Aggarwal AK, Downey LE, Prinja S. National Healthcare Economic Evaluation Guidelines: A Cross-Country Comparison. PHARMACOECONOMICS - OPEN 2021; 5:349-364. [PMID: 33423205 PMCID: PMC8333164 DOI: 10.1007/s41669-020-00250-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Globally, a number of countries have developed guidelines that describe the design and conduct of economic evaluations as part of health technology assessment (HTA) or pharmacoeconomic analysis for decision making. The current scoping review was undertaken with an objective to summarize the recommendations made on methods of economic evaluation by the national healthcare economic evaluation (HEE) guidelines. METHODOLOGY A comprehensive search was undertaken in the website repositories of the International Society for Pharmacoeconomic and Outcomes Research (ISPOR) and Guide to Economic Analysis and Research (GEAR), and websites of national HTA agencies and ministries of health of individual countries. All guidelines in the English language were included in this review. Data were extracted with respect to general and methodological characteristics, and a descriptive analysis of recommendations made across the countries was undertaken. RESULTS Overall, our review included 31 national HEE guidelines, published between 1997 and August 2020. Nearly half (45%) of the guidelines targeted the evaluation of pharmaceuticals. The nature of the guidelines was either mandatory (31%), recommendatory (42%), or voluntary (16%). There was a substantial consensus among the guidelines on several key principles, including type of economic evaluation (cost-utility analysis), time horizon of the analysis (long enough), health outcome measure (quality-adjusted life-years) and use of sensitivity analyses. The recommendations on study perspective, comparator, discount rate and type of costs to be included (particularly the inclusion of indirect costs) varied widely. CONCLUSION Despite similarity in the overall processes, variation in several recommendations given by various national HEE guidelines was observed. This is perhaps unsurprising given the differences in the health systems and financing mechanisms, capacity of local researchers, and data availability. This review offers important lessons and a starting point for countries that are planning to develop their own HEE guidelines.
Collapse
Affiliation(s)
- Deepshikha Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Arun Kumar Aggarwal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | | | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| |
Collapse
|
19
|
Gupta N, Prinja S, Patil V, Bahuguna P. Cost-Effectiveness of Temozolamide for Treatment of Glioblastoma Multiforme in India. JCO Glob Oncol 2021; 7:108-117. [PMID: 33449801 PMCID: PMC8081547 DOI: 10.1200/go.20.00288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Glioblastoma multiforme (GBM) has poor outcomes following surgery and radiation. Adjuvant temozolamide along with radiation therapy has been shown to improve survival. In this paper, we evaluate the cost-effectiveness of concomitant temozolamide with radiation and maintenance temozolamide for 6 months of treatment for GBM in India. MATERIALS AND METHODS We used a Markov model to evaluate the lifetime costs and consequences of treating GBM with radiation alone versus radiation with adjuvant temozolamide. The model was calibrated using the published evidence from European Organisation for Research and Treatment of Cancer-NCIC trial on progression-free survival and overall survival to estimate the life years (LYs) and quality-adjusted LYs (QALYs). Cost of treatment and management of complications were estimated using the data from the National Health System Cost Database and Indian studies. Future cost and consequences were discounted at 3%. Incremental cost per QALY gained with temozolamide was estimated to assess cost effectiveness. RESULTS Temozolamide resulted in an increase of 0.59 (0.53-0.66) LY and 0.33 (0.29-0.40) QALY per person at an incremental cost of ₹75,120 in Indian national rupee (INR) (59,337-93,960). Overall, the use of temozolamide incurs an incremental cost of ₹212,020 INR (138,127-401,466) per QALY gained, which has a 4.7% probability to be cost-effective at 1-time per capita Gross Domestic Product (GDP) threshold. In case the current price of temozolamide could be decreased by 90%, the probability of its use for GBM being cost-effective increases to 80%. CONCLUSION Temozolamide is not cost-effective for treatment of patients with GBM in India. This evidence should be used while framing guidelines for treatment and price regulation.
Collapse
Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
20
|
Nagi MA, Luangsinsiri C, Thavorncharoensap M. A systematic review of economic evaluations of vaccines in Middle East and North Africa countries: is existing evidence good enough to support policy decision-making? Expert Rev Pharmacoecon Outcomes Res 2021; 21:1159-1178. [PMID: 34252335 DOI: 10.1080/14737167.2021.1954508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION A vaccine introduction process should be systematic and transparent and take into account many factors, including cost-effectiveness evidence. This study aimed to assess quantity, characteristic, and quality of economic evaluation (EE) studies on vaccines performed in Middle East and North Africa (MENA) countries. AREAS COVERED PubMed and Scopus electronic databases were searched since inception to December 2019 to identify published EE studies of vaccines, which were conducted in the 26 MENA countries. Methodological quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. EXPERT OPINION Of the 616 studies identified, 46 were included in the review. Most studies (65%) were conducted in Iran, Israel, and Turkey. The most commonly evaluated vaccines were rotavirus vaccine (n = 15; 33%), human Papillomavirus vaccine (n = 8; 17%), and pneumococcal vaccine (n = 7; 15%). We classified 5 (11%), 27 (59%), 12 (26%), and 2 (4%) studies as excellent, good, moderate, and poor quality, respectively. There were limited cost-effectiveness evidences in the region. It is imperative to have local guidelines on good practice and reporting, availability of local data, and funding sources to improve quantity and quality of EE studies of vaccines in the region, thereby, facilitating transparent and consistent decision-making processes.
Collapse
Affiliation(s)
- Mouaddh Abdulmalik Nagi
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.,Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen
| | - Chaisiri Luangsinsiri
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.,Department of Clinical Pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Montarat Thavorncharoensap
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Rajathevi, Bangkok, Thailand
| |
Collapse
|
21
|
Gupta N, Verma RK, Gupta S, Prinja S. Cost Effectiveness of Trastuzumab for Management of Breast Cancer in India. JCO Glob Oncol 2021; 6:205-216. [PMID: 32045547 PMCID: PMC7051799 DOI: 10.1200/jgo.19.00293] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE We undertook this study to evaluate the incremental cost per quality-adjusted life-year (QALY) gained with use of adjuvant trastuzumab as compared with chemotherapy alone among patients with nonmetastatic breast cancer in India. METHODS We used a Markov model to estimate the incremental cost of using trastuzumab (for 1 year, 6 months, or 9 weeks) as compared with chemotherapy alone using a societal perspective, excluding indirect productivity losses. Although the outcomes (QALYs) in the standard chemotherapy arm were estimated after calibrating the model as per survival data from 2 Indian cancer registries, effectiveness estimates from the HERA trial and a joint analysis of the NSABP B-31 and NCCTG N9831 trials were used to estimate the consequences of 1-year trastuzumab use. The cost of treatment was estimated using national standard treatment guidelines and real-world use estimates for different treatment modalities as per data from Indian cancer registries. Probabilistic sensitivity analysis was undertaken to evaluate parameter uncertainty. RESULTS For 1 year of trastuzumab use, the incremental benefit per patient, incremental cost per QALY gained, and probability of being cost effective using HERA trial estimates were 1.29 QALYs, 178,877 Indian national rupees (INRs; US$2,558), and 4%, respectively, whereas the corresponding figures using joint analysis estimates were 1.69 QALYs, INR 134,413 (US$1,922), and 57.3%, respectively. CONCLUSION Use of trastuzumab for 1 year is not cost effective in India at the current price. However, trastuzumab use for 9 weeks is cost effective and should be included in clinical guidelines and reimbursement policies. A price reduction of 15% to 35% increases the probability of 1-year trastuzumab use being cost effective, to 90%.
Collapse
Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Rohan Kumar Verma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudeep Gupta
- Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
22
|
Adherence to country-specific guidelines among economic evaluations undertaken in three high-income and middle-income countries: a systematic review. Int J Technol Assess Health Care 2021; 37:e73. [PMID: 34193325 DOI: 10.1017/s0266462321000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the adherence of economic evaluations to the recommendations on principles of economic evaluation as stated in the country-specific guidelines for three countries across different income groups, namely, Canada, South Africa, and Egypt. METHODS Searches were undertaken in three databases to identify economic evaluations meeting predefined inclusion criteria. Methodological and reporting standards listed in the country-specific guidelines were converted into discrete binary variables to calculate mean adherence scores. Quality appraisal was done using Drummond's checklist. Stratified analysis was undertaken to identify independent variables affecting adherence. RESULTS We identified forty-four, seventy-nine, and sixteen economic evaluations for Canada, South Africa, and Egypt, respectively. The mean adherence score was the highest for Canada (71%), followed by South Africa (65%) and Egypt (60%). Adherence to guidelines was positively correlated with quality of studies, r = .72. Furthermore, the mean adherence score was significantly (p < .05) higher for studies using a cost-utility analysis design (72%), having local/national funding aid (72%), undertaken by a health economist (71%) and for pharmacoeconomic evaluations (70%). CONCLUSION The quality of economic evaluations improves with adherence to country-specific guidelines. Locally funded and health-economist led health technology assessments (HTAs) should be encouraged for greater adherence to the guidelines. The HTA researchers and the HTA bodies should lay emphasis on adherence to the country-specific guidelines for improving the quality of HTA evidence.
Collapse
|
23
|
Prinja S, Jyani G, Gupta N, Rajsekar K. Adapting health technology assessment for drugs, medical devices, and health programs: Methodological considerations from the Indian experience. Expert Rev Pharmacoecon Outcomes Res 2021; 21:859-868. [PMID: 33882762 DOI: 10.1080/14737167.2021.1921575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Heterogeneity in methods of economic evaluation makes the use of health technology assessment (HTA) evidence difficult. Thereby, several countries including India have developed their own standard guidelines for conducting HTAs. However, diverse HTA studies involving drugs, medical devices, health programs, and platforms require an adaptation of the standard methods. AREAS COVERED This review presents the specific characteristics of HTAs involving medical devices and health programs requiring adaptation of the standard guidelines. We use recent HTA studies in India to illustrate specific issues. These considerations involve the nature of decision-making problems, multiple scenarios in case of health programs, and specific attention to costing and the valuation of consequences. In case of medical devices, we discuss the issue of costing application of devices, multiple usage, learning curve for achieving effects, long causal path for health outcomes, and the issue of valuing false positives. EXPERT OPINION While standard guidelines are essential, specific features of health programs and medical devices need to be considered while undertaking HTAs. Additionally, the context in which the HTA is being undertaken, characteristics of the health system, methods of financing healthcare, and demand-side characteristics of healthcare utilization should be reflected in the HTA for health programs and medical devices.
Collapse
Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| |
Collapse
|
24
|
Prinja S, Singh MP, Rajsekar K, Sachin O, Gedam P, Nagar A, Bhargava B. Translating Research to Policy: Setting Provider Payment Rates for Strategic Purchasing under India's National Publicly Financed Health Insurance Scheme. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:353-370. [PMID: 33462775 DOI: 10.1007/s40258-020-00631-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND In 2018, the Government of India launched Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY), a large tax-funded health insurance scheme. In this paper, we present findings of the Costing of Health Services in India (CHSI) study, describe the process of use of cost evidence for price-setting under AB PM-JAY, and estimate its fiscal impact. METHODS Reference costs were generated from the first phase of CHSI study, which sampled 11 tertiary public hospitals from 11 Indian states. Cost for Health Benefit Packages (HBPs) was estimated using mixed (top-down and bottom-up) micro-costing methods. The process adopted for price-setting under AB PM-JAY was observed. The cost of each HBP was compared with AB PM-JAY prices before and after the revision, and the budgetary impact of this revision in prices was estimated. FINDINGS Following the CHSI study evidence and price consultations, 61% of AB PM-JAY HBP prices were increased while 18% saw a decline in the prices. In absolute terms, the mean increase in HBP price was ₹14,000 (₹450-₹1,65,000) and a mean decline of ₹6,356 (₹200-₹74,500) was observed. Nearly 42% of the total HBPs, in 2018, had a price that was less than 50% of the true cost, which declined to 20% in 2019. The evidence-informed revision of HBP prices is estimated to have a minimal fiscal impact (0.7%) on the AB PM-JAY claims pay-out. INTERPRETATION Evidence-informed price-setting helped to reduce wide disparities in cost and price, as well as aligning incentives towards broader health system goals. Such strategic purchasing and price-setting requires the creation of systems of generating evidence on the cost of health services. Further research is recommended to develop a cost-function to study changes in cost with variations in time, region, prices, skill-mix and other factors.
Collapse
Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
| | - Maninder Pal Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Oshima Sachin
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Praveen Gedam
- National Health Authority, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Anu Nagar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Balram Bhargava
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
- Indian Council of Medical Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| |
Collapse
|
25
|
Kaur A, Jayashree M, Prinja S, Singh R, Baranwal AK. Cost analysis of pediatric intensive care: a low-middle income country perspective. BMC Health Serv Res 2021; 21:168. [PMID: 33622310 PMCID: PMC7901186 DOI: 10.1186/s12913-021-06166-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background Globally, Pediatric Intensive Care Unit (PICU) admissions are amongst the most expensive. In low middle-income countries, out of pocket expenditure (OOP) constitutes a major portion of the total expenditure. This makes it important to gain insights into the cost of pediatric intensive care. We undertook this study to calculate the health system cost and out of pocket expenditure incurred per patient during PICU stay. Methods Prospective study conducted in a state of the art tertiary level PICU of a teaching and referral hospital. Bottom-up micro costing methods were used to assess the health system cost. Annual data regarding hospital resources used for PICU care was collected from January to December 2018. Data regarding OOP was collected from 299 patients admitted from July 2017 to December 2018. The latter period was divided into four intervals, each of four and a half months duration and data was collected for 1 month in each interval. Per patient and per bed day costs for treatment were estimated both from health system and patient’s perspective. Results The median (inter-quartile range, IQR) length of PICU stay was 5(3–8) days. Mean ± SD Pediatric Risk of Mortality Score (PRISM III) score of the study cohort was 22.23 ± 7.3. Of the total patients, 55.9% (167) were ventilated. Mean cost per patient treated was US$ 2078(₹ 144,566). Of this, health system cost and OOP expenditure per patient were US$ 1731 (₹ 120,425) and 352 (₹ 24,535) respectively. OOP expenditure of a ventilated child was twice that of a non- ventilated child. Conclusions The fixed cost of PICU care was 3.8 times more than variable costs. Major portion of cost was borne by the hospital. Severe illness, longer ICU stay and ventilation were associated with increased costs. This study can be used to set the reimbursement package rates under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Tertiary level intensive care in a public sector teaching hospital in India is far less expensive than developed countries.
Collapse
Affiliation(s)
- Amrit Kaur
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ranjana Singh
- Department of Hospital Administration, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Arun K Baranwal
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
26
|
Chugh Y, Premkumar M, Grover GS, Dhiman RK, Teerawattananon Y, Prinja S. Cost-effectiveness and budget impact analysis of facility-based screening and treatment of hepatitis C in Punjab state of India. BMJ Open 2021; 11:e042280. [PMID: 33589457 PMCID: PMC7887370 DOI: 10.1136/bmjopen-2020-042280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Despite treatment availability, chronic hepatitis C virus (HCV) public health burden is rising in India due to lack of timely diagnosis. Therefore, we aim to assess incremental cost per quality-adjusted life year (QALY) for one-time universal screening followed by treatment of people infected with HCV as compared with a no screening policy in Punjab, India. STUDY DESIGN Decision tree integrated with Markov model was developed to simulate disease progression. A societal perspective and a 3% annual discount rate were considered to assess incremental cost per QALY gained. In addition, budgetary impact was also assessed with a payer's perspective and time horizon of 5 years. STUDY SETTING Screening services were assumed to be delivered as a facility-based intervention where active screening for HCV cases would be performed at 22 district hospitals in the state of Punjab, which will act as integrated testing as well as treatment sites for HCV. INTERVENTION Two intervention scenarios were compared with no universal screening and treatment (routine care). Scenario I-screening with ELISA followed by confirmatory HCV-RNA quantification and treatment. Scenario II-screening with rapid diagnostic test (RDT) kit followed by confirmatory HCV-RNA quantification and treatment. PRIMARY AND SECONDARY OUTCOME MEASURES Lifetime costs; life years and QALY gained; and incremental cost-effectiveness ratio for each of the above-mentioned intervention scenario as compared with the routine care. RESULTS Screening with ELISA and RDT, respectively, results in a gain of 0.028 (0.008 to 0.06) and 0.027 (0.008 to 0.061) QALY per person with costs decreased by -1810 Indian rupees (-3376 to -867) and -1812 Indian rupees (-3468 to -850) when compared with no screening. One-time universal screening of all those ≥18 years at a base coverage of 30%, with ELISA and RDT, would cost 8.5 and 8.3 times more, respectively, when compared with screening the age group of the cohort 40-45 years old. CONCLUSION One-time universal screening followed by HCV treatment is a dominant strategy as compared with no screening. However, budget impact of screening of all ≥18-year-old people seems unsustainable. Thus, in view of findings from both cost-effectiveness and budget impact, we recommend beginning with screening the age cohort with RDT around mean age of disease presentation, that is, 40-45 years, instead of all ≥18-year-old people.
Collapse
Affiliation(s)
- Yashika Chugh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research School of Public Health, Chandigarh, Punjab, India
| | - Madhumita Premkumar
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gagandeep Singh Grover
- Department of Health and Family Welfare, National Viral Hepatitis Control Program, Government of Punjab, Chandigarh, India
| | - Radha K Dhiman
- Director, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Mueang Nonthaburi, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore, Singapore
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
27
|
Eggleston K, Jain R. Cost-effective interventions to prevent non-communicable diseases: increasing the evidence base in India and other low- and middle-income settings. BMC Med 2020; 18:379. [PMID: 33292216 PMCID: PMC7724870 DOI: 10.1186/s12916-020-01850-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Karen Eggleston
- Freeman Spogli Institute for International Studies (FSI), Asia Health Policy Program, Asia-Pacific Research Center (APARC), Stanford University, Stanford, USA.
| | - Radhika Jain
- Freeman Spogli Institute for International Studies (FSI), Asia Health Policy Program, Asia-Pacific Research Center (APARC), Stanford University, Stanford, USA
| |
Collapse
|
28
|
Karekar S, Shetty Y. Assessment of the quality and trend of reporting of health economic evaluation research in India. Expert Rev Pharmacoecon Outcomes Res 2020; 21:595-599. [PMID: 33249942 DOI: 10.1080/14737167.2021.1858055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: This study was conducted to assess the reporting quality of health economic evaluation studies using Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement along with an analysis of their trend in India.Methods: Following ethical review exemption, PubMed and Google scholar were searched for Indian studies published in 5 years (2014-2019). Keywords used were cost-effectiveness, cost-benefit, cost-utility, and cost-minimization analysis, economic evaluation, and India. CHEERS statement was used to assess the reporting quality and trend was studied using variables like a published year, type of analysis, therapy area, intervention. Data were analyzed using descriptive statistics.Results: Of the 39 studies analyzed, 17 scored less than 18 (represents 75% compliance) with a minimum score of 9 and a maximum of 23. The reporting quality was deficient with respect to heterogeneity characterization (25 studies), discount rate (18 studies), model choice, and assumptions (18 studies). Cost - effectiveness was the most common PE analysis (27 studies). The most commonly studied therapy area was infectious disorders (10) followed by oncology (5), and the commonest intervention was drugs (22).Conclusion: Inadequacy in reporting quality of health economic evaluation studies is evident. The trend revealed cost-effectiveness to be the most commonly performed type of analysis.Expert Opinion: Health economic evaluation research has gained considerable importance in healthcare decision making. Reporting quality is critical to enable efficient interpretation of health economic evaluation research. These studies have many elements, each of which have a significant impact on the conduct and outcome of the study. Hence, it is advisable to refer to any of the available guidelines [eg. CHEERS checklist] while preparing the manuscript so as to ensure all crucial elements of the study have been reported.
Collapse
Affiliation(s)
- Sonali Karekar
- Department of Pharmacology & Therapeutics, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Yashashri Shetty
- Department of Pharmacology & Therapeutics, Seth GS Medical College & KEM Hospital, Mumbai, India
| |
Collapse
|
29
|
Downey L, Dabak S, Eames J, Teerawattananon Y, De Francesco M, Prinja S, Guinness L, Bhargava B, Rajsekar K, Asaria M, Rao N, Selvaraju V, Mehndiratta A, Culyer A, Chalkidou K, Cluzeau F. Building Capacity for Evidence-Informed Priority Setting in the Indian Health System: An International Collaborative Experience. HEALTH POLICY OPEN 2020; 1:100004. [PMID: 33392500 PMCID: PMC7772949 DOI: 10.1016/j.hpopen.2020.100004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/09/2019] [Accepted: 02/17/2020] [Indexed: 11/16/2022] Open
Abstract
India's rapid economic growth has been accompanied by slower improvements in population health. Given the need to reconcile the ambitious goal of achieving Universal Coverage with limited resources, a robust priority-setting mechanism is required to ensure that the right trade-offs are made and the impact on health is maximised. Health Technology Assessment (HTA) is endorsed by the World Health Assembly as the gold standard approach to synthesizing evidence systematically for evidence-informed priority setting (EIPS). India is formally committed to institutionalising HTA as an integral component of the EIPS process. The effective conduct and uptake of HTA depends on a well-functioning ecosystem of stakeholders adept at commissioning and generating policy-relevant HTA research, developing and utilising rigorous technical, transparent, and inclusive methods and processes, and a strong multisectoral and transnational appetite for the use of evidence to inform policy. These all require myriad complex and complementary capacities to be built at each level of the health system . In this paper we describe how a framework for targeted and locally-tailored capacity building for EIPS, and specifically HTA, was collaboratively developed and implemented by an international network of priority-setting expertise, and the Government of India.
Collapse
Affiliation(s)
- L.E. Downey
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
- Corresponding author at: Imperial College London, St Mary’s Hospital, Praed Street, London W2 1NY, United Kingdom.
| | - S. Dabak
- Health Intervention Technology Assessment Program (HITAP), Bangkok, Thailand
| | - J. Eames
- Health Intervention Technology Assessment Program (HITAP), Bangkok, Thailand
| | - Y. Teerawattananon
- Health Intervention Technology Assessment Program (HITAP), Bangkok, Thailand
| | - M. De Francesco
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - S. Prinja
- School of Public Health, Post Graduate Medical Institute of Health Education and Research (PGIMER) Chandigarh, India
| | - L. Guinness
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - B. Bhargava
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - K. Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - M. Asaria
- London School of Economics and Political Science, London, United Kingdom
| | - N.V. Rao
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - V. Selvaraju
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - A. Mehndiratta
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - A. Culyer
- Centre for Health Economics, University of York, York, United Kingdom
| | - K. Chalkidou
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
- Centre for Global Development Europe, London, United Kingdom
| | - F.A. Cluzeau
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
30
|
Jyani G, Prinja S, Kar SS, Trivedi M, Patro B, Purba F, Pala S, Raman S, Sharma A, Jain S, Kaur M. Valuing health-related quality of life among the Indian population: a protocol for the Development of an EQ-5D Value set for India using an Extended design (DEVINE) Study. BMJ Open 2020; 10:e039517. [PMID: 33444194 PMCID: PMC7682473 DOI: 10.1136/bmjopen-2020-039517] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Quality-adjusted life year (QALY) has been recommended by the government as preferred outcome measure for Health Technology Assessment (HTA) in India. As country-specific health-related quality of life tariff values are essential for accurate measurement of QALYs, the government of India has commissioned the present study. The aim of this paper is to describe the methods for the Development of an EQ-5D Value set for India using an Extended design (DEVINE) Study. Additionally, this study aspires to establish if the design of 10-time trade-off (TTO) blocks is enough to generate valid value sets. METHODS AND ANALYSIS A cross-sectional survey using the EuroQol Group's Valuation Technology (EQ-VT) will be undertaken in a sample of 2700 respondents selected from six different states of India using a multistage stratified random sampling technique. The participants will be interviewed using computer-assisted personal interviewing technique. The TTO valuation will be done using 10 composite TTO (c-TTO) tasks and 7 discrete choice experiment (DCE) tasks. Hybrid modelling approach using both c-TTO and DCE data to estimate the potential value set will be applied. Values of all 3125 health states will be predicted using both the conventional EQ-VT design of 10 blocks of 10 TTO tasks, and an extended design of 18 blocks of 10 TTO tasks. The potential added value of the eight additional blocks in overall validity will be tested. The study will deliver value set for India and assess the adequacy of existing 10-blocks design to be able to correctly predict the values of all 3125 health states. ETHICS AND DISSEMINATION The ethical approval has been obtained from Institutional Ethics Committee of PGIMER, Chandigarh, India. The anonymised EQ-5D-5L value set will be available for general use and in the HTAs commissioned by India's central HTA Agency.
Collapse
Affiliation(s)
- Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India
| | - Mayur Trivedi
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Binod Patro
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Fredrick Purba
- Department of Developmental Psychology, Universitas Padjadjaran, Jatinangor, West Jawa, Indonesia
| | - Star Pala
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Swati Raman
- Academy of Management Sciences, Lucknow, Uttar Pradesh, India
| | - Atul Sharma
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalu Jain
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
31
|
Prinja S, Rajsekhar K, Gauba VK. Health technology assessment in India: Reflection & future roadmap. Indian J Med Res 2020; 152:444-447. [PMID: 33707385 PMCID: PMC8157896 DOI: 10.4103/ijmr.ijmr_115_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Shankar Prinja
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Kavitha Rajsekhar
- Department of Health Research, Ministry of Health & Family Welfare, Government of India, New Delhi 110 001, India
| | - Vijay Kumar Gauba
- Department of Health Research, Ministry of Health & Family Welfare, Government of India, New Delhi 110 001, India
- Formerly Senior Deputy Director General, Indian Council of Medical Research, New Delhi 110 029, India
| |
Collapse
|
32
|
Bahuguna P, Guinness L, Sharma S, Chauhan AS, Downey L, Prinja S. Estimating the Unit Costs of Healthcare Service Delivery in India: Addressing Information Gaps for Price Setting and Health Technology Assessment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:699-711. [PMID: 32170666 PMCID: PMC7519005 DOI: 10.1007/s40258-020-00566-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND India's flagship National Health insurance programme (AB-PMJAY) requires accurate cost information for evidence-based decision-making, strategic purchasing of health services and setting reimbursement rates. To address the challenge of limited health service cost data, this study used econometric methods to identify determinants of cost and estimate unit costs for each Indian state. METHODS Using data from 81 facilities in six states, models were developed for inpatient and outpatient services at primary and secondary level public health facilities. A best-fit unit cost function was identified using guided stepwise regression and combined with data on health service infrastructure and utilisation to predict state-level unit costs. RESULTS Health service utilisation had the greatest influence on unit cost, while number of beds, facility level and the state were also good predictors. For district hospitals, predicted cost per inpatient admission ranged from 1028 (313-3429) Indian Rupees (INR) to 4499 (1451-14,159) INR and cost per outpatient visit ranged from 91 (44-196) INR to 657 (339-1337) INR, across the states. For community healthcare centres and primary healthcare centres, cost per admission ranged from 412 (148-1151) INR to 3677 (1359-10,055) INR and cost per outpatient visit ranged from 96 (50-187) INR to 429 (217-844) INR. CONCLUSION This is the first time cost estimates for inpatient admissions and outpatient visits for all states have been estimated using standardised data. The model demonstrates the usefulness of such an approach in the Indian context to help inform health technology assessment, budgeting and forecasting, as well as differential pricing, and could be applied to similar country contexts where cost data are limited.
Collapse
Affiliation(s)
- Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | | | - Sameer Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Laura Downey
- International Decision Support Initiative, London, UK
- School of Public Health, Imperial College London, London, W2 1NY, UK
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| |
Collapse
|
33
|
Assessing the capacity of Ghana to introduce health technology assessment: a systematic review of economic evaluations conducted in Ghana. Int J Technol Assess Health Care 2020; 36:500-507. [PMID: 32981532 DOI: 10.1017/s0266462320000689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Ghana is in the process of formally introducing health technology assessment (HTA) for health decision making. Similar to other low- and middle-income countries, evidence suggests that the lack of data and human capacity is a major barrier to the conduct and use of HTA. This study assessed the current human and data capacity available in Ghana to undertake HTA. METHODS As economic evaluation (EE) forms an integral part of HTA, a systematic review of EE studies undertaken in Ghana was conducted to identify the quality and number of studies available, methods and source of data used, and local persons involved. The literature search was undertaken in EMBASE (including MEDLINE), PUBMED, and Google Scholar. The quality of studies was evaluated using the Consolidated Health Economics Evaluation Reporting Standards. The number of local Ghanaians who contributed to authorship were used as a proxy for assessing human capacity for HTA. RESULTS Thirty-one studies were included in the final review. Overall, studies were of good quality. Studies derived their effectiveness, resource utilization and cost data mainly from Ghana. The most common source of cost data was from the National Health Insurance Scheme pricing list for medicines and tariffs. Effectiveness data were mostly derived from either single study or intervention programs. Sixty out of 199 authors were Ghanaians (30 percent); these authors were mostly involved in data collection and study conceptualization. CONCLUSIONS Human capacity for HTA in Ghana is limited. To introduce HTA successfully in Ghana, policy makers would need to develop more local capacity to undertake Ghanaian-specific HTA.
Collapse
|
34
|
Prinja S, Singh MP, Guinness L, Rajsekar K, Bhargava B. Establishing reference costs for the health benefit packages under universal health coverage in India: cost of health services in India (CHSI) protocol. BMJ Open 2020; 10:e035170. [PMID: 32690737 PMCID: PMC7375634 DOI: 10.1136/bmjopen-2019-035170] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION To achieve universal health coverage, the Government of India has introduced Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB - PMJAY), a large tax-funded national health insurance scheme for the provision of secondary and tertiary care services in public and private hospitals. AB - PMJAY reimburses care for 1573 health benefit packages (HBPs). HBPs are designed to cover the treatment of diseases/conditions with high incidence/prevalence or which contribute to high out-of-pocket expenditure. However, there is a dearth of reference cost data against which provider payment rates can be assessed. METHODS AND ANALYSIS The CHSI (Cost of Health Services in India) study will collect cost data from 13 Indian states covering 52 public and 40 private hospitals, using a mixed economic costing methodology (top-down and bottom-up), to generate unit costs for the HBPs. States will be sampled to capture economic status, development indicators and health service utilisation heterogeneity. The public sector hospitals will be chosen at secondary and tertiary care level. One tertiary facility will be selected from each state. At secondary level, three districts per state will be selected randomly from the district composite development score ranking. The private sector hospital sample will be stratified by nature of ownership (for-profit and not-for-profit), type of city (tier 1, 2 or 3) and size of the hospital (number of beds). Average costs for each HBP will be calculated across the different facility types. Multiple scenarios will be used to suggest rates which could be negotiated with the providers. Overall, the study will provide economic cost data for price setting, strategic purchasing, health technology assessment and a national cost database of India. ETHICS AND DISSEMINATION The approval has been obtained from the Institutional Ethics Committee and Institutional Collaborative Committee of the Post Graduate Institute of Medical Education and Research, Chandigarh, India. The results shall be disseminated in conferences and peer-reviewed articles.
Collapse
Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Maninder Pal Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Lorna Guinness
- Independent Researcher, Imperial College, London, UK
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health & Family welfare, New Delhi, India
| | - Balram Bhargava
- Department of Health Research, Ministry of Health & Family welfare, New Delhi, India
- Indian Council of Medical Research, New Delhi, Delhi, India
| |
Collapse
|
35
|
Bahuguna P, Prinja S, Lahariya C, Dhiman RK, Kumar MP, Sharma V, Aggarwal AK, Bhaskar R, De Graeve H, Bekedam H. Cost-Effectiveness of Therapeutic Use of Safety-Engineered Syringes in Healthcare Facilities in India. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:393-411. [PMID: 31741306 PMCID: PMC7250963 DOI: 10.1007/s40258-019-00536-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Globally, 16 billion injections are administered each year of which 95% are for curative care. India contributes 25-30% of the global injection load. Over 63% of these injections are reportedly unsafe or deemed unnecessary. OBJECTIVES To assess the incremental cost per quality-adjusted life-year (QALY) gained with the introduction of safety-engineered syringes (SES) as compared to disposable syringes for therapeutic care in India. METHODS A decision tree was used to compute the volume of needle-stick injuries (NSIs) and reuse episodes among healthcare professionals and the patient population. Subsequently, three separate Markov models were used to compute lifetime costs and QALYs for individuals infected with hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Three SES were evaluated-reuse prevention syringe (RUP), sharp injury prevention (SIP) syringe, and syringes with features of both RUP and SIP. A lifetime study horizon starting from a base year of 2017 was considered appropriate to cover all costs and consequences comprehensively. A systematic review was undertaken to assess the SES effects in terms of reduction in NSIs and reuse episodes. These were then modelled in terms of reduction in transmission of blood-borne infections, life-years and QALYs gained. Future costs and consequences were discounted at the rate of 3%. Incremental cost per QALY gained was computed to assess the cost-effectiveness. A probabilistic sensitivity analysis was undertaken to account for parameter uncertainties. RESULTS The introduction of RUP, SIP and RUP + SIP syringes in India is estimated to incur an incremental cost of Indian National Rupee (INR) 61,028 (US$939), INR 7,768,215 (US$119,511) and INR 196,135 (US$3017) per QALY gained, respectively. A total of 96,296 HBV, 44,082 HCV and 5632 HIV deaths are estimated to be averted due to RUP in 20 years. RUP has an 84% probability to be cost-effective at a threshold of per capita gross domestic product (GDP). The RUP syringe can become cost saving at a unit price of INR 1.9. Similarly, SIP and RUP + SIP syringes can be cost-effective at a unit price of less than INR 1.2 and INR 5.9, respectively. CONCLUSION RUP syringes are estimated to be cost-effective in the Indian context. SIP and RUP + SIP syringes are not cost-effective at the current unit prices. Efforts should be made to bring down the price of SES to improve its cost-effectiveness.
Collapse
Affiliation(s)
- Pankaj Bahuguna
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | | | - Radha Krishan Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhumita Prem Kumar
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vineeta Sharma
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Arun Kumar Aggarwal
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | | | - Hilde De Graeve
- World Health Organization Country Office for India, New Delhi, India
| | - Henk Bekedam
- World Health Organization Country Office for India, New Delhi, India
| |
Collapse
|
36
|
Prinja S, Brar S, Singh MP, Rajsekhar K, Sachin O, Naik J, Singh M, Tomar H, Bahuguna P, Guinness L. Process evaluation of health system costing - Experience from CHSI study in India. PLoS One 2020; 15:e0232873. [PMID: 32401763 PMCID: PMC7219765 DOI: 10.1371/journal.pone.0232873] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/23/2020] [Indexed: 12/03/2022] Open
Abstract
Background A national study, ‘Costing of healthcare services in India’ (CHSI) aimed at generating reliable healthcare cost estimates for health technology assessment and price-setting is being undertaken in India. CHSI sampled 52 public and 40 private hospitals in 13 states and used a mixed micro-costing approach. This paper aims to outline the process, challenges and critical lessons of cost data collection to feed methodological and quality improvement of data collection. Methods An exploratory survey with 3 components–an online semi-structured questionnaire, group discussion and review of monitoring data, was conducted amongst CHSI data collection teams. There were qualitative and quantitative components. Difficulty in obtaining individual data was rated on a Likert scale. Results Mean time taken to complete cost data collection in one department/speciality was 7.86(±0.51) months, majority of which was spent on data entry and data issues resolution. Data collection was most difficult for determination of equipment usage (mean difficulty score 6.59±0.52), consumables prices (6.09±0.58), equipment price(6.05±0.72), and furniture price(5.64±0.68). Human resources, drugs & consumables contributed to 78% of total cost and 31% of data collection time. However, furniture, overheads and equipment consumed 51% of time contributing only 9% of total cost. Seeking multiple permissions, absence of electronic records, multiple sources of data were key challenges causing delays. Conclusions Micro-costing is time and resource intensive. Addressing key issues prior to data collection would ease the process of data collection, improve quality of estimates and aid priority setting. Electronic health records and availability of national cost data base would facilitate conducting costing studies.
Collapse
Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
| | - Sehr Brar
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Maninder Pal Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kavitha Rajsekhar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Oshima Sachin
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Jyotsna Naik
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Malkeet Singh
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Himanshi Tomar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | | | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lorna Guinness
- Independent Researcher, Imperial College London, London, England
| |
Collapse
|
37
|
Prinja S, Chauhan AS, Rajsekhar K, Downey L, Bahuguna P, Sachin O, Guinness L. Addressing the Cost Data Gap for Universal Healthcare Coverage in India: A Call to Action. Value Health Reg Issues 2020; 21:226-229. [DOI: 10.1016/j.vhri.2019.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/10/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
|
38
|
Gupta N, Verma R, Dhiman RK, Rajsekhar K, Prinja S. Cost-Effectiveness Analysis and Decision Modelling: A Tutorial for Clinicians. J Clin Exp Hepatol 2020; 10:177-184. [PMID: 32189934 PMCID: PMC7068010 DOI: 10.1016/j.jceh.2019.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
Cost-effectiveness analysis (CEA) provides information on how much extra do we need to spend per unit gain in health outcomes with introduction of any new healthcare intervention or treatment as compared to the alternative. This information is crucial to make decision regarding funding any new drug, diagnostic test or determining standard treatment protocol. It becomes even more important to consider this evidence in resource constrained low-income and middle-income country settings. Generating evidence on costs and consequences of a treatment or intervention could be performed in the setting of a randomized controlled trial, which is the perfect platform to evaluate efficacy or effectiveness. However, we argue that randomized controlled trial (RCT) offers an incomplete setting to generate comprehensive data on all costs and consequences for the purpose of a CEA. Hence, it is needed to use a decision model, either in combination with the evidence from RCT or alone. In this article, we demonstrate the application of decision model-based economic evaluation using 2 separate techniques - a decision tree and a Markov model. We argue that application of a decision model allows computation of health benefits in terms of utility-based measure such as a quality-adjusted life year or disability-adjusted life year which is preferred for a CEA, measure distal costs and consequences which are much more downstream to the application of intervention, allows comparison with multiple intervention and comparators, and provides opportunity of making use of evidence from multiple sources rather than a single RCT which may have limited generalizability. This makes the use of such evidence much more acceptable for clinical use and policy relevant.
Collapse
Key Words
- BCLC, Barcelona Clinic Liver Cancer
- BSC, Best Supportive Care
- CAD, Coronary Artery Disease
- CEA, Cost-Effectiveness Analysis
- DALY, Disability Adjusted Life Year
- EE, Economic Evaluation
- HCC, Hepatocellular Carcinoma
- HCV, Hepatitis C Virus
- HPV, Human Papillomavirus
- Hib, Hemophilus Influenza
- ICER, Incremental Cost-Effectiveness Ratio
- PD, Progressive Disease
- PFS, Progression-Free State
- QALY, Quality Adjusted Life Year
- RCT, Randomized controlled trial
- SNCU, Special Newborn Care Unit
- cost-effectiveness
- decision model
- decision tree
- economic evaluation
- markov model
Collapse
Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Rohan Verma
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha K. Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kavitha Rajsekhar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Shankar Prinja, Additional Professor of Health Economics School of Public Health, Post Graduate Institute of Medical Education and Research Sector-12, Chandigarh, 60012, India.
| |
Collapse
|
39
|
Ku Abd Rahim KN, Kamaruzaman HF, Dahlui M, Wan Puteh SE. From Evidence to Policy: Economic Evaluations of Healthcare in Malaysia: A Systematic Review. Value Health Reg Issues 2019; 21:91-99. [PMID: 31698173 DOI: 10.1016/j.vhri.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/26/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify and describe the various economic evaluation studies in Malaysia and to determine the range of incremental cost-effectiveness ratios (ICERs) as reported in these studies. METHODS A comprehensive search of the scientific electronic databases was conducted (Medline, EBM Reviews, Embase, and hand search) to identify all published economic evaluation studies related to Malaysian healthcare. Two researchers assessed the quality of selected studies using the Critical Appraisal Skills Programme (CASP) checklist and Quality of Health Economic Studies instrument. The assessment was also reviewed by expert members of the Technical Advisory Committee of Health Technology Economic Evaluations (TACHTEE). RESULTS A total of 64 full-text articles were assessed for eligibility and included in this systematic review. Thirty studies were partial economic evaluations; the full economic evaluations included 17 cost-effectiveness analyses and 17 cost-utility analyses. From all the reported ICERs, the majority (68%) were categorized as highly cost-effective (ICER of less than 1 gross domestic product (GDP) per capita per quality-adjusted life-years or disability-adjusted life-years gained). CONCLUSION This review identifies information gaps and loopholes in health economics research in Malaysia. Additionally, this study provides the information that the majority of published interventions in Malaysia fell within the cost-effectiveness threshold of 1 GDP per capita per quality-adjusted life-years or disability-adjusted life-years gained.
Collapse
Affiliation(s)
- Ku Nurhasni Ku Abd Rahim
- Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia, Federal Territory of Putrajaya, Malaysia
| | - Hanin Farhana Kamaruzaman
- Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia, Federal Territory of Putrajaya, Malaysia.
| | - Maznah Dahlui
- Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Faculty of Public Health, Airlangga University, Surabaya, East Java, Indonesia
| | | |
Collapse
|
40
|
Chugh Y, Dhiman RK, Premkumar M, Prinja S, Singh Grover G, Bahuguna P. Real-world cost-effectiveness of pan-genotypic Sofosbuvir-Velpatasvir combination versus genotype dependent directly acting anti-viral drugs for treatment of hepatitis C patients in the universal coverage scheme of Punjab state in India. PLoS One 2019; 14:e0221769. [PMID: 31465503 PMCID: PMC6715223 DOI: 10.1371/journal.pone.0221769] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/14/2019] [Indexed: 02/07/2023] Open
Abstract
Background We undertook this study to assess the incremental cost per quality adjusted life year (QALY) gained with the use of pan-genotypic sofosbuvir (SOF) + velpatasvir (VEL) for HCV patients, as compared to the current treatment regimen under the universal free treatment scheme in Punjab state. Methodology A Markov model depicting natural history of HCV was developed to simulate the progression of disease. Three scenarios were compared: I (Current Regimen)—use of SOF + daclatasvir (DCV) for non-cirrhotic patients and ledipasvir (LDV) or DCV with SOF ± ribavirin (RBV) according to the genotype for cirrhotic patients; II—use of SOF + DCV for non-cirrhotic patients and use of SOF+VEL for compensated cirrhotic patients (with RBV in decompensated cirrhosis patients) and III—use of SOF+VEL for both non-cirrhotic and compensated cirrhotic patients (with RBV in decompensated cirrhosis patients). The lifetime costs, life-years and QALYs were assessed for each scenario, using a societal perspective. All the future costs and health outcomes were discounted at an annual rate of 3%. Finally, the incremental cost per QALY gained was computed for each of scenario II and III, as compared to scenario I and for scenario III as compared to II. In addition, we evaluated the lifetime costs and QALYs among HCV patients for each of scenario I, II and III against the counterfactual of ‘no universal free treatment scheme’ scenario which involves patients purchasing care in routine setting of from public and private sector. Results Each of the scenarios I, II and III dominate over the no universal free treatment scheme scenario, i.e. have greater QALYs and lesser costs. The use of SOF+VEL only for cirrhotic patients (scenario II) increases QALYs by 0.28 (0.03 to 0.71) per person, and decreases the cost by ₹ 5,946 (₹ 1,198 to ₹ 14,174) per patient, when compared to scenario I. Compared to scenario I, scenario III leads to an increase in QALYs by 0.44 (0.14 to 1.01) per person, and is cost-neutral. While the mean cost difference between scenario III and I is—₹ 2,676 per patient, it ranges from a cost saving of ₹ 14,835 to incurring an extra cost of ₹ 3,456 per patient. For scenario III as compared II, QALYs increase by 0.16 (0.03 to 0.36) per person as well as costs by ₹ 3,086 per patient which ranges from a cost saving of ₹ 1,264 to incurring an extra cost of ₹ 6,344. Shift to scenario II and III increases the program budget by 5.5% and 60% respectively. Conclusion Overall, the use of SOF+VEL is highly recommended for the treatment of HCV infection. In comparison to the current practice (scenario I), scenario II is a dominant option. Scenario III is cost-effective as compared to scenario II at a threshold of one-time GDP per capita. If budget is an important constraint, velpatasvir should be given to HCV infected cirrhotic patients. However, if no budget constraint, universal use of velpatasvir for HCV treatment is recommended.
Collapse
Affiliation(s)
- Yashika Chugh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha Krishan Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Mukh Mantri Punjab Hepatitis C Relief Fund (MMPHCRF), Punjab Government, Punjab, India
- Technical Resource Group, National Viral Hepatitis Control Program (NVHCP), Government of India, Ministry of Health and Family Welfare, New Delhi, India
| | - Madhumita Premkumar
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
| | | | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
41
|
Nair CK, Selvaraj K, Raghavan V, A M, Shenoy PK, Kurup AR, Duraisamy K, Shringarpure K, Venugopal V. Limiting factors for autologous transplantation among transplant-eligible multiple myeloma patients: Lesson from a Tertiary Cancer Centre in rural India. Leuk Res 2019; 83:106167. [PMID: 31200146 DOI: 10.1016/j.leukres.2019.106167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 12/22/2022]
Abstract
There is limited data from low and middle income countries on the exact proportion of Myeloma patients undergoing transplant even if they are eligible for the same. In this retrospective analysis of all newly diagnosed transplant eligible Myeloma treated between January 2011 to June 2017, number of patients undergoing transplant were recorded and among those not opting for transplant, reasons for the same were noted. Among 89 eligible patients, 23 (26%) patients could undergo transplantation. Most common reasons for not undergoing transplant were fear of the complications in 42 (47%) and financial reasons in 41 (46%) of patients. The transplanted group had better progression free survival when compared against the non-transplanted group (3 year PFS of 80% versus 36%, HR = 0.09, 95%CI 0.02-0.4, p = 0.001). Future studies may be conducted to arrive at measures, for correcting the transplant related concerns and fears, through psycho-social interventions.
Collapse
Affiliation(s)
- Chandran K Nair
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
| | - Kalaiselvi Selvaraj
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Vineetha Raghavan
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Manuprasad A
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Praveen Kumar Shenoy
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Anju R Kurup
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | | | - Kalpita Shringarpure
- Department of Preventive and Social Medicine, Medical College Baroda, Vadodara, Gujarat, India
| | - Vinayagamoorthy Venugopal
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| |
Collapse
|
42
|
Impact and cost effectiveness of pneumococcal conjugate vaccine in India. Vaccine 2019; 37:623-630. [PMID: 30587430 DOI: 10.1016/j.vaccine.2018.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 11/19/2022]
|
43
|
Dabak SV, Pilasant S, Mehndiratta A, Downey LE, Cluzeau F, Chalkidou K, Luz ACG, Youngkong S, Teerawattananon Y. Budgeting for a billion: applying health technology assessment (HTA) for universal health coverage in India. Health Res Policy Syst 2018; 16:115. [PMID: 30486827 PMCID: PMC6262968 DOI: 10.1186/s12961-018-0378-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND India recently launched the largest universal health coverage scheme in the world to address the gaps in providing healthcare to its population. Health technology assessment (HTA) has been recognised as a tool for setting priorities as the government seeks to increase public health expenditure. This study aims to understand the current situation for healthcare decision-making in India and deliberate on the opportunities for introducing HTA in the country. METHODS A paper-based questionnaire, adapted from a survey developed by the International Decision Support Initiative (iDSI), was administered on the second day of the Topic Selection Workshop that was conducted as part of the HTA Awareness Raising Workshop held in New Delhi on 25-27 July, 2016. Participants were invited to respond to questions covering the need, demand and supply for HTA in their context as well as the role of their organisation vis-à-vis HTA. The response rate for the survey was about 68% with 41 participants having completed the survey. RESULTS Three quarters of the respondents (71%) stated that the government allocated healthcare resources on the basis of expert opinion. Most respondents indicated reimbursement of individual health technologies and designing a basic health benefit package (93% each) were important health policy areas while medical devices and screening programmes were cited as important technologies (98% and 92%, respectively). More than half of the respondents noted that relevant local data was either not available or was limited. Finally, technical capacity was seen as a strength and a constraint facing organisations. CONCLUSION The findings from this study shed light on the current situation, the opportunities, including potential topics, and challenges in conducting HTA in India. There are limitations to the study and further studies may need to be conducted to inform the role that HTA will play in the design or implementation of universal health coverage in India.
Collapse
Affiliation(s)
| | - Songyot Pilasant
- Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
| | - Abha Mehndiratta
- Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Laura Emily Downey
- Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Francoise Cluzeau
- Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Kalipso Chalkidou
- Global Health and Development Group, Imperial College London, London, United Kingdom
- Center for Global Development, London, United Kingdom
| | | | - Sitaporn Youngkong
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
- National Health Foundation, Bangkok, Thailand
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), Singapore, Singapore
| |
Collapse
|
44
|
Prinja S, Gupta A, Bahuguna P, Nimesh R. Cost analysis of implementing mHealth intervention for maternal, newborn & child health care through community health workers: assessment of ReMIND program in Uttar Pradesh, India. BMC Pregnancy Childbirth 2018; 18:390. [PMID: 30285669 PMCID: PMC6171293 DOI: 10.1186/s12884-018-2019-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 09/23/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The main intervention under ReMiND program consisted of a mobile health application which was used by community health volunteers, called ASHAs, for counselling pregnant women and nursing mothers. This program was implemented in two rural blocks in Uttar Pradesh state of India with an overall aim to increase quality of health care, thereby increasing utilization of maternal & child health services. The aim of the study was to assess annual & unit cost of ReMiND program and its scale up in UP state. METHOD AND MATERIALS Economic costing was done from the health system and patient's perspectives. All resources used during designing & planning phase i.e., development of application; and implementation of the intervention, were quantified and valued. Capital costs were annualised, after assessing their average number of years for which a product could be used and accounting for its depreciation. Shared or joint costs were apportioned for the time value a resource was utilized under intervention. Annual cost of implementing ReMiND in two blocks of UP along and unit cost per pregnant woman were estimated. Scale-up cost for implementing the intervention in entire state was calculated under two scenarios - first, if no extra human resource were employed; and second, if the state government adopted the same pattern of human resource as employed under this program. RESULTS The annual cost for rolling out ReMiND in two blocks of district Kaushambi was INR 12.1 million (US $ 191,894). The annualised start-up cost constituted 9% of overall cost while rest of cost was attributed to implementation of the intervention. The health system program costs in ReMiND were estimated to be INR 31.4 (US $ 0.49) per capita per year and INR 1294 (US $ 20.5) per registered women. The per capita incremental cost of scale up of intervention in UP state was estimated to be INR 4.39 (US $ 0.07) when no additional supervisory staffs were added. CONCLUSION The cost of scale up of ReMiND in Uttar Pradesh is 6% of annual budget for 'reproductive and child health' line item under state budget, and hence appears to be financially sustainable.
Collapse
Affiliation(s)
- Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Aditi Gupta
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Pankaj Bahuguna
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Ruby Nimesh
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| |
Collapse
|
45
|
Cost Effectiveness of Hematopoietic Stem Cell Transplantation Compared with Transfusion Chelation for Treatment of Thalassemia Major. Biol Blood Marrow Transplant 2018; 24:2119-2126. [DOI: 10.1016/j.bbmt.2018.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/02/2018] [Indexed: 01/19/2023]
|
46
|
Kaur G, Prinja S, Ramachandran R, Malhotra P, Gupta KL, Jha V. Cost of hemodialysis in a public sector tertiary hospital of India. Clin Kidney J 2018; 11:726-733. [PMID: 30288270 PMCID: PMC6165756 DOI: 10.1093/ckj/sfx152] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/28/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Nearly 220000 patients are diagnosed with end-stage renal disease (ESRD) every year, which calls for an additional demand of 34 million dialysis sessions in India. The government of India has announced a National Dialysis Programme to provide for free dialysis in public hospitals. In this article we estimate the overall cost of performing hemodialysis (HD) in a tertiary care hospital. Second, we assess the catastrophic impact of out-of-pocket expenditures (OOPEs) for HD on households and its determinants. METHODS The economic health system cost of HD was estimated using bottom-up costing methods. All resources, capital and recurrent, utilized for service delivery from April 2015 to March 2016 were identified, measured and valued. Capital costs were annualized after accounting for their useful life and discounting at 3% for future years. Sensitivity analyses were undertaken to determine the effect of variation in the input prices and other assumptions on the annual health system cost. OOPEs were assessed by interviewing 108 patients undergoing HD in the study hospital to account for costs from the patient's perspective. The prevalence of catastrophic health expenditures (CHEs) was computed per threshold of 40% of non-food expenditures. RESULTS The overall average cost incurred by the health system per HD session was INR 4148 (US$64). Adjusting for capacity utilization, the health system incurred INR 3025 (US$47) per HD at 100% bed occupancy. The mean OOPE per patient per session was INR 2838 (US$44; 95% confidence interval US$34-55). The major components of this OOPE were medicines and consumables (64.1%). The prevalence of a CHE per HD session was 11.1%. CONCLUSION Our study findings would be useful in the context of planning for dialysis services, setting provider payment rates for dialysis under various publicly sponsored health insurance schemes and undertaking future cost-effectiveness analysis to guide resource allocation decisions.
Collapse
Affiliation(s)
- Gunjeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Ramachandran
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishan Lal Gupta
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivekanand Jha
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- George Institute for Global Health, New Delhi, India
| |
Collapse
|
47
|
Prinja S, Bahuguna P, Gupta A, Nimesh R, Gupta M, Thakur JS. Cost effectiveness of mHealth intervention by community health workers for reducing maternal and newborn mortality in rural Uttar Pradesh, India. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:25. [PMID: 29983645 PMCID: PMC6020234 DOI: 10.1186/s12962-018-0110-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 06/13/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A variety of mobile-based health technologies (mHealth) have been developed for use by community health workers to augment their performance. One such mHealth intervention-ReMiND program, was implemented in a poor performing district of India. Despite some research on the extent of its effectiveness, there is significant dearth of evidence on cost-effectiveness of such mHealth interventions. In this paper we evaluated the incremental cost per disability adjusted life year (DALY) averted as a result of ReMiND intervention as compared to routine maternal and child health programs without ReMiND. METHODS A decision tree was parameterized on MS-Excel spreadsheet to estimate the change in DALYs and cost as a result of implementing ReMiND intervention compared with routine care, from both health system and societal perspective. A time horizon of 10 years starting from base year of 2011 was considered appropriate to cover all costs and effects comprehensively. All costs, including those during start-up and implementation phase, besides other costs on the health system or households were estimated. Consequences were measured as part of an impact assessment study which used a quasi-experimental design. Proximal outputs in terms of changes in service coverage were modelled to estimate maternal and infant illnesses and deaths averted, and DALYs averted in Uttar Pradesh state of India. Probabilistic sensitivity analysis was undertaken to account for parameter uncertainties. RESULTS Cumulatively, from year 2011 to 2020, implementation of ReMiND intervention in UP would result in a reduction of 312 maternal and 149,468 neonatal deaths. This implies that ReMiND program led to a reduction of 0.2% maternal and 5.3% neonatal deaths. Overall, ReMiND is a cost saving intervention from societal perspective. From health system perspective, ReMiND incurs an incremental cost of INR 12,993 (USD 205) per DALY averted and INR 371,577 (USD 5865) per death averted. CONCLUSIONS Overall, findings of our study suggest strongly that the mHealth intervention as part of ReMiND program is cost saving from a societal perspective and should be considered for replication elsewhere in other states.
Collapse
Affiliation(s)
- Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Pankaj Bahuguna
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Aditi Gupta
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Ruby Nimesh
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Madhu Gupta
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Jarnail Singh Thakur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| |
Collapse
|
48
|
Gupta I, Roy A. Economic Studies on Non-Communicable Diseases and Injuries in India: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:303-315. [PMID: 29611047 DOI: 10.1007/s40258-018-0370-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The burden from non-communicable diseases and injuries (NCDI) in India is increasing rapidly. With low public sector investment in the health sector generally, and a high financial burden on households for treatment, it is important that economic evidence is used to set priorities in the context of NCDI. OBJECTIVE Our objective was to understand the extent to which economic analysis has been used in India to (1) analyze the impact of NCDI and (2) evaluate prevention and treatment interventions. Specifically, this analysis focused on the type of economic analysis used, disease categories, funding patterns, authorship, and author characteristics. METHODS We conducted a systematic review based on economic keywords to identify studies on NCDI in India published in English between January 2006 and November 2016. In all, 96 studies were included in the review. The analysis used descriptive statistics, including frequencies and percentages. RESULTS A majority of the studies were economic impact studies, followed by economic evaluation studies, especially cost-effectiveness analysis. In the costing/partial economic evaluation category, most were cost-description and cost-analysis studies. Under the economic impact/economic burden category, most studies investigated out-of-pocket spending. The studies were mostly on cardiovascular disease, diabetes, and neoplasms. Slightly over half of the studies were funded, with funding coming mainly from outside of India. Half of the studies were led by domestic authors. In most of the studies, the lead author was a clinician or a public health professional; however, most of the economist-led studies were by authors from outside India. CONCLUSIONS The results indicate the lack of engagement of economists generally and health economists in particular in research on NCDI in India. Demand from health policy makers for evidence-based decision making appears to be lacking, which in turn solidifies the divergence between economics and health policy, and highlights the need to prioritize scarce resources based on evidence regarding what works. Capacity building in health economics needs focus, and the government's support in this is recommended.
Collapse
Affiliation(s)
- Indrani Gupta
- Institute of Economic Growth, University of Delhi Enclave, Delhi, 110007, India.
| | - Arjun Roy
- Institute of Economic Growth, University of Delhi Enclave, Delhi, 110007, India
| |
Collapse
|
49
|
Adeagbo CU, Rattanavipapong W, Guinness L, Teerawattananon Y. The Development of the Guide to Economic Analysis and Research (GEAR) Online Resource for Low- and Middle-Income Countries' Health Economics Practitioners: A Commentary. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:569-572. [PMID: 29753354 PMCID: PMC5947918 DOI: 10.1016/j.jval.2017.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 05/15/2023]
Abstract
Public health authorities around the world are increasingly using economic evaluation to set priorities and inform decision making in health policy, especially in the development of health benefit packages. Nevertheless, researchers in low- and middle-income countries (LMICs) encounter many barriers when conducting economic evaluations. In 2015, the Health Intervention and Technology Assessment Program identified key technical and context-specific challenges faced in conducting and using health economic evaluations in LMICs. On the basis of these research findings, the Guide to Economic Analysis and Research (GEAR) online resource (www.gear4health.com) was developed as a reliable aid to researchers in LMICs that would help overcome those challenges. Funded by the Thailand Research Fund and the Bill and Melinda Gates Foundation, GEAR is a free online resource that provides a visual aid tool for planning economic evaluation studies (GEAR mind maps), a repository of national and international economic evaluation guidelines (GEAR guideline comparison), and an active link to a network of volunteer international experts (GEAR: Ask an expert). GEAR will evolve over time to provide relevant, reliable, and up-to-date information through inputs from its users (e.g., periodic survey on methodological challenges) and experts (e.g., in responding to users' questions). The objective of this commentary was to give a brief description of the development and key features of this unique collective information hub aimed at facilitating high-quality research and empowering health care decision makers and stakeholders to use economic evaluation evidence.
Collapse
Affiliation(s)
- Chiaki Urai Adeagbo
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand.
| | - Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Lorna Guinness
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| |
Collapse
|
50
|
Prinja S, Downey LE, Gauba VK, Swaminathan S. Health Technology Assessment for Policy Making in India: Current Scenario and Way Forward. PHARMACOECONOMICS - OPEN 2018; 2:1-3. [PMID: 29464668 PMCID: PMC5820238 DOI: 10.1007/s41669-017-0037-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Laura E Downey
- Global Health and Development, Imperial College London, St Mary's Campus, London, W2 1NY, UK
| | - Vijay K Gauba
- Department of Health Research (DHR), Ministry of Health and Family Welfare, New Delhi, India
| | - Soumya Swaminathan
- Department of Health Research (DHR), Ministry of Health and Family Welfare, New Delhi, India
- Indian Council of Medical Research (ICMR), New Delhi, India
| |
Collapse
|