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Otte M, Dauben HP, Ahn J, Gutierrez Ibarluzea I, Drummond M, Simoens S, Kaló Z, Suh DC. Value based healthcare and Health Technology Assessment for emerging market countries: joint efforts to overcome barriers. Expert Rev Pharmacoecon Outcomes Res 2024:1-6. [PMID: 39221874 DOI: 10.1080/14737167.2024.2398482] [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: 07/29/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION This paper summarizes the results from a forum of healthcare experts, academia representatives, and public agency officials from emerging and established market countries on Value-Based Healthcare (VBHC) and Health Technology Assessment (HTA). Presentations from experts provided insights into current developments and challenges, followed by interactive roundtable discussions. Emerging markets have unique healthcare systems, patient populations, resource constraints and needs. AREAS COVERED Each roundtable explored specific topics including the role of HTA and Real-world evidence (RWE) in healthcare decision-making, challenges in biosimilar value assessment and incorporating non-price criteria reflecting context-related specifications of emerging markets such as the multifaceted nature of value in healthcare decision-making, emphasizing stakeholder perspectives and system complexities. EXPERT OPINION RWE emerged as important in understanding biosimilar value recognition and decision-making processes, with insights into its applications and challenges. Recommendations were provided for utilizing Multi-Criteria Decision Analysis (MCDA) in pharmaceutical procurement, particularly for off-patent medicines, underscoring the importance of comprehensive evaluation frameworks and adherence to value-based principles. Overall findings suggest avenues for collaboration between industry, academia, and public agencies to address implementation barriers and promote equitable, efficient, and high-quality healthcare systems in emerging markets through public-private partnerships, joint capacity building and training initiatives, and knowledge transfers.
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Affiliation(s)
| | | | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, South Korea
| | | | | | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | - Dong-Churl Suh
- Korea Institute for Pharmaceutical Policy Affairs, Seoul, South Korea
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Hedibel M, Ghanassi FZ, El-Fass KA, Fasseeh AN, Abaza S, Kaló Z. Designing a Roadmap for Health Technology Assessment Implementation in Algeria. Cureus 2024; 16:e65558. [PMID: 39192895 PMCID: PMC11349251 DOI: 10.7759/cureus.65558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/29/2024] Open
Abstract
Background The scarcity of resources restricts healthcare financing decisions, affecting the population's health. Health technology assessment (HTA) balances restricted budgets with the best possible health outcomes. We aim to characterize the current status of HTA in Algeria and describe the future directions for HTA implementation according to the priorities set by local stakeholders. Methods Stakeholders from the public and private sectors responded to a policy survey about the current and preferred future status of HTA implementation in Algeria. The survey was administered during an online workshop and used a widely accepted international scorecard covering eight domains: capacity building, HTA financing, process and organizational structure, scope of HTA implementation, decision criteria, standardization of methodology, use of local data, and international collaboration. After that, one-on-one interviews with another local expert were conducted to validate and modify the draft recommendations. The interviewees were representatives from government agencies, hospitals, and pharmaceutical companies. Results Thirty-one experts filled out the HTA scorecard survey; most of them were from the public sector (74%). They highlighted that project-based HTA workshops or short courses were the most common form of HTA education in Algeria and recommended the establishment of postgraduate HTA training programs in the future to build sustainable capacities. They reported a lack of funding for HTA research and critical appraisal and recommended an increased public budget for HTA and the introduction of submission fees by manufacturers. There was consensus about the need for local HTA evidence generation in the future. Most of the experts advocated an explicit soft decision threshold. The interviewees further recommended using multi-criteria decision analysis in the short term. The application of quality indicators was believed to improve the reliability of the HTA process. Conclusion The results of our policy research delineate the gap between the current and preferred future status of HTA in Algeria based on insights from multiple stakeholders. The need to improve the educational HTA programs in Algeria, use local data in policy decisions, and increase funding for HTA were the most advocated recommendations.
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Affiliation(s)
- Meriem Hedibel
- Pharmaceutics and Industrial Pharmacy Research Laboratory, Faculty of Pharmacy, University of Algiers, Algiers, DZA
| | - Fatma-Zohra Ghanassi
- Pharmaceutics and Industrial Pharmacy Research Laboratory, Faculty of Pharmacy, University of Algiers, Algiers, DZA
| | | | - Ahmad N Fasseeh
- Modelling, Syreon Middle East, Alexandria, EGY
- Faculty of Pharmacy, Alexandria University, Alexandria, EGY
| | - Sherif Abaza
- Health Economics, Syreon Middle East, Cairo, EGY
| | - Zoltán Kaló
- Health Economics, Syreon Research Institute, Budapest, HUN
- Center for Health Technology Assessment, Semmelweis University, Budapest, HUN
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Nemzoff C, Shah HA, Heupink LF, Regan L, Ghosh S, Pincombe M, Guzman J, Sweeney S, Ruiz F, Vassall A. Adaptive Health Technology Assessment: A Scoping Review of Methods. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1549-1557. [PMID: 37285917 DOI: 10.1016/j.jval.2023.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/13/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Health technology assessment (HTA) is an established mechanism for explicit priority setting to support universal health coverage. However, full HTA requires significant time, data, and capacity for each intervention, which limits the number of decisions it can inform. Another approach systematically adapts full HTA methods by leveraging HTA evidence from other settings. We call this "adaptive" HTA (aHTA), although in settings where time is the main constraint, it is also called "rapid HTA." METHODS The objectives of this scoping review were to identify and map existing aHTA methods, and to assess their triggers, strengths, and weaknesses. This was done by searching HTA agencies' and networks' websites, and the published literature. Findings have been narratively synthesized. RESULTS This review identified 20 countries and 1 HTA network with aHTA methods in the Americas, Europe, Africa, and South-East Asia. These methods have been characterized into 5 types: rapid reviews, rapid cost-effectiveness analyses, rapid manufacturer submissions, transfers, and de facto HTA. Three characteristics "trigger" the use of aHTA instead of full HTA: urgency, certainty, and low budget impact. Sometimes, an iterative approach to selecting methods guides whether to do aHTA or full HTA. aHTA was found to be faster and more efficient, useful for decision makers, and to reduce duplication. Nevertheless, there is limited standardization, transparency, and measurement of uncertainty. CONCLUSIONS aHTA is used in many settings. It has potential to improve the efficiency of any priority-setting system, but needs to be better formalized to improve uptake, particularly for nascent HTA systems.
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Affiliation(s)
- Cassandra Nemzoff
- International Decision Support Initiative, Center for Global Development, Washington, DC, USA; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England, UK.
| | - Hiral A Shah
- International Decision Support Initiative, Center for Global Development, Washington, DC, USA
| | | | - Lydia Regan
- International Decision Support Initiative, Center for Global Development, Washington, DC, USA
| | - Srobana Ghosh
- International Decision Support Initiative, Center for Global Development, Washington, DC, USA
| | - Morgan Pincombe
- International Decision Support Initiative, Center for Global Development, Washington, DC, USA
| | - Javier Guzman
- International Decision Support Initiative, Center for Global Development, Washington, DC, USA
| | - Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England, UK
| | - Francis Ruiz
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England, UK
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England, UK
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Lee IH, Bloor K, Bae EY. A Comparative Analysis of Anticancer Drug Appraisals Including Managed Entry Agreements in South Korea and England. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:347-359. [PMID: 36536231 DOI: 10.1007/s40258-022-00778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study aimed to compare appraisal decisions about anticancer drugs between the health technology assessment (HTA) agencies in Korea and England, and investigate whether the decisions and supporting evidence are comparable. METHODS This study identified 49 anticancer drugs listed by the Korean Ministry of Health and Welfare between January 2014 and December 2019. Of those, 46 anticancer drugs for 58 indications were included for analysis. Official appraisal documents from both countries for 58 drug-indication pairs were compared and assessed in terms of clinical and economic evidence. Evidence items and their groups for analysis were predefined. RESULTS Three-quarters of cases were recommended with managed entry agreements (MEAs) in England and three-fifths in Korea. Finance-based MEA types were most common in both countries. Korean and English authorities made consistent decisions in 48 cases (83%) when classifying decisions as 'recommended' and 'not recommended', while the degree of agreement lowered to 16 cases (28%) when subdividing decisions according to MEA types. When the evidence base was identical, their decisions were more likely to be consistent. Regarding clinical evidence, while the majority of cases referred to the same pivotal studies, differences between the committees' recognized comparators and the appraisal date caused discrepancies in decisions. Economic evidence, including incremental cost-effectiveness ratio (ICER) estimates, was identical in only 12 cases (21%), which contributed to discrepancies. CONCLUSION England relies on economic evaluation, with increasing use of data collection agreements, in contrast with Korea's new procedure exempting companies from providing economic evaluation. While there is possibility for international cooperation in the assessment of clinical evidence, transferability issues exist, particularly with regard to economic evidence.
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Affiliation(s)
- Iyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
- Department of Health Sciences, University of York, York, UK
| | - Karen Bloor
- Department of Health Sciences, University of York, York, UK
| | - Eun-Young Bae
- College of Pharmacy, Gyeongsang National University, Jinju, Republic of Korea.
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Health Technology Assessment in Turkey: Current Status and Perspectives on Future Implementation. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Ramponi F, Twea P, Chilima B, Nkhoma D, Kazanga Chiumia I, Manthalu G, Mfutso-Bengo J, Revill P, Drummond M, Sculpher M. Assessing the potential of HTA to inform resource allocation decisions in low-income settings: The case of Malawi. Front Public Health 2022; 10:1010702. [PMID: 36388387 PMCID: PMC9650047 DOI: 10.3389/fpubh.2022.1010702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023] Open
Abstract
Health technology assessment (HTA) offers a set of analytical tools to support health systems' decisions about resource allocation. Although there is increasing interest in these tools across the world, including in some middle-income countries, they remain rarely used in low-income countries (LICs). In general, the focus of HTA is narrow, mostly limited to assessments of efficacy and cost-effectiveness. However, the principles of HTA can be used to support a broader series of decisions regarding new health technologies. We examine the potential for this broad use of HTA in LICs, with a focus on Malawi. We develop a framework to classify the main decisions on health technologies within health systems. The framework covers decisions on identifying and prioritizing technologies for detailed assessment, deciding whether to adopt an intervention, assessing alternative investments for implementation and scale-up, and undertaking further research activities. We consider the relevance of the framework to policymakers in Malawi and we use two health technologies as examples to investigate the main barriers and enablers to the use of HTA methods. Although the scarcity of local data, expertise, and other resources could risk limiting the operationalisation of HTA in LICs, we argue that even in highly resource constrained health systems, such as in Malawi, the use of HTA to support a broad range of decisions is feasible and desirable.
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Affiliation(s)
- Francesco Ramponi
- Centre for Health Economics, University of York, Heslington, United Kingdom
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Pakwanja Twea
- Department of Planning and Policy Development, Ministry of Health Malawi, Lilongwe, Malawi
| | - Benson Chilima
- Public Health Institute, Ministry of Health Malawi, Lilongwe, Malawi
| | - Dominic Nkhoma
- Health Economics and Policy Unit (HEPU), College of Medicine, University of Malawi, Zomba, Malawi
| | - Isabel Kazanga Chiumia
- Health Economics and Policy Unit (HEPU), College of Medicine, University of Malawi, Zomba, Malawi
| | - Gerald Manthalu
- Department of Planning and Policy Development, Ministry of Health Malawi, Lilongwe, Malawi
| | - Joseph Mfutso-Bengo
- Health Economics and Policy Unit (HEPU), College of Medicine, University of Malawi, Zomba, Malawi
| | - Paul Revill
- Centre for Health Economics, University of York, Heslington, United Kingdom
| | - Michael Drummond
- Centre for Health Economics, University of York, Heslington, United Kingdom
| | - Mark Sculpher
- Centre for Health Economics, University of York, Heslington, United Kingdom
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Drummond MF, Augustovski F, Bhattacharyya D, Campbell J, Chaiyakanapruk N, Chen Y, Galindo-Suarez RM, Guerino J, Mejía A, Mujoomdar M, Ollendorf D, Ronquest N, Torbica A, Tsiao E, Watkins J, Yeung K. Challenges of Health Technology Assessment in Pluralistic Healthcare Systems: An ISPOR Council Report. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1257-1267. [PMID: 35931428 DOI: 10.1016/j.jval.2022.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 06/15/2023]
Abstract
Health technology assessment (HTA) has been growing in use over the past 40 years, especially in its impact on decisions regarding the reimbursement, adoption, and use of new drugs, devices, and procedures. In countries or jurisdictions with "pluralistic" healthcare systems, there are multiple payers or sectors, each of which could potentially benefit from HTA. Nevertheless, a single HTA, conducted centrally, may not meet the needs of these different actors, who may have different budgets, current standards of care, populations to serve, or decision-making processes. This article reports on the research conducted by an ISPOR Health Technology Assessment Council Working Group established to examine the specific challenges of conducting and using HTA in countries with pluralistic healthcare systems. The Group used its own knowledge and expertise, supplemented by a narrative literature review and survey of US payers, to identify existing challenges and any initiatives taken to address them. We recommend that countries with pluralistic healthcare systems establish a national focus for HTA, develop a uniform set of HTA methods guidelines, ensure that HTAs are produced in a timely fashion, facilitate the use of HTA in the local setting, and develop a framework to encourage transparency in HTA. These efforts can be enhanced by the development of good practice guidance from ISPOR or similar groups and increased training to facilitate local use of HTA.
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Affiliation(s)
| | | | | | | | - Nathorn Chaiyakanapruk
- University of Utah, Salt Lake City, UT, USA; Monash University, Selangor, Malaysia; IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | | | | | | | | | - Michelle Mujoomdar
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
| | | | | | | | - Emily Tsiao
- Premera Blue Cross, Mountlake Terrace, WA, USA
| | | | - Kai Yeung
- Kaiser Permanente Washington Health Research Centre, Seattle, WA, USA
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Tachkov K, Zemplenyi A, Kamusheva M, Dimitrova M, Siirtola P, Pontén J, Nemeth B, Kalo Z, Petrova G. Barriers to Use Artificial Intelligence Methodologies in Health Technology Assessment in Central and East European Countries. Front Public Health 2022; 10:921226. [PMID: 35910914 PMCID: PMC9330148 DOI: 10.3389/fpubh.2022.921226] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/20/2022] [Indexed: 12/05/2022] Open
Abstract
The aim of this paper is to identify the barriers that are specifically relevant to the use of Artificial Intelligence (AI)-based evidence in Central and Eastern European (CEE) Health Technology Assessment (HTA) systems. The study relied on two main parallel sources to identify barriers to use AI methodologies in HTA in CEE, including a scoping literature review and iterative focus group meetings with HTx team members. Most of the other selected articles discussed AI from a clinical perspective (n = 25), and the rest are from regulatory perspective (n = 13), and transfer of knowledge point of view (n = 3). Clinical areas studied are quite diverse—from pediatric, diabetes, diagnostic radiology, gynecology, oncology, surgery, psychiatry, cardiology, infection diseases, and oncology. Out of all 38 articles, 25 (66%) describe the AI method and the rest are more focused on the utilization barriers of different health care services and programs. The potential barriers could be classified as data related, methodological, technological, regulatory and policy related, and human factor related. Some of the barriers are quite similar, especially concerning the technologies. Studies focusing on the AI usage for HTA decision making are scarce. AI and augmented decision making tools are a novel science, and we are in the process of adapting it to existing needs. HTA as a process requires multiple steps, multiple evaluations which rely on heterogenous data. Therefore, the observed range of barriers come as a no surprise, and experts in the field need to give their opinion on the most important barriers in order to develop recommendations to overcome them and to disseminate the practical application of these tools.
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Affiliation(s)
| | - Antal Zemplenyi
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pecs, Pecs, Hungary
| | - Maria Kamusheva
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Maria Dimitrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Pekka Siirtola
- Biomimetics and Intelligent Systems Group, University of Oulu, Oulu, Finland
| | - Johan Pontén
- Dental and Pharmaceutical Benefits Agency, Stockholm, Sweden
| | | | - Zoltan Kalo
- Syreon Research Institute, Budapest, Hungary
- Centre for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Guenka Petrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
- *Correspondence: Guenka Petrova
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Santos M, Monteiro AL, Biz AN, Guerra A, Cramer H, Canuto V, Cruz L, Pinto M, Viegas M, Fernandes R, Zimmermann I. Guidelines for Utility Measurement for Economic Analysis: The Brazilian Policy. Value Health Reg Issues 2022; 31:67-73. [PMID: 35533599 DOI: 10.1016/j.vhri.2022.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 02/07/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Health-related quality of life is expressed in utilities, also referred to as utility estimates or parameters. Considerations about the source and type of utility values are especially important in a modeling context, where the lack of transparency, including the lack of a hierarchy for utility data sources, is a major issue to any estimation and can potentially compromise model reliability. OBJECTIVES This document aims to present the first version of the Brazilian guidelines for utility measurement to support economic analysis. METHODS A virtual workshop and a modified Delphi panel with 10 health technology specialists followed a rapid evaluation of 110 technical documents and indexed publications. The recommendations are based on the proposition that has received the most votes, although contentious issues are addressed in the suggestion or discussion. The rationale for the final decision is included in the text. RESULTS The consensus includes 50 recommendations with the following topics: Transparency and Reliability, Model Design, Conditions Under Which Generic Questionnaires Are Not Sensible or Valid, Utility Evidence Hierarchy, Utility Data Searching, Modeling Utility Values, Extrapolating Quality Adjusted Life-Years for Models With Lifetime Horizons, Caregiver Utility, Utility Data Synthesis, Quality/Certainty of the Evidence, and Utility Estimates in End-of-Life Conditions. CONCLUSIONS The goal of this project is to create unified national standards for using utility metrics in economic analysis in Brazil. This set of recommendations is not obligatory, but it is meant to serve as a guide and lead to the development of better and more transparent economic models in the country.
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Affiliation(s)
- Marisa Santos
- National Institute of Cardiology, Rio de Janeiro, Brazil.
| | - Andrea Liborio Monteiro
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Aline Navega Biz
- Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Sheffield, England, UK
| | - Augusto Guerra
- Department of Social Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Helena Cramer
- National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Vania Canuto
- Department of Management and Incorporation of Health Technologies, Ministry of Health, Brazil
| | - Luciane Cruz
- Research Project Office, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Marcia Pinto
- National Institute of Women's, Children's and Adolescents' Health Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - Ivan Zimmermann
- Faculty of Medicine, University of Brasilia, Brasilia, Brazil
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Transferability of a EUnetHTA Relative Effectiveness Assessment (REA) to Low- and Middle-income Countries Setting. Int J Technol Assess Health Care 2022; 38:e42. [PMID: 35477587 DOI: 10.1017/s0266462322000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Indirectness (transferability) is critical when considering existing economic evaluations for GRADE Clinical Practice Guidelines: A systematic review. J Clin Epidemiol 2022; 148:81-92. [PMID: 35462047 DOI: 10.1016/j.jclinepi.2022.04.011] [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: 01/03/2021] [Revised: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE GRADE practice guideline developers often perform systematic reviews of potential economic evaluations to inform recommendation decision-making. We aimed to identify indirectness characteristics of economic evaluations, related to GRADE evidence-to-decision (EtD) theoretical frameworks, that influence selection of these articles. STUDY DESIGN AND SETTING MEDLINE, EMBASE, CINAHL and EconLit were systematically searched to May 2020 to identify indirectness characteristics relevant for economic evaluation transferability to GRADE evidence-to-decision (EtD) theoretical frameworks. Four reviewers screened citations to identify articles of any type that explored study characteristics most important or relevant to economic evaluation transferability, restricted to English language We generated frequencies of article features, used thematic analysis to summarize study characteristics and assessed certainty in the evidence using GRADE-CERQual. RESULTS We included 57 articles, with a dearth of empirical literature - some may have been missed. We identified 8 general themes and 28 sub-themes most important to transferability from 41% of articles. Moderate-to-high confidence evidence suggested that GRADE EtD domains of population, intervention and comparison research question elements, resource use estimation and methodology, and provider and decision-maker acceptability are most important indirectness study characteristics that economists consider when choosing economic evaluation outcomes for use in recommendation decision-making. CONCLUSION We have identified factors important for guideline developers to consider when selecting economic evaluations as research evidence. An economic competency on the development team facilitates these endeavors. This supports the GRADE Working Group's tenant of transparent reporting or availability of sufficient information elsewhere to assess indirectness.
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Saygın Avşar T, Jackson L, McLeod H. Potential for health economics to influence policies on tobacco use during pregnancy in low-income and middle-income countries: a qualitative case study. BMJ Open 2021; 11:e045624. [PMID: 34880008 PMCID: PMC8655542 DOI: 10.1136/bmjopen-2020-045624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/18/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Tobacco control during pregnancy is a policy priority in high-income countries (HICs) because of the significant health and inequality consequences. However, little evidence exists on interventions to reduce tobacco use in low-income and middle-income countries (LMICs), especially for pregnant women. This study aimed to assess how health economics evidence, which is mainly produced in HICs, could be adopted for tobacco cessation policies for pregnant women in LMICs. METHODS A qualitative case study was conducted in an international public health organisation. The organisation was chosen due to its capacity to influence health policies around the world. Tobacco control experts working in the organisation were identified through purposeful sampling and snowballing. Semistructured interviews were conducted with 18 informants with relevant experience of countries from all of the regions covered by the organisation. Data were analysed using the framework method. RESULTS In practice, tobacco cessation during pregnancy was not viewed as a priority in LMICs despite international recognition of the issue. In LMICs, factors including the recorded country-specific prevalence of tobacco use during pregnancy, availability of healthcare resources and the characteristics of potential interventions all affected the use of health economics evidence for policy making. CONCLUSION The scale of tobacco use among pregnant women might be greater than reported in LMICs. Health economics evidence produced in HICs has the potential to inform health policies in LMICs around tobacco cessation interventions if the country-specific circumstances are addressed. Economic evaluations of cessation interventions integrated into antenatal care with a household perspective would be especially relevant in LMICs.
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Affiliation(s)
- Tuba Saygın Avşar
- National Institute for Health Research Applied Research Collaboration (NIHR ARC) North Thames, Department of Applied Health Research, University College London, London, UK
| | - Louise Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Hugh McLeod
- Population Health Sciences, Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Almomani E, Alabbadi I, Fasseeh A, Al-Qutob R, Al-Sharu E, Hayek N, Tarawneh MR, Kaló Z. Implementation Road Map of Health Technology Assessment in Middle-Income Countries: The Case of Jordan. Value Health Reg Issues 2021; 25:126-134. [PMID: 34015521 DOI: 10.1016/j.vhri.2021.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 11/13/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Health technology assessment (HTA) can increase the appropriateness and transparency of pricing and reimbursement decisions. Jordan is still in the early phase of its HTA implementation, although the country has very limited public resources for the coverage of healthcare technologies. The study objective was to explore and validate priorities in the HTA road map for Jordan and propose to facilitate the preferred HTA status. METHODS Health policy experts from the public and private sectors were asked to participate in a survey to explore the current and future status of HTA implementation in Jordan. Semistructured interviews with senior policy makers supported by literature review were conducted to validate survey results and make recommendations for specific actions. RESULTS Survey and interview results indicated a need for increased HTA training, including both short courses and academic programs and gradually increasing public funding for technology assessment and appraisal. Multiple HTA bodies with central coordination can be the most feasible format of HTA institutionalization. The weight of cost-effectiveness criterion based on local data with published reports and explicit decision thresholds should be increased in policy decisions of pharmaceutical and nonpharmaceutical technologies. CONCLUSION Currently, HTA has limited impact on health policy decisions in Jordan, and when it is used to support pharmaceutical reimbursement decisions, it is mainly based on results from other countries without considering transferability of international evidence. Policy makers should facilitate HTA institutionalization and use in policy decisions by increasing the weight of local evidence in HTA recommendations.
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Affiliation(s)
- Emad Almomani
- Jordanian Royal Medical Services, Department for Health Technology Assessment, Amman, Jordan; High Health Council, Department for Health Economics and Financing, Amman, Jordan.
| | - Ibrahim Alabbadi
- The University of Jordan, Faculty of Pharmacy, Amman, Jordan; Faculty of Pharmaceutical Science, UCSI University, Malaysia
| | - Ahmad Fasseeh
- Doctoral School of Sociology, Faculty of Social Sciences, Eötvös Loránd University Budapest, Budapest, Hungary; Syreon Middle East, Alexandria, Egypt
| | - Raeda Al-Qutob
- The University of Jordan, School of Medicine, Dept of Family and Community Medicine, Amman, Jordan
| | - Emad Al-Sharu
- Jordanian Royal Medical Services, Department for Health Technology Assessment, Amman, Jordan
| | - Noha Hayek
- Theodore Bilharz Reseach Institute, Giza, Egypt
| | | | - Zoltán Kaló
- Semmelweis University, Center for Health Technology Assessment, Budapest, Hungary; Syreon Research Institute, Budapest, Hungary
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14
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Daubner-Bendes R, Kovács S, Niewada M, Huic M, Drummond M, Ciani O, Blankart CR, Mandrik O, Torbica A, Yfantopoulos J, Petrova G, Holownia-Voloskova M, Taylor RS, Al M, Piniazhko O, Lorenzovici L, Tarricone R, Zemplényi A, Kaló Z. Quo Vadis HTA for Medical Devices in Central and Eastern Europe? Recommendations to Address Methodological Challenges. Front Public Health 2021; 8:612410. [PMID: 33490024 PMCID: PMC7820783 DOI: 10.3389/fpubh.2020.612410] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/07/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives: Methodological challenges in the evaluation of medical devices (MDs) may be different for early and late technology adopter countries, as well as the potential health technology assessment (HTA) solutions to tackle them. This study aims to provide guidance to Central and Eastern European (CEE) countries on how to address key challenges of HTA for MDs with special focus on the transferability of scientific evidence. Methods: As part of the COMED Horizon 2020 project, a comprehensive list of issues related to MD HTA were identified based on a targeted literature review. Health technology assessment issues which pose a greater challenge or require different solutions in late technology adopter countries were selected. Draught recommendations to address these issues were developed and discussed in a focus group. The recommendations were then validated with a wider group of experts, including HTA and reimbursement decision makers from CEE countries in May and June 2020. Results: A consolidated list of 11 recommendations were developed in 3 major areas: (1) clinical value assessment, focusing on the use of joint EU work, relying on real-world evidence, use of coverage with evidence development schemes, transferring evidence from foreign countries and addressing the challenges of learning curve and centre effect; (2) economic value assessment, covering cost calculation of complex medical devices and transferability of economic evaluations of MDs; (3) HTA processes, related to the frequent product modifications and various indications of MDs. Conclusions: Central and Eastern European countries with limited resources for conducting HTA, can benefit from HTA methods and evidence generated in early technology adopter countries. Considering the appropriate reuse of international HTA materials, late technology adopter countries can still implement HTA, even for MDs, which have a more limited evidence base compared with pharmaceuticals.
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Affiliation(s)
| | - Sándor Kovács
- Syreon Research Institute, Budapest, Hungary.,Centre for Health Technology Assessment, University of Pécs, Pécs, Hungary
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | | | - Michael Drummond
- Centre for Health Economics, University of York, York, United Kingdom
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy.,Evidence Synthesis and Modelling for Health Improvement, College of Medicine and Health, Institute of Health Research, University of Exeter, Exeter, United Kingdom
| | - Carl Rudolf Blankart
- KPM Center for Public Management, University of Bern, Bern, Switzerland.,sitem-insel AG, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Olena Mandrik
- School of Health and Related Research, Health Economics and Decision Science, The University of Sheffield, Sheffield, United Kingdom
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy.,Department of Social and Political Science, Bocconi University, Milan, Italy
| | - John Yfantopoulos
- School of Economics and Political Science, University of Athens, Athens, Greece
| | - Guenka Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Malwina Holownia-Voloskova
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.,Health Technology Assessment Department, State Budgetary Institution "Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department", Moscow, Russia
| | - Rod S Taylor
- Evidence Synthesis and Modelling for Health Improvement, College of Medicine and Health, Institute of Health Research, University of Exeter, Exeter, United Kingdom.,MRC/CSO Social and Public Health Sciences Unit and Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, United Kingdom
| | - Maiwenn Al
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Oresta Piniazhko
- HTA Department of State Expert Centre of Ministry of Health of Ukraine, Kyiv, Ukraine
| | - László Lorenzovici
- G. E. Palade University of Medicine, Pharmacy, Science and Technology, Tirgu Mures, Romania.,Syreon Research Romania, Tirgu Mures, Romania
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy.,Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Antal Zemplényi
- Syreon Research Institute, Budapest, Hungary.,Division of Pharmacoeconomics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary.,Centre for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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15
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Economic analysis of healthcare-associated infection prevention and control interventions in medical and surgical units: systematic review using a discounting approach. J Hosp Infect 2020; 106:134-154. [PMID: 32652215 PMCID: PMC7341040 DOI: 10.1016/j.jhin.2020.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
Nosocomial or healthcare-associated infections (HCAIs) are associated with a financial burden that affects both patients and healthcare institutions worldwide. The clinical best care practices (CBPs) of hand hygiene, hygiene and sanitation, screening, and basic and additional precautions aim to reduce this burden. The COVID-19 pandemic has confirmed these four CBPs are critically important prevention practices that limit the spread of HCAIs. This paper conducted a systematic review of economic evaluations related to these four CBPs using a discounting approach. We searched for articles published between 2000 and 2019. We included economic evaluations of infection prevention and control of Clostridioides difficile-associated diarrhoea, meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Gram-negative bacilli. Results were analysed with cost-minimization, cost-effectiveness, cost-utility, cost-benefit and cost-consequence analyses. Articles were assessed for quality. A total of 11,898 articles were screened and seven were included. Most studies (4/7) were of overall moderate quality. All studies demonstrated cost effectiveness of CBPs. The average yearly net cost savings from the CBPs ranged from $252,847 (2019 Canadian dollars) to $1,691,823, depending on the rate of discount (3% and 8%). The average incremental benefit cost ratio of CBPs varied from 2.48 to 7.66. In order to make efficient use of resources and maximize health benefits, ongoing research in the economic evaluation of infection control should be carried out to support evidence-based healthcare policy decisions.
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16
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Kaló Z, Zemplényi A, Rutten-van Mölken M, Looman W, Huić M, Tandara Haček R, Petrova G, Piniazhko O, Tesar T, Csanádi M, Pitter JG. Development of transferability guidance for integrated care models with special focus on Central and Eastern European countries. Croat Med J 2020; 61:252-259. [PMID: 32643342 PMCID: PMC7358690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/10/2020] [Indexed: 03/30/2024] Open
Abstract
AIM To develop pragmatic recommendations for Central and Eastern European (CEE) policymakers about transferability assessment of integrated care models established in higher income European Union (EU) countries. METHODS Draft recommendations were developed based on Horizon 2020-funded SELFIE project deliverables related to 17 promising integrated care models for multimorbid patients throughout Europe, as well as on an online survey among CEE stakeholders on the relevance of implementation barriers. Draft recommendations were discussed at the SELFIE transferability workshop and finalized together with 22 experts from 12 CEE countries. RESULTS Thirteen transferability recommendations are provided in three areas. Feasibility of local implementation covers the identification and prioritization of implementation barriers and proposals for potential solutions. Performance measurement of potentially transferable models focuses on the selection of models with proven benefits and assurance of performance monitoring. Transferability of financing methods for integrated care explores the relevance of financing methodologies and planning of adequate initial and long-term financing. CONCLUSIONS Implementation of international integrated care models cannot be recommended without evidence on its local feasibility or scientifically sound and locally relevant performance assessment in the country of origin. However, if the original financing method is not transferable to the target region, development of a locally relevant alternative financing method can be considered.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Marcell Csanádi
- Marcell Csanádi, Syreon Research Institute, Mexikói Str. 65/a., Budapest, Hungary,
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17
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Salas M, Lopes LC, Godman B, Truter I, Hartzema AG, Wettermark B, Fadare J, Burger JR, Appenteng K, Donneyong M, Arias A, Ankrah D, Ogunleye OO, Lubbe M, Horne L, Bernet J, Gómez-Galicia DL, Del Carmen Garcia Estrada M, Oluka MN, Massele A, Alesso L, Herrera Comoglio R, da Costa Lima E, Vilaseca C, Bergman U. Challenges facing drug utilization research in the Latin American region. Pharmacoepidemiol Drug Saf 2020; 29:1353-1363. [PMID: 32419226 DOI: 10.1002/pds.4989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/20/2019] [Accepted: 02/03/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The International Society of Pharmacoepidemiology (ISPE) in collaboration with the Latin America Drug Utilization Research Group (LatAm DURG), the Medicines Utilization Research in Africa (MURIA) group, and the Uppsala Monitoring Center, is leading an initiative to understand challenges to drug utilization research (DUR) in the Latin American (LatAm) and African regions with the goal of communicating results and proposing solutions to these challenges in four scientific publications. The purpose of this first manuscript is to identify the main challenges associated with DUR in the LatAm region. METHODS Drug utilization (DU) researchers in the LatAm region voluntarily participated in multiple discussions, contributed with local data and reviewed successive drafts and the final manuscript. Additionally, we carried out a literature review to identify the most relevant publications related to DU studies from the LatAm region. RESULTS Multiple challenges were identified in the LatAm region for DUR including socioeconomic inequality, access to medical care, complexity of the healthcare system, limited investment in research and development, limited institutional and organization resources, language barriers, limited health education and literacy. Further, there is limited use of local DUR data by decision makers particularly in the identification of emerging health needs coming from social and demographic transitions. CONCLUSIONS The LatAm region faces challenges to DUR which are inherent in the healthcare and political systems, and potential solutions should target changes to the system.
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Affiliation(s)
- Maribel Salas
- Daiichi Sankyo, Inc, Basking Ridge, USA.,CCEB/CPeRT, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Luciane C Lopes
- Pharmaceutical Science graduate Course, Universidade de Sorocaba UNISO, Sao Paulo, Brazil
| | - Brian Godman
- Karolinska Institute, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Gainesville, Glasgow, UK.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, South Africa
| | | | - Bjorn Wettermark
- Clinical epidemiology & Clinical pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Pharmacy, Disciplinary Domain of Medicine and Pharmacy, Uppsala University
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria
| | - Johanita R Burger
- Medicine Usage in South Africa (MUSA), North-West University, Potchefstroom, South Africa
| | - Kwame Appenteng
- Department of Epidemiology, Astellas Pharma US, Northbrook, IL
| | - Macarius Donneyong
- Pharmacy Practice and Science, College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Ariel Arias
- Centre for Biologics Evaluation, Health Canada, Ottawa, ON and Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | | | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Martha Lubbe
- Medicine Usage in South Africa (MUSA), North-West University, Potchefstroom, South Africa
| | - Laura Horne
- Department of Epidemiology, Daiichi Sankyo, Inc, Basking Ridge, NJ
| | - Jorgelina Bernet
- School of Medicine, Cordoba National University, Cordoba, Argentina
| | - Diana L Gómez-Galicia
- Facultad de Farmacia, Universidad Autónoma del Estado de Morelos, Cuernavaca, México
| | | | | | - Amos Massele
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Luis Alesso
- School of Medicine, Cordoba National University, Cordoba, Argentina
| | | | - Elisangela da Costa Lima
- Observatorio de Vigilancia e Uso de Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Cidade Universitária, Rio de Janeiro, RJ
| | - Carmen Vilaseca
- Colegio de Bioquimica y Farmacia, La Paz, Bolivia, Plurinational State
| | - Ulf Bergman
- Departments of Clinical Pharmacology and Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, Huddinge
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18
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Alabbadi I, Almomani E, Alshazili M. Drug Selection for Formulary Inclusion: An Exploratory Case Study of Oncology Medicines in Jordan. Value Health Reg Issues 2020; 21:211-221. [PMID: 32305828 DOI: 10.1016/j.vhri.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/28/2019] [Accepted: 12/19/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Access to healthcare services including innovative treatments is one of the most important objectives of healthcare system in Jordan. This research summarized one of the actual practices pertaining to health priority setting in Jordan with official requirement to use cost-effectiveness analysis. OBJECTIVES To address the role of economic evidence to inform the decisions and rationales drawn by health policy experts to optimize resources mobilization for new cancer drugs. METHOD The research reported a case study of formulary setting priority in Jordan. Documentary collation and analysis of a secondary source (meeting minutes) produced by decision committee were conducted by the research team. The decisions and rationales shaped by panelists for 22 newly registered oncology drugs at Jordan Food and Drug Administration were reviewed and described. RESULTS It was found that the absence of official health economic guidelines in the country and informal use of cost-effectiveness analysis by the panelists appeared to flaw the importance of incremental cost-effectiveness ratio (ICER). Nevertheless, "the lower the ICER, the better the drug" was the primary factor in all committee's decisions to inform resources mobilization. Despite of the latter, 7 drugs were selected for formulary inclusion for different oncology disease areas in Jordan. CONCLUSIONS Priority setting for new cancer drugs is not well-informed in Jordan. Nevertheless, this research revealed different disadvantages that appear to militate against the perspective of the study. Recommendations for implementation and enhancement of health economic evaluation include further investment in capacity building (eg, prepare qualified health economists) and create incentive to improve availability and accessibility of local data.
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Affiliation(s)
| | - Emad Almomani
- Center for Health Technology Assessment, Jordanian Royal Medical Services, Amman, Jordan
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19
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Rais C, Kaló Z, Csanádi M, Negulescu V. Current and future perspectives for the implementation of health technology assessment in Romania. HEALTH POLICY AND TECHNOLOGY 2020. [DOI: 10.1016/j.hlpt.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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20
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Tesar T, Obsitnik B, Kaló Z, Kristensen FB. How Changes in Reimbursement Practices Influence the Financial Sustainability of Medicine Policy: Lessons Learned from Slovakia. Front Pharmacol 2019; 10:664. [PMID: 31249529 PMCID: PMC6584090 DOI: 10.3389/fphar.2019.00664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/23/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of this study was to review the impact of new reimbursement requirements for medicines in the Slovak Republic based on legislation that came into force in January 2018. Methods: The new legislation was reviewed. The reimbursement dossiers for medicines and health technology assessments and appraisals, justifications for reimbursement decisions, final reimbursement decisions, and all aspects of the appeal mechanisms have been transparently published on the website of the Slovak Ministry of Health and were used for this analysis. Results: Based on the new legislation, there was no need to submit information about relative effectiveness and cost-effectiveness of medicines with less than 1:50,000 eligible patients prior to reimbursement decisions, and the cost-effectiveness threshold has been increased for all other medicines. The estimated impact of the 2-year budget for the 59 medicines submitted for reimbursement without relative effectiveness and cost-effectiveness analysis was €181,273,698, based on the published submission dossiers. The estimated impact of the 2-year budget for the 45 medicines with evidence of relative effectiveness and cost-effectiveness was €178,566,634. In contrast to the easier market access criteria for new original medicines, the new legislation enforces stricter price erosion criteria for generic and biosimilar medicines. Consequently, the number of generic and biosimilar entries was reduced from 242 in 2017 to 224 in 2018. Conclusions: Although some of the new reimbursement applications were not approved by the Ministry of Health, many new medicines were added to the Slovak pharmaceutical reimbursement list based on "balanced assessment" requirements; hence, the system became financially unsustainable. It was necessary to change the legislation from January 2019.
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Affiliation(s)
- Tomas Tesar
- Department of Organisation and Management in Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Slovakia
| | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy and Health Economics, Eötvös Loránd University (ELTE), Budapest, Hungary
| | - Finn Børlum Kristensen
- Research Unit of User Perspectives, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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21
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Health Economics and Outcomes Research Knowledge Needs Assessment for Latin America. Value Health Reg Issues 2019; 20:2-6. [PMID: 30634087 DOI: 10.1016/j.vhri.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/30/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND An increasing awareness of the importance of health economics and outcomes research (HEOR) skills has been reported in Latin America. There is, however, no published study directly assessing perceived knowledge levels and knowledge gaps on specific HEOR topics among professionals and students in the region. OBJECTIVES To assess perceived HEOR knowledge levels and identify knowledge gaps in Latin America. METHODS An online needs assessment survey was developed to quantify perceived HEOR knowledge levels and identify knowledge gaps. Members of the International Society for Pharmacoeconomics and Outcomes Research in the Latin American region, regional chapters, and student chapter presidents were invited to participate in the survey. The survey, developed using the SurveyMonkey tool, was distributed to participants electronically. Data were extracted from the survey and analyzed using Microsoft Excel. Data analysis was conducted using descriptive statistics to summarize the survey respondents' demographic information, current and desired knowledge levels, and preferred method/format for delivery of educational training. RESULTS Survey responses were collected from 106 participants. The largest knowledge gap was calculated for methods for integrating medication adherence and persistence in health economic evaluations (mean = 2.30 ± 1.48). The smallest knowledge gap was calculated for types of healthcare costs (mean = 1.01 ± 1.17). Most respondents (74% [n = 66]) preferred to receive educational materials related to HEOR topics through online learning and continuing education programs. CONCLUSIONS The knowledge gap assessment provided current knowledge gap perceptions among members of the International Society for Pharmacoeconomics and Outcomes Research in Latin America. The survey data collected support a need for developing educational programs for topics with the highest perceived knowledge gap.
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22
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Kristensen FB, Husereau D, Huić M, Drummond M, Berger ML, Bond K, Augustovski F, Booth A, Bridges JFP, Grimshaw J, IJzerman MJ, Jonsson E, Ollendorf DA, Rüther A, Siebert U, Sharma J, Wailoo A. Identifying the Need for Good Practices in Health Technology Assessment: Summary of the ISPOR HTA Council Working Group Report on Good Practices in HTA. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:13-20. [PMID: 30661627 DOI: 10.1016/j.jval.2018.08.010] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 05/11/2023]
Abstract
The systematic use of evidence to inform healthcare decisions, particularly health technology assessment (HTA), has gained increased recognition. HTA has become a standard policy tool for informing decision makers who must manage the entry and use of pharmaceuticals, medical devices, and other technologies (including complex interventions) within health systems, for example, through reimbursement and pricing. Despite increasing attention to HTA activities, there has been no attempt to comprehensively synthesize good practices or emerging good practices to support population-based decision-making in recent years. After the identification of some good practices through the release of the ISPOR Guidelines Index in 2013, the ISPOR HTA Council identified a need to more thoroughly review existing guidance. The purpose of this effort was to create a basis for capacity building, education, and improved consistency in approaches to HTA-informed decision-making. Our findings suggest that although many good practices have been developed in areas of assessment and some other key aspects of defining HTA processes, there are also many areas where good practices are lacking. This includes good practices in defining the organizational aspects of HTA, the use of deliberative processes, and measuring the impact of HTA. The extent to which these good practices are used and applied by HTA bodies is beyond the scope of this report, but may be of interest to future researchers.
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Affiliation(s)
| | - Don Husereau
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
| | - Mirjana Huić
- Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia
| | | | | | - Kenneth Bond
- Patient Engagement, Ethics and International Affairs, Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, ON, Canada
| | - Federico Augustovski
- Economic Evaluations and HTA Department, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andrew Booth
- ScHARR, The University of Sheffield, Sheffield, UK
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeremy Grimshaw
- Cochrane Canada and Professor of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Maarten J IJzerman
- School of Population and Global Health, University of Melbourne, Melbourne, Australia; Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands
| | - Egon Jonsson
- Institute of Health Economics, Edmonton, AB, Canada
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health (CEVR), Tufts University, Boston, MA, USA
| | - Alric Rüther
- International Affairs, Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; Division of Health Technology Assessment, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria; Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jitendar Sharma
- AP MedTech Zone & Advisor (Health), Department of Health & Family Welfare, Andhra Pradesh, India
| | - Allan Wailoo
- ScHARR, The University of Sheffield, Sheffield, UK; NICE Decision Support Unit, Sheffield, UK
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23
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Kulchaitanaroaj P, Kaló Z, West R, Cheung KL, Evers S, Vokó Z, Hiligsmann M, de Vries H, Owen L, Trapero-Bertran M, Leidl R, Pokhrel S. Understanding perceived availability and importance of tobacco control interventions to inform European adoption of a UK economic model: a cross-sectional study. BMC Health Serv Res 2018; 18:115. [PMID: 29444679 PMCID: PMC5813331 DOI: 10.1186/s12913-018-2923-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 02/06/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The evidence on the extent to which stakeholders in different European countries agree with availability and importance of tobacco-control interventions is limited. This study assessed and compared stakeholders' views from five European countries and compared the perceived ranking of interventions with evidence-based ranking using cost-effectiveness data. METHODS An interview survey (face-to-face, by phone or Skype) was conducted between April and July 2014 with five categories of stakeholders - decision makers, service purchasers, service providers, evidence generators and health promotion advocates - from Germany, Hungary, the Netherlands, Spain, and the United Kingdom. A list of potential stakeholders drawn from the research team's contacts and snowballing served as the sampling frame. An email invitation was sent to all stakeholders in this list and recruitment was based on positive replies. Respondents were asked to rate availability and importance of 30 tobacco control interventions. Kappa coefficients assessed agreement of stakeholders' views. A mean importance score for each intervention was used to rank the interventions. This ranking was compared with the ranking based on cost-effectiveness data from a published review. RESULTS Ninety-three stakeholders (55.7% response rate) completed the survey: 18.3% were from Germany, 17.2% from Hungary, 30.1% from the Netherlands, 19.4% from Spain, and 15.1% from the UK. Of those, 31.2% were decision makers, 26.9% evidence generators, 19.4% service providers, 15.1% health-promotion advocates, and 7.5% purchasers of services/pharmaceutical products. Smoking restrictions in public areas were rated as the most important intervention (mean score = 1.89). The agreement on availability of interventions between the stakeholders was very low (kappa = 0.098; 95% CI = [0.085, 0.111] but the agreement on the importance of the interventions was fair (kappa = 0.239; 95% CI = [0.208, 0.253]). A correlation was found between availability and importance rankings for stage-based interventions. The importance ranking was not statistically concordant with the ranking based on published cost-effectiveness data (Kendall rank correlation coefficient = 0.40; p-value = 0.11; 95% CI = [- 0.09, 0.89]). CONCLUSIONS The intrinsic differences in stakeholder views must be addressed while transferring economic evidence Europe-wide. Strong engagement with stakeholders, focussing on better communication, has a potential to mitigate this challenge.
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Affiliation(s)
- Puttarin Kulchaitanaroaj
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Robert West
- Health Behaviour Research Centre, University College London, London, UK
- National Centre for Smoking Cessation and Training, Birmingham, UK
| | - Kei Long Cheung
- Department of Health Promotion, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Silvia Evers
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Mickael Hiligsmann
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Lesley Owen
- National Institute for Health and Care Excellence, London, UK
| | - Marta Trapero-Bertran
- Centre for Research in Economics and Health, University Pompeu Fabra, Barcelona, Spain
| | - Reiner Leidl
- Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München, Oberschleißheim, Germany
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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Olry de Labry Lima A, Espín Balbino J, Lemgruber A, Caro Martínez A, García-Mochón L, Martín Ruiz E, Lessa F. Health technology assessment process of a cardiovascular medical device in four different settings. J Comp Eff Res 2017; 6:591-600. [PMID: 29039685 DOI: 10.2217/cer-2016-0098] [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: 11/21/2022] Open
Abstract
AIM Health technology assessment (HTA) is a tool to help the decision-making process. The aim is to describe methods and processes used in the reimbursement decision making for drug-eluting stents (DES) in four different settings. METHODS DES as a technology under study was selected according to different criteria, all of them agreed by a working group. A survey of key informants was designed. RESULTS DES was evaluated following well-structured HTA processes. Nonetheless, scope for improvement was observed in relation to the data considered for the final decision, the transparency and inclusiveness of the process as well as in the methods employed. CONCLUSION An attempt to describe the HTA processes of a well-known medical device.
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Affiliation(s)
- Antonio Olry de Labry Lima
- Escuela Andaluza de Salud Pública (EASP), Campus Universitario de Cartuja, Granada, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.,Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Jaime Espín Balbino
- Escuela Andaluza de Salud Pública (EASP), Campus Universitario de Cartuja, Granada, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.,Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Alexandre Lemgruber
- Pan American Health Organization (PAHO)/Organización Panamericana de la Salud (OPS), Washington DC 20037, USA
| | - Araceli Caro Martínez
- Escuela Andaluza de Salud Pública (EASP), Campus Universitario de Cartuja, Granada, Spain
| | - Leticia García-Mochón
- Escuela Andaluza de Salud Pública (EASP), Campus Universitario de Cartuja, Granada, Spain.,Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Eva Martín Ruiz
- Escuela Andaluza de Salud Pública (EASP), Campus Universitario de Cartuja, Granada, Spain
| | - Fernanda Lessa
- Pan American Health Organization (PAHO)/Organización Panamericana de la Salud (OPS), Washington DC 20037, USA
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25
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Is It Time for Joint Health Technology Assessment in Asia? Opportunities and Challenges. Value Health Reg Issues 2017. [PMID: 28648323 DOI: 10.1016/j.vhri.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rosselli D, Quirland-Lazo C, Csanádi M, Ruiz de Castilla EM, González NC, Valdés J, Abicalaffe C, Garzón W, Leon G, Kaló Z. HTA Implementation in Latin American Countries: Comparison of Current and Preferred Status. Value Health Reg Issues 2017; 14:20-27. [PMID: 29254537 DOI: 10.1016/j.vhri.2017.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/13/2017] [Accepted: 02/22/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To provide an overview about the current status of health technology assessment (HTA) implementation in Latin American countries and to identify long-term objectives considering regional commonalities. METHODS We conducted a survey among participants of the 5th Latin American Future Trends Conference in October 2015. Thirty-seven respondents from eight Latin American countries provided insights about the current and preferred future status of HTA implementation related to human capacity building, HTA financing, process and organizational structure for HTA, scope of mandatory HTA, decision criteria, standardization of HTA methodology, mandating the use of local data, and international collaboration in HTA. RESULTS Survey respondents reported insufficient human resources and public investment for HTA implementation. Organizational structure and legislation framework of HTA differ considerably across countries. According to survey respondents, in the future policymakers should rely more on the assessment of therapeutic value, cost-effectiveness, and budget impact criteria by applying explicit thresholds, potentially in a multicriteria decision analysis framework. HTA should not be restricted to policy decisions of new technologies but it should also be used for the revision of previous decisions. In addition, the quality and transparency of HTA have to be strengthened. CONCLUSIONS HTA plays an increasingly important role in Latin American countries. Each country needs to record its current implementation status and identify components for improvement. Duplication of efforts can be reduced if international collaboration is integrated into national HTA implementation.
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Affiliation(s)
- Diego Rosselli
- Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | | | | | | | - Julio Valdés
- Consejo de Ministros de Salud de Centroamérica y República Dominicana (COMISCA), Antiguo Cuscatlán, El Salvador
| | | | | | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary; Faculty of Social Sciences, Department of Health Policy and Health Economics, Institute of Economics, Eötvös Loránd University, Budapest, Hungary.
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OVERVIEW ON THE CURRENT IMPLEMENTATION OF HEALTH TECHNOLOGY ASSESSMENT IN THE HEALTHCARE SYSTEM IN HUNGARY. Int J Technol Assess Health Care 2017; 33:333-338. [PMID: 28434433 DOI: 10.1017/s0266462317000071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Our objectives were to assess the current implementation of health technology assessment (HTA) in Hungary and to identify country-specific patterns of challenges and potential improvements. METHODS We applied a structure that can be used to create HTA implementation roadmaps to evaluate various issues regarding HTA implementation. A comprehensive description of the Hungarian HTA system is presented according to relevant literature and experiences of the authors. RESULTS By investigating eight components of HTA implementation, we identified the most important strengths and weaknesses of the Hungarian system. More specifically, we were mainly focusing on the emergence of HTA capacity, the establishment and current role of Department of HTA, the complex process of decision making, the quality elements developed in the near past, and the activity of Hungarian experts at international collaborations. CONCLUSIONS We concluded that there is a sophisticated methodological and educational basis for HTA in Hungary. A permanent focus on capacity building and changes to the reimbursement procedure can further improve transparency and the scientific basis of decision making in the country.
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Zelei T, Molnár MJ, Szegedi M, Kaló Z. Systematic review on the evaluation criteria of orphan medicines in Central and Eastern European countries. Orphanet J Rare Dis 2016; 11:72. [PMID: 27259284 PMCID: PMC4893267 DOI: 10.1186/s13023-016-0455-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/19/2016] [Indexed: 12/11/2022] Open
Abstract
Background In case of orphan drugs applicability of the standard health technology assessment (HTA) process is limited due to scarcity of good clinical and health economic evidence. Financing these premium priced drugs is more controversial in the Central and Eastern European (CEE) region where the public funding resources are more restricted, and health economic justification should be an even more important aspect of policy decisions than in higher income European countries. Objectives To explore and summarize the recent scientific evidence on value drivers related to the health technology assessment of ODs with a special focus on the perspective of third party payers in CEE countries. The review aims to list all potentially relevant value drivers in the reimbursement process of orphan drugs. Methods A systematic literature review was performed; PubMed and Scopus databases were systematically searched for relevant publications until April 2015. Extracted data were summarized along key HTA elements. Results From the 2664 identified publications, 87 contained relevant information on the evaluation criteria of orphan drugs, but only 5 had direct information from the CEE region. The presentation of good clinical evidence seems to play a key role especially since this should be the basis of cost-effectiveness analyses, which have more importance in resource-constrained economies. Due to external price referencing of pharmaceuticals, the relative budget impact of orphan drugs is expected to be higher in CEE than in Western European (WE) countries unless accessibility of patients remains more limited in poorer European regions. Equity principles based on disease prevalence and non-availability of alternative treatment options may increase the price premium, however, societies must have some control on prices and a rationale based on multiple criteria in reimbursement decisions. Conclusions The evaluation of orphan medicines should include multiple criteria to appropriately measure the clinical added value of orphan drugs. The search found only a small number of studies coming from CEE, therefore European policies on orphan drugs may be based largely on experiences in WE countries. More research should be done in the future in CEE because financing high-priced orphan drugs involves a greater burden for these countries. Electronic supplementary material The online version of this article (doi:10.1186/s13023-016-0455-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tamás Zelei
- Department of Health Policy and Health Economics, Institute of Economics, Faculty of Social Sciences, Eötvös Loránd University, Pázmány Péter sétány 1/A, 1117, Budapest, Hungary
| | - Mária J Molnár
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tömő u. 25-29, 1083, Budapest, Hungary
| | - Márta Szegedi
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Tömő u. 25-29, 1083, Budapest, Hungary
| | - Zoltán Kaló
- Department of Health Policy and Health Economics, Institute of Economics, Faculty of Social Sciences, Eötvös Loránd University, Pázmány Péter sétány 1/A, 1117, Budapest, Hungary. .,Syreon Research Institute, Mexikói út 65/A, 1142, Budapest, Hungary.
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