1
|
Al-Jedai AH, Lomas J, Almudaiheem HY, Al-Ruthia YSH, Alghamdi S, Awad N, Alghamdi A, Alowairdhi MA, Alabdulkarim H, Almadi M, Bunyan RF, Ochalek J. Informing a cost-effectiveness threshold for Saudi Arabia. J Med Econ 2023; 26:128-138. [PMID: 36576804 DOI: 10.1080/13696998.2022.2157141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/07/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Saudi Arabia's Vision 2030 aims to reform health care across the Kingdom, with health technology assessment being adopted as one tool promising to improve the efficiency with which resources are used. An understanding of the opportunity costs of reimbursement decisions is key to fulfilling this promise and can be used to inform a cost-effectiveness threshold. This paper is the first to provide a range of estimates of this using existing evidence extrapolated to the context of Saudi Arabia. METHODS AND MATERIALS We use four approaches to estimate the marginal cost per unit of health produced by the healthcare system; drawing from existing evidence provided by a cross-country analysis, two alternative estimates from the UK context, and based on extrapolating a UK estimate using evidence on the income elasticity of the value of health. Consequences of estimation error are explored. RESULTS Based on the four approaches, we find a range of SAR 42,046 per QALY gained (48% of GDP per capita) to SAR 215,120 per QALY gained (246% of GDP per capita). Calculated potential central estimates from the average of estimated health gains based on each source gives a range of SAR 50,000-75,000. The results are in line with estimates from the emerging literature from across the world. CONCLUSION A cost-effectiveness threshold reflecting health opportunity costs can aid decision-making. Applying a cost-effectiveness threshold based on the range SAR 50,000 to 75,000 per QALY gained would ensure that resource allocation decisions in healthcare can in be informed in a way that accounts for health opportunity costs. LIMITATIONS A limitation is that it is not based on a within-country study for Saudi Arabia, which represents a promising line of future work.
Collapse
Affiliation(s)
- Ahmed Hamdan Al-Jedai
- Therapeutic Affairs, Ministry of Health Saudi Arabia, Riyadh, Saudi Arabia
- Colleges of Pharmacy and Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - James Lomas
- Department of Economics and Related Studies, University of York, York, United Kingdom
| | | | | | | | - Nancy Awad
- IQVIA Dubai, Dubai, United Arab Emirates
| | - Ahlam Alghamdi
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Hana Alabdulkarim
- Drug Policy and Economic Center, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Majid Almadi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Reem F Bunyan
- Center for Improving Value in Health, Ministry of Health, Riyadh, Saudi Arabia
- King Fahad Specialist Hospital, Dammam, Ash Sharqiyah, Saudi Arabia
| | - Jessica Ochalek
- Centre for Health Economics, University of York, York, United Kingdom
| |
Collapse
|
2
|
Impact of Health Technology Assessment Implementation with Special Focus on Middle-Income Countries. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
3
|
Nagi MA, Dewi PEN, Thavorncharoensap M, Sangroongruangsri S. A Systematic Review on Economic Evaluation Studies of Diagnostic and Therapeutic Interventions in the Middle East and North Africa. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:315-335. [PMID: 34931297 DOI: 10.1007/s40258-021-00703-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Due to the increase in healthcare budget constraint, economic evaluation (EE) evidence is increasingly required to inform resource allocation decisions. This study aimed to systematically review quantity, characteristics, and quality of full EE studies on diagnostic and therapeutic interventions conducted in 26 Middle East and North Africa (MENA) countries. METHODS PubMed and Scopus databases were comprehensively searched to identify the published EE studies in the MENA region. The quality of reviewed studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS The search identified 69 studies. The cost-utility approach was adopted in 49 studies (71 %). More than half (38 studies; 55 %) were conducted in Iran and Turkey. Sixteen countries (62 %) did not have any EE studies. The most frequently analyzed therapeutic areas were infectious diseases (19 studies; 28 %), cardiovascular diseases (11 studies; 16 %), and malignancies (10 studies; 14 %). Ten studies (14 %), 46 (67 %), 12 (17 %), and 1 study (1 %) were classified as excellent, high, moderate, and poor quality, respectively. The mean of items reported was 85.10 % (standard deviation 13.32 %). Characterizing heterogeneity, measurement of effectiveness, time horizon, and discount rate were missed in 21 (60 %), 22 (32 %), 20 (29 %) and 15 (25 %) studies, respectively. Data on effectiveness and utility relied primarily on studies conducted outside the region. CONCLUSIONS The quantity of EE studies in the MENA region remains low; however, overall quality is high to excellent. The availability of local data, capacity building, and national guidelines are vital to improve both the quantity and quality of EE studies in the region.
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.
| | - Pramitha Esha Nirmala Dewi
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Department of Pharmacy Profession, Faculty of Medicine and health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Montarat Thavorncharoensap
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400, Thailand
| | - Sermsiri Sangroongruangsri
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400, Thailand
| |
Collapse
|
4
|
Almansour HA, Aloudah NM, Alhawassi TM, Chaar B, Krass I, Saini B. Physicians' views on cardiovascular disease risk prevention services by pharmacists and potential for collaboration. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 4:100077. [PMID: 35479842 PMCID: PMC9029915 DOI: 10.1016/j.rcsop.2021.100077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/10/2021] [Accepted: 09/26/2021] [Indexed: 10/26/2022] Open
|
5
|
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
|
6
|
Almazrou SH, Alaujan SS, Al-Aqeel SA. Barriers and facilitators to conducting economic evaluation studies of Gulf Cooperation Council (GCC) countries: a survey of researchers. Health Res Policy Syst 2021; 19:71. [PMID: 33933093 PMCID: PMC8088636 DOI: 10.1186/s12961-021-00721-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 04/12/2021] [Indexed: 12/21/2022] Open
Abstract
Background The number of published economic evaluations of Gulf Cooperation Council (GCC) countries is notably scarce. Limited local evidence could have a major impact on the implementation of economic evaluation recommendations in the decision-making process in GCC countries. Little is known about the factors affecting researchers who seek to conduct economic evaluations. Therefore, we aimed to assess researcher barriers and facilitators in conducting such studies of GCC countries. Methods A cross-sectional survey of health economic researchers working in GCC countries was conducted online between January and February 2020. The survey instrument collected researchers’ perceived barriers and facilitators and demographic information. For barriers, respondents rated their agreement on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree”. For facilitators, respondents rated the importance of each facilitator on a six-point scale ranging from “extremely important” to “not very important”. Then, participants were asked to select the three most important barriers and facilitators from the lists. The data collected were examined using descriptive analysis. Results Fifty-one researchers completed the survey (37% response rate). The majority of participants (more than 80%) agreed that lack of quality of effectiveness data and restricted access to unit cost data are the main barriers to conducting economic research. Availability of relevant local data was reported as an important facilitator, followed by collaboration between health economic researchers, policy-makers and other stakeholders. Conclusions The results of this study provide an exploratory view of the issues faced by health economics researchers in GCC countries. Recommendations to GCC countries based on international experiences, such as to use real-world data in economic evaluation research, were provided.
Collapse
Affiliation(s)
- Saja H Almazrou
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
| | - Shiekha S Alaujan
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sinaa A Al-Aqeel
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
7
|
Zrubka Z, Rashdan O, Gulácsi L. Health Economic Publications From the Middle East and North Africa Region: A Scoping Review of the Volume and Methods of Research. ACTA ACUST UNITED AC 2020. [DOI: 10.36401/jqsh-20-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ABSTRACT
Introduction
We reviewed the scope of countries, diseases, technologies, and methods involved in the health economic evaluations published in the Middle East and North Africa (MENA) region.
Methods
PRISMA guidelines were followed. A PubMed search was conducted up to December 15, 2019. English language full-text articles were included if they reported original research on humans; involved the local population from Algeria, Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Syria, Tunisia, United Arab Emirates, or Yemen; reported costs; and involved a full or partial health economic analysis comparing alternative health technologies. Data on publication year, country of origin, disease area according to ICD-10, type of health technology, and applied methods were extracted.
Results
From 105 eligible articles, 57.1% were published between 2015 and 2019. Egypt (30.5%) and Saudi Arabia (27.6%) were the most frequently involved countries. Infectious diseases were most often studied (27.6%). The assessed technology was a system (eg, infection control, screening, coverage/access, hospital management, or healthcare delivery program) in 41.9% of studies. Cost-utility analysis (CUA) was the most frequent method (29.5%) and was growing rapidly. Health system perspective was adopted in 52.4% of studies, whereas societal perspective was scarce (8.6%). The majority of studies (46.7%) were published in Scimago Q1 journals. Over half of the studies (54.2%) did not report or did not have a funding source.
Conclusions
From 2015, health economic analysis became more frequent in the MENA region, providing input to value-based health policy and financing. For further growth, in addition to the development of the institutional background, valid and more standardized local cost and outcome data should be available.
Collapse
Affiliation(s)
- Zsombor Zrubka
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Omar Rashdan
- Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| |
Collapse
|
8
|
Almansour HA, Aloudah NM, Alhawassi TM, Chaar B, Krass I, Saini B. Health consumer engagement in developing novel preventive health community pharmacy roles in cardiovascular disease in Saudi Arabia: A qualitative analysis. Saudi Pharm J 2020; 28:529-537. [PMID: 32435133 PMCID: PMC7229330 DOI: 10.1016/j.jsps.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/08/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Cardiovascular diseases (CVD) are one of key leading causes of mortality worldwide. Both modifiable and non-modifiable risk factors contribute to the development of CVD. Modifiable risk factors such as smoking, unhealthy diets and lack of exercise are increasing in prevalence in Saudi Arabia but may be mitigated using pharmacological and non-pharmacological approaches. Thus, identifying, assessing and managing these modifiable risks at an early stage is essential. Pharmacists are highly accessible primary health professionals and can play a crucial role in screening and managing these risk factors in collaboration with primary care physicians. There is currently no research in Saudi Arabia exploring the views of health consumers with CVD risk factors regarding their preferences for or willingness to engage with community pharmacy CVD preventive health services. Objectives To explore the perceptions of health consumers about current and feasible future services by pharmacists with a specific focus on CVD risk screening and management in Saudi Arabia. Methods Semi-structured interviews were conducted with consumers with at least one modifiable CVD risk factor. The interviews were audio-recorded, transcribed verbatim, translated into English and then thematically analysed. Results A total of 25 individuals, most of whom were Saudi (88%) and women (65%), participated in face to face interviews. Five main themes emerged from the analysis of consumers’ responses. 1. Perception of pharmacists’ role, the pharmacists’ main role was perceived as medication supply. 2. Trust and satisfaction with current service, most participants appeared to have low trust in pharmacists. 3. Preferences for future pharmacy services, most participants were willing to engage in future pharmacy delivered CVD preventive health services, provided there was stringent regulation and oversight of the quality of such services. 4. Viability of new pharmacy services was raised with promotion of such services to the public, collaboration with other health professionals, financial incentivization and motivational rewards thought of as essential ingredient to ensure service feasibility. 5. Health beliefs and help seeking behaviours of consumers were diverse and low health literacy was evident; it was thought that pharmacists can help in these matters by educating and advocating for such consumers. Overall, the data suggested that clinical, communication and professional skills need to be enhanced among Saudi pharmacists to enable them to provide optimal patient cantered services. Conclusion Health consumers participants were willing to participate and utilise CVD risk screening and management pharmacy-based services, when offered, provided their concerns are addressed. Therefore, in light of the burden of CVD disease in the country, development, implementation and evaluation of pharmacist provided CVD risk screening and management should be undertaken.
Collapse
Affiliation(s)
- Hadi A Almansour
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nouf M Aloudah
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M Alhawassi
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Betty Chaar
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ines Krass
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
9
|
Kabel AM, Bakr MM, Alshanbari AM, Alwagdani SM, Altalhi HA, Alzaidi SH, Altowairqi MH. Perceptions and Attitudes Towards Clinical Pharmacy Services and Their Impact on The Management of Cancer in Taif, Saudi Arabia. Asian Pac J Cancer Prev 2020; 21:531-538. [PMID: 32102535 PMCID: PMC7332119 DOI: 10.31557/apjcp.2020.21.2.531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Indexed: 12/16/2022] Open
Abstract
Aim: To assess the perception and attitude of HCPs and health-related science colleges’ students regarding the clinical pharmacists’ roles and responsibilities in providing better pharmaceutical care to patients in Taif, Saudi Arabia and to detect its impact on management of cancer. Methods: This study was conducted in four randomly selected hospitals in Taif and three health-related science colleges in Taif University. A questionnaire was distributed to HCPs and another questionnaire to students of health-related science colleges. Results: Three quarters of students perceived that the clinical pharmacist is an important part of the healthcare team. Two-thirds of HCPs expressed confidence in the ability of clinical pharmacists to minimize medication errors. Although two-thirds of HCPs reported that they did not have clinical pharmacists in their institutions, there was substantial willingness among HCPs to cooperate with the clinical pharmacists. Most HCPs expressed the view that the clinical pharmacist is an important integral part of the healthcare team and has a positive impact on cancer management. Conclusion: HCPs and students of health-related science colleges valued the role of clinical pharmacists in healthcare delivery and management of cancer. However, new developments in clinical pharmacy services in Taif hospitals are recommended to improve perception and attitudes towards the clinical pharmacy services. Also, well-organized programs should be conducted to students of health-related science colleges to improve their perceptions and attitudes towards the clinical pharmacy services which may have a positive impact on cancer management.
Collapse
Affiliation(s)
- Ahmed M Kabel
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif, Saudi Arabia.,Department of Pharmacology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Morouj M Bakr
- Pharm D, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | | | | | - Hanan A Altalhi
- Pharm D, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Shayma H Alzaidi
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif, Saudi Arabia.,PharmD candidate, Medical University of South Carolina, USA
| | | |
Collapse
|