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Sharma D, Prinja S, Aggarwal AK, Rajsekar K, Bahuguna P. Development of the Indian Reference Case for undertaking economic evaluation for health technology assessment. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 16:100241. [PMID: 37694178 PMCID: PMC10485782 DOI: 10.1016/j.lansea.2023.100241] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/24/2023] [Accepted: 06/02/2023] [Indexed: 09/12/2023]
Abstract
Background Health technology assessment (HTA) is globally recognised as an important tool to guide evidence-based decision-making. However, heterogeneity in methods limits the use of any such evidence. The current research was undertaken to develop a set of standards for conduct of economic evaluations for HTA in India, referred to as the Indian Reference Case. Methods Development of the reference case comprised of a four-step process: (i) review of existing international HTA guidelines; (ii) systematic review of economic evaluations for three countries to assess adherence with pre-existing country-specific HTA guidelines; (iii) empirical analysis to assess the impact of alternate assumptions for key principles of economic evaluation on the results of cost-effectiveness analysis; (iv) stakeholder consultations to assess appropriateness of the recommendations. Based on the inferences drawn from the first three processes, a preliminary draft of the reference case was developed, which was finalised based on stakeholder consultations. Findings The Indian Reference Case provides twelve recommendations on eleven key principles of economic evaluation: decision problem, comparator, perspective, source of effectiveness evidence, measure of costs, health outcomes, time-horizon, discounting, heterogeneity, uncertainty analysis and equity analysis, and for presentation of results. The recommendations are user-friendly and have scope to allow for context-specific flexibility. Interpretation The Indian Reference Case is expected to provide guidance in planning, conducting, and reporting of economic evaluations. It is anticipated that adherence to the Reference Case would increase the quality and policy utilisation of future evaluations. However, with advancement in the field of health economics efforts aimed at refining the Indian Reference Case would be needed. Funding This research received no specific grant from any funding agency, commercial, or not-for-profit sectors. The research was undertaken as part of doctoral thesis of Sharma D, who received scholarship from the Indian Council of Medical Research (ICMR), New Delhi, India.
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Affiliation(s)
- Deepshikha Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun K. Aggarwal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Teerawattananon Y, Painter C, Dabak S, Ottersen T, Gopinathan U, Chola L, Chalkidou K, Culyer AJ. Avoiding health technology assessment: a global survey of reasons for not using health technology assessment in decision making. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:62. [PMID: 34551780 PMCID: PMC8456560 DOI: 10.1186/s12962-021-00308-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Despite the documented benefits of using health technology assessments (HTA) to inform resource allocation in health care systems, HTA remains underused, especially in low- and middle-income countries. A survey of global health practitioners was conducted to reveal the top reasons ("excuses") that they had heard from colleagues, policymakers or other stakeholders for not using HTA in their settings. METHODS There were 193 respondents to the survey. Most responses were from individuals in research organisations (37%), ministries of health (27%) and other government agencies (14%). Participants came from Southeast Asia (40%), the Western Pacific (30%), Africa (15%), Europe (7%), the Americas (7%) and the Eastern Mediterranean region (2%). RESULTS The top five reasons encountered by respondents related to lack of data, lack of technical skills for HTA, the technocratic nature of the work, the lack of explicit decision rules and the perception that HTA puts a "price on life". CONCLUSIONS This study aimed to understand and address the top reasons for not using HTA. They fall into three categories: (1) misconceptions about HTA; (2) feasibility issues; and (3) values, attitudes and politics. Previous literature has shown that these reasons can be addressed when identified, and even imperfect HTA analyses can provide useful information to a decision-maker.
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Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Chris Painter
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.
| | - Saudamini Dabak
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | | | | | - Lumbwe Chola
- Norwegian Institute of Public Health, Oslo, Norway
| | - Kalipso Chalkidou
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
- Imperial College London, London, UK
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Prinja S, Dixit J, Gupta N, Mehra N, Singh A, Krishnamurthy MN, Gupta D, Rajsekar K, Kalaiyarasi JP, Roy PS, Malik PS, Mathew A, Pandey A, Malhotra P, Gupta S, Kumar L, Kataki A, Singh G. Development of National Cancer Database for Cost and Quality of Life (CaDCQoL) in India: a protocol. BMJ Open 2021; 11:e048513. [PMID: 34326050 PMCID: PMC8323373 DOI: 10.1136/bmjopen-2020-048513] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The rising economic burden of cancer on healthcare system and patients in India has led to the increased demand for evidence in order to inform policy decisions such as drug price regulation, setting reimbursement package rates under publicly financed health insurance schemes and prioritising available resources to maximise value of investments in health. Economic evaluations are an integral component of this important evidence. Lack of existing evidence on healthcare costs and health-related quality of life (HRQOL) makes conducting economic evaluations a very challenging task. Therefore, it is imperative to develop a national database for health expenditure and HRQOL for cancer. METHODS AND ANALYSIS The present study proposes to develop a National Cancer Database for Cost and Quality of Life (CaDCQoL) in India. The healthcare costs will be estimated using a patient perspective. A cross-sectional study will be conducted to assess the direct out-of-pocket expenditure (OOPE), indirect cost and HRQOL among cancer patients who will be recruited at seven leading cancer centres from six states in India. Mean OOPE and HRQOL scores will be estimated by cancer site, stage of disease and type of treatment. Economic impact of cancer care on household financial risk protection will be assessed by estimating prevalence of catastrophic health expenditures and impoverishment. The national database would serve as a unique open access data repository to derive estimates of cancer-related OOPE and HRQOL. These estimates would be useful in conducting future cost-effectiveness analyses of management strategies for value-based cancer care. ETHICS AND DISSEMINATION Approval was granted by Institutional Ethics Committee vide letter no. PGI/IEC-03/2020-1565 of Post Graduate Institute of Medical Education and Research, Chandigarh, India. The study results will be published in peer-reviewed journals and presented to the policymakers at national level.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute-WIA, Chennai, Tamil Nadu, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | | | - Dharna Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, India Ministry of Health and Family Welfare, New Delhi, Delhi, India
| | | | - Partha Sarathi Roy
- Department of Medical Oncology, Dr B Borooah Cancer Society Trust, Guwahati, Assam, India
| | | | - Anisha Mathew
- Department of Medical Oncology, AIIMS, New Delhi, Delhi, India
| | - Awadhesh Pandey
- Radiotherapy and Oncology, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Sudeep Gupta
- Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Lalit Kumar
- Department of Medical Oncology, AIIMS, New Delhi, Delhi, India
| | - Amal Kataki
- Department of Gynaecologic Oncology, Dr B Borooah Cancer Society Trust, Guwahati, Assam, India
| | - Gurpreet Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Dopp AR, Kerns SEU, Panattoni L, Ringel JS, Eisenberg D, Powell BJ, Low R, Raghavan R. Translating economic evaluations into financing strategies for implementing evidence-based practices. Implement Sci 2021; 16:66. [PMID: 34187520 PMCID: PMC8240424 DOI: 10.1186/s13012-021-01137-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation researchers are increasingly using economic evaluation to explore the benefits produced by implementing evidence-based practices (EBPs) in healthcare settings. However, the findings of typical economic evaluations (e.g., based on clinical trials) are rarely sufficient to inform decisions about how health service organizations and policymakers should finance investments in EBPs. This paper describes how economic evaluations can be translated into policy and practice through complementary research on financing strategies that support EBP implementation and sustainment. MAIN BODY We provide an overview of EBP implementation financing, which outlines key financing and health service delivery system stakeholders and their points of decision-making. We then illustrate how economic evaluations have informed decisions about EBP implementation and sustainment with three case examples: (1) use of Pay-for-Success financing to implement multisystemic therapy in underserved areas of Colorado, USA, based in part on the strength of evidence from economic evaluations; (2) an alternative payment model to sustain evidence-based oncology care, developed by the US Centers for Medicare and Medicaid Services through simulations of economic impact; and (3) use of a recently developed fiscal mapping process to collaboratively match financing strategies and needs during a pragmatic clinical trial for a newly adapted family support intervention for opioid use disorder. CONCLUSIONS EBP financing strategies can help overcome cost-related barriers to implementing and sustaining EBPs by translating economic evaluation results into policy and practice. We present a research agenda to advance understanding of financing strategies in five key areas raised by our case examples: (1) maximize the relevance of economic evaluations for real-world EBP implementation; (2) study ongoing changes in financing systems as part of economic evaluations; (3) identify the conditions under which a given financing strategy is most beneficial; (4) explore the use and impacts of financing strategies across pre-implementation, active implementation, and sustainment phases; and (5) advance research efforts through strong partnerships with stakeholder groups while attending to issues of power imbalance and transparency. Attention to these research areas will develop a robust body of scholarship around EBP financing strategies and, ultimately, enable greater public health impacts of EBPs.
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Affiliation(s)
- Alex R Dopp
- Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Suzanne E U Kerns
- Graduate School of Social Work, University of Denver, Craig Hall, 2148 South High St, Denver, 80208, CO, USA
- The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado, 13123 E 16th Ave, Aurora, CO, 80045, USA
| | - Laura Panattoni
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Jeanne S Ringel
- Department of Economics, Sociology, and Statistics, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Daniel Eisenberg
- Fielding School of Public Health, University of California Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
- Department of Psychiatry and Behavioral Sciences, University of California Los Angeles, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Roger Low
- America Forward, 1400 Eye St. NW, Suite 900, Washington, DC, 20005, USA
| | - Ramesh Raghavan
- Silver School of Social Work, New York University, 1 Washington Square North, Room 301, New York, NY, 10003, USA
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Assessing the capacity of Ghana to introduce health technology assessment: a systematic review of economic evaluations conducted in Ghana. Int J Technol Assess Health Care 2020; 36:500-507. [PMID: 32981532 DOI: 10.1017/s0266462320000689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Ghana is in the process of formally introducing health technology assessment (HTA) for health decision making. Similar to other low- and middle-income countries, evidence suggests that the lack of data and human capacity is a major barrier to the conduct and use of HTA. This study assessed the current human and data capacity available in Ghana to undertake HTA. METHODS As economic evaluation (EE) forms an integral part of HTA, a systematic review of EE studies undertaken in Ghana was conducted to identify the quality and number of studies available, methods and source of data used, and local persons involved. The literature search was undertaken in EMBASE (including MEDLINE), PUBMED, and Google Scholar. The quality of studies was evaluated using the Consolidated Health Economics Evaluation Reporting Standards. The number of local Ghanaians who contributed to authorship were used as a proxy for assessing human capacity for HTA. RESULTS Thirty-one studies were included in the final review. Overall, studies were of good quality. Studies derived their effectiveness, resource utilization and cost data mainly from Ghana. The most common source of cost data was from the National Health Insurance Scheme pricing list for medicines and tariffs. Effectiveness data were mostly derived from either single study or intervention programs. Sixty out of 199 authors were Ghanaians (30 percent); these authors were mostly involved in data collection and study conceptualization. CONCLUSIONS Human capacity for HTA in Ghana is limited. To introduce HTA successfully in Ghana, policy makers would need to develop more local capacity to undertake Ghanaian-specific HTA.
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Essue BM, Kapiriri L. Priority setting for health system strengthening in low income countries. A qualitative case study illustrating the complexities. Health Syst (Basingstoke) 2020; 10:222-237. [PMID: 34377445 DOI: 10.1080/20476965.2020.1758596] [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] [Indexed: 10/24/2022] Open
Abstract
Health systems are critical to the realisation of Universal Health Coverage. There has been insufficient attention to the evaluation of priority setting for health system strengthening within low income countries, including evaluation of the local capacity to implement priorities. This study evaluated the extent to which health system strengthening was prioritized in Uganda. The Kapiriri & Martin framework was used to evaluate health system priority setting from 2005-2015. A document analysis was triangulated with interview data (n = 67) from global, national and subnational stakeholders and analysed using content analysis. Health system strengthening was perceived to be circumvented by a lack of resources as well as influential actors with disease focused, rather than system-oriented, interests. There were defined processes with explicit criteria for identifying priorities and evidence was highly valued. But sub-optimal transparency and weak accountability often compromised the integrity of priority setting and contributed to stalling progress on health system strengthening and achieving health system outcomes. The strengths in the current planning processes should be harnessed. In addition, a systematic approach to priority setting, potentially through the establishment of an independent body, and stronger oversight mechanisms, would strengthen health system planning in this setting.
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Affiliation(s)
- Beverley M Essue
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
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Yuniar P, Robinson S, Moorin R, Norman R. Economic Evaluation of Breast Cancer Early Detection Strategies in Asia: A Systematic Review. Value Health Reg Issues 2020; 21:252-263. [PMID: 32388197 DOI: 10.1016/j.vhri.2020.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/01/2019] [Accepted: 01/05/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This article aims to support the development of practical guidelines for early detection of breast cancer in Asia by systematically reviewing economic evaluation studies of such early detection strategies in Asian countries. METHODS A systematic literature review was conducted following the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols checklist. The quality of reviewed studies was examined using the Consolidated Health Economic Evaluation Reporting Standards statement. RESULTS A total of 15 articles on the economic evaluation of breast cancer early detection based in Asia were reviewed. Cost-effectiveness was used in all the studies as the analytic method to compare the cost and consequences of different screening policies. Ten studies were categorized as incorporating the modeled approach. Fourteen studies analysed the cost-effectiveness of the organized population-based approach, in which mammography screening was the prevailing screening modality. Only one study evaluated the cost-effectiveness of early diagnosis for breast cancer patients in order to provide early treatment. The results from the identified economic evaluations, and consequent recommendations concerning optimal early detection strategies varied among studies, and depended on key parameters and assumption used, as well as differences in inter-country health resources, breast cancer incidence, prevalence and early detection pathways. CONCLUSIONS The economic evaluation of breast cancer early detection programs is still limited in Asia. Policy decisions on organized mammography screening in women <50 are economically attractive in the region, despite the lack of evidence to provide recommendations on opportunistic screening strategy and early diagnosis strategy. Future studies need to provide better transparency of the data used and cover more comprehensive strategies, to make them relevant and adaptable to other Asian countries, resulting in clear policy recommendations on breast cancer early detection strategies.
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Affiliation(s)
- Popy Yuniar
- School of Public Health, Curtin University, Perth, Western Australia; Universitas Indonesia, West Java, Indonesia.
| | - Suzanne Robinson
- School of Public Health, Curtin University, Perth, Western Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Western Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Western Australia
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Prinja S, Chauhan AS, Rajsekhar K, Downey L, Bahuguna P, Sachin O, Guinness L. Addressing the Cost Data Gap for Universal Healthcare Coverage in India: A Call to Action. Value Health Reg Issues 2020; 21:226-229. [DOI: 10.1016/j.vhri.2019.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/10/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
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Mariño R, Zaror C. Economic evaluations in water-fluoridation: a scoping review. BMC Oral Health 2020; 20:115. [PMID: 32299417 PMCID: PMC7164347 DOI: 10.1186/s12903-020-01100-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Background Community water fluoridation (CWF) is considered one of the 10 greatest public health achievements of the twentieth century and has been a cornerstone strategies for the prevention and control of dental caries in many countries. However, for decision-makers the effectiveness and safety of any given intervention is not always sufficient to decide on the best option. Economic evaluations (EE) provide key information that managers weigh, alongside other evidence. This study reviews the relevant literature on EE in CWF. Methods A systematic database search up to August 2019 was carried out using MEDLINE, EMBASE, Cochrane Library, LILACS, Paediatric Economic Database Evaluation and National Health Service Economic Evaluation Database. The review included full economic evaluations on CWF programs, written in English, Spanish or Portuguese. The selection process and data extraction were carried out by two researchers independently. A qualitative synthesis of the results was performed. Results Of 498 identified articles, 24 studies met the inclusion criteria; 11 corresponded to cost-benefit analysis; nine were cost-effectiveness analyses; and four cost-utility studies. Two cost-utility studies used Disability-Adjusted Life Years,, one used Quality-Adjusted Tooth Years, and another Quality-Adjusted Life Years. EEs were conducted in eight countries. All studies concluded that water fluoridation was a cost-effective strategy when it was compared with non-fluoridated communities, independently of the perspective, time horizon or discount rate applied. Four studies adopted a lifetime time horizon. The outcome measures included caries averted (n = 14) and savings cost of dental treatment (n = 4). Most of the studies reported a caries reduction effects between 25 and 40%. Conclusion Findings indicated that CWF represents an appropriate use of communities’ resources, using a range of economic evaluation methods and in different locations. These findings provide evidence to decision-makers which they could use as an aid to deciding on resource allocation.
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Affiliation(s)
- Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Carlos Zaror
- Department of Pediatric Dentistry and Orthodontics; Faculty of Dentistry, Universidad de La Frontera, Manuel Montt #112, Temuco, Chile. .,Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.
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Addo R, Hall J, Haas M, Goodall S. The knowledge and attitude of Ghanaian decision-makers and researchers towards health technology assessment. Soc Sci Med 2020; 250:112889. [PMID: 32146238 DOI: 10.1016/j.socscimed.2020.112889] [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: 09/18/2019] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 11/26/2022]
Abstract
Although health technology assessment (HTA) is intended to provide policymakers with objective information, the likelihood that a health decision-maker (HDM) will use this information is associated with their knowledge, role and perception of the HTA process. In Ghana, policymakers are working towards formalising the use of HTA, but HDM knowledge of and attitude towards HTA are not known. Between March and May 2016, we conducted in-depth interviews and used inductive thematic analysis to explore Ghanaian HDMs (n = 23) and researchers' (n = 4) perceptions of and barriers to HTA and identify ways to promote HTA. We compare our findings with those reported in previous studies conducted in low-and-middle-income countries. Common themes were that resources, political and cultural factors act as barriers to HTA use. Recommendations made in previous studies which were also identified in this study included the need for the development of both human and data capacity, allocating funds to HTA and stakeholder involvement in HTA processes. Specific recommendations made by Ghanaian HDMs and researchers in this study focused on the establishment of an HTA body: its location, the constitution of the appraisal team, the type of evidence to appraise and who makes the final decision. The findings provide important information in the context of current planning to institutionalise HTA in Ghana. Addressing the identified barriers will enable policymakers to maximise the chances of realising the expected benefits of HTA, as participants who are potential producers and end-users are likely to use what they have contributed to.
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Affiliation(s)
- Rebecca Addo
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, Sydney, Australia.
| | - Jane Hall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, Sydney, Australia
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, Sydney, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, Sydney, Australia
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Oliva-Moreno J, Puig-Junoy J, Trapero-Bertran M, Epstein D, Pinyol C, Sacristán JA. Economic Evaluation for Pricing and Reimbursement of New Drugs in Spain: Fable or Desideratum? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:25-31. [PMID: 31952669 DOI: 10.1016/j.jval.2019.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/23/2019] [Accepted: 06/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The economic evaluation of healthcare technologies has become in many countries a basic tool for reimbursement, pricing and purchasing decisions. OBJECTIVE The objective of this article is to examine the institutional, legal, and political factors that have impeded the application of economic evaluation and the criterion of efficiency in the process of pricing and reimbursement of new medicines in Spain. METHODS Narrative description of the current institutional framework for the use of economic evaluation in pricing and reimbursement in Spain, legal and policy framework in the field of evaluation of new medicines, and stakeholder initiatives and policies related to the use of economic evaluation outside of the pricing and reimbursement process. RESULTS Spain has an institutional framework created and established over the last years that could have facilitated a formal use of economic evaluation in the process of pricing and reimbursement. Nevertheless, the real use of economic evaluation at the central or regional level is still unknown, although application of the efficiency criterion, linking to cost-effectiveness, has been clearly required by Spanish laws and regulations at the national level. We highlight a certain degree of moral hazard from the central government that is not directly responsible for the budget impact of reimbursement and pricing decisions. There are currently a number of ongoing initiatives in the field of economic evaluation by various agents, but they remain uncoordinated. CONCLUSIONS Poor governance at the highest level of decision making is the main reason for the lack of interest in economic evaluation. A profound political change, supported by transparency and accountability, is required before the criterion of efficiency can be fully considered in the process of pricing and reimbursement of new medicines in Spain.
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Affiliation(s)
- Juan Oliva-Moreno
- Department of Economic Analysis and Finance, Universidad de Castilla La-Mancha, Toledo, Spain.
| | - Jaume Puig-Junoy
- Barcelona School of Management, Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Trapero-Bertran
- Institut de Recerca en Avaluació i Polítiques Públiques, Universitat Internacional de Catalunya, Barcelona, Spain
| | - David Epstein
- Department of Applied Economics, University of Granada, Granada, Spain
| | - Carme Pinyol
- Market Access Department, Pierre Fabre Ibérica, Barcelona, Spain; ISPOR Spain Chapter, Barcelona, Spain
| | - José Antonio Sacristán
- Department of Epidemiology and Public Health, Universidad Autonoma de Madrid, Madrid, Spain; Medical Department, Lilly, Madrid, Spain
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Qin S, Kruger E, Tan SC, Cheng S, Wang N, Liang J. Cost-effectiveness analysis of FOLFOX4 and sorafenib for the treatment of advanced hepatocellular carcinoma in China. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:29. [PMID: 30087583 PMCID: PMC6076412 DOI: 10.1186/s12962-018-0112-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022] Open
Abstract
Objectives Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally. In China, sorafenib and oxaliplatin plus infusional-fluorouracil/leucovorin (FOLFOX4) are approved for the systemic treatment of advanced HCC. This study compared the cost-effectiveness of these therapies from a healthcare system perspective and a patient perspectives. Methods A Markov model was constructed using overall and progression-free survival rates and adverse event (AE) rate from two randomized controlled studies of advanced HCC patients from Asia: EACH for FOLFOX4 and ORIENTAL for sorafenib. The patients in the Markov model were followed until death, the length of each Markov cycle was 1 month, and the survival was adjusted for quality-adjusted life years (QALYs). Direct medical costs included costs of therapies, AE treatment, general ward and tests. Costs were derived from published sources, interviews with oncologists and hospital data from China. One-way and probabilistic sensitivity analyses (PSA) were performed to test the robustness of the results. Results From the healthcare system perspective, FOLFOX4 dominated sorafenib with lower therapy costs (FOLFOX4: US$ 6972; sorafenib: US$ 12,289), lower direct medical costs (FOLFOX4: US$ 8428; sorafenib: US$ 12,798), and higher QALYs (FOLFOX4: 0.42; sorafenib: 0.38) per patient. This result was robust according to comprehensive one-way sensitivity analyses. According to the PSA, at the cost-effectiveness threshold for China (3 × GDP, US$ 22,073), FOLFOX4 should be chosen in 63.9% of simulations. From the patient perspective, FOLFOX4 also dominated sorafenib. Conclusions The study results indicate that FOLFOX4 dominates sorafenib because it appears to provide higher effectiveness with significantly lower costs in treating Chinese advanced HCC patients.
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Affiliation(s)
- Shukui Qin
- Department of Medical Oncology, People's Liberation Army Cancer Center, Eight One Hospital, Nanjing, China
| | - Eliza Kruger
- Economics and Outcomes, Real World Evidence, IMS Health, San Francisco, USA
| | - Seng Chuen Tan
- Economics and Outcomes, Real World Evidence, IMS Health, Singapore, Singapore
| | - Shuqun Cheng
- 4Department of Hepatic Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Nanya Wang
- 5Cancer Center, First Hospital of Jilin University, Jilin, China
| | - Jun Liang
- 6Department of Medical Oncology, Peking University Cancer Hospital, Peking University International Hospital, No. 1 Life Garden Road, Zhongguancun Life Science Park, Changping District, Beijing, 102206 China
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Adeagbo CU, Rattanavipapong W, Guinness L, Teerawattananon Y. The Development of the Guide to Economic Analysis and Research (GEAR) Online Resource for Low- and Middle-Income Countries' Health Economics Practitioners: A Commentary. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:569-572. [PMID: 29753354 PMCID: PMC5947918 DOI: 10.1016/j.jval.2017.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 05/15/2023]
Abstract
Public health authorities around the world are increasingly using economic evaluation to set priorities and inform decision making in health policy, especially in the development of health benefit packages. Nevertheless, researchers in low- and middle-income countries (LMICs) encounter many barriers when conducting economic evaluations. In 2015, the Health Intervention and Technology Assessment Program identified key technical and context-specific challenges faced in conducting and using health economic evaluations in LMICs. On the basis of these research findings, the Guide to Economic Analysis and Research (GEAR) online resource (www.gear4health.com) was developed as a reliable aid to researchers in LMICs that would help overcome those challenges. Funded by the Thailand Research Fund and the Bill and Melinda Gates Foundation, GEAR is a free online resource that provides a visual aid tool for planning economic evaluation studies (GEAR mind maps), a repository of national and international economic evaluation guidelines (GEAR guideline comparison), and an active link to a network of volunteer international experts (GEAR: Ask an expert). GEAR will evolve over time to provide relevant, reliable, and up-to-date information through inputs from its users (e.g., periodic survey on methodological challenges) and experts (e.g., in responding to users' questions). The objective of this commentary was to give a brief description of the development and key features of this unique collective information hub aimed at facilitating high-quality research and empowering health care decision makers and stakeholders to use economic evaluation evidence.
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Affiliation(s)
- Chiaki Urai Adeagbo
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand.
| | - Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Lorna Guinness
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
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Luz A, Santatiwongchai B, Pattanaphesaj J, Teerawattananon Y. Identifying priority technical and context-specific issues in improving the conduct, reporting and use of health economic evaluation in low- and middle-income countries. Health Res Policy Syst 2018; 16:4. [PMID: 29402314 PMCID: PMC5800077 DOI: 10.1186/s12961-018-0280-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 01/10/2018] [Indexed: 12/12/2022] Open
Abstract
Background The use of economic evaluation in healthcare policies and decision-making, which is limited in low- and middle-income countries (LMICs), might be promoted through the improvement of the conduct and reporting of studies. Although the literature indicates that there are many issues affecting the conduct, reporting and use of this evidence, it is unclear which factors should be prioritised in finding solutions. This study aims to identify the top priority issues that impede the conduct, reporting and use of economic evaluation as well as potential solutions as an input for future research topics by the international Decision Support Initiative and other movements. Methods A survey on issues regarding the conduct, reporting and use of economic evaluation as well as on potential solutions was conducted using an online questionnaire among researchers who have experience in conducting economic evaluations in LMICs. The respondents were requested to consider the list of issues provided, rank the most important ones and propose solutions. A scoring system was applied to derive the ranking of difficulties according to researchers’ responses. Issues were grouped into technical and context-specific difficulties and analysed separately as a whole and by region. Results Researchers considered the lack of quality local clinical data, poor reporting and insufficient data to conduct the analysis from the chosen perspective as the most important technical difficulties. On the other hand, the non-integration of economic evaluations into decision-making was considered the most important context-specific issue. Finally, context-specific issues were considered the larger barrier to the use of economic evaluation. Conclusion The technical issues that were considered most important were closely linked with the lack of an appropriately functioning information system as well as the capacity to generate essential contextual information (e.g. data and locally relevant utility values), especially when the methodology is complex. To overcome this, simpler approaches to collect data that yields information of comparable quality to more rigorous methods should be developed. The international community can play a major role through research on methodologies feasible for LMIC settings as well as in building research capacity in countries. Context-specific issues, which were recognised as larger barriers, should be improved in parallel. Electronic supplementary material The online version of this article (10.1186/s12961-018-0280-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alia Luz
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
| | - Benjarin Santatiwongchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand.
| | - Juntana Pattanaphesaj
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
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Culyer A, Chalkidou K, Teerawattananon Y, Santatiwongchai B. Rival perspectives in health technology assessment and other economic evaluations for investing in global and national health. Who decides? Who pays? F1000Res 2018; 7:72. [PMID: 29904588 PMCID: PMC5961761 DOI: 10.12688/f1000research.13284.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 11/20/2022] Open
Abstract
There seems to be a general agreement amongst practitioners of economic evaluations, including Health Technology Assessment, that the explicit statement of a perspective is a necessary element in designing and reporting research. Moreover, there seems also to be a general presumption that the ideal perspective is “societal”. In this paper we endorse the first principle but dissent from the second. A review of recommended perspectives is presented. The societal perspective is frequently not the one recommended. The societal perspective is shown to be less comprehensive than is commonly supposed, is inappropriate in many contexts and, in any case, is in general not a perspective to be determined independently of the context of a decision problem. Moreover, the selection of a perspective, societal or otherwise, is not the prerogative of analysts.
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Affiliation(s)
- Anthony Culyer
- Department of Economics & Related Studies, University of York, UK, York, YO10 5DD, UK.,Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, SW7 2AZ, UK
| | - Kalipso Chalkidou
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, SW7 2AZ, UK.,Center for Global Development, Westminster Impact Hub, London, SW1Y 4TE, UK
| | - Yot Teerawattananon
- Department of Health, Ministry of Public Health, Thailand, Nonthaburi, 11000, Thailand
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Quality Assessment of Published Articles in Iranian Journals Related to Economic Evaluation in Health Care Programs Based on Drummond's Checklist: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2017; 42:427-436. [PMID: 29234174 PMCID: PMC5722959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Health economic evaluation research plays an important role in selecting cost-effective interventions. The purpose of this study was to assess the quality of published articles in Iranian journals related to economic evaluation in health care programs based on Drummond's checklist in terms of numbers, features, and quality. In the present review study, published articles (Persian and English) in Iranian journals related to economic evaluation in health care programs were searched using electronic databases. In addition, the methodological quality of articles' structure was analyzed by Drummond's standard checklist. Based on the inclusion criteria, the search of databases resulted in 27 articles that fully covered economic evaluation in health care programs. A review of articles in accordance with Drummond's criteria showed that the majority of studies had flaws. The most common methodological weakness in the articles was in terms of cost calculation and valuation. Considering such methodological faults in these studies, it is anticipated that these studies would not provide an appropriate feedback to policy makers to allocate health care resources correctly and select suitable cost-effective interventions. Therefore, researchers are required to comply with the standard guidelines in order to better execute and report on economic evaluation studies.
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Zegeye EA, Mbonigaba J, Kaye SB, Wilkinson T. Economic Evaluation in Ethiopian Healthcare Sector Decision Making: Perception, Practice and Barriers. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:33-43. [PMID: 27637919 DOI: 10.1007/s40258-016-0280-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Globally, economic evaluation (EE) is increasingly being considered as a critical tool for allocating scarce healthcare resources. However, such considerations are less documented in low-income countries, such as in Ethiopia. In particular, to date there has been no assessment conducted to evaluate the perception and practice of and barriers to health EE. OBJECTIVE This paper assesses the use and perceptions of EE in healthcare decision-making processes in Ethiopia. METHODS In-depth interview sessions with decision makers/healthcare managers and program coordinators across six regional health bureaus were conducted. A qualitative analysis approach was conducted on three thematic areas. RESULTS A total of 57 decision makers/healthcare managers were interviewed from all tiers of the health sector in Ethiopia, ranging from the Federal Ministry of Health down to the lower levels of the health facility pyramid. At the high-level healthcare decision-making tier, only 56 % of those interviewed showed a good understanding of EE when explaining in terms of cost and consequences of alternative courses of action and value for money. From the specific program perspective, 50 % of the prevention of mother-to-child transmission of HIV/AIDS program coordinators indicated the relevance of EE to program planning and decision making. These respondents reported a limited application of costing studies on the HIV/AIDS prevention and control program, which were most commonly used during annual planning and budgeting. CONCLUSION The study uncovered three important barriers to growth of EE in Ethiopia: a lack of awareness, a lack of expertise and skill, and the traditional decision-making culture.
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Affiliation(s)
- Elias Asfaw Zegeye
- Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa.
| | - Josue Mbonigaba
- Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
| | - Sylvia Blanche Kaye
- School of Public Management and Economics, Durban University of Technology, Durban, South Africa
| | - Thomas Wilkinson
- PRICELESS SA, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Teerawattananon Y, Tantivess S, Yamabhai I, Tritasavit N, Walker DG, Cohen JT, Neumann PJ. The influence of cost-per-DALY information in health prioritisation and desirable features for a registry: a survey of health policy experts in Vietnam, India and Bangladesh. Health Res Policy Syst 2016; 14:86. [PMID: 27912780 PMCID: PMC5135838 DOI: 10.1186/s12961-016-0156-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 11/14/2016] [Indexed: 11/22/2022] Open
Abstract
Background Economic evaluation has been implemented to inform policy in many areas, including coverage decisions, technology pricing, and the development of clinical practice guidelines. However, there are barriers to evidence-based policy in low- and middle-income countries (LMICs) that include limited stakeholder awareness, resources and data availability, as well as the lack of capacity to conduct country-specific economic evaluations. This study aims to survey health policy experts’ opinions on barriers to use of cost-effectiveness data in these settings and to obtain their advice on how to make a new cost-per-DALY database being developed by Tufts Medical Center more relevant to LMICs. It also identifies the factors influencing transferability. Methods In-depth interviews were conducted with 32 participants, including policymakers, technical advisors, and researchers in Health Ministries, universities and non-governmental organisations in Bangladesh, India (New Delhi, Tamil Nadu and Karnataka) and Vietnam. Results The survey revealed that, in all settings, the use of cost-effectiveness information in policy development is lacking, owing to limited knowledge among policymakers and inadequate human resources with health economics expertise in the government sector. Furthermore, researchers in universities do not have close connections with health authorities. In India and Vietnam, the demand for evidence to inform coverage decisions tends to increase as the countries are moving towards universal health coverage. The informants in all countries argue that cost-effectiveness data are useful for decision-makers; however, most of them do not perform data searches by themselves but rely on the information provided by the technical advisor counterparts. Most interviewees were familiar with using evidence from other countries and were also aware of the influences of contextual elements as a limitation of transferability. Finally, strategies to promote the newly developed database include training on basic economic evaluation for policymakers and researchers, and effective communication programs, with support from reputable global agencies. Conclusions Although cost-effectiveness information is recognised as essential in resource allocation, there are several impediments in the generation and use of such evidence to inform priority setting in LMICs. As such, the Cost-per-DALY database should be well-designed and introduced with appropriate promotion strategies so that it will be helpful in real-world policymaking. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0156-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Sripen Tantivess
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.
| | - Inthira Yamabhai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Nattha Tritasavit
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
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Li T, Liu M, Ben H, Xu Z, Zhong H, Wu B. Clopidogrel versus aspirin in patients with recent ischemic stroke and established peripheral artery disease: an economic evaluation in a Chinese setting. Clin Drug Investig 2016; 35:365-74. [PMID: 25985838 DOI: 10.1007/s40261-015-0290-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Clopidogrel or aspirin are indicated for patients with recent ischemic stroke (IS) or established peripheral artery disease (PAD). We compared the cost effectiveness of clopidogrel with that of aspirin in Chinese patients with recent IS or established PAD. METHODS A discrete-event simulation was developed to evaluate the economic implications of secondary prevention with clopidogrel versus aspirin. All available evidence was derived from clinical studies. Costs from a Chinese healthcare perspective in 2013 US dollars and quality-adjusted life-years (QALYs) were projected over patients' lifetimes. Uncertainties were addressed using sensitivity analyses. RESULTS Compared with aspirin, clopidogrel yielded a marginally increased life expectancy by 0.46 and 0.21 QALYs at an incremental cost-effectiveness ratio of $US5246 and $US9890 per QALY in patients with recent IS and established PAD, respectively. One-way sensitivity analyses showed that the evaluation of patients with PAD and recent IS was robust except for the parameter of patient age. Given a willingness-to-pay of $US19,877 per QALY gained, clopidogrel had a probability of 90 and 68% of being cost effective in the recent IS or established PAD subgroups compared with aspirin, respectively. CONCLUSIONS The analysis suggests that clopidogrel for secondary prevention is cost effective for patients with either PAD or recent IS in a Chinese setting in comparison with aspirin.
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Affiliation(s)
- Te Li
- Department of Pharmacy, Yuxi People's Hospital, affiliated with the Kunming Medical College, Yuxi, China,
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20
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Dang A, Likhar N, Alok U. Importance of Economic Evaluation in Health Care: An Indian Perspective. Value Health Reg Issues 2016; 9:78-83. [DOI: 10.1016/j.vhri.2015.11.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/17/2015] [Accepted: 11/05/2015] [Indexed: 02/05/2023]
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Hammad EA. The Use of Economic Evidence to Inform Drug Pricing Decisions in Jordan. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:233-238. [PMID: 27021758 DOI: 10.1016/j.jval.2015.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/06/2015] [Accepted: 11/24/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Drug pricing is an example of a priority setting in a developing country with official requirements for the use of cost-effectiveness (CE) evidence. OBJECTIVE To describe the role of economic evidence in drug pricing decisions in Jordan. METHODS A prospective review of all applications submitted between November 2013 and May 2015 to the Jordan Food and Drug Association's drug pricing committee was carried out. All applications that involved requests for CE evidence were reviewed. Details on the type of study, the extent, and whether the evidence submitted was part of the formal deliberations were extracted and summarized. RESULTS The committee reviewed a total of 1608 drug pricing applications over the period of the study. CE evidence was requested in only 11 applications. The submitted evidence was of limited use to the committee due to concerns about quality, relevance of studies, and lack of pharmacoeconomic expertise. There were also no clear rules describing how CE would inform pricing decisions. CONCLUSIONS Limited local data and health economic experience were the main barriers to the use of economic evidence in drug pricing decisions in Jordan. In addition, there are no official rules describing the elements and process by which the CE evidence would inform drug pricing decisions. This study summarized accumulated observations for the current use of economic evaluations and evidence-based decision making in Jordan. Recommendations have been proposed to applicants and key decision makers to enhance the role of economic evidence in influencing health policies and evidence-based decision making across priority settings.
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Affiliation(s)
- Eman A Hammad
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan.
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Abstract
Dengue is a major public health concern in tropical and subtropical areas of the world. The prospects for dengue prevention have recently improved with the results of efficacy trials of a tetravalent dengue vaccine. Although partially effective, once licensed, its introduction can be a public health priority in heavily affected countries because of the perceived public health importance of dengue. This review explores the most immediate economic considerations of introducing a new dengue vaccine and evaluates the published economic analyses of dengue vaccination. Findings indicate that the current economic evidence base is of limited utility to support country-level decisions on dengue vaccine introduction. There are a handful of published cost-effectiveness studies and no country-specific costing studies to project the full resource requirements of dengue vaccine introduction. Country-level analytical expertise in economic analyses, another gap identified, needs to be strengthened to facilitate evidence-based decision-making on dengue vaccine introduction in endemic countries.
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Affiliation(s)
- Yesim Tozan
- a College of Global Public Health , New York University , New York , NY , USA
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Mohd-Tahir NA, Paraidathathu T, Li SC. Quality use of medicine in a developing economy: Measures to overcome challenges in the Malaysian healthcare system. SAGE Open Med 2015; 3:2050312115596864. [PMID: 26770795 PMCID: PMC4679320 DOI: 10.1177/2050312115596864] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/21/2015] [Indexed: 11/16/2022] Open
Abstract
Malaysia inherits a highly subsidized tax-based public healthcare system complemented by a fee-for-service private sector. Population health in Malaysia has considerably improved since independence using a relatively small amount of gross domestic product (~4%). Brain drain of highly specialized personnel, growth in healthcare spending, demographic and disease pattern changes and increase in patients’ demands and expectations towards better medical care are exerting pressure on the sustainability of the system to continuously provide efficient and effective services at relatively low cost. Malaysia has adopted and implemented some of the quality use of medicine concepts such as National Essential Medicine List, health technology assessment and promotion of generic medicines in their health policy, but so far the results may not be optimal. Activities to further promote these strategies are needed for successful implementation to achieve more positive and sustained beneficial outcomes. Better strategic planning, management and collaboration between various stakeholders, considering the needs and barriers of the strategies, are important to ensure effective implementation of the strategies. More emphasis should be placed upon more equitable and rational distribution of healthcare resources to cater for rapid urbanization. Additionally, a sustainable health financing structure that is more progressive and does not encourage moral hazard should be established. In conclusion, Malaysia has achieved good outcomes in population health with relatively low financial inputs since independence. However, changes in the overall environment have created issues which would threaten the long-term viability of the healthcare system if not tackled properly. The numbers of internationally trialled strategies could be used to deal with these challenges. In addition, coordinated implementation of these strategies and effective engagement and communication between various stakeholders are necessary to further strengthen the Malaysian healthcare system effectively.
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Affiliation(s)
- Nurul-Ain Mohd-Tahir
- Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia; Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Shu-Chuen Li
- Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
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Santatiwongchai B, Chantarastapornchit V, Wilkinson T, Thiboonboon K, Rattanavipapong W, Walker DG, Chalkidou K, Teerawattananon Y. Methodological variation in economic evaluations conducted in low- and middle-income countries: information for reference case development. PLoS One 2015; 10:e0123853. [PMID: 25950443 PMCID: PMC4423853 DOI: 10.1371/journal.pone.0123853] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/1969] [Accepted: 07/20/1969] [Indexed: 11/18/2022] Open
Abstract
Information generated from economic evaluation is increasingly being used to inform health resource allocation decisions globally, including in low- and middle- income countries. However, a crucial consideration for users of the information at a policy level, e.g. funding agencies, is whether the studies are comparable, provide sufficient detail to inform policy decision making, and incorporate inputs from data sources that are reliable and relevant to the context. This review was conducted to inform a methodological standardisation workstream at the Bill and Melinda Gates Foundation (BMGF) and assesses BMGF-funded cost-per-DALY economic evaluations in four programme areas (malaria, tuberculosis, HIV/AIDS and vaccines) in terms of variation in methodology, use of evidence, and quality of reporting. The findings suggest that there is room for improvement in the three areas of assessment, and support the case for the introduction of a standardised methodology or reference case by the BMGF. The findings are also instructive for all institutions that fund economic evaluations in LMICs and who have a desire to improve the ability of economic evaluations to inform resource allocation decisions.
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Affiliation(s)
| | | | - Thomas Wilkinson
- NICE International, National Institute for Health and Care Excellence, London, United Kingdom
| | | | | | - Damian G Walker
- Global Health Program, Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Kalipso Chalkidou
- NICE International, National Institute for Health and Care Excellence, London, United Kingdom
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Zhang R, Modaresi F, Borisenko O. Health economic evaluations of medical devices in the People's Republic of China: A systematic literature review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:195-204. [PMID: 25914551 PMCID: PMC4399785 DOI: 10.2147/ceor.s78752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The objective of this study is to identify and review the methodological quality of health economic evaluations of medical devices performed in the People’s Republic of China. To our knowledge, no such investigations have been performed to date. Methods A systematic literature review involving searches of Medline, Medline In-Process, the National Health Service Economic Evaluation Database, the Cost-Effectiveness Analysis Registry of the Tufts Medical Center, and the Wanfang Database was performed. The search spanned the period from 1990 to 2013. Studies on health economic evaluations of medical devices, in-vitro diagnostics, procedures, and the use of medical devices in Chinese health care settings were included. Full-text articles and conference abstracts in English and Chinese were included. Results Fifty-seven publications were included, 26 (46%) of which were in English and 31 (54%) of which were in Chinese. The included publications covered a wide range of clinical areas, such as surgery (n=23, 40%), screening (n=9, 16%), imaging use (n=6, 11%), kidney intervention (n=4, 7%), and nine other technological areas. Most of the studies (n=31, 54%) were cost analyses. Among the others, 13 (50%) studies used modeling, and another 13 (50%) were within-trial evaluations. Among studies that used modeling, eleven (85%) conducted sensitivity analyses, six of which had one-way sensitivity analysis, whereas one conducted both one-way and two-way sensitivity analyses; four of these eleven modeling-based analyses included probabilistic sensitivity analyses. The incremental cost-effectiveness ratio was reported in ten (18%) studies, eight of which were screening studies. The remaining two modeling studies were in areas of imaging and oncology. Conclusion This study indicates that there are major limitations and deficiencies in the health economic evaluations on medical devices performed in the People’s Republic of China. Further efforts are required from different stakeholders – academic, governmental, and privatized – to improve health economic research capacity and to put it to use when informative decisions are made in the health care setting.
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Haghparast-Bidgoli H, Kiadaliri AA, Skordis-Worrall J. Do economic evaluation studies inform effective healthcare resource allocation in Iran? A critical review of the literature. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2014; 12:15. [PMID: 25050084 PMCID: PMC4105166 DOI: 10.1186/1478-7547-12-15] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 06/28/2014] [Indexed: 11/10/2022] Open
Abstract
To aid informed health sector decision-making, data from sufficient high quality economic evaluations must be available to policy makers. To date, no known study has analysed the quantity and quality of available Iranian economic evaluation studies. This study aimed to assess the quantity, quality and targeting of economic evaluation studies conducted in the Iranian context. The study systematically reviewed full economic evaluation studies (n = 30) published between 1999 and 2012 in international and local journals. The findings of the review indicate that although the literature on economic evaluation in Iran is growing, these evaluations were of poor quality and suffer from several major methodological flaws. Furthermore, the review reveals that economic evaluation studies have not addressed the major health problems in Iran. While the availability of evidence is no guarantee that it will be used to aid decision-making, the absence of evidence will certainly preclude its use. Considering the deficiencies in the data identified by this review, current economic evaluations cannot be a useful source of information for decision makers in Iran. To improve the quality and overall usefulness of economic evaluations we would recommend; 1) developing clear national guidelines for the conduct of economic evaluations, 2) highlighting priority areas where information from such studies would be most useful and 3) training researchers and policy makers in the calculation and use of economic evaluation data.
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Affiliation(s)
| | - Aliasghar Ahmad Kiadaliri
- Health Economics Unit, Department of Clinical Sciences-Malmö, Lund University, Lund, Sweden ; Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jolene Skordis-Worrall
- Institute for Global Health, University College London, London, UK ; Department for Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Jain B, Hiligsmann M, Mathew JL, Evers SM. Analysis of a Small Group of Stakeholders Regarding Advancing Health Technology Assessment in India. Value Health Reg Issues 2014; 3:167-171. [PMID: 29702922 DOI: 10.1016/j.vhri.2014.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study aimed to explore and understand the perspectives of a small group of stakeholders involved in health technology assessment (HTA) for evidence-informed decision making on policy in the Indian health system. METHODS Semi-structured interviews were conducted in April-June 2013 with policymakers, academicians, industry experts, and community representatives in India to understand their knowledge of, position regarding, and interest in HTA. A semi-structured questionnaire was designed on the basis of a World Health Organization framework for evidence-informed health care policymaking. RESULTS Seven key informant interviews were conducted to represent the various stakeholders. Although there is a good understanding of HTA among the national-level policymakers, academicians, civil society representatives, and industry experts, there is lack of knowledge about the subject among policymakers at the lower level. There is a positive perception about producing and using HTA for decision making among all the stakeholders interviewed. Nevertheless, at the national level, institutions prefer to treat the use of HTA evidence with caution because the capacity for adopting evidence-based tools in the health system is very limited. CONCLUSIONS This small-size stakeholder analysis suggests a mixed response in implementing HTA in India. There are, however, factors involved in implementing such tools that can be dealt with using various approaches. Finally, there is a positive view on the national level toward pushing the HTA agenda forward to improve the decision-making process in health care.
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Affiliation(s)
- Bhavesh Jain
- Health Finance and Governance Project, Abt Associates, New Delhi, India.
| | - Mickaël Hiligsmann
- Department of Health Services Research, School for Primary Care and Public Health (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | - Silvia M Evers
- Department of Health Services Research, School for Primary Care and Public Health (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Nguyen TA, Knight R, Roughead EE, Brooks G, Mant A. Policy options for pharmaceutical pricing and purchasing: issues for low- and middle-income countries. Health Policy Plan 2014; 30:267-80. [PMID: 24425694 DOI: 10.1093/heapol/czt105] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pharmaceutical expenditure is rising globally. Most high-income countries have exercised pricing or purchasing strategies to address this pressure. Low- and middle-income countries (LMICs), however, usually have less regulated pharmaceutical markets and often lack feasible pricing or purchasing strategies, notwithstanding their wish to effectively manage medicine budgets. In high-income countries, most medicines payments are made by the state or health insurance institutions. In LMICs, most pharmaceutical expenditure is out-of-pocket which creates a different dynamic for policy enforcement. The paucity of rigorous studies on the effectiveness of pharmaceutical pricing and purchasing strategies makes it especially difficult for policy makers in LMICs to decide on a course of action. This article reviews published articles on pharmaceutical pricing and purchasing policies. Many policy options for medicine pricing and purchasing have been found to work but they also have attendant risks. No one option is decisively preferred; rather a mix of options may be required based on country-specific context. Empirical studies in LMICs are lacking. However, risks from any one policy option can reasonably be argued to be greater in LMICs which often lack strong legal systems, purchasing and state institutions to underpin the healthcare system. Key factors are identified to assist LMICs improve their medicine pricing and purchasing systems.
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Affiliation(s)
- Tuan Anh Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia
| | - Rosemary Knight
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia
| | - Elizabeth Ellen Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia
| | - Geoffrey Brooks
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia
| | - Andrea Mant
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia
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Health sector priority setting at meso-level in lower and middle income countries: lessons learned, available options and suggested steps. Soc Sci Med 2013; 102:190-200. [PMID: 24565157 DOI: 10.1016/j.socscimed.2013.11.056] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/25/2013] [Accepted: 11/29/2013] [Indexed: 11/23/2022]
Abstract
Setting priority for health programming and budget allocation is an important issue, but there is little consensus on related processes. It is particularly relevant in low resource settings and at province- and district- or "meso-level", where contextual influences may be greater, information scarce and capacity lower. Although recent changes in disease epidemiology and health financing suggest even greater need to allocate resources effectively, the literature is relatively silent on evidence-based priority-setting in low and middle income countries (LMICs). We conducted a comprehensive review of the peer-reviewed and grey literature on health resource priority-setting in LMICs, focussing on meso-level and the evidence-based priority-setting processes (PSPs) piloted or suggested there. Our objective was to assess PSPs according to whether they have influenced resource allocation and impacted the outcome indicators prioritised. An exhaustive search of the peer-reviewed and grey literature published in the last decade yielded 57 background articles and 75 reports related to priority-setting at meso-level in LMICs. Although proponents of certain PSPs still advocate their use, other experts instead suggest broader elements to guide priority-setting. We conclude that currently no process can be confidently recommended for such settings. We also assessed the common reasons for failure at all levels of priority-setting and concluded further that local authorities should additionally consider contextual and systems limitations likely to prevent a satisfactory process and outcomes, particularly at meso-level. Recent literature proposes a list of related attributes and warning signs, and facilitated our preparation of a simple decision-tree or roadmap to help determine whether or not health systems issues should be improved in parallel to support for needed priority-setting; what elements of the PSP need improving; monitoring, and evaluation. Health priority-setting at meso-level in LMICs can involve common processes, but will often require additional attention to local health systems.
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Moat KA, Lavis JN, Abelson J. How contexts and issues influence the use of policy-relevant research syntheses: a critical interpretive synthesis. Milbank Q 2013; 91:604-48. [PMID: 24028700 DOI: 10.1111/1468-0009.12026] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
CONTEXT Evidence briefs have emerged as a promising approach to synthesizing the best available research evidence for health system policymakers and stakeholders. An evidence brief may draw on systematic reviews and many other types of policy-relevant information, including local data and studies, to describe a problem, options for addressing it, and key implementation considerations. We conducted a systematic review to examine the ways in which context- and issue-related factors influence the perceived usefulness of evidence briefs among their intended users. METHODS We used a critical interpretive synthesis approach to review both empirical and nonempirical literature and to develop a model that explains how context and issues influence policymakers' and stakeholders' views of the utility of evidence briefs prepared for priority policy issues. We used a "compass" question to create a detailed search strategy and conducted electronic searches in CINAHL, EMBASE, HealthSTAR, IPSA, MEDLINE, OAIster (gray literature), ProQuest A&I Theses, ProQuest (Sociological Abstracts, Applied Social Sciences Index and Abstracts, Worldwide Political Science Abstracts, International Bibliography of Social Sciences, PAIS, Political Science), PsychInfo, Web of Science, and WilsonWeb (Social Science Abstracts). Finally, we used a grounded and interpretive analytic approach to synthesize the results. FINDINGS Of the 4,461 papers retrieved, 3,908 were excluded and 553 were assessed for "relevance," with 137 included in the initial sample of papers to be analyzed and an additional 23 purposively sampled to fill conceptual gaps. Several themes emerged: (1) many established types of "evidence" are viewed as useful content in an evidence brief, along with several promising formatting features; (2) contextual factors, particularly the institutions, interests, and values of a given context, can influence views of evidence briefs; (3) whether an issue is polarizing and whether it is salient (or not) and familiar (or not) to actors in the policy arena can influence views of evidence briefs prepared for that issue; (4) influential factors can emerge in several ways (as context driven, issue driven, or a result of issue-context resonance); (5) these factors work through two primary pathways, affecting either the users or the producers of briefs; and (6) these factors influence views of evidence briefs through a variety of mechanisms. CONCLUSIONS Those persons funding and preparing evidence briefs need to consider a variety of context- and issue-related factors when deciding how to make them most useful in policymaking.
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Kularatna S, Whitty JA, Johnson NW, Scuffham PA. Health state valuation in low- and middle-income countries: a systematic review of the literature. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:1091-1099. [PMID: 24041360 DOI: 10.1016/j.jval.2013.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 04/17/2013] [Accepted: 05/13/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Cost-utility analysis is widely used in high-income countries to inform decisions on efficient health care resource allocation. Cost-utility analysis uses the quality-adjusted life-year as the outcome measure of health. High-income countries have undertaken health state valuation (HSV) studies to determine country-specific utility weights to facilitate valuation of health-related quality of life. Despite an evident need, however, the extent of HSVs in low- and middle-income countries (LMICs) is unclear. METHODS The literature was searched systematically by using four databases and additional Web searches to identify HSV studies carried out in LMICs. The Preferred Reporting System for Systematic Reviews and Meta-Analysis (PRISMA) strategy was followed to ensure systematic selection of the articles. RESULTS The review identified 17 HSV studies from LMICs. Twelve studies were undertaken in upper middle-income countries, while lower middle- and low-income countries contributed three and two studies, respectively. There were 7 generic HSV and 10 disease-specific HSV studies. The seven generic HSVs included five EuroQol five-dimensional questionnaire, one six-dimensional health state short form (derived from short-form 36 health survey), and one Assessment of Quality of Life valuations. Time trade-off was the predominant valuation method used across all studies. CONCLUSIONS This review found that health state valuations from LMICs are uncommon and utility weights are generally unavailable for these countries to carry out health economic evaluation. More HSV studies need to be undertaken in LMICs to facilitate efficient resource allocation in their respective health systems.
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Affiliation(s)
- Sanjeewa Kularatna
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia; Population and Social Health Research Programme, Griffith Health Institute, Griffith University, Queensland, Australia.
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Jit M, Levin C, Brisson M, Levin A, Resch S, Berkhof J, Kim J, Hutubessy R. Economic analyses to support decisions about HPV vaccination in low- and middle-income countries: a consensus report and guide for analysts. BMC Med 2013; 11:23. [PMID: 23363734 PMCID: PMC3582485 DOI: 10.1186/1741-7015-11-23] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 01/30/2013] [Indexed: 11/10/2022] Open
Abstract
Low- and middle-income countries need to consider economic issues such as cost-effectiveness, affordability and sustainability before introducing a program for human papillomavirus (HPV) vaccination. However, many such countries lack the technical capacity and data to conduct their own analyses. Analysts informing policy decisions should address the following questions: 1) Is an economic analysis needed? 2) Should analyses address costs, epidemiological outcomes, or both? 3) If costs are considered, what sort of analysis is needed? 4) If outcomes are considered, what sort of model should be used? 5) How complex should the analysis be? 6) How should uncertainty be captured? 7) How should model results be communicated? Selecting the appropriate analysis is essential to ensure that all the important features of the decision problem are correctly represented, but that the analyses are not more complex than necessary. This report describes the consensus of an expert group convened by the World Health Organization, prioritizing key issues to be addressed when considering economic analyses to support HPV vaccine introduction in these countries.
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Affiliation(s)
- Mark Jit
- Modelling and Economics Unit, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Carol Levin
- PATH, 2201 Westlake Avenue, Suite 200 Seattle, WA 98121 USA
| | - Marc Brisson
- Centre de recherche du CHU de Québec, Hôpital Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec, G1S 4L8, Canada
- Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Ann Levin
- Independent Consultant, 6414 Hollins Dr., Bethesda, MD 20817 USA
| | - Stephen Resch
- Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Ave, Boston, MA 02130, USA
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Centre, PO box 7057, 1007 MB Amsterdam, The Netherlands
| | - Jane Kim
- Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Ave, Boston, MA 02130, USA
| | - Raymond Hutubessy
- Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
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La Vincente S, Aldaba B, Firth S, Kraft A, Jimenez-Soto E, Clark A. Supporting local planning and budgeting for maternal, neonatal and child health in the Philippines. Health Res Policy Syst 2013; 11:3. [PMID: 23343218 PMCID: PMC3557176 DOI: 10.1186/1478-4505-11-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 01/14/2013] [Indexed: 12/04/2022] Open
Abstract
Background Responsibility for planning and delivery of health services in the Philippines is devolved to the local government level. Given the recognised need to strengthen capacity for local planning and budgeting, we implemented Investment Cases (IC) for Maternal, Neonatal and Child Health (MNCH) in three selected sub-national units: two poor, rural provinces and one highly-urbanised city. The IC combines structured problem-solving by local policymakers and planners to identify key health system constraints and strategies to scale-up critical MNCH interventions with a decision-support model to estimate the cost and impact of different scaling-up scenarios. Methods We outline how the initiative was implemented, the aspects that worked well, and the key limitations identified in the sub-national application of this approach. Results Local officials found the structured analysis of health system constraints helpful to identify problems and select locally appropriate strategies. In particular the process was an improvement on standard approaches that focused only on supply-side issues. However, the lack of data available at the local level is a major impediment to planning. While the majority of the strategies recommended by the IC were incorporated into the 2011 plans and budgets in the three study sites, one key strategy in the participating city was subsequently reversed in 2012. Higher level systemic issues are likely to have influenced use of evidence in plans and budgets and implementation of strategies. Conclusions Efforts should be made to improve locally-representative data through routine information systems for planning and monitoring purposes. Even with sound plans and budgets, evidence is only one factor influencing investments in health. Political considerations at a local level and issues related to decentralisation, influence prioritisation and implementation of plans. In addition to the strengthening of capacity at local level, a parallel process at a higher level of government to relieve fund channelling and coordination issues is critical for any evidence-based planning approach to have a significant impact on health service delivery.
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Affiliation(s)
- Sophie La Vincente
- Centre for International Child Health, Murdoch Childrens Research Institute, University of Melbourne, University of Melbourne Education Offices, East Level 2, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia
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Kuchenbecker R, Polanczyk CA. Institutionalizing Health Technology Assessment in Brazil: Challenges Ahead. Value Health Reg Issues 2012; 1:257-261. [PMID: 29702910 DOI: 10.1016/j.vhri.2012.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The evolving process of institutionalizing health technology assessment (HTA) in low- and middle-income countries is not yet fully understood. The present article aims to provide an analysis of some of the most recent changes in the development of HTA in Brazil, as well as the main challenges and potential barriers that may determine the process of institutionalizing HTA in the country vis-à-vis the recent approval of its federal HTA law at the end of 2011. Based on the authors' experience in HTA from an academic research perspective as well as from national and regional/local policymaking implementations, this article also proposes some measures to foster the institutionalization of HTA, for which Brazil would have to overcome three fundamental challenges for decision making: 1) Brazil has to complete an unfinished agenda regarding the implementation of its national Unified Health System (SUS), 2) the complex governance of the SUS has to be thoroughly reassessed, and 3) HTA institutionalization is to be promoted to strengthen decision making. The recent creation of a Brazilian national HTA body represents an important step not only in terms of the development of HTA in the country but also regarding the consolidation of the universal access to health care that is guaranteed by the Brazilian Federal Constitution since the creation of SUS in 1988. There is an urgent need to promote broader approaches to assess the complexity of the governance of the SUS, thus strengthening the process of HTA within the decision-making process.
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Affiliation(s)
- Ricardo Kuchenbecker
- Institute of Health Technology Assessment (IATS/CNPq), Hospital de Clinicas de Porto Alegre and Graduate Studies in Epidemiology, Federal University of Rio Grande do Sul, Brazil.
| | - Carisia A Polanczyk
- Institute of Health Technology Assessment (IATS/CNPq), Hospital de Clinicas de Porto Alegre and Graduate Studies in Epidemiology, Federal University of Rio Grande do Sul, Brazil
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Lafi R, Robinson S, Williams I. Economic evaluation and the Jordan Rational Drug List: an exploratory study of national-level priority setting. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:771-776. [PMID: 22867788 DOI: 10.1016/j.jval.2012.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 02/19/2012] [Accepted: 04/07/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To explore the extent of and barriers to the use of economic evaluation in compiling the Jordan Rational Drug List in the health care system of Jordan. METHODS The research reported in this article involved a case study of the Jordan Rational Drug List. Data collection methods included semi-structured interviews with decision makers and analysis of secondary documentary sources. The case study was supplemented by additional interviews with a small number of Jordanian academics involved in the production of economic evaluation. RESULTS The research found that there was no formal requirement for cost-effectiveness information submitted as part of the decision-making process for the inclusion of new technologies on the Jordan Rational Drug List. Both decision makers and academics suggested that economic evidence was not influential in formulary decisions. This is unusual for national formulary bodies. The study identified a number of barriers that prevent substantive and routine use of economic evaluation. While some of these echo findings of previous studies, others-notably the extent to which the sectional interests of clinical groups and commercial (pharmaceutical) industry exert undue influence over decision making-more obviously result from the specific Jordanian context. CONCLUSIONS Economic evaluation was not found to be influential in the Jordan Rational Drug List. Recommendations for improvement include enhancing capacity in relation to generating, accessing, and/or applying health economic analysis to priority setting decisions. There is a further need to incentivize the use of economic evaluation, and this requires that organizational and structural impediments be removed.
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Affiliation(s)
- Rania Lafi
- Health Services Management Centre, University of Birmingham, UK
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Economic Evaluation of Anastrozole Versus Tamoxifen for Early Stage Breast Cancer in Singapore. Value Health Reg Issues 2012; 1:46-53. [DOI: 10.1016/j.vhri.2012.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Glassman A, Chalkidou K, Giedion U, Teerawattananon Y, Tunis S, Bump JB, Pichon-Riviere A. Priority-setting institutions in health: recommendations from a center for global development working group. Glob Heart 2012; 7:13-34. [PMID: 25691165 DOI: 10.1016/j.gheart.2012.01.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The rationing problem is common to all health systems-the challenge of managing finite resources to address unlimited demand for services. In most low- and middle-income countries, rationing occurs as an ad hoc, haphazard series of nontransparent choices that reflect the competing interests of governments, donors, and other stakeholders. Yet in a growing number of countries, more explicit processes, with strengths and limitations, are under development that merit better support. Against this background, the purpose of the Center for Global Development Working Group, which is to examine how priorities are set currently, and to propose institutional arrangements that promote country ownership and improve health outcomes by more systematically managing this complex process of politics and economics, is discussed. Current global and national priority-setting practices in low- and middle-income countries, the potential for strengthened national institutions, and increased global support are reviewed. Recommendations for action are provided.
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Affiliation(s)
| | - Kalipso Chalkidou
- National Institute for Health and Clinical Excellence, London, United Kingdom
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Department of Health Ministry of Public Health, Nonthaburi, Thailand
| | - Sean Tunis
- Center for Medical Technology Policy, Baltimore, MD, USA
| | - Jesse B Bump
- Department of International Health, Georgetown University, Washington, DC, USA
| | - Andres Pichon-Riviere
- Health Technology Assessment and Economic Evaluations, Institute for Clinical Effectiveness and Health Policy, University of Buenos Aires, Buenos Aires, Argentina
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