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Nemzoff C, Ahmed N, Olufiranye T, Igiraneza G, Kalisa I, Chadha S, Hakiba S, Rulisa A, Riro M, Chalkidou K, Ruiz F. Rapid cost-effectiveness analysis: hemodialysis versus peritoneal dialysis for patients with acute kidney injury in Rwanda. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:35. [PMID: 38689271 PMCID: PMC11059575 DOI: 10.1186/s12962-024-00545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND To ensure the long-term sustainability of its Community-Based Health Insurance scheme, the Government of Rwanda is working on using Health Technology Assessment (HTA) to prioritize its resources for health. The objectives of the study were to rapidly assess (1) the cost-effectiveness and (2) the budget impact of providing PD versus HD for patients with acute kidney injury (AKI) in the tertiary care setting in Rwanda. METHODS A rapid cost-effectiveness analysis for patients with AKI was conducted to support prioritization. An 'adaptive' HTA approach was undertaken by adjusting the international Decision Support Initiative reference case for time and data constraints. Available local and international data were used to analyze the cost-effectiveness and budget impact of peritoneal dialysis (PD) compared with hemodialysis (HD) in the tertiary hospital setting. RESULTS The analysis found that HD was slightly more effective and slightly more expensive in the payer perspective for most patients with AKI (aged 15-49). HD appeared to be cost-effective when only comparing these two dialysis strategies with an incremental cost-effectiveness ratio of 378,174 Rwandan francs (RWF) or 367 United States dollars (US$), at a threshold of 0.5 × gross domestic product per capita (RWF 444,074 or US$431). Sensitivity analysis found that reducing the cost of HD kits would make HD even more cost-effective. Uncertainty regarding PD costs remains. Budget impact analysis demonstrated that reducing the cost of the biggest cost driver, HD kits, could produce significantly more savings in five years than switching to PD. Thus, price negotiations could significantly improve the efficiency of HD provision. CONCLUSION Dialysis is costly and covered by insurance in many countries for the financial protection of patients. This analysis enabled policymakers to make evidence-based decisions to improve the efficiency of dialysis provision.
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Affiliation(s)
- Cassandra Nemzoff
- London School of Hygiene and Tropical Medicine, London, UK.
- Center for Global Development, International Decision Support Initiative, iDSI, London, UK.
| | - Nurilign Ahmed
- Center for Global Development, International Decision Support Initiative, iDSI, London, UK
| | - Tolulope Olufiranye
- Rwanda Social Security Board, Kigali, Rwanda
- Clinton Health Access Initiative, Kigali, Rwanda
| | | | - Ina Kalisa
- World Health Organization, Kigali, Rwanda
| | | | | | | | - Matiko Riro
- Clinton Health Access Initiative, Kigali, Rwanda
| | | | - Francis Ruiz
- London School of Hygiene and Tropical Medicine, London, UK
- Center for Global Development, International Decision Support Initiative, iDSI, London, UK
- Imperial College London, London, UK
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Sangthawan P, Klyprayong P, Geater SL, Tanvejsilp P, Anutrakulchai S, Boongird S, Gojaseni P, Kuhiran C, Lorvinitnun P, Noppakun K, Parapiboon W, Sirilak S, Tankee P, Taruangsri P, Sangsupawanich P, Sritara P, Chaiyakunapruk N, Kitiyakara C. The hidden financial catastrophe of chronic kidney disease under universal coverage and Thai "Peritoneal Dialysis First Policy". Front Public Health 2022; 10:965808. [PMID: 36311589 PMCID: PMC9606783 DOI: 10.3389/fpubh.2022.965808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Universal health coverage can decrease the magnitude of the individual patient's financial burden of chronic kidney disease (CKD), but the residual financial hardship from the patients' perspective has not been well-studied in low and middle-income countries (LMICs). This study aimed to evaluate the residual financial burden in patients with CKD stage 3 to dialysis in the "PD First Policy" under Universal Coverage Scheme (UCS) in Thailand. Methods This multicenter nationwide cross-sectional study in Thailand enrolled 1,224 patients with pre-dialysis CKD, hemodialysis (HD), and peritoneal dialysis (PD) covered by UCS and other health schemes for employees and civil servants. We interviewed patients to estimate the proportion with catastrophic health expenditure (CHE) and medical impoverishment. The risk factors associated with CHE were analyzed by multivariable logistic regression. Results Under UCS, the total out-of-pocket expenditure in HD was over two times higher than PD and nearly six times higher than CKD stages 3-4. HD suffered significantly more CHE and medical impoverishment than PD and pre-dialysis CKD [CHE: 8.5, 9.3, 19.5, 50.0% (p < 0.001) and medical impoverishment: 8.0, 3.1, 11.5, 31.6% (p < 0.001) for CKD Stages 3-4, Stage 5, PD, and HD, respectively]. In the poorest quintile of UCS, medical impoverishment was present in all HD and two-thirds of PD patients. Travel cost was the main driver of CHE in HD. In UCS, the adjusted risk of CHE increased in PD and HD (OR: 3.5 and 16.3, respectively) compared to CKD stage 3. Conclusions Despite universal coverage, the residual financial burden remained high in patients with kidney failure. CHE was considerably lower in PD than HD, although the rates remained alarmingly high in the poor. The "PD First' program" could serve as a model for other LMICs. However, strategies to minimize financial distress should be further developed, especially for the poor.
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Affiliation(s)
- Pornpen Sangthawan
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pinkaew Klyprayong
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sarayut L. Geater
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pimwara Tanvejsilp
- Department of Pharmacy Administration, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand
| | - Sirirat Anutrakulchai
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sarinya Boongird
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsathorn Gojaseni
- Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand
| | - Charan Kuhiran
- Department of Medicine, Somdej Pranangchao Sirikit Hospital, Chonburi, Thailand
| | - Pichet Lorvinitnun
- Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Kajohnsak Noppakun
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Watanyu Parapiboon
- Department of Medicine, Maharat Nakhonratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Supinda Sirilak
- Department of Internal Medicine, Naresuan University Hospital, Naresuan University, Phitsanulok, Thailand
| | - Pluemjit Tankee
- Department of Medicine, Vachiraphuket Hospital, Phuket, Thailand
| | | | - Pasuree Sangsupawanich
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Piyamitr Sritara
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States,IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States,*Correspondence: Nathorn Chaiyakunapruk
| | - Chagriya Kitiyakara
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Chagriya Kitiyakara
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Iyengar A, McCulloch MI. Paediatric kidney transplantation in under-resourced regions-a panoramic view. Pediatr Nephrol 2022; 37:745-755. [PMID: 33837847 PMCID: PMC8035609 DOI: 10.1007/s00467-021-05070-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/21/2020] [Accepted: 03/24/2021] [Indexed: 01/10/2023]
Abstract
Kidney transplantation is the ideal choice of kidney replacement therapy in children as it offers a low risk of mortality and a better quality of life. A wide variance in the access to kidney replacement therapies exists across the world with only 21% of low- and low-middle income countries (LLMIC) undertaking kidney transplantation. Pediatric kidney transplantation rates in these under-resourced regions are reported to be as low as < 4 pmcp [per million child population]. A robust kidney failure care program forms the cornerstone of a transplant program. Even the smallest transplant program entails a multidisciplinary workforce and expertise besides ensuring family commitment towards long-term care and economic burden. In general, the short-term graft survival rates from under-resourced regions are comparable to most high-income countries (HIC) and the challenge lies in the long-term outcomes. This review focuses on specific issues relevant to kidney transplants in children in under-resourced regions by highlighting limitations in the capacity and health workforce, regulatory norms, medical issues, economic burden, factors beyond financial hardship and ethical considerations relevant to these regions. Finally, the perspective of strengthening transplant programs in these regions should factor in the bigger challenges that exist in achieving the health-related sustainable development goals by 2030.
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Affiliation(s)
- Arpana Iyengar
- Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India.
| | - M I McCulloch
- Pediatric Nephrology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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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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Missing In-Center Hemodialysis Sessions among Patients with End Stage Renal Disease in Banda Aceh, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179215. [PMID: 34501804 PMCID: PMC8431045 DOI: 10.3390/ijerph18179215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/04/2021] [Accepted: 08/28/2021] [Indexed: 01/13/2023]
Abstract
Indonesian universal health coverage was implemented in 2013 and hemodialysis services became universally accessible, yet few studies have examined patient adherence to hemodialysis schedules. We examined the rates of missed in-center hemodialysis sessions in Banda Aceh and the factors associated with non-attendance. This cross-sectional questionnaire survey included 193 patients receiving in-center hemodialysis. Approximately 28% of the patients missed ≥ 1 hemodialysis session in the month prior to the questionnaire’s administration. About 65% reported attending religious activities as the reason for missing hemodialysis. The level of health literacy was generally low with a mean score of 14.38 out of 26 (55.3%). Multivariate logistic regression analyses showed that patients with educational levels higher than elementary school were less likely to miss hemodialysis sessions. Participants who performed more self-care behaviors had lower odds of missing hemodialysis sessions. Every unit increase in the health literacy score was associated with increased odds of missing hemodialysis sessions. Emphasizing the importance of attending hemodialysis sessions and modifying hemodialysis schedules based on patients’ needs is essential. Patients who miss hemodialysis sessions should be reminded of all self-care behaviors. Health literacy among hemodialysis patients should be improved, with emphasis on patient safety, advanced knowledge, and critical health literacy.
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Chan KW, Yu KY, Lee PW, Lai KN, Tang SCW. Global REnal Involvement of CORonavirus Disease 2019 (RECORD): A Systematic Review and Meta-Analysis of Incidence, Risk Factors, and Clinical Outcomes. Front Med (Lausanne) 2021; 8:678200. [PMID: 34113640 PMCID: PMC8185046 DOI: 10.3389/fmed.2021.678200] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/09/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction: The quantitative effect of underlying non-communicable diseases on acute kidney injury (AKI) incidence and the factors affecting the odds of death among coronavirus disease 2019 (COVID-19) AKI patients were unclear at population level. This study aimed to assess the association between AKI, mortality, underlying non-communicable diseases, and clinical risk factors. Methods: A systematic search of six databases was performed from January 1, 2020, until October 5, 2020. Peer-reviewed observational studies containing quantitative data on risk factors and incidence of renal manifestations of COVID-19 were included. Location, institution, and time period were matched to avoid duplicated data source. Incidence, prevalence, and odds ratio of outcomes were extracted and pooled by random-effects meta-analysis. History of renal replacement therapy (RRT) and age group were stratified for analysis. Univariable meta-regression models were built using AKI incidence as dependent variable, with underlying comorbidities and clinical presentations at admission as independent variables. Results: Global incidence rates of AKI and RRT in COVID-19 patients were 20.40% [95% confidence interval (CI) = 12.07-28.74] and 2.97% (95% CI = 1.91-4.04), respectively, among patients without RRT history. Patients who developed AKI during hospitalization were associated with 8 times (pooled OR = 9.03, 95% CI = 5.45-14.94) and 16.6 times (pooled OR = 17.58, 95% CI = 10.51-29.38) increased odds of death or being critical. At population level, each percentage increase in the underlying prevalence of diabetes, hypertension, chronic kidney disease, and tumor history was associated with 0.82% (95% CI = 0.40-1.24), 0.48% (95% CI = 0.18-0.78), 0.99% (95% CI = 0.18-1.79), and 2.85% (95% CI = 0.93-4.76) increased incidence of AKI across different settings, respectively. Although patients who had a kidney transplant presented with a higher incidence of AKI and RRT, their odds of mortality was lower. A positive trend of increased odds of death among AKI patients against the interval between symptom onset and hospital admission was observed. Conclusion: Underlying prevalence of non-communicable diseases partly explained the heterogeneity in the AKI incidence at population level. Delay in admission after symptom onset could be associated with higher mortality among patients who developed AKI and warrants further research.
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Affiliation(s)
- Kam Wa Chan
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Kam Yan Yu
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Pak Wing Lee
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kar Neng Lai
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Sydney Chi-Wai Tang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Chan KW, Hung IFN, Tsang OTY, Wu TC, Tso EYK, Lung KC, Lam CM, Chan GCW, Wong SSH, Yu KY, Chan JWM, Tang SCW. Mass Screening Is Associated with Low Rates of Acute Kidney Injury among COVID-19 Patients in Hong Kong. Am J Nephrol 2021; 52:161-172. [PMID: 33765681 DOI: 10.1159/000514234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/23/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Renal involvement in COVID-19 is less well characterized in settings with vigilant public health surveillance, including mass screening and early hospitalization. We assessed kidney complications among COVID-19 patients in Hong Kong, including the association with risk factors, length of hospitalization, critical presentation, and mortality. METHODS Linked electronic records of all patients with confirmed COVID-19 from 5 major designated hospitals were extracted. Duplicated records due to interhospital transferal were removed. Primary outcome was the incidence of in-hospital acute kidney injury (AKI). Secondary outcomes were AKI-associated mortality, incident renal replacement therapy (RRT), intensive care admission, prolonged hospitalization and disease course (defined as >90th percentile of hospitalization duration [35 days] and duration from symptom onset to discharge [43 days], respectively), and change of estimated glomerular filtration rate (GFR). Patients were further stratified into being symptomatic or asymptomatic. RESULTS Patients were characterized by young age (median: 38.4, IQR: 28.4-55.8 years) and short time (median: 5, IQR: 2-9 days) from symptom onset to admission. Among the 591 patients, 22 (3.72%) developed AKI and 4 (0.68%) required RRT. The median time from symptom onset to in-hospital AKI was 15 days. AKI increased the odds of prolonged hospitalization and disease course by 2.0- and 3.5-folds, respectively. Estimated GFR 24 weeks post-discharge reduced by 7.51 and 1.06 mL/min/1.73 m2 versus baseline (upon admission) in the AKI and non-AKI groups, respectively. The incidence of AKI was comparable between asymptomatic (4.8%, n = 3/62) and symptomatic (3.7%, n = 19/519) patients. CONCLUSION The overall rate of AKI among COVID-19 patients in Hong Kong is low, which could be attributable to a vigilant screening program and early hospitalization. Among patients who developed in-hospital AKI, the duration of hospitalization is prolonged and kidney function impairment can persist for up to 6 months post-discharge. Mass surveillance for COVID-19 is warranted in identifying asymptomatic subjects for earlier AKI management.
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Affiliation(s)
- Kam Wa Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Ivan Fan-Ngai Hung
- Division of Infectious Diseases, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong SAR, China
| | - Owen Tak-Yin Tsang
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
- Hospital Authority Infectious Disease Centre, Princess Margaret Hospital, Hong Kong SAR, China
| | - Tak Chiu Wu
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Eugene Yuk-Keung Tso
- Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong SAR, China
| | - Kwok Cheung Lung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Chung Man Lam
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| | | | - Sunny Sze-Ho Wong
- Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong SAR, China
| | - Kam Yan Yu
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | | | - Sydney Chi-Wai Tang
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
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8
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Abstract
Public policy for kidney replacement therapy eludes most low- and middle-income countries owing to the seemingly low number of cases and high cost. Countries such as Thailand have shown that public health authorities can effectively provide treatment and elevate health care for populations by overcoming some common challenges.
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Cookson R, Griffin S, Norheim OF, Culyer AJ, Chalkidou K. Distributional Cost-Effectiveness Analysis Comes of Age. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:118-120. [PMID: 33431145 PMCID: PMC7813213 DOI: 10.1016/j.jval.2020.10.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/06/2020] [Indexed: 05/23/2023]
Affiliation(s)
- Richard Cookson
- Centre for Health Economics, University of York, York, England, UK.
| | - Susan Griffin
- Centre for Health Economics, University of York, York, England, UK
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Anthony J Culyer
- Centre for Health Economics, University of York, York, England, UK
| | - Kalipso Chalkidou
- Faculty of Medicine, School of Public Health, Imperial College London, London, England, UK
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Chalkidou K, Claxton K, Silverman R, Yadav P. Value-based tiered pricing for universal health coverage: an idea worth revisiting. Gates Open Res 2020; 4:16. [PMID: 32185365 PMCID: PMC7059551 DOI: 10.12688/gatesopenres.13110.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 10/03/2023] Open
Abstract
The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those.
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Affiliation(s)
- Kalipso Chalkidou
- Global Health Policy, Center for Global Development, London, UK
- Medicine, School of Public Health, Imperial College London, London, UK
| | - Karl Claxton
- Department of Economics, University of York, UK, York, UK
| | | | - Prashant Yadav
- Global Health Policy, Center for Global Development, London, UK
- Technology and Operations Management, INSEAD, Fontainebleau, France
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11
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Chalkidou K, Claxton K, Silverman R, Yadav P. Value-based tiered pricing for universal health coverage: an idea worth revisiting. Gates Open Res 2020; 4:16. [PMID: 32185365 PMCID: PMC7059551 DOI: 10.12688/gatesopenres.13110.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 01/29/2023] Open
Abstract
The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those.
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Affiliation(s)
- Kalipso Chalkidou
- Global Health Policy, Center for Global Development, London, UK.,Medicine, School of Public Health, Imperial College London, London, UK
| | - Karl Claxton
- Department of Economics, University of York, UK, York, UK
| | | | - Prashant Yadav
- Global Health Policy, Center for Global Development, London, UK.,Technology and Operations Management, INSEAD, Fontainebleau, France
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Isaranuwatchai W, Teerawattananon Y, Archer RA, Luz A, Sharma M, Rattanavipapong W, Anothaisintawee T, Bacon RL, Bhatia T, Bump J, Chalkidou K, Elshaug AG, Kim DD, Reddiar SK, Nakamura R, Neumann PJ, Shichijo A, Smith PC, Culyer AJ. Prevention of non-communicable disease: best buys, wasted buys, and contestable buys. BMJ 2020; 368:m141. [PMID: 31992592 PMCID: PMC7190374 DOI: 10.1136/bmj.m141] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Wanrudee Isaranuwatchai and colleagues highlight the importance of local context in making decisions about implementing interventions for preventing non-communicable diseases
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Affiliation(s)
- Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Programme, Bangkok, Thailand
- University of Toronto, Toronto, Canada
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Programme, Bangkok, Thailand
- National University of Singapore, Singapore
- National Health Foundation, Bangkok, Thailand
| | - Rachel A Archer
- Health Intervention and Technology Assessment Programme, Bangkok, Thailand
| | - Alia Luz
- Health Intervention and Technology Assessment Programme, Bangkok, Thailand
| | - Manushi Sharma
- Health Intervention and Technology Assessment Programme, Bangkok, Thailand
| | | | | | - Rachel L Bacon
- Tufts Medical Center, Boston, USA
- Boston University, Boston, USA
| | | | - Jesse Bump
- Harvard TH Chan School of Public Health, Boston, USA
| | - Kalipso Chalkidou
- Centre for Global Development, London, UK
- Imperial College London, London, UK
| | - Adam G Elshaug
- University of Sydney, Sydney, Australia
- Brookings Institution, Washington DC, USA
| | | | | | | | - Peter J Neumann
- Tufts Medical Center, Boston, USA
- Tufts University School of Medicine, Boston, USA
| | | | - Peter C Smith
- University of York, York, UK
- Imperial College Business School, London, UK
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