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Tambo E, Ugwu CE, Alemayehu A, Krishna A, Binagwaho A. Evidence-based universal health coverage interventions delivery in infectious disease of poverty elimination and eradication. Infect Dis Poverty 2024; 13:1. [PMID: 38167334 PMCID: PMC10759407 DOI: 10.1186/s40249-023-01169-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
The recent 78th United Natiions General Assembly (UNGA) declaration relaunched a new health priority and political commitment in accelerating Universal Health Coverage (UHC), adopted by the United Nations (UN) in 2015 and are intended to be met by 2030. At mid-way point of UHC implementation, we advocate for the much needed programmatic implementation research, evidence-based interventions (EBIs) policies and strategies leadership and management capacity building to enable robust, resilient and sustainable multi-sectoral partnerships, integrated coordination and governance mechanisms capabilities in accelerating UHC package mainly infectious diseases of poverty elimination and eradication agenda.
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Affiliation(s)
- Ernest Tambo
- Center for Leadership in Global Health Equity, University of Global Health Equity, Kigali, Rwanda.
- Africa Disease Intelligence, Preparedness and Response (ADIPR), Yaoundé, Cameroon.
- Higher Institute of Health Sciences, Faculty of Medicine, Bangangte, Cameroon.
| | - Chidiebere E Ugwu
- Department of Human Biochemistry, Nnamdi Azikiwe University, Nnewi, Anambra, Nigeria
| | - Amberbir Alemayehu
- Institute for Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda
| | - Anil Krishna
- Center for Leadership in Global Health Equity, University of Global Health Equity, Kigali, Rwanda
| | - Agnes Binagwaho
- Center for Leadership in Global Health Equity, University of Global Health Equity, Kigali, Rwanda
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Mbau R, Vassall A, Gilson L, Barasa E. Factors Influencing the Institutionalization of Health Technology Assessment: A Scoping Literature Review. Health Syst Reform 2023; 9:2360315. [PMID: 39158224 DOI: 10.1080/23288604.2024.2360315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/24/2024] [Accepted: 05/22/2024] [Indexed: 08/20/2024] Open
Abstract
There is global interest in institutionalizing Health Technology Assessment (HTA) to inform resource allocation decisions. However, institutionalization of HTA remains limited particularly in low- and lower-middle-income countries. We conducted this scoping review to synthesize evidence on factors that influence the institutionalization of HTA at the macro (national)-level across countries globally. We searched for relevant literature in six databases namely PubMed, Embase, CINAHL, Scopus, EconLit, and Google Scholar. We conducted the last search on December 31, 2021. We identified 77 articles that described factors that influence institutionalization of HTA across 135 high-, middle-, and low-income countries. We analyzed these articles thematically. We identified five sets of factors that influence the institutionalization of HTA across countries of different income levels. These factors include: (1) organizational resources such as organizational structures, and skilled human, financial, and information resources; (2) legal frameworks, policies, and guidelines for HTA; (3) learning and advocacy for HTA; (4) stakeholder-related factors such as stakeholders' interests, awareness, and understanding; and (5) collaborative support for HTA through international networks and non-governmental and multi-lateral organizations. Countries seeking to institutionalize HTA should map the availability of the factors identified in this review. Developing these factors wherever necessary can influence a country's capacity to institutionalize the conduct and use of HTA.
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Affiliation(s)
- Rahab Mbau
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Gilson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
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Hidayat B. Evolution of Health Technology Assessment in Indonesia: Supply Landscape, Implementation, and Future Directions. Health Syst Reform 2023; 9:2371470. [PMID: 39008816 DOI: 10.1080/23288604.2024.2371470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/19/2024] [Indexed: 07/17/2024] Open
Abstract
In 2014, Indonesia's Ministry of Health established the Indonesian Health Technology Assessment Committee (InaHTAC) to prioritize evidence-based health care technology for inclusion in the national health insurance benefits package. This commentary provides an overview of the current state of the health care technology supply landscape in Indonesia, as well as the impact of HTA studies on priority-setting decisions. Indonesia's decision-making process for health care technology approval and patient access involves multiple stakeholders and follows several evaluation principles. The licensing, inclusion, and evaluation of health care technology is complex and time consuming, however, requiring input from stakeholders with different roles and interests. Although efforts have been made to establish an HTA ecosystem by, for example, engaging in capacity-building activities and issuing guidelines, challenges remain, including a lack of infrastructure, financial resources, and technical capacity and inadequate stakeholder involvement. Additionally, the current position of the HTA unit, which is connected to the Ministry of Health (MOH), and political pressures from the pharmaceutical industry can result in delayed or ignored HTA recommendations. Therefore, the establishment of an independent and robust HTA body that can inform policy makers about health technology development, licensing, dissemination, and use, along with strong regulations to ensure harmonization and coordination among stakeholders, is necessary. This requires a step-by-step approach to address inadequate overall HTA resources.
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Affiliation(s)
- Budi Hidayat
- Center for Health Economics and Policy Studies (CHEPS), Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
- Indonesian Health Technology Assessments Committee (InaHTAC), Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
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Lim MY, Kamaruzaman HF, Wu O, Geue C. Health financing challenges in Southeast Asian countries for universal health coverage: a systematic review. Arch Public Health 2023; 81:148. [PMID: 37592326 PMCID: PMC10433621 DOI: 10.1186/s13690-023-01159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Universal Health Coverage (UHC) has received much attention and many countries are striving to achieve it. The Southeast Asian region, in particular, comprises many developing countries with limited resources, exacerbating challenges around attaining UHC. This paper aims to specifically explore the health financing challenges these countries face in achieving UHC via a systematic review approach and formulate recommendations that will be useful for policymakers. METHODS The systematic review followed the guidelines as recommended by PRISMA. The narrative synthesis approach was used for data synthesis, followed by identifying common themes. RESULTS The initial search returned 160 articles, and 32 articles were included after the screening process. The identified challenges in health financing towards achieving UHC in the Southeast Asian region are categorised into six main themes, namely (1) Unsustainability of revenue-raising methods, (2) Fragmented health insurance schemes, (3) Incongruity between insurance benefits and people's needs, (4) Political and legislative indifference, (5) Intractable and rapidly rising healthcare cost, (6) Morally reprehensible behaviours. CONCLUSIONS The challenges identified are diverse and therefore require a multifaceted approach. Regional collaborative efforts between countries will play an essential role in the progress towards UHC and in narrowing the inequity gap. At the national level, individual countries must work towards sustainable health financing strategies by leveraging innovative digital technologies and constantly adapting to dynamic health trends. REGISTRATION This study is registered with PROSPERO, under registration number CRD42022336624.
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Affiliation(s)
- Ming Yao Lim
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK.
| | - Hanin Farhana Kamaruzaman
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
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Chavarina KK, Faradiba D, Sari EN, Wang Y, Teerawattananon Y. Health economic evaluations for Indonesia: a systematic review assessing evidence quality and adherence to the Indonesian Health Technology Assessment (HTA) Guideline. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 13:100184. [PMID: 37383554 PMCID: PMC10306002 DOI: 10.1016/j.lansea.2023.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/07/2022] [Accepted: 03/16/2023] [Indexed: 06/30/2023]
Abstract
Background The Government of Indonesia implemented health technology assessment (HTA) to ensure quality and cost control in the National Health Insurance Program (Jaminan Kesehatan Nasional/JKN). The current aim of the study was to improve the usefulness of future economic evaluation for resource allocation by appraising current methodology, reporting, and source of evidence quality of studies. Methods The inclusion and exclusion criteria were applied to search for relevant studies using a systematic review. The methodology and reporting adherence were appraised according to Indonesia's HTA Guideline issued in 2017. The differences in adherence before and after the guideline dissemination were compared using Chi-square and Fisher's exact tests for methodology adherence wherever appropriate, and the Mann-Whitney test for reporting adherence. The source of evidence quality was assessed using evidence hierarchy. Two scenarios of the study start date and the guideline dissemination period were tested using sensitivity analyses. Findings Eighty-four studies were obtained from PubMed, Embase, Ovid, and two local journals. Only two articles cited the guideline. No statistically significant difference (P > 0.05) was found between the pre-dissemination and post-dissemination period with respect to methodology adherence, except for outcome choice. Studies during the post-dissemination period showed a higher score for reporting which was statistically significant (P = 0.01). However, the sensitivity analyses revealed no statistically significant difference (P > 0.05) in methodology (except for modelling type, P = 0.03) and reporting adherence between the two periods. Interpretation The guideline did not impact the methodology and reporting standard used in the included studies. Recommendations were provided to improve the usefulness of economic evaluations for Indonesia. Funding The Access and Delivery Partnership (ADP) hosted by the United Nations Development Programme (UNDP) and the Health Systems Research Institute (HSRI).
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Affiliation(s)
- Kinanti Khansa Chavarina
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
| | - Dian Faradiba
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
| | - Ella Nanda Sari
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand
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Pinilla-Dominguez P, Taha S, McGuire H, Elagamy A, Sedrak A, Gamal M, Eldebeiky M, Dawoud D. Institutionalizing health technology assessment in Egypt: Situational analysis and roadmap. Front Pharmacol 2022; 13:1014658. [PMID: 36438785 PMCID: PMC9682258 DOI: 10.3389/fphar.2022.1014658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022] Open
Abstract
Objective: To conduct a situational analysis with the aim to inform future health technology assessment efforts (HTA) in Egypt. Introduction: The Egyptian government has set universal health coverage as a 2030 target. Several agencies have been created in the context of the ongoing healthcare reform. The Egyptian Authority for Unified Procurement, Medical Supply and the Management of Medical Technology (UPA) is one of them and was established to support strategic procurement using HTA. Methods: Description of the development of HTA in Egypt supported by a literature search as part of a scoping exercise, and a stakeholder analysis and identification of HTA capacity survey, based on previous surveys, with relevant stakeholders conducted in 2022. This was followed by a stakeholder event where results were shared and further contextualized. Results: The UPA is expected to evaluate the cost-effectiveness of health technologies and public health programs. The HTA process is being developed, focusing on the assessment of the value of new pharmaceuticals being introduced to the Egyptian market. A total of 16 participants responded on behalf of their organizations to the stakeholder analysis and identification of HTA capacity survey. More than 80% of the respondents were familiar with current efforts conducted by UPA and strongly support the implementation of HTA in Egypt. Transparency was highlighted as an important criterion. Over 90% of the respondents mentioned economic analyses as an HTA product being developed in Egypt, and medicines were the type of technology that stakeholders ranked as first in the rank of health technologies that need the output from HTA urgently. Capability building and training were highlighted as areas in which further support is required. Conclusion: This study represents the first attempt to describe the current path for HTA in Egypt. There seems to be momentum in Egypt to proceed and advance with HTA institutionalization. It would be important that next steps are built on the skills and capabilities already in place in Egypt, ensure methods and processes are in place and up to date and involve the wider system in Egypt so stakeholders can appropriately contribute and participate in the HTA process.
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Affiliation(s)
- Pilar Pinilla-Dominguez
- NICE International—National Institute for Health and Care Excellence (NICE), London, United Kingdom
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas, Spain
- *Correspondence: Pilar Pinilla-Dominguez, ; Shorouk Taha, ; Ahmed Elagamy, ; Dalia Dawoud,
| | - Shorouk Taha
- Central Administration of Health Technology Management (CAHTM), Egyptian Authority for Unified Procurement, Medical Supply and Technology Management (UPA), Cairo, Egypt
- *Correspondence: Pilar Pinilla-Dominguez, ; Shorouk Taha, ; Ahmed Elagamy, ; Dalia Dawoud,
| | - Hugh McGuire
- NICE International—National Institute for Health and Care Excellence (NICE), London, United Kingdom
| | - Ahmed Elagamy
- Central Administration of Health Technology Management (CAHTM), Egyptian Authority for Unified Procurement, Medical Supply and Technology Management (UPA), Cairo, Egypt
- *Correspondence: Pilar Pinilla-Dominguez, ; Shorouk Taha, ; Ahmed Elagamy, ; Dalia Dawoud,
| | - Amal Sedrak
- Central Administration of Health Technology Management (CAHTM), Egyptian Authority for Unified Procurement, Medical Supply and Technology Management (UPA), Cairo, Egypt
- Faculty of Medicine, Department of Public Health, Cairo University, Cairo, Egypt
| | - Mary Gamal
- Central Administration of Health Technology Management (CAHTM), Egyptian Authority for Unified Procurement, Medical Supply and Technology Management (UPA), Cairo, Egypt
| | - Mariam Eldebeiky
- Central Administration of Health Technology Management (CAHTM), Egyptian Authority for Unified Procurement, Medical Supply and Technology Management (UPA), Cairo, Egypt
| | - Dalia Dawoud
- NICE Science, Policy & Research, National Institute for Health and Care Excellence, London, United Kingdom
- Faculty of Pharmacy, Cairo University, Cairo, Egypt
- *Correspondence: Pilar Pinilla-Dominguez, ; Shorouk Taha, ; Ahmed Elagamy, ; Dalia Dawoud,
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Sharma M, John R, Afrin S, Zhang X, Wang T, Tian M, Sahu KS, Mash R, Praveen D, Saif-Ur-Rahman KM. Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review. Front Public Health 2022; 10:820750. [PMID: 35345509 PMCID: PMC8957212 DOI: 10.3389/fpubh.2022.820750] [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: 11/23/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022] Open
Abstract
Almost all low- and middle-income countries (LMICs) have instated a program to control and manage non-communicable diseases (NCDs). Population screening is an integral component of this strategy and requires a substantial chunk of investment. Therefore, testing the screening program for economic along with clinical effectiveness is essential. There is significant proof of the benefits of incorporating economic evidence in health decision-making globally, although evidence from LMICs in NCD prevention is scanty. This systematic review aims to consolidate and synthesize economic evidence of screening programs for cardiovascular diseases (CVD) and diabetes from LMICs. The study protocol is registered on PROSPERO (CRD42021275806). The review includes articles from English and Chinese languages. An initial search retrieved a total of 2,644 potentially relevant publications. Finally, 15 articles (13 English and 2 Chinese reports) were included and scrutinized in detail. We found 6 economic evaluations of interventions targeting cardiovascular diseases, 5 evaluations of diabetes interventions, and 4 were combined interventions, i.e., screening of diabetes and cardiovascular diseases. The study showcases numerous innovative screening programs that have been piloted, such as using mobile technology for screening, integrating non-communicable disease screening with existing communicable disease screening programs, and using community health workers for screening. Our review reveals that context is of utmost importance while considering any intervention, i.e., depending on the available resources, cost-effectiveness may vary—screening programs can be made universal or targeted just for the high-risk population.
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Affiliation(s)
- Manushi Sharma
- The George Institute for Global Health, New Delhi, India
| | - Renu John
- The George Institute for Global Health, New Delhi, India
| | - Sadia Afrin
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh
| | - Xinyi Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Tengyi Wang
- School of Public Health, Harbin Medical University, Harbin, China
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, China.,Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Kirti Sundar Sahu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Robert Mash
- Department of Family and Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Devarsetty Praveen
- The George Institute for Global Health, New Delhi, India.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - K M Saif-Ur-Rahman
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh.,Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Widyaningsih V, Febrinasari RP, Pamungkasari EP, Mashuri YA, Sumardiyono S, Balgis B, Koot J, Landsman-Dijkstra J, Probandari A. Missed opportunities in hypertension risk factors screening in Indonesia: a mixed-methods evaluation of integrated health post (POSBINDU) implementation. BMJ Open 2022; 12:e051315. [PMID: 35190419 PMCID: PMC8862503 DOI: 10.1136/bmjopen-2021-051315] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To assess the implementation and contextual barriers of POSBINDU, a community-based activity focusing on screening of non-communicable diseases (NCDs), mainly hypertension and diabetes, in Indonesia. DESIGN This was a concurrent mixed-methods study, with a cross-sectional analysis of secondary data and focus group discussions (FGDs) on stakeholder of POSBINDU. SETTING The study was conducted in seven districts in three provinces in Indonesia, with approximately 50% of the primary healthcare (PHC) were selected as areas for data collection (n PHC=100). PARTICIPANTS From 475 POSBINDU sites, we collected secondary data from 54 224 participants. For the qualitative approach, 21 FGDs and 2 in-depth interviews were held among a total of 223 informants. PRIMARY OUTCOMES AND MEASURES Proportion of POSBINDU visitors getting the hypertension screening and risk factors' assessment, and barriers of POSBINDU implementation. RESULTS Out of the 114 581 POSBINDU visits by 54 224 participants, most (80%) were women and adults over 50 years old (50%) showing a suboptimal coverage of men and younger adults. Approximately 95.1% of visitors got their blood pressure measured during their first visit; 35.3% of whom had elevated blood pressure. Less than 25% of the visitors reported to be interviewed for NCDs risk factors during their first visit, less than 80% had anthropometric measurements and less than 15% had blood cholesterol examinations. We revealed lack of resources and limited time to perform the complexities of activities and reporting as main barrier for effective hypertension screening in Indonesia. CONCLUSIONS This study showed missed opportunities in hypertension risk factors screening in Indonesia. The barriers include a lack of access and implementation barriers (capability, resources and protocols).
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Affiliation(s)
| | | | | | | | | | - Balgis Balgis
- Public Health, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Jaap Koot
- Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Ari Probandari
- Public Health, Universitas Sebelas Maret, Surakarta, Indonesia
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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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Gopinathan U, Ottersen T, Cyr PR, Chalkidou K. Evidence-Informed Deliberative Processes for HTA Around the Globe: Exploring the Next Frontiers of HTA and Best Practices Comment on "Use of Evidence-informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe". Int J Health Policy Manag 2021; 10:232-236. [PMID: 32772012 PMCID: PMC8167266 DOI: 10.34172/ijhpm.2020.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/21/2020] [Indexed: 11/14/2022] Open
Abstract
This comment reflects on an article by Oortwijn, Jansen, and Baltussen about the use and features of 'evidence-informed deliberative processes' (EDPs) among health technology assessment (HTA) agencies around the world and the need for more guidance. First, we highlight procedural aspects that are relevant across key steps of EDP, focusing on conflict of interest, the different roles of stakeholders throughout a HTA and public justification of decisions. Second, we discuss new knowledge and models needed to maximize the value of deliberative processes at the expanding frontiers of HTA, paying special attention to when HTA is applied in primary care, employed for public health interventions, and is produced through international collaboration.
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Affiliation(s)
- Unni Gopinathan
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Trygve Ottersen
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Pascale-Renée Cyr
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kalipso Chalkidou
- Global Health Development Group, Imperial College London School of Public Health, London, UK
- Center for Global Development Europe, London, UK
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A landscape analysis of health technology assessment capacity in the Association of South-East Asian Nations region. Health Res Policy Syst 2021; 19:19. [PMID: 33573676 PMCID: PMC7879649 DOI: 10.1186/s12961-020-00647-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Progress towards achieving Universal Health Coverage and institutionalizing healthcare priority setting through health technology assessment (HTA) in the Association of South-East Asian Nations (ASEAN) region varies considerably across countries because of differences in healthcare expenditure, political support, access to health information and technology infrastructure. To explore the status and capacity of HTA in the region, the ASEAN Secretariat requested for member countries to be surveyed to identify existing gaps and to propose solutions to help countries develop and streamline their priority-setting processes for improved healthcare decision-making. Methods A mixed survey questionnaire with open- and closed-ended questions relating to HTA governance, HTA infrastructure, supply and demand of HTA and global HTA networking opportunities in each country was administered electronically to representatives of HTA nodal agencies of all ASEAN members. In-person meetings or email correspondence were used to clarify or validate any unclear responses. Results were collated and presented quantitatively. Results Responses from eight out of ten member countries were analysed. The results illustrate that countries in the ASEAN region are at different stages of HTA institutionalization. While Malaysia, Singapore and Thailand have well-established processes and methods for priority setting through HTA, other countries, such as Cambodia, Indonesia, Lao PDR, Myanmar, the Philippines and Vietnam, have begun to develop HTA systems in their countries by establishing nodal agencies or conducting ad-hoc activities. Discussion and conclusion The study provides a general overview of the HTA landscape in ASEAN countries. Systematic efforts to mitigate the gaps between the demand and supply of HTA in each country are required while ensuring adequate participation from stakeholders so that decisions for resource allocation are made in a fair, legitimate and transparent manner and are relevant to each local context.
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Chi YL, Blecher M, Chalkidou K, Culyer A, Claxton K, Edoka I, Glassman A, Kreif N, Jones I, Mirelman AJ, Nadjib M, Morton A, Norheim OF, Ochalek J, Prinja S, Ruiz F, Teerawattananon Y, Vassall A, Winch A. What next after GDP-based cost-effectiveness thresholds? Gates Open Res 2020; 4:176. [PMID: 33575544 PMCID: PMC7851575 DOI: 10.12688/gatesopenres.13201.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/30/2022] Open
Abstract
Public payers around the world are increasingly using cost-effectiveness thresholds (CETs) to assess the value-for-money of an intervention and make coverage decisions. However, there is still much confusion about the meaning and uses of the CET, how it should be calculated, and what constitutes an adequate evidence base for its formulation. One widely referenced and used threshold in the last decade has been the 1-3 GDP per capita, which is often attributed to the Commission on Macroeconomics and WHO guidelines on Choosing Interventions that are Cost Effective (WHO-CHOICE). For many reasons, however, this threshold has been widely criticised; which has led experts across the world, including the WHO, to discourage its use. This has left a vacuum for policy-makers and technical staff at a time when countries are wanting to move towards Universal Health Coverage
. This article seeks to address this gap by offering five practical options for decision-makers in low- and middle-income countries that can be used instead of the 1-3 GDP rule, to combine existing evidence with fair decision-rules or develop locally relevant CETs. It builds on existing literature as well as an engagement with a group of experts and decision-makers working in low, middle and high income countries.
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Affiliation(s)
- Y-Ling Chi
- Center for Global Development, London, SW1P 3SE, UK
| | | | - Kalipso Chalkidou
- Center for Global Development, London, SW1P 3SE, UK.,Department of Infectious Disease Epidemiology, Imperial College London, London, SW7 2AZ, UK
| | - Anthony Culyer
- Centre for Health Economics, Department of Economics and Related Studies, University of York, York, YO10 5DD, UK
| | - Karl Claxton
- Centre for Health Economics, Department of Economics and Related Studies, University of York, York, YO10 5DD, UK
| | - Ijeoma Edoka
- School of Public Health, Wits University, Parktown, 2193, South Africa
| | | | - Noemi Kreif
- Centre for Health Economics, Department of Economics and Related Studies, University of York, York, YO10 5DD, UK
| | - Iain Jones
- Sightsavers, Haywards Health, RH16 3BW, UK
| | - Andrew J Mirelman
- Centre for Health Economics, Department of Economics and Related Studies, University of York, York, YO10 5DD, UK
| | - Mardiati Nadjib
- Faculty of Public Health, Department of Health Policy and Administration, Universitas Indonesia, Depok, Indonesia
| | | | - Ole Frithjof Norheim
- BCEPS, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jessica Ochalek
- Centre for Health Economics, Department of Economics and Related Studies, University of York, York, YO10 5DD, UK
| | - Shankar Prinja
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Francis Ruiz
- Center for Global Development, London, SW1P 3SE, UK.,Department of Infectious Disease Epidemiology, Imperial College London, London, SW7 2AZ, UK
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand, Nonthaburi, 11000, Thailand
| | - Anna Vassall
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - Alexander Winch
- Department of Infectious Disease Epidemiology, Imperial College London, London, SW7 2AZ, UK
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