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Connolly E, Mohan S, Twea P, Msuku T, Kees A, Sharma L, Heung S, Nkhoma D, Manthalu G. Revision of Malawi's Health Benefits Package: A Critical Analysis of Policy Formulation and Implementation. Value Health Reg Issues 2024; 39:84-94. [PMID: 38041898 DOI: 10.1016/j.vhri.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES Health benefits packages (HBPs), which define specific health services that can be offered for free or at a reduced cost to fit within public revenues, have been recommended for over 30 years to maximize population health in resource-limited settings. However, there remain gaps in defining and operationalizing HBPs. We propose a combination of design and prioritization methods along with practical strategies to improve the implementation of future iterations of the HBP in Malawi. METHODS For HBP development for Malawi's Third Health Sector Strategic Plan, we combined cost-effectiveness analysis with a quantitative, consultative multicriteria decision analysis. Throughout the process of development, we documented challenges and opportunities to improve HBP design and application. RESULTS The primary and secondary HBP included 115 interventions. However, the definition of an HBP is just one step toward focusing limited resources, with functional operationalization as the most critical component. Full implementation of previous HBPs has been limited by challenges in aid coordination with the misalignment of nonfungible vertical donor funding for the HBP without accounting for the complexity and interconnectedness of the health system. Opportunities for improved application include creation of a complementary minimum health service package to guide overall resource inputs through an integrative approach. CONCLUSIONS We believe that expanded participatory HBP methods that consider value, equity, and social considerations, along with a shift to providing integrated health service packages at all levels of care, will improve the efficiency of using scarce resources along the journey to universal health coverage.
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Affiliation(s)
- Emilia Connolly
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi; Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, OH, USA.
| | - Sakshi Mohan
- Center for Health Economics, University of York, York, England, UK
| | - Pakwanja Twea
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
| | - Thulasoni Msuku
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
| | - Andreas Kees
- Clinton Health Access Initiative, Lilongwe, Malawi
| | - Lalit Sharma
- Clinton Health Access Initiative, Lilongwe, Malawi
| | | | - Dominic Nkhoma
- Health Economics Policy Unit, Kamuzu University for Health Sciences, Lilongwe, Malawi
| | - Gerald Manthalu
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
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Obeng-Kusi M, Martin J, Abraham I. The economic burden of Ebola virus disease: a review and recommendations for analysis. J Med Econ 2024; 27:309-323. [PMID: 38299454 DOI: 10.1080/13696998.2024.2313358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/30/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Ebola virus disease (EVD) continues to be a major public health threat globally, particularly in the low-and-middle-income countries (LMICs) of Africa. The social and economic burdens of EVD are substantial and have triggered extensive research into prevention and control. We aim to highlight the impact and economic implications, identify research gaps, and offer recommendations for future economic studies pertaining to EVD. METHOD We conducted a comprehensive librarian-led search in PubMed/Medline, Embase, Google Scholar, EconLit and Scopus for economic evaluations of EVD. After study selection and data extraction, findings on the impact and economics of EVD were synthesized using a narrative approach, while identifying gaps, and recommending critical areas for future EVD economic studies. RESULTS The economic evaluations focused on the burden of illness, vaccine cost-effectiveness, willingness-to-pay for a vaccine, EVD funding, and preparedness costs. The estimated economic impact of the 2014 EVD outbreak in Guinea, Liberia, and Sierra Leone across studies ranged from $30 billion to $50 billion. Facility construction and modification emerged as significant cost drivers for preparedness. The EVD vaccine demonstrated cost-effectiveness in a dynamic transmission model; resulting in an incremental cost-effectiveness ratio of about $96 per additional disability adjusted life year averted. Individuals exhibited greater willingness to be vaccinated if it incurred no personal cost, with a minority willing to pay about $1 for the vaccine. CONCLUSIONS The severe impact of EVD puts pressure on governments and the international community for better resource utilization and re-allocation. Several technical and methodological issues related to economic evaluation of EVD remain to be addressed, especially for LMICs. We recommend conducting cost-of-sequelae and cost-of-distribution analyses in addition to adapting existing economic analytical methods to EVD. Characteristics of the affected regions should be considered to provide evidence-based economic plans and economic-evaluation of mitigations that enhance resource allocation for prevention and treatment.
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Affiliation(s)
- Mavis Obeng-Kusi
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| | - Jennifer Martin
- Arizona Health Sciences Library, University of Arizona, Tucson, AZ, USA
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
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Hamad A, Elazzazy S, Bujassoum S, Rasul K, Gaziev J, Cherif H, Al-Boloshi Z, Hanssens Y, Saleh A, Rasheed HA, Al-Badriyeh D, Babiker A, Hmaidan AA, Al-Hail M. Applying value-based strategies to accelerate access to novel cancer medications: guidance from the Oncology Health Economics Expert Panel in Qatar (Q-OHEP). BMC Health Serv Res 2023; 23:15. [PMID: 36609388 PMCID: PMC9816531 DOI: 10.1186/s12913-022-08981-5] [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: 06/24/2022] [Accepted: 12/16/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In line with global trends, cancer incidence and mortality may have decreased for specific types of cancer in Qatar. However, the cancer-related burden on patients, healthcare systems, and the economy is expected to expand; thus, cancer remains a significant public healthcare issue in Qatar. Qatar's free access to cancer care represents a considerable economic burden. Ensuring the best utilization of financial resources in the healthcare sector is important to provide unified and fair access to cancer care for all patients. Experts from the Qatar Oncology Health Economics Expert Panel (Q-OHEP) aimed to establish a consistent and robust base for evaluating oncology/hematology medications; involve patients' insights to accelerate access to cutting-edge medications; increase the value of cancer care; and reach a consensus for using cost-effective strategies and efficient methodologies in cancer treatment. METHODS The Q-OHEP convened on 30 November 2021 for a 3-hour meeting to discuss cancer management, therapeutics, and health economics in Qatar, focusing on four domains: (1) regulatory, (2) procurement, (3) treatment, and (4) patients. Discussions, guided by a moderator, focused on a list of suggested open-ended questions. RESULTS Some of the salient recommendations included the development of a formal, fast-track, preliminary approval pathway for drugs needed by patients with severe disease or in critical condition; and encouraging and promoting the conduct of local clinical trials and real-world observational studies using existing registry data. The Q-OHEP also recommended implementing a forecast system using treatment center data based on the supply/demand of formulary oncology drugs to detect treatment patterns, estimate needs, expedite procurement, and prevent shortages/delays. Furthermore, the panel discussed the needs to define value concerning cancer treatment in Qatar, implement value-based models for reimbursement decision-making such as health technology assessment and multiple-criteria decision analysis, and promote patient education and involvement/feedback in developing and implementing cancer management guidelines. CONCLUSION Herein, we summarize the first Q-OHEP consensus recommendations, which aim to provide a solid basis for evaluating, registering, and approving new cancer medications to accelerate patient access to novel cancer treatments in Qatar; promote/facilitate the adoption and collection of patient-reported outcomes; and implement value-based cancer care in Qatar.
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Affiliation(s)
- Anas Hamad
- grid.413548.f0000 0004 0571 546XPharmacy Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Shereen Elazzazy
- grid.413548.f0000 0004 0571 546XPharmacy Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Salha Bujassoum
- grid.466917.b0000 0004 0637 4417Medical Oncology Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Kakil Rasul
- grid.466917.b0000 0004 0637 4417Medical Oncology Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Javid Gaziev
- grid.413548.f0000 0004 0571 546XHematology Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Honar Cherif
- grid.413548.f0000 0004 0571 546XHematology Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Zakiya Al-Boloshi
- grid.413548.f0000 0004 0571 546XDrug Supply Department, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Yolande Hanssens
- grid.413548.f0000 0004 0571 546XPharmacy Executive Office, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ayman Saleh
- grid.467063.00000 0004 0397 4222Division of Pediatric Hematology/Oncology, Sidra Medicine, PO Box 26999, Doha, Qatar
| | - Hadi Abu Rasheed
- Professional Development & Scientific Research Department, Qatar Cancer Society, PO Box 22944, Doha, Qatar
| | - Daoud Al-Badriyeh
- grid.412603.20000 0004 0634 1084College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Ahmed Babiker
- grid.498619.bRegistration & Drugs Pricing Section, Pharmacy & Drug Control Department, Ministry of Public Health, PO Box 42, Doha, Qatar
| | - Amid Abu Hmaidan
- grid.498619.bNational Cancer Program, Directorate of Policy, Ministry of Public Health, PO Box 42, Doha, Qatar
| | - Moza Al-Hail
- grid.413548.f0000 0004 0571 546XPharmacy Executive Office, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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Pepin KM, Davis AJ, Epanchin-Niell RS, Gormley AM, Moore JL, Smyser TJ, Shaffer HB, Kendall WL, Shea K, Runge MC, McKee S. Optimizing management of invasions in an uncertain world using dynamic spatial models. ECOLOGICAL APPLICATIONS : A PUBLICATION OF THE ECOLOGICAL SOCIETY OF AMERICA 2022; 32:e2628. [PMID: 35397481 DOI: 10.1002/eap.2628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/13/2021] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
Dispersal drives invasion dynamics of nonnative species and pathogens. Applying knowledge of dispersal to optimize the management of invasions can mean the difference between a failed and a successful control program and dramatically improve the return on investment of control efforts. A common approach to identifying optimal management solutions for invasions is to optimize dynamic spatial models that incorporate dispersal. Optimizing these spatial models can be very challenging because the interaction of time, space, and uncertainty rapidly amplifies the number of dimensions being considered. Addressing such problems requires advances in and the integration of techniques from multiple fields, including ecology, decision analysis, bioeconomics, natural resource management, and optimization. By synthesizing recent advances from these diverse fields, we provide a workflow for applying ecological theory to advance optimal management science and highlight priorities for optimizing the control of invasions. One of the striking gaps we identify is the extremely limited consideration of dispersal uncertainty in optimal management frameworks, even though dispersal estimates are highly uncertain and greatly influence invasion outcomes. In addition, optimization frameworks rarely consider multiple types of uncertainty (we describe five major types) and their interrelationships. Thus, feedbacks from management or other sources that could magnify uncertainty in dispersal are rarely considered. Incorporating uncertainty is crucial for improving transparency in decision risks and identifying optimal management strategies. We discuss gaps and solutions to the challenges of optimization using dynamic spatial models to increase the practical application of these important tools and improve the consistency and robustness of management recommendations for invasions.
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Affiliation(s)
- Kim M Pepin
- National Wildlife Research Center, United States Department of Agriculture, Animal and Plant Health Inspection Service, Wildlife Services, Fort Collins, Colorado, USA
| | - Amy J Davis
- National Wildlife Research Center, United States Department of Agriculture, Animal and Plant Health Inspection Service, Wildlife Services, Fort Collins, Colorado, USA
| | - Rebecca S Epanchin-Niell
- Resources for the Future, Washington, District of Columbia, USA
- Department of Agricultural and Resource Economics, University of Maryland, College Park, Maryland, USA
| | | | - Joslin L Moore
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Timothy J Smyser
- National Wildlife Research Center, United States Department of Agriculture, Animal and Plant Health Inspection Service, Wildlife Services, Fort Collins, Colorado, USA
| | - H Bradley Shaffer
- Department of Ecology and Evolutionary Biology, and La Kretz Center for California Conservation Science, Institute of the Environment and Sustainability, University of California, Los Angeles, Los Angeles, California, USA
| | - William L Kendall
- U.S. Geological Survey, Colorado Cooperative Fish and Wildlife Research Unit, Colorado State University, Fort Collins, Colorado, USA
| | - Katriona Shea
- Department of Biology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Michael C Runge
- U.S. Geological Survey Patuxent Wildlife Research Center, Laurel, Maryland, USA
| | - Sophie McKee
- National Wildlife Research Center, United States Department of Agriculture, Animal and Plant Health Inspection Service, Wildlife Services, Fort Collins, Colorado, USA
- Department of Economics, Colorado State University, Fort Collins, Colorado, USA
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Abstract
Micro- or minimally invasive glaucoma surgeries (MIGS) have been the latest addition to the glaucoma surgical treatment paradigm. This term refers not to a single surgery, but rather to a group of distinct procedures and devices that aim to decrease intraocular pressure. Broadly, MIGS can be categorized into surgeries that increase the trabecular outflow [Trabectome, iStent (first and second generations), Hydrus microstent, Kahook Dual Blade and gonioscopy-assisted transluminal trabeculotomy], surgeries that increase suprachoroidal outflow (Cypass microstent and iStent Supra), and conjunctival bleb-forming procedures (Xen gel stent and InnFocus microshunt). Compared to traditional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves), MIGS are touted to have less severe complications and shorter surgical time. MIGS represent an evolving field, and the efficacy and complications of each procedure should be considered independently, giving more importance to high-quality and longer-term studies.
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Affiliation(s)
- David J Mathew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario M5T 2S8, Canada;
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario M5T 2S8, Canada;
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van den Bogaart EHA, Kroese MEAL, Spreeuwenberg MD, Ruwaard D, Tsiachristas A. Economic Evaluation of New Models of Care: Does the Decision Change Between Cost-Utility Analysis and Multi-Criteria Decision Analysis? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:795-803. [PMID: 34119077 DOI: 10.1016/j.jval.2021.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/30/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To experiment with new approaches of collaboration in healthcare delivery, local authorities implement new models of care. Regarding the local decision context of these models, multi-criteria decision analysis (MCDA) may be of added value to cost-utility analysis (CUA), because it covers a wider range of outcomes. This study compares the 2 methods using a side-by-side application. METHODS A new Dutch model of care, Primary Care Plus (PC+), was used as a case study to compare the results of CUA and MCDA. Data of patients referred to PC+ or care-as-usual were retrieved by questionnaires and administrative databases with a 3-month follow-up. Propensity score matching together with generalized linear regression models was used to reduce confounding. Univariate and probabilistic sensitivity analyses were performed to explore uncertainty in the results. RESULTS Although both methods indicated PC+ as the dominant alternative, complementary differences were observed. MCDA provided additional evidence that PC+ improved access to care (standardized performance score of 0.742 vs 0.670) and that improvement in health-related quality of life was driven by the psychological well-being component (standardized performance score of 0.710 vs 0.704). Furthermore, MCDA estimated the budget required for PC+ to be affordable in addition to preferable (€521.42 per patient). Additionally, MCDA was less sensitive to the utility measures used. CONCLUSIONS MCDA may facilitate an auditable and transparent evaluation of new models of care by providing additional information on a wider range of outcomes and incorporating affordability. However, more effort is needed to increase the usability of MCDA among local decision makers.
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Affiliation(s)
- Esther H A van den Bogaart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Mariëlle E A L Kroese
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marieke D Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Research Center for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Hohmeier KC, Shelton C, Havrda D, Gatwood J. The need to prioritize "prioritization" in clinical pharmacy service practice and implementation. Res Social Adm Pharm 2020; 16:1785-1788. [PMID: 32414658 DOI: 10.1016/j.sapharm.2020.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 11/28/2022]
Abstract
Pharmacists are increasingly asked to incorporate new and greater amounts of clinical services into their traditional medication distribution responsibilities, but many barriers exist. Given the demanding pharmacy practice environment, improved time management may improve implementation rates. One area not previously explored within this area is the clinical skill of "prioritization" of medication related problems (MRPs). Prioritization is vital as the workload demand for pharmacist time exceeds time available; however, the underdeveloped skills of prioritizing is a concern in the field of pharmacy practice, as it also is across professions in healthcare. Previous research has suggested that pharmacists and student pharmacists inexperienced in implementing clinical services struggle knowing where to begin when providing direct patient care, given the complex patient care regimens, a complex pharmacy practice workload, and the numerous preventative care interventions possible for a given patient. This paper provides a review of theory and science of prioritization in patient care service delivery, including Multicriteria Decision Analysis (MCDA), Lean Six Sigma (LSS), and Jaen's Competing Demands framework. A case study is shared which emphasizes both the need for and potential impact of a renewed focus on workload management skills, such as prioritization.
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Affiliation(s)
- Kenneth C Hohmeier
- University of Tennessee Health Science Center, College of Pharmacy, 301 S Perimeter Park Drive, Suite 220, Nashville, TN, 37211, USA.
| | - Chasity Shelton
- University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue Memphis, TN, 38103, USA
| | - Dawn Havrda
- University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue Memphis, TN, 38103, USA
| | - Justin Gatwood
- University of Tennessee Health Science Center, College of Pharmacy, 301 S Perimeter Park Drive, Suite 220, Nashville, TN, 37211, USA
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Bloom DE, Cadarette D, Dayalu R, Sullivan J. Introduction: priority setting in global health. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:49. [PMID: 30455608 PMCID: PMC6225612 DOI: 10.1186/s12962-018-0115-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Daniel Cadarette
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Rashmi Dayalu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jessica Sullivan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
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