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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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Hutubessy R, Lauer JA, Giersing B, Sim SY, Jit M, Kaslow D, Botwright S. The Full Value of Vaccine Assessments (FVVA): a framework for assessing and communicating the value of vaccines for investment and introduction decision-making. BMC Med 2023; 21:229. [PMID: 37400797 PMCID: PMC10318807 DOI: 10.1186/s12916-023-02929-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/08/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Several economic obstacles can deter the development and use of vaccines. This can lead to limited product options for some diseases, delays in new product development, and inequitable access to vaccines. Although seemingly distinct, these obstacles are actually interrelated and therefore need to be addressed through a single over-arching strategy encompassing all stakeholders. METHODS To help overcome these obstacles, we propose a new approach, the Full Value of Vaccines Assessments (FVVA) framework, to guide the assessment and communication of the value of a vaccine. The FVVA framework is designed to facilitate alignment across key stakeholders and to enhance decision-making around investment in vaccine development, policy-making, procurement, and introduction, particularly for vaccines intended for use in low- and middle-income countries. RESULTS The FVVA framework has three key elements. First, to enhance assessment, existing value-assessment methods and tools are adapted to include broader benefits of vaccines as well as opportunity costs borne by stakeholders. Second, to improve decision-making, a deliberative process is required to recognize the agency of stakeholders and to ensure country ownership of decision-making and priority setting. Third, the FVVA framework provides a consistent and evidence-based approach that facilitates communication about the full value of vaccines, helping to enhance alignment and coordination across diverse stakeholders. CONCLUSIONS The FVVA framework provides guidance for stakeholders organizing global-level efforts to promote investment in vaccines that are priorities for LMICs. By providing a more holistic view of the benefits of vaccines, its application also has the potential to encourage greater take-up by countries, thereby leading to more sustainable and equitable impacts of vaccines and immunization programmes.
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Affiliation(s)
- Raymond Hutubessy
- Immunization, Vaccines and Biologicals Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
| | - Jeremy A. Lauer
- Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | - Birgitte Giersing
- Immunization, Vaccines and Biologicals Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
| | - So Yoon Sim
- Immunization, Vaccines and Biologicals Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - David Kaslow
- PATH Center for Vaccine Innovation and Access, Seattle, USA
| | - Siobhan Botwright
- Immunization, Vaccines and Biologicals Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland
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Mbau R, Vassall A, Gilson L, Barasa E. Factors influencing institutionalization of health technology assessment in Kenya. BMC Health Serv Res 2023; 23:681. [PMID: 37349812 DOI: 10.1186/s12913-023-09673-4] [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: 11/30/2022] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND There is a global interest in institutionalizing health technology assessment (HTA) as an approach for explicit healthcare priority-setting. Institutionalization of HTA refers to the process of conducting and utilizing HTA as a normative practice for guiding resource allocation decisions within the health system. In this study, we aimed to examine the factors that were influencing institutionalization of HTA in Kenya. METHODS We conducted a qualitative case study using document reviews and in-depth interviews with 30 participants involved in the HTA institutionalization process in Kenya. We used a thematic approach to analyze the data. RESULTS We found that institutionalization of HTA in Kenya was being supported by factors such as establishment of organizational structures for HTA; availability of legal frameworks and policies on HTA; increasing availability of awareness creation and capacity-building initiatives for HTA; policymakers' interests in universal health coverage and optimal allocation of resources; technocrats' interests in evidence-based processes; presence of international collaboration for HTA; and lastly, involvement of bilateral agencies. On the other hand, institutionalization of HTA was being undermined by limited availability of skilled human resources, financial resources, and information resources for HTA; lack of HTA guidelines and decision-making frameworks; limited HTA awareness among subnational stakeholders; and industries' interests in safeguarding their revenue. CONCLUSIONS Kenya's Ministry of Health can facilitate institutionalization of HTA by adopting a systemic approach that involves: - (a) introducing long-term capacity-building initiatives to strengthen human and technical capacity for HTA; (b) earmarking national health budgets to ensure adequate financial resources for HTA; (c) introducing a cost database and promoting timely data collection to ensure availability of data for HTA; (d) developing context specific HTA guidelines and decision-making frameworks to facilitate HTA processes; (e) conducting deeper advocacy to strengthen HTA awareness among subnational stakeholders; and (f) managing stakeholders' interests to minimize opposition to institutionalization of HTA.
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Affiliation(s)
- Rahab Mbau
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, 197 Lenana Place, P.O. BOX 43640-00100, Nairobi, Kenya.
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Lucy Gilson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road 7925, Cape Town, South Africa
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, 197 Lenana Place, P.O. BOX 43640-00100, Nairobi, Kenya
- Centre for Global Health and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Roosevelt Drive, Oxford, OX3 7LG, UK
- Institute of Healthcare Management, Strathmore University, Karen Ole Sangale Road, P.O. BOX 59857-00200, Nairobi, Kenya
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Baltussen R, Jansen M, Oortwijn W. Evidence-Informed Deliberative Processes for Legitimate Health Benefit Package Design - Part I: Conceptual Framework. Int J Health Policy Manag 2022; 11:2319-2326. [PMID: 34923808 PMCID: PMC9808261 DOI: 10.34172/ijhpm.2021.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Countries around the world are increasingly rethinking the design of their health benefit packages to achieve universal health coverage (UHC). Health technology assessment (HTA) bodies support governments in these decisions, but employ value frameworks that do not sufficiently account for the intrinsically complex and value-laden political reality of benefit package design. METHODS Several years ago, evidence-informed deliberative processes (EDPs) were developed to address this issue. An EDP is a practical and stepwise approach for HTA bodies to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, and to interpret available evidence on these values. We further developed the conceptual framework and initial 2019 guidance based on academic knowledge exchange, analysing practices of HTA bodies, surveying HTA bodies and experts around the globe, and implementation of EDPs in several countries around the world. RESULTS EDPs stem from the general concept of legitimacy, which is translated into four elements - stakeholder involvement ideally operationalised through stakeholder participation with deliberation; evidence-informed evaluation; transparency; and appeal. The 2021 practical guidance distinguishes six practical steps of a HTA process and provides recommendations on how these elements can be implemented in each of these steps. CONCLUSION There is an increased attention for legitimacy, deliberative processes for HTA and health benefit package design, but the development of theories and methods for such processes remain behind. The added value of EDPs lies in the operationalisation of the general concept of legitimacy into practical guidance for HTA bodies.
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Affiliation(s)
- Rob Baltussen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Oortwijn W, Jansen M, Baltussen R. Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide. Int J Health Policy Manag 2022; 11:2327-2336. [PMID: 34923809 PMCID: PMC9808268 DOI: 10.34172/ijhpm.2021.159] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Countries around the world are using health technology assessment (HTA) for health benefit package design. Evidence-informed deliberative processes (EDPs) are a practical and stepwise approach to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. This paper reports on the development of practical guidance on EDPs, while the conceptual framework of EDPs is described in a companion paper. METHODS The first guide on EDPs (2019) is further developed based on academic knowledge exchange, surveying 27 HTA bodies and 66 experts around the globe, and the implementation of EDPs in several countries. We present the revised steps of EDPs and how selected HTA bodies (in Australia, Brazil, Canada, France, Germany, Scotland, Thailand and the United Kingdom) organize key issues of legitimacy in their processes. This is based on a review of literature via PubMed and HTA bodies' websites. RESULTS HTA bodies around the globe vary considerable in how they address legitimacy (stakeholder involvement ideally through participation with deliberation; evidence-informed evaluation; transparency; and appeal) in their processes. While there is increased attention for improving legitimacy in decision-making processes, we found that the selected HTA bodies are still lacking or just starting to develop activities in this area. We provide recommendations on how HTA bodies can improve on this. CONCLUSION The design and implementation of EDPs is in its infancy. We call for a systematic analysis of experiences of a variety of countries, from which general principles on EDPs might subsequently be inferred.
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Affiliation(s)
- Wija Oortwijn
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Culyer AJ, Chalkidou K. Organising Research and Development for evidence-informed health care: some universal characteristics and a case study from the UK. HEALTH ECONOMICS, POLICY, AND LAW 2021; 16:489-504. [PMID: 33843559 PMCID: PMC8460448 DOI: 10.1017/s1744133121000074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 07/13/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022]
Abstract
Research and Development (R&D) in health and health care has several intriguing characteristics which, separately and in combination, have significant implications for the ways in which it is organised, funded and managed. We review the characteristics, some of which apply under most circumstances and others of which may be context-specific, explore their implications for the organisation and management of health-related R&D, and illustrate the main features from the UK experience in the 1990s.
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Affiliation(s)
- Anthony J. Culyer
- University of York – Centre for Health Economics, York, United Kingdom of Great Britain and Northern Ireland
| | - Kalipso Chalkidou
- University of York – Centre for Health Economics, York, United Kingdom of Great Britain and Northern Ireland
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Joore M, Grimm S, Boonen A, de Wit M, Guillemin F, Fautrel B. Health technology assessment: a framework. RMD Open 2021; 6:rmdopen-2020-001289. [PMID: 33148786 PMCID: PMC7856136 DOI: 10.1136/rmdopen-2020-001289] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Manuela Joore
- KEMTA, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sabine Grimm
- KEMTA, Maastricht University Medical Center, Maastricht, Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, and the CAPHRI Research Institute Maastricht University, Maastricht, Netherlands
| | - Maarten de Wit
- Patient Research Partner, EULAR, Zaltbommel, Netherlands
| | - Francis Guillemin
- School of Public Health, Nancy, France.,CHRU-Nancy, Inserm, Université de Lorraine, CIC Epidémiologie clinique, Nancy, France
| | - Bruno Fautrel
- Rheumatology, Assistance Publique-Hopitaux De Paris, Paris, France.,GRC08-IPLESP, UPMC Faculte De Medecine, Paris, France
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Hollingworth S, Fenny AP, Yu SY, Ruiz F, Chalkidou K. Health technology assessment in sub-Saharan Africa: a descriptive analysis and narrative synthesis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:39. [PMID: 34233710 PMCID: PMC8261797 DOI: 10.1186/s12962-021-00293-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background Countries in Sub-Saharan Africa (SSA) are moving towards universal health coverage. The process of Health Technology Assessment (HTA) can support decisions relating to benefit package design and service coverage. HTA involves institutional cooperation with agreed methods and procedural standards. We systematically reviewed the literature on policies and capacity building to support HTA institutionalisation in SSA. Methods We systematically reviewed the literature by searching major databases (PubMed, Embase, etc.) until June 2019 using terms considering three aspects: HTA; health policy, decision making; and SSA. We quantitatively extracted and descriptively analysed content and conducted a narrative synthesis eliciting themes from the selected literature, which varied in study type and apporach. Results Half of the 49 papers identified were primary research studies and mostly qualitative. Five countries were represented in six of ten studies; South Africa, Ghana, Uganda, Cameroon, and Ethiopia. Half of first authors were from SSA. Most informants were policy makers. Five themes emerged: (1) use of HTA; (2) decision-making in HTA; (3) values and criteria for setting priority areas in HTA; (4) involving stakeholders in HTA; and (5) specific examples of progress in HTA in SSA. The first one was the main theme where there was little use of evidence and research in making policy. The awareness of HTA and economic evaluation was low, with inadequate expertise and a lack of local data and tools. Conclusions Despite growing interest in HTA in SSA countries, awareness remains low and HTA-related activities are uncoordinated and often disconnected from policy. Further training and skills development are needed, firmly linked to a strategy focusing on strengthening within-country partnerships, particularly among researchers and policy makers. The international community has an important role here by supporting policy- relevant technical assistance, highlighting that sustainable financing demands evidence-based processes for effective resource allocation, and catalysing knowledge-sharing opportunities among countries facing similar challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-021-00293-5.
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Affiliation(s)
- Samantha Hollingworth
- School of Pharmacy, University of Queensland, 20 Cornwall St, Woolloongabba, Brisbane, QLD, 4102, Australia. .,Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Ama Pokuaa Fenny
- Institute of Statistical, Social and Economics Research, University of Ghana, Accra, Ghana
| | - Su-Yeon Yu
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Francis Ruiz
- iDSI, London School of Hygiene and Tropical Medicine, London, UK
| | - Kalipso Chalkidou
- The Global Fund To Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
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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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Wang D, Vasconcelos NPD, Poirier MJ, Chieffi A, Mônaco C, Sritharan L, Van Katwyk SR, Hoffman SJ. Health technology assessment and judicial deference to priority-setting decisions in healthcare: Quasi-experimental analysis of right-to-health litigation in Brazil. Soc Sci Med 2020; 265:113401. [PMID: 33250316 PMCID: PMC7769796 DOI: 10.1016/j.socscimed.2020.113401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/05/2020] [Accepted: 09/24/2020] [Indexed: 12/02/2022]
Abstract
The constitutional right to health in Brazil has entitled patients to litigate against the government-funded national health system (SUS), claiming access to various health treatments including those excluded from the health system's benefits package. Courts have tended to rely on a single medical prescription to judge these cases in favor of individual patients and against the health system. The large volume of cases has had a substantial financial impact on the government's health budget and has created unfairness in accessing healthcare. To change courts' behavior, a new health technology assessment (HTA) body - CONITEC - was created in 2011. Its creation was accompanied by an administrative procedure that made decisions about the health system's benefits package more transparent, accountable, participative and evidence-informed. It was expected that this HTA system would bring more legitimacy to the government's priority-setting decisions and promote deference from the courts. This study tests whether Brazil's new HTA system succeeded in encouraging judicial deference by analyzing a stratified random sample of 13,263 court decisions for whether the existence of a CONITEC report resulted in less frequent court orders to provide treatment for individual litigants. The results show that the creation of CONITEC did not change courts' behavior; courts still decide in favor of patients in most cases. Indeed, even when there was a CONITEC report recommending against government funding for a particular healthcare treatment, the vast majority of the relatively few patients who were unsuccessful in obtaining a health benefit at their first court hearing later obtained a favorable decision after appealing to a higher court. This finding was confirmed through an interrupted time-series analysis that did not find an impact of having a CONITEC report on courts' willingness to override a government priority-setting decision. In fact, CONITEC was rarely cited in court decisions, even when litigants mentioned the existence of a CONITEC report.
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Affiliation(s)
- Daniel Wang
- Fundação Getulio Vargas (FGV), Law School in São Paulo, Brazil.
| | | | - Mathieu Jp Poirier
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health & Osgoode Hall Law School, York University, Toronto, Canada; School of Global Health, York University, Toronto, Canada
| | - Ana Chieffi
- Deapartment of Health of the State of São Paulo, São Paulo, Brazil
| | - Cauê Mônaco
- Centro Universitário São Camilo, School of Medicine, São Paulo, Brazil
| | - Lathika Sritharan
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health & Osgoode Hall Law School, York University, Toronto, Canada
| | - Susan Rogers Van Katwyk
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health & Osgoode Hall Law School, York University, Toronto, Canada
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health & Osgoode Hall Law School, York University, Toronto, Canada; School of Global Health, York University, Toronto, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster Health Forum, McMaster University, Hamilton, Canada
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Kettler H, Lehtimaki S, Schwalbe N. Accelerating access to medicines in a changing world. Bull World Health Organ 2020; 98:641-643. [PMID: 33012865 PMCID: PMC7463195 DOI: 10.2471/blt.19.249664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | - Nina Schwalbe
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 West 168 Street, New York, 10032, USA
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Abstract
This article describes the characteristics of the health system and reviews the history of health technology assessment (HTA) in Iran, including its inception, processes, challenges, and lessons learned. This study was conducted by analyzing existing documents, reports, and guidelines related to HTA and published articles in the field. HTA in Iran has been established since the late 2000s and was first introduced as a secretariat by the Deputy of Health at the Ministry of Health and Medical Education. The mission of the HTA office is to systematically assess technologies to improve evidence-informed decision making. Despite its 10 years of existence, HTA in Iran still faces some challenges. The most pressing problems currently facing HTA in Iran include conflicts of interest among researchers performing the HTAs, the absence of a systematic structure for identifying and introducing new technologies, the lack of interest in HTA results among high-level policy makers, and the lack of external oversight for HTA projects.
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14
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Oortwijn W, Jansen M, Baltussen R. Use of Evidence-Informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe. Int J Health Policy Manag 2020; 9:27-33. [PMID: 31902192 PMCID: PMC6943303 DOI: 10.15171/ijhpm.2019.72] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Evidence-informed deliberative processes (EDPs) were recently introduced to guide health technology assessment (HTA) agencies to improve their processes towards more legitimate decision-making. The EDP framework provides guidance that covers the HTA process, ie, contextual factors, installation of an appraisal committee, selecting health technologies and criteria, assessment, appraisal, and communication and appeal. The aims of this study were to identify the level of use of EDPs by HTA agencies, identify their needs for guidance, and to learn about best practices. Methods: A questionnaire for an online survey was developed based on the EDP framework, consisting of elements that reflect each part of the framework. The survey was sent to members of the International Network of Agencies for Health Technology Assessment (INAHTA). Two weeks following the invitation, a reminder was sent. The data collection took place between September-December 2018. Results: Contact persons from 27 member agencies filled out the survey (response rate: 54%), of which 25 completed all questions. We found that contextual factors to support HTA development and the critical elements regarding conducting and reporting on HTA are overall in place. Respondents indicated that guidance was needed for specific elements related to selecting technologies and criteria, appraisal, and communication and appeal. With regard to best practices, the Canadian Agency for Drugs and Technologies and the National Institute for Health and Care Excellence (NICE, UK) were most often mentioned. Conclusion: This is the first survey among HTA agencies regarding the use of EDPs and provides useful information for further developing a practical guide for HTA agencies around the globe. The results could support HTA agencies in improving their processes towards more legitimate decision-making, as they could serve as a baseline measurement for future monitoring and evaluation.
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Affiliation(s)
- Wija Oortwijn
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maarten Jansen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rob Baltussen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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15
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Culyer AJ. Expanding HTA – Correcting a Misattribution, Clarifying the Scope of HTA and CEA Comment on "Ethics in HTA: Examining the ‘Need for Expansion’". Int J Health Policy Manag 2019; 8:732-733. [PMID: 31779302 PMCID: PMC6885861 DOI: 10.15171/ijhpm.2019.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/03/2019] [Indexed: 11/15/2022] Open
Abstract
Abrishami, Oortwijn, and Hofman (AOH) attribute to me a position I do not hold and an argument I did not make. The purpose of this note is make clear what my position actually is and to clarify the main differences between health technology assessment (HTA) and cost-effectiveness analysis (CEA).
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Affiliation(s)
- Anthony J. Culyer
- Department of Economics and Related Studies and Centre for Health Economics, University of York, York, UK
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16
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Campillo-Artero C, Puig-Junoy J, Culyer AJ. Authors' Reply to Angelis and Kanavos: "Does MCDA Trump CEA?". APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:125. [PMID: 30460622 DOI: 10.1007/s40258-018-0446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Carlos Campillo-Artero
- Center for Research in Health and Economics, Pompeu Fabra University, Ramon Trias Fargas 25-27, 08005, Barcelona, Spain
| | - Jaume Puig-Junoy
- Center for Research in Health and Economics, Pompeu Fabra University, Ramon Trias Fargas 25-27, 08005, Barcelona, Spain.
- Department of Economics and Business, Pompeu Fabra University, Ramon Trias Fargas 25-27, 08005, Barcelona, Spain.
| | - Anthony J Culyer
- Department of Economics and Related Studies and Center for Health Economics, University of York, York, YO10 5DD, UK
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17
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Isaranuwatchai W, Li R, Glassman A, Teerawattananon Y, Culye AJ, Chalkidou K. Disease Control Priorities Third Edition: Time to Put a Theory of Change Into Practice Comment on "Disease Control Priorities Third Edition Is Published: A Theory of Change Is Needed for Translating Evidence to Health Policy". Int J Health Policy Manag 2019; 8:132-135. [PMID: 30980627 PMCID: PMC6462203 DOI: 10.15171/ijhpm.2018.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 11/17/2018] [Indexed: 01/17/2023] Open
Abstract
The Disease Control Priorities program (DCP) has pioneered the use of economic evidence in health. The theory of change (ToC) put forward by Norheim is a further welcome and necessary step towards translating DCP evidence into better priority setting in low- and middle-income countries (LMICs). We also agree that institutionalising evidence for informed priority-setting processes is crucial. Unfortunately, there have been missed opportunities for the DCP program to challenge ill-judged global norms about opportunity costs and too little respect has been shown for the wider set of local circumstances that may enable, or disable, the productive application of the DCP evidence base. We suggest that the best way forward for the global health community is a new platform that integrates the many existing development initiatives and that is driven by countries’ asks.
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Affiliation(s)
- Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, Toronto, ON, Canada
| | - Ryan Li
- School of Public Health, Imperial College London, London, UK
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Anthony J Culye
- Department of Economics and Related Studies and Centre for Health Economics, University of York, York, UK
| | - Kalipso Chalkidou
- School of Public Health, Imperial College London, London, UK.,Center for Global Development, London, UK
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18
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Beane A, De Silva AP, Athapattu PL, Jayasinghe S, Abayadeera AU, Wijerathne M, Udayanga I, Rathnayake S, Dondorp AM, Haniffa R. Addressing the information deficit in global health: lessons from a digital acute care platform in Sri Lanka. BMJ Glob Health 2019; 4:e001134. [PMID: 30775004 PMCID: PMC6352842 DOI: 10.1136/bmjgh-2018-001134] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/08/2018] [Accepted: 12/13/2018] [Indexed: 12/19/2022] Open
Abstract
Lack of investment in low-income and middle-income countries (LMICs) in systems capturing continuous information regarding care of the acutely unwell patient is hindering global efforts to address inequalities, both at facility and national level. Furthermore, this of lack of data is disempowering frontline staff and those seeking to support them, from progressing setting-relevant research and quality improvement. In contrast to high-income country (HIC) settings, where electronic surveillance has boosted the capability of governments, clinicians and researchers to engage in service-wide healthcare evaluation, healthcare information in resource-limited settings remains almost exclusively paper based. In this practice paper, we describe the efforts of a collaboration of clinicians, administrators, researchers and healthcare informaticians working in South Asia, in addressing the inequality in access to patient information in acute care. Harnessing a clinician-led collaborative approach to design and evaluation, we have implemented a national acute care information platform in Sri Lanka that is tailored to priorities of frontline staff. Iterative adaptation has ensured the platform has the flexibility to integrate with legacy paper systems, support junior team members in advocating for acutely unwell patients and has made information captured accessible to diverse stakeholders to improve service delivery. The same platform is now empowering clinicians to participate in international research and drive forwards improvements in care. During this journey, we have also gained insights on how to overcome well-described barriers to implementation of digital information tools in LMIC. We anticipate that this north-south collaborative approach to addressing the challenges of health system implementation in acute care may provide learning and inspiration to other partnerships seeking to engage in similar work.
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Affiliation(s)
- Abi Beane
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | | | | | - Saroj Jayasinghe
- Department of Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Mandika Wijerathne
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ishara Udayanga
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
| | | | | | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
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19
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Calnan M. Decisions of Value: Going Backstage Comment on "Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis". Int J Health Policy Manag 2018; 7:1067-1069. [PMID: 30624883 PMCID: PMC6326632 DOI: 10.15171/ijhpm.2018.81] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/19/2018] [Indexed: 11/13/2022] Open
Abstract
This commentary expands on two of the key themes briefly raised in the paper involving analysis of the evidence about key contextual influences on decisions of value. The first theme focuses on the need to explore in more detail what is called backstage decision-making looking at how actual decisions are made drawing on evidence from ethnographies about decision-making. These studies point to less of an emphasis on instrumental and calculative forms of decision-making with more of an emphasis on more pragmatic rationality. The second related theme picks up on the issue of sources of information as a contextual influence particularly highlighting the salience of uncertainty or information deficits. It is argued that there are a range of different types of uncertainties, not only associated with information deficits, which are found particularly in allocative types of decisions of value. This means that the decision-making process although attempting to be linear and rational, tends to be characterised by a form of navigation where the decision-makers navigate their way through the uncertainties inherent and overtly manifested in the decision-making process.
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Affiliation(s)
- Michael Calnan
- Social Policy, Sociology and Social Research (SSPSSR), University of Kent, Canterbury, UK
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20
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Mutale W, Bosomprah S, Shankalala P, Mweemba O, Chilengi R, Kapambwe S, Chishimba C, Mukanu M, Chibutu D, Heimburger D. Assessing capacity and readiness to manage NCDs in primary care setting: Gaps and opportunities based on adapted WHO PEN tool in Zambia. PLoS One 2018; 13:e0200994. [PMID: 30138318 PMCID: PMC6107121 DOI: 10.1371/journal.pone.0200994] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 07/08/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Sub-Saharan Africa is experiencing an epidemiological transition as the burden of NCDs overtake communicable diseases. However, it is unknown what capacity and gaps exist at primary care level to address the growing burden of NCDs. This study aimed to assess the Zambian health system’s capacity to address in NCDs, using an adapted WHO Essential Non Communicable Disease Interventions (WHO PEN) tool. Methodology This was a cross-sectional facility survey in the three districts conducted from September 2017 to October 2017. We defined facility readiness along five domains: basic equipment, essential services, diagnostic capacity, counseling services, and essential medicines. For each domain, we calculated an index as the mean score of items expressed as percentage. These indices were compared to an agreed cutoff at 70%, meaning that a facility index or district index below 70% off was considered as ‘not ready’ to manage NCDs at that level. All analysis were performed using Stata 15 MP. Results There appeared to be wide heterogeneity between facilities in respect of readiness to manage NCDs. Only 6 (including the three 1st level hospitals) out of the 46 facilities were deemed ready to manage NCDs. Only the first level hospitals scored a mean index higher than the 70% cut off; With regard to medications needed to manage NCDs, urban and rural health facilities were comparably equipped. However, there was evidence that calcium channel blockers (p = 0.013) and insulin (p = 0.022) were more likely to be available in urban and semi-urban health facilities compared to rural facilities. Conclusion Our study revealed gaps in primary health care capacity to manage NCDs in Zambia, with almost all health facilities failing to reach the minimum threshold. These results could be generalized to other similar districts in Zambia and the sub-region, where health systems remain focused on infectious rather than non-communicable Disease. These results should attract policy attention and potentially form the basis to review current approach to NCD care at the primary care level in Zambia and Sub-Saharan Africa.
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Affiliation(s)
- Wilbroad Mutale
- University of Zambia, School of Public Health, Lusaka, Zambia
- * E-mail:
| | - Samuel Bosomprah
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | - Oliver Mweemba
- University of Zambia, School of Public Health, Lusaka, Zambia
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | | | - Mulenga Mukanu
- University of Zambia, School of Public Health, Lusaka, Zambia
| | - Daniel Chibutu
- University of Zambia, School of Public Health, Lusaka, Zambia
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21
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Broqvist M, Sandman L, Garpenby P, Krevers B. The meaning of severity – do citizenś views correspond to a severity framework based on ethical principles for priority setting? Health Policy 2018; 122:630-637. [DOI: 10.1016/j.healthpol.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/05/2018] [Accepted: 04/13/2018] [Indexed: 11/25/2022]
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22
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MacQuilkan K, Baker P, Downey L, Ruiz F, Chalkidou K, Prinja S, Zhao K, Wilkinson T, Glassman A, Hofman K. Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa. Glob Health Action 2018; 11:1527556. [PMID: 30326795 PMCID: PMC6197020 DOI: 10.1080/16549716.2018.1527556] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/19/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resource allocation in health is universally challenging, but especially so in resource-constrained contexts in the Global South. Pursuing a strategy of evidence-based decision-making and using tools such as Health Technology Assessment (HTA), can help address issues relating to both affordability and equity when allocating resources. Three BRICS and Global South countries, China, India and South Africa have committed to strengthening HTA capacity and developing their domestic HTA systems, with the goal of getting evidence translated into policy. Through assessing and comparing the HTA journey of each country it may be possible to identify common problems and shareable insights. OBJECTIVES This collaborative paper aimed to share knowledge on strengthening HTA systems to enable enhanced evidence-based decision-making in the Global South by: Identifying common barriers and enablers in three BRICS countries in the Global South; and Exploring how South-South collaboration can strengthen HTA capacity and utilisation for better healthcare decision-making. METHODS A descriptive and explorative comparative analysis was conducted comprising a Within-Case analysis to produce a narrative of the HTA journey in each country and an Across-Case analysis to explore both knowledge that could be shared and any potential knowledge gaps. RESULTS Analyses revealed that China, India and South Africa share many barriers to strengthening and developing HTA systems such as: (1) Minimal HTA expertise; (2) Weak health data infrastructure; (3) Rising healthcare costs; (4) Fragmented healthcare systems; and (5) Significant growth in non-communicable diseases. Stakeholder engagement and institutionalisation of HTA were identified as two conducive factors for strengthening HTA systems. CONCLUSION China, India and South Africa have all committed to establishing robust HTA systems to inform evidence-based priority setting and have experienced similar challenges. Engagement among countries of the Global South can provide a supportive platform to share knowledge that is more applicable and pragmatic.
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Affiliation(s)
- Kim MacQuilkan
- Priority Cost Effective Lessons for System Strengthening South Africa (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Peter Baker
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Laura Downey
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Francis Ruiz
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Kalipso Chalkidou
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kun Zhao
- Division of Health Technology Assessment and Policy Evaluation, China National Health Development Research Center (CHNHDR), Ministry of Health, Beijing, China
| | - Thomas Wilkinson
- Priority Cost Effective Lessons for System Strengthening South Africa (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Karen Hofman
- Priority Cost Effective Lessons for System Strengthening South Africa (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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23
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Jansen MP, Baltussen R, Mikkelsen E, Tromp N, Hontelez J, Bijlmakers L, van der Wilt GJ. Evidence-Informed Deliberative Processes - Early Dialogue, Broad Focus and Relevance: A Response to Recent Commentaries. Int J Health Policy Manag 2018; 7:96-97. [PMID: 29325411 PMCID: PMC5745876 DOI: 10.15171/ijhpm.2017.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/16/2017] [Indexed: 12/04/2022] Open
Affiliation(s)
- Maarten P Jansen
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Rob Baltussen
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Evelinn Mikkelsen
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Noor Tromp
- KIT (Royal Tropical Institute), Amsterdam, The Netherlands
| | - Jan Hontelez
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Institute of Public Health, Heidelberg University, Heidelberg, Germany.,Africa Health Research Institute, Mtubatuba, South Africa
| | - Leon Bijlmakers
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
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24
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Abstract
OBJECTIVES The INTEGRATE-HTA project recommends that complexity be taken into account when conducting health technology assessments (HTAs) and suggests a five-step process for doing that. This study examines whether the approach suggested by INTEGRATE-HTA could be useful, appropriate, and feasible in the context of low- and middle-income countries (LMIC) given some of the typical challenges that healthcare systems face in those countries. METHODS A nonexhaustive literature review was performed on the implementation in low and middle income countries of the five aspects recommended by the INTEGRATE-HTA project, using the following search terms: national health planning, health sector strategy, health sector performance, assessment criteria, health (management) information, complexity, context, stakeholder consultation. RESULTS HTA is being practiced in LMIC in various ways and through different mechanisms, for example in health sector reviews, even though it is usually not referred to as HTA. It does not necessarily follow the five steps distinguished in the INTEGRATE-HTA model (scoping; defining the initial logic model; providing concepts and methods to identify, collect, and synthesize evidence in relation to various dimensions; extracting and presenting evidence in respect of agreed assessment criteria; providing guidance to draw conclusions and formulate recommendations). CONCLUSIONS The conditions for functional HTA are not always fulfilled in LMICs. At least four aspects would require special attention: (a) the scope and quality of routine health information that can support and be fed into health technology assessments and strategic planning; (b) consensus on health system performance assessment frameworks and their main criteria, in particular the inclusion of social disparities/equity and sustainability;
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25
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Abstract
With aid budgets shrinking in richer countries and more money for healthcare becoming available from domestic sources in poorer ones, the rhetoric of value for money or improved efficiency of aid spending is increasing. Taking healthcare as one example, we discuss the need for and potential benefits of (and obstacles to) the establishment of a national institute for aid effectiveness. In the case of the UK, such an institute would help improve development spending decisions made by DFID, the country's aid agency, as well as by the various multilaterals, such as the Global Fund, through which British aid monies is channelled. It could and should also help countries becoming increasingly independent from aid build their own capacity to make sure their own resources go further in terms of health outcomes and more equitable distribution. Such an undertaking will not be easy given deep suspicion amongst development experts towards economists and arguments for improving efficiency. We argue that it is exactly because needs matter that those who make spending decisions must consider the needs not being met when a priority requires that finite resources are diverted elsewhere. These chosen unmet needs are the true costs; they are lost health. They must be considered, and should be minimised and must therefore be measured. Such exposition of the trade-offs of competing investment options can help inform an array of old and newer development tools, from strategic purchasing and pricing negotiations for healthcare products to performance based contracts and innovative financing tools for programmatic interventions.
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Affiliation(s)
- Kalipso Chalkidou
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, SW7 2AZ, UK
| | - Anthony J. Culyer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
- Department of Economics & Related Studies, University of York, York, YO10 5DD, UK
| | | | - Ryan Li
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, SW7 2AZ, UK
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26
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Li R, Ruiz F, Culyer AJ, Chalkidou K, Hofman KJ. Evidence-informed capacity building for setting health priorities in low- and middle-income countries: A framework and recommendations for further research. F1000Res 2017; 6:231. [PMID: 28721199 PMCID: PMC5497935 DOI: 10.12688/f1000research.10966.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 02/02/2023] Open
Abstract
Priority-setting in health is risky and challenging, particularly in resource-constrained settings. It is not simply a narrow technical exercise, and involves the mobilisation of a wide range of capacities among stakeholders - not only the technical capacity to "do" research in economic evaluations. Using the Individuals, Nodes, Networks and Environment (INNE) framework, we identify those stakeholders, whose capacity needs will vary along the evidence-to-policy continuum. Policymakers and healthcare managers require the capacity to commission and use relevant evidence (including evidence of clinical and cost-effectiveness, and of social values); academics need to understand and respond to decision-makers' needs to produce relevant research. The health system at all levels will need institutional capacity building to incentivise routine generation and use of evidence. Knowledge brokers, including priority-setting agencies (such as England's National Institute for Health and Care Excellence, and Health Interventions and Technology Assessment Program, Thailand) and the media can play an important role in facilitating engagement and knowledge transfer between the various actors. Especially at the outset but at every step, it is critical that patients and the public understand that trade-offs are inherent in priority-setting, and careful efforts should be made to engage them, and to hear their views throughout the process. There is thus no single approach to capacity building; rather a spectrum of activities that recognises the roles and skills of all stakeholders. A range of methods, including formal and informal training, networking and engagement, and support through collaboration on projects, should be flexibly employed (and tailored to specific needs of each country) to support institutionalisation of evidence-informed priority-setting. Finally, capacity building should be a two-way process; those who build capacity should also attend to their own capacity development in order to sustain and improve impact.
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Affiliation(s)
- Ryan Li
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Francis Ruiz
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Anthony J Culyer
- University of York, York, UK
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kalipso Chalkidou
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Karen J Hofman
- Priority Cost Effective Lessons for System Strengthening South Africa (PRICELESS SA), MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits University School of Public Health, Johannesburg, South Africa
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