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Rojas-Roque C, Palacios A. A Systematic Review of Health Economic Evaluations and Budget Impact Analyses to Inform Healthcare Decision-Making in Central America. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:419-440. [PMID: 36720754 DOI: 10.1007/s40258-023-00791-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Little is known about the quality, quantity and disease areas analysed by health economic research that inform healthcare decision-making in Central America. This study aimed to review the existing health economic evaluations (HEEs) and budget impact analyses (BIAs) evidence in Central America based on scope and reporting quality. METHODS HEEs and BIAs published from 2000 to April 2021 were searched in five electronic databases: PubMed, Embase, LILACS (Latin American and Caribbean Health Science Literature), EconLIT and OVID Global Health. Two reviewers assessed titles, abstracts and full texts of studies for eligibility. The quality appraisal for the reporting was based on La Torre and colleagues' version of the Drummond checklist and the ISPOR good practices for BIA. For each country, we correlated the number of studies by disease area with their respective burden of disease to identify under-researched health areas. RESULTS 102 publications were eligible for this review. Ninety-four publications reported a HEE, six publications reported a BIA, and two studies reported both a HEE and a BIA. Costa Rica had the highest number of publications (n = 28, 27.5%), followed by Guatemala (n = 25, 24.5%). Cancer and respiratory infections were the most common types of disease studied. Diabetes mellitus, chronic kidney diseases, and mental disorders were under-researched relative to their disease burden in most of the countries. The overall mean quality reporting score for HEE and BIA studies were 71/119 points (60%) and 7/10 points (70%), respectively; however, these assessments were made on different scales. CONCLUSION In Central America, health economic research is sparse and is considered as suboptimal quality for reporting. The findings reported information useful to other low- and middle-income countries with similar advances in the application of economics to promote health policy decision-making.
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Affiliation(s)
- Carlos Rojas-Roque
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina.
| | - Alfredo Palacios
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Facultad de Ciencias Económicas, Universidad de Buenos Aires, Buenos Aires, Argentina
- Centre for Health Economics (CHE), University of York, York, UK
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Al-Jedai AH, Lomas J, Almudaiheem HY, Al-Ruthia YSH, Alghamdi S, Awad N, Alghamdi A, Alowairdhi MA, Alabdulkarim H, Almadi M, Bunyan RF, Ochalek J. Informing a cost-effectiveness threshold for Saudi Arabia. J Med Econ 2023; 26:128-138. [PMID: 36576804 DOI: 10.1080/13696998.2022.2157141] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/07/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Saudi Arabia's Vision 2030 aims to reform health care across the Kingdom, with health technology assessment being adopted as one tool promising to improve the efficiency with which resources are used. An understanding of the opportunity costs of reimbursement decisions is key to fulfilling this promise and can be used to inform a cost-effectiveness threshold. This paper is the first to provide a range of estimates of this using existing evidence extrapolated to the context of Saudi Arabia. METHODS AND MATERIALS We use four approaches to estimate the marginal cost per unit of health produced by the healthcare system; drawing from existing evidence provided by a cross-country analysis, two alternative estimates from the UK context, and based on extrapolating a UK estimate using evidence on the income elasticity of the value of health. Consequences of estimation error are explored. RESULTS Based on the four approaches, we find a range of SAR 42,046 per QALY gained (48% of GDP per capita) to SAR 215,120 per QALY gained (246% of GDP per capita). Calculated potential central estimates from the average of estimated health gains based on each source gives a range of SAR 50,000-75,000. The results are in line with estimates from the emerging literature from across the world. CONCLUSION A cost-effectiveness threshold reflecting health opportunity costs can aid decision-making. Applying a cost-effectiveness threshold based on the range SAR 50,000 to 75,000 per QALY gained would ensure that resource allocation decisions in healthcare can in be informed in a way that accounts for health opportunity costs. LIMITATIONS A limitation is that it is not based on a within-country study for Saudi Arabia, which represents a promising line of future work.
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Affiliation(s)
- Ahmed Hamdan Al-Jedai
- Therapeutic Affairs, Ministry of Health Saudi Arabia, Riyadh, Saudi Arabia
- Colleges of Pharmacy and Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - James Lomas
- Department of Economics and Related Studies, University of York, York, United Kingdom
| | | | | | | | - Nancy Awad
- IQVIA Dubai, Dubai, United Arab Emirates
| | - Ahlam Alghamdi
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Hana Alabdulkarim
- Drug Policy and Economic Center, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Majid Almadi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Reem F Bunyan
- Center for Improving Value in Health, Ministry of Health, Riyadh, Saudi Arabia
- King Fahad Specialist Hospital, Dammam, Ash Sharqiyah, Saudi Arabia
| | - Jessica Ochalek
- Centre for Health Economics, University of York, York, United Kingdom
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Yi S, Hong J, Yoon H, Lim YN, Bae EY. Systematic Review and Quality Assessment of Health Economic Evaluation Studies (2007-2019) Conducted in South Korea. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:819-834. [PMID: 35869356 DOI: 10.1007/s40258-022-00746-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND South Korea formally adopted economic evaluation in December 2006 to aid drug reimbursement decision-making. While this policy change is applied only to pharmaceuticals, it has also sparked interest in economic evaluations for non-pharmaceutical interventions and programmes. OBJECTIVE This study aimed to provide a snapshot of the current practice for published health economic evaluation studies and critically assess the quality of these studies. METHODS An electronic search was performed on multiple databases (EMBASE, PubMed, NHS Economic Evaluation Database, Scopus, Korean Medical database, Korean studies Information Service System, and Research Information Sharing Service) to identify health economic evaluation studies published between January 2007 and December 2019. The inclusion criteria were peer-reviewed, original health economic evaluations (cost-utility, cost-effectiveness, cost-minimisation, and cost-benefit analyses) published in English or Korean. Two reviewers selected studies for inclusion and extracted data from the included studies. Key characteristics of these studies were descriptively summarised, and study quality was assessed using the Quality of Health Economic Studies (QHES) instrument on a 100-point scale. RESULTS A total of 162 studies were included in this review (63 for drugs, 51 for non-pharmaceutical treatments/health technologies, and 48 for health programmes). These numbers confirm a significant increase in the number of publications since the policy introduction. However, the quality of these studies remained relatively low, with a mean QHES score of 57.9 (± 16.0). Study quality also varied substantially, with the QHES scores ranging from 15 to 87. The scores were notably lower in studies with non-pharmaceutical interventions and programmes, cost-effectiveness analyses or cost-benefit analyses, retrospective study-based or simple modelling-based analyses, and those locally published. In addition, a considerable proportion of these studies did not state or specify essential components of economic evaluation, such as perspectives (30.2%), time horizons (29.6%), discount rates (34.6%), and sensitivity analyses (24.7%). While the use of local data either fully or partially was relatively higher for unit costs (94.4%) and resource utilisation (90.1%), it was lower for utility weights (47.1%), treatment effects (63.0%), and baseline risks (70.4%). Transferability or generalisability issues were infrequently discussed when relying on foreign sources. In addition, the included studies were often not well structured, making it difficult to assess their quality. CONCLUSION These findings suggest that there is still much room for improving the quality of health economic evaluation studies conducted in South Korea. Policymakers should critically evaluate available cost-effectiveness evidence, especially for non-pharmaceutical interventions and programmes, when using it for decision-making in South Korea.
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Affiliation(s)
- Sunghyun Yi
- Department of Health Policy and Management, General Graduate School of Gachon University, Seongnam, South Korea
| | - Jihyung Hong
- Department of Healthcare Management, College of Social Science, Gachon University, Seongnam, 13120, South Korea.
| | - Haemin Yoon
- Department of Economics and Related Studies, University of York, York, UK
| | - You-Na Lim
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Eun-Young Bae
- College of Pharmacy, Gyeongsang National University, Jinju, South Korea
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Zrubka Z, Péntek M, Mhanna L, Abu-Zahra T, Mahdi-Abid M, Fgaier M, El-Dahiyat F, Al-Abdulkarim H, Drummond M, Gulácsi L. Disease-Related Costs Published in The Middle East and North Africa Region: Systematic Review and Analysis of Transferability. PHARMACOECONOMICS 2022; 40:587-599. [PMID: 35578009 PMCID: PMC9130178 DOI: 10.1007/s40273-022-01146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In the Middle East and North Africa (MENA) the scarcity of local cost data is a key barrier to conducting health economic evaluations. We systematically reviewed reports of disease-related costs from MENA and analysed their transferability within the region. METHODS We searched PubMed and included full text English papers that reported disease-related costs from the local populations of Algeria, Bahrain, Egypt, Iraq, Jordan, Saudi Arabia, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Syria, Tunisia, United Arab Emirates and Yemen between 1995 and 2019. Screening, study selection and data extraction were done in duplicate. Study-related variables, costing methods, all costs and their characteristics were extracted and analysed via descriptive methods. From multi-country studies of MENA employing homogenous costing methods, we estimated the ratio (cost transfer coefficient) between the relative differences in direct medical costs and macroeconomic indicators via robust regression. We predicted each cost via the estimated cost transfer formula and evaluated prediction error between true and predicted (transferred) costs. RESULTS The search yielded 1646 records, 206 full text papers and 3525 costs from 84 diagnoses. Transferability was analysed involving 144 direct medical costs from eight multi-country studies. Adjusting the average of available foreign costs by 0.28 times the relative difference in GDP per capita provided the most accurate estimates. The correlation between true and predicted costs was 0.96; 68% of predicted costs fell in the true ± 50% range. Predictions were more accurate for costs from studies that involved the largest number of countries, for countries outside the Gulf region and for drug costs versus unit or disease costs. CONCLUSION The estimated cost transfer formula allows the prediction of missing costs in MENA if only GDP per capita is available for adjustment to the local setting. Input costs for the formula should be collected from multiple sources and match the decision situation.
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Affiliation(s)
- Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University Budapest, Óbudai Egyetem, Bécsi út 96, Budapest, 1034 Hungary
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - Márta Péntek
- Health Economics Research Center, University Research and Innovation Center, Óbuda University Budapest, Óbudai Egyetem, Bécsi út 96, Budapest, 1034 Hungary
| | - Lea Mhanna
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, Budapest, Hungary
| | - Teebah Abu-Zahra
- Health Policy and Financing Masters Course, Corvinus University of Budapest, Budapest, Hungary
| | - Mohamed Mahdi-Abid
- Research Center of Epidemiology and Statistics, Paris University, Paris, France
| | - Meriem Fgaier
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, Budapest, Hungary
| | - Faris El-Dahiyat
- College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
| | - Hana Al-Abdulkarim
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, Budapest, Hungary
- Drug Policy and Economic Center, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | | | - László Gulácsi
- Health Economics Research Center, University Research and Innovation Center, Óbuda University Budapest, Óbudai Egyetem, Bécsi út 96, Budapest, 1034 Hungary
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
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Nagi MA, Dewi PEN, Thavorncharoensap M, Sangroongruangsri S. A Systematic Review on Economic Evaluation Studies of Diagnostic and Therapeutic Interventions in the Middle East and North Africa. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:315-335. [PMID: 34931297 DOI: 10.1007/s40258-021-00703-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Due to the increase in healthcare budget constraint, economic evaluation (EE) evidence is increasingly required to inform resource allocation decisions. This study aimed to systematically review quantity, characteristics, and quality of full EE studies on diagnostic and therapeutic interventions conducted in 26 Middle East and North Africa (MENA) countries. METHODS PubMed and Scopus databases were comprehensively searched to identify the published EE studies in the MENA region. The quality of reviewed studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS The search identified 69 studies. The cost-utility approach was adopted in 49 studies (71 %). More than half (38 studies; 55 %) were conducted in Iran and Turkey. Sixteen countries (62 %) did not have any EE studies. The most frequently analyzed therapeutic areas were infectious diseases (19 studies; 28 %), cardiovascular diseases (11 studies; 16 %), and malignancies (10 studies; 14 %). Ten studies (14 %), 46 (67 %), 12 (17 %), and 1 study (1 %) were classified as excellent, high, moderate, and poor quality, respectively. The mean of items reported was 85.10 % (standard deviation 13.32 %). Characterizing heterogeneity, measurement of effectiveness, time horizon, and discount rate were missed in 21 (60 %), 22 (32 %), 20 (29 %) and 15 (25 %) studies, respectively. Data on effectiveness and utility relied primarily on studies conducted outside the region. CONCLUSIONS The quantity of EE studies in the MENA region remains low; however, overall quality is high to excellent. The availability of local data, capacity building, and national guidelines are vital to improve both the quantity and quality of EE studies in the region.
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Affiliation(s)
- Mouaddh Abdulmalik Nagi
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
- Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen.
| | - Pramitha Esha Nirmala Dewi
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Department of Pharmacy Profession, Faculty of Medicine and health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Montarat Thavorncharoensap
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400, Thailand
| | - Sermsiri Sangroongruangsri
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400, Thailand
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Maraiki F, Bazarbashi S, Scuffham P, Tuffaha H. Methodological Approaches to Cost-Effectiveness Analysis in Saudi Arabia: What Can We Learn? A Systematic Review. MDM Policy Pract 2022; 7:23814683221086869. [PMID: 35647291 PMCID: PMC9133871 DOI: 10.1177/23814683221086869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/22/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The recent establishment of the health technology assessment (HTA) entity in the Kingdom of Saudi Arabia (KSA) has resulted in increased interest in economic evaluation. The aim of this study is to evaluate the technical approaches used in published economic evaluations and the limitations reported by the authors of the respective studies that could affect the ability to perform economic evaluations in the KSA. METHODS We conducted a systematic literature review of published economic evaluations performed for the KSA over the past 10 years. An electronic literature search of the PubMed, EMBASE, and Cochrane databases was performed. A CHEERS checklist was used to assess the quality of reporting. Reported limitations were classified into domains including the definition of perspectives, identification of comparators, estimation of costs and resources, and use of the incremental cost-effectiveness ratio threshold. RESULTS Twelve evaluations were identified; most involved cost-effectiveness analysis (92%). Missing and unclear data were found within the CHEERS criteria. Regardless of the perspective used, most described the perspective as an "institutional" perspective (70%) and almost half were reclassified by the current reviewer (42%). Most did not clearly state the comparator (83%), and published model comparators were commonly used (50%). Resource estimation was mostly performed by the authors of the respective studies (67%), and costs were mostly obtained from hospital institutional data (75%). The lack of an established threshold for the country-specific willingness to pay was observed in 50% of the analyses. CONCLUSIONS Economic evaluations from the KSA are limited. Capacity building and country-specific HTA guidelines could improve the quality of evaluations to better inform decision making. HIGHLIGHTS Economic analysis of health technology should follow standard guidelines. Unfortunately, these guides are often underutilized, and our findings identify considerable missing, not clearly stated, or incomplete data within the analyses, which can weaken the impact of the recommendations.The limitations reported by the authors of the respective studies emphasize the suboptimal quality of the reporting. A lack of data was frequently identified and resulted in using "institutional" practice as a major source of data input for the analyses.In light of the call for the establishment of an HTA entity in the KSA, framing a standard analytic approach when conducting economic evaluations will support HTA in informing resource allocation decisions. We hope that our findings highlight the need for country-specific guidance to improve practice and enhance future research.
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Affiliation(s)
- Fatma Maraiki
- Fatma Maraiki, King Faisal Hospital and
Research Centre, P.O. Box 3354, Riyadh, 11211, Saudi Arabia;
()
| | - Shouki Bazarbashi
- Oncology Centre, King Faisal Hospital and
Research Centre, Riyadh, Saudi Arabia
- Centre for Applied Health Economics, School of
Medicine, Griffith University, Nathan, Queensland, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, School of
Medicine, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute, Griffith University,
Gold Coast, Queensland, Australia
| | - Haitham Tuffaha
- Centre for the Business and Economics of
Health, The University of Queensland, Brisbane, Queensland, Australia
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Al-Aqeel S, Alnaim L, Alghaith J, Almosabhi L. Cancer Impacts on Out-of-Pocket Expenses, Income Loss, and Informal (Unpaid) Care: A Cross-Sectional Study of Patient Perspective. J Patient Exp 2021; 8:23743735211049651. [PMID: 34676289 PMCID: PMC8524680 DOI: 10.1177/23743735211049651] [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] [Indexed: 12/04/2022] Open
Abstract
A paper-based questionnaire was used to measure out-of-pocket expenses, income
loss, and informal (unpaid) care from the cancer patient’s perspective. A total
of 181 adult solid cancer patients on chemotherapy for at least 3 months were
recruited from 1 teaching hospital in Riyadh, Saudi Arabia. The majority were
female (66%) and 41% were 60 years of age or older. A total of 107 respondents
used their own car for transport to and from the hospital to receive
chemotherapy (median distance 42 km). Over the last 4 weeks, 21% purchased
medications, 18% visited a physician, and 8% visited a physiotherapist, spending
a median amount of $47, $220, and $793, respectively. A total of 47 participants
were employed at the time of their cancer diagnoses, and 32% of them reported
some loss of income. A total of 85% of respondents were escorted by a carer
during chemotherapy sessions. Approximately 64%, 31%, 61%, 43%, and 28% reported
getting help from a carer for housework, child care, shopping, medicine taking,
and personal care, respectively. The carer spent on average 50 h per week
looking after the patient.
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Affiliation(s)
- Sinaa Al-Aqeel
- 1 Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Lamya Alnaim
- 1 Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Jeelan Alghaith
- 1 Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Latifa Almosabhi
- 1 Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Al-Aqeel SA, AlAujan SS, Almazrou SH. The Institute for Medical Technology Assessment Productivity Cost Questionnaire (iPCQ) and the Medical Consumption Questionnaire (iMCQ): Translation and Cognitive Debriefing of the Arabic Version. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147232. [PMID: 34299684 PMCID: PMC8303958 DOI: 10.3390/ijerph18147232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/28/2022]
Abstract
The aim of this study was to translate the Institute for Medical Technology Assessment Productivity Cost Questionnaire (iPCQ) and the Medical Consumption Questionnaire (iMCQ) from English into Arabic and perform cognitive debriefing in a Saudi Arabian setting. We conducted the translation according to guidelines, including two independent forward translations and a backward translation. Cognitive debriefing was carried out in two stages. First, the pre-final translated versions of the two questionnaires were tested on a group of respondents (n = 5) using face-to-face or telephone interviews. The participants completed a copy of the questionnaires, identified items or questions that were confusing or misunderstood, and then answered a series of open-ended questions about their understanding of each instruction, question and response option. Second, another group of participants (n = 17) completed the questionnaire and circled any word that was confusing or difficult to understand and provided comments on the questionnaires. The Arabic translation and linguistic validation were realized without any major difficulties. The few changes made after cognitive debriefing generally related to changing one word to a more appropriate Arabic word. The final Arabic translation needs to be validated for psychometric properties such as validity and reliability before being recommended for use in future research.
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Sharkawy MN, Dastan I. A scoping review of health economic evaluation in the World Health Organization Eastern Mediterranean region. Expert Rev Pharmacoecon Outcomes Res 2021; 21:877-884. [PMID: 34024232 DOI: 10.1080/14737167.2021.1933949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Economic evaluations are widely used tools that greatly contribute to evidence-based health policy and decision-making. However, economic evidence is not commonly used in the countries of the World Health Organization Eastern Mediterranean Region.Areas covered: The aim of this scoping review is to map the existing literature of health economic evaluation studies in the countries of the World Health Organization Eastern Mediterranean Region. Also, the review aims to identify the research gaps in the field of health economic evaluation in the region and finally provide recommendations for research and policy making. We searched six electronic databases. Six items were extracted from each of the included studies: first author, publication year, country of the study, study type, health technology assessed, and perspective.Expert opinion: The quality and quantity of HEE studies should be improved in the region. There is a need to follow evidence-based methodological rigor to aid in informed health-care decision-making and efficient use of health-care resources.
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Affiliation(s)
- Mennatollah Nagy Sharkawy
- Health Economics and Financing (HEF) unit, Division of Universal Health Systems (UHS), World Health Organization (WHO), Eastern Mediterranean Regional Office (EMRO), Cairo, Egypt
| | - Ilker Dastan
- WHO Country Office for Tajikistan, Dushanbe, Tajikistan
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Adherence to country-specific guidelines among economic evaluations undertaken in three high-income and middle-income countries: a systematic review. Int J Technol Assess Health Care 2021; 37:e73. [PMID: 34193325 DOI: 10.1017/s0266462321000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the adherence of economic evaluations to the recommendations on principles of economic evaluation as stated in the country-specific guidelines for three countries across different income groups, namely, Canada, South Africa, and Egypt. METHODS Searches were undertaken in three databases to identify economic evaluations meeting predefined inclusion criteria. Methodological and reporting standards listed in the country-specific guidelines were converted into discrete binary variables to calculate mean adherence scores. Quality appraisal was done using Drummond's checklist. Stratified analysis was undertaken to identify independent variables affecting adherence. RESULTS We identified forty-four, seventy-nine, and sixteen economic evaluations for Canada, South Africa, and Egypt, respectively. The mean adherence score was the highest for Canada (71%), followed by South Africa (65%) and Egypt (60%). Adherence to guidelines was positively correlated with quality of studies, r = .72. Furthermore, the mean adherence score was significantly (p < .05) higher for studies using a cost-utility analysis design (72%), having local/national funding aid (72%), undertaken by a health economist (71%) and for pharmacoeconomic evaluations (70%). CONCLUSION The quality of economic evaluations improves with adherence to country-specific guidelines. Locally funded and health-economist led health technology assessments (HTAs) should be encouraged for greater adherence to the guidelines. The HTA researchers and the HTA bodies should lay emphasis on adherence to the country-specific guidelines for improving the quality of HTA evidence.
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Almazrou SH, Alaujan SS, Al-Aqeel SA. Barriers and facilitators to conducting economic evaluation studies of Gulf Cooperation Council (GCC) countries: a survey of researchers. Health Res Policy Syst 2021; 19:71. [PMID: 33933093 PMCID: PMC8088636 DOI: 10.1186/s12961-021-00721-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 04/12/2021] [Indexed: 12/21/2022] Open
Abstract
Background The number of published economic evaluations of Gulf Cooperation Council (GCC) countries is notably scarce. Limited local evidence could have a major impact on the implementation of economic evaluation recommendations in the decision-making process in GCC countries. Little is known about the factors affecting researchers who seek to conduct economic evaluations. Therefore, we aimed to assess researcher barriers and facilitators in conducting such studies of GCC countries. Methods A cross-sectional survey of health economic researchers working in GCC countries was conducted online between January and February 2020. The survey instrument collected researchers’ perceived barriers and facilitators and demographic information. For barriers, respondents rated their agreement on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree”. For facilitators, respondents rated the importance of each facilitator on a six-point scale ranging from “extremely important” to “not very important”. Then, participants were asked to select the three most important barriers and facilitators from the lists. The data collected were examined using descriptive analysis. Results Fifty-one researchers completed the survey (37% response rate). The majority of participants (more than 80%) agreed that lack of quality of effectiveness data and restricted access to unit cost data are the main barriers to conducting economic research. Availability of relevant local data was reported as an important facilitator, followed by collaboration between health economic researchers, policy-makers and other stakeholders. Conclusions The results of this study provide an exploratory view of the issues faced by health economics researchers in GCC countries. Recommendations to GCC countries based on international experiences, such as to use real-world data in economic evaluation research, were provided.
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Affiliation(s)
- Saja H Almazrou
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
| | - Shiekha S Alaujan
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sinaa A Al-Aqeel
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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AlAujan SS, Almazrou SH, Al-Aqeel SA. A Systematic Review of Sources of Outcomes and Cost Data Utilized in Economic Evaluation Research Conducted in the Gulf Cooperation Council. Risk Manag Healthc Policy 2021; 14:209-220. [PMID: 33505174 PMCID: PMC7829123 DOI: 10.2147/rmhp.s285359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/10/2020] [Indexed: 01/28/2023] Open
Abstract
Background Transparency and clarity in reporting of methods used to identify, measure, and value outcomes and resources in published economic evaluations is crucial. Objective The aims of this review were to identify and assess the quality of published economic evaluation studies in the Gulf Cooperation Council (GCC) region, with a specific focus on methods used to identify, measure, and value cost and outcomes data. Methods An electronic search of publications from 2009 to October 2019 was performed in three clinical (Medline, Scopus, and EMBASE) and one economic (NHS EED) databases. Full economic evaluations undertaken in GCC countries from any perspective were included. Reference lists of three reviews on the same topic and area were also searched for further eligible articles. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used for methodological quality assessment. Data on type and source of cost and outcomes data were collected. Results Out of 1857 studies identified, 14 relevant studies were eligible and included. Eleven studies were based in Saudi Arabia, and the remaining studies were published in the United Arab of Emirates (UAE), Qatar, and Oman. Majority of the evaluations were based on the Markov modelling (n=8). None of the studies fully fulfilled the CHEERS quality criteria. Quality-adjusted life years (QALYs) was the main outcome (n=10). The EQ-5D was valued using the UK value set tariff (n=6). Published literature was the source of outcomes data in seven studies. Hospital-based data were used as a source of healthcare resource use data in four studies, whereas hospital-based costs (n = 7) combined with other sources such as local/national data were the sources of unit cost data in the majority of the studies. Conclusion Rigorous economic evaluations are lacking in the region leading to inaccurate information being given to decision-makers.
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Affiliation(s)
- Shiekha S AlAujan
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Saja H Almazrou
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sinaa A Al-Aqeel
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Gheorghe A, Gad M, Ismail SA, Chalkidou K. Capacity for health economics research and practice in Jordan, Lebanon, the occupied Palestinian territories and Turkey: needs assessment and options for development. Health Res Policy Syst 2020; 18:99. [PMID: 32883285 PMCID: PMC7469424 DOI: 10.1186/s12961-020-00586-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background Capacity for health economics analysis and research is indispensable for evidence-informed allocations of scarce health resources; however, little is known about the experience and capacity strengthening preferences of academics and practitioners in the Eastern Mediterranean region. This study aimed to assess the needs for strengthening health economics capacity in Jordan, Lebanon, the occupied Palestinian territories and Turkey as part of the Research for Health in Conflict in the Middle East and North Africa (R4HC) project. Methods We combined a bibliometric analysis of health economics outputs based on a literature search conducted across seven databases with an online survey of academic researchers and non-academic practitioners. The records included in the bibliometric analysis were original studies and reviews with an explicit economic outcome related to health, disease or disability, had at least one author in Jordan, Lebanon, Palestine or Turkey, and were published between January 2014 and December 2018. Two types of analyses were conducted using VOSviewer software, namely keyword co-occurrence and co-publication networks across countries and organisations. The online survey asked academic researchers, analysts and decision-makers – identified through the bibliometric analysis and regional professional networks – about previous exposure to and priorities for capacity development in health economics. Results Of 15,185 records returned by the literature search, 566 were included in the bibliometric analysis. Organisations in Turkey contributed more than 80% of records and had the broadest and most diverse network of collaborators, nationally and internationally. Only 1% (n = 7) of studies were collaborations between researchers in two or more different jurisdictions. Cost analysis, cost-effectiveness analysis and health system economics were the main health economics topics across the included studies. Economic evaluations, measuring the economic burden of disease and health equity, were reported by survey respondents (n = 80) as the most important areas to develop in. Short courses, learn-by-doing and mentoring from an experienced professional were, in aggregate, the most preferred learning styles. Conclusions Existing pockets of health economic expertise in the region can constitute the base of future capacity development efforts. Building confidence toward applying specific methods and trust toward stimulating cross-jurisdiction collaborations appear essential components for sustainably developing health economics capacity.
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Affiliation(s)
- Adrian Gheorghe
- Global Health and Development, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
| | - Mohamed Gad
- Global Health and Development, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Sharif A Ismail
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Kalipso Chalkidou
- Global Health and Development, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.,Center for Global Development, London, United Kingdom
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Zrubka Z, Rashdan O, Gulácsi L. Health Economic Publications From the Middle East and North Africa Region: A Scoping Review of the Volume and Methods of Research. ACTA ACUST UNITED AC 2020. [DOI: 10.36401/jqsh-20-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ABSTRACT
Introduction
We reviewed the scope of countries, diseases, technologies, and methods involved in the health economic evaluations published in the Middle East and North Africa (MENA) region.
Methods
PRISMA guidelines were followed. A PubMed search was conducted up to December 15, 2019. English language full-text articles were included if they reported original research on humans; involved the local population from Algeria, Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Syria, Tunisia, United Arab Emirates, or Yemen; reported costs; and involved a full or partial health economic analysis comparing alternative health technologies. Data on publication year, country of origin, disease area according to ICD-10, type of health technology, and applied methods were extracted.
Results
From 105 eligible articles, 57.1% were published between 2015 and 2019. Egypt (30.5%) and Saudi Arabia (27.6%) were the most frequently involved countries. Infectious diseases were most often studied (27.6%). The assessed technology was a system (eg, infection control, screening, coverage/access, hospital management, or healthcare delivery program) in 41.9% of studies. Cost-utility analysis (CUA) was the most frequent method (29.5%) and was growing rapidly. Health system perspective was adopted in 52.4% of studies, whereas societal perspective was scarce (8.6%). The majority of studies (46.7%) were published in Scimago Q1 journals. Over half of the studies (54.2%) did not report or did not have a funding source.
Conclusions
From 2015, health economic analysis became more frequent in the MENA region, providing input to value-based health policy and financing. For further growth, in addition to the development of the institutional background, valid and more standardized local cost and outcome data should be available.
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Affiliation(s)
- Zsombor Zrubka
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Omar Rashdan
- Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
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Foo J, Cook DA, Walsh K, Golub R, Abdalla ME, Ilic D, Maloney S. Cost evaluations in health professions education: a systematic review of methods and reporting quality. MEDICAL EDUCATION 2019; 53:1196-1208. [PMID: 31402515 DOI: 10.1111/medu.13936] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/27/2019] [Accepted: 06/20/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT High-quality research into education costs can inform better decision making. Improvements to cost research can be guided by information about the research questions, methods and reporting of studies evaluating costs in health professions education (HPE). Our objective was to appraise the overall state of the field and evaluate temporal trends in the methods and reporting quality of cost evaluations in HPE research. METHODS We searched the MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, Business Source Complete and ERIC (Education Resources Information Centre) databases on 31 July 2017. To evaluate trends over time, we sampled research reports at 5-year intervals (2001, 2006, 2011 and 2016). All original research studies in HPE that reported a cost outcome were included. The Medical Education Research Study Quality Instrument (MERSQI) and the BMJ economic checklist were used to appraise methodological and reporting quality, respectively. Trends in quality over time were analysed. RESULTS A total of 78 studies were included, of which 16 were published in 2001, 15 in 2006, 20 in 2011 and 27 in 2016. The region most commonly represented was the USA (n = 43). The profession most commonly referred to was that of the physician (n = 46). The mean ± standard deviation (SD) MERSQI score was 10.9 ± 2.6 out of 18, with no significant change over time (p = 0.55). The mean ± SD BMJ score was 13.5 ± 7.1 out of 35, with no significant change over time (p = 0.39). A total of 49 (63%) studies stated a cost-related research question, 23 (29%) stated the type of cost evaluation used, and 31 (40%) described the method of estimating resource quantities and unit costs. A total of 16 studies compared two or more interventions and reported both cost and learning outcomes. CONCLUSIONS The absolute number of cost evaluations in HPE is increasing. However, there are shortcomings in the quality of methodology and reporting, and these are not improving over time.
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Affiliation(s)
- Jonathan Foo
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - David A Cook
- Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | | | - Robert Golub
- Northwestern University Feinberg School of Medicine Chicago, Chicago, Illinois, USA
- JAMA Editorial Office, Chicago, Illinois, USA
| | | | - Dragan Ilic
- School of Public Health and Preventive Medicine, Monash University, Frankston, Victoria, Australia
- Monash Centre for Scholarship in Health Education, Monash University, Frankston, Victoria, Australia
| | - Stephen Maloney
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
- Monash Centre for Scholarship in Health Education, Monash University, Frankston, Victoria, Australia
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Abdel Rida N, Mohamed Ibrahim MI, Babar Z. Pharmaceutical pricing policies in Qatar and Lebanon: narrative review and document analysis. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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A Systematic Review on the Extent and Quality of Pharmacoeconomic Publications in Egypt. Clin Drug Investig 2019; 39:157-168. [PMID: 30460486 DOI: 10.1007/s40261-018-0730-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Egypt faces many challenges when matching patient needs with available resources. Consequently, there has been an increasing interest in pharmacoeconomics as an aid tool in health decision-making to better allocate resources. OBJECTIVES To review and evaluate the volume and the quality of published pharmacoeconomic studies in Egypt. METHODS A literature search was conducted in August 2018 using PubMed, Google Scholar, and Cochrane library to identify published Egyptian pharmacoeconomic studies. Articles were included if they were original economic studies, written and published in English, and conducted in Egypt. Each article was assessed independently by two reviewers using the 100-point Quality of Health Evaluation Studies (QHES) scale. RESULTS Fifteen studies published between 2002 and 2017 were included in the review. Most of them were cost-effectiveness analyses (60%). The minority used secondary data (33.3%) or adopted modeling techniques (40%). The mean QHES score of the included studies was 70.1 ± 21.8, and approximately 40% of them had a QHES score of more than 80. CONCLUSION Pharmacoeconomic evaluations in Egypt are still in their infancy. The Egyptian guidelines for economic evaluation should be adopted and the EQ-5D-5L value sets should be developed to increase the quality of economic research.
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Eljilany I, El-Dahiyat F, Curley LE, Babar ZUD. Evaluating quantity and quality of literature focusing on health economics and pharmacoeconomics in Gulf Cooperation Council countries. Expert Rev Pharmacoecon Outcomes Res 2018; 18:403-414. [PMID: 29779401 DOI: 10.1080/14737167.2018.1479254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The importance of pharmacoeconomics and health economics has been augmented. It has the potential to provide evidence to aid in optimal decision-making in the funding of cost-effective medicines and services in Gulf Cooperation Council countries (G.C.C). OBJECTIVE To evaluate the quality and quantity of health economic researches published until the end of 2017 in G.C.C. and to identify the factors that affect the quality of studies. METHOD Studies were included according to predefined inclusion and exclusion criteria. The quantity was recorded, and the quality was assessed using the Quality of Health Economic Studies (QHES) instrument. RESULTS Forty-nine studies were included. The mean (SD) quality score of all studies was 57.83 (25.05), and a high number of reviewed studies (47%) were evaluated as either poor or extremely poor quality. The factors that affect the quality of studies with statistical significance were, the type and method of economic evaluation, the economic outcome was the objective of the research, author`s background, the perspective of the study, health intervention and source of funding. CONCLUSION The use of economic evaluation studies in G.C.C was limited. Different factors that affect the quality of articles such as performing a full economic evaluation and choosing societal perspective were identified. Strategies to improve the quality of future studies were recommended.
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Affiliation(s)
- Islam Eljilany
- a Independent Researcher , Pharmacoeconomics Expert , Qatar
| | - Faris El-Dahiyat
- b College of Pharmacy , Al Ain University of Science and Technology , Al Ain , United Arab Emirates
| | - Louise Elizabeth Curley
- c School of Pharmacy, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
| | - Zaheer-Ud-Din Babar
- c School of Pharmacy, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand.,d Department of Pharmacy , University of Huddersfield , Huddersfield , United Kingdom
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Affiliation(s)
- Sinaa Al-Aqeel
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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20
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Adeagbo CU, Rattanavipapong W, Guinness L, Teerawattananon Y. The Development of the Guide to Economic Analysis and Research (GEAR) Online Resource for Low- and Middle-Income Countries' Health Economics Practitioners: A Commentary. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:569-572. [PMID: 29753354 PMCID: PMC5947918 DOI: 10.1016/j.jval.2017.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 05/15/2023]
Abstract
Public health authorities around the world are increasingly using economic evaluation to set priorities and inform decision making in health policy, especially in the development of health benefit packages. Nevertheless, researchers in low- and middle-income countries (LMICs) encounter many barriers when conducting economic evaluations. In 2015, the Health Intervention and Technology Assessment Program identified key technical and context-specific challenges faced in conducting and using health economic evaluations in LMICs. On the basis of these research findings, the Guide to Economic Analysis and Research (GEAR) online resource (www.gear4health.com) was developed as a reliable aid to researchers in LMICs that would help overcome those challenges. Funded by the Thailand Research Fund and the Bill and Melinda Gates Foundation, GEAR is a free online resource that provides a visual aid tool for planning economic evaluation studies (GEAR mind maps), a repository of national and international economic evaluation guidelines (GEAR guideline comparison), and an active link to a network of volunteer international experts (GEAR: Ask an expert). GEAR will evolve over time to provide relevant, reliable, and up-to-date information through inputs from its users (e.g., periodic survey on methodological challenges) and experts (e.g., in responding to users' questions). The objective of this commentary was to give a brief description of the development and key features of this unique collective information hub aimed at facilitating high-quality research and empowering health care decision makers and stakeholders to use economic evaluation evidence.
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Affiliation(s)
- Chiaki Urai Adeagbo
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand.
| | - Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Lorna Guinness
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
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Decimoni TC, Leandro R, Rozman LM, Craig D, Iglesias CP, Novaes HMD, de Soárez PC. Systematic Review of Health Economic Evaluation Studies Developed in Brazil from 1980 to 2013. Front Public Health 2018; 6:52. [PMID: 29541630 PMCID: PMC5835950 DOI: 10.3389/fpubh.2018.00052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 02/09/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Brazil has sought to use economic evaluation to support healthcare decision-making processes. While a number of health economic evaluations (HEEs) have been conducted, no study has systematically reviewed the quality of Brazilian HEE. The objective of this systematic review was to provide an overview regarding the state of HEE research and to evaluate the number, characteristics, and quality of reporting of published HEE studies conducted in a Brazilian setting. METHODS We systematically searched electronic databases (MEDLINE, EMBASE, Latin American, and Caribbean Literature on Health Sciences Database, Scientific Electronic Library Online, NHS Economic Evaluation Database, health technology assessment Database, Bireme, and Biblioteca Virtual em Saúde Economia da Saúde); citation indexes (SCOPUS, Web of Science), and Sistema de Informação da Rede Brasileira de Avaliação de Tecnologia em Saúde. Partial and full HEEs published between 1980 and 2013 that referred to a Brazilian setting were considered for inclusion. RESULTS In total, 535 studies were included in the review, 36.8% of these were considered to be full HEE. The category of healthcare technologies more frequently assessed were procedures (34.8%) and drugs (28.8%) which main objective was treatment (72.1%). Forty-four percent of the studies reported their funding source and 36% reported a conflict of interest. Overall, the full HEE quality of reporting was satisfactory. But some items were generally poorly reported and significant improvement is required: (1) methods used to estimate healthcare resource use quantities and unit costs, (2) methods used to estimate utility values, (3) sources of funding, and (4) conflicts of interest. CONCLUSION A steady number of HEE have been published in Brazil since 1980. To improve their contribution to inform national healthcare policy efforts need to be made to enhance the quality of reporting of HEEs and promote improvements in the way HEEs are designed, implemented (i.e., using sound methods for HEEs) and reported.
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Affiliation(s)
- Tassia Cristina Decimoni
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Roseli Leandro
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luciana Martins Rozman
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Dawn Craig
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
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Luz A, Santatiwongchai B, Pattanaphesaj J, Teerawattananon Y. Identifying priority technical and context-specific issues in improving the conduct, reporting and use of health economic evaluation in low- and middle-income countries. Health Res Policy Syst 2018; 16:4. [PMID: 29402314 PMCID: PMC5800077 DOI: 10.1186/s12961-018-0280-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 01/10/2018] [Indexed: 12/12/2022] Open
Abstract
Background The use of economic evaluation in healthcare policies and decision-making, which is limited in low- and middle-income countries (LMICs), might be promoted through the improvement of the conduct and reporting of studies. Although the literature indicates that there are many issues affecting the conduct, reporting and use of this evidence, it is unclear which factors should be prioritised in finding solutions. This study aims to identify the top priority issues that impede the conduct, reporting and use of economic evaluation as well as potential solutions as an input for future research topics by the international Decision Support Initiative and other movements. Methods A survey on issues regarding the conduct, reporting and use of economic evaluation as well as on potential solutions was conducted using an online questionnaire among researchers who have experience in conducting economic evaluations in LMICs. The respondents were requested to consider the list of issues provided, rank the most important ones and propose solutions. A scoring system was applied to derive the ranking of difficulties according to researchers’ responses. Issues were grouped into technical and context-specific difficulties and analysed separately as a whole and by region. Results Researchers considered the lack of quality local clinical data, poor reporting and insufficient data to conduct the analysis from the chosen perspective as the most important technical difficulties. On the other hand, the non-integration of economic evaluations into decision-making was considered the most important context-specific issue. Finally, context-specific issues were considered the larger barrier to the use of economic evaluation. Conclusion The technical issues that were considered most important were closely linked with the lack of an appropriately functioning information system as well as the capacity to generate essential contextual information (e.g. data and locally relevant utility values), especially when the methodology is complex. To overcome this, simpler approaches to collect data that yields information of comparable quality to more rigorous methods should be developed. The international community can play a major role through research on methodologies feasible for LMIC settings as well as in building research capacity in countries. Context-specific issues, which were recognised as larger barriers, should be improved in parallel. Electronic supplementary material The online version of this article (10.1186/s12961-018-0280-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alia Luz
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
| | - Benjarin Santatiwongchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand.
| | - Juntana Pattanaphesaj
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
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Quality Assessment of Published Articles in Iranian Journals Related to Economic Evaluation in Health Care Programs Based on Drummond's Checklist: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2017; 42:427-436. [PMID: 29234174 PMCID: PMC5722959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Health economic evaluation research plays an important role in selecting cost-effective interventions. The purpose of this study was to assess the quality of published articles in Iranian journals related to economic evaluation in health care programs based on Drummond's checklist in terms of numbers, features, and quality. In the present review study, published articles (Persian and English) in Iranian journals related to economic evaluation in health care programs were searched using electronic databases. In addition, the methodological quality of articles' structure was analyzed by Drummond's standard checklist. Based on the inclusion criteria, the search of databases resulted in 27 articles that fully covered economic evaluation in health care programs. A review of articles in accordance with Drummond's criteria showed that the majority of studies had flaws. The most common methodological weakness in the articles was in terms of cost calculation and valuation. Considering such methodological faults in these studies, it is anticipated that these studies would not provide an appropriate feedback to policy makers to allocate health care resources correctly and select suitable cost-effective interventions. Therefore, researchers are required to comply with the standard guidelines in order to better execute and report on economic evaluation studies.
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Mayer S, Kiss N, Łaszewska A, Simon J. Costing evidence for health care decision-making in Austria: A systematic review. PLoS One 2017; 12:e0183116. [PMID: 28806728 PMCID: PMC5555669 DOI: 10.1371/journal.pone.0183116] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/28/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With rising healthcare costs comes an increasing demand for evidence-informed resource allocation using economic evaluations worldwide. Furthermore, standardization of costing and reporting methods both at international and national levels are imperative to make economic evaluations a valid tool for decision-making. The aim of this review is to assess the availability and consistency of costing evidence that could be used for decision-making in Austria. It describes systematically the current economic evaluation and costing studies landscape focusing on the applied costing methods and their reporting standards. Findings are discussed in terms of their likely impacts on evidence-based decision-making and potential suggestions for areas of development. METHODS A systematic literature review of English and German language peer-reviewed as well as grey literature (2004-2015) was conducted to identify Austrian economic analyses. The databases MEDLINE, EMBASE, SSCI, EconLit, NHS EED and Scopus were searched. Publication and study characteristics, costing methods, reporting standards and valuation sources were systematically synthesised and assessed. RESULTS A total of 93 studies were included. 87% were journal articles, 13% were reports. 41% of all studies were full economic evaluations, mostly cost-effectiveness analyses. Based on relevant standards the most commonly observed limitations were that 60% of the studies did not clearly state an analytical perspective, 25% of the studies did not provide the year of costing, 27% did not comprehensively list all valuation sources, and 38% did not report all applied unit costs. CONCLUSION There are substantial inconsistencies in the costing methods and reporting standards in economic analyses in Austria, which may contribute to a low acceptance and lack of interest in economic evaluation-informed decision making. To improve comparability and quality of future studies, national costing guidelines should be updated with more specific methodological guidance and a national reference cost library should be set up to allow harmonisation of valuation methods.
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Affiliation(s)
- Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Noemi Kiss
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Agata Łaszewska
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute Applied Diagnostics, General Hospital Vienna, Vienna, Austria
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Thiboonboon K, Santatiwongchai B, Chantarastapornchit V, Rattanavipapong W, Teerawattananon Y. A Systematic Review of Economic Evaluation Methodologies Between Resource-Limited and Resource-Rich Countries: A Case of Rotavirus Vaccines. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:659-672. [PMID: 27475634 DOI: 10.1007/s40258-016-0265-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND For more than three decades, the number and influence of economic evaluations of healthcare interventions have been increasing and gaining attention from a policy level. However, concerns about the credibility of these studies exist, particularly in studies from low- and middle- income countries (LMICs). This analysis was performed to explore economic evaluations conducted in LMICs in terms of methodological variations, quality of reporting and evidence used for the analyses. These results were compared with those studies conducted in high-income countries (HICs). METHODS Rotavirus vaccine was selected as a case study, as it is one of the interventions that many studies in both settings have explored. The search to identify individual studies on rotavirus vaccines was performed in March 2014 using MEDLINE and the National Health Service Economic Evaluation Database. Only full economic evaluations, comparing cost and outcomes of at least two alternatives, were included for review. Selected criteria were applied to assess methodological variation, quality of reporting and quality of evidence used. RESULTS Eighty-five studies were included, consisting of 45 studies in HICs and 40 studies in LMICs. Seventy-five percent of the studies in LMICs were published by researchers from HICs. Compared with studies in HICs, the LMIC studies showed less methodological variety. In terms of the quality of reporting, LMICs had a high adherence to technical criteria, but HICs ultimately proved to be better. The same trend applied for the quality of evidence used. CONCLUSION Although the quality of economic evaluations in LMICs was not as high as those from HICs, it is of an acceptable level given several limitations that exist in these settings. However, the results of this study may not reflect the fact that LMICs have developed a better research capacity in the domain of health economics, given that most of the studies were in theory led by researchers from HICs. Putting more effort into fostering the development of both research infrastructure and capacity building as well as encouraging local engagement in LMICs is thus necessary.
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Affiliation(s)
- Kittiphong Thiboonboon
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Muang, Nonthaburi, 11000, Thailand.
| | - Benjarin Santatiwongchai
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Muang, Nonthaburi, 11000, Thailand
| | - Varit Chantarastapornchit
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Muang, Nonthaburi, 11000, Thailand
| | - Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Muang, Nonthaburi, 11000, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Muang, Nonthaburi, 11000, Thailand
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Rizk R, Hiligsmann M, Karavetian M, Evers SMAA. Economic evaluations of interventions to manage hyperphosphataemia in adult haemodialysis patients: A systematic review. Nephrology (Carlton) 2016; 21:178-87. [DOI: 10.1111/nep.12584] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Rana Rizk
- Department of Health Services Research; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
| | - Mirey Karavetian
- Department of Natural Sciences in Public Health; College of Sustainability Sciences and Humanities; Zayed University; Dubai United Arab Emirates
| | - Silvia MAA Evers
- Department of Health Services Research; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
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Santatiwongchai B, Chantarastapornchit V, Wilkinson T, Thiboonboon K, Rattanavipapong W, Walker DG, Chalkidou K, Teerawattananon Y. Methodological variation in economic evaluations conducted in low- and middle-income countries: information for reference case development. PLoS One 2015; 10:e0123853. [PMID: 25950443 PMCID: PMC4423853 DOI: 10.1371/journal.pone.0123853] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/1969] [Accepted: 07/20/1969] [Indexed: 11/18/2022] Open
Abstract
Information generated from economic evaluation is increasingly being used to inform health resource allocation decisions globally, including in low- and middle- income countries. However, a crucial consideration for users of the information at a policy level, e.g. funding agencies, is whether the studies are comparable, provide sufficient detail to inform policy decision making, and incorporate inputs from data sources that are reliable and relevant to the context. This review was conducted to inform a methodological standardisation workstream at the Bill and Melinda Gates Foundation (BMGF) and assesses BMGF-funded cost-per-DALY economic evaluations in four programme areas (malaria, tuberculosis, HIV/AIDS and vaccines) in terms of variation in methodology, use of evidence, and quality of reporting. The findings suggest that there is room for improvement in the three areas of assessment, and support the case for the introduction of a standardised methodology or reference case by the BMGF. The findings are also instructive for all institutions that fund economic evaluations in LMICs and who have a desire to improve the ability of economic evaluations to inform resource allocation decisions.
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Affiliation(s)
| | | | - Thomas Wilkinson
- NICE International, National Institute for Health and Care Excellence, London, United Kingdom
| | | | | | - Damian G Walker
- Global Health Program, Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Kalipso Chalkidou
- NICE International, National Institute for Health and Care Excellence, London, United Kingdom
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Zhang R, Modaresi F, Borisenko O. Health economic evaluations of medical devices in the People's Republic of China: A systematic literature review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:195-204. [PMID: 25914551 PMCID: PMC4399785 DOI: 10.2147/ceor.s78752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The objective of this study is to identify and review the methodological quality of health economic evaluations of medical devices performed in the People’s Republic of China. To our knowledge, no such investigations have been performed to date. Methods A systematic literature review involving searches of Medline, Medline In-Process, the National Health Service Economic Evaluation Database, the Cost-Effectiveness Analysis Registry of the Tufts Medical Center, and the Wanfang Database was performed. The search spanned the period from 1990 to 2013. Studies on health economic evaluations of medical devices, in-vitro diagnostics, procedures, and the use of medical devices in Chinese health care settings were included. Full-text articles and conference abstracts in English and Chinese were included. Results Fifty-seven publications were included, 26 (46%) of which were in English and 31 (54%) of which were in Chinese. The included publications covered a wide range of clinical areas, such as surgery (n=23, 40%), screening (n=9, 16%), imaging use (n=6, 11%), kidney intervention (n=4, 7%), and nine other technological areas. Most of the studies (n=31, 54%) were cost analyses. Among the others, 13 (50%) studies used modeling, and another 13 (50%) were within-trial evaluations. Among studies that used modeling, eleven (85%) conducted sensitivity analyses, six of which had one-way sensitivity analysis, whereas one conducted both one-way and two-way sensitivity analyses; four of these eleven modeling-based analyses included probabilistic sensitivity analyses. The incremental cost-effectiveness ratio was reported in ten (18%) studies, eight of which were screening studies. The remaining two modeling studies were in areas of imaging and oncology. Conclusion This study indicates that there are major limitations and deficiencies in the health economic evaluations on medical devices performed in the People’s Republic of China. Further efforts are required from different stakeholders – academic, governmental, and privatized – to improve health economic research capacity and to put it to use when informative decisions are made in the health care setting.
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Glassman A, Giedion U, McQueston K. Priority setting for health in emerging markets. J Comp Eff Res 2014; 2:283-91. [PMID: 24236627 DOI: 10.2217/cer.13.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The use of health technology assessment research in emerging economies is becoming an increasingly important tool to determine the uses of health spending. As low- and middle-income countries' gross domestic product grows, the funding available for health has increased in tandem. There is growing evidence that comparative effectiveness research and cost-effectiveness can be used to improve health outcomes within a predefined financial space. The use of these evaluation tools, combined with a systematized process of priority setting, can help inform national and global health payers. This review of country institutions for health technology assessment illustrates two points: the efforts underway to use research to inform priorities are widespread and not confined to wealthier countries; and many countries' efforts to create evidence-based policy are incomplete and more country-specific research will be needed. Further evidence shows that there is scope to reduce these gaps and opportunity to support better incorporation of data through better-defined priority-setting processes.
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Affiliation(s)
- Amanda Glassman
- Center for Global Development, 1800 Massachusetts Avenue NW, Third Floor, Washington, DC 20036, USA
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Haghparast-Bidgoli H, Kiadaliri AA, Skordis-Worrall J. Do economic evaluation studies inform effective healthcare resource allocation in Iran? A critical review of the literature. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2014; 12:15. [PMID: 25050084 PMCID: PMC4105166 DOI: 10.1186/1478-7547-12-15] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 06/28/2014] [Indexed: 11/10/2022] Open
Abstract
To aid informed health sector decision-making, data from sufficient high quality economic evaluations must be available to policy makers. To date, no known study has analysed the quantity and quality of available Iranian economic evaluation studies. This study aimed to assess the quantity, quality and targeting of economic evaluation studies conducted in the Iranian context. The study systematically reviewed full economic evaluation studies (n = 30) published between 1999 and 2012 in international and local journals. The findings of the review indicate that although the literature on economic evaluation in Iran is growing, these evaluations were of poor quality and suffer from several major methodological flaws. Furthermore, the review reveals that economic evaluation studies have not addressed the major health problems in Iran. While the availability of evidence is no guarantee that it will be used to aid decision-making, the absence of evidence will certainly preclude its use. Considering the deficiencies in the data identified by this review, current economic evaluations cannot be a useful source of information for decision makers in Iran. To improve the quality and overall usefulness of economic evaluations we would recommend; 1) developing clear national guidelines for the conduct of economic evaluations, 2) highlighting priority areas where information from such studies would be most useful and 3) training researchers and policy makers in the calculation and use of economic evaluation data.
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Affiliation(s)
| | - Aliasghar Ahmad Kiadaliri
- Health Economics Unit, Department of Clinical Sciences-Malmö, Lund University, Lund, Sweden ; Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jolene Skordis-Worrall
- Institute for Global Health, University College London, London, UK ; Department for Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Saudi Arabia is the largest country in the region and it is the largest oil producing country in the world. It is one of the few countries in the world which was not affected significantly by the global economic crisis. Health care spending is led mainly by governmental expenditure. Private sector share of the health care services is supported by the government and increasing. The demands for pharmaceutical products, medical devices and health care services is fueled by the rapidly growing population and the wide spread of chronic diseases. Publications and expertise in the field of pharmacoeconomics is scarce within the country. There is an urgent need to establish a national center for pharmacoeconomics to lead the country efforts in controlling the cost of health care services. Such a center is needed to promote pharmacoeconomics research and train health care professionals in this field.
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Affiliation(s)
- Abdullah Alkhenizan
- Department of Family Medicine and Polyclinic, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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