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Tantivess S, Chalkidou K, Tritasavit N, Teerawattananon Y. Health Technology Assessment capacity development in low- and middle-income countries: Experiences from the international units of HITAP and NICE. F1000Res 2017; 6:2119. [PMID: 29333249 PMCID: PMC5749126 DOI: 10.12688/f1000research.13180.1] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 12/04/2022] Open
Abstract
Health Technology Assessment (HTA) is policy research that aims to inform priority setting and resource allocation. HTA is increasingly recognized as a useful policy tool in low- and middle-income countries (LMICs), where there is a substantial need for evidence to guide Universal Health Coverage policies, such as benefit coverage, quality improvement interventions and quality standards, all of which aim at improving the efficiency and equity of the healthcare system. The Health Intervention and Technology Assessment Program (HITAP), Thailand, and the National Institute for Health and Care Excellence (NICE), UK, are national HTA organizations providing technical support to governments in LMICs to build up their priority setting capacity. This paper draws lessons from their capacity building programs in India, Colombia, Myanmar, the Philippines, and Vietnam. Such experiences suggest that it is not only technical capacity, for example analytical techniques for conducting economic evaluation, but also management, coordination and communication capacity that support the generation and use of HTA evidence in the respective settings. The learned lessons may help guide the development of HTA capacity in other LMICs.
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Affiliation(s)
- Sripen Tantivess
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand, Muang, Nonthaburi, 11000, Thailand
| | | | - Nattha Tritasavit
- International Unit, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand, Muang, Nonthaburi, 11000, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand, Muang, Nonthaburi, 11000, Thailand
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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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Babigumira JB, Jenny AM, Bartlein R, Stergachis A, Garrison LP. Health technology assessment in low- and middle-income countries: a landscape assessment. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2016. [DOI: 10.1111/jphs.12120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Objectives
Health technology assessment (HTA) for a wide range of healthcare technologies is an essential component of well-functioning health systems. Knowledge of the use of HTA in low- and middle-income countries (LMICs) is limited.
Methods
We performed a survey of HTA in selected LMICs. We interviewed key stakeholders on the use, conduct and challenges of performing HTA in their countries. We performed mixed-methods analyses to identify, characterize and describe HTA and how it relates to gross domestic product and government effectiveness.
Key findings
Of the 19 countries selected for participation, stakeholders in 12 (63%) countries responded to the survey – Afghanistan, Bangladesh, Democratic Republic of Congo (DR Congo), Dominican Republic, Ethiopia, Jordan, Kenya, Namibia, Rwanda, South Africa, Swaziland and Vietnam. Eight countries surveyed have some form of informal HTA activity conducted by stakeholders including academia, industry, government and the World Health Organization. There is evidence of knowledge sharing with five countries using HTAs from their neighbouring countries or from more developed countries. We found no evidence of formal HTA performed through dedicated, independent bodies in the LMICs surveyed. There was some evidence that HTA was moderately related to GDP per capita and strongly related to degree of centralization (government effectiveness). Respondents identified resources, both financial and human, as challenges to conducting HTA.
Conclusions
Formal HTA appears to be non-existent or limited in the LMICs surveyed but some evidence of informal HTA exists. Efforts to formalize HTA and to use existing HTA evidence will improve the quality of regulatory, coverage, formulary and reimbursement decisions, and individual and public health.
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Affiliation(s)
- Joseph B Babigumira
- Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Alisa M Jenny
- Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Andy Stergachis
- Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Louis P Garrison
- Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA
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Musuuza JS, Singer ME, Mandalakas AM, Katamba A. Key actors' perspectives on cost-effectiveness analysis in Uganda: a cross-sectional survey. BMC Health Serv Res 2014; 14:539. [PMID: 25363234 PMCID: PMC4232642 DOI: 10.1186/s12913-014-0539-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/20/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cost effectiveness analysis (CEA) is a useful tool for allocation of constrained resources, yet CEA methodologies are rarely taught or implemented in developing nations. We aimed to assess exposure to, and interest in CEA, and identify barriers to implementation in Uganda. METHODS A cross-sectional survey was carried out in Uganda using a newly developed self-administered questionnaire (via online and paper based approaches), targeting the main health care actors as identified by a previous study. RESULTS Overall, there was a 68% response rate, with a 92% (69/75) response rate among the paper-based respondents compared to a 40% (26/65) rate with the online respondents. Seventy eight percent (74/95) of the respondents had no exposure to CEA. None of those with a master of medicine degree had any CEA exposure, and 80% of technical officers, who are directly involved in policy formulation, had no CEA exposure. Barriers to CEA identified by more than 50% of the participants were: lack of information technology (IT) infrastructure (hardware and software); lack of local experts in the field of CEA; lack of or limited local data; limited CEA training in schools; equity or ethical issues; and lack of training grants incorporating CEA. 93% reported a lot of interest in learning to conduct CEA, and over 95% felt CEA was important for clinical decision making and policy formulation. CONCLUSIONS Among health care actors in Uganda, there is very limited exposure to, but substantial interest in conducting CEA and including it in clinical decision making and health care policy formation. Capacity to undertake CEA needs to be built through incorporation into medical training and use of regional approaches.
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Comparing cost-effectiveness results for a vaccine across different countries worldwide: what can we learn? Adv Ther 2014; 31:1095-108. [PMID: 25331617 PMCID: PMC4209096 DOI: 10.1007/s12325-014-0160-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Cost-effectiveness analysis (CEA) using country-specific thresholds tied to gross domestic product (GDP) might not be appropriate in countries with low healthcare investment and a high disease burden as a consequence. METHODS Using data from previously published CEA of rotavirus vaccination across nine countries worldwide, we calculated the cost neutral price (Pn) for the new intervention that reflects the price resulting in no net increase in health care costs compared with the current situation, and the maximum price (Pm) obtained with an incremental cost-effectiveness ratio (ICER) at the threshold value of 1×GDP/capita. RESULTS In countries with low GDP/capita, the paradoxical finding for rotavirus vaccination is that the Pm is much higher than in countries with a high GDP/capita. On the other hand, the Pn for the low GDP/capita countries is much lower than for high GDP/capita countries because of the low investment in health care. CONCLUSION In countries with low healthcare investment and a high disease burden, the difference between the Pn and Pm for rotavirus vaccine which is the price range within which the ICER is below the World Health Organization (WHO) threshold value, is large. One reason could be that the WHO threshold value may not properly account for the local opportunity cost of health care expenditures. Therefore, either alternative threshold values should be selected or alternative economic assessment tools should be considered, such as budget optimisation or return on investment, if we want to communicate about real economic value of new vaccines in those countries.
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Nguyen TA, Knight R, Roughead EE, Brooks G, Mant A. Policy options for pharmaceutical pricing and purchasing: issues for low- and middle-income countries. Health Policy Plan 2014; 30:267-80. [PMID: 24425694 DOI: 10.1093/heapol/czt105] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pharmaceutical expenditure is rising globally. Most high-income countries have exercised pricing or purchasing strategies to address this pressure. Low- and middle-income countries (LMICs), however, usually have less regulated pharmaceutical markets and often lack feasible pricing or purchasing strategies, notwithstanding their wish to effectively manage medicine budgets. In high-income countries, most medicines payments are made by the state or health insurance institutions. In LMICs, most pharmaceutical expenditure is out-of-pocket which creates a different dynamic for policy enforcement. The paucity of rigorous studies on the effectiveness of pharmaceutical pricing and purchasing strategies makes it especially difficult for policy makers in LMICs to decide on a course of action. This article reviews published articles on pharmaceutical pricing and purchasing policies. Many policy options for medicine pricing and purchasing have been found to work but they also have attendant risks. No one option is decisively preferred; rather a mix of options may be required based on country-specific context. Empirical studies in LMICs are lacking. However, risks from any one policy option can reasonably be argued to be greater in LMICs which often lack strong legal systems, purchasing and state institutions to underpin the healthcare system. Key factors are identified to assist LMICs improve their medicine pricing and purchasing systems.
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Affiliation(s)
- Tuan Anh Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia
| | - Rosemary Knight
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia
| | - Elizabeth Ellen Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia
| | - Geoffrey Brooks
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia
| | - Andrea Mant
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia Pharmacoeconomic and Pharmaceutical Administration Department, Hanoi University of Pharmacy, 13-15 Le Thanh Tong St., Hanoi, Vietnam School of Public Health and Community Medicine, University of New South Wales, High St, Kensington NSW 2052, Australia and Pharmaceutical Consultant, Adelaide Parade, Woollahra, NSW 2025, Australia
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Catić T, Skrbo S. Pharmacoeconomic education for pharmacy students in bosnia and herzegovina. Mater Sociomed 2013; 25:282-5. [PMID: 24511276 PMCID: PMC3914744 DOI: 10.5455/msm.2013.25.282-285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/25/2013] [Indexed: 11/29/2022] Open
Abstract
Pharmacoeconomic (PE) is becoming more important in pharmaceutical reimbursement decision and drug evaluation. To ensure its appropriate application, conduction and assessment of studies it is important to have well trained and educated professionals. Pharmaceutical faculties all over the world have established PE in under- and post-graduate curricula's. In this pilot research we examine situation in B&H. In Bosnia-Herzegovina, education in this field is poor and only one faculty for pharmacy has introduced PE as subject in its program. Objective of this study is to explore understanding of PE and its concept and analysis and to evaluated adopted knowledge among graduate (fifth year/tenth semester) pharmacy students who have listened subject "pharmacoeconomics" in previous semester. A self-administered questionnaire was developed consisted of 12 questions and survey was conducted among students. Results are analyzed in MS Excel and we used descriptive statistics. Even graduate students have lessons from PE they understand its scope and definition, but do not feel capable for conducting PE studies, but show interest in additional education and getting competencies in this field finding it applicable in their future professional engagements.
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Affiliation(s)
- Tarik Catić
- Society for Pharmacoeconomics and Outcomes Research in Bosnia and Herzegovina - ISPOR BH, Sarajevo, Bosnia and Herzegovina
| | - Selma Skrbo
- Faculty for Pharmacy University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Soliman AM, Hussein M, Abdulhalim AM. Pharmacoeconomic education in Egyptian schools of pharmacy. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2013; 77:57. [PMID: 23610475 PMCID: PMC3631732 DOI: 10.5688/ajpe77357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 10/28/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE. To investigate the status of pharmacoeconomics education in Egyptian schools of pharmacy and compile and construct recommendations on how Egypt and similar countries could improve their educational infrastructure in pharmacoeconomics. METHODS. A modified version of a published survey instrument was sent to all schools of pharmacy in Egypt (n= 24). The data were assessed to identify associations between offering pharmacoeconomics education and school characteristics. RESULTS. Usable responses were obtained from 20 schools (response rate: 83%). Only 7 schools offered pharmacoeconomics education, with a median of 20 teaching hours per semester. Among respondents, 4 schools had instructors with some training in pharmacoeconomics and only 1 school had a faculty member with PhD-level training. Only 4 schools offered graduate-level courses in pharmacoeconomics. Eight additional schools expressed interest in teaching pharmacoeconomics in the near future. Having 1 or more faculty members with training in pharmacoeconomics was significantly associated with offering pharmacoeconomics education (p = 0.03). CONCLUSIONS. Pharmacoeconomics education in Egypt is still in its infancy and there exists a unique opportunity for well-trained instructors and researchers to fill this gap. Providing structured pharmacoeconomics education to student pharmacists, researchers, and stakeholders can help countries establish an integrated scientific community that can start applying pharmacoeconomic evidence to healthcare decision-making.
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Affiliation(s)
- Ahmed M Soliman
- The University of Minnesota College of Pharmacy, 308 Harvard St SE,Minneapolis, MN 55455, USA.
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EARLY AWARENESS AND ALERT ACTIVITIES IN LATIN AMERICA: CURRENT SITUATION IN FOUR COUNTRIES. Int J Technol Assess Health Care 2012; 28:315-20. [DOI: 10.1017/s0266462312000311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives: The aim of this study was to briefly describe the current state of early awareness and alert (EAA) activities and systems in four Latin-American countries (Argentina, Brazil, Colombia, and Mexico).Methods: Key informants were selected and completed an open questionnaire that included the following domains: current state of EAA activities and systems in each country, potential role for EAA systems in the health system, and future EAA projects that are currently being considered.Results: In all four countries, health technology assessment (HTA) processes are used to prioritize the use of health resources, albeit at varying degrees and with different mechanisms and methodologies. EAA activities are still limited and there are virtually no institutions or units with specific functions explicitly devoted to EAA activity. However, most countries have developed some initial forms of EAA systems. Being in its initial stages there is no clear differentiation between these early awareness activities and other HTA functions, and no specific methodologies or processes are used to anticipate the emergence of new technologies. Consequently, early evaluation of technologies generally occurs in a reactive manner, after they have been introduced in the market and under the pressure of different stakeholders.Conclusions: There is growing awareness that the early identification and assessment of emerging technologies should be an integral part of HTA and the decision-making process. Many initiatives are currently focusing on building partnerships between the various regulatory bodies involved in the incorporation of technologies at national levels. It is reasonable to foresee that EAA activities will continue to develop and expand in the region.
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Lafi R, Robinson S, Williams I. Economic evaluation and the Jordan Rational Drug List: an exploratory study of national-level priority setting. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:771-776. [PMID: 22867788 DOI: 10.1016/j.jval.2012.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 02/19/2012] [Accepted: 04/07/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To explore the extent of and barriers to the use of economic evaluation in compiling the Jordan Rational Drug List in the health care system of Jordan. METHODS The research reported in this article involved a case study of the Jordan Rational Drug List. Data collection methods included semi-structured interviews with decision makers and analysis of secondary documentary sources. The case study was supplemented by additional interviews with a small number of Jordanian academics involved in the production of economic evaluation. RESULTS The research found that there was no formal requirement for cost-effectiveness information submitted as part of the decision-making process for the inclusion of new technologies on the Jordan Rational Drug List. Both decision makers and academics suggested that economic evidence was not influential in formulary decisions. This is unusual for national formulary bodies. The study identified a number of barriers that prevent substantive and routine use of economic evaluation. While some of these echo findings of previous studies, others-notably the extent to which the sectional interests of clinical groups and commercial (pharmaceutical) industry exert undue influence over decision making-more obviously result from the specific Jordanian context. CONCLUSIONS Economic evaluation was not found to be influential in the Jordan Rational Drug List. Recommendations for improvement include enhancing capacity in relation to generating, accessing, and/or applying health economic analysis to priority setting decisions. There is a further need to incentivize the use of economic evaluation, and this requires that organizational and structural impediments be removed.
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Affiliation(s)
- Rania Lafi
- Health Services Management Centre, University of Birmingham, UK
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TRANSFERABILITY OF HEALTH TECHNOLOGY ASSESSMENT REPORTS IN LATIN AMERICA: AN EXPLORATORY SURVEY OF RESEARCHERS AND DECISION MAKERS. Int J Technol Assess Health Care 2012; 28:180-6. [DOI: 10.1017/s0266462312000074] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: HTA agencies, especially in developing countries, are under resourced and unable to conduct the desired amount of assessments. Adapting HTA reports (HTAs) from other jurisdictions is an alternative for saving resources.Objectives: To explore HTA transferability experiences in Latin-America and Caribbean (LAC): are decision makers (DMs) using HTAs from other jurisdictions? Are researchers adapting HTAs when developing local reports? How useful is the information found in HTAs from other jurisdictions?Methods: Web-based survey sent to 13031 HTA researchers and DMs.Results: We received 671 responses from 19 countries. DMs reported using HTAs from other jurisdictions to guide decisions in the majority of the situations: 52.6 percent HTAs from outside LAC (e.g., Europe), 23.1 percent from other LAC countries, and only 24.3 percent HTAs from their own countries. 63 percent of researchers reported using HTAs from other jurisdictions. Usefulness scored significantly higher for HTAs from other jurisdictions as compared to local HTAs (7.1 versus 6.0 in a 1–10 scale; p < .01). Both DMs and researchers considered the information regarding safety and effectiveness more applicable than the information on social aspects, or economic evaluation. Barriers that limit transferability had significantly different scores for HTAs from other LAC countries as compared to those from regions outside LAC (i.e., poor methodological quality 6.7 versus 5.3, different epidemiological context 6.0 versus 7.4; all p < .01).Conclusions: HTAs from outside the region are commonly used. However, DMs and researchers agreed that HTAs from LAC had the greatest potential for transferability, provided that barriers such as poor methodological quality could be overcome.
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Simpson KN, Baran RW, Kirbach SE, Dietz B. Economics of switching to second-line antiretroviral therapy with lopinavir/ritonavir in Africa: estimates based on DART trial results and costs for Uganda and Kenya. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:1048-54. [PMID: 22152173 DOI: 10.1016/j.jval.2011.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 06/19/2011] [Accepted: 06/20/2011] [Indexed: 05/21/2023]
Abstract
BACKGROUND Substantial immunological improvement has been reported for HIV-infected patients who switch from a failing regimen to a protease inhibitor regimen with Lopinavir/ritonavir (LPV/r). We use decision analysis modeling to estimate health and economic consequences expected from this switch. METHODS A Markov model combined best evidence for CD4(+) T-cell response, infectious disease events, death rates, and quality of life for African populations with Kenyan and Ugandan data on drug and medical care costs. We estimate the incremental cost-effectiveness ratio of switching to an LPV/r-based regimen versus remaining on a failed first antiretroviral (ARV) regimen or discontinuing all ARV drugs. The model assumes concurrent use of cotrimoxazole, and 4% annual loss to follow-up. Local effects due to prevalence of malaria and tuberculosis are included in the model. Sensitivity analysis examines the effects of varying disease, ARV therapy and CD4(+) T-cell cost, and ART discontinuation assumptions. RESULTS The base model estimates an improvement of 20 months in average survival for the LPV/r group. The respective LPV/r ICER for Kenya is $1483 per quality-adjusted life year (QALY) compared to $1673/QALY for Uganda. The ICERs increase to $1517 and $1707, respectively, if CD4(+) T-cell tests cost $25. The model comparing switching to LPV/r to discontinuing all ARV drugs decreases both costs and benefits proportionally for the treatment groups. CONCLUSION The estimates are clearly below the most stringent World Health Organization benchmark for cost-effectiveness for Kenya and within the acceptable range of cost-effectiveness for Uganda. Thus, the switch to second-line therapy with LPV/r in these countries appears to be a cost-effective use of resources.
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Affiliation(s)
- Kit N Simpson
- Department of Health Leadership and Management, Medical University of South Carolina, Charleston, SC 29425, USA.
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Ijaz S, Marinho VCC, Croucher R, Onwude O, Rutterford C. Professionally applied fluoride paint-on solutions for the control of dental caries in children and adolescents. Hippokratia 2010. [DOI: 10.1002/14651858.cd008364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sharea Ijaz
- Queen Mary University of London; Clinical and Diagnostic Oral Sciences, Barts and The London School of Medicine and Dentistry; Turner Street Whitechapel London UK E1 2AD
| | - Valeria CC Marinho
- Queen Mary University of London; Clinical and Diagnostic Oral Sciences, Barts and The London School of Medicine and Dentistry; Turner Street Whitechapel London UK E1 2AD
| | - Ray Croucher
- Queen Mary University of London; Clinical and Diagnostic Oral Sciences, Barts and The London School of Medicine and Dentistry; Turner Street Whitechapel London UK E1 2AD
| | - Obinna Onwude
- Queen Mary University of London; Clinical and Diagnostic Oral Sciences, Barts and The London School of Medicine and Dentistry; Turner Street Whitechapel London UK E1 2AD
| | - Clare Rutterford
- Queen Mary University of London; Centre for Health Sciences; 2.05 Abernathy building 2 Newark Street London UK E1 2AT
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Yothasamut J, Tantivess S, Teerawattananon Y. Using economic evaluation in policy decision-making in Asian countries: mission impossible or mission probable? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12 Suppl 3:S26-S30. [PMID: 20586976 DOI: 10.1111/j.1524-4733.2009.00623.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES AND METHODS This article provides an extensive review of literature and an in-depth analysis aimed at introducing potential applications of economic evaluation and at addressing the barriers that could prohibit the use or diminish the usefulness of economic evaluation in Asian settings. It also proposes the probable solutions to overcome these barriers. RESULTS Potential uses of economic evaluation include the development of public reimbursement lists, price negotiation, the development of clinical practice guidelines, and communicating with prescribers. Two types of barriers to using economic evaluation, namely barriers relating to the production of economic evaluation data and decision context-related barriers, are identified. For the first sort of barrier, the development of the national guidelines, the development of economic evaluation database, planning and use of economic evaluation in a systematic manner, and prioritization of topics for assessment are recommended. Furthermore, educating potential users and the public, making the economic evaluation process transparent and participatory, and incorporating other health preferences into the decision-making framework have been promoted to conquer decision context-related barriers. CONCLUSIONS It seems practically impossible to adopt other countries' approaches using economic evaluation for priority setting because of several constraints specifically related to the context of each setting. Nevertheless, given a better understanding of its resistance, and proper policies and strategies to overcome the barriers applied, it is more than probable that a method with system/mechanisms specifically designed to fit particular settings will be used.
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Affiliation(s)
- Jomkwan Yothasamut
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.
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Baltussen R, Acharya A, Antioch K, Chisholm D, Grieve R, Kirigia J, Torres-Edejer TT, Walker D, Evans D. Cost-Effectiveness and Resource Allocation (CERA) - directions for the future. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2009; 7:14. [PMID: 19627597 PMCID: PMC2728096 DOI: 10.1186/1478-7547-7-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 07/23/2009] [Indexed: 11/10/2022] Open
Abstract
The journal Cost-Effectiveness and Resource Allocation (CERA) is now in its seventh year, and is an excellent example of how open access publishing can improve dissemination. Now the journal is through its infancy, it is time to reflect on its orientation and to define the strategy for the years to come. Firstly, the journal will pay particular attention to stimulating and publishing studies originating from low- and middle-income countries. Second, CERA will continue to solicit contributions originating from high-income countries, but with the caveat that such studies should be of interest to the broad international readership of the journal. Third, the journal encourages submissions on methodological work from any setting, that is generalisable between low-, middle-, and high income countries. Fourth, CERA recognizes the development of national health accounts and expenditure tracking as a first step to improved resource allocation, and solicit manuscripts of this nature. Finally, CERA recognizes that cost and cost-effectiveness analysis alone may not provide sufficient information to decision makers to guide their choices on the allocation of resources, and therefore encourages submission of studies that advance the broader field of priority-setting.
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Affiliation(s)
- Rob Baltussen
- Department of Community and Primary Care, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
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Baltussen R, Smith A. Cost-effectiveness of selected interventions for hearing impairment in Africa and Asia: A mathematical modelling approach. Int J Audiol 2009; 48:144-58. [DOI: 10.1080/14992020802538081] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Augustovski F, Iglesias C, Manca A, Drummond M, Rubinstein A, Martí SG. Barriers to generalizability of health economic evaluations in Latin America and the Caribbean region. PHARMACOECONOMICS 2009; 27:919-929. [PMID: 19888792 DOI: 10.2165/11313670-000000000-00000] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Use and acceptance of health economic evaluations (HEEs) has been much greater in developed than in developing nations. Nevertheless, while developing countries lag behind in the development of HEE methods, they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs. HEEs, as context-specific tools, are not easily generalizable from setting to setting. Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries. Therefore, a legitimate question for policy makers in Latin America and the Caribbean region (LAC) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC (trans-regional) and to other LAC countries (intra-regional), respectively. We conducted a systematic review, searching the NHS Economic Evaluation Database (NHS EED), Office of Health Economics Health Economic Evaluation Database (HEED), LILACS (Latin America health bibliographic database) and NEVALAT (Latin American Network on HEE) to identify HEEs published between 1980 and 2004. We included individual patient- and model-based HEEs (cost-effectiveness, cost-utility, cost-benefit and cost-consequences analyses) that involved at least one LAC country. Data were extracted by three independent reviewers using a checklist validated by regional and international experts. From 521 studies retrieved, 72 were full HEEs (39% randomized controlled trials [RCTs], 32% models, 17% non-randomized studies and 12% mixed trial-modeling approach). Over one-third of identified studies did not specifically report the type of HEE. Cost-effectiveness and cost-consequence analyses accounted for almost 80% of the studies. The three Latin American countries with the highest participation in HEE studies were Brazil, Argentina and Mexico. While we found relatively good standards of reporting the study's question, population, interventions, comparators and conclusions, the overall reporting was poor, and evidence of unfamiliarity with international guidelines was evident (i.e. absence of incremental analysis, of discounting long-term costs and effects). Analysis or description of place-to-place variability was infrequent. Of the 49 trial-based analyses, 43% were single centre, 33% multinational and 18% multicentre national. Main reporting problems included issues related to sample representativeness, data collection and data analysis. Of the 32 model-based studies (most commonly using epidemiological models), main problems included the inadequacy of search strategy, range selection for sensitivity analysis and theoretical justifications. There are a number of issues associated with the reporting and methodology used in multinational and local HEE studies relevant for LAC that preclude the assessment of their generalizability and potential transferability. Although the quality of reporting and methodology used in model-based HEEs was somewhat higher than those from trial-based HEEs, economic evaluation methodology was usually weak and less developed than the analysis of clinical data. Improving these aspects in LAC HEE studies is paramount to maximizing their potential benefits such as increasing the generalizability/transferability of their results.
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Affiliation(s)
- Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria-Servicio de Medicina Familiar y Comunitaria, Hospital Italiano, Buenos Aires, Argentina
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Tantivess S, Teerawattananon Y, Mills A. Strengthening cost-effectiveness analysis in Thailand through the establishment of the health intervention and technology assessment program. PHARMACOECONOMICS 2009; 27:931-945. [PMID: 19888793 DOI: 10.2165/11314710-000000000-00000] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Capacity is limited in the developing world to conduct cost-effectiveness analysis (CEA) of health interventions. In Thailand, there have been concerted efforts to promote evidence-based policy making, including the introduction of economic appraisals within health technology assessment (HTA). This paper reviews the experience of this lower middle-income country, with an emphasis on the creation of the Health Intervention and Technology Assessment Program (HITAP), including its mission, management structures and activities. Over the past 3 decades, several HTA programmes were implemented in Thailand but not sustained or developed further into a national institute. As a response to increasing demands for HTA evidence including CEA information, the HITAP was created in 2007 as an affiliate unit of a semi-autonomous research arm of the Ministry of Public Health. An advantage of this HTA programme over previous initiatives was that it was hosted by a research institute with long-term experience in conducting health systems and policy research and capacity building of its research staff, and excellent research and policy networks. To deal with existing impediments to conducting health economics research, the main strategies of the HITAP were carefully devised to include not only capacity strengthening of its researchers and administrative staff, but also the development of essential elements for the country's health economic evaluation methodology. These included, for example, methodological guidelines, standard protocols and benchmarks for resource allocation, many of which have been adopted by national policy-making bodies including the three major public health insurance plans. Networks and collaborations with domestic and foreign institutes have been sought as a means of resource mobilization and exchange. Although the HITAP is well financed by a number of government agencies and international organizations, the programme is vulnerable to shortages of qualified research staff, as most staff work on a part-time or temporary basis. To enhance the utilization of its research findings by policy makers, practitioners and consumers, the HITAP has adopted the principles of technical excellence, policy relevance, transparency, effective communication and participation of key stakeholders. These principles have been translated into good practice at every step of HTA management. In 2007 and 2008, the HITAP carried out assessments of a wide range of health products, medical procedures and public health initiatives. Although CEA and other economic evaluation approaches were employed in these studies, the tools and underlying efficiency goal were considered inadequate to provide complete information for prioritization. As suggested by official stakeholders, some of the projects investigated broader issues of management, feasibility, performance and socio-political implications of interventions. As yet, it is unclear what role HITAP research and associated recommendations have played in policy decisions. It is hoped that the lessons drawn on the creation of the HITAP and its experience during the first 2 years, as well as information on its main strategies and management structures, may be helpful for other resource-constrained countries when considering how best to strengthen their capacity to conduct economic appraisals of health technologies and interventions.
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Affiliation(s)
- Sripen Tantivess
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.
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Forum. Pharmaceut Med 2008. [DOI: 10.1007/bf03256710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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