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Hamilton MP, Gao C, Wiesner G, Filia KM, Menssink JM, Plencnerova P, Baker DG, McGorry PD, Parker A, Karnon J, Cotton SM, Mihalopoulos C. A Prototype Software Framework for Transferable Computational Health Economic Models and Its Early Application in Youth Mental Health. PHARMACOECONOMICS 2024:10.1007/s40273-024-01378-8. [PMID: 38767713 DOI: 10.1007/s40273-024-01378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/22/2024]
Abstract
We are developing an economic model to explore multiple topics in Australian youth mental health policy. To help make that model more readily transferable to other jurisdictions, we developed a software framework for authoring modular computational health economic models (CHEMs) (the software files that implement health economic models). We specified framework user requirements for: a simple programming syntax; a template CHEM module; tools for authoring new CHEM modules; search tools for finding existing CHEM modules; tools for supplying CHEM modules with data; reproducible analysis and reporting tools; and tools to help maintain a CHEM project website. We implemented the framework as six development version code libraries in the programming language R that integrate with online services for software development and research data archiving. We used the framework to author five development version R libraries of CHEM modules focussed on utility mapping in youth mental health. These modules provide tools for variable validation, dataset description, multi-attribute instrument scoring, construction of mapping models, reporting of mapping studies and making out of sample predictions. We assessed these CHEM module libraries as mostly meeting transparency, reusability and updatability criteria that we have previously developed, but requiring more detailed documentation and unit testing of individual modules. Our software framework has potential value as a prototype for future tools to support the development of transferable CHEMs.Code: Visit https://www.ready4-dev.com for more information about how to find, install and apply the prototype software framework.
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Affiliation(s)
- Matthew P Hamilton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- Orygen, Parkville, Australia.
| | - Caroline Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | - Kate M Filia
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jana M Menssink
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Petra Plencnerova
- Headspace National Youth Mental Health Foundation, Melbourne, Australia
| | - David G Baker
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Patrick D McGorry
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Alexandra Parker
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
- Institute for Health and Sport, Victoria University, Footscray, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Sue M Cotton
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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2
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Rosselli D. High cost drugs in Latin America: access and barriers. Expert Rev Pharmacoecon Outcomes Res 2023. [PMID: 37185151 DOI: 10.1080/14737167.2023.2207825] [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: 05/17/2023]
Abstract
INTRODUCTION Latin America comprises a large set of culturally diverse middle-income countries sharing an inequality gap and a rapidly ageing population. A better informed growing middle class adds to the pressure on fragmented health systems that strive to attain universal coverage. Cost containment becomes crucial for sustainability. AREAS COVERED Using "high cost" as free term, together with individual country names, a search was performed in Pubmed and Scopus databases for relevant documents centered on pharmaceutical products. References of selected articles were also reviewed. EXPERT OPINION In the region as elsewhere improving health information systems has been the starting point. Official health technology assessment agencies have been established in several countries, supporting decisions on best available evidence. A few centralized procurement and price regulation schemes using international reference pricing have been successful. Fast-track approval of generics and biosimilars, or establishing a separate funding source for high cost technologies are other options that, with varying degrees of success, have been. Since Latin America is characterized by its social, geographical and political diversity, each health system needs to recognize its individual priorities, learn from successful experiences elsewhere, and adapt possible alternative interventions to the different local contexts.
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Affiliation(s)
- Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Bogota, Colombia
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3
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Heupink LF, Peacocke EF, Sæterdal I, Chola L, Frønsdal K. Considerations for transferability of health technology assessments: a scoping review of tools, methods, and practices. Int J Technol Assess Health Care 2022; 38:e78. [PMID: 36321421 DOI: 10.1017/s026646232200321x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Health technology assessment (HTA) is commonly used to guide evidence-informed decisions to optimize resource use, prioritize policies, and support countries to achieve universal health coverage. Producing HTAs requires time, scientific expertise, and political commitment, but these are not available in all settings - especially in low- and middle-income countries (LMIC) where HTA processes may be less institutionalized. Transferring and adapting existing HTAs to local settings may offer a solution while reducing duplication efforts. This scoping review aims to provide an overview of tools, methods, approaches, and considerations which can aid HTA transfers. We systematically searched (from 2005 to 2020) six databases and, using predefined inclusion criteria, included twenty-two studies. Data extraction followed a structured process, while synthesis was more iterative. We identified a common approach for HTA transfers. It follows the de novo process of undertaking original HTAs, but with additional steps to assess relevance (applicability), quality, and transferability, as well as steps to adapt parameters where necessary. The EUnetHTA Adaptation Toolkit was the only tool that provided guidance for adapting multiple HTA domains. Other tools were specific to systematic reviews (n = 1) or economic evaluations (n = 12), where one provided guidance for systematic reviews of economic evaluations. Eight papers reported transferring an HTA, with only one transferring to an LMIC. Finally, we reported issues that may facilitate or hinder transferability. In conclusion, we identified fourteen transfer approaches in the form of guidance or checklists, but harmonized and pragmatic guidance for HTA transfers to suit settings with limited HTA capacity seems warranted.
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Affiliation(s)
- Lieke Fleur Heupink
- Norwegian Institute of Public Health, Global Health, Division for Health Services Oslo, Norway
| | | | - Ingvil Sæterdal
- Norwegian Institute of Public Health, Global Health, Division for Health Services Oslo, Norway
| | - Lumbwe Chola
- Norwegian Institute of Public Health, Global Health, Division for Health Services Oslo, Norway
| | - Katrine Frønsdal
- Norwegian Institute of Public Health, Global Health, Division for Health Services Oslo, Norway
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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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Indirectness (transferability) is critical when considering existing economic evaluations for GRADE Clinical Practice Guidelines: A systematic review. J Clin Epidemiol 2022; 148:81-92. [PMID: 35462047 DOI: 10.1016/j.jclinepi.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE GRADE practice guideline developers often perform systematic reviews of potential economic evaluations to inform recommendation decision-making. We aimed to identify indirectness characteristics of economic evaluations, related to GRADE evidence-to-decision (EtD) theoretical frameworks, that influence selection of these articles. STUDY DESIGN AND SETTING MEDLINE, EMBASE, CINAHL and EconLit were systematically searched to May 2020 to identify indirectness characteristics relevant for economic evaluation transferability to GRADE evidence-to-decision (EtD) theoretical frameworks. Four reviewers screened citations to identify articles of any type that explored study characteristics most important or relevant to economic evaluation transferability, restricted to English language We generated frequencies of article features, used thematic analysis to summarize study characteristics and assessed certainty in the evidence using GRADE-CERQual. RESULTS We included 57 articles, with a dearth of empirical literature - some may have been missed. We identified 8 general themes and 28 sub-themes most important to transferability from 41% of articles. Moderate-to-high confidence evidence suggested that GRADE EtD domains of population, intervention and comparison research question elements, resource use estimation and methodology, and provider and decision-maker acceptability are most important indirectness study characteristics that economists consider when choosing economic evaluation outcomes for use in recommendation decision-making. CONCLUSION We have identified factors important for guideline developers to consider when selecting economic evaluations as research evidence. An economic competency on the development team facilitates these endeavors. This supports the GRADE Working Group's tenant of transparent reporting or availability of sufficient information elsewhere to assess indirectness.
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The transcatheter aortic valve implantation: an assessment of the generalizability of the economic evidences following a systematic review. Int J Technol Assess Health Care 2022; 38:e27. [PMID: 35321767 DOI: 10.1017/s0266462321001720] [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: 11/05/2022]
Abstract
OBJECTIVES Scientific literature debates on the economic affordability of transcatheter aortic valve implantation (TAVI) in order to give a useful support to decision makers aiming at establishing a reimbursement scheme for TAVI. For this reason, it is important to assess the quality and the generalizability of the existing economic evidences. METHODS The first step was to run a literature search according to a predefined population, intervention, comparator, and outcome on the cost and effectiveness of the TAVI procedure in comparison to medical therapy and traditional surgery. Second, a manual search was carried out on the Web sites of the main HTA agencies. Third, the checklist developed by Augustovski et al. was applied in order to assess the quality and the generalizability of the articles resulting from the selection process. RESULTS Overall, 106 articles were obtained. Of these, sixty-five articles were excluded since the title was not consistent with the objective. Further selection took place after abstract and full-text reading. In the end, thirty-one documents were included for the review. According to the checklist, none of the articles was considered generalizable and only one was considered transferable which compares the TAVI procedure with Medical Management in inoperable patients. CONCLUSIONS Despite the overall quality of the selected studies was considered good, there is still a lack of evidence on whether evidences generated in different contexts can be considered generalizable. Further research on resource consumption and preferences is needed in order to provide decision makers with more robust evidences.
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Saadatfar N, Jadidfard MP. Parents' preferences for preventive and curative dental services: A comparison between fissure sealant and composite filling using willingness-to-pay method. Int J Paediatr Dent 2021; 31:792-800. [PMID: 33548081 DOI: 10.1111/ipd.12778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 01/23/2021] [Accepted: 01/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The early years of life play a significant role in the lifelong health of humans and parents have an important role in healthcare decision making. Thus, it seems necessary for policymakers and clinicians to be aware of how parents value pediatric health services. Willingness to pay (WTP) is a recommended method for measuring the stated utility of health services/goods or health states. AIM This study aimed to elicit and compare parents' WTP for health services such as fissure sealant and composite filling. DESIGN An originally developed questionnaire was used to guide interviews with a sample of 290 parents attending a public pediatric healthcare center. Related-samples Wilcoxon signed-rank test was performed for comparing the difference in absolute WTP amounts between the two services, and linear regression was used to assess the association between WTP and relevant variables using SPSS version 21. RESULTS Mean WTP for fissure sealant and filling was 269 724 and 555 327 Tomans, respectively, and the difference between them was statistically significant (P < .001). Higher WTP amounts found in both services were associated with income levels of 4 and 5 (P < .05). CONCLUSIONS Respondents highly valued the considered services and stated a significantly higher relative preference for filling. Public awareness should be promoted about the importance of prevention of oral health diseases and the attributes of the oral healthcare system services.
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Affiliation(s)
- Navid Saadatfar
- Department of Community Oral Health, School of Dentistry, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Pooyan Jadidfard
- Department of Community Oral Health, School of Dentistry, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
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Teimourizad A, Rezapour A, Sadeghian S, Tajdini M. Cost-effectiveness of cardiac resynchronization therapy plus an implantable cardioverter-defibrillator in patients with heart failure: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:31. [PMID: 34020661 PMCID: PMC8139093 DOI: 10.1186/s12962-021-00285-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Heart failure (HF) is an unusual heart function that causes reduction in cardiac or pulmonary output. Cardiac resynchronization therapy (CRT) is a mechanical device that helps to recover ventricular dysfunction by pacing the ventricles. This study planned to systematically review cost-effectiveness of CRT combined with an implantable cardioverter-defibrillator (ICD) versus ICD in patients with HF. METHODS We used five databases (NHS Economic Evaluation Database, Cochrane Library, Medline, PubMed, and Scopus) to systematically reviewed studies published in the English language on the cost-effectiveness of CRT with defibrillator (CRT-D) Vs. ICD in patients with HF over 2000 to 2020. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was applied to assess the quality of the selected studies. RESULTS Five studies reporting the cost-effectiveness of CRT-D vs ICD were finally identified. The results revealed that time horizon, direct medical costs, type of model, discount rate, and sensitivity analysis obviously mentioned in almost all studies. All studies used quality-adjusted life years (QALYs) as an effectiveness measurement. The highest and the lowest Incremental cost-effectiveness ratio (ICER) were reported in the USA ($138,649per QALY) and the UK ($41,787per QALY), respectively. CONCLUSION Result of the study showed that CRT-D compared to ICD alone was the most cost-effective treatment in patients with HF.
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Affiliation(s)
- Abedin Teimourizad
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Saeed Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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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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Ruggeri M, Drago C, Rosiello F, Orlando V, Santori C. Economic Evaluation of Treatments for Migraine: An Assessment of the Generalizability Following a Systematic Review. PHARMACOECONOMICS 2020; 38:473-484. [PMID: 32107743 DOI: 10.1007/s40273-019-00879-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND All health economics reviews on chronic and episodic migraine published to date underline the heterogeneity of results. Currently, the need for the generalizability of economic evaluations across different jurisdictions is considered a key issue to avoid unnecessary overlaps and to minimize the time to reimbursement decisions. OBJECTIVE The aim of this study was to review the economic evaluations on the prophylaxis and treatments for migraine published in the previous 10 years (since 2009) and to perform a critical assessment of their generalizability. METHODS We searched PubMed, EMBASE, and EconLit databases. Articles underwent a three-stage selection process. To assess the level of generalizability, we used the checklist implemented by Augustovski et al. Studies were classified as: (1) generalizable; (2) transferable; and (3) context specific. RESULTS In total, 227 articles were identified after running the search string and 11 studies were included in our review. Overall, none of the studies was judged as generalizable and three were judged transferable according to the established criteria. CONCLUSIONS Our review suggests that no evidence on the economic value of either acute or prophylactic treatments against migraine is generalizable to different jurisdictions. However, the majority of studies reporting results about prophylactic treatments were found to be transferable.
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Affiliation(s)
- Matteo Ruggeri
- National Center for HTA, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162, Rome, Italy.
- St. Camillus International University of Health Sciences, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
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Jafari A, Rezapour A, Hajahmadi M. Cost-effectiveness of B-type natriuretic peptide-guided care in patients with heart failure: a systematic review. Heart Fail Rev 2019; 23:693-700. [PMID: 29744629 DOI: 10.1007/s10741-018-9710-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Measuring the level of B-type natriuretic peptide (BNP), as a guide to pharmacotherapy, can increase the survival of patients with heart failure. This study is aimed at systematically reviewing the studies conducted on the cost-effectiveness of BNP-guided care in patients with heart failure. Using the systematic review method, we reviewed the published studies on the cost-effectiveness of BNP-guided care in patients with heart failure during the years 2004 to 2017. The results showed that all studies clearly stated the time horizon of the study and included direct medical costs in their analysis. In addition, most of the studies used the Markov model. The quality-adjusted life years (QALYs) were the main outcome used for measuring the effectiveness. The studies reported various ranges of the incremental cost-effectiveness ratio (ICER); accordingly, the highest ratio was observed in the USA ($32,748) and the lowest ratio was observed in Canada ($6251). Although the results of the studies were different in terms of a number of aspects, such as the viewpoint of the study, the study horizons, and the costs of expenditure items, they reached similar results. Based on the results of the present study, it seems that the use of BNP or N-terminal pro-BNP (NT-pro-BNP) in patients with heart failure may reduce cost compared to the symptom-based clinical care and increase QALY. In this regard, these studies were designed and conducted in high-income countries; thus, the application of these results in low- and middle-income countries will be limited.
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Affiliation(s)
- Abdosaleh Jafari
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Marjan Hajahmadi
- Cardiovascular Department, Rasoul Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
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12
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Gholami SS, Azar FEF, Rezapour A, Tajdini M. Cost-effectiveness of coronary artery bypass graft and percutaneous coronary intervention compared to medical therapy in patients with coronary artery disease: a systematic review. Heart Fail Rev 2019; 24:967-975. [PMID: 31179517 DOI: 10.1007/s10741-019-09811-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Coronary artery disease (CAD) has significant social and economic implications. It is necessary to create tools to identify the most cost-effectiveness treatments, which can assist clinicians in their therapeutic decisions so that the maximum possible benefit is reached with the lowest possible cost. Effectiveness must be measured by final treatment goals in which the most effective interventions are those with the lowest costs. This study is aimed to systematically review and compare the studies conducted on the cost-effectiveness of the three coronary artery disease treatment strategies (medical treatment, percutaneous coronary intervention, and coronary artery bypass graft). In this systematic review, the databases NHS Economic Evaluation Database, Embase, MEDLINE, Science Direct, and Scopus were searched for studies on the cost-effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) compared to medical therapy (MT) in patients with coronary artery disease between 1 January 2004 to 30 September 2018. The quality appraisal of the included studies was examined using the Consolidated Health Economics Evaluation Reporting Standards (CHEERS) statement. Out of 186 unique retrievals, 8 studies were included. The results showed that the all studies clearly stated the time horizon of the study and included direct medical costs in their analysis. In addition, in most of the studies, quality-adjusted life years (QALY) were the main outcome used for measuring the effectiveness. The studies reported various ranges of the incremental cost-effectiveness ratio (ICER); accordingly, the highest ratio was observed in the USA ($212,800) for PCI v MT and the lowest ratio was observed in Brazil ($4403) for CABG v MT. Although the results of the studies were different in terms of a number of aspects, such as the viewpoint of the study, the study horizons, and the costs of expenditure items, they reached similar results. Based on the result of the present study, it seems that each three treatment strategies for CAD yielded improvements in QALY.
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Affiliation(s)
- Saeed Sheikh Gholami
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farbod Ebadi Fard Azar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Health Economics and Outcomes Research Knowledge Needs Assessment for Latin America. Value Health Reg Issues 2019; 20:2-6. [PMID: 30634087 DOI: 10.1016/j.vhri.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/30/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND An increasing awareness of the importance of health economics and outcomes research (HEOR) skills has been reported in Latin America. There is, however, no published study directly assessing perceived knowledge levels and knowledge gaps on specific HEOR topics among professionals and students in the region. OBJECTIVES To assess perceived HEOR knowledge levels and identify knowledge gaps in Latin America. METHODS An online needs assessment survey was developed to quantify perceived HEOR knowledge levels and identify knowledge gaps. Members of the International Society for Pharmacoeconomics and Outcomes Research in the Latin American region, regional chapters, and student chapter presidents were invited to participate in the survey. The survey, developed using the SurveyMonkey tool, was distributed to participants electronically. Data were extracted from the survey and analyzed using Microsoft Excel. Data analysis was conducted using descriptive statistics to summarize the survey respondents' demographic information, current and desired knowledge levels, and preferred method/format for delivery of educational training. RESULTS Survey responses were collected from 106 participants. The largest knowledge gap was calculated for methods for integrating medication adherence and persistence in health economic evaluations (mean = 2.30 ± 1.48). The smallest knowledge gap was calculated for types of healthcare costs (mean = 1.01 ± 1.17). Most respondents (74% [n = 66]) preferred to receive educational materials related to HEOR topics through online learning and continuing education programs. CONCLUSIONS The knowledge gap assessment provided current knowledge gap perceptions among members of the International Society for Pharmacoeconomics and Outcomes Research in Latin America. The survey data collected support a need for developing educational programs for topics with the highest perceived knowledge gap.
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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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Lessa F, Caccavo F, Curtis S, Ouimet-Rathé S, Lemgruber A. Strengthening and implementing health technology assessment and the decision-making process in the Region of the Americas. Rev Panam Salud Publica 2017; 41:e165. [PMID: 31384277 PMCID: PMC6650625 DOI: 10.26633/rpsp.2017.165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 08/01/2017] [Indexed: 01/18/2023] Open
Abstract
Objective. Health technology assessment (HTA) has been adopted by countries in order to
improve allocative efficiency in their health systems. This study aimed to
describe and analyze the HTA decision-making process in the Region of the
Americas. Methods. A literature review was done to better understand the HTA situation in the
Region. Also, in 2014 and 2015, individuals responsible for conducting HTA
in countries of the Americas were identified and received a questionnaire on
HTA and the decision-making process. Results. A total of 46 questionnaire responses were obtained, from 30 countries. The
respondents were similar in terms of their institutions, main funding
sources, and technology types assessed. Of the 46 respondents, 23 (50%) work
for their respective ministry of health. Also, 36 (78%) undertake and/or
coordinate HTA through coverage and reimbursement/pricing decisions and
other HTA-related activities, while 24 (52%) use HTA for emerging
technologies. While some countries in the Region have created formal HTA
units, there is a weak link between the HTA process and decision-making.
Most of the countries with recognized HTA institutions are members of the
Health Technology Assessment Network of the Americas (RedETSA). Despite the
advances in the Region overall, most countries in Central America and the
Caribbean are still at the early stages of implementing HTA to support
decision-making. Conclusions. Many countries in the Americas have benefited from the exchange and
capacity-building opportunities within RedETSA. However, there are still
many challenges to overcome in the Region in terms of the discussion and
creation of HTA-related policies.
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Affiliation(s)
- Fernanda Lessa
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Francisco Caccavo
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Stephanie Curtis
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Stéphanie Ouimet-Rathé
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Alexandre Lemgruber
- Medicines and Health Technologies Unit Pan American Health Organization/World Health Organization Washington, D.C. United States of America Medicines and Health Technologies Unit, Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
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Kuhlmann J, Keaei M, Conde R, Evers SMAA, Gonzalez J, Govers M, Hiligsmann M. A Cost-of-Illness Study of Patients with HIV/AIDS in Bogotá, Colombia. Value Health Reg Issues 2017; 14:103-107. [PMID: 29254533 DOI: 10.1016/j.vhri.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2014, 0.3% of the total population in Colombia was living with HIV/AIDS. The data currently available regarding the costs of these patients are very limited. OBJECTIVES To estimate the societal costs of patients with HIV/AIDS in Bogotá, Colombia. METHODS This study is a quantitative, cross-sectional cost-of-illness study. Costs were assessed with a prevalence-based, bottom-up approach. The data of 124 patients were collected from their medical records in a Bogotá hospital and a questionnaire was developed to measure other health care costs, as well as patient and family costs. Subgroup analyses were performed according to sex, age, Centers for Disease Control and Prevention classification, and CD4 count (cluster of differentiation 4). RESULTS The mean annual cost per patient with HIV/AIDS was estimated at $11,505 ± 18,658 (2014 US dollars). The larger part was attributable to drug costs (a mean annual cost of $8,616, 75% of the total), whereas productivity costs represented a mean annual cost of $1,044 (10%). Total costs per patient were estimated for a CD4 count of 500 or more, 200 to 499, and less than 200 cells/µl at $13,116, $9,077, and $10,741, respectively (all values in 2014 US dollars). CONCLUSIONS HIV/AIDS represents a high societal burden in Colombia. In comparison with the gross domestic product per capita of $7,904 in 2014, the mean annual cost per patient with HIV/AIDS was 40% higher, estimated at $11,505. The largest part of the HIV/AIDS costs was attributed to drugs, followed by productivity costs. Using extrapolation, the total cost of HIV/AIDS for the Colombian society would be $1.431 billion.
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Affiliation(s)
- Julien Kuhlmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Mussa Keaei
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rafael Conde
- Asistencia Cientifica de Alta Complejidad, Bogotá, Colombia; Rosario University, Bogotá, Colombia
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | | | - Mark Govers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
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Falavigna A, Scheverin N, Righesso O, Teles AR, Gullo MC, Cheng JS, Riew KD. Economic value of treating lumbar disc herniation in Brazil. J Neurosurg Spine 2016; 24:608-14. [DOI: 10.3171/2015.7.spine15441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECT
Lumbar discectomy is one of the most common surgical spine procedures. In order to understand the value of this surgical care, it is important to understand the costs to the health care system and patient for good results. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life year (QALY) gained for patients in Brazil.
METHODS
The authors performed a prospective cohort study involving 143 consecutive patients who underwent open discectomy for lumbar disc herniation (LDH). Patient-reported outcomes were assessed utilizing the SF-6D, which is derived from a 12-month variation of the SF-36. Direct medical costs included medical reimbursement, costs of hospital care, and overall resource consumption. Disability losses were considered indirect costs. A 4-year horizon with 3% discounting was applied to health-utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and US dollars ($), applying an exchange rate of 2.4:1 (the rate at the time of manuscript preparation).
RESULTS
The direct and indirect costs of open lumbar discectomy were estimated at an average of R$3426.72 ($1427.80) and R$2027.67 ($844.86), respectively. The mean total cost of treatment was estimated at R$5454.40 ($2272.66) (SD R$2709.17 [$1128.82]). The SF-6D utility gain was 0.044 (95% CI 0.03197–0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$30,828.35 ($12,845.14) per QALY gained. The sensitivity analysis showed a range of R$25,690.29 ($10,714.28) to R$38,535.44 ($16,056.43) per QALY gained.
CONCLUSIONS
The use of open lumbar discectomy to treat LDH is associated with a significant improvement in patient outcomes as measured by the SF-6D. Open lumbar discectomy performed in the Brazilian supplementary health care system provides a cost-utility ratio of R$30,828.35 ($12,845.14) per QALY. The value of acceptable cost-effectiveness will vary by country and region.
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Affiliation(s)
- Asdrubal Falavigna
- 1Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders and
| | - Nicolas Scheverin
- 2Department of Orthopaedics, Hospital Dr. Diego E. Thompson, Buenos Aires, Argentina
| | - Orlando Righesso
- 1Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders and
| | - Alisson R. Teles
- 1Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders and
| | - Maria Carolina Gullo
- 3Accountancy and Economic Sciences Center, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Joseph S. Cheng
- 4Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - K. Daniel Riew
- 5Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri
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Teles AR, Righesso O, Gullo MCR, Ghogawala Z, Falavigna A. Perspective of Value-Based Management of Spinal Disorders in Brazil. World Neurosurg 2016; 87:346-54. [DOI: 10.1016/j.wneu.2015.11.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/12/2015] [Accepted: 11/14/2015] [Indexed: 01/22/2023]
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de Paiva Haddad LB, Decimoni TC, Turri JA, Leandro R, de Soárez PC. Economic evaluations in gastroenterology in Brazil: A systematic review. World J Gastrointest Pharmacol Ther 2016; 7:162-70. [PMID: 26855823 PMCID: PMC4734950 DOI: 10.4292/wjgpt.v7.i1.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 11/13/2015] [Accepted: 12/01/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To systematically review economic evaluations in gastroenterology, relating to Brazil, published between 1980 and 2013. METHODS We selected full and partial economic evaluations from among those retrieved by searching the following databases: MEDLINE (PubMed); Excerpta Medica; the Latin American and Caribbean Health Sciences Literature database; the Scientific Electronic Library Online; the database of the Centre for Reviews and Dissemination; the National Health Service (NHS) Economic Evaluation Database; the NHS Health Technology Assessment database; the Health Economics database of the Brazilian Virtual Library of Health; Scopus; Web of Science; and the Brazilian Network for the Evaluation of Health Technologies. Two researchers, working independently, selected the studies and extracted the data. RESULTS We identified 535 health economic evaluations relating to Brazil and published in the 1980-2013 period. Of those 535 articles, only 40 dealt with gastroenterology. Full and partial economic evaluations respectively accounted for 23 (57.5%) and 17 (42.5%) of the 40 studies included. Among the 23 full economic evaluations, there were 11 cost-utility analyses, seven cost-effectiveness analyses, four cost-consequence analyses, and one cost-minimization analysis. Of the 40 studies, 25 (62.5%) evaluated medications; 7 (17.5%) evaluated procedures; and 3 (7.5%) evaluated equipment. Most (55%) of the studies were related to viral hepatitis, and most (63.4%) were published after 2010. Other topics included gastrointestinal cancer, liver transplantation, digestive diseases and hernias. Over the 33-year period examined, the number of such economic evaluations relating to Brazil, especially of those evaluating medications for the treatment of hepatitis, increased considerably. CONCLUSION Further studies are needed in order to ensure that expenditures on health care in Brazil are made as fairly and efficiently as possible.
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CHALLENGES FACED IN TRANSFERRING ECONOMIC EVALUATIONS TO MIDDLE INCOME COUNTRIES. Int J Technol Assess Health Care 2016; 31:442-8. [PMID: 26831815 DOI: 10.1017/s0266462315000604] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Decision makers in middle-income countries are using economic evaluations (EEs) in pricing and reimbursement decisions for pharmaceuticals. However, whilst many of these jurisdictions have local submission guidelines and local expertise, the studies themselves often use economic models developed elsewhere and elements of data from countries other than the jurisdiction concerned. The objectives of this study were to describe the current situation and to assess the challenges faced by decision makers in transferring data and analyses from other jurisdictions. METHODS Experienced health service researchers in each region conducted an interview survey of representatives of decision making bodies from jurisdictions in Asia, Central and Eastern Europe, and Latin America that had at least 1 year's experience of using EEs. RESULTS Representatives of the relevant organizations in twelve countries were interviewed. All twelve jurisdictions had developed official guidelines for the conduct of EEs. All but one of the organizations evaluated studies submitted to them, but 9 also conducted studies and 7 commissioned them. Nine of the organizations stated that, in evaluating EEs submitted to them, they had consulted a study performed in a different jurisdiction. Data on relevant treatment effect was generally considered more transferable than those on prices/unit costs. Views on the transferability of epidemiological data, data on resource use and health state preference values were more mixed. Eight of the respondents stated that analyses submitted to them had used models developed in other jurisdictions. Four of the organizations had a policy requiring models to be adapted to reflect local circumstances. The main obstacles to transferring EEs were the different patterns of care or wealth of the developed countries from which most economic evaluations originate. CONCLUSIONS In middle-income countries it is commonplace to deal with the issue of transferring analyses or data from other jurisdictions. Decision makers in these countries face several challenges, mainly due to differences in current standard of care, practice patterns, or gross domestic product between the developed countries where the majority of the studies are conducted and their own jurisdiction.
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Pitt C, Goodman C, Hanson K. Economic Evaluation in Global Perspective: A Bibliometric Analysis of the Recent Literature. HEALTH ECONOMICS 2016; 25 Suppl 1:9-28. [PMID: 26804359 PMCID: PMC5042080 DOI: 10.1002/hec.3305] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 05/02/2023]
Abstract
We present a bibliometric analysis of recently published full economic evaluations of health interventions and reflect critically on the implications of our findings for this growing field. We created a database drawing on 14 health, economic, and/or general literature databases for articles published between 1 January 2012 and 3 May 2014 and identified 2844 economic evaluations meeting our criteria. We present findings regarding the sensitivity, specificity, and added value of searches in the different databases. We examine the distribution of publications between countries, regions, and health areas studied and compare the relative volume of research with disease burden. We analyse authors' country and institutional affiliations, journals and journal type, language, and type of economic evaluation conducted. More than 1200 economic evaluations were published annually, of which 4% addressed low-income countries, 4% lower-middle-income countries, 14% upper-middle-income countries, and 83% high-income countries. Across country income levels, 53, 54, 86, and 100% of articles, respectively, included an author based in a country within the income level studied. Biomedical journals published 74% of economic evaluations. The volume of research across health areas correlates more closely with disease burden in high-income than in low-income and middle-income countries. Our findings provide an empirical basis for further study on methods, research prioritization, and capacity development in health economic evaluation.
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Affiliation(s)
- Catherine Pitt
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
| | - Catherine Goodman
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
| | - Kara Hanson
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
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Ruggeri M, Manca A, Coretti S, Codella P, Iacopino V, Romano F, Mascia D, Orlando V, Cicchetti A. Investigating the Generalizability of Economic Evaluations Conducted in Italy: A Critical Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:709-720. [PMID: 26297100 DOI: 10.1016/j.jval.2015.03.1795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 02/27/2015] [Accepted: 03/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the methodological quality of Italian health economic evaluations and their generalizability or transferability to different settings. METHODS A literature search was performed on the PubMed search engine to identify trial-based, nonexperimental prospective studies or model-based full economic evaluations carried out in Italy from 1995 to 2013. The studies were randomly assigned to four reviewers who applied a detailed checklist to assess the generalizability and quality of reporting. The review process followed a three-step blinded procedure. The reviewers who carried out the data extraction were blind as to the name of the author(s) of each study. Second, after the first review, articles were reassigned through a second blind randomization to a second reviewer. Finally, any disagreement between the first two reviewers was solved by a senior researcher. RESULTS One hundred fifty-one economic evaluations eventually met the inclusion criteria. Over time, we observed an increasing transparency in methods and a greater generalizability of results, along with a wider and more representative sample in trials and a larger adoption of transition-Markov models. However, often context-specific economic evaluations are carried out and not enough effort is made to ensure the transferability of their results to other contexts. In recent studies, cost-effectiveness analyses and the use of incremental cost-effectiveness ratio were preferred. CONCLUSIONS Despite a quite positive temporal trend, generalizability of results still appears as an unsolved question, even if some indication of improvement within Italian studies has been observed.
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Affiliation(s)
- Matteo Ruggeri
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
| | - Silvia Coretti
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Paola Codella
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Iacopino
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Romano
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniele Mascia
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Orlando
- Inter-departmental Research Centre of PharmacoEconomics and Drug utilization (CIRFF), Center of Pharmacoeconomics, Federico II University of Naples, Naples, Italy
| | - Americo Cicchetti
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
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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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Cruz L, Lima AFDS, Graeff-Martins A, Maia CRM, Ziegelmann P, Miguel S, Fleck M, Polanczyk C. Mental health economics: insights from Brazil. J Ment Health 2013; 22:111-21. [PMID: 23574503 DOI: 10.3109/09638237.2012.759193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND As the responsibility and demand on health care grows and resources do not increase at the same pace, the healthcare system has been forced to reconsider the benefits and costs of their actions, to ensure a rational and effective decision-making process regarding the adoption of interventions and allocation of resources. Cost-effectiveness (CE) studies represent one of the basic tools to achieve this goal. AIMS To present the current state of Health Technology Assessment (HTA) and health economics in mental health in Brazil and its importance to the decision-making process. METHODOLOGY Descriptive paper on HTA and health economics in Brazil. Databases from government and universities as well as some scientific databases to assess the information are presented. RESULTS AND CONCLUSION Economic analysis to evaluate interventions in mental health care is a relatively recent addition to the field of health economics; in Brazil, it is also considered a topic within Epidemiology research area. There have been an increased number of studies developed in high-income countries. However, there are fewer CE studies in low- and middle-income ones. Psychiatric disorders represent a significant burden in developing countries, where resources devoted to health care are even scarcer.
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Affiliation(s)
- Luciane Cruz
- Health Technology Assessment Institute IATS, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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El uso de evaluación económica para la toma de decisiones en intervenciones oncológicas: la experiencia de México, Colombia y Brasil. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Inotai A, Pékli M, Jóna G, Nagy O, Remák E, Kaló Z. Attempt to increase the transparency of fourth hurdle implementation in Central-Eastern European middle income countries: publication of the critical appraisal methodology. BMC Health Serv Res 2012; 12:332. [PMID: 22999574 PMCID: PMC3465229 DOI: 10.1186/1472-6963-12-332] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 09/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In middle income countries the number of trained health technology assessment specialists is limited and the public budget for health technology assessment is considerably lower compared to developed countries. These countries therefore must develop their own solutions to improve the quality and efficiency of health technology assessment implementation in reimbursement decisions. Our study aimed to develop a scientifically rigorous and detailed appraisal checklist for economic evaluations of pharmaceuticals in the single health technology assessment process. METHODS The research design entailed a review of economic evaluations, submitted for reimbursement of pharmaceuticals, by two independent academic reviewers to identify the most common methodological problems. Fifty economic evaluations submitted in 2007-2008, randomly selected by the Health Technology Assessment Office served as data sources. The new checklist was developed by an iterative working process: first by assessing ten economic evaluations, then improving the checklist by generating new question items, then employing the improved checklist to assess the next ten economic evaluations. After appraising 25 documents, the reviewers reconciled their opinions and improved the checklist with the researchers of the Health Technology Assessment Office during an expert panel discussion. The reviewers scrutinized the second 25 economic evaluations, after which the expert panel finalized the checklist with consensus. RESULTS The final checklist consists of 91 yes or no questions in 11 main topics concerning comparator selection, efficacy, effectiveness, costs, sensitivity analysis, methodological approach, transparency, and interpretation of results. The new checklist is based on current Hungarian evaluation practice. As the published checklist will be part of the official single health technology assessment process of pharmaceuticals, submitters will be able to assure the quality of their economic evaluation. CONCLUSIONS The transparent critical appraisal method should improve the consistency of pharmaceutical reimbursement decisions and facilitate the utilization of economic evaluations in other fields of health care decision-making in other Central-Eastern European countries.
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Affiliation(s)
- András Inotai
- University Pharmacy, Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary.
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Saramago P, Manca A, Sutton AJ. Deriving input parameters for cost-effectiveness modeling: taxonomy of data types and approaches to their statistical synthesis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:639-649. [PMID: 22867772 DOI: 10.1016/j.jval.2012.02.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 01/24/2012] [Accepted: 02/19/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND The evidence base informing economic evaluation models is rarely derived from a single source. Researchers are typically expected to identify and combine available data to inform the estimation of model parameters for a particular decision problem. The absence of clear guidelines on what data can be used and how to effectively synthesize this evidence base under different scenarios inevitably leads to different approaches being used by different modelers. OBJECTIVES The aim of this article is to produce a taxonomy that can help modelers identify the most appropriate methods to use when synthesizing the available data for a given model parameter. METHODS This article developed a taxonomy based on possible scenarios faced by the analyst when dealing with the available evidence. While mainly focusing on clinical effectiveness parameters, this article also discusses strategies relevant to other key input parameters in any economic model (i.e., disease natural history, resource use/costs, and preferences). RESULTS The taxonomy categorizes the evidence base for health economic modeling according to whether 1) single or multiple data sources are available, 2) individual or aggregate data are available (or both), or 3) individual or multiple decision model parameters are to be estimated from the data. References to examples of the key methodological developments for each entry in the taxonomy together with citations to where such methods have been used in practice are provided throughout. CONCLUSIONS The use of the taxonomy developed in this article hopes to improve the quality of the synthesis of evidence informing decision models by bringing to the attention of health economics modelers recent methodological developments in this field.
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Affiliation(s)
- Pedro Saramago
- Centre for Health Economics, University of York, York, 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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Salomon JA, Carvalho N, Gutiérrez-Delgado C, Orozco R, Mancuso A, Hogan DR, Lee D, Murakami Y, Sridharan L, Medina-Mora ME, González-Pier E. Intervention strategies to reduce the burden of non-communicable diseases in Mexico: cost effectiveness analysis. BMJ 2012; 344:e355. [PMID: 22389335 PMCID: PMC3292518 DOI: 10.1136/bmj.e355] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To inform decision making regarding intervention strategies against non-communicable diseases in Mexico, in the context of health reform. DESIGN Cost effectiveness analysis based on epidemiological modelling. INTERVENTIONS 101 intervention strategies relating to nine major clusters of non-communicable disease: depression, heavy alcohol use, tobacco use, cataracts, breast cancer, cervical cancer, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes. DATA SOURCES Mexican data sources were used for most key input parameters, including administrative registries; disease burden and population estimates; household surveys; and drug price databases. These sources were supplemented as needed with estimates for Mexico from the WHO-CHOICE unit cost database or with estimates extrapolated from the published literature. MAIN OUTCOME MEASURES Population health outcomes, measured in disability adjusted life years (DALYs); costs in 2005 international dollars ($Int); and costs per DALY. RESULTS Across 101 intervention strategies examined in this study, average yearly costs at the population level would range from around ≤$Int1m (such as for cataract surgeries) to >$Int1bn for certain strategies for primary prevention in cardiovascular disease. Wide variation also appeared in total population health benefits, from <1000 DALYs averted a year (for some components of cancer treatments or aspirin for acute ischaemic stroke) to >300,000 averted DALYs (for aggressive combinations of interventions to deal with alcohol use or cardiovascular risks). Interventions in this study spanned a wide range of average cost effectiveness ratios, differing by more than three orders of magnitude between the lowest and highest ratios. Overall, community and public health interventions such as non-personal interventions for alcohol use, tobacco use, and cardiovascular risks tended to have lower cost effectiveness ratios than many clinical interventions (of varying complexity). Even within the community and public health interventions, however, there was a 200-fold difference between the most and least cost effective strategies examined. Likewise, several clinical interventions appeared among the strategies with the lowest average cost effectiveness ratios-for example, cataract surgeries. CONCLUSIONS Wide variations in costs and effects exist within and across intervention categories. For every major disease area examined, at least some strategies provided excellent value for money, including both population based and personal interventions.
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Affiliation(s)
- Joshua A Salomon
- Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
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Alcaraz A, González-Zuelgaray J, Augustovski F. [Cost effectiveness of implantable cardioverter-defibrillators for patients who are at risk for sudden death in Argentina]. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:S33-S38. [PMID: 21839896 DOI: 10.1016/j.jval.2011.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness and cost-utility of the cardioverter-defibrillator (ICD) among patients who are at risk for sudden death in Argentina, from three scenarios: public health, social security and private sector. METHODS We developed a Markov model to evaluate the survival, quality of life and cost of the prophylactic implantation of an ICD, as compared with pharmacological therapy, among three different target populations according to clinical trials selected using a systematic review, and choosing epidemiological, effectiveness, resource use and cost parameters. A healthcare system perspective was adopted. A 3% discount rate was used. RESULTS The use of the ICD was more costly and more effective than control therapy. The cohort with greater benefits was represented by MADIT I study, showing an incremental cost effectiveness rate (ICER) of $8,539 (dollar 2009) for public, $9,371 for social security and $10,083 for private sector. ICERs for secondary prevention population were $21,016, $22,520 and $24,012, and for MADIT II population were $17,379, $18,574 and $19,799. The analysis was robust to different deterministic and probabilistic sensitivity analyses, except for the cost of ICD and for battery life. CONCLUSIONS The results varied considerably depending on the cohort and discretely according to the health system. ICD could be cost-effective in Argentina, mainly in the MADIT I patients.
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Affiliation(s)
- Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
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Galante J, Augustovski F, Colantonio L, Bardach A, Caporale J, Marti SG, Kind P. Estimation and comparison of EQ-5D health states' utility weights for pneumococcal and human papillomavirus diseases in Argentina, Chile, and the United Kingdom. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:S60-S64. [PMID: 21839901 DOI: 10.1016/j.jval.2011.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To estimate and compare EuroQol instrument (EQ-5D) health states' values for pneumococcal and human papillomavirus (HPV) diseases in Argentina, Chile, and the United Kingdom. METHODS Twelve vignettes were designed, pilot-tested, and administered to a convenience sample in a cross-sectional design to elicit descriptive EQ-5D state data. Country-specific EQ-5D time-trade-off-based weights were used to map these descriptive health states into local country preference weights. Descriptive analysis is reported and intercountry differences for each condition were compared using repeated measures analysis of variance. RESULTS Seventy-three subjects completed the survey. Pneumococcal disease-related health states mean values ranged from -0.331 (sepsis, Chile) to 0.727 (auditive sequelae, Argentina). HPV-related conditions ranged from 0.152 (cervical cancer, United Kingdom) to 0.848 (cervical intraepithelial neoplasia 1, Argentina). Chile had consistently the lowest mean values in pneumococcal states and in one HPV state, whereas those of the United Kingdom were the lowest in most HPV states. Argentina had the highest mean values in both diseases. Differences in country-specific values for each health state were statistically (P < 0.001) significant except for six health states in which differences between Chilean and United Kingdom weights were nonsignificant. CONCLUSIONS Utility values for most conditions differed statistically relevantly among analyzed countries, even though the same health states' descriptive set was valued for each. These results reflect the difference in social weights among different countries, which could be attributed to either different population values or valuation study methodologies. They stress the importance of using local preference weights for context-specific decision making.
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Affiliation(s)
- Julieta Galante
- Institute of Clinical Effectiveness and Health Policy, Ciudad Autónoma de Buenos Aires, Argentina
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Augustovski F, Ferraz MB. Pharmacoeconomics and outcomes research in Latin America: a promising and developing field. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:S1-S2. [PMID: 21839878 DOI: 10.1016/j.jval.2011.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Shepard DS, Coudeville L, Halasa YA, Zambrano B, Dayan GH. Economic impact of dengue illness in the Americas. Am J Trop Med Hyg 2011; 84:200-7. [PMID: 21292885 PMCID: PMC3029168 DOI: 10.4269/ajtmh.2011.10-0503] [Citation(s) in RCA: 255] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 10/12/2010] [Indexed: 01/17/2023] Open
Abstract
The growing burden of dengue in endemic countries and outbreaks in previously unaffected countries stress the need to assess the economic impact of this disease. This paper synthesizes existing studies to calculate the economic burden of dengue illness in the Americas from a societal perspective. Major data sources include national case reporting data from 2000 to 2007, prospective cost of illness studies, and analyses quantifying underreporting in national routine surveillance systems. Dengue illness in the Americas was estimated to cost $2.1 billion per year on average (in 2010 US dollars), with a range of $1-4 billion in sensitivity analyses and substantial year to year variation. The results highlight the substantial economic burden from dengue in the Americas. The burden for dengue exceeds that from other viral illnesses, such as human papillomavirus (HPV) or rotavirus. Because this study does not include some components (e.g., vector control), it may still underestimate total economic consequences of dengue.
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Colantonio LD, Martí SG, Rubinstein AL. Economic evaluations on cardiovascular preventive interventions in Argentina. Expert Rev Pharmacoecon Outcomes Res 2010; 10:465-73. [PMID: 20715922 DOI: 10.1586/erp.10.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiovascular diseases are the main cause of death in Argentina. This article analyzes economic evaluations on cardiovascular prevention for this country. A literature search was conducted in five electronic databases during December 2009. Inclusion criteria were complete economic evaluations addressing at least one cardiovascular health outcome for the Argentinean population. Finally, nine studies were included evaluating 14 comparisons. Interventions oriented to primary or secondary prevention in patients that had undergone coronary angioplasty, with a previous cardiovascular event or equivalents, with a hospitalization for heart failure or general population were evaluated. Bread salt reduction, antihypertensive treatment, mass educational campaigns and polypill strategies could be considered cost effective. The available economic evidence to guide resource allocation in cardiovascular disease in Argentina seems to be scarce and limited.
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Affiliation(s)
- Lisandro Damián Colantonio
- Institute for Clinical Effectiveness and Health Policy, Viamonte 2146, 3rd Floor, C1056ABH, Buenos Aires, Argentina.
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Health technology assessment for resource allocation decisions: Are key principles relevant for Latin America? Int J Technol Assess Health Care 2010; 26:421-7. [DOI: 10.1017/s0266462310001042] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: A set of fifteen key principles (KP) has been recently proposed to guide decisions on the structure of HTA programs, the methods of HTA, the processes for conducting HTA and the use of HTA findings in decision-making. The objective of this research is to explore whether these KPs are relevant and useful in Latin America (LA), and to what extent they are being applied.Methods: A Web-based survey was sent to 11,792 HTA researchers and users in LA to explore the perceived relevance of each KP, its current level of application and the gap between these two.Results: We received 1,142 responses from nineteen LA countries (9.7 percent response rate). The subgroup of KP related to Methods and to the Use of HTA received the higher mean scores in the relevance scale (9.00 and 8.94). Level of current application scored low in all KP (3.2 to 4.9). Higher gaps were observed in principles related to the use of HTA in decision making and to the processes for conducting HTA. Countries with more developed HTA showed higher scores in the degree of current application (5.3 versus 3.4, p < .01) and lower gaps (3.84 versus 5.21, p < .01). Researchers, compared with research users, scored the relevance of the KPs higher.Conclusions: KPs seem to be very relevant to most HTA researchers and users in LA. However, the current level of application was considered uniformly poor. Higher gaps were observed in KPs related to the link between HTA and decision making, highlighting one of the major challenges for the countries in the region.
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