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Wilkinson M, Hofman KJ, Young T, Schmidt BM, Kredo T. Health economic evidence in clinical guidelines in South Africa: a mixed-methods study. BMC Health Serv Res 2021; 21:738. [PMID: 34304743 PMCID: PMC8310693 DOI: 10.1186/s12913-021-06747-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/30/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Evidence-informed clinical practice guidelines (CPGs) are useful tools to inform transparent healthcare decision-making. Consideration of health economic evidence (HEE) during CPG development in a structured manner remains a challenge globally and locally. This study explored the views, current practice, training needs and challenges faced by CPG developers in the production and use of HEE for CPGs in South Africa. METHODS This mixed-methods study comprised an online survey and a focus group discussion. The survey was piloted and subsequently sent to CPG role players - evidence reviewers, CPG panellists, academics involved with training in relevant disciplines like health economics and public health, implementers and funders. The focus group participants hold strategic roles in CPG development and health economic activities nationally. The survey evaluated mean values, measures of variability, and percentages for Likert scales, while narrative components were thematically analysed. Focus group data were manually coded, thematically analysed and verified. RESULTS The survey (n = 55 respondents to 245 surveys distributed) and one focus group (n = 5 participants from 10 people invited) occurred between October 2018 and February 2019. We found the most consistent reason why HEE should inform CPG decisions was 'making more efficient use of limited financial resources'. This was explained by numerous context and methodological barriers. Focus groups participants noted that consideration of complex HEE are not achievable without bolstering skills in applying evidence-based medicine principles. Further concerns include lack of clarity of standard methods; inequitable and opaque topic selection across private and public sectors; inadequate skills of CPG panel members to use HEE; and the ability of health economists to communicate results in accessible ways. Overall, in the absence of clarity about process and methods, politics and interests may drive CPG decisions about which interventions to implement. CONCLUSIONS HEE should ideally be considered in CPG decisions in South Africa. However, this will remain hampered until the CPG community agree on methods and processes for using HEE in CPGs. Focused investment by national government to address the challenges identified by the study is imperative for a better return on investment as National Health Insurance moves forward.
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Affiliation(s)
- Maryke Wilkinson
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, South Africa.
| | - Karen J Hofman
- SAMRC Centre for Health Economics and Decision Science, PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Taryn Young
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, South Africa
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
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Kim T, Sharma M, Teerawattananon Y, Oh C, Ong L, Hangoma P, Adhikari D, Pempa P, Kairu A, Orangi S, Dabak SV. Addressing Challenges in Health Technology Assessment Institutionalization for Furtherance of Universal Health Coverage Through South-South Knowledge Exchange: Lessons From Bhutan, Kenya, Thailand, and Zambia. Value Health Reg Issues 2021; 24:187-192. [PMID: 33838558 PMCID: PMC8163602 DOI: 10.1016/j.vhri.2020.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/19/2020] [Accepted: 12/06/2020] [Indexed: 12/03/2022]
Abstract
Health Technology Assessment (HTA), a tool for priority setting, has emerged as a means of ensuring the sustainability of a Universal Health Coverage (UHC) system. However, setting up an effective HTA system poses multiple challenges and knowledge exchange can play a crucial role in helping countries achieve their UHC targets. This article reports the results of the discussion during a preconference session at the 2019 HTAsiaLink Conference, an annual gathering of HTA agencies in Asia, which supports knowledge transfer and exchange among HTA practitioners. As part of this discourse, 3 main HTA challenges were identified based on experiences of selected countries in Asia and Africa, namely Bhutan, Kenya, Thailand, and Zambia: availability of funding, building technical capacity, and achieving buy-in among stakeholders for successful translation of HTA research into UHC policy. The potential solutions identified through this South-South engagement included establishing a legal mandate for HTA, building local technical capacity through partnerships and enhancing strategic communication with stakeholders to increase awareness, among others. South-South Knowledge Exchange can therefore be instrumental in sharing lessons learned from common challenges and offer potential solutions to address capacity building initiatives for HTA in LMICs.
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Affiliation(s)
- Taeyoung Kim
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
| | - Manushi Sharma
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Cecilia Oh
- HIV, Health and Development Team, United Nations Development Programme, Bangkok, Thailand
| | - Leslie Ong
- HIV, Health and Development Team, United Nations Development Programme, Bangkok, Thailand
| | - Peter Hangoma
- Department of Health Policy and Management, University of Zambia, Lusaka, Zambia
| | - Deepika Adhikari
- Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Thimphu, Bhutan
| | - Pempa Pempa
- Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Thimphu, Bhutan
| | - Angela Kairu
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Stacey Orangi
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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Kantamaturapoj K, Kulthanmanusorn A, Witthayapipopsakul W, Viriyathorn S, Patcharanarumol W, Kanchanachitra C, Wibulpolprasert S, Tangcharoensathien V. Legislating for public accountability in universal health coverage, Thailand. Bull World Health Organ 2019; 98:117-125. [PMID: 32015582 PMCID: PMC6986221 DOI: 10.2471/blt.19.239335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 12/26/2022] Open
Abstract
Sustaining universal health coverage requires robust active public participation in policy formation and governance. Thailand’s universal coverage scheme was implemented nationwide in 2002, allowing Thailand to achieve full population coverage through three public health insurance schemes and to demonstrate improved health outcomes. Although Thailand’s position on the World Bank worldwide governance indicators has deteriorated since 1996, provisions for voice and accountability were embedded in the legislation and design of the universal coverage scheme. We discuss how legislation related to citizens’ rights and government accountability has been implemented. Thailand’s constitution allowed citizens to submit a draft bill in which provisions on voice and accountability were successfully embedded in the legislative texts and adopted into law. The legislation mandates registration of beneficiaries, a 24/7 helpline, annual public hearings and no-fault financial assistance for patients who have experienced adverse events. Ensuring the right to health services, and that citizens’ voices are heard and action taken, requires the institutional capacity to implement legislation. For example, Thailand needed the capacity to register 47 million people and match them with the health-care provider network in the district where they live, and to re-register members who move out of their districts. Annual public hearings need to be inclusive of citizens, health-care providers, civil society organizations and stakeholders such as local governments and patient groups. Subsequent policy and management responses are important for building trust in the process and citizens’ ownership of the scheme. Annual public reporting of outcomes and performance of the scheme fosters transparency and increases citizens’ trust.
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Affiliation(s)
- Kanang Kantamaturapoj
- Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Anond Kulthanmanusorn
- International Health Policy Program, Ministry of Public Health, Tiwanond Road, Nonthaburi, Thailand 11000
| | - Woranan Witthayapipopsakul
- International Health Policy Program, Ministry of Public Health, Tiwanond Road, Nonthaburi, Thailand 11000
| | - Shaheda Viriyathorn
- International Health Policy Program, Ministry of Public Health, Tiwanond Road, Nonthaburi, Thailand 11000
| | - Walaiporn Patcharanarumol
- International Health Policy Program, Ministry of Public Health, Tiwanond Road, Nonthaburi, Thailand 11000
| | | | - Suwit Wibulpolprasert
- International Health Policy Program, Ministry of Public Health, Tiwanond Road, Nonthaburi, Thailand 11000
| | - Viroj Tangcharoensathien
- International Health Policy Program, Ministry of Public Health, Tiwanond Road, Nonthaburi, Thailand 11000
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4
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Leaving No One Behind: Participatory Technology Appraisal as a Platform for Agenda Setting to Address Disparities in Access to Health Services in Thailand. Int J Technol Assess Health Care 2019; 35:340-345. [PMID: 31292013 DOI: 10.1017/s0266462319000394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This article discusses how participatory technology appraisal as part of the Universal Coverage Scheme (UCS) in Thailand contributes to improving access to essential health services among vulnerable populations. METHODS Document review was conducted on health technology appraisal approaches introduced by the UCS. The review involves health benefit proposals advanced by stakeholders and also meeting minutes of relevant working groups and committees published between 2010 and 2015. RESULTS From the establishment of the UCS participatory technology appraisal mechanism in 2010 until 2015, a total of 133 health interventions have been nominated. Some nominations highlight problems in access to care among vulnerable populations. As policy advocates continue to be involved in the latter stages of coverage decisions, they have opportunities to persuade policy makers and other stakeholders to agree to the rationales of their proposals. Some interventions were rejected because they did not meet value for money, affordability, and feasibility criteria; however, topic nominations from stakeholders as well as relevant deliberation throughout the technology appraisal processes have a potential to improve accessibility of health care among the disadvantaged. CONCLUSIONS Through participation in the UCS policy-making processes, key stakeholders are able to direct the attention of decision makers to significant gaps in access to services among vulnerable citizens, a health system problem rarely brought to discussion by policy elites and experts. The Thai experience reaffirms participatory technology appraisal as a supportive measure to providing universal health coverage.
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Health Technology Assessment in Thailand: Institutionalization and Contribution to Healthcare Decision Making: Review of Literature. Int J Technol Assess Health Care 2019; 35:467-473. [PMID: 31190670 DOI: 10.1017/s0266462319000321] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To explore health technology assessment (HTA) in Thailand focusing on its institutionalization, key elements for HTA introduction, and HTA contribution to policy. METHODS A review of literature covered a wide range of topics, including the institutionalization of HTA, elements of HTA introduction, and the role of HTA in policy decision making in Thai context. Additional information from the authors' involvement in the policy decision-making process in Thailand was also considered. RESULTS HTA institutionalization comprises processes of introducing HTA, including evidence generation and use in policymaking, building capacity of HTA practitioners, organizations, system infrastructure, and collaborations. In Thailand, HTA has been formally integrated into coverage decisions, including in the development of the National List of Essential Medicines and the Universal Health Coverage Scheme benefits package. Contributing factors included political will and leadership, capacity building on HTA-related disciplines, adequate resources, technical expertise, and data. Conversely, challenges faced included the absence of a governing body and strategic plan for HTA systems development, a lack of formal mechanisms for mobilizing financial support, an inadequate number of HTA researchers in nonprofit institutes, and the rise in advanced biotechnologies. CONCLUSIONS HTA plays an important role in evidence-based healthcare decision making. However, key elements of HTA institutionalization need to be strengthened, especially governance structure and policy for HTA systems development, building and retaining capacity of HTA practitioners to meet demand, addressing the challenges of complex and highly innovative health interventions. Lessons learned from the Thai experience may be used as guidance for HTA institutionalization in other developing countries.
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Winser S, Lee SH, Law HS, Leung HY, Bello UM, Kannan P. Economic evaluations of physiotherapy interventions for neurological disorders: a systematic review. Disabil Rehabil 2019; 42:892-901. [DOI: 10.1080/09638288.2018.1510993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Stanley Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Sing Hong Lee
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Hung Sing Law
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Hei Yuen Leung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Umar Muhammad Bello
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Wang P, Liu GG, Jo MW, Purba FD, Yang Z, Gandhi M, Pattanaphesaj J, Ahn J, Wong ELY, Shafie AA, Busschbach JJ, Luo N. Valuation of EQ-5D-5L health states: a comparison of seven Asian populations. Expert Rev Pharmacoecon Outcomes Res 2018; 19:445-451. [PMID: 30523723 DOI: 10.1080/14737167.2019.1557048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: To compare the time trade-off (TTO) utility values of EQ-5D-5L health states elicited from different general populations in Asia. Methods: We analyzed the TTO data from seven Asian EQ-5D-5L valuation studies in which utility values of 86 EQ-5D-5L health states were elicited from general population samples. An eight-parameter multiplicative regression model including five dimension parameters (mobility [MO], self-care, usual activities [UA], pain/discomfort, anxiety/depression) and three level parameters (level 2 [L2], level 3 [L3], and level 4 [L4]) was used to model the data from each of the populations. The model coefficients were compared to understand how the valuations of EQ-5D-5L health states differ. Results: For dimension parameters, Korea and Indonesia generally had the highest and lowest values among the populations, respectively; UA and MO commonly had the highest and lowest values among the parameters, respectively. For level parameters, Singapore and Korea generally had the highest and lowest values, respectively; L2 showed less variance compared to L3 and L4. Koreans, Indonesians, and Singaporeans appeared to have different health preferences compared with other populations. Conclusion: Utility values of EQ-5D-5L health states differ among Asian populations, suggesting that each health system should establish and use its own value set.
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Affiliation(s)
- Pei Wang
- a School of Public Health, Fudan University, Shanghai, China.,b Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, China
| | - Gordon G Liu
- c National School of Development, Peking University, Beijing, China
| | - Min-Woo Jo
- d Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Frederick Dermawan Purba
- e Medical Psychology, Erasmus MC, Rotterdam, Netherlands.,f Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Zhihao Yang
- e Medical Psychology, Erasmus MC, Rotterdam, Netherlands
| | - Mihir Gandhi
- g Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore.,h Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.,i Center for Child Health Research, University of Tampere, Tampere, Finland
| | | | - Jeonghoon Ahn
- k Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Eliza Lai-Yi Wong
- l JC School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Arsul A Shafie
- m Discipline of Social & Administrative Pharmacy, Universiti Sains Malaysia, Penang, Malaysia
| | | | - Nan Luo
- n Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Marsh K, Thokala P, Youngkong S, Chalkidou K. Incorporating MCDA into HTA: challenges and potential solutions, with a focus on lower income settings. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:43. [PMID: 30455602 PMCID: PMC6225551 DOI: 10.1186/s12962-018-0125-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Multicriteria decision analysis (MCDA) has the potential to bring more structure and transparency to health technology assessment (HTA). The objective of this paper is to highlight key methodological and practical challenges facing the use of MCDA for HTA, with a particular focus on lower and middle-income countries (LMICs), and to highlight potential solutions to these challenges. Methodological challenges Key lessons from existing applications of MCDA to HTA are summarized, including: that the socio-technical design of the MCDA reflect the local decision problem; the criteria set properties of additive models are understood and applied; and the alternative approaches for estimating opportunity cost, and the challenges with these approaches are understood. Practical challenges Existing efforts to implement HTA in LMICs suggest a number of lessons that can help overcome the practical challenges facing the implementation of MCDA in LMICs, including: adapting inputs from other settings and from expert opinion; investing in technical capacity; embedding the MCDA in the decision-making process; and ensuring that the MCDA design reflects local cultural and social factors. Conclusion MCDA has the potential to improve decision making in LMICs. For this potential to be achieved, it is important that the lessons from existing applications of MCDA are learned.
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Affiliation(s)
- Kevin Marsh
- Patient Centred Research, Evidera, London, UK
| | | | | | - Kalipso Chalkidou
- 4School of Public Health, Imperial College, London, UK.,Center for Global Development, London, UK
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Zegeye EA, Reshad A, Bekele EA, Aurgessa B, Gella Z. The State of Health Technology Assessment in the Ethiopian Health Sector: Learning from Recent Policy Initiatives. Value Health Reg Issues 2018; 16:61-65. [PMID: 30195092 DOI: 10.1016/j.vhri.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 07/02/2018] [Accepted: 07/11/2018] [Indexed: 11/25/2022]
Abstract
Health technology assessment (HTA) has previously been implemented only in a fragmented manner in the Ethiopian health sector decision-making cycle, and the sector has been hampered by limited institutional capacity and skilled human resources to inform evidence-based decision making. The country is in the midst of widescale implementation of a community-based health insurance scheme and is preparing for the launch of a social health insurance scheme. The country continues to face a limited financial resource envelope, undergoing an epidemiological transition, and is facing a much greater burden of noncommunicable diseases, for which the essential health benefit package, defined 12 years ago, may no longer be suitable. This has called for an in-depth review of the application of HTA in the context of the current health needs and institutional settings. To meet the increasing need for HTA, the Health Economics and Financing Analysis (HEFA) team was established within the Finance Resource Mobilization Department under the Ministry of Health. The HEFA team is tasked with spearheading the application of evidence-based health care decision making in Ethiopia by organizing available evidence, costing interventions, and defining effectiveness measures of the different health programs and then supporting policymakers at the national and regional levels. Improving and harmonizing the institutional approach to HTA, including staffing the HEFA team with the appropriate mix of expertise, and networking with relevant sector organizations will improve Ethiopia's ability to tackle the current health sector challenges as well as protect fledgling insurance schemes' progress toward universal health coverage.
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Affiliation(s)
- Elias Asfaw Zegeye
- Health Economics and Financing Analysis Team, Finance Resource Mobilization Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia.
| | | | - Eyersualem Animut Bekele
- Partnership and Coordination Team, Finance Resource Mobilization Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Belay Aurgessa
- Partnership and Coordination Team, Finance Resource Mobilization Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Zenebech Gella
- Health Economics and Financing Analysis Team, Finance Resource Mobilization Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
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Jan S, Laba TL, Essue BM, Gheorghe A, Muhunthan J, Engelgau M, Mahal A, Griffiths U, McIntyre D, Meng Q, Nugent R, Atun R. Action to address the household economic burden of non-communicable diseases. Lancet 2018; 391:2047-2058. [PMID: 29627161 DOI: 10.1016/s0140-6736(18)30323-4] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 09/04/2017] [Accepted: 01/19/2018] [Indexed: 01/05/2023]
Abstract
The economic burden on households of non-communicable diseases (NCDs), including cardiovascular diseases, cancer, respiratory diseases, and diabetes, poses major challenges to global poverty alleviation efforts. For patients with NCDs, being uninsured is associated with 2-7-fold higher odds of catastrophic levels of out-of-pocket costs; however, the protection offered by health insurance is often incomplete. To enable coverage of the predictable and long-term costs of treatment, national programmes to extend financial protection should be based on schemes that entail compulsory enrolment or be financed through taxation. Priority should be given to eliminating financial barriers to the uptake of and adherence to interventions that are cost-effective and are designed to help the poor. In concert with programmes to strengthen national health systems and governance arrangements, comprehensive financial protection against the growing burden of NCDs is crucial in meeting the UN's Sustainable Development Goals.
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Affiliation(s)
- Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Tracey-Lea Laba
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Beverley M Essue
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Adrian Gheorghe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Janani Muhunthan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Engelgau
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
| | - Ulla Griffiths
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Diane McIntyre
- Health Economics Unit, University of Cape Town, Cape Town, South Africa
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, China
| | - Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
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11
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Tantivess S, Chalkidou K, Tritasavit N, Teerawattananon Y. Health Technology Assessment capacity development in low- and middle-income countries: Experiences from the international units of HITAP and NICE. F1000Res 2017; 6:2119. [PMID: 29333249 PMCID: PMC5749126 DOI: 10.12688/f1000research.13180.1] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 12/04/2022] Open
Abstract
Health Technology Assessment (HTA) is policy research that aims to inform priority setting and resource allocation. HTA is increasingly recognized as a useful policy tool in low- and middle-income countries (LMICs), where there is a substantial need for evidence to guide Universal Health Coverage policies, such as benefit coverage, quality improvement interventions and quality standards, all of which aim at improving the efficiency and equity of the healthcare system. The Health Intervention and Technology Assessment Program (HITAP), Thailand, and the National Institute for Health and Care Excellence (NICE), UK, are national HTA organizations providing technical support to governments in LMICs to build up their priority setting capacity. This paper draws lessons from their capacity building programs in India, Colombia, Myanmar, the Philippines, and Vietnam. Such experiences suggest that it is not only technical capacity, for example analytical techniques for conducting economic evaluation, but also management, coordination and communication capacity that support the generation and use of HTA evidence in the respective settings. The learned lessons may help guide the development of HTA capacity in other LMICs.
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Affiliation(s)
- Sripen Tantivess
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand, Muang, Nonthaburi, 11000, Thailand
| | | | - Nattha Tritasavit
- International Unit, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand, Muang, Nonthaburi, 11000, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand, Muang, Nonthaburi, 11000, Thailand
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12
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Downey LE, Mehndiratta A, Grover A, Gauba V, Sheikh K, Prinja S, Singh R, Cluzeau FA, Dabak S, Teerawattananon Y, Kumar S, Swaminathan S. Institutionalising health technology assessment: establishing the Medical Technology Assessment Board in India. BMJ Glob Health 2017; 2:e000259. [PMID: 29225927 PMCID: PMC5717947 DOI: 10.1136/bmjgh-2016-000259] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 11/04/2022] Open
Abstract
India is at crossroads with a commitment by the government to universal health coverage (UHC), driving efficiency and tackling waste across the public healthcare sector. Health technology assessment (HTA) is an important policy reform that can assist policy-makers to tackle inequities and inefficiencies by improving the way in which health resources are allocated towards cost-effective, appropriate and feasible interventions. The equitable and efficient distribution of health budget resources, as well as timely uptake of good value technologies, are critical to strengthen the Indian healthcare system. The government of India is set to establish a Medical Technology Assessment Board to evaluate existing and new health technologies in India, assist choices between comparable technologies for adoption by the healthcare system and improve the way in which priorities for health are set. This initiative aims to introduce a more transparent, inclusive, fair and evidence-based process by which decisions regarding the allocation of health resources are made in India towards the ultimate goal of UHC. In this analysis article, we report on plans and progress of the government of India for the institutionalisation of HTA in the country. Where India is home to one-sixth of the global population, improving the health services that the population receives will have a resounding impact not only for India but also for global health.
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Affiliation(s)
- Laura E Downey
- Global Health and Development, Imperial College London, London, UK
| | - Abha Mehndiratta
- Global Health and Development, Imperial College London, London, UK
| | - Ashoo Grover
- Indian Council of Medical Research, New Delhi, Delhi, India
| | - Vijay Gauba
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, Delhi, India
| | - Kabir Sheikh
- Public Health Foundation of India, New Delhi, Delhi, India
| | | | - Ravinder Singh
- Indian Council of Medical Research, New Delhi, Delhi, India
| | | | - Saudamini Dabak
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
| | | | - Sanjiv Kumar
- National Health Systems Resource Centre, Delhi, India
| | - Soumya Swaminathan
- Indian Council of Medical Research, New Delhi, Delhi, India.,Public Health Foundation of India, New Delhi, Delhi, India
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Doherty JE, Wilkinson T, Edoka I, Hofman K. Strengthening expertise for health technology assessment and priority-setting in Africa. Glob Health Action 2017; 10:1370194. [PMID: 29035166 PMCID: PMC5700536 DOI: 10.1080/16549716.2017.1370194] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/17/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Achieving sustainable universal health coverage depends partly on fair priority-setting processes that ensure countries spend scarce resources wisely. While general health economics capacity-strengthening initiatives exist in Africa, less attention has been paid to developing the capacity of individuals, institutions and networks to apply economic evaluation in support of health technology assessment and effective priority-setting. OBJECTIVE On the basis of international lessons, to identify how research organisations and partnerships could contribute to capacity strengthening for health technology assessment and priority-setting in Africa. METHODS A rapid scan was conducted of international formal and grey literature and lessons extracted from the deliberations of two international and regional workshops relating to capacity-building for health technology assessment. 'Capacity' was defined in broad terms, including a conducive political environment, strong public institutional capacity to drive priority-setting, effective networking between experts, strong research organisations and skilled researchers. RESULTS Effective priority-setting requires more than high quality economic research. Researchers have to engage with an array of stakeholders, network closely other research organisations, build partnerships with different levels of government and train the future generation of researchers and policy-makers. In low- and middle-income countries where there are seldom government units or agencies dedicated to health technology assessment, they also have to support the development of an effective priority-setting process that is sensitive to societal and government needs and priorities. CONCLUSIONS Research organisations have an important role to play in contributing to the development of health technology assessment and priority-setting capacity. In Africa, where there are resource and capacity challenges, effective partnerships between local and international researchers, and with key government stakeholders, can leverage existing skills and knowledge to generate a critical mass of individuals and institutions. These would help to meet the priority-setting needs of African countries and contribute to sustainable universal health coverage.
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Affiliation(s)
- Jane E Doherty
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Thomas Wilkinson
- PRICELESS SA (Priority Cost-Effective Lessons for Systems Strengthening South Africa), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Ijeoma Edoka
- PRICELESS SA (Priority Cost-Effective Lessons for Systems Strengthening South Africa), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Karen Hofman
- PRICELESS SA (Priority Cost-Effective Lessons for Systems Strengthening South Africa), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, Balch C, Brennan MF, Dare A, D'Cruz A, Eggermont AMM, Fleming K, Gueye SM, Hagander L, Herrera CA, Holmer H, Ilbawi AM, Jarnheimer A, Ji JF, Kingham TP, Liberman J, Leather AJM, Meara JG, Mukhopadhyay S, Murthy SS, Omar S, Parham GP, Pramesh CS, Riviello R, Rodin D, Santini L, Shrikhande SV, Shrime M, Thomas R, Tsunoda AT, van de Velde C, Veronesi U, Vijaykumar DK, Watters D, Wang S, Wu YL, Zeiton M, Purushotham A. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 2016; 16:1193-224. [PMID: 26427363 DOI: 10.1016/s1470-2045(15)00223-5] [Citation(s) in RCA: 409] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.
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Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
| | | | - Benjamin O Anderson
- University of Washington School of Medicine, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Ajay Aggarwal
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Charles Balch
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Anna Dare
- Centre for Global Health Research, St Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anil D'Cruz
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Kenneth Fleming
- Green Templeton College, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Trust, Oxford, UK
| | - Serigne Magueye Gueye
- University Cheikh Anta Diop, Dakar, Senegal; Grand Yoff General Hospital, Dakar, Senegal
| | - Lars Hagander
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - Cristian A Herrera
- Cabinet of the Minister, Ministry of Health, Santiago, Chile; Department of Public Health, School of Medicine, Pontificia Universidad Católica, Santiago, Chile
| | - Hampus Holmer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - André M Ilbawi
- University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Union for International Cancer Control, Geneva, Switzerland
| | - Anton Jarnheimer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jia-Fu Ji
- Peking University Cancer Hospital and Institute, Beijing, China; Chinese Anti-Cancer Association, Tianjin, China
| | | | | | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - John G Meara
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Swagoto Mukhopadhyay
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shilpa S Murthy
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA; Department of General Surgery, Indiana University, Bloomington, IN, USA
| | | | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; University of Zambia, Lusaka, Zambia
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Luiz Santini
- INCA (Brazilian National Cancer Institute), Rio de Janeiro, Brazil
| | | | - Mark Shrime
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Thomas
- Department of Health & Human Services, Melbourne, VIC, Australia
| | - Audrey T Tsunoda
- Gyne-Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Cornelis van de Velde
- Department of Surgical Oncology, Endocrine and Gastrointestinal Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | | | | | - David Watters
- Deakin University, Geelong, VIC, Australia; Barwon Health, Geelong, VIC, Australia
| | - Shan Wang
- Peking University People's Hospital, Beijing, China; Chinese College of Surgeons, Beijing, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangzhou, China; Guangdong Academy of Medical Sciences, Guangzhou, China; Chinese Society of Clinical Oncology, Beijing, China
| | - Moez Zeiton
- Sadeq Institute, Tripoli, Libya; Trauma and Orthopaedic Rotation, North-West Deanery, Manchester, UK
| | - Arnie Purushotham
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
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15
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Babigumira JB, Jenny AM, Bartlein R, Stergachis A, Garrison LP. Health technology assessment in low- and middle-income countries: a landscape assessment. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2016. [DOI: 10.1111/jphs.12120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Objectives
Health technology assessment (HTA) for a wide range of healthcare technologies is an essential component of well-functioning health systems. Knowledge of the use of HTA in low- and middle-income countries (LMICs) is limited.
Methods
We performed a survey of HTA in selected LMICs. We interviewed key stakeholders on the use, conduct and challenges of performing HTA in their countries. We performed mixed-methods analyses to identify, characterize and describe HTA and how it relates to gross domestic product and government effectiveness.
Key findings
Of the 19 countries selected for participation, stakeholders in 12 (63%) countries responded to the survey – Afghanistan, Bangladesh, Democratic Republic of Congo (DR Congo), Dominican Republic, Ethiopia, Jordan, Kenya, Namibia, Rwanda, South Africa, Swaziland and Vietnam. Eight countries surveyed have some form of informal HTA activity conducted by stakeholders including academia, industry, government and the World Health Organization. There is evidence of knowledge sharing with five countries using HTAs from their neighbouring countries or from more developed countries. We found no evidence of formal HTA performed through dedicated, independent bodies in the LMICs surveyed. There was some evidence that HTA was moderately related to GDP per capita and strongly related to degree of centralization (government effectiveness). Respondents identified resources, both financial and human, as challenges to conducting HTA.
Conclusions
Formal HTA appears to be non-existent or limited in the LMICs surveyed but some evidence of informal HTA exists. Efforts to formalize HTA and to use existing HTA evidence will improve the quality of regulatory, coverage, formulary and reimbursement decisions, and individual and public health.
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Affiliation(s)
- Joseph B Babigumira
- Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Alisa M Jenny
- Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Andy Stergachis
- Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Louis P Garrison
- Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA
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Faria BM, Gonçalves J, Reis LP, Rocha Á. A Clinical Support System Based on Quality of Life Estimation. J Med Syst 2015; 39:308. [PMID: 26277614 DOI: 10.1007/s10916-015-0308-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/04/2015] [Indexed: 11/28/2022]
Abstract
Quality of life is a concept influenced by social, economic, psychological, spiritual or medical state factors. More specifically, the perceived quality of an individual's daily life is an assessment of their well-being or lack of it. In this context, information technologies may help on the management of services for healthcare of chronic patients such as estimating the patient quality of life and helping the medical staff to take appropriate measures to increase each patient quality of life. This paper describes a Quality of Life estimation system developed using information technologies and the application of data mining algorithms to access the information of clinical data of patients with cancer from Otorhinolaryngology and Head and Neck services of an oncology institution. The system was evaluated with a sample composed of 3013 patients. The results achieved show that there are variables that may be significant predictors for the Quality of Life of the patient: years of smoking (p value 0.049) and size of the tumor (p value < 0.001). In order to assign the variables to the classification of the quality of life the best accuracy was obtained by applying the John Platt's sequential minimal optimization algorithm for training a support vector classifier. In conclusion data mining techniques allow having access to patients additional information helping the physicians to be able to know the quality of life and produce a well-informed clinical decision.
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Affiliation(s)
- Brígida Mónica Faria
- LIACC - Lab. Inteligência Artificial e Ciência de Computadores, Porto, Portugal,
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17
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Bredenkamp C, Evans T, Lagrada L, Langenbrunner J, Nachuk S, Palu T. Emerging challenges in implementing universal health coverage in Asia. Soc Sci Med 2015; 145:243-8. [PMID: 26271404 DOI: 10.1016/j.socscimed.2015.07.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/28/2015] [Accepted: 07/23/2015] [Indexed: 11/16/2022]
Abstract
As countries in Asia converge on the goal of universal health coverage (UHC), some common challenges are emerging. One is how to ensure coverage of the informal sector so as to make UHC truly universal; a second is how to design a benefit package that is responsive and appropriate to current health challenges, yet fiscally sustainable; and a third is how to ensure "supply-side readiness", i.e. the availability and quality of services, which is a necessary condition for translating coverage into improvements in health outcomes. Using examples from the Asia region, this paper discusses these three challenges and how they are being addressed. On the first challenge, two promising approaches emerge: using general revenues to fully cover the informal sector, or employing a combination of tax subsidies, non-financial incentives and contributory requirements. The former can produce fast results, but places pressure on government budgets and may induce informality, while the latter will require a strong administrative mandate and systems to track the ability-to-pay. With respect to benefit packages, we find considerable variation in the nature and rigor of processes underlying the selection and updating of the services included. Also, in general, packages do not yet focus sufficiently on non-communicable diseases (NCDs) and related preventive outpatient care. Finally, there are large variations and inequities in the supply-side readiness, in terms of availability of infrastructure, equipment, essential drugs and staffing, to deliver on the promises of UHC. Health worker competencies are also a constraint. While the UHC challenges are common, experience in overcoming these challenges is varied and many of the successes appear to be highly context-specific. This implies that researchers and policymakers need to rigorously, and regularly, assess different approaches, and share these findings across countries in Asia - and across the world.
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18
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Thorat T, Lin PJ, Neumann PJ. The State of Cost-Utility Analyses in Asia: A Systematic Review. Value Health Reg Issues 2015; 6:7-13. [PMID: 29698196 DOI: 10.1016/j.vhri.2015.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 01/26/2015] [Accepted: 02/06/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review and evaluate published cost-utility analyses (CUAs) targeting populations in Asia. METHODS We examined data from the Tufts Medical Center Cost-Effectiveness Analysis Registry, which contains detailed information on more than 3700 English-language CUAs in peer-reviewed journals through 2012. We focused on CUAs pertaining to Asian countries (Asian CUAs), summarized study features and methodological practices, and compared them with CUAs focusing on non-Asian countries (non-Asian CUAs) from 2000 to 2012. RESULTS We identified 175 published CUAs pertaining to Asian populations (representing 5.1% of all CUAs) from 2000 to 2012. The number has increased from 19 CUAs in the period 2000 to 2004 to 107 CUAs in the period 2009 to 2012. Roughly one-third focused on Japan (33.1%), followed by Taiwan (15.4%), China (14.9%), and Thailand (8.0%). The diseases targeted in Asian CUAs were cancer (24.6%), infectious diseases (13.7%), cardiovascular diseases (8.6%), and musculoskeletal and rheumatological diseases (5.7%). More Asian CUAs evaluated primary prevention interventions (e.g., vaccinations and screenings) compared with non-Asian CUAs (21.7% vs. 16.5%, P = 0.069). Compared with non-Asian CUAs, significantly more studies in Asia suggest that the health interventions examined provide reasonable value for money. Asian and non-Asian CUAs did not differ in adherence to good methodological practices, including clearly stating the perspective, discounting costs and quality-adjusted life-years, stating a time horizon, and correctly conducting incremental cost-effectiveness analysis. Asian CUAs, however, lagged in reporting sensitivity analyses, disclosing funding status, and currency year. CONCLUSIONS The number of CUAs in Asia has grown steadily, with more than half focused on pharmaceuticals. The literature reveals that CUAs generally follow good methodological practices though areas for improvement exist.
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Affiliation(s)
- Teja Thorat
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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Lu C, Tsai S, Ruhumuriza J, Umugiraneza G, Kandamutsa S, Salvatore PP, Zhang Z, Binagwaho A, Ngabo F. Tracking rural health facility financial data in resource-limited settings: a case study from Rwanda. PLoS Med 2014; 11:e1001763. [PMID: 25460586 PMCID: PMC4251825 DOI: 10.1371/journal.pmed.1001763] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Chunling Lu and colleagues describe a project for tracking health center financial data in two rural districts of Rwanda, which could be adapted for other low- or middle-income countries. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Chunling Lu
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sandy Tsai
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | | | | | | | | | - Zibiao Zhang
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
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20
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Tangcharoensathien V, Limwattananon S, Patcharanarumol W, Thammatacharee J, Jongudomsuk P, Sirilak S. Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing. Health Policy Plan 2014; 30:1152-61. [PMID: 25378527 PMCID: PMC4597041 DOI: 10.1093/heapol/czu120] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 11/18/2022] Open
Abstract
Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser–provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite annual budget.
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Affiliation(s)
- Viroj Tangcharoensathien
- International Health Policy Program (IHPP), Ministry of Public Health, Thanon Tiwanon, Nonthaburi 11000 Thailand,
| | - Supon Limwattananon
- Faculty of Pharmaceutical Sciences, Khon Kaen University, 123 Mitraparp Highway, Khon Kaen 40002 Thailand
| | - Walaiporn Patcharanarumol
- International Health Policy Program (IHPP), Ministry of Public Health, Thanon Tiwanon, Nonthaburi 11000 Thailand
| | - Jadej Thammatacharee
- National Health Security Office, Government Complex, Changwattana, Bangkok 10210 Thailand and
| | - Pongpisut Jongudomsuk
- National Health Security Office, Government Complex, Changwattana, Bangkok 10210 Thailand and
| | - Supakit Sirilak
- Health Technical Office, Ministry of Public Health, Thanon Tiwanon, Nonthaburi 11000 Thailand
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21
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Musuuza JS, Singer ME, Mandalakas AM, Katamba A. Key actors' perspectives on cost-effectiveness analysis in Uganda: a cross-sectional survey. BMC Health Serv Res 2014; 14:539. [PMID: 25363234 PMCID: PMC4232642 DOI: 10.1186/s12913-014-0539-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/20/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cost effectiveness analysis (CEA) is a useful tool for allocation of constrained resources, yet CEA methodologies are rarely taught or implemented in developing nations. We aimed to assess exposure to, and interest in CEA, and identify barriers to implementation in Uganda. METHODS A cross-sectional survey was carried out in Uganda using a newly developed self-administered questionnaire (via online and paper based approaches), targeting the main health care actors as identified by a previous study. RESULTS Overall, there was a 68% response rate, with a 92% (69/75) response rate among the paper-based respondents compared to a 40% (26/65) rate with the online respondents. Seventy eight percent (74/95) of the respondents had no exposure to CEA. None of those with a master of medicine degree had any CEA exposure, and 80% of technical officers, who are directly involved in policy formulation, had no CEA exposure. Barriers to CEA identified by more than 50% of the participants were: lack of information technology (IT) infrastructure (hardware and software); lack of local experts in the field of CEA; lack of or limited local data; limited CEA training in schools; equity or ethical issues; and lack of training grants incorporating CEA. 93% reported a lot of interest in learning to conduct CEA, and over 95% felt CEA was important for clinical decision making and policy formulation. CONCLUSIONS Among health care actors in Uganda, there is very limited exposure to, but substantial interest in conducting CEA and including it in clinical decision making and health care policy formation. Capacity to undertake CEA needs to be built through incorporation into medical training and use of regional approaches.
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22
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Mohara A, Youngkong S, Velasco RP, Werayingyong P, Pachanee K, Prakongsai P, Tantivess S, Tangcharoensathien V, Lertiendumrong J, Jongudomsuk P, Teerawattananon Y. Using health technology assessment for informing coverage decisions in Thailand. J Comp Eff Res 2014; 1:137-46. [PMID: 24237374 DOI: 10.2217/cer.12.10] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This article aims to illustrate and critically analyze the results from the 1-year experience of using health technology assessment (HTA) in the development of the Thai Universal Coverage health benefit package. We review the relevant documents and give a descriptive analysis of outcomes resulting from the development process in 2009-2010. Out of 30 topics nominated by stakeholders for prioritization, 12 were selected for further assessment. A total of five new interventions were recommended for inclusion in the benefit package based on value for money, budget impact, feasibility and equity reasons. Different stakeholders have diverse interests and capabilities to participate in the process. In conclusion, HTA is helpful for informing coverage decisions for health benefit packages because it enhances the legitimacy of policy decisions by increasing the transparency, inclusiveness and accountability of the process. There is room for improvement of the current use of HTA, including providing technical support for patient representatives and civic groups, better communication between health professionals, and focusing more on health promotion and disease prevention.
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Affiliation(s)
- Adun Mohara
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
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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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Teerawattananon Y, Tritasavit N, Suchonwanich N, Kingkaew P. The use of economic evaluation for guiding the pharmaceutical reimbursement list in Thailand. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 108:397-404. [DOI: 10.1016/j.zefq.2014.06.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/19/2014] [Accepted: 06/26/2014] [Indexed: 10/24/2022]
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Moat KA, Lavis JN, Abelson J. How contexts and issues influence the use of policy-relevant research syntheses: a critical interpretive synthesis. Milbank Q 2013; 91:604-48. [PMID: 24028700 DOI: 10.1111/1468-0009.12026] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
CONTEXT Evidence briefs have emerged as a promising approach to synthesizing the best available research evidence for health system policymakers and stakeholders. An evidence brief may draw on systematic reviews and many other types of policy-relevant information, including local data and studies, to describe a problem, options for addressing it, and key implementation considerations. We conducted a systematic review to examine the ways in which context- and issue-related factors influence the perceived usefulness of evidence briefs among their intended users. METHODS We used a critical interpretive synthesis approach to review both empirical and nonempirical literature and to develop a model that explains how context and issues influence policymakers' and stakeholders' views of the utility of evidence briefs prepared for priority policy issues. We used a "compass" question to create a detailed search strategy and conducted electronic searches in CINAHL, EMBASE, HealthSTAR, IPSA, MEDLINE, OAIster (gray literature), ProQuest A&I Theses, ProQuest (Sociological Abstracts, Applied Social Sciences Index and Abstracts, Worldwide Political Science Abstracts, International Bibliography of Social Sciences, PAIS, Political Science), PsychInfo, Web of Science, and WilsonWeb (Social Science Abstracts). Finally, we used a grounded and interpretive analytic approach to synthesize the results. FINDINGS Of the 4,461 papers retrieved, 3,908 were excluded and 553 were assessed for "relevance," with 137 included in the initial sample of papers to be analyzed and an additional 23 purposively sampled to fill conceptual gaps. Several themes emerged: (1) many established types of "evidence" are viewed as useful content in an evidence brief, along with several promising formatting features; (2) contextual factors, particularly the institutions, interests, and values of a given context, can influence views of evidence briefs; (3) whether an issue is polarizing and whether it is salient (or not) and familiar (or not) to actors in the policy arena can influence views of evidence briefs prepared for that issue; (4) influential factors can emerge in several ways (as context driven, issue driven, or a result of issue-context resonance); (5) these factors work through two primary pathways, affecting either the users or the producers of briefs; and (6) these factors influence views of evidence briefs through a variety of mechanisms. CONCLUSIONS Those persons funding and preparing evidence briefs need to consider a variety of context- and issue-related factors when deciding how to make them most useful in policymaking.
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Pai NP, Sollis K, Peeling RW. Rapid hepatitis C tests: better than the gold standard? Expert Rev Mol Diagn 2013; 13:221-3. [PMID: 23570397 DOI: 10.1586/erm.13.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Ditsuwan V, Lennert Veerman J, Bertram M, Vos T. Cost-effectiveness of interventions for reducing road traffic injuries related to driving under the influence of alcohol. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:23-30. [PMID: 23337212 DOI: 10.1016/j.jval.2012.08.2209] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 08/17/2012] [Accepted: 08/23/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness of interventions to reduce road traffic injuries caused by driving under the influence of alcohol in Thailand. METHODS We used generalized cost-effectiveness analysis and included costs from a health sector perspective. The model considered road traffic crash victims who were injured, disabled, or died. We obtained proportions of alcohol-related crashes from the Thai Injury Surveillance system. Intervention effectiveness was derived from published reviews and a study in one province of Thailand. Random breath testing, selective breath testing, and mass media campaigns, both current and intervention scenarios, were compared with a "do-nothing" scenario. We calculated intervention costs and cost offsets of prevented treatment costs in 2004 Thai baht (US $1 = 41 baht) and measured benefits in terms of disability-adjusted life-years averted. Interventions with incremental cost-effectiveness ratios below 110,000 Thai baht (1×gross domestic product per capita) per disability-adjusted life-year (US $2,680) were considered very cost-effective. RESULTS Compared with doing nothing, mass media campaigns, random breath testing, and selective breath testing are all cost saving. When averted treatment costs are ignored and only intervention costs are included, all three interventions are very cost-effective, with incremental cost-effectiveness ratios of 10,300, 14,300 and 13,000 baht/disability-adjusted life-year, respectively. The current mix of mass media campaigns and sobriety checkpoints is therefore also cost-effective, but underinvestment in checkpoints limits its overall effect. CONCLUSIONS A greater intensity of conducting sobriety checkpoints in Thailand is recommended to complement the investment in mass media campaigns. Together these interventions have the potential to reduce the burden of alcohol-related road traffic injuries by 24%.
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Affiliation(s)
- Vallop Ditsuwan
- Faculty of Health and Sports Science, Thaksin University, Phatthalung Province, Thailand.
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Anothaisintawee T, Leelahavarong P, Ratanapakorn T, Teerawattananon Y. The use of comparative effectiveness research to inform policy decisions on the inclusion of bevacizumab for the treatment of macular diseases in Thailand's pharmaceutical benefit package. CLINICOECONOMICS AND OUTCOMES RESEARCH 2012; 4:361-74. [PMID: 23248574 PMCID: PMC3520463 DOI: 10.2147/ceor.s37458] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
There is increasing impetus to use pharmaceutical interventions, ie, ranibizumab or bevacizumab, for the treatment of particular macular diseases. This paper describes the evidence and decision-making of the National List of Essential Medicines Committee that recently announced the inclusion of bevacizumab for the treatment of macular diseases in its pharmaceutical benefit package. The findings of a systematic review and meta-analysis in this paper indicate that the intravitreal administration of bevacizumab is superior to nonpharmaceutical treatments for age-related macular degeneration (AMD) and diabetic macular edema (DME), but inconclusive for retinal vein occlusion, given the limited evidence. The study also failed to distinguish among the differences in terms of visual acuity improvement, reduction of central macular thickness, and response to treatment between AMD and DME patients treated with bevacizumab and those treated with ranibizumab. Although bevacizumab was not licensed for AMD and DME, the committee decided to include bevacizumab in the National List of Essential Medicines. It is expected that many patients who are in need of treatment but who are unable to afford the expensive alternative drug, ranibizumab, will be able to receive this effective treatment instead and be prevented from suffering irreversible loss of vision. At the same time, this policy will help generate evidence about the real-life effectiveness and safety profiles of the drug for future policy development in Thailand and other settings.
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Affiliation(s)
- Thunyarat Anothaisintawee
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand ; Family Medicine Department and Section of Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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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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IMPLEMENTATION OF LOCAL/HOSPITAL-BASED HEALTH TECHNOLOGY ASSESSMENT INITIATIVES IN LOW- AND MIDDLE-INCOME COUNTRIES. Int J Technol Assess Health Care 2012; 28:445-51. [DOI: 10.1017/s026646231200058x] [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
Objectives:The objective of this study is to review the implementation of health technology assessment (HTA) at the local and hospital levels in low- and middle-income countries (LMIC). This review will provide a starting point for identifying the conditions for HTA implementation in hospitals in LMIC through the analysis of experiments conducted in these countries.Methods:A systematic review of the literature was conducted to document the local-/hospital-level HTA experiments performed in LMIC.Results:This systematic review showed that few experiments of local HTA in LMIC have been published to date, with only five articles found in our survey. These documents report studies of clinical effectiveness and economic evaluation at the local level in certain Asian and Latin American countries. In addition, pharmaceuticals and medical devices were the most common topics covered by HTA at the local level in these countries.Conclusions:Currently, HTA plays an increasingly important role in healthcare systems in supporting decision making for healthcare policies and practices. This systematic review contributes to identify priorities in the process and methodology of HTA implementation at the local/hospital level in LMIC. The paucity of HTA in LMIC is often assumed to be due to the lack of formally tasked HTA agencies, to politics and to shortage of resources.
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Clark S, Weale A. Social values in health priority setting: a conceptual framework. J Health Organ Manag 2012; 26:293-316. [DOI: 10.1108/14777261211238954] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tonmukayakul U, Velasco RP, Tantivess S, Teerawattananon Y. Lessons drawn from research utilization in the maternal iodine supplementation policy development in Thailand. BMC Public Health 2012; 12:391. [PMID: 22646063 PMCID: PMC3490728 DOI: 10.1186/1471-2458-12-391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/30/2012] [Indexed: 11/10/2022] Open
Abstract
In this paper, the authors share their experience on evidence utilization in the development of Thailand’s maternal iodine supplementation policy in 2009–2010. Observations and reflections on their experience of engaging with research for policymaking are illustrated. The case study indicates that rapid approaches in conducting research, namely a targeted literature review and cross-sectional survey of professionals’ opinions and current practices were efficient in achieving the timeliness of evidence provision. In addition pro-activity, trust and interaction between researchers and policymakers enhanced the research–policy integration. The Thai experience may be useful for other developing countries which pursue evidence-informed policymaking, despite differences in the health system context.
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Affiliation(s)
- Utsana Tonmukayakul
- Health Intervention and Technology Assessment Program (HITAP), 6th floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Road, Muang, Nonthaburi, 11000, Thailand
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Velasco RP, Teerawattananon Y. Is there a role for pharmacoeconomics in developing countries? PHARMACOECONOMICS 2011; 29:433-437. [PMID: 21504242 DOI: 10.2165/11591060-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Kamae I. Value-based approaches to healthcare systems and pharmacoeconomics requirements in Asia: South Korea, Taiwan, Thailand and Japan. PHARMACOECONOMICS 2010; 28:831-838. [PMID: 20831290 DOI: 10.2165/11538360-000000000-00000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Asian healthcare systems are very diverse, representing cultures, political systems and economies from more than 30 countries with varying histories. Despite the diversity in the region, there has been enormous growth in health economics and outcomes research since the beginning of the 21st century. Whilst Japan has seen very limited use of health technology assessment (HTA), South Korea, Taiwan and Thailand have had remarkable success in establishing government agencies for HTA, employing HTA concepts from the UK National Institute for Health and Clinical Excellence (NICE). These three countries are driven by the following common factors: (i) a desire to establish universal healthcare insurance coverage in their respective nations; (ii) the need for rational allocation of scarce resources; (iii) a desire for government to provide leadership in HTA; and (iv) availability of HTA professionals and faculties through international networks. The HTA models introduced by these three countries are both similar to and different from those of HTA agencies in Europe, but might work well as examples for other countries in the region.
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Affiliation(s)
- Isao Kamae
- Japanese Pharmaceutical Manufacturer's Association (JPMA) Pharmacoeconomics Program, Graduate School of Health Management, Keio University, Fujisawa, Kanagawa, Japan.
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Yothasamut J, Tantivess S, Teerawattananon Y. Using economic evaluation in policy decision-making in Asian countries: mission impossible or mission probable? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12 Suppl 3:S26-S30. [PMID: 20586976 DOI: 10.1111/j.1524-4733.2009.00623.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES AND METHODS This article provides an extensive review of literature and an in-depth analysis aimed at introducing potential applications of economic evaluation and at addressing the barriers that could prohibit the use or diminish the usefulness of economic evaluation in Asian settings. It also proposes the probable solutions to overcome these barriers. RESULTS Potential uses of economic evaluation include the development of public reimbursement lists, price negotiation, the development of clinical practice guidelines, and communicating with prescribers. Two types of barriers to using economic evaluation, namely barriers relating to the production of economic evaluation data and decision context-related barriers, are identified. For the first sort of barrier, the development of the national guidelines, the development of economic evaluation database, planning and use of economic evaluation in a systematic manner, and prioritization of topics for assessment are recommended. Furthermore, educating potential users and the public, making the economic evaluation process transparent and participatory, and incorporating other health preferences into the decision-making framework have been promoted to conquer decision context-related barriers. CONCLUSIONS It seems practically impossible to adopt other countries' approaches using economic evaluation for priority setting because of several constraints specifically related to the context of each setting. Nevertheless, given a better understanding of its resistance, and proper policies and strategies to overcome the barriers applied, it is more than probable that a method with system/mechanisms specifically designed to fit particular settings will be used.
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Affiliation(s)
- Jomkwan Yothasamut
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.
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Historical development of health technology assessment in Thailand. Int J Technol Assess Health Care 2009; 25 Suppl 1:241-52. [PMID: 19527543 DOI: 10.1017/s0266462309090709] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aims to review the development of health technology assessment (HTA), including the socioeconomic context, outputs, and policy utilization in the Thai setting. METHODS This study was conducted through extensive document reviews including these published in both domestic and international literature. RESULTS Evidence suggests that contextual elements of the health system, especially the country's economic status and health financing reforms, as well as their effects on government budgeting for medical and public health services, played an important role in the increasing needs and demands for HTA information among policy makers. In the midst of substantial economic growth during the years 1982 to 1996, several studies reported the rapid diffusion and poor distribution of health technologies, and inequitable access to high-cost technology in public and private hospitals. At the same time, economic analysis and its underpinning concept of efficiency were suggested by groups of scholars and health officials to guide national policy on the investment in health technology equipment. Related research and training programs were subsequently launched. However, none of these HTA units could be institutionalized into national bodies. From 1997 to 2005, an economic recession, followed by the introduction of a universal health coverage plan, triggered the demands for effective measures for cost containment and prioritization of health interventions. This made policy makers and researchers at the Ministry of Public Health (MOPH) pay increasing attention to economic appraisals, and several HTA programs were established in the Ministry. Despite the rising number of Thai health economic publications, a major problem at that period involved the poor quality of studies. Since 2006, economic recovery and demands from different interests to include expensive technologies in the public health benefit package have been crucial factors promoting the role of HTA in national policy decisions. Meanwhile, HTA capacity has been strengthened through the establishment of many health economic and HTA initiatives. An illustration of the work and contributions of the Health Intervention and Technology Assessment Program (HITAP) is provided. In this phase, HTA policy integration has been enhanced through different mechanisms and organizations. CONCLUSION Over the past two decades a notable progression has been made in relation to the capacity building of HTA research and its policy utility in Thailand. Such development has been shaped by multiple factors. It is anticipated that experience gained among academics, health officials, and civil society organizations will be helpful not only in sustaining the momentum but also in improving formal HTA systems in the future.
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