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Oude Wolcherink MJ, Pouwels XGLV, van Dijk SHB, Doggen CJM, Koffijberg H. Can artificial intelligence separate the wheat from the chaff in systematic reviews of health economic articles? Expert Rev Pharmacoecon Outcomes Res 2023; 23:1049-1056. [PMID: 37573521 DOI: 10.1080/14737167.2023.2234639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/02/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Artificial intelligence-powered tools, such as ASReview, could reduce the burden of title and abstract screening. This study aimed to assess the accuracy and efficiency of using ASReview in a health economic context. METHODS A sample from a previous systematic literature review containing 4,994 articles was used. Previous manual screening resulted in 134 articles included for full-text screening (FT) and 50 for data extraction (DE). Here, accuracy and efficiency was evaluated by comparing the number of identified relevant articles with ASReview versus manual screening. Pre-defined stopping rules using sampling criteria and heuristic criteria were tested. Robustness of the AI-tool's performance was determined using 1,000 simulations. RESULTS Considering included stopping rules, median accuracy for FT articles remained below 85%, but reached 100% for DE articles. To identify all relevant articles, a median of 89.9% of FT articles needed to be screened, compared to 7.7% for DE articles. Potential time savings between 49 and 59 hours could be achieved, depending on the stopping rule. CONCLUSIONS In our case study, all DE articles were identified after screening 7.7% of the sample, allowing for substantial time savings. ASReview likely has the potential to substantially reduce screening time in systematic reviews of health economic articles.
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Affiliation(s)
- M J Oude Wolcherink
- Department of Health Technology and Services Research, Technical Medical Centre, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - X G L V Pouwels
- Department of Health Technology and Services Research, Technical Medical Centre, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - S H B van Dijk
- Department of Health Technology and Services Research, Technical Medical Centre, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - C J M Doggen
- Department of Health Technology and Services Research, Technical Medical Centre, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - H Koffijberg
- Department of Health Technology and Services Research, Technical Medical Centre, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, The Netherlands
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Health technology assessment and reimbursement policy for oncology orphan drugs in Central and Eastern Europe. Orphanet J Rare Dis 2020; 15:277. [PMID: 33032634 PMCID: PMC7545889 DOI: 10.1186/s13023-020-01556-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/23/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The reimbursement of orphan drugs (OD) is an increasingly important for country policymakers, and still insufficiently understood, especially in Central and Eastern Europe. The aim of this research was to provide a comprehensive description of country-specific health technology assessment (HTA) policies as well as evaluate the percentage of HTA recommendations and reimbursement decisions for oncology OD. In addition, the study was designed to elucidate the impact of reimbursement of these drugs on the public budget and the agreement between HTA recommendations and reimbursement decisions in the analysed countries. A questionnaire survey was used to collect data on the reimbursement status, HTA recommendation, marketing authorisation, and public expenses on reimbursement in 2014, 2015, and 2016 for all oncology drugs with an orphan designation by the European Medicine Agency in 2017 in Bulgaria, Croatia, Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, and Slovakia. The agreement between the HTA recommendation and reimbursement status was assessed using the kappa coefficient. The Pearson's correlation was used to analyse the relationship between gross domestic product (GDP) and GDP per capita and reimbursement expenses. RESULTS A total of 36 drugs were analysed (25% conditionally approved; 5.56% approved under exceptional circumstances). The share of reimbursed drugs ranged from 11.11% in Latvia to 41.67% in Poland. The highest share of positive recommendations was observed for Bulgaria and Estonia (36.11%), and the lowest, for Latvia (11.11%). The agreement varied from 0.4 for Poland to 1 for Latvia, Hungary, and Slovakia. Expenses were correlated with GDP (0.95 [0.81-0.99]), and not with GDP per capita (0.54 [- 0.136 to 0.873]). Expenses per capita were not correlated with GDP per capita (0.52 [- 0.15 to 0.87]). CONCLUSIONS In Hungary, Latvia, and Slovakia, a positive recommendation was associated with a reimbursement, and a negative one, with the lack of reimbursement. The reimbursement of oncology OD is associated with a growing burden for public budget, and the expenses are correlated with the total GDP. The highest share of drugs with any recommendation was observed in Poland, and the lowest, in Latvia and Romania. The share of reimbursed drugs was the lowest in Latvia and the highest in Poland.
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Hohmann NS, Garza KB, Surry D, Hansen RA, Harris I, Kiptanui Z, Oguntimein O, Frost MM, Qian J. Healthcare provider opinions about a generic drug educational newsletter. Res Social Adm Pharm 2019; 16:1228-1236. [PMID: 31838057 DOI: 10.1016/j.sapharm.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/05/2019] [Accepted: 12/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Increasing the prescribing and dispensing of generic drugs, compared to branded drugs, may increase patient access to affordable drug treatments. Healthcare providers have information needs regarding generic drugs, but available, tailored education materials designed for provider use are lacking. OBJECTIVES To examine healthcare provider opinions and receptivity regarding generic drug educational materials in content, format and design, delivery channel, and level of satisfaction. METHODS A national online survey was conducted in summer 2018 to gather practicing healthcare prescribers' (i.e., physicians, nurse practitioners, physician assistants) and pharmacists' opinions on an educational newsletter developed through a collaboration between the investigators and the U.S. Food and Drug Administration (FDA). Survey data were analyzed using descriptive statistics. Quantitative analyses were performed using SPSS version 24 (IBM, Armonk, NY), while responses to open-ended questions were assessed using qualitative content analysis in Excel. RESULTS A total of 208 surveys were completed. Overall, participants expressed positive opinions about the newsletter's content and format/design. About 69% of prescribers and 60% of pharmacists stated the newsletter gave information that will help them better serve patients. While 15% of surveyed pharmacists stated that they did not have resources to help them get information on generic drug availability and cost, more prescribers (37%) responded similarly. Both prescribers and pharmacists preferred to receive this newsletter via email from the FDA or a professional association. CONCLUSIONS Findings indicate the feasibility of educational outreach programs about generic drugs targeted towards healthcare providers. There is room for improvement in making prescribers and pharmacists aware of resources for learning about generic drug availability and cost. Future studies may test alternate versions of the newsletter that have been tailored to the needs of specific provider specialties or provider practices serving specific patient sub-groups, as well as preferred dissemination frequency.
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Affiliation(s)
- Natalie S Hohmann
- Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn University, 4201 Walker Building, Auburn, AL, 36849, USA.
| | - Kimberly B Garza
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA.
| | - Daniel Surry
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA.
| | - Richard A Hansen
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA.
| | - Ilene Harris
- IMPAQ International LLC, IMPAQ Int., Columbia, MD, 21044, USA.
| | | | - Oluwamurewa Oguntimein
- U.S. Food and Drug Administration (FDA), Office of Generic Drugs (OGD), 10903 New Hampshire Avenue Bldg. 75, Silver Spring, MD, 20993-0002, USA.
| | - Mitchell M Frost
- U.S. Food and Drug Administration (FDA), Office of Generic Drugs (OGD), 10903 New Hampshire Avenue Bldg. 75, Silver Spring, MD, 20993-0002, USA.
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA.
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Hu X, Qu S, Yao X, Li C, Liu Y, Wang J. Abiraterone acetate and docetaxel with androgen deprivation therapy in high-volume metastatic hormone-sensitive prostate cancer in China: an indirect treatment comparison and cost analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:27. [PMID: 31871432 PMCID: PMC6911273 DOI: 10.1186/s12962-019-0193-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 11/15/2019] [Indexed: 01/04/2023] Open
Abstract
Background To conduct an indirect treatment comparison of patients with high-volume mHSPC and a cost analysis between Abi-ADT and Doc-ADT therapies in China. Methods The Bucher technique for indirect treatment comparison was used. A cost analysis was conducted from both healthcare and patient perspectives. Results The indirect treatment comparison demonstrated no significant difference in PFS for Abi-ADT versus Doc-ADT (HR: 0.84, 95% CI 0.66–1.07). Doc-ADT therapy costs less than Abi-ADT, with potential savings of up to RMB 887,057 per patient from the healthcare perspective and RMB 226,210 per patient from the patient perspective. Conclusions No significant differences in PFS between Doc-ADT and Abi-ADT therapy for patients with high-volume mHSPC. Doc-ADT therapy is a cost-saving alternative to Abi-ADT in China.
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Affiliation(s)
- Xin Hu
- 1Department of Pharmacy, Beijing Hospital, Beijing, China
| | - Shuli Qu
- Real World Solutions, IQVIA, Shanghai, China
| | - Xingxing Yao
- 3Health Economics & Outcome Research, Sanofi, Shanghai, China
| | - Chaoyun Li
- 3Health Economics & Outcome Research, Sanofi, Shanghai, China
| | - Yanjun Liu
- Real World Solutions, IQVIA, Shanghai, China
| | - Jianye Wang
- 4Department of Urology, Beijing Hospital, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730 China
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Malinowski KP, Kawalec P, Trąbka W, Czech M, Petrova G, Manova M, Savova A, Draganić P, Vostalová L, Slabý J, Männik A, Márky K, Rugaja Z, Gulbinovic J, Tesar T, Paveliu MS. Reimbursement Legislations and Decision Making for Orphan Drugs in Central and Eastern European Countries. Front Pharmacol 2019; 10:487. [PMID: 31139080 PMCID: PMC6518361 DOI: 10.3389/fphar.2019.00487] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 04/17/2019] [Indexed: 01/30/2023] Open
Abstract
Background Reimbursement policies influence access of patients to orphan drugs in the European countries. Objectives To provide a comprehensive description of orphan drug reimbursement policies and to assess reimbursement decision-making process in the EU-CEE countries as well as the impact of the type of approval and disease on reimbursement decisions. Methods For each drug, the information regarding conditional approval or approval under exceptional circumstances was obtained from the EMA website. The reimbursement status for analyzed drugs was collected in a questionnaire survey performed in a group of experts in reimbursement policy. The agreement between countries was assessed using the κ coefficient, nominal variables tests were compared using the χ2 test or the Fisher exact test. The impact of the EMA’s conditional approval and approval under exceptional circumstances was assessed using logistic regression and presented as an odds ratio (OR). Results The analysis revealed that most orphan drugs were authorized for the treatment of oncological or metabolic diseases [36 drugs (38%) and 22 drugs (23%), respectively]. The shares of reimbursed orphan drugs varied significantly (p = 0.0031) from 6.3% in Latvia to 27.4% in Poland. No correlation (r = 0.02; p = 0.9583) with GDP per capita was observed. The highest agreement in reimbursement decisions was observed between Estonia and Lithuania, and the lowest – between Estonia and Latvia, with kappa of 0.69 and 0.11, respectively. Significant impact of the type of approval and reimbursement status was observed for Czechia, Lithuania and Slovakia where conditional approval and exceptional circumstances negatively influenced reimbursement decision. Type of disease has significant influence on reimbursement decision in 4 out of 10 analyzed countries with significant outweigh of positive decisions for oncological diseases. Conclusion In considered countries specific regulations on reimbursement of orphan drugs are valid but in Lithuania and Romania no formal HTA process was employed; in case of some countries higher ICER values for orphans are used. The share of reimbursed orphan drugs varied significantly across the countries, but it was not associated with GDP per capita.
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Affiliation(s)
- Krzysztof Piotr Malinowski
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Kawalec
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech Trąbka
- Bioinformatics and Public Health Department, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother and Child, Warsaw, Poland
| | - Guenka Petrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Manoela Manova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria.,National Council on Prices and Reimbursement of Medicinal Products, Sofia, Bulgaria
| | - Alexandra Savova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria.,National Council on Prices and Reimbursement of Medicinal Products, Sofia, Bulgaria
| | - Pero Draganić
- Agency for Medicinal Products and Medical Devices of Croatia, Zagreb, Croatia.,Department of Biotechnology, University of Rijeka, Rijeka, Croatia
| | - Lenka Vostalová
- Pricing and Reimbursement Regulation Branch, State Institute for Drug Control, Prague, Czechia
| | - Juraj Slabý
- Pricing and Reimbursement Regulation Branch, State Institute for Drug Control, Prague, Czechia
| | - Agnes Männik
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kristóf Márky
- National Institute of Health Insurance Fund Management, Budapest, Hungary
| | | | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Tesar
- Department of Organisation and Management in Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
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Malinowski KP, Kawalec P, Trabka W, Sowada C, Pilc A. Reimbursement of Orphan Drugs in Europe in Relation to the Type of Authorization by the European Medicines Agency and the Decision Making Based on Health Technology Assessment. Front Pharmacol 2018; 9:1263. [PMID: 30483124 PMCID: PMC6240661 DOI: 10.3389/fphar.2018.01263] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess shares of reimbursed orphan drugs and agreement in reimbursement decision-making in different European Union member states as well as to define odds for reimbursement influenced by the presence of conditional approval or exceptional circumstances granted by the European Medicines Agency (EMA) or by type of the disease. Methods: The list of authorized drugs with current orphan designations was collected from the website of the EMA. For each drug, the information regarding conditional approval or approval under exceptional circumstances was collected. The reimbursement statuses were available on national reimbursement or HTA agencies websites. The agreement for reimbursement decisions between selected countries was assessed using the κ coefficient for the measurement of agreement. The impact of the EMA's conditional approval as well as approval under exceptional circumstances was assessed using the logistic regression and presented as odds ratio. Results: The percentage of reimbursed orphan drugs varied significantly from 27% in Poland to 88% in Denmark, with an average value of 51% (p < 0.0001). Regarding the reimbursement status, the highest, substantial agreement was observed between Spain and Italy, and the lowest agreement was observed between Germany and England, with κ of 0.64 and 0.01, respectively. Conditional approval status significantly decreased the chance for reimbursement in France, Italy, and Spain by 77-80%; however, approval granted under exceptional circumstances had significant impact only in Germany with 85% decrease in chances for reimbursement. The type of the disease (oncology or metabolic) was significantly associated with both conditional approval (p of 0.03-oncology drugs were more likely to be conditionally approved then the rest of analyzed drugs) and exceptional circumstances (p of 0.02-drugs for metabolic diseases were more likely to be approved under exceptional circumstances). Conclusions: Access to reimbursed orphan drugs varies significantly across EU countries. The highest, substantial agreement in reimbursement decisions was observed between Italy and Spain and the lowest between Germany and England. Conditional approval and approval under exceptional circumstances were significant negative predictors of reimbursement in some countries and they were significantly associated with the type of the disease (oncology or metabolic).
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Affiliation(s)
- Krzysztof Piotr Malinowski
- Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Kawalec
- Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Trabka
- Bioinformatics and Public Health Department, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Christoph Sowada
- Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Pilc
- Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland.,Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
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Jakovljevic M, Camilleri C, Rancic N, Grima S, Jurisevic M, Grech K, Buttigieg SC. Cold War Legacy in Public and Private Health Spending in Europe. Front Public Health 2018; 6:215. [PMID: 30128309 PMCID: PMC6088206 DOI: 10.3389/fpubh.2018.00215] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Abstract
Cold War Era (1946-1991) was marked by the presence of two distinctively different economic systems, namely the free-market (The Western ones) and central-planned (The Eastern ones) economies. The main goal of this study refers to the exploration of development pathways of Public and Private Health Expenditure in all of the countries of the European WHO Region. Based on the availability of fully comparable data from the National Health Accounts system, we adopted the 1995-2014 time horizon. All countries were divided into two groups: those defined in 1989 as free market economies and those defined as centrally-planned economies. We observed six major health expenditures: Total Health Expenditure (% of GDP), Total Health Expenditure (PPP unit), General government expenditure on health (PPP), Private expenditure on health (PPP), Social security funds (PPP) and Out-of-pocket expenditure (PPP). All of the numerical values used refer exclusively to per capita health spending. In a time-window from the middle of the 1990s towards recent years, total health expenditure was rising fast in both groups of countries. Expenditure on health % of GDP in both group of countries increased over time with the increase in the Free-market economies seen to be more rapid. The steeper level of total expenditure on health for the Free-market as of 1989 market economies, is due mainly to a steep increase in both the government and private expenditure on health relative to spending by centrally-planned economies as of the same date, with the out-of-pocket expenditure and the social security funds in the same market economies category following the same steepness. Variety of governments were leading Eastern European countries into their transitional health care reforms. We may confirm clear presence of obvious divergent upward trends in total governmental and private health expenditures between these two groups of countries over the past two decades. The degree of challenge to the fiscal sustainability of these health systems will have to be judged for each single nation, in line with its own local circumstances and perspectives.
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Affiliation(s)
- Mihajlo Jakovljevic
- Department of Global Health, Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Carl Camilleri
- Department of Economics, Faculty of Economics, Management and Accountancy, University of Malta, Msida, Malta
| | - Nemanja Rancic
- Centre for Clinical Pharmacology, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Simon Grima
- Department of Insurance, Faculty of Economics, Management and Accountancy, University of Malta, Msida, Malta
| | - Milena Jurisevic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Kenneth Grech
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Sandra C Buttigieg
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta.,Clinical Performance Unit, Mater Dei Hospital, Msida, Malta
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Serje J, Bertram MY, Brindley C, Lauer JA. Global health worker salary estimates: an econometric analysis of global earnings data. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018. [PMID: 29541000 PMCID: PMC5845154 DOI: 10.1186/s12962-018-0093-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Human resources are consistently cited as a leading contributor to health care costs; however the availability of internationally comparable data on health worker earnings for all countries is a challenge for estimating the costs of health care services. This paper describes an econometric model using cross sectional earnings data from the International Labour Organization (ILO) that the World Health Organizations (WHO)-Choosing Interventions that are Cost-effective programme (CHOICE) has used to prepare estimates of health worker earnings (in 2010 USD) for all WHO member states. Methods The ILO data contained 324 observations of earnings data across 4 skill levels for 193 countries. Using this data, along with the assumption that data were missing not at random, we used a Heckman two stage selection model to estimate earning data for each of the 4 skill levels for all WHO member states. Results It was possible to develop a prediction model for health worker earnings for all countries for which GDP data was available. Health worker earnings vary both within country due to skill level, as well as across countries. As a multiple of GDP per capita, earnings show a negative correlation with GDP-that is lower income countries pay their health workers relatively more than higher income countries. Conclusions Limited data on health worker earnings is a limiting factor in estimating the costs of global health programmes. It is hoped that these estimates will support robust health care intervention costings and projections of resources needs over the Sustainable Development Goal period.
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Affiliation(s)
- Juliana Serje
- Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia 20, Geneva, Switzerland
| | - Melanie Y Bertram
- Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia 20, Geneva, Switzerland
| | - Callum Brindley
- Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia 20, Geneva, Switzerland
| | - Jeremy A Lauer
- Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia 20, Geneva, Switzerland
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