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Dixon S, Tyagi K, Singh M, Kar SS, Bagepally BS, Prinja S, Booth A, Carroll C, Sohail A, Mehndiratta A. Development of a competency framework for health technology assessment in India. BMJ Evid Based Med 2024:bmjebm-2023-112488. [PMID: 39237367 DOI: 10.1136/bmjebm-2023-112488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 09/07/2024]
Affiliation(s)
- Simon Dixon
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Kirti Tyagi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Malkeet Singh
- Center for Global Development, Washington, District of Columbia, USA
| | | | | | - Shankar Prinja
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Andrew Booth
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Chris Carroll
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Aamir Sohail
- Indian Institute of Science, Bangalore, Karnataka, India
| | - Abha Mehndiratta
- Center for Global Development, Washington, District of Columbia, USA
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Al Rabayah A, Roudijk B, Purba FD, Rencz F, Jaddoua S, Siebert U. Valuation of the EQ-5D-3L in Jordan. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01712-z. [PMID: 39225720 DOI: 10.1007/s10198-024-01712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 07/17/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND In Jordan, no national value set is available for any preference-accompanied health utility measure. OBJECTIVE This study aims to develop a value set for EQ-5D-3L based on the preferences of the Jordanian general population. METHODS A representative sample of the Jordanian general population was obtained through quota sampling involving age, gender, and region. Participants aged above 18 years were interviewed via videoconferencing using the EuroQol Valuation Technology 2.1 protocol. Participants completed ten composite time trade-offs (cTTO) and ten discrete choice experiments (DCE) tasks. cTTO and DCE data were analyzed using linear and logistic regression models, respectively, and hybrid models were applied to the combined DCE and cTTO data. RESULTS A total of 301 participants with complete data were included in the analysis. The sample was representative of the general population regarding region, age, and gender. All model types applied, that is, random intercept model, random intercept Tobit, linear model with correction for heteroskedasticity, Tobit with correction for heteroskedasticity, and all hybrid models, were statistically significant. They showed logical consistency in terms of higher utility decrements with more severe levels. The hybrid model corrected for heteroskedasticity was selected to construct the Jordanian EQ-5D-3L value set as it showed the best fit and lowest mean absolute error. The predicted value for the most severe health state (33333) was - 0.563. Utility decrements due to mobility had the largest weight, followed by anxiety/depression, while usual activities had the smallest weight. CONCLUSION This study provides the first EQ-5D-3L value set in the Middle East. The Jordanian EQ-5D-3L value set can now be used in health technology assessments for health policy planning by the Jordanian health sector's decision-makers.
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Affiliation(s)
- Abeer Al Rabayah
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria.
- Center for Drug Policy and Technology Assessment, Pharmacy Department, King Hussein Cancer Center, Amman, Jordan.
| | - Bram Roudijk
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | | | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
| | - Saad Jaddoua
- Pharmacy Department, King Hussein Cancer Center, Amman, Jordan
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria
- Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Alnaqbi KA, Elshamy AM, Gebran N, Fahmy S, Aldallal S, Korra N, Fasseeh AN, Kaló Z. Consensus-Based Recommendations for the Implementation of Health Technology Assessment in the United Arab Emirates. Value Health Reg Issues 2024; 43:101012. [PMID: 38861786 DOI: 10.1016/j.vhri.2024.101012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES Healthcare research and development have accelerated at an unprecedented rate creating a challenge even for high-income countries to finance all new technologies. Health technology assessment (HTA) aims to maximize health gains out of available resources. Our study aimed to provide tailor-made recommendations for HTA implementation in the United Arab Emirates (UAE). METHODS We conducted a policy survey to explore the gap between the current and preferred future environment of HTA implementation in the UAE. The survey was distributed in 2 workshops discussing the importance of HTA implementation, and results were further aggregated to yield a list of draft recommendations. Recommendations were then assessed for their feasibility in a round table discussion with experts in the field to generate actions for HTA implementation. RESULTS Survey results and round table discussion indicated the need to leverage HTA for value-based decision making. Experts confirmed the unmet need for broader coverage of graduate and postgraduate HTA training with the aim of specific PhD programs in the UAE. Public funding for HTA appraisals and expanding the scope of HTA to nonpharmaceuticals was recommended. Furthermore, experts recommended that several HTA bodies should be coordinated centrally and highlighted the importance of having an explicit soft cost-effectiveness threshold for common technologies and a higher threshold for orphan drugs. CONCLUSIONS Although HTA in the UAE is still in its early stages, strong initiatives are being taken for its implementation. Our survey results served as a step in developing a detailed action plan for HTA implementation that will enhance the sustainability of the healthcare system.
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Affiliation(s)
- Khalid A Alnaqbi
- Rheumatology Division, Tawam Hospital, Al Ain, United Arab Emirates; Internal Medicine Department, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
| | | | - Nicole Gebran
- Internal Medicine Department, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates; Abu Dhabi Healthcare Services Company (SEHA), Abu Dhabi, United Arab Emirates
| | - Sahar Fahmy
- College of Pharmacy, Helwan University, Cairo, Egypt
| | - Sara Aldallal
- Dubai Health Authority, Dubai, United Arab Emirates; Emirates Health Economics Society, United Arab Emirates
| | | | - Ahmad Nader Fasseeh
- Syreon Middle East, Alexandria, Egypt; Faculty of Pharmacy Alexandria University, Alexandria, Egypt
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary; Syreon Research Institute, Budapest, Hungary
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Hedibel M, Ghanassi FZ, El-Fass KA, Fasseeh AN, Abaza S, Kaló Z. Designing a Roadmap for Health Technology Assessment Implementation in Algeria. Cureus 2024; 16:e65558. [PMID: 39192895 PMCID: PMC11349251 DOI: 10.7759/cureus.65558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/29/2024] Open
Abstract
Background The scarcity of resources restricts healthcare financing decisions, affecting the population's health. Health technology assessment (HTA) balances restricted budgets with the best possible health outcomes. We aim to characterize the current status of HTA in Algeria and describe the future directions for HTA implementation according to the priorities set by local stakeholders. Methods Stakeholders from the public and private sectors responded to a policy survey about the current and preferred future status of HTA implementation in Algeria. The survey was administered during an online workshop and used a widely accepted international scorecard covering eight domains: capacity building, HTA financing, process and organizational structure, scope of HTA implementation, decision criteria, standardization of methodology, use of local data, and international collaboration. After that, one-on-one interviews with another local expert were conducted to validate and modify the draft recommendations. The interviewees were representatives from government agencies, hospitals, and pharmaceutical companies. Results Thirty-one experts filled out the HTA scorecard survey; most of them were from the public sector (74%). They highlighted that project-based HTA workshops or short courses were the most common form of HTA education in Algeria and recommended the establishment of postgraduate HTA training programs in the future to build sustainable capacities. They reported a lack of funding for HTA research and critical appraisal and recommended an increased public budget for HTA and the introduction of submission fees by manufacturers. There was consensus about the need for local HTA evidence generation in the future. Most of the experts advocated an explicit soft decision threshold. The interviewees further recommended using multi-criteria decision analysis in the short term. The application of quality indicators was believed to improve the reliability of the HTA process. Conclusion The results of our policy research delineate the gap between the current and preferred future status of HTA in Algeria based on insights from multiple stakeholders. The need to improve the educational HTA programs in Algeria, use local data in policy decisions, and increase funding for HTA were the most advocated recommendations.
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Affiliation(s)
- Meriem Hedibel
- Pharmaceutics and Industrial Pharmacy Research Laboratory, Faculty of Pharmacy, University of Algiers, Algiers, DZA
| | - Fatma-Zohra Ghanassi
- Pharmaceutics and Industrial Pharmacy Research Laboratory, Faculty of Pharmacy, University of Algiers, Algiers, DZA
| | | | - Ahmad N Fasseeh
- Modelling, Syreon Middle East, Alexandria, EGY
- Faculty of Pharmacy, Alexandria University, Alexandria, EGY
| | - Sherif Abaza
- Health Economics, Syreon Middle East, Cairo, EGY
| | - Zoltán Kaló
- Health Economics, Syreon Research Institute, Budapest, HUN
- Center for Health Technology Assessment, Semmelweis University, Budapest, HUN
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Fasseeh AN, Korra N, Elezbawy B, Sedrak AS, Gamal M, Eldessouki R, Eldebeiky M, George M, Seyam A, Abourawash A, Khalifa AY, Shaheen M, Abaza S, Kaló Z. Framework for developing cost-effectiveness analysis threshold: the case of Egypt. J Egypt Public Health Assoc 2024; 99:12. [PMID: 38825614 PMCID: PMC11144683 DOI: 10.1186/s42506-024-00159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/01/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Cost-effectiveness analyses rarely offer useful insights to policy decisions unless their results are compared against a benchmark threshold. The cost-effectiveness threshold (CET) represents the maximum acceptable monetary value for achieving a unit of health gain. This study aimed to identify CET values on a global scale, provide an overview of using multiple CETs, and propose a country-specific CET framework specifically tailored for Egypt. The proposed framework aims to consider the globally identified CETs, analyze global trends, and consider the local structure of Egypt's healthcare system. METHODS We conducted a literature review to identify CET values, with a particular focus on understanding the basis of differentiation when multiple thresholds are present. CETs of different countries were reviewed from secondary sources. Additionally, we assembled an expert panel to develop a national CET framework in Egypt and propose an initial design. This was followed by a multistakeholder workshop, bringing together representatives of different governmental bodies to vote on the threshold value and finalize the recommended framework. RESULTS The average CET, expressed as a percentage of the gross domestic product (GDP) per capita across all countries, was 135%, with a range of 21 to 300%. Interestingly, while the absolute value of CET increased with a country's income level, the average CET/GDP per capita showed an inverse relationship. Some countries applied multiple thresholds based on disease severity or rarity. In the case of Egypt, the consensus workshop recommended a threshold ranging from one to three times the GDP per capita, taking into account the incremental relative quality-adjusted life years (QALY) gain. For orphan medicines, a CET multiplier between 1.5 and 3.0, based on the disease rarity, was recommended. A two-times multiplier was proposed for the private reimbursement threshold compared to the public threshold. CONCLUSION The CET values in most countries appear to be closely related to the GDP per capita. Higher-income countries tend to use a lower threshold as a percentage of their GDP per capita, contrasted with lower-income countries. In Egypt, experts opted for a multiple CET framework to assess the value of health technologies in terms of reimbursement and pricing.
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Affiliation(s)
- Ahmad N Fasseeh
- Faculty of Pharmacy Alexandria University, Alexandria, Egypt
- Syreon Middle East, Alexandria, Egypt
| | | | | | - Amal S Sedrak
- Department of Public Health, Cairo University, Cairo, Egypt
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Mary Gamal
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Randa Eldessouki
- Department of Community Health, Fayoum University, Fayoum, Egypt
| | - Mariam Eldebeiky
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | | | - Ahmed Seyam
- Universal Health Insurance Authority, Cairo, Egypt
| | | | - Ahmed Y Khalifa
- World Health Organization Representative Office, Cairo, Egypt
| | | | | | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
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Zisis K, Pavi E, Geitona M, Athanasakis K. Real-world data: a comprehensive literature review on the barriers, challenges, and opportunities associated with their inclusion in the health technology assessment process. JOURNAL OF PHARMACY & PHARMACEUTICAL SCIENCES : A PUBLICATION OF THE CANADIAN SOCIETY FOR PHARMACEUTICAL SCIENCES, SOCIETE CANADIENNE DES SCIENCES PHARMACEUTIQUES 2024; 27:12302. [PMID: 38481726 PMCID: PMC10932954 DOI: 10.3389/jpps.2024.12302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/01/2024] [Indexed: 07/23/2024]
Abstract
Objective: This review aimed to assess the current use and acceptance of real-world data (RWD) and real-world evidence (RWE) in health technology assessment (HTA) process. It additionally aimed to discern stakeholders' viewpoints concerning RWD and RWE in HTA and illuminate the obstacles, difficulties, prospects, and consequences associated with the incorporation of RWD and RWE into the realm of HTA. Methods: A comprehensive PRISMA-based systematic review was performed in July 2022 in PubMed/Medline, Scopus, IDEAS-RePEc, International HTA database, and Centre for Reviews and Dissemination with ad hoc supplementary search in Google Scholar and international organization websites. The review included pre-determined inclusion criteria while the selection of eligible studies, the data extraction process and quality assessment were carried out using standardized and transparent methods. Results: Twenty-nine (n = 29) studies were included in the review out of 2,115 studies identified by the search strategy. In various global contexts, disparities in RWD utilization were evident, with randomized controlled trials (RCTs) serving as the primary evidence source. RWD and RWE played pivotal roles, surpassing relative effectiveness assessments (REAs) and significantly influencing decision-making and cost-effectiveness analyses. Identified challenges impeding RWD integration into HTA encompassed limited local data access, complexities in non-randomized trial design, data quality, privacy, and fragmentation. Addressing these is imperative for optimal RWD utilization. Incorporating RWD/RWE in HTA yields multifaceted advantages, enhancing understanding of treatment efficacy, resource utilization, and cost analysis, particularly via patient registries. RWE complements assessments of advanced therapy medicinal products (ATMPs) and rare diseases. Local data utilization strengthens HTA, bridging gaps when RCT data is lacking. RWD aids medical device decision-making, cancer drug reassessment, and indirect treatment comparisons. Challenges include data availability, stakeholder acceptance, expertise, and privacy. However, standardization, training, collaboration, and guidance can surmount these barriers, fostering enhanced RWD utilization in HTA. Conclusion: This study highlights the intricate global landscape of RWD and RWE acceptance in HTA. Recognizing regional nuances, addressing methodological challenges, and promoting collaboration are pivotal, among others, for leveraging RWD and RWE effectively in healthcare decision-making.
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Affiliation(s)
- Konstantinos Zisis
- Laboratory for Health Technology Assessment (LabHTA), Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
- Institute for Health Economics, Athens, Greece
| | - Elpida Pavi
- Laboratory for Health Technology Assessment (LabHTA), Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Mary Geitona
- Department of Social and Educational Policy, Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece
| | - Kostas Athanasakis
- Laboratory for Health Technology Assessment (LabHTA), Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
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Mohamad NF, Mansor Z, Mahmud A, Mohamed Ghazali IM, Sarimin R. Preparing future doctors for evidence-based practice: a study on health technology assessment awareness and its predictors in Malaysia. Int J Technol Assess Health Care 2024; 40:e18. [PMID: 38415300 DOI: 10.1017/s0266462324000102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES To determine the level of awareness of health technology assessment (HTA) and its predictors among clinical year medical students in public universities in Klang Valley, Malaysia. METHODS A cross-sectional study using the stratified random sampling method was conducted among clinical year medical students in four public universities in Klang Valley, Malaysia. Data on the level of awareness of HTA and its associated factors were collected using a self-administered online questionnaire. Descriptive, bivariate, and multivariate analyses were performed using IBM SPSS version 27 to determine the level of awareness of HTA and its predictors. RESULTS Majority (69 percent) of participants had a low level of awareness of HTA. The predictors of high-level awareness of HTA were attitude toward HTA (adjusted odds ratio (AOR) = 7.417, 95 percent confidence interval (CI): 3.491, 15.758), peer interaction on HTA (AOR = 0.320, 95 percent CI: 0.115, 0.888), and previous training on HTA (AOR = 4.849, 95 percent CI: 1.096, 21.444). CONCLUSIONS Most future doctors in public universities exhibit a low awareness of HTA. This study highlights the interplay between attitudes toward HTA, peer interaction, and previous training as influential predictors of HTA awareness. An integrated and comprehensive educational approach is recommended to cultivate a positive attitude and harness the positive aspects of peer interaction while mitigating the potential negative impact of misconceptions. Emphasizing early exposure to HTA concepts through structured programs is crucial for empowering the upcoming generation of healthcare professionals, enabling them to navigate HTA complexities and contribute to evidence-based healthcare practices in Malaysia and beyond.
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Affiliation(s)
- Nur Farhana Mohamad
- Malaysian Health Technology Assessment Section (MaHTAS), Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Zawiah Mansor
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Malaysia
| | - Aidalina Mahmud
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Malaysia
| | - Izzuna Mudla Mohamed Ghazali
- Malaysian Health Technology Assessment Section (MaHTAS), Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Roza Sarimin
- Malaysian Health Technology Assessment Section (MaHTAS), Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
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Alnaqbi KA, Elezbawy B, Fasseeh AN, Bangash AR, Elshamy A, Shendi H, Aftab MI, AlMarshoodi M, Gebran N, AlDhaheri N, Fahmy SA, Al Dallal S, Al Naeem W, Abaza S, Kaló Z. Development of the Emirates Multi-Criteria Decision Analysis Tool for Orphan Drugs. Cureus 2024; 16:e55215. [PMID: 38558740 PMCID: PMC10981202 DOI: 10.7759/cureus.55215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Background The number of orphan drug approvals is currently increasing globally. This creates a significant burden on payers and healthcare systems. This study aimed to create a multi-criteria decision analysis (MCDA) tool for evaluating orphan drugs within the United Arab Emirates (UAE). The intended result of the tool is to provide evidence-based guidance to decision-makers in reimbursement and procurement decisions. Methods We conducted a literature search and local expert interviews to identify relevant preliminary criteria for the MCDA tool. Then we conducted a structured consensus-building session for healthcare experts and decision-makers in the UAE to develop the Emirati MCDA tool for orphan drugs. The experts voted for the criteria to be included in the tool and their ranking according to importance, as well as the weight of each criterion and its scoring function. To improve understanding and facilitate the voting process, experts were provided with a brief illustration of similar tools conducted in other countries before the voting sessions. Finally, the tool was developed in a Microsoft Excel sheet (Microsoft Corporation, Redmond, Washington, United States), and it was validated and tested based on real case studies, then it was fine-tuned accordingly based on the experts' discussions. The final tool was provided to the attendees to guide their decisions in the reimbursement and procurement of orphan drugs. Results The created tool provides a score for each analyzed orphan drug based on its value. Ten criteria were included in the final MCDA tool. These were cost-effectiveness (25.1% of the weight), magnitude of health gain (20.1%), availability of therapeutic alternative (14.3%), disease severity (11%), budget impact (7.9%), disease rarity (5.6%), strength of clinical evidence (5.6%), burden on households (4.5%), indication uniqueness (3.2%), and patients' age (2.6%). Conclusions Implementation of evidence-based healthcare necessitates assessing the fair value of each health technology. Addressing the high unmet medical needs and improving healthcare for patients with rare diseases are priorities within the UAE. The created Emirates MCDA tool for orphan drugs has the potential to help decision-makers implement value-based and evidence-based reimbursement decisions for orphan drugs.
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Affiliation(s)
- Khalid A Alnaqbi
- Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, ARE
- Internal Medicine/Rheumatology, Tawam Hospital, Al Ain, ARE
| | - Baher Elezbawy
- Evidence Synthesis, Syreon Middle East, Alexandria, EGY
- Doctoral School of Pharmaceutical Sciences, Semmelweis University, Budapest, HUN
| | - Ahmad N Fasseeh
- Modelling, Syreon Middle East, Alexandria, EGY
- Faculty of Pharmacy, Alexandria University, Alexandria, EGY
| | - Abdul Rauf Bangash
- Benefit Design and Strategic Purchasing, Department of Health, Abu Dhabi, ARE
| | - Amin Elshamy
- Wellbeing and Sustainable Development, Ministry of Health and Prevention, Dubai, ARE
| | | | | | | | - Nicole Gebran
- Clinical Pharmacy, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, ARE
| | - Noura AlDhaheri
- Pediatrics/Genetics and Genomics, United Arab Emirates University, Al Ain, ARE
| | - Sahar A Fahmy
- Drugs and Medical Products Regulation, Department of Health, Abu Dhabi, ARE
| | | | - Waeil Al Naeem
- Clinical Pharmacy, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, ARE
| | - Sherif Abaza
- Health Economics, Syreon Middle East, Cairo, EGY
| | - Zoltán Kaló
- Health Economics, Syreon Research Institute, Budapest, HUN
- Health Technology Assessment, Semmelweis Univeristy, Budapest, HUN
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Connolly E, Mohan S, Twea P, Msuku T, Kees A, Sharma L, Heung S, Nkhoma D, Manthalu G. Revision of Malawi's Health Benefits Package: A Critical Analysis of Policy Formulation and Implementation. Value Health Reg Issues 2024; 39:84-94. [PMID: 38041898 DOI: 10.1016/j.vhri.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES Health benefits packages (HBPs), which define specific health services that can be offered for free or at a reduced cost to fit within public revenues, have been recommended for over 30 years to maximize population health in resource-limited settings. However, there remain gaps in defining and operationalizing HBPs. We propose a combination of design and prioritization methods along with practical strategies to improve the implementation of future iterations of the HBP in Malawi. METHODS For HBP development for Malawi's Third Health Sector Strategic Plan, we combined cost-effectiveness analysis with a quantitative, consultative multicriteria decision analysis. Throughout the process of development, we documented challenges and opportunities to improve HBP design and application. RESULTS The primary and secondary HBP included 115 interventions. However, the definition of an HBP is just one step toward focusing limited resources, with functional operationalization as the most critical component. Full implementation of previous HBPs has been limited by challenges in aid coordination with the misalignment of nonfungible vertical donor funding for the HBP without accounting for the complexity and interconnectedness of the health system. Opportunities for improved application include creation of a complementary minimum health service package to guide overall resource inputs through an integrative approach. CONCLUSIONS We believe that expanded participatory HBP methods that consider value, equity, and social considerations, along with a shift to providing integrated health service packages at all levels of care, will improve the efficiency of using scarce resources along the journey to universal health coverage.
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Affiliation(s)
- Emilia Connolly
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi; Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, OH, USA.
| | - Sakshi Mohan
- Center for Health Economics, University of York, York, England, UK
| | - Pakwanja Twea
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
| | - Thulasoni Msuku
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
| | - Andreas Kees
- Clinton Health Access Initiative, Lilongwe, Malawi
| | - Lalit Sharma
- Clinton Health Access Initiative, Lilongwe, Malawi
| | | | - Dominic Nkhoma
- Health Economics Policy Unit, Kamuzu University for Health Sciences, Lilongwe, Malawi
| | - Gerald Manthalu
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
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Garot C, Schoffit S, Monfoulet C, Machillot P, Deroy C, Roques S, Vial J, Vollaire J, Renard M, Ghanem H, El-Hafci H, Decambron A, Josserand V, Bordenave L, Bettega G, Durand M, Manassero M, Viateau V, Logeart-Avramoglou D, Picart C. 3D-Printed Osteoinductive Polymeric Scaffolds with Optimized Architecture to Repair a Sheep Metatarsal Critical-Size Bone Defect. Adv Healthc Mater 2023; 12:e2301692. [PMID: 37655491 DOI: 10.1002/adhm.202301692] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/10/2023] [Indexed: 09/02/2023]
Abstract
The reconstruction of critical-size bone defects in long bones remains a challenge for clinicians. A new osteoinductive medical device is developed here for long bone repair by combining a 3D-printed architectured cylindrical scaffold made of clinical-grade polylactic acid (PLA) with a polyelectrolyte film coating delivering the osteogenic bone morphogenetic protein 2 (BMP-2). This film-coated scaffold is used to repair a sheep metatarsal 25-mm long critical-size bone defect. In vitro and in vivo biocompatibility of the film-coated PLA material is proved according to ISO standards. Scaffold geometry is found to influence BMP-2 incorporation. Bone regeneration is followed using X-ray scans, µCT scans, and histology. It is shown that scaffold internal geometry, notably pore shape, influenced bone regeneration, which is homogenous longitudinally. Scaffolds with cubic pores of ≈870 µm and a low BMP-2 dose of ≈120 µg cm-3 induce the best bone regeneration without any adverse effects. The visual score given by clinicians during animal follow-up is found to be an easy way to predict bone regeneration. This work opens perspectives for a clinical application in personalized bone regeneration.
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Affiliation(s)
- Charlotte Garot
- CNRS EMR 5000 Biomimetism and Regenerative Medicine (BRM), INSERM U1292 Biosanté, CEA, Université Grenoble Alpes, 17 avenue des Martyrs, Grenoble, F-38054, France
| | - Sarah Schoffit
- Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94704, France
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | - Cécile Monfoulet
- INSERM, Institut Bergonié, University of Bordeaux, CIC 1401, Bordeaux, F-33000, France
- CIC-IT, INSERM, Institut Bergonié, CHU de Bordeaux, CIC 1401, Bordeaux, F-33000, France
| | - Paul Machillot
- CNRS EMR 5000 Biomimetism and Regenerative Medicine (BRM), INSERM U1292 Biosanté, CEA, Université Grenoble Alpes, 17 avenue des Martyrs, Grenoble, F-38054, France
| | - Claire Deroy
- INSERM, Institut Bergonié, University of Bordeaux, CIC 1401, Bordeaux, F-33000, France
- CIC-IT, INSERM, Institut Bergonié, CHU de Bordeaux, CIC 1401, Bordeaux, F-33000, France
| | - Samantha Roques
- INSERM, Institut Bergonié, University of Bordeaux, CIC 1401, Bordeaux, F-33000, France
- CIC-IT, INSERM, Institut Bergonié, CHU de Bordeaux, CIC 1401, Bordeaux, F-33000, France
| | - Julie Vial
- Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94704, France
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | - Julien Vollaire
- INSERM U1209, Institute of Advanced Biosciences, Grenoble, F-38000, France
- Institute of Advanced Biosciences, Université Grenoble Alpes, Grenoble, F-38000, France
| | - Martine Renard
- INSERM, Institut Bergonié, University of Bordeaux, CIC 1401, Bordeaux, F-33000, France
- CIC-IT, INSERM, Institut Bergonié, CHU de Bordeaux, CIC 1401, Bordeaux, F-33000, France
| | - Hasan Ghanem
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | - Hanane El-Hafci
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | - Adeline Decambron
- Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94704, France
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | - Véronique Josserand
- INSERM U1209, Institute of Advanced Biosciences, Grenoble, F-38000, France
- Institute of Advanced Biosciences, Université Grenoble Alpes, Grenoble, F-38000, France
| | - Laurence Bordenave
- INSERM, Institut Bergonié, University of Bordeaux, CIC 1401, Bordeaux, F-33000, France
- CIC-IT, INSERM, Institut Bergonié, CHU de Bordeaux, CIC 1401, Bordeaux, F-33000, France
| | - Georges Bettega
- INSERM U1209, Institute of Advanced Biosciences, Grenoble, F-38000, France
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier Annecy Genevois, 1 avenue de l'hôpital, Epagny Metz-Tessy, F-74370, France
| | - Marlène Durand
- INSERM, Institut Bergonié, University of Bordeaux, CIC 1401, Bordeaux, F-33000, France
- CIC-IT, INSERM, Institut Bergonié, CHU de Bordeaux, CIC 1401, Bordeaux, F-33000, France
| | - Mathieu Manassero
- Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94704, France
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | - Véronique Viateau
- Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94704, France
- CNRS, INSERM, ENVA, B3OA, Université Paris Cité, Paris, F-75010, France
| | | | - Catherine Picart
- CNRS EMR 5000 Biomimetism and Regenerative Medicine (BRM), INSERM U1292 Biosanté, CEA, Université Grenoble Alpes, 17 avenue des Martyrs, Grenoble, F-38054, France
- Institut Universitaire de France (IUF), 1 rue Descartes, Paris CEDEX 05, 75231, France
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11
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Fasseeh AN, Elezbawy B, El-Fass KA, GamaI M, Seyam A, Hayek N, Abdel Rahman N, Abdelhamid S, Fasseeh N, Saad AS, Elagamy A, Mahmoud A, Sedrak AS, Elshazly K, Eldebeiky M, Talaat M, Mohamed NM, Abdelaziz RA, Refaat R, Akeel S, Abaza S, Kaló Z. Maximizing the benefits of using biosimilars in Egypt. J Pharm Policy Pract 2023; 16:79. [PMID: 37365620 DOI: 10.1186/s40545-023-00581-w] [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: 02/04/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Biosimilars constitute a pathway for sustainable financing of healthcare systems in the era of expensive biologics. However, such a pathway is not free of challenges. Since the biosimilars market is expanding in Egypt, there is an urgent need for a policy framework to optimize their use and diffusion in the market. We aim to characterize a national framework based on the experiences of other countries and consultation with local experts. METHODS A narrative literature review was conducted to identify biosimilars' policy elements worldwide. A workshop was organized with experts to discuss the narrative review findings and create consensus on recommendations. RESULTS The narrative literature review highlighted the need for biosimilar policy actions in four areas: market authorization, pricing, reimbursement, and uptake. Eighteen experts representing the Egyptian healthcare authorities attended the workshop. The most significant conclusions from the workshop included setting the price of the biosimilar at 30-40% less than its originator's price and establishing financing protocols, in which the more expensive biologics with significant price premiums should be excluded from the formulary. CONCLUSIONS A summarized national framework policy recommendation for biosimilars was created by local experts from the main public healthcare entities in Egypt. These recommendations coincide with the international policies adopted across different countries that aim to improve patient access while sustaining health expenditure.
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Affiliation(s)
- Ahmad Nader Fasseeh
- Syreon Middle East, Alexandria, Egypt.
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
| | | | | | - Mary GamaI
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Ahmed Seyam
- Universal Health Insurance Authority, Cairo, Egypt
| | - Noha Hayek
- Theodor Bilharz Research Institute, Giza, Egypt
| | | | | | - Nader Fasseeh
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Ahmed Elagamy
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | | | - Amal Samir Sedrak
- Universal Health Insurance Authority, Cairo, Egypt
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mariam Eldebeiky
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | | | | | | | - Remonda Refaat
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Shaimaa Akeel
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | | | - Zoltán Kaló
- Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
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12
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Falkowski A, Ciminata G, Manca F, Bouttell J, Jaiswal N, Farhana Binti Kamaruzaman H, Hollingworth S, Al-Adwan M, Heggie R, Putri S, Rana D, Mukelabai Simangolwa W, Grieve E. How Least Developed to Lower-Middle Income Countries Use Health Technology Assessment: A Scoping Review. Pathog Glob Health 2023; 117:104-119. [PMID: 35950264 PMCID: PMC9970250 DOI: 10.1080/20477724.2022.2106108] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Health Technology Assessment (HTA) is a multidisciplinary tool to inform healthcare decision-making. HTA has been implemented in high-income countries (HIC) for several decades but has only recently seen a growing investment in low- and middle-income countries. A scoping review was undertaken to define and compare the role of HTA in least developed and lower middle-income countries (LLMIC). MEDLINE and EMBASE databases were searched from January 2015 to August 2021. A matrix comprising categories on HTA objectives, methods, geographies, and partnerships was used for data extraction and synthesis to present our findings. The review identified 50 relevant articles. The matrix was populated and sub-divided into further categories as appropriate. We highlight topical aspects of HTA, including initiatives to overcome well-documented challenges around data and capacity development, and identify gaps in the research for consideration. Those areas we found to be under-studied or under-utilized included disinvestment, early HTA/implementation, system-level interventions, and cross-sectoral partnerships. We consider broad practical implications for decision-makers and researchers aiming to achieve greater interconnectedness between HTA and health systems and generate recommendations that LLMIC can use for HTA implementation. Whilst HIC may have led the way, LLMIC are increasingly beginning to develop HTA processes to assist in their healthcare decision-making. This review provides a forward-looking model that LLMIC can point to as a reference for their own implementation. We hope this can be seen as timely and useful contributions to optimize the impact of HTA in an era of investment and expansion and to encourage debate and implementation.
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Affiliation(s)
- Anna Falkowski
- Division of Communicable Disease, Michigan Department of Health and Human Services, State of Michigan, USA
| | - Giorgio Ciminata
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Francesco Manca
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Janet Bouttell
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Nishant Jaiswal
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Hanin Farhana Binti Kamaruzaman
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow.,Malaysian Health Technology Assessment Section (MaHTAS), Ministry of Health Malaysia, Putrajaya
| | | | - Mariana Al-Adwan
- F. Hoffman-La Roche Ltd, Amman, Jordan and Jordan ISPOR Chapter, Amman, Jordan
| | - Robert Heggie
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Septiara Putri
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow.,Health Policy and Administration Department, Faculty of Public Health, University of Indonesia, Depok, West Java, Indonesia
| | - Dikshyanta Rana
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Warren Mukelabai Simangolwa
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa and Patient and Citizen Involvement in Health, Lusaka, Zambia
| | - Eleanor Grieve
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
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13
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Scaling up health technology assessment capacities in selected African countries - A conceivable route ahead. Int J Technol Assess Health Care 2023; 39:e9. [PMID: 36710506 DOI: 10.1017/s0266462323000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study aimed to provide a structured description of the commonalities and differences in healthcare structures across Africa to establish a reliable basis for the health technology assessment (HTA) of nutrition and nutrition interventions. A ranking of current nutrition conditions in the general population of the participating countries was included to gain a better understanding of the factors influencing hospital malnutrition (HMN), which will inform future multi-country research. METHOD A questionnaire on the structure of the health systems was distributed among ten African countries. Subsections were included that inquired about the drivers or barriers to using principles of HTA to assess nutritional care. Analysis and ranking of malnutrition data were based on data from the Global Hunger Index report and two poverty indicators used by the World Bank. RESULTS The health system structure of each country was identified and described, whereas questions about HTA could not always be analyzed due to a lack of adequate in-depth knowledge and skills in most countries. Early experience from some countries demonstrates a conceivable route ahead for African countries in strengthening the capacity for and implementing HTA in accordance with distinct national healthcare contexts and social determinants of health. CONCLUSION Problems related to nutritional care represent one of the major priorities in the surveyed countries. A future HMN multi-country study will provide valuable insight into the potential of low-cost primary prevention orientations.
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14
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Alluhidan M, Alabdulkarim H, Alrumaih A, Al-Turaiki A, Alshahrani A, Al-Qahtani S, Alhossan A, Al-Jedai A. Budget impact of introducing oral semaglutide to the public healthcare benefit package in Saudi Arabia. J Med Econ 2023; 26:1455-1468. [PMID: 37933169 DOI: 10.1080/13696998.2023.2277056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The Kingdom of Saudi Arabia (KSA) has embarked on a Health Sector Transformation Program as part of the Kingdom's Vision 2030 initiatives with the facilitation of access to healthcare services for the millions in KSA with diabetes an essential part of the Program. Decision-making tools, such as budget impact models, are required to consider the addition of new medications like oral semaglutide that have multifaceted health benefits and address barriers related to therapeutic inertia to reduce diabetes-related complications. OBJECTIVE To determine the financial impact of the introduction of oral semaglutide as a treatment option for people with type 2 diabetes mellitus (T2DM) in KSA. METHODS From the public payer's perspective, the budget impact model estimates the costs before and after the introduction of oral semaglutide over a 5-year time horizon. The budget impact of introducing oral semaglutide (primary comparator) compared with three different classes of diabetes medicines: glucagon-like peptide-1 receptor agonists (GLP-1), sodium-glucose transport protein 2 inhibitors (SGLT 2i) and dipeptidyl peptidase 4 inhibitors (DDP-4i) have been calculated based on the projected market shares. The model includes the cost of care through the incorporation of health outcomes that have an impact on the national payer's budget in Saudi Riyals (SAR). RESULTS The budget impact over the five-year time horizon indicates a medication cost increase (17,424,788 SAR), and cost offsets which include a difference in diabetes management costs (-3,625,287 SAR), CV complications costs (-810,733 SAR) and weight loss savings of 453,936 SAR. The cumulative total cost difference is 12,427,858 SAR (0.66%). CONCLUSION The introduction of oral semaglutide 14 mg as a second-line treatment option after metformin is indicated as budget-neutral to slightly budget-inflating for the public pharmaceutical formulary of KSA. The price difference is offset by positive health outcomes and costs. This conclusion was confirmed through a probabilistic sensitivity analysis.
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Affiliation(s)
| | - Hana Alabdulkarim
- Drug Policy and Economic Centre, Ministry of National Guards Health Affairs, Riyadh, Saudi Arabia
- Doctoral School of Applied Informatics and Applied Mathematics, Obuda University, Budapest, Hungary
| | - Ali Alrumaih
- Pharmaceutical Care Department, Medical Services Directorate, Ministry of Defence, Riyadh, Saudi Arabia
| | - Abdulrahman Al-Turaiki
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, King Abdul Aziz Medical City, Riyadh, Saudi Arabia
| | | | | | | | - Ahmed Al-Jedai
- College of Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
- Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
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15
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Horgan D, Hamdi Y, Lal JA, Nyawira T, Meyer S, Kondji D, Francisco NM, De Guzman R, Paul A, Nallamalla KR, Park WY, Triapthi V, Tripathi R, Johns A, Singh MP, Phipps ME, Dube F, Abu Rasheed HM, Kozaric M, Pinto JA, Stefani SD, Aponte Rueda ME, Alarcon RF, Barrera-Saldana HA. Empowering quality data - the gordian knot of bringing real innovation into healthcare system. Diagnosis (Berl) 2022; 10:140-157. [PMID: 36548810 DOI: 10.1515/dx-2022-0115] [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: 10/19/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The introduction of Personalised Medicine (PM) into healthcare systems could benefit from a clearer understanding of the distinct national and regional frameworks around the world. Recent engagement by international regulators on maximising the use of real-world evidence (RWE) has highlighted the scope for improving the exploitation of the treasure-trove of health data that is currently largely neglected in many countries. The European Alliance for Personalised Medicine (EAPM) led an international study aimed at identifying the current status of conditions. METHODS A literature review examined how far such frameworks exist, with a view to identifying conducive factors - and crucial gaps. This extensive review of key factors across 22 countries and 5 regions revealed a wide variety of attitudes, approaches, provisions and conditions, and permitted the construction of a comprehensive overview of the current status of PM. Based on seven key pillars identified from the literature review and expert panels, the data was quantified, and on the basis of further analysis, an index was developed to allow comparison country by country and region by region. RESULTS The results show that United States of America is leading according to overall outcome whereas Kenya scored the least in the overall outcome. CONCLUSIONS Still, common approaches exist that could help accelerate take-up of opportunities even in the less prosperous parts of the world.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering Sam Higginbottom University of Agriculture, Technology and Sciences Prayagraj, India
| | - Yosr Hamdi
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Jonathan A Lal
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering Sam Higginbottom University of Agriculture, Technology and Sciences Prayagraj, India
- Department of Genetics and Cell Biology, GROW School of Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Institute for Public Health Genomics, Maastricht University, Maastricht, Netherlands
| | - Teresia Nyawira
- National Commission for Science, Technology and Innovation in Kenya (NACOSTI), Nairobi Kenya, Kenya
| | | | - Dominique Kondji
- Health & Development Communication, Building Capacity for Better Health in Africa Building Capacities for Better Health in AFRICA, Yaounde, Cameroun
| | - Ngiambudulu M Francisco
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde (National Institute for Health Research), Luanda, Angola
| | - Roselle De Guzman
- Oncology and Pain Management Section, Manila Central University-Filemon D. Tanchoco Medical Foundation Hospital, Caloocan City, Philippines
| | - Anupriya Paul
- Department of Mathematics and Statistics, Faculty of Science, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, India
| | | | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Vijay Triapthi
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering Sam Higginbottom University of Agriculture, Technology and Sciences Prayagraj, India
| | - Ravikant Tripathi
- Department Health Govt of India, Ministry of labor, New Delhi, India
| | - Amber Johns
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Cancer Division, Sydney, Australia
| | - Mohan P Singh
- Center of Biotechnology, University of Allahabad, Allahabad, India
| | - Maude E Phipps
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
| | - France Dube
- Astra Zeneca, Concord Pike, Wilmington, DE, USA
| | | | - Marta Kozaric
- European Alliance for Personalised Medicine, Brussels, Belgium
| | - Joseph A Pinto
- Center for Basic and Translational Research, Auna Ideas, Lima, Peru
| | | | | | - Ricardo Fujita Alarcon
- Centro de Genética y Biología Molecular, Universidad de San Martín de Porres, Lima, Perú
| | - Hugo A Barrera-Saldana
- Innbiogem SC/Vitagenesis SA at National Laboratory for Services of Research, Development, and Innovation for the Pharma and Biotech Industries (LANSEIDI) of CONACyT Vitaxentrum Group, Monterrey, Mexico
- Schools of Medicine and Biology, Autonomous University of Nuevo Leon, Monterrey, Mexico
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16
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Fasseeh AN, Elezbawy B, Gamal M, Seyam A, Abourawash A, George M, Anwar M, Amin M, Khalifa AY, Elshalakani A, Hatem A, Abdelhamid S, Elsamouly H, Fasseeh N, Adel R, Dawood H, Abaza S, Kaló Z. A roadmap toward implementing health technology assessment in Egypt. Front Public Health 2022; 10:896175. [PMID: 36582366 PMCID: PMC9792961 DOI: 10.3389/fpubh.2022.896175] [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: 03/14/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background The Egyptian healthcare system is currently in the early phase of health technology assessment (HTA) implementation. The aim of this study is to propose an implementation roadmap based on the national healthcare system status. Methods A survey was conducted among Egyptian healthcare sector decision-makers to assess the current and future (preferred) HTA implementation status in Egypt based on a widely used international scorecard methodology. Subsequently, interviews were conducted with experts representing middle- and top-tier management in the Egyptian healthcare system to interpret the survey results and recommend specific actions. Results Experts recommended more capacity-building programs for HTA and health economics. Additionally, they proposed establishing HTA units in separate healthcare authorities and merging them into a single central HTA unit in the long term. Regarding the scope of implementation, experts recommended commencing with the assessment of innovative pharmaceuticals, and thereafter, expanding the scope to cover all health technologies in the long term. Additionally, they recommended using innovative tools such as "multi-criteria decision analysis (MCDA)" for tendering, and "managed entry agreements" for reimbursement decisions. Local burden of diseases and costing studies were also recommended to facilitate the implementation of HTA. Conclusion Experts agreed that several actions are required for successful HTA implementation in Egypt, including coordination between HTA bodies, application of an explicit MCDA framework, and strengthening of local evidence generation. To implement these actions, investment in technical capacity-building is indispensable. Most experts favored using multiple and soft cost-effectiveness thresholds. Efforts should be made to publish HTA submission guidelines and timelines of the processes.
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Affiliation(s)
- Ahmad Nader Fasseeh
- Syreon Middle East, Alexandria, Egypt,Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary,*Correspondence: Ahmad Nader Fasseeh
| | | | - Mary Gamal
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Ahmed Seyam
- Universal Health Insurance Authority, Cairo, Egypt
| | | | - Mohsen George
- Universal Health Insurance Authority, Cairo, Egypt,Health Insurance Organization, Cairo, Egypt
| | - Mohamed Anwar
- Department of Data Management and Decision Support, General Authority of Healthcare, Cairo, Egypt
| | - Magdy Amin
- Department of Surgery, Military Medical Academy, Cairo, Egypt
| | | | - Amr Elshalakani
- Health, Nutrition and Population Global Practice, World Bank, Cairo, Egypt
| | - Ashraf Hatem
- Faculty of Medicine, Cairo University, Cairo, Egypt,American University in Cairo, Cairo, Egypt
| | | | | | - Nader Fasseeh
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Hatem Dawood
- Janssen Pharmaceutical Companies of Johnson & Johnson, Cairo, Egypt
| | | | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary,Syreon Research Institute, Budapest, Hungary
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17
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Pinilla-Dominguez P, Taha S, McGuire H, Elagamy A, Sedrak A, Gamal M, Eldebeiky M, Dawoud D. Institutionalizing health technology assessment in Egypt: Situational analysis and roadmap. Front Pharmacol 2022; 13:1014658. [PMID: 36438785 PMCID: PMC9682258 DOI: 10.3389/fphar.2022.1014658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022] Open
Abstract
Objective: To conduct a situational analysis with the aim to inform future health technology assessment efforts (HTA) in Egypt. Introduction: The Egyptian government has set universal health coverage as a 2030 target. Several agencies have been created in the context of the ongoing healthcare reform. The Egyptian Authority for Unified Procurement, Medical Supply and the Management of Medical Technology (UPA) is one of them and was established to support strategic procurement using HTA. Methods: Description of the development of HTA in Egypt supported by a literature search as part of a scoping exercise, and a stakeholder analysis and identification of HTA capacity survey, based on previous surveys, with relevant stakeholders conducted in 2022. This was followed by a stakeholder event where results were shared and further contextualized. Results: The UPA is expected to evaluate the cost-effectiveness of health technologies and public health programs. The HTA process is being developed, focusing on the assessment of the value of new pharmaceuticals being introduced to the Egyptian market. A total of 16 participants responded on behalf of their organizations to the stakeholder analysis and identification of HTA capacity survey. More than 80% of the respondents were familiar with current efforts conducted by UPA and strongly support the implementation of HTA in Egypt. Transparency was highlighted as an important criterion. Over 90% of the respondents mentioned economic analyses as an HTA product being developed in Egypt, and medicines were the type of technology that stakeholders ranked as first in the rank of health technologies that need the output from HTA urgently. Capability building and training were highlighted as areas in which further support is required. Conclusion: This study represents the first attempt to describe the current path for HTA in Egypt. There seems to be momentum in Egypt to proceed and advance with HTA institutionalization. It would be important that next steps are built on the skills and capabilities already in place in Egypt, ensure methods and processes are in place and up to date and involve the wider system in Egypt so stakeholders can appropriately contribute and participate in the HTA process.
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Affiliation(s)
- Pilar Pinilla-Dominguez
- NICE International—National Institute for Health and Care Excellence (NICE), London, United Kingdom
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas, Spain
- *Correspondence: Pilar Pinilla-Dominguez, ; Shorouk Taha, ; Ahmed Elagamy, ; Dalia Dawoud,
| | - Shorouk Taha
- Central Administration of Health Technology Management (CAHTM), Egyptian Authority for Unified Procurement, Medical Supply and Technology Management (UPA), Cairo, Egypt
- *Correspondence: Pilar Pinilla-Dominguez, ; Shorouk Taha, ; Ahmed Elagamy, ; Dalia Dawoud,
| | - Hugh McGuire
- NICE International—National Institute for Health and Care Excellence (NICE), London, United Kingdom
| | - Ahmed Elagamy
- Central Administration of Health Technology Management (CAHTM), Egyptian Authority for Unified Procurement, Medical Supply and Technology Management (UPA), Cairo, Egypt
- *Correspondence: Pilar Pinilla-Dominguez, ; Shorouk Taha, ; Ahmed Elagamy, ; Dalia Dawoud,
| | - Amal Sedrak
- Central Administration of Health Technology Management (CAHTM), Egyptian Authority for Unified Procurement, Medical Supply and Technology Management (UPA), Cairo, Egypt
- Faculty of Medicine, Department of Public Health, Cairo University, Cairo, Egypt
| | - Mary Gamal
- Central Administration of Health Technology Management (CAHTM), Egyptian Authority for Unified Procurement, Medical Supply and Technology Management (UPA), Cairo, Egypt
| | - Mariam Eldebeiky
- Central Administration of Health Technology Management (CAHTM), Egyptian Authority for Unified Procurement, Medical Supply and Technology Management (UPA), Cairo, Egypt
| | - Dalia Dawoud
- NICE Science, Policy & Research, National Institute for Health and Care Excellence, London, United Kingdom
- Faculty of Pharmacy, Cairo University, Cairo, Egypt
- *Correspondence: Pilar Pinilla-Dominguez, ; Shorouk Taha, ; Ahmed Elagamy, ; Dalia Dawoud,
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Health Technology Assessment in Turkey: Current Status and Perspectives on Future Implementation. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Ramponi F, Twea P, Chilima B, Nkhoma D, Kazanga Chiumia I, Manthalu G, Mfutso-Bengo J, Revill P, Drummond M, Sculpher M. Assessing the potential of HTA to inform resource allocation decisions in low-income settings: The case of Malawi. Front Public Health 2022; 10:1010702. [PMID: 36388387 PMCID: PMC9650047 DOI: 10.3389/fpubh.2022.1010702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023] Open
Abstract
Health technology assessment (HTA) offers a set of analytical tools to support health systems' decisions about resource allocation. Although there is increasing interest in these tools across the world, including in some middle-income countries, they remain rarely used in low-income countries (LICs). In general, the focus of HTA is narrow, mostly limited to assessments of efficacy and cost-effectiveness. However, the principles of HTA can be used to support a broader series of decisions regarding new health technologies. We examine the potential for this broad use of HTA in LICs, with a focus on Malawi. We develop a framework to classify the main decisions on health technologies within health systems. The framework covers decisions on identifying and prioritizing technologies for detailed assessment, deciding whether to adopt an intervention, assessing alternative investments for implementation and scale-up, and undertaking further research activities. We consider the relevance of the framework to policymakers in Malawi and we use two health technologies as examples to investigate the main barriers and enablers to the use of HTA methods. Although the scarcity of local data, expertise, and other resources could risk limiting the operationalisation of HTA in LICs, we argue that even in highly resource constrained health systems, such as in Malawi, the use of HTA to support a broad range of decisions is feasible and desirable.
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Affiliation(s)
- Francesco Ramponi
- Centre for Health Economics, University of York, Heslington, United Kingdom
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Pakwanja Twea
- Department of Planning and Policy Development, Ministry of Health Malawi, Lilongwe, Malawi
| | - Benson Chilima
- Public Health Institute, Ministry of Health Malawi, Lilongwe, Malawi
| | - Dominic Nkhoma
- Health Economics and Policy Unit (HEPU), College of Medicine, University of Malawi, Zomba, Malawi
| | - Isabel Kazanga Chiumia
- Health Economics and Policy Unit (HEPU), College of Medicine, University of Malawi, Zomba, Malawi
| | - Gerald Manthalu
- Department of Planning and Policy Development, Ministry of Health Malawi, Lilongwe, Malawi
| | - Joseph Mfutso-Bengo
- Health Economics and Policy Unit (HEPU), College of Medicine, University of Malawi, Zomba, Malawi
| | - Paul Revill
- Centre for Health Economics, University of York, Heslington, United Kingdom
| | - Michael Drummond
- Centre for Health Economics, University of York, Heslington, United Kingdom
| | - Mark Sculpher
- Centre for Health Economics, University of York, Heslington, United Kingdom
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Capacity Building for Health Technology Assessment in Jordan: Institutionalization and Its Use in Pricing and Reimbursement Decisions. Value Health Reg Issues 2022; 32:47-53. [PMID: 36075139 DOI: 10.1016/j.vhri.2022.07.006] [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: 09/20/2021] [Revised: 06/24/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to describe the process of the institutionalization of health technology assessment (HTA) in Jordan. In particular, this study presents local policy perspectives on capacity building for HTA and the progress made toward its use in pricing and reimbursement decisions. HTA CAPACITY BUILDING University-based education and professional development training in pharmacoeconomics and pharmaceutical policy have been the starting points to create a receptive environment, necessary expertise, and local tools across many settings in Jordan. International collaboration with HTA supporting bodies helped to build connections and informed policy development on local levels through projects, meetings, and discussions. HTA INSTITUTIONALIZATION AND ITS USE IN PRICING AND REIMBURSEMENT DECISIONS: Institutionalizing HTA in the King Hussein Cancer Center and the Royal Medical Services was the driving factor for HTA implementation and practice advancement; nevertheless, process transparency and experience sharing through reports and publications are still limited. The Jordan Food and Drug Administration's pricing and formulary decisions require pharmacoeconomic consultation in selected cases according to the Jordanian Drug Law. Nevertheless, there is a lack of local methodological guidelines for conducting HTA. In addition, HTA practitioners and the regulatory scope of future HTA activities in Jordan cannot be determined yet. RECOMMENDATIONS AND FUTURE DIRECTIONS Over the past 2 decades, Jordan has crossed a number of milestones and advanced further to implement HTA as a tool for evaluating health interventions. As a next step, legislation is needed to mandate the use of HTA and to enhance transparency in decision-making processes.
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Nagi MA, Rezq MAA, Sangroongruangsri S, Thavorncharoensap M, Dewi PEN. Does health economics research align with the disease burden in the Middle East and North Africa region? A systematic review of economic evaluation studies on public health interventions. Glob Health Res Policy 2022; 7:25. [PMID: 35879742 PMCID: PMC9309606 DOI: 10.1186/s41256-022-00258-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/11/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Economic evaluation studies demonstrate the value of money in health interventions and enhance the efficiency of the healthcare system. Therefore, this study reviews published economic evaluation studies of public health interventions from 26 Middle East and North Africa (MENA) countries and examines whether they addressed the region's major health problems. METHODS PubMed and Scopus were utilized to search for relevant articles published up to June 26, 2021. The reviewers independently selected studies, extracted data, and assessed the quality of studies using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS The search identified 61 studies. Approximately half (28 studies; 46%) were conducted in Israel and Iran. The main areas of interest for economic evaluation studies were infectious diseases (21 studies; 34%), cancers (13 studies; 21%), and genetic disorders (nine studies; 15%). Five (8%), 39 (64%), 16 (26%), and one (2%) studies were classified as excellent, high, average, and poor quality, respectively. The mean of CHEERS checklist items reported was 80.8% (SD 14%). Reporting the structure and justification of the selected model was missed in 21 studies (37%), while price and conversion rates and the analytical methods were missed in 21 studies (34%). CONCLUSIONS The quantity of economic evaluation studies on public health interventions in the MENA region remains low; however, the overall quality is high to excellent. There were obvious geographic gaps across countries regarding the number and quality of studies and gaps within countries concerning disease prioritization. The observed research output, however, did not reflect current and upcoming disease burden and risk factors trends in the MENA region.
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Affiliation(s)
- Mouaddh Abdulmalik Nagi
- Doctor of Philosophy Program in Social, Economic and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen
| | - Mustafa Ali Ali Rezq
- Master of Public Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Faculty of Pharmacy, Sana’a University, Sana’a, Yemen
| | - Sermsiri Sangroongruangsri
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400 Thailand
| | - Montarat Thavorncharoensap
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400 Thailand
| | - Pramitha Esha Nirmala Dewi
- Doctor of Philosophy Program in Social, Economic and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Department of Pharmacy Profession, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
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Barriers and Facilitators of Pharmacoeconomic Studies: A Review of Evidence from the Middle Eastern Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137862. [PMID: 35805521 PMCID: PMC9265831 DOI: 10.3390/ijerph19137862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
The world is facing a continuous increase in medical costs. Due to the surge in disease prevalence, medical science is becoming more sensitive to the economic impact of medications and drug therapies. This brings about the importance of pharmacoeconomics, which is concerned with the effective use of health resources to optimize the efficiency and costs of medications of treatment for the best outcomes. This review was conducted to find out the potential barriers and facilitators to implementing pharmacoeconomic studies in the Middle Eastern region having both high- and low-income countries. The varying economies in the region depict diverse healthcare systems where implementation of pharmacoeconomics faces a large number of challenges and is also aided by numerous facilitators that contribute to the growth of its implementation. In this context, we have reviewed the status of pharmacoeconomics in Middle Eastern countries in research databases (Google Scholar, MEDLINE, Science Direct and Scopus) using keywords (“pharmacoeconomics”, “barriers”, “facilitators”, “Middle East”). The study reported that Yemen, Syria, Palestine, Iran, Iraq, Jordan and Lebanon are the lowest-income countries in the Middle East and the implementation of pharmacoeconomics is the poorest in these states. The UAE, Saudi Arabia and Israel are high-income rich states where economic aspects were comparatively better but still a large number of barriers hinder the way to its effective implementation. These include the absence of national governing bodies, the lack of data on the effectiveness of medications, the absence of sufficient pharmacoeconomic experts and the lack of awareness of the importance of pharmacoeconomics. The main facilitators were the availability of pharmacoeconomic guidelines, the encouragement of pharmacoeconomic experts and the promotion of group discussions and collaborations between researchers and policymakers. Cost-benefit analysis is still evolving in Middle Eastern countries, and there is a great need for improvement so that states can effectively benefit from cost analysis tools and utilize their health resources. In this regard, governments should develop national governing bodies to evaluate, implement pharmacoeconomics at the local and state levels and bring about innovation in the field through further research and development incorporating all sectors of pharmacy and pharmaceutics. The data presented in this research can further be extended in future studies to cover the various domains of pharmacoeconomics including cost-minimization analysis, cost-effectiveness analysis and cost-benefit analysis and their applications within the healthcare sectors of Middle Eastern countries.
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Nagi MA, Dewi PEN, Thavorncharoensap M, Sangroongruangsri S. A Systematic Review on Economic Evaluation Studies of Diagnostic and Therapeutic Interventions in the Middle East and North Africa. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:315-335. [PMID: 34931297 DOI: 10.1007/s40258-021-00703-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Due to the increase in healthcare budget constraint, economic evaluation (EE) evidence is increasingly required to inform resource allocation decisions. This study aimed to systematically review quantity, characteristics, and quality of full EE studies on diagnostic and therapeutic interventions conducted in 26 Middle East and North Africa (MENA) countries. METHODS PubMed and Scopus databases were comprehensively searched to identify the published EE studies in the MENA region. The quality of reviewed studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS The search identified 69 studies. The cost-utility approach was adopted in 49 studies (71 %). More than half (38 studies; 55 %) were conducted in Iran and Turkey. Sixteen countries (62 %) did not have any EE studies. The most frequently analyzed therapeutic areas were infectious diseases (19 studies; 28 %), cardiovascular diseases (11 studies; 16 %), and malignancies (10 studies; 14 %). Ten studies (14 %), 46 (67 %), 12 (17 %), and 1 study (1 %) were classified as excellent, high, moderate, and poor quality, respectively. The mean of items reported was 85.10 % (standard deviation 13.32 %). Characterizing heterogeneity, measurement of effectiveness, time horizon, and discount rate were missed in 21 (60 %), 22 (32 %), 20 (29 %) and 15 (25 %) studies, respectively. Data on effectiveness and utility relied primarily on studies conducted outside the region. CONCLUSIONS The quantity of EE studies in the MENA region remains low; however, overall quality is high to excellent. The availability of local data, capacity building, and national guidelines are vital to improve both the quantity and quality of EE studies in the region.
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Affiliation(s)
- Mouaddh Abdulmalik Nagi
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
- Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen.
| | - Pramitha Esha Nirmala Dewi
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Department of Pharmacy Profession, Faculty of Medicine and health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Montarat Thavorncharoensap
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400, Thailand
| | - Sermsiri Sangroongruangsri
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400, Thailand
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Elezbawy B, Fasseeh AN, Fouly E, Esba LCA, Al Abdulkarim H, Al-Haddab M, Al-Sheikh A, Altawil E, Al Turaiki A, Eshmawi M, Hamadah I, Tannira M, Dalle H, Aderian S, Roshdy A, Jaheen A, Hamad T, Abaza S, Kaló Z. The humanistic and economic burden of atopic dermatitis among adults and adolescents in Saudi Arabia. J Med Econ 2022; 25:1231-1239. [PMID: 36426726 DOI: 10.1080/13696998.2022.2152234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Aims: Atopic dermatitis (AD) is a chronic skin disease that creates a significant burden to patients and society. There is scarcity in local data about the burden of AD in the Kingdom of Saudi Arabia (KSA). We aimed to fill in this gap and quantify the humanistic and economic burden of AD among adults and adolescents in KSA.Materials and methods: A literature search and local expert interviews were conducted to assess the disease burden. Prevalence values were estimated through the literature. International data about health-related quality of life lost owing to AD was adjusted to age and prevalence in KSA. Direct and indirect costs were calculated using a bottom-up approach. Resource utilization data were collected from local dermatologists through online interviews, and indirect costs were based on absenteeism and presenteeism estimates. Validation meetings were conducted with local experts to adjust the final estimates.Results: The age-standardized health loss per patient due to AD is 0.187 quality-adjusted life-years (QALYs) annually, aggregating to 64 thousand lost QALYs in KSA. The annual average direct cost for a patient with AD was 2924 Saudi Riyal (SAR; 780 USD), totaling 373 million SAR in KSA (99.5 million USD). This value represents 0.2% of the annual health expenditure in KSA. The total productivity loss due to AD was 1.36 billion SAR (363.7 million USD). Overall, the economic burden of AD consumes up to 0.059% of the national gross domestic product.Limitations: Local quality of life and productivity lost data were not available for KSA, so global averages were used, assuming these numbers also apply to KSA.Conclusion: Indirect costs represent a large proportion of AD burden in KSA. The disease has a substantial effect on patient quality of life and social well-being. Alleviating the burden might result in significant savings in resources to society.
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Affiliation(s)
| | | | | | | | - Hana Al Abdulkarim
- Ministry of National Guard-Health Affairs, King Abdul Aziz Medical City, Saudi Arabia
| | | | - Afaf Al-Sheikh
- Ministry of National Guard-Health Affairs, King Abdul Aziz Medical City, Saudi Arabia
| | - Esraa Altawil
- King Saud University Medical City, Riyadh, Saudi Arabia
| | | | | | - Issam Hamadah
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Hala Dalle
- AbbVie BioPharmaceuticals, Kuwait City, Kuwait
| | | | | | | | | | | | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
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Chaker Masmoudi H, Rhili A, Zamali I, Ben Hmid A, Ben Ahmed M, Khrouf MR. Multi-Criteria Decision Analysis to Prioritize People for COVID-19 Vaccination When Vaccines Are in Short Supply. FRONTIERS IN HEALTH SERVICES 2022; 2:760626. [PMID: 36925795 PMCID: PMC10012629 DOI: 10.3389/frhs.2022.760626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022]
Abstract
COVID-19 pandemic underscored the need for a rapid tool supporting decision-makers in prioritizing patients in the immediate and overwhelming context of pandemics, where shortages in different healthcare resources are faced. We have proposed Multi-Criteria Decision Analysis (MCDA) to create a system of criteria and weights to prioritize uses of COVID-19 vaccines in groups of people at significantly higher risk of severe COVID-19 disease or death, when vaccines are in short supply, for use in Tunisia. The prioritization criteria and the levels within each criterion were identified based on available COVID-19 evidence with a focus on the criteria selected by Tunisian scientific committees. To determine the weights for the criteria and levels, reflecting their relative importance, a panel of frontline physicians treating COVID-19 were invited to participate in an online survey using 1,000 minds MCDA software (www.1000minds.com) which implements the PAPRIKA (Potentially All Pairwise RanKings of all possible Alternatives) method. Ten criteria and twenty-three levels have been selected for prioritizing the uses of COVID-19 vaccines in groups of people at significantly higher risk of severe disease or death. Among the invited physicians, sixty have completed the survey. The obtained scores were, in decreasing order of importance (mean weights in parentheses, summing to 100%). Obesity (16.2%), Age (12.7%), Chronic pulmonary diseases (10.8%), Chronic cardiovascular conditions (10.3%), Bone marrow or organ transplantation (10.1%), Immunodeficiency or Immunosuppression (9.6%), Diabetes (9%), Renal failure (8.4%), evolutive cancer (6.9%), and high blood pressure (6%). MCDA-based prioritization scoring system comprising explicit criteria and weights provides an adaptable and multicriteria approach that can assist policy-makers to prioritize uses of COVID-19 vaccines.
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Affiliation(s)
- Hend Chaker Masmoudi
- Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia.,Department of Histology and Cytogenetics, Institute Pasteur of Tunis, Tunis, Tunisia
| | - Amal Rhili
- Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Imen Zamali
- Department of Clinical Immunology, Pasteur Institute of Tunis, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ahlem Ben Hmid
- Department of Clinical Immunology, Pasteur Institute of Tunis, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Melika Ben Ahmed
- Department of Clinical Immunology, Pasteur Institute of Tunis, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Myriam Razgallah Khrouf
- Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia.,Direction de la Pharmacie et du Médicament, Tunis, Tunisia
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Green innovation in the MENA healthcare industry - A knowledge-based view. INTERNATIONAL JOURNAL OF TECHNOLOGY AND HUMAN INTERACTION 2022. [DOI: 10.4018/ijthi.299072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Drawing on the knowledge-based perspective, this research developed and tested a model consisting of five technological innovation characteristics (relative advantage, complexity, compatibility, observability, and triability) as antecedents, green innovation as a mediator, sustainable competitive advantage as an outcome, and government environmental support as a moderator. A survey was administered to 305 participants from the Middle Eastern healthcare sector and 305 participants from the North African healthcare sector. The findings were antagonistic to what was hypothesized by revealing heterogeneity rather than homogeneity in technological and green innovation perceptions. This research calls for the implementation of newly developed rather than adopted green innovation strategies across the Middle East and North Africa.
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Economic evaluation guidelines in low- and middle-income countries: a systematic review. Int J Technol Assess Health Care 2021; 38:e1. [PMID: 34931601 DOI: 10.1017/s0266462321000659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To systematically identify the latest versions of official economic evaluation guidelines (EEGs) in low- and middle-income countries (LMICs) and explore similarities and differences in their content. METHODS We conducted a systematic search in MEDLINE (Ovid), PubMed, EconLit, Embase (Ovid), the Cochrane Library, and the gray literature. Using a predefined checklist, we extracted the key features of economic evaluation and the general characteristics of EEGs. We conducted a comparative analysis, including a summary of similarities and differences across EEGs. RESULTS Thirteen EEGs were identified, three pertaining to lower-middle-income countries (Bhutan, Egypt, and Indonesia), nine to upper-middle-income countries (Brazil, China, Colombia, Cuba, Malaysia, Mexico, Russian Federation, South Africa, and Thailand), in addition to Mercosur, and none to low-income countries. The majority (n = 12) considered cost-utility analysis and health-related quality-of-life outcome. Half of the EEGs recommended the societal perspective, whereas the other half recommended the healthcare perspective. Equity considerations were required in ten EEGs. Most EEGs (n = 11) required the incremental cost-effectiveness ratio and recommended sensitivity analysis, as well as the presentation of a budget impact analysis (n = 10). Seven of the identified EEGs were mandatory for pharmacoeconomics submission. Methodological gaps, contradictions, and heterogeneity in terminologies used were identified within the guidelines. CONCLUSION As the importance of health technology assessment is increasing in LMICs, this systematic review could help researchers explore key aspects of existing EEGs in LMICs and explore differences among them. It could also support international organizations in guiding LMICs to develop their own EEGs and improve the methodological framework of existing ones.
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Al-Omar HA, Aljuffali IA, Solà-Morales O. Value drivers for pharmaceutical products in health technology assessment (HTA) in Saudi Arabia: Results from a capacity Building, Multi-Stakeholder workshop. Saudi Pharm J 2021; 29:946-954. [PMID: 34588840 PMCID: PMC8463512 DOI: 10.1016/j.jsps.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/01/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Capacity building exercises are important to increase understanding of healthcare processes by key stakeholders, and to facilitate open discussions to build consensus. This study explored the views of a multi-stakeholder group of local Saudi experts on possible value elements that could be important for health technology assessment (HTA) processes and methods regarding pharmaceutical products in Saudi Arabia ('value drivers'). METHODS A diversified group of local experts were invited to a two-day capacity building workshop from 18 to 19 December 2019 in Riyadh, Saudi Arabia. Information regarding the participants' demographic and educational/professional background, along with their self-assessed knowledge and experience of HTAs and the concept of value in the pharmaceutical market was collected. For each of 22 value drivers identified during a targeted literature search, participants were asked either to 'opt out' of its consideration for future HTA assessments, or rate it from 1 to 10 (low-high) on feasibility and acceptability. RESULTS Efficacy and safety were the highest rated value drivers for acceptability and feasibility. Explicit cost-effectiveness thresholds had the lowest ratings for acceptability and feasibility. Participants highlighted data availability and accuracy as a potential challenge to HTA implementation in Saudi Arabia. CONCLUSIONS Participants valued a pharmaceutical product's efficacy and safety alongside the consideration of disease characteristics for HTA processes. Participants also valued a binding HTA recommendation and the use of local real-world evidence, where available, to support HTA submissions.
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Affiliation(s)
- Hussain A. Al-Omar
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, Zip Code 11451, Saudi Arabia
- Director of Health Technology Assessment Unit, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, Zip Code 11451, Saudi Arabia
- Advisor for Health Technology Assessment and Pharmaceutical Pricing and Reimbursement Ministry of Health, Riyadh, Saudi Arabia
| | - Ibrahim A. Aljuffali
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Advisor to the Minister of Health for Pharmaceutical Sector Development, Chief Strategic Purchasing Officer Program for Health Assurance and Purchasing of Health Services (PHAP), Ministry of Health, Riyadh, Saudi Arabia
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Pharmacoeconomics Education in the Middle East and North Africa Region: A Web-Based Research Project. Value Health Reg Issues 2021; 25:182-188. [PMID: 34425467 DOI: 10.1016/j.vhri.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 04/27/2021] [Accepted: 05/17/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Pharmacoeconomics (PE) is a relatively new science that is gaining special attention in many countries of the Middle East and North Africa (MENA) region that have limited healthcare resources. Therefore, education is crucial for capacity building in PE in the region. This study aimed to assess the current status of PE education in schools of pharmacy in the MENA region and shed some light on the role played by ISPOR chapters in PE education. METHODS A survey containing 5 questions about PE education in 14 MENA countries was self-answered by 2 investigators after screening information available on college or school of pharmacy official websites. RESULTS Of 176 schools of pharmacy in the MENA region, only 80 offer PE educational courses. Egypt and Jordan have the highest number of schools offering PE teaching, especially on the professional level for undergraduates. The graduate level of PE education was offered mostly in Iran and Egypt. The fundamentals of PE was the topic most taught, whereas decision analysis and modeling topics were the least taught topics. Different ISPOR chapters were found to play a crucial role in developing focused health economics education for better healthcare decision making. CONCLUSIONS There has been an increase in the number of schools of pharmacy offering PE education in the MENA region; however, PE education and research need improvement. Providing structured PE education should be encouraged to establish the infrastructure needed for allocation of limited healthcare resources. Furthermore, updating websites of schools of pharmacy is essential to obtain a complete picture of the PE education in the MENA region.
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Nagi MA, Luangsinsiri C, Thavorncharoensap M. A systematic review of economic evaluations of vaccines in Middle East and North Africa countries: is existing evidence good enough to support policy decision-making? Expert Rev Pharmacoecon Outcomes Res 2021; 21:1159-1178. [PMID: 34252335 DOI: 10.1080/14737167.2021.1954508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION A vaccine introduction process should be systematic and transparent and take into account many factors, including cost-effectiveness evidence. This study aimed to assess quantity, characteristic, and quality of economic evaluation (EE) studies on vaccines performed in Middle East and North Africa (MENA) countries. AREAS COVERED PubMed and Scopus electronic databases were searched since inception to December 2019 to identify published EE studies of vaccines, which were conducted in the 26 MENA countries. Methodological quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. EXPERT OPINION Of the 616 studies identified, 46 were included in the review. Most studies (65%) were conducted in Iran, Israel, and Turkey. The most commonly evaluated vaccines were rotavirus vaccine (n = 15; 33%), human Papillomavirus vaccine (n = 8; 17%), and pneumococcal vaccine (n = 7; 15%). We classified 5 (11%), 27 (59%), 12 (26%), and 2 (4%) studies as excellent, good, moderate, and poor quality, respectively. There were limited cost-effectiveness evidences in the region. It is imperative to have local guidelines on good practice and reporting, availability of local data, and funding sources to improve quantity and quality of EE studies of vaccines in the region, thereby, facilitating transparent and consistent decision-making processes.
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Affiliation(s)
- Mouaddh Abdulmalik Nagi
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.,Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen
| | - Chaisiri Luangsinsiri
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.,Department of Clinical Pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Montarat Thavorncharoensap
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Rajathevi, Bangkok, Thailand
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31
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Sharkawy MN, Dastan I. A scoping review of health economic evaluation in the World Health Organization Eastern Mediterranean region. Expert Rev Pharmacoecon Outcomes Res 2021; 21:877-884. [PMID: 34024232 DOI: 10.1080/14737167.2021.1933949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Economic evaluations are widely used tools that greatly contribute to evidence-based health policy and decision-making. However, economic evidence is not commonly used in the countries of the World Health Organization Eastern Mediterranean Region.Areas covered: The aim of this scoping review is to map the existing literature of health economic evaluation studies in the countries of the World Health Organization Eastern Mediterranean Region. Also, the review aims to identify the research gaps in the field of health economic evaluation in the region and finally provide recommendations for research and policy making. We searched six electronic databases. Six items were extracted from each of the included studies: first author, publication year, country of the study, study type, health technology assessed, and perspective.Expert opinion: The quality and quantity of HEE studies should be improved in the region. There is a need to follow evidence-based methodological rigor to aid in informed health-care decision-making and efficient use of health-care resources.
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Affiliation(s)
- Mennatollah Nagy Sharkawy
- Health Economics and Financing (HEF) unit, Division of Universal Health Systems (UHS), World Health Organization (WHO), Eastern Mediterranean Regional Office (EMRO), Cairo, Egypt
| | - Ilker Dastan
- WHO Country Office for Tajikistan, Dushanbe, Tajikistan
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Survey investigating the knowledge and awareness of payers and patient advocacy groups about the health technology assessment process in Lebanon. Int J Technol Assess Health Care 2021; 37:e72. [PMID: 34193326 DOI: 10.1017/s026646232100043x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The survey aims to assess the knowledge and awareness of Reimbursement Bodies (RBs) and Patient Advocacy Groups (PAGs) in Lebanon and the possible involvement of patients in the health technology assessment (HTA) process in the absence of a well-established HTA structure and to identify the actions to be taken at this level. Structured questionnaires were administered to eleven key participants from both RBs and PAGs. The survey utilized two different questionnaires, each composed of two open-ended questions and ten close-ended questions. RBs recognized the need for clinical and technical guidelines to optimize the HTA process, whereas PAGs stated that they are familiar with the current assessment and reimbursement process. A lack of interaction between the payers and the PAGs was reported mainly due to the absence of laws that involve patients in the assessment process. All the payers and three out of five of PAGs encouraged the involvement of PAGs in the assessment process. They reported that patients require support, education, and training to be efficiently involved. A short-term plan for involving patients in the assessment process can be implemented in light of RBs' and PAGs' openness for such involvement. In the long run, the collaboration between both parties needs to be more formalized and structured. Education and training programs are to be suggested for other PAGs. The institutionalization of an HTA body that unifies all the fragmented RBs, including a patient's representation to optimize the reimbursement process and to engage patients, is recommended.
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Alkhaldi M, Al Basuoni A, Matos M, Tanner M, Ahmed S. Health Technology Assessment in High, Middle, and Low-income Countries: New Systematic and Interdisciplinary Approach For Sound Informed-policy Making: Research Protocole. Risk Manag Healthc Policy 2021; 14:2757-2770. [PMID: 34234591 PMCID: PMC8254407 DOI: 10.2147/rmhp.s310215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/26/2021] [Indexed: 11/23/2022] Open
Abstract
Technological innovation has a significant role in improving health systems (HSs) and achieving universal health coverage (UHC). The World Health Organization (WHO) has declared resolutions on Health Technology Assessment (HTA) and other global organizations emphasized on HTA systems to achieve the Sustainable Development Goals (SDGs). HTA is a modern multidisciplinary decision-making framework linking knowledge and policymaking by assessing the medical, social, economic, organizational, and ethical effects, and/or impacts within health and social systems. The research significance lies in the growing need for HTA at these moments than ever as it is seen as an essential development approach to tackle the current global challenges and pandemics, particularly in developing countries. The research aims to comprehensively evaluate and understand HTA systems concerning the level of knowledge about HTA, current HTA structure, practices, application, capacity, gaps, and solutions. The project starts in January 2021 and ends in January 2022 and will be carried out in seven countries: Canada, Switzerland, Brazil, Lebanon, Jordan, Palestine, and Tanzania. A mixed-methods, quantitative and qualitative, along with a literature review will be applied. In each country, ten HTA-associated institutions will complete an adapted electronic survey, developed by the WHO, and ten key-informants selected purposively from the government, academia, NGOs, and private sectors to participate in ten individual in-depth interviews. One government representative from each country will participate in one expanded inter-country workshop. Excel, IBM Statistical Package for the Social Sciences (SPSS), and MAXQDA software programs will be used for data management and analysis. The research will form cutting-edge evidence not only for the seven countries, but also for the global, regional, and national endeavors with regards to opening a room for HTA best application and optimization. It will reveal lessons learned, determine gaps, and build a well-enabled and institutionalized HTA for better UHC, health systems, and multi-sectoral development.
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Affiliation(s)
- Mohammed Alkhaldi
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Canada.,Department of Public Health, University of Basel, Basel, Switzerland.,The Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Aisha Al Basuoni
- Projects Unit, Gaza Community Mental Health Programme, Gaza, Palestine
| | - Márcia Matos
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Canada
| | - Marcel Tanner
- Department of Public Health, University of Basel, Basel, Switzerland.,The Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Sara Ahmed
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Canada
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Farghaly MN, Al Dallal SAM, Fasseeh AN, Monsef NA, Suliman EAMA, Tahoun MA, Abaza S, Kaló Z. Recommendation for a Pilot MCDA Tool to Support the Value-Based Purchasing of Generic Medicines in the UAE. Front Pharmacol 2021; 12:680737. [PMID: 34168564 PMCID: PMC8217964 DOI: 10.3389/fphar.2021.680737] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/24/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: In recent periods the United Arab Emirates (UAE) has strengthened economic measures in its pharmaceutical policy by promoting local manufacturing and facilitating the use of generic medicines. International examples indicate the importance of quality control elements in the implementation of cost containment policies. Multicriteria Decision Analysis (MCDA) is increasingly used in health care to facilitate health care decision based on multiple objectives. Our objective was to develop a pilot MCDA tool for repeated use to support the value-based purchasing of generic medicines in the UAE. Methods: An international evidence framework was adapted to UAE in a multistakeholder workshop organized by Dubai Health Authority. After validating the relevance of nine criteria in the local jurisdiction, participants decided the ranking and weight of each criterion by anonymous voting. Results: The top four criteria focused on quality elements starting with real-world clinical or economic outcomes (with 19.8% weight), followed by the quality assurance of manufacturing (17.3%), then evidence on the equivalence with the original product (14.8%), and drug formulation and stability (12.3%). The pharmaceutical acquisition cost criteria ranked fifth with 9.4% weight. The bottom four criteria, including reliability of drug supply, macroeconomic benefit, pharmacovigilance and added value services related to the product had similar weights in the range of 5.5–7.7%. Conclusion: Policy-makers in Dubai put high emphasis of value-based health care by incentivizing manufacturers of off-patent pharmaceuticals to generate additional scientific evidence compared to the mandatory minimum and acknowledging efforts to improve quality standards. The MCDA tool is considered suitable to improve the transparency and consistency of decision making in UAE for off-patent pharmaceuticals, and subsequently for other health technologies.
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Affiliation(s)
| | | | - Ahmad Nader Fasseeh
- Doctoral School of Sociology, Eötvös Loránd University, Budapest, Hungary.,Syreon Middle East, Alexandria, Egypt
| | | | | | - Mohamed Attia Tahoun
- Established Pharmaceuticals Division, Abbott Laboratories, Dubai, United Arab Emirates
| | | | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary.,Syreon Research Institute, Budapest, Hungary
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Almomani E, Alabbadi I, Fasseeh A, Al-Qutob R, Al-Sharu E, Hayek N, Tarawneh MR, Kaló Z. Implementation Road Map of Health Technology Assessment in Middle-Income Countries: The Case of Jordan. Value Health Reg Issues 2021; 25:126-134. [PMID: 34015521 DOI: 10.1016/j.vhri.2021.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 11/13/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Health technology assessment (HTA) can increase the appropriateness and transparency of pricing and reimbursement decisions. Jordan is still in the early phase of its HTA implementation, although the country has very limited public resources for the coverage of healthcare technologies. The study objective was to explore and validate priorities in the HTA road map for Jordan and propose to facilitate the preferred HTA status. METHODS Health policy experts from the public and private sectors were asked to participate in a survey to explore the current and future status of HTA implementation in Jordan. Semistructured interviews with senior policy makers supported by literature review were conducted to validate survey results and make recommendations for specific actions. RESULTS Survey and interview results indicated a need for increased HTA training, including both short courses and academic programs and gradually increasing public funding for technology assessment and appraisal. Multiple HTA bodies with central coordination can be the most feasible format of HTA institutionalization. The weight of cost-effectiveness criterion based on local data with published reports and explicit decision thresholds should be increased in policy decisions of pharmaceutical and nonpharmaceutical technologies. CONCLUSION Currently, HTA has limited impact on health policy decisions in Jordan, and when it is used to support pharmaceutical reimbursement decisions, it is mainly based on results from other countries without considering transferability of international evidence. Policy makers should facilitate HTA institutionalization and use in policy decisions by increasing the weight of local evidence in HTA recommendations.
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Affiliation(s)
- Emad Almomani
- Jordanian Royal Medical Services, Department for Health Technology Assessment, Amman, Jordan; High Health Council, Department for Health Economics and Financing, Amman, Jordan.
| | - Ibrahim Alabbadi
- The University of Jordan, Faculty of Pharmacy, Amman, Jordan; Faculty of Pharmaceutical Science, UCSI University, Malaysia
| | - Ahmad Fasseeh
- Doctoral School of Sociology, Faculty of Social Sciences, Eötvös Loránd University Budapest, Budapest, Hungary; Syreon Middle East, Alexandria, Egypt
| | - Raeda Al-Qutob
- The University of Jordan, School of Medicine, Dept of Family and Community Medicine, Amman, Jordan
| | - Emad Al-Sharu
- Jordanian Royal Medical Services, Department for Health Technology Assessment, Amman, Jordan
| | - Noha Hayek
- Theodore Bilharz Reseach Institute, Giza, Egypt
| | | | - Zoltán Kaló
- Semmelweis University, Center for Health Technology Assessment, Budapest, Hungary; Syreon Research Institute, Budapest, Hungary
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36
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Balkhi B, Alshayban D, Alotaibi NM. Impact of Healthcare Expenditures on Healthcare Outcomes in the Middle East and North Africa (MENA) Region: A Cross-Country Comparison, 1995-2015. Front Public Health 2021; 8:624962. [PMID: 33614570 PMCID: PMC7890180 DOI: 10.3389/fpubh.2020.624962] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022] Open
Abstract
The association between healthcare expenditures and outcomes, mainly mortality and life expectancy, is complex. The real explanation for this association is not clear, especially in the Middle East and North Africa (MENA) region. This study assesses the impact of health expenditures on improving healthcare systems and health status and finds a relationship between health expenditures and health outcomes across different region. Annual time series data on healthcare spending and outcomes from 1995 to 2015 were used for MENA region in comparison to developed and developing countries. Health expenditure was adjusted by the consumer price index equation to the 2015 US dollar eliminate the impact of inflation on our results. For many countries, spending on healthcare continues to rise, Among MENA countries, we found that the United Arab Emirates and Kuwait spent more per capita on health, $1,711 and $1,420, respectively, than any other countries in the region. Although this study demonstrated a relationship between total healthcare expenditure and outcomes, some countries spend more on healthcare but have shorter life expectancy. In most countries, efficient and effective utilization of healthcare resources is the key strategy for improving health outcomes in any country. The lack of a positive correlation between healthcare spending and life expectancy may indicate that health resources are not allocated effectively. In those cases, increasing health spending does not guarantee that there is any kind of improvement in healthcare.
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Affiliation(s)
- Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Dhfer Alshayban
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nawaf M Alotaibi
- Department of Pharmaceutics, Faculty of Pharmacy, Northern Border University, Rafha, Saudi Arabia
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37
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Ogunleye OO, Basu D, Mueller D, Sneddon J, Seaton RA, Yinka-Ogunleye AF, Wamboga J, Miljković N, Mwita JC, Rwegerera GM, Massele A, Patrick O, Niba LL, Nsaikila M, Rashed WM, Hussein MA, Hegazy R, Amu AA, Boahen-Boaten BB, Matsebula Z, Gwebu P, Chirigo B, Mkhabela N, Dlamini T, Sithole S, Malaza S, Dlamini S, Afriyie D, Asare GA, Amponsah SK, Sefah I, Oluka M, Guantai AN, Opanga SA, Sarele TV, Mafisa RK, Chikowe I, Khuluza F, Kibuule D, Kalemeera F, Mubita M, Fadare J, Sibomana L, Ramokgopa GM, Whyte C, Maimela T, Hugo J, Meyer JC, Schellack N, Rampamba EM, Visser A, Alfadl A, Malik EM, Malande OO, Kalungia AC, Mwila C, Zaranyika T, Chaibva BV, Olaru ID, Masuka N, Wale J, Hwenda L, Kamoga R, Hill R, Barbui C, Bochenek T, Kurdi A, Campbell S, Martin AP, Phuong TNT, Thanh BN, Godman B. Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future. Front Pharmacol 2020; 11:1205. [PMID: 33071775 PMCID: PMC7533592 DOI: 10.3389/fphar.2020.01205] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. OBJECTIVE Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. OUR APPROACH Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. ONGOING ACTIVITIES Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. CONCLUSION There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other.
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Affiliation(s)
- Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Debjani Mueller
- Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | | | - R. Andrew Seaton
- Healthcare Improvement Scotland, Glasgow, United Kingdom
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
- University of Glasgow, Glasgow, United Kingdom
| | | | - Joshua Wamboga
- Uganda Alliance of Patients’ Organizations (UAPO), Kampala, Uganda
| | - Nenad Miljković
- Institute of Orthopaedic Surgery “Banjica”, University of Belgrade, Belgrade, Serbia
| | - Julius C. Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, University of Botswana and Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Okwen Patrick
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon
- Faculty of Health and Medical Sciences, Adelaide University, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon
- Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | | | | | - Rehab Hegazy
- Pharmacology Department, Medical Division, National Research Centre, Giza, Egypt
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | | | | | | | | | | | | | | | | | - Daniel Afriyie
- Pharmacy Department, Ghana Police Hospital, Accra, Ghana
| | - George Awuku Asare
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Seth Kwabena Amponsah
- Department of Medical Pharmacology, University of Ghana Medical School, Accra, Ghana
| | - Israel Sefah
- Ghana Health Service, Pharmacy Department, Keta Municipal Hospital, Keta-Dzelukope, Ghana
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Hohoe, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N. Guantai
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia A. Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Tebello Violet Sarele
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville-campus, Durban, South Africa
| | | | - Ibrahim Chikowe
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University , Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Laurien Sibomana
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gwendoline Malegwale Ramokgopa
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Carmen Whyte
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Tshegofatso Maimela
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Johannes Hugo
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
- Department of Family Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Enos M. Rampamba
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacy, Tshilidzini Hospital, Shayandima, South Africa
| | - Adel Visser
- Eugene Marais Hospital, Pretoria, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Elfatih M. Malik
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- Community Medicine Council, SMSB, Khartoum, Sudan
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Kampala, Uganda
| | | | - Chiluba Mwila
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Ioana D. Olaru
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nyasha Masuka
- Zimbabwe College of Public Health Physicians, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | | | - Regina Kamoga
- Uganda Alliance of Patients’ Organizations (UAPO), Kampala, Uganda
- Community Health and Information Network (CHAIN), Kampala, Uganda
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tomasz Bochenek
- Department of Nutrition and Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Antony P. Martin
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- HCD Economics, The Innovation Centre, Daresbury, United Kingdom
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Binh Nguyen Thanh
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Alefan Q, Hamdouni E, Alhamad H, Mukattash T, Rascati K. Barriers to implementing pharmacoeconomics: interview study. Expert Rev Pharmacoecon Outcomes Res 2020; 21:93-104. [DOI: 10.1080/14737167.2020.1766969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Qais Alefan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Esra’a Hamdouni
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Hamza Alhamad
- Department of Pharmacy Practice, Faculty of Pharmacy, Zarqa University, Zarqa, Jordan
| | - Tareq Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Karen Rascati
- Health Outcomes & Pharmacy Practice, The University of Texas at Austin, Austin, TX, USA
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