REVIEW OF ECONOMIC EVALUATIONS
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Background
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Methods
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Findings
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The case of Malaria
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Conclusions
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Increasing costs of healthcare mean that health resources
need to be prioritised
•
A number of priority setting tools are in available
o
HTA is recommended globally by the WHO
•
Ghana’s current state of NHIS and the health system as a
whole gives the impetus for using such tools
•
Plans already under way to use HTA
o
Collaboration with NICE UK
o
Draft health bill
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J
E
C
T
I
V
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M
a
i
n
•
To assess Ghana’s readiness to use economic
evaluation studies for priority setting
To do this, the review specifically:
1.
Assessed the availability (scope and quantity) of
studies
2.
Assessed the quality of studies
3.
Determined if such evidence can be used for decision
making
4.
Determined the labour capacity available
M
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T
H
O
D
S
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A comprehensive literature search on databases such
as Embase, Pubmed, Ovid medline from 1990-2015
o
Key words include “cost effectiveness analysis”, “cost benefit analysis”,
“cost utility analysis”, “costs”, “economic evaluation”
•
Quality of studies assessed with reference to the
Consolidated Economic Evaluation Reporting
Standards (CHEERS) checklist
•
Used studies conducted on Malaria as a case study to
access their usefulness for decision making
F
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N
D
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S
–
O
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1
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–
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1
&
4
*
Treatment interventions are those that do not include
pharmaceutical or diagnostics
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(
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B
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2
)
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Mean quality
score –
20.41 counts
(out of 24)
•
Titles,
abstract and
introduction
well defined
for all 17
studies
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o
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2
)
D
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n
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Generalizability (17)
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Current knowledge (17)
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Limitations (17)
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3
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L
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A
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6 out of 7 studies targeted
children under 5 years
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All studies were funded by
donor agencies
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Similar preventive
interventions e.g. prophylaxis
treatment
•
Varied effectiveness outcome
•
Variations in other
methodological approaches
e.g. discount rates, time
horizon, cost components
Time horizon
Discount rate
Comparison of time horizon and discount
rates used by studies
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J
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3
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F
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P
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N
G
•
Using the WHO recommended
decision rule; interventions with
ICER/CER less than 3x GDP of the
country is cost effective
o
All Malaria interventions reviewed were cost
effective
•
However, economic evaluation
evidence currently available hinders
comparison between similar and/or
alternative interventions
o
Methodological variations (such as discount
rate, outcome measure, cost components)
I
S
G
H
A
N
A
R
E
A
D
Y
•
Availability
o
Quality
o
Scope
o
Quantity
•
The supply of economic
evaluation studies
o
Limited labour
o
Data for studies
•
Non-existence of a
methodological guideline
•
Decision rule ??
C
O
N
C
L
U
S
I
O
N
•
Develop or adopt a methodological standard
for conducting economic evaluation
•
The need to build local capacity
•
Invest in national data repository and
economic evaluation studies
L
I
M
I
T
A
T
I
O
N
S
A
N
D
F
U
T
U
R
E
W
O
R
K
•
Limitations
o
Possible underestimation of quantity
o
Using number of local persons involved in studies as proxy
for labour capacity
o
Possible bias in quality assessment
•
Future work
o
Knowledge and perception of decision makers on the use of
HTA
o
HTA case study to determine feasibility of use in Ghana
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In this systematic review, the readiness of Ghana to use economic evaluation for priority setting in healthcare is assessed. The study examines the availability, quality, and potential utilization of economic evaluation studies, focusing on the case of Malaria as a key example. The main objectives, methods used, and findings related to the assessment are outlined in detail.
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Presentation Transcript
IS GHANA READY TO USE EVIDENCE FROM ECONOMIC EVALUATION FOR PRIORITY SETTING IN HEALTH CARE? A SYSTEMATIC REVIEW OF ECONOMIC EVALUATIONS CONDUCTED IN GHANA REBECCA ADDO (JANE HALL, STEPHEN GOODALL, MARION HAAS) chere.uts.edu.au
PRESENTATION OUTLINE Background Methods Findings o The case of Malaria Conclusions chere.uts.edu.au
BACKGROUND Increasing costs of healthcare mean that health resources need to be prioritised A number of priority setting tools are in available HTA is recommended globally by the WHO o Ghana s current state of NHIS and the health system as a whole gives the impetus for using such tools Plans already under way to use HTA Collaboration with NICE UK o Draft health bill o
OBJECTIVES Main To assess Ghana s readiness to use economic evaluation studies for priority setting To do this, the review specifically: 1. Assessed the availability (scope and quantity) of studies 2. Assessed the quality of studies 3. Determined if such evidence can be used for decision making 4. Determined the labour capacity available
METHODS A comprehensive literature search on databases such as Embase, Pubmed, Ovid medline from 1990-2015 o Key words include cost effectiveness analysis , cost benefit analysis , cost utility analysis , costs , economic evaluation Quality of studies assessed with reference to the Consolidated Economic Evaluation Reporting Standards (CHEERS) checklist Used studies conducted on Malaria as a case study to access their usefulness for decision making
FINDINGS OBJECTIVE 1 3 records identified through publication alert 1709 records identified through database search Identification # of records after duplicates removed = 1648 Screening # of records excluded by titles and abstracts = 1624 # of records screened = 1648 Non-human studies = 4 Newsletter = 17 Cost of illness studies = 37 WHO reports & software = 5 Other studies = 1561 Eligibility # of abstracts and/or full texts articles excluded = 5 # of abstracts and/or full texts articles assessed for eligibility = 22 Only abstracts/not located =4 Commentary = 1 # of full text articles included in the qualitative review/analysis = 17 Included 9 CUA, 8 CEA
FINDINGS OBJECTIVES 1 & 4 *Treatment interventions are those that do not include pharmaceutical or diagnostics
FINDINGS - QUALITY OF STUDIES (OBJECTIVE 2) Methods Mean quality score 20.41 counts (out of 24) Titles, abstract and introduction well defined for all 17 studies
FINDINGS - QUALITY OF STUDIES (OBJECTIVE 2) Discussion - Generalizability (17) - Current knowledge (17) - Limitations (17)
OBJECTIVE 3 - THE CASE OF MALARIA Comparison of time horizon and discount rates used by studies 6 out of 7 studies targeted children under 5 years 60 6 All studies were funded by donor agencies 50 5 Discount rate Time horizon 40 4 Similar preventive interventions e.g. prophylaxis treatment 30 3 20 2 10 1 0 0 Varied effectiveness outcome Time horizon (months) Discount rate (%) Variations in other methodological approaches e.g. discount rates, time horizon, cost components
OBJECTIVE 3- IMPLICATIONS FOR PRIORITY SETTING Using the WHO recommended decision rule; interventions with ICER/CER less than 3x GDP of the country is cost effective o All Malaria interventions reviewed were cost effective However, economic evaluation evidence currently available hinders comparison between similar and/or alternative interventions o Methodological variations (such as discount rate, outcome measure, cost components)
IS GHANA READY Availability Quality o Scope o Quantity o The supply of economic evaluation studies Limited labour o Data for studies o Non-existence of a methodological guideline Decision rule ??
CONCLUSION Develop or adopt a methodological standard for conducting economic evaluation The need to build local capacity Invest in national data repository and economic evaluation studies
LIMITATIONS AND FUTURE WORK Limitations o Possible underestimation of quantity o Using number of local persons involved in studies as proxy for labour capacity o Possible bias in quality assessment Future work o Knowledge and perception of decision makers on the use of HTA o HTA case study to determine feasibility of use in Ghana
