136 results found
Squires N, Colville S, Chalkidou K, et al., 2020, Medical training for universal health coverage: a review of Cuba – South Africa collaboration, Human Resources for Health, Vol: 18, ISSN: 1478-4491
Achieving improvements in Universal Health Coverage will require a re-orientation of medical education towards astronger focus on primary health care. Innovative medical curricula have been implemented in some countries, butin many low- and middle-income countries (LMICs), the emphasis remains focused on hospital and specialityservices. Cuba has a long history of supporting LMICs and has made major contributions to African health care andmedical training. A scheme for training South African students in Cuba was established 20 years ago and expandedmore recently, with around 700 Cuban-trained graduates returning to South Africa each year from 2018 to 2022.The current strategy is to re-orientate and re-train these graduates in South African medical schools for up to 3years as they are perceived to have inadequate skills. This negative narrative on Cuban-trained doctors in SouthAfrica could be changed dramatically. They have highly appropriate skills in primary care and prevention and couldprovide much needed services to rural and urban under-served populations whilst gaining an orientation to thehealth problems of South Africa and strengthening their skills. Bilateral arrangements between South Africa and theUnited Kingdom are providing mechanisms to support such schemes. The Cuban approach to medical educationmay have lessons for many countries attempting to meet the challenges of Universal Health Coverage.
Petkovic J, Riddle A, Akl EA, et al., 2020, Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation, SYSTEMATIC REVIEWS, Vol: 9
Gad M, Lord J, Chalkidou K, et al., 2020, Supporting the Development of Evidence-Informed Policy Options: An Economic Evaluation of Hypertension Management in Ghana, VALUE IN HEALTH, Vol: 23, Pages: 171-179, ISSN: 1098-3015
Isaranuwatchai W, Teerawattananon Y, Archer RA, et al., 2020, Prevention of non-communicable disease: best buys, wasted buys, and contestable buys, BMJ-BRITISH MEDICAL JOURNAL, Vol: 368, ISSN: 1756-1833
Teerawattananon Y, Luz ACG, Culyer A, et al., 2020, Charging for the use of survey instruments on population health: the case of quality-adjusted life years, BULLETIN OF THE WORLD HEALTH ORGANIZATION, Vol: 98, Pages: 59-65, ISSN: 0042-9686
Hollingworth S, Gyansa-Lutterodt M, Dsane-Selby L, et al., 2019, Implementing health technology assessment in Ghana to support universal health coverage: building relationships that focus on people, policy, and process., Int J Technol Assess Health Care, Pages: 1-4
Ghana is one of the few African countries to enact legislation and earmark significant funding to establish universal health coverage (UHC) through the National Health Insurance Scheme, although donor funds have declined recently. Given a disproportionate level of spending on medicines, health technology assessment (HTA) can support resource allocation decisions in the face of highly constrained budgets, as commonly found in low-resource settings. The Ghanaian Ministry of Health, supported by the International Decision Support Initiative (iDSI), initiated a HTA study in 2016 to examine the cost-effectiveness of antihypertensive medicines. We aimed to summarize key insights from this work that highlights success factors beyond producing purely technical outputs. These include the need for capacity building, academic collaboration, and ongoing partnerships with a broad range of experts and stakeholders. By building on this HTA study, and with ongoing interactions with iDSI, HTAi, WHO, and others, Ghana will be well positioned to institutionalize HTA in resource allocation decisions and support progress toward UHC.
Jain V, Crosby L, Baker P, et al., 2019, Equity as a consideration in evaluations of health taxes: a systematic review, National Conference on Public Health Science Dedicated to New Research in UK Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 8-8, ISSN: 0140-6736
Wilkinson T, Chalkidou K, 2019, Improving the quality of economic evaluation in health in low- and middle-income countries: where are we now?, JOURNAL OF COMPARATIVE EFFECTIVENESS RESEARCH, Vol: 8, Pages: 1041-1043, ISSN: 2042-6305
Alshreef A, MacQuilkan K, Dawkins B, et al., 2019, Cost-effectiveness of docetaxel and paclitaxel for adjuvant treatment of early breast cancer: adaptation of a model-based economic evaluation from the United Kingdom to South Africa, Value in Health Regional Issues, Vol: 19, Pages: 65-74, ISSN: 2212-1099
OBJECTIVES: Transferability of economic evaluations to low- and middle-income countries through adaptation of models is important; however, several methodological and practical challenges remain. Given its significant costs and the quality-of-life burden to patients, adjuvant treatment of early breast cancer was identified as a priority intervention by the South African National Department of Health. This study assessed the cost-effectiveness of docetaxel and paclitaxel-containing chemotherapy regimens (taxanes) compared with standard (non-taxane) treatments. METHODS: A cost-utility analysis was undertaken based on a UK 6-health-state Markov model adapted for South Africa using the Mullins checklist. The analysis assumed a 35-year time horizon. The model was populated with clinical effectiveness data (hazard ratios, recurrence rates, and adverse events) using direct comparisons from clinical trials. Resource use patterns and unit costs for estimating cost parameters (drugs, diagnostics, consumables, personnel) were obtained from South Africa. Uncertainty was assessed using probabilistic and deterministic sensitivity analyses. RESULTS: The incremental cost per patient for the docetaxel regimen compared with standard treatment was R6774. The incremental quality-adjusted life years (QALYs) were 0.24, generating an incremental cost-effectiveness ratio of R28430 per QALY. The cost of the paclitaxel regimen compared with standard treatment was estimated as -R578 and -R1512, producing an additional 0.03 and 0.025 QALYs, based on 2 trials. Paclitaxel, therefore, appears to be a dominant intervention. The base case results were robust to all sensitivity analyses. CONCLUSIONS: Based on the adapted model, docetaxel and paclitaxel are predicted to be cost-effective as adjuvant treatment for early breast cancer in South Africa.
Surgey G, Chalkidou K, Reuben W, et al., 2019, Introducing health technology assessment in Tanzania., Int J Technol Assess Health Care, Pages: 1-7
OBJECTIVES: Health technology assessment (HTA) is a cost-effective resource allocation tool in healthcare decision-making processes; however, its use is limited in low-income settings where countries fall short on both absorptive and technical capacity. This paper describes the journey of the introduction of HTA into decision-making processes through a case study revising the National Essential Medicines List (NEMLIT) in Tanzania. It draws lessons on establishing and strengthening transparent priority-setting processes, particularly in sub-Saharan Africa. METHODS: The concept of HTA was introduced in Tanzania through revision of the NEMLIT by identifying a process for using HTA criteria and evidence-informed decision making. Training was given on using economic evidence for decision making, which was then put into practice for medicine selection for the NEMLIT. During the revision process, capacity-building workshops were held with reinforcing messages on HTA. RESULTS: Between the period 2014 and 2018, HTA was introduced in Tanzania with a formal HTA committee being established and inaugurated followed by the successful completion and adoption of HTA into the NEMLIT revision process by the end of 2017. Consequently, the country is in the process of institutionalizing HTA for decision making and priority setting. CONCLUSION: While the introduction of HTA process is country-specific, key lessons emerge that can provide an example to stakeholders in other low- and middle-income countries (LMICs) wishing to introduce priority-setting processes into health decision making.
Sui X, Reddy P, Nyembezi A, et al., 2019, Cuban medical training for South African students: A mixed methods study, BMC Medical Education, Vol: 19, ISSN: 1472-6920
BackgroundAchieving universal health care coverage will require greater investment in primary health care, particularly in rural and underserved populations in low and middle-income countries. South Africa has invested in training black students from disadvantaged backgrounds in Cuba and large numbers of these Cuban-trained students are now returning for final year and internship training in South Africa. There is controversy about the scheme, the quality and relevance of training received and the place of Cuban-trained doctors in the health care system. Exploring the experiences of Cuban- and South African-trained students, recent graduates and medical school faculty may help understand and resolve the current controversy.MethodsUsing a mixed methods approach, in-depth interviews and a focus group discussion were held with deans of medical schools, senior faculty, and Cuban-trained and South African-trained students and recent graduates. An online structured questionnaire, adapted from the USA medical student survey, was developed and administered to Cuban- and South African-trained students and recent graduates.ResultsSouth African students trained in Cuba have had beneficial experiences which orientate them towards primary health care and prevention. Their subsequent training in South Africa is intended to fill skill gaps related to TB, HIV and major trauma. However this training is ad hoc and variable in duration and demoralizing for some students. Cuban-trained students have stronger aspirations than those trained in South Africa to work in rural and underserved communities from which many of them are drawn.ConclusionAttempts to assimilate returning Cuban-trained students will require a reframing of the current negative narrative by focusing on positive aspects of their training, orientation towards primary care and public health, and their aspirations to work in rural and under-served urban areas. Cuban-trained doctors could be part of the solution to South Af
Gheorghe A, Chalkidou K, Culyer A, 2019, How concentrated are academic publications of countries' progression towards universal health coverage?, LANCET GLOBAL HEALTH, Vol: 7, Pages: E696-E697, ISSN: 2214-109X
Friebel R, Silverman R, Glassman A, et al., 2019, On results reporting and evidentiary standards: spotlight on the Global Fund, LANCET, Vol: 393, Pages: 2006-2008, ISSN: 0140-6736
Emerson J, Panzer A, Cohen JT, et al., 2019, Adherence to the iDSI reference case among published cost-per-DALY averted studies, PLOS ONE, Vol: 14, ISSN: 1932-6203
Steuten L, Garau M, Gomez G, et al., 2019, HEALTH-ECONOMIC MODELLING TO INFORM PRIVATE SECTOR INVESTMENT IN INFECTIOUS DISEASE TREATMENTS IN MIDDLE-INCOME COUNTRIES: THE CASE OF TUBERCULOSIS, Publisher: ELSEVIER SCIENCE INC, Pages: S209-S209, ISSN: 1098-3015
Wu Y, Li S, Patel A, et al., 2019, Effect of a Quality of Care Improvement Initiative in Patients With Acute Coronary Syndrome in Resource-Constrained Hospitals in China: A Randomized Clinical Trial., JAMA Cardiol
Importance: Prior observational studies suggest that quality of care improvement (QCI) initiatives can improve the clinical outcomes of acute coronary syndrome (ACS). To our knowledge, this has never been demonstrated in a well-powered randomized clinical trial. Objective: To determine whether a clinical pathway-based, multifaceted QCI intervention could improve clinical outcomes among patients with ACS in resource-constrained hospitals in China. Design, Setting, Participants: This large, stepped-wedge cluster randomized clinical trial was conducted in nonpercutaneous coronary intervention hospitals across China and included all patients older than 18 years and with a final diagnosis of ACS who were recruited consecutively between October 2011 and December 2014. We excluded patients who died before or within 10 minutes of hospital arrival. We recruited 5768 and 0 eligible patients for the control and intervention groups, respectively, in step 1, 4326 and 1365 in step 2, 3278 and 3059 in step 3, 1419 and 4468 in step 4, and 0 and 5645 in step 5. Interventions: The intervention included establishing a QCI team, training clinical staff, implementing ACS clinical pathways, sequential site performance assessment and feedback, online technical support, and patient education. The usual care was the control that was compared. Main Outcomes and Measures: The primary outcome was the incidence of in-hospital major adverse cardiovascular events (MACE), comprising all-cause mortality, reinfarction/myocardial infarction, and nonfatal stroke. Secondary outcomes included 16 key performance indicators (KPIs) and the composite score developed from these KPIs. Results: Of 29 346 patients (17 639 men [61%]; mean [SD] age for control, 64.1 [11.6] years; mean [SD] age for intervention, 63.9 [11.7] years) who were recruited from 101 hospitals, 14 809 (50.5%) were in the control period and 14 537 (49.5%) were in the intervention period. There was no significant difference in the incidence
Littlejohns P, Chalkidou K, Culyer AJ, et al., 2019, National Institute for Health and Care Excellence, social values and healthcare priority setting., J R Soc Med, Pages: 141076819842846-141076819842846
Skinner J, Chalkidou K, Jamison DT, 2019, Valuing protection against health-related financial risks, Journal of Benefit-Cost Analysis, Vol: 10, Pages: 106-131, ISSN: 2194-5888
There is strong interest in both developing and developed countries toward expanding health insurance coverage. How should the benefits, and costs, of expanded coverage be measured? While the value of reducing the financial risks that result from insurance coverage have long been recognized, there has been less attention in how best to measure such benefits. In this paper, we first provide a framework for assessing the financial value from health insurance. We focus on three distinct potential benefits: Pooling the risk of unexpected medical expenditures between healthy and sick households, redistributing resources from high- to low-income recipients and smoothing consumption over time. We then use this theoretical framework and an illustrative example to provide practical guidelines for benefit-cost analysis in capturing the full benefits (and costs) of expanding health insurance coverage. We conclude by considering other potential financial effects of broad insurance coverage, such as the ability to consolidate purchases and thus lower input prices.
Isaranuwatchai W, Li R, Glassman A, et al., 2019, Disease Control Priorities Third Edition: Time to put a theory of change into practice; Comment on "Disease Control Priorities Third Edition is published: A theory of change is needed for translating evidence to health policy", International Journal of Health Policy and Management, Vol: 8, Pages: 132-135, ISSN: 2322-5939
The Disease Control Priorities program (DCP) has pioneered the use of economic evidence in health. The theory of change (ToC) put forward by Norheim is a further welcome and necessary step towards translating DCP evidence into better priority setting in low- and middle-income countries (LMICs). We also agree that institutionalising evidence for informed priority-setting processes is crucial. Unfortunately, there have been missed opportunities for the DCP program to challenge ill-judged global norms about opportunity costs and too little respect has been shown for the wider set of local circumstances that may enable, or disable, the productive application of the DCP evidence base. We suggest that the best way forward for the global health community is a new platform that integrates the many existing development initiatives and that is driven by countries’ asks.
Culyer AJ, Chalkidou K, 2019, Economic Evaluation for Health Investments En Route to Universal Health Coverage: Cost-Benefit Analysis or Cost-Effectiveness Analysis?, VALUE IN HEALTH, Vol: 22, Pages: 99-103, ISSN: 1098-3015
Hauck K, Morton A, Chalkidou K, et al., 2019, How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations, Social Science and Medicine, Vol: 220, Pages: 141-149, ISSN: 0277-9536
Health interventions often depend on a complex system of human and capital infrastructure that is shared with other interventions, in the form of service delivery platforms, such as healthcare facilities, hospitals, or community services. Most forms of health system strengthening seek to improve the efficiency or effectiveness of such delivery platforms. This paper presents a typology of ways in which health system strengthening can improve the economic efficiency of health services. Three types of health system strengthening are identified and modelled: (1) investment in the efficiency of an existing shared platform that generates positive benefits across a range of existing interventions; (2) relaxing a capacity constraint of an existing shared platform that inhibits the optimization of existing interventions; (3) providing an entirely new shared platform that supports a number of existing or new interventions. Theoretical models are illustrated with examples, and illustrate the importance of considering the portfolio of interventions using a platform, and not just piecemeal individual analysis of those interventions. They show how it is possible to extend principles of conventional cost-effectiveness analysis to identify an optimal balance between investing in health system strengthening and expenditure on specific interventions. The models developed in this paper provide a conceptual framework for evaluating the cost-effectiveness of investments in strengthening healthcare systems and, more broadly, shed light on the role that platforms play in promoting the cost-effectiveness of different interventions.
O'Brien N, Li R, Isaranuwatchai W, et al., 2019, How can we make better health decisions a Best Buy for all?: Commentary based on discussions at iDSI roundtable on 2 nd May 2019 London, UK., Gates Open Res, Vol: 3
The World Health Organization (WHO) resolution calling on Member States to work towards achieving universal health coverage (UHC) has increased the need for prioritizing health spending. Such need will soon accelerate as low- and middle-income countries transition from external aid. Countries will have to make difficult decisions on how best to integrate and finance previously donor-funded technologies and health services into their UHC packages in ways that are equitable, and operationally and financially sustainable. The International Decision Support Initiative (iDSI) is a global network of health, policy and economic expertise which supports countries in making better decisions about how best and how much to spend public money on healthcare. iDSI core partners include Center For Global Development, China National Health Development Research Center, Clinton Health Access Initiative, Health Intervention and Technology Assessment Program, Thailand / National Health Foundation, Imperial College London, Kenya Medical Research Institute, and the Norwegian Institute of Public Health. In May 2019, iDSI convened a roundtable entitled Why strengthening health systems to make better decisions is a Best Buy. The event brought together members of iDSI, development partners and other organizations working in the areas of evidence-informed priority-setting, resource allocation and purchasing. The roundtable participants identified key challenges and activities that could be undertaken by the broader health technology assessment (HTA) community to further country-led capacity building, as well to foster deeper collaboration between the community itself. HTA is a tool which can assist governments and development partners with evaluating alternative investment options in a defensible and accountable fashion. The definition and scope of HTA, and what it can achieve and support, can be presented more clearly and cohesively to stakeholders. Organizations engaging in HTA must develop
Dabak SV, Pilasant S, Mehndiratta A, et al., 2018, Budgeting for a billion: applying health technology assessment (HTA) for universal health coverage in India, Health Research Policy and Systems, Vol: 16, ISSN: 1478-4505
BackgroundIndia recently launched the largest universal health coverage scheme in the world to address the gaps in providing healthcare to its population. Health technology assessment (HTA) has been recognised as a tool for setting priorities as the government seeks to increase public health expenditure. This study aims to understand the current situation for healthcare decision-making in India and deliberate on the opportunities for introducing HTA in the country.MethodsA paper-based questionnaire, adapted from a survey developed by the International Decision Support Initiative (iDSI), was administered on the second day of the Topic Selection Workshop that was conducted as part of the HTA Awareness Raising Workshop held in New Delhi on 25–27 July, 2016. Participants were invited to respond to questions covering the need, demand and supply for HTA in their context as well as the role of their organisation vis-à-vis HTA. The response rate for the survey was about 68% with 41 participants having completed the survey.ResultsThree quarters of the respondents (71%) stated that the government allocated healthcare resources on the basis of expert opinion. Most respondents indicated reimbursement of individual health technologies and designing a basic health benefit package (93% each) were important health policy areas while medical devices and screening programmes were cited as important technologies (98% and 92%, respectively). More than half of the respondents noted that relevant local data was either not available or was limited. Finally, technical capacity was seen as a strength and a constraint facing organisations.ConclusionThe findings from this study shed light on the current situation, the opportunities, including potential topics, and challenges in conducting HTA in India. There are limitations to the study and further studies may need to be conducted to inform the role that HTA will play in the design or implementation of universal health coverage i
Marsh K, Thokala P, Youngkong S, et al., 2018, Incorporating MCDA into HTA: challenges and potential solutions, with a focus on lower income settings, COST EFFECTIVENESS AND RESOURCE ALLOCATION, Vol: 16, ISSN: 1478-7547
Friebel R, Molloy A, Leatherman S, et al., 2018, Achieving high-quality universal health coverage: a perspective from the National Health Service in England, BMJ GLOBAL HEALTH, Vol: 3, ISSN: 2059-7908
Reddy P, Desai R, Sifunda S, et al., 2018, "You Travel Faster Alone, but Further Together": Learning From a Cross Country Research Collaboration From a British Council Newton Fund Grant, INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT, Vol: 7, Pages: 977-981, ISSN: 2322-5939
MacQuilkan K, Baker P, Downey L, et al., 2018, Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa., Global Health Action, Vol: 11, ISSN: 1654-9880
BACKGROUND: Resource allocation in health is universally challenging, but especially so in resource-constrained contexts in the Global South. Pursuing a strategy of evidence-based decision-making and using tools such as Health Technology Assessment (HTA), can help address issues relating to both affordability and equity when allocating resources. Three BRICS and Global South countries, China, India and South Africa have committed to strengthening HTA capacity and developing their domestic HTA systems, with the goal of getting evidence translated into policy. Through assessing and comparing the HTA journey of each country it may be possible to identify common problems and shareable insights. OBJECTIVES: This collaborative paper aimed to share knowledge on strengthening HTA systems to enable enhanced evidence-based decision-making in the Global South by: Identifying common barriers and enablers in three BRICS countries in the Global South; and Exploring how South-South collaboration can strengthen HTA capacity and utilisation for better healthcare decision-making. METHODS: A descriptive and explorative comparative analysis was conducted comprising a Within-Case analysis to produce a narrative of the HTA journey in each country and an Across-Case analysis to explore both knowledge that could be shared and any potential knowledge gaps. RESULTS: Analyses revealed that China, India and South Africa share many barriers to strengthening and developing HTA systems such as: (1) Minimal HTA expertise; (2) Weak health data infrastructure; (3) Rising healthcare costs; (4) Fragmented healthcare systems; and (5) Significant growth in non-communicable diseases. Stakeholder engagement and institutionalisation of HTA were identified as two conducive factors for strengthening HTA systems. CONCLUSION: China, India and South Africa have all committed to establishing robust HTA systems to inform evidence-based priority setting and have experienced similar challenges. Engagement among cou
Chi Y-L, Gad M, Bauhoff S, et al., 2018, Mind the costs, too: towards better cost-effectiveness analyses of PBF programmes, BMJ Global Health, Vol: 3, Pages: e000994-e000994, ISSN: 2059-7908
Koffijberg H, Rothery C, Chalkidou K, et al., 2018, Value of Information Choices that Influence Estimates: A Systematic Review of Prevailing Considerations, MEDICAL DECISION MAKING, Vol: 38, Pages: 888-900, ISSN: 0272-989X
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.