Publications
181 results found
Gheorghe A, Ismail S, Gad M, et al., 2020, Capacity for health economics research and practice in Jordan, Lebanon, the occupied Palestinian territories and Turkey: needs assessment and options for development, Health Research Policy and Systems, Vol: 18, ISSN: 1478-4505
Background: Capacity for health economics analysis and research is indispensable for evidence-informed allocations of scarce health resources, however little is known about the experience and capacity strengthening preferences of academics and practitioners in the Eastern Mediterranean region. This study aimed to assess the needs for strengthening health economics capacity in Jordan, Lebanon, the occupied Palestinian territories and Turkey as part of the Research for Health in Conflict in Middle East and North Africa (R4HC-MENA) project.Methods: Bibliometric analysis of health economics outputs combined with an online survey of academic researchers and non-academic practitioners. The bibliometric analysis was based on a literature search conducted across seven databases. Included records were original studies and reviews with an explicit economic outcome related to health, disease or disability; had at least one author in Jordan, Lebanon, Palestine or Turkey; and were published between January 2014 and December 2018. Two types of analyses were conducted using VOSviewer software: keyword co-occurrence; and co-publication networks across countries and organizations. The online survey asked academic researchers, analysts and decision-makers – identified through the bibliometric analysis and regional professional networks – about previous exposure to and preference for capacity development in health economics.Results: Of 15,185 records returned by the literature search, 566 were included in the bibliometric analysis. Organizations in Turkey contributed more than 80% of records and had the broadest and most diverse network of collaborators, nationally and internationally. Only 1% (n=7) studies were collaborations between researchers in two or more different jurisdictions. Cost analysis, cost-effectiveness analysis and health system economics were the main health economics topics across the included studies. Economic evaluation, measuring the economic burden o
Jain V, Crosby L, Baker P, et al., 2020, Distributional equity as a consideration in economic and modelling evaluations of health taxes: A systematic review, HEALTH POLICY, Vol: 124, Pages: 919-931, ISSN: 0168-8510
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- Citations: 11
Megiddo I, Nonvignon J, Owusu R, et al., 2020, Fairer financing of vaccines in a world living with COVID-19, BMJ Global Health, Vol: 5, Pages: 1-4, ISSN: 2059-7908
Broadbent A, Walker D, Chalkidou K, et al., 2020, Lockdown is not egalitarian: the costs fall on the global poor, LANCET, Vol: 396, Pages: 21-22, ISSN: 0140-6736
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- Citations: 18
Jain V, Baker P, Chalkidou K, 2020, Harnessing the power of health taxes, BMJ-BRITISH MEDICAL JOURNAL, Vol: 369, ISSN: 0959-535X
Abdul-Khalek RA, Guo P, Sharp F, et al., 2020, The economic burden of cancer care for Syrian refugees: a population-based modelling study, LANCET ONCOLOGY, Vol: 21, Pages: 637-644, ISSN: 1470-2045
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- Citations: 18
Hollingworth SA, Downey L, Ruiz FJ, et al., 2020, What do we need to know? Data sources to support evidence-based decisions using health technology assessment in Ghana., Health Research Policy and Systems, Vol: 18, Pages: 1-12, ISSN: 1478-4505
BACKGROUND: Evidence-based decision-making for prioritising health is assisted by health technology assessment (HTA) to integrate data on effectiveness, costs and equity to support transparent decisions. Ghana is moving towards universal health coverage, facilitated mainly by the National Health Insurance Scheme (NHIS) established in 2003. The Government of Ghana is committed to institutionalising HTA for priority-setting. We aimed to identify and describe the sources of accessible data to support HTA in Ghana. METHODS: We identified and described data sources encompassing six main domains using an existing framework. The domains were epidemiology, clinical efficacy, costs, health service use and consumption, quality of life, and equity. We used existing knowledge, views of stakeholders, and searches of the literature and internet. RESULTS: The data sources for each of the six domains vary in extent and quality. Ghana has several large data sources to support HTA (e.g. Demographic Health Surveys) that have rigorous quality assurance processes. Few accessible data sources were available for costs and resource utilisation. The NHIS is a potentially rich source of data on resource use and costs but there are some limits on access. There are some data on equity but data on quality of life are limited. CONCLUSIONS: A small number of quality data sources are available in Ghana but there are some gaps with respect to HTA based on greater use of local and contextualised information. Although more data are becoming available for monitoring, challenges remain in terms of their usefulness for HTA, and some information may not be available in disaggregated form to enable specific analyses. We support recent initiatives for the routine collection of comprehensive and reliable data that is easily accessible for HTA users. A commitment to HTA will require concerted efforts to leverage existing data sources, for example, from the NHIS, and develop and maintain new data (e.g. local
Hangoma P, Bulawayo M, Chewe M, et al., 2020, The potential health and revenue effects of a tax on sugar sweetened beverages in Zambia, BMJ Global Health, Vol: 5, Pages: 1-9, ISSN: 2059-7908
The global burden of non-communicable diseases (NCDs) has been rising. A key risk factor for NCDs is obesity, which has been partly linked to consumption of sugar sweetened beverages (SSBs). A tax on SSBs is an attractive control measure to curb the rising trend in NCDs, as it has the potential to reduce consumption of SSBs. However, studies on the potential effects of SSB taxes have been concentrated in high-income countries with limited studies in low-income and middle-income countries. Using data from the 2015 Zambia Living Conditions Monitoring Survey (LCMS) data, the 2017 Zambia NCD STEPS Survey, and key parameters from the literature, we simulated the effect of a 25% SSB tax in Zambia on energy intake and the corresponding change in body mass index (BMI), obesity prevalence, deaths averted, life years gained and revenues generated using a mathematical model developed using Microsoft Excel. We conducted Monte Carlo simulations to construct 95% confidence bands and sensitivity analyses to account for uncertainties in key parameters. We found that a 25% SSB would avert 2526 deaths, though these results were not statistically significant overall. However, when broken down by gender, the tax was found to significantly avert 1133 deaths in women (95% CI 353 to 1970). The tax was found to potentially generate an additional US$5.46 million (95% CI 4.66 to 6.14) in revenue annually. We conclude that an SSB tax in Zambia has the potential to significantly decrease the amount of disability-adjusted life years lost to lifestyle-related diseases in women, highlighting important health equity outcomes. Women have higher baseline BMI and therefore are at higher risk for NCDs. In addition, an SSB tax will provide government with additional revenue which if earmarked for health could contribute to healthcare financing in Zambia.
Crosby L, Baker P, Hangoma P, et al., 2020, Dialysis in Africa: the need for evidence-informed decision making, LANCET GLOBAL HEALTH, Vol: 8, Pages: E476-E477, ISSN: 2214-109X
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- Citations: 6
Surgey G, Chalkidou K, Reuben W, et al., 2020, Introducing health technology assessment in Tanzania, INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE, Vol: 36, Pages: 80-86, ISSN: 0266-4623
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- Citations: 10
Chalkidou K, Towse A, Silverman R, et al., 2020, Market-driven, value-based, advance commitment (MVAC): accelerating the development of a pathbreaking universal drug regimen to end TB, BMJ GLOBAL HEALTH, Vol: 5, ISSN: 2059-7908
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- Citations: 2
Gheorghe A, Chalkidou K, Shamieh O, et al., 2020, The economics of paediatric cancer in four Eastern Mediterranean countries: a comparative assessment, Journal of Global Oncology, ISSN: 2378-9506
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
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- Citations: 64
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
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- Citations: 11
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: 0959-535X
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- Citations: 17
O'Brien N, Li R, Isaranuwatchai W, et al., 2020, How can we make better health decisions a Best Buy for all? [version2; peer review: 3 approved], Gates Open Research, Vol: 3, Pages: 1543-1543, ISSN: 2572-4754
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
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
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- Citations: 3
Chi Y-L, Blecher M, Chalkidou K, et al., 2020, What next after GDP-based cost-effectiveness thresholds?, Gates Open Res, Vol: 4
Public payers around the world are increasingly using cost-effectiveness thresholds (CETs) to assess the value-for-money of an intervention and make coverage decisions. However, there is still much confusion about the meaning and uses of the CET, how it should be calculated, and what constitutes an adequate evidence base for its formulation. One widely referenced and used threshold in the last decade has been the 1-3 GDP per capita, which is often attributed to the Commission on Macroeconomics and WHO guidelines on Choosing Interventions that are Cost Effective (WHO-CHOICE). For many reasons, however, this threshold has been widely criticised; which has led experts across the world, including the WHO, to discourage its use. This has left a vacuum for policy-makers and technical staff at a time when countries are wanting to move towards Universal Health Coverage . This article seeks to address this gap by offering five practical options for decision-makers in low- and middle-income countries that can be used instead of the 1-3 GDP rule, to combine existing evidence with fair decision-rules or develop locally relevant CETs. It builds on existing literature as well as an engagement with a group of experts and decision-makers working in low, middle and high income countries.
Hollingworth S, Gyansa-Lutterodt M, Dsane-Selby L, et al., 2020, Implementing health technology assessment in Ghana to support universal health coverage: building relationships that focus on people, policy, and process, INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE, Vol: 36, Pages: 8-11, ISSN: 0266-4623
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- Citations: 13
Chalkidou K, Claxton K, Silverman R, et al., 2020, Value-based tiered pricing for universal health coverage: an idea worth revisiting., Gates Open Res, Vol: 4
The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those.
Hollingworth SA, Ruiz F, Gad M, et al., 2020, Health technology assessment capacity at national level in sub-Saharan Africa: an initial survey of stakeholders., F1000Res, Vol: 9
Background: Health technology assessment (HTA) is an effective tool for supporting priority setting (PS) in health. Stakeholder groups need to understand HTA appropriate to their role and to interpret and critique the evidence produced. We aimed to rapidly assess current health system priorities and policy areas of demand for HTA in Sub-Saharan Africa, and identify key gaps in data and skills to inform targeted capacity building. Methods: We revised an existing survey, delivered it to 357 participants, then analysed responses and explored key themes. Results: There were 51 respondents (14%, 30 full completions) across 14 countries. HTA was considered an important and valuable PS tool with a key role in the design of health benefits packages, clinical guideline development, and service improvement. Medicines were identified as a technology type that would especially benefit from the application of HTA. Using HTA to address safety issues (e.g. low-quality medicines) and value for money concerns was particularly highlighted. The perceived availability and accessibility of suitable local data to support HTA varied widely but was mostly considered inadequate and limited. Respondents also noted a need for training support in research methodology and data gathering. Conclusions: While important in raising awareness of HTA as a tool for PS, this study had a low response rate, and that respondents were self-selected. A more refined survey will be developed to support engagement strategies and capacity building.
Chalkidou K, Culyer AJ, 2019, Deliberative processes in decisions about best buys, wasted buys and contestable buys: Uncertainty and credibility, Non-communicable disease prevention: Best buys, wasted buys and contestable buys, Pages: 147-169, ISBN: 9781783748648
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- Citations: 1
Friebel R, Silverman R, Glassman A, et al., 2019, The Global Fund impact Reply, LANCET, Vol: 394, Pages: 1709-1709, ISSN: 0140-6736
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
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- Citations: 2
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.
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
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- Citations: 1
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
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- Citations: 8
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