1,721,098 research outputs found
Supporting the development of evidence-informed policy options: an economic evaluation of hypertension management in Ghana
No full textObjectivesUniversal healthcare coverage in low- and middle-income countries requires challenging resource allocation decisions. Health technology assessment is one important tool to support such decision making. The International Decision Support Initiative worked with the Ghanaian Ministry of Health to strengthen health technology assessment capacity building, identifying hypertension as a priority topic area for a relevant case study.MethodsBased on guidance from a national technical working group of researchers and policy makers, an economic evaluation and budget impact analysis were undertaken for the main antihypertensive medicines used for uncomplicated, essential hypertension. The analysis aimed to address specific policy questions relevant to the National Health Insurance Scheme.ResultsThe evaluation found that first-line management of essential hypertension with diuretics has an incremental cost per disability-adjusted life-year avoided of GH¢ 276 (7189 in 2017; 160% of gross national income per capita). Diuretics provide better health outcomes at a lower cost than angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or beta-blockers. Budget impact analysis highlighted the potential for cost saving through enhanced price negotiation and increased use of better-value drugs. We also illustrate how savings could be reinvested to improve population health.ConclusionsEconomic evaluation enabled decision makers to assess hypertension medicines in a Ghanaian context and estimate the impact of using such evidence to change policy. This study contributes to addressing challenges associated with the drive for universal healthcare coverage in the context of constrained budgets
Comparative effectiveness research around the globe: a valuable tool for achieving and sustaining universal healthcare
No full textUniversal healthcare coverage (UHC) is now firmly on the global health agenda. In December 2012, the UN Assembly voted for UHC, with wide-ranging support including from the US and UK governments, and calling on countries to provide “access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost” [1]. The Washington Post ran the news with the headline ‘Obamacare Everywhere’ [2], drawing parallels with the US debate on expanding insurance to cover all Americans (although recent developments may curb the political commitment to UHC in the USA). Yet, given scarce resources, UHC cannot feasibly provide every beneficial health service to those in need. So, a critical first step to delivering on these aspirations is deciding which services and policies to prioritize and make available and at what cost, if any, to beneficiaries. As UHC is defined as ‘a comprehensive range of key services…well aligned with other social goals’ [3], the question naturally arises: ‘how comprehensive is comprehensive’? The Institute of Medicine (IOM) Committee on designing essential health benefits [4], reporting around the same time as the UN resolution, exemplifies how balancing “the tensions between comprehensiveness and affordability” is faced not only by poorer countries but also by the world's biggest spender on health, the USA. Far from making clear recommendations on what is in and what is out, the IOM Committee limited itself to general rules and principles for guiding others with the tough task of making coverage decisions.
One tool not mentioned by the IOM, and which can help policy-makers make and defend such hard choices for including or rejecting new or (less often) excluding existing interventions, is what in the USA is known as comparative effectiveness research (CER) and overseas as health technology assessment (HTA), a more pragmatic version of evidence-based medicine, where budgets and cost–effectiveness analyses (CEA) matter at least as much as comparative clinical effectiveness [5]. As UHC is necessarily country-specific, since the demography, epidemiology, spending requirements and prices or costs of products and interventions are different for every country, CER or HTA is also heavily context specific. So, it makes sense perhaps to discuss here how other countries around the world are setting out to attain or sustain UHC, whether they use CER as a means to such an ambitious end, and, if so, in what way. I use the terms CER and HTA interchangeably while being fully aware of the strange prejudice against considering resource constraints in the US context, which makes the term HTA less meaningful. In that sense, the USA is a policy (and expenditure) outlier.Full Tex
The role of Tip60 and acetylation in prostate cancer
No full textEThOS - Electronic Theses Online ServiceGBUnited Kingdo
Is competition bad for our health(care)? We simply don't know
No full textIn The Lancet Oncology, Ajay Aggarwal and colleagues1 apply innovative analytics to study the movement patterns of almost 20 000 patients accessing prostate cancer surgery across the National Health Service (NHS) in England between 2010 and 2014. They find that, in the presence of pressures to centralise surgical services and intense competition, and in the absence of any publicly accessible measure of service quality to allow comparisons, those providers who invest in high tech, in this case robotic, surgery equipment, fare better than those who don't in attracting patients and growing their business. In fact, those who don't, risk closure. One in four of the country's 65 radical prostatectomy centres closed between 2010 and 2017, with a trebling of the number of robotic centres over the same period. None of the 16 NHS centres that closed had invested in robotic equipment. Nor had any of the centres that closed done so because of explicit evidence of poorer quality. Moreover, in a previous analysis of referral patterns for specialised prostate cancer surgery,2 the same authors showed that patients who travel longer distances, bypassing their local centres, tend to be younger, less ill, and of higher socioeconomic background than those who do not.Full Tex
Improving the quality of economic evaluation in health in low- and middle-income countries: where are we now?
No full textAn extensive review of published economic evaluations globally found that as of 2016, >230 economic evaluations were produced annually in low and middle income countries (LMIC), a substantial increase from just a decade earlier [1]. Although the review found room for methodological improvement [2], the demand for economic evaluation to inform health policy will ensure that this continues to be a rapidly evolving field. While increases in the volume of economic evaluations in LMIC are encouraging, the quality of these evaluations will be critical. How then, must we define ‘quality’? Is it accuracy, comprehensiveness, adherence with quality checklists? These measures of quality are clearly important in their own right, but they are proxies for the reason we conduct economic evaluation in the first place: to make the ‘right’ allocation and/or investment decisions.
Such decisions are commonly about what should or should not (or, can or cannot) be funded, reimbursed or procured in our health systems by governments, insurers and provider networks, and donors and development partners.
If the quality of an economic evaluation is a function of the decision it intends to inform, we need to acknowledge the dynamics of health policy decisions where economic evaluations are being used: whether these decisions are prospective or retrospective, are routine institutional or one-off decisions, and whether the interventions assessed are individual technologies such as medicines or are complex multi-interventional programmes (or somewhere in-between).No Full Tex
Setting fundable priorities for universal healthcare coverage: global concept, local applications
No full textBetween 20-40% of the 36bn) (2) – and if global health gains are to be made –as codified in the recently-endorsed Global Goals (3)- aid must leverage greater efficiency of spending in low- and middle-income countries themselves (4). Since the goal of moving towards universal health coverage is gaining support globally and locally, it raises public expectations in health investment, not only to ensure good health but also equitable access to health services (5). To achieve defensible resource allocation decisions which improve efficiency and meet the distributional objectives of societies and their representatives, priority setting processes must be put in place which allow comparative evidence (including economic evidence) and values to be accounted for (6), (7). For the past ten years or so, the authors have been working on enhancing the institutional, technical and evidential capacities for evidence-informed priority setting through effective South-South and North-South partnerships of policy makers, researchers and frontline practitioners. More recently, their work has been carried out through the international Decision Support Initiative (www.idsihealth.org), a network funded by the UK's DFID, BMGF and Rockefeller. IDSI is a demand driven collaborative and practical support network with active presence in Indonesia, India, China, South Africa, Ghana, Myanmar and Vietnam.S T Le
Organising Research and Development for evidence-informed health care:some universal characteristics and a case study from the UK
Full text linkResearch and Development (R&D) in health and health care has several intriguing characteristics which, separately and in combination, have significant implications for the ways in which it is organised, funded and managed. We review the characteristics, some of which apply under most circumstances and others of which may be context-specific, explore their implications for the organisation and management of health-related R&D, and illustrate the main features from the UK experience in the 1990s
Making Choices on the Journey to Universal Health Care Coverage: From Advocacy to Analysis
No full textUniversal health care coverage (UHC) is now an integral part of the global health agenda, with the adoption of a resolution of the United Nations by most country governments in 2012 that committed to attain and sustain UHC for their populations [1]. The subsequent commitment to health intervention and tech-nology assessment at the 2014 World Assembly (the World Health Organization’s [WHO’s] decision-making body) [2] and the numerous public statements by leaders at the WHO and the World Bank to the same effect reinforced this view. At the center of UHC is “a set of services that is available when needed without causing financial hardship to the population” [3]; indeed, the UN resolution describes UHC as “access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost,” and also calls for UHC to deliver equitable opportunities for the “highest attainable standard of physical and mental health.” The obvious questions remain: How best may countries determine what is truly “key”? How might that judgment change as time passes and further development happens? By what trajectory might the barriers to access be removed and full population coverage achieved—not merely in name but also in reality?No Full Tex
9. Deliberative Processes in Decisions about Best Buys, Wasted Buys and Contestable Buys
No full text9.1 Introduction Deciding whether a prospective buy in the field of Non-Communicable Disease is likely to be a Best Buy is a tricky business. It is tricky for at least the following reasons: the criteria for deciding what is a Best or Wasted Buy may not be agreed; the alternative best uses of resources (the opportunity costs) are rarely obvious and may lie outside the health sector; the health benefits of NCD interventions are often in the long rather than the short term; the evidence upon wh..
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