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Simões Corrêa Galendi J, Caramori CA, Lemmen C, Müller D, Stock S. Expectations for the Development of Health Technology Assessment in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11912. [PMID: 34831668 PMCID: PMC8625173 DOI: 10.3390/ijerph182211912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
The implementation of health technology assessment (HTA) in emerging countries depends on the characteristics of the health care system and the needs of public health care. The objective of this survey was to investigate experts' expectations for the development of HTA in Brazil and to derive measures to strengthen the impact of HTA in Brazil on health care decisions. Based on a scoping literature review, a questionnaire was developed proposing eight theses for seven domains of HTA: (i) capacity building, (ii) public involvement, (iii) role of cost-effectiveness analysis (CEA), (iv) institutional framework, (v) scope of HTA studies, (vi) methodology of HTA, and (vii) HTA as the basis for jurisdiction. Thirty experts responded in full to the survey and agreed to five of the eight theses proposed. Experts suggested several measures to promote HTA within the scope of each domain, thus addressing capacity building related to HTA, availability, and reliability of population data, and legal endowment of the HTA system. Finally, HTA processes in Brazil should also address public health issues (e.g., appraisal of interventions directed at chronic diseases).
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Affiliation(s)
- Julia Simões Corrêa Galendi
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (C.L.); (D.M.); (S.S.)
| | - Carlos Antonio Caramori
- Department of Internal Medicine, Medical School, São Paulo State University (UNESP), 18618687 Botucatu, Brazil;
| | - Clarissa Lemmen
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (C.L.); (D.M.); (S.S.)
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (C.L.); (D.M.); (S.S.)
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (C.L.); (D.M.); (S.S.)
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Gopinathan U, Ottersen T, Cyr PR, Chalkidou K. Evidence-Informed Deliberative Processes for HTA Around the Globe: Exploring the Next Frontiers of HTA and Best Practices Comment on "Use of Evidence-informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe". Int J Health Policy Manag 2021; 10:232-236. [PMID: 32772012 PMCID: PMC8167266 DOI: 10.34172/ijhpm.2020.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/21/2020] [Indexed: 11/14/2022] Open
Abstract
This comment reflects on an article by Oortwijn, Jansen, and Baltussen about the use and features of ‘evidence-informed deliberative processes’ (EDPs) among health technology assessment (HTA) agencies around the world and the need for more guidance. First, we highlight procedural aspects that are relevant across key steps of EDP, focusing on conflict of interest, the different roles of stakeholders throughout a HTA and public justification of decisions. Second, we discuss new knowledge and models needed to maximize the value of deliberative processes at the expanding frontiers of HTA, paying special attention to when HTA is applied in primary care, employed for public health interventions, and is produced through international collaboration.
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Affiliation(s)
- Unni Gopinathan
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Trygve Ottersen
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Pascale-Renée Cyr
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kalipso Chalkidou
- Global Health Development Group, Imperial College London School of Public Health, London, UK.,Center for Global Development Europe, London, UK
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Olivera MJ, Palencia-Sánchez F, Riaño-Casallas M. The Cost of Lost Productivity Due to Premature Chagas Disease-Related Mortality: Lessons from Colombia (2010-2017). Trop Med Infect Dis 2021; 6:tropicalmed6010017. [PMID: 33513668 PMCID: PMC7838814 DOI: 10.3390/tropicalmed6010017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/12/2020] [Accepted: 06/30/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Economic burden due to premature mortality has a negative impact not only in health systems but also in wider society. The aim of this study was to estimate the potential years of work lost (PYWL) and the productivity costs of premature mortality due to Chagas disease in Colombia from 2010 to 2017. Methods: National data on mortality (underlying cause of death) were obtained from the National Administrative Department of Statistics in Colombia between 2010 and 2017, in which Chagas disease was mentioned on the death certificate as an underlying or associated cause of death. Chagas disease as a cause of death corresponded to category B57 (Chagas disease) including all subcategories (B57.0 to B57.5), according to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The electronic database contains the number of deaths from all causes by sex and 5-year age group. Economic data, including wages, unemployment rates, labor force participation rates and gross domestic product, were derived from the Bank of the Republic of Colombia. The human capital approach was applied to estimate both the PYWL and present value of lifetime income lost due to premature deaths. A discount rate of 3% was applied and results are presented in 2017 US dollars (USD). Results: There were 1261 deaths in the study, of which, 60% occurred in males. Premature deaths from Chagas resulted in 48,621 PYWL and a cost of USD 29 million in the present value of lifetime income forgone. Conclusion: The productivity costs of premature mortality due to Chagas disease are significant. These results provide an economic measure of the Chagas burden which can help policy makers allocate resources to continue with early detection programs.
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Affiliation(s)
- Mario J. Olivera
- Grupo de Parasitología, Instituto Nacional de Salud, Bogotá 111321, D.C., Colombia
- Programme in Health Economics, Pontificia Universidad Javeriana, Bogotá 110231, D.C., Colombia
- Correspondence: ; Tel.: +57-1-220-7700
| | - Francisco Palencia-Sánchez
- Facultad de Medicina, Departamento de Medicina Preventiva y Social, Pontificia Universidad Javeriana, Bogotá 110231, D.C., Colombia;
| | - Martha Riaño-Casallas
- Facultad de Ciencias Económicas, Universidad Nacional de Colombia, Bogotá 111321, D.C., Colombia;
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Insua JT. Principialismo, bioética personalista y principios de acción en medicina y en servicios de salud. PERSONA Y BIOÉTICA 2018. [DOI: 10.5294/pebi.2018.22.2.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Dado que hay una brecha y diferencias entre conceptos bioéticos y otros principios de acción provenientes de la práctica de la medicina moderna, su comparación es razonable. La medicina moderna ha generado principios de acción basados en la evidencia y principios de calidad en medicina, y la argumentación bioética recurre frecuentemente al principialismo, o a la bioética personalista. Este artículo pretende ilustrar las características de las relaciones entre estos conceptos y su potencial enriquecimiento mutuo. Se propone una matriz de comparación simple y práctica, para cotejar la relación entre los principios. Estos conceptos tienen una superposición significativa. Sin embargo, tanto en la historia de las ideas como en su formulación son muy diferentes. Se enfatiza el valor contextual de este análisis dado por las tendencias de la salud global, y algunas implicaciones para la medicina de bioética personalista.
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Abstract
Objectives The aim of this study was to describe the historical development of the HTAsiaLink network, draw lessons for other similar initiatives globally, and to analyze key determinants of its success and challenges for its future development. Methods This study is based on the collective and direct experiences of the founding members of the HTAsiaLink Network. Data were collected from presentations they made at various international forums and additional information was reviewed. Data analysis was done using the framework developed by San Martin-Rodriguez et al. Results and Conclusions HTAsiaLink is a network of health technology assessment (HTA) agencies in Asia established in 2011 with the aim of strengthening individual and institutional HTA capacity, reducing duplication and optimizing resources, transfer and sharing of HTA-related lessons among members, and beyond. During its 6 years, the network has expanded, initiating several capacity building activities and joint-research projects, raising awareness of the importance of HTA within the region and beyond, and gaining global recognition while establishing relationships with other global networks. The study identifies the determinants of success of the collaboration. The systemic factors include the favorable outlook toward HTA as an approach for healthcare priority setting in countries with UHC mandates. On organizational factors, the number of newly established HTA agencies in the region with similar needs for capacity building and peer-to-peer support was catalytic for the network development. The interactional aspects include ownership, trust, and team spirit among network members. The network, however, faces challenges notably, financial sustainability and management of the expanded network.
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STAKEHOLDER INVOLVEMENT IN THE HEALTH TECHNOLOGY ASSESSMENT PROCESS IN LATIN AMERICA. Int J Technol Assess Health Care 2018; 34:248-253. [PMID: 29888698 DOI: 10.1017/s0266462318000302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Latin American countries are taking important steps to expand and strengthen universal health coverage, and health technology assessment (HTA) has an increasingly prominent role in this process. Participation of all relevant stakeholders has become a priority in this effort. Key issues in this area were discussed during the 2017 Latin American Health Technology Assessment International (HTAi) Policy Forum. METHODS The Forum included forty-one participants from Latin American HTA agencies; public, social security, and private insurance sectors; and the pharmaceutical and medical device industry. A background paper and presentations by invited experts and Forum members supported discussions. This study presents a summary of these discussions. RESULTS Stakeholder involvement in HTA remains inconsistently implemented in the region and few countries have established formal processes. Participants agreed that stakeholder involvement is key to improve the HTA process, but the form and timing of such improvements must be adapted to local contexts. The legitimization of both HTA and decision-making processes was identified as one of the main reasons to promote stakeholder involvement; but to be successful, the entire system of assessment and decision making must be properly staffed and organized, and certain basic conditions must be met, including transparency in the HTA process and a clear link between HTA and decision making. CONCLUSIONS Participants suggested a need for establishing clear rules of participation in HTA that would protect HTA producers and decision makers from potentially distorting external influences. Such rules and mechanisms could help foster trust and credibility among stakeholders, supporting actual involvement in HTA processes.
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HEALTH TECHNOLOGY ASSESSMENT FOR DECISION MAKING IN LATIN AMERICA: GOOD PRACTICE PRINCIPLES. Int J Technol Assess Health Care 2018; 34:241-247. [PMID: 29888696 DOI: 10.1017/s0266462318000326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of this study was to identify good practice principles for health technology assessment (HTA) that are the most relevant and of highest priority for application in Latin America and to identify potential barriers to their implementation in the region. METHODS HTA good practice principles proposed at the international level were identified and then explored during a deliberative process in a forum of assessors, funders, and product manufacturers. RESULTS Forty-two representatives from ten Latin American countries participated. Good practice principles proposed at the international level were considered valid and potentially relevant to Latin America. Five principles were identified as priority and with the greatest potential to be strengthened at this time: transparency in the production of HTA, involvement of relevant stakeholders in the HTA process, mechanisms to appeal decisions, clear priority-setting processes in HTA, and a clear link between HTA and decision making. The main challenge identified was to find a balance between the application of these principles and the available resources in a way that would not detract from the production of reports and adaptation to the needs of decision makers. CONCLUSIONS The main recommendation was to progress gradually in strengthening HTA and its link to decision making by developing appropriate processes for each country, without trying to impose, in the short-term, standards taken from examples at the international level without adequate adaptation of these to local contexts.
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Dams F, Gonzalez Rodriguez JL, Cheung KL, Wijnen BFM, Hiligsmann M. Relevance of barriers and facilitators in the use of health technology assessment in Colombia. J Med Econ 2018. [PMID: 29513062 DOI: 10.1080/13696998.2018.1449751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Several studies, mostly from developed countries, have identified barriers and facilitators with regard to the uptake of health technology assessment (HTA). This study elicited, using best-worst scaling (BWS), what HTA experts in Colombia consider to be the most important barriers and facilitators in the use of HTA, and makes a comparison to results from the Netherlands. METHODS Two object case surveys (one for barriers, one for facilitators) were conducted among 18 experts (policymakers, health professionals, PhD students, senior HTA-researchers) from Colombia. Seven respondents were employees of the national HTA agency Instituto de Evaluación Tecnológica de Salud (IETS). In total, 22 barriers and 19 facilitators were included. In each choice task, participants were asked to choose the most and least important barrier/facilitator from a set of five. Hierarchical Bayes modeling was used to compute the mean relative importance scores (RIS) for each factor, and a subgroup analysis was conducted to assess differences between IETS and non-IETS respondents. The final ranking was further compared to the results from a similar study conducted in the Netherlands. RESULTS The three most important barriers (RIS >6.00) were "Inadequate presentation format", "Absence of policy networks", and "Insufficient legal support". The six most important facilitators (RIS >6.00) were "Appropriate timing", "Clear presentation format", "Improving longstanding relation", "Appropriate incentives", "Sufficient qualified human resources", and "Availability to relevant HTA research". The perceived relevance of the barriers and facilitators differed slightly between IETS and non-IETS employees, while the differences between the rankings in Colombia and the Netherlands were substantial. CONCLUSION The study suggests that barriers and facilitators related to technical aspects of processing HTA reports and to the contact and interaction between researchers and policymakers had the greatest importance in Colombia.
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Affiliation(s)
- Florian Dams
- a Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
- b Center of Competence for Public Management , University of Bern , Bern , Switzerland
- c Swiss Institute for Translational and Entrepreneurial Medicine, sitem-insel AG , Bern , Switzerland
| | | | - Kei Long Cheung
- e Department of Health Services Research , CAPHRI - Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
- f Department of Health Promotion , CAPHRI - Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
| | - Ben F M Wijnen
- e Department of Health Services Research , CAPHRI - Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
| | - Mickaël Hiligsmann
- e Department of Health Services Research , CAPHRI - Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
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Pichon-Riviere A, Soto NC, Augustovski FA, García Martí S, Sampietro-Colom L. [Health technology assessment for decision-making in Latin America: good practice principles]. Rev Panam Salud Publica 2018; 41:e138. [PMID: 29466522 PMCID: PMC6660880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/31/2017] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Identify the most relevant, applicable, and priority good practice principles in health technology assessment (HTA) in Latin America, and potential barriers to implementing them in the region. METHODS HTA good practice principles postulated worldwide were identified and then explored through a deliberative process in a forum of evaluators, funders, and technology producers. RESULTS Forty-two representatives from ten Latin American countries participated in the forum. The good practice principles postulated at the international level were considered valid and potentially applicable in Latin America. Five principles were identified as priorities and as having greater potential to be expanded at this time: transparency in carrying out HTA; involvement of stakeholders in the HTA process; existence of mechanisms to appeal decisions; existence of clear mechanisms for HTA priority-setting; and existence of a clear link between assessment and decision-making. The main challenge identified was to find a balance between application of these principles and available resources, to prevent the planned improvements from jeopardizing report production times and failing to meet decision-makers' needs. CONCLUSIONS The main recommendation was to gradually advance in improving HTA and its link to decision-making by developing appropriate processes for each country, without attempting to impose, in the short term, standards taken from examples at the international level without adequate adaptation to the local context.
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Affiliation(s)
- Andrés Pichon-Riviere
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
| | - Natalie C Soto
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
| | - Federico Ariel Augustovski
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
| | - Sebastián García Martí
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
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Pichon-Riviere A, Soto NC, Augustovski FA, García Martí S, Sampietro-Colom L. Evaluación de tecnologías sanitarias para la toma de decisiones en Latinoamérica: principios de buenas prácticas. Rev Panam Salud Publica 2017. [PMID: 29466522 PMCID: PMC6660880 DOI: 10.26633/rpsp.2017.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Identificar los principios de buenas prácticas en la Evaluación de las Tecnologías Sanitarias (ETESA) más relevantes, aplicables y prioritarios en Latinoamérica; y las potenciales barreras para implementarlos en la región. Métodos. Se identificaron los principios de buenas prácticas en ETESA postulados a nivel mundial y luego se exploraron mediante un proceso deliberativo en un Foro de evaluadores, financiadores y productores de tecnologías. Resultados. El Foro contó con la participación de 42 representantes de diez países Latinoamericanos. Los principios de buenas prácticas postulados a nivel internacional fueron considerados válidos y potencialmente aplicables en Latinoamérica. Cinco principios fueron identificados como prioritarios y con mayor potencial para ser profundizados en estos momentos: transparencia en los procesos de realización de ETESA; Involucramiento de actores relevantes en el proceso de ETESA; existencia de mecanismos de apelación de las decisiones; existencia de mecanismos claros para el establecimiento de prioridades en ETESA; y existencia de un vínculo claro entre la evaluación y la toma de decisión. El principal reto identificado fue encontrar un equilibrio entre la aplicación de estos principios y los recursos disponibles para prevenir que las mejoras a introducir atenten contra los tiempos de producción de informes y la adecuación a las necesidades de los decisores. Conclusiones. La principal recomendación fue avanzar gradualmente en mejorar la ETESA y su vínculo con la toma de decisión desarrollando procesos apropiados para cada país, sin pretender imponer a corto plazo estándares tomados de ejemplos a nivel internacional sin la adecuada adaptación al contexto local.
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Affiliation(s)
| | - Natalie C Soto
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
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Rosselli D, Quirland-Lazo C, Csanádi M, Ruiz de Castilla EM, González NC, Valdés J, Abicalaffe C, Garzón W, Leon G, Kaló Z. HTA Implementation in Latin American Countries: Comparison of Current and Preferred Status. Value Health Reg Issues 2017; 14:20-27. [PMID: 29254537 DOI: 10.1016/j.vhri.2017.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/13/2017] [Accepted: 02/22/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To provide an overview about the current status of health technology assessment (HTA) implementation in Latin American countries and to identify long-term objectives considering regional commonalities. METHODS We conducted a survey among participants of the 5th Latin American Future Trends Conference in October 2015. Thirty-seven respondents from eight Latin American countries provided insights about the current and preferred future status of HTA implementation related to human capacity building, HTA financing, process and organizational structure for HTA, scope of mandatory HTA, decision criteria, standardization of HTA methodology, mandating the use of local data, and international collaboration in HTA. RESULTS Survey respondents reported insufficient human resources and public investment for HTA implementation. Organizational structure and legislation framework of HTA differ considerably across countries. According to survey respondents, in the future policymakers should rely more on the assessment of therapeutic value, cost-effectiveness, and budget impact criteria by applying explicit thresholds, potentially in a multicriteria decision analysis framework. HTA should not be restricted to policy decisions of new technologies but it should also be used for the revision of previous decisions. In addition, the quality and transparency of HTA have to be strengthened. CONCLUSIONS HTA plays an increasingly important role in Latin American countries. Each country needs to record its current implementation status and identify components for improvement. Duplication of efforts can be reduced if international collaboration is integrated into national HTA implementation.
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Affiliation(s)
- Diego Rosselli
- Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | | | | | | | - Julio Valdés
- Consejo de Ministros de Salud de Centroamérica y República Dominicana (COMISCA), Antiguo Cuscatlán, El Salvador
| | | | | | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary; Faculty of Social Sciences, Department of Health Policy and Health Economics, Institute of Economics, Eötvös Loránd University, Budapest, Hungary.
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Chalkidou K. Comparative effectiveness research around the globe: a valuable tool for achieving and sustaining universal healthcare. J Comp Eff Res 2017; 6:89-93. [DOI: 10.2217/cer-2016-0097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Kalipso Chalkidou
- Director, Global Health & Development Group, Institute for Global Health Innovation, Imperial College London, UK
- Visiting Professor, King's College, London, UK
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Ruiz R, Strasser-Weippl K, Touya D, Herrero Vincent C, Hernandez-Blanquisett A, St. Louis J, Bukowski A, Goss PE. Improving access to high-cost cancer drugs in Latin America: Much to be done. Cancer 2017; 123:1313-1323. [DOI: 10.1002/cncr.30549] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Rossana Ruiz
- Instituto Nacional de Enfermedades Neoplásicas; Lima Peru
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital; Boston Massachusetts
| | | | - Diego Touya
- “Dr. Manuel Quintela” Hospital Clinics; Montevideo Uruguay
| | | | | | - Jessica St. Louis
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital; Boston Massachusetts
| | - Alexandra Bukowski
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital; Boston Massachusetts
| | - Paul E. Goss
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital; Boston Massachusetts
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Perfetto EM, Oehrlein EM, Boutin M, Reid S, Gascho E. Value to Whom? The Patient Voice in the Value Discussion. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:286-291. [PMID: 28237211 DOI: 10.1016/j.jval.2016.11.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/10/2016] [Accepted: 11/13/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Professional societies and other organizations have recently taken a visible role trying to define treatment value via value frameworks and assessments, providing payer or provider recommendations, and potentially impacting patient access. Patient perspectives routinely differ from those of other stakeholders. Yet, it is not always apparent that patients were engaged in value framework development or assessment. OBJECTIVES To describe the development and content of the National Health Council's (NHC's) Rubric, a tool that includes criteria for evaluation of value frameworks specifically with regard to patient-centeredness and meaningful patient engagement. METHODS The NHC held a multistakeholder, invitational roundtable in Washington, DC, in 2016. Participants reviewed existing patient-engagement rubrics, discussed experiences with value frameworks, debated and thematically grouped hallmark patient-centeredness characteristics, and developed illustrative examples of the characteristics. These materials were organized into the rubric, and subsequently vetted via multistakeholder peer review. RESULTS The resulting rubric describes six domains of patient-centered value frameworks: partnership, transparency, inclusiveness, diversity, outcomes, and data sources. Each domain includes specific examples illustrating how patient engagement and patient-centeredness can be operationalized in value framework processes. CONCLUSIONS The NHC multistakeholder roundtable's recommendations are captured in the NHC's Rubric to assess value framework and model patient-centeredness and patient engagement. The Rubric is a tool that will be refined over time on the basis of feedback from patient, patient group, framework developer, and other stakeholder-use experiences.
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Affiliation(s)
- Eleanor M Perfetto
- National Health Council, Washington, DC, USA; University of Maryland, Baltimore, MD, USA.
| | - Elisabeth M Oehrlein
- National Health Council, Washington, DC, USA; University of Maryland, Baltimore, MD, USA
| | - Marc Boutin
- National Health Council, Washington, DC, USA
| | - Sarah Reid
- National Health Council, Washington, DC, USA
| | - Eric Gascho
- National Health Council, Washington, DC, USA
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Dowie J, Kaltoft MK, Nielsen JB, Salkeld G. Caveat emptor NICE: biased use of cost-effectiveness is inefficient and inequitable. F1000Res 2015; 4:1078. [PMID: 27803795 PMCID: PMC5074351 DOI: 10.12688/f1000research.7191.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 11/29/2022] Open
Abstract
Concern with the threshold applied in cost-effectiveness analyses by bodies such as NICE distracts attention from their biased use of the principle. The bias results from the prior requirement that an intervention be effective (usually 'clinically effective') before its cost-effectiveness is considered. The underlying justification for the use of cost-effectiveness as a criterion, whatever the threshold adopted, is that decisions in a resource-constrained system have opportunity costs. Their existence rules out any restriction to those interventions that are 'incrementally cost-effective' at a chosen threshold and requires acceptance of those that are 'decrementally cost-effective' at the same threshold. Interventions that fall under the linear ICER line in the South-West quadrant of the cost-effectiveness plane are cost-effective because they create net health benefits, as do those in the North-East quadrant. If there is objection to the fact that they are cost-effective by reducing effectiveness as well as costs, it is possible to reject them, but only on policy grounds other than their failure to be cost-effective. Having established this, the paper considers and seeks to counter the arguments based on these other grounds. Most notably these include those proposing a different threshold in the South-West quadrant from the North-East one, i.e. propose a 'kinked ICER'. Another undesirable consequence of the biased use of cost-effectiveness is the failure to stimulate innovations that would increase overall health gain by being less effective in the condition concerned, but generate more benefits elsewhere. NICE can only reward innovations that cost more.
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Affiliation(s)
- Jack Dowie
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Jesper Bo Nielsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Glenn Salkeld
- Faculty of Medicine, University of Sydney, Sydney, Australia
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