A roadmap toward implementing health technology assessment in Egypt

Fasseeh, A.N.; Elezbawy, Baher; Gamal, Mary; Seyam, Ahmed; Abourawash, A; George, Mohsen; Anwar, Mohamed; Amin, Magdy; Khalifa, Ahmed Yehia; Elshalakani, Amr; Hatem, Ashraf; Abdelhamid, Sohir; Elsamouly, Hossam; Fasseeh, Nader; Adel, Randa; Dawood, Hatem; Abaza, Sherif; Kaló, Zoltán

doi:10.3389/fpubh.2022.896175

Cited by 7 publications

(14 citation statements)

References 11 publications

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“…A study in 2013 by Elsisi et al emphasized the importance of benchmarking the ICER derived from economic evaluations in Egypt [ 12 ]. More recently, Fasseeh et al outlined an action plan endorsed by Egyptian decision-makers for the implementation of HTA, recommending the establishment of explicit multiple thresholds within a timeframe of 1–2 years [ 13 ]. Furthermore, the Egyptian Association for Health Economics (EAHE) encouraged the development of a local CET.…”

Section: Introductionmentioning

confidence: 99%

Framework for developing cost-effectiveness analysis threshold: the case of Egypt

Fasseeh,

Korra,

Elezbawy

et al. 2024

J. Egypt. Public. Health. Assoc.

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Background Cost-effectiveness analyses rarely offer useful insights to policy decisions unless their results are compared against a benchmark threshold. The cost-effectiveness threshold (CET) represents the maximum acceptable monetary value for achieving a unit of health gain. This study aimed to identify CET values on a global scale, provide an overview of using multiple CETs, and propose a country-specific CET framework specifically tailored for Egypt. The proposed framework aims to consider the globally identified CETs, analyze global trends, and consider the local structure of Egypt’s healthcare system. Methods We conducted a literature review to identify CET values, with a particular focus on understanding the basis of differentiation when multiple thresholds are present. CETs of different countries were reviewed from secondary sources. Additionally, we assembled an expert panel to develop a national CET framework in Egypt and propose an initial design. This was followed by a multistakeholder workshop, bringing together representatives of different governmental bodies to vote on the threshold value and finalize the recommended framework. Results The average CET, expressed as a percentage of the gross domestic product (GDP) per capita across all countries, was 135%, with a range of 21 to 300%. Interestingly, while the absolute value of CET increased with a country’s income level, the average CET/GDP per capita showed an inverse relationship. Some countries applied multiple thresholds based on disease severity or rarity. In the case of Egypt, the consensus workshop recommended a threshold ranging from one to three times the GDP per capita, taking into account the incremental relative quality-adjusted life years (QALY) gain. For orphan medicines, a CET multiplier between 1.5 and 3.0, based on the disease rarity, was recommended. A two-times multiplier was proposed for the private reimbursement threshold compared to the public threshold. Conclusion The CET values in most countries appear to be closely related to the GDP per capita. Higher-income countries tend to use a lower threshold as a percentage of their GDP per capita, contrasted with lower-income countries. In Egypt, experts opted for a multiple CET framework to assess the value of health technologies in terms of reimbursement and pricing.

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Section: Introductionmentioning

confidence: 99%

Framework for developing cost-effectiveness analysis threshold: the case of Egypt

Fasseeh,

Korra,

Elezbawy

et al. 2024

J. Egypt. Public. Health. Assoc.

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“…The survey results came from a scorecard that was previously used in many countries (Csan� adi et al, 2019;Atikeler et al, 2023;Rais et al, 2020;Fasseeh et al, 2022a;Almomani et al, 2021) to support HTA implementation. Using the same scorecard allows comparisons among different countries, which showed several commonalities in some key elements of HTA implementation but also some diversity in other aspects.…”

Section: Discussionmentioning

confidence: 99%

“…A scorecard designed to support the formulation of HTA roadmaps in individual countries was adopted in Oman. Several countries have already explored the gap between the current and preferred future status of HTA implementation using the same scorecard including Egypt, Jordan, Romania, Turkey and Ukraine (Csan� adi et al, 2019;Atikeler et al, 2023;Rais et al, 2020;Fasseeh et al, 2022a;Almomani et al, 2021). Additionally, the survey was conducted in Latin America and in the Middle East and North Africa region (Rosselli et al, 2017;Fasseeh et al, 2020).…”

Section: Surveymentioning

confidence: 99%

A roadmap towards implementing health technology assessment in Oman

Al Rashdi,

Al Balushi,

Al Shuaili

et al. 2024

JHOM

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PurposeHealth technologies are advancing rapidly and becoming more expensive, posing a challenge for financing healthcare systems. Health technology assessment (HTA) improves the efficiency of resource allocation by facilitating evidence-informed decisions on the value of health technologies. Our study aims to create a customized HTA roadmap for Oman based on a gap analysis between the current and future status of HTA implementation.Design/methodology/approachWe surveyed participants of an advanced HTA training program to assess the current state of HTA implementation in Oman and explore long-term goals. A list of draft recommendations was developed in areas with room for improvement. The list was then validated for its feasibility in a round table discussion with senior health policy experts to conclude on specific actions for HTA implementation.FindingsSurvey results aligned well with expert discussions. The round table discussion concluded with a phasic action plan for HTA implementation. In the short term (1–2 years), efforts will focus on building capacity through training programs. For medium-term actions (3–5 years), plans include expanding the HTA unit and introducing multiple cost-effectiveness thresholds while from 6–10 years, publishing of HTA recommendations, critical appraisal reports, and timelines is recommended.Originality/valueAlthough the HTA system in Oman is still in its early stages, strong initiatives are being taken for its advancement. This structured approach ensures a comprehensive integration of HTA into the healthcare system, enhancing decision-making and promoting a sustainable, evidence-based system addressing the population’s needs.

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“…Healthcare policymakers aim to maximize health gain while minimizing costs and maintaining financial sustainability [ 36 , 37 ]. Some limited-budget countries restrict access to costly biologics to contain pharmaceutical spending.…”

Section: Discussionmentioning

confidence: 99%

“…We believe that in LMIC (low-middle-income countries), where HTA is not widely implemented biosimilars should not be a priority when it comes to HTA implementation as those countries do not have the capacity [ 55 ]. Furthermore, considering limited resources to conduct HTA high budget impact innovative pharmaceuticals should be the priority when implementing HTA [ 37 , 55 – 57 ].…”

Section: Discussionmentioning

confidence: 99%

Maximizing the benefits of using biosimilars in Egypt

Fasseeh,

Elezbawy,

El-Fass

et al. 2023

J of Pharm Policy and Pract

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Background Biosimilars constitute a pathway for sustainable financing of healthcare systems in the era of expensive biologics. However, such a pathway is not free of challenges. Since the biosimilars market is expanding in Egypt, there is an urgent need for a policy framework to optimize their use and diffusion in the market. We aim to characterize a national framework based on the experiences of other countries and consultation with local experts. Methods A narrative literature review was conducted to identify biosimilars’ policy elements worldwide. A workshop was organized with experts to discuss the narrative review findings and create consensus on recommendations. Results The narrative literature review highlighted the need for biosimilar policy actions in four areas: market authorization, pricing, reimbursement, and uptake. Eighteen experts representing the Egyptian healthcare authorities attended the workshop. The most significant conclusions from the workshop included setting the price of the biosimilar at 30–40% less than its originator’s price and establishing financing protocols, in which the more expensive biologics with significant price premiums should be excluded from the formulary. Conclusions A summarized national framework policy recommendation for biosimilars was created by local experts from the main public healthcare entities in Egypt. These recommendations coincide with the international policies adopted across different countries that aim to improve patient access while sustaining health expenditure.

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A roadmap toward implementing health technology assessment in Egypt

Cited by 7 publications

References 11 publications

Framework for developing cost-effectiveness analysis threshold: the case of Egypt

Framework for developing cost-effectiveness analysis threshold: the case of Egypt

A roadmap towards implementing health technology assessment in Oman

Maximizing the benefits of using biosimilars in Egypt

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