Economic Evaluation of Health Interventions: Tanzania Perspectives

Robberstad, Bjarne; Hemed, Yusuf

doi:10.1007/978-0-387-78665-0_33

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…This finding is not surprising, considering the limited role of pharmacoeconomics in developing countries [49] . Several studies have cited the low availability of pharmacoeconomic studies in Tanzania [33] , [42] , [50] as the main barrier, but this study found that a lack of training could also be an important limitation. Studies have shown that, without training, decision-makers cannot understand, translate or apply economic evidence even when it is made available to them [47] , [48] .…”

Section: Discussionmentioning

confidence: 74%

The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania

et al. 2014

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BackgroundInsufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making.MethodsThis is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data.FindingsThe Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised.ConclusionsRecent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence.

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Section: Discussionmentioning

confidence: 74%

The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania

et al. 2014

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“…WHO proposed the use of evidence-based approach in the selection process of essential medicines, with cost-effectiveness comparisons being one of the key criteria [ 14 ]. Little country specific cost-effectiveness evidence is available for Tanzania [ 15 ], which raises questions on whether, how and to what extent such evidence is actually used to guide priority-setting decisions. Therefore this systematic review aims to identify and briefly describe pharmacoeconomic studies which have been conducted in Tanzania and assess their influence on the priority-setting process for selection of essential medicines.…”

Section: Introductionmentioning

confidence: 99%

Pharmacoeconomics and its implication on priority-setting for essential medicines in Tanzania: a systematic review

Mori

Robberstad

2012

BMC Med Inform Decis Mak

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BackgroundDue to escalating treatment costs, pharmacoeconomic analysis has been assigned a key role in the quest for increased efficiency in resource allocation for drug therapies in high-income countries. The extent to which pharmacoeconomic analysis is employed in the same role in low-income countries is less well established. This systematic review identifies and briefly describes pharmacoeconomic studies which have been conducted in Tanzania and further assesses their influence in the selection of essential medicines.MethodsPubmed, Embase, Cinahl and Cochrane databases were searched using “economic evaluation”, “cost-effectiveness analysis”, “cost-benefit analysis” AND “Tanzania” as search terms. We also scanned reference lists and searched in Google to identify other relevant articles. Only articles reporting full economic evaluations about drug therapies and vaccines conducted in Tanzania were included. The national essential medicine list and other relevant policy documents related to the identified articles were screened for information regarding the use of economic evaluation as a criterion for medicine selection.ResultsTwelve pharmacoeconomic studies which met our inclusion criteria were identified. Seven studies were on HIV/AIDS, malaria and diarrhoea, the three highest ranked diseases on the disease burden in Tanzania. Six studies were on preventive and treatment interventions targeting pregnant women and children under the age of five years. The national essential medicine list and the other identified policy documents do not state the use of economic evaluation as one of the criteria which has influenced the listing of the drugs.ConclusionCountry specific pharmacoeconomic analyses are too scarce and inconsistently used to have had a significant influence on the selection of essential medicines in Tanzania. More studies are required to fill the existing gap and to explore whether decision-makers have the ability to interpret and utilise pharmacoeconomic evidence. Relevant health authorities in Tanzania should also consider how to apply pharmacoeconomic analyses more consistently in the future priority-setting decisions for selection of essential medicines.

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“…Cost-effectiveness studies in LMICs have predominantly focused on low-cost treatments of infectious diseases, such as malaria and intestinal parasites, with relatively strong evidence to support the cost-effectiveness of these interventions. 30 A 2010 review 30 found 23 analyses reporting costs and benefits for health interventions in Tanzania, with costs per effect ranging from $1.3/correctly identified infection for schistosomiasis in children (urine samples) 31 to $4,589/DALY in the treatment of cardiovascular disease. 32 Although acceptability thresholds for LMICs such as Tanzania continue to be debated, 25 the ICERs included in this study, ranging from $242/QALY to $390/QALY, fall well within range of other accepted interventions for both communicable and noncommunicable diseases.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of prosthesis provision for patients with transfemoral amputation in Tanzania

Donnelley

Kaeppler

Hetherington

et al. 2022

Prosthetics &Amp; Orthotics International

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Background: Limb loss leads to significant disability. Prostheses may mitigate this disability but are not readily accessible in low-and middle-income countries (LMICs). Cost-effectiveness data related to prosthesis provision in resource-constrained environments such as Tanzania is greatly limited.Objectives: This study aimed to compare the cost-effectiveness of a prosthesis intervention compared with that of no prosthesis for persons with transfemoral amputations in an LMIC.Study design: This is a prospective cohort study. Methods: Thirty-eight patients were prospectively followed up. Clinical improvement with prosthesis provision was measured using EuroQuol-5D, represented as quality-adjusted life years gained. Direct and indirect costs were measured. The primary outcome was incremental cost per quality-adjusted life year, measured at 1 year and projected over a lifetime using a Markov model. Reference case was set as a single prosthesis provided without replacement from a payer perspective. Additional scenarios included the societal perspective and replacement of the prosthesis. Uncertainty was measured with one-way probabilistic sensitivity analysis. Results: From the payer perspective, the incremental cost-effectiveness ratio (ICER) was $242 for those without prosthetic replacement over a lifetime, and the ICER was $390 for those with prosthetic replacement over a lifeime. From the societal perspective, prosthesis provision was both less expensive and more effective. One-way sensitivity analysis demonstrated the ICER remained below the willingness to pay threshold up to prosthesis costs of $763. Conclusions: These findings suggest prosthesis provision in an LMIC may be cost-effective, but further studies with long-term follow up are needed to validate the results.

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Economic Evaluation of Health Interventions: Tanzania Perspectives

Cited by 4 publications

References 29 publications

The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania

The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania

Pharmacoeconomics and its implication on priority-setting for essential medicines in Tanzania: a systematic review

Cost-effectiveness analysis of prosthesis provision for patients with transfemoral amputation in Tanzania

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