Growth and capacity for cost‐effectiveness analysis in Africa

Abstract

As economic evaluation becomes increasingly essential to support universal health coverage (UHC), we aim to understand the growth, characteristics, and quality of cost‐effectiveness analyses (CEA) conducted for Africa and to assess institutional capacity and relationship patterns among authors. We searched the Tufts Medical Center CEA Registries and four databases to identify CEAs for Africa. After extracting relevant information, we examined study characteristics, cost‐effectiveness ratios, individual and institutional contribution to the literature, and network dyads at the author, institution, and country levels. The 358 identified CEAs for Africa primarily focused on sub‐Saharan Africa (96%) and interventions for communicable diseases (77%). Of 2,121 intervention‐specific ratios, 8% were deemed cost‐saving, and most evaluated immunizations strategies. As 64% of studies included at least one African author, we observed widespread collaboration among international researchers and institutions. However, only 23% of first authors were affiliated with African institutions. The top producers of CEAs among African institutions are more adherent to methodological and reporting guidelines. Although economic evidence in Africa has grown substantially, the capacity for generating such evidence remains limited. Increasing the ability of regional institutions to produce high‐quality evidence and facilitate knowledge transfer among African institutions has the potential to inform prioritization decisions for designing UHC.

Perspective and Costing in Cost-Effectiveness Analysis, 1974–2018

“…The CEA and GHCEA registries catalog only English-language, published cost-per-QALY-gained and cost-per-DALY-averted studies and do not capture the gray literature (e.g., HTA reports that may not be disseminated in regularly published, indexed journals) or other databases. Still, one study found that our registry databases reached 95% of published cost-per-QALY or cost-per-DALY literature [59]. In addition, the classification of the analytic perspective and costing approach involves reviewer judgment based on the available information (e.g., whether the stated perspective was matched with cost components presented).…”

Contextualization of cost-effectiveness evidence from literature for 382 health interventions for the Ethiopian essential health services package revision

“…For example, we found an ACER for only 13 interventions in studies from Ethiopia, eight from Kenya, seven from Malawi, six from Tanzania, five from Uganda, and four from Zambia. A recent analysis of Tufts Medical Center’s CEA registry indicates the same [ 27 ]. Furthermore, as was agreed upon in preparing the roadmap for revising the Ethiopian EHSP, we included studies conducted from a health systems perspective and studies reporting ACERs [ 6 ].…”

A protocol for a systematic literature review of economic evaluation studies of interventions to address antimicrobial resistance

“…Economic analysis on interventions to address AMR is a necessary part of the required evidence base for justifying government expenditure and investment in interventions of this type and therefore is a key step in AMR prevention and control. LMICs have developed growing capacity to conduct health economic evaluations in recent years [ 14 ], yet the most recent systematic review on the cost-effectiveness of measures to contain the occurrence of AMR dates back to 2002 [ 15 ]. This study highlighted that inadequate evidence was available on this subject of economics for AMR interventions and more investigation was required.…”