Using Economic Evidence to Set Healthcare Priorities in Low‐Income and Lower‐Middle‐Income Countries: A Systematic Review of Methodological Frameworks

Abstract

Policy makers in low‐income and lower‐middle‐income countries (LMICs) are increasingly looking to develop ‘evidence‐based’ frameworks for identifying priority health interventions. This paper synthesises and appraises the literature on methodological frameworks – which incorporate economic evaluation evidence – for the purpose of setting healthcare priorities in LMICs. A systematic search of Embase, MEDLINE, Econlit and PubMed identified 3968 articles with a further 21 articles identified through manual searching. A total of 36 papers were eligible for inclusion. These covered a wide range of health interventions with only two studies including health systems strengthening interventions related to financing, governance and human resources. A little under half of the studies (39%) included multiple criteria for priority setting, most commonly equity, feasibility and disease severity. Most studies (91%) specified a measure of ‘efficiency’ defined as cost per disability‐adjusted life year averted. Ranking of health interventions using multi‐criteria decision analysis and generalised cost‐effectiveness were the most common frameworks for identifying priority health interventions. Approximately a third of studies discussed the affordability of priority interventions. Only one study identified priority areas for the release or redeployment of resources. The paper concludes by highlighting the need for local capacity to conduct evaluations (including economic analysis) and empowerment of local decision‐makers to act on this evidence.

Economic Evaluation in Global Perspective: A Bibliometric Analysis of the Recent Literature

“…At the same time, further work is needed to generate demand for economic evaluation both at national level, through the institutionalization of priority setting (Odame, 2013, Mori andRobberstad, 2012), and globally, through transparent priority-setting initiatives at global funding bodies and continuing efforts to strengthen the role of economic evaluation in policy making at the WHO (Wiseman et al, 2016), whose policy recommendations play a particularly large role in LICs and lower-MICs (WHO, 2012).…”

Foreword: Health Economic Evaluations in Low‐ and Middle‐income Countries: Methodological Issues and Challenges for Priority Setting

“…Finally, three articles consider the use of economic evaluations in priority setting. Wiseman and colleagues present a systematic review of methodological frameworks for priority setting, which incorporate economic evaluation evidence in low-income and lower-middle-income countries (Wiseman et al, 2016). They find a number of frameworks were used, most commonly multi-criteria decision analysis and generalised costeffectiveness analysis.…”

Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa

“…Low- and Middle-Income Countries (LMICs) face difficult decisions regarding resource allocation, due to scarce resources and large disease burdens [1,2]. Lack of systematic priority setting can lead to inefficient resource allocation and poor-quality healthcare [3].…”