Incorporating Distributional Concerns into Practical Tools for Priority-Setting

2019 ◽  
pp. 181-204
Author(s):  
Ole F. Norheim ◽  
Trygve Ottersen ◽  
Mieraf Taddesse Tolla ◽  
Solomon Tessema Memirie ◽  
Kjell Arne Johansson
Keyword(s):  
Health Economic ◽  
Cost Effectiveness ◽  
Health Services ◽  
Low Income ◽  
Priority Setting ◽  
Decision Rules ◽  
Low Income Country ◽  
The Third ◽  
Normative Issues ◽  
Economic Tools

The aim of this chapter is to provide examples of how distributional concerns can be incorporated into practical tools for priority-setting, and to discuss the underlying normative technical choices in doing so. The first section presents a Norwegian proposal for how priority to the worse-off can be integrated with cost-effectiveness thresholds for reimbursement policies. The proposed method is simple and not technically very demanding but relates directly to important discussions about the appropriate decision rules for reimbursement of new and costly technologies. The second section presents priority-weighted cost-effectiveness ranking of essential health services in Ethiopia, a low-income country that is in the process of expanding the health services that it covers. Both methods build on existing health economic tools and are motivated by a prioritarian normative framework. The third and final section discusses some underlying normative issues in methods for integrating distributional concerns that have not hitherto been adequately discussed.

The Future of Priority-Setting in Global Health

2019 ◽  
pp. 317-326
Author(s):  
Trygve Ottersen ◽  
Joseph Millum ◽  
Jennifer Prah Ruger ◽  
Stéphane Verguet ◽  
Kjell Arne Johansson ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Global Health ◽  
Health Effects ◽  
Priority Setting ◽  
Systematic Approach ◽  
Current Practice ◽  
Evidence Based ◽  
Normative Issues ◽  
Distributional Impact

This book has sought to inform efforts to improve systematic, evidence-based priority-setting by assessing the state-of-the-art of methods for priority-setting, engaging with the fundamental normative issues at stake, and providing specific recommendations for improving current practice. This final chapter, written by the eight editors of this volume, provides seven key recommendations for future priority-setting in global health: (1) A more systematic approach to priority-setting in health is needed; (2) Information on cost-effectiveness is essential; (3) Distributional impact needs to be integrated; (4) Stillbirths need to be integrated; (5) Non-health effects need to be integrated; (6) Process needs to be emphasized alongside substantive criteria; and (7) New methods and tools need to be used and further developed.

scholarly journals Task sharing for the care of severe mental disorders in a low-income country (TaSCS): study protocol for a randomised, controlled, non-inferiority trial

Trials ◽  
2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Charlotte Hanlon ◽  
Atalay Alem ◽  
Girmay Medhin ◽  
Teshome Shibre ◽  
Dawit A. Ejigu ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Cost Effectiveness ◽  
Mental Disorders ◽  
Mental Health Care ◽  
Low Income ◽  
Psychiatric Nurse ◽  
Task Sharing ◽  
Low Income Country ◽  
Randomised Controlled

Abstract Background Task sharing mental health care through integration into primary health care (PHC) is advocated as a means of narrowing the treatment gap for mental disorders in low-income countries. However, the effectiveness, acceptability, feasibility and sustainability of this service model for people with a severe mental disorder (SMD) have not been evaluated in a low-income country. Methods/Design A randomised, controlled, non-inferiority trial will be carried out in a predominantly rural area of Ethiopia. A sample of 324 people with SMD (diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder or major depressive disorder) with an ongoing need for mental health care will be recruited from 1) participants in a population-based cohort study and 2) people attending a psychiatric nurse-led out-patient clinic. The intervention is a task-sharing model of locally delivered mental health care for people with SMD integrated into PHC delivered over 18 months. Participants in the active control arm will receive the established and effective model of specialist mental health care delivered by psychiatric nurses at an out-patient clinic within a centrally located general hospital. The hypothesis is that people with SMD who receive mental health care integrated into PHC will have a non-inferior clinical outcome, defined as a mean symptom score on the Brief Psychiatric Rating Scale, expanded version, of no more than six points higher, compared to participants who receive the psychiatric nurse-led service, after 12 months. The primary outcome is change in symptom severity. Secondary outcomes are functional status, relapse, service use costs, service satisfaction, drop-out and medication adherence, nutritional status, physical health care, quality of care, medication side effects, stigma, adverse events and cost-effectiveness. Sustainability and cost-effectiveness will be further evaluated at 18 months. Randomisation will be stratified by health centre catchment area using random permuted blocks. The outcome assessors and investigators will be masked to allocation status. Discussion Evidence about the effectiveness of task sharing mental health care for people with SMD in a rural, low-income African country will inform the World Health Organisation’s mental health Gap Action Programme to scale-up mental health care globally. Trial registration NCT02308956 (ClinicalTrials.gov). Date of registration: 3 December 2014.

scholarly journals Dental Health Services Utilization and Associated Factors in Children 6 to 12 Years Old in a Low-Income Country

2008 ◽  
Vol 68 (1) ◽  
pp. 39-45 ◽  
Author(s):  
Carlo Eduardo Medina-Solis ◽  
Gerardo Maupomé ◽  
Miriam del Socorro Herrera ◽  
Ricardo Pérez-Núñez ◽  
Leticia Ávila-Burgos ◽  
...  
Keyword(s):  
Health Services ◽  
Low Income ◽  
Associated Factors ◽  
Health Services Utilization ◽  
Dental Health ◽  
Income Country ◽  
Services Utilization ◽  
Dental Health Services ◽  
Low Income Country

scholarly journals Country contextualisation of cost-effectiveness studies: lessons from Ethiopia

2019 ◽  
Vol 4 (6) ◽  
pp. e001320 ◽  
Author(s):  
Kjell Arne Johansson ◽  
Mieraf Taddesse Tolla ◽  
Solomon Tessema Memirie ◽  
Ingrid Miljeteig ◽  
Mahlet Kifle Habtemariam ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Low Income ◽  
Priority Setting ◽  
Health Benefits ◽  
Neonatal Resuscitation ◽  
Low Income Countries ◽  
Health Coverage ◽  
Policy Makers ◽  
Life Years ◽  
Per Capita

Emerging demographic, epidemiological and health system changes in low-income countries require revisions of national essential health services packages in accordance with standard healthcare priority setting methods. Policy makers are in need of explicit and user-friendly methods to compare impact of multiple interventions. We provide experiences of country contextualisation of WHO-CHOICE methods and models to a country level. Results from three contextualised cost-effectiveness analyses (CEAs) are presented, and we discuss how this evidence can inform priority setting in Ethiopia. Existing models for a range of interventions in obstetric and neonatal care, psychiatric and neurological treatment and prevention and treatment of cardiovascular diseases are contextualised to the Ethiopian setting. CEAs are defined as contextualised if they include national analysts and use country-specific input for either costs, epidemiology, demography, baseline coverage or effects. Interventions (n=61) are ranked according to incremental cost-effectiveness rates (ICERs), and expected health outcomes (Disability Adjusted Life Years (DALYs) averted) and budget impacts are presented for each intervention. Dominated interventions (n=30) were excluded. A US$2.8 increase per capita in the annual health budget is needed in Ethiopia (currently at US$28 per capita) for increasing coverage by 20%–75% for all the 22 interventions with positive net health benefits. This investment is expected to give a net benefit at around 0.5 million DALYs averted in return in total, with a willingness to pay threshold at US$2000 per DALY averted. In particular, three interventions, neonatal resuscitation, kangaroo mother care and antibiotics for newborn sepsis, stand out as best buys in an Ethiopian setting. Our method of contextualised CEAs provides important information for policy makers. Rank ordering of interventions by ICERs, together with presentations of expected budget impact and net health benefits, is a clear and policy friendly illustration of possible efficient stepwise pathways towards universal health coverage.

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