The Future of Priority-Setting in Global Health

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.

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When cost-effective interventions are unaffordable: Integrating cost-effectiveness and budget impact in priority setting for global health programs

PLoS Medicine ◽

10.1371/journal.pmed.1002397 ◽

2017 ◽

Vol 14 (10) ◽

pp. e1002397 ◽

Cited By ~ 33

Author(s):

Alyssa Bilinski ◽

Peter Neumann ◽

Joshua Cohen ◽

Teja Thorat ◽

Katherine McDaniel ◽

...

Keyword(s):

Cost Effectiveness ◽

Global Health ◽

Priority Setting ◽

Budget Impact ◽

Cost Effective ◽

Health Programs ◽

Effective Interventions

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Reflections on Norheim (2018), Disease Control Priorities Third Edition Is Published Comment on "Disease Control Priorities Third Edition Is Published: A Theory of Change Is Needed for Translating Evidence to Health Policy"

International Journal of Health Policy and Management ◽

10.15171/ijhpm.2019.09 ◽

2019 ◽

Vol 8 (6) ◽

pp. 375-377 ◽

Cited By ~ 1

Author(s):

Rachel Nugent

Keyword(s):

Health Policy ◽

Cost Effectiveness ◽

Global Health ◽

Disease Control ◽

Priority Setting ◽

Theory Of Change ◽

High Quality ◽

Middle Income ◽

Middle Income Countries ◽

Quality Health

The publication of Disease Control Priorities, 3rd edition (DCP3) is a major milestone in the global health world. DCP3 reviews and summarizes high quality health intervention effectiveness and cost-effectiveness evidence relevant to low- and middle-income countries and is freely available to users. This Commentary summarizes Norheim’s (2018) assessment of DCP3’s role in country health priority-setting and offers reflections on what DCP3 can continue to offer countries seeking to improve their purchasing of health.

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Incorporating Distributional Concerns into Practical Tools for Priority-Setting

Global Health Priority-Setting ◽

10.1093/oso/9780190912765.003.0011 ◽

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.

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Global Health Priority-Setting

10.1093/oso/9780190912765.001.0001 ◽

2019 ◽

Cited By ~ 1

Keyword(s):

Global Health ◽

Priority Setting ◽

Health Resources ◽

Decision Makers ◽

Health Priorities ◽

Health Coverage ◽

Household Finances ◽

Health Gains ◽

Global Priority ◽

Financing Gap

Global health is at a crossroads. The 2030 Agenda for Sustainable Development has come with ambitious targets for health and health services worldwide. To reach these targets, many more billions of dollars need to be spent on health. However, development assistance for health has plateaued and domestic funding on health in most countries is growing at rates too low to close the financing gap. National and international decision-makers face tough choices about how scarce health care resources should be spent. Should additional funds be spent on primary prevention of stroke, treating childhood cancer, or expanding treatment for HIV/AIDS? Should health coverage decisions take into account the effects of illness on productivity, household finances, and children’s educational attainment, or should they just focus on health outcomes? Does age matter for priority-setting or should it be ignored? Are health gains far in the future less important than gains in the present? Should higher priority be given to people who are sicker or poorer? This book provides a framework for how to think about evidence-based priority-setting in health. Over 18 chapters, ethicists, philosophers, economists, policymakers, and clinicians from around the world assess the state of current practice in national and global priority-setting, describe new tools and methodologies to address establishing global health priorities, and tackle the most important ethical questions that decision-makers must consider in allocating health resources.

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Sharing power in global health research: an ethical toolkit for designing priority-setting processes that meaningfully include communities

International Journal for Equity in Health ◽

10.1186/s12939-021-01453-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Bridget Pratt

Keyword(s):

Global Health ◽

Priority Setting ◽

Health Research ◽

Reflective Equilibrium ◽

Empirical Work ◽

The Philippines ◽

Project Planning ◽

Global Health Research ◽

Research Priority ◽

Health Research Priority Setting

AbstractTo promote social justice and equity, global health research should meaningfully engage communities throughout projects: from setting agendas onwards. But communities, especially those that are considered disadvantaged or marginalised, rarely have a say in the priorities of the research projects that aim to help them. So far, there remains limited ethical guidance and resources on how to share power with communities in health research priority-setting. This paper presents an “ethical toolkit” for academic researchers and their community partners to use to design priority-setting processes that meaningfully include the communities impacted by their projects. An empirical reflective equilibrium approach was employed to develop the toolkit. Conceptual work articulated ethical considerations related to sharing power in g0l0o0bal health research priority-setting, developed guidance on how to address them, and created an initial version of the toolkit. Empirical work (51 in-depth interviews, 1 focus group, 2 case studies in India and the Philippines) conducted in 2018 and 2019 then tested those findings against information from global health research practice. The final ethical toolkit is a reflective project planning aid. It consists of 4 worksheets (Worksheet 1- Selecting Partners; Worksheet 2- Deciding to Partner; Worksheet 3- Deciding to Engage with the Wider Community; Worksheet 4- Designing Priority-setting) and a Companion Document detailing how to use them. Reflecting on and discussing the questions in Worksheets 1 to 4 before priority-setting will help deliver priority-setting processes that share power with communities and projects with research topics and questions that more accurately reflect their healthcare and system needs.

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Adverse Health Effects of Frailty: Systematic Review and Meta‐Analysis of Middle‐Aged and Older Adults With Implications for Evidence‐Based Practice

Worldviews on Evidence-Based Nursing ◽

10.1111/wvn.12508 ◽

2021 ◽

Author(s):

Wen Chu ◽

Shu‐Fang Chang ◽

Hsu‐Yu Ho

Keyword(s):

Systematic Review ◽

Older Adults ◽

Health Effects ◽

Evidence Based Practice ◽

Meta Analysis ◽

Evidence Based ◽

Middle Aged ◽

Adverse Health Effects ◽

Adverse Health

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Evidence‐based priorities of under‐served pregnant and parenting adolescents: addressing inequities through a participatory approach to contextualizing evidence syntheses

International Journal for Equity in Health ◽

10.1186/s12939-021-01458-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Anna Dion ◽

Aime Klevor ◽

Amy Nakajima ◽

Neil Andersson

Keyword(s):

Social Services ◽

Adolescent Mothers ◽

Priority Setting ◽

Service Providers ◽

Post Partum ◽

Perinatal Outcomes ◽

Health Inequities ◽

Participatory Approach ◽

Perinatal Health ◽

Evidence Based

Abstract Purpose This study describes an interdiscursive evidence-based priority setting process with pregnant and parenting adolescents and their services providers. Methods A mixed methods literature review identified studies reporting on perinatal outcomes and experiences of adolescents during pregnancy to 12 months post-partum published in Canada after 2000. We also calculated relative risks for common perinatal risk factors and outcomes for adolescents compared to adult populations from 2012 to 2017 based on data from a provincial database of maternal and newborn outcomes. Two trained peer researchers identified outcomes most relevant to their peers. We shared syntheses results with four service providers and 13 adolescent mothers accessing services at a community service organization, who identified and prioritized their areas of concern. We repeated the process for the identified priority issue and expanded upon it through semi-structured interviews. Results Adolescent mothers face higher rates of poverty, abuse, anxiety and depression than do adult mothers. Adolescents prioritized the experience of judgment in perinatal health and social services, particularly as it contributed to them being identified as a child protection risk. Secondary priorities included loss of social support and inaccessibility of community resources. The experience of judgment in adolescent perinatal health literature was summarized around: being invisible, seen as incapable and seen as a risk. Adolescent mothers adapted these categories, emphasizing organizational and social barriers. Conclusions Young marginalized women are disproportionately affected by inequities in perinatal outcomes, yet their perspectives are rarely centered in efforts to address these inequities. This research addresses health inequities by presenting a robust, transparent and participatory approach to priority setting as a way to better represent the perspectives of those who carry the greatest burden of health inequities in evidence syntheses. In our work, marginalized adolescent parents adapted published literature around the experience and consequences of social stigma on perinatal outcomes, shifting our understanding of root causes and possible solutions.

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CLINICAL AND COST-EFFECTIVENESS OF DONEPEZIL, RIVASTIGMINE, AND GALANTAMINE FOR ALZHEIMER'S DISEASE

International Journal of Technology Assessment in Health Care ◽

10.1017/s026646230200034x ◽

2002 ◽

Vol 18 (3) ◽

pp. 497-507 ◽

Cited By ~ 48

Author(s):

Andrew Clegg ◽

Jackie Bryant ◽

Tricia Nicholson ◽

Linda McIntyre ◽

Sofie De Broe ◽

...

Keyword(s):

Quality Of Life ◽

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cost Effectiveness ◽

Global Health ◽

Cochrane Library ◽

The Impact ◽

Health Cognition ◽

Economic Studies

Objectives: Systematic review of the clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for people suffering from Alzheimer's disease.Methods: Sixteen electronic databases (including MEDLINE, the Cochrane Library, and Embase) and bibliographies of related papers were searched for published/unpublished English language studies, and experts and pharmaceutical companies were consulted for additional information. Randomized controlled trials (RCTs) and economic studies were selected. Clinical effectiveness was assessed on measurement scales assessing progression of Alzheimer's disease on the person's global health, cognition, functional ability, behavior and mood, and quality of life. Cost-effectiveness was presented as incremental cost per year spent in a nonsevere state (by Mini Mental Health State Examination) or quality-adjusted life-year.Results: Twelve of 15 RCTs included were judged to be of good quality. Although donepezil had beneficial effects in Alzheimer's patients on global health and cognition, rivastigmine on global health, and galantamine on global health, cognition, and functional scales, these improvements were small and may not be clinically significant. Measures of quality of life and behavior and mood were rarely assessed. Adverse effects were usually mild and transient. Cost-effectiveness base case estimates ranged from £2,415 savings to £49,476 additional cost (1997 prices) per unit of effect for donepezil and a small savings for rivastigmine. Estimates were not considered robust or generalizable.Conclusions: Donepezil, rivastigmine, and galantamine appear to have some clinical effect for people with Alzheimer's disease, although the extent to which these translate into real differences in everyday life remains unclear. Due to the nature of current economic studies, cost-effectiveness remains uncertain and the impact on different care sectors has been inadequately investigated. Further research is needed to establish the actual benefits of acetylcholinesterase inhibitors (AChEls) for people with Alzheimer's disease and their caregivers, the relationship of these changes to clinical management, and careful prospective evaluation of resource and budgetary consequences.

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