Gates RC | iDSI

HTAsiaLink 7th newsletter features iDSI

Global Health and Development — Mon, 01 Jun 2015 13:26:16 +0000

The Jul-Dec 2015 edition of the the Reference Case for Economic Evaluation, as well a special interview with Prof Tony Culyer on the role of universities in capacity building for HTA.

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Development of the Reference Case (2014)

Global Health and Development — Wed, 31 Dec 2014 09:22:06 +0000

The Gates Reference Case is launched at the Houses of Parliament

June 2014

NICE International launched the Gates Reference Case, a principle-based standardised methodology for good practice in the planning, conduct and reporting of economic evaluation for informing priority setting in health.

Senior academics, donors and policy makers attended the launch at the Houses of parliament, which was hosted by APPG Global Health, chaired by Lord Crisp and Meg Hillier MP. There followed a technical workshop to discuss why and how the Gates Reference Case was developed and what it means for researchers, donors, and policy makers working in low and middle income countries as well as next steps in the development and implementation of the reference case.

The MEEP final report (PDF) contains the full Gates Reference Case and background to the project. A guide to the Reference Case – what it is, why it’s important and how to use it – can be found here.

Discussing the Reference Case at the World Health Organisation and the Global Fund

NICE International were joined by Prof Karl Claxton and Paul Revill from the University of York on a visit to the headquarters of the World Health Organisation in Geneva to discuss the Gates Reference Case and provide an update on the International Decision Support Initiative.

A roundtable discussion event was chaired by Kees de Joncheere, Director of the Department of Essential Medicines and Health Products. Also in attendance were individuals from various teams within the WHO, including Department of Health Systems Governance and Finance and the Policy Access and Use Unit. The roundtable enabled event enabled discussion about the Reference Case and its applicability to WHO programmes of work.

Following discussion with WHO staff, NICE International and colleagues from the University of York attended a meeting of the Health Economic Affinity Group, hosted by the Global Fund. The group aims to draw together individuals who work in institutions around Geneva who have in interest in health economics. More than 40 people from organisations such as WHO, Global Fund, UNITAIDs, the GAVI Alliance, and the Global Fund were in attendance. NICE International introduced the Reference Case and discussed the International Decision Support Initiative with the group. Professor Karl Claxton discussed the importance of a principle-based approach to the production of evidence to inform accountable and reasonable decisions.

These two events highlighted the continued relevance of the use of evidence in decision making and the wide applicability of the principles behind the Reference Case to a range institutions. These institutions make decisions which have a substantial impact on health care provision in many low and middle income counties around the world.

As focus on the processes and evidence supporting decision making becomes increasingly important, NICE International will continue to work with major partners to provide information and help.

The Gates Reference Case at ISPOR Europe

November 2014

Colleagues from University of York, Universiti Sains Malaysia, and NICE International held a Gates-Reference Case workshop session at the ISPOR Europe conference in Amsterdam in November 2014. The workshop was well attended and furthered efforts to reach out and engage with a range of different stakeholders with an interest in the Reference Case.

Mark Sculpher (University of York) provided an overview to the session and chaired discussion, Tommy Wilkinson (NICE International) presented the background and structure the Reference Case, Paul Revill (University of York) outlined each of the Reference Case principles and why they are important, and Asrul Shafie (School of Pharmaceutical Sciences, Universiti Sains Malaysia) provided an overview of the current status of economic evaluation methodology in Malaysia and some useful observations on the applicability of the RC to the Malaysian setting.

The workshop enabled some interesting discussion ranging from particular methodological specifications such as the DALY outcome measure to the status of the Reference Case going forward and applicability to high income countries.

Gates Foundation calls for more principled cost-effectiveness in health

admin — Wed, 11 Jun 2014 11:01:59 +0000

This is a post by Amanda Glassman reproduced with permission of the Center for Global Development

Cost-effectiveness studies compare the costs and benefits of different interventions with the aim of improving decisions on the allocation of scarce resources for health. Or, put simply, they allow policy-makers to set priorities for health spending and consider how the next dollar available can get more health for the money.

The Bill & Melinda Gates Foundation (BMGF) funds about a fifth of all published cost-effectiveness studies on interventions to address AIDS, tuberculosis, malaria, and vaccine-preventable diseases in low- and middle-income countries. BMGF also plays a high-profile role in promoting the concept of cost effectiveness as a criterion for global health decision making and spending.

But for cost-effectiveness studies to actually improve decisions, methods must be appropriate and reporting must be clear and accurate. If not done well, these analyses can be difficult to interpret and can lead to suboptimal or even incorrect decisions.

So BMGF recently commissioned NICE International, the University of York, and the Health Intervention and Technology Appraisal Program (Thailand) to develop the Gates Reference Case, a principle-based standardized methodology for economic evaluation in developing countries. The principles are described in detail here, and cover issues of transparency, comparators, better use of evidence, and measures of outcomes, among others. Using these principles, they also assess retrospectively how published BMGF-funded studies have fared since 2000.

The results of the study were disappointing. Paraphrasing the report:

“Most studies provided insufficient information about currency conversions and/or methods for adjusting costs to account for temporal disparities. Where information was provided, crude exchange rates were frequently used to convert unit costs drawn from other settings (often high-income countries). There was poor adherence to the three key methodological specifications for DALY estimation, raising significant concerns as variant approaches to DALY calculation limit comparability between studies. Although widely considered as the most comprehensive method of dealing with the various sources of uncertainty in economic evaluations, few studies presented probabilistic sensitivity analyses. Generalizability and transferability of results and equity implications of evaluated interventions were discussed in less than one-third of all reviewed studies. Only 35% of studies discussed the affordability of the interventions being assessed, despite these studies being undertaken in very resource-limited settings.”

Bottom line: it is tough to use this body of evidence to make better decisions.

Reference cases have been in the public domain for some time, and have been adopted by the US Panel on Cost-Effectiveness in Health and Medicine, the World Health Organization, and NICE itself, as a means to improve quality and comparability in the conduct and reporting of cost-effectiveness analyses. BMGF adoption could greatly improve the quality of economic evaluation for global health, particularly if the case is used as a condition for funding and a criterion for a specialized peer review as part of the commissioning and oversight of cost-effectiveness studies.

At the recent launch of the Reference Case, the Foundation announced plans to create incentives for researchers to adhere more closely to the best practice principles laid out in the Reference Case. Other cost-effectiveness analysis funders should follow suit; Wellcome Trust/MRC, DFID, USAID, and others could use the same standards and even the same peer review mechanism. Widespread use could enable more meaningful and explicit comparison of analyses and findings across multiple studies, which in turn will allow cost-effectiveness analyses to better guide health care spending decisions in developing countries.

The Gates Reference Case is launched at the Houses of Parliament, London

admin — Wed, 11 Jun 2014 10:11:43 +0000

NICE International launches the Gates Reference Case, a principle-based standardised methodology for good practice in the planning, conduct and reporting of economic evaluation for informing priority setting in health.

The Methods for Economic Evaluation Project (MEEP) was established by the Bill & Melinda Gates Foundation in 2013 to improve the quality and transparency of economic evaluation and to guide researchers in undertaking and reporting well-conducted and robust analyses.

MEEP was a novel collaboration led by NICE International and included partners from institutions around the world including the Health Intervention and Technology Appraisal Program (Thailand), the University of York, the London School of Hygiene and Tropical Medicine, and the University of Glasgow.

A key output of MEEP was the production of the Gates Reference Case, a set of principles, methodological specifications and reporting standards to support health economic evaluations funded by the Bill & Melinda Gates Foundation.

Senior academics, donors and policy makers attended the launch at the Houses of Parliament, followed by a technical workshop to discuss why and how the Gates Reference Case was developed; what it means for researchers, donors, and policy makers working in low and middle income countries; and next steps in the development and implementation of the reference case.

The MEEP final report contains the full Gates Reference Case and background to the project, download here:

Methods for Economic Evaluation Project (MEEP): final report

Methods for Economic Evaluation Project (MEEP): appendices