The burden of NCDs remains high in low and middle-income countries (LMICs). Reducing this burden is at the forefront of the global health agenda, but how do countries go about doing this?

HITAP and partners from expert institutions have been commissioned by the Prince Mahidol Award Conference (PMAC); Institute for Population and Social Research; and Mahidol University to develop a book that draws on examples of cost-effective interventions for NCDs, dubbed ‘best buys’; cost-ineffective interventions for NCDs (‘wasted buys’) and controversies that can often proliferate both. We are delighted to have this work supported by the Thai Health Promotion Foundation and iDSI and hope the end product will capture what good investments have been for NCD prevention, whilst at the same time detailing obstacles policy makers must navigate, such as public opinion; commercial and trade interest; and unique health system challenges.

The project team are looking forward to launching the book as an ‘evidence package’ that will draw upon examples where lessons can be learned; and provide readers with the tools to review the evidence available.

Chapter authors and co-investigators met at the Center for Global Development Europe in London last month to review preliminary findings and decide on next steps for the project. One of the key points raised was the unavoidable, harsh reality that there is not just a dichotomy between ‘best buys’ and ‘wasted buys’. What may be a best buy in one setting can be wasted in another; and evidence on effectiveness can be weak or absent altogether in certain settings. Authors agreed that addressing uncertainties needs to be at the core of this project.

As well as raising local contextual questions, the project team agree the books content needs to highlight the monitoring and evaluation of interventions once implemented – effectiveness is not static and a ‘best buy’ can soon become a ‘wasted buy’.

Public health specialist and policy advocator Dr Suwit Wibulpolprasert, from Thailand’s Ministry of Public Health, said: “This is a dynamic research project that should not limit itself to a book but rather a continuous evidence-based social movement.”

We still have a year to go until the launch of the evidence package on UHC Day 2019 (12 December), in the meantime the project team can be found presenting preliminary findings at PMAC 2019. We will be at the PS2.5 session on Saturday 2 February 2019, 10.30am-12.30pm. Hope to see you there!

At the end of March 2017, Professor Jo Lord, Director of the Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, and Dr Kalipso Chalkidou travelled to Accra, Ghana to meet with colleagues and follow up on latest developments. iDSI is co-producing with our Ghanaian partners a full report on the technical and data aspects of the model, discussing the likely characteristics of a Ghana-specific Reference Case for economic evaluation and setting out specific policy angles of interest to Ghanaian policy makers, including the potential linkage between HTA and reimbursement. We aim to set out a vision for joint working over the next 2-3 years, based on the country’s priorities and commitment to building the needed capacities for effectively using economic and clinical evidence of comparative effectiveness to inform spending decisions. The report will offer robust estimates of savings from shifts in current practice, from changes in prescribing behaviour to reductions in prices and population level prevention and screening initiatives, to inform Ghanaian policy makers about resources that can be released to expand the breadth and depth of coverage, without harming quality. We hope to do more such analyses on NCDs, including diabetes and end stage kidney disease as well as mental health, as we continue our joint efforts.

At a time where Ghana is transitioning away from aid whilst striving to expand and ensure the financial sustainability of its health insurance scheme, transparency and accountability when it comes to important investment decisions, become even more important. Building on strong institutional structures for multi-stakeholder engagement and evidence informed policy such as the Essential Medicines List and the Standard Treatment Guidelines and the recently formed HTA Working Group, and on existing academic groups with a track record in the field of HTA at Kumasi (KNUST) and Accra (School of Public Health) this is an opportunity to help build a Ghanaian HTA system better to control escalating costs and inform future investment and disinvestment decisions.

A case for further investment in health cannot be made unless systems are in place to ensure good value for money for every Cedi spent. Identifying, in an evidence informed way, opportunities for releasing resources for reinvestment to expand coverage whilst ensuring health outcomes remain the same or improve, is a powerful argument for more and better spending in health. Our report will go some way towards making the case for an HTA mechanism for strengthening the handle of the Ghanaian authorities over its own budget through tackling a specific cased of high spending and high burden, namely hypertension management. Using Ghanaian data and making all assumptions explicit, the analysis will point to areas for improved spending, quantifies potential savings and health gains from reallocation and make a case for an institutionalised approach to HTA in Ghana, as an important tool for transitioning away from aid and towards sustainable and affordable Universal Healthcare Coverage.

Health Technology Assessment offers a framework for decision making though multi-stakeholder processes and a multidisciplinary approach which aims to incorporate evidence and values, locally relevant, to drive better decisions. But it relies heavily on implementation levers such as provider payment, contracting, patient and professional education and strong regulation to make a difference.

“up to 68 percent of out of pocket health costs in resource-limited countries is for medication… inclusion of off-label drugs in the UHC benefit package, as shown in the use of bevacizumab in Thailand, serves as an example of how to offer high-cost NCD treatment in a safe and effective way”

The blog also emphasises the importance of evidence-based decision making and use of HTA in considerations about access to medicines.

“No matter what measures are adopted, the decision-making should be an evidence-based process participated in by multiple stakeholders and supported by health technology assessment (HTA), which takes into account human rights, cost-effectiveness, safety, and intellectual property rights“