Economic evaluation guidelines in low- and middle-income countries: a systematic review

Abstract

Objectives To systematically identify the latest versions of official economic evaluation guidelines (EEGs) in low- and middle-income countries (LMICs) and explore similarities and differences in their content. Methods We conducted a systematic search in MEDLINE (Ovid), PubMed, EconLit, Embase (Ovid), the Cochrane Library, and the gray literature. Using a predefined checklist, we extracted the key features of economic evaluation and the general characteristics of EEGs. We conducted a comparative analysis, including a summary of similarities and differences across EEGs. Results Thirteen EEGs were identified, three pertaining to lower-middle-income countries (Bhutan, Egypt, and Indonesia), nine to upper-middle-income countries (Brazil, China, Colombia, Cuba, Malaysia, Mexico, Russian Federation, South Africa, and Thailand), in addition to Mercosur, and none to low-income countries. The majority (n = 12) considered cost–utility analysis and health-related quality-of-life outcome. Half of the EEGs recommended the societal perspective, whereas the other half recommended the healthcare perspective. Equity considerations were required in ten EEGs. Most EEGs (n = 11) required the incremental cost-effectiveness ratio and recommended sensitivity analysis, as well as the presentation of a budget impact analysis (n = 10). Seven of the identified EEGs were mandatory for pharmacoeconomics submission. Methodological gaps, contradictions, and heterogeneity in terminologies used were identified within the guidelines. Conclusion As the importance of health technology assessment is increasing in LMICs, this systematic review could help researchers explore key aspects of existing EEGs in LMICs and explore differences among them. It could also support international organizations in guiding LMICs to develop their own EEGs and improve the methodological framework of existing ones.

The development process of economic evaluation guidelines in low- and middle-income countries: a systematic review

“…Specifically, we noted that one-third of the identified EEGs failed to report or to engage multisectoral or multidisciplinary developers, and approximately 14 percent did not follow or did not report any recommended step as part of the development process. These results are in line with those reported by the systematic review of EEGs in LMICs, whereby countries with the lowest quality scores for the two domains had the most methodological weaknesses and gaps observed (7). Unfortunately, to our knowledge, the quality of the development process of EEGs in developed countries has not been previously assessed.…”

“…A transparent approach to reporting the development process of EEGs is fundamental to assessing this process and generating information that can be beneficial for guidelines developers (13;38). This is especially true for LMICs, where experience in developing EEGs is limited and this process is uniquely challenging (7). In this paper, we systematically reviewed the development process of fourteen EEGs in LMICs, that is, the participants and the steps or the methods followed, and we assessed the quality of this process.…”

“…We identified fourteen EEGs in LMICs, compared with the thirteen reported by Daccache et al in the systematic review conducted in June 2020 (7). This highlights that guidelines development is an ongoing process in LMICs, which are slowly but steadily adopting EEGs as a support tool for advice about the allocation of their scarce resources.…”

“…Economic evaluation (EE) is an essential component of HTA, requested in many countries to support reimbursement decisions by providing information on the cost-effectiveness of health technologies (3;4). For harmonization and comparability purposes, economic evaluation guidelines (EEG) have been developed and applied in many countries, particularly European and North American countries, where HTA is well established (5–7). Along with other health systems guidance (HSG), EEGs provide critical input and support for decision-making for effective health system programs; accordingly, a well-described process is essential to ensure the transparency and objectivity of these guidelines (8;9).…”

“…Recently, the interest in and use of HTA has increased in low- and middle-income countries (LMICs), leading to the development of EEGs in these countries, such as Brazil, Cuba, Egypt, and Indonesia (7). Although EEGs are emerging in LMICs, several countries do not yet have an established EEG (7). Developing national EEGs is crucial to providing researchers with practical steps for conducting their EEs (10).…”