Health Economic Publications From the Middle East and North Africa Region: A Scoping Review of the Volume and Methods of Research

Abstract

Introduction We reviewed the scope of countries, diseases, technologies, and methods involved in the health economic evaluations published in the Middle East and North Africa (MENA) region. Methods PRISMA guidelines were followed. A PubMed search was conducted up to December 15, 2019. English language full-text articles were included if they reported original research on humans; involved the local population from Algeria, Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Syria, Tunisia, United Arab Emirates, or Yemen; reported costs; and involved a full or partial health economic analysis comparing alternative health technologies. Data on publication year, country of origin, disease area according to ICD-10, type of health technology, and applied methods were extracted. Results From 105 eligible articles, 57.1% were published between 2015 and 2019. Egypt (30.5%) and Saudi Arabia (27.6%) were the most frequently involved countries. Infectious diseases were most often studied (27.6%). The assessed technology was a system (eg, infection control, screening, coverage/access, hospital management, or healthcare delivery program) in 41.9% of studies. Cost-utility analysis (CUA) was the most frequent method (29.5%) and was growing rapidly. Health system perspective was adopted in 52.4% of studies, whereas societal perspective was scarce (8.6%). The majority of studies (46.7%) were published in Scimago Q1 journals. Over half of the studies (54.2%) did not report or did not have a funding source. Conclusions From 2015, health economic analysis became more frequent in the MENA region, providing input to value-based health policy and financing. For further growth, in addition to the development of the institutional background, valid and more standardized local cost and outcome data should be available.

Does health economics research align with the disease burden in the Middle East and North Africa region? A systematic review of economic evaluation studies on public health interventions

“…First is a geographical gap; there was a complete absence of economic evaluation studies from several high-income countries (i.e., Bahrain, Kuwait, Qatar, Saudi Arabia and UAE), middle-income countries (i.e., Djibouti, Iraq, Mauritania and Palestine), and low-income countries (Sudan and Yemen). In these countries, HE and HTA studies are not mandatory in decision-making [ 6 , 18 , 19 , 84 , 85 ]. Meanwhile, these countries share some common features: the lack of HTA institutionalization, the absence of national HE guidelines, the lack of HE and HTA graduate and post-graduate academic programs, the limited technical capacity to conduct economic evaluation studies, and the fragility of UHC programs [ 6 , 18 , 19 , 84 , 85 ].…”

“…In these countries, HE and HTA studies are not mandatory in decision-making [ 6 , 18 , 19 , 84 , 85 ]. Meanwhile, these countries share some common features: the lack of HTA institutionalization, the absence of national HE guidelines, the lack of HE and HTA graduate and post-graduate academic programs, the limited technical capacity to conduct economic evaluation studies, and the fragility of UHC programs [ 6 , 18 , 19 , 84 , 85 ]. Another possible explanation for the low number of economic evaluation studies in high-income and low-income countries in MENA is that high-income countries (Gulf States) have sufficient financial resources to adopt expensive interventions, while public health interventions in low-income countries are mainly funded by donors and international agencies.…”

Disease-Related Costs Published in The Middle East and North Africa Region: Systematic Review and Analysis of Transferability

“…To the best of our knowledge, our study is the first systematic review of disease-related costs and their transferability within MENA. Health economic research has been systematically reviewed for Saudi Arabia by Al-Aqueel et al [ 11 ] up to 2011 ( n = 15 studies), for the Gulf cooperation by Eljilany et al [ 9 ] up to 2017 ( n = 49), for Egypt by Farid et al [ 10 ] up to 2017 ( n = 15), for the entire MENA region by Zrubka et al [ 12 ] up to 2019 ( n = 105) and most recently by AlAujan [ 13 ] for the Gulf region ( n = 14) and Sharkawy et al [ 51 ] including the entire WHO Eastern Mediterranean Region ( n = 624). In general, the methodological and reporting quality of studies showed great variation and many shortcomings [ 9 – 11 , 13 ].…”

“…Health economic evaluations in MENA have been systematically reviewed in multiple studies [ 9 – 13 ]. In addition to limited funding as well as organizational and human resource barriers, a commonly cited constraint to the implementation of HTA in the region is the limited availability of relevant local data on costs and outcomes [ 9 , 10 , 12 – 14 ].…”

Reporting Quality of Cost-Effectiveness Analyses Conducted in Saudi Arabia: A Systematic Review

“…According to a recently published review, health economic publication between 2015 and 2019 from Saudi Arabia represents around 28% of all publications from the MENA region, second only to Egypt (30.5%). 6 CEA studies depend on 2 main parts, as the name implies: cost and effectiveness. The effectiveness part could be collected directly from a clinical trial or from the literature, whereas the cost could be collected also from a reliable and updated source or could be obtained by the investigators directly.…”