Need for HTA supported risk factor screening for hypertension and diabetes in Nepal: A systematic scoping review

Abstract

ObjectiveHealth Technology Assessment (HTA) is a comprehensive and important tool for assessment and decision-making in public health and healthcare practice. It is recommended by the WHO and has been applied in practice in many countries, mostly the developed ones. HTA might be an important tool to achieve universal health coverage (UHC), especially beneficial to low-and-middle-income countries (LMIC). Even though the Package for Essential Non-communicable Diseases (PEN) has already been initiated, there is a clear policy gap in the HTA of any health device, service, or procedure, including the assessment of cardiovascular risk factors (CVRFs) in Nepal. Hence, we carried out the review to document the HTA supported evidence of hypertension and diabetes screening, as CVRFs in Nepal.Materials and methodsWe searched in PubMed, Cochrane, and Google Scholar, along with some gray literature published in the last 6 years (2016–2021) in a systematic way with a controlled vocabulary using a well-designed and pilot tested search strategy, screened them, and a total of 53 articles and reports that matched the screening criteria were included for the review. We then, extracted the data in a pre-designed MS-Excel format, first in one, and then, from it, in two, with more specific data.ResultsOf 53 included studies, we reported the prevalence and/or proportion of hypertension and diabetes with various denominators. Furthermore, HTA-related findings such as cost, validity, alternative tool or technology, awareness, and intervention effectiveness have been documented and discussed further, however, not summarized due to their sparingness.ConclusionOverall, the prevalence of DM (4.4–18.8%) and HTN (17.2–70.0%) was reported in most studies, with a few, covering other aspects of HTA of DM/HTN. A national policy for establishing an HTA agency and some immediately implementable actions are highly recommended.

Universal health coverage evolution, ongoing trend, and future challenge: A conceptual and historical policy review

“…As a result, the programs, resources, and delivery systems have been distributed throughout, increasing the probability of duplication among them. Furthermore, lacking a health technology assessment (HTA) body further jeopardizes the situation in achieving the UHC ( 62 ). To prevent duplication of the program, the efficiency of resource integration of SHP and UHC is useful.…”

Adopting social health insurance in Nepal: A mixed study

“…Having surety of risk will make higher chances of enrolling, thereby diminishing the utility of risk pooling ( 11 ). Furthermore, before including any medicine or healthcare in the benefits package, a process of the Health Technology Assessment (HTA) is needed, not only from a cost perspective but also to reach the UHC ( 34 ). Updating the benefits package has also been emphasized as an alternate strategy for UHC ( 30 ).…”

Editorial: Asian health sector growth in the next decade—Optimism despite challenges ahead

“…In order to achieve UHC, the health sector in the next decade is expected to grow and move beyond HSD. For this, in addition to financial and non-financial barriers to health insurance, alternative strategies to existing insurance schemes are crucial, including social health insurance (HI), as some Asian and African countries are moving closer to UHC by HI reforms ( 7 , 8 ); improved governance through localized employees; public health screening with cost-effective tools and strategies, such as portable ECGs and the gastric cancer risk score scale (GCRSS), which can be further captivated with the Health Technology Assessment (HTA) ( 9 ) and may further help in reducing the ongoing catastrophic expenditures of households with noncommunicable diseases (NCDs) ( 10 ); and the leadership skills and training of health care professionals. Another area of growth in the health sector is health tourism, for which patient satisfaction and enhancing the trust between the health professionals and the patient are warranted.…”