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Rapid Priority-Setting in Health: a New iDSI Guide

With thanks to contributors to the guide released today: Srobana Ghosh, Javier Guzman, Lieke Fleur Heupink, Andrés Pichon-Riviere, Shankar Prinja, and the iDSI network.

Priority-setting in health is a critical function of all health systems, enabling countries to focus their spending on services that have the biggest impact on their citizens’ health. This works—for every dollar spent on priority-setting, countries get nine dollars of better health system impact. However, previous efforts have taken up considerable time, effort, and data, which are in short supply in all countries, but especially low- and middle-income countries (LMICs).

Recently, CGD and partners in the international Decision Support Initiative (iDSI) have developed and piloted a new, faster approach, which can enable countries to rapidly review and adjust analyses and decisions from other countries, often in a matter of weeks rather than months. This can dramatically increase decision-making efficiency, enabling countries to make many more evidence-informed decisions, resulting in better healthcare for their population. Today the iDSI network has released a global guide to this method, and looks forward to seeing how countries adapt it to their contexts.

Adaptive health technology assessment (aHTA)

Over the last 25 years, health technology assessment (HTA) has become a common approach to review the benefits and costs of a technology, to inform which services should be provided by publicly-funded health systems. Demand for HTA in LMICs is strong, and countries are making progress. Over the last ten years, the iDSI network has identified an urgent need for a structured approach to use international evidence to reduce the time, capacity, and data required for HTA. This broad field has become known as adaptive HTA (aHTA).

Rapid review of international HTA reports

There are many aHTA approaches under development, but because this is a new area, there is not yet guidance on how countries should implement it. The guide released today fills this gap. It provides a structured and easy-to-implement method that countries can adapt and adopt, based on iDSI’s experiences in Romania, Indonesia, India, and Ghana. This adaptive HTA method is known as the Rapid Review of International HTAs. The method has seven core steps that would apply to all countries, plus four optional modules, should analysts and decision-makers in the local setting wish to augment their efforts (see Figure 1).

Figure 1: Summary of core and optional modules in the Rapid Review of International HTA Reports

Chart illustration summarizing the core and optional modules in the Rapid Review of International HTA Reports

There are three notable features of this approach:

  1. Adaptive HTA is the default for new topics, protecting country HTA capacity for the more challenging and uncertain decisions that would require full, traditional HTA.
  2. The focus is on reviewing HTA reports, and evidence is then extracted from HTAs from established agencies. Additional evidence sources are of secondary importance. Utilising HTAs from other jurisdictions is particularly powerful because it enables countries to leverage other countries’ technical capacity in collating, synthesising, and appraising the quality of evidence on a topic. This makes the approach efficient but only possible on subjects that have already been reviewed.
  3. Decision-making requires MORE expert judgement. Transferring evidence from another setting increases uncertainty, and requires appraisal by experts who understand both the major conclusions from the available evidence AND the local context in which it will be applied. Supporting analysis such as price benchmarking may inform discussions, but expert deliberation is critical.

Recommendations

The Rapid Review of International HTAs guide offers countries an opportunity to scale up evidence-informed decision-making and improve the value for money of their health systems. Based on our experience in developing the guide, we recommend that:

  • All countries should adopt context appropriate adaptive HTA processes, modifying them as necessary, building them into their priority-setting processes, and sharing their experiences.
  • Researchers and funders should continue to develop, refine, and improve these approaches, given the uncertainties inherent in translating analytic outputs such as cost-effectiveness estimates between settings.
  • All HTA agencies should increase the transparency and availability of HTA reports to enable adaptive HTA processes to be more effective and cover more topics.
  • The World Health Organization should produce normative global guidance supporting the adoption of adaptive HTA approaches, and promote and coordinate lesson sharing and learning between countries.
  • Regional initiatives, such as the Africa Centres for Disease Control and Prevention, should develop guidance on the approach and coordinate production of full HTAs on priority regional topics to avoid duplication and focus the use of adaptive HTA approaches where they are most needed.

Disclaimer

CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.


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