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Assessing the capacity of Ghana to introduce health technology assessment: a systematic review of economic evaluations conducted in Ghana

Published online by Cambridge University Press:  25 September 2020

Rebecca Addo Open the ORCID record for Rebecca Addo [Opens in a new window] ,
Stephen Goodall ,
Jane Hall  and
Marion Haas
Rebecca Addo
Affiliation:
Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, Sydney, Australia
Stephen Goodall
Affiliation:
Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, Sydney, Australia
Jane Hall
Affiliation:
Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, Sydney, Australia
Marion Haas
Affiliation:
Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, Sydney, Australia
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Abstract

Objectives

Ghana is in the process of formally introducing health technology assessment (HTA) for health decision making. Similar to other low- and middle-income countries, evidence suggests that the lack of data and human capacity is a major barrier to the conduct and use of HTA. This study assessed the current human and data capacity available in Ghana to undertake HTA.

Methods

As economic evaluation (EE) forms an integral part of HTA, a systematic review of EE studies undertaken in Ghana was conducted to identify the quality and number of studies available, methods and source of data used, and local persons involved. The literature search was undertaken in EMBASE (including MEDLINE), PUBMED, and Google Scholar. The quality of studies was evaluated using the Consolidated Health Economics Evaluation Reporting Standards. The number of local Ghanaians who contributed to authorship were used as a proxy for assessing human capacity for HTA.

Results

Thirty-one studies were included in the final review. Overall, studies were of good quality. Studies derived their effectiveness, resource utilization and cost data mainly from Ghana. The most common source of cost data was from the National Health Insurance Scheme pricing list for medicines and tariffs. Effectiveness data were mostly derived from either single study or intervention programs. Sixty out of 199 authors were Ghanaians (30 percent); these authors were mostly involved in data collection and study conceptualization.

Conclusions

Human capacity for HTA in Ghana is limited. To introduce HTA successfully in Ghana, policy makers would need to develop more local capacity to undertake Ghanaian-specific HTA.

Keywords

Health technology assessmentCapacity assessmentEconomic evaluationSystematic reviewGhana
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 36 , Issue 5 , October 2020 , pp. 500 - 507
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

World Health Organization WHA67.23: Health intervention and technology assessment in support of universal health coverage; 2014. Available from http://apps.who.int/medicinedocs/documents/s21463en/s21463en.pdf. Accessed 2016.Google Scholar
World Health Organization Health technology assessment; 2017. Available from http://www.who.int/health-technology-assessment/about/Defining/en/. Accessed 2019.Google Scholar
Chalkidou, K, Marten, R, Cutler, D, Culyer, T, Smith, R, Yot, T, Cluzeau, F et al. Health technology assessment in universal health coverage. The Lancet. 2013;382:e48–49 .10.1016/S0140-6736(13)62559-3CrossRefGoogle ScholarPubMed
Cumming, J. Health economics and health policy: Experiences from New Zealand. Appl Health Econ Health Policy. 2015;13:281–89.10.1007/s40258-014-0149-yCrossRefGoogle ScholarPubMed
Tantivess, S. Health technology assessment and policy making in Thailand. Regional World Health Summit. Singapore: World health Summit p. 18; 2013.Google Scholar
Sorenson, C, Chalkidou, K. Reflections on the evolution of health technology assessment in Europe. Health Economics. Policy Law. 2012;7:25–45.Google Scholar
Yothasamut, J, Tantivess, S, Teerawattananon, Y. Using economic evaluation in policy decision-making in Asian countries: Mission impossible or mission probable? Value Health. 2009;12:S26–30.10.1111/j.1524-4733.2009.00623.xCrossRefGoogle ScholarPubMed
Chalkidou, K, Levine, R, Dillon, A. Helping poorer countries make locally informed health decisions. Br Med J. 2010;341:c3651.10.1136/bmj.c3651CrossRefGoogle ScholarPubMed
Kriza, C, Hanass-Hancock, J, Odame, EA, Deghaye, N, Aman, R, Wahlster, P et al. A systematic review of Health Technology Assessment tools in sub-Saharan Africa: Methodological issues and implications. Health Res Policy Syst. 2014;12:66.10.1186/1478-4505-12-66CrossRefGoogle ScholarPubMed
National Health Insurance Authority Republic of Ghana National Health Insurance Authority 2013 Annual Report; 2013. Available from http://www.nhis.gov.gh/files/2013%20Annual%20Report-Final%20ver%2029.09.14.pdf. Accessed 2017.Google Scholar
Durairaj, V, D'Almeida, S, Kirigia, J. Ghana's approach to social health protection. World health report 2010 background paper, No 2: Geneva: WHO; 2010.Google Scholar
Ministry of Health Republic of Ghana Ghana essential medicines list. 6th ed.; 2010. Ministry of Health; Accra. Available from http://ghndp.org/images/downloads/eml2010.pdf. Accessed 2017.Google Scholar
Ministry of Health Republic of Ghana Standard treatment guidelines. 6th ed.; 2010. Ministry of Health; Accra. Available from http://ghndp.org/images/downloads/stg2010.pdf. Accessed 2017.Google Scholar
Addo, R, Hall, J, Goodall, S, Haas, M. VP66 perception of decision makers and researchers towards health technology assessment in Ghana. Int J Technol Assess Health Care. 2018;33:179–80.10.1017/S0266462317003427CrossRefGoogle Scholar
Lopert, R. Institutionalising health technology assessment (HTA) in Ghana to support access to new health technologies. Final inception report PATH and ADP; 2017.Google Scholar
Gad, M, Lord, J, Chalkidou, K, Asare, B, Lutterodt, MG. & Ruiz, F. Supporting the development of evidence-informed policy options: An economic evaluation of hypertension management in Ghana. Value Health. 2020;23:171–79.10.1016/j.jval.2019.09.2749CrossRefGoogle ScholarPubMed
Chalkidou, K, Lord, J, Gad, M. Improving the quality and efficiency of healthcare services in Ghana through HTA. Final report: Cost-effective care for managing hypertension in Ghana. University of Southampton: Southampton Health Technology Assessments Centre; 2017.Google Scholar
Ministry of Health Republic of Ghana Ghana national medicines policy. 3rd ed. Ghana National Drugs Programme (GNDP), Ministry of Health; Accra. 2017.Google Scholar
Hollingworth, S, Gyansa-Lutterodt, M, Dsane-Selby, L, Nonvignon, J, Lopert, R, Gad, M. et al. Implementing health technology assessment in Ghana to support universal health coverage: Building relationships that focus on people, policy, and process. Int J Technol Assess Health Care. 2020;36:8–11. doi:10.1017/S0266462319000795.CrossRefGoogle ScholarPubMed
Erntoft, S. Pharmaceutical priority setting and the use of health economic evaluations: A systematic literature review. Value Health. 2011;14:587–99.10.1016/j.jval.2010.10.036CrossRefGoogle ScholarPubMed
Merlo, G, Page, K, Ratcliffe, J, Halton, K, Graves, N. Bridging the gap: Exploring the barriers to using economic evidence in healthcare decision making and strategies for improving uptake. Appl Health Econ Health Policy. 2015;13:303–09.10.1007/s40258-014-0132-7CrossRefGoogle ScholarPubMed
Teerawattananon, Y, Russell, S. A difficult balancing act: Policy actors' perspectives on using economic evaluation to inform health-care coverage decisions under the Universal Health Insurance Coverage scheme in Thailand. Value Health. 2008;11:S52–60.10.1111/j.1524-4733.2008.00367.xCrossRefGoogle ScholarPubMed
Moharra, M, Kubesch, N, Estrada, MD, Parada, A, Cortes, M. & Espallargues, M. EUnetHTA project. Survey report on HTA organisations; 2008. Available from: https://5026.makemeweb.net/sites/5026.fedimbo.belgium.be/files/Survey%20report%20on%20HTA%20organisations.pdf. Accessed 2019.Google Scholar
World Health Organisation 2015 Global survey on health technology assessment by national authorities. Main findings; 2015. Available from: https://www.who.int/health-technology-assessment/MD_HTA_oct2015_final_web2.pdf?ua=1. Accessed 2019.Google Scholar
de Labry Lima, AO, Mochon, LG, Martínez, AC, Ruiz, EM. & Balbino, JE. Mapping capacity to conduct health technology assessment in Central, Eastern and South-Eastern Europe. Croat Med J. 2016;57:66–70. doi.org/10.3325/cmj.2016.57.66CrossRefGoogle ScholarPubMed
Hollingworth, SA, Ruiz, F, Gad, M, Chalkidou, K. Health technology assessment capacity at national level in sub-Saharan Africa: An initial survey of stakeholders. F1000Res. 2020;9:364. https://doi.org/10.12688/f1000research.23263.1CrossRefGoogle ScholarPubMed
Husereau, D, Drummond, M, Petrou, S, Carswell, C, Moher, D, Greenberg, D et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)—explanation and elaboration: A report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health. 2013;16:231–50.10.1016/j.jval.2013.02.002CrossRefGoogle ScholarPubMed
Abbott, C, Tiede, B, Armah, G, Mahmoud, A. Evaluation of cost-effectiveness of live oral pentavalent reassortant rotavirus vaccine introduction in Ghana. Vaccine 2012;30:2582–87.10.1016/j.vaccine.2012.01.076CrossRefGoogle ScholarPubMed
Dalaba, MA, Akweongo, P, Aborigo, RA, Saronga, HP, Williams, J, Blank, A et al. Cost-effectiveness of clinical decision support system in improving maternal health care in Ghana. PLoS ONE 2015;10:e0125920.10.1371/journal.pone.0125920CrossRefGoogle ScholarPubMed
Goodman, DM, Ramaswamy, R, Jeuland, M, Srofenyoh, EK, Engman, CM, Olufolabi, AJ et al. The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana. PLoS ONE 2017;12:e0180929.10.1371/journal.pone.0180929CrossRefGoogle Scholar
Nonvignon, J, Atherly, D, Pecenka, C, Aikins, M, Gazley, L, Groman, D et al. Cost-effectiveness of rotavirus vaccination in Ghana: Examining impacts from 2012 to 2031. Vaccine 2017;26:7215–21.Google Scholar
Pitt, C, Tawiah, T, Soremekun, S, ten Asbroek, AHA, Manu, A, Tawiah-Agyemang, C, Hill, Z et al. Cost and cost-effectiveness of newborn home visits: Findings from the Newhints cluster-randomised controlled trial in rural Ghana. The Lancet Global Health. 2016;4:e45–56.10.1016/S2214-109X(15)00207-7CrossRefGoogle ScholarPubMed
Russell, LB, Kim, S-Y, Cosgriff, B, Pentakota, SR, Schrag, SJ, Sobanjo-ter Meulen, A et al. Cost-effectiveness of maternal GBS immunization in low-income sub-Saharan Africa. Vaccine 2017;35:6905–14.10.1016/j.vaccine.2017.07.108CrossRefGoogle ScholarPubMed
Willcox, M, Harrison, H, Asiedu, A, Nelson, A, Gomez, P. & LeFevre, A. Incremental cost and cost-effectiveness of low-dose, high-frequency training in basic emergency obstetric and newborn care as compared to status quo: Part of a cluster-randomized training intervention evaluation in Ghana. Global Health. 2017;13:88.10.1186/s12992-017-0313-xCrossRefGoogle Scholar
Escribano Ferrer, B, Hansen, KS, Gyapong, M, Bruce, J, Narh Bana, SA, Narh, CT et al. Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia. Malar J. 2017;16:277.10.1186/s12936-017-1906-9CrossRefGoogle ScholarPubMed
Anderson, JD, Bagamian, KH, Muhib, F, Baral, R, Laytner, LA, Amaya, M et al. Potential impact and cost-effectiveness of future ETEC and Shigella vaccines in 79 low- and lower middle-income countries. Vaccine 2019;X2:100024.Google Scholar
Renner, L, Shah, S, Bhakta, N, Denburg, A, Horton, S. & Gupta, S. Evidence from Ghana indicates that childhood cancer treatment in sub-Saharan Africa is very cost effective: A report from the Childhood cancer 2030 network. JGlobal Oncol. 2018;2018:1–9.Google Scholar
Willcox, M, Moorthy, A, Mohan, D, Romano, K, Hutchful, D, Mehl, G et al. Mobile technology for community health in Ghana: Is maternal messaging and provider use of technology cost-effective in improving maternal and child health outcomes at scale? J Med Internet Res. 2019;21:e11268.10.2196/11268CrossRefGoogle ScholarPubMed
Pecenka, C, Debellut, F, Bar-Zeev, N, Anwari, P, Nonvignon, J, Shamsuzzaman, M et al. Re-evaluating the cost and cost-effectiveness of rotavirus vaccination in Bangladesh, Ghana, and Malawi: A comparison of three rotavirus vaccines. Vaccine 2018;36:7472–78.10.1016/j.vaccine.2018.10.068CrossRefGoogle ScholarPubMed
Abotsi, AK, Inkoom, E, Le Mentec, R, Levy, P, Lafarge, H. & de Sousa, A. Cost effectiveness of intermittent preventive treatment of malaria in infants in Ghana. Int J Trop Dis Health. 2012;2:1–5.Google Scholar
Ansah, EK, Epokor, M, Whitty, CJM, Yeung, S, Hansen, KS. Cost-effectiveness analysis of introducing RDTs for malaria diagnosis as compared to microscopy and presumptive diagnosis in central and peripheral public health facilities in Ghana. Am J Trop Med Hyg. 2013;89:724–36.10.4269/ajtmh.13-0033CrossRefGoogle ScholarPubMed
Binka, FN, Mensah, OA, Mills, A. The cost-effectiveness of permethrin impregnated bednets in preventing child mortality in Kassena-Nankana district of Northern Ghana. Health Policy 1997;41:229–39.10.1016/S0168-8510(97)00035-3CrossRefGoogle ScholarPubMed
Nonvignon, J, Aryeetey, GC, Issah, S, Ansah, P, Malm, KL, Ofosu, W et al. Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana. Malar J. 2016;15:367.10.1186/s12936-016-1418-zCrossRefGoogle ScholarPubMed
Paintain, LS, Awini, E, Addei, S, Kukula, V, Nikoi, C, Sarpong, S et al. Evaluation of a universal long-lasting insecticidal net (LLIN) distribution campaign in Ghana: Cost effectiveness of distribution and hang-up activities. Malar J. 2014;13:71.10.1186/1475-2875-13-71CrossRefGoogle Scholar
Tawiah, T, Hansen, KS, Baiden, F, Bruce, J, Tivura, M, Delimini, R et al. Cost-effectiveness analysis of test-based versus presumptive treatment of uncomplicated malaria in children under five years in an area of high transmission in Central Ghana. PLoS One 2016;11:e0164055.10.1371/journal.pone.0164055CrossRefGoogle Scholar
Nonvignon, J, Chinbuah, MA, Gyapong, M, Abbey, M, Awini, E, Gyapong, JO et al. Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District. Trop Med Int Health. 2012;17:951–57.CrossRefGoogle ScholarPubMed
Conteh, L, Patouillard, E, Kweku, M, Legood, R, Greenwood, B. & Chandramohan, D. Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine & artesunate or sulphadoxine-pyrimethamine in Ghanaian children. PLoS One 2010;5:e12223.10.1371/journal.pone.0012223CrossRefGoogle ScholarPubMed
van Hulst, M, Hubben, G, Sagoe, K, Promwong, C, permpikul, P, Fongsatitkul, L et al. Web interface-supported transmission risk assessment and cost-effectiveness analysis of postdonation screening: A global model applied to Ghana, Thailand, and the Netherlands. Transfusion 2009;49:2729–42.10.1111/j.1537-2995.2009.02351.xCrossRefGoogle ScholarPubMed
Van Hulst, M, Sagoe, KW, Vermande, JE, van Der Schaaf, IP, van der Tuuk Adriani, WPA, Torpey, K et al. Cost-effectiveness of HIV screening of blood donations in Accra (Ghana). Value Health. 2008;11:809–19.CrossRefGoogle Scholar
VanDeusen, A, Paintsil, E, Agyarko-Poku, T, Long, EF. Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: Evidence from Kumasi, Ghana. BMC Infect Dis. 2015;15:130.CrossRefGoogle ScholarPubMed
Shillcutt, SD, Clarke, MG, Kingsnorth, AN. Cost-effectiveness of groin hernia surgery in the Western Region of Ghana. Arch Surg. 2010;145:954–61.10.1001/archsurg.2010.208CrossRefGoogle ScholarPubMed
Basu, S, Shankar, V, Yudkin, JS. Comparative effectiveness and cost-effectiveness of target- versus benefit-based treatment of type 2 diabetes in low- and middle-income countries. Lancet Diabetes Endocrinol. 2016;4:922–32.10.1016/S2213-8587(16)30270-4CrossRefGoogle Scholar
Asamani, J. The cost-effectiveness of Entresto™ (Sacubitril and Valsartan) compared with enalapril in managing chronic heart failure in Ghana: Decision analytic modelling. Health Econ Outcome Res 2017;3. 10.4172/2471-268x.1000145, 1–6.10.4172/2471-268X/1000145CrossRefGoogle Scholar
Wittenborn, JS, Rein, DB. The cost-effectiveness of glaucoma interventions in Barbados and Ghana. Optom Vis Sci. 2011;88:155.10.1097/OPX.0b013e3181fc30f3CrossRefGoogle ScholarPubMed
Hu, D, Grossman, D, Levin, C, Blanchard, K, Adanu, R. & Goldie, SJ Cost-effectiveness analysis of unsafe abortion and alternative first-trimester pregnancy termination strategies in Nigeria and Ghana. Afr J Reprod Health. 2010;14:85–103.Google ScholarPubMed
Zelle, SG, Nyarko, KM, Bosu, WK, Aikins, M, Niens, LM, Lauer, JA et al. Costs, effects and cost-effectiveness of breast cancer control in Ghana. Trop Med Int Health. 2012;17:1031–43.10.1111/j.1365-3156.2012.03021.xCrossRefGoogle ScholarPubMed
Frempong, SN, Sutton, AJ, Davenport, C, Barton, P. Early economic evaluation to identify the necessary test characteristics of a new typhoid test to be cost effective in Ghana. PharmacoEconomics Open 4 (1): 143–157, 2019. 10.1007/s41669-019-0159-7Google Scholar
Gyedu, A, Gaskill, C, Boakye, G, Abantanga, F. Cost-effectiveness of a locally organized surgical outreach mission: Making a case for strengthening local non-governmental organizations. World J Surg. 2017;41:3074–82.10.1007/s00268-017-4131-3CrossRefGoogle ScholarPubMed
Ministry of Health Republic of Ghana The health sector in Ghana: Facts and figures 2010. Ministry of Health; Accra, 2012.Google Scholar
Teerawattananon, Y, Russell, S, Mugford, M. A systematic review of economic evaluation literature in Thailand. Pharmacoeconomics 2007;25:467–79.10.2165/00019053-200725060-00003CrossRefGoogle ScholarPubMed
Prinja, S, Chauhan, AS, Angell, B, Gupta, I, Jan, S. A systematic review of the state of economic evaluation for health care in India. Appl Health Econ Health Policy. 2015;13:595–613.CrossRefGoogle ScholarPubMed
Gavaza, P, Rascati, KL, Oladapo, AO, Khoza, S. The state of health economic research in South Africa. Pharmacoeconomics 2012;30:925–40.10.2165/11589450-000000000-00000CrossRefGoogle ScholarPubMed
Hoque, ME, Khan, JA, Hossain, SS et al. A systematic review of economic evaluations of health and health-related interventions in Bangladesh. Cost Eff Resour Alloc. 2011;9:12.CrossRefGoogle ScholarPubMed
Gavaza, P, Rascati, KL, Oladapo, AO, Khoza, S. The state of health economic evaluation research in Nigeria. Pharmacoeconomics 2010;28:539–53.10.2165/11536170-000000000-00000CrossRefGoogle ScholarPubMed
Gavaza, P, Rascati, K, Brown, C, Lawson, K, Mann, T. The state of health economic and pharmacoeconomic evaluation research in Zimbabwe: A review. Curr Ther Res. 2008;69:268–85.10.1016/j.curtheres.2008.06.005CrossRefGoogle ScholarPubMed
Desai, PR, Chandwani, HS, Rascati, KL. Assessing the quality of pharmacoeconomic studies in India. Pharmacoeconomics 2012;30:749–62.10.2165/11590140-000000000-00000CrossRefGoogle ScholarPubMed
Tran, BX, Nong, VM, Maher, RM, Nguyen, PK, Luu, HN. A systematic review of scope and quality of health economic evaluation studies in Vietnam. PLoS ONE 2014;9:e103825.10.1371/journal.pone.0103825CrossRefGoogle ScholarPubMed
Ofman, JJ, Sullivan, SD, Neumann, PJ, Chiou, C-F, Henning, JM, Wadw, SW et al. Examining the value and quality of health economic analyses: Implications of utilizing the QHES. J Manag Care Pharm. 2003;9:53–61.10.18553/jmcp.2003.9.1.53CrossRefGoogle ScholarPubMed
Claxton, KP, Revill, P, Sculpher, M, Wilkonson, T, Cairns, J. & Briggs, A. The gates reference case for economic evaluation (MEEP). London: NICE International; 2014.Google Scholar
Hutubessy, R, Chisholm, D, Edejer, TT-T. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc. 2003;1:8.10.1186/1478-7547-1-8CrossRefGoogle ScholarPubMed
Wilkinson, T, Sculpher, MJ, Claxton, K, Revill, P, Briggs, A, Cairns, JA et al. The international decision support initiative reference case for economic evaluation: An aid to thought. Value Health. 2016;19:921–28.CrossRefGoogle ScholarPubMed
Barbieri, M, Drummond, M, Rutten, F, Cook, J, Glick, HA, Lis, J et al. What do international pharmacoeconomic guidelines say about economic data transferability? Value Health. 2010;13:1028–37. 10.1111/j.1524-4733.2010.00771.x10.1111/j.1524-4733.2010.00771.xCrossRefGoogle ScholarPubMed
Drummond, M, Barbieri, M, Cook, J, Glick, HA, Lis, J, Malik, F et al. Transferability of economic evaluations across jurisdictions: ISPOR good research practices task force report. Value Health. 2009;12:409–18.10.1111/j.1524-4733.2008.00489.xCrossRefGoogle ScholarPubMed
Drummond, MF, Sculpher, MJ, Claxton, K, Stoddart, GL, Torrance, GW. Methods for the economic evaluation of health care programmes. Oxford University Press; Oxford: 2015.Google Scholar
Evers, S, Goossens, M, De Vet, H, Van Tulder, M, Ament, A. Criteria list for assessment of methodological quality of economic evaluations: Consensus on health economic criteria. Int J Technol Assess Health Care. 2005;21:240–45.10.1017/S0266462305050324CrossRefGoogle ScholarPubMed
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