Evidence-informed policy formulation: the case of the voucher scheme for maternal and child health in Myanmar.

Introduction: In 2010, with financial support from the Global Alliance for Vaccine and Immunization’s Health System Strengthening programme, the Government of Myanmar established a scheme to improve coverage of maternal and child health (MCH) services. Employing qualitative approaches, this article reviews the processes through which this scheme was devised, focusing on evidence generation and the use of such evidence to inform policy formulation. To address the problem of high mortality rates among mothers and infants, collaborative research was conducted by Myanmar’s Ministry of Health, the World Health Organization, and a research arm of Thailand’s Ministry of Public Health, between March 2010 and September 2011. In the early phase of this study, key barriers to governmentprovided MCH services were identified. Based on a comprehensive review of the literature, the introduction of a voucher scheme was raised for consideration by ministry of health decision-makers and respective stakeholders. Despite the successful experience of this financing strategy in low-income countries, a series of surveys, an economic evaluation, and focus group discussions were carried out to assess the feasibility and potential health and economic implications of this scheme in the Myanmar context. The research findings were then used to guide the design and adoption of the newly established initiative.

Cost-utility analysis of recombinant human erythropoietin in anemic cancer patients induced by chemotherapy in Thailand.

OBJECTIVE: To conduct a cost-utility analysis on recombinant human erythropoietin (rHuEPO) for treating anemic cancer patients induced by chemotherapy compared to blood transfusion alone under the Thai health care setting. MATERIALS AND METHODS: A health care provider's perspective was used to examine relevant costs and outcomes using the Markov model. Cost data were estimated based on the reference price set by the Ministry of Public Health. The effectiveness data were obtained from a systematic review of published literature. The results were presented in terms of incremental cost-effectiveness ratio (ICER) in Thai Baht per Quality Adjusted Life Years (QALYs) gained. A probabilistic sensitivity analysis method was performed. RESULTS: The ICERs of rHuEPO compared to blood transfusion alone were 3.7 and 2.7 millions Baht per QALY for patients with hemoglobin less than 8 g/dl and 8-9 g/dl, respectively. The rHuEPO required additional resources (more costly) with less benefit compared to blood transfusion for patients with hemoglobin 9-10 g/dl. CONCLUSIONS: The rHuEPO may be cost-ineffective for the treatment of anemia caused by chemotherapy in cancer patients in Thailand.

Presentation of economic evaluation results.

In Thailand, economic evaluation results are being increasingly used for making health care resource allocation decisions. To assess the usefulness of economic evaluation information, users of studies such as policy decision makers or health care providers need to know whether the methods used in the study are appropriate and whether the results are valid. The quality of previous economic evaluation studies, however, was quite poor. The objectives of this article are to review the similarities and differences in reporting formats based on existing reporting formats suggested by published methodological guidelines for economic evaluation, and to provide recommendations for economic evaluation result presentation for Thai Health Technology Assessment guidelines. The article presents a recommended reporting format including ten key elements necessary for economic evaluation techniques. The recommended format will increase the transparency of studies as well as facilitate comparisons between studies. This may eventually lead to high-quality and reliable economic evaluation studies available for policy decision making in Thailand.

Thai health technology assessment guideline development.

Health Technology Assessment (HTA) is a comprehensive form of policy research that provides information on the consequences of the application of health technology. It is used primarily to guide health care resource allocation decisions. In Thailand, there is increasing impetus to use HTA information to allow more explicit and transparent health care priority setting. A previous study indicated that serious attention needed to be given to the quality of reporting and the use of information in the analyses. These problems could be reduced by setting up standard guidelines for conducting HTA to stimulate the provision of standardized, reliable and good quality information for policy makers. Nevertheless, Thailand has not yet set up such guidelines. This may lead to low quality evaluations. Therefore, the objective of this article was to describe the rationale for guideline development, supporting principles, guideline development process, sources of information, and future challenges for HTA.

A determination of topics for health technology assessment in Thailand: making decision makers involved.

This study is to describe experiences and findings from the topic selection process for health technology assessment (HTA) conducted by Health Intervention and Technology Assessment Program. The process comprised of 5 stages namely: (1) determining objectives, scope and involved stakeholders; (2) requesting potential topics for assessment from decision makers at the national health authorities; (3) reviewing related literature on and prioritizing the proposed HTA topics by HITAP researchers; (4) selecting the HTA topics by decisionmakers; (5) analyzing the strengths and weaknesses of the current topic selection processes by HITAP staff The strengths of the topic selection were systematic and transparent. It also required participation from stakeholders; however the limitations were topics prioritization methods and time constraints. Lessons learnt from this procedure can be useful for improving the next HTA topic selection in order to increase the usefulness of the future HTA results.

The cost-effectiveness analysis of initiating HIV/AIDS treatment with efavirenz-based regimens compared with nevirapine-based regimens in Thailand.

OBJECTIVES: The aim of this study is to evaluate the cost-utility of the treatment, starting with EFZ-based therapy, compared with NVP-based therapy in Thai HIV/AIDS patients. MATERIAL AND METHOD: The study adopted a health care provider perspective. A probabilistic Markov model was applied to Thai HIV/AIDS patients aged 15 to 65 years. Input parameters were extracted from a cohort study of four regional hospitals. The study explored the effects of uncertainty around input parameters. RESULTS: For those patients with a different baseline CD4, initial therapy using EFZ-based regimens was the preferable choice for all subgroups. Given a maximum acceptable willingness to pay (WTP) threshold of 300,000 Baht/DALY averted starting with EFZ-based regimens was cost-effective for patients with a baseline CD4 count less than 250 cells/mm3 and in all patient age groups, except those who were 20 years old. CONCLUSIONS: The results suggest that starting with EFZ-based regimens was the preferable choice and it should be used as the first line regimen for Thai HIV/AIDS patients.

Making health technology assessment information available for decision making: the development of a Thai database.

In Thailand, there is an attempt to develop the Thai HTA database in order to improve the accessibility and usefulness of HTA information. At present, the database is available online at www.db.hitap.net. The database includes (1) economic evaluation studies i.e. cost-minimization analysis, cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis, (2) outcome assessment studies i.e. randomized controlled trials, and (3) quantitative measured quality of life studies. All HTA studies related to the Thai context, and published in either Thai or English from 1990 onward, are eligible for inclusion in the database. In addition, there is a quality evaluation for each economic evaluation study which will help readers, who have limited knowledge about the method, to understand and make appropriate use of the information in their own settings. This may also raise awareness among researchers, who will conduct economic evaluation studies in the future, to adhere to the standard methodological guidelines because the quality evaluation was developed based on the national guidelines published in this supplement journal.

Measurement of clinical effects.

The measurement and valuation of clinical effects is a significant component of economic evaluation. Decision makers are commonly interested in how a particular health intervention works in everyday practice; therefore, the resulting outcome under this circumstance is called the effectiveness. Clinical effects usually measure final intended effects of a proposed health technology in terms of the ultimate change in health state brought about by the technology. The systematic review and meta-analysis of high quality RCTs is the most favorable method to synthesize evidence because they are disciplined and transparent methods. The present chapter focuses on how to make a valid measure of clinical effects for use in cost-effectiveness analysis and how clinical effect is to be appropriately defined and measured.