Bill and Melinda Gates Foundation iDSI

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The Gates Reference Case 2,What this booklet is about. This booklet is intended for those who use or who would like to use the evidence produced from. economic evaluation to inform decision making in health and for those who conduct economic. evaluations intended to inform decision making in health It explains the Gates Reference Case Gates. RC why it is important and how to use it, This booklet is a summarized version of the full Gates RC which can be found in the Methods for. Economic Evaluation Project Final Report published by NICE International. www nice org uk niceinternational,How was the Gates Reference Case developed. The Bill and Melinda Gates Foundation BMGF is one of the largest investors in research on the value. of health care interventions in low and middle income countries LMICs In 2013 a novel collaboration. known as the Methods for Economic Evaluation Project MEEP was established by BMGF to improve. the quality and transparency of this research and to guide researchers in undertaking and reporting well. conducted and robust analyses MEEP was a collaboration led by NICE International including partners. from institutions including the Health Intervention and Technology Appraisal Program Thailand the. University of York the London School of Hygiene and Tropical Medicine and the University of Glasgow. An important stage in MEEP was a workshop held at the Bill and Melinda Gates Foundation. headquarters in Seattle in June 2013 that was attended by researchers policy makers methodologists. and donors The workshop proceedings were a major part of the Gates RC development. A key output of MEEP was the Gates RC The Gates RC document was drafted by Karl Claxton Paul. Revill and Mark Sculpher University of York Tommy Wilkinson NICE International John Cairns. London School of Hygiene and Tropical Medicine and Andrew Briggs University of Glasgow Its. development also benefited from substantive comments from the following people in alphabetical. Kalipso Chalkidou Director NICE International, Tony Culyer Centre for Health Economics University of York Institute of Health Policy. Management and Evaluation University of Toronto, Ruth Faden Wagley Professor and Director Johns Hopkins Berman Institute of Bioethics.
Marthe Gold Logan Professor of Community Health and Social Medicine City College NY. Barbara Jauregui Technical Officer Pan American Health Organization. Kjell Arne Johansson Associate Professor Bioethics Department of Global and Public Health. and Primary Care University of Bergen, Carol Levin Clinical Associate Professor Disease Control Priorities Network Department of. Global Health University of Washington, Ruth Lopert Adjunct Professor Department of Health Policy George Washington University. Francis Ruiz Senior Advisor NICE International,Peter Smith Professor Imperial College London. Yot Teerawattananon Program Leader Senior Researcher Health Intervention and Technology. Assessment Program Thailand, Anna Vassall Senior Lecturer Department of Global Health and Development London School of. Hygiene Tropical Medicine, Damian Walker Senior Program Officer Integrated Delivery BMGF.
Simon Walker Research Fellow University of York,The Gates Reference Case 3. What are the key issues for the Gates Reference Case. Priority setting decisions It s axiomatic that resources will always be finite and as a result. in health are unavoidable expenditure choices must be made This means that priorities need to. be assigned some things may not be funded at all or may need to. be delayed in favour of others considered to be of higher priority As a. result some benefits will be foregone, Priority setting decisions When decision makers assign priorities we would like them to do so. can and should be as objectively as possible In order to do this they need to have clarity. optimized about the costs and benefits the value of different options. How can this be done Economic evaluation methods can provide a systematic approach to. relating costs and benefits and thereby determining value. Are there different ways to Yes but that s part of the problem Until now there has been a lot of. do this variation in both the approaches and methods used as well as in the. quality of studies Unfortunately this limits their usefulness not just. for local policy makers but also for decision makers in other. countries and for BMGF itself, Are there ways to make One approach is to develop and deploy a reference case this is the. findings clearer and more name given to a way of standardizing methods so that both the. easily comparable approach to the analysis and the presentation of the results are more. consistent, What is the value of using Using a reference case can not only improve the quality of economic. a reference case evaluations but can also enable the results of different analyses to be. more easily understood and compared so we can avoid the pitfalls. of comparing apples and oranges, How is a reference case There are a number of different ways The Gates Reference Case.
developed Gates RC builds on eleven key principles to guide the planning. conduct and reporting of economic evaluations Each of these eleven. principles is supported by a set of methods and reporting standards. that taken together make up a comprehensive template or guide to. undertaking and presenting sound economic evaluations. This booklet explains how,The Gates Reference Case 4. PART 1 Why there is a Gates Reference Case,Introduction Good decisions better decisions. Primum non nocere first do no harm is universally accepted as a fundamental tenet of health care Good. decisions in health are those that maximise benefits and minimise harms But in an environment where. resources are finite choices must be made and activities prioritized It s an unfortunate reality that in setting. priorities there will inevitably be opportunity costs associated with even the most carefully considered. decisions For example choosing to invest in an intervention that benefits a particular patient group inevitably. means less is available to be spent and therefore benefits will be foregone in another Some degree of. harm in the form of unrealized health gains or untreated disease is unavoidable. Determining the relative importance of benefits and harms is challenging enough but decision making in. health is also inherently value laden with individual and collective beliefs needs and aspirations driving. different perspectives about priorities in spending Failing to recognise or consider these values will lead to. priority setting decisions that don t reflect prevailing social values This means that for decision makers. whether they are local or national policy makers clinicians institutions non government organisations. NGOs or global funding bodies to make the best possible decisions they not only need sound evidence of. the likely costs and benefits of their choices but that evidence must also be filtered through a prism of. societal values, How then can this evidence be obtained Economic evaluation when applied to health technologies is a term. used for a suite of methods designed to identify costs and resources used in association with a health care. intervention and to then weigh these against the likely outcomes of alternative health policy options thereby. improving resource allocation decisions by enhancing efficiency in health care 1 Over the past three decades. methods for economic evaluation have gained increasing attention from decision makers in wealthy and. resource poor countries as well as among global donors Importantly economic evaluation has been. identified as crucial for governments around the world to realise the benefits of universal health insurance. coverage by facilitating the efficient and equitable allocation of health care resources. Many contexts multiple methods or why there s a problem. While economic evaluation is important for making sound policy decisions about health technologies it s. useful only if appropriate methods are used and the results reported with clarity and accuracy If not done. well these analyses can be difficult to interpret and can lead to suboptimal or frankly erroneous decisions. This is a particular risk in low and middle income countries where guidelines for undertaking these analyses. may not have been established or reliable data sources may be scarce 1 2 Together with limited expertise this. can lead to economic evaluations that are conducted poorly or reported inconsistently. What s the Bill and Melinda Gates Foundation s role in this. Established in 2000 the mission of the Bill and Melinda Gates Foundation BMGF is to improve health and. reduce extreme poverty through a broad ranging series of Global Programmes BMGF supports its grantees. and partners in advancing knowledge developing innovative approaches and providing services in areas. beset by particular health problems including HIV AIDS maternal and child health issues and vaccine. preventable diseases 3, As part of its mission BMGF is a well established funder of economic evaluations in low and middle income. countries LMICs utilising these not only in its own decision making but also making these available for in. country decision makers BMGF is also an advocate for improved decision making as well as a stakeholder. supporting improved population health at the local level In each of these roles BMGF s interests are furthered. by improving the quality of health economic evaluations. 1 Economic evaluation in this context incorporates the term health technology assessment HTA. The Gates Reference Case 5,What is a reference case.
A reference case is essentially a mechanism for enhancing the ability of economic evaluations to inform good. decision making for resource allocation in health by standardizing methods so that both the approach to the. analysis and the presentation of the results are robust and consistent But more than this a reference case is. a position statement on a range of scientific and social values held by institutions or individuals who want to. use economic evaluation to inform their decision making. In 1996 the US Panel on Cost Effectiveness in Health and Medicine first proposed the use of a reference. case as a means of improving the quality and comparability in the conduct and reporting of cost effectiveness. analyses CEAs 4 Seven years later the World Health Organisation WHO published a Guide to Cost. Effectiveness Analysis5 not only to improve the comparability of studies and facilitate consistency in decision. making but perhaps more importantly to increase their generalizability so that each country need not. undertake its own analyses The use of the reference case approach by decision makers was subsequently. boosted by the adoption of a reference case by the National Institute for Health and Care Excellence NICE. in 2004 revised most recently in 2013 6 NICE s analyses and guidance inform resource allocation in the. National Health Service in England and Wales particularly with regard to new technologies and services. What s the case for a reference case, Put simply using a reference case can not only support better individual decisions through robust standards. for planning conducting and reporting economic evaluations but also facilitates more consistent decision. making over time The use of a reference case enables a meaningful and explicit comparison of the analyses. and findings across multiple studies put simply it helps avoid having to compare apples with oranges For. example where studies use different analytical perspectives cost data will not be directly comparable even if. the interventions and their application are the same This will be true for comparisons of evaluations of. different interventions undertaken within a country as well as for those between evaluations of the same. intervention in different countries A reference case also represents a statement determining what elements of. an economic evaluation are important for decision makers implicitly defining the decision space in which local. decisions can operate, Are there any disadvantages in using a reference case. Economic evaluation of health technologies is a rapidly evolving field and there are still some methodological. issues about which it s fair to say consensus hasn t yet been reached As a result some people believe that. prescriptive guidelines for undertaking and reporting evaluations are premature Some might even argue that. progress in the development of methods could be discouraged by the greater use of reference cases. Promoting the use of a particular reference case also carries some risk that certain practices become set in. stone and in this way create barriers for researchers attempting to secure funding for studies that diverge. from standard methods In the UK the Medical Research Council is addressing this by funding with direct. support from NICE on going research in methods for economic evaluation. Finally the balance of advantages and disadvantages of the use of a reference case is strongly influenced by. how prescriptive it is A highly prescriptive reference case will enhance comparability and may improve quality. but risks the application of methods that are inappropriate to the decision problem and the context in which it. is being addressed limiting the ability of the economic evaluation to inform good decisions A reference case. that is less prescriptive may not be adequate to facilit. The Bill and Melinda Gates Foundation BMGF is one of the largest investors in research on the value of health care interventions in low and middle income countries LMICs In 2013 a novel collaboration known as the Methods for Economic Evaluation Project MEEP was established by BMGF to improve the quality and transparency of this research and to guide researchers in undertaking and

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