Informing a cost-effectiveness threshold for Saudi Arabia.

BACKGROUND: Saudi Arabia's Vision 2030 aims to reform health care across the Kingdom, with health technology assessment being adopted as one tool promising to improve the efficiency with which resources are used. An understanding of the opportunity costs of reimbursement decisions is key to fulfilling this promise and can be used to inform a cost-effectiveness threshold. This paper is the first to provide a range of estimates of this using existing evidence extrapolated to the context of Saudi Arabia. METHODS AND MATERIALS: We use four approaches to estimate the marginal cost per unit of health produced by the healthcare system; drawing from existing evidence provided by a cross-country analysis, two alternative estimates from the UK context, and based on extrapolating a UK estimate using evidence on the income elasticity of the value of health. Consequences of estimation error are explored. RESULTS: Based on the four approaches, we find a range of SAR 42,046 per QALY gained (48% of GDP per capita) to SAR 215,120 per QALY gained (246% of GDP per capita). Calculated potential central estimates from the average of estimated health gains based on each source gives a range of SAR 50,000-75,000. The results are in line with estimates from the emerging literature from across the world. CONCLUSION: A cost-effectiveness threshold reflecting health opportunity costs can aid decision-making. Applying a cost-effectiveness threshold based on the range SAR 50,000 to 75,000 per QALY gained would ensure that resource allocation decisions in healthcare can in be informed in a way that accounts for health opportunity costs. LIMITATIONS: A limitation is that it is not based on a within-country study for Saudi Arabia, which represents a promising line of future work.

Healthcare in Saudi Arabia is undergoing wide-ranging reform through Saudi Arabia's Vision 2030. One aim of these reforms is to ensure that money spent on healthcare generates the most improvement in population health possible. To do this requires understanding the trade-offs that exist: funding one pharmaceutical drug means that same money is not available to fund another pharmaceutical drug. This is relevant whether the new drug would be funded from within the existing budget for healthcare or from an expansion of it. If the drugs apply to the same patient population and have the same price, the question is simply, "which one generates more health?" In reality, we need to compare pharmaceutical drugs for different diseases, patient populations, and at a range of potential prices to understand whether the drug in question would generate more health per riyal spent than what is currently funded by the healthcare system. This paper provides the first estimates of the amount of health, measured in terms of quality adjusted life years (QALYs), generated by the Saudi Arabian healthcare system. We find that the healthcare system generates health at a rate of one QALY produced for every 50,000­75,000 riyals spent (58­86% of GDP per capita). Using the range we estimate to inform cost-effectiveness threshold can aid decision-making.

The characteristics and distribution of dentist workforce in Saudi Arabia: A descriptive cross-sectional study.

BACKGROUND: The Kingdom of Saudi Arabia has shown steady growth in the dental workforce over the last 20 years. Although the number of dental colleges has significantly increased in the last decade, there is not any study so far that described the status of the licensed dentist workforce in the kingdom. The present study aimed to explore the demographic distribution and professional characteristics of licensed dentist workforce in Saudi Arabia. METHODS: This was a descriptive cross-sectional study using the Saudi Commission for Health Specialties (SCFHS) database to identify the number of licensed dentists in Saudi Arabia as well as their professional and demographic characteristics as of December 2016. The data was categorized based on gender, nationality, dental specialty, health sector, geographic location, and professional rank. RESULTS: The number of licensed dentists working in the kingdom as of December 2016 was 16887 dentists, and the vast majority of them are professionally registered as general dentists (70.27%). The percentage of general dentists among the professionally registered female dentists is significantly higher than their male counterparts (79.71% vs. 64.80%; P < 0.001). Only 22.08% of the dentists working in the kingdom are Saudi. Most of the dentist workforce in the kingdom are male (61.06%). The mean age of the Saudi dentists is slightly but significantly younger than non-Saudi dentists (37.7 vs. 40.7 years; P < 0.001). Over 80% of the Saudi dentists are working in the regions of Riyadh, Makkah, and Eastern province. About 66% of the Saudi dentists are working in the public health sector in comparison to only 20.46% of the non-Saudi dentists (P < 0.001). CONCLUSIONS: Most of the dental care in Saudi Arabia is provided by non-Saudi dentists in both private and public health sectors. With the rising unemployment rate among Saudi dentists, the governmental bodies that are responsible of dental labor market regulations such as the ministries of health, economy and planning, and labor should come up with a policy to gradually but carefully replace the non-Saudi dentists in both public and private sectors with Saudi dentists.