Economic evaluation guidelines in low- and middle-income countries: a systematic review.

OBJECTIVES: To systematically identify the latest versions of official economic evaluation guidelines (EEGs) in low- and middle-income countries (LMICs) and explore similarities and differences in their content. METHODS: We conducted a systematic search in MEDLINE (Ovid), PubMed, EconLit, Embase (Ovid), the Cochrane Library, and the gray literature. Using a predefined checklist, we extracted the key features of economic evaluation and the general characteristics of EEGs. We conducted a comparative analysis, including a summary of similarities and differences across EEGs. RESULTS: Thirteen EEGs were identified, three pertaining to lower-middle-income countries (Bhutan, Egypt, and Indonesia), nine to upper-middle-income countries (Brazil, China, Colombia, Cuba, Malaysia, Mexico, Russian Federation, South Africa, and Thailand), in addition to Mercosur, and none to low-income countries. The majority (n = 12) considered cost-utility analysis and health-related quality-of-life outcome. Half of the EEGs recommended the societal perspective, whereas the other half recommended the healthcare perspective. Equity considerations were required in ten EEGs. Most EEGs (n = 11) required the incremental cost-effectiveness ratio and recommended sensitivity analysis, as well as the presentation of a budget impact analysis (n = 10). Seven of the identified EEGs were mandatory for pharmacoeconomics submission. Methodological gaps, contradictions, and heterogeneity in terminologies used were identified within the guidelines. CONCLUSION: As the importance of health technology assessment is increasing in LMICs, this systematic review could help researchers explore key aspects of existing EEGs in LMICs and explore differences among them. It could also support international organizations in guiding LMICs to develop their own EEGs and improve the methodological framework of existing ones.

A discrete choice experiment to assess patients' preferences for HIV treatment in the rural population in Colombia.

Aim: To elicit patients' preferences for HIV treatment of the rural population in Colombia.Methods: A discrete choice experiment (DCE), conducted in a HIV clinic in Bogotá, was used to examine the trade-off between five HIV treatment attributes: effect on life expectancy, effect on physical activity, risk of moderate side-effects, accessibility to clinic, and economic costs to access controls. Attributes selection was based on literature review, expert consultation and a focus group with six patients. An efficient experimental design was used to define two versions of the questionnaire with each of 12 choice sets and a dominance task was added to check reliability. A mixed logit model was then used to analyse the data and sub-group analyses were conducted on the basis of age, gender, education, and sexual preference.Results: A total of 129 HIV patients were included for analysis. For all treatment attributes, significant differences between at least two levels were observed, meaning that all attributes were significant predictors of choice. Patients valued the effect on physical activity (conditional relative importance of 27.5%) and the effect on life expectancy (26.0%) the most. Sub-group analyses regard age and education showed significant differences: younger patients and high educated patients valued the effect on physical activity the most important, whereas older patients mostly valued the effect on life expectancy and low educated patients mostly valued the accessibility to clinic.Limitations: One potential limitation is selection bias, as only patients from one HIV clinic were reached. Additionally, questionnaires were partly administered in the waiting rooms, which potentially led to noise in the data.Conclusions: This study suggests that all HIV treatment characteristics included in this DCE were important and that HIV patients from rural Colombia valued short-term efficacy (i.e. effect on physical activity) and long-term efficacy (i.e. effect on life expectancy) the most.

A discrete choice experiment to assess patients' preferences for HIV treatment in the urban population in Colombia.

Aim: This study aimed to assess patients' preferences for HIV treatment in an urban Colombian population.Methods: A Discrete Choice Experiment (DCE) was conducted. Urban Colombian HIV patients were asked to repetitively choose between two hypothetical treatments that differ in regard to five attributes 'effect on life expectancy', 'effect on physical activity', 'risk of moderate side effects, 'accessibility to clinic' and 'economic cost to access controls'. Twelve choice sets were made using an efficient design. A Mixed Logit Panel Model was used for the analysis and subgroup analyses were performed according to age, gender, education level and sexual preference.Results: A total of 224 HIV patients were included. All attributes were significant, indicating that there were differences between at least two levels of each attribute. Patients preferred to be able to perform all physical activity without difficulty, to have large positive effects on life expectancy, to travel less than 2 h, to have lower risk of side-effects and to have subsidized travel costs. The attributes 'effect on physical activity' and 'effects on life expectancy' were deemed the most important. Sub-analyses showed that higher educated patients placed more importance on the large positive effects of HIV treatment, and a more negative preference for subsidized travel cost (5% level).Limitations: A potential limitation is selection bias as it is difficult to make a systematic urban/rural division of respondents. Additional, questionnaires were partly administered in the waiting rooms, which potentially led to some noise in the data.Conclusions: Findings suggests that short-term efficacy (i.e. effect on physical activity) and long-term efficacy (i.e. effect on life expectancy) are the most important treatment characteristics for HIV urban patients in Colombia. Preference data could provide relevant information for clinical and policy decision-making to optimize HIV care.

A discrete choice experiment to investigate patient preferences for HIV testing programs in Bogotá, Colombia.

BACKGROUND: To assess patients' preferences for HIV testing in Colombia. METHODS: A discrete choice experiment was used to assess preferences of patients diagnosed with HIV, for HIV testing in two HIV clinics in Bogotá, Colombia. Patients were asked to choose repeatedly between two hypothetical HIV testing options that varied with respect to five attributes: distance to testing site, confidentiality, testing days, sample collection method, and the services if HIV positive. A random parameter model was used to analyze the data. RESULTS: A total of 249 questionnaires were eligible for data analysis. Respondents showed a preference for testing on weekdays, nobody being aware, a sample taken from the arm, and receiving medications through a referral. The respondents showed a high negative preference for many people being aware, followed by testing during the weekend and home testing. Subgroup analyses by gender and prior testing history did not reveal significant differences. CONCLUSION: This study suggests that patients' preferences for HIV testing focused especially on confidentiality, availability during weekdays, and using a sample from the arm. This information could be useful to improve uptake of HIV testing in Bogotá, Colombia.

Relevance of barriers and facilitators in the use of health technology assessment in Colombia.

OBJECTIVES: Several studies, mostly from developed countries, have identified barriers and facilitators with regard to the uptake of health technology assessment (HTA). This study elicited, using best-worst scaling (BWS), what HTA experts in Colombia consider to be the most important barriers and facilitators in the use of HTA, and makes a comparison to results from the Netherlands. METHODS: Two object case surveys (one for barriers, one for facilitators) were conducted among 18 experts (policymakers, health professionals, PhD students, senior HTA-researchers) from Colombia. Seven respondents were employees of the national HTA agency Instituto de Evaluación Tecnológica de Salud (IETS). In total, 22 barriers and 19 facilitators were included. In each choice task, participants were asked to choose the most and least important barrier/facilitator from a set of five. Hierarchical Bayes modeling was used to compute the mean relative importance scores (RIS) for each factor, and a subgroup analysis was conducted to assess differences between IETS and non-IETS respondents. The final ranking was further compared to the results from a similar study conducted in the Netherlands. RESULTS: The three most important barriers (RIS >6.00) were "Inadequate presentation format", "Absence of policy networks", and "Insufficient legal support". The six most important facilitators (RIS >6.00) were "Appropriate timing", "Clear presentation format", "Improving longstanding relation", "Appropriate incentives", "Sufficient qualified human resources", and "Availability to relevant HTA research". The perceived relevance of the barriers and facilitators differed slightly between IETS and non-IETS employees, while the differences between the rankings in Colombia and the Netherlands were substantial. CONCLUSION: The study suggests that barriers and facilitators related to technical aspects of processing HTA reports and to the contact and interaction between researchers and policymakers had the greatest importance in Colombia.

A Cost-of-Illness Study of Patients with HIV/AIDS in Bogotá, Colombia.

BACKGROUND: In 2014, 0.3% of the total population in Colombia was living with HIV/AIDS. The data currently available regarding the costs of these patients are very limited. OBJECTIVES: To estimate the societal costs of patients with HIV/AIDS in Bogotá, Colombia. METHODS: This study is a quantitative, cross-sectional cost-of-illness study. Costs were assessed with a prevalence-based, bottom-up approach. The data of 124 patients were collected from their medical records in a Bogotá hospital and a questionnaire was developed to measure other health care costs, as well as patient and family costs. Subgroup analyses were performed according to sex, age, Centers for Disease Control and Prevention classification, and CD4 count (cluster of differentiation 4). RESULTS: The mean annual cost per patient with HIV/AIDS was estimated at $11,505 ± 18,658 (2014 US dollars). The larger part was attributable to drug costs (a mean annual cost of $8,616, 75% of the total), whereas productivity costs represented a mean annual cost of $1,044 (10%). Total costs per patient were estimated for a CD4 count of 500 or more, 200 to 499, and less than 200 cells/µl at $13,116, $9,077, and $10,741, respectively (all values in 2014 US dollars). CONCLUSIONS: HIV/AIDS represents a high societal burden in Colombia. In comparison with the gross domestic product per capita of $7,904 in 2014, the mean annual cost per patient with HIV/AIDS was 40% higher, estimated at $11,505. The largest part of the HIV/AIDS costs was attributed to drugs, followed by productivity costs. Using extrapolation, the total cost of HIV/AIDS for the Colombian society would be $1.431 billion.

The impact of comorbidities on costs, utilities and health-related quality of life among HIV patients in a clinical setting in Bogotá.

BACKGROUND: This study aimed to assess the impact of comorbidities (CMs) on costs, utilities and health-related quality of life (HRQOL) among HIV patients in Colombia. METHODS: A cross-sectional study was conducted among 138 HIV patients at an outpatient clinic in Bogotá to assess their costs, utilities (EQ5D-5L) and HRQOL (EQ-VAS). CMs and other covariates were gathered from patient records. Multiple regression models were conducted to assess the impact of CMs. RESULTS: Of all patients, 72% experienced CMs; of these, half experienced ≥2 CMs (N = 49). CMs had a statistically significant impact on utilities when the EQ5D-5L (P = 0.022) was applied among patient with ≥2 CMs. No statistical significance was found for the impact of CMs on costs. CONCLUSION: This study suggests that having multiple CMs significantly influences utility, and CMs have some impact on HRQOL measured using the EQ-VAS but this effect is at the border of significance. No significant impact was observed on costs.

Health-Related Quality of Life of Patients with HIV/AIDS in Bogotá, Colombia.

BACKGROUND: There has rarely been any reporting on health-related quality of life (HRQOL) of patients with HIV/AIDS in developing countries. OBJECTIVES: To estimate the health utilities of people with HIV/AIDS in Bogotá, Columbia. METHODS: A cross-sectional survey was conducted for 181 patients receiving antiretroviral therapy from an outpatient HIV/AIDS clinic in Bogotá. The five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L) and the EuroQol visual analogue scale (EQ-VAS) were used to estimate HRQOL scores. To derive utilities on the basis of the EQ-5D-5L, the Spanish value set was used. Subgroup analyses were performed according to sex, age, the Centers for Disease Control and Prevention classification, and CD4 cell count. RESULTS: The mean utility of the EQ-5D-5L was estimated at 0.85 ± 0.21 and the EQ-VAS score was estimated at 84 ± 14. Pain/discomfort and anxiety/depression were the two EQ-5D-5L dimensions associated with the poorer outcomes. Subgroup analyses revealed significantly higher utilities (using the EQ-5D-5L) for men than for women (0.88 vs. 0.76; P = 0.002) and lower utilities for patients with severe HIV (0.83 for CD4 < 200 vs. 0.87 for CD4 ≥ 500; P = 0.024). CONCLUSIONS: The HRQOL scores of patients with HIV/AIDS receiving antiretroviral therapy were relatively high in Bogotá, Colombia, using the EuroQol questionnaire. The utility data could be useful, in combination with cost data, for future economic evaluations.