Gates Reference Case: background, structure and content

Transcription

1 Gates Reference Case: background, structure and content Tommy Wilkinson Advisor (Health Economics) NICE International NICE copyright

2 Methods for Economic Evaluation Project (MEEP) Led by NICE International in collaboration with key partners: University of York, HITAP (Thailand) LSHTM, University of Glasgow, Centre for Global Development Formative workshop June 2013, BMGF HQ Initial remit: Explore the current state of BMGF-economic evaluation methodology Recommend quality and comparability methodological improvements Major output: The Gates-Reference Case MEEP recommendations 3 Which outcome measure? Outcome measure reported in published EE four programme areas (LMIC setting) CBA 1% 28% of all cost-per-daly studies funded by BMGF 43% of all BMGF-funded studies used cost-per-daly WTP Death 7% averted/ly saved 10% QALY 10% DALY 36% Programme areas: Vaccines (n=110) HIV/AIDS (n=58) Malaria (n = 41) Tuberculosis (n = 15) Disease/ programmespecific only 36% 4 2

3 How are BMGF-funded economic evaluations* being reported? % Describing intervention and comparator(s) being compared 85 Informing reasons for choosing the comparator(s) 50 Reporting characteristics of target populations 90 Describing the perspectives adopted 90 Reporting time horizon used 65 Discounting costs, where relevant 92 Discounting outcomes, where relevant 92 Informing unit of cost data 100 Informing price date 75 Explaining currency conversion method 40 Describing the method of cost adjustment for time differences 35 Describing all key model parameters, where relevant 79 Reporting ICERs 85 Discussing generalisability/transferability 30 Discussing equity considerations 30 *using the DALYs-averted outcome measure (n = 20) Discussing affordability Informing role of funders Describing conflicts of interest

4 Who will use it, what will they use it for, and who will be affected by the decision? Decision makers Investment types Constituencies Governments (MoH, MoF) BMGF (investment decisions) Partners of BMGF ( e.g. Global Fund) Other global or regional funders Medical technologies (e.g. HIV treatments, vaccines) Public health initiatives Program Evaluations Global Regional National Provincial Local Whose value judgement? 4

5 The Reference Case Building blocks: Optimize the A minimum Facilitate value Ensure of clarity standard economic comparisons of evaluations transparency quality of the to quality ensure to and decision and to fitness improve relevance making of purpose the in of health economic comparability evaluations of both across the content time and results context 9 The Reference Case Example: time horizon and discount rate The Lifetime horizon time horizon Clearly should be state (or of sufficient time horizon to length capture and to discount relevant capture rates costs all costs and and effects) effects relevant Report to the decision Annual any additional discount problem; time rate an horizon appropriate of 3% for and/or costs discount discount and effects rate rates should used be used If 3% annual discount rate not used, clearly justify reasons to discount cost and effects to present values 10 5

6 BMGF: Where to for the Reference Case? Incorporation into BMGF grant applications where there is an economic evaluation component NICE International and partners: Informing within-country demonstration projects and capacity building initiatives Framework for methodological research agenda Other development institutions : Opportunity to consider the applicability of Reference Case principles and/or review current analytical processes 11 Why NICE? 13 6

7 Thank you International-projects/International-Decision-Support-Initiative Statement of principle An economic evaluation should be communicated clearly and transparently to allow the decision maker(s) to interpret the methods and results The comparators against which costs and effects are measured should accurately reflect the decision problem. An economic evaluation should consider all available evidence relevant to the decision problem. The measure of health outcome should be appropriate to the decision problem, should capture positive and negative effects on length of life and quality of life, and should be generalizable across disease states. All differences between the intervention and the comparator in expected resource use and costs of delivery to the target population(s) should be incorporated into the evaluation. The time horizon used in an economic evaluation should be of sufficient length to capture all costs and effects relevant to the decision problem; an appropriate discount rate should be used to discount cost and effects to present values 15 7

8 Statement of principle 7 Non-health effects and costs associated with gaining or providing access to health interventions that don't accrue to the health budget should be identified where relevant to the decision problem. All costs and effects should be disaggregated, either by sector of the economy or to whom they accrue.. 8 The cost and effects of the intervention on sub-populations within the decision problem should be explored and the implications appropriately characterized The uncertainty associated with an economic evaluation should be appropriately characterised. The impact of implementing the intervention on the health budget and on other constraints should be identified clearly and separately. An economic evaluation should explore the equity implications of implementing the intervention. 8