Table 3.
Priority‐setting studies in LMICs: methods and data sources
| Article | Criteria | Efficiency measure | PS approach | Highest priority interventions | Data source |
|---|---|---|---|---|---|
| #1 | Efficiency, severity of disease, number of potential beneficiaries, age of beneficiaries, individual health benefits, poverty reduction | Cost‐effectiveness (cost per DALY averted) | DCE to derive criteria. Ranking interventions based on MCDAa | TB control, followed by oral rehydration therapy for diarrhoea and case management of pneumonia in child health and several interventions in HIV/AIDS. AIDS control including the provision of antiretroviral therapy. | Literature + expert opinion |
| #2 | Efficiency, important health problems | Cost‐effectiveness (cost per DALY averted) | Ranking of interventions based on relative CE (grouped by health problem) | Curative treatment at health centres and hospital outpatient departments of pneumonia, severe diarrhoeal diseases, peptic ulcer, dysentery, malaria, trachoma, schistosomiasis haematobium and glaucoma. | Literature + local survey data + expert opinion |
| #3 | Severity of disease, benefit of the intervention; cost of the intervention, efficiency; quality of the data on effectiveness; the patients age; place of residence; lifestyle; importance of providing equity of access to health care and the community's viewsb | Cost‐effectiveness (no ratio given) | N/A (identify criteria only) | N/A (identify criteria only). | Local survey data |
| #4 | Benefit the greatest number; impact greatly on morbidity and mortality; prevention focused; accessible and affordable; efficient; impact on performance; improve financial and management sustainability | Not specified | Explicit approach akin to PBMAc – used agreed criteria as basis for prioritising in 3 key areas and identify the necessary resource shifts | Malaria prevention (bed nets and selected spraying in the highlands), safe motherhood and family planning, immunisation, STI/HIV/AIDS. | Expert opinion |
| #5 | Efficiency; poverty reduction; severity of disease; age of target group; budget impact; individual health effect | Cost‐effectiveness (no ratio given) | Ranking based on 2 steps: define who should be targeted (step 1), use DCE to derive weights for relative criteria for PS, then scored/mapped interventions against these to develop rank ordering of interventions to targeted groups (step 2) | Prevention of mother‐to‐child HIV/AIDS transmission and oral rehydration therapy to treat diarrhoea in childhood (whole population), case‐management of pneumonia in childhood (targeting the poor). | Literature + expert opinion |
| #6 | Efficiency; poverty reduction; severity of disease; age of target group; budget impact; health effects | Cost‐effectiveness (cost per DALY averted) | DCE to derive criteria. Ranking interventions based on MCDA | Prevention of mother to child transmission in HIV/AIDS control and treatment of pneumonia and Diarrhoea in childhood. | Local survey data |
| #7 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEAd – ranking of interventions based on relative CE | Interventions using older antipsychotic drugs combined with psychosocial treatment, delivered via a community‐based service model. | Literature + local survey data + expert opinion |
| #8 | Efficiency; severity of the condition; socioeconomic status; age group of patients | Cost‐effectiveness (cost per QALY gained) | Ranking of interventions based on MCDA | Antimalarials, treatments for asthma and antibacterials for urinary tract infection. | Literature + expert opinion |
| #9 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – Ranking of interventions based on relative CE | N/A (priority interventions can be found in individual papers from this series (#33–37)). | Literature + local survey data + expert opinion |
| #10 | Efficiency | Cost‐effectiveness (cost per DALY averted) | Ranking of interventions based on relative CE | Cervical cancer control – screening through cervical smear tests or visual inspection with acetic acid in combination with treatment. Colorectal cancer control – increasing the coverage of treatment interventions. | Literature + expert opinion |
| #11 | Targeting vulnerable populations; efficiency, severity of disease; number of beneficiaries; diseases of the poor | Cost‐effectiveness (cost per DALY averted) | DCE to derive criteria. Ranking interventions based on MCDA | Childhood interventions, most interventions targeting communicable diseases and two reproductive health interventions (supervised deliveries and emergency obstetric care). | Literature + local survey data + expert opinion |
| #12 | Efficiency | Cost‐effectiveness (cost per DALY averted) | Ranking of interventions based on relative CE | See full publication for priority interventions for 94 diseases and conditions. | Literature + local survey data + expert opinion |
| #13 | Prevalence; disease burden; coverage; severity of disease; efficacy; efficiency; equity | Cost‐effectiveness (ratio not given) | Balance sheet methode to derive ranking of interventions | N/A (development and testing of a model for incorporating scientific evidence and societal values in priority setting). | Literature + local survey data + expert opinion |
| #14 | Effectiveness; quality of the evidence; magnitude of individual health impact; acceptability; efficiency; technical complexity; affordability; safety; geographical coverage; accessibility | Cost‐effectiveness (ratio not given) | N/A (develop criteria only) | N/A (development of a rating tool to assess the impact of breast cancer interventions on multiple criteria). | Literature + expert opinion |
| #15 | Efficiency; disease severity; treatment access; target population size; curative or preventative; budgetary and other practical constraints; evidence quality; political factors | Not specified | Ranking of interventions based on MCDA | N/A (summarises existing approaches for MCDA of healthcare interventions and lessons learnt). | Literature |
| #16 | Efficiency | Cost‐effectiveness (cost per DALY averted) | Ranking of interventions based on relative CE | Male circumcision in Mozambique and cataract repair in Nepal. | Literature + expert opinion |
| #17 | Efficiency; severity of disease; capacity of the intervention to reduce poverty; age; anticipated health gains; financial impactf | Not specified | Ranking of interventions based on MCDA | N/A (summarises article #6). | Literature + expert opinion |
| #18 | Efficiency | Cost‐effectiveness (cost per additional case, death, and DALY averted) | Ranking of interventions based on relative CE | N/A (tool for measles strategic planning). | Literature + expert opinion |
| #19 | Efficiency | Cost‐effectiveness (cost per DALY averted and cost per infection averted) | Ranking of interventions based on relative CE | Mass media messages, peer education, condom distribution, treatment of sexually transmitted diseases for commercial sex workers, treatment of tuberculosis is highly cost‐effective in those who are HIV‐positive as well as the general population. | Literature + expert opinion |
| #20 | Efficiency | Cost–benefit analysis (BCR) | Ranking of interventions based on BCRsg | Biosand filter and point of use chlorination interventions offer the largest benefits to a household's well‐being. | Literature |
| #21 | Ability to meet national policy priorities; reduce maternal mortality and/or morbidity; improve services; efficient and financially sustainable | Cost‐effectiveness (ratio not specified) | Not specified | N/A (describes process involving key stakeholders to elicit and prioritise evaluation needs for safe motherhood). | Primary data |
| #22 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – ranking of interventions based on relative CE | Community‐based newborn care package, antenatal care (tetanus toxoid, screening for pre‐eclampsia, screening and treatment of asymptomatic bacteriuria and syphilis), skilled attendance at birth, offering first level maternal and neonatal care around childbirth, emergency obstetric and neonatal care around and after birth. | Literature + expert opinion |
| #23 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – ranking of interventions based on relative CE | Treating only smear‐positive cases, treatment for both smear‐positive and smear‐negative and extra‐pulmonary cases at a coverage level of 95%. | Literature + expert opinion |
| #24 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – ranking of interventions based on relative CE | Treatment of chronic otitis media, extracapsular cataract surgery, trichiasis surgery, treatment for meningitis, and annual screening of school children for refractive error. | Literature + expert opinion |
| #25 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – ranking of interventions based on relative CE | Disease clusters cover over 500 interventions. A subset of 53 interventions is deemed ‘highly’ cost‐effective. See full article for details. | Literature |
| #26 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – ranking of interventions based on relative CE | Single most cost‐effective intervention varies by region. Combined intervention strategy that simultaneously enforces multiple road safety laws (e.g. the combined enforcement of speed limits, drink‐driving laws, and motorcycle helmet use). | Literature |
| #27 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – ranking of interventions based on relative CE | Population‐based alcohol control (Africa), drug treatment of epilepsy in primary care (South‐East Asia). | Literature |
| #28 | Efficacy; effectiveness; feasibility; efficiency | Cost‐effectiveness (cost per DALY averted) | Ranking of interventions based on relative CE | Family care/low birthweight care, Emergency obstetric care, family care/low birthweight care + community‐based case management of pneumonia, Skilled maternal and immediate neonatal care, emergency obstetric care + corticosteroids for preterm labour + antibiotics for preterm premature rupture of membranes. | Literature + expert opinion |
| #29 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – ranking of interventions based on relative CE | Fortification with zinc or vitamin A. | Literature + expert opinion |
| #30 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – ranking of interventions based on relative CE | High coverage with artemisinin‐based combination treatments. | Literature + expert opinion |
| #31 | Efficiency | Cost‐effectiveness (cost per DALY averted) | Ranking of interventions based on relative CE | Demand reduction strategies of the Framework Convention for Tobacco Control; combination drug therapy for people with a >25% chance of experiencing a cardiovascular event over the next decade, either alone or together with specific multidrug regimens for the secondary prevention of post‐acute ischaemic heart disease and stroke; and retinopathy screening and glycaemic control for patients with diabetes. | Literature |
| #32 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – ranking of interventions based on relative CE | Low‐dose inhaled corticosteroids for mild persistent asthma. | Literature + expert opinion |
| #33 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – ranking of interventions based on relative CE | Education and treatment of sexually transmitted infections for sex workers. | Literature + expert opinion |
| #34 | Efficiency | Cost‐effectiveness (cost per DALY averted) | Ranking of interventions based on relative CE | Health information and communication strategies that improve population awareness about the benefits of healthy eating and physical activity, fiscal measures that increase the price of unhealthy food content or reduce the cost of healthy foods rich in fibre, regulatory measures that improve nutritional information or restrict the marketing of unhealthy foods to children. | Literature + expert opinion |
| #35 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – ranking of interventions based on relative CE | Nicotine replacement therapy or brief physician advice (individual level); taxation of alcoholic or tobacco products (population‐wide level). | Literature + expert opinion |
| #36 | Efficiency | Cost‐effectiveness (cost per DALY averted) | GCEA – ranking of interventions based on relative CE | For schizophrenia: community‐based treatment with older antipsychotic drugs plus psychosocial support or case management. For depression, epilepsy, and alcohol use disorders: older antidepressants, with or without proactive case management in primary care, older anticonvulsants in primary care, and random breath testing for motor vehicle drivers. | Literature + local survey data + expert opinion |
LMICs, low‐income and lower‐middle‐income countries; DALY, disability‐adjusted life year; PS, priority setting; CE, cost‐effectiveness; N/A, not applicable; BCR, benefit–cost ratios; DCE, discrete choice experiment.
a
MCDA (multi‐criteria decision analysis) involves describing criteria, arranging the criteria on a performance matrix and assigning ratings for each program option to aid transparent and consistent decision making (Baltussen et al., 2007).
b
High‐weight criteria. The authors also identified ‘average’‐weight and ‘low’‐weight criteria.
c
PBMA (programme budgeting and marginal analysis) priority‐setting toolkit that helps decision‐makers maximise the impact of healthcare resources on the health needs of a local population and examines how resources are currently spent and the costs and effects of changing spending patterns (Mitton and Donaldson, 2004).
d
GCEA – generalised cost‐effectiveness approach. Interventions classified into those are very cost‐effective, cost‐ineffective, and somewhere in between (Hutubessy et al., 2002).
e
Balance sheet method = model for incorporating scientific evidence and societal values in priority setting (Eddy, 1990).
f
Authors suggested criteria for LMICs.
g
While authors discuss how BCRs can inform priority ranking of interventions, data limitations prevent them from doing so in this context.