Table 4.
Appraisal of priority‐setting frameworks
| Article | Author(s) | Was the perspective of the economic analysis specified? | Was allowance made for uncertainty in the estimates of costs and consequences? | Was affordability assessed? | Did the exercise investigate disinvestment as well as investment? | Was the study embedded in the local policy and planning context? |
|---|---|---|---|---|---|---|
| #1 | Baltussen et al, 2007 | Y (societala) | N | N | N | N |
| #2 | Hansen & Chapman, 2008 | Y (provider) | Y | N | N | N |
| #3 | Kapiriri & Norheim, 2004b | N | N/A | N/A | N/A | N |
| #4 | Kase, 2006 | Y (provider) | N | Y – budget thresholdc | Y | Y |
| #5 | Baltussen, 2006 | Y (provider) | N | Y – budget impact analysisd | N | N |
| #6 | Baltussen et al., 2006 | Y (societal) | N | Y – budget impact analysise | N | N |
| #7 | Chisholm et al, 2008 | N | Y | N | N | N/A |
| #8 | Diaby & Lachane, 2011 | Y (provider) | Y | Y – budget impact analysisf | N | N |
| #9 | Evans, Lim et al, 2005 | Y (provider) | Y | Y – budget thresholdg | N | N/A |
| #10 | Ginsberg et al, 2012 | Y (societal)h | Y | N | N | N/A |
| #11 | Jehu‐Appiah et al, 2008 | Y (societal) | N | N | N | Y |
| #12 | Laxminarayan et al., 2006 | Y (provider) | N | N | N | N/A |
| #13 | Makundi et al., 2007 | N | N | N | N | N |
| #14 | Venhorst et al, 2014 | N | N | Y – measure not specified | N | N/A |
| #15 | Marsh et al., 2014 | Somei | Somej | Some – budget impact analysisk | N | N/A |
| #16 | Chao et al, 2014 | Some | Somel | N | N | N/A |
| #17 | Diaby et al., 2011 | Y (provider) | N | Y – budget impact analysism | N | N/A |
| #18 | Simons et al, 2011 | Y (providern) | Y | N | N | N/A |
| #19 | Canning, 2006 | N | N | N | N | N/A |
| #20 | Whittington et al., 2012 | N | Y | N | N | N/A |
| #21 | Madi et al., 2007, o | N/A | N/A | N/A | N/A | Y |
| #22 | Adam et al., 2005 | Y (societalh) | N | Y – budget thresholdg | Y | N/A |
| #23 | Baltussen et al, 2005 | Y (societalh) | Y | Y – budget thresholdg | N | N/A |
| #24 | Baltussen, 2012 | Y (societalh, p) | Y | N | N | N/A |
| #25 | Chisholm, Baltussen et al, 2012 | Y (societalh) | N | N | N | N/A |
| #26 | Chisholm, Naci et al, 2012 | Y (societalh) | Y | N | N | N/A |
| #27 | Chisholm, Saxena et al, 2012 | Y (societalh) | Y | Y – budget thresholdq | N | N/A |
| #28 | Darmstadt et al, 2005 | Y (societalh) | Y | Y – budget thresholdq | N | N/A |
| #29 | Edejer et al, 2005 | Y (societalh) | Y | Y – budget thresholdg | N | N/A |
| #30 | Morel et al, 2005 | Y (provider) | Y | Y – budget thresholdg | N | N/A |
| #31 | Ortegon et al, 2012 | Y (societalh) | Y | Y – budget thresholdr | N | N/A |
| #32 | Stanciole et al, 2012 | Y (societalh) | Y | Y – budget thresholdq | N | N/A |
| #33 | Hogan et al, 2005 | Y (societal) | Y | Y – budget thresholdg | N | N/A |
| #34 | Cecchini et al 2010 | N | Y | N | N | N |
| #35 | Chisholm, Doran et al, 2006 | N | Somes | N | N | N/A |
| #36 | Gureje et al, 2007 | N | N | Y – budget thresholdt | N | N |
Y, Yes; N, No; N/A, not applicable; Some.
Cost‐effectiveness data are derived from the WHO CHOICE project, which is reported to take a societal perspective (Evans et al., 2005).
This study only sought to derive criteria for priority setting.
Threshold not specified.
Budget impact was one of the criteria for priority setting. Budget impact was not measured.
Intervention was defined as having a large budget impact when it costs more than (an arbitrarily defined) $US15 million (i.e. >10% of annual public health expenditure).
Budget Impact Analysis (BIA) suggests that the new priority list of reimbursable drugs deemed affordable if the real economic impact of drugs per member is less than $US66.
Interventions to be highly cost‐effective if they cost less than the gross domestic product per capita to avert each disability adjusted life years (DALY) and cost‐effective if each DALY could be averted at a cost of between one and three times the gross domestic product per capita. Other interventions are not cost‐effective. According to the authors, this incorporates an element of affordability as regions and countries with lower national income will have lower cut‐off points.
These classifications are based on estimates of gross national income (GNI) per capita for the previous year (World Bank, 2014).
This review includes a checklist that assesses whether a ‘well‐defined question was posed in answerable form’ (Drummond et al., 2005). This was taken to include a description of study viewpoint.
According to the authors, approximately half of the studies in the review conducted a sensitivity analysis.
Of the 40 studies, three included budget impact as a criterion for priority setting. Budget impact was not measured.
According to the authors, the majority of studies included in the review conducted a sensitivity analysis.
Budget impact analysis was recommended as one of the drug selection criterion. Budget impact not measured as part of the proposed framework.
Obtained from companion costing paper by Wolfson et al. (2008).
This study only sought to derive criteria for priority setting.
Authors note that they did not include time costs of people seeking and undergoing care or changes in productivity losses as a result of the interventions.
Intervention packages deemed ‘very cost effective’ if below average per‐person GDP, or Intl$1391. Implies an element of affordability as countries with lower national income will have lower cut‐off points.
Uses average per capita income (which in both sub‐regions is close to $Int2000) as a threshold for considering an intervention to be highly cost‐effective. Implies an element of affordability as regions and countries with lower national income will have lower cut‐off points.
According to the authors, the majority of studies performed a sensitivity analysis.
Uses average per capita income in Nigeria (which is $US320) as a threshold for considering an intervention to be highly cost‐effective. According to the authors, the total financial outlay of government for the most highly cost‐effective package of mental health interventions is estimated to be relatively small (less than $US1 per capita).