Abstract：
Pakistan embarked on a process of designing an essential package of health services (EPHS) as a pathway towards universal health coverage (UHC). The EPHS design followed an evidence-informed deliberative process; evidence on 170 interventions was introduced along multiple stages of appraisal engaging different stakeholders tasked with prioritising interventions for inclusion. We report on the composition of the package at different stages, analyse trends of prioritised and deprioritised interventions and reflect on the trade-offs made.
Quantitative evidence on cost-effectiveness, budget impact, and avoidable burden of disease was presented to stakeholders in stages. We recorded which interventions were prioritised and deprioritised at each stage and carried out three analyses: (1) a review of total number of interventions prioritised at each stage, along with associated costs per capita and disability-adjusted life years (DALYs) averted, to understand changes in affordability and efficiency in the package, (2) an analysis of interventions broken down by decision criteria and intervention characteristics to analyse prioritisation trends across different stages, and (3) a description of the trajectory of interventions broken down by current coverage and cost-effectiveness.
Value for money generally increased throughout the process, although not uniformly. Stakeholders largely prioritised interventions with low budget impact and those preventing a high burden of disease. Highly cost-effective interventions were also prioritised, but less consistently throughout the stages of the process. Interventions with high current coverage were overwhelmingly prioritised for inclusion.
Evidence-informed deliberative processes can produce actionable and affordable health benefit packages. While cost-effective interventions are generally preferred, other factors play a role and limit efficiency.
Quantitative evidence on cost-effectiveness, budget impact, and avoidable burden of disease was presented to stakeholders in stages. We recorded which interventions were prioritised and deprioritised at each stage and carried out three analyses: (1) a review of total number of interventions prioritised at each stage, along with associated costs per capita and disability-adjusted life years (DALYs) averted, to understand changes in affordability and efficiency in the package, (2) an analysis of interventions broken down by decision criteria and intervention characteristics to analyse prioritisation trends across different stages, and (3) a description of the trajectory of interventions broken down by current coverage and cost-effectiveness.
Value for money generally increased throughout the process, although not uniformly. Stakeholders largely prioritised interventions with low budget impact and those preventing a high burden of disease. Highly cost-effective interventions were also prioritised, but less consistently throughout the stages of the process. Interventions with high current coverage were overwhelmingly prioritised for inclusion.
Evidence-informed deliberative processes can produce actionable and affordable health benefit packages. While cost-effective interventions are generally preferred, other factors play a role and limit efficiency.
摘要：
背景：巴基斯坦开始了设计基本卫生服务包（EPHS）的过程，以此作为实现全民健康覆盖（UHC）的途径。EPHS的设计遵循了以证据为依据的审议过程；在评估的多个阶段引入了170项干预措施的证据，该评估涉及不同的利益相关者，其任务是优先考虑纳入干预措施。我们报告不同阶段的包装组成，分析优先和优先干预措施的趋势，并反思所做的权衡。
方法：关于成本效益的定量证据，预算影响，可避免的疾病负担分阶段提交给利益相关者。我们记录了每个阶段优先考虑和取消优先考虑的干预措施，并进行了三项分析：（1）审查每个阶段优先考虑的干预措施总数，以及避免的人均相关成本和残疾调整生命年(DALYs)，为了了解包装中可负担性和效率的变化，（2）分析按决策标准和干预特征细分的干预措施，以分析不同阶段的优先顺序趋势，（3）描述按当前覆盖范围和成本效益细分的干预措施的轨迹。
结果：在整个过程中，物有所值通常会增加，虽然不是统一的。利益相关者在很大程度上优先考虑预算影响低的干预措施和预防高疾病负担的干预措施。高成本效益的干预措施也被优先考虑，但在整个过程的各个阶段都不那么一致。目前高覆盖率的干预措施绝大多数优先考虑纳入。
结论：有证据的审议过程可以产生可操作和负担得起的健康福利方案。虽然成本效益高的干预措施通常是首选，其他因素发挥作用并限制效率。
方法：关于成本效益的定量证据，预算影响，可避免的疾病负担分阶段提交给利益相关者。我们记录了每个阶段优先考虑和取消优先考虑的干预措施，并进行了三项分析：（1）审查每个阶段优先考虑的干预措施总数，以及避免的人均相关成本和残疾调整生命年(DALYs)，为了了解包装中可负担性和效率的变化，（2）分析按决策标准和干预特征细分的干预措施，以分析不同阶段的优先顺序趋势，（3）描述按当前覆盖范围和成本效益细分的干预措施的轨迹。
结果：在整个过程中，物有所值通常会增加，虽然不是统一的。利益相关者在很大程度上优先考虑预算影响低的干预措施和预防高疾病负担的干预措施。高成本效益的干预措施也被优先考虑，但在整个过程的各个阶段都不那么一致。目前高覆盖率的干预措施绝大多数优先考虑纳入。
结论：有证据的审议过程可以产生可操作和负担得起的健康福利方案。虽然成本效益高的干预措施通常是首选，其他因素发挥作用并限制效率。
