Abstract：
BACKGROUND: Countries designing a health benefit package (HBP) to support progress towards universal health coverage (UHC) require robust cost-effectiveness evidence. This paper reports on Pakistan\'s approach to assessing the applicability of global cost-effectiveness evidence to country context as part of a HBP design process.
METHODS: A seven-step process was developed and implemented with Disease Control Priority 3 (DCP3) project partners to assess the applicability of global incremental cost-effectiveness ratios (ICERs) to Pakistan. First, the scope of the interventions to be assessed was defined and an independent, interdisciplinary team was formed. Second, the team familiarized itself with intervention descriptions. Third, the team identified studies from the Tufts Medical School Global Health Cost-Effectiveness Analysis (GH-CEA) registry. Fourth, the team applied specific knock-out criteria to match identified studies to local intervention descriptions. Matches were then cross-checked across reviewers and further selection was made where there were multiple ICER matches. Sixth, a quality scoring system was applied to ICER values. Finally, a database was created containing all the ICER results with a justification for each decision, which was made available to decision-makers during HBP deliberation.
RESULTS: We found that less than 50% of the interventions in DCP3 could be supported with evidence of cost-effectiveness applicable to the country context. Out of 78 ICERs identified as applicable to Pakistan from the Tufts GH-CEA registry, only 20 ICERs were exact matches of the DCP3 Pakistan intervention descriptions and 58 were partial matches.
CONCLUSIONS: This paper presents the first attempt globally to use the main public GH-CEA database to estimate cost-effectiveness in the context of HBPs at a country level. This approach is a useful learning for all countries trying to develop essential packages informed by the global database on ICERs, and it will support the design of future evidence and further development of methods.
METHODS: A seven-step process was developed and implemented with Disease Control Priority 3 (DCP3) project partners to assess the applicability of global incremental cost-effectiveness ratios (ICERs) to Pakistan. First, the scope of the interventions to be assessed was defined and an independent, interdisciplinary team was formed. Second, the team familiarized itself with intervention descriptions. Third, the team identified studies from the Tufts Medical School Global Health Cost-Effectiveness Analysis (GH-CEA) registry. Fourth, the team applied specific knock-out criteria to match identified studies to local intervention descriptions. Matches were then cross-checked across reviewers and further selection was made where there were multiple ICER matches. Sixth, a quality scoring system was applied to ICER values. Finally, a database was created containing all the ICER results with a justification for each decision, which was made available to decision-makers during HBP deliberation.
RESULTS: We found that less than 50% of the interventions in DCP3 could be supported with evidence of cost-effectiveness applicable to the country context. Out of 78 ICERs identified as applicable to Pakistan from the Tufts GH-CEA registry, only 20 ICERs were exact matches of the DCP3 Pakistan intervention descriptions and 58 were partial matches.
CONCLUSIONS: This paper presents the first attempt globally to use the main public GH-CEA database to estimate cost-effectiveness in the context of HBPs at a country level. This approach is a useful learning for all countries trying to develop essential packages informed by the global database on ICERs, and it will support the design of future evidence and further development of methods.
摘要：
背景：设计健康福利一揽子计划（HBP）以支持实现全民健康覆盖（UHC）的国家需要强有力的成本效益证据。本文报告了巴基斯坦评估全球成本效益证据对国家环境的适用性的方法，作为HBP设计过程的一部分。
方法：与疾病控制优先事项3（DCP3）项目合作伙伴一起制定并实施了七步程序，以评估全球增量成本效益比（ICER）对巴基斯坦的适用性。首先,要评估的干预措施的范围是确定的，并且是独立的，跨学科团队成立。第二,团队熟悉干预描述。第三，研究小组确定了塔夫茨医学院全球健康成本效益分析(GH-CEA)注册研究.第四，研究小组应用特定的剔除标准,将已确定的研究与当地干预描述相匹配.然后在审阅者之间交叉检查匹配项，并在有多个ICER匹配项的情况下进行进一步选择。第六,对ICER值采用质量评分系统.最后,创建了一个数据库，其中包含ICER的所有结果，并为每个决定提供理由，在HBP审议期间提供给决策者。
结果：我们发现，只有不到50％的DCP3干预措施可以得到适用于国家背景的成本效益证据的支持。在塔夫茨GH-CEA登记册中确定适用于巴基斯坦的78个ICER中，只有20个ICER与DCP3巴基斯坦干预描述完全匹配,58个为部分匹配.
结论：本文首次尝试在全球范围内使用主要的公共GH-CEA数据库来估算国家HBPs背景下的成本效益。这种方法对于所有试图根据全球ICER数据库制定基本一揽子计划的国家来说都是有益的学习，它将支持未来证据的设计和方法的进一步发展。
方法：与疾病控制优先事项3（DCP3）项目合作伙伴一起制定并实施了七步程序，以评估全球增量成本效益比（ICER）对巴基斯坦的适用性。首先,要评估的干预措施的范围是确定的，并且是独立的，跨学科团队成立。第二,团队熟悉干预描述。第三，研究小组确定了塔夫茨医学院全球健康成本效益分析(GH-CEA)注册研究.第四，研究小组应用特定的剔除标准,将已确定的研究与当地干预描述相匹配.然后在审阅者之间交叉检查匹配项，并在有多个ICER匹配项的情况下进行进一步选择。第六,对ICER值采用质量评分系统.最后,创建了一个数据库，其中包含ICER的所有结果，并为每个决定提供理由，在HBP审议期间提供给决策者。
结果：我们发现，只有不到50％的DCP3干预措施可以得到适用于国家背景的成本效益证据的支持。在塔夫茨GH-CEA登记册中确定适用于巴基斯坦的78个ICER中，只有20个ICER与DCP3巴基斯坦干预描述完全匹配,58个为部分匹配.
结论：本文首次尝试在全球范围内使用主要的公共GH-CEA数据库来估算国家HBPs背景下的成本效益。这种方法对于所有试图根据全球ICER数据库制定基本一揽子计划的国家来说都是有益的学习，它将支持未来证据的设计和方法的进一步发展。
