Health Economics and HIV/AIDs Research Division, University of KwaZulu Natal, Durban, South Africa.
Centre for Health Economics Financing and Technology Assessment, Patient and Citizen Involvement in Health, 3739 Kwacha Road, P.O Box 310159, Olympia, Lusaka, Zambia.
BMC Health Serv Res. 2024 Nov 18;24(1):1426. doi: 10.1186/s12913-024-11914-z.
Health technology assessment uses explicit economic evaluation evidence to support health benefits package design. However, the limited availability of technical expertise, data, and methods has restricted the production of economic evaluation evidence in low- and middle-income countries. Zambia has initiated a roadmap to support its policy of reviewing and implementing its national benefits package. This study characterises economic evaluation evidence to support this process's evidence mapping, synthesis, and appraisal stages.
This systematic review applies deductive analysis and the preferred reporting items for systematic review and meta-analyses. Four databases were searched to identify studies from 1993 that coincided with Zambia's health benefits package reform.
A total of 61 studies met the inclusion criteria. Most of the studies were first authored by nonlocal authors, and the number of local-based authors in each study was low. Almost all funding for economic evaluation research was not local, and only a few studies sought local ethical clearance to conduct research. Infectious diseases were the highest disease control priority for the studies, with HIV research having the highest output. Most of the studies were cost-effectiveness studies that utilised trial-based data and a combination of program, published, and unpublished data for analysis. The studies generally utilised direct cost and applied the ingredient-based costing approach. Natural units were predominantly used for outcomes alongside DALYs. Most studies reported using a 3% discount rate for both costs and outcomes, with only a few reporting methods for sensitivity analysis.
Economic evaluation evidence in Zambia has increased, revealing limited local research leadership, methodological inconsistencies, and a focus on infectious diseases. These findings are crucial for revising Zambia's benefits package and may guide researchers and decision-makers in improving the transparency and quality of future research.
卫生技术评估利用明确的经济评估证据来支持卫生福利套餐设计。然而，由于技术专长、数据和方法有限，中低收入国家的经济评估证据的产生受到限制。赞比亚已启动了一项路线图，以支持其审查和实施国家福利套餐的政策。本研究描述了支持这一过程的证据绘制、综合和评估阶段的经济评估证据。
本系统评价应用演绎分析和系统评价和荟萃分析的首选报告项目。从 1993 年开始，四个数据库被搜索以识别与赞比亚卫生福利套餐改革相吻合的研究。
共有 61 项研究符合纳入标准。大多数研究的第一作者是非当地作者，每篇研究中的本地作者数量较少。几乎所有经济评估研究的资金都不是本地的，只有少数研究寻求本地伦理批准进行研究。传染病是研究中最高的疾病控制优先事项，艾滋病毒研究的产出最高。大多数研究是成本效益研究，利用试验数据和方案、已发表和未发表的数据进行分析。这些研究通常使用直接成本，并采用基于成分的成本核算方法。自然单位主要用于结果以及 DALYs。大多数研究报告使用 3%的贴现率对成本和结果进行贴现，只有少数研究报告了敏感性分析方法。
赞比亚的经济评估证据有所增加，这表明本地研究领导力有限、方法不一致以及对传染病的关注。这些发现对于修订赞比亚的福利套餐至关重要，并可能为研究人员和决策者提供指导，以提高未来研究的透明度和质量。
