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Table 1 Extraction form for study characteristics

From: A systematic review of Health Technology Assessment tools in sub-Saharan Africa: methodological issues and implications

Author(s) Mathew Abaza and Tawfik Hutubessy et al. Miot et al. Govender et al. Ueffing et al.
Study name KNOW ESSENTIALS: A tool for informed decisions in the absence of formal HTA systems Appropriate medical technologies for developing countries: application to cardiovascular disorders Generalized cost-effectiveness analysis for national-level priority-setting in the health sector Field testing of a multicriteria decision analysis (MCDA) framework for coverage of a screening test for cervical cancer in South Africa Purchasing of medical equipment in public hospitals: the mini-HTA tool Equity-oriented toolkit for health technology assessment and knowledge translation: application to scaling up of training and education for health workers
Published date 2011 2008 2003 2012 2011 2009
Study funding source(s) None Not stated Not stated Not stated Not stated Not stated
Possible conflicts of interest None Not stated None None None Three authors expressed competing interests because of their affiliation with the WHO
Objective Describes a tool, “KNOW ESSENTIALS” that includes current best evidence on health technologies, incorporates relevant contextual issues, and is objective, reproducible, transparent, and affordable Provide an acquisition methodology by which healthcare providers can minimize the underutilization of medical devices to be purchased when certain diseases are to be dealt with and allow non-technical personnel to make correct and appropriate acquisitions Outline the process by which country level decision makers and programme managers can carry out their own context-specific analysis of the relative cost-effectiveness of interventions for reducing leading causes of national disease burden using cost-effective analysis (CEA) information from the WHO-CHOICE project Field testing of the EVIDEM framework for decision-making on a screening test by a private health plan in South Africa Adapt and use the Danish Centre for Evaluation and Health Technology Assessment (DACEHTA) mini-HTA tool to assess past decisions made by South African hospital managers, as applied to selected medical devices Propose a toolkit for decision-makers to scale up training and education of health workers
Target population Settings lacking formal HTA systems Developing countries Low-income settings Low-resource settings South African hospitals Economically disadvantaged areas
Was tool/approach applied? Yes, pilot tested Yes, pilot tested No Yes Yes No
Site/setting Africa (hypothetical) Not stated n/a South Africa South Africa n/a
Study focus Favourability of artemisinin-based treatment for severe or complicated malaria in children using KNOW ESSENTIALS Cardiovascular disorder equipment purchases with support database software n/a Cervical cancer screening decision-making Decision support checklist for hospital managers to inform decisions about the acquisition of health technologies (drugs, devices, and other health interventions) n/a
Expressed need for tool or approach Lack of formal HTA or low level of application in developing countries; decisions are highly subjective and expert based rather than research based Lack of HTA and the recognition for the need of HTA in developing countries Shortage of technical expertise and health service capacity to utilize CEA information Need for transparency and greater access to evidence through a systematic and explicit process Existence of management information gaps in South African public hospitals and need for a customized tool to support decision makers in medical device management Need to address the shortage of health workers which are considered part of health care resources
HTA tool proposed and designed to be applied for specific medical technologies KNOW ESSENTIALS Decision support database software n/a n/a Mini-HTA tool/ hospital-based HTA tool Equity-Oriented Toolkit (EOT)
HTA approach used in the paper (if new tool not proposed) n/a n/a Use of CEA information from the WHO-CHOICE project, generalized CEA Use of the EVIDEM (Evidence and Value: Impact on DEcision Making) framework, brings together HTA and MCDA n/a n/a
Applied in the context of medical devices? No Yes No Yes Yes No
Description of tool or approach Elements addressing different aspects of HTA divided into background issues (KN, O, W), essential criteria (E, S, S, E), and other criteria (N, T, I, A, L, S). Critical appraisal through a systematic review process with meta-analysis, or using other clearly defined search strategies with justification. Colour coding of elements when available information favours (green)/does not favour (red) the medical technology, or (yellow) if available information is insufficient to classify green or red. For last six elements, not applicable (white) code available. If any Background Issues coded red, health technology is rejected, if not it proceeds to Essential Criteria. If any coded red, health technology is rejected, if not proceeds to Other Criteria. If majority red, health technology is rejected, considered favourably if mostly green, deferred if mostly yellow Database constructed by compiling data about cardiovascular disease equipment specifications. Database comprised of three main forms. First form enables user to select criteria on the disease, the brand, equipment type, and non-diagnostic features. Second form lists relevant equipment according to selected criteria. Equipment is ordered by a priority scheme depending on total number of diagnostic features, number of unused diagnostic features, and number of diagnostic features for arrhythmias labelled and highlights less recommended equipment based on these features. The third form allows user to examine selected equipment more closely Generalized CEA identifies current allocative inefficiencies as well as opportunities presented by new interventions and presents it in a way that can be translated across settings by i) evaluating the costs and health benefits of a set of related interventions, singly and in combination, with the “null scenario”; ii) using CEA results to classify interventions into those that are very cost-effective, cost-ineffective, and somewhere in between rather than using the traditional league table approach After a literature review and input form a clinical committee of the health plan, a HTA report on liquid based cytology (LBC) for cervical cancer screening was tailored to investigate 14 MCDA inclusion criteria and four contextual criteria (appraised qualitatively) proposed by healthcare funder. The contents of report were tailored to local context. Committee engaged in workshops where members assigned weights to each criterion of the MCDA matrix and scores for LBC for each criterion of the MCDA matrix based on the data of the HTA report. Members then assigned qualitative impact of system-related criteria on the appraisal. Adoptability and utility of framework were explored through a post-testing survey Adaptation of the DACEHTA tool, which is separated into the following sections: introduction, technology, patient, organization, economy. The tool was adapted into the following cluster: patients, technology, economy, and organizational influence. The tool was used as a prospective cross-sectional survey concerning the decision-making process of purchasing medical devices over the past year, administered to 21 hospital managers Adaptation of the WHO’s Needs-Based Toolkit for Health Technology Assessment that was created to aid health policy makers and planners to allocate resources efficiently, fairly, and effectively. A perspective of “equity” was added in the EOT, based on clinical and population health status. Four major steps: burden of illness, community effectiveness, economic evaluation, and knowledge translation and implementation. Recommendations were given for scaling up education and training of health workers.
Stand-alone tool or a support tool for existing decision making process? Stand alone Support Support Stand alone Support Stand alone
Results of implementation Atemisinin-based treatment for severe or complicated malaria in children should be incorporated as the first-line treatment in the National guideline. (hypothetical) Concluded that this tool would save effort from technical personnel and is friendly enough to be used by non-technical personnel. It would also be a helpful tool for the determination of budget and other non-diagnostic criteria. n/a Resulted in a consideration by the health plan to only fund for LBC up to the value of conventional pap smears. A negotiation process was started with the pathology laboratories and the fee for LBC was reduced to an amount which was considered appropriate for full funding; 50% of members felt that EVIDEM improved understanding of the intervention, access to quality assessment of the evidence on the intervention, and consideration of all key elements of the decision; 56% felt it improved transparency of decision making. No member thought it worse than existing process Study results showed deficiencies for medical technology: no sufficient consideration of risks related to a medical technology or on the impact on staff or costs n/a