Table 2 Ghana Health technology Assessment (HTA) hypertension case study and data sources
Data domain & Aspect | HTA model – source | Comment, gap |
|---|---|---|
1. Epidemiology | ||
Prevalence of hypertension, mortality estimates, probabilities of incidence of CVD, diabetes, incidence of related complications | - Prevalence of hypertension from Ghana Statistical Service & DHS Census Data (2012, 2014) | - 2014 Ghana DHS included measurement of blood pressure for a representative sample of the population |
- Mortality rates from WHO estimated life table for Ghana | - Preferable to use estimates of incidence of adverse events from Ghana but not able to identify good quality local cohort studies with longitudinal follow-up | |
- Annual probabilities of incidence of CVD + diabetes from international literature | ||
- Baseline estimates of the incidence of CVD from multivariate analysis of primary care data, black African patients in the United Kingdom (QRisk2 algorithm) | ||
2 Clinical efficacy | ||
Effectiveness of AHM; incidence of adverse events | NICE model | - Good evidence that the effects of the main classes of antihypertensive drugs vary by ethnicity |
Meta-analyses from international literature for black African population (not specifically Ghanaian) | ||
- Estimates of adverse events were not available from any West population cohort | ||
3 Cost | ||
Antihypertensive medicines, interactions with the health system | - Unit costs of service from NHIS price for drugs on the essential medicines list, NHIS tariffs | - NHIS tariffs are updated annually but may not be publicly available |
- Daily dose and healthcare intervention assumptions from recommendations in Ghana Standard Treatment Guidelines for hypertension | - Some data not available by brand or formulation | |
- Costs to other healthcare insurers, OOPE and the value of lost production due to ill-health or use of healthcare were not included in the model | ||
4 Service use | ||
Health services and events, treatment of adverse events | - NHIS protocols | - NHIS data is restricted access |
- Expert opinion | - 30% data are available electronically | |
5 Quality of life | ||
DALYs, disability weights | 2004 GBD study | - Ghana burden of disease study to validate GBD data |
- More recent summary estimates were not available for the conditions of interest (stroke, CHD, diabetes and heart failure) | ||
6 Equity | ||
Impact of geography, gender, socioeconomic status, or other differentiating factors on health outcomes | Not considered in the pilot | Results could be disaggregated by geography; urban/rural using DHS data in future analyses |