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M 09: Evaluation and Characterization of Health Economics and Outcomes Research in SAARC Nations
Manthan Nikesh Mehta
Topiwala National Medical College & BYL Nair Charitable Hospital India
To identify, evaluate and characterize the variety, quality, and intent of the health economics and outcomes research studies being conducted in SAARC (South Asian Association for Regional Cooperation) nations.
Studies published in English language between 1990 and 2015 were retrieved from Medline databases using relevant search strategies. Studies were independently reviewed as per Cochrane methodology and information on the type of research and outcomes were extracted. Quality of reporting was assessed.
Of the 2638 studies screened from eight SAARC nations, a total of 179 were included for review. (India=140; Bangladesh=12; Sri Lanka=08; Pakistan= 07; Afghanistan=05; Nepal= 04; Bhutan=02; Maldives=01) The broad study categories were cost-effectiveness analyses [CEA=76 studies], cost analyses [35 studies], and burden of illness [BOI=26 studies]. The outcomes evaluated were direct costs, indirect costs, and incremental cost-effectiveness ratio (ICER), quality-adjusted life years (QALYs), and disability-adjusted life years (DALYs). Cost of medicines, consultation and hospital charges, and monitoring costs were assessed as direct medical costs along with non-direct medical costs such as travel and food for patients and caregivers. The components of indirect costs were loss of incocme of patients and caregivers and loss of productivity. Quality of life (QoL) was assessed in 48 studies. The most commonly used instrument for assessing QoL was the WHo-Quality of Life BREF (WHOQOL-BREF) questionnaire (76%). The Quality of Health Economic Studies (QHES) score was used for quality assessment of full economic studies [44 studies]. The mean QHES score was 43.76.
This review identifies various patterns of health economic studies in eight SAARC nations. The quality of economic evaluation studies for heath care in India, Bangladesh, Sri Lanka, Pakistan, Afghanistan, Nepal, Bhutam & Maldives needs improvement. There is a need to generate capacity of researchers to undertake quality economic evaluations as well as an orientation of the policy makers so that there is demand for such studies as well as a scope for its use in policy making.