Health economic evidence in clinical guidelines in South Africa: a mixed-methods study
Abstract Background Evidence-informed clinical practice guidelines (CPGs) are useful tools to inform transparent healthcare decision-making. Consideration of health economic evidence (HEE) during CPG development in a structured manner remains a challenge globally and locally. This study explored the...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-021-06747-z |
| _version_ | 1818653191014711296 |
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| author | Maryke Wilkinson Karen J. Hofman Taryn Young Bey-Marrié Schmidt Tamara Kredo |
| author_facet | Maryke Wilkinson Karen J. Hofman Taryn Young Bey-Marrié Schmidt Tamara Kredo |
| author_sort | Maryke Wilkinson |
| collection | DOAJ |
| description | Abstract Background Evidence-informed clinical practice guidelines (CPGs) are useful tools to inform transparent healthcare decision-making. Consideration of health economic evidence (HEE) during CPG development in a structured manner remains a challenge globally and locally. This study explored the views, current practice, training needs and challenges faced by CPG developers in the production and use of HEE for CPGs in South Africa. Methods This mixed-methods study comprised an online survey and a focus group discussion. The survey was piloted and subsequently sent to CPG role players - evidence reviewers, CPG panellists, academics involved with training in relevant disciplines like health economics and public health, implementers and funders. The focus group participants hold strategic roles in CPG development and health economic activities nationally. The survey evaluated mean values, measures of variability, and percentages for Likert scales, while narrative components were thematically analysed. Focus group data were manually coded, thematically analysed and verified. Results The survey (n = 55 respondents to 245 surveys distributed) and one focus group (n = 5 participants from 10 people invited) occurred between October 2018 and February 2019. We found the most consistent reason why HEE should inform CPG decisions was ‘making more efficient use of limited financial resources’. This was explained by numerous context and methodological barriers. Focus groups participants noted that consideration of complex HEE are not achievable without bolstering skills in applying evidence-based medicine principles. Further concerns include lack of clarity of standard methods; inequitable and opaque topic selection across private and public sectors; inadequate skills of CPG panel members to use HEE; and the ability of health economists to communicate results in accessible ways. Overall, in the absence of clarity about process and methods, politics and interests may drive CPG decisions about which interventions to implement. Conclusions HEE should ideally be considered in CPG decisions in South Africa. However, this will remain hampered until the CPG community agree on methods and processes for using HEE in CPGs. Focused investment by national government to address the challenges identified by the study is imperative for a better return on investment as National Health Insurance moves forward. |
| first_indexed | 2024-12-17T02:33:58Z |
| format | Article |
| id | doaj.art-98b94273b2b145e4af1b3e9548004721 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-17T02:33:58Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-98b94273b2b145e4af1b3e95480047212022-12-21T22:06:54ZengBMCBMC Health Services Research1472-69632021-07-0121111210.1186/s12913-021-06747-zHealth economic evidence in clinical guidelines in South Africa: a mixed-methods studyMaryke Wilkinson0Karen J. Hofman1Taryn Young2Bey-Marrié Schmidt3Tamara Kredo4Cochrane South Africa, South African Medical Research CouncilSAMRC Centre for Health Economics and Decision Science, PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the WitwatersrandCentre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityCochrane South Africa, South African Medical Research CouncilCochrane South Africa, South African Medical Research CouncilAbstract Background Evidence-informed clinical practice guidelines (CPGs) are useful tools to inform transparent healthcare decision-making. Consideration of health economic evidence (HEE) during CPG development in a structured manner remains a challenge globally and locally. This study explored the views, current practice, training needs and challenges faced by CPG developers in the production and use of HEE for CPGs in South Africa. Methods This mixed-methods study comprised an online survey and a focus group discussion. The survey was piloted and subsequently sent to CPG role players - evidence reviewers, CPG panellists, academics involved with training in relevant disciplines like health economics and public health, implementers and funders. The focus group participants hold strategic roles in CPG development and health economic activities nationally. The survey evaluated mean values, measures of variability, and percentages for Likert scales, while narrative components were thematically analysed. Focus group data were manually coded, thematically analysed and verified. Results The survey (n = 55 respondents to 245 surveys distributed) and one focus group (n = 5 participants from 10 people invited) occurred between October 2018 and February 2019. We found the most consistent reason why HEE should inform CPG decisions was ‘making more efficient use of limited financial resources’. This was explained by numerous context and methodological barriers. Focus groups participants noted that consideration of complex HEE are not achievable without bolstering skills in applying evidence-based medicine principles. Further concerns include lack of clarity of standard methods; inequitable and opaque topic selection across private and public sectors; inadequate skills of CPG panel members to use HEE; and the ability of health economists to communicate results in accessible ways. Overall, in the absence of clarity about process and methods, politics and interests may drive CPG decisions about which interventions to implement. Conclusions HEE should ideally be considered in CPG decisions in South Africa. However, this will remain hampered until the CPG community agree on methods and processes for using HEE in CPGs. Focused investment by national government to address the challenges identified by the study is imperative for a better return on investment as National Health Insurance moves forward.https://doi.org/10.1186/s12913-021-06747-zEconomic evidenceEvidence-informed decision-makingSurveyFocus groupClinical practice guidelines |
| spellingShingle | Maryke Wilkinson Karen J. Hofman Taryn Young Bey-Marrié Schmidt Tamara Kredo Health economic evidence in clinical guidelines in South Africa: a mixed-methods study BMC Health Services Research Economic evidence Evidence-informed decision-making Survey Focus group Clinical practice guidelines |
| title | Health economic evidence in clinical guidelines in South Africa: a mixed-methods study |
| title_full | Health economic evidence in clinical guidelines in South Africa: a mixed-methods study |
| title_fullStr | Health economic evidence in clinical guidelines in South Africa: a mixed-methods study |
| title_full_unstemmed | Health economic evidence in clinical guidelines in South Africa: a mixed-methods study |
| title_short | Health economic evidence in clinical guidelines in South Africa: a mixed-methods study |
| title_sort | health economic evidence in clinical guidelines in south africa a mixed methods study |
| topic | Economic evidence Evidence-informed decision-making Survey Focus group Clinical practice guidelines |
| url | https://doi.org/10.1186/s12913-021-06747-z |
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