Pharmacoeconomics and its implication on priority-setting for essential medicines in Tanzania: a systematic review

BackgroundDue to escalating treatment costs, pharmacoeconomic analysis has been assigned a key role in the quest for increased efficiency in resource allocation for drug therapies in high-income countries. The extent to which pharmacoeconomic analysis is employed in the same role in low-income countries is less well established. This systematic review identifies and briefly describes pharmacoeconomic studies which have been conducted in Tanzania and further assesses their influence in the selection of essential medicines.MethodsPubmed, Embase, Cinahl and Cochrane databases were searched using “economic evaluation”, “cost-effectiveness analysis”, “cost-benefit analysis” AND “Tanzania” as search terms. We also scanned reference lists and searched in Google to identify other relevant articles. Only articles reporting full economic evaluations about drug therapies and vaccines conducted in Tanzania were included. The national essential medicine list and other relevant policy documents related to the identified articles were screened for information regarding the use of economic evaluation as a criterion for medicine selection.ResultsTwelve pharmacoeconomic studies which met our inclusion criteria were identified. Seven studies were on HIV/AIDS, malaria and diarrhoea, the three highest ranked diseases on the disease burden in Tanzania. Six studies were on preventive and treatment interventions targeting pregnant women and children under the age of five years. The national essential medicine list and the other identified policy documents do not state the use of economic evaluation as one of the criteria which has influenced the listing of the drugs.ConclusionCountry specific pharmacoeconomic analyses are too scarce and inconsistently used to have had a significant influence on the selection of essential medicines in Tanzania. More studies are required to fill the existing gap and to explore whether decision-makers have the ability to interpret and utilise pharmacoeconomic evidence. Relevant health authorities in Tanzania should also consider how to apply pharmacoeconomic analyses more consistently in the future priority-setting decisions for selection of essential medicines.

[1]  H. Kidanto,et al.  Induction of labor with misoprostol or oxytocin in Tanzania , 2007, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[2]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2010, International journal of surgery.

[3]  Ada Verloren.  The United Nations Children's Fund , 2009 .

[4]  F. Pang,et al.  Generalisability in economic evaluation studies in healthcare: a review and case studies. , 2004, Health technology assessment.

[5]  C. Whitty,et al.  Cost-Effectiveness Study of Three Antimalarial Drug Combinations in Tanzania , 2006, PLoS medicine.

[6]  J. Critchley,et al.  Sub Saharan Africa: TB and Diabetes Mellitus, HIV and Metabolic Syndrome, and the impact of globalization , 2009 .

[7]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2010, International journal of surgery.

[8]  Leonard E. G. Mboera,et al.  Annual Health Statistical Abstract , 2006 .

[9]  R. Martorell,et al.  Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials. , 2000, The American journal of clinical nutrition.

[10]  G. Schmid,et al.  Cost-effectiveness of nevirapine to prevent mother-to-child HIV transmission in eight African countries , 2004, AIDS (London).

[11]  D. Chandramohan,et al.  Duration of Protection Against Clinical Malaria Provided by Three Regimens of Intermittent Preventive Treatment in Tanzanian Infants , 2010, PloS one.

[12]  Dominicus Haule.  Involvement and Incorporation of Essential Health Interventions Into Health Curriculum: A Case of Diploma in Nursing Schools Dar es salaam, Tanzania , 2012 .

[13]  R. Black,et al.  Cost-effectiveness of zinc as adjunct therapy for acute childhood diarrhoea in developing countries. , 2004, Bulletin of the World Health Organization.

[14]  E. Fèvre,et al.  Estimating human rabies mortality in the United Republic of Tanzania from dog bite injuries. , 2002, Bulletin of the World Health Organization.

[15]  A. Galvani,et al.  Evaluating the cost-effectiveness of rabies post-exposure prophylaxis: a case study in Tanzania. , 2009, Vaccine.

[16]  M. Tanner,et al.  Cost-effectiveness of iron supplementation and malaria chemoprophylaxis in the prevention of anaemia and malaria among Tanzanian infants. , 2000, Bulletin of the World Health Organization.

[17]  S. Wilson.  Methods for the economic evaluation of health care programmes , 1987 .

[18]  C. Guerriero,et al.  Cost-Effectiveness Analysis of Administering Tranexamic Acid to Bleeding Trauma Patients Using Evidence from the CRASH-2 Trial , 2011, PloS one.

[19]  C. Murray,et al.  Cost effectiveness of chemotherapy for pulmonary tuberculosis in three sub-Saharan African countries , 1991, The Lancet.

[20]  S. Brophy,et al.  Interventions for latent autoimmune diabetes (LADA) in adults. , 2011, The Cochrane database of systematic reviews.

[21]  B. Robberstad,et al.  Preventing Mother to Child Transmission of HIV With Highly Active Antiretroviral Treatment in Tanzania-a Prospective Cost-Effectiveness Study , 2010, Journal of acquired immune deficiency syndromes.

[22]  N Mittmann,et al.  Economic guidelines for oncology products: Adaptation of the Canadian Agency for Drugs and Technologies in Health (CADTH) technology assessment guidance document. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[23]  Peter E. Hilsenrath,et al.  The World Health Report 2000 , 2002 .

[24]  J. Sachs.  Macroeconomics and health: investing in health for economic development , 2002 .

[25]  Andy Gray,et al.  The selection and use of essential medicines. , 2008, World Health Organization technical report series.

[26]  K. Goa,et al.  Tranexamic acid: a review of its use in surgery and other indications. , 1999, Drugs.

[27]  O. Norheim,et al.  Cost Effectiveness and Resource Allocation Cost-effectiveness of Medical Interventions to Prevent Cardiovascular Disease in a Sub-saharan African Country – the Case of Tanzania , 2007 .

[28]  M C McCormick,et al.  The contribution of low birth weight to infant mortality and childhood morbidity. , 1985, The New England journal of medicine.

[29]  L. Sanchez.  Pharmacoeconomics and Formulary Decision Making , 2012, PharmacoEconomics.

[30]  M. Tanner,et al.  Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania. , 2009, Bulletin of the World Health Organization.

[31]  E. Kaale,et al.  Priority setting for the implementation of artemisinin-based combination therapy policy in Tanzania: evaluation against the accountability for reasonableness framework , 2012, Implementation Science.

[32]  S. Abdulla,et al.  The costs, effects and cost-effectiveness of changing the first line drug for the treatment of malaria in Tanzania , 2000 .

[33]  M Sculpher,et al.  A pilot study on the use of decision theory and value of information analysis as part of the NHS Health Technology Assessment programme. , 2004, Health technology assessment.

[34]  A. Anell.  Priority setting for pharmaceuticals. The use of health economic evidence by reimbursement and clinical guidance committees. , 2004, The European journal of health economics : HEPAC : health economics in prevention and care.

[35]  Nancy Fullman,et al.  Global malaria mortality between 1980 and 2010: a systematic analysis , 2012, The Lancet.

[36]  M. Tanner,et al.  The Cost-Effectiveness of Intermittent Preventive Treatment for Malaria in Infants in Sub-Saharan Africa , 2010, PloS one.

[37]  R. Snow,et al.  Impact of Malaria during Pregnancy on Low Birth Weight in Sub-Saharan Africa , 2004, Clinical Microbiology Reviews.

[38]  Grazyna Adamiak,et al.  Methods for the economic evaluation of health care programmes, 3rd ed , 2006 .

[39]  I. Roberts,et al.  Effect of consent rituals on mortality in emergency care research , 2011, The Lancet.

[40]  C. Guerriero,et al.  Giving tranexamic acid to reduce surgical bleeding in sub-Saharan Africa: an economic evaluation , 2010, Cost effectiveness and resource allocation : C/E.

[41]  M. Tanner,et al.  Cluster-randomized study of intermittent preventive treatment for malaria in infants (IPTi) in southern Tanzania: evaluation of impact on survival , 2011, Malaria Journal.

[42]  The selection and use of essential medicines. Report of the WHO Expert Committee, 2002 (including the 12th Model list of essential medicines). , 2003, World Health Organization technical report series.

[43]  K. Ker,et al.  Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. , 2011, The Cochrane database of systematic reviews.

[44]  Pedro Alonso,et al.  Efficacy and safety of intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis of six randomised, placebo-controlled trials , 2009, The Lancet.

[45]  Thomas A. Smith,et al.  Predicting the cost-effectiveness of introducing a pre-erythrocytic malaria vaccine into the expanded program on immunization in Tanzania. , 2006, The American journal of tropical medicine and hygiene.

[46]  B. Robberstad,et al.  Economic Evaluation of Health Interventions: Tanzania Perspectives , 2010 .

[47]  Z. Babar,et al.  Is There A Role For Pharmacoeconomics In Developing Countries? , 2012, PharmacoEconomics.