The methods of economic evaluation and HTA should be based on best practices and standards, tailored to unique country contexts that can be systematically applied to inform decisions. This paper outlines standards for the conduct of economic evaluations for HTA in Ghana.

A five-step process was followed to develop the HTA reference case as a methodological and reporting benchmark. These include (a) a review of literature and evidence synthesis, (b) a review of country policies, (c) a review and adaption of international frameworks, (d) expert/stakeholder consultations, and (e) the development of a methodological framework. A series of stakeholder consultations were done to refine, finalize, and validate the outcomes of the processes to generate a finalized reference case.

The Ghana reference case is made up of 14 components comprising: evidence synthesis, evaluation type, perspectives on cost, perspectives of outcomes, choice of comparator, data sources, outcome measures, discount rate, uncertainty, equity considerations, time horizon, heterogeneity, transparency, and budget impact. These provide methodological considerations and reporting requirements for economic evaluations for HTA. It provides a framework to ensure the best research methods are adopted to harmonize the evidence-generation process with the expectations of policy and decision-makers and ensure that policy decisions are based on uniform evidence.

Recommendations set out in this reference case when followed can provide context-specific evidence to support a rigorous and transparent system for evaluating healthcare interventions and technologies. It will support decision-making, ultimately improving the quality and efficiency of healthcare delivery in the country.

There is a need to consider whether treatments included in essential medicine lists, standard treatment guidelines, and health benefits packages are cost effective, improve financial sustainability, and increase equitable access to health care. This assessment evaluated the cost effectiveness of selected antidiabetic medicines for inclusion on Ghana’s Essential Medicines List and updated standard treatment guidelines, and reimbursement by the National Health Insurance Authority.

This study was produced in line with the broad steps of the Ghana health technology assessment (HTA) process guideline using an adaptive HTA (aHTA) approach and following the process used by the National Cancer Grid of India. High quality HTA evidence was sourced from four HTA agencies based on the population (children aged two years or older and adults older than 18 years using antidiabetics), intervention, comparator, and outcomes framework using an adaptability checklist developed by the researchers. A price benchmarking analysis was conducted to generate context relevant evidence on medicine prices in terms of local value for money.

The study found that all medicines evaluated (sitagliptin, vildagliptin, saxagliptin, insulin detemir, insulin degludec, insulin glargine, insulin glusiline, insulin aspart, and insulin lispro) were efficacious. The price benchmark analysis showed that insulin detemir, glargine, and degludec had higher price ratios than their comparators, and an annual drug cost per patient that was approximately two to four times higher. Insulin lispro, aspart, and glulisine had price ratios of 0.22 to 0.44 and an estimated annual cost of GHS1,894 to GHS3,552 (USD163.3 to USD306.2), which was two to five times higher per patient than the comparators. The cost of saxagliptin and vildagliptin were four and three times lower than those in the benchmark country (the UK).

The study revealed that all medicines included are efficacious and potentially cost effective. The price benchmark analysis showed that, except for gliclazide 80 mg, Ghana is paying less for antidiabetic medications than the UK. Cost effectiveness may not be a sufficient basis to include or exclude medicines for reimbursement because they have a potentially significant budget impact for the payer.

In Ghana, the reimbursement of iron polymaltose complex (IPC) for iron-deficiency anemia treatment raises concerns as a potential cost driver for the National Health Insurance Scheme (NHIS). Prioritizing value for money is crucial for NHIS sustainability. With Ghana’s established health technology assessment (HTA) framework, we provide insights and preliminary findings in this case study on anemia treatment.

To further support institutionalization, we follow the Ghana HTA process guidelines and Ghana HTA reference case. Simultaneously, to build wider capacity for HTA in Ghana, relatively new trained staff was engaged while anchoring the team at the HTA Secretariat from the Ministry of Health. We started a situational analysis, which includes desktop review and key-stakeholder interviews. An umbrella review was commenced simultaneously to identify systematic reviews assessing clinical effectiveness of IPC compared to other medicines on the essential medicine lists for all population groups. We will assess cost-effectiveness to ultimately inform coverage decisions and possible implications for organizational structures.

Anemia is a persistent public health issue in Ghana, impacting children under five, young women, and expectant mothers. The essential medicine list includes various treatments, but ambiguity exists in the standard treatment guidelines regarding when to administer IPC versus alternative medicines. Under the NHIS, the intravenous formulation of IPC stands out as the most expensive treatment. A systematic review identified three papers, focusing on infants, children, adults, and pregnant women. Preliminary findings suggest weak overall evidence supporting IPC’s superiority, although adults may exhibit higher tolerance for IPC compared to alternative treatments.

Conducting an HTA on anemia treatments, despite the low treatment costs, is still significant as technical efficiencies can be achieved with high-volume drugs by analyzing prescription patterns and generating evidence to support potential changes. Findings from this HTA can be used elsewhere, especially in resource-constrained settings. Next steps involve finalizing the HTA and disseminating results to stakeholders.

Coverage of childhood cancer treatment under the Ghanaian National Health Insurance Scheme (NHIS) has been a policy discussion recently. To improve priority setting, Ghana introduced and used health technology assessment (HTA) processes to guide the resource allocation. To understand the role of stakeholders throughout the HTA lifecycle and for this decision, a stakeholder mapping and engagement was undertaken. We share our results of this mapping and analysis for improving management and financing of childhood cancers in Ghana.

We used two main approaches; first, we undertook a systematic policy documents and literature review of stakeholders relevant in childhood cancer management and financing in Ghana. This was followed by a stakeholder engagement workshop of key stakeholders from the Ministry of Health, Ghana Health Service (GHS), National Health Insurance Authority (NHIA), academia, non-governmental organizations (NGOs), private sector, teaching hospitals, patient groups, and civil society organizations. Participation was done in-person and virtual. Questions were moderated using a focus group discussion approach where responses were recorded. Data were analysed using synthesis and development of themes. Mapping of stakeholders was done using Mendelow’s power-interest grid.

The mapping identified eight key stakeholders in different roles: policy makers (Ministry of Health), payer (NHIA), healthcare providers (teaching hospitals, GHS, private hospitals), pharmaceutical companies, patient group (Ghana Parents Association for Childhood Cancers), and advocacy group (NGOs). Analysis showed that power and interest are concentrated with Ministry of Health and NHIA primarily because of control over resources. Also, while healthcare providers, patient groups, and advocacy groups have high interest, their power ranges from low to moderate. Further analysis of data from the workshop revealed that inability to pay for high cost of treatment leads to treatment abandonment. Payment for treatment was mainly out-of-pocket and by donation from philanthropist.

There was a strong will from stakeholders to extend coverage of the NHIS to childhood cancers in Ghana. Stakeholder engagement is a powerful tool and should be an integral part of every HTA process.