{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T08:42:50Z","timestamp":1780044170124,"version":"3.53.1"},"reference-count":48,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T00:00:00Z","timestamp":1733961600000},"content-version":"unspecified","delay-in-days":346,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int J Technol Assess Health Care"],"published-print":{"date-parts":[[2024]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S0266462324000448_sec01\">\n\t    <jats:title>Background<\/jats:title>\n\t    <jats:p>Constrained resources under universal health coverage (UHC) necessitate a balance between medication costs and essential health system requirements. Policymakers practice priority-setting, as either implicit or explicit rationing, embedded in evidence-informed decision-making processes to guide funding decisions. Health technology assessment (HTA) is a method that may assist explicit evidence-informed priority setting. South Africa developed an official HTA methods guide in 2022, however before this, commissioning and performing economic evaluations was not standardized.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S0266462324000448_sec02\" sec-type=\"methods\">\n\t    <jats:title>Methods<\/jats:title>\n\t    <jats:p>We conducted a descriptive collective case study to explore the impact of economic analyses on the selection of, and access to, essential medicines in South Africa. Four cases were purposefully selected, and both official information and secondary data, including media reports, were reviewed. Data elements were extracted and organized in a matrix. Cases were reported narratively with a positivist epistemological approach, presenting the authors\u2019 reflections.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S0266462324000448_sec03\" sec-type=\"results\">\n\t    <jats:title>Results<\/jats:title>\n\t    <jats:p>We found economic analyses that reflected methodologies described in the HTA guide: international reference pricing, cost-minimization, cost-effectiveness, cost-utility, and budget impact analyses. Economic analyses informing the \u2018resource-use\u2019 domain in the GRADE evidence-to-decision framework supported decision-making, influenced market-shaping with price reductions of interventions through benchmarking (fosfomycin, flucytosine), improved equitable access nationally (flucytosine), and prioritized a defined patient group in a justifiable and transparent manner (bortezomib).<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S0266462324000448_sec04\" sec-type=\"conclusions\">\n\t    <jats:title>Conclusion<\/jats:title>\n\t    <jats:p>A standardized HTA evaluation process guided by a nationally accepted framework is necessary for evidence-informed decision-making. Economic analyses (cost-effectiveness, affordability, and resource use) should be consistently included when making decisions on new interventions.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/s0266462324000448","type":"journal-article","created":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T08:51:29Z","timestamp":1733993489000},"source":"Crossref","is-referenced-by-count":0,"title":["Case studies of health economic analyses informing pharmaceutical health technology assessments for essential medicine selection and public-sector guidelines in South Africa"],"prefix":"10.1017","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2687-7751","authenticated-orcid":false,"given":"Trudy D","family":"Leong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7070-3826","authenticated-orcid":false,"given":"Jacqui","family":"Miot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy","family":"Parrish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Riddin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmina","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Kredo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2024,12,12]]},"reference":[{"key":"S0266462324000448_r19","unstructured":"19. Tomlinson, C. What the approval of flucytosine means for the treatment of cryptococcal meningitis in South Africa. Daily Maverick [Internet]. [2022 Apr 20; cited 2023 May 25]. Available from: https:\/\/www.dailymaverick.co.za\/article\/2022-04-20-flucytosine-in-sa-what-it-means-for-cryptococcal-meningitis-treatment\/."},{"key":"S0266462324000448_r20","unstructured":"20. Tomlinson, C. In-depth: What the approval of flucytosine means for the treatment of cryptococcal meningitis in SA. Spotlight [Internet]. [2022 Apr 19; cited 2023 Nov 6]. Available from: https:\/\/www.spotlightnsp.co.za\/2022\/04\/19\/in-depth-what-the-approval-of-flucytosine-means-for-the-treatment-of-cryptococcal-meningitis-in-sa\/."},{"key":"S0266462324000448_r11","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1017\/S0266462320000215","article-title":"The new definition of health technology assessment: A milestone in international collaboration","volume":"36","author":"O\u2019Rourke","year":"2020","journal-title":"Int J Technol Assess Health Care"},{"key":"S0266462324000448_r25","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(21)00033-5"},{"key":"S0266462324000448_r7","doi-asserted-by":"publisher","DOI":"10.7196\/SAMJ.2020.v110i11.15271"},{"key":"S0266462324000448_r34","unstructured":"34. World Health Organization. Guidelines for the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children [Internet]. [2018; cited 2023 May 10]. Available from: http:\/\/www.who.int\/hiv\/pub\/guidelines\/cryptococcal-disease\/en\/."},{"key":"S0266462324000448_r40","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.02515"},{"key":"S0266462324000448_r16","unstructured":"16. National Department of Health. Rifapentine as part of Isoniazid\u2010rifapentine (3HP) TPT regimen in PLHIV [Internet]. [2019 Nov 14; cited 2023 May 10]. Available from: https:\/\/www.knowledgehub.org.za\/."},{"key":"S0266462324000448_r37","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2013.02.002"},{"key":"S0266462324000448_r4","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17249524"},{"key":"S0266462324000448_r1","unstructured":"1. The World Bank. GDP (current US$) \u2013 Sub-Saharan Africa. [2023, cited 2023 May 10]. Available from: https:\/\/data.worldbank.org\/indicator\/NY.GDP.MKTP.CD?locations=ZG."},{"key":"S0266462324000448_r10","unstructured":"10. National Essential Medicines List Committee, South Africa. Position statement on the relevance of the World Health Organization Model List of Essential Medicines for South African Medicines selection processes, September 2019 [Internet]. [2019 Sep; cited 2023 May 10]. Available from: https:\/\/www.knowledgehub.org.za\/system\/files\/elibdownloads\/2023-02\/NEMLC%20-position%20statement%20on%20WHO%20EML_finalised.pdf."},{"key":"S0266462324000448_r29","unstructured":"29. National Department of Health. Adult review update: Rifapentine as TPT in PLHIV [Internet]. [2016; cited 2023 May 10]. Available from: https:\/\/www.knowledgehub.org.za\/."},{"key":"S0266462324000448_r31","doi-asserted-by":"crossref","first-page":"2292","DOI":"10.1186\/s12889-022-14766-6","article-title":"Cost-effectiveness of 3-months isoniazid and rifapentine compared to 9-months isoniazid for latent tuberculosis infection: A systematic review","volume":"22","author":"Lai","year":"2022","journal-title":"BMC Public Health"},{"key":"S0266462324000448_r24","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(22)00149-9"},{"key":"#cr-split#-S0266462324000448_r8.1","unstructured":"8. South African National Department of Health. Health technology assessment methods guide to inform the selection of medicines to the South African National Essential Medicines List, 2022-2027. [Sep 2023"},{"key":"#cr-split#-S0266462324000448_r8.2","unstructured":"cited 2024 Mar 11]. Available from: https:\/\/knowledgehub.health.gov.za\/elibrary\/health-technology-assessment-hta-methods-guide-inform-selection-medicines-national."},{"key":"S0266462324000448_r18","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06268-9"},{"key":"S0266462324000448_r15","unstructured":"15. National Department of Health. Fosfomycin international price comparison report [Internet]. [2016 Feb 23; cited 2023 May 10]. Available from: https:\/\/www.knowledgehub.org.za\/."},{"key":"S0266462324000448_r3","unstructured":"3. Health Policy Project. Health financing profile: South Africa. Health Policy Project [Internet]. [2016 May; cited 2023 Nov 6]. Available from: https:\/\/www.healthpolicyproject.com\/pubs\/7887\/SouthAfrica_HFP.pdf."},{"key":"S0266462324000448_r9","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating the quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"S0266462324000448_r5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)13375-2"},{"key":"S0266462324000448_r12","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12913-016-1946-9","article-title":"Selection of essential medicines for South Africa \u2013 An analysis of in-depth interviews with national essential medicines list committee members","volume":"17","author":"Perumal-Pillay","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"S0266462324000448_r6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.19459"},{"key":"S0266462324000448_r21","unstructured":"21. OANDA. OANDA currency converter: OANDA average exchange rate [Internet]. [2023\u20132024; cited 2023 May 10\/ 2024 Mar 16]. Available from: https:\/\/www.oanda.com\/currency-converter\/en\/."},{"key":"S0266462324000448_r13","unstructured":"13. Republic of South Africa [Internet]. National Health Insurance Act No. 20 of 2023, 16 May 2024 [2024; cited 2024 May]. Available from: https:\/\/www.parliament.gov.za\/storage\/app\/media\/Acts\/2023\/Act_20_of_2023_National_Health_Insurance.pdf."},{"key":"S0266462324000448_r30","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.14024"},{"key":"#cr-split#-S0266462324000448_r2.1","unstructured":"2. Council for Medical Schemes. Council for Medical Schemes annual report, 2021\/2 [Internet]. [2022"},{"key":"#cr-split#-S0266462324000448_r2.2","unstructured":"cited 2023 May 10]. Available from: https:\/\/www.medicalschemes.co.za\/ https:\/\/www.medicalschemes.co.za\/."},{"key":"S0266462324000448_r23","unstructured":"23. National Department of Health. Single Exit Price database [Internet]. [2023 Dec; cited 2024 Mar 16]. Available from: https:\/\/www.health.gov.za\/."},{"key":"S0266462324000448_r43","unstructured":"43. Republic of South Africa, National Treasury. Budget review, 2024. [2024 Feb 21, cited 16 Mar 2024]. Available from: https:\/\/www.treasury.gov.za\/documents\/National%20Budget\/2024\/review\/FullBR.pdf."},{"key":"S0266462324000448_r36","unstructured":"36. National Department of Health. Public sector price for flucytosine 500mg, 100 tablets: Contract circular HP02-2023AI [Internet]. [2023 Oct; cited 2023 Nov 6]. Available from: https:\/\/www.health.gov.za\/."},{"key":"S0266462324000448_r35","doi-asserted-by":"crossref","first-page":"e143","DOI":"10.1016\/S1473-3099(18)30493-6","article-title":"Leave no one behind: Response to new evidence and guidelines for the management of cryptoscoccal meningitis in low-income and middle-income countries","volume":"19","author":"Loyse","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"S0266462324000448_r39","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31594-X"},{"key":"S0266462324000448_r28","first-page":"CD000171","article-title":"Treatment of latent tuberculosis infection in HIV infected persons","author":"Akolo","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"S0266462324000448_r14","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/1471-2288-11-100","article-title":"The case study approach","volume":"11","author":"Crowe","year":"2011","journal-title":"BMC Med Res Methodol"},{"key":"S0266462324000448_r22","unstructured":"22. National Department of Health. Public-sector price for fosfomycin 3g sachet: Contract circular HP02-2023AI\/01 [Internet]. [2023; cited 2023 Mar 16]. Available from: https:\/\/www.health.gov.za\/."},{"key":"S0266462324000448_r33","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1710922"},{"key":"S0266462324000448_r44","doi-asserted-by":"crossref","first-page":"111241","DOI":"10.1016\/j.jclinepi.2023.111241","article-title":"GRADE concept 7: Issues and insights linking guideline recommendations to trustworthy essential medicine lists","volume":"166","author":"Piggott","year":"2024","journal-title":"J Clin Epidemiol"},{"key":"S0266462324000448_r41","first-page":"1309","article-title":"International reference pricing for prescription drugs: A landscape analysis","volume":"27","author":"Rand","year":"2021","journal-title":"J Manag Care Spec Pharm"},{"key":"S0266462324000448_r46","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-020-00647-0"},{"key":"S0266462324000448_r42","unstructured":"42. Republic of South Africa, National Treasury. National Budget, 2022 \u2013 Vote 18. Health. Budget summary. 2022\/23 [Internet]. [2022; cited 2023 May 10]. Available from: https:\/\/www.treasury.gov.za\/."},{"key":"S0266462324000448_r45","unstructured":"45. Republic of South Africa. Public Finance Management Act, 1 of 1999 [Internet]. [1999; cited 2023 May 10]. Available from: https:\/\/www.treasury.gov.za\/legislation\/pfma\/act.pdf."},{"key":"S0266462324000448_r26","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-007124"},{"key":"S0266462324000448_r27","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01245-2015"},{"key":"S0266462324000448_r32","unstructured":"32. National Department of Health. Contract circular HP02-2021AI\/01 [Internet]. [2021; cited 2023 May 10]. Available from: https:\/\/www.health.gov.za\/."},{"key":"S0266462324000448_r17","unstructured":"17. National Department of Health. Rapid review of Economic Evaluation literature and a basic cost-effectiveness analysis: Bortezomib as induction for Multiple Myeloma for transplant eligible population [Internet]. [2021 Mar 25; cited 2023 May 25]. Available from: https:\/\/www.knowledgehub.org.za\/."},{"key":"S0266462324000448_r38","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-02-408922"}],"container-title":["International Journal of Technology Assessment in Health Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0266462324000448","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T08:51:49Z","timestamp":1733993509000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0266462324000448\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024]]}},"alternative-id":["S0266462324000448"],"URL":"https:\/\/doi.org\/10.1017\/s0266462324000448","relation":{},"ISSN":["0266-4623","1471-6348"],"issn-type":[{"value":"0266-4623","type":"print"},{"value":"1471-6348","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024]]},"article-number":"e76"}}