Improving the quality and efficiency of healthcare services in Ghana through HTA
Creators: name: Kalipso  Chalkidou
name: Joanne  Lord
name: Gad, Mohamed
Publisher: name: F1000 Research Limited
Year: 2018

description: A case for further investment in health cannot be made unless systems are in place to ensure good value for money for every Cedi spent. Identifying in an evidence informed way, opportunities for releasing resources for reinvestment to expand coverage whilst ensuring health outcomes remain the same or improve, is a powerful argument for more and better spending on health in Ghana. This report goes some way towards making the case for an HTA mechanism for strengthening the handle of the Ghanaian authorities over its own budget through tackling a specific case of high spending and high burden area, namely hypertension management. Using Ghanaian data and making all assumptions explicit, this analysis points to areas for improved spending, quantifies potential savings and health gains from reallocation and makes a case for an institutionalised approach to HTA in Ghana, as an important tool for transitioning away from aid and move towards sustainable and affordable Universal Healthcare Coverage.<br><br>A technical working group comprised of UK and Ghanaian members adapted an existing Excel model, initially developed for the 2006 update of the NICE clinical guidelines on hypertension. This model compared the cost-effectiveness of the four main classes of antihypertensive drugs (ACE inhibitors/ ARBs, beta-blockers (BB), calcium channel blockers (CCBs), thiazide-like diuretics (TZD), and no intervention). The model predicted that in the Ghanaian context, diuretics and CCBs would be more effective and less expensive than other drug classes. Compared with no treatment, diuretics cost an additional GH¢ 642 per DALY avoided, while the incremental cost per DALY avoided for CCBs compared with diuretics was much higher at GH¢ 32,482.<br><br>Furthermore, in order to enhance the policy relevance and usefulness of the model to Ghanaian policy makers, the report goes through a number of policy scenarios. The extent to which there are policy levers for acting on them (e.g. drug price), and whether the model could offer credible analytics to back such policy actions were discussed.<br><br>The results show substantial potential for cost savings, if such policy scenarios could be implemented. For instance, a 10% reduction in mean drug cost would yield the greatest savings, over GH¢ 25 million over the first five years. This was followed by 10% prescription shift from CCB to TZD, with five-year savings of over GH¢ 18 million, and 10% shift from ACEi/ARB/BB to TZD yielding 5-year savings of over GH¢ 5 million, not to mention the addition of health benefits following such shift.<br><br>Finally, the findings of this report consider the reallocation of savings from these cost saving scenarios to improve health benefits and coverage in Ghana. For example, providing diuretic treatment to all patients with diagnosed but untreated hypertension would only cost an extra GH¢ 5.9 million over five years, only using a fraction of the savings of above scenarios, as well as yielding a net gain of avoiding over 46,000 extra DALYs.