Developing methods for use of the iDSI Reference Case

By Madeleine Stewart Jan. 23, 2018

Research groups developing methods to support the use of the iDSI Reference Case (RC) for economic evaluation met to discuss work to date at a workshop in Glasgow.

The iDSI RC sets out a principle-based framework as an ‘aid to thinking’ to inform better decision making in health in low-to-middle income countries (LMICs).

Representatives from Imperial College London, University of York, University of Glasgow and London School of Hygiene & Tropical Medicine (LSHTM) presented on:

  • Estimating cost-effectiveness thresholds in LMICs: the example of Indonesia (University of York);
  • Estimating the value of HTA: a mixed methods approach (University of Glasgow);
  • Modelling optimal choice of treatments that rely on shared service delivery platforms: a health system perspective (Imperial College London); and
  • Applying the iDSI RC to infectious disease transmission models and presenting disaggregated social perspectives (London School of Hygiene and Tropical Medicine).

The two-day workshop provided opportunities for the research groups to exchange ideas, obtain input on their progress so far and highlight any challenges. 

The key aim of the research, which was commissioned by iDSI in 2016, is to develop practical methods guidance to be used alongside the iDSI RC. Each of the commissioned academic groups intend to develop detailed research reports and peer-reviewed academic publications. With iDSI support, accessible summaries will be produced targeting key users including policy-makers as well as economic evaluation practitioners.

Opening the presentations on day one, the University of York discussed their work on the evaluation of the impact of public health insurance reforms on infant mortality in Indonesia (using roll-out of public health insurance as a natural experiment). The objective of this work is to feed into an empirical estimate of a cost-effectiveness threshold in the country (using an approach based on opportunity costs).

Eleanor Grieve presented on the University of Glasgow’s work developing a mixed-methods framework to quantify the value of HTA. This work involves an explicit consideration of costs and benefits of implementation of HTA decisions (for instance, inclusion of a new drug or exclusion of a health technology no longer cost-effective). Two frameworks will be combined to address this question: a net health benefit “Return on Investment” and a mixed methods “Realist Evaluation” framework. The team are currently working on an application of this framework using real life data.

Dr Katharina Hauck and Professor Peter Smith from Imperial College London opened day two with a presentation on their work on the intersection between health systems strengthening and cost-effectiveness analyses. Their framework intends to help inform decision-makers on the optimal investments between health system strengthening, such as improving information systems, and other interventions. The team is working on a case study for this framework, which seeks to look at cost-effectiveness of separate and joint provision of home-based testing and counselling for HIV and active case finding for tuberculosis (TB).

Professor Anna Vassall, Michelle Remme and Dr Gabriela Gomez from LSHTM presented their work on taking into account disaggregated societal perspective and equity considerations in economic evaluations. The work on disaggregated societal perspective is important as many interventions conducted in the health sectors will have health and non-health effects and costs (for instance, on education or workforce productivity). The framework, developed by Michelle Remme and Professor Vassal, will lay out the requirements and value positions of different approaches for incorporating non-health consequences. The work on providing guidance to support capturing equity considerations in economic evaluations will focus on applications related to disease-transmission models.

The workshop was chaired by IDSI Senior Adviser Francis Ruiz and took place on 18 and 19 January 2018.