Adapting Pharmacoeconomics To Shape Efficient Health Systems En Route To Uhc - A Conceptual Framework

Abstract

Today, many countries are in some stage of implementing or using pharmacoeconomics to improve patient and health system outcomes. This conceptual paper aims at identifying the factors that determine the design and applications of the pharmacoeconomic toolkit in different health systems internationally. With a focus on methodological alternatives and different approaches towards integrating and institutionalising pharmacoeconomics within health systems, the paper seeks to provide guidance on processes for the design, implementation and optimisation of pharmacoeconomics as a steering tool within a health system under the universal health coverage (UHC) paradigm. The design of the underlying conceptual framework is based on a review of international literature as well as on policy observations and case studies. The paper analyses ways in which the choice of pharmacoeconomic instruments, their mode and timing of introduction and embedding in an overarching regulatory framework have been shaped by factors that fall into two spheres: health systems characteristics on the one hand and specific contextual factors on the other. The very distinct case studies of South Africa and Germany inform the identification of these determinants and guide the analysis of their influence on forming pharmacoeconomic policy and practice in different contexts. The case studies also serve to illustrate the relevance of particular policy decisions by highlighting the dynamic dimension of decisions made in the case study countries, e.g. regarding certain elements of the General Methods of the German Institute for Quality and Efficiency in Health Care and of the South African National Department of Health’s pharmacoeconomic guidelines. The paper concludes with a structured analytical overview of determinants, designs and implications. The findings are used to spell out clear recommendations for a context-sensitive process towards optimising pharmacoeconomic policy and practice in specific country contexts with a view to UHC.