Conduct Cost-effectiveness Analyses Research Articles

How Consistent is the Relationship between Improved Glucose Control and Modelled Health Outcomes for People with Type 2 Diabetes Mellitus?a Systematic Review.

BackgroundThere are an increasing number of studies using simulation models to conduct cost-effectiveness analyses for type 2 diabetes mellitus.ObjectiveTo evaluate the relationship between improvements in glycosylated haemoglobin (HbA1c) and simulated health outcomes in type 2 diabetes cost-effectiveness studies.MethodsA systematic review was conducted on MEDLINE and EMBASE to collect cost-effectiveness studies using type 2 diabetes simulation models that reported modelled health outcomes of blood glucose-related interventions in terms of quality-adjusted life-years (QALYs) or life expectancy (LE). The data extracted included information used to characterise the study cohort, the intervention’s treatment effects on risk factors and model outcomes. Linear regressions were used to test the relationship between the difference in HbA1c (∆HbA1c) and incremental QALYs (∆QALYs) or LE (∆LE) of intervention and control groups. The ratio between the ∆QALYs and ∆LE was calculated and a scatterplot between the ratio and ∆HbA1c was used to explore the relationship between these two.ResultsSeventy-six studies were included in this research, contributing to 124 pair of comparators. The pooled regressions indicated that the marginal effect of a 1% HbA1c decrease in intervention resulted in an increase in life-time QALYs and LE of 0.371 (95% confidence interval 0.286–0.456) and 0.642 (95% CI 0.494–0.790), respectively. No evidence of heterogeneity between models was found. An inverse exponential relationship was found and fitted between the ratio (∆QALY/∆LE) and ∆HbA1c.ConclusionThere is a consistent relationship between ∆HbA1c and ∆QALYs or ∆LE in cost-effectiveness analyses using type 2 diabetes simulation models. This relationship can be used as a diagnostic tool for decision makers.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-016-0466-0) contains supplementary material, which is available to authorized users.

A cardiovascular disease policy model: part 2—preparing for economic evaluation and to assess health inequalities

ObjectivesThis is the second of the two papers introducing a cardiovascular disease (CVD) policy model. The first paper described the structure and statistical underpinning of the state-transition model, demonstrating how...

Making Sense of Methods and Measurement: Cost-Effectiveness Research

The evidence is in and high quality simulation activities can provide an effective alternative to traditional clinical experiences (Hayden, Smiley, Alexander, KardongEdgren, & Jeffries, 2014). Research in nursing and health science education overwhelmingly supports the use of simulation for improving a variety of student and patient outcomes. However, few studies include costeffectiveness or cost-benefit analyses of simulation activities (Zendejas, Wang, Brydges, Hamstra, & Cook, 2013). The question remains, ‘‘Do the effects of clinical simulation outweigh the costs?’’ To answer this simple yet challenging question, simulation researchers need to adopt new methods for assessing the effectiveness and the costs associated with simulation (Zendejas, Wang, Brydges, Hamstra, & Cook, 2013). Previously, in Making Sense of Methods and Measurement ,w e underscored the importance of conducting, ‘‘rigorous research that produces valid and reliable data about the effectiveness of clinical simulation’’ (Prion & Adamson, 2012, p. e193). It is equally important to produce evidence describing the costs associated with clinical simulation. Accurately demonstrating both sides of this costeffectiveness equation is the only way nurse educators will be able to provide maximum effectiveness with limited resources. Although cost-effectiveness research is a specialty of its own and the intricacies of the calculations involved are beyond the scope of this column, we hope to inspire readers with a brief explanation and a few resources for conducting cost-effectiveness analyses as a part of their own research. The basic idea behind cost-effectiveness research involves (a) calculating the costs associated with the intervention (simulation), (b) calculating the effectiveness of the intervention, and then (c) comparing the costs and effectiveness to draw conclusions about the value of the intervention. Figure illustrates an example of this comparison.

University-Based Smoking Cessation Program Through Pharmacist-Physician Initiative: An Economic Evaluation.

Annually, especially in poor resourced countries, significant amount of money is spent to treat chronic diseases. The money instead could be saved by spending on health promotion programs for preventing chronic diseases. To conduct cost-effectiveness analysis of various intervention modules in the "Smoking Cessation" program conducted in Universiti Sains Malaysia (USM). This was an observational study design. Cost-effectiveness analysis was used to assess the costs and outcomes of the intervention. Data were collected retrospectively from medical records of all clients (n= 129) and then all the participants were followed-up for at least 6 months from the date of participation. Data were analysed descriptively using frequency (%) and mean (sd). Kolmogorov-Smirnov test was carried out to test for normality. Chi-square and Kruskal-Wallis tests were used at alpha level of 0.05. All analyses were done using SPSS version 19. The findings of the study showed that the majority of participants were Malays (n= 108; 83.7%), males (n= 128; 99.2%), USM's staff (n= 71; 55.0%) and within an age group of 23 years or less (n= 38; 29.5%). Among those who successfully quit were male (n= 30; 100%), Malays (n= 29; 96.7%), staff (n= 19; 63.3%), moreover, their age ranged from 35 to 56-year-old (n= 15; 50.0%). Further analysis of data showed that there were significant associations between success rate and modules of intervention, occupation, motivation factors, and frequency of counselling. Total cost of the Smoking Cessation Program was MYR 38,634.66 (during a period of 34.5 months), with a success rate equal to 29.1%. The most cost-effective module of intervention was counselling alone (CE ratio equal to MYR360.00 per 1% of success rate). The study found counselling with patch was ineffective during the study period. Counselling alone module was the most cost-effective in Smoking Cessation program conducted in USM, Malaysia.

Incorporating Life-Cycle Price Modelling into Pharmaceutical Cost-Effectiveness Evaluations

Why might the launch price of a new drug be a poor indicator of future expenditure for a drug? Which are the factors that determine the future prices and market shares of a drug? Understanding the answers to these questions can be crucial when conducting cost-effectiveness analyses i.e. when studying if it is desirable to publicly fund reimburse a new drug. This paper models and studies the price of a new drug along its life-cycle, from launch to discontinuation, to understand how the price of the drug evolves and to help inform cost-effectiveness evaluations.

Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes Zoster

IntroductionVaricella zoster virus (VZV) is the etiological agent of varicella and herpes zoster (HZ). It has been hypothesised that immune boosting of latently infected persons by contact with varicella reduces the probability of HZ. If true, universal varicella vaccination may increase HZ incidence due to reduced VZV circulation. To inform decision-making, we conduct cost-effectiveness analyses of varicella vaccination, including effects on HZ. MethodsEffects of varicella vaccination are simulated with a dynamic transmission model, parameterised with Dutch VZV seroprevalence and HZ incidence data, and linked to an economic model. We consider vaccination scenarios that differ by whether or not they include immune boosting, and reactivation of vaccine virus. ResultsVaricella incidence decreases after introduction of vaccination, while HZ incidence may increase or decrease depending on whether or not immune boosting is present. Without immune boosting, vaccination is expected to be cost-effective or even cost-saving. With immune boosting, vaccination at 95% coverage is not expected to be cost-effective, and may even cause net health losses. ConclusionsCost-effectiveness of varicella vaccination depends strongly on the impact on HZ and the economic time horizon. Our findings reveal ethical dilemmas as varicella vaccination may result in unequal distribution of health effects between generations.

Treating Urge Incontinence in Older Women: A Cost-Effective Investment in Quality-Adjusted Life-Years (QALY)

Objectives. To conduct cost-effectiveness analyses of urge incontinence treatments for older women. Methods. Decision-analytic models assessed three treatment pathways: (1) limited behavioral therapy (LBT); (2) full behavioral therapy (FBT) with biofeedback; and (3) drug (DRUG), with allowances for crossover options following initial treatments. Model inputs were gathered from published data. Cost data were based on third party payer reimbursement. Outcomes were measured as the number of incontinence episodes avoided and quality-adjusted life years gained (QALYs). Results. At baseline values costs per QALY gained ranged from US$3696 to $10609. LBT was the least costly with the lowest benefit. Switching from LBT to FBT, with the greatest gain, was $415 per additional QALY. DRUG was the most expensive option. Sensitivity analyses showed that only small changes in key inputs were required for DRUG to generate greater gains than FBT. Medication costs had to fall substantially for DRUG to be cost competitive. Conclusion. All treatment strategies provide QALYs gains at a bargain price, compared to the standard of US$50,000 per QALY gained. No single treatment strategy dominated under all conditions. Clinicians should offer multiple treatment options to older women with urge incontinence.

Cost-Effectiveness of Treatment and Secondary Prevention of Acute Myocardial Infarction in India: A Modeling Study

BackgroundCardiovascular diseases are the single largest cause of death in India, with acute myocardial infarction (AMI) accounting for one-third of all heart disease deaths. Although effective treatment is available for AMI, access to treatment is dictated by cost and ability to pay. With scarce treatment resources, healthcare decisions are guided by local cost-effectiveness, for which country-level data are lacking. ObjectivesWe calculate the cost-effectiveness of policies that expand the use of aspirin, injection streptokinase, beta-blockers, angiotensin-converting enzyme inhibitors, and statins for the treatment and secondary prevention of AMI in India. We also estimate the cost-effectiveness of a hypothetical polypill (combining aspirin, beta blockers, angiotensin-converting enzyme inhibitors, and statins) for secondary prevention. MethodsWe conduct cost-effectiveness analyses of AMI treatment and secondary prevention for patients with previous coronary heart disease events in India. We estimate coronary heart disease events using Framingham risk scores and disease prevalence using a cohort ordinary differential model. Other parameter estimates are from the literature. Polypill treatment is assumed to cost less than the additive cost of all 4 oral medications, but it is not assumed to increase adherence. We conduct a Latin hypercube sampling sensitivity analysis on the model parameters. ResultsIncreasing coverage of AMI treatment with aspirin and streptokinase would be cost-effective and could avert approximately 335,000 (191,000 to 503,000) disability-adjusted life years among 30- to 69-year-olds in India. Secondary prevention with aspirin and beta-blockers at 80% coverage (and at lower rates) would be highly cost-effective, and the addition of angiotensin-converting enzyme inhibitors would also be cost-effective. Introducing the polypill dominates a strategy of a 4-drug regimen with the aforementioned drugs and statins. The cost-effectiveness ratio of 80% coverage with the polypill would be $1,690 ($1,220 to $2,410) per disability-adjusted life years averted. ConclusionsPolicies expanding both treatment and preventive therapies are cost-effective, based on gross domestic product per capita comparison. Introducing the polypill would be more effective than providing its components separately, even without accounting for the likely increase in treatment adherence.

Do Changes in Drug Coverage Policy Point to an Increased Role for Cost-Effectiveness Analysis in the USA?

Compared with other countries, cost-effectiveness analysis has traditionally had a limited role in US health care. Rather, US payers have typically accommodated the introduction of expensive technology by passing an increasing proportion of costs to patients, through raising insurance premiums and/or by increasing copayments, coinsurance, and deductibles. However, in what may prove to be a tipping point, the two largest pharmacy benefit managers have chosen to exclude drugs from their formularies that offer uncertain health benefit compared with cheaper alternatives. This paper argues that cost-effectiveness analysis should be used to inform these value-based decisions, and that by using information other than robust cost-effectiveness evidence, payers risk wrongly denying beneficiaries access to important medical technologies. If cost-effectiveness analysis were to be used in this way, it would be another in a growing number of examples of its use across public and private payers. In the absence of a centralized agency conducting cost-effectiveness analysis, the recently inaugurated 2nd Panel on Cost-Effectiveness in Health and Medicine has an important role to play in standardizing methods and promoting best practice.

Cost-Effectiveness of Linezolid versus Vancomycin among Patients with Methicillin-Resistant Staphylococcus aureus Confirmed Nosocomial Pneumonia in China

ObjectiveTo estimate the cost-effectiveness of intravenous linezolid as a first-line agent against intravenous vancomycin in treating methicillin-resistant Staphylococcus aureus–confirmed nosocomial pneumonia in four Chinese cities. MethodsA decision-analytic model of 4-week time horizon was used to conduct cost-effectiveness analyses from the payer’s perspective. Clinical outcomes and resource use data were derived from a head-to-head trial, supplemented with local cost estimates based on hospital data via an expert panel. A series of scenario analyses were conducted to evaluate the impact of uncertainty around model inputs. All results were reported in 2012 Chinese Renminbi. ResultsThe predicted probability of overall treatment success was 0.629 and 0.602 for linezolid and vancomycin, respectively. Total inpatient costs varied across the four cities, ranging from ¥58,835 to ¥86,894 for linezolid and ¥58,390 to ¥87,033 for vancomycin, respectively. Linezolid was demonstrated to be a dominant treatment strategy in Guangzhou. In Beijing, Nanjing, and Xi’an, incremental cost-effectiveness ratios in terms of additional successfully treated patient were ¥1,861, ¥163, and ¥16,509, respectively. Dominance by linezolid was observed in some scenario analyses with parameters such as treatment duration, inclusion of cost of managing adverse events, and drug acquisition costs being the main drivers of cost-effectiveness results. ConclusionsDespite linezolid’s higher drug acquisition cost, its superior clinical efficacy renders it a likely cost-effective alternative for the treatment of methicillin-resistant Staphylococcus aureus–confirmed nosocomial pneumonia as compared with branded vancomycin from the payer perspectives of Beijing, Guangzhou, Nanjing, and Xi’an.

A mapping algorithm of health preferences from EORTC QLQ C30 to health utility index mark 3 (HUI3) in advanced colorectal cancer.

547 Background: The National Cancer Institute of Canada CO17 study, which showed that patients with advanced colorectal cancer had improved overall survival and derived health related quality of life benefits (measured with EORTC QLQ C30) when treated with cetuximab, collected health preferences with HUI3 prospectively. We examined the relationship between baseline health utilities and quality of life, and constructed a mapping algorithm to derive health utilities from EORTC QLQ C30. Methods: Data from 545 patients including baseline characteristics (age, gender, treatment arm, K-ras, ECOG PS, etc.), health preferences (HUI3), EORTC QLQ C30 five function scales, a two-item global health status (GHS) scale, three symptom scales, and six single items were obtained from the CO17 dataset. Correlations among HUI3 and EORTC QLQ C30 scales and baseline characteristics were examined. Multivariable linear regression model was constructed to develop a mapping algorithm to derive HUI3 from EORTC QLQ C30 scales and/or baseline characteristics. Leave-one-out cross validation (LOOCV) mean absolute error (MAE) and root mean square error (RMSE) were calculated to examine predictive ability. Results: The mean HUI3 was 0.717 (SD = 0.235). HUI3 was significantly correlated with baseline ECOG PS, number of disease sites and the presence of liver metastasis, but not with age, gender, treatment arms or K-ras. HUI3 was also significantly correlated with all EORTC QLQ C30 scales except the diarrhea scale. Multivariable regression showed that HUI3 remained significantly associated with four of the five functional scales (physical, role, cognitive and emotional), the pain scale and the GHS scale. A mapping algorithm consisting of these 6 scales resulted in a model with an adjusted R2 of 0.61, and LOOCV mean error of -0.00014, MAE of 0.11, and RMSE of 0.15. Conclusions: Health preferences as measured by HUI3 are significantly associated with HRQL as measured by EORTC QLQ C30 in patients with advanced refractory colorectal cancer. Our mapping will allow for the generation of health preference values in advanced colorectal cancer when only EORTC QLQ C30 results exist in order to conduct cost-effectiveness analysis.

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Transformation of Markov Models for Cost-Effectiveness Analysis into the System Dynamics Methodology

Markov cohort models are one of the standard methodologies for conducting cost-effectiveness analyses of health care interventions of chronic diseases. The system dynamics (SD) approach, where a model consists of stocks and their interconnecting flows, is rarely used, but in principle it can be used to conduct the same type of analysis. The authors show that a simple transformation from the transition probabilities of a Markov model to relative rates always leads to an equivalent system dynamics model. Here the stocks match the Markov states, because they store the same number of patients as in the corresponding state. The authors demonstrate an approach on an exemplary cost-effectiveness analysis for a smoking cessation programme for chronic obstructive pulmonary disease (COPD) with a simplified Markov model based on Menn (2009). Both the Markov model and the system dynamics model lead to nearly identical results. However, the latter offers more flexibility as it can incorporate interactions between different patient groups.

Modelling the Cost Effectiveness of Disease-Modifying Treatments for Multiple Sclerosis

Several cost-effectiveness models of disease-modifying treatments (DMTs) for multiple sclerosis (MS) have been developed for different populations and different countries. Vast differences in the approaches and discrepancies in the results give rise to heated discussions and limit the use of these models. Our main objective is to discuss the methodological challenges in modelling the cost effectiveness of treatments for MS. We conducted a review of published models to describe the approaches taken to date, to identify the key parameters that influence the cost effectiveness of DMTs, and to point out major areas of weakness and uncertainty. Thirty-six published models and analyses were identified. The greatest source of uncertainty is the absence of head-to-head randomized clinical trials. Modellers have used various techniques to compensate, including utilizing extension trials. The use of large observational cohorts in recent studies aids in identifying population-based, 'real-world' treatment effects. Major drivers of results include the time horizon modelled and DMT acquisition costs. Model endpoints must target either policy makers (using cost-utility analysis) or clinicians (conducting cost-effectiveness analyses). Lastly, the cost effectiveness of DMTs outside North America and Europe is currently unknown, with the lack of country-specific data as the major limiting factor. We suggest that limited data should not preclude analyses, as models may be built and updated in the future as data become available. Disclosure of modelling methods and assumptions could improve the transferability and applicability of models designed to reflect different healthcare systems.

Long-Term Cost-Effectiveness Model of Interferon Beta-1b in the Early Treatment of Multiple Sclerosis in the United States

BackgroundMultiple sclerosis (MS) is a potentially debilitating autoimmune disease that affects the brain and spinal cord. Disease-modifying therapies have been shown to slow disease progression but were not believed to prolong the survival of patients with MS. The recent 21-Year Long-Term Follow-Up (21Y-LTF) study found a significant survival advantage for patients receiving early treatment with interferon beta (IFNβ)-1b compared with placebo (no early treatment). ObjectivesThe aim of this study was to conduct cost-effectiveness analyses estimating the long-term benefit of early treatment with IFNβ-1b among MS patients from a US societal perspective. MethodsA Markov model was developed to simulate the experience of patients with MS from the 21Y-LTF study over a lifetime. Patients were randomized to receive either IFNβ-1b or placebo for up to 5 years and then receive a variety of MS treatments (including no treatment) thereafter. Survival data reported from the 21Y-LTF study were incorporated into the model. The model assumes that patients' MS was managed in similar ways for both groups during the uncontrolled phase of the 21Y-LTF study (ie, survival difference between the 2 groups is the result of early use of IFNβ-1b). Health outcomes were life-years and quality-adjusted life-years (QALYs). Costs included treatments, direct disease management, informal care, and lost productivities and were reported in 2011 US dollars. ResultsIn the modeled placebo group, the median age at death was predicted to be 63.7 years, and the median survival time from disease onset was 36.7 years. Early treatment with IFNβ-1b reduced the lost health benefits by 2.8 life-years and 1.9 QALYs, respectively, after discounting. Total discounted cost for IFNβ-1b–treated patients was $86,223 higher than that of patients receiving placebo. The incremental cost-effectiveness ratio was $46,357 per QALY gained and $30,967 per life-year gained. Sensitivity analyses indicate the robustness of the model's results. ConclusionsTreatment with IFNβ-1b during the earlier disease phase of patients with MS significantly increased patient life-years and QALYs. IFNβ-1b is likely to be a cost-effective intervention for MS.

A Study of Consuming Behaviors of Budget Coffee

This research aims to explore the benefits of budget coffee shop chains pursued by the consumers, conduct cost effectiveness analysis on product purchases, compare the differences between the different types of consumer characteristics, and attempt to conduct an in-depth analysis on the budget coffee shop chains’ current situations and their relation with consumer behavior. The source of the research sample is 480 randomly selected consumers in Taichung, including 168 males and 312 females. The data was collected via a closed questionnaire, and the linear relationships for basic individual information and consumer behavior in regards to consumer consideration and characteristics were tested via the SPSS version 12.0 of hierarchical regression. The results showed that, amongst elements of consumer considerations, ‘server friendliness’ seems to be most important, and ‘media advertising’ seems to be the least important. As for consumer characteristics, ‘personal preference’ is most important, and ‘coffee has already become a part of life’ is the least important. As indicated from the regression analysis, consumers with monthly incomes between NT$20,000 and NT$30,000 have significantly higher consumer characteristics than consumers with monthly incomes of lower than NT$20,000. Moreover, consumers with steady jobs possess significantly higher consumer characteristics than consumers without jobs. Consumers purchasing more than once a week have higher consumer characteristics than those who make purchases less than once a week, and weekday consumers have significantly higher consumer characteristics than weekend consumers.

PCV17 Cost-Effectiveness Analysis of Bosentan and Sildenafil Compared with Standard therapy in Treatment of Primary Pulmonary Arterial Hypertension in Russian Federation

To conduct cost-effectiveness analysis of bosentan and sildenafil compared with standard therapy (ST, i.e. calcium channel blockers and warfarin) in treatment of primary pulmonary arterial hypertension (PAH) in Russian Federation. We undertook cost-effectiveness analysis of bosentan (62.5 mg bid during first 4 weeks and 125 mg bid further) and sildenafil (25 mg tid) and estimated incremental cost-effectiveness ratios (ICER) for each drug vs ST. A cohort of 20 patients with PAH, functional class (FC) III was simulated in a model. The patients either received bosentan+ST, or sildenafil+ST, or ST only. The number of patients whose health state improves by one FC was considered a criterion of efficacy. Costs of hospitalization, standard therapy medications, and investigational drugs were calculated in the model. Data on clinical efficacy of bosentan, sildenafil, and ST were extracted from clinical trials. Patient's treatment scheme considered in the model was based on the results of peer interview. In our model treatment with bosentan was the most effective: 9 of 20 patients versus 6 and 2 of 20 patients who had improved by one FC with bosentan, sildenafil and ST, respectively. Also, the highest overall costs were in the bosentan group: 1,163,948 USD per 20 patients per year. Overall costs in case of sildenafil and standard therapy were 724,520 and 57,969 USD per group per year, respectively. However, comparison of bosentan with ST yielded lower ICER than comparison of sildenafil with ST: 157,997 and 166,638 USD per one patient with improvement by one FC, respectively. Trend in the results remained the same with bosentan price up to 4400 USD per pack in one-way sensitivity analysis. The results of this study suggest that treatment of FC III PAH with bosentan is more preferable than treatment with sildenafil.

Cost-Effectiveness Analysis in Markets with High Fixed Costs

We consider how to conduct cost-effectiveness analysis when the social cost of a resource differs from the posted price. From the social perspective, the true cost of a medical intervention is the marginal cost of delivering another unit of a treatment, plus the social cost (deadweight loss) of raising the revenue to fund the treatment. We focus on pharmaceutical prices, which have high markups over marginal cost due to the monopoly power granted to pharmaceutical companies when drugs are under patent. We find that the social cost of a branded drug is approximately one-half the market price when the treatment is paid for by a public insurance plan and one-third the market price for mandated coverage by private insurance. We illustrate the importance of correctly accounting for social costs using two examples: coverage for statin drugs and approval for a drug to treat kidney cancer (sorafenib). In each case, we show that the correct social perspective for cost-effectiveness analysis would be more lenient than researcher recommendations.

Sports injury prevention: The proof of the pudding is in the eating: Brisbane City Council supported speaker

Sports injuries are an unwanted side-effect of participation in physical activity programmes and (un-)organized sports. In order to minimize the sports injury problem a systematic approach is needed in which first the extent of the problem is established. Next, the risk factors and mechanisms should be identified. Based on this information an intervention programme can be designed, of which the effectiveness should be evaluated, preferably by conducting a randomized clinical trial (RCT). This conceptual approach was suggested by me in 1992. At that time sports injury epidemiology was in its infancy and little systematic scientific research had been done up until that time. Purpose of this presentation is to give an overview of how the field has evolved since in terms of designing evidence-based (cost-)effective sports injury prevention interventions. The overview will be based on an analysis of studies listed in PubMed regarding three distinct research outcomes: (1) assessing the extent of the injury; (2) identifying risk factors for sports injuries; (3) evaluating the (cost-)effectiveness of sports injury prevention programmes. In addition, some reflections will be shared on the need for: the RCT as the preferred study design; intervention mapping as a tool for designing effective interventions and; conducting cost-effectiveness analysis along effectiveness trials.

Strengthening Cost-Effectiveness Analysis in Thailand through the Establishment of the Health Intervention and Technology Assessment Program

Capacity is limited in the developing world to conduct cost-effectiveness analysis (CEA) of health interventions. In Thailand, there have been concerted efforts to promote evidence-based policy making, including the introduction of economic appraisals within health technology assessment (HTA). This paper reviews the experience of this lower middle-income country, with an emphasis on the creation of the Health Intervention and Technology Assessment Program (HITAP), including its mission, management structures and activities. Over the past 3 decades, several HTA programmes were implemented in Thailand but not sustained or developed further into a national institute. As a response to increasing demands for HTA evidence including CEA information, the HITAP was created in 2007 as an affiliate unit of a semi-autonomous research arm of the Ministry of Public Health. An advantage of this HTA programme over previous initiatives was that it was hosted by a research institute with long-term experience in conducting health systems and policy research and capacity building of its research staff, and excellent research and policy networks. To deal with existing impediments to conducting health economics research, the main strategies of the HITAP were carefully devised to include not only capacity strengthening of its researchers and administrative staff, but also the development of essential elements for the country's health economic evaluation methodology. These included, for example, methodological guidelines, standard protocols and benchmarks for resource allocation, many of which have been adopted by national policy-making bodies including the three major public health insurance plans. Networks and collaborations with domestic and foreign institutes have been sought as a means of resource mobilization and exchange. Although the HITAP is well financed by a number of government agencies and international organizations, the programme is vulnerable to shortages of qualified research staff, as most staff work on a part-time or temporary basis. To enhance the utilization of its research findings by policy makers, practitioners and consumers, the HITAP has adopted the principles of technical excellence, policy relevance, transparency, effective communication and participation of key stakeholders. These principles have been translated into good practice at every step of HTA management. In 2007 and 2008, the HITAP carried out assessments of a wide range of health products, medical procedures and public health initiatives. Although CEA and other economic evaluation approaches were employed in these studies, the tools and underlying efficiency goal were considered inadequate to provide complete information for prioritization. As suggested by official stakeholders, some of the projects investigated broader issues of management, feasibility, performance and socio-political implications of interventions. As yet, it is unclear what role HITAP research and associated recommendations have played in policy decisions. It is hoped that the lessons drawn on the creation of the HITAP and its experience during the first 2 years, as well as information on its main strategies and management structures, may be helpful for other resource-constrained countries when considering how best to strengthen their capacity to conduct economic appraisals of health technologies and interventions.