Growth and capacity for cost-effectiveness analysis in Africa

Abstract

As economic evaluation becomes increasingly essential to support universal health coverage (UHC), we aim to understand the growth, characteristics, and quality of cost-effectiveness analyses (CEA) conducted for Africa and to assess institutional capacity and relationship patterns among authors. We searched the Tufts Medical Center CEA Registries and four databases to identify CEAs for Africa. After extracting relevant information, we examined study characteristics, cost-effectiveness ratios, individual and institutional contribution to the literature, and network dyads at the author, institution, and country levels. The 358 identified CEAs for Africa primarily focused on sub-Saharan Africa (96%) and interventions for communicable diseases (77%). Of 2,121 intervention-specific ratios, 8% were deemed cost-saving, and most evaluated immunizations strategies. As 64% of studies included at least one African author, we observed widespread collaboration among international researchers and institutions. However, only 23% of first authors were affiliated with African institutions. The top producers of CEAs among African institutions are more adherent to methodological and reporting guidelines. Although economic evidence in Africa has grown substantially, the capacity for generating such evidence remains limited. Increasing the ability of regional institutions to produce high-quality evidence and facilitate knowledge transfer among African institutions has the potential to inform prioritization decisions for designing UHC.

Keywords: Africa; cost-effectiveness analysis; economic evaluation; network analysis; universal health coverage.

FIGURE 1

Growth of African cost‐effectiveness analyses over time. Note: This figure shows the growth of African CEAs over time. The first CEA in our sample was published in 1992, which is not shown in the Figure. Studies reporting both QALYs and DALYs as health outcome measures are categorized separately. [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Number of cost‐effectiveness analyses by African countries. Note: Cost‐effectiveness analyses include cost‐per‐QALY and cost‐per‐DALY studies. (See Appendix S6: Figures B and C for the literature‐specific maps.) In this figure, green indicates a relatively low number of studies while red indicates a relatively high number of studies. For example, the top three countries include Uganda (N = 103), South Africa (N = 101), and Kenya (N = 91), whereas the lowest three are Libya (N = 6), Tunisia (N = 9), and South Sudan (N = 10) [Colour figure can be viewed at wileyonlinelibrary.com]