The feasibility of health technology assessment in the Ghanaian health system

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The increasing costs and demands for new health technologies, which is compounded by an increase in production, has resulted in decision makers requiring high quality evidence to prioritise and allocate resources in the health system. Health technology assessment (HTA) provides such evidence and is used worldwide mostly by developed countries. HTA use is not widespread in developing country settings due to the limited human, data and financial resources available to support it. Developing countries like Ghana are planning to introduce HTA with no evidence regarding its feasibility: which systems are available to support it, and which form of HTA is most suitable for the Ghanaian setting. This thesis sought to examine these issues and make recommendations on how Ghana can proceed. To assess the Ghanaian health system for HTA, quantitative and qualitative methods were used to examine the current decision-making practices from the perspective of national, district and clinical decision makers. Qualitative in-depth interviews were used to assess the knowledge and attitudes of decision makers and researchers about HTA. The technical capacity of Ghana for HTA was assessed using a systematic review of economic evaluation studies in Ghana. Lastly, a case study was conducted using tamoxifen for the hormonal treatment of breast cancer among pre- and peri-menopausal women. The study was designed to assess the applicability and transferability of international data to the Ghanaian context. The results of the research conducted for this thesis revealed that Ghanaian decision makers were open to a more efficient way of making decisions that considered not only the wellbeing of the patient, but also the economic implications of such decisions, reinforcing the importance of pursuing HTA. However, lack of resources and knowledge on HTA and politico-cultural factors were reported as potential barriers and participants made suggestions to address them. The findings also highlighted the limited human and data capacity available to conduct HTA, which meant relying on international data. However, these data need to be transformed to be context-specific before they are suitable for use in an economic evaluation. It was concluded that Ghana will be able to adopt HTA if and when the barriers and challenges reported in this thesis are addressed. However, in the short to medium term, it is recommended that the HTA effort in Ghana focus on appraising generic medicines and unpatented technologies. Findings from these appraisals can guide funding decisions to ensure financial sustainability of the health system.
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