Systematic Review of Transferred Costs in Economic Evaluations from the Middle East North Africa Region

Abstract

Objectives: The Middle East and North Africa (MENA) region is striving to provide their populations with quality healthcare. The challenge for MENA countries is aggravated by the scarcity of health-related cost data which strains their health systems and puts pressure on decision-makers to efficiently allocate resources. Transferring costs from another setting might be a suitable solution to ease the resulting pressure. This paper aims to identify literature utilizing regionally transferred costs and to evaluate their methodology and reporting quality. Methods: Literature search was performed in June 2022 to identify health economic evaluations which reported transferred costs from other jurisdictions between January 2000 and May 2022. Studies selection and data extraction were performed in duplicates. The Consolidated Health Economic Evaluation Reporting Standards 2022 and the Fukuda transparency categorization were used to evaluate the quality of the extracted costs. Results: 104 costs were examined from 13 studies. Cost transferability is a recent practice in the region with a slight lead of Gulf Council countries. The majority of donor costs were of poor quality and the selection of donor and destination countries was often poorly justified. Conclusions: The applied methodology was heterogenous and authors have not referred to available international transferability guidelines. We propose a preliminary checklist for structured evaluation of cost-transfer methods to improve reporting tranparency and advance evidence-based health policy making in MENA. Plain summary: The Middle East and North Africa region (MENA) is under significant challenge to implement health technology assessment practice following the scarcity of locally collected economic data. This systematic review explores the transferability of health-related costs as a potential solution to the scarcity of local cost data in the region. 13 studies which reported using 104 transferred costs from MENA countries were included in the final analysis. We concluded that cost transferability practice is recently adopted within MENA, and Golf region is slightly leading with 7 studies transferring over half of the included costs to Golf countries settings. No standard methodologies and references were reported by authors when transferring these costs and both reporting and selection criteria between donor and destination costs and countries were mostly of poor quality and often not justified. We propose a preliminary checklist for structured evaluation of cost transfer methods to improve reporting transparency and advance evidence-based health policy making in MENA.