Priority-Setting Processes for Expensive Treatments in Cardiometabolic Diseases
Authors: Yuna Sakuma, Amanda Glassman, Claudia Vaca
Challenges facing evidence-based resource allocation for health are highlighted in this chapter, especially to meet the increasing demand for the treatment of cardiovascular, respiratory, and related chronic disorders. Policy makers in low- and middle-income countries (LMICs) must weigh prevention, affordability, and ethical considerations in addition to cost-effectiveness when deciding on whom and for what the government will spend. Interventions, both preventive and curative, can prove cost-effective, depending on the context, such as disease progression, but the priority-setting process can prove greatly influenced by political considerations. Case studies show countries can benefit from reviewing available interventions in addition to new ones. Crucially, the examples show the importance of institutional capacity in carrying out the process of explicit priority setting to guide technology adoption decisions. A better priority-setting system can provide a fair and transparent mechanism for managing the politics of resource allocation, connect evidence-based decisions to budgets, and create permanent institutional channels for considering resource allocation choices over time.