Recommendations for Evidence Generation Activities Supportive of National HTA in the South African Public Health Sector

BACKGROUND: The South African public healthcare sector is evolving towards the use of health technology assessments (HTAs) and implementation of cost-effective health technologies into the national benefits package supporting the sustainability of the proposed National Health (NHI) Insurance Fund.

OBJECTIVES: To make recommendations for evidence generation activities supportive of national HTA in the public health sector, focussing on South African health-related quality of life (HRQoL) data generated for cost-utility analyses (CUAs), and the organisations conducting such research.

METHODS: The study involved two stages. The first evaluated the South African Guideline for Pharmacoeconomic Submissions' (SAGPS) data requirements using the EUnetHTA Core Model^® framework. The second stage consisted of a 2019 systematic review conducted according to Cochrane methods across multiple literature databases. The retrieved publications were quantitatively and qualitatively analysed using HTA methods guides and the Vosviewer software to describe the attributes of the studies and data, and the research field in South Africa. To comment on the quality of the HRQoL instrument translation methodology used in the studies, the dataset was updated in 2021 with a non-systematic literature review.

RESULTS: The SAGPS constituted a comprehensive HTA framework, but had several shortcomings. The 2019 systematic review identified 123 publications (104 studies) with HRQoL data. Thirty-nine studies described HRQoL instrument translation methods or translated versions. Most studies were observational, cross-sectional and lacked reporting on the methodological details necessary to determine the study’s merit according to HTA requirements. HRQoL research in South Africa was driven by local researchers and institutions, but their performance was below that of international counterparts. Currently, few HRQoL instruments are suitable for CUAs because they lack validity within the South African context.

CONCLUSIONS: HTA stakeholders should acquaint themselves with South African HTA data requirements in the SAGPS as it could inform HTAs under NHI. Additionally, data generation activities should incorporate the recommendations from this study.