HEALTH ECONOMIC EVALUATION OF BIBLIOMETRIC TRENDS IN SUB-SAHARAN AFRICA

HEALTH ECONOMIC EVALUATION OF BIBLIOMETRIC TRENDS

IN SUB-SAHARAN AFRICADr Karla Hernandez-Villafuertea, Dr Ryan Lib, Professor Karen J Hofmanc

aOffice of Health Economics, bNICE International, c PRICELESS SA, Wits/MRC Burden of Disease Unit, University of Witwatersrand, School of Public Health

HTAi 2016Tokyo, Japan 2016

www.pricelesssa.ac.za

HEALTH ECONOMIC EVALUATION OF BIBLIOMETRIC TRENDS IN SUB-SAHARAN AFRICA

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Agenda• Background• Objectives• Analysis divided into two:

1. Characteristics of the economic evaluations in the Sub-Sahara Africa

2. Patterns of collaboration of Sub-Saharan Africa researchers

• Conclusions


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BackgroundSub-Saharan Africa

Allocation of scarce health care resources is a key challenge for the LMIC• Priority setting using economic evaluations identified as one tool

Sub-Saharan Africa• Lack of human technical capacity• Lack of health state valuations (e.g. EQ-5D) • Quality of the evidence

Countries share similarities• Epidemiological profiles• Organisation and the architecture of a health care system• Health priorities, accessibility to services and quality of health care

Countries with less capacity might benefit from adopting, adapting and contextualising transferrable evidence generated

by neighbouring countries in the region

Varies between countries in the region


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BackgroundCollaboration patterns• Effect of collaboration

• Little evidence of the effect on the transferability of evidence related to economic evaluations

• Other areas of health research: Effect on research outputs• Other fields of research

– Collaborations between researchers triggers spillovers – Expansion of ideas

Collaboration patterns between countries might indicate the extent to which the generation and transfer of evidence could support

decision making processes

• The study of co-authored publications has become the standard way to measure research collaborations


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OBJECTIVES• To consider the potential in the region to take advantage of

the results and methods of available HTA analysis• To analyse the main trends of the HTA literature in Sub-

Saharan Africa 1. Characteristics of the economic evaluations in the

Sub-Sahara Africa– Diseases – Types of intervention

2. Author with affiliation from a Sub-Saharan African country– Patterns of collaboration between authors within and

outside of Sub-Saharan Africa


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1) MethodologyRapid evidence assessment

• NHS Economic Evaluation Database (NHS EED)• Over 16,000 economic evaluations of health care interventions

worldwide (cost-benefit, cost-utility cost-effectiveness analysis)• Search criteria

• Names of the 15 countries that are members of the Sub-Saharan African Development Community (SADC)

• Ghana, Kenya, Nigeria, Ethiopia and Uganda– HTA analysis has experience a considerable development

• NHS EED includes only economic evaluations


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Botswana (5)Congo (5)

Lesotho (3)Swaziland (3)

Madagascar (2)Namibia (2)

Seychelles (2)Angola (0)

Mauritius (0)

South Africa (105) Uganda (56)Kenya (40)

Tanzania (34)Zambia (26)Nigeria (23) Ghana (13)

Mozambique (13)Zimbabwe (13)Ethiopia (11)Malawi (11)


Sub-Saharan African countries with more than 10 articles listed in the

NHS EED database:345 articles

Sub-Saharan African countries with fewer than 10 articles listed in the



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Articles included in the analysis:13 articles

Sub-Saharan African countries with more than 10 articles listed in the


Name of the country in the title:198 articles

Random Selection of 10 articles per country: 110 articles

Articles included in the analysis:106 articles

Duplicated articles:5 articles

Sub-Saharan African countries with fewer than 10 articles listed in the


119 selected articles

Excluded

Excluded

Not Sub-Saharan African affi liation

and only mentioned in passing: 4 articles

Duplicated articles, not Sub-Saharan African affi liation

and only mentioned in

passing: 9 articles


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1) Results: DiseasesFour communicable diseases:

• HIV (35.29%), malaria (21.85%), tuberculosis (5.04%) and diarrhoea (3.36%).

Other conditions:• 3.36% studies related to cancer (breast and cervical cancer), 2.52%

to acute malnutrition and 1.68% to maternal mortality.• One example for the prevention of cardiovascular disease and

another for the use of antihypertensive medications. 6% of the articles are not related to any particular disease.

• Articles related to the health system organisation• Evaluation of preventative interventions, but without a clear link

to any particular disease• Methodological approaches


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1) Results: Type of Intervention

Classification used by the UK Medical Research Council (MRC) in its document “Outputs, Outcomes and Impact of MRC Research”


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1) Results: Authors by Region of Affiliation

First Author* Second Author* Third Author*

Africa 31 50 54Outside Africa 77 62 54More than one affiliation and at least one from Africa 11 6 4

Total 119 118 112

*# Authors


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2) MethodologySub-Saharan African affiliation

• First author → main researcher• 42 articles: first author affiliated to one Sub-Saharan African

country• Three appear twice: Subsample - 39 researchers

• Research network • Co-authorship: Proxy for collaboration

• 39 authors all publications between 1990 and 2014 • 729 publications → network-articles• First author → the strongest collaborator

– Name and country of affiliation – When the first author was the same as the author of the NHS EDD

subsample the second author was used


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2) Results: Connection map


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2) Results: Connection map


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2) Results: Research network• Sub-Saharan African authors are collaborating first with authors

of their own country• Botswana, Kenya, Madagascar or Nigeria: more than 65% of the

network-articles - first two authors in the same country• Uganda: more than 50% of the network-articles

• Strong connection with researchers from the USA and Europe• The UK: South Africa (24/124) and Nigeria (14/102)• The USA: South Africa (30/124) and Madagascar (16/22)

• Little indication of collaborations with other African countries• Even in the case of South Africa and Uganda

– Highly active in the production of articles


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Conclusions• High variation in the quantity of economic evaluations

• Differences in capacity• South Africa

• The highest production of economic evaluations and the highest number of connection with other African countries

• A more developed organisation to support evidence based decisions • A possibility is this as a centre for the creation of a network

• Economic evaluations are biased towards treatments of communicable diseases (HIV and malaria)• Reflects the health priorities of the region

– Among the five leading causes of disease burden in Africa • These are a central part of the MDG


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Conclusions• Collaboration between researchers from Sub-Saharan Africa and

researchers from different African countries is weaker than with researchers in the USA and Europe• Economic evaluations are influenced by the USA and the UK

Collaboration between researchers is important in the generation and transfer of evidence to support the decision making process

Organizations and institutions from high income countries interested in supporting the resource allocation process in

Sub-Saharan African could include the promotion of collaboration as part of their agendas


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THANKS FOR YOUR ATTENTION

This study was prepared as part of the International Decision Support Initiative (www.idsihealth.org), a global initiative to support decision makers in priority-setting for universal health coverage.

This work received funding support from the Bill & Melinda Gates Foundation, the Department for International Development (UK), and the Rockefeller Foundation. The funders played no role in the

study design, data collection, analysis and interpretation, or writing of the manuscript.

To enquire about additional information and analyses, please contact Dr. Karla Hernandez-Villafuerte at [email protected]

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OHE’s publications may be downloaded free of charge in our website.


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2) Results: Herfindahl Index (HI)• Concentration of co-authors in any one given country

• 0 = co-authors from a large number of countries • 1 = co-authors only in the same country

•Results from the HI:• 10 authors have a HI equal to 1• 12 authors have a HI between 0.5 and 0.99• 17 authors have a HI between 0.19 (minimum value) and 0.49• Authors with the highest number of articles do not have the lowest

HI– A well-established career does not necessarily means a

broader range of countries to collaborate with– Further analysis should be done to extract any final conclusions

HEALTH ECONOMIC EVALUATION OF BIBLIOMETRIC TRENDS IN SUB-SAHARAN AFRICA

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