Developing Standard Treatment Guidelines, Designing Health Benefit Packages to Improve the Efficiency of Pools (STG - HBP)
This research project aims to support evidence-informed priority setting and the provision of high-quality healthcare services by focusing on tour key outcome areas. First, it seeks to improve value-for-money decisions in the design and revision of Health Benefit Packages (HBPs) by key public health insurers. including the National Health Authority (NHA). Second, focuses or establishing sustainable cost systems that systematically generate cost evidence from network providers using digital platforms to inform price setting. Third, it endeavours to effectively translate Health Technology Assessment (HTA) evidence to inform health policies. Lastly, it aims to strengthen the quality of care and foster a culture of evidence-based medicine through the development and implementation of high-quality clinical guidelines.
Developing Capacity to Strengthen District Systems for PHC Performance
The goal of this research project is to identify and support the implementation of support strategies to achieve India?s goal of a patient-centred, equitable and high-quality primary healthcare system that delivers better health outcomes. This research project will have a dual focus on two important policy areas- ?Transformed health sector governance, accountability, institutional and management capacity? and ?Improved quality of CPHC service delivery?.
Estimation of Cost-effectiveness Threshold (CET) for India
Increasing healthcare costs and limited resources warrant the need for evidence-based priority setting followed by efficient resource allocation. Such decision-making, in turn, requires careful consideration, given the availability of competing healthcare technologies and the associated opportunity costs for allocating resources to a given intervention. Consequently, the use of health technology assessment (HTA) and economic evaluations has gained importance worldwide as a tool to guide the sustainable allocation of resources. HTA has been widely used to guide policy decisions in India and in the world. To interpret the outcome of such analyses, that is, the incremental cost-effectiveness ratio (ICER), a benchmark is required, which indicates the maximum amount of money a decision-maker is willing to pay for generating an additional unit of health gain. This is commonly known as the cost-effectiveness threshold (CET). Generally, if the ICER (with effectiveness often measured in QALYs gained or disability-adjusted life years averted) is less than the CET, it implies that funding the intervention will maximise population health for a given cost and vice-versa. However, there lies an uncertainty around the estimate of CET that should be used to judge the interventions that are under evaluation. Earlier, the WHO?s Commission on Macroeconomics and Health suggested the use of 1?3 times GDP per capita as the threshold. Nevertheless, the revised guidance by WHO on the interpretation of threshold criteria reveals that such criteria are not decision rules but just a guide to policymakers to assess value for money. In addition, WHO recommends that an intervention should also be assessed in terms of affordability, budget impact, fairness, feasibility and any other criteria considered important in the local context. Therefore, to make decisions regarding the cost-effectiveness of interventions in the Indian context, there is a need to generate a CET value against which the outcomes of HTA studies can be compared. In the absence of such a benchmark, it is not possible to make decisions regarding the potential cost-effectiveness of interventions. To ensure that the evidence generated by health technology assessment (HTA) is translated to policy, it is important to generate a threshold value against which the outcomes of HTA studies can be compared. In this context, the present study delineates the methods that will be deployed to estimate such a value for India.
Cost-effectiveness of Pradhan Mantri Janaushadhi Pariyojna (PMBP) and its impact on Financial Risk Protection in India
?Jan Aushadhi? is the novel project launched by Government of India in the year 2008 for the noble cause ? Quality Medicines at Affordable Prices for All. The Campaign was undertaken through sale of generic medicines through exclusive outlets namely ?Pradhan Mantri Janaushadhi Kendra? (PMJAK) in various districts of the country [1]. Pharmaceuticals & Medical Devices Bureau of India (PMBI) is the implementing agency of Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP). PMBI was established in December 2008 under the Department of Pharmaceuticals, Government of India. The main objective of the study is to assess the coverage and impact of Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) in achieving financial risk protection and ensuring universal health coverage in India from patient?s perspective and to conduct an extended cost-effectiveness of implementing Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) in India for government?s/ payer?s perspective.
Centre for Health Insurance Evidence Synthesis & Financing (CHIEF)
The Government of India launched the world's largest tax-funded health insurance scheme - Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY), in 2018, which is covering 100 million families with an annual coverage of INR 500,000 per family for inpatient services at public and private hospitals empanelled under the scheme. The scheme provides cashless treatment for 1,573 Health Benefit Packages (HBPs) packages through a network of empanelled healthcare providers. The HBPs have undergone four revisions till date, from HBP 1.0 to HBP 2.0 in November 2019, HBP 2.1 in November 2020, HBP 2.2 in November 2021, and HBP 2022 in April 2022. HBP 1.0 covers 1394 packages among 24 specialties which were modified to 27 specialties with 1949 procedures during HBP 2022. These all-recent revisions emanate supply-side characteristics. The latest version, HBP 2022, introduced the concept of differential pricing. The fixed price, referred to as the National Reference Price (NRP), serves as a benchmark, and additional incentives are applied based on hospital characteristics to calculate reimbursement rates. This incorporates incentives based on the location of the hospital (Tier 1, 2, or 3 cities), the level of care (secondary or tertiary), and the type of procedure (medical or surgical). Further, incentives are provided to hospitals accredited by the National Accreditation Board for Hospitals & Healthcare Providers (NABH) (15%) and those located in aspiring districts (10%). However, the prices of procedures are not currently adjusted based on patient-level characteristics. In view of this, this research project aims to assess the impact of various HBP policy interventions including changes in prices, nomenclature, package construct or both on service utilization. Further, the study also proposes a method for refining the existing reimbursement rates under PMJAY based on patient-level characteristics.
Strengthening Health Economics Evidence for India
A review of a pilot-initiative led by the National Health Authority (NHA) to inform differential pricing of reimbursement rates for Health Benefit Packages (HBPs) under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) was undertaken. The findings highlighted concerns regarding the sustainability of the cost surveillance pilot and the quality of the information being generated, emphasizing the necessity of establishing a viable and scalable healthcare cost surveillance system. Additionally, a methods guide to systematize the processes for revising and updating HBPs under PM-JAY, and a CPHC process manual for undertaking adaptive HTA for timely generation of evidence were developed.
Evaluation of implementation of Beti Bachao Beti Padhao (B3P) Programme in Haryana state, India.
Over the past decade, India has implemented numerous programs aimed at improving child survival and development, with a focus on bringing social change. To ensure the effectiveness of these initiatives, a thorough evaluation of their outcomes is crucial to inform program and policy decisions. The project "Evaluation of Implementation of Beti Bachao Beti Padhao Programme, Women and Child Development Scheme and Validation of Civil Registration System in Haryana" aimed to assess the impact of various government schemes on child survival and development. The study evaluated the Beti Bachao Beti Padhao (B3P) program's effect on the sex ratio at birth, the accuracy and coverage of Civil Registration System (CRS) records, and the utilization of maternal and infant health services under ICDS. Additionally, the study assessed the awareness, coverage, and utilization of other schemes like Mukhya Mantri Doodh Uphaar Yojana, Pradhan Mantri Matru Vandana Yojana, and Apki Beti Hamari Beti.
Exploring The Content Validity of the EQ-5D Across Cultures Using Standardized Qualitative Methods
This project was the first attempt to fill a long-standing knowledge gap in relation to EQ-5D and its cultural relevance outside Europe. The purpose of this research was to understand the general public?s view of what characterizes ?poor health?. These are seen as ?characteristics of poor health?. Members of the general public were also asked to think about aspects of ?good health? that contribute to positive quality of life, or ?characteristics of good health?. This research also analysed that how do these health perceptions compare to the dimensions covered by the EQ-5D across all participating countries (Netherlands, Spain, USA, Argentina, China, India and Indonesia). It provided evidence, which was scientifically relevant, and strategically important to the EuroQoL Group. The information it generated has deepened the EuroQoL Group?s understanding of those aspects of health which are important to people in different areas of the world, help to better understand and explain the appropriateness of the instrument in those regions, and provide a strong foundation for future research in this direction
Intra-Partum Care Bundle to Prevent Epilepsy Caused by Birth
The Prevention Task Force of the International League Against Epilepsy estimated that perinatal brain insults accounted for the largest attributable fraction of paediatric and adult epilepsy in LMICs. It is hypothesized that epilepsy from perinatal brain injury can be reduced by the use of a pragmatic, evidenced based and generalisable intrapartum care bundle that involves birth companions, intelligent foetal heart rate monitoring, an e- partogram and brain oriented neonatal resuscitation, in Indian public sector hospitals. The study aimed to estimate the health system costs and out-of-pocket expenditure for intrapartum care, treating brain injury and epilepsy; followed by estimating the incremental cost per quality adjusted life year gained using the intrapartum care bundle as compared to current standards of care.
Price Regulation and Value Based Pricing for anti-cancer Drugs: Implications for Patients, Industry, Insurer and Regulator
The rising economic burden of cancer on health-care system and patients in India has led to the increased demand for evidence in order to inform policy decisions such as drug price regulation, setting reimbursement package rates under publicly financed health insurance schemes and prioritizing available resources to maximize value of investments in health. Economic evaluations are an integral component of this important evidence. In order to facilitate such analyses, strong information systems are needed to be put in place. High out-of-pocket payments and the indirect costs associated with cancer treatment, often result in financial toxicity. Therefore, characterization and prediction of these costs, alongside other health outcomes such as both quantity and quality of life, is important for planning strategies to mitigate the financial hardship due to cancer treatment. Several types of specific cancers do not even have a single case. Thus, another important evidence for conducting HTA is robust data for OOPE among cancer patients, which can be stratified by type of cancer, its health states, levels of severity and type of treatment. Considering the increasing costs of diagnostics and therapeutic interventions for cancer, their formal assessment is imperative to inform value-based standard treatment guidelines. Therefore, the present study aimed to evaluate the value-based prices for 42 anticancer drugs, which have come under price regulation