HTAi Toyko 2016

1. HEALTH ECONOMIC EVALUATION OF
BIBLIOMETRIC TRENDS
IN SUB-SAHARAN AFRICA
Dr 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 2016
Tokyo, Japan 2016
www.pricelesssa.ac.za

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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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Background
Sub-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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Background
Collaboration 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) Methodology
Rapid 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)
1) Methodology
Rapid evidence assessment
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
NHS EED database:
22 articles

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1) Methodology
Rapid evidence assessment
Articles included in the analysis:
13articles
Sub-Saharan African countries with
more than 10 articles listed in the
NHS EED database:
345 articles
Name of the country in the title:
198articles
Random Selection of 10articles per
country: 110articles
Articles included in the analysis:
106articles
Duplicated articles:
5articles
Sub-Saharan African countries with
fewer than 10 articles listed in the
NHS EED database:
22 articles
119selected articles
Excluded
Excluded
Not Sub-Saharan
African affiliation
and only mentioned
in passing: 4 articles
Duplicated articles,
not Sub-Saharan
African affiliation
and only
mentioned in
passing:
9 articles

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1) Results: Diseases
Four 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 54
Outside Africa 77 62 54
More than one affiliation and
at least one from Africa
11 6 4
Total 119 118 112
*# Authors

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2) Methodology
Sub-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 KHernandez-Villafuerte@ohe.org
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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