title: Piloting the development of a cost-effective evidence-informed clinical pathway: managing hypertension in Jordanian primary care.
abstract: OBJECTIVE
  The UK's National Institute for Health and Clinical Excellence (NICE) and the Jordan office of the Medicines Transparency Alliance embarked on a pilot project to design an evidence-based guideline for cost-effective pharmacological treatment of essential hypertension in Jordan. The project's objectives were to directly address a major health problem for Jordan by producing a guideline; and to delineate the strengths and weaknesses of Jordan's healthcare process to allow similar future efforts to be planned more efficiently.
  
  
  METHODS
  The pilot spanned a period of approximately 8 months. Activities were overseen by local technical and guideline development teams, as well as experts from NICE. NICE's hypertension guidelines and economic model were used as a starting point. Parameters in the economic model were adjusted according to input and feedback from local experts with regards to Jordanian physician and patient practices, resource costs, and quality of life estimates. The results of the economic model were integrated with the updated available clinical trial literature.
  
  
  RESULTS
  The outputs of the economic model were used to inform recommendations, in the form of a clinical algorithm. A report of the process and the strengths and weaknesses observed was developed, and recommendations for improvements were made.
  
  
  CONCLUSIONS
  The pilot represented the start of what is intended to be a healthcare process change for the country of Jordan. Issues emerged which can inform strategies to ensure a more cohesive and comprehensive approach to the cost-effective use of appropriate drugs in managing chronic disease in Jordan and countries operating in a similarly resource-constrained environment. Furthermore, our pilot highlights how richer countries with relevant experience in evidence-informed healthcare policy making can assist others in strengthening their decision-making methods and processes.
authors.affiliation: NICE International, National Institute for Health and Clinical Excellence, MidCity Place, 71 High Holborn, London, WC1V 6NA, UK. kalipso.chalkidou@nice.org.uk
authors.forename: Kalipso
authors.initials: K
authors.lastname: Chalkidou
authors.forename: Joanne
authors.initials: J
authors.lastname: Lord
authors.forename: Nour A
authors.initials: NA
authors.lastname: Obeidat
authors.forename: Ibriham A
authors.initials: IA
authors.lastname: Alabbadi
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Stanley
authors.forename: Rania
authors.initials: R
authors.lastname: Bader
authors.forename: Aiman
authors.initials: A
authors.lastname: Momani
authors.forename: Rachel M
authors.initials: RM
authors.lastname: O'Mahony
authors.forename: Lara
authors.initials: L
authors.lastname: Qatami
authors.forename: Derek
authors.initials: D
authors.lastname: Cutler
mesh_terms: D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000191:economics*; D003657:Decision Making; D020000:Decision Support Systems, Clinical / Q000191:economics; D003906:Developing Countries; D004493:Education / Q000191:economics; D019317:Evidence-Based Medicine / Q000191:economics*; D017144:Focus Groups; D006801:Humans; D006973:Hypertension / Q000191:economics*; D019458:Insurance Coverage / Q000191:economics; D007597:Jordan; D017145:Models, Educational; D010865:Pilot Projects; D011320:Primary Health Care / Q000191:economics*; D016730:Program Development; D015397:Program Evaluation / Q000191:economics*; D011788:Quality of Life; D013673:Technology Assessment, Biomedical / Q000191:economics; D006113:United Kingdom