title: The influence of cost-per-DALY information in health prioritisation and desirable features for a registry: a survey of health policy experts in Vietnam, India and Bangladesh.
abstract: BACKGROUND
  Economic evaluation has been implemented to inform policy in many areas, including coverage decisions, technology pricing, and the development of clinical practice guidelines. However, there are barriers to evidence-based policy in low- and middle-income countries (LMICs) that include limited stakeholder awareness, resources and data availability, as well as the lack of capacity to conduct country-specific economic evaluations. This study aims to survey health policy experts' opinions on barriers to use of cost-effectiveness data in these settings and to obtain their advice on how to make a new cost-per-DALY database being developed by Tufts Medical Center more relevant to LMICs. It also identifies the factors influencing transferability.
  
  
  METHODS
  In-depth interviews were conducted with 32 participants, including policymakers, technical advisors, and researchers in Health Ministries, universities and non-governmental organisations in Bangladesh, India (New Delhi, Tamil Nadu and Karnataka) and Vietnam.
  
  
  RESULTS
  The survey revealed that, in all settings, the use of cost-effectiveness information in policy development is lacking, owing to limited knowledge among policymakers and inadequate human resources with health economics expertise in the government sector. Furthermore, researchers in universities do not have close connections with health authorities. In India and Vietnam, the demand for evidence to inform coverage decisions tends to increase as the countries are moving towards universal health coverage. The informants in all countries argue that cost-effectiveness data are useful for decision-makers; however, most of them do not perform data searches by themselves but rely on the information provided by the technical advisor counterparts. Most interviewees were familiar with using evidence from other countries and were also aware of the influences of contextual elements as a limitation of transferability. Finally, strategies to promote the newly developed database include training on basic economic evaluation for policymakers and researchers, and effective communication programs, with support from reputable global agencies.
  
  
  CONCLUSIONS
  Although cost-effectiveness information is recognised as essential in resource allocation, there are several impediments in the generation and use of such evidence to inform priority setting in LMICs. As such, the Cost-per-DALY database should be well-designed and introduced with appropriate promotion strategies so that it will be helpful in real-world policymaking.
authors.affiliation: Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Yot
authors.initials: Y
authors.lastname: Teerawattananon
authors.affiliation: Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand. sripen.t@hitap.net.
authors.forename: Sripen
authors.identifier: http://orcid.org/0000-0003-2326-0422
authors.initials: S
authors.lastname: Tantivess
authors.affiliation: Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Inthira
authors.initials: I
authors.lastname: Yamabhai
authors.affiliation: Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Nattha
authors.initials: N
authors.lastname: Tritasavit
authors.affiliation: Bill and Melinda Gates Foundation, Seattle, WA, USA.
authors.forename: Damian G
authors.initials: DG
authors.lastname: Walker
authors.affiliation: Tufts Medical Center, Tufts University, Boston, MA, USA.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Cohen
authors.affiliation: Tufts Medical Center, Tufts University, Boston, MA, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Neumann
mesh_terms: D001459:Bangladesh; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003657:Decision Making; D003906:Developing Countries; D006233:Persons with Disabilities; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006291:Health Policy; D006292:Health Priorities / Q000191:economics; D006801:Humans; D007182:Income; D007194:India; D011050:Policy Making; D019057:Quality-Adjusted Life Years; D012042:Registries; D012106:Research; D012108:Research Personnel; D040841:Resource Allocation; D011795:Surveys and Questionnaires; D014744:Vietnam
keywords: Cost per DALY; Database; Economic evaluation; Low- and middle-income countries; Policy decisions; Registry