@article{31f2ec32797a4f8fbaf4402efb9426d8,
title = "The Value of Explicit, Deliberative, and Context-Specified Ethics Analysis for Health Technology Assessment: Evidence From a Novel Approach Piloted in South Africa",
abstract = "Objectives: This article explores the perceived value, including associated strengths and challenges, of using a context-specified ethics framework to guide deliberative health technology appraisals. Methods: The South African Values and Ethics for Universal Health Coverage (SAVE-UHC) approach, piloted in South Africa, consisted of 2 phases: (1) convening a national multistakeholder working group to develop a provisional ethics framework and (2) testing the provisional ethics framework through simulated health technology assessment appraisal committee meetings (SACs). Three SACs each reviewed 2 case studies of sample health interventions using the framework. Participants completed postappraisal questionnaires and engaged in focus group discussions. Results: The SACs involved 27 participants across 3 provinces. Findings from the postappraisal questionnaires demonstrated general support for the SAVE-UHC approach and content of the framework, high levels of satisfaction with the recommendations produced, and general sentiment that participants were able to actively contribute to appraisals. Qualitative data showed participants perceived using a context-specified ethics framework in deliberative decision making: (1) supported wider consideration of and deliberation about morally relevant features of the health coverage decisions, thereby contributing to quality of appraisals; (2) could improve transparency; and (3) offered benefits to those directly involved in the priority-setting process. Participants also identified some challenges and concerns associated with the approach. Conclusions: The SAVE-UHC approach presents a novel way to develop and pilot a locally contextualized, explicit ethics framework for health priority setting. This work highlights how the combination of a context-specified ethics framework and structured deliberative appraisals can contribute to the quality of health technology appraisals and transparency of health priority setting.",
keywords = "ethics, ethics analysis, health equity, health priority setting",
author = "Krubiner, {Carleigh B.} and Aviva Tugendhaft and DiStefano, {Michael J.} and Barsdorf, {Nicola W.} and Merritt, {Maria W.} and Goldstein, {Susan J.} and Atiya Mosam and Sunita Potgieter and Hofman, {Karen J.} and Faden, {Ruth R.}",
note = "Funding Information: Funding/Support: This work received funding support from Wellcome (grant #208045/Z/17/Z). Certain members of the writing group also received supplemental funding support: KJH, SG, AT, and AM are supported under the South African Medical Research Council – Wits Centre for Health Economics and Decision Science – PRICELESS SA (grant number: 23108) and MWM received funding support as a 2020 to 2021 Visiting Scholar in the National Institutes of Health Department of Bioethics. The views expressed here are solely the authors{\textquoteright}, independent of the official views of the National Institutes of Health. Funding Information: Funding/Support: This work received funding support from Wellcome (grant #208045/Z/17/Z). Certain members of the writing group also received supplemental funding support: KJH, SG, AT, and AM are supported under the South African Medical Research Council – Wits Centre for Health Economics and Decision Science – PRICELESS SA (grant number: 23108) and MWM received funding support as a 2020 to 2021 Visiting Scholar in the National Institutes of Health Department of Bioethics. The views expressed here are solely the authors{\textquoteright}, independent of the official views of the National Institutes of Health.This research was made possible through the funding support of Wellcome (208045/Z/17/Z). The research team thank all those who participated in the SAVE-UHC Working Group and the Simulated Appraisal Committee meetings, without whom this work would not have been possible. The authors also express their gratitude to various colleagues at their respective institutions who contributed to this project. Particular thanks go to Ijeoma Edoka, Heather Fraser, Agnes Erzse, Safura Abdool Karim, Aarika Sing, Ravikanthi Rapiti, and other members of the PRICELESS team for their valuable and varied contributions, as well as Debbie Marais and Cynthia Ngwalo at Stellenbosch University for their support in development of case study materials. The authors gratefully recognize Daphney Conco for her facilitation of the simulated appraisal committee meetings. The authors are thankful to Kalipso Chalkidou and Ryan Li for their contributions to the research methodology, as well as Peter Littlejohns and Tony Culyer for their inputs, guidance, and support during the early stages of this work. Funding Information: This research was made possible through the funding support of Wellcome (208045/Z/17/Z). The research team thank all those who participated in the SAVE-UHC Working Group and the Simulated Appraisal Committee meetings, without whom this work would not have been possible. The authors also express their gratitude to various colleagues at their respective institutions who contributed to this project. Particular thanks go to Ijeoma Edoka, Heather Fraser, Agnes Erzse, Safura Abdool Karim, Aarika Sing, Ravikanthi Rapiti, and other members of the PRICELESS team for their valuable and varied contributions, as well as Debbie Marais and Cynthia Ngwalo at Stellenbosch University for their support in development of case study materials. The authors gratefully recognize Daphney Conco for her facilitation of the simulated appraisal committee meetings. The authors are thankful to Kalipso Chalkidou and Ryan Li for their contributions to the research methodology, as well as Peter Littlejohns and Tony Culyer for their inputs, guidance, and support during the early stages of this work. Publisher Copyright: {\textcopyright} 2022 International Society for Health Economics and Outcomes Research",
year = "2023",
month = mar,
doi = "10.1016/j.vhri.2022.10.003",
language = "English (US)",
volume = "34",
pages = "23--30",
journal = "Value in Health Regional Issues",
issn = "2212-1099",
publisher = "Elsevier USA",
}