Reflecting Social Values in HTA Methods: A Case Study of South Africa.

Background and objective: South Africa proposes the creation of a new health technology assessment (HTA) agency. In anticipation, the South African Values and Ethics for Universal Health Coverage (SAVE-UHC) value assessment framework has been created to make explicit the attributes of social value to inform priority setting. However, operationalising these values in an HTA process requires technical economic evaluation-based methods and little consideration has been given to appropriate approaches to determine these. We therefore used a novel pragmatic approach to identify economic evaluation methods to incorporate the SAVE-UHC value attributes in HTA methods.

Methods: We mapped the SAVE-UHC elements to value attributes described in an existing value assessment framework to help identify previously described methods. A survey of experts and a workshop were conducted to supplement the methods identified in the mapping. The combined results were compiled as a list of ways the SAVE-UHC elements could be measured, valued and incorporated into economic evaluation methods.

Results: The results revealed a comprehensive list of approaches to measuring and valuing the SAVE-UHC elements. The results were further categorised into health and the distribution of health, financial risk, healthcare utilisation, well-being, healthcare costs, performance indicators and constraints.

Conclusions: South Africa is in the process of institutionalising HTA to guide prioritisation of new healthcare technologies. This research presents a wide range of methods that could be used in South Africa to implement SAVE-UHC. The approach could also be used in other countries seeking to implement their own value assessment frameworks and identify appropriate methods to incorporate them in HTA processes.