Barriers to and facilitators of implementing the Lebanese Health Economic Evaluation Guideline: An initial exploration.

Objective: To identify the major barriers to and facilitators of implementing the Lebanese Health Economic Evaluation Guideline (LEEG) according to Lebanese stakeholders, supported by their insights.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬.

Methods: We conducted a survey asking 16 key stakeholders to rate LEEG's importance, its necessity for Lebanon, and its applicability in decision-making, and Likert scale questions to rate barriers and facilitators. Following the survey, an individual face-to-face interview using open-ended questions was arranged to validate the survey's data, to collect further insights regarding LEEG's implementation in Lebanon, and to identify relevant barriers and facilitators.

Results: All participants considered LEEG to be very important for Lebanon. The majority considered it very important for decision-making, while there was some disagreement on the applicability of economic evaluation as a criterion for decision-making. The most important barriers were 'lack of political willingness to adopt economic evaluation and use health technology assessment findings' and 'the absence of policy networks.' The most important facilitators were 'the strong need to implement national guidelines in Lebanon' and 'acceptability to payers.'

Conclusion: We reported on important barriers to and facilitators of implementing LEEG related to the national context and methodological concerns. This will pave the way for developing strategies essential for effective implementation and, consequently, a better healthcare system, advancing progress to universal health coverage.