Maryam Huda - Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
Nichola Kitson - Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
Nuru Saadi - Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
Saira Kanwal - Health Planning Systems Strengthening and Information Analysis Unit (HPSIU), Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan
Urooj Gul - Health Planning Systems Strengthening and Information Analysis Unit (HPSIU), Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan
Maarten Jansen - Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
Sergio Torres-Rueda - Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
Rob Baltussen - Department of Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
Ala Alwan - DCP۳ Country Translation Project, London School of Hygiene and Tropical Medicine, London, UK
Sameen Siddiqi - Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
Anna Vassall - Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK

Background  Countries designing a health benefit package (HBP) to support progress towards universal health coverage (UHC) require robust cost-effectiveness evidence. This paper reports on Pakistan’s approach to assessing the applicability of global cost-effectiveness evidence to country context as part of a HBP design process. Methods  A seven-step process was developed and implemented with Disease Control Priority ۳ (DCP۳) project partners to assess the applicability of global incremental cost-effectiveness ratios (ICERs) to Pakistan. First, the scope of the interventions to be assessed was defined and an independent, interdisciplinary team was formed. Second, the team familiarized itself with intervention descriptions. Third, the team identified studies from the Tufts Medical School Global Health Cost-Effectiveness Analysis (GH-CEA) registry. Fourth, the team applied specific knock-out criteria to match identified studies to local intervention descriptions. Matches were then cross-checked across reviewers and further selection was made where there were multiple ICER matches. Sixth, a quality scoring system was applied to ICER values. Finally, a database was created containing all the ICER results with a justification for each decision, which was made available to decision-makers during HBP deliberation. Results  We found that less than ۵۰% of the interventions in DCP۳ could be supported with evidence of cost-effectiveness applicable to the country context. Out of ۷۸ ICERs identified as applicable to Pakistan from the Tufts GH-CEA registry, only ۲۰ ICERs were exact matches of the DCP۳ Pakistan intervention descriptions and ۵۸ were partial matches.  Conclusion  This paper presents the first attempt globally to use the main public GH-CEA database to estimate costeffectiveness in the context of HBPs at a country level. This approach is a useful learning for all countries trying to develop essential packages informed by the global database on ICERs, and it will support the design of future evidence and further development of methods.

Cost-Effectiveness, Transferability, Health Technology Assessment, Priority Setting