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Co-production of Budget Impact Analysis by NIPH & PNIPH: Part of HTA on Mammographic Screening in the West Bank
On the 25th of February, the core-team members from the Palestinian National Institute of Public Health (PNIPH) and Norwegian Institute of Public Health (NIPH), who collaborate on the production of a Health Technology Assessment (HTA) on Mammographic Screening in the West Bank, met to discuss and align their views on the application of budget impact analyses. The HTA on breast cancer screening was commissioned by the PNIPH and the work is funded by the Norwegian Agency for Development and Cooperation (Norad). The aim of the HTA pilot-project is to build on the existing capacities through strengthening skills relevant for HTA, systematic review, and health economics within PNIPH and raising awareness on the use of these processes and methods that aid the institutionalisation of evidence-based decision making in Palestine.
Two health economists from the Global Health Cluster at NIPH presented an introduction to Budget Impact Analysis (BIA) and applied it on an assessment for breast cancer screening program in the West Bank. In an interactive fashion, first the underlying theory of BIA was discussed followed by an application of these methods. The theoretical presentation highlighted among other things the difference between economic and financial costs, definitions for budget impact analysis, the framework by ISPOR for budget impact analysis, the common three underlying analytical frameworks, and other aspects to consider while designing a BIA.
The applied methods of BIA, focused on the design of the deterministic model, the calculated (dummy) cost, underlying assumptions, use (and possibilities of use) of real data from the West Bank, and preliminary results. This, again an interactive discussion, highlighted some of the limitations from the modelling exercise and the need for further research. It also provided (preliminary) estimations of the possible budget impact, might Palestine decided to switch to a different protocol for mammographic screening as recommended by the EU or WHO.
After the meeting, the ISPOR guidance article on BIA and an BIA of breast cancer screening in Spain by Comas et al. (2014), whose model was used as inspiration for the deterministic model applied in the BIA for the West Bank, were shared for further reading. The slides for this presentation are training materials that are made freely available here.