A health economic evaluation guideline in low- and middle-income countries: a case study from Lebanon

Health Technology Assessment (HTA) and particularly economic evaluation (EE) are essential to support decision-makers in efficiently allocating their scarce health care resources. This requires the development of a health economic evaluation guideline (EEG) to standardize EEs, and enhance their quality. This Thesis developed a health economic evaluation guideline for Lebanon (a lower-middle income country). It systematically identified and reviewed the official versions of EEGs in LMICs and their development process. EEGs are absent in LICs. Countries with a low-quality development process had the most methodological weaknesses in their EEGs. It provided a transparent report on developing the Lebanese health economic evaluation guideline (LEEG):to set up a Guideline development group, to establish the rationale for developing the guideline in Lebanon, to identify its scope, to search and retrieve evidence through two systematic reviews, to assess and present the evidence, to translate the evidence into guidelines through a deliberative process (a survey, an in-person interview, and a consensus workshop), and to consult international experts (Prof. Dr. Silvia (S.M.A.A.) Evers and Dr. Mickaël Hiligsmann from Maastricht University). It reported the LEEG’s recommendations and its reference case. It identified the barriers to and facilitators of implementing the LEEG. The most important barriers were “lack of political willingness to adopt EE and use HTA 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.”