Article Text

Concomitant health benefits package design and research prioritisation: development of a new approach and an application to Malawi
  1. Laetitia Schmitt1,
  2. Jessica Ochalek1,
  3. Karl Claxton1,
  4. Paul Revill1,
  5. Dominic Nkhoma2,
  6. Beth Woods1
  1. 1Centre for Health Economics, University of York, York, UK
  2. 2Health Economics and Policy Unit, Kamuzu University of Health Sciences, Lilongwe, Malawi
  1. Correspondence to Dr Laetitia Schmitt; laetitia.schmitt{at}


Health benefits packages (HBPs) are increasingly used in many countries to guide spending priorities on the path towards universal health coverage. Their design is, however, informed by an uncertain evidence base but research funds available to address this are limited. This gives rise to the question of which piece of research relating to the cost-effectiveness of interventions would most contribute to improving resource allocation. We propose to incorporate research prioritisation as an integral part of HBP design. We have, therefore, developed a framework and a freely available companion stand-alone tool, to quantify in terms of net disability-adjusted life-years (DALYs) averted, the value of research for the interventions considered for inclusion in a package. Using the tool, the framework can be implemented using sensitivity analysis results typically reported in cost-effectiveness studies. To illustrate the framework, we applied the tool to the evidence base that informed the Malawi Health Sector Strategic Plan 2017–2022. Out of 21 interventions considered, 8 investment decisions were found to be uncertain and three showed strong potential for research to generate large health gains: ‘male circumcision’, ‘community-management of acute malnutrition in children’ and ‘isoniazid preventive therapy in HIV +individuals’, with a potential to avert up to 65 762, 36 438 and 20 132 net DALYs, respectively. Our work can help set research priorities in resource-constrained settings so that research funds are invested where they have the largest potential to impact on the population health generated via HBPs.

  • health economics
  • health services research
  • public Health

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  • Handling editor Seye Abimbola

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  • Contributors LS conducted the analysis, wrote the manuscript and acts as guarantor for the overall content. All authors conceived of and planned the paper, reviewed analysis results and edited the manuscript.

  • Funding The study was supported by the GCRF Thanzi la Onse (Health of All) research programme (MR/P028004/1).

  • Competing interests All authors had financial support from the UK Medical Research Council Global Challenges Research Fund (GCRF). The study was supported by the GCRF Thanzi la Onse (Health of All) research programme (MR/P028004/1).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.