Reflections on the use of the World Health Organization’s (WHO) OneHealth Tool: Implications for health planning in low and middle income countries (LMICs)

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Wong" }, { "@type": "Person", "name": "Nel Jason Haw" }, { "@type": "Person", "name": "Jhanna Uy" }, { "@type": "Person", "name": "Diana Beatriz Bayani" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": "The World Health Organization (WHO) launched the OneHealth Tool (OHT) to help low and middle income countries to develop their capacities for sector-wide priority setting. In 2016, we sought to use the OHT to aid the Philippine Health Insurance Corporation (PHIC), the national health insurer of the Philippines, in decisions to expand benefit packages using cost-effectiveness analyses. With technical support from the WHO, we convened health planning officers from the Philippine Department of Health (DOH) and the Philippine Health Insurance Corporation (PHIC) conduct generalized cost-effective analyses (GCEA) of selected un-financed noncommunicable disease interventions using OHT. We collected epidemiological and cost data through health facility surveys, review of literature such as cost libraries and clinical practice guidelines, and expert consultations. Although we were unable to use GCEA results directly to set policy, we learnt important policy lessons which we outline here that might help inform other countries looking to inform service coverage decisions. Additionally, the entire process and GCEA visualizations helped high-level policymakers in the health sector, who have traditionally relied on ad hoc decision making, to realize the need for a systematic and transparent priority-setting process that can continuously provide the evidence needed to inform service coverage decisions." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/7-157", "name": "Reflections on the use of the World Health Organization’s (WHO) OneHealth..." } } ] } Home Browse Reflections on the use of the World Health Organization’s (WHO) OneHealth... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Wong JQ, Haw NJ, Uy J and Bayani DB. Reflections on the use of the World Health Organization’s (WHO) OneHealth Tool: Implications for health planning in low and middle income countries (LMICs) [version 2; peer review: 2 approved] . F1000Research 2018, 7 :157 ( https://doi.org/10.12688/f1000research.13824.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Brief Report Revised Reflections on the use of the World Health Organization’s (WHO) OneHealth Tool: Implications for health planning in low and middle income countries (LMICs) [version 2; peer review: 2 approved] John Q. Wong 1 , Nel Jason Haw https://orcid.org/0000-0003-2602-4214 1 , Jhanna Uy https://orcid.org/0000-0002-5353-2903 1 , Diana Beatriz Bayani https://orcid.org/0000-0002-0042-8547 2 John Q. Wong 1 , Nel Jason Haw https://orcid.org/0000-0003-2602-4214 1 , Jhanna Uy https://orcid.org/0000-0002-5353-2903 1 , Diana Beatriz Bayani https://orcid.org/0000-0002-0042-8547 2 PUBLISHED 05 Mar 2018 Author details Author details 1 EpiMetrics Inc., Parañaque City, 1713, Philippines 2 Health Policy Development and Planning Bureau, Department of Health, Manila, 1003, Philippines John Q. Wong Roles: Conceptualization, Funding Acquisition, Investigation, Project Administration, Supervision, Writing – Review & Editing Nel Jason Haw Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Jhanna Uy Roles: Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Diana Beatriz Bayani Roles: Investigation, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract The World Health Organization (WHO) launched the OneHealth Tool (OHT) to help low and middle income countries to develop their capacities for sector-wide priority setting. In 2016, we sought to use the OHT to aid the Philippine Health Insurance Corporation (PHIC), the national health insurer of the Philippines, in decisions to expand benefit packages using cost-effectiveness analyses. With technical support from the WHO, we convened health planning officers from the Philippine Department of Health (DOH) and the Philippine Health Insurance Corporation (PHIC) conduct generalized cost-effective analyses (GCEA) of selected un-financed noncommunicable disease interventions using OHT. We collected epidemiological and cost data through health facility surveys, review of literature such as cost libraries and clinical practice guidelines, and expert consultations. Although we were unable to use GCEA results directly to set policy, we learnt important policy lessons which we outline here that might help inform other countries looking to inform service coverage decisions. Additionally, the entire process and GCEA visualizations helped high-level policymakers in the health sector, who have traditionally relied on ad hoc decision making, to realize the need for a systematic and transparent priority-setting process that can continuously provide the evidence needed to inform service coverage decisions. READ ALL READ LESS Keywords priority-setting, low and middle income countries, WHO CHOICE, generalized cost-effectiveness analysis, OneHealth Tool, sector-wide planning Corresponding Author(s) Nel Jason Haw ( [email protected] ) Close Corresponding author: Nel Jason Haw Competing interests: No competing interests were disclosed. Grant information: The project was funded jointly by the United Nations Children’s Fund (UNICEF) and the Philippine Health Insurance Corporation (PHIC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2018 Wong JQ et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication). How to cite: Wong JQ, Haw NJ, Uy J and Bayani DB. Reflections on the use of the World Health Organization’s (WHO) OneHealth Tool: Implications for health planning in low and middle income countries (LMICs) [version 2; peer review: 2 approved] . F1000Research 2018, 7 :157 ( https://doi.org/10.12688/f1000research.13824.2 ) First published: 07 Feb 2018, 7 :157 ( https://doi.org/10.12688/f1000research.13824.1 ) Latest published: 05 Mar 2018, 7 :157 ( https://doi.org/10.12688/f1000research.13824.2 ) Revised Amendments from Version 1 We have added one more person in the Acknowledgments section, who was forgotten from the version 1. We apologize for this oversight. No other changes have been made. We have added one more person in the Acknowledgments section, who was forgotten from the version 1. We apologize for this oversight. No other changes have been made. To read any peer review reports and author responses for this article, follow the "read" links in the Open Peer Review table. READ REVIEWER RESPONSES Introduction Striving for universal health coverage requires priority setting to maximize health gains from limited resources ( Chalkidou et al ., 2016 ). Countries like the Philippines struggle with building technical and institutional capacity for health technology assessment (HTA). In 2015, the national insurer Philippine Health Insurance Corporation (PHIC) wanted to redefine their health benefits package. We developed a list of priority conditions based on disease burden and a corresponding list of cost-effective interventions ( Wong et al ., 2018 ). This paper documents our subsequent attempt on a more definitive list of interventions using cost-effectiveness analyses (CEA) in the Philippine setting. At that time, however, we had insufficient technical capacity to conduct the volume of necessary primary CEAs within the timeframe of our policy window. We sought the help of the World Health Organization (WHO) to conduct generalized cost-effectiveness analysis (GCEA) using their OneHealth Tool (OHT) software. The appeal of GCEA and OHT was its perceived feasibility for our purposes. OHT had been used successfully in 20 low and middle income countries (LMICs) for sector-wide planning ( Avenir Health, 2017 ), and WHO-CHOICE had conducted regional-level GCEA for a good range of diseases in our priority list of conditions ( World Health Organization, 2017 ). Because GCEA uses a “do nothing” comparator, we would be able to simultaneously analyze multiple diseases and new and existing alternatives within and outside the health sector to determine the most efficient mix of interventions to fund at the national-level ( Hutubessy et al. , 2003 ). Lastly, GCEA could be done through the user-friendly OHT software with its built-in health impact models, templates for costing and epidemiological inputs, and data visualization functions. We hope that our reflections on our experience with GCEA using OHT will aid other LMICs looking to scale up their priority setting efforts. Methods Based on the available models in the OHT at that time (April 2016), twelve interventions across three diseases - cardiovascular disease, diabetes, chronic obstructive pulmonary disorder - were chosen for analysis. OHT has global or regional defaults for all of the values in the models, and we attempted to replace all of the defaults with the best available local data. To do this, we collected epidemiological and cost data from health facility surveys, desk reviews, and clinical experts. A summary of data sources for each input is detailed in Table 1 . Table 1. Data sources used for inputs in the OneHealth Tool. Input Data source Remarks Composition of cost items under each intervention Available local clinical practice guidelines (CPGs) Expert opinion Global or United States CPGs were used if local CPGs were not available, as used by specialists in their clinical practice If no CPGs are utilized in the Philippine context, then opinions of the medical consultants in the workshop were sought Demographic data United Nations Population Division World Population Prospectus 2015 OHT lets users load country-specific demographic information upon set-up of a new project file; projections reflect Philippine census data in 2015 Disease epidemiology Global Burden of Disease (GBD) 2013 data Modeling using DISMOD II 1.04 Desk review of published and gray literature All inputs were replaced by a mix of these sources except the age-specific disability weights, as the defaults were retained as they were expected to be somewhat constant across different countries Effectiveness of intervention Desk review of published and gray literature Some of the default data were retained when the effectiveness data came from a systematic review or meta-analysis Coverage rates of intervention (target and expected) Desk review of published and gray literature Interview with experts Experts were recruited from various medical professional societies, and program managers from the DOH For items where more than one expert was consulted, the average was taken Some default data were retained when experts refused to estimate Intervention costs Primary data collection in 24 purposively selected health facilities across the Philippines (6 government hospitals, 9 government primary care clinics, 6 private hospitals, and 3 private clinics) 2015 Drug Price Reference Index (DPRI) Management Sciences for Health (MSH) International Drug Price Indicator Guide The average of each cost item was taken across all facilities Overhead costs were estimated from available budgets of selected government hospitals Yearly list released by DOH on median procurement prices of certain drugs in government hospitals Used when drug price was not collected at the facility survey or not found in the DPRI Program costs DOH 2015 budget Note: A full documentation of the changes, together with the references and notes, are found in Supplementary File 1 . We invited WHO-Geneva to conduct a five-day workshop on the use of OHT, with DOH and PHIC planning officers, and some senior officials as participants. Over the course of the workshop, we used the default parameters of the model as a starting point of discussion. We used a consensus approach in modifying these defaults. We first consulted available data we had gathered, then all workshop participants discussed iteratively which data inputs and resource requirements were appropriate in the Philippine context until a consensus was reached. On the last day, we plotted the cost-effectiveness results on an isoquant graph. Each intervention represents a point, and the graph is to be interpreted diagonally. The graph ( Figure 1 ) shows the cost of the intervention on the horizontal axis, and effectiveness on the vertical axis. We have also added price tags to each data point to indicate the five-year budget impact. Figure 1. Isoquant graph of selected non-communicable interventions with budget impact price tags. Calculations made using OneHealth Tool. Lessons learned Our study raised awareness among policy makers that cost-effectiveness can be used for making decisions on service coverage. They found the GCEA results straightforward and understandable. However, for the policy question, GCEA methods were deemed insufficient to satisfy policy makers’ demands. GCEA was geared for choosing a complement of mutually compatible interventions based on a ‘do-nothing’ scenario. The results ended up validating the programs already covered, but failed to address the question of expanding service coverage. We realized that a CEA with current practice as the comparator would be more appropriate. Another limitation of GCEA is the limited availability of models, making it difficult to conduct a sector-wide exercise that completely incorporates the Philippine baseline context. While more models have been added since our last use, such as modules on neglected tropical diseases, it will take time before the full breadth of interventions will be covered. Most of the disease packages available were based on WHO’s list of global priorities, which were already covered in the Philippines. In addition, the process of modifying defaults in the OHT was more difficult than expected. Expert opinion and clinical practice guidelines varied widely, which made it challenging to reconcile the input values, especially in the absence of a local methods guideline for economic evaluation. The undertaking also led to the policy makers’ realization that no systematic process existed within PHIC for developing benefit packages. The failure in providing an answer to the question of “Which intervention to cover next?” through the GCEA pushed all stakeholders to consider setting up a process and value framework for priority setting alongside an institution that will facilitate such processes. While PHIC and DOH are not completely new to HTA, there was a need to establish a single, harmonized priority setting process for the health sector that would enable these two institutions to make better policy decisions based the questions they are currently faced with. This envisioned an HTA system, characterized by societal principles, with specific criteria and steps and supporting legal framework that would respond to the next level of questions such as which drug to reimburse, given that both institutions are flooded by demands from various stakeholders to cover a wide range of interventions. This whole exercise re-emphasizes that defining a health benefits package cannot be a one-off exercise. It is influenced by a myriad of factors, and entails much stakeholder consultation and awareness of societal and institutional values. We recognize that the next step for the Philippines is to embed in the health system a process of both evidence generation and use for making investment decisions in the public sector. Developing capacity at both technical and sectoral dimensions must also be prioritized. Despite the limitations of the GCEA, it was a practical exercise to demonstrate the importance of evidence use in supporting policy surrounding service coverage decisions. Data and software availability The OneHealth Tool (OHT) may be downloaded freely at from Avenir Health . At the time this study was conducted, the Spectrum version of the OHT was 5.42. The results may be recreated by following the detailed documentation of changes to the OHT defaults found in Supplementary File 1 . Data entered into OHT was obtained from sources listed in Table 1 Competing interests No competing interests were disclosed. Grant information The project was funded jointly by the United Nations Children’s Fund (UNICEF) and the Philippine Health Insurance Corporation (PHIC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Acknowledgments We would like to thank the other members of the project team who helped us with data collection and analysis - John Valdes, Kathy Chavez, Luisa Isabel Misa, Deo Estanislao, Ingrid Espinosa, Michael Mo, Katherine Reyes, and Christian Nuevo. We would also like to thank planning staff and senior officers of the Philippine Department of Health (DOH) and the Philippine Health Insurance Corporation (PHIC) for attending the workshop and contributing to the analysis of the results. Finally, we would like to thank the World Health Organization (WHO) Geneva, specifically the Department of Health Financing and Governance (HGF) for providing the necessary technical assistance to conduct the analysis. Supplementary material Supplemental File 1. Documentation of changes to WHO OneHealth Tool (OHT). Input-by-input changes to the interventions considered to recreate the results of the study. Click here to access the data . Faculty Opinions recommended References Avenir Health: Avenir Health: OneHealth Tool Country Applications. 2017. Reference Source Chalkidou K, Glassman A, Marten R, et al. : Priority-setting for achieving universal health coverage. Bull World Health Organ. 2016; 94 (6): 462–467. PubMed Abstract | Publisher Full Text | Free Full Text Hutubessy R, Chisholm D, Edejer TT, et al. : Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc. 2003; 1 (1): 8. PubMed Abstract | Publisher Full Text | Free Full Text WHO: World Health Organization: WHO-CHOICE Interventions. 2017. Reference Source Wong JQ, Uy J, Haw NJ, et al. : Priority Setting for Health Service Coverage Decisions Supported by Public Spending: Experience from the Philippines. Health Systems and Reform. 2018; 4 (1): 19–29. Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 07 Feb 2018 ADD YOUR COMMENT Comment Author details Author details 1 EpiMetrics Inc., Parañaque City, 1713, Philippines 2 Health Policy Development and Planning Bureau, Department of Health, Manila, 1003, Philippines John Q. Wong Roles: Conceptualization, Funding Acquisition, Investigation, Project Administration, Supervision, Writing – Review & Editing Nel Jason Haw Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Jhanna Uy Roles: Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Diana Beatriz Bayani Roles: Investigation, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The project was funded jointly by the United Nations Children’s Fund (UNICEF) and the Philippine Health Insurance Corporation (PHIC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) version 2 Revised Published: 05 Mar 2018, 7:157 https://doi.org/10.12688/f1000research.13824.2 version 1 Published: 07 Feb 2018, 7:157 https://doi.org/10.12688/f1000research.13824.1 Copyright © 2018 Wong JQ et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication). Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Wong JQ, Haw NJ, Uy J and Bayani DB. Reflections on the use of the World Health Organization’s (WHO) OneHealth Tool: Implications for health planning in low and middle income countries (LMICs) [version 2; peer review: 2 approved] . F1000Research 2018, 7 :157 ( https://doi.org/10.12688/f1000research.13824.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 07 Feb 2018 Views 0 Cite How to cite this report: Steuten LMG. Reviewer Report For: Reflections on the use of the World Health Organization’s (WHO) OneHealth Tool: Implications for health planning in low and middle income countries (LMICs) [version 2; peer review: 2 approved] . F1000Research 2018, 7 :157 ( https://doi.org/10.5256/f1000research.15027.r30629 ) The direct URL for this report is: https://f1000research.com/articles/7-157/v1#referee-response-30629 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 01 Mar 2018 Lotte M.G. Steuten , Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA Approved VIEWS 0 https://doi.org/10.5256/f1000research.15027.r30629 The authors have described their reflections on the experience with Generalized Cost Effectiveness Analysis (GCEA) using the WHO One Health Tool (OHT), to aid other Low-Middle Income Countries (LMICs) looking to scale up their priority setting efforts. ... Continue reading READ ALL The authors have described their reflections on the experience with Generalized Cost Effectiveness Analysis (GCEA) using the WHO One Health Tool (OHT), to aid other Low-Middle Income Countries (LMICs) looking to scale up their priority setting efforts. They clearly describe the rationale and aim of using this tool to support redefining the benefits package of the national insurer of the Philippines. Most importantly, they identify key limitations on various levels: 1) limitations of the OHT itself; 2) limitations in availability of models and data specific to the Philippine context; and 3) the unmet need to establish a single, harmonized priority setting process for the health sector that would enable multiple stakeholders (in this case the Department of Health and the Philippine Health Insurance Corporation) to make better policy decisions based on the questions they are currently faced with. Based on these limitations and their experiences the authors provide general recommendations that are relevant to the Philippines and to other LMICs. The paper is valuable and sound, given that its aims are quite humbly to share reflections on the use of the OHT for a priority setting exercise. However, these reflections –however well described and sensible- should not be read as (and are not intended to be) the result of a systematic evaluation of experiences based on all stakeholders inputs. A degree of subjectivity should be acknowledged and the paper would have benefit from more specific or detailed suggestions to improve the priority setting exercise and experience, from the perspective of the different participants. That said, this paper is a valuable contribution to the literature and more examples such as these should be welcomed and shared to drive the HTA field forward, globally as well as locally. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Health Technology Assessment, priority setting, comparative effectiveness, cost-effectiveness analyses I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Steuten LMG. Reviewer Report For: Reflections on the use of the World Health Organization’s (WHO) OneHealth Tool: Implications for health planning in low and middle income countries (LMICs) [version 2; peer review: 2 approved] . F1000Research 2018, 7 :157 ( https://doi.org/10.5256/f1000research.15027.r30629 ) The direct URL for this report is: https://f1000research.com/articles/7-157/v1#referee-response-30629 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Chalkidou K. Reviewer Report For: Reflections on the use of the World Health Organization’s (WHO) OneHealth Tool: Implications for health planning in low and middle income countries (LMICs) [version 2; peer review: 2 approved] . F1000Research 2018, 7 :157 ( https://doi.org/10.5256/f1000research.15027.r30630 ) The direct URL for this report is: https://f1000research.com/articles/7-157/v1#referee-response-30630 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 Feb 2018 Kalipso Chalkidou , Global Health and Development Team, Imperial College London, London, UK Approved VIEWS 0 https://doi.org/10.5256/f1000research.15027.r30630 This is a valuable and original contribution describing the analytical methods, data sources and overall policy approach to reviewing and attempting to adjust the health benefits package in the Philippines (based on a selection of mostly NCD interventions) using WHO’s ... Continue reading READ ALL This is a valuable and original contribution describing the analytical methods, data sources and overall policy approach to reviewing and attempting to adjust the health benefits package in the Philippines (based on a selection of mostly NCD interventions) using WHO’s OneHealth tool. A number of middle income countries are currently in a similar position, en route to Universal Healthcare Coverage and making a systematic attempt at revising their Benefits Package as part of the national or social health insurance funds and not many resources exist on how such a process can be carried out (e.g. see https://www.cgdev.org/publication/whats-in-whats-out-designing-benefits-universal-health-coverage for the Centre for Global Development guide to designing benefits packages). The authors succinctly summarise the challenges they faced including the limited breadth of the OneHealth models available to cover the whole spectrum of diseases the country faces. They also highlight the problematic assumption of the “null comparator”. The latter is a core element of the WHO approach to cost effectiveness analysis and makes structuring the decision problem in a way that reflects the reality policy makers are faced with, where the option of doing nothing is neither realistic nor ethical, impossible. The authors also flag up as major weaknesses the lack of national guidelines on the methods and processes for revising the package. Again there is limited global guidance as to best practice in the methods (for one example see the iDSI Reference Case to economic evaluation here http://www.idsihealth.org/resource-items/idsi-reference-case-for-economic-evaluation/ ) and processes for managing such a methodologically and politically challenging exercise. We need more such examples to be publicised and for a dialogue to start within and between countries as to how best to support policy makers achieve UHC in a fair and sustainable way. The authors may not have the answers but pose important questions for driving discussion as well as research. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Chalkidou K. Reviewer Report For: Reflections on the use of the World Health Organization’s (WHO) OneHealth Tool: Implications for health planning in low and middle income countries (LMICs) [version 2; peer review: 2 approved] . F1000Research 2018, 7 :157 ( https://doi.org/10.5256/f1000research.15027.r30630 ) The direct URL for this report is: https://f1000research.com/articles/7-157/v1#referee-response-30630 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 07 Feb 2018 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 05 Mar 18 Version 1 07 Feb 18 read read Kalipso Chalkidou , Imperial College London, London, UK Lotte M.G. Steuten , Fred Hutchinson Cancer Research Center, Seattle, USA Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2018 Steuten L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 01 Mar 2018 | for Version 1 Lotte M.G. Steuten , Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA 0 Views copyright © 2018 Steuten L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have described their reflections on the experience with Generalized Cost Effectiveness Analysis (GCEA) using the WHO One Health Tool (OHT), to aid other Low-Middle Income Countries (LMICs) looking to scale up their priority setting efforts. They clearly describe the rationale and aim of using this tool to support redefining the benefits package of the national insurer of the Philippines. Most importantly, they identify key limitations on various levels: 1) limitations of the OHT itself; 2) limitations in availability of models and data specific to the Philippine context; and 3) the unmet need to establish a single, harmonized priority setting process for the health sector that would enable multiple stakeholders (in this case the Department of Health and the Philippine Health Insurance Corporation) to make better policy decisions based on the questions they are currently faced with. Based on these limitations and their experiences the authors provide general recommendations that are relevant to the Philippines and to other LMICs. The paper is valuable and sound, given that its aims are quite humbly to share reflections on the use of the OHT for a priority setting exercise. However, these reflections –however well described and sensible- should not be read as (and are not intended to be) the result of a systematic evaluation of experiences based on all stakeholders inputs. A degree of subjectivity should be acknowledged and the paper would have benefit from more specific or detailed suggestions to improve the priority setting exercise and experience, from the perspective of the different participants. That said, this paper is a valuable contribution to the literature and more examples such as these should be welcomed and shared to drive the HTA field forward, globally as well as locally. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Health Technology Assessment, priority setting, comparative effectiveness, cost-effectiveness analyses I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Steuten LMG. Peer Review Report For: Reflections on the use of the World Health Organization’s (WHO) OneHealth Tool: Implications for health planning in low and middle income countries (LMICs) [version 2; peer review: 2 approved] . F1000Research 2018, 7 :157 ( https://doi.org/10.5256/f1000research.15027.r30629) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/7-157/v1#referee-response-30629 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2018 Chalkidou K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 08 Feb 2018 | for Version 1 Kalipso Chalkidou , Global Health and Development Team, Imperial College London, London, UK 0 Views copyright © 2018 Chalkidou K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a valuable and original contribution describing the analytical methods, data sources and overall policy approach to reviewing and attempting to adjust the health benefits package in the Philippines (based on a selection of mostly NCD interventions) using WHO’s OneHealth tool. A number of middle income countries are currently in a similar position, en route to Universal Healthcare Coverage and making a systematic attempt at revising their Benefits Package as part of the national or social health insurance funds and not many resources exist on how such a process can be carried out (e.g. see https://www.cgdev.org/publication/whats-in-whats-out-designing-benefits-universal-health-coverage for the Centre for Global Development guide to designing benefits packages). The authors succinctly summarise the challenges they faced including the limited breadth of the OneHealth models available to cover the whole spectrum of diseases the country faces. They also highlight the problematic assumption of the “null comparator”. The latter is a core element of the WHO approach to cost effectiveness analysis and makes structuring the decision problem in a way that reflects the reality policy makers are faced with, where the option of doing nothing is neither realistic nor ethical, impossible. The authors also flag up as major weaknesses the lack of national guidelines on the methods and processes for revising the package. Again there is limited global guidance as to best practice in the methods (for one example see the iDSI Reference Case to economic evaluation here http://www.idsihealth.org/resource-items/idsi-reference-case-for-economic-evaluation/ ) and processes for managing such a methodologically and politically challenging exercise. We need more such examples to be publicised and for a dialogue to start within and between countries as to how best to support policy makers achieve UHC in a fair and sustainable way. The authors may not have the answers but pose important questions for driving discussion as well as research. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Chalkidou K. Peer Review Report For: Reflections on the use of the World Health Organization’s (WHO) OneHealth Tool: Implications for health planning in low and middle income countries (LMICs) [version 2; peer review: 2 approved] . F1000Research 2018, 7 :157 ( https://doi.org/10.5256/f1000research.15027.r30630) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/7-157/v1#referee-response-30630 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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