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Senegal: Introduction of HTA

Since 2016, the Research Center for Health Policy and Economics in the Hitotsubashi Institute for Advanced Study (HIAS Health) at Hitotsubashi University has been working with the Japan International Cooperation Agency (JICA) to conduct a quantitative evaluation of the UHC project in the Republic of Senegal in West Africa. If UHC were implemented, it ensures that all people have “access to appropriate health promotion, prevention, treatment, and functional recovery services at a cost they can afford.” This is one of the SDGs adopted by the United Nations (UN) General Assembly in 2015.


In collaboration with JICA, the Senegalese government, and the World Bank, the UHC evaluation project in Senegal has been investigating (1) the governance and operational capacity of the community insurance schemes that form the core of UHC policy in Senegal; and (2) whether local residents have access to health care services and whether the majority of their household finances are devoted to medical costs, resulting in financial difficulties. The study found that the health care services and medicines provided by community insurance schemes remain limited, meaning that it is necessary to expand services through a more substantial policy.


The use of HTAs, such as economic evaluations of health interventions, is becoming increasingly widespread worldwide. An HTA process typically involves assessments to determine which new health care services should be provided within a limited budget based on the cost and effectiveness of these services. In this project, research is conducted on the promotion of HTA as a means of scientifically formulating health benefit packages to be provided by community insurance schemes. In the project’s first year, several online interviews with senior officials of the Senegalese Universal Health Coverage Agency (ACMU) revealed that human resource development and support for an HTA institutionalization process within the government are necessary. In addition, the project collaborates with the Access and Delivery Partnership being promoted by the UN Development Programme. In the fiscal year 2021 (FY2021), the scope of HTA application in Senegal was examined, and regular discussion for setting agenda of the institutionalization were undertaken with the collaboration of the Senegalese ACMU and Thai Ministry of Public Health.


The process of introducing HTA policy in Senegal was also examined in terms of its efficient operation within the UHC framework. Given that the insurance coverage rate in Senegal is low—roughly 30% as of 2018—there are plans for a trial in which nudge interventions will be used to promote insurance coverage among members of the population (especially in the informal sector) in the Thiès Region, after which a cost-effectiveness evaluation of such behavioral interventions will be developed in conjunction with the Thiès branch of the ACMU.

Thailand: HTA of Lifestyle-Related Disease Control

Deaths from lifestyle-related diseases have now reached their highest levels in low-, middle-, and high-income countries. Therefore, the need to allocate public funds to prevention is increasing worldwide. One of the most significant interventions for combatting lifestyle-related diseases is the improvement of exercise habits. Governments are planning and implementing health intervention policies to promote healthy exercise habits in people’s daily lives, especially in the workplace.


This study aims to evaluate the effectiveness and cost effectiveness of behavioral economic interventions aimed at promoting exercise habits in various departments of the Ministry of Public Health in the Thai government.
Specifically, the effects of three interventions aimed at increasing individual exercise levels and labor productivity will be measured: financial incentives for exercise habits; reminders on Internet browsers or personal computers that encourage breaks and healthy exercise habits; and communication of social norms regarding exercise during breaks.
The cost-effectiveness of the interventions is analyzed. Based on this analysis, the feasibility of introducing these interventions in the entire country will then be presented to the Thai Ministry of Public Health.


The intervention experiment was started in the fiscal year 2020 (FY2020), the protocol for which was published in a peer-reviewed journal. The interventions were continued in FY2021, and an interim evaluation of the effects of the intervention was conducted based on the subjects’ biomarkers and records of their exercise habits.

Thailand, Singapore, and Japan: Prioritization of COVID-19 Vaccination Targets and HTA

The spread of COVID-19 has caused a large number of infections and deaths worldwide. Although vaccination is considered the most effective countermeasure currently available, vaccine production is limited, and state governments, including the Japanese government, are unable to vaccinate all citizens at the same time.


For this reason, the prioritization of the allocation of vaccines to national population groups should be determined by considering multiple factors, including the number of deaths, the number of acute care beds available, and the resumption of economic activities. To provide scientific data for this purpose, Japan, Singapore, and Thailand will develop an epidemiological and economic model that is tailored to each country’s context (availability of vaccines and other political, economic and cultural) in order to examine vaccine prioritization and relevant assessments including HTA.
In FY2021, an infection model for Japan was constructed, and numbers of infections, severe cases, and deaths were predicted using official data, such as infection data released by the Ministry of Health, Labour and Welfare.


Based on the current efficacy levels of vaccines and vaccination procedures, the Japanese people were categorized according to their age groups and the presence of pre-existing conditions. The groups that should be prioritized for vaccination in order to minimize the number of infections, severe cases, and deaths were determined using this model. The results will be presented in a paper.
Between FY2021 and FY2022, the results will be disseminated to the Japanese and select international governments, including Thailand and Singapore, through seminars and other activities.

Establishing a Monitoring System for Infectious Diseases in ASEAN Countries

In FY2021, a survey was conducted on the infection monitoring functions in the ASEAN region and Japan, which was combined with a basic survey on the preparatory status of each government in terms of issuing “vaccine passports” for vaccines received in the region and the concerns related thereto (e.g., whether the existence of passports leads to discrimination). The operation of the passport program in ASEAN countries, as well as in Japan and South Korea, was also discussed.
Results of the discussion will be summarized in a policy-oriented academic paper.

Bhutan: HTA Promotion (Quantification of Cost-Effectiveness Thresholds)

Since the fall of 2019, HIAS Health at Hitotsubashi University has been conducting a HTA-related study in Bhutan in collaboration with HITAP in response to a request by the Bhutanese Ministry of Health.


Specifically, two projects are underway that aim to quantify the cost-effectiveness thresholds used by the Bhutanese government when updating the list of essential medicines being informed by their HTA initiative.


In the first study, national healthcare budget data as well as national health data are provided by the Bhutanese Ministry of Health, to quantify the relationship between health budget input and health outcomes, to quantitatively estimate a marginal productivity of the Bhutanese public health care system. In the second study, a national survey is being used to determine the amount each household is prepared to pay for healthy life expectancy in order to quantify the demand for health care in Bhutan. Outcomes of the two studies can be used as a cost-effectiveness threshold in the country.