Table 1 Methodological barriers to health economic evidence use in CPG development

1. Lack of agreed methods and reporting standards

• Inconsistent methods / poor standardisation (e.g. clinical end-points or comparators selected)

• Poor reporting of methods

• Methods not agreed by stakeholders in South Africa

• Develop methods and reporting standards informed by broad based stakeholder consultation

2. Lack of available data

• Data from South Africa of costs:

- Costs vary by sectors (i.e. public vs. private), settings (e.g. provinces) and levels of care (i.e. primary vs secondary)

- Poor availability of costing data

• Outcomes data to inform decisions

• Strengthen data collection systems

• Develop registries for data collection

• Investment in research

3. Lack of skills to conduct analyses and use economic evidence

• Lack of trained health economists, statisticians, mathematicians, team with multi-disciplinary skills

• Lack of skills for CPG developers to read and use HEE

• Train economists and statisticians to work on HEE for CPGs

4. Lack of funding/ insufficient resources

• Training and building necessary skills

• Collecting data/evidence to inform economic models (e.g. clinical outcomes, registries)

• Investment in research and training

5. Lack of trust and inability to share

• Poor sharing of available data (e.g. private to public)

• Develop agreements between groups to share data respectfully