Incorporating feasibility in priority setting : a case study of tuberculosis control in South Africa

Priority setting for infectious disease control has evolved beyond simple descriptions of costs and consequences of single interventions. Applications of economic evaluation alongside disease transmission modelling now include user-friendly models, which account for setting-specific variations in input prices and epidemiological characteristics, as well as optimisation routines. These developments allow the straightforward assessment of the local cost-effectiveness of new health technologies and rankings of multiple intervention options. At the same time, priority setting increasingly recognises that policymakers may be fulfilling multiple objectives alongside efficient resource allocation, such as pursuing equity in health outcomes, access to health care and financial protection, and that they are faced with a range of health system constraints in any given settings. These constraints may encompass physical input shortages on the supply side (e.g. lack of skilled human resources or disruptions in procuring supplies) and lack of uptake on the demand side (e.g. financial or other barriers such as hesitancy or stigma). Failure to take these into account can result in unfeasible health interventions being recommended ... (continues)