Beschreibung:
<jats:p>Health technology assessment aims to enable the prioritisation of efficient and equitable services and enhance responsiveness to population preferences. Resting on foundations of distributive and procedural justice, it is a fundamental component of a universal health coverage system. The required decision-making for the COVID-19 response stimulated the demand for evidence-informed processes and provides an opportunity to demonstrate how health technology assessment can be conducted in the South African environment. This chapter contributes to strengthening health technology assessment by reflecting on insights gained from research on the cost-effectiveness of in-patient care for COVID-19.</jats:p> <jats:p>Rapid economic evaluations of in-patient interventions for COVID-19, including intensive care, dexamethasone and remdesivir were conducted. These evaluations aimed to inform urgent health policy decisions related to the COVID-19 response and to demonstrate the use and feasibility of a pragmatic approach to health technology assessment. Costs from the health systems perspective, deaths, and disability-adjusted life years (DALYs) averted were estimated. Incremental cost-effectiveness ratios were compared to the estimated marginal productivity of the public health system to gauge cost-effectiveness. Open access models were published to encourage transparency and policy translation.</jats:p> <jats:p>Results indicated that purchasing private sector intensive care was unlikely to be cost-effective, dexamethasone was cost-effective, and remdesivir was cost-saving. Corresponding national policy included a signed service-level agreement to purchase private ICU beds for public patients, and recommendations in favour of dexamethasone and against remdesivir. Policy decisions did not align with findings of two of the three economic evaluations.</jats:p> <jats:p>These analyses and associated policy dissemination demonstrate that health technology assessment need not wait for the perfect system. Rigorous, transparent and rapid economic evaluation to support such assessment for urgent, priority policy decisions can be conducted in the South African context. Institutionalising health technology assessment, including strengthening capacity and funding of analyses, will assist decision-making and sustainability in the National Health Insurance environment.</jats:p>