In a country where healthcare costs have risen sharply, and many people struggle to access essential services, decisions about the allocation of limited resources have become increasingly important. Lebanon needs valid data not only on whether a treatment is effective, but also on whether it offers good value for money. Health economic evaluations provide this evidence by comparing the cost of interventions with the benefits they provide. 

A study, titled “The Lebanese health economic evaluation guideline,” published in Expert Review of Pharmacoeconomics & Outcomes Research, introduces a national framework for conducting these evaluations with more consistency and transparency.

Co-led by Dr. Rana Rizk, assistant professor of nutrition at the School of Arts and Sciences, the paper outlines key components of Lebanon’s first health economic evaluation guideline and how it can support evidence-based decision-making.

The researchers followed a structured process that combined evidence from previous studies with input from Lebanese stakeholders and international experts.

This involved systematically reviewing existing guidelines, developing a survey, conducting interviews with 16 Lebanese stakeholders, holding a consensus workshop, and consulting with international experts. The stakeholders represented a range of perspectives, including public payers, hospitals, private insurance companies, medical providers, patient advocacy, bioethics, academia, and health economics.

The investigation led to the development of the Lebanese Health Economic Evaluation Guideline, or LEEG.

Based on consensus among stakeholders and experts, the LEEG applies to all health interventions, including medicines, medical devices, procedures, and vaccines. It is also intended to serve as a national guideline for researchers, decision-makers, health economists, healthcare professionals, and other parties involved in producing or assessing health economic evidence in Lebanon. 

The LEEG sets out how future health economic evaluations should be conducted. It recommends evaluating costs and outcomes from a societal perspective, specifically taking into account costs to patients, families, productivity losses, and other sectors, and not only the healthcare system. It also encourages comparing new interventions with all relevant alternatives currently available in Lebanese practice, using Lebanese reference prices when possible.

One preferred approach is cost-utility analysis, which measures health outcomes using quality-adjusted life years (QALYs), a metric that combines how long people live and the quality of those years. When such data are not available, cost-effectiveness analysis, which expresses outcomes in natural health units, can be used with justification. The guideline recommends using the strongest available clinical evidence, giving preference to real-world effectiveness where possible.

Beyond the technical framework, developing the LEEG itself highlighted some of the key system-level challenges in Lebanon, noted Dr. Rizk. Bringing together policymakers, payers, clinicians, academics, and patient advocates required sustained facilitation, and reaching consensus across such diverse groups was not straightforward, she said. 

On the methodological side, “a persistent challenge was the lack of a health technology assessment (HTA) research infrastructure needed to support sustained economic evaluation,” added Dr. Rizk. As a result, the researchers “had to make recommendations that acknowledge these [data] gaps while still providing actionable, evidence-based guidance.”

Despite these challenges, what emerged from the stakeholders’ interviews was a widespread recognition of the value of the guideline. Across sectors, “participants identified it as a meaningful step toward greater transparency and accountability in health decision-making in Lebanon,” said Dr. Rizk.  The biggest challenge, she added, is ensuring it “lands in a policy environment with the institutional capacity to act on it.”

Looking ahead, Dr. Rizk stressed that “the guideline itself is a starting point, not an endpoint.” From a research perspective, she identified several urgent priorities, which include building valid, publicly accessible cost databases across payers such as the Ministry of Public Health, the National Social Security Fund, and private insurers, as the fragmented spending data can limit the ability to conduct reproducible economic evaluations.  

Implementation research is as important as data infrastructure, added Dr. Rizk. Early findings suggest that the main barriers to adopting health economic evaluation in Lebanon are not purely technical but also institutional and political. Future studies, she argued, should examine how policy networks form, how institutional champions can be supported, and what accountability mechanisms are needed to ensure that HTA evidence is actually used in decision-making.

Ultimately, she concluded, “everything we do in this space, the research, the stakeholder engagement, the methodological work, etc. is driven by the hope that our collective efforts contribute to a more evidence-based, equitable, and transparent health decision-making in Lebanon; one that places scientific evidence, and the dignity and wellbeing of people at its center.”

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