Expert Review of Pharmacoeconomics & Outcomes Research最新文献

Background: Chronic hepatitis C (CHC) remains a major public health challenge in China. Currently, direct-acting antivirals (DAAs) are the mainstay of clinical treatment. This study employed a discrete choice experiment (DCE) to investigate physicians' preferences regarding DAAs for the treatment of CHC.

Methods: A DCE was designed based on the Chinese Guideline for Comprehensive Clinical Evaluation of Drugs and relevant literature, incorporating seven core attributes: safety, efficacy, economy, innovativeness, appropriateness, accessibility, and affordability. Fourteen choice sets were constructed. Physicians' preferences were analyzed using conditional logit models, from which willingness-to-pay (WTP) and relative importance of attributes were derived. Latent class analysis (LCA) was further applied to explore heterogeneity in physicians' preferences.

Results: Data were collected from 159 hospitals across 27 provinces in China, with 185 valid questionnaires included. Efficacy emerged as the most important determinant of prescribing preference, followed by affordability and economy, then accessibility, safety, and appropriateness, while innovativeness was not a significant concern. The LCA identified three distinct latent classes, which were significantly associated with demographic variables.

Conclusions: In China's healthcare setting, beyond the central importance of efficacy, physicians also place great emphasis on affordability and economic value, with marked heterogeneity in preferences depending on background characteristics.

Background: Given the critical role of timely monitoring in diabetes management, effective and accessible testing strategies are increasingly vital. This study evaluated the cost-effectiveness of point-of-care A1c (POC-A1c) testing compared with traditional laboratory-based A1c testing in primary care settings in Iran.

Research design and methods: A lifetime (40 year) Markov model was developed to estimate expected costs (valued in 2023 PPP-adjusted US dollars), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) for the two strategies. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in key model parameters.

Results: POC-A1C was associated with an incremental cost of US$1,647.76 and a 0.15 QALY gain versus traditional laboratory testing, yielding an ICER of US$10,717.27 per QALY. Consequently, it was cost-effective at a willingness-to-pay threshold equal to Iran's 2023 per capita GDP. Also, based on probabilistic sensitivity analysis, the probability of POC-A1C being cost-effective was 58%.

Conclusions: These findings suggest that integrating POC-A1c testing into primary care may represent a valuable strategy for strengthening diabetes management in Iran. While associated with higher direct costs, its potential to improve glycemic control and long-term health outcomes supports consideration by policymakers, particularly in the context of expanding access to timely diabetes monitoring.

Background: Greenhouse gas emissions, especially the atmospheric trapping of carbon dioxide (CO₂), are widely linked to increased weather variability, thereby affecting other aspects of human activity and nature. The increased occurrence of intense rainfall, heat waves, flooding, and droughts worsens the volatility of financial markets.

Research design and methods: The present study aims to investigate the cross-impacts of climate change and pharmaceutical sector activities, particularly in the United States (US) and India. Climate risks are predominant in emerging economies such as India, which lack sufficient resources for climate change mitigation and adaptation. In this context, we employ transfer entropy, BEKK GARCH (Baba, Engle, Kraft, and Kroner Generalized Autoregressive Conditional Heteroskedasticity), and coherence wavelet approaches to examine the relationship between the two aspects.

Results: India's pharmaceutical index contributes more to climate risk. Interestingly, US pharmaceutical market co-movements with climate risks are high despite low volatility spillover. This suggests developed nations like the US possess superior resources to manage climate risks compared to developing economies like India.

Conclusions: While this outcome is limited to the contexts of India and the US, it offers insights to decision-makers, investors, and relevant portfolio managers on the vulnerability of essential sectors to climate-related risks.

Background: This study investigated the impact of changes in health state duration in a discrete choice experiment where duration is an attribute (DCE_TTO).

Methods: A sample of the general population in Quebec, Canada, completed DCE_TTO in two phases using SF-6Dv2. In the first phase (DCE_original), participants were presented with binary choice sets, each containing two health states and associated durations. In the second phase (DCE_changed), they completed the same choice sets as before, but with modified durations. Adjustments were made based on participants' initial responses. Durations were 1, 4, 7, 10, 14, and 20 years. McNemar's Test was used to evaluate the change in respondents' choices before and after the duration modification.

Results: A total of 411 participants were included. Significant increases in duration of the option not chosen (by a factor of two or more) led it to become the preferred option (p < 0.05). A decrease in the duration of the option chosen could still lead to its acceptance. Overall, participants showed a strong anchoring effect of their initial choice, while changes in duration had a moderate positive effect on the likelihood of switching choices.

Conclusions: Findings highlight non-linear effects of time on preferences and have important implications for the design of DCE_TTO studies.

Background: This study evaluates the cost-effectiveness of tucatinib plus trastuzumab compared to pertuzumab plus trastuzumab for chemotherapy-refractory, HER2-positive, RAS wild-type unresectable or metastatic colorectal cancer (CRC) from the perspective of healthcare payers in China.

Research design and methods: An economic evaluation utilizing a 3-state partitioned survival model assessed the cost-effectiveness of tucatinib plus trastuzumab versus pertuzumab plus trastuzumab.

Results: When the price of tucatinib was based on that of lapatinib in China, the estimated cost for tucatinib plus trastuzumab was higher than that of pertuzumab plus trastuzumab (29,130.32 USD vs 12,160.58 USD). The estimated utility was also greater compared to that of pertuzumab plus trastuzumab (2.07 QALYs vs 1.07 QALYs). The ICER was calculated at 17,075.25 USD/QALY, suggesting the tucatinib plus trastuzumab treatment was cost-effective compared to pertuzumab plus trastuzumab for chemotherapy-refractory, HER2-positive, RAS wild-type unresectable or metastatic CRC at a WTP threshold of 40,000 USD/ QALY.

Conclusions: Tucatinib plus trastuzumab was cost-effective if its price was the same as lapatinib for chemotherapy-refractory, HER2-positive, RAS wild-type unresectable or metastatic CRC from the perspective of healthcare payers in China. Our exploratory result could provide a reference for clinical application of tucatinib plus trastuzumab when they are correctly interpreted.

Introduction: High sickness absence and disability claims create major societal and budget pressures, making return-to-work (RTW) interventions a central policy priority. Because decisions often hinge on whether productivity gains are counted, robust long-horizon economic models are influential - but also vulnerable to strong extrapolation assumptions.

Areas covered: This Key Paper Evaluation examines a recent modeling study of RTWinterventions comparing a 3½-week inpatient multimodal occupational rehabilitation (I-MORE) with outpatient Acceptance and Commitment Therapy (ACT). The authors link a randomized trial to 7 years of registry follow-up and project costs and effects over a 25-year horizon from healthcare and societal perspectives.

Expert commentary: The analysis is transparent and well executed, but the study's headline finding - lifetime dominance of I-MORE when productivity is counted - hinges on structural assumptions that effectively extend a 3½-week inpatient program into persistent productivity gains over a 25-year horizon: transition intensities are frozen beyond 4 years, and within-state absence-day differences are held constant thereafter, generating persistent productivity gains even after state prevalences converge. Health-related quality of life is observed only to 14 months and then modeled as state-specific constants, compressing incremental quality-adjusted life years and leaving the healthcare-only incremental cost-effectiveness ratio unfavorable. We argue that lifetime savings should be treated as upper-bound estimates and that decision relevance would be strengthened by waning-effect scenarios, mid-term horizons, and tests of the absorbing disability state. We also highlight the need for diagnosis-by-treatment analyses and stepped-care sequences given the heterogeneous population and fixed-dose ACT comparator.