Expert Review of Pharmacoeconomics & Outcomes Research最新文献

Objective: To evaluate the effects of standardized pharmaceutical service (SPS) on medication adherence, anxiety, and depression in patients with chronic obstructive pulmonary disease (COPD).

Research design and methods: A prospective, randomized controlled study design was adopted. 184 COPD patients hospitalized at the First Hospital of Putian City between March and August 2023 were randomly assigned to a control group receiving routine care or observation group receiving SPS provided by clinical pharmacists. SPS included health records establishment, education, medication guidance, psychological support and medication simplification. Patients were followed for 6 months. Eight-Item Morisky Medication Adherence Scale (MMAS-8), the Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS) were used to assess outcomes.

Results: At 3- and 6-month, the observation group had higher MMAS-8 scores (P < 0.05) and a greater of good-to-moderate adherence at 6 months (66.30% vs.35.87%; P < 0.01). Moderate-to-severe anxiety and depression rates were significantly lower in the observation group (53.26% and 54.35%) than in controls (P < 0.001). Fewer adverse events were recorded in the observation group (3 vs. 8), though not statistically significant.

Conclusion: SPS enhance medication adherence and reduce anxiety and depression in COPD patients, supporting its integration into routine COPD management.

Introduction: Despite decades of HIV prevention efforts, key populations - MSM, transgender people, PWUD, sex workers, and migrants - remain disproportionately affected by HIV. Although prevention tools are widely available, global targets remain unmet, largely due to persistent structural and sociocultural barriers, resulting in an important societal cost.

Areas covered: This scoping review analyzes 197 studies (2018-2022) quantitative and qualitative, from 48 countries to map barriers to HIV prevention across five key populations and five continents, using Medline and Scopus databases according to the PRISMA-ScR methodology. It reveals widespread legal and institutional obstacles: lack of health insurance, criminalization of their condition, stigma (including HIV and internalized stigma), violence, poverty, low health literacy, and healthcare mistrust. It also identifies major gaps in research coverage around the world.

Expert opinion: Despite major progress in HIV prevention, inequities persist in implementation and access. Our study highlights the urgent need of coordinated governmental and institutional efforts to ensure universal access to prevention tools, social protection, and stigma reduction interventions, as requested by UNAIDS. An intersectional approach that responds to the overlapping vulnerabilities faced by key populations is essential. Without systemic change, biomedical progress alone will not be sufficient to put an end to HIV.

Introduction: Antimicrobial resistance (AMR) is a complex global health challenge with significant, yet underutilized economic dimensions. Beyond the clinical aspect, this growing threat demands interdisciplinary solutions that bridge economic theory and practice.

Areas covered: This scoping review synthesizes economic perspectives on AMR through systematic analysis from Ovid MEDLINE, Scopus, EconLit, and PubMed (December 2023 to June 2025). We examine four critical domains: (1) foundational economic theories explaining AMR drivers through public goods theory, tragedy of commons, externalities, and market failures; (2) real-world market dynamics including supply-demand imbalances and principal-agent relationships in clinical settings; (3) policy interventions spanning regulatory frameworks, fiscal measures, and behavioral economics applications in antimicrobial stewardship; and (4) economic evaluation methodologies encompassing descriptive, evaluative, and predictive analyses. Our analysis reveals how theoretical economic frameworks arise in healthcare practice and why comprehensive multi-component interventions outperform single-approach strategies.

Expert opinion: Sustainable AMR mitigation requires fundamentally rethinking policy design through these interconnected economic lenses, transitioning from fragmented interventions to economically coherent frameworks that align short-term clinical decisions with long-term antimicrobial preservation. These changes demand unprecedented collaboration between economists, clinicians, and policymakers to align individual incentives with collective health security.

Background: Atopic dermatitis (AD) is a chronic skin disease that affects patients' quality of life. Adequate treatment is important but patients' preferences are not fully understood. This study aimed to investigate which treatment attributes are most important for adult European AD patients.

Research design and methods: A discrete choice experiment was conducted. Participants were asked to choose their preferred hypothetical treatment option in 15 choice sets. Six included attributes were identified by consulting literature, patients, physicians, and preference experts. A mixed logit model was applied to estimate preference coefficients.

Results: All attributes were important for seventy-five participants (79% female, mean age 37.8 years). Itch reduction was most relevant (55.95%), followed by infection risk (15.96%), mode of administration (9.64%), long-term diseases management (8.11%), onset time (5.33%), and availability on the market (5.01%). Participants prefer emollients without preservatives and oral pills, while emollients with preservatives and self-injections are associated with utility loss.

Conclusions: This study identified most important treatment attributes for AD patients. It could improve AD patients' access to suitable therapies as findings might support development of better aligned treatments and provide new perspectives for joint treatment decision-making. Main limitation was low number of participants, although significant results were still achieved.

Background: One approach to address the limitations of the EQ-5D-5L questionnaire is to add additional dimensions. This study investigated the effect of adding a vision dimension to the EQ-5D-5L questionnaire on health state valuations in people with visual impairments.

Methods: This cross-sectional study was conducted using both the standard EQ-5D-5L and an expanded version (EQ-5D-5L + V, including a vision dimension) through face-to-face interviews with 300 individuals with visual impairments. Twenty health states, with and without the vision dimension, were assessed using the Time Trade-Off (TTO) method according to the EQ-VT protocol. Data were analyzed using Chi-square and Fisher's exact tests, independent t-tests, and multivariate regression.

Results: The addition of the vision dimension significantly increased the differences in health state valuations, particularly for severe health states (P < 0.001). The largest differences in TTO scores were observed for severe health states 555555, 555553, 532441, and 351431.

Conclusion: Adding a vision dimension to the EQ-5D-5L instrument significantly affects health state valuations, especially for severe levels (4 and 5) and severe health states. Future studies should further explore the impact of adding vision and other bolt-on dimensions, focusing on the levels of the added dimensions.

Background: Cancer survivors face ongoing health challenges that can reduce work capacity, yet the economic impact of workplace productivity losses remains underexamined. We aim to estimate workplace productivity losses, specifically absenteeism and presenteeism, among Australian cancer survivors and quantified associated wage costs.

Methods: We analyzed four waves (2009-2021) of the Household, Income and Labour Dynamics in Australia (HILDA) Survey, including adults aged ≥15 years in the labor force reporting cancer, non-cancer serious illness, or no serious illness. Absenteeism (annual days off work) was modeled using zero-inflated Poisson regression, and presenteeism (self-reported reduced work performance) using logistic regression, adjusting for sociodemographic, health, and employment factors. Sensitivity analyses explored alternative absenteeism definitions.

Results: Cancer survivors had a 33% higher rate of absenteeism (Incidence Rate Ratio [IRR]: 1.33; 95% CI: 1.31-1.35, p-value < 0.001) and approximately double the odds of presenteeism (Adjsusted Odds Ratio [aOR] : 2.04; 95% CI: 1.71-2.43; p-value < 0.001) compared with individuals without serious illness. Estimated average annual absenteeism-related wage loss was AU$1425.45, predominantly among working-age adults (25-64 years).

Conclusion: Cancer imposes substantial workplace productivity losses with significant economic implications. Findings support the development of evidence-based workplace policies and targeted occupational health interventions to sustain employment and reduce economic burden among cancer survivors.

Background: Ribociclib plus letrozole significantly improves survival in HR+/HER2- advanced-stage or metastatic postmenopausal breast cancer (BC) patients.

Aim: To evaluate the cost-effectiveness of first-line ribociclib plus letrozole versus palbociclib plus letrozole for HR+/HER2- advanced BC in the Chilean public healthcare system.

Methods: A partitioned survival model with a 1-month cycle and 40-year horizon was utilized. Data were drawn from PALOMA-2 and MONALEESA-2 trials. Utility values were sourced from trial data and literature. Costs included drug acquisition, disease monitoring, subsequent therapies, and adverse events. Deterministic sensitivity analysis (DSA), probabilistic sensitivity analysis (PSA), and scenario analyses with varying clinical efficacy estimates were conducted to address uncertainty.

Results: Ribociclib plus letrozole consistently dominated palbociclib plus letrozole, showing better effectiveness at lower costs. In the base case, ribociclib saved $5,724 with an additional 0.506 QALYs. Scenario 1 showed savings of $4,942 and 0.398 QALYs, while Scenario 2 indicated $9,830 saved with 1.282 QALYs gained. PSA confirmed a 100% probability of ribociclib being cost-effective at a willingness-to-pay threshold of 1 GDP per capita.

Conclusion: Ribociclib plus letrozole is cost-saving and cost-effective compared to palbociclib plus letrozole for the first-line treatment of postmenopausal women with HR+/HER2- advanced BC in Chile.

Background: Multiple sclerosis (MS) is a chronic neurodegenerative disease impacting young adults, reducing quality of life and imposing economic burdens.

Objectives: This study estimated MS costs in Algeria from a societal perspective, analyzed cost variations by disease severity, and provided insights for enhancing MS management and healthcare planning.

Methods: A cross-sectional, bottom-up cost-of-illness study used a validated questionnaire to collect demographic, clinical, and socioeconomic data from MS patients. Data included disease-modifying therapy (DMT) use, MS course, and EDSS scores. Direct costs (medical and non-medical) and indirect costs (productivity losses from absenteeism and early retirement) were calculated. Cost drivers were analyzed using generalized linear models.

Results: Among 354 patients, the total annual societal cost per MS patient was $9,636.5 (95% CI: 9101.2 -10,178), with a mean EDSS score of 3.1 (SD 2.1). Direct costs accounted for 93.31%, with DMTs comprising 94.42% of direct medical costs. Costs rose with disease severity, from $8,697.9 (95% CI: 8060.9-9326.8) for mild MS to $12,450.8 (95% CI: 10137.2 -14,773.6) for severe MS (p < 0.001).

Conclusions: This study highlights MS's economic burden in Algeria, with DMTs as the primary cost driver. Optimized resource allocation and cost-effective DMT strategies are essential to improve MS care.

Background: Higher prices for drugs targeting rarer cancers may be justified, but the extent remains uncertain. This research analyses the determinants of cancer drug prices in Germany and France.

Research design and methods: Cancer drugs approved in EU between 2011 and 2022 with available benefit assessments and prices were analyzed. Monthly treatment cost was the dependent variable; approval year, orphan status, benefit rating, number of comparators, and target population size were independent variables. Univariate and multiple regression analyses were conducted.

Results: The analysis included 107 drugs in Germany and 70 in France. In Germany, univariate analysis showed significance for benefit magnitude, orphan status, number of comparators, target population, and approval year. In France, orphan status, number of comparators, target population, and approval year were significant. Regression models showed that log target population (p < 0.0001), approval year (p = 0.021), and major/considerable benefit (p < 0.0001) were significant in Germany; log target population (p = 0.001) and ASMR II/III (p = 0.017) were significant in France.

Conclusions: Target population and benefit rating are drivers of cancer drug prices in Germany and France. The analysis provides quantitative evidence on the association between cancer rarity and price, which could inform policy.

Introduction: Digitally delivered patient decision aids are becoming more prevalent to support prenatal decision-making. However, the effect of digital decision aids on prenatal outcomes is unclear. The objective of this systematic review and meta-analysis is to synthesize the currently available evidence on the effect of digital decision aids on prenatal outcomes, and quantitatively analyze the effect of interventions on prenatal outcomes across studies.

Methods: Studies that used digital decision aids (I) and measured prenatal care outcomes (O) for pregnant women (P) were eligible for inclusion. Ovid MEDLINE, CINAHL, Scopus, and Cochrane were searched from inception to November 2024. The protocol was registered on Open Science Framework.

Results: 3106 results were identified from databases. After deduplication, 2494 were screened. 11 studies were included in the review. Decision aids were found to improve knowledge and reduce decisional conflict. In a meta-analysis analyzing decisional conflict, interventions were favored (SMD -0.15; 95%CI -0.24, -0.06).

Conclusions: Digital decision aids can improve prenatal decisional quality, though we found less evidence for their effect on changing interventional decisions. Research is still needed on the most effective digital formats and strategies for implementation of decision aids in real-world environments to assess the benefits of digital decision aids for prenatal care.

Registration: The protocol was registered on Open Science Framework (osf.io/p2vb5).