Expert Review of Pharmacoeconomics & Outcomes Research最新文献

Background: Patients with obesity or overweight are at increased risk for obesity-related complications (ORCs), including cardiovascular disease. Treatment with once-weekly (OW) semaglutide 2.4 mg has demonstrated clinical efficacy, however its impact on healthcare resource utilization (HCRU) and costs warrants further investigation.

Research design and methods: This retrospective real-world study evaluated HCRU and costs (excluding pharmacy) among patients with obesity or overweight and ≥1 ORC in the Komodo Healthcare Map database. Baseline characteristics of patients starting OW semaglutide 2.4 mg treatment were matched to obesity medication (OM) non-users. HCRU and medical costs estimates at 12-month follow-up, both all-cause and ORC-related, were compared between the two cohorts.

Results: Patients treated with semaglutide 2.4 mg vs OM non-users had 37% and 21% lower incidence of all-cause inpatient (IP) and emergency room (ER) visits, respectively, and 45% and 29% lower incidence of ORC-related IP and ER visits, respectively. All-cause and ORC-related total medical costs were lower among patients treated with semaglutide 2.4 mg (11% and 15% lower, respectively), translating to an observed savings of $3,342 and $2,408 at 12 months.

Conclusions: In patients with obesity or overweight, OW semaglutide 2.4 mg treatment was associated with decreased total medical HCRU and costs at 12 months.

Objective: To identify the major barriers to and facilitators of implementing the Lebanese Health Economic Evaluation Guideline (LEEG) according to Lebanese stakeholders, supported by their insights.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬.

Methods: We conducted a survey asking 16 key stakeholders to rate LEEG's importance, its necessity for Lebanon, and its applicability in decision-making, and Likert scale questions to rate barriers and facilitators. Following the survey, an individual face-to-face interview using open-ended questions was arranged to validate the survey's data, to collect further insights regarding LEEG's implementation in Lebanon, and to identify relevant barriers and facilitators.

Results: All participants considered LEEG to be very important for Lebanon. The majority considered it very important for decision-making, while there was some disagreement on the applicability of economic evaluation as a criterion for decision-making. The most important barriers were 'lack of political willingness to adopt economic evaluation and use health technology assessment findings' and 'the absence of policy networks.' The most important facilitators were 'the strong need to implement national guidelines in Lebanon' and 'acceptability to payers.'

Conclusion: We reported on important barriers to and facilitators of implementing LEEG related to the national context and methodological concerns. This will pave the way for developing strategies essential for effective implementation and, consequently, a better healthcare system, advancing progress to universal health coverage.

Introduction: This systematic review synthesizes recent evidence on the cost-effectiveness of HIV prevention interventions in sub-Saharan Africa (SSA), where over 70% of the global HIV burden resides.

Methods: Following PRISMA 2020 guidelines, we searched five databases (2019-2025) for full economic evaluations of HIV prevention in SSA. Studies were assessed using CHEERS 2022 and Drummond checklists. Costs were adjusted to 2024 USD and compared to GDP per capita thresholds. Results were synthesized narratively.

Results: 30 studies were included; 28 used model-based designs, 2 used trial or cohort data. The most frequently evaluated interventions were PrEP (n = 7), PMTCT (n = 4), and HIV testing innovations (n = 3). Oral PrEP was the dominant form, though two studies evaluated long-acting injectable PrEP. Interventions were considered cost-effective if the Incremental Cost Effectiveness Ratio (ICER) was below 1-3 times GDP per capita. For example, dolutegravir-based PMTCT had an ICER of USD109/DALY averted. Peer-delivered self-testing and maternal HIV screening in immunization clinics showed strong economic efficiency. Few studies incorporated real-world data on medication adherence, drop-out or service delivery costs.

Conclusions: Targeted, integrated HIV prevention strategies are cost-effective in SSA. Future studies should improve use of empirical adherence and implementation data and expand focus to underrepresented populations and regions.

Introduction: There is global consensus on the critical role of prevention in improving population health and reducing long-term healthcare costs. However, investment in prevention remains comparatively limited. With governments increasingly prioritizing prevention, this may be poised to change.

Areas covered: To estimate the economic value of preventive health technologies and support their prioritization for a sustainable healthcare system, we propose three essential themes for economic evaluation: recognizing the value of prevention, estimating its uncertain benefits, and enabling system-level change. We outline key objectives within each theme and highlight emerging methods and approaches to address them.

Expert opinion: The key challenge ahead lies in translating these methodological advancements into policy-relevant evidence that supports effective and sustainable prevention strategies. By integrating interdisciplinary perspectives and advancing economic evaluation approaches, we can help ensure prevention receives the recognition and investment needed to foster healthier, more resilient societies.

Objective: To assess the cost-effectiveness of cenobamate in epileptic people with focal seizures in the Netherlands.

Methods: A Markov model was used to simulate lifetime costs and quality-adjusted life years (QALYs) for cenobamate compared to perampanel, brivaracetam, and lacosamide from the Dutch societal perspective. Data from a randomized controlled trial and open-label extension were used to determine the transition probability, efficacy and safety of treatment with cenobamate. Treatment, administration, routine monitoring, seizure event management, adverse events and productivity costs were included. Both one-way and probabilistic sensitivity analyses were conducted to explore the uncertainty.

Results: Cenobamate was associated with an average total cost of €466,560 and 9.922 QALY gained. Among the four drugs tested, treatment with cenobamate indicated lowest cost and highest QALY gained, suggesting cenobamate dominates all comparators. One-way sensitivity analysis confirms the robustness of our results. Probabilistic sensitivity analyses revealed that at the willingness to pay threshold of €50,000/QALY, the probability that cenobamate is cost-effective was 100%.

Conclusion: With the acknowledgment of the limitations, we concluded that cenobamate is less costly and more effective, which can be considered a cost-effective treatment option for patients with drug-resistant focal seizures in the Netherlands. Future real-world data are needed to confirm our findings.

Background: This study evaluated the efficiency CE-latanoprost unidose (cationic emulsion of latanoprost) versus latanoprost unidose (non-emulsion formulation) in open-angle glaucoma and ocular hypertension (OAG/OHT) with concomitant ocular surface disease (OSD) patients' treatment in Spain.

Methods: A cost-utility analysis was performed using a Markov model simulating the progression of OAG/OHT. From a Spanish National Health System perspective over a 5-year time horizon, quality-adjusted life years (QALYs) and the total cost of each therapy were estimated (annual discount rate: 3%). Therapy efficacy included adherence, disease progression, and OSD reduction. Utility values for OAG/OHT and OSD-related disutility values were obtained from literature. Five ophthalmologists validated all included parameters. Total costs (€, 2023) included CE-latanoprost or latanoprost drug acquisition (€10/30 single-dose), glaucoma diagnosis, patient follow-up, and OAG management costs.

Results: The base case results showed that CE-latanoprost unidose increased health outcomes (2.69 vs. 2.49 QALYs) and lowered costs (€5,292.12 vs. €5,441.55) being a dominant option (0.21 QALYs gained and €149.43 less) compared to latanoprost unidose.

Conclusions: CE-latanoprost unidose was a cost-effective option for the treatment of patients with OAG/OHT and OSD in comparison to latanoprost unidose (non-emulsion formulation). In addition to its clinical benefits, the economic analysis supports using CE-latanoprost in terms of efficiency.

Introduction: Preference research is crucial in shaping effective patient-centered preventive healthcare strategies. Preventive measures such as vaccinations, screenings, and proactive treatment of asymptomatic high-risk conditions aim to reduce future health risks, often in healthy individuals. Understanding patient preferences in these contexts is vital to ensure that interventions are clinically effective, acceptable, and actionable. Failing to consider patient preferences when developing preventive strategies may result in low uptake and adherence to prevention programs, ultimately limiting their impact on patient and population health.

Background: The Japanese National Immunization Program against pneumococcal disease (PD) includes 23-valent pneumococcal polysaccharide vaccine (PPSV23) but does not provide vaccination for adults aged ≥66 years. We evaluated the cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) in adults aged 66-84 years with no history of PPSV23 vaccination in Japan and assessed the potential economic and health impact of introducing PCV20 on the local government (specifically, Shiga prefecture).

Research design and methods: Using a Markov model, we assessed lifetime costs, quality-adjusted life-years (QALYs), and number of prevented cases and deaths caused by PD.

Results: In national-level analysis, PCV20 was cost-effective compared with no vaccination under incremental cost-effectiveness ratio threshold of Japanese yen (JPY) 5,000,000/QALY, i.e. JPY1,677,401/QALY and JPY1,351,811/QALY from payer and societal perspectives, respectively. PCV20 was dominant (less costly and more effective) compared with PPSV23. In local-level analysis, the introduction of PCV20 required initial costs but resulted in greater cost savings related to medical expenses (-JPY424 and -JPY430 per person) and nursing care (-JPY560 and -JPY575 per person) compared to PPSV23 and no vaccination, respectively.

Conclusions: PCV20 is cost-effective compared with PPSV23 and no vaccination in adults aged 66-84 years, which could reduce the future healthcare burden in Japan.

Objectives: The objective of this study is to evaluate the cost-effectiveness of different Magnetic Resonance Imaging strategies for the early detection of prostate cancer.

Methods: A comprehensive search was conducted up to 15 December 2024, utilizing databases such as PubMed and Scopus. The focus was on full economic evaluations, excluding non-English articles and reviews. The quality of the studies was assessed using the QHES checklist. The following data were extracted: settings, interventions, populations, types of economic evaluations, health outcomes, costs, and ICERs.

Results: Of the 110 articles that were assessed, 9 were selected for qualitative analysis, resulting in an overall high-quality score. The findings demonstrated that the range of MRI costs applied differed across countries. While the financial implications of non-screening are comparatively lower, the effectiveness of using screening strategies for early detection of cancer is superior to that of non-screening. Specifically, MRI was found to be more cost-effective than conventional methods. The utilization of MRI prior to biopsy has the potential to reduce unnecessary procedures while enhancing clinical cancer detection.

Conclusion: The economic viability of integrating advanced MRI techniques into prostate cancer screening is demonstrated, leading to enhanced patient outcomes by facilitating early detection and minimizing overtreatment.

Registration: PROSPERO (CRD42024572261).

Introduction: Methodological choices need to be made during model development. These choices can influence the outcome of a National Institute for Health and Care Excellence (NICE) assessment.

Areas covered: This review aims to identify, assess, and describe possible trends within the methodological aspects of economic evaluations used in NICE assessments of treatments for metastatic breast cancer (mBC). The NICE website was searched to identify technology appraisals submitted between 1 January 2009, and 31 December 2023. In this review methodological aspects are analyzed and discussed in three clusters - input data, model settings, and model outcomes - across the following characteristics: clinical trial information, quality-of-life measures, treatments used, model structure, health states, time horizon, threshold applied, and the NICE recommendations. This review provides a reference for stakeholders who want to understand previous NICE assessments of treatments for mBC, and the settings used in those, which can optimize decisions during model development.

Expert opinion: Uniformity in the methodological choices made during model development and the economic evaluations can increase transparency, increase comparability, and reduce complexity of the NICE assessment.