Journal of Health Economics and Outcomes Research最新文献

[This corrects the article DOI: 10.36469/jheor.2024.124604.].

Background: Migraine is a prevalent, underdiagnosed, highly debilitating neurological condition that affects individuals' quality of life and often negatively influences normal daily activities. Objectives: The study objective is to estimate the economic burden of migraine to the Argentine government by assessing the impact of the disease on tax revenue, absenteeism, and social support transfers. Methods: The analysis combines a cross-sectional model utilizing national demographic data and published migraine prevalence rates to estimate the annual burden for the entire migraine-affected cohort, and a longitudinal model assessing the average burden per individual from the age of 40, over a 20-year horizon. A fiscal framework based on generational accounting evaluated the impact of migraine on government finances. Sources of revenue such as direct and indirect taxes were weighted against elements of public expenditure (public sector absenteeism, healthcare expenses, and financial support) and compared with the general population. The effect of migraine on occupational outcomes was sourced from peer-reviewed publications, and costs were sourced from national databases. Results were reported as incremental fiscal consequences (2023 US dollars) and were discounted at 3% annually. Results: The fiscal burden of migraine in Argentina was estimated to be $6505perindividualand$ 1237 million across the entire migraine population. Annually, 29% of government costs were due to public sector absenteeism, 39% related to healthcare costs, 19% to foregone direct and indirect tax revenue, and 12% to foregone corporation taxes. Additional government transfers represented a minor contribution to the overall fiscal impact of migraine in Argentina. Discussion: The high rate of informal employment is likely to undermine disease burden estimates. Gender disparities were notable, with women bearing 76% of the burden, highlighting the need for gender-specific interventions. Conclusions: This study reveals a significant economic burden of migraine to the Argentinian government, primarily driven by absenteeism, healthcare costs, and foregone tax contributions. Targeted, gender-responsive healthcare and labor policies, especially for sectors with high informal employment, could help reduce these fiscal impacts.

Background: Glycogen storage disease type Ia (GSDIa) is a rare inherited disorder that can lead to renal and hepatic complications, brain damage, and death. There is a lack of qualitative research describing the impact of GSDIa on individuals and their caregivers. Objective: This study was designed to describe the individual experiences of those affected by GSDIa through qualitative methods. Methods: Individuals with GSDIa and caregivers were recruited through two patient associations (US, UK). Participants were asked to write narratives about their experiences with GSDIa in their own words, with no set questions or topics. The resulting narrative accounts were analyzed thematically using a primarily inductive approach. Themes describing the impact of GSDIa on individuals and caregivers were identified. Results: Eight caregivers, three of whom had lost a child to GSDIa, and 11 individuals living with GSDIa provided written summaries of their experiences of life with the condition. Participants described symptoms, the burden of managing frequent cornstarch feeds, and the broader impacts of GSDIa. These included effects on daily activities, family, emotional and social functioning, romantic relationships, and educational/professional impacts. Participants also described challenges related to obtaining diagnosis and support, and the lack of GSDIa knowledge from healthcare professionals. Discussion: This study provided novel insights into the impact of GSDIa on individuals living with the condition and their caregivers. Participants reported a wide range of issues in their narratives and openly shared sensitive information about their experiences, which may not have been captured if they had taken part in a semi-structured interview format. Conclusion: The narrative method yielded a rich data set that provided details of the varied and individual experiences of GSDIa not captured by traditional quantitative methods or structured interviews. The narratives highlighted the unmet needs of both caregivers of and patients with GSDIa around cornstarch management, obstacles to proper treatment from healthcare professionals, and the absence of effective treatments. The open-ended narrative approach had advantages over standard qualitative methods to capture greater insight into individual experiences directly from participants in their own words.

Background: The disease burden of heart failure is mainly driven by high hospital readmission rates. Remote monitoring devices can be used to assess the status of patients after discharge and identify early signs of worsening symptoms. Initial studies indicated that Heart Failure Management System (HFMS), a novel monitoring device, can prevent hospital readmission. Objective: To determine the cost effectiveness of HFMS compared with standard of care (SOC) in the United States. Methods: A Markov model was developed to follow patients after their discharge from index hospitalization for heart failure. The costs and outcomes were estimated for 5 years. The patient cohort was initially in "outpatient care," where they are at risk of an emergency room visit or hospital readmission. If hospitalized, patients returned to a second outpatient care health state. An "escalation of care" (eg, surgical intervention) may have removed patients from the intervention. The model took the payer perspective with costs in 2022 US dollars. The incremental cost-effectiveness ratio measured effectiveness through hospital readmissions. The willingness-to-pay threshold was set to the published cost of a heart failure rehospitalization ($10 737). Sensitivity and scenario analyses explored the robustness of the model to changes in inputs. Results: Compared with SOC, HFMS reduced the mean cost of care by $6723($ 155 122 vs $161 846) over the 5-year period. The mean number of hospital readmissions was reduced to 1.075 with HFMS from 1.201 with SOC (-0.126 events). The incremental cost-effectiveness ratio showed that HFMS was a dominant strategy compared with SOC, leading to reduced costs and hospital readmissions in 93.4% of the 1000 Monte Carlo simulations; 94.1% of the simulations fell below the willingness-topay threshold. Savings with HFMS emerged from the third month. Discussion: The results indicated the cost-effectiveness of HFMS compared with SOC. The sensitivity analyses supported this finding. Reducing costly hospital readmissions may help to alleviate the burden of heart failure. Longer-term data on HFMS are encouraged to confirm or contest the model outcomes. Conclusions: The use of HFMS is expected to save costs and reduce hospitalizations over a 5-year period compared with the current SOC.

Introduction: In Saudi Arabia, patients with metastatic colorectal cancer (mCRC) with wild-type RAS mutations may be treated with either cetuximab plus chemotherapy (CET + CT) or panitumumab plus chemotherapy (PAN + CT), which are epidermal growth factor receptor (EGFR) antibodies. This study calculated the costs of adverse event (AE) management linked to anti-EGFR treatment in Saudi Arabia's national health budget from payer and societal perspectives. Methods: An adaptation of a global model developed in Microsoft Excel® was performed to estimate the costs of AE management associated with the first-line treatment (CET + CT and PAN + CT) of RAS wild-type mCRC patients in Saudi healthcare settings. The frequencies of common and highly common AEs were sourced from the summaries of product characteristics of CET and PAN, whereas AE severity was captured from a meta-analysis. Unit costs in Saudi Riyal (SAR) were obtained from the National Guard of Health Affairs and Ministry of Health 2024 price lists. The model assumptions, inputs, and results were validated using a local Delphi panel. Results: Within the Saudi payer perspective model, treatment with CET + CT vs PAN + CT resulted in average population cost savings of SAR 9 246 133 (4 741 606 international dollars [Intl $\left]\right)andper-patientcostsavingsofSAR20\hspace{0.17em}321(Intl$ 10 421) for severe AEs, and average population cost savings of SAR 16 039 427 (Intl $8\hspace{0.17em}225\hspace{0.17em}347)andper-patientcostsavingsofSAR35\hspace{0.17em}251(Intl$ 18 077) for all-grade AEs. On the other hand, within the Saudi societal perspective model, treatment with CET + CT vs PAN + CT resulted in average population cost savings of SAR 11 386 314 (Intl