Value in health regional issues最新文献

Objectives: Gastric cancer (GC) imposes a significant burden of disease globally. Multiple treatments are available but are associated with high costs and potentially detrimental effects on quality of life. The utility values of health status are measures of patient preference over quality of life, which are increasingly used for health and economic decision-making. Currently, there is little systematized information on the utility values for different stages of GC. This systematic review synthesizes and meta-analyses the literature on GC utilities.

Methods: A search was conducted in PubMed, Embase, MEDLINE, and Cochrane Library for studies reporting utility values calculated using direct and indirect methods. Information from the selected studies was extracted and appraised, and meta-analyses of utility values based on GC health states were performed.

Results: Twelve studies involving 4585 patients were included. Random-effects meta-analysis estimates showed a mean utility of 0.77 (95% CI 0.7-0.85) for stage I, 0.75 (95% CI 0.65-0.85) for stage II, 0.70 (95% CI 0.63-0.96) for stage III, and 0.64 (95% CI 0.56-0.32) for stage IV. All estimates showed considerable heterogeneity.

Conclusions: Our study provides an updated overview of the literature on utility values in GC and presents a discussion of the relevance of GC stages for its analysis. Decision-makers should consider patients' preferences in the proposal of policies and clinical decisions.

Objectives: To analyze the difference in type 2 diabetes mellitus (T2DM) disability costs subsidized by the Mexican Social Security Institute for employees with normoglycemia and normotension (n = 547 488) from the 2016 to 2018 National Census of Workers with T2DM registered with the Mexican Social Security Institute.

Methods: We tested whether the control of these indicators reduced disability payments at work, the costs of subsidy distribution in different salary groups, and their associated diseases.

Results: Differences (P < .001) emerged in disability leave costs for employees who did not control their blood pressure. Highest-earning employees had the highest costs compared with lower-earning workers. The most frequent subsidized diseases included gastric problems, lower-back disorders, and respiratory infections.

Conclusions: Based on data from all the insured employees with T2DM registered in the National Census, this study enjoyed strong internal validity, indicating that failure to control blood pressure levels correlated with higher costs. The highest costs resulted from noncomplicated diseases. Employees earning higher incomes accounted for the highest costs, suggesting the existence of unequal subsidy conditions.

Objectives: To describe the characteristics of the demands for health technologies submitted to the Brazilian Government.

Methodology: A descriptive analysis was carried out by surveying the reports produced by the National Committee for the Incorporation of Health Technologies since its creation in Brazil until 2023. The extracted data were tabulated in 3 domains: identification of demand, epidemiological profile of the disease, and clinical evidence and economic assessment.

Results: A total of 778 among 813 reports were included (95.7%), of which 266 (34.2%) were related to rare diseases. Of these, 86 (32.3%) were related to oncology, for 73.3% of which there were requests for the incorporation of medicines, 51.0% from external demand, 48.2% related to public entities, and 58.7% had the recommendation as a final opinion. The total and average incremental budgetary impact of the incorporated technologies was R$36 683 014 441.02 and R$1 111 606 498.20 and the total and average incremental cost-effectiveness ratio was R$1 024 897.50/QALY and R$68 326.50/QALY, whereas for nonincorporated technologies it was R$3 055 888 437.38; R$ 127 328 684.89; R$ 952 263.85/QALY and; R$52 903.54/QALY, respectively.

Conclusion: The oncology area had greater representation among the demands evaluated, with rare cancers representing the largest portion of health technologies demanded, and the decision to incorporate was the majority. The incremental budgetary impact and incremental cost-effectiveness ratio were greater for the incorporated technologies, 2 among them exceeded the cost-effectiveness threshold adopted by the National Committee for the Incorporation of Health Technologies.

Objectives: This analysis evaluated the cost-effectiveness of inclisiran plus standard of care (SoC; comprising statins, ezetimibe, and fenofibrate) in primary hypercholesterolemia or mixed dyslipidemia from a Singapore healthcare system perspective. Inclisiran + SoC was separately compared with SoC, alirocumab + SoC, and evolocumab + SoC.

Methods: A lifetime Markov model in the United Kingdom (UK) was adapted to the Singapore setting. The modeled population (comprising 4 separate subpopulations: "primary prevention heterozygous familial hypercholesterolemia [HeFH]," "secondary prevention HeFH," "atherosclerotic cardiovascular disease [ASCVD]," "primary prevention with elevated risk") and efficacy of inclisiran were informed by the ORION-9, ORION-10, and ORION-11 trials. Comparative efficacies of inclisiran versus comparators were informed by a network meta-analysis. Baseline cardiovascular event risks were obtained from a large UK real-world data set and the Netherlands, and UK-based utilities were applied. Baseline population characteristics, distribution of patients in the ASCVD subpopulation, and costs were sourced from local clinicians and published literature. A willingness-to-pay threshold of S$45 000/quality-adjusted life-year (QALY) was selected.

Results: Across all subpopulations, inclisiran + SoC resulted in higher QALYs and total costs than SoC (incremental cost-effectiveness ratios, S$35 658-163 896/QALY) and dominated evolocumab + SoC and alirocumab + SoC. At the selected threshold, inclisiran + SoC is cost-effective among patients with ASCVD and secondary prevention HeFH. The deterministic sensitivity analysis found that the model was most sensitive to inclisiran's acquisition cost and efficacy and rate ratios translating reductions in low-density lipoprotein cholesterol levels to the risk of cardiovascular death.

Conclusions: Compared with SoC, evolocumab + SoC, and alirocumab + SoC, inclisiran + SoC is cost-effective in patients with primary hypercholesterolemia or mixed dyslipidemia in Singapore at the selected threshold.

Objectives: This study aimed to analyze the direct healthcare costs and early complications associated with pretransplant portal vein thrombosis (PVT) in cirrhotic patients undergoing their first orthotopic liver transplant (LT) at a hospital in Colombia from 2013 to 2021.

Methods: A registry-based retrospective follow-up study was conducted on cirrhotic patients aged 14 years or older who underwent their first LT at the San Vicente Fundación Rionegro Hospital between January 2013 and April 2021. The primary outcomes were early (30-day) vascular and biliary complications and direct healthcare costs. The generalized linear model was used to estimate observed and adjusted mean differences in costs and risk ratios for complications based on pretransplant PVT. Costs were expressed in 2020 international dollars.

Results: The medical records of 161 patients were analyzed, with 15.5% having pretransplant PVT. Patients with pretransplant PVT exhibited a statistically significant higher risk of early vascular complications (adjusted risk ratio 2.17; 95% CI 1.04-4.51; P = .039). However, there was no statistically significant difference in the risk of early biliary complications (P = .225). Patients with grade I PVT did not show a significant difference in costs compared with patients without PVT (P = .661). For patients with grade II-IV PVT, the adjusted mean difference in the healthcare cost was 33 175 international dollars (95% CI 730-65 620).

Conclusions: Patients with pretransplant grade II-IV PVT have a higher risk of early vascular complications and require more medical resources, leading to increased costs associated with LT.

Objectives: Despite the increasing investments in Latin American healthcare, the corresponding improvement in population health is not proportional. This discrepancy may be attributed to the efficiency of resource utilization. This study used the data envelopment analysis (DEA) methodology to assess the efficiency of healthcare systems in 23 Latin American and Caribbean countries.

Methods: We used the most recent data from the World Bank (2017). Our analysis included healthcare expenditure (percentage of gross domestic product), hospital beds per 1000 inhabitants, physicians per 1000 inhabitants, and nurses per 1000 inhabitants as input variables. Life expectancy at birth and infant mortality rate were used as output variables. We conducted sensitivity analyses on model parameters to understand their influence. Linear and Tobit regressions were developed to comprehend the relationship between variables and DEA scores. Finally, we performed a temporal analysis of efficiencies to identify trends and patterns within the sample.

Results: The DEA model classified 13 of the 23 analyzed countries as efficient, with 10 consistently maintaining this level throughout the 10 years of the temporal analysis: Belize, Chile, Colombia, Costa Rica, Cuba, Guatemala, Honduras, Jamaica, Mexico, and Peru. Conversely, 4 countries were never considered efficient: Barbados, Brazil, Nicaragua, and Uruguay.

Conclusions: This study provides valuable insights for Latin American and Caribbean countries, offering a roadmap to manage their resources better and provide quality and equitable service to their people despite economic challenges.

Objectives: To estimate the direct healthcare costs related to outpatient care and hospital stays for adults with epilepsy in the context of the Colombian healthcare system.

Methods: A cost analysis was conducted from a base case, which included direct medical costs related to diagnosis, follow-up, pharmacological and surgical treatment, and in-hospital care for status epilepticus. A Delphi panel was carried out to identify and quantify cost-generating events. The monetary valuation was estimated using official databases and tariff manuals available in Colombia. The cost distribution was obtained using the bootstrapping method. Two one-way deterministic sensitivity analyses were performed.

Results: The total annual cost of an adult patient with epilepsy without including hospital stays is US dollars $2416.31. If at least 1 intensive care unit stay (8-day average) is included to treat a patient with status epilepticus, the total annual cost increases to $61 567.72. The total cost of resective surgery is $14 894.44, and the vagus nerve stimulation implant costs $26 565.86.

Conclusions: Epilepsy in adults represents a significant economic burden for the Colombian healthcare system, comparable to that of other upper-middle-income countries. The majority of expenditure is attributed to intensive care unit stays, less financial resources would be required if patients achieve better control of the disease.

Objectives: In Brazil, cases of Alzheimer's disease (AD) are particularly prevalent in the southeastern region, including Minas Gerais, the largest state in the area. This study aimed to estimate the disease burden and healthcare costs from 2018 to 2022.

Methods: Data on life expectancy, human development index, population size, and gross domestic product per capita were extracted to calculate disability-adjusted life-years (DALYs). Hospital admission data for AD were obtained from the Brazilian Unified Health System Department of Informatics (DATASUS) database, including the number of cases, deaths, age-specific data, and treatment costs. These variables, along with health, social, and environmental data, were processed to create risk factor layers, and the mean cost per DALY was calculated. Generalized estimating equation models were used to analyze the relationship between DALYs and various predictors, controlling for spatial autocorrelation. Maps were created to visualize the distribution of DALYs and cost per DALY.

Results: There were 323 221 deaths from AD in Brazil, with cities averaging 3.61 deaths (range 1-73) and 5.43 hospitalizations (range 1-91) annually. The mean cost per city over these years was $9935.87 (range $44.22 to $787 307.93). In Minas Gerais, significant predictors of the estimated burden of AD include the percentage of the population aged 65 years and older, the human development index, and the prevalence of cardiovascular diseases. DALYs were higher than observed, indicating potential underreporting and insufficient resource allocation for AD treatment and prevention.

Conclusions: These results emphasize the need for region-specific policies and strategies to address the AD burden effectively. Policy makers should use this information to improve planning and allocate resources appropriately for treatment and prevention.

Objectives: This study aimed to evaluate the potential reduction in distance and travel time with a hypothetical municipal distribution of specialized component medicines in the state of Paraná.

Methods: This was a cross-sectional study. Distances and travel times from all the 1025 residential locations in the state of Paraná to dispensing pharmacies were calculated in 2 different models: centralized model with drugs dispensed in the 22 state-owned pharmacies and decentralized model with drugs dispensed in the 399 municipal pharmacies. Road routes were calculated using the Google Maps Distance Matrix API and Euclidean distance using the haversine formula for the southern hemisphere. A sinuosity index was computed by the quotient between these 2 distances. Differences were evaluated through bivariate analyses and effect size measures were reported.

Results: In the centralized model, the mean distance to the pharmacy was 59.5 km (SD 34.1), with a travel time of 1.0 hour (SD 0.5) and 579 residential locations (56.7%) more than 50 km away from the pharmacy, 286 (28.0%) between 25 and 50 km, and 156 (15.3%) less than 25 km. In the decentralized model, the mean distance was 10.8 km (SD 16.6), with a travel time of 0.2 hours (SD 0.3) and 14 locations (1.4%) more than 50 km away from the pharmacy, 96 (9.4%) between 25 and 50 km, and 911 (89.2%) less than 25 km. The decentralized model significantly reduced the sinuosity index.

Conclusions: Implementing a decentralized dispensing of the specialized component drugs in the state of Paraná would produce a significant reduction in distance and travel time for patients enhancing drug accessibility.