Value in health regional issues最新文献

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.

Objectives: In mid-2020, the Ghana Health Service introduced Zipline's aerial logistics (centralized storage and delivery by drones) in the Western North Region to enhance health supply chain resilience. This intervention led to improved vaccination coverage in high-utilization districts. This study assessed the cost-effectiveness of aerial logistics as an intervention to improve immunization coverage.

Methods: An attack rate model, adjusted for vaccination coverage and vaccine efficacy, was used to estimate disease incidence among vaccinated and unvaccinated populations, focusing on 17 022 infants. Incremental cost-effectiveness ratios of US dollar per averted disability-adjusted life-year (DALY) were evaluated from societal and government perspectives, using real-world operations data. Probabilistic sensitivity analysis was performed using Monte Carlo simulations.

Results: In 2021, aerial logistics averted 688 disease cases. Incremental cost-effectiveness ratios were $41 and $58 per averted DALY from the societal and government perspectives, respectively. The intervention was cost-saving when at least 20% of vaccines delivered by aerial logistics replaced those that would have been delivered by ground transportation, with potential government savings of up to $250 per averted DALY. Sensitivity analysis confirmed the robustness of these findings.

Conclusions: Under conservative assumptions, aerial logistics was a highly cost-effective intervention to increase immunization coverage. The intervention was cost-saving even with low levels of replacement of traditional last mile delivery. These findings support expanding aerial logistics within the national immunization program and have significant implications for other low- and middle-income countries seeking cost-effective health supply chain solutions.

Objectives: This study aimed to provide the typology of real-world evidence (RWE) and challenges associated with improving the use of RWE in Asian countries.

Methods: This article is divided into 2 subsections. First, a narrative review was conducted to classify RWE based on available real-world data. This method was also used to develop a typology of RWE, particularly considering the nature of the data, the potential evidence generated, and the integration methods into health technology assessment (HTA). Finally, a scoping review was undertaken to identify and filter studies focusing on the implementation of RWE in Asia.

Results: The use of RWE is associated with many caveats, and therefore, its use in Asia is particularly limited. Based on the narrative review, RWE is divided into 3 broad categories: macro-, meso-, and micro-RWE; each represents a different quality of evidence and range of use as evidence for HTA. Although typology helps with consolidating RWE choices for supporting HTA decision making, challenges still persist in using it for HTA purposes. Institutional support, technical capacity, and infrastructure, including data-related issues, may hinder progress in improving the RWE ecosystem for HTA in Asia.

Conclusions: RWE is a helpful tool that can assist in decision making, especially in reimbursement-related decisions. Although knowing facets of RWE helps in choosing appropriate evidence to assist in policy making, challenges associated with its implementation, especially in the Asian context, need to be anticipated.

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 quantified the health and economic benefits of improving low-density lipoprotein cholesterol (LDL-C) control in Malaysian patients with established atherosclerotic cardiovascular disease (ASCVD). It aimed to inform policy discussions and healthcare planning for effective ASCVD management.

Methods: A deterministic, prevalence-based model was used to project the annual health burden and direct medical costs associated with recurrent ASCVD events over a 10-year horizon. The target population included adults (≥30 years) with established ASCVD and uncontrolled LDL-C levels (>1.8 mmol/L). The model comprised 3 modules: population size projection, recurrent ASCVD risk calculation (by means of the Secondary Manifestations of ARTerial disease [SMART] risk model), and direct medical and productivity cost estimation. The current status quo and a scenario with a 50% improvement in mean LDL-C were compared.

Results: We projected over 800 000 adults with established ASCVD in 2023, increasing to approximately 1.4 million by 2032. Under the status quo, about 55 000 recurrent ASCVD events were expected within 10 years, with significant direct medical costs and productivity losses. Improved LDL-C control could potentially reduce recurrent events by 7000 cases (13% reduction), prevent 2100 premature deaths, and save approximately 32 400 years of life. Economically, this could lead to a reduction of approximately 72 million MYR in direct medical costs and a gain of approximately 132.4 million MYR in productivity over a decade.

Conclusions: Optimizing LDL-C control in high-risk patients with ASCVD presents a critical opportunity to reduce health and economic burdens in Malaysia.

Objectives: The Short Form-8 (SF-8) is a widely used 8-item tool for health-related quality of life assessment. This study aimed to evaluate the psychometric properties of the Slovak version of the SF-8 in a population sample.

Methods: A cross-sectional survey on a Slovak representative sample (n = 1018; mean age 46.24 ± 16.56 years; 51.3% women) monitoring health and well-being was performed in 2019. Exploratory network analysis and confirmatory factor analysis were used to assess the construct validity of the scale. Reliability and sociodemographic differences were evaluated.

Results: A 2-factor model had an adequate fit to the data [χ²(19) = 186.2, P < .001, comparative fit index = 0.998, Tucker-Lewis index = 0.997, root mean square error of approximation = 0.093, standardized root mean of residuals = 0.039], with high reliability (α = 0.93, ω = 0.95). The physical component score and mental component score (MCS) were negatively associated with the presence of chronic health conditions. Lower physical component score and MCS were associated with higher age (P < .001), and lower MCS were associated with female gender (P < .001).

Conclusions: The Slovak version of the SF-8 represents a valuable tool for measuring health-related quality of life in the Slovak population in both practice and research.

Objective: This study aimed to determine stakeholders' decision criteria preferences for formulary decisions of cancer drugs in the Ministry of Health. The secondary objective was to identify the outcome measures of interest for assessment of clinical benefits for cancer drugs.

Methods: A survey questionnaire was administered online and as hard copy using purposive sampling to 32 healthcare facilities providing cancer services and the Formulary Management Branch in the Ministry of Health. Respondents reported whether a criterion "will be considered" and weighted its relative importance on a 5-point scale. The choice of safety and efficacy/effectiveness outcomes were ranked from 1 to 5, and the minimum value of benefit for the efficacy/effectiveness outcome ranked 1 was provided. Trade-offs between survival and quality of life were also explored. Inferential statistics were used to explore difference in responses.

Results: A total of 316 healthcare professionals responded to the survey. The most important criteria for value assessment of cancer drug were safety and effectiveness. Other criteria deemed important were quality of evidence, disease severity, and patient-reported outcomes. There was no difference in the criteria preference and weights across the various respondent groups. Overall survival was the most preferred clinical benefit outcome. Overall, willingness to pay was higher for life-prolonging treatment than treatment that improved quality of life.

Conclusions: This study revealed that a wide range of criteria beyond the traditional decision-making criteria of efficacy, safety, and cost-effectiveness are important for value assessment of cancer drugs for the purpose of formulary decisions.

Objectives: Bladder cancer incurs the highest lifetime treatment cost per patient among various cancers. Current guidelines endorse several cisplatin-based regimens as neoadjuvant chemotherapy. This cost-utility analysis aimed to compare 2 primary neoadjuvant chemotherapy regimens-dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) and gemcitabine and cisplatin (GC)-for patients with muscle-invasive bladder cancer, providing economic evidence to inform treatment guidelines in Iran.

Methods: A Markov decision model was constructed, incorporating 4 states: after radical cystectomy without recurrence, no radical cystectomy, recurrence, and death over a lifetime horizon. Clinical outcomes were derived from the VESPER (French Genito-Urinary Tumor Group and French Association of Urology V05) phase 3 randomized controlled trial, whereas costs were obtained from local Iranian data. The main result involved determining an incremental cost-effectiveness ratio within the simulated population, with a willingness-to-pay threshold of 1656 USD (equivalent to Iran's gross domestic product per capita in 2023). Costs and benefits were discounted at 5.8% per annum, and probabilistic and univariate deterministic sensitivity analyses were conducted.

Results: From the perspective of the Iranian healthcare payer, 6 cycles of dd-MVAC yielded 0.02 greater quality-adjusted life-years compared with 4 cycles of GC, resulting in a cost saving of 1 173 491 USD and an incremental cost-effectiveness ratio of -78 708 870. Consequently, dd-MVAC emerged as the dominant option over a lifetime horizon (23 years). The model proved most sensitive to variations in recurrence and toxicity probabilities during treatment.

Conclusions: Based on this study's results, dd-MVAC represents a cost-saving treatment regimen per patient in the Iranian health system compared with GC, with superior utility.