Value in health regional issues最新文献

Disparities in Out-of-Pocket Expenditures Among Hospitalized Patients With COVID-19 in Iran: A Decomposition Analysis of Inequality.

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-03-03 DOI: 10.1016/j.vhri.2025.101093

Ahmad Dehghani Ahmadabad, Sayyed Morteza Hosseini Shokouh, Parisa Mehdizadeh, Mohammad Meskarpour Amiri Ara

Objectives: Limited information is available on the extent of inequality in out-of-pocket (OOP) expenditures among patients with COVID-19 in Iran and the factors contributing to this disparity. This study aimed to examine the inequality in OOP expenditures among hospitalized patients with COVID-19 and identify the associated factors.

Methods: This study used the Gini coefficient as the primary measure of inequality in OOP expenditures among hospitalized patients with COVID-19. The analysis was conducted using Stata 16 software, supplemented by the Distributive Analysis Stata Package extension. The Gini coefficient was calculated to quantify the degree of inequality and was visualized using graphs. To examine the Gini coefficient across population subgroups, a Distributive Analysis Stata Package extension, the diginig module, was used.

Results: Analysis of the Lorenz curve and the calculated Gini coefficient (0.69) confirmed the presence of inequality in OOP expenditures among hospitalized patients with COVID-19. Additionally, examination of inequality across population subgroups revealed that insurance status and type, clinical characteristics, and temporal patterns of hospitalization significantly contributed to the observed disparities in OOP expenditures among patients with COVID-19.

Conclusions: This study highlights the enduring impact of insurance status, clinical characteristics, and temporal patterns of hospitalization on the financial burden. The findings emphasize the need for targeted interventions to reduce financial barriers and promote equitable access to care, thus offering important insights for managing future public health crises.

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引用次数: 0

Quality of Life of Older Adults Living With Dementia and Caregiver Strain in Benin

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-02-26 DOI: 10.1016/j.vhri.2025.101080

Angeladine Kenne Malaha MPH, PhD , Clémence Thébaut PhD , Sem Harris Ahouantchede MSc , Dismand Stephan Houinato MD, PhD , Dieu donné Gnonlonfoun MD, PhD , Thierry Adoukonou MD, PhD , Grégoire Magloire Gansou MD , Pierre-Marie Preux MD, PhD , Maëlenn Guerchet PhD

Objectives

This study aimed at assessing the quality of life (QoL) of older adults living with dementia and caregiver strain in Benin, a West African country.

Methods

A cross-sectional study was conducted from October to November 2021, recruiting participants aged 60 and over and their caregivers from health facilities and a rural community in Benin. QoL of older adults and caregiver burden were collected using standardized instruments, namely the World Health Organization’s dementia QoL and Zarit Burden Interview, respectively.

Results

A total of 114 older adults (mean age 73 ± 10 years, 51% female) and their primary caregivers (mean age 49 ± 16 years, 70% female) participated, of whom 73 were recruited from health facilities and 41 from rural communities. Fifty percent of older adults were diagnosed with mild to severe dementia. The overall QoL was good, with rural participants scoring higher in daily life and urban participants scoring higher in emotion. Factors associated with decreased QoL were higher disability levels and greater caregiver burden. The mean caregiver burden score was 17 ± 13, with higher scores among those caring for older men. Increased disability in older adults and lower socioeconomic status were linked to higher caregiver strain, whereas better QoL in older adults and higher socioeconomic status reduced caregiver burden.

Conclusion

Enhancing access to healthcare, strengthening social support systems, and providing caregiver training and support are crucial for improving the well-being and care of individuals living with dementia in Benin.

{"title":"Quality of Life of Older Adults Living With Dementia and Caregiver Strain in Benin","authors":"Angeladine Kenne Malaha MPH, PhD , Clémence Thébaut PhD , Sem Harris Ahouantchede MSc , Dismand Stephan Houinato MD, PhD , Dieu donné Gnonlonfoun MD, PhD , Thierry Adoukonou MD, PhD , Grégoire Magloire Gansou MD , Pierre-Marie Preux MD, PhD , Maëlenn Guerchet PhD","doi":"10.1016/j.vhri.2025.101080","DOIUrl":"10.1016/j.vhri.2025.101080","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed at assessing the quality of life (QoL) of older adults living with dementia and caregiver strain in Benin, a West African country.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted from October to November 2021, recruiting participants aged 60 and over and their caregivers from health facilities and a rural community in Benin. QoL of older adults and caregiver burden were collected using standardized instruments, namely the World Health Organization’s dementia QoL and Zarit Burden Interview, respectively.</div></div><div><h3>Results</h3><div>A total of 114 older adults (mean age 73 ± 10 years, 51% female) and their primary caregivers (mean age 49 ± 16 years, 70% female) participated, of whom 73 were recruited from health facilities and 41 from rural communities. Fifty percent of older adults were diagnosed with mild to severe dementia. The overall QoL was good, with rural participants scoring higher in daily life and urban participants scoring higher in emotion. Factors associated with decreased QoL were higher disability levels and greater caregiver burden. The mean caregiver burden score was 17 ± 13, with higher scores among those caring for older men. Increased disability in older adults and lower socioeconomic status were linked to higher caregiver strain, whereas better QoL in older adults and higher socioeconomic status reduced caregiver burden.</div></div><div><h3>Conclusion</h3><div>Enhancing access to healthcare, strengthening social support systems, and providing caregiver training and support are crucial for improving the well-being and care of individuals living with dementia in Benin.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"47 ","pages":"Article 101080"},"PeriodicalIF":1.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Matching-Adjusted Indirect Comparison Studies in Oncology: A Scoping Review Focused on Reporting Quality

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-02-24 DOI: 10.1016/j.vhri.2025.101088

Cecília Menezes Farinasso MSc , Vinícius Lins Ferreira PhD , Flávia Cordeiro Medeiros PhD , Aline Pereira da Rocha PhD , Patrícia do Carmo Silva Parreira PhD , Layssa Andrade Oliveira MSc , Lays Pires Marra PhD , Rosa Camila Lucchetta PhD , Haliton Alves de Oliveira Jr. PhD

Objectives

Matching-adjusted indirect comparisons (MAICs) can be used in case of cross-trial heterogeneity or availability of only single-arm trials. Although the National Institute for Health and Care Excellence (NICE) provides MAIC-development orientation, many still do not adhere to it. Our goal was to map MAIC oncology studies and whether NICE recommendations were observed.

Methods

We included MAIC studies comparing treatments in oncology from 2010. We searched PubMed, Embase, and the Cochrane Library up to October 1, 2024. We analyzed MAIC characteristics such as previous systematic reviews, whether the analysis was anchored or unanchored, selection of variables, and individual patient data (IPD) reporting. We adopted NICE recommendations for the assessment of MAIC studies.

Results

We included 117 MAIC studies, which often explored multiple myeloma (n = 19%) and non–small cell lung cancer (17%) more frequently. Most MAICs were unanchored (72%), with an average of 1.9 comparisons per study. MAIC studies generally reported using pseudo-IPD (69%) but did not report the source of IPD (78%). In general, MAICs did not conduct systematic reviews to select trials for inclusion (66%). The average sample size reduction, in comparison with the original trials, was 44.9%. Only 3 MAICs fulfilled all NICE recommendations. The least reported aspects were the adjustment for all effect modifiers and prognostic variables (for unanchored MAICs), evidence of effect modifier status, and distribution of weights.

Conclusions

Most MAIC models did not follow NICE recommendations. Our review highlights the importance of rigorous methodological standards and thorough reporting of MAIC studies to enhance their credibility.

{"title":"Matching-Adjusted Indirect Comparison Studies in Oncology: A Scoping Review Focused on Reporting Quality","authors":"Cecília Menezes Farinasso MSc , Vinícius Lins Ferreira PhD , Flávia Cordeiro Medeiros PhD , Aline Pereira da Rocha PhD , Patrícia do Carmo Silva Parreira PhD , Layssa Andrade Oliveira MSc , Lays Pires Marra PhD , Rosa Camila Lucchetta PhD , Haliton Alves de Oliveira Jr. PhD","doi":"10.1016/j.vhri.2025.101088","DOIUrl":"10.1016/j.vhri.2025.101088","url":null,"abstract":"<div><h3>Objectives</h3><div>Matching-adjusted indirect comparisons (MAICs) can be used in case of cross-trial heterogeneity or availability of only single-arm trials. Although the National Institute for Health and Care Excellence (NICE) provides MAIC-development orientation, many still do not adhere to it. Our goal was to map MAIC oncology studies and whether NICE recommendations were observed.</div></div><div><h3>Methods</h3><div>We included MAIC studies comparing treatments in oncology from 2010. We searched PubMed, Embase, and the Cochrane Library up to October 1, 2024. We analyzed MAIC characteristics such as previous systematic reviews, whether the analysis was anchored or unanchored, selection of variables, and individual patient data (IPD) reporting. We adopted NICE recommendations for the assessment of MAIC studies.</div></div><div><h3>Results</h3><div>We included 117 MAIC studies, which often explored multiple myeloma (n = 19%) and non–small cell lung cancer (17%) more frequently. Most MAICs were unanchored (72%), with an average of 1.9 comparisons per study. MAIC studies generally reported using pseudo-IPD (69%) but did not report the source of IPD (78%). In general, MAICs did not conduct systematic reviews to select trials for inclusion (66%). The average sample size reduction, in comparison with the original trials, was 44.9%. Only 3 MAICs fulfilled all NICE recommendations. The least reported aspects were the adjustment for all effect modifiers and prognostic variables (for unanchored MAICs), evidence of effect modifier status, and distribution of weights.</div></div><div><h3>Conclusions</h3><div>Most MAIC models did not follow NICE recommendations. Our review highlights the importance of rigorous methodological standards and thorough reporting of MAIC studies to enhance their credibility.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"47 ","pages":"Article 101088"},"PeriodicalIF":1.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cost-Utility Analysis and Efficiency Frontier of Drugs Available in Brazil for the Treatment of Relapsing-Remitting Multiple Sclerosis

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-02-20 DOI: 10.1016/j.vhri.2025.101092

Bruno M. Barros MSc , Marcelo G. Correia MSc , Bernardo R. Tura PhD , Carlos S. Magliano PhD

Objectives

In the Brazilian Public Health System (SUS), the different drugs for the treatment of relapsing-remitting multiple sclerosis (RRMS) are used in an escalating approach, through therapeutic lines from lowest to highest efficacy. Early intensive treatment, indicating the use of more effective drugs for the first symptoms of the disease, has been advocated by some specialists; however, the clinical and economic impact of this strategy is unknown. The aim of this study was to conduct cost-utility, net benefit, and efficiency frontier (EF) analyses for all drugs approved in Brazil for RRMS.

Methods

A Markov model was constructed from the SUS perspective to conduct economic analyses. The outcomes of the annualized relapse rate and sustained disability progression were modeled, considering disease progression according to changes in levels on the Expanded Disability Status Scale. Net benefit and EF analyses were also conducted.

Results

In the cost-utility assessment, 12 of the 14 drugs were dominated by alemtuzumab and teriflunomide. An EF was established between the 2 drugs with an incremental cost-effectiveness ratio of $8231.87/quality-adjusted life-years. Teriflunomide obtained the best results in the net benefit assessment. Most drugs had an incremental cost-effectiveness ratio below the cost-utility threshold ($8000.00/quality-adjusted life-years) in the probabilistic sensitivity analysis.

Conclusions

Early intensive treatment of EF may modify the current RRMS treatment paradigm, and the results presented may help define the cost utility of new entrants to the SUS.

目的在巴西公共卫生系统（SUS）中，治疗复发性-缓解性多发性硬化症（RRMS）的不同药物是按照疗效从低到高的治疗路线逐步升级使用的。一些专家提倡早期强化治疗，即在疾病出现最初症状时使用更有效的药物；然而，这一策略对临床和经济的影响尚不清楚。本研究旨在对巴西批准的所有治疗 RRMS 的药物进行成本效用、净效益和效率前沿（EF）分析。根据残疾状况扩展量表（Expanded Disability Status Scale）水平的变化考虑疾病进展，对年复发率和持续残疾进展结果进行建模。结果在成本效用评估中，14 种药物中有 12 种以阿来珠单抗和特立氟胺为主。这两种药物的增量成本效益比为 8231.87 美元/质量调整生命年，确立了 EF。特立氟胺在净效益评估中获得了最佳结果。在概率敏感性分析中，大多数药物的增量成本效益比都低于成本效用阈值（8000.00美元/质量调整生命年）。结论早期强化治疗EF可能会改变目前的RRMS治疗模式，所提供的结果可能有助于确定新加入SUS的药物的成本效用。

{"title":"Cost-Utility Analysis and Efficiency Frontier of Drugs Available in Brazil for the Treatment of Relapsing-Remitting Multiple Sclerosis","authors":"Bruno M. Barros MSc , Marcelo G. Correia MSc , Bernardo R. Tura PhD , Carlos S. Magliano PhD","doi":"10.1016/j.vhri.2025.101092","DOIUrl":"10.1016/j.vhri.2025.101092","url":null,"abstract":"<div><h3>Objectives</h3><div>In the Brazilian Public Health System (SUS), the different drugs for the treatment of relapsing-remitting multiple sclerosis (RRMS) are used in an escalating approach, through therapeutic lines from lowest to highest efficacy. Early intensive treatment, indicating the use of more effective drugs for the first symptoms of the disease, has been advocated by some specialists; however, the clinical and economic impact of this strategy is unknown. The aim of this study was to conduct cost-utility, net benefit, and efficiency frontier (EF) analyses for all drugs approved in Brazil for RRMS.</div></div><div><h3>Methods</h3><div>A Markov model was constructed from the SUS perspective to conduct economic analyses. The outcomes of the annualized relapse rate and sustained disability progression were modeled, considering disease progression according to changes in levels on the Expanded Disability Status Scale. Net benefit and EF analyses were also conducted.</div></div><div><h3>Results</h3><div>In the cost-utility assessment, 12 of the 14 drugs were dominated by alemtuzumab and teriflunomide. An EF was established between the 2 drugs with an incremental cost-effectiveness ratio of $8231.87/quality-adjusted life-years. Teriflunomide obtained the best results in the net benefit assessment. Most drugs had an incremental cost-effectiveness ratio below the cost-utility threshold ($8000.00/quality-adjusted life-years) in the probabilistic sensitivity analysis.</div></div><div><h3>Conclusions</h3><div>Early intensive treatment of EF may modify the current RRMS treatment paradigm, and the results presented may help define the cost utility of new entrants to the SUS.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"48 ","pages":"Article 101092"},"PeriodicalIF":1.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cost-Effectiveness Analysis of Idursulfase for the Long-Term Treatment of Hunter Syndrome Using a Partitioned-Survival Model Approach in R

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-02-19 DOI: 10.1016/j.vhri.2025.101089

Khairu Hazwan Mustaffa MSc , Asrul Akmal Shafie PhD , Lock-Hock Ngu MBBS , Rowani Mohd-Rawi MBBS

Objectives

Hunter syndrome is among the costliest life-long genetic conditions associated with a substantial burden-of-illness and a significant impact on the health systems, families, and society. We estimated the cost-effectiveness of long-term enzyme replacement therapy with idursulfase versus the standard of care from a societal perspective using a streamlined modeling strategy in R.

Methods

A de novo 4-state partitioned survival model was developed to compare lifetime cost and outcomes of 2 care models operationalized in R. The disease progression was based on independent survival modeling of relevant Kaplan-Meier data. The healthcare and out-of-pocket costs were drawn from the local setting. The quality of life was measured using the EQ5D5L and the time trade-off valuation of health-state vignettes that match the states in the model. Probabilistic and deterministic sensitivity analyses were conducted to test the uncertainty around the model results.

Results

The lifetime incremental quality-adjusted life years were 4.1 years (95% CI, 2.37-5.68). Incremental costs were estimated to be $9.5 million (95% CI, 9.0 million-10.0 million), which primarily consists of drug costs (99%). The incremental costs per quality-adjusted life year were estimated to be approximately $2.4 million (95% CI, 1.7 million-3.8 million). Sensitivity analyses showed that the key drivers of incremental cost-effectiveness ratio were quality of life in the preprogression state and differential discounting approach, besides the acquisition cost of enzyme replacement therapy of idursulfase.

Conclusions

The incremental cost-effectiveness ratios were beyond any conventionally used cost-effectiveness threshold in all cases. At the current price, there is a significant discrepancy between the therapy’s funding decision and the cost-effectiveness assessment as a basis for guiding healthcare prioritization in Malaysia.

{"title":"Cost-Effectiveness Analysis of Idursulfase for the Long-Term Treatment of Hunter Syndrome Using a Partitioned-Survival Model Approach in R","authors":"Khairu Hazwan Mustaffa MSc , Asrul Akmal Shafie PhD , Lock-Hock Ngu MBBS , Rowani Mohd-Rawi MBBS","doi":"10.1016/j.vhri.2025.101089","DOIUrl":"10.1016/j.vhri.2025.101089","url":null,"abstract":"<div><h3>Objectives</h3><div>Hunter syndrome is among the costliest life-long genetic conditions associated with a substantial burden-of-illness and a significant impact on the health systems, families, and society. We estimated the cost-effectiveness of long-term enzyme replacement therapy with idursulfase versus the standard of care from a societal perspective using a streamlined modeling strategy in R.</div></div><div><h3>Methods</h3><div>A de novo 4-state partitioned survival model was developed to compare lifetime cost and outcomes of 2 care models operationalized in R. The disease progression was based on independent survival modeling of relevant Kaplan-Meier data. The healthcare and out-of-pocket costs were drawn from the local setting. The quality of life was measured using the EQ5D5L and the time trade-off valuation of health-state vignettes that match the states in the model. Probabilistic and deterministic sensitivity analyses were conducted to test the uncertainty around the model results.</div></div><div><h3>Results</h3><div>The lifetime incremental quality-adjusted life years were 4.1 years (95% CI, 2.37-5.68). Incremental costs were estimated to be $9.5 million (95% CI, 9.0 million-10.0 million), which primarily consists of drug costs (99%). The incremental costs per quality-adjusted life year were estimated to be approximately $2.4 million (95% CI, 1.7 million-3.8 million). Sensitivity analyses showed that the key drivers of incremental cost-effectiveness ratio were quality of life in the preprogression state and differential discounting approach, besides the acquisition cost of enzyme replacement therapy of idursulfase.</div></div><div><h3>Conclusions</h3><div>The incremental cost-effectiveness ratios were beyond any conventionally used cost-effectiveness threshold in all cases. At the current price, there is a significant discrepancy between the therapy’s funding decision and the cost-effectiveness assessment as a basis for guiding healthcare prioritization in Malaysia.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101089"},"PeriodicalIF":1.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Budget Impact Analysis of Intravitreal Injections Used to Treat Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema in the Dubai Healthcare System

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-02-19 DOI: 10.1016/j.vhri.2025.101083

Sara Al Dallal MSc , Ahmed El Khashab , Rao Prasan , Amar Safar , Mahmoud Wael MEc , Fadwa Abdellatif MSc , Ahmed Ibrahim

Objectives

With the rising prevalence of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), this study assesses the budget impact of current intravitreal injections (faricimab, brolucizumab, ranibizumab, and aflibercept) on Dubai’s private sector. The aim is to identify the most cost-effective intervention by evaluating utilization costs based on injection frequencies and direct acquisition expenses.

Methods

An Excel-based budget impact model, aligned with the current standard of care, incorporates direct medical costs only, acquisition prices of the 4 interventions, procedure costs, optical coherence tomography diagnosis and consultation visit costs, and average administration costs in Dubai’s healthcare system. Local experts’ opinions shape the clinical approach and costs. The model spans a 5-year horizon, considering a complete replacement or gradual increase in faricimab uptake. One-way sensitivity analysis ensures outcome robustness.

Results

The model, based on an estimated prevalence of 722 nAMD patients and 14 885 DME patients, projects faricimab’s growing market share yielding estimated total savings of 402 908 275 Arab Emirates Dirham over 5 years compared with current market shares. The savings stem from faricimab’s lower injection frequency and acquisition cost in managing DME and nAMD in Dubai’s healthcare system.

Conclusions

Increasing faricimab uptake promises substantial budget savings. Decision makers in Ophthalmology Care in the United Arab Emirates can efficiently allocate resources by endorsing faricimab as the primary treatment for nAMD and DME based on these findings.

{"title":"Budget Impact Analysis of Intravitreal Injections Used to Treat Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema in the Dubai Healthcare System","authors":"Sara Al Dallal MSc , Ahmed El Khashab , Rao Prasan , Amar Safar , Mahmoud Wael MEc , Fadwa Abdellatif MSc , Ahmed Ibrahim","doi":"10.1016/j.vhri.2025.101083","DOIUrl":"10.1016/j.vhri.2025.101083","url":null,"abstract":"<div><h3>Objectives</h3><div>With the rising prevalence of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), this study assesses the budget impact of current intravitreal injections (faricimab, brolucizumab, ranibizumab, and aflibercept) on Dubai’s private sector. The aim is to identify the most cost-effective intervention by evaluating utilization costs based on injection frequencies and direct acquisition expenses.</div></div><div><h3>Methods</h3><div>An Excel-based budget impact model, aligned with the current standard of care, incorporates direct medical costs only, acquisition prices of the 4 interventions, procedure costs, optical coherence tomography diagnosis and consultation visit costs, and average administration costs in Dubai’s healthcare system. Local experts’ opinions shape the clinical approach and costs. The model spans a 5-year horizon, considering a complete replacement or gradual increase in faricimab uptake. One-way sensitivity analysis ensures outcome robustness.</div></div><div><h3>Results</h3><div>The model, based on an estimated prevalence of 722 nAMD patients and 14 885 DME patients, projects faricimab’s growing market share yielding estimated total savings of 402 908 275 Arab Emirates Dirham over 5 years compared with current market shares. The savings stem from faricimab’s lower injection frequency and acquisition cost in managing DME and nAMD in Dubai’s healthcare system.</div></div><div><h3>Conclusions</h3><div>Increasing faricimab uptake promises substantial budget savings. Decision makers in Ophthalmology Care in the United Arab Emirates can efficiently allocate resources by endorsing faricimab as the primary treatment for nAMD and DME based on these findings.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101083"},"PeriodicalIF":1.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparing the Measurement Properties of the Preliminary Version of the EuroQol Health and Well-Being and EQ-5D-5L in Patients, Healthy General Public, and Caregivers

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-02-17 DOI: 10.1016/j.vhri.2025.101081

Guangjie Zhang MSc , Zhihao Yang PhD , Nan Luo PhD , Jan Busschbach PhD

Objectives

The EuroQol Health and Well-Being (EQ-HWB) is a new generic quality of life (QOL) questionnaire to capture broader aspects of health and well-being than EQ-5D-5L. This study examined the measurement properties of the preliminary EQ-HWB version in patients, healthy individuals, and healthy caregivers.

Methods

Respondents (1) with or without caregiver tasks, (2) with different diseases, or (3) in full health were recruited online. Ceiling effects, convergent and divergent validity, known disease, and caregiver group differences were explored, and an exploratory factor analysis was used.

Results

A total of 500 respondents were recruited, including 100 healthy individuals (excluding 40 healthy caregivers), 122 with chronic hepatitis B, 101 with HIV/AIDS, 107 with depression, and 90 with generalized anxiety disorder. The EQ-HWB activities dimension correlated most highly with the EQ-5D-5L mobility, self-care, and usual activities dimensions, whereas EQ-HWB physical sensation dimension was strongly related to the EQ-5D-5L pain/discomfort dimension. Additional EQ-HWB dimensions (self-identity, cognition, autonomy, feelings and emotions, and relationships) aligned most closely with the EQ-5D-5L anxiety/depression dimension. Both instruments differentiated disease burden across healthy individuals and patients and identified caregiving roles. The EQ-5D-5L revealed 3 factors in exploratory factor analysis, whereas the EQ-HWB included 2 additional factors (F1 cognition, F2 physical activity, F3 feelings and emotions, F4 positive items, and F5 physical sensation).

Conclusions

EQ-HWB is able to measure health-related QOL in healthy people, patients, and caregivers given that it shares the same conceptual structure with EQ-5D. EQ-HWB is more sensitive in patients with mental health conditions than the EQ-5D. These results support that EQ-HWB captures well-being alongside health-related QOL.

{"title":"Comparing the Measurement Properties of the Preliminary Version of the EuroQol Health and Well-Being and EQ-5D-5L in Patients, Healthy General Public, and Caregivers","authors":"Guangjie Zhang MSc , Zhihao Yang PhD , Nan Luo PhD , Jan Busschbach PhD","doi":"10.1016/j.vhri.2025.101081","DOIUrl":"10.1016/j.vhri.2025.101081","url":null,"abstract":"<div><h3>Objectives</h3><div>The EuroQol Health and Well-Being (EQ-HWB) is a new generic quality of life (QOL) questionnaire to capture broader aspects of health and well-being than EQ-5D-5L. This study examined the measurement properties of the preliminary EQ-HWB version in patients, healthy individuals, and healthy caregivers.</div></div><div><h3>Methods</h3><div>Respondents (1) with or without caregiver tasks, (2) with different diseases, or (3) in full health were recruited online. Ceiling effects, convergent and divergent validity, known disease, and caregiver group differences were explored, and an exploratory factor analysis was used.</div></div><div><h3>Results</h3><div>A total of 500 respondents were recruited, including 100 healthy individuals (excluding 40 healthy caregivers), 122 with chronic hepatitis B, 101 with HIV/AIDS, 107 with depression, and 90 with generalized anxiety disorder. The EQ-HWB activities dimension correlated most highly with the EQ-5D-5L mobility, self-care, and usual activities dimensions, whereas EQ-HWB physical sensation dimension was strongly related to the EQ-5D-5L pain/discomfort dimension. Additional EQ-HWB dimensions (self-identity, cognition, autonomy, feelings and emotions, and relationships) aligned most closely with the EQ-5D-5L anxiety/depression dimension. Both instruments differentiated disease burden across healthy individuals and patients and identified caregiving roles. The EQ-5D-5L revealed 3 factors in exploratory factor analysis, whereas the EQ-HWB included 2 additional factors (F1 cognition, F2 physical activity, F3 feelings and emotions, F4 positive items, and F5 physical sensation).</div></div><div><h3>Conclusions</h3><div>EQ-HWB is able to measure health-related QOL in healthy people, patients, and caregivers given that it shares the same conceptual structure with EQ-5D. EQ-HWB is more sensitive in patients with mental health conditions than the EQ-5D. These results support that EQ-HWB captures well-being alongside health-related QOL.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"47 ","pages":"Article 101081"},"PeriodicalIF":1.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cost-Effectiveness Analysis of Upadacitinib in Patients With Moderately to Severely Active Ulcerative Colitis in Greece

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-02-14 DOI: 10.1016/j.vhri.2025.101091

Charalampos Tzanetakos MSc , Marina Psarra MSc , Ilias Kotsis MSc , George Gourzoulidis MSc

Objectives

This study aimed to evaluate the cost-effectiveness of upadacitinib in patients with moderately to severely active ulcerative colitis (UC), who have had an inadequate response, lost response, or were intolerant to either conventional therapy (bio-naïve) or a biologic agent (bio-exposed), in Greece.

Methods

A cost-effectiveness model, consisting of an 8-week decision tree model (induction period) and a long-term Markov state-transition model with a 4-week cycle length (maintenance period), was locally adapted from a public payer perspective over the patient’s lifetime. Upadacitinib was compared with other UC marketed biologics and small molecule agents in Greece. Clinical and utility data were retrieved from published literature. Direct costs pertaining to drug acquisition, administration, disease management, and adverse events were considered in the analysis. All cost inputs were indexed to 2023 euros. Model outcomes were patients’ quality-adjusted life-years (QALYs), total costs, and incremental cost-effectiveness ratios (ICERs).

Results

In the bio-naïve population, compared with adalimumab, golimumab, infliximab, ozanimod, tofacitinib, ustekinumab, and vedolizumab, upadacitinib was found to be more effective (QALY gains: 0.833, 0.670, 0.671, 0.783, 0.314, 0.577, and 0.522, respectively) and cost-effective (ICERs: €18 618, €21 682, €17 864, €15 637, €30 061, €12 776, and €16 263, respectively). In the bio-exposed population, compared with adalimumab, ozanimod, tofacitinib, ustekinumab, and vedolizumab, upadacitinib demonstrated again a more effective (QALY gains: 0.784, 0.697, 0.514, 0.723, and 0.719, respectively) and cost-effective profile (ICERs: €16 396, €13 661, €17 074, €10 975, and €13 881, respectively).

Conclusions

Upadacitinib was estimated to be the most effective and cost-effective treatment among all advanced treatments for moderately to severely active UC in Greece.

{"title":"Cost-Effectiveness Analysis of Upadacitinib in Patients With Moderately to Severely Active Ulcerative Colitis in Greece","authors":"Charalampos Tzanetakos MSc , Marina Psarra MSc , Ilias Kotsis MSc , George Gourzoulidis MSc","doi":"10.1016/j.vhri.2025.101091","DOIUrl":"10.1016/j.vhri.2025.101091","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate the cost-effectiveness of upadacitinib in patients with moderately to severely active ulcerative colitis (UC), who have had an inadequate response, lost response, or were intolerant to either conventional therapy (bio-naïve) or a biologic agent (bio-exposed), in Greece.</div></div><div><h3>Methods</h3><div>A cost-effectiveness model, consisting of an 8-week decision tree model (induction period) and a long-term Markov state-transition model with a 4-week cycle length (maintenance period), was locally adapted from a public payer perspective over the patient’s lifetime. Upadacitinib was compared with other UC marketed biologics and small molecule agents in Greece. Clinical and utility data were retrieved from published literature. Direct costs pertaining to drug acquisition, administration, disease management, and adverse events were considered in the analysis. All cost inputs were indexed to 2023 euros. Model outcomes were patients’ quality-adjusted life-years (QALYs), total costs, and incremental cost-effectiveness ratios (ICERs).</div></div><div><h3>Results</h3><div>In the bio-naïve population, compared with adalimumab, golimumab, infliximab, ozanimod, tofacitinib, ustekinumab, and vedolizumab, upadacitinib was found to be more effective (QALY gains: 0.833, 0.670, 0.671, 0.783, 0.314, 0.577, and 0.522, respectively) and cost-effective (ICERs: €18 618, €21 682, €17 864, €15 637, €30 061, €12 776, and €16 263, respectively). In the bio-exposed population, compared with adalimumab, ozanimod, tofacitinib, ustekinumab, and vedolizumab, upadacitinib demonstrated again a more effective (QALY gains: 0.784, 0.697, 0.514, 0.723, and 0.719, respectively) and cost-effective profile (ICERs: €16 396, €13 661, €17 074, €10 975, and €13 881, respectively).</div></div><div><h3>Conclusions</h3><div>Upadacitinib was estimated to be the most effective and cost-effective treatment among all advanced treatments for moderately to severely active UC in Greece.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101091"},"PeriodicalIF":1.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cost-Effectiveness of Mineralocorticoid Receptor Antagonists in Ischemic and Nonischemic Heart Failure With Reduced Ejection Fraction: Perspective From a Universal Healthcare System

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-02-12 DOI: 10.1016/j.vhri.2025.101084

Cristiane Koeche BPharm, MSc , Ana Claudia Cavalcante Nogueira MD, MSc , Giselle Pinto da Silva Amaral MD , Adriana J.B.A. Guimarães MD, PhD , Yasmim Botelho Neiva , Alexandre Magno Oliveira de Souza , Marta Duran Fernandez MSc , Luís Eduardo Rohde MD, PhD , Andrei C. Sposito MD, PhD , Luiz Sérgio F. de Carvalho MD, PhD

Objectives

Mineralocorticoid receptor antagonists (MRAs) are cornerstones in the management of heart failure (HF) with reduced ejection fraction (HFrEF). New MRAs with improved safety profile, such as finerenone and eplerenone, were recently introduced. However, because of typical budget restrictions in middle-income countries, evaluating their cost-effectiveness is essential for optimizing treatment strategies.

Methods

We used a Bayesian network and Markov influence diagrams to estimate the incremental cost-effectiveness ratios (ICERs) in international dollars (Int$) per quality-adjusted life-year (QALY). Our model was fed by a systematic review and a network meta-analysis to compare MRAs effectiveness and used data from a cohort of 1066 Brazilian individuals with HFrEF (36% with ischemic and 64% with nonischemic disease).

Results

Over a 10-year time horizon, the treatment with spironolactone, eplerenone, and finerenone compared with no MRA utilization yielded discounted QALY per person of 0.072, 0.111, and 0.034, respectively. The ICERs were Int$7955, Int$6460, and Int$109 840 per QALY gained, respectively. Compared with spironolactone, eplerenone showed an ICER of Int$6178 per QALY gained. Assuming a willingness-to-pay threshold of 1 Brazilian per capita gross domestic product (Int$17 589) per QALY gained, the probabilistic sensitivity analyses suggest that spironolactone and eplerenone were cost-effective, respectively, in 87% and 92% of iterations. The 95% CIs were Int$2282 to Int$13 149 for spironolactone and Int$1795 to Int$12 351 for eplerenone per QALY gained. These findings were consistent across several scenarios including ischemic/nonischemic HF.

Conclusions

Eplerenone is likely the most cost-effective MRA in Brazil considering individuals with both ischemic and nonischemic HFrEF.

{"title":"Cost-Effectiveness of Mineralocorticoid Receptor Antagonists in Ischemic and Nonischemic Heart Failure With Reduced Ejection Fraction: Perspective From a Universal Healthcare System","authors":"Cristiane Koeche BPharm, MSc , Ana Claudia Cavalcante Nogueira MD, MSc , Giselle Pinto da Silva Amaral MD , Adriana J.B.A. Guimarães MD, PhD , Yasmim Botelho Neiva , Alexandre Magno Oliveira de Souza , Marta Duran Fernandez MSc , Luís Eduardo Rohde MD, PhD , Andrei C. Sposito MD, PhD , Luiz Sérgio F. de Carvalho MD, PhD","doi":"10.1016/j.vhri.2025.101084","DOIUrl":"10.1016/j.vhri.2025.101084","url":null,"abstract":"<div><h3>Objectives</h3><div>Mineralocorticoid receptor antagonists (MRAs) are cornerstones in the management of heart failure (HF) with reduced ejection fraction (HFrEF). New MRAs with improved safety profile, such as finerenone and eplerenone, were recently introduced. However, because of typical budget restrictions in middle-income countries, evaluating their cost-effectiveness is essential for optimizing treatment strategies.</div></div><div><h3>Methods</h3><div>We used a Bayesian network and Markov influence diagrams to estimate the incremental cost-effectiveness ratios (ICERs) in international dollars (Int$) per quality-adjusted life-year (QALY). Our model was fed by a systematic review and a network meta-analysis to compare MRAs effectiveness and used data from a cohort of 1066 Brazilian individuals with HFrEF (36% with ischemic and 64% with nonischemic disease).</div></div><div><h3>Results</h3><div>Over a 10-year time horizon, the treatment with spironolactone, eplerenone, and finerenone compared with no MRA utilization yielded discounted QALY per person of 0.072, 0.111, and 0.034, respectively. The ICERs were Int$7955, Int$6460, and Int$109 840 per QALY gained, respectively. Compared with spironolactone, eplerenone showed an ICER of Int$6178 per QALY gained. Assuming a willingness-to-pay threshold of 1 Brazilian per capita gross domestic product (Int$17 589) per QALY gained, the probabilistic sensitivity analyses suggest that spironolactone and eplerenone were cost-effective, respectively, in 87% and 92% of iterations. The 95% CIs were Int$2282 to Int$13 149 for spironolactone and Int$1795 to Int$12 351 for eplerenone per QALY gained. These findings were consistent across several scenarios including ischemic/nonischemic HF.</div></div><div><h3>Conclusions</h3><div>Eplerenone is likely the most cost-effective MRA in Brazil considering individuals with both ischemic and nonischemic HFrEF.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"47 ","pages":"Article 101084"},"PeriodicalIF":1.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Valuing an Index of Sanitation-Related Quality of Life in Urban Mozambique: A Discrete Choice Experiment

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-02-11 DOI: 10.1016/j.vhri.2025.101087

Patrick V. Katana MSc , Neiva Banze MD , Cremildo Manhiça BSc , Catildo Cubai BSc , Lucia Viera MD , Edi Fulai MD , Oliver Cumming MSc , Edna Viegas PhD , Igor Capitine PhD , Ian Ross PhD

Objectives

A total of 1.5 billion people live without basic sanitation. A 5-attribute index of sanitation-related quality of life (SanQoL-5) has been applied in 9 countries. SanQoL-5 attributes and their levels require weighting (valuation), with the resulting index ranging from 0 to 1. To date, SanQoL-5 valuation applied simple methods such as rank sum, not robust methods such as discrete choice experiment (DCE). We aimed to value SanQoL-5 using a DCE in urban Mozambique.

Methods

We enrolled 601 adults in the cities of Maputo and Dondo, sampling women and men equally. The DCE task was a choice of which was “better” among 2 combinations of SanQoL-5 attribute levels (always, sometimes, never). Each respondent completed 10 tasks and a dominance test. After fitting a mixed logit model, we rescaled coefficients to derive the index.

Results

The highest-valued attribute was disgust (“never feel disgusted while using the toilet”) at 0.25. The other attributes had similar values (ranging 0.18-0.19). People valued “sometimes” levels at approximately 60% of “never” levels. Therefore, moving from the middle level to the worst involves a larger decrement than moving from the best to the middle. Mean SanQoL-5 by toilet type followed a gradient with Sustainable Development Goal 6 categories: “open defecation” 0.30, “unimproved” 0.45, “limited” 0.60, and “at least basic” 0.70.

Conclusions

To our knowledge, this is the first DCE-based valuation of any index of sanitation-related quality of life, enabling SanQoL-5 to be used in economic evaluation. Identifying sanitation service transitions associated with the greatest quality of life gains could inform more efficient resource allocation.

{"title":"Valuing an Index of Sanitation-Related Quality of Life in Urban Mozambique: A Discrete Choice Experiment","authors":"Patrick V. Katana MSc , Neiva Banze MD , Cremildo Manhiça BSc , Catildo Cubai BSc , Lucia Viera MD , Edi Fulai MD , Oliver Cumming MSc , Edna Viegas PhD , Igor Capitine PhD , Ian Ross PhD","doi":"10.1016/j.vhri.2025.101087","DOIUrl":"10.1016/j.vhri.2025.101087","url":null,"abstract":"<div><h3>Objectives</h3><div>A total of 1.5 billion people live without basic sanitation. A 5-attribute index of sanitation-related quality of life (SanQoL-5) has been applied in 9 countries. SanQoL-5 attributes and their levels require weighting (valuation), with the resulting index ranging from 0 to 1. To date, SanQoL-5 valuation applied simple methods such as rank sum, not robust methods such as discrete choice experiment (DCE). We aimed to value SanQoL-5 using a DCE in urban Mozambique.</div></div><div><h3>Methods</h3><div>We enrolled 601 adults in the cities of Maputo and Dondo, sampling women and men equally. The DCE task was a choice of which was “better” among 2 combinations of SanQoL-5 attribute levels (always, sometimes, never). Each respondent completed 10 tasks and a dominance test. After fitting a mixed logit model, we rescaled coefficients to derive the index.</div></div><div><h3>Results</h3><div>The highest-valued attribute was disgust (“never feel disgusted while using the toilet”) at 0.25. The other attributes had similar values (ranging 0.18-0.19). People valued “sometimes” levels at approximately 60% of “never” levels. Therefore, moving from the middle level to the worst involves a larger decrement than moving from the best to the middle. Mean SanQoL-5 by toilet type followed a gradient with Sustainable Development Goal 6 categories: “open defecation” 0.30, “unimproved” 0.45, “limited” 0.60, and “at least basic” 0.70.</div></div><div><h3>Conclusions</h3><div>To our knowledge, this is the first DCE-based valuation of any index of sanitation-related quality of life, enabling SanQoL-5 to be used in economic evaluation. Identifying sanitation service transitions associated with the greatest quality of life gains could inform more efficient resource allocation.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"47 ","pages":"Article 101087"},"PeriodicalIF":1.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0