Value in health regional issues最新文献

The Economic Burden of Foodborne Diseases in Singapore 新加坡食源性疾病的经济负担

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-16 DOI: 10.1016/j.vhri.2025.101499

Jia Hao Wong MPH , Julian Lim MPH , Benjamin Er MSc , Abigail Wong MPH , Kyaw Thu Aung PhD , Kenneth Chow BSc , Cynthia Chen PhD

Objectives

Foodborne Diseases (FBD) are a significant public health issue worldwide, affecting both low and high income countries with over 600 million cases reported in a year. This study provided the first estimate of the economic cost of FBD in Singapore.

Methods

The incidence of FBD was first estimated using local data sources. We estimated the cases in the community by applying relevant foodborne and underreporting multipliers elicited through expert opinion and the existing literature. The direct and indirect costs associated with the cases were used to estimate the total economic cost due to FBD from known pathogens and gastroenteritis. Direct costs included both inpatient and primary healthcare utilization. Indirect costs included productivity losses due to absenteeism and wage loss due to premature mortality.

Results

There were 6080 cases of FBD from known pathogens, with a total societal cost of $15.1 million). There were 184 000 cases of unspecified gastroenteritis, which cost $67.1 million. Nontyphoidal Salmonella contributed the most significant number of cases (n = 2050) and the highest societal cost ($8.12 million) among the known pathogens, whereas Listeria had the highest societal cost per case ($49 900).

Conclusions

Our study showed similar results to studies conducted in other countries. This study estimates the true economic burden of FBD. It would help policy makers prioritize FBD so that targeted preventive measures can be implemented to reduce the costs associated with FBD, which pose significant economic costs to society.

食源性疾病（FBD）是一个全球性的重大公共卫生问题，影响着低收入和高收入国家，每年报告的病例超过6亿例。这项研究首次估算了新加坡FBD的经济成本。方法首先利用当地资料估计FBD的发病率。我们通过应用专家意见和现有文献得出的相关食源性和漏报乘数来估计社区中的病例。与病例相关的直接和间接成本用于估计由已知病原体和肠胃炎引起的FBD的总经济成本。直接费用包括住院费用和初级保健费用。间接成本包括因缺勤造成的生产力损失和因过早死亡造成的工资损失。结果共有6080例已知病原菌FBD，社会总成本为1510万美元。有18.4万宗未指明的肠胃炎个案，花费6710万元。在已知病原体中，非伤寒沙门氏菌造成的病例数量最多（n = 2050），社会成本最高（812万美元），而李斯特菌的每例社会成本最高（4.49万美元）。结论我们的研究结果与其他国家的研究结果相似。本研究估计了FBD的真实经济负担。这将有助于决策者优先考虑FBD，以便实施有针对性的预防措施，以减少与FBD相关的成本，这些成本给社会带来了巨大的经济成本。

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引用次数: 0

Cost-Effectiveness of Hydroxyurea for Treatment of Children With Sickle Cell Anemia in Ghana 羟基脲治疗加纳儿童镰状细胞性贫血的成本效益

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-16 DOI: 10.1016/j.vhri.2025.101586

Sinaï Francisco Dias MSc , Brian Asare MSc , Lumbwe Chola PhD

Objectives

Most African children born with sickle cell disease (SCD) will die before their fifth birthday. Hydroxyurea has proven therapeutic benefits for SCD yet remains inaccessible to many children in low- and middle-income countries. To inform policy on coverage and reimbursement, this study evaluates the cost-effectiveness of hydroxyurea for pediatric SCD in Ghana, compared with the standard of care.

Methods

We developed a Markov model of SCD progression, incorporating costs and effects from a Ghanaian payer perspective, over a 17-year time horizon. Outcomes were life-years gained and disability-adjusted life-years averted. Cost-effectiveness was determined using the World Health Organization willingness-to-pay threshold of 1 times the per-capita gross domestic product and an alternative country-specific threshold based on health opportunity cost ($580.52). One-way and probabilistic sensitivity analyses were undertaken. Costs and effects were discounted at 3% per annum.

Results

In the base case, the incremental cost-effectiveness ratio was $1440.34 per disability-adjusted life-year averted and $1823.89 per life-year gained. The intervention was potentially cost-effective using the World Health Organization threshold but not cost-effective using the alternative threshold. The 1-way sensitivity analysis highlighted the incremental cost-effectiveness ratio’s sensitivity to price changes, emphasizing the importance of price negotiations.

Conclusions

Hydroxyurea can provide substantial health benefits for Ghanaian children with SCD. The results provide a strong argument for the incorporation of hydroxyurea into the Ghana national health insurance benefits package. Future research should address the disparity in threshold outcomes and the need for country-specific data on the long-term effects and broader economic impact of hydroxyurea in Ghana.

大多数出生时患有镰状细胞病（SCD）的非洲儿童将在5岁前死亡。羟基脲已被证明对SCD有治疗作用，但低收入和中等收入国家的许多儿童仍无法获得。为了为覆盖范围和报销政策提供信息，本研究评估了羟基脲治疗加纳儿科SCD的成本效益，并与护理标准进行了比较。我们建立了SCD进展的马尔可夫模型，从加纳付款人的角度考虑了17年时间范围内的成本和效果。结果是获得生命年和避免残疾调整生命年。成本效益是根据世界卫生组织人均国内生产总值1倍的支付意愿阈值和基于保健机会成本（580.52美元）的替代性国家特定阈值确定的。进行了单向和概率敏感性分析。成本和效果按每年3%折现。结果在基本情况下，每个残疾调整生命年减少的增量成本效益比为1440.34美元，每个生命年增加的增量成本效益比为1823.89美元。使用世界卫生组织的阈值，干预措施可能具有成本效益，但使用替代阈值则不具有成本效益。单向敏感性分析强调了增量成本效益比对价格变化的敏感性，强调了价格谈判的重要性。结论氢脲可为加纳SCD患儿提供实质性的健康益处。研究结果为将羟基脲纳入加纳国民健康保险福利方案提供了强有力的论据。未来的研究应解决阈值结果的差异，并需要关于加纳羟基脲的长期影响和更广泛的经济影响的具体国家数据。

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引用次数: 0

How Can Mortality Trajectory Analysis Improve Health Policy and Research in Southeast Asia? 死亡率轨迹分析如何改善东南亚的卫生政策和研究？

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-10 DOI: 10.1016/j.vhri.2025.101583

Jeff Clyde G. Corpuz PhD

引用次数: 0

Economic Evaluation and Budget Impact Analysis of Secukinumab as a Second-Line Treatment Among Patients With Psoriatic Arthritis Who Were Tumor Necrosis Factor Inadequate Responders in Thailand 泰国肿瘤坏死因子反应不足的银屑病关节炎患者Secukinumab作为二线治疗的经济评价和预算影响分析

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-10 DOI: 10.1016/j.vhri.2025.101570

Unchalee Permsuwan PhD , Ratree Sawangjit PhD , Piyameth Dilokthornsakul PharmD, PhD

Objectives

Secukinumab has demonstrated a promising efficacy among patients with psoriatic arthritis (PsA) who had an inadequate response to tumor necrosis factor inhibitors (TNF-IR). This study aimed to assess the cost-utility and budget impact of secukinumab compared with standard treatment among PsA patients who were TNF-IR in Thailand.

Methods

A hybrid model from a societal perspective was undertaken. Patients with PsA who were TNF-IR and aged 40 years were simulated. Secukinumab 150 mg, secukinumab 300 mg, and secukinumab 150 mg with escalated dose to 300 mg if not responded at 6 months (switching) were compared with standard of care. All inputs were collected from comprehensive literature review. The incremental cost-effectiveness ratio per quality-adjusted life-year (QALY) was calculated. A budget impact was also estimated.

Results

Secukinumab 150 mg, secukinumab 300 mg, and secukinumab switching had 0.10, 0.30, and 0.89 additional QALYs, respectively. However, secukinumab 150 mg required an additional lifetime cost of 74 783 Thai baht (THB) ($2149), whereas secukinumab 300 mg required 238 457 THB ($6851) and secukinumab switching required 338 540 THB ($9726). The incremental cost-effectiveness ratios for secukinumab 150 mg, secukinumab 300 mg, and secukinumab switching were 724 964 THB/QALY ($20 828/QALY), 793 652 THB/QALY ($22 802/QALY), and 380 445 THB ($10 930/QALY), respectively. Average net budget impacts for the first 5 year were 90 million THB ($2.95 million), 1117 million THB ($32.09 million), and 871 million ($25.02 million) for secukinumab 150 mg, secukinumab 300 mg, and secukinumab switching, respectively.

Conclusions

Secukinumab provided clinical benefits for PsA patients who were TNF-IR, but it is not a cost-effective option at its current price.

目的：Secukinumab在对肿瘤坏死因子抑制剂（TNF-IR）反应不足的银屑病关节炎（PsA）患者中显示出有希望的疗效。本研究旨在评估在泰国TNF-IR的PsA患者中，与标准治疗相比，secukinumab的成本效用和预算影响。方法：采用社会视角的混合模型。模拟了年龄为40岁的PsA患者的TNF-IR。将Secukinumab 150mg、Secukinumab 300mg和Secukinumab 150mg与标准护理进行比较，如果在6个月时没有反应（切换），则将剂量增加到300mg。所有资料收集自综合文献综述。计算每个质量调整生命年（QALY）的增量成本-效果比。还估计了预算影响。结果：Secukinumab 150 mg、Secukinumab 300 mg和Secukinumab转换分别有0.10、0.30和0.89个额外的qaly。然而，secukinumab 150 mg需要额外的终身成本为74 783泰铢（2149美元），而secukinumab 300 mg需要238 457泰铢（6851美元），secukinumab转换需要338 540泰铢（9726美元）。secukinumab 150 mg、secukinumab 300 mg和secukinumab转换的增量成本-效果比分别为724 964 THB/QALY（20828美元/QALY）、793 652 THB/QALY（22 802美元/QALY）和380 445 THB（10 930美元/QALY）。前5年的平均净预算影响分别为9000万泰铢（295万美元）、1.17亿泰铢（3209万美元）和8.71亿泰铢（2502万美元），分别用于secukinumab 150 mg、secukinumab 300 mg和secukinumab转换。结论：Secukinumab为TNF-IR的PsA患者提供了临床益处，但以目前的价格来看，它不是一个具有成本效益的选择。

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引用次数: 0

Budget Impact Analysis of Fam-Trastuzumab-Deruxtecan as a Second Line in Patients With HER2-Positive Metastatic Breast Cancer in Oman 阿曼her2阳性转移性乳腺癌患者采用fam -曲妥珠单抗-德鲁西替康二线治疗的预算影响分析

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-08 DOI: 10.1016/j.vhri.2025.101575

Rana Aljaber MSc , Rawan F. Al Froukh MSc , Amna Al Hashar PhD

Objectives

Despite advancements, breast cancer remains a major global health and financial challenge. Trastuzumab-based therapies, particularly Fam-Trastuzumab-Deruxtecan (T-DXd), have shown superior outcomes, leading to its recommendation as a preferred second-line treatment. However, its high cost necessitates a budget impact analysis (BIA) to evaluate financial feasibility. This study assesses the 1-year budget impact of replacing Trastuzumab Emtansine (TDM1) with T-DXd for HER2+ metastatic breast cancer in an Omani cancer center.

Methods

A static BIA model was built based on National Institute for Health and Care Excellence template with adaptation as required. The model time horizon was 1 year then projected over another 2 years, using 2022 as the baseline year, adopting Omani healthcare-payer perspective. The analysis considered 2 scenarios: (1) TDM1 as the current formulary drug and (2) T-DXd is introduced instead of TDM1, assuming that treatment share would be 100%. One-way sensitivity analysis is performed to assess the model’s robustness.

Results

The BIA demonstrated that replacing TDM1 with T-DXd for the eligible patients would lead to increase in the budget expenditure. Over a 3-year period, considering the provided assumptions and input data, the cumulative excess amount to €5 909 481.67. The primary contributing factors are the drug acquisition cost and the median treatment duration. The sensitivity analysis results suggest the model is robust to changes in adverse drug reaction costs, unlike changes in treatment duration and drug cost.

Conclusions

Although T-DXd improves clinical outcomes, its adoption as a second-line treatment in Oman poses a substantial financial burden, necessitating careful budget planning to ensure long-term affordability.

尽管取得了进展，但乳腺癌仍然是全球健康和财政方面的一个重大挑战。基于曲妥珠单抗的治疗，特别是fam -曲妥珠单抗-德鲁西替康（T-DXd），已经显示出优越的结果，导致其被推荐为首选的二线治疗。然而，它的高成本需要预算影响分析（BIA）来评估财务可行性。本研究评估了阿曼癌症中心用T-DXd替代曲妥珠单抗Emtansine （TDM1）治疗HER2+转移性乳腺癌的1年预算影响。方法基于美国国家卫生与保健研究所模板，根据需要进行调整，建立静态BIA模型。模型时间范围为1年，然后采用阿曼医疗保健支付者的观点，以2022年为基准年，再预测2年。分析考虑了两种情况：(1)TDM1作为当前的处方药物；(2)引入T-DXd代替TDM1，假设治疗份额为100%。进行单向敏感性分析以评估模型的稳健性。结果BIA结果表明，对符合条件的患者用T-DXd替代TDM1会导致预算支出的增加。在3年期间，考虑到所提供的假设和输入数据，累计超额金额为5 909 481.67欧元。主要影响因素是药物获取成本和中位治疗时间。敏感性分析结果表明，该模型对药物不良反应成本的变化具有鲁棒性，而对治疗时间和药物成本的变化具有鲁棒性。结论：虽然T-DXd改善了临床结果，但在阿曼，将其作为二线治疗带来了巨大的财政负担，需要仔细的预算规划，以确保长期负担得起。

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引用次数: 0

Estimation of Health Utility Values for Health States in Head and Neck Cancers Using Real-World Data 使用真实世界数据估计头颈癌患者健康状态的健康效用值

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-05 DOI: 10.1016/j.vhri.2025.101576

Krishnakumar Thankappan MCh , Shivali Kamath PharmD , Lakshmi Ravunniarth Menon MCh , Tejal Patel MCh , Deepak Balasubramanian MCh , Manu Raj DNB , Moni Abraham Kuriakose MD , Sujha Subramanian PhD , Subramania Iyer MCh

Objectives

To generate India-specific health state utility values for head and neck cancers (HNCs) using EuroQol 5-Dimension 5-Level (EQ-5D-5L) and EuroQol Visual Analog Scale (EQ-VAS) instruments, enabling context-relevant cost-utility analyses and health technology assessments.

Methods

A cross-sectional study was conducted at a tertiary HNC center in India from July 2023 to June 2024. Adults with confirmed HNCs across 53 predefined health states were enrolled. A health state is a specific condition of overall well-being, represented by a utility value indicating how preferable it is compared with perfect health or death. Utility scores were derived from the EQ-5D-5L index using the Indian tariff set and the EQ-VAS. Utility variations across treatment phases, tumor subsites, stage, and comorbidity status were also examined.

Results

Of 767 recruited patients, 753 were included for analysis across 48 health states, excluding 5 health states with less sample size. The mean EQ-5D-5L utility was 0.84 (SD 0.20), significantly higher than EQ-VAS (mean 0.73, SD 0.18; P < .001). Utilities varied significantly across treatment phases (P < .001). Clinically, patients in active treatment and palliative recurrence had the poorest perceived health, whereas those in remission showed the highest utility, mirroring expected functional recovery patterns. EQ-5D-5L produced consistently higher utility values than EQ-VAS, reflecting differences between population-weighted and self-perceived health assessments.

Conclusions

To our knowledge, this is the first Indian data set of real-world health state utility values in HNC. These values provide essential inputs for economic evaluations and health technology assessments in oncology, supporting more accurate, locally relevant healthcare decision making in resource-limited settings.

目的：使用EuroQol 5维5级（EQ-5D-5L）和EuroQol视觉模拟量表（EQ-VAS）工具生成印度特定的头颈癌（HNCs）健康状态效用值，从而实现与环境相关的成本效用分析和卫生技术评估。方法：于2023年7月至2024年6月在印度三级HNC中心进行横断面研究。在53个预先确定的健康状态中，确认患有HNCs的成年人被纳入研究。健康状态是整体幸福的具体状况，用效用值表示，表明与完美健康或死亡相比，它有多可取。效用得分来自EQ-5D-5L指数，使用印度关税集和EQ-VAS。还研究了治疗阶段、肿瘤亚位、分期和合并症状态的效用变化。结果：在767名招募的患者中，753名患者被纳入48个健康状态的分析，排除了5个样本量较少的健康状态。EQ-5D-5L的平均效用为0.84 (SD 0.20)，显著高于EQ-VAS（平均值0.73,SD 0.18; P < 0.001）。各个治疗阶段的效用差异显著（P < 0.001）。在临床上，接受积极治疗和姑息性复发的患者的健康状况最差，而缓解期患者的效用最高，反映了预期的功能恢复模式。EQ-5D-5L产生的效用值始终高于EQ-VAS，反映了人口加权和自我感知健康评估之间的差异。结论：据我们所知，这是印度第一个关于HNC中真实世界健康状态效用值的数据集。这些价值为肿瘤学的经济评估和卫生技术评估提供了必要的投入，支持在资源有限的情况下做出更准确、与当地相关的卫生保健决策。

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引用次数: 0

Person-Centered Intervention for People Living With HIV in the Philippines: A Cost-Effective Approach for Resource Allocation Decisions 菲律宾艾滋病毒感染者以人为本的干预：资源分配决策的成本效益方法。

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-01 DOI: 10.1016/j.vhri.2025.101170

Dalmacito A. Cordero Jr. PhD

引用次数: 0

Cost-Effectiveness of Text Messaging to Reengage Culturally and Linguistically Diverse Communities to Breast Cancer Screening: A Modeling Study 短信的成本效益，以重新参与文化和语言多样化的社区乳腺癌筛查：建模研究。

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-01 DOI: 10.1016/j.vhri.2025.101150

Anita Lal PhD , Eliza Mudford MHECon , Jessica Elsworth BPHHP , Lisa Hochberg BHP , Lan Gao PhD

Objectives

To promote equity in breast cancer screening for culturally and linguistically diverse (CALD) communities, language-specific initiatives were implemented in Victoria, Australia. This study aims to evaluate the cost-effectiveness of in-language short message service (SMS) reminders for overdue clients.

Methods

A cost-utility analysis was conducted to evaluate in-language SMS reminders for women aged between 50 and 72 years, overdue for their routine breast screen in 2021 (n = 3294), compared with English SMS. In-language SMS reminders to book a screen were sent to the women in the North Western and St Vincent’s BreastScreen Reading and Assessment regions in Melbourne, Victoria. A Markov microsimulation model simulated the development of breast cancer, estimating the cost per quality-adjusted life-year (QALY) gained over a 50-year time horizon from a healthcare perspective. Healthcare costs were sourced from Australian studies and are in 2021 Australian dollars.

Results

Booking response rates were higher for the lapsed in-language SMS than the lapsed SMS sent in English (12.7% and 8.2%, respectively). Intervention costs averaged $1.24/person. The estimated cost/QALY was $1595 (95% uncertainty interval dominated to $7637). Because of the in-language initiative, there were an estimated 14 more breast cancers and 5 more ductal carcinomas in situ detected and 3 fewer breast cancer deaths.

Conclusions

In-language SMS reminders to increase breast cancer screening targeting lapsed screeners from CALD communities were effective and cost-effective relative to the willingness-to-pay threshold of $50 000/QALY. Introducing these types of initiatives as standard practice can potentially increase equity in breast cancer screening for CALD groups in well-resourced countries.

目的：为了促进文化和语言多样性（CALD）社区乳腺癌筛查的公平性，在澳大利亚维多利亚州实施了针对语言的倡议。本研究的目的是评估语言短讯息服务（SMS）对逾期客户的成本效益。方法：通过成本-效用分析，与英文短信相比，对50 - 72岁逾期2021年常规乳房筛查的女性（n = 3294）进行了语言短信提醒的评估。在维多利亚州墨尔本的西北和圣文森特乳房筛查阅读和评估地区，用语言短信提醒预订筛查的妇女。一个马尔可夫微观模拟模型模拟了乳腺癌的发展，从医疗保健的角度估计了50年时间范围内每个质量调整生命年（QALY）的成本。医疗保健费用来源于澳大利亚的研究，以2021年的澳元计算。结果：失效的语言短信的预订回复率高于失效的英语短信（分别为12.7%和8.2%）。干预费用平均为每人1.24美元。估计成本/质量aly为1595美元（95%不确定区间占主导地位为7637美元）。由于语言倡议，估计乳腺癌增加了14例，原位导管癌增加了5例，乳腺癌死亡人数减少了3例。结论：相对于5万美元/QALY的支付意愿阈值而言，针对CALD社区的漏诊者增加乳腺癌筛查的语言短信提醒是有效且具有成本效益的。在资源充足的国家，将这些类型的举措作为标准做法，可能会增加CALD群体乳腺癌筛查的公平性。

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引用次数: 0

Reducing the Travel Burden for Patients to Access Specialized Medicines in Paraná, Brazil 在巴西帕拉纳岛减轻患者获得专业药物的旅行负担。

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-01 DOI: 10.1016/j.vhri.2024.101065

Paula Rossignoli PhD , Roberto Pontarolo PhD , Fernando Fernandez-Llimos PhD

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.

目的：本研究旨在评估潜在的距离和旅行时间的减少与一个假设的城市分布的专业成分药物在帕拉纳州。方法：采用横断面研究。采用集中式模式（22家国有药店）和分散式模式（399家市属药店）两种不同的模式计算从帕拉南州1025个居民点到调剂药店的距离和出行时间。道路路线计算使用谷歌地图距离矩阵API和欧几里得距离使用哈弗斯公式南半球。通过这两个距离之间的商计算出一个曲度指数。通过双变量分析和效应量测量来评估差异。结果：集中式模型中，居民到药店的平均距离为59.5 km (SD为34.1)，出行时间为1.0 h (SD为0.5)；579个居民点（56.7%）距离药店大于50 km， 286个居民点（28.0%）在25 ~ 50 km之间，156个居民点（15.3%）距离药店小于25 km。在分散式模型中，平均距离为10.8 km (SD为16.6)，出行时间为0.2 h (SD为0.3)，距离药店超过50 km的有14个（1.4%），距离25 ~ 50 km的有96个（9.4%），距离药店小于25 km的有911个（89.2%）。分散模型显著降低了弯曲度指数。结论：在帕拉纳州实施分散式专业成分药的配药，将大大减少患者的路程和出行时间，提高药品可及性。

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引用次数: 0

Disparities in Out-of-Pocket Expenditures Among Hospitalized Patients With COVID-19 in Iran: A Decomposition Analysis of Inequality 伊朗新冠肺炎住院患者自费支出差异：不平等的分解分析

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-01 DOI: 10.1016/j.vhri.2025.101093

Ahmad Dehghani_Ahmadabad PhD, Sayyed Morteza Hosseini Shokouh PhD, Parisa Mehdizadeh PhD, Mohammad Meskarpour Amiri_Ara PhD

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.

目标：关于伊朗COVID-19患者自费支出不平等的程度以及造成这种差异的因素，现有信息有限。本研究旨在探讨COVID-19住院患者OOP支出的不平等，并确定相关因素。方法：本研究采用基尼系数作为衡量COVID-19住院患者OOP支出不平等的主要指标。分析使用Stata 16软件进行，并辅以分布式分析Stata包扩展。基尼系数的计算是为了量化不平等的程度，并使用图形可视化。为了检验人口亚群之间的基尼系数，使用了分布分析软件包扩展，即数字模块。结果：Lorenz曲线分析和计算的基尼系数（0.69）证实了COVID-19住院患者的OOP支出存在不平等。此外，对人口亚组之间不平等的检查显示，保险状况和类型、临床特征和住院时间模式显著导致了观察到的COVID-19患者OOP支出差异。结论：本研究强调了保险状况、临床特征和住院时间模式对经济负担的持久影响。研究结果强调需要采取有针对性的干预措施，以减少财政障碍和促进公平获得医疗服务，从而为管理未来的公共卫生危机提供重要见解。

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引用次数: 0