Value in health regional issues最新文献_第10页

Cost-effectiveness Analysis of Pharmacological Treatment for Adult Kidney Transplant Recipients in Colombia 哥伦比亚成年肾移植受者药物治疗的成本效益分析

IF 2 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2024-04-25 DOI: 10.1016/j.vhri.2024.02.001

Daysi Sanmartin MSc , Camilo Tamayo MSc , Luis Esteban Orozco MSc , Angélica Ordóñez MSc , Juliana Huertas BSc , Diego Ávila MSc , Johanna Echeverry MSc , Mónica Caicedo MSc , Paola García NEP

Objectives

To evaluate cost-effective pharmacological treatment in adult kidney transplant recipients from the perspective of the Colombian health system.

Methods

A decision tree model for the induction phase and a Markov model for the maintenance phase were built. A review of the clinical literature was conducted to extract probabilities, and the life-years were used as the outcome. Costs were calculated using the administrative databases. The evaluating treatment schemes are organized by groups of evidence with direct comparisons.

Results

In the induction phase, anti-thymocyte immunoglobulin+ methylprednisolone is dominant, more effective, and less expensive, compared with basiliximab+methylprednisolone. In the maintenance phase, azathioprine (AZA) is dominant in contrast to mycophenolate mofetil (MFM) both with cyclosporine (CIC)+ corticosteroids (CE); CIC is dominant relative to sirolimus (SIR) and tacrolimus (TAC) (both with MFM+CE or AZA+CE), and TAC is dominant compared with SIR (in addition with MFM+CE or mycophenolate sodium [MFS]+CE); MFM is dominant in relation to MFS and everolimus, and SIR is more effective MFM but it does not exceed the threshold (in sum with TAC+CE); MFS and MFM are dominant relative to everolimus, and SIR is more effective than MFM, but it does not exceed the threshold (in addiction with CIC+CE); MFM is dominant in relation to TAC (in sum with SIR+CE), and CIC+AZA+CE is dominant in relation to TAC+MFM+CE.

Conclusions

The base-case results for all evidence groups are consistent with the different sensitivity analyses.

方法建立了诱导阶段的决策树模型和维持阶段的马尔可夫模型。对临床文献进行回顾以提取概率，并将寿命年数作为结果。成本则通过行政数据库进行计算。结果在诱导阶段，抗胸腺细胞免疫球蛋白+甲基强的松龙与巴利昔单抗+甲基强的松龙相比占优势、更有效、费用更低。在维持治疗阶段，硫唑嘌呤（AZA）与霉酚酸酯（MFM）相比，在环孢素（CIC）+皮质类固醇（CE）的情况下，硫唑嘌呤（AZA）占主导地位；与西罗莫司（SIR）和他克莫司（TAC）相比，西罗莫司（CIC）占主导地位（MFM+CE 或 AZA+CE）；与 SIR 相比，TAC 占主导地位（此外还有 MFM+CE 或霉酚酸钠[MFS]+CE）；与 MFS 和依维莫司相比，MFM 占优，SIR 比 MFM 更有效，但未超过阈值（与 TAC+CE 相加）；与依维莫司相比，MFS 和 MFM 占优，SIR 比 MFM 更有效，但未超过阈值（与 CIC+CE 相加）；与 TAC 相比，MFM 占优（与 SIR+CE 相加），与 TAC+MFM+CE 相比，CIC+AZA+CE 占优。结论所有证据组的基本情况结果与不同的敏感性分析结果一致。

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引用次数: 0

Cost-effectiveness Analysis of Triptorelin, Goserelin, and Leuprolide in the Treatment of Patients with Metastatic Prostate Cancer: A Societal Perspective 治疗转移性前列腺癌患者的曲普瑞林、戈舍瑞林和亮丙瑞林的成本效益分析：社会视角

IF 2 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2024-04-24 DOI: 10.1016/j.vhri.2024.01.004

Mehdi Rezaee MSc , Iman Karimzadeh Pharm D, PhD , Amir Hashemi-Meshkini PhD , Shahryar Zeighami MD , Mohammad Bazyar Pharm D , Farhad Lotfi PhD , Khosro Keshavarz PhD

Objectives

Metastatic prostate cancer is the most common malignant cancer and the second leading cause of death due to various types of cancer among men after lung cancer. This study aimed to analyze the cost-effectiveness of triptorelin, goserelin, and leuprolide in the treatment of the patients with metastatic prostate cancer from the societal perspective in Iran in 2020.

Methods

This is a cost-effectiveness study in which a 20-year Markov transition modeling was applied. In this study, local cost and quality-of-life data of each health state were gathered from cohort of patients. The TreeAge pro 2020 and Microsoft Excel 2016 software were used to simulate cost-effectiveness of each treatment in the long term. The one-way and probabilistic sensitivity analyses were also performed to measure robustness of the model outputs.

Results

The findings indicated that the mean costs and utility gained over a 20-year horizon for goserelin, triptorelin, and leuprolide treatments were $ 13 539.13 and 6.365 quality-adjusted life-years (QALY), $ 18 124.75 and 6.658 QALY, and $ 26 006.92 and 6.856 QALY, respectively. Goserelin was considered as a superior treatment option, given the estimated incremental cost-effectiveness ratio. The one-way and probabilistic sensitivity analyses confirmed the robustness of the study outcomes.

Conclusions

According to the results of the present study, goserelin was the most effective and cost-effective strategy versus 2 other options. It could be recommended to policy makers of the Iran healthcare system to prioritize it in clinical guidelines and reimbursement policies.

目标转移性前列腺癌是最常见的恶性肿瘤，也是仅次于肺癌的导致男性死亡的第二大癌症。本研究旨在从伊朗社会角度分析 2020 年曲普瑞林、戈舍瑞林和利优普瑞治疗转移性前列腺癌患者的成本效益。在这项研究中，从患者队列中收集了各健康状态下的当地成本和生活质量数据。使用 TreeAge pro 2020 和 Microsoft Excel 2016 软件模拟了每种治疗方法的长期成本效益。结果研究结果表明，戈舍瑞林、曲普瑞林和利优普瑞治疗 20 年的平均成本和效用分别为 13 539.13 美元和 6.365 质量调整生命年（QALY）、18 124.75 美元和 6.658 QALY 以及 26 006.92 美元和 6.856 QALY。根据估计的增量成本效益比，戈舍瑞林被认为是一种更优的治疗方案。单向和概率敏感性分析证实了研究结果的稳健性。结论根据本研究的结果，戈舍瑞林与其他两种方案相比是最有效、最具成本效益的策略。建议伊朗医疗系统的政策制定者在临床指南和报销政策中优先考虑戈舍瑞林。

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引用次数: 0

Peripherally Inserted Central Catheter Versus Centrally Inserted Central Catheter for In-Hospital Infusion Therapy: A Cost-Effectiveness Analysis 用于院内输液治疗的外周置入中心导管与中心置入中心导管：成本效益分析

IF 2 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2024-02-23 DOI: 10.1016/j.vhri.2023.12.006

Simone de Souza Fantin RN, MSc, ScD , Marina Scherer dos Santos RN , Eduarda Bordini Ferro RN , Vania Naomi Hirakata MSc , André Ferreira de Azeredo da Silva MD, PhD , Eneida Rejane Rabelo-Silva RN, MSc, ScD

Objectives

To evaluate the comparative effectiveness and cost-effectiveness of peripherally inserted central catheters (PICCs) compared with centrally inserted central catheters (CICCs).

Methods

Prospective cohort study was followed by an economic analysis over a 30-day time horizon. Propensity score matching was used to select hospitalized adults with similar indications for PICC or CICC. The composite outcome was device removal or replacement because of complications before the end of treatment. The economic evaluation was based on a decision tree model for cost-effectiveness analysis, with calculation of the incremental cost-effectiveness ratio (ICER) per catheter removal avoided. All costs are presented in Brazilian reais (BRL) (1 BRL = 0.1870 US dollar).

Results

A total of 217 patients were followed in each group; 172 (79.3%) of those receiving a PICC and 135 (62.2%) of those receiving a CICC had no device-related complication, respectively. When comparing the events leading to device removal, the risk of composite endpoint was significantly higher in the CICC group (hazard ratio 0.20; 95% CI 0.11-0.35). The cost of PICC placement was BRL 1290.98 versus BRL 467.16 for a CICC. In the base case, the ICER for placing a PICC instead of a CICC was BRL 3349.91 per removal or replacement avoided. On univariate sensitivity analyses, the model proved to be robust within an ICER range of 2500.00 to 4800.00 BRL.

Conclusions

PICC placement was associated with a lower risk of complications than CICC placement. Although the cost of a PICC is higher, its use avoided complications and need for catheter replacement before the end of treatment.

目的评估外周置入中心导管（PICC）与中心置入中心导管（CICC）的比较效果和成本效益。方法进行前瞻性队列研究，然后在 30 天的时间跨度内进行经济分析。采用倾向评分匹配法选择具有类似 PICC 或 CICC 适应症的住院成人。综合结果是在治疗结束前因并发症而移除或更换装置。经济评估采用决策树模型进行成本效益分析，计算每次避免拔除导管的增量成本效益比 (ICER)。所有成本均以巴西雷亚尔（BRL）表示（1 雷亚尔 = 0.1870 美元）。结果每组共有 217 名患者接受了随访；在接受 PICC 和 CICC 的患者中，分别有 172 人（79.3%）和 135 人（62.2%）未发生与设备相关的并发症。在比较导致装置移除的事件时，CICC 组的复合终点风险明显更高（危险比为 0.20；95% CI 为 0.11-0.35）。PICC 置入成本为 1290.98 BRL，而 CICC 为 467.16 BRL。在基础病例中，放置 PICC 而不是 CICC 每避免一次移除或更换的 ICER 为 3349.91 BRL。在单变量敏感性分析中，该模型在 2500.00 至 4800.00 BRL 的 ICER 范围内证明是稳健的。虽然 PICC 的费用较高，但使用 PICC 可以避免并发症和在治疗结束前更换导管的需要。

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引用次数: 0

Examining the Impact of the Current Reimbursement Regulation on Patient Access to Innovative Medical Devices in Taiwan: Insights From 8 Years’ Reimbursement Data 研究台湾现行报销规定对患者获得创新医疗设备的影响：八年报销数据的启示

IF 2 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2024-02-12 DOI: 10.1016/j.vhri.2023.12.009

Jhao-Yang Peng MBA , Sang-Soo Lee PhD , Chun-Ru Lin MD , Haine Lee MPharm , Yong-Chen Chen PhD

Objectives

This study aimed to assess the impact of the reimbursement regulation of medical devices (Regulation), introduced by the National Health Insurance Administration (NHIA) in 2013, on patients’ access to innovative medical devices in Taiwan.

Methods

Analysis of the amount of time needed from application for NHIA reimbursement for new medical devices to receiving the decision from NHIA was done using the nonreimbursement product list featured on the NHIA website. Additionally, Welch analysis of variance was used to compare the amount of time it took from application to NHIA with reimbursement decisions made by the NHIA for different nonreimbursement code categories. Further, related Pharmaceutical Benefit Reimbursement Scheme meeting minutes were analyzed to obtain more detailed information concerning medical devices’ reimbursement or not.

Results

From December 2012 to June 2021, the overall reimbursement percentage was 56.7%, and the average amount of time between application and reimbursement was 856.7 ± 474.7 days. The mandatory reimbursement rate was about 45%. NHIA reimbursement decisions as special medical devices also take a longer amount of time, because the applicants need to agree to the decision (P < .05). The NHIA decision-making process for nonreimbursement medical devices requires a significantly longer amount of time than for general materials (eg, suture, etc) decisions.

Conclusions

Although the Regulation resolves payment issues, it also increases the amount of time to reach reimbursement decisions, thus hindering patient access to innovative medical devices. The study suggests that the review process needs to be simplified concerning reimbursement notification, using local real-world data to support reimbursement decisions.

本研究旨在评估国家健康保险署（NHIA）于 2013 年出台的《医疗器械报销条例》（以下简称《条例》）对台湾地区患者使用创新医疗器械的影响。方法利用国家健康保险署网站上的非报销产品列表，分析新型医疗器械从申请国家健康保险署报销到获得国家健康保险署决定所需的时间。此外，还采用韦尔奇方差分析法，比较了从向 NHIA 提出申请到 NHIA 做出报销决定所花费的时间，以及 NHIA 针对不同的非报销代码类别做出的报销决定。结果从 2012 年 12 月至 2021 年 6 月，总体报销比例为 56.7%，从申请到报销的平均时间为 856.7 ± 474.7 天。强制报销率约为 45%。作为特殊医疗器械，NHIA 的报销决定也需要更长的时间，因为申请人需要同意该决定（P < .05）。结论虽然《条例》解决了支付问题，但也增加了做出报销决定的时间，从而阻碍了患者获得创新医疗器械。研究表明，需要简化有关报销通知的审查程序，利用当地的实际数据来支持报销决定。

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引用次数: 0

Cost-Effectiveness Analysis of Implant-Supported Single Crown and Tooth-Supported Fixed Dental Prostheses in Türkiye 土耳其种植体支持单冠和牙齿支持固定牙科修复体的成本效益分析》（Cost-Effectiveness Analysis of Implant-Supported Single Crown and Tooth-Supported Fixed Dental Prostheses in Türkiye.

IF 2 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2024-02-09 DOI: 10.1016/j.vhri.2024.01.001

Lütfiye Tekpınar PhD , Vahit Yiğit PhD

Objectives

The most cost-effective option for replacing lost teeth is not evident because there is a dearth of evidence-based information on implant-supported single crowns versus tooth-supported fixed dental prostheses. This study conducted the analysis of cost-effectiveness of implant-supported single crown and tooth-supported fixed dental prostheses from a social perspective in Türkiye.

Methods

Costs were calculated in the analysis from a social perspective for 2021. Costs and quality-adjusted prosthesis year (QAPY) values were computed over a 20-year period in the study using the Markov model. The computed values were discounted by 5%. The results are presented as the incremental cost-effectiveness ratio. To assess the impact of uncertainty on cost-effectiveness analyses, a tornado diagram and Monte Carlo simulations were created.

Results

Throughout the 20-year time horizon, tooth-supported fixed dental prostheses cost $985.58 cumulatively, whereas implant-supported single crown cost $2161.64 (US $1 = 9.22 ₺ as of 15 October 2021). The calculated incremental cost-effectiveness ratio is 1.333 per QAPY. Compared with the implant-supported single crown tooth-supported fixed dental prostheses, it offers a QAPY of 0.882 over a 20-year period, while costing an additional $1176.06.

Conclusions

These results suggest that the implant-supported single crown provided higher QAPY value but was costlier. When the research’s findings are compared with the literature, it becomes clear that Türkiye has lower dental care expenses than most other nations.

目的：由于缺乏有关种植体支持单冠与牙齿支持固定义齿的循证信息，因此替代脱落牙齿最具成本效益的方案并不明显。本研究从社会角度对土耳其种植体支持单冠和牙齿支持固定义齿的成本效益进行了分析：从社会角度分析计算了 2021 年的成本。研究中使用马尔可夫模型计算了 20 年内的成本和质量调整修复年 (QAPY) 值。计算值的贴现率为 5%。计算结果以增量成本效益比表示。为了评估不确定性对成本效益分析的影响，我们绘制了龙卷风图并进行了蒙特卡罗模拟：在 20 年的时间跨度内，牙齿支持的固定义齿累计成本为 985.58 美元，而种植体支持的单个牙冠成本为 2161.64 美元（截至 2021 年 10 月 15 日，1 美元 = 9.22 ₺）。计算得出的增量成本效益比为 1.333/QAPY。与种植体支持的单冠牙支持固定义齿相比，20 年内的 QAPY 为 0.882，而成本却增加了 1176.06 美元：这些结果表明，种植体支持单冠的 QAPY 值更高，但成本更高。如果将研究结果与文献进行比较，就会发现土耳其的牙科保健费用低于其他大多数国家。

{"title":"Cost-Effectiveness Analysis of Implant-Supported Single Crown and Tooth-Supported Fixed Dental Prostheses in Türkiye","authors":"Lütfiye Tekpınar PhD , Vahit Yiğit PhD","doi":"10.1016/j.vhri.2024.01.001","DOIUrl":"10.1016/j.vhri.2024.01.001","url":null,"abstract":"<div><h3>Objectives</h3><p>The most cost-effective option for replacing lost teeth is not evident because there is a dearth of evidence-based information on implant-supported single crowns versus tooth-supported fixed dental prostheses. This study conducted the analysis of cost-effectiveness of implant-supported single crown and tooth-supported fixed dental prostheses from a social perspective in Türkiye.</p></div><div><h3>Methods</h3><p>Costs were calculated in the analysis from a social perspective for 2021. Costs and quality-adjusted prosthesis year (QAPY) values were computed over a 20-year period in the study using the Markov model. The computed values were discounted by 5%. The results are presented as the incremental cost-effectiveness ratio. To assess the impact of uncertainty on cost-effectiveness analyses, a tornado diagram and Monte Carlo simulations were created.</p></div><div><h3>Results</h3><p>Throughout the 20-year time horizon, tooth-supported fixed dental prostheses cost $985.58 cumulatively, whereas implant-supported single crown cost $2161.64 (US $1 = 9.22 ₺ as of 15 October 2021). The calculated incremental cost-effectiveness ratio is 1.333 per QAPY. Compared with the implant-supported single crown tooth-supported fixed dental prostheses, it offers a QAPY of 0.882 over a 20-year period, while costing an additional $1176.06.</p></div><div><h3>Conclusions</h3><p>These results suggest that the implant-supported single crown provided higher QAPY value but was costlier. When the research’s findings are compared with the literature, it becomes clear that Türkiye has lower dental care expenses than most other nations.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"42 ","pages":"Pages 11-17"},"PeriodicalIF":2.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139716475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Estimating the SF-6Dv1 Value Set for a Population-Based Sample in Lebanon 估算黎巴嫩人口样本的 SF-6Dv1 值集。

IF 2 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2024-02-09 DOI: 10.1016/j.vhri.2023.12.008

Samer A. Kharroubi PhD , Clara Mukuria PhD , Dalia Dawoud PhD , Donna Rowen PhD

Objectives

The SF-6Dv1 is a preference-based measure derived from the SF-36 for use in quality-adjusted life-year estimation for cost-utility analysis. Country-specific value sets for SF-6Dv1 are needed to reflect societal preferences but none are available for Lebanon and other Arabic countries. This study aimed to generate a value set for SF-6Dv1 for Lebanon and to compare results with the UK set.

Methods

A sample of 249 health states defined by the SF-6Dv1 were valued by a representative sample of 577 members of the Lebanon general population, using standard gamble. Several multivariate regression models at mean and individual level were fitted to estimate utilities for all SF-6Dv1 states with selection of best fitting models based on predictive ability, consistency, and model fit. The best fitting models were compared with those fitted in the UK study.

Results

Data from 553 eligible respondents providing 3308 valuations were used for the analysis. Lebanese values were consistently higher than UK values, indicating differences in preferences, and there were no negative values. The random effects model using only main effects was the best performing model. There were inconsistencies in 2 dimensions, thereby consistent models were estimated with values ranging from 0.367 to 1. The results are consistent with the UK results.

Conclusions

This study provides the first population-based value set for SF-6Dv1 health states for Lebanon, making it possible to generate quality-adjusted life-years for cost-utility analysis studies. The potential for applications of a standardized utility measure is enormous both in Lebanon and all Arab countries.

目的：SF-6Dv1 是一种基于偏好的测量方法，源自 SF-36，用于成本效用分析中的质量调整生命年估算。为反映社会偏好，需要针对具体国家的 SF-6Dv1 值集，但黎巴嫩和其他阿拉伯国家尚无此类值集。本研究旨在为黎巴嫩生成 SF-6Dv1 的价值集，并将结果与英国的价值集进行比较：方法：对 SF-6Dv1 中定义的 249 种健康状况进行了抽样调查，调查对象是黎巴嫩具有代表性的 577 名普通民众，调查采用了标准赌博法。根据预测能力、一致性和模型拟合程度，选择最佳拟合模型，对平均水平和个体水平的多个多元回归模型进行拟合，以估算所有 SF-6Dv1 状态的效用。将最佳拟合模型与英国研究中的拟合模型进行比较：分析使用了 553 位符合条件的受访者提供的 3308 个估值数据。黎巴嫩人的估价一直高于英国人，这表明他们的偏好存在差异，而且没有负值。仅使用主效应的随机效应模型是表现最好的模型。在 2 个维度上存在不一致，因此估算出了一致的模型，数值范围在 0.367 到 1 之间：这项研究为黎巴嫩提供了第一套基于人群的 SF-6Dv1 健康状态值，从而为成本效用分析研究提供了质量调整生命年。在黎巴嫩和所有阿拉伯国家，标准化效用测量的应用潜力巨大。

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引用次数: 0

Service Utilization Patterns and Direct Medical Costs of Hospitalization in Patients With Renal Failure Before and After Initiating Home Peritoneal Dialysis 肾衰竭患者在开始家庭腹膜透析前后的服务利用模式和住院直接医疗费用

IF 2 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2024-02-06 DOI: 10.1016/j.vhri.2023.12.004

Marisol Torres-Toledano ScM , Víctor Granados-García ScD , Laura Cortés-Sanabria ScD , Alfonso Martín Cueto-Manzano PharmD , Yvonne N. Flores PhD , Jorge Salmerón ScD

Objectives

This study aimed to determine the hospital service utilization patterns and direct healthcare hospital costs before and during peritoneal dialysis (PD) at home.

Methods

A retrospective cohort study of patients with kidney failure (KF) was conducted at a Mexican Social Security Institute hospital for the year 2014. Cost categories included inpatient emergency room stays, inpatient services at internal medicine or surgery, and hospital PD. The study groups were (1) patients with KF before initiating home PD, (2) patients with less than 1 year of home PD (incident), and (3) patients with more than 1 year of home PD (prevalent). Costs were actualized to international dollars (Int$) 2023.

Results

We found that 53% of patients with KF used home PD services, 42% had not received any type of PD, and 5% had hospital dialysis while waiting for home PD. The estimated costs adjusting for age and sex were Int$5339 (95% CI 4680-9746) for patients without home PD, Int$17 556 (95% CI 15 314-19 789) for incident patients, and Int$7872 (95% CI 5994-9749) for prevalent patients; with significantly different averages for the 3 groups (P < .001).

Conclusions

Although the use of services and cost is highest at the time of initiating PD, over time, using home PD leads to a significant reduction in use of hospital services, which translates into institutional cost savings. Our findings, especially considering the high rates of KF in Mexico, suggest a pressing need for interventions that can reduce healthcare costs at the beginning of renal replacement therapy.

本研究旨在确定在家进行腹膜透析（PD）之前和期间的医院服务使用模式和医院直接医疗费用。方法在墨西哥社会保障局的一家医院对 2014 年肾衰竭（KF）患者进行了回顾性队列研究。费用类别包括急诊住院、内科或外科住院服务以及住院透析。研究分组为：（1）在开始居家起搏前患有 KF 的患者；（2）居家起搏不足 1 年的患者（偶发）；（3）居家起搏超过 1 年的患者（流行）。结果我们发现，53% 的 KF 患者使用了家庭透析服务，42% 的患者未接受过任何类型的透析，5% 的患者在等待家庭透析期间进行了医院透析。对年龄和性别进行调整后，未接受家庭透析患者的估计费用为 Int$5339 (95% CI 4680-9746)，偶发患者为 Int$17 556 (95% CI 15 314-19 789)，流行患者为 Int$7872 (95% CI 5994-9749)；3 组患者的平均费用有显著差异（P < .001）。结论虽然在开始使用腹膜透析时服务的使用率和成本最高，但随着时间的推移，使用家庭腹膜透析可显著减少医院服务的使用，从而节省机构成本。我们的研究结果，尤其是考虑到墨西哥的 KF 患病率较高，表明在肾脏替代疗法开始阶段迫切需要能够降低医疗成本的干预措施。

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引用次数: 0

The Short-Term Cost-Effectiveness of a Fixed-Ratio Combination of Insulin Degludec and Aspart: A Cost of Control Analysis in Australia and India 德鲁代克胰岛素和阿斯巴特固定比例组合的短期成本效益：澳大利亚和印度的控制成本分析

IF 2 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2024-02-05 DOI: 10.1016/j.vhri.2023.12.007

Jack Garcia Uranga Romano MSc , Samuel Joseph Paul Malkin MSc , Barnaby Hunt MSc

Objectives

The real-world ARISE study demonstrated initiation of fixed-ratio combination insulin degludec and aspart (IDegAsp) led to improvements in people achieving key glycemic control targets compared with prior therapies in Australia and India. This study evaluated the short-term cost-effectiveness of IDegAsp in these countries, in terms of the cost per patient achieving these targets.

Methods

A model was developed to evaluate the cost of control (treatment costs divided by the proportion of patients achieving each target) of IDegAsp versus prior therapies received in ARISE for 2 endpoints: glycated hemoglobin (HbA1c) <7.0%, and HbA1c less than a predefined individual treatment target. Costs, expressed from a healthcare payer perspective, were captured in 2022 Australian dollars (AUD) and 2022 Indian rupees (INR).

Results

The number of patients needed to treat to bring one to endpoints of HbA1c <7.0% and less than an individualized target with IDegAsp was 51% and 87% lower, respectively, than with prior therapies in Australia, and 52% and 66% lower, respectively, versus prior therapies in India. Cost of control was AUD 2449 higher and AUD 64 863 lower with IDegAsp versus prior therapies for endpoints of HbA1c <7.0% and less than an individualized target, respectively, in Australia and INR 211 142 and INR 537 490 lower with IDegAsp compared with prior therapies in India.

Conclusions

IDegAsp was estimated to be cost-effective versus prior therapies when considering an individualized HbA1c target in Australia, and when considering an individualized HbA1c target and HbA1c <7.0% in India.

目的真实世界的 ARISE 研究表明，在澳大利亚和印度，与之前的疗法相比，开始使用固定比值的德鲁达和阿斯巴特复合胰岛素（IDegAsp）可改善患者实现主要血糖控制目标的情况。本研究评估了 IDegAsp 在这些国家的短期成本效益，即每名患者实现这些目标的成本。方法建立了一个模型，评估 IDegAsp 与 ARISE 中接受的先前疗法在 2 个终点（糖化血红蛋白 (HbA1c) <7.0%，以及 HbA1c 低于预定义的个人治疗目标）上的控制成本（治疗成本除以实现每个目标的患者比例）。结果在澳大利亚，使用IDegAsp达到HbA1c <7.0%终点和HbA1c小于个体化治疗目标所需的患者人数分别比之前的疗法低51%和87%，在印度则分别比之前的疗法低52%和66%。在澳大利亚，对于 HbA1c <7.0%和小于个体化目标的终点，IDegAsp 的控制成本与之前的疗法相比分别高出 2449 澳元和低出 64 863 澳元；在印度，与之前的疗法相比，IDegAsp 的控制成本分别低出 211 142 印度卢比和 537 490 印度卢比。结论在澳大利亚，考虑到个体化 HbA1c 目标，以及在印度考虑到个体化 HbA1c 目标和 HbA1c <7.0%，IDegAsp 与之前的疗法相比具有成本效益。

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引用次数: 0

A Step Toward the Development of the First National Multi-Criteria Decision Analysis Framework to Support Healthcare Decision Making in Saudi Arabia 沙特阿拉伯首个支持医疗决策的国家多标准决策分析框架的开发步骤。

IF 2 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2024-02-02 DOI: 10.1016/j.vhri.2023.12.005

Ahmed Al-Jedai MBA , Hajer Almudaiheem PharmD , Yazeed Alruthia PhD , Abdullah Althemery PhD , Hana Alabdulkarim PharmD , Rita Ojeil MSc , Ali Alrumaih PharmD , Suliman AlGhannam MD , AbdulAali AlMutairi PhD , Zuhair Hasnan MD

Objectives

To assess the feasibility of implementing multi-criteria decision analysis (MCDA) and to select the criteria for preparing a national MCDA framework for health technology assessment of orphan drugs in the Kingdom of Saudi Arabia (KSA).

Methods

The study was conducted in 3 phases. In phase I, a targeted literature review was performed to gather relevant information on the implementation of MCDA in healthcare decision making. Phase II was a cross-sectional survey, conducted to obtain insights from different stakeholders and key opinion leaders on specific topics from the KSA perspective. Phase III included a round-table discussion involving experts to validate the results obtained in the phase II survey and further elaborate on specific requirements that may be critical for developing the first national MCDA framework in the KSA.

Results

All the key opinion leaders involved in the study acknowledged the importance of implementing MCDA in the KSA. The Ministry of Health was assigned the responsibility of chairing the MCDA decision process. The experts selected the quantitative, qualitative, and economic criteria to be considered for the MCDA framework. The stakeholders decided to initiate a pilot phase using the deliberative MCDA methodology for the assessment of orphan drugs based on the selected criteria for a period of 1 year and then reevaluate the need to adapt the pragmatic MCDA model.

Conclusion

This article describes the novel initiative that examined the feasibility and process required for the development of the first MCDA framework in the KSA to support healthcare decision making.

目的评估实施多标准决策分析（MCDA）的可行性，并为沙特阿拉伯王国（KSA）制定孤儿药卫生技术评估国家 MCDA 框架选择标准：研究分三个阶段进行。在第一阶段，进行了有针对性的文献综述，以收集在医疗决策中实施 MCDA 的相关信息。第二阶段是横断面调查，从不同利益相关者和关键意见领袖的角度，了解他们对 KSA 特定主题的见解。第三阶段包括一次有专家参与的圆桌讨论，以验证第二阶段调查所获得的结果，并进一步阐述对于在 KSA 制定首个国家 MCDA 框架至关重要的具体要求：结果：参与研究的所有主要意见领袖都承认在 KSA 实施 MCDA 的重要性。卫生部负责主持 MCDA 决策过程。专家们为 MCDA 框架选择了需要考虑的定量、定性和经济标准。利益相关方决定启动一个试点阶段，根据选定的标准，使用审议型 MCDA 方法评估孤儿药，为期一年，然后重新评估是否需要调整实用型 MCDA 模型：本文介绍了一项新举措，该举措研究了在 KSA 开发首个 MCDA 框架以支持医疗决策的可行性和所需流程。

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引用次数: 0

Impact of Lung Cancer on Health-Related Quality of Life, Financial Toxicity, and Household Economics in Patients From the Public and the Private Healthcare Sector in Argentina 肺癌对阿根廷公立和私立医疗机构患者与健康相关的生活质量、经济毒性和家庭经济的影响。

IF 2 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2024-01-29 DOI: 10.1016/j.vhri.2023.12.001

Federico Augustovski PhD , Florencia Tsou MD , Lucas González MSc , Claudio Martín MD , Silvina Vigo MD , Carolina Gabay MD , Andrea Alcaraz MSc , Fernando Argento MSc

Objectives

Non–small cell lung cancer (NSCLC) is Argentina’s first cause of cancer death. Most patients have an advanced stage at diagnosis, with poor expected survival. This study aimed to characterize the health-related quality of life (HRQOL) and economic impact of patients treated in the private healthcare sector and compare it with that of the public sector.

Methods

We undertook an observational cross-sectional study that extended a previous study to a referral private center in Argentina. Outcomes included the EuroQol EQ-5D-3L (to assess HRQOL), Comprehensive Score for Financial Toxicity (financial toxicity instrument), Work Productivity and Activity Impairment – General Health (to assess productivity loss), and out-of-pocket expenses in adults diagnosed of NSCLC.

Results

We included 30 consecutive patients from a private healthcare center (July 2021 to March 2022), totaling 131 patients (n = 101 from previous public study). The whole sample had low quality of life and relevant economic impact. Patients in the private healthcare sector showed lower disease severity and higher educational level and household income. In addition, private healthcare system patients showed higher utility (0.77 vs 0.73; P < .05) and lower impairment of daily activities (41% vs 59%; P = .01). Private health system patients also showed lower financial toxicity as measured by the Comprehensive Score for Financial Toxicity score (23.9 vs 20.14; P < .05) but showed no differences when financial toxicity was assessed as a dichotomic variable.

Conclusions

Although patients with NSCLC treated in a private healthcare center in Argentina showed a relevant HRQOL and economic impact, this impact was smaller than the one observed in publicly funded hospitals.

目标：非小细胞肺癌（NSCLC非小细胞肺癌（NSCLC）是阿根廷第一大癌症死因。大多数患者在确诊时已是晚期，预期生存率较低。本研究旨在了解在私立医疗机构接受治疗的患者的健康相关生活质量（HRQOL）和经济影响，并将其与公立医疗机构的情况进行比较：我们开展了一项观察性横断面研究，将之前的一项研究扩展到阿根廷的一家转诊私立中心。研究结果包括：EuroQol EQ-5D-3L（评估 HRQOL）、财务毒性综合评分（财务毒性工具）、工作生产率和活动障碍--一般健康（评估生产率损失），以及确诊为 NSCLC 的成人的自付费用：我们纳入了一家私立医疗中心的 30 名连续患者（2021 年 7 月至 2022 年 3 月），共计 131 名患者（n = 101，来自之前的公共研究）。整个样本的生活质量和相关经济影响较低。私立医疗机构的患者疾病严重程度较低，教育水平和家庭收入较高。此外，私立医疗系统患者的实用性更高（0.77 对 0.73；P < .05），日常活动能力受损程度更低（41% 对 59%；P = .01）。根据财务毒性综合评分，私立医疗系统患者的财务毒性也较低（23.9 vs 20.14；P < .05），但如果将财务毒性作为二分变量进行评估，则两者没有差异：尽管在阿根廷一家私立医疗中心接受治疗的 NSCLC 患者的 HRQOL 和经济效益受到了相关影响，但这种影响小于在公立医院观察到的影响。

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引用次数: 0