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

Revision of Malawi’s Health Benefits Package: A Critical Analysis of Policy Formulation and Implementation 修订马拉维一揽子保健福利:对政策制定和执行的批判性分析

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-12-01 DOI: 10.1016/j.vhri.2023.10.007

Emilia Connolly DO, MPH , Sakshi Mohan MS , Pakwanja Twea BA , Thulasoni Msuku MS , Andreas Kees MS , Lalit Sharma BA , Stephanie Heung BA , Dominic Nkhoma PhD , Gerald Manthalu PhD

Objectives

Health benefits packages (HBPs), which define specific health services that can be offered for free or at a reduced cost to fit within public revenues, have been recommended for over 30 years to maximize population health in resource-limited settings. However, there remain gaps in defining and operationalizing HBPs. We propose a combination of design and prioritization methods along with practical strategies to improve the implementation of future iterations of the HBP in Malawi.

Methods

For HBP development for Malawi’s Third Health Sector Strategic Plan, we combined cost-effectiveness analysis with a quantitative, consultative multicriteria decision analysis. Throughout the process of development, we documented challenges and opportunities to improve HBP design and application.

Results

The primary and secondary HBP included 115 interventions. However, the definition of an HBP is just one step toward focusing limited resources, with functional operationalization as the most critical component. Full implementation of previous HBPs has been limited by challenges in aid coordination with the misalignment of nonfungible vertical donor funding for the HBP without accounting for the complexity and interconnectedness of the health system. Opportunities for improved application include creation of a complementary minimum health service package to guide overall resource inputs through an integrative approach.

Conclusions

We believe that expanded participatory HBP methods that consider value, equity, and social considerations, along with a shift to providing integrated health service packages at all levels of care, will improve the efficiency of using scarce resources along the journey to universal health coverage.

30多年来，为了在资源有限的情况下最大限度地提高人口健康水平，一直建议采用一揽子健康福利方案(HBPs)，该方案确定了可免费提供或根据公共收入降低成本提供的特定卫生服务。然而，在定义和实施HBPs方面仍然存在差距。我们提出了一种结合设计和优先排序方法的实用策略，以改进马拉维未来HBP迭代的实施。方法为马拉维第三个卫生部门战略计划制定HBP，我们将成本效益分析与定量、协商性多标准决策分析相结合。在整个开发过程中，我们记录了改进HBP设计和应用的挑战和机遇。结果原发性和继发性高血压包括115项干预措施。然而，HBP的定义只是集中有限资源的一步，功能操作是最关键的组成部分。由于在没有考虑卫生系统的复杂性和相互关联性的情况下，援助协调方面存在不可替代的纵向捐助方资金不协调问题，以往卫生保健计划的全面实施受到了限制。改进应用的机会包括制定一套补充性的最低限度保健服务，以通过综合办法指导总体资源投入。结论:我们认为，考虑价值、公平和社会因素的扩大参与式HBP方法，以及向在各级护理中提供综合卫生服务包的转变，将在实现全民健康覆盖的过程中提高稀缺资源的使用效率。

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引用次数: 1

Demands for Intersectoral Actions to Meet Health Challenges in East and Southern Africa and Methods for Their Evaluation 为应对东部和南部非洲卫生挑战而采取部门间行动的需求及其评价方法

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-11-25 DOI: 10.1016/j.vhri.2023.09.001

Francesco Ramponi PhD , Aloysius Ssennyonjo MSc , Stephen Banda MSc , Tom Aliti PhD , Dominic Nkhoma PhD , Oliver Kaonga PhD , Susan Griffin PhD , Paul Revill MSc , Edward Kataika MA , Juliet Nabyonga-Orem PhD

Objectives

Focusing on the East, Central, and Southern African region, this study examines both regional and country-level initiatives aimed at promoting multisectoral collaboration to improve population health and the methods for their economic evaluation.

Methods

We explored the interventions that necessitate cooperation among policymakers from diverse sectors and the mechanisms that facilitate effective collaboration and coordination across these sectors. To gain insights into the demand for multisectoral collaboration in the East, Central, and Southern African region, we presented 3 country briefs, highlighting policy areas and initiatives that have successfully incorporated health-promoting actions from outside the health sector in Zimbabwe, Uganda, and Malawi. Additionally, we showcased initiatives undertaken by the Ministry of Health in each country to foster coordination with national and international stakeholders, along with existing coordination mechanisms established for intersectoral collaboration. Drawing on these examples, we identified the primary challenges in the economic evaluation of multisectoral programs aimed at improving health in the region.

Results

We illustrated how decision making in reality differs from the traditional single-sector and single-decision-maker perspective commonly used in cost-effectiveness analyses. To ensure economic evaluations can inform decision making in diverse settings and facilitate regional collaboration, we highlighted 3 fundamental principles: identifying policy objectives, defining the perspective of the analysis, and considering opportunity costs. We emphasized the importance of adopting a flexible and context-specific approach to economic evaluation.

Conclusions

Through this work, we contribute to bridging the gap between theory and practice in the context of intersectoral activities aimed at improving health outcomes.

本研究以东部、中部和南部非洲地区为重点，审查了旨在促进多部门合作以改善人口健康的区域和国家一级举措及其经济评估方法。方法:我们探讨了需要不同部门决策者之间合作的干预措施，以及促进这些部门之间有效合作和协调的机制。为了深入了解东非、中非和南部非洲区域对多部门合作的需求，我们提出了3个国家简报，重点介绍了津巴布韦、乌干达和马拉维卫生部门以外已成功纳入健康促进行动的政策领域和举措。此外，我们还展示了各国卫生部为促进与国家和国际利益攸关方的协调而采取的举措，以及为部门间协作建立的现有协调机制。根据这些例子，我们确定了旨在改善该地区健康状况的多部门项目的经济评估面临的主要挑战。结果我们说明了现实中的决策与成本效益分析中常用的传统单一部门和单一决策者的观点有何不同。为了确保经济评估能够为不同环境下的决策提供信息，并促进区域合作，我们强调了3个基本原则:确定政策目标，定义分析视角，考虑机会成本。我们强调对经济评价采取灵活和具体情况的办法的重要性。通过这项工作，我们有助于在旨在改善健康结果的部门间活动中弥合理论与实践之间的差距。

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引用次数: 1

Breast Cancer Screening in Georgia: Choosing the Most Optimal and Cost-Effective Strategy 乳腺癌筛查在格鲁吉亚:选择最优和最具成本效益的策略。

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-11-22 DOI: 10.1016/j.vhri.2023.09.002

Abyan Irzaldy MD, MSc , Rema Gvamichava MD, PhD , Tina Beruchashvili PhD , Lela Sturua MD, PhD , Nicolien T. van Ravesteyn PhD , Harry J. de Koning MD, PhD , Eveline A.M. Heijnsdijk PhD

Objectives

To define the optimal and cost-effective breast cancer screening strategy for Georgia.

Methods

We used the Microsimulation Screening Analysis-Breast (MISCAN-Breast) model that has been adapted to the Georgian situation to evaluate 736 mammography screening strategies varied by interval (biennial and triennial), starting ages (40-60 years), stopping ages (64-84 years), and screening modality (with and without clinical breast examination [CBE]). Quality-adjusted life-years (QALYs) and additional cost (healthcare perspective) compared with no screening per 1000 women were calculated with 3% discount. Major uncertainties (eg, costs) are addressed as sensitivity analyses.

Results

Strategies using a combination of mammography and CBE yielded in substantially higher costs with minimal differences in outcomes compared with mammography-only strategies. The current screening strategy, biennial mammography screening from the age of 40 until 70 years with CBE, is close to the frontier line but requires high additional cost given the QALY gains (€16 218/QALY), well above the willingness-to-pay threshold of €12 720. The optimal strategy in Georgia would be triennial mammography-only screening from age 45 to 66 years with an incremental cost-effectiveness ratio of €12 507.

Conclusions

Biennial screening strategies are resource-intensive strategies and may not be feasible for Georgia. By switching to triennial mammography-only strategy from the age of 45 until 66 years, it is possible to offer screening to more eligible women while still gaining substantial screening benefits. This is to address capacity issues which is a common barrier for many Eastern European countries.

目的:确定乔治亚州最佳的、具有成本效益的乳腺癌筛查策略。方法:我们使用适应格鲁吉亚情况的微模拟筛查分析乳房(MISCAN-Breast)模型来评估736种乳房x线摄影筛查策略，这些筛查策略不同于间隔(两年和三年)、起始年龄(40-60岁)、停止年龄(64-84岁)和筛查方式(有无临床乳房检查[CBE])。质量调整生命年(QALYs)和额外费用(从医疗保健角度来看)与不进行筛查的每1000名妇女相比有3%的折扣。主要的不确定性(如成本)作为敏感性分析来处理。结果:与仅使用乳房x光检查相比，使用乳房x光检查和CBE相结合的策略产生了更高的成本，结果差异很小。目前的筛查策略是，从40岁到70岁的CBE患者进行两年一次的乳房x光检查，这接近于底线，但考虑到QALY的收益(16 218欧元/QALY)，需要很高的额外费用，远高于12 720欧元的支付意愿门槛。乔治亚州的最佳策略是每三年进行一次乳房x光检查，年龄从45岁到66岁，增量成本效益比为12507欧元。结论:两年一次的筛查策略是资源密集型策略，可能不适合格鲁吉亚。通过从45岁到66岁转换为三年一次的乳房x光检查策略，有可能为更多符合条件的妇女提供筛查，同时仍然获得实质性的筛查益处。这是为了解决能力问题，这是许多东欧国家的共同障碍。

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引用次数: 0

Cost-Utility Model of Nirmatrelvir/Ritonavir in Brazil: Analysis of a Vaccinated Population 巴西尼马特韦/利托那韦的成本效用模型:对接种人群的分析。

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-11-22 DOI: 10.1016/j.vhri.2023.09.005

Ricardo R.A. Fernandes PhD , Bruno M. Barros MSc , Milene R. da Costa PhD , Carlos A.S. Magliano PhD , Bernardo R. Tura PhD , Quenia Cristina D. Morais MSc , Marisa Santos PhD

Objectives

The aim of this study is to conduct a cost-utility analysis of the use of the antiviral nirmatrelvir/ritonavir, applied to a vaccinated Brazilian population against COVID-19, from the perspective of the Brazilian Public Health System (SUS).

Methods

A microsimulation model was created with individual-level data and daily cycles, with a 1-year time horizon, to compare the current scenario of standard care with a scenario in which nirmatrelvir/ritonavir is offered to the population. Adults of any age group that received ≥2 doses of the COVID-19 vaccine formed the investigated population. Direct medical costs of the outpatients and inpatients admitted to the ward or intensive care unit were included. The effectiveness of the model was measured in quality-adjusted life-years (QALYs).

Results

In all simulations, the use of nirmatrelvir/ritonavir resulted in incremental costs per patient of US dollar (USD)245.86 and incremental effectiveness of 0.009 QALY, over a year. The incremental cost-utility ratio was USD27 220.70/QALY. The relative risk of the vaccinated population was the factor that affected the outcome most, according to the univariate sensitivity analysis. The probabilistic sensitivity analysis resulted in 100% of the simulations being more costly and effective, but that only 4% of them were below the established cost-effectiveness threshold of USD24 000.00/QALY. In the scenario considering only the population over 60 years old and immunosuppressed (of any age), the incremental cost-utility ratio was USD7589.37/QALY.

Conclusions

The use of nirmatrelvir/ritonavir in the treatment of COVID-19 in a vaccinated population was cost-effective only for immunosuppressed individuals and people over 60 years of age.

目的:本研究的目的是从巴西公共卫生系统(SUS)的角度，对巴西接种COVID-19疫苗的人群使用抗病毒药物nirmatrelvir/ritonavir进行成本效用分析。方法:建立了一个微观模拟模型，其中包含个人层面的数据和1年时间范围内的每日周期，以比较目前标准治疗方案与向人群提供尼马特利韦/利托那韦的方案。接受≥2剂COVID-19疫苗的任何年龄组的成年人构成调查人群。门诊病人和住院病人入住病房或重症监护病房的直接医疗费用也包括在内。该模型的有效性以质量调整生命年(QALYs)来衡量。结果:在所有模拟中，使用尼马特利韦/利托那韦导致每名患者一年的增量成本为245.86美元，增量有效性为0.009 QALY。增量成本效用比为27220.70美元/QALY。根据单变量敏感性分析，接种人群的相对风险是影响结果最大的因素。概率敏感性分析结果表明，100%的模拟成本和效果更高，但只有4%的模拟低于既定的成本-效果阈值usd24000.00 /QALY。在仅考虑60岁以上人群和免疫抑制人群(任何年龄)的情况下，增量成本-效用比为7589.37美元/QALY。结论:在接种疫苗的人群中，使用尼马特利韦/利托那韦治疗COVID-19仅对免疫抑制个体和60岁以上的人群具有成本效益。

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引用次数: 0

Evolving Trends and Economic Burden of Benzodiazepine Use: Insights From a 10-Year Predictive Model 苯二氮卓类药物使用的演变趋势和经济负担:来自10年预测模型的见解。

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-11-18 DOI: 10.1016/j.vhri.2023.10.005

Andro Koren , Luciana Koren , Robert Marcec MD , Darko Marcinko MD, PhD , Robert Likic MD, PhD

Objectives

Benzodiazepines (BZDs) are widely prescribed in Croatia to treat anxiety, insomnia, mood disorders, and epileptic seizures. Long-term BZD use is associated with memory loss, Alzheimer’s disease, dependence, addiction, falls in elderly populations, and increased traffic accident risk.

Methods

Drug consumption data were obtained from the Agency for Medicinal Products and Medical Devices of Croatia website. Autoregressive integrated moving average models, constructed using R programming language, forecasted diazepam, alprazolam, and overall BZD utilization and financial costs at a national level over 10 years.

Results

BZD consumption increased by up to 18.6% between 2012 and 2020. During the same period, diazepam utilization rose by 29.1%, and alprazolam consumption increased by 19.4%. Our model predicts that, by 2032, BZD, diazepam, and alprazolam utilization will increase substantially. The total projected financial expenditure for BZDs in 2032 is estimated at 14.22 million euros, with diazepam and alprazolam expenditures at 7.39 and 4.12 million euros, respectively. These increases will result in significant growth in healthcare spending and a rise in adverse effects related to long-term use.

Conclusions

National healthcare decision makers should consider implementing regulatory and legislative measures to quantify, specify, and limit monthly BZD use for each patient. This would help control the negative side effects of prolonged BZD use while continuing to provide treatment for patients who genuinely need it.

目的:苯二氮卓类药物(BZDs)在克罗地亚广泛用于治疗焦虑、失眠、情绪障碍和癫痫发作。长期服用BZD与记忆丧失、阿尔茨海默病、依赖、成瘾、老年人跌倒和交通事故风险增加有关。方法:药物消费数据来自克罗地亚药品和医疗器械管理局网站。利用R编程语言构建自回归综合移动平均模型，预测了10年来全国范围内地西泮、阿普唑仑和BZD的总体利用率和财务成本。结果:2012年至2020年，BZD的消费量增长了18.6%。在同一时期，安定的使用量增加了29.1%，阿普唑仑的使用量增加了19.4%。我们的模型预测，到2032年，BZD、地西泮和阿普唑仑的使用率将大幅增加。预计2032年bzd的总财务支出预计为1422万欧元，地西泮和阿普唑仑的支出分别为739万欧元和412万欧元。这些增长将导致医疗保健支出的显著增长以及与长期使用相关的不良反应的增加。结论:国家卫生保健决策者应考虑实施监管和立法措施，量化、规定和限制每位患者每月BZD的使用。这将有助于控制长期使用BZD的负面副作用，同时继续为真正需要它的患者提供治疗。

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引用次数: 0

Economical Evaluation of Prostate Cancer Treatment Using Intensity-Modulated Radiation Therapy, 3-Dimensional Conformal Radiation Therapy and Radical Prostatectomy: A Systematic Review 调强放疗、三维适形放疗和根治性前列腺切除术治疗前列腺癌的经济评价:一项系统综述。

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-11-17 DOI: 10.1016/j.vhri.2023.08.009

Amin Adel PhD , Aziz Rezapour PhD , Ali Aboutorabi PhD , Ali Taghizadeh Kermani MD , Hamidreza Ghorbani MD

Objectives

Prostate cancer is a common form of cancer among men worldwide. The objective of this study was to conduct a systematic review of the economic evaluations of prostate cancer treatment strategies.

Methods

This systematic review was conducted using multiple electronic databases up to May 2021. English-language economic evaluation studies that compared intensity-modulated radiation therapy (IMRT), 3-dimensional conformal radiation therapy (3DCRT), and radical prostatectomy (RP) were included. The studies were evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist. The search yielded 1151 potentially relevant publications, which were screened based on the title and abstract. After the removal of duplicates, 55 studies remained, and 9 studies were screened in full text. Finally, textual data were analyzed manually using by-content analysis method.

Results

All studies were cost-effective and evaluated quality-adjusted life year as the efficacy indicator. The studies were conducted from either payers' or health systems' perspectives, and the time horizon varied from 5 to 20 years. We included only full economic evaluation studies. The use of IMRT in comparison with 3DCRT was evaluated in 6 studies, based on which IMRT increased health and reduced side effects of treatment. According to incremental cost-effectiveness ratio (ICER) results, IMRT was more cost-effective than 3DCRT. Three studies evaluated the use of RP in comparison with radiotherapy. Based on these studies, radiotherapy was more effective than RP.

Conclusion

IMRT was found to be more cost-effective than 3DCRT in all 6 studies compared with the threshold. Radiotherapy was found to be more effective than RP. However, long-term clinical trial studies are needed to confirm these findings and to provide more definitive conclusions.

目的:前列腺癌是世界范围内男性常见的一种癌症。本研究的目的是对前列腺癌治疗策略的经济评价进行系统回顾。方法:本系统评价使用多个电子数据库进行，截止到2021年5月。纳入了比较调强放疗(IMRT)、三维适形放疗(3DCRT)和根治性前列腺切除术(RP)的英文经济评价研究。这些研究采用综合卫生经济评价报告标准清单进行评估。我们根据题目和摘要筛选了1151篇可能相关的出版物。删除重复项后，仍有55项研究，其中9项研究被全文筛选。最后，采用分内容分析法对文本数据进行手工分析。结果:所有研究均具有成本效益，以质量调整生命年为疗效指标。这些研究是从付款人或卫生系统的角度进行的，时间范围从5年到20年不等。我们只纳入了完整的经济评估研究。6项研究对IMRT与3DCRT的使用进行了评估，基于IMRT增加了健康并减少了治疗的副作用。增量成本-效果比(ICER)结果显示，IMRT比3DCRT更具成本效益。三项研究评估了RP与放疗的比较。基于这些研究，放疗比RP更有效。结论:与阈值相比，所有6项研究均发现IMRT比3DCRT更具成本效益。放疗比RP更有效。然而，需要长期的临床试验研究来证实这些发现并提供更明确的结论。

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引用次数: 0

Choosing the Best Instrument for Measuring Health Spillover Effect in Caregivers of Patients With Multiple Sclerosis 选择测量多发性硬化症患者照护者健康溢出效应的最佳工具。

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-11-17 DOI: 10.1016/j.vhri.2023.08.008

Hoda Faraji PharmD, PhD , Fatemeh Soleymani PharmD, MPH, PhD , Mehdi Yaseri PhD , Mohammad Ali Sahraian MD , Akbar Abdollahiasl PharmD, PhD , Azin Meftah MSc , Shekoufeh Nikfar PharmD, MPH, PhD

Objectives

To measure the health spillover effect in caregivers of patients with multiple sclerosis (MS), we aimed to select the best instrument from 2 common health-related quality of life (QoL) instruments, the 3-level EQ-5D (EQ-5D-3L) and the Health Utilities Index Mark 3 (HUI-3), by assessing them.

Methods

Using consecutive sampling, 452 primary caregivers of patients with MS were asked to fill out a Care-related QoL instrument (CarerQol-7D), EQ-5D-3L, HUI-3, and the Center for Epidemiologic Studies Depression Scale between October 2019 and May 2020. Convergent and clinical validity were assessed to measure spillover effect in caregivers of patients with MS.

Results

A strong correlation of health-utility scores between EQ-5D-3L and HUI-3 (r = 0.914, P < .01) was observed. The 95% limit of agreement (LoA) for CarerQol-7D and HUI-3 (−10.6 to 8.2) was narrower than the LoA for CarerQol-7D and EQ-5D-3L (−15.1 to 17.1). Both EQ-5D-3L and HUI-3 proved clinical validity for the QoL of caregivers. The CarerQoL-7D score was significantly lower in female (P < .001), single (P < .014), lower-educated (P < .001), parent’s relatives (P < .001), and unemployed (P < .001) caregivers.

Conclusions

We found that both, EQ-5D-3L and HUI-3, were appropriate for measuring caregivers’ QoL, although HUI-3 was a better choice because of its narrower LoA. Our findings suggest researchers should use HUI-3 to measure the quality-adjusted life-year of caregivers to aggregate with the QoL of patients in the denominator of an economic evaluation equation, such as the cost-effective ratio.

目的:为了衡量多发性硬化症(MS)患者护理人员的健康溢出效应，我们旨在通过对两种常见的与健康相关的生活质量(QoL)工具，即3级EQ-5D (EQ-5D- 3l)和健康效用指数标记3 (HUI-3)进行评估，从中选择最佳工具。方法:采用连续抽样的方法，于2019年10月至2020年5月期间，要求452名MS患者的主要护理人员填写护理相关生活质量量表(CarerQol-7D)、EQ-5D-3L、HUI-3和流行病学研究中心抑郁量表。结果:EQ-5D-3L与HUI-3的健康效用评分具有较强的相关性(r = 0.914, P < 0.01)。CarerQol-7D和HUI-3的95%一致度限(LoA)(-10.6 ~ 8.2)小于CarerQol-7D和EQ-5D-3L的95%一致度限(LoA)(-15.1 ~ 17.1)。EQ-5D-3L和HUI-3对护理人员生活质量的评估均具有临床有效性。CarerQoL-7D评分在女性(P < .001)、单身(P < .014)、受教育程度较低(P < .001)、父母亲属(P < .001)和失业(P < .001)照顾者中显著较低。结论:我们发现EQ-5D-3L和HUI-3都适用于衡量照顾者的生活质量，尽管HUI-3是更好的选择，因为它的LoA更窄。我们的研究结果表明，研究人员应该使用HUI-3来衡量护理人员的质量调整生命年，并将患者的生活质量汇总到经济评估方程的分母中，如成本效益比。

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引用次数: 0

Costs of Receiving Developmental Services for Children With Global Developmental Delay at Siriraj Hospital in Bangkok, Thailand 泰国曼谷Siriraj医院全球发育迟缓儿童接受发展服务的费用。

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-11-17 DOI: 10.1016/j.vhri.2023.09.004

Krittaporn Sinpho MD , Pat Rojmahamongkol MD

Objectives

To identify the cost from the societal, caregiver, and hospital perspectives for receiving developmental services for children with global developmental delay (GDD) at Siriraj Hospital.

Methods

This descriptive study collected data from children under 5 years old with GDD from November, 2021 to October, 2022. The hospital’s perspective cost and caregivers’ direct medical costs were obtained from the Siriraj database. Caregivers were interviewed about their expenses for direct nonmedical and indirect costs. Caregivers and hospital perspective costs were summed to total societal perspective.

Results

Of the 100 caregivers, most (39%) of their children had Universal Coverage; however, 22% of the caregivers decided not to use any healthcare coverage. The median annual cost of the societal perspective was 209.81 (range 14.51-2134.08) US dollar (USD)/child. Median annual caregiver’s perspective, direct medical, direct nonmedical and indirect costs were 119.82 (range 9.20-2068.91), 0 (range 0-231.89), 68.96 (range 2.87-2068.91), and 0 (range 0-1293.07) USD/child, respectively. The mean proportion of the expenses of each child among direct medical, direct nonmedical, and indirect costs was 11:71:18. The median annual hospital perspective cost was 71.38 (range 5.17-807.13) USD/child.

Conclusion

The annual societal economic burden for each Thai child with GDD was 209.81 USD. The direct nonmedical cost, especially transportation, was the largest proportion of the total cost from the caregiver’s perspective. Effective referral system, proper specialist allocation throughout the country, and developing of the service system are crucial for the alleviation of this burden.

目的:从社会、护理者和医院的角度确定在Siriraj医院接受全球发育迟缓(GDD)儿童发展服务的成本。方法:本描述性研究收集了2021年11月至2022年10月5岁以下GDD患儿的数据。医院的角度成本和护理人员的直接医疗成本从Siriraj数据库中获得。对护理人员进行了直接非医疗费用和间接费用的访谈。从护理人员和医院的角度来看，费用总和为总社会角度。结果:在100名护理人员中，大多数(39%)的孩子有全民覆盖;然而，22%的护理人员决定不使用任何医疗保险。从社会角度来看，每名儿童的平均年成本为209.81美元(14.51-2134.08美元)。看护人每年的直接医疗、直接非医疗和间接费用中位数分别为119.82美元/儿童(9.20-2068.91)、0美元/儿童(0-231.89)、68.96美元/儿童(2.87-2068.91)和0美元/儿童(0-1293.07)。每个儿童的直接医疗费用、直接非医疗费用和间接费用的平均比例为11:71:18。每年的医院费用中位数为71.38美元/儿童(范围5.17-807.13)。结论:泰国GDD儿童的年社会经济负担为209.81美元。从护理者的角度来看，直接非医疗费用，尤其是交通费用，在总费用中所占比例最大。有效的转诊制度、在全国范围内适当分配专家、发展服务体系是减轻这一负担的关键。

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引用次数: 0

Automated Peritoneal Dialysis With Remote Patient Monitoring: Clinical Effects and Economic Consequences for Poland 远程病人监测的自动腹膜透析:波兰的临床效果和经济后果。

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-11-16 DOI: 10.1016/j.vhri.2023.09.011

Joanna Augustyńska MSc , Monika Lichodziejewska-Niemierko MD, PhD , Beata Naumnik MD, PhD , Michał Seweryn PhD , Agnieszka Leszczyńska MSc , Ryszard Gellert MD, PhD , Bengt Lindholm MD, PhD , Jacek Lange MD , Justyna Kopel MSc

Objectives

Remote patient monitoring (RPM) of patients treated with automated peritoneal dialysis (APD) at home allows clinicians to supervise and adjust the dialysis process remotely. This study aimed to review recent scientific studies on the use of RPM in patients treated with APD and based on extracted relevant data assess possible clinical implications and potential economic value of introducing such a system into practice in Poland.

Methods

A systematic literature review was performed in the MEDLINE, EMBASE, and Cochrane databases. The model of clinical effects and costs associated with APD was built as a cost-effectiveness analysis with a 10-year time horizon from the Polish National Health Fund perspective. Cost-effectiveness analysis compared 2 strategies: APD with RPM versus APD without RPM.

Results

Thirteen publications assessing the clinical value of RPM among patients with APD were found. The statistical significance of APD with RPM compared with APD without RPM was identified for the main clinical outcomes: frequency and length of hospitalizations, APD technique failure, and death. An incremental cost-effectiveness ratio was equal to €27 387 per quality-adjusted life-year. The obtained incremental cost-effectiveness ratio is below the willingness-to-pay threshold for the use of medical technologies in Poland (€36 510 per quality-adjusted life-year), which means that APD with RPM was a cost-effective technology.

Conclusions

RPM in patients starting APD is a clinical option that is worth considering in Polish practice because it has the potential to decrease the frequency of APD technique failure and shorten the length of hospitalization.

目的:对在家接受自动腹膜透析(APD)治疗的患者进行远程患者监测(RPM)，使临床医生能够远程监督和调整透析过程。本研究旨在回顾最近关于在APD患者中使用RPM的科学研究，并根据提取的相关数据评估在波兰引入该系统的可能临床意义和潜在经济价值。方法:在MEDLINE、EMBASE和Cochrane数据库中进行系统的文献综述。建立了与APD相关的临床效果和成本模型，从波兰国家卫生基金的角度进行了为期10年的成本效益分析。成本-效果分析比较了两种策略:APD加RPM与APD不加RPM。结果:共找到13篇评估APD患者RPM临床价值的文献。APD合并RPM与APD不合并RPM的主要临床结果有统计学意义:住院次数和时间、APD技术失败和死亡。增量成本效益比率等于每个质量调整生命年27 387欧元。所获得的增量成本效益比低于波兰使用医疗技术的支付意愿阈值(每质量调整生命年36 510欧元)，这意味着APD与RPM是一种具有成本效益的技术。结论:在波兰的实践中，RPM是一种值得考虑的临床选择，因为它有可能减少APD技术失败的频率，缩短住院时间。

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引用次数: 0

Adapting Economic Evaluation Methods to Shifting Global Health Priorities: Assessing the Value of Health System Inputs 调整经济评估方法以适应不断变化的全球卫生重点:评估卫生系统投入的价值。

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-11-16 DOI: 10.1016/j.vhri.2023.08.005

Finn McGuire PhD , Sakshi Mohan MSc , Simon Walker PhD , Juliet Nabyonga-Orem PhD , Freddie Ssengooba PhD , Edward Kataika PhD , Paul Revill PhD

Objectives

We highlight the importance of undertaking value assessments for health system inputs if allocative efficiency is to be achieve with health sector resources, with a focus on low- and middle-income countries. However, methodological challenges complicated the application of current economic evaluation techniques to health system input investments.

Methods

We undertake a review of the literature to examine how assessments of investments in health system inputs have been considered to date, highlighting several studies that have suggested ways to address the methodological issues. Additionally, we surveyed how empirical economic evaluations of health system inputs have approached these issues. Finally, we highlight the steps required to move toward a comprehensive standardized framework for undertaking economic evaluations to make value assessments for investments in health systems.

Results

Although the methodological challenges have been illustrated, a comprehensive framework for value assessments of health system inputs, guiding the evidence required, does not exist. The applied literature of economic evaluations of health system inputs has largely ignored the issues, likely resulting in inaccurate assessments of cost-effectiveness.

Conclusions

A majority of health sector budgets are spent on health system inputs, facilitating the provision of healthcare interventions. Although economic evaluation methods are a key component in priority setting for healthcare interventions, such methods are less commonly applied to decision making for investments in health system inputs. Given the growing agenda for investments in health systems, a framework will be increasingly required to guide governments and development partners in prioritizing investments in scarce health sector budgets.

目标:我们强调，如果要实现卫生部门资源的分配效率，就必须对卫生系统投入进行价值评估，重点是低收入和中等收入国家。然而，方法上的挑战使当前经济评价技术应用于卫生系统投入投资变得复杂。方法:我们对文献进行了回顾，以检查迄今为止如何考虑对卫生系统投入的投资进行评估，重点介绍了几项研究，这些研究提出了解决方法问题的方法。此外，我们调查了卫生系统投入的实证经济评估如何处理这些问题。最后，我们强调需要采取的步骤，以建立一个全面的标准化框架，进行经济评估，对卫生系统的投资进行价值评估。结果:虽然方法上的挑战已经说明，但并不存在一个全面的卫生系统投入价值评估框架，指导所需的证据。对卫生系统投入进行经济评价的应用文献在很大程度上忽略了这些问题，可能导致对成本效益的评估不准确。结论:卫生部门预算的大部分用于卫生系统投入，促进了卫生保健干预措施的提供。虽然经济评价方法是确定卫生保健干预措施优先事项的关键组成部分，但这种方法较少应用于卫生系统投入投资的决策。鉴于对卫生系统投资的议程越来越多，将越来越需要一个框架来指导政府和发展伙伴对稀缺的卫生部门预算进行优先投资。

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引用次数: 1