Value in health regional issues最新文献_第2页

Measurement Properties of English and Chinese Versions of HeartQoL in a Multiethnic Asian Cohort With Cardiovascular Disease 亚洲多民族心血管疾病患者心脏生活质量中英文对照的测量特性

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-07-01 Epub Date: 2025-12-09 DOI: 10.1016/j.vhri.2025.101554

Rehena Sultana MSc , Felicia Jia Ler Ang PhD , Shir Lynn Lim MMed (Int Med) , Ru-San Tan MBBS , Nan Luo PhD , Yin Bun Cheung PhD , Mihir Gandhi PhD

Objectives

To evaluate the measurement properties of the HeartQoL questionnaire in assessing health-related quality of life (HRQoL) among multiethnic Asian patients with cardiovascular diseases (CVDs).

Methods

A cross-sectional survey was conducted among 556 CVD patients from 2 tertiary hospitals in Singapore. Patients self-assessed HRQoL using HeartQoL (a heart-disease-specific measure) and EuroQol 5-Dimension 5-Level (EQ-5D-5L) (a generic measure). HeartQoL includes a global scale and 2 subscales (physical and emotional), with higher values indicating better HRQoL. Measurement properties of HeartQoL were evaluated through convergent validity (Spearman’s ρ), internal consistency (Cronbach’s α), discriminative validity, and language equivalence between English and Chinese (Mandarin) versions.

Results

The mean age of recruited patients was 57.7 years (SD 11.5). 72.2% were male, and 461 (82.9%) responded to the survey in English. Cronbach’s α for the HeartQoL emotional, physical, and global scales were 0.86, 0.88, and 0.89, respectively. All scales were significantly positively correlated with relevant EQ-5D-5L items (r ≥ 0.4, P < .01) and negatively associated with CVD functional classification (P for trend < .01). Among Chinese ethnic patients, the 90% confidence interval for mean differences in HeartQoL scales between English and Mandarin versions was within ±0.5 SD, confirming measurement equivalence between the 2 language versions.

Conclusions

The HeartQoL demonstrated robust measurement properties in Asian CVD patients. The finding supports its use in clinical practice and research to assess and compare HRQoL among patients with CVDs.

目的：评价心脏质量问卷（HeartQoL）在评估亚洲多民族心血管疾病（cvd）患者健康相关生活质量（HRQoL）中的测量特性。方法：对新加坡2所三级医院556例心血管疾病患者进行横断面调查。患者使用HeartQoL（一种心脏病特异性测量）和EuroQol 5-Dimension 5-Level (EQ-5D-5L)（一种通用测量）自我评估HRQoL。HeartQoL包括整体量表和2个子量表（身体和情感），数值越高表明HRQoL越好。通过收敛效度（Spearman’s ρ）、内部一致性（Cronbach’s α）、判别效度和中英文（普通话）版本的语言等效性来评估HeartQoL的测量特性。结果：入选患者的平均年龄为57.7岁（SD 11.5）。72.2%为男性，461人（82.9%）用英语回答。HeartQoL情绪、身体和整体量表的Cronbach's α分别为0.86、0.88和0.89。各量表与相关EQ-5D-5L项呈显著正相关（r≥0.4,P < 0.01），与CVD功能分级呈显著负相关（P < 0.01）。在华裔患者中，英文和中文版本的HeartQoL量表平均差异的90%置信区间在±0.5 SD内，证实了两种语言版本之间的测量等效性。结论：HeartQoL在亚洲CVD患者中显示出可靠的测量特性。该发现支持其在临床实践和研究中用于评估和比较心血管疾病患者的HRQoL。

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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 : 2026-07-01 Epub 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

Costing of Cervical Cancer Screening and Treatment Pathways: Case Studies in Bangladesh and Uganda 子宫颈癌筛查和治疗途径的成本计算：孟加拉国和乌干达的案例研究

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-07-01 Epub Date: 2025-12-27 DOI: 10.1016/j.vhri.2025.101566

Marat Sultanov PhD , Fengming Pan MSc , Nazrul Naheed MD , Aminur Rahman MD , Johnblack Kabukye PhD , Carolyn Nakisige MD , Janine de Zeeuw PhD , Jurjen van der Schans PhD

Objectives

Cervical cancer is a major public health challenge in low- and middle-income countries, where access to effective screening and treatment is limited. However, cost data to inform the implementation of cervical cancer screening are often unavailable. This study estimated the costs of cervical cancer screening and treatment pathway components in Uganda and Bangladesh of both existing visual inspection with acetic acid strategies and the World Health Organization-recommended high-risk human papillomavirus testing approaches.

Methods

A mixed-methods costing study was conducted using data collected from multiple healthcare facilities to estimate cost of screening, including screening tests, triage, diagnosis, and the treatment of both precancerous lesions and cervical cancer. Depending on data availability, both micro and gross costing approaches were used from a top-down perspective. Costs are reported in 2022 international dollars (I$).

Results

Screening and treatment costs varied by procedure and country. In both countries, the cost per screening test was higher for high-risk human papillomavirus self-testing (Uganda, I$51.77; Bangladesh, I$66.24) than for visual inspection-with-acetic-acid-based screening (Uganda, to I$20.27; Bangladesh, I$18.41). Ablative treatment for precancerous lesions cost I$29.43 in Uganda and I$37.24 in Bangladesh, whereas cancer treatment costs were substantially higher, with gross estimates exceeding I$700 for chemotherapy and radiotherapy in Uganda.

Conclusions

This study provides context-specific cost estimates for cervical cancer screening and treatment in 2 low- and middle-income countries that can support early-stage planning and policy decisions. The findings highlight the need for local data collection to strengthen future economic evaluations.

在获得有效筛查和治疗的机会有限的低收入和中等收入国家，宫颈癌是一个主要的公共卫生挑战。然而，通常无法获得为实施宫颈癌筛查提供信息的费用数据。本研究估计了乌干达和孟加拉国宫颈癌筛查和治疗途径组成部分的成本，包括现有的醋酸目视检查策略和世界卫生组织推荐的高危人乳头瘤病毒检测方法。方法采用从多家医疗机构收集的数据进行一项混合方法成本计算研究，以估计筛查的成本，包括筛查试验、分诊、诊断和癌前病变和宫颈癌的治疗。根据数据的可用性，从自上而下的角度使用了微观和总成本计算方法。费用以2022年国际美元（I$）报告。结果筛查和治疗费用因手术和国家而异。在这两个国家，高风险人乳头瘤病毒自我检测的每次筛查测试费用（乌干达，51.77美元；孟加拉国，66.24美元）高于目视检查和基于醋酸的筛查（乌干达，20.27美元；孟加拉国，18.41美元）。在乌干达，癌前病变的消融治疗费用为29.43美元，在孟加拉国为37.24美元，而癌症治疗费用则要高得多，乌干达化疗和放疗的总估计费用超过700美元。本研究为两个低收入和中等收入国家的宫颈癌筛查和治疗提供了具体情况的成本估算，可以支持早期规划和政策决策。调查结果强调需要收集当地数据，以加强今后的经济评价。

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引用次数: 0

Drug Market in Brazil: An Analysis of Drug Discontinuation From 2018 to 2022 巴西药品市场：2018 - 2022年药品停药情况分析

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-07-01 Epub Date: 2025-12-23 DOI: 10.1016/j.vhri.2025.101562

Naiane Lima Costa MSc, Cristina Mariano Ruas PhD

Objectives

Given the structural vulnerabilities and international dependency of the Brazilian pharmaceutical sector, exacerbated by the COVID-19 pandemic, this study aims to analyze drug market discontinuation patterns and their associated pricing trends in Brazil between 2018 and 2022.

Methods

Using data from the Brazilian Health Surveillance Agency’s Notification Panel, we performed a descriptive analysis of drug discontinuations and public procurement pricing trends.

Results

The study cataloged 11 657 drug discontinuations; approximately 38% occurred during the COVID-19 health crisis. Most (76.37%) were transient, primarily attributed to commercial factors. Notably, cardiovascular drugs were significantly affected, accounting for approximately 22% of total discontinuations during the pandemic. Analysis of public procurement pricing revealed substantial fluctuations, with some medications seeing cumulative price surges exceeding 100% over the 5-year period. The steepest median price escalation occurred in 2020, coinciding with the pandemic’s onset.

Conclusions

These findings underscore the urgent need to reform Brazil’s price regulation policies and increase investments in the national pharmaceutical industry. Such measures are essential to mitigate external dependency and ensure the consistent availability of essential medicines for the Brazilian population.

鉴于2019冠状病毒病大流行加剧了巴西制药行业的结构性脆弱性和国际依赖性，本研究旨在分析2018年至2022年巴西药品市场停售模式及其相关定价趋势。方法：使用来自巴西卫生监督机构通报小组的数据，我们对药物停药和公共采购定价趋势进行了描述性分析。结果：该研究共收录了11 657例停药病例；约38%发生在COVID-19卫生危机期间。大多数（76.37%）是暂时性的，主要归因于商业因素。值得注意的是，心血管药物受到严重影响，约占大流行期间停药总量的22%。对公共采购价格的分析显示出大幅波动，一些药物在5年期间的累计价格涨幅超过100%。价格上涨幅度最大的中位数出现在2020年，与新冠肺炎大流行的爆发同时发生。结论：这些发现强调了改革巴西价格监管政策和增加对国家制药工业投资的迫切需要。这些措施对于减轻对外依赖和确保巴西人口持续获得基本药物至关重要。

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引用次数: 0

The Impoverishment Effect of Out-of-Pocket Expenditure for Hypertension in Ghana 自费高血压治疗在加纳的贫困效应

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-07-01 Epub Date: 2025-12-11 DOI: 10.1016/j.vhri.2025.101557

Kofi Aduo-Adjei MPhil , Øystein Ariansen Haaland PhD , Lumbwe Chola PhD , James Akazili PhD

Objectives

The rising prevalence of hypertension in Ghana and the associated household expenditures have become major policy concerns. High out-of-pocket (OOP) payments restrict access to care and increase the risk of impoverishment. This study examines the level and effect of household impoverishment due to care-seeking for hypertension in Ghana.

Methods

We analyzed data from a catastrophic health expenditure survey conducted between December 2023 and February 2024 at 2 primary healthcare facilities: Weija Gbawe Municipal Hospital (WGMH) and Shai Osudoku District Hospital (SODH) in the Greater Accra Region. The analysis involved descriptive statistics and estimation of the impact of OOP payment on impoverishment, including a pen’s parade of household per capita expenditure.

Results

The findings show that OOP led to an increase in the poverty headcount by 3.14% and 0.26% using US dollars $2.15/per day and $3.65/per day, respectively. At a lower threshold, the household poverty gap increased from $40.10 to $46.57 and widened from $83.86 to $90.79. The normalized poverty gap grew from 62.17% to 72.20% at a lower poverty line and from 76.58% to 82.92% at the higher threshold. It also emerged that the normalized mean poverty also increased from 61.78% to 69.62% at a poverty threshold of $2.15 and from 129.8% to 141.92% at $3.65 of the poverty line.

Conclusions

Our findings suggest that without financial risk protection, households are likely to be pushed into extreme poverty because of expenditures on hypertension care. Urgent intervention is needed to mitigate the impoverishing effects of noncommunicable diseases in Ghana.

加纳高血压患病率的上升和相关的家庭支出已成为主要的政策关注点。高额的自付费用限制了获得医疗服务的机会，增加了贫困的风险。本研究考察了加纳因高血压求诊而导致的家庭贫困水平和影响。方法分析了2023年12月至2024年2月在大阿克拉地区Weija Gbawe市医院（WGMH）和Shai Osudoku区医院（SODH）两家初级卫生保健机构进行的灾难性卫生支出调查数据。这项分析涉及描述性统计和估计OOP付款对贫困的影响，包括对家庭人均支出的大笔统计。结果研究结果表明，以2.15美元/天和3.65美元/天为标准，面向对象计划使贫困人口分别增加了3.14%和0.26%。在较低的门槛下，家庭贫困差距从40.10美元扩大到46.57美元，从83.86美元扩大到90.79美元。贫困线较低时，标准化贫困差距从62.17%扩大到72.20%；贫困线较高时，标准化贫困差距从76.58%扩大到82.92%。在2.15美元的贫困线上，标准化平均贫困率也从61.78%上升到69.62%，在3.65美元的贫困线上，标准化平均贫困率从129.8%上升到141.92%。结论研究结果表明，如果没有财务风险保护，家庭很可能因高血压护理支出而陷入极端贫困。需要采取紧急干预措施，以减轻非传染性疾病在加纳造成的贫困影响。

{"title":"The Impoverishment Effect of Out-of-Pocket Expenditure for Hypertension in Ghana","authors":"Kofi Aduo-Adjei MPhil , Øystein Ariansen Haaland PhD , Lumbwe Chola PhD , James Akazili PhD","doi":"10.1016/j.vhri.2025.101557","DOIUrl":"10.1016/j.vhri.2025.101557","url":null,"abstract":"<div><h3>Objectives</h3><div>The rising prevalence of hypertension in Ghana and the associated household expenditures have become major policy concerns. High out-of-pocket (OOP) payments restrict access to care and increase the risk of impoverishment. This study examines the level and effect of household impoverishment due to care-seeking for hypertension in Ghana.</div></div><div><h3>Methods</h3><div>We analyzed data from a catastrophic health expenditure survey conducted between December 2023 and February 2024 at 2 primary healthcare facilities: Weija Gbawe Municipal Hospital (WGMH) and Shai Osudoku District Hospital (SODH) in the Greater Accra Region. The analysis involved descriptive statistics and estimation of the impact of OOP payment on impoverishment, including a pen’s parade of household per capita expenditure.</div></div><div><h3>Results</h3><div>The findings show that OOP led to an increase in the poverty headcount by 3.14% and 0.26% using US dollars $2.15/per day and $3.65/per day, respectively. At a lower threshold, the household poverty gap increased from $40.10 to $46.57 and widened from $83.86 to $90.79. The normalized poverty gap grew from 62.17% to 72.20% at a lower poverty line and from 76.58% to 82.92% at the higher threshold. It also emerged that the normalized mean poverty also increased from 61.78% to 69.62% at a poverty threshold of $2.15 and from 129.8% to 141.92% at $3.65 of the poverty line.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that without financial risk protection, households are likely to be pushed into extreme poverty because of expenditures on hypertension care. Urgent intervention is needed to mitigate the impoverishing effects of noncommunicable diseases in Ghana.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"54 ","pages":"Article 101557"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737562","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

Feasibility of Home Hemodialysis for Colombia, Cost-Effectiveness Perspective 哥伦比亚家庭血液透析的可行性，成本效益视角。

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-07-01 Epub Date: 2025-12-22 DOI: 10.1016/j.vhri.2025.101561

Camilo A. Gonzalez-Gonzalez MD, MSc , Edna Zambrano-Cardona MSc , Julian Serrano MD , Dario Londoño MD, MSc

Objectives

To assess the incremental cost-utility ratio of home hemodialysis (HHD) compared with in-center hemodialysis (HD) among Colombian patients with end-stage renal disease with contraindications or failure of peritoneal dialysis.

Methods

A Markov model was constructed from the healthcare system and societal perspectives over a 5-year horizon. The primary outcomes were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios. Costs included direct medical costs from microcosting and indirect costs based on patient surveys. Data were collected in Colombian pesos (COP) and converted to USD (2022 average exchange rate: USD 1 = COP 4255.44). Sensitivity analyses were conducted using Monte Carlo simulations in R Studio.

Results

From the payer perspective, HHD generated incremental costs of USD 25 928 and 0.31 additional QALYs compared with HD, yielding an incremental cost-effectiveness ratios of USD 82 674 per QALY gained, exceeding the cost-effectiveness threshold for Colombia (USD 6630 per QALY). From the societal perspective, incorporating indirect costs significantly improved HHD’s cost-effectiveness profile, demonstrating potential economic viability.

Conclusions

Although home hemodialysis is not cost-effective from a third-party payer perspective in Colombia, it becomes a viable alternative when considering indirect costs and out-of-pocket expenses. This study highlights the need for health policy decisions in Latin America to be based on comprehensive assessments that go beyond direct medical costs.

目的：评估在哥伦比亚有腹膜透析禁忌症或失败的终末期肾病患者中，家庭血液透析（HHD）与中心血液透析（HD）的增量成本-效用比。方法：从医疗保健系统和社会的角度构建了一个5年的马尔可夫模型。主要结局为质量调整生命年（QALYs）和增量成本-效果比。费用包括微观成本计算的直接医疗费用和基于病人调查的间接费用。数据以哥伦比亚比索（COP）收集，并转换为美元（2022年平均汇率：1美元= COP 4255.44）。在R Studio中使用蒙特卡罗模拟进行敏感性分析。结果：从付款人的角度来看，HHD与HD相比增加了25 928美元的增量成本和0.31个额外的质量年，每个质量年的增量成本效益比为82 674美元，超过了哥伦比亚的成本效益门槛（6630美元/质量年）。从社会角度来看，纳入间接成本显著提高了HHD的成本效益，证明了潜在的经济可行性。结论：虽然从哥伦比亚第三方支付者的角度来看，家庭血液透析并不具有成本效益，但在考虑间接成本和自付费用时，它成为一种可行的选择。这项研究强调，拉丁美洲的卫生政策决定需要基于全面评估，而不仅仅是直接医疗费用。

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引用次数: 0

Patient Preferences for Radiology Appointments and Factors Influencing Attendance Adherence: A Discrete Choice Experiment in Singapore Based on Behavioral Economics 患者对放射科预约的偏好和影响出席依从性的因素：新加坡基于行为经济学的离散选择实验。

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-05-01 Epub Date: 2025-11-19 DOI: 10.1016/j.vhri.2025.101525

Jolene W.L. Ooi DHealth , Max Western PhD

Objectives

Missed radiology appointments disrupt timely diagnosis and result in resource inefficiencies. This study aims to investigate patient preferences for radiology appointments and explore adherence factors through the lens of behavioral economics.

Methods

A discrete choice experiment survey was developed based on 6 attributes: (1) “Waiting time for the radiology appointment,” (2) “Choice of appointment time,” (3) “Reminder system,” (4) “Out-of-pocket (OOP) costs,” (5) “Upfront deposit fee,” and (6) “Time taken to receive results.” The online survey was administered in English, and responses were collected face to face. Respondents were outpatients aged 21 years and older with radiology appointments. Data analysis was performed using the Stata version 16.1, with conditional logit and mixed logit models used to analyze the discrete choice experiment data.

Results

OOP costs were the primary driver of patient preferences for radiology appointments, followed by waiting time, timeliness of results, and choice of appointment reminders, whereas deposit requirements had mixed effects and appointment time had little impact. Both conditional and mixed logit models produced consistent attribute rankings, with OOP costs accounting for more than 80% of total utility. The mixed logit model revealed significant preference heterogeneity, particularly for costs and reminders. Willingness-to-pay estimates showed that patients valued flexible reminder systems the most, being willing to pay more than SGD 200 compared with reminder-only services, while requiring compensation for deposits or longer waiting times.

Conclusions

Optimising OOP costs and providing flexible reminders with cancellation or rescheduling options may improve patient adherence, engagement, and satisfaction in radiology.

目的：错过放射科预约扰乱及时诊断，导致资源效率低下。本研究旨在通过行为经济学的视角，探讨患者对放射科预约的偏好，并探讨依从性因素。方法：基于6个属性(1)“预约等待时间”、(2)“预约时间选择”、(3)“提醒系统”、(4)“自费（OOP）费用”、（5)“预付押金”、(6)“收到结果所需时间”）进行离散选择实验调查。在线调查以英语进行，并面对面收集回答。受访者为年龄在21岁及以上的门诊患者。使用Stata version 16.1进行数据分析，采用条件logit和混合logit模型对离散选择实验数据进行分析。结果：面向对象的费用是患者对放射预约偏好的主要驱动因素，其次是等待时间、结果的及时性和预约提醒的选择，而存款要求的影响是混合的，预约时间的影响很小。条件和混合logit模型都产生了一致的属性排名，OOP成本占总效用的80%以上。混合logit模型显示了显著的偏好异质性，特别是对成本和提醒。支付意愿评估显示，患者最看重灵活的提醒系统，与只提供提醒的服务相比，他们愿意支付超过200新元的费用，同时要求对押金进行补偿或延长等待时间。结论：优化OOP成本和提供灵活的取消或重新安排选项提醒可以提高患者对放射学的依从性、参与度和满意度。

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引用次数: 0

Cost-Effectiveness of Vascular Endothelial Growth Factor Inhibitors in the Management of Wet Age-Related Macular Degeneration: A Systematic Review 血管内皮生长因子抑制剂治疗湿性年龄相关性黄斑变性的成本-效果：一项系统综述

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-05-01 Epub Date: 2025-11-25 DOI: 10.1016/j.vhri.2025.101542

Ganesh S. Paneerselvam PhD , Ng J. Wai Bpharm , Lim J. Sheng Bpharm , Lee K.C. Kenneth PhD

Objectives

To evaluate the cost-effectiveness of VEGF inhibitors, ranibizumab, aflibercept, bevacizumab, brolucizumab, pegaptanib, and conbercept for wAMD treatment.

Methods

A systematic search was conducted in PubMed, Cochrane, and SpringerLink databases to identify cost-effectiveness analyses and cost-utility analyses related to wAMD treatment. Eligible studies were assessed using Drummond’s 10-point checklist to evaluate methodological quality. The extracted data included intervention costs, quality-adjusted life-years, and incremental cost-effectiveness ratios.

Results

Twenty-two studies met the inclusion criteria. Bevacizumab and brolucizumab were frequently reported as cost-effective alternatives, offering comparable or superior visual outcomes at lower costs than ranibizumab or aflibercept. Pegaptanib was consistently less cost-effective. Findings for ranibizumab versus aflibercept varied by treatment regimen and analytic assumptions. Across studies, cost-effectiveness estimates were influenced by model perspective, time horizon, exclusion of adverse events, and single-eye modeling. A further limitation is that in contexts of non-inferior efficacy, small incremental quality-adjusted life-years differences may artificially inflate incremental cost-effectiveness ratios, potentially overstating the costs relative to benefits.

Conclusions

Decision making in wAMD treatment requires more thorough economic evaluations that incorporate standardized methodologies and lengthy cost assessments.

目的评价VEGF抑制剂、雷尼单抗、阿非利塞普、贝伐单抗、brolucizumab、pegaptanib和conbercept在wAMD治疗中的成本-效果。方法系统检索PubMed、Cochrane和SpringerLink数据库，确定与wAMD治疗相关的成本-效果分析和成本-效用分析。使用Drummond的10点检查表评估合格的研究，以评估方法学质量。提取的数据包括干预成本、质量调整寿命年和增量成本-效果比。结果22项研究符合纳入标准。贝伐单抗和布卢珠单抗经常被报道为具有成本效益的替代品，以更低的成本提供与雷尼单抗或阿非利塞相当或更好的视力结果。Pegaptanib的成本效益一直较低。雷尼单抗与阿非利赛的结果因治疗方案和分析假设而异。在所有研究中，成本-效果估计受到模型视角、时间范围、排除不良事件和单眼建模的影响。进一步的限制是，在非劣效的情况下，小的增量质量调整寿命年差异可能人为地夸大增量成本-效果比，潜在地夸大了相对于收益的成本。结论：wAMD治疗的决策需要更彻底的经济评估，包括标准化的方法和冗长的成本评估。

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引用次数: 0

Economic Evaluation and Budget Impact of Biosimilar Trastuzumab for HER2-Positive Metastatic Breast Cancer in Thailand: Policy Implications for Access and Affordability 泰国生物仿制药曲妥珠单抗治疗her2阳性转移性乳腺癌的经济评估和预算影响：对可及性和可负担性的政策影响

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-05-01 Epub Date: 2025-11-18 DOI: 10.1016/j.vhri.2025.101523

Surasit Lochid-amnuay PhD , Ronnachai Kongsakon MD

Objectives

To evaluate the cost-utility and budget impact of biosimilar trastuzumab plus paclitaxel versus paclitaxel monotherapy for HER2-positive metastatic breast cancer in Thailand and to explore policy implications for access and affordability.

Methods

A Markov model was developed from a societal perspective over a lifetime horizon, simulating 3 health states: stable disease, progressive disease, and death, in 3-week cycles. Two trastuzumab-based strategies were evaluated: (1) fixed-duration treatment for 1 year and (2) continuous treatment until disease progression. All costs were updated to 2024 values using local data. Clinical effectiveness was measured in quality-adjusted life-years (QALYs). A probabilistic sensitivity analysis and a 5-year budget impact analysis were performed.

Results

Compared with paclitaxel monotherapy, trastuzumab plus paclitaxel increased life-years by 0.31 and QALYs by 0.27. The incremental cost-effectiveness ratios were Thai Baht (THB) 195 541/QALY for the 1-year regimen and THB 231 119/QALY for the continuous regimen, both exceeding Thailand’s cost-effectiveness threshold of THB 160 000/QALY. The 5-year budget impact was estimated at THB 166.3 million and THB 199.3 million, respectively. Price reductions would be required for trastuzumab to achieve cost-effectiveness under the Thai threshold.

Conclusions

Although biosimilar trastuzumab has improved affordability, it remains not cost-effective at current prices. However, the relatively modest budget impact supports the feasibility of expanding access through targeted price negotiation and policy interventions. Threshold analysis indicated that price reductions to approximately THB 3700 per vial (1-year regimen) and THB 2950 per vial (until-progression regimen) would be required for trastuzumab to achieve cost-effectiveness under the Thai threshold.

目的：评估生物仿制药曲妥珠单抗加紫杉醇与紫杉醇单药治疗泰国her2阳性转移性乳腺癌的成本效用和预算影响，并探讨其可及性和可负担性的政策影响。方法：从社会角度建立一个马尔可夫模型，以3周为周期模拟3种健康状态：疾病稳定、疾病进展和死亡。评估了两种基于曲妥珠单抗的策略：(1)固定持续治疗1年；(2)持续治疗直至疾病进展。所有成本使用本地数据更新为2024值。临床疗效以质量调整生命年（QALYs）衡量。进行了概率敏感性分析和5年预算影响分析。结果：与紫杉醇单药治疗相比，曲妥珠单抗联合紫杉醇使生命年增加0.31年，质量年增加0.27年。1年方案的增量成本-效果比为195 541泰铢/QALY，连续方案的增量成本-效果比为231 119泰铢/QALY，均超过泰国的成本-效果阈值16万泰铢/QALY。五年预算影响估计分别为1.663亿泰铢和1.993亿泰铢。为了达到低于泰国门槛的成本效益，曲妥珠单抗需要降价。结论：尽管曲妥珠单抗生物仿制药提高了可负担性，但以目前的价格来看，它仍然不具有成本效益。然而，相对较小的预算影响支持通过有针对性的价格谈判和政策干预扩大准入的可行性。阈值分析表明，曲妥珠单抗要达到泰国阈值下的成本效益，需要将价格降至约3700泰铢/瓶（1年方案）和2950泰铢/瓶（直至进展方案）。

{"title":"Economic Evaluation and Budget Impact of Biosimilar Trastuzumab for HER2-Positive Metastatic Breast Cancer in Thailand: Policy Implications for Access and Affordability","authors":"Surasit Lochid-amnuay PhD , Ronnachai Kongsakon MD","doi":"10.1016/j.vhri.2025.101523","DOIUrl":"10.1016/j.vhri.2025.101523","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the cost-utility and budget impact of biosimilar trastuzumab plus paclitaxel versus paclitaxel monotherapy for HER2-positive metastatic breast cancer in Thailand and to explore policy implications for access and affordability.</div></div><div><h3>Methods</h3><div>A Markov model was developed from a societal perspective over a lifetime horizon, simulating 3 health states: stable disease, progressive disease, and death, in 3-week cycles. Two trastuzumab-based strategies were evaluated: (1) fixed-duration treatment for 1 year and (2) continuous treatment until disease progression. All costs were updated to 2024 values using local data. Clinical effectiveness was measured in quality-adjusted life-years (QALYs). A probabilistic sensitivity analysis and a 5-year budget impact analysis were performed.</div></div><div><h3>Results</h3><div>Compared with paclitaxel monotherapy, trastuzumab plus paclitaxel increased life-years by 0.31 and QALYs by 0.27. The incremental cost-effectiveness ratios were Thai Baht (THB) 195 541/QALY for the 1-year regimen and THB 231 119/QALY for the continuous regimen, both exceeding Thailand’s cost-effectiveness threshold of THB 160 000/QALY. The 5-year budget impact was estimated at THB 166.3 million and THB 199.3 million, respectively. Price reductions would be required for trastuzumab to achieve cost-effectiveness under the Thai threshold.</div></div><div><h3>Conclusions</h3><div>Although biosimilar trastuzumab has improved affordability, it remains not cost-effective at current prices. However, the relatively modest budget impact supports the feasibility of expanding access through targeted price negotiation and policy interventions. Threshold analysis indicated that price reductions to approximately THB 3700 per vial (1-year regimen) and THB 2950 per vial (until-progression regimen) would be required for trastuzumab to achieve cost-effectiveness under the Thai threshold.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"53 ","pages":"Article 101523"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557735","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

Economic Impact of Self-Injected Biologics for Rheumatoid Arthritis in Japan: A Propensity Score-Matched Analysis From a Public Healthcare Payer Perspective 日本自注射类风湿性关节炎生物制剂的经济影响：从公共医疗保健支付者的角度进行倾向评分匹配分析

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-05-01 Epub Date: 2025-10-23 DOI: 10.1016/j.vhri.2025.101511

Kazuhiko Takahata MSc , Shingo Akutsu , Eiichi Tanaka MD, PhD , Ryoko Sakai PhD, MPH , Manabu Akazawa PhD, MPH

Objectives

Rheumatoid arthritis (RA) is a chronic inflammatory disease commonly treated with high-cost biologic disease-modifying antirheumatic drugs (bDMARDs). As of May 2025, 12 bDMARDs (9 originators and 3 biosimilars) are approved in Japan, with 10 available for self-injection (SI). Although SI may reduce hospital visits, its overall impact on prescribing patterns and healthcare costs remains unclear.

Methods

We conducted a retrospective cohort study using Japanese health insurance claims data (DeSC Healthcare, April 2014-August 2023). Patients with RA were identified based on diagnostic codes and bDMARDs prescriptions. Patients initiating SI within 3 months of their first bDMARD prescription were classified as the SI group; others were assigned to the non-SI group. Propensity score matching (1:1) was performed using 25 covariates. From the public payer’s perspective, we compared monthly direct healthcare costs, bDMARDs prescription volume, and annual hospital visit frequency.

Results

A total of 6784 patients were matched (mean age: 73.5 years; 73.2% female). The SI group incurred higher monthly healthcare costs ($774.0; 95% confidence interval [CI]: 763.3-784.6) compared with the non-SI group ($608.3; 95% CI 598.3-618.4; P < .05). bDMARDs prescription volume was greater in the SI group (2.9 vs 1.9 units/patient/month; P < .05). However, the SI group had significantly fewer annual hospital visits (9.5 vs 25.0 visits/year; P < .05).

Conclusions

SI increased direct costs because of higher bDMARDs utilization but reduced hospital visits, suggesting a potential for indirect cost savings. These findings may support future reimbursement and care models for RA.

目的类风湿关节炎（RA）是一种慢性炎症性疾病，通常使用高成本的生物抗风湿药物（bDMARDs）治疗。截至2025年5月，日本批准了12个bdmard（9个原研药和3个生物仿制药），其中10个可用于自注射（SI）。虽然SI可能减少医院就诊，但其对处方模式和医疗费用的总体影响尚不清楚。方法采用日本健康保险索赔数据进行回顾性队列研究（DeSC Healthcare， 2014年4月- 2023年8月）。根据诊断代码和bDMARDs处方确定RA患者。首次服用bDMARD后3个月内开始自伤的患者被归类为自伤组；其他人被分配到非si组。使用25个协变量进行倾向评分匹配（1:1）。从公共支付者的角度，我们比较了每月直接医疗费用、bDMARDs处方量和年度医院就诊频率。结果共匹配6784例患者，平均年龄73.5岁，女性73.2%。与非SI组（608.3美元；95%可信区间[CI]: 598.3-618.4; P < 0.05）相比，SI组每月的医疗保健费用更高（774.0美元；95%可信区间[CI]: 763.3-784.6）。bdmard处方量在SI组更大（2.9 vs 1.9单位/患者/月；P < 0.05）。然而，SI组的年度医院就诊次数明显减少（9.5次vs 25.0次/年；P < 0.05）。结论si增加了直接成本，因为bdmard的使用率更高，但减少了医院就诊次数，表明可能节省间接成本。这些发现可能支持未来类风湿关节炎的报销和护理模式。

{"title":"Economic Impact of Self-Injected Biologics for Rheumatoid Arthritis in Japan: A Propensity Score-Matched Analysis From a Public Healthcare Payer Perspective","authors":"Kazuhiko Takahata MSc , Shingo Akutsu , Eiichi Tanaka MD, PhD , Ryoko Sakai PhD, MPH , Manabu Akazawa PhD, MPH","doi":"10.1016/j.vhri.2025.101511","DOIUrl":"10.1016/j.vhri.2025.101511","url":null,"abstract":"<div><h3>Objectives</h3><div>Rheumatoid arthritis (RA) is a chronic inflammatory disease commonly treated with high-cost biologic disease-modifying antirheumatic drugs (bDMARDs). As of May 2025, 12 bDMARDs (9 originators and 3 biosimilars) are approved in Japan, with 10 available for self-injection (SI). Although SI may reduce hospital visits, its overall impact on prescribing patterns and healthcare costs remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using Japanese health insurance claims data (DeSC Healthcare, April 2014-August 2023). Patients with RA were identified based on diagnostic codes and bDMARDs prescriptions. Patients initiating SI within 3 months of their first bDMARD prescription were classified as the SI group; others were assigned to the non-SI group. Propensity score matching (1:1) was performed using 25 covariates. From the public payer’s perspective, we compared monthly direct healthcare costs, bDMARDs prescription volume, and annual hospital visit frequency.</div></div><div><h3>Results</h3><div>A total of 6784 patients were matched (mean age: 73.5 years; 73.2% female). The SI group incurred higher monthly healthcare costs ($774.0; 95% confidence interval [CI]: 763.3-784.6) compared with the non-SI group ($608.3; 95% CI 598.3-618.4; <em>P</em> < .05). bDMARDs prescription volume was greater in the SI group (2.9 vs 1.9 units/patient/month; <em>P</em> < .05). However, the SI group had significantly fewer annual hospital visits (9.5 vs 25.0 visits/year; <em>P</em> < .05).</div></div><div><h3>Conclusions</h3><div>SI increased direct costs because of higher bDMARDs utilization but reduced hospital visits, suggesting a potential for indirect cost savings. These findings may support future reimbursement and care models for RA.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"53 ","pages":"Article 101511"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365171","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