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

Cost-Utility Analysis of Adjuvant Osimertinib in Resected Epidermal-Growth-Factor-Receptor-Mutated Early-Stage Non-Small Cell Lung Cancer 奥西替尼佐剂治疗切除的表皮生长因子受体突变的早期非小细胞肺癌的成本-效用分析

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-12-26 DOI: 10.1016/j.vhri.2025.101567

Supitchaya Changsatja PharmD, MA , Chayanis Kositamongkol PharmD, MSc , Lucksamon Thamlikitkul MD, PhD , Pochamana Phisalprapa MD, PhD , Touchanun Komonpaisarn PhD

Objectives

Lung cancer is the most common cancer and the leading cause of cancer death worldwide. One-third of non-small cell lung cancer (NSCLC) patients are diagnosed at a resectable stage, for which surgery is the standard curative treatment. However, most patients recur within 2 years. Adjuvant osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, significantly reduces recurrence and prolongs survival in completely resected EGFR-mutated NSCLC. This study assessed the cost-utility and budget impact of adjuvant osimertinib versus placebo for resected stage IB-IIIA EGFR-mutated NSCLC from Thailand’s societal perspective.

Methods

A Markov model with a lifetime horizon and 4-week cycle was developed, including 3 health states: disease-free, recurrent disease, and death. Patients received osimertinib or placebo in the disease-free state, with recurrence categorized as locoregional or distant. Subsequent treatments were modeled based on recurrence timing. Health outcomes were obtained from a systematic review, and costs followed Thai health technology assessment guidelines. Results were reported as incremental cost-effectiveness ratios in 2023 USD per quality-adjusted life-years (QALY) gained. Sensitivity analyses addressed uncertainty.

Results

Osimertinib yielded 2.36 additional QALYs at an incremental cost of USD 62 604.90, with an incremental cost-effectiveness ratio of USD 26 474.02/QALY, exceeding Thailand’s willingness-to-pay threshold (USD 4619). An 85.07% price reduction is required for cost-effectiveness. Probabilistic sensitivity analysis showed 0% probability of cost-effectiveness at the current threshold, increasing to 52% at USD 25 981.97/QALY. The 5-year budget impact analysis was estimated at USD 678.73 million.

Conclusions

Adjuvant osimertinib is not cost-effective in Thailand under current pricing but could be with major price reductions or risk-sharing strategies.

目的肺癌是世界上最常见的癌症，也是癌症死亡的主要原因。三分之一的非小细胞肺癌（NSCLC）患者被诊断为可切除阶段，手术是标准的治疗方法。然而，大多数患者在2年内复发。佐剂奥希替尼是第三代表皮生长因子受体（EGFR）酪氨酸激酶抑制剂，可显著降低完全切除的EGFR突变的NSCLC的复发并延长生存期。本研究从泰国的社会角度评估了辅助奥希替尼与安慰剂对切除IB-IIIA期egfr突变NSCLC的成本效用和预算影响。方法建立生命周期为4周的马尔可夫模型，包括无病、复发和死亡3种健康状态。患者在无病状态下接受奥西替尼或安慰剂治疗，复发分为局部或远处。根据复发时间对后续治疗进行建模。通过系统审查获得了健康结果，费用遵循泰国卫生技术评估指南。结果报告为每质量调整生命年（QALY）获得2023美元的增量成本-效果比。敏感性分析解决了不确定性。结果索司替尼额外获得2.36个QALY，增量成本为62 604.90美元，增量成本-效果比为26 474.02美元/QALY，超过泰国的支付意愿阈值（4619美元）。为了达到成本效益，需要降价85.07%。概率敏感性分析显示，在当前阈值下成本-效果的概率为0%，在25 981.97美元/QALY时增加到52%。5年预算影响分析估计为6.7873亿美元。结论在目前的价格下，辅助用药奥希替尼在泰国不具有成本效益，但可以采用大幅降价或风险分担策略。

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引用次数: 0

Cost-Utility and Budget Impact Analysis of Pharmacogenetic-Guided Antiplatelet Therapy for Acute Coronary Syndrome in Thailand 泰国药物遗传学引导的急性冠脉综合征抗血小板治疗的成本-效用和预算影响分析。

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-12-24 DOI: 10.1016/j.vhri.2025.101565

Nathapol Samprasit MPharm , Nattanichcha Kulthanachairojana PhD , Chamipa Phanudulkitti PhD , Jatapat Hemapanpairoa PharmD

Objectives

Pharmacogenetic (PGx) testing for CYP2C19 genotypes offers a precision medicine approach to dual antiplatelet therapy in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). PGx testing is limited in Thailand because of policy constraints. This study evaluated the cost-utility and budget impact of PGx-guided dual antiplatelet therapy compared with universal clopidogrel in Thailand.

Methods

A hybrid decision tree and Markov model were developed to estimate lifetime costs and health outcomes for patients with post-PCI ACS from a societal perspective. The model compared universal clopidogrel with 2 PGx-guided strategies for CYP2C19 loss-of-function allele carriers. Key outcomes included life-years and quality-adjusted life-years (QALYs) gained. One-way and probabilistic sensitivity analyses were conducted to assess model uncertainty. A 5-year budget impact analysis was performed from a payer perspective.

Results

Compared with universal clopidogrel, the PGx-guided ticagrelor strategy was dominant with lower costs and higher QALYs. The PGx-guided prasugrel strategy exceeded the willingness-to-pay threshold, with an incremental cost-effectiveness ratio of 247 604 Thai Baht (THB)/QALY. Probabilistic sensitivity analyses indicated a 99.9% probability that the ticagrelor strategy would be a cost-effective strategy at the Thai willingness-to-pay threshold. The 5-year budget impact analysis, assuming 100% access to PGx testing, estimated a budget saving of 240.54 million THB for ticagrelor. In contrast, prasugrel was associated with an additional requirement of 1520.89 million THB.

Conclusions

In Thailand’s healthcare setting, PGx-guided ticagrelor is a dominant strategy for patients with post-PCI ACS. These findings support revising the National List of Essential Medicines to incorporate genotype-guided prescribing and enable broader access to precision medicine.

目的：CYP2C19基因型的药物遗传学（PGx）检测为急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）的双重抗血小板治疗提供了一种精准医学方法。由于政策限制，PGx检测在泰国受到限制。本研究评估了泰国pgx引导的双重抗血小板治疗与通用氯吡格雷的成本效用和预算影响。方法：采用混合决策树和马尔可夫模型，从社会角度估计pci后ACS患者的终身成本和健康结果。该模型比较了通用氯吡格雷与2种pgx引导的CYP2C19功能缺失等位基因携带者策略。主要结局包括获得的生命年和质量调整生命年（QALYs）。进行了单向和概率敏感性分析来评估模型的不确定性。从付款人的角度进行了5年预算影响分析。结果：与通用氯吡格雷相比，pgx引导的替格瑞洛策略具有更低的成本和更高的qaly优势。pgx指导的普拉格雷策略超过了支付意愿阈值，增量成本-效果比为247 604泰铢/QALY。概率敏感性分析表明，在泰国人的支付意愿阈值上，替格瑞洛策略具有成本效益的概率为99.9%。5年预算影响分析，假设100%获得PGx检测，估计替格瑞洛可节省预算2.4054亿泰铢。相比之下，普拉格雷与152089万泰铢的额外需求相关。结论：在泰国的医疗环境中，pgx引导的替格瑞洛是pci后ACS患者的主要策略。这些发现支持修订《国家基本药物清单》，以纳入基因型指导处方，并使更广泛地获得精准医疗。

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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 : 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

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 : 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

Economic Evaluation of a Problem-Solving Intervention With Workplace Involvement Among Employees With Common Mental Disorder in Swedish Primary Care: Results From a Cluster-Randomized Controlled Trial 瑞典初级保健中常见精神障碍员工工作场所参与问题解决干预的经济评价：来自一项集群随机对照试验的结果。

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-12-16 DOI: 10.1016/j.vhri.2025.101558

Hanna Gyllensten PhD , Gunnar Bergström PhD , Sara Freyland MSc , Elisabeth Björk Brämberg PhD

Objectives

The aim of this study was to evaluate the cost-effectiveness of a problem-solving intervention with workplace involvement (PSI-WPI) compared with care as usual (CAU) among employees on sick leave due to common mental disorders in Swedish primary healthcare centers.

Methods

Employees aged 18 to 59 years on sick leave for common mental disorders (n = 197) were included in a controlled cluster-randomized trial by coordinators (n = 19) recruited at primary care centers in Region Västra Götaland, Sweden. The study was conducted between February 2018 and August 2021, with 18 months of follow-up per participant. The economic evaluation included a cost-effectiveness analysis comparing changes in sick leave with direct costs from a healthcare perspective, calculated from register data, and intervention costs; a cost-utility analysis based on EQ-5D questionnaires and a societal perspective included indirect costs calculated from registered sick leave. Sensitivity analyses explored robustness to alternative missingness assumptions.

Results

The PSI-WPI resulted in more sickness absence (average 40 extra days; 95% confidence interval, 3-77 days) compared with CAU and higher healthcare costs (SEK 21 650, SEK 4962-48 262) over 18 months. At 12 months, the cost of care was SEK 23 734 (SEK 537-46 931) higher in the PSI-WPI group. The difference in quality-adjusted life-years between the groups was negligible. The sensitivity analysis indicated robust results, and diagnoses not targeted by the study were important cost drivers.

Conclusions

The PSI-WPI was not cost-effective for employees on sick leave due to common mental disorders compared with CAU only.

目的：本研究的目的是评估在瑞典初级卫生保健中心因常见精神障碍而请病假的员工中，工作场所参与解决问题干预（PSI-WPI）与照护（CAU）相比的成本效益。方法：在瑞典Västra Götaland地区的初级保健中心招募协调员（n = 19），将年龄在18至59岁因常见精神障碍请病假的员工（n = 197）纳入一项对照聚类随机试验。该研究于2018年2月至2021年8月进行，每位参与者随访18个月。经济评估包括成本效益分析，比较病假的变化与医疗保健角度的直接成本（根据登记数据计算）和干预成本；基于EQ-5D问卷和社会视角的成本效用分析包括从登记病假计算的间接成本。敏感性分析探讨了对替代缺失假设的稳健性。结果：与CAU相比，PSI-WPI在18个月内导致更多的病假（平均多40天；95%置信区间，3-77天）和更高的医疗费用（21 650瑞典克朗，4962-48 262瑞典克朗）。在12个月时，PSI-WPI组的护理费用高出23734瑞典克朗（537- 46931瑞典克朗）。两组间质量调整寿命年的差异可以忽略不计。敏感性分析显示了可靠的结果，研究未针对的诊断是重要的成本驱动因素。结论：与CAU相比，PSI-WPI对因常见精神障碍而请病假的员工不具有成本效益。

{"title":"Economic Evaluation of a Problem-Solving Intervention With Workplace Involvement Among Employees With Common Mental Disorder in Swedish Primary Care: Results From a Cluster-Randomized Controlled Trial","authors":"Hanna Gyllensten PhD , Gunnar Bergström PhD , Sara Freyland MSc , Elisabeth Björk Brämberg PhD","doi":"10.1016/j.vhri.2025.101558","DOIUrl":"10.1016/j.vhri.2025.101558","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this study was to evaluate the cost-effectiveness of a problem-solving intervention with workplace involvement (PSI-WPI) compared with care as usual (CAU) among employees on sick leave due to common mental disorders in Swedish primary healthcare centers.</div></div><div><h3>Methods</h3><div>Employees aged 18 to 59 years on sick leave for common mental disorders (<em>n</em> = 197) were included in a controlled cluster-randomized trial by coordinators (<em>n</em> = 19) recruited at primary care centers in Region Västra Götaland, Sweden. The study was conducted between February 2018 and August 2021, with 18 months of follow-up per participant. The economic evaluation included a cost-effectiveness analysis comparing changes in sick leave with direct costs from a healthcare perspective, calculated from register data, and intervention costs; a cost-utility analysis based on EQ-5D questionnaires and a societal perspective included indirect costs calculated from registered sick leave. Sensitivity analyses explored robustness to alternative missingness assumptions.</div></div><div><h3>Results</h3><div>The PSI-WPI resulted in more sickness absence (average 40 extra days; 95% confidence interval, 3-77 days) compared with CAU and higher healthcare costs (SEK 21 650, SEK 4962-48 262) over 18 months. At 12 months, the cost of care was SEK 23 734 (SEK 537-46 931) higher in the PSI-WPI group. The difference in quality-adjusted life-years between the groups was negligible. The sensitivity analysis indicated robust results, and diagnoses not targeted by the study were important cost drivers.</div></div><div><h3>Conclusions</h3><div>The PSI-WPI was not cost-effective for employees on sick leave due to common mental disorders compared with CAU only.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"54 ","pages":"Article 101558"},"PeriodicalIF":1.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145775945","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

Learning From Local Contexts: Practical Pathways Toward Health Equity 从当地情况学习：实现卫生公平的实际途径。

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-12-13 DOI: 10.1016/j.vhri.2025.101563

Stacey Kowal MSc

引用次数: 0

What Role Does Equity Play in Australia’s Health Technology Assessment Processes? A Review of the Pharmaceutical Benefits Advisory Committee Recommendations Regarding Vaccines 公平在澳大利亚卫生技术评估过程中扮演什么角色？药品效益咨询委员会关于疫苗的建议综述

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-12-13 DOI: 10.1016/j.vhri.2025.101559

Marie-Anne Boujaoude MEc , Nancy Devlin PhD , Mackenzie Bourke MHealthEc , Kim Dalziel PhD , Natalie Carvalho PhD

Objective

The Australian Pharmaceutical Benefits Advisory Committee (PBAC) makes recommendations to the government on the listing of vaccines on the National Immunisation Program. This health technology assessment body considers evidence on comparative effectiveness, safety, cost-effectiveness, financial implications, and other factors such as equity. This study aimed to identify which aspects of equity have been considered and how they are incorporated in PBAC recommendations.

Methods

We reviewed vaccine public summary documents published by PBAC from 2005 to 2024. We extracted and summarized information from the submissions including variables reflecting equity-specific dimensions mentioned or considered in the evaluation and quantitative equity-informative methods used.

Results

Equity-related dimensions mentioned were presence of special healthcare needs and past health loss (55% of reviewed public summary documents); race, denoting Aboriginal and Torres Strait Islander peoples (47%); gender (14%); pregnancy (6%); parental status (4%); geographic location (6%); socioeconomic status (3%); culturally and linguistically diverse groups (1%); sexual orientation (1%); and refugee status (1%). Subgroup analysis, in 21% of the vaccine submissions, was the only quantitative method used to address distributional concerns. Equity dimensions and subgroup analysis appeared more frequently in resubmissions and from 2021 to 2024.

Conclusions

Despite increasing mentions of many equity-relevant dimensions, limited equity-informative economic evaluation methods are being used in vaccine submissions. This review provides a pivotal opportunity to advocate for (1) a better understanding of decision makers’ needs and preferences around the integration of equity-informative methods, (2) greater transparency and more detailed documentation of deliberations, and (3) clearer guidance on presenting equity-relevant evidence in submissions.

目的澳大利亚药品利益咨询委员会（PBAC）就国家免疫规划的疫苗清单向政府提出建议。该卫生技术评估机构考虑有关相对有效性、安全性、成本效益、财务影响以及公平性等其他因素的证据。本研究旨在确定公平的哪些方面已被考虑，以及它们如何被纳入PBAC的建议。方法回顾2005 ~ 2024年PBAC发表的疫苗公开摘要文件。我们从提交的信息中提取和总结信息，包括反映评估中提到或考虑的股票特定维度的变量和使用的定量股票信息方法。结果与安全性相关的维度包括存在特殊医疗需求和过去的健康损失（55%的被审查的公共摘要文件）；种族，指土著人和托雷斯海峡岛民（47%）；性别(14%);怀孕(6%);父母身份（4%）；地理位置（6%）；社会经济地位（3%）；文化和语言多样化群体（1%）；性取向（1%）；难民身份（1%）。在21%的疫苗提交中，亚组分析是用于解决分配问题的唯一定量方法。从2021年到2024年，股权维度和亚组分析在重新提交中出现的频率更高。尽管越来越多地提到了许多与公平相关的维度，但在疫苗提交中使用的是有限的公平信息经济评估方法。这篇综述提供了一个关键的机会来倡导(1)更好地理解决策者在整合股权信息方法方面的需求和偏好，(2)提高透明度和更详细的审议文件，以及(3)在提交文件中提供更清晰的股权相关证据指导。

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引用次数: 0

Custo-Efetividade da Teriparatida em Homens com Osteoporose Grave no Brasil 特利帕肽治疗巴西男性严重骨质疏松症的成本-效果

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-12-12 DOI: 10.1016/j.vhri.2025.101553

Cid Manso de Mello Vianna PhD , Gabriela Bittencourt Gonzalez Mosegui PhD , Tácio de Mendonça Lima PhD , Tayna Felicíssimo Gomes de Souza Bandeira MS , Marcus Paulo da Silva Rodrigues PhD

Objectives

To calculate the cost-effectiveness ratio and the budget impact of teriparatide use in men with severe osteoporosis and history of fractures in Brazil.

Methods

Three hypothetical cohorts of men with severe osteoporosis and history of fracture, with initial ages of 50, 60, and 70 years, were simulated using a Markov Model to calculate the cost-effectiveness ratio between teriparatide and alendronate and risedronate, from the perspective of the Unified Health System (SUS). The time horizon was 10 years, with cycles of 1 year. Effectiveness outcomes were measured in quality-adjusted life-years (QALY). Deterministic and probabilistic sensitivity analyses were performed.

Results

Teriparatide compared with alendronate and risedronate has an incremental cost-effectiveness ratio of 77,002/79,808 R$/QALY, 305,435/439,636 R$/QALY, and 327,869/460,333 R$/QALY for 50, 60, and 70 years, respectively. The deterministic and probabilistic evaluations did not produce results that altered the previous conclusion and, in all situations, the teriparatide was not cost-effective for a threshold of R$ 40,000.00/QALY. The analysis of the budget impact estimated that the use of teriparatide for a market share of 60% in 5 years would have an additional cost of approximately R$ 187 million.

Conclusions

In the analyzed scenarios, the use of bisphosphonates produces resource savings in relation to teriparatide in the treatment of men. Teriparatide was not cost-effective in any situation.

目的计算特立帕肽在巴西重度骨质疏松和有骨折史的男性患者中的成本-效果比和预算影响。方法采用马尔可夫模型，从统一卫生系统（SUS）的角度计算特立帕肽与阿仑膦酸钠和利塞膦酸钠的成本-效果比，对初始年龄分别为50岁、60岁和70岁、有严重骨质疏松和骨折史的男性进行模拟。时间范围为10年，周期为1年。有效性结果以质量调整生命年（QALY）衡量。进行了确定性和概率敏感性分析。结果与阿仑膦酸钠和利塞膦酸钠相比，50年、60年和70年的增量成本-效果比分别为77,002/79,808 R$/QALY、305,435/439,636 R$/QALY和327,869/460,333 R$/QALY。确定性和概率评估没有产生改变先前结论的结果，在所有情况下，特立帕肽在40,000.00雷亚尔/QALY的阈值下都不具有成本效益。对预算影响的分析估计，在5年内使用特立帕肽以获得60%的市场份额将产生约1.87亿雷亚尔的额外费用。结论在分析的情况下，使用双膦酸盐在男性治疗中比使用特立帕肽节省了资源。特立帕肽在任何情况下都不具有成本效益。

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引用次数: 0

Adapting a Benefit Trade-Off Instrument to Measure Health Inequality Aversion in the United States 采用利益权衡工具来衡量美国人对健康不平等的厌恶

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-12-12 DOI: 10.1016/j.vhri.2025.101556

Salome Ricci PharmD, MS , Stacey Kowal MSc , Susan dosReis PhD , Julia F. Slejko PhD

Objectives

Health equity is increasingly central to healthcare decision making, necessitating robust methods to incorporate equity considerations into health technology assessment. The benefit trade-off (BTO) approach measures health inequality aversion—how much total population health individuals would sacrifice to reduce health inequalities. However, these complex preference measurement tools need to be adapted and contextualized for use in different country settings. In this work, we aimed to adapt a BTO instrument, originally developed in the United Kingdom, to measure health inequality aversion in the United States general population.

Methods

We modified the BTO instrument through an iterative process that addressed US-specific contextual elements and technical comprehension requirements. We conducted 3 rounds of pretesting (n = 11) followed by pilot testing (n = 150) to optimize the instrument. The final BTO was implemented in an online survey completed by 2064 participants, recruited through a Qualtrics panel, with demographic quotas aligned to US Census data.

Results

Adaptation to enhance technical and conceptual comprehension included the development of localized instructional videos and implementation of new comprehension checks. Among complete responses, 63% provided valid responses suitable for inequality aversion parameter analysis, up from 33% in the initial pilot. The final sample was representative of US adults, although with higher age and educational attainment.

Conclusions

Our adaptation used a structured approach, similar to other ongoing studies, for measuring societal health inequality preferences. By achieving valid response rates in line with the original UK study, our US study adds to the evidence base for best practice guidance, informing future adaptations across different country settings.

卫生公平在卫生保健决策中越来越重要，因此需要强有力的方法将公平考虑纳入卫生技术评估。利益权衡（BTO）方法衡量的是对健康不平等的厌恶程度——为了减少健康不平等，总健康个体会牺牲多少。然而，这些复杂的偏好测量工具需要进行调整，并根据不同国家的情况加以使用。在这项工作中，我们的目标是采用最初在英国开发的BTO工具来衡量美国普通人群对健康不平等的厌恶。方法：我们通过一个迭代过程修改了BTO仪器，以解决美国特定的上下文元素和技术理解要求。我们进行了3轮预试（n = 11）和中试（n = 150）来优化仪器。最终的BTO是在一项由2064名参与者完成的在线调查中实施的，这些参与者是通过qualics小组招募的，人口配额与美国人口普查数据一致。结果提高技术和概念理解的适应措施包括开发本地化教学视频和实施新的理解测试。在完整的回答中，63%的人提供了适合不平等厌恶参数分析的有效回答，高于初始试点的33%。最后一个样本是具有代表性的美国成年人，尽管他们的年龄和受教育程度更高。与其他正在进行的研究类似，我们采用结构化方法来衡量社会健康不平等偏好。通过实现与英国原始研究一致的有效回复率，我们的美国研究增加了最佳实践指导的证据基础，为未来在不同国家环境下的适应提供了信息。

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引用次数: 0

Cost-Analysis of Adherence to Antimicrobial Guidelines as Part of Antimicrobial Stewardship Strategies in 6 Latin American Countries: A Pilot Experience Focusing on Economic Impact 6个拉丁美洲国家遵守抗微生物药物指南作为抗微生物药物管理战略一部分的成本分析：侧重于经济影响的试点经验

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-12-12 DOI: 10.1016/j.vhri.2025.101550

Natalia Restrepo-Arbeláez MD, MPH , Elkin V. Lemos-Luengas MD, PhD , Juan Carlos García-Betancur PhD , Wanda Cornistein MD , Diogo Boldim-Ferreira MD , Rodrigo Ahumada MD , Jorge Chaverri-Murillo MD , Paulo Castañeda-Méndez MD , Luis Hercilla MD , María Virginia Villegas MD, MSc

Objectives

This study presents a pilot cost analysis and case-study comparison of adherence to antimicrobial stewardship (AMS) guidelines across 6 high-complexity healthcare institutions in Latin America and the Caribbean. It aims to evaluate the economic impact of adhering to these guidelines in hospitals implementing step-by-step processes to establish AMS programs within their institutions.

Methods

A multicenter, retrospective, observational study was conducted in Argentina, Brazil, Chile, Costa Rica, United Mexican States, and Peru. A standardized Cost Report Form collected data on 2 comparable patients per institution, 1 treated according to AMS guidelines and 1 without adherence. Data included hospitalization days, intensive care unit costs, antibiotic use, and total management expenses, converted to US dollars. A sensitivity analysis varied key cost parameters (hospitalization, intensive care unit stays, and antibiotics) by ±20% to assess cost stability.

Results

Adherence to AMS guidelines led to hospitalization net cost reductions across all institutions: Peru (57.8%), Argentina (49.6%), United Mexican States (38.9%), Brazil (2.6%), Chile (10.2%), and Costa Rica (7.6%). Daily cost savings per patient ranged from US dollars $3 (Brazil) to $570 (Peru). Sensitivity analysis confirmed stability under varying conditions, with adjusted savings from $810 to $9.999.

Conclusions

This case-study highlights the economic benefits of AMS adherence, including reduced hospitalization and antibiotic costs. Findings provide insights supporting AMS program expansion across Latin America and the Caribbean healthcare systems to optimize resources.

目的：本研究对拉丁美洲和加勒比地区6家高复杂性医疗机构抗菌剂管理（AMS）指南的遵守情况进行了试点成本分析和案例研究比较。它的目的是评估遵守这些指导方针的经济影响，在医院实施逐步的过程，在他们的机构内建立辅助医疗系统。方法在阿根廷、巴西、智利、哥斯达黎加、墨西哥合众国和秘鲁进行了一项多中心回顾性观察研究。一份标准化的成本报告表收集了每家机构2名可比较患者的数据，1名患者按照AMS指南治疗，1名患者没有依从治疗。数据包括住院天数、重症监护病房费用、抗生素使用和折合成美元的总管理费用。敏感性分析将关键成本参数（住院、重症监护病房和抗生素）变化±20%，以评估成本稳定性。结果：秘鲁（57.8%）、阿根廷（49.6%）、美国（38.9%）、巴西（2.6%）、智利（10.2%）和哥斯达黎加（7.6%）等所有机构的住院净成本均因遵循AMS指南而降低。每位患者每天节省的费用从3美元（巴西）到570美元（秘鲁）不等。敏感性分析证实了在不同条件下的稳定性，调整后的节省从810美元到9.999美元。本案例研究强调了AMS依从性的经济效益，包括减少住院和抗生素费用。研究结果为支持AMS项目在拉丁美洲和加勒比地区医疗保健系统的扩展提供了见解，以优化资源。

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