Value in health regional issues最新文献_第4页

Measurement Properties and Cross-Cultural Invariance of the French Decisional Conflict Scale in Chronic Pain: Secondary Analysis of the DECIDE-PAIN Survey 法国慢性疼痛决策冲突量表的测量特性和跨文化不变性：decision - Pain调查的二次分析

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-11-29 DOI: 10.1016/j.vhri.2025.101551

Florian Naye PhD , Maxime Sasseville PhD , Karine Toupin-April PhD , France Légaré PhD , Chloé Cachinho MSc , Thomas Gérard MSc , Valentin Vaillant MSc , Alison M. Hoens MSc , Yannick Tousignant-Laflamme PhD , Simon Décary PhD

Objectives

Evidence on the validity of the French version of the Decisional Conflict Scale (DCS) remains limited, especially among people living with chronic noncancer pain in Canada. This study examined the measurement properties of the French 16-item DCS and assessed its cross-cultural measurement invariance in this population.

Methods

We conducted a secondary analysis of a pan-Canadian cross-sectional online survey following the Consensus-Based Standards for the Selection of Health Measurement Instruments guidance. We evaluated score distribution, including ceiling and floor effects. We assessed readability, internal consistency, structural validity of a hypothesized 5-factor model, and convergent and discriminant validities. We tested measurement invariance between the French and English versions.

Results

We analyzed data from 270 French-speaking Canadians (mean age = 51; 60% male; 54.8% with less than a university diploma; and 70.4% with limited health literacy). The French DCS showed good readability (Flesch-Kincaid Grade Level: 5.6), no ceiling or floor effects for the total score, and high internal consistency (ω = 0.95). The 5-factor structure was supported (CFI = 0.98). Convergent validity was confirmed (AVE: 0.61-0.72), but discriminant validity was poor (AVE < squared interfactor correlations). Measurement invariance was supported at configural, metric, scalar, and strict levels when compared with 985 English-speaking respondents (mean age = 51; 47.5% male; 50% with less than a university diploma; and 71.3% with limited health literacy).

Conclusions

The French 16-item DCS has acceptable measurement properties and cross-cultural measurement invariance in people living with chronic noncancer pain. Further research is necessary to enhance its validity, possibly by reexamining its factor structure.

关于法语版决策冲突量表（DCS）有效性的证据仍然有限，特别是在加拿大患有慢性非癌性疼痛的人群中。本研究考察了法语16项DCS的测量特性，并评估了其在该人群中的跨文化测量不变性。方法：我们根据基于共识的健康测量工具选择标准指南，对一项泛加拿大横断面在线调查进行了二次分析。我们评估了分数分布，包括上限和下限效应。我们评估了一个假设的五因素模型的可读性、内部一致性、结构效度以及收敛效度和判别效度。我们测试了法语和英语版本之间的测量不变性。结果：我们分析了270名讲法语的加拿大人的数据（平均年龄为51岁，60%为男性，54.8%的人没有大学文凭，70.4%的人健康知识有限）。法语DCS具有良好的可读性（Flesch-Kincaid Grade Level: 5.6），总分没有上限或下限效应，内部一致性高（ω = 0.95）。5因子结构得到支持（CFI = 0.98）。收敛效度得到证实（AVE: 0.61-0.72），但区分效度较差（AVE <；因子间相关的平方）。与985名说英语的受访者（平均年龄为51岁，47.5%为男性，50%低于大学文凭，71.3%健康知识有限）相比，测量不变性在构形、公制、标量和严格水平上得到了支持。结论法国16项DCS在慢性非癌性疼痛患者中具有可接受的测量特性和跨文化测量不变性。有必要进一步研究以提高其有效性，可能需要重新审视其因素结构。

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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 : 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

Cost-Effectiveness of Resmetirom for Metabolic Dysfunction-Associated Steatohepatitis in Brazil 雷舒美治疗巴西代谢功能障碍相关脂肪性肝炎的成本-效果

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-11-20 DOI: 10.1016/j.vhri.2025.101526

Windson Hebert Araújo Soares BPharm , Guilherme Grossi Lopes Cançado MD, MSc, PhD , André Soares Motta-Santos PhD

Objectives

To assess the cost-effectiveness of resmetirom for the treatment of metabolic dysfunction-associated steatohepatitis in Brazil.

Methods

A Markov model was developed using TreeAge Pro® 2009 from the perspective of the Brazilian public healthcare system. The model used a 20-year time horizon with annual cycles. Seven health states were included: absence of fibrosis (F0), mild to advanced fibrosis (F1, F2, and F3), cirrhosis (F4), liver transplantation, and mortality. Costs were reported in Brazilian reais (BRL) and purchasing power parity US dollars (PPP-USD), and outcomes were measured in quality-adjusted life-years (QALYs). Both deterministic and probabilistic sensitivity analyses were performed. Incremental cost-effectiveness ratios (ICERs) were compared with multiple willingness-to-pay thresholds to determine cost-effectiveness.

Results

Resmetirom demonstrated an average incremental cost of 121 762 PPP-USD and an incremental gain of 1.05 QALYs compared with placebo. The mean ICER was approximately 40 017 PPP-USD/QALY, with a symmetric distribution and moderate variability (30 869-50 234 PPP-USD/QALY). The ICER scatterplot showed a predominance in the northeast quadrant, with no instances of dominance. The model was consistent across variations in input parameters.

Conclusions

Resmetirom was more effective than placebo but incurred higher costs. From the healthcare system perspective, it was not considered cost-effective under Brazil’s conventional willingness-to-pay thresholds (1 to 3 times gross domestic product per capita per QALY) or thresholds based on opportunity cost. These findings underscore the need for caution in coverage and reimbursement decisions.

目的评估雷司替罗治疗巴西代谢功能障碍相关脂肪性肝炎的成本-效果。方法采用TreeAge Pro®2009软件从巴西公共卫生系统的角度建立马尔可夫模型。该模型使用了20年的时间范围，并以年为周期。包括7种健康状态：无纤维化（F0）、轻度至晚期纤维化（F1、F2和F3）、肝硬化（F4）、肝移植和死亡率。成本以巴西雷亚尔（BRL）和购买力平价美元（PPP-USD）报告，结果以质量调整生命年（QALYs）衡量。进行了确定性和概率敏感性分析。将增量成本-效果比（ICERs）与多个支付意愿阈值进行比较，以确定成本-效果。结果与安慰剂相比，resmetirom的平均增量成本为121 762 PPP-USD，增量收益为1.05 qaly。平均ICER约为40 017 PPP-USD/QALY，具有对称分布和中等变异性（30 869-50 234 PPP-USD/QALY）。ICER散点图显示东北象限为优势，无优势实例。该模型在输入参数的变化中是一致的。结论瑞司替龙的治疗效果优于安慰剂，但成本较高。从医疗保健系统的角度来看，在巴西传统的支付意愿阈值（每QALY人均国内生产总值的1至3倍）或基于机会成本的阈值下，它被认为不具有成本效益。这些发现强调了在覆盖范围和报销决定方面需要谨慎。

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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 : 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

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 : 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":"2025-11-18","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

Psychometric Performance of EQ-HWB and EQ-HWB-9 Self-Complete and Interviewer-Administered Versions in Literate, Low-Literacy, and Patient Populations in Indonesia EQ-HWB和EQ-HWB-9自填版本和访谈者管理版本在印尼识字、低识字和患者人群中的心理测量表现。

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-11-18 DOI: 10.1016/j.vhri.2025.101543

Fredrick Dermawan Purba MPsi, PhD, Psikolog , Grace Helena Firmansyah Putri MPsi, Psikolog , Putu Getsha Pradnyan Rarasati Mudita SPsi, MPsi

Objectives

This study aimed to evaluate the psychometric performance, including test-retest reliability, ceiling/floor effects, and construct validity of the interviewer-administered (IA) and self-completion (SC) versions of EQ Health and Well-being instrument (EQ-HWB) and EQ-HWB-9.

Methods

A longitudinal survey in Bandung, Indonesia, recruited 300 respondents using stratified quota sampling, comprising 200 literate individuals, 50 with low literacy or illiteracy, and 50 patients. Respondents completed EQ-HWB, EQ-5D-5L, and Warwick-Edinburgh Mental Well-being Scale using either IA or SC modes. Psychometric analyses included ceiling/floor effects, convergent and known-group validity, and test-retest reliability (Gwet’s AC2, intraclass correlation coefficients).

Results

The final sample (mean age 39.22 ± 15.81, 62.67% female) demonstrated ceiling effects on EQ-HWB items ranging from 24.0% (“Exhaustion”) to 86.33% (“Hearing”), with 5 items exceeding the 70% threshold. In contrast, EQ-HWB-9 showed lower ceiling effects, with only 1 item (“Getting around inside and outside”) reaching the ceiling criterion (71.67%). Strong IA-SC agreement was observed (eg, AC2 = 0.95 for “Getting around inside and outside”). In the illiterate subgroup, item-level agreement remained strong, and instrument-level reliability was acceptable, supporting the feasibility of interviewer administration in low-literacy populations. Convergent validity was established with EQ-5D-5L and Warwick-Edinburgh Mental Well-being Scale. Known-group comparisons based on EQ-VAS (<80 vs ≥80) and patient status showed significant discrimination.

Conclusions

To our knowledge, this is the first study to validate the experimental IA versions of EQ-HWB and EQ-HWB-9 in Indonesia. The findings support their robust psychometric properties and feasibility for use in low-literacy and patient populations.

目的：本研究旨在评估情商健康与幸福量表（EQ- hwb）和EQ- hwb -9 （EQ- hwb -9）的访谈者自编版本（IA）和自我完成版本（SC）的心理测量性能，包括重测信度、上限/下限效应和结构效度。方法：在印度尼西亚万隆进行纵向调查，采用分层配额抽样方法招募300名受访者，其中包括200名识字的人，50名低识字或文盲，以及50名患者。受访者使用IA或SC模式完成EQ-HWB、EQ-5D-5L和Warwick-Edinburgh心理健康量表。心理测量分析包括天花板/地板效应、收敛效度和已知组效度以及重测信度（Gwet的AC2，类内相关系数）。结果：最终样本（平均年龄39.22±15.81岁，女性62.67%）在EQ-HWB项目上表现出天花板效应，范围从24.0%（“疲惫”）到86.33%（“听力”），有5个项目超过70%的阈值。EQ-HWB-9的上限效应较低，只有1项（“室内外活动”）达到上限标准（71.67%）。观察到强IA-SC一致性（例如，“inside and outside”的AC2 = 0.95）。在文盲亚组中，项目水平的一致性仍然很强，工具水平的可靠性是可以接受的，支持在低识字率人群中采访者管理的可行性。采用EQ-5D-5L和Warwick-Edinburgh心理健康量表建立收敛效度。结论：据我们所知，这是印度尼西亚首次验证EQ-HWB和EQ-HWB-9实验IA版本的研究。这些发现支持了它们强大的心理测量特性和在低文化水平和患者群体中使用的可行性。

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引用次数: 0

Long-Term Changes in Health-Related Quality of Life and Economic Burden After a SARS-CoV-2 Infection: Analysis of the Long COVID Prospective Cohort Study in Nairobi SARS-CoV-2感染后健康相关生活质量和经济负担的长期变化：内罗毕长期COVID前瞻性队列研究分析

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-11-18 DOI: 10.1016/j.vhri.2025.101545

Ângela Jornada Ben MD, PhD , Isaac Kisiangani MSc , Idah Kinya MSc , Elke Wynberg PhD , Menno D. de Jong PhD , Constance Schultsz PhD , Gershim Asiki PhD , Anna Vassall PhD

Objectives

To characterize long-term changes in health-related quality of life (HRQoL) and factors associated with catastrophic expenditures and catastrophic costs after a SARS-CoV-2 infection.

Methods

Data from 291 participants of the Long COVID Prospective Cohort Study in Nairobi were analyzed. Participants were enrolled between 2022 and 2023 and followed up for 12 months. Possible factors and outcomes (HRQoL, catastrophic expenditures, and catastrophic costs) were measured every 3 months. Changes in outcomes over time were assessed using generalized estimating equations.

Results

HRQoL was significantly reduced by 11.4% (95% CI −16.3% to −6.5%), 8.6% (95% CI −12.5% to −4.6%), 6.1% (95% CI −10.5% to −1.8%), and 4.1% (95% CI −7.9% to −0.3%) at 6, 9, 12, and 15 months after a positive polymerase chain reaction test, respectively, compared with the period before COVID-19. HRQoL was significantly reduced by 3.3% (95% CI −6.2% to −0.5%), and 10.9% (95% CI −16.5% to −5.3%), respectively, in participants with any COVID-19-related symptoms or fatigue. Older age (odds ratio [OR] 5.83, 95% CI 2.11 to 16.15), no COVID-19 vaccination (OR 5.83, 95% CI 2.11 to 16.15), any COVID-19-related symptoms (OR 2.22, 95% CI 1.15 to 4.28), and pay cut or reduced income due to COVID-19-related symptoms (OR 17.36, 95% CI 2.28 to 132.07) were associated with high odds of experiencing catastrophic expenditures. Severe/critical SARS-CoV-2 infection (OR 4.77, 95% CI 1.72 to 13.25) and fatigue (OR 2.27, 95% CI 1.03 to 4.96) significantly increased the odds of experiencing catastrophic costs, whereas better HRQoL (OR 0.12, 95% CI 0.02 to 0.57) and social support (OR 0.30, 95% CI 0.09 to 0.93) decreased the odds.

Conclusions

HRQoL remains reduced up to 15 months after a SARS-CoV-2 infection compared with pre-COVID-19 levels, with participants in better health and socioeconomic status less likely to experience catastrophic expenditures and catastrophic costs.

目的：描述SARS-CoV-2感染后健康相关生活质量（HRQoL）的长期变化以及与灾难性支出和灾难性成本相关的因素。方法：对来自内罗毕的291名长期COVID前瞻性队列研究参与者的数据进行分析。参与者在2022年至2023年间注册，并随访了12个月。每3个月测量一次可能的因素和结果（HRQoL、灾难性支出和灾难性成本）。使用广义估计方程评估结果随时间的变化。结果：与COVID-19前相比，聚合酶链反应试验阳性后6、9、12和15个月，HRQoL分别显著降低11.4% （95% CI -16.3%至-6.5%）、8.6% （95% CI -12.5%至-4.6%）、6.1% （95% CI -10.5%至-1.8%）和4.1% （95% CI -7.9%至-0.3%）。在有任何与covid -19相关症状或疲劳的参与者中，HRQoL分别显着降低3.3% （95% CI -6.2%至-0.5%）和10.9% （95% CI -16.5%至-5.3%）。年龄较大（比值比[OR] 5.83, 95% CI 2.11至16.15）、未接种COVID-19疫苗（比值比[OR] 5.83, 95% CI 2.11至16.15）、任何与COVID-19相关的症状（比值比[OR] 2.22, 95% CI 1.15至4.28）以及因COVID-19相关症状导致的减薪或收入减少（比值比[OR] 17.36, 95% CI 2.28至132.07）与发生灾难性支出的高几率相关。严重/危重SARS-CoV-2感染（OR 4.77, 95% CI 1.72至13.25）和疲劳（OR 2.27, 95% CI 1.03至4.96）显著增加了经历灾难性成本的几率，而较好的HRQoL （OR 0.12, 95% CI 0.02至0.57）和社会支持（OR 0.30, 95% CI 0.09至0.93）降低了这一几率。结论：与covid -19前的水平相比，SARS-CoV-2感染后长达15个月的HRQoL仍然降低，健康状况和社会经济地位较好的参与者不太可能经历灾难性支出和灾难性成本。

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引用次数: 0

Real-World Data on Cervical Cancer: The Impact of 2020 COVID-19 Outbreak on the Treatment Patterns and Healthcare Resources Utilization in Brazilian Public Health System 宫颈癌的真实世界数据：2020年COVID-19疫情对巴西公共卫生系统治疗模式和医疗资源利用的影响

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-11-17 DOI: 10.1016/j.vhri.2025.101508

Thabata Martins do Carmo MSc , Maria Amelia Carlos Souto Maior Borba PhD , Paula de Mendonça Batista BPharm, Spc , Maria Aparecida do Carmo Rego MD, PhD , Mariana Papaleo Rosim PhD , Cicera Pimenta Marcelino MSc , Paula Cristina Pungartnik MSc , Ana Beatriz Machado de Almeida MSc , Angelica Carreira dos Santos PhD , Angélica Nogueira Rodrigues MD, PhD

Objectives

To assess the treatment patterns and healthcare resources utilization of patients with cervical cancer (CC) within the Brazilian public health system (SUS) in 2020 versus previous years, according to the stage of disease at the diagnosis.

Methods

An observational retrospective study was conducted using the data from SUS administrative database. The period of analysis comprised 2014 to 2019 for pre-COVID-19 pandemic period and 2020 for the first year of the COVID-19 pandemic. The study included patients with at least 1 claim under the ICD-10 code C53, and patients were classified as non-advanced CC (naCC) (stages I-II) and advanced CC (aCC) (stages III-IV).

Results

From 2014 to 2020, a total of 206 861 women were eligible, and staging information was available for 90 073 patients (43.5%) that composed the final cohort of this study. In the 2014 to 2019 period, 60.5% of patients had CC in advanced stages, whereas in 2020 the proportion was 63.3%. Between 2014 and 2019, chemoradiotherapy was the most common treatment for both naCC (37.4%) and aCC (42.4%). In 2020, chemoradiotherapy remained the top treatment for naCC (34.8%), whereas chemotherapy only (CT only) was the most performed treatment for aCC (40.2%). In 2020, the proportion of patients with at least 1 hospitalization and outpatient visits was lower across all stages.

Conclusions

The findings of this study underscore the need for targeted policy interventions to improve the postpandemic healthcare landscape in Brazil. Stakeholders should prioritize the development and implementation of public policies aimed at strengthening screening programs and promoting early diagnosis of CC.

目的：根据诊断时的疾病阶段，评估2020年巴西公共卫生系统（SUS）内宫颈癌（CC）患者的治疗模式和医疗资源利用情况。方法：利用SUS管理数据库的数据进行观察性回顾性研究。分析期间包括2014年至2019年（COVID-19大流行前期）和2020年（COVID-19大流行第一年）。该研究包括在ICD-10代码C53下至少有1项索赔的患者，患者分为非晚期CC (naCC) （I-II期）和晚期CC (aCC) （III-IV期）。结果：2014年至2020年，共有206861名女性入选，9073名（43.5%）患者的分期信息可获得，这些患者构成了本研究的最终队列。2014 - 2019年，晚期CC患者占60.5%，而2020年这一比例为63.3%。在2014年至2019年期间，放化疗是naCC（37.4%）和aCC（42.4%）最常见的治疗方法。2020年，放化疗仍然是naCC的首选治疗方法（34.8%），而化疗（仅CT）是aCC最常用的治疗方法（40.2%）。2020年，所有阶段至少住院和门诊一次的患者比例都较低。结论：本研究的结果强调需要有针对性的政策干预，以改善巴西大流行后的卫生保健状况。利益相关者应优先制定和实施旨在加强筛查项目和促进CC早期诊断的公共政策。

{"title":"Real-World Data on Cervical Cancer: The Impact of 2020 COVID-19 Outbreak on the Treatment Patterns and Healthcare Resources Utilization in Brazilian Public Health System","authors":"Thabata Martins do Carmo MSc , Maria Amelia Carlos Souto Maior Borba PhD , Paula de Mendonça Batista BPharm, Spc , Maria Aparecida do Carmo Rego MD, PhD , Mariana Papaleo Rosim PhD , Cicera Pimenta Marcelino MSc , Paula Cristina Pungartnik MSc , Ana Beatriz Machado de Almeida MSc , Angelica Carreira dos Santos PhD , Angélica Nogueira Rodrigues MD, PhD","doi":"10.1016/j.vhri.2025.101508","DOIUrl":"10.1016/j.vhri.2025.101508","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the treatment patterns and healthcare resources utilization of patients with cervical cancer (CC) within the Brazilian public health system (SUS) in 2020 versus previous years, according to the stage of disease at the diagnosis.</div></div><div><h3>Methods</h3><div>An observational retrospective study was conducted using the data from SUS administrative database. The period of analysis comprised 2014 to 2019 for pre-COVID-19 pandemic period and 2020 for the first year of the COVID-19 pandemic. The study included patients with at least 1 claim under the ICD-10 code C53, and patients were classified as non-advanced CC (naCC) (stages I-II) and advanced CC (aCC) (stages III-IV).</div></div><div><h3>Results</h3><div>From 2014 to 2020, a total of 206 861 women were eligible, and staging information was available for 90 073 patients (43.5%) that composed the final cohort of this study. In the 2014 to 2019 period, 60.5% of patients had CC in advanced stages, whereas in 2020 the proportion was 63.3%. Between 2014 and 2019, chemoradiotherapy was the most common treatment for both naCC (37.4%) and aCC (42.4%). In 2020, chemoradiotherapy remained the top treatment for naCC (34.8%), whereas chemotherapy only (CT only) was the most performed treatment for aCC (40.2%). In 2020, the proportion of patients with at least 1 hospitalization and outpatient visits was lower across all stages.</div></div><div><h3>Conclusions</h3><div>The findings of this study underscore the need for targeted policy interventions to improve the postpandemic healthcare landscape in Brazil. Stakeholders should prioritize the development and implementation of public policies aimed at strengthening screening programs and promoting early diagnosis of CC.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"52 ","pages":"Article 101508"},"PeriodicalIF":1.5,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551203","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

Navigating the Transition to Value-Based Healthcare in Saudi Arabia: A Qualitative Study of Policy-Maker Perspectives 导航过渡到以价值为基础的医疗保健在沙特阿拉伯：政策制定者视角的定性研究

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-11-13 DOI: 10.1016/j.vhri.2025.101544

Bayan A. Hariri MSc , Faisal M. Albagmi PhD , Afnan A. Aljaffary PhD

Objectives

This article examines the implementation of value-based healthcare (VBHC) in Saudi Arabia, focusing on policy makers’ and health system leaders’ perceptions of the challenges and facilitators to its adoption. The study aims to identify key factors that can inform policy and resource allocation in the context of the country’s healthcare transformation and Vision 2030 initiative.

Methods

A qualitative approach was used through interviews with system leaders, followed by an inductive thematic analysis to identify the challenges and facilitators of VBHC implementation.

Results

Four major themes were identified: (1) Health System Structure, (2) Health Financing Structures, (3) Data Governance, and (4) Knowledge Translation in the Health Workforce. Subthemes were categorized according to the challenges and facilitators described by the experts.

Conclusions

This study emphasizes that the success of VBHC in Saudi Arabia depends on a comprehensive transformation, not just isolated technical fixes. Addressing interconnected challenges through aligned incentives, data systems, and governance is essential for sustainable healthcare value.

本文考察了沙特阿拉伯实施基于价值的医疗保健（VBHC），重点关注政策制定者和卫生系统领导者对其采用的挑战和促进因素的看法。该研究旨在确定在该国医疗保健转型和2030年愿景倡议背景下可以为政策和资源分配提供信息的关键因素。方法通过对系统领导者的访谈，采用定性方法，然后进行归纳性专题分析，以确定VBHC实施的挑战和促进因素。结果确定了四个主要主题：(1)卫生系统结构，(2)卫生融资结构，(3)数据治理，(4)卫生人力资源的知识转化。根据专家描述的挑战和促进因素对分主题进行了分类。本研究强调，沙特阿拉伯VBHC的成功取决于全面的改造，而不仅仅是孤立的技术修复。通过一致的激励措施、数据系统和治理来应对相互关联的挑战，对于实现可持续的医疗保健价值至关重要。

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引用次数: 0

Evaluating the Performance of Claude 3.7 Sonnet in Data Extraction Automation for Systematic Literature Reviews 评价Claude 3.7十四行诗在数据提取自动化中的性能，用于系统文献综述。

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-11-11 DOI: 10.1016/j.vhri.2025.101539

Ellen Kasireddy MHSc, Cuthbert Chow MSc, Jun Collet MSc, Mir-Masoud Pourrahmat MSc, Mir Sohail Fazeli PhD

Objectives

To evaluate the performance of Claude 3.7 Sonnet in automating data extraction for systematic literature reviews (SLRs).

Methods

An artificial intelligence (AI) extraction model based on the Claude 3.7 Sonnet large language model was developed through a structured process, including targeted training using a master data list and selected full-text articles. The master data list enhanced the model’s contextual knowledge, guiding data extraction. Seven full-text articles from 4 oncology-focused treatment efficacy and safety SLRs were used for early testing and iterative refinement through error analysis. Model performance was then evaluated using 20 full-text articles, drawn from the same SLRs but not used for model development, and benchmarked against human extractions. Evaluation metrics included precision, recall, and F1 score. Extraction time was also compared across 3 different approaches: AI model-only, hybrid (AI model with human verification), and traditional human extraction.

Results

The AI model extracted 117 889 data points across 106 variables, achieving an overall precision of 98.2%, recall of 96.6%, and F1-score of 97.4%. Extraction performance was highest for Study Characteristics (precision: 97.7%, recall: 98.7%) and Participant Characteristics (precision: 97.3%, recall: 98.7%). Outcome data showed 96.4% recall and 98.7% precision. Intervention Characteristics achieved 97.5% precision and 94.6% recall. Extraction using the AI model alone averaged 4.5 minutes per article, compared with 64.5 minutes with the hybrid approach and approximately 240 minutes with traditional human extraction.

Conclusions

The Claude 3.7 Sonnet-based model demonstrated strong performance, supporting efficient and reliable AI-driven data extraction in oncology SLRs, with potential for broader applicability.

目的：评价Claude 3.7 Sonnet在系统文献综述（SLRs）中自动数据提取的性能。方法：基于Claude 3.7 Sonnet大语言模型，通过结构化的过程，包括使用主数据列表和选择的全文文章进行有针对性的训练，开发人工智能（AI）提取模型。主数据列表增强了模型的上下文知识，指导数据提取。来自4个肿瘤治疗疗效和安全性slr的7篇全文文章被用于早期测试和通过误差分析进行迭代改进。然后使用20篇全文文章对模型性能进行评估，这些文章取自相同的单反，但不用于模型开发，并对人类提取进行基准测试。评估指标包括准确率、召回率和F1分数。还比较了三种不同方法的提取时间：仅人工智能模型、混合（人工验证的人工智能模型）和传统的人工提取。结果：人工智能模型在106个变量中提取了117889个数据点，总体精度为98.2%，召回率为96.6%，f1得分为97.4%。研究特征（精密度：97.7%，召回率：98.7%）和参与者特征（精密度：97.3%，召回率：98.7%）的提取性能最高。结果数据显示召回率为96.4%，准确率为98.7%。干预特征的准确率为97.5%，召回率为94.6%。单独使用人工智能模型的提取平均每篇文章4.5分钟，而混合方法的提取时间为64.5分钟，传统的人工提取时间约为240分钟。结论：基于Claude 3.7十四行诗的模型表现出强大的性能，支持高效可靠的ai驱动的肿瘤单反数据提取，具有更广泛的适用性。

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引用次数: 0