This letter offers a critical yet constructive reflection on the study by Pasenggong et al, which developed mapping algorithms to estimate EQ-5D-5L utility scores using the Impact of Vision Impairment questionnaire in Thai patients. We commend the methodological rigor and timely relevance of the work while expanding on its implications for real-world clinical utility, patient stratification, and policy making in Thai health economics. We propose additional perspectives on enhancing mapping precision and generalizability, especially for advanced vision impairment stages. This discussion provides a multidimensional synthesis, aiming to support the application of disease-specific tools in economic evaluations in low- and middle-income settings.
{"title":"Expanding the Utility of Vision-Specific Instruments in Thai Health Economic Evaluation: Reflections on Mapping Impact of Vision Impairment Questionnaire to EQ-5D-5L","authors":"Schawanya Kaewpitoon Rattanapitoon MD , Jun Norkaew MPH , Natnapa Heebkaew Padchasuwan PhD , Nathkapach Kaewpitoon Rattanapitoon PhD","doi":"10.1016/j.vhri.2025.101541","DOIUrl":"10.1016/j.vhri.2025.101541","url":null,"abstract":"<div><div>This letter offers a critical yet constructive reflection on the study by Pasenggong et al, which developed mapping algorithms to estimate EQ-5D-5L utility scores using the Impact of Vision Impairment questionnaire in Thai patients. We commend the methodological rigor and timely relevance of the work while expanding on its implications for real-world clinical utility, patient stratification, and policy making in Thai health economics. We propose additional perspectives on enhancing mapping precision and generalizability, especially for advanced vision impairment stages. This discussion provides a multidimensional synthesis, aiming to support the application of disease-specific tools in economic evaluations in low- and middle-income settings.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"52 ","pages":"Article 101541"},"PeriodicalIF":1.5,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496676","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}
Pub Date : 2025-11-10DOI: 10.1016/j.vhri.2025.101540
Samer A. Kharroubi PhD , Donna Rowen PhD , Rouba Ballout MSc
Objectives
Lebanon’s socio-economic situation has deteriorated significantly in recent years, a decline further exacerbated by the COVID-19 pandemic. This multifaceted crisis may have shaped how individuals perceive and value different health states. The primary objective of this study was to assess and compare health state preferences of the general Lebanese population before and after the COVID-19 pandemic using the Short Form 6-dimension (SF-6D) measure. A secondary objective was to identify key predictors of these preferences, including sociodemographic, health, and lifestyle factors.
Methods
A cross-sectional study was conducted before and after the pandemic. A total of 249 SF-6D-defined health states were valued by 577 participants from the general population using standard gamble. Independent-samples t tests and chi-square analyses examined differences in characteristics, whereas linear regression models identified predictors of SF-6D utility scores.
Results
Data from 553 eligible respondents provided 3308 valuations: 1813 from 303 respondents pre-COVID (July-October 2019) and 1495 from 250 respondents post-COVID (February-July 2022). Results showed a significant shift in health state preferences post-COVID, with higher mean utility scores (pre-COVID: 0.646 ± 0.284; post-COVID: 0.719 ± 0.258). Multiple regression analysis, adjusting for sociodemographic and health state dimensions, identified time (pre/post-COVID) (B = 0.070; P < .001), number of children ≤ 14 (B = −0.017; P < .001), educational (B = 0.006; P = .039), smoking (B = −0.006; P < .001), and health conditions such as asthma (B = 0.028; P = .024) and liver problems (B = 0.055; P = .006) as significant predictors.
Conclusions
This study highlights important shifts in health state preferences in Lebanon post-COVID. The influence of family burden and lifestyle factors on valuations has implications for public health policy, particularly when relying on prepandemic data.
目标：近年来，黎巴嫩的社会经济状况严重恶化，COVID-19大流行进一步加剧了这种恶化。这种多方面的危机可能影响了个人对不同健康状态的看法和价值。本研究的主要目的是使用短格式6维（SF-6D）测量方法评估和比较黎巴嫩普通人群在COVID-19大流行前后的健康状况偏好。第二个目标是确定这些偏好的关键预测因素，包括社会人口、健康和生活方式因素。方法：在大流行前后进行横断面研究。来自普通人群的577名参与者使用标准赌博对总共249种sf - 6d定义的健康状态进行了评估。独立样本t检验和卡方分析检验了特征差异，而线性回归模型确定了SF-6D效用得分的预测因子。结果：来自553名合格受访者的数据提供了3308个估值：来自covid前（2019年7月至10月）的303名受访者提供了1813个估值，来自covid后（2022年2月至7月）的250名受访者提供了1495个估值。结果显示，冠状病毒感染后，健康状态偏好发生了显著变化，平均效用得分更高（冠前：0.646±0.284；冠后：0.719±0.258）。多元回归分析，调整社会人口统计学和健康状况维度，确定时间（covid前/后）（B = 0.070, P < 0.001）、儿童人数≤14 （B = -0.017, P < 0.001）、教育程度（B = 0.006, P = 0.039）、吸烟（B = -0.006, P < 0.001）和健康状况(如哮喘（B = 0.028, P = 0.024）和肝脏问题（B = 0.055, P = 0.006）为显著预测因素。结论：本研究突出了黎巴嫩疫情后健康状况偏好的重要变化。家庭负担和生活方式因素对估值的影响对公共卫生政策有影响，特别是在依赖大流行前数据时。
{"title":"Comparative Assessment of Short Form 6-Dimension Health State Preferences Among Lebanese Population Pre- and Post-COVID-19 Pandemic","authors":"Samer A. Kharroubi PhD , Donna Rowen PhD , Rouba Ballout MSc","doi":"10.1016/j.vhri.2025.101540","DOIUrl":"10.1016/j.vhri.2025.101540","url":null,"abstract":"<div><h3>Objectives</h3><div>Lebanon’s socio-economic situation has deteriorated significantly in recent years, a decline further exacerbated by the COVID-19 pandemic. This multifaceted crisis may have shaped how individuals perceive and value different health states. The primary objective of this study was to assess and compare health state preferences of the general Lebanese population before and after the COVID-19 pandemic using the Short Form 6-dimension (SF-6D) measure. A secondary objective was to identify key predictors of these preferences, including sociodemographic, health, and lifestyle factors.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted before and after the pandemic. A total of 249 SF-6D-defined health states were valued by 577 participants from the general population using standard gamble. Independent-samples <em>t</em> tests and chi-square analyses examined differences in characteristics, whereas linear regression models identified predictors of SF-6D utility scores.</div></div><div><h3>Results</h3><div>Data from 553 eligible respondents provided 3308 valuations: 1813 from 303 respondents pre-COVID (July-October 2019) and 1495 from 250 respondents post-COVID (February-July 2022). Results showed a significant shift in health state preferences post-COVID, with higher mean utility scores (pre-COVID: 0.646 ± 0.284; post-COVID: 0.719 ± 0.258). Multiple regression analysis, adjusting for sociodemographic and health state dimensions, identified time (pre/post-COVID) (B = 0.070; <em>P</em> < .001), number of children ≤ 14 (B = −0.017; <em>P</em> < .001), educational (B = 0.006; <em>P</em> = .039), smoking (B = −0.006; <em>P</em> < .001), and health conditions such as asthma (B = 0.028; <em>P</em> = .024) and liver problems (B = 0.055; <em>P</em> = .006) as significant predictors.</div></div><div><h3>Conclusions</h3><div>This study highlights important shifts in health state preferences in Lebanon post-COVID. The influence of family burden and lifestyle factors on valuations has implications for public health policy, particularly when relying on prepandemic data.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"53 ","pages":"Article 101540"},"PeriodicalIF":1.5,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496761","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}
Pub Date : 2025-11-07DOI: 10.1016/j.vhri.2025.101524
Marisa Santos PhD , Marcelo G. Correia MSc , Vanessa R. von Doellinger PhD , Sylvia Lordello MD , Andrea L. Monteiro PhD
Objectives
The EQ Health and Well-being (EQ-HWB) is an instrument designed to measure quality of life across health and social care. This study aimed to evaluate the responsiveness of the short version (EQ-HWB-9) in a Brazilian vulnerable population.
Methods
A pre- and postcohort design was used to evaluate the effects of a 6-month multidimensional social intervention. Data were collected at baseline and follow-up from 98 participants using an electronic questionnaire via REDCap, including official electronic versions of EQ-HWB-9, EQ-5D-5L, and the Perceived Change Scale. A single trained interviewer conducted all interviews. Known-groups comparisons and responsiveness were examined using descriptive statistics, paired tests (Wilcoxon and t tests), and subgroup analyses. Health index values were derived using validated scoring algorithms, including the UK value set for EQ-HWB-9 and the Brazilian EQ-5D-3L crosswalk for EQ-5D-5L.
Results
EQ-HWB-9 distinguished between groups with different health statuses and perceived changes. Significant improvements were observed from baseline to follow-up for EQ-HWB-9 and EQ-5D-5L (P < .001); Visual Analog Scale (VAS) scores had increased but were not statistically significant (P = .152).
Conclusions
In this pre-post cohort, EQ-HWB-9 detected 6-month improvements across multiple domains during a multidimensional program in Brazil, suggesting utility for outcome monitoring while not permitting causal inference.
{"title":"Assessing the Impact of a Social Program Using EQ-HWB-9 and EQ-5D-5L: The Dara Project","authors":"Marisa Santos PhD , Marcelo G. Correia MSc , Vanessa R. von Doellinger PhD , Sylvia Lordello MD , Andrea L. Monteiro PhD","doi":"10.1016/j.vhri.2025.101524","DOIUrl":"10.1016/j.vhri.2025.101524","url":null,"abstract":"<div><h3>Objectives</h3><div>The EQ Health and Well-being (EQ-HWB) is an instrument designed to measure quality of life across health and social care. This study aimed to evaluate the responsiveness of the short version (EQ-HWB-9) in a Brazilian vulnerable population.</div></div><div><h3>Methods</h3><div>A pre- and postcohort design was used to evaluate the effects of a 6-month multidimensional social intervention. Data were collected at baseline and follow-up from 98 participants using an electronic questionnaire via REDCap, including official electronic versions of EQ-HWB-9, EQ-5D-5L, and the Perceived Change Scale. A single trained interviewer conducted all interviews. Known-groups comparisons and responsiveness were examined using descriptive statistics, paired tests (Wilcoxon and <em>t</em> tests), and subgroup analyses. Health index values were derived using validated scoring algorithms, including the UK value set for EQ-HWB-9 and the Brazilian EQ-5D-3L crosswalk for EQ-5D-5L.</div></div><div><h3>Results</h3><div>EQ-HWB-9 distinguished between groups with different health statuses and perceived changes. Significant improvements were observed from baseline to follow-up for EQ-HWB-9 and EQ-5D-5L (<em>P</em> < .001); Visual Analog Scale (VAS) scores had increased but were not statistically significant (<em>P</em> = .152).</div></div><div><h3>Conclusions</h3><div>In this pre-post cohort, EQ-HWB-9 detected 6-month improvements across multiple domains during a multidimensional program in Brazil, suggesting utility for outcome monitoring while not permitting causal inference.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"53 ","pages":"Article 101524"},"PeriodicalIF":1.5,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467756","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}
This study aimed to evaluate the cost-utility of adding vericiguat to standard-of-care therapy for patients with heart failure with reduced ejection fraction (HFrEF) and worsening heart failure (HF) events in the context of Thailand’s healthcare system.
Methods
A Markov model using Microsoft Excel was conducted to simulate the lifetime economic outcomes of adding vericiguat to standard-of-care therapy (SoCT) compared with SoCT alone for Thai patients with HFrEF. Model parameters were derived from the VICTORIA trial and supplemented with local data on healthcare costs and utilities. Sensitivity, subgroup, and threshold analyses were also performed.
Results
Adding vericiguat to SoCT increased total life-years (LYs) from 5.80 to 5.98 and quality-adjusted life-years (QALYs) from 2.74 to 2.85. However, it also increased total lifetime costs by 114 740 THB ($3114) per patient compared with SoCT alone, resulting in an incremental cost-effectiveness ratio of 1 063 375 THB ($28 857) per QALY gained. Subgroup analysis based on NT-proBNP levels demonstrated that vericiguat had a more favorable incremental cost-effectiveness ratio of 557 427 THB ($15 127) per QALY gained in patients with NT-proBNP ≤ 4000 pg/mL. Considering the current willingness-to-pay threshold of 160 000 THB ($4342) per QALY gained in Thailand, vericiguat did not meet the cost-effectiveness criteria.
Conclusions
Despite its clinical benefits in reducing HF hospitalizations and cardiovascular mortality, vericiguat as an adjunct to SoCT for patients with HFrEF in Thailand exceeds the accepted cost-effectiveness threshold of 4342 USD/QALY gained. A price reduction of 90.2% would be necessary to achieve the current Thai willingness-to-pay threshold.
{"title":"Cost-Utility Analysis of Add-On Vericiguat to Standard Treatment in Thai Patients With Heart Failure and Reduced Ejection Fraction","authors":"Tanawan Kongmalai MD, PhD , Kanchalaporn Jirataiporn RN , Rungroj Krittayaphong MD","doi":"10.1016/j.vhri.2025.101514","DOIUrl":"10.1016/j.vhri.2025.101514","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate the cost-utility of adding vericiguat to standard-of-care therapy for patients with heart failure with reduced ejection fraction (HFrEF) and worsening heart failure (HF) events in the context of Thailand’s healthcare system.</div></div><div><h3>Methods</h3><div>A Markov model using Microsoft Excel was conducted to simulate the lifetime economic outcomes of adding vericiguat to standard-of-care therapy (SoCT) compared with SoCT alone for Thai patients with HFrEF. Model parameters were derived from the VICTORIA trial and supplemented with local data on healthcare costs and utilities. Sensitivity, subgroup, and threshold analyses were also performed.</div></div><div><h3>Results</h3><div>Adding vericiguat to SoCT increased total life-years (LYs) from 5.80 to 5.98 and quality-adjusted life-years (QALYs) from 2.74 to 2.85. However, it also increased total lifetime costs by 114 740 THB ($3114) per patient compared with SoCT alone, resulting in an incremental cost-effectiveness ratio of 1 063 375 THB ($28 857) per QALY gained. Subgroup analysis based on NT-proBNP levels demonstrated that vericiguat had a more favorable incremental cost-effectiveness ratio of 557 427 THB ($15 127) per QALY gained in patients with NT-proBNP ≤ 4000 pg/mL. Considering the current willingness-to-pay threshold of 160 000 THB ($4342) per QALY gained in Thailand, vericiguat did not meet the cost-effectiveness criteria.</div></div><div><h3>Conclusions</h3><div>Despite its clinical benefits in reducing HF hospitalizations and cardiovascular mortality, vericiguat as an adjunct to SoCT for patients with HFrEF in Thailand exceeds the accepted cost-effectiveness threshold of 4342 USD/QALY gained. A price reduction of 90.2% would be necessary to achieve the current Thai willingness-to-pay threshold.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"53 ","pages":"Article 101514"},"PeriodicalIF":1.5,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467755","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}
Pub Date : 2025-11-06DOI: 10.1016/j.vhri.2025.101517
Hui Zi PhD
{"title":"From Model to Clinic: Practical Considerations for Applying the Chinese Diabetes Risk Score in Prediabetes Screening","authors":"Hui Zi PhD","doi":"10.1016/j.vhri.2025.101517","DOIUrl":"10.1016/j.vhri.2025.101517","url":null,"abstract":"","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"51 ","pages":"Article 101517"},"PeriodicalIF":1.5,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472185","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}
Cancer care in Ethiopia imposes a significant financial burden, with high direct costs (eg, treatment and hospital stays) and indirect costs (eg, lost productivity). Despite the growing cancer burden, comprehensive data on its economic impact and cost-effectiveness remain limited. This systematic review assesses the economic burden of cancer care and the cost-effectiveness of interventions in Ethiopia, focusing on both adult and pediatric cancers.
Methods
A systematic search was conducted in PubMed, Embase, Scopus, and the Cochrane Library following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting Ethiopian-specific cost data, including direct and indirect costs, catastrophic health expenditure, and cost-effectiveness, were included. Economic evaluations and observational studies covering prevention to palliative care were considered. Cost data were standardized to 2019 values using the Campbell and Cochrane Economics Methods Group and the Evidence for Policy and Practice Information and Coordinating-Centre cost converter. Two independent reviewers’ extracted data, with quality assessment using the Consolidated Health Economic Evaluation Reporting Standards checklist.
Results
Of 656 identified records, 11 studies met the inclusion criteria. Cancer care costs were substantial, with medications, treatment, and hospital stays being the primary cost drivers. Lost productivity further exacerbated the burden. Pediatric oncology care and human papillomavirus vaccination were consistently cost-effective. Methodological approaches included decision trees, Markov models, and cost-effectiveness analyses. Gaps in uncertainty analysis, discount rates, and sensitivity analysis were noted.
Conclusions
Cancer care in Ethiopia remains a financial challenge, but cost-effective interventions, such as pediatric oncology programs and human papillomavirus vaccination, can mitigate costs. Strengthening financial protection mechanisms and conducting more detailed economic evaluations are crucial to informing policy and improving cancer care affordability.
{"title":"Economic Burden and Cost-Effectiveness of Cancer Care in Ethiopia: A Systematic Review","authors":"Tenaw Baye Tarekegn MSc, Getachew Ashagrie MSc, Abebe Tarekegn Kassaw MSc, Desye Gebrie MSc, Fentaw Girmaw MSc","doi":"10.1016/j.vhri.2025.101515","DOIUrl":"10.1016/j.vhri.2025.101515","url":null,"abstract":"<div><h3>Objectives</h3><div>Cancer care in Ethiopia imposes a significant financial burden, with high direct costs (eg, treatment and hospital stays) and indirect costs (eg, lost productivity). Despite the growing cancer burden, comprehensive data on its economic impact and cost-effectiveness remain limited. This systematic review assesses the economic burden of cancer care and the cost-effectiveness of interventions in Ethiopia, focusing on both adult and pediatric cancers.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in PubMed, Embase, Scopus, and the Cochrane Library following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting Ethiopian-specific cost data, including direct and indirect costs, catastrophic health expenditure, and cost-effectiveness, were included. Economic evaluations and observational studies covering prevention to palliative care were considered. Cost data were standardized to 2019 values using the Campbell and Cochrane Economics Methods Group and the Evidence for Policy and Practice Information and Coordinating-Centre cost converter. Two independent reviewers’ extracted data, with quality assessment using the Consolidated Health Economic Evaluation Reporting Standards checklist.</div></div><div><h3>Results</h3><div>Of 656 identified records, 11 studies met the inclusion criteria. Cancer care costs were substantial, with medications, treatment, and hospital stays being the primary cost drivers. Lost productivity further exacerbated the burden. Pediatric oncology care and human papillomavirus vaccination were consistently cost-effective. Methodological approaches included decision trees, Markov models, and cost-effectiveness analyses. Gaps in uncertainty analysis, discount rates, and sensitivity analysis were noted.</div></div><div><h3>Conclusions</h3><div>Cancer care in Ethiopia remains a financial challenge, but cost-effective interventions, such as pediatric oncology programs and human papillomavirus vaccination, can mitigate costs. Strengthening financial protection mechanisms and conducting more detailed economic evaluations are crucial to informing policy and improving cancer care affordability.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"52 ","pages":"Article 101515"},"PeriodicalIF":1.5,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459694","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}
Pub Date : 2025-11-01Epub Date: 2025-08-07DOI: 10.1016/j.vhri.2025.101158
Rontgene M Solante, Dionisio Tiu, Kezia Tan, Jia Hao Wong, Kaywei Low, Evan Payawal, Winniefer Nua
Objectives: Ceftazidime/avibactam (CAZ-AVI) is a novel antibiotic approved for hospital-acquired pneumonia, including ventilator-associated pneumonia (HAP/VAP). This study evaluated the cost-effectiveness of CAZ-AVI as second-line therapy, after meropenem, in patients with HAP/VAP. Its economic benefits are assessed against available second-line comparators from the societal perspective in the Philippines.
Methods: A patient-level, sequential simulation model of the HAP/VAP clinical course was developed using Excel. Data inputs were collected between June 2023 and August 2023. Costs and benefits to society were discounted at 7% over a 5-year time horizon. Clinical data were sourced from the REPROVE trial, other published literature and expert opinion. The model also incorporated the impact of resistant pathogens using global and local surveillance data, as well as expert insights.
Results: The base-case analysis demonstrated that the intervention sequence (empiric meropenem followed by CAZ-AVI) had a higher clinical cure rate (+9.82%) versus the comparator sequence (empiric meropenem followed by colistin + high-dose meropenem). This led to a shorter hospital stay (-1.57 days per patient) and incremental quality-adjusted life-years gains (+0.08) per patient. The intervention sequence also reduced costs by 218 405 PHP per patient, yielding an incremental cost-effectiveness ratio of -2 859 584 PHP/quality-adjusted life-year. The incremental cost-effectiveness ratio was robust across a range of sensitivity and scenario analyses.
Conclusions: CAZ-AVI is expected to be a highly cost-effective second-line treatment compared with colistin + high-dose meropenem from the societal perspective in the Philippines.
{"title":"Cost-Effectiveness Analysis Comparing Ceftazidime/Avibactam With Standard of Care in the Treatment of Hospital and Ventilator-Acquired Pneumonia in the Philippines.","authors":"Rontgene M Solante, Dionisio Tiu, Kezia Tan, Jia Hao Wong, Kaywei Low, Evan Payawal, Winniefer Nua","doi":"10.1016/j.vhri.2025.101158","DOIUrl":"10.1016/j.vhri.2025.101158","url":null,"abstract":"<p><strong>Objectives: </strong>Ceftazidime/avibactam (CAZ-AVI) is a novel antibiotic approved for hospital-acquired pneumonia, including ventilator-associated pneumonia (HAP/VAP). This study evaluated the cost-effectiveness of CAZ-AVI as second-line therapy, after meropenem, in patients with HAP/VAP. Its economic benefits are assessed against available second-line comparators from the societal perspective in the Philippines.</p><p><strong>Methods: </strong>A patient-level, sequential simulation model of the HAP/VAP clinical course was developed using Excel. Data inputs were collected between June 2023 and August 2023. Costs and benefits to society were discounted at 7% over a 5-year time horizon. Clinical data were sourced from the REPROVE trial, other published literature and expert opinion. The model also incorporated the impact of resistant pathogens using global and local surveillance data, as well as expert insights.</p><p><strong>Results: </strong>The base-case analysis demonstrated that the intervention sequence (empiric meropenem followed by CAZ-AVI) had a higher clinical cure rate (+9.82%) versus the comparator sequence (empiric meropenem followed by colistin + high-dose meropenem). This led to a shorter hospital stay (-1.57 days per patient) and incremental quality-adjusted life-years gains (+0.08) per patient. The intervention sequence also reduced costs by 218 405 PHP per patient, yielding an incremental cost-effectiveness ratio of -2 859 584 PHP/quality-adjusted life-year. The incremental cost-effectiveness ratio was robust across a range of sensitivity and scenario analyses.</p><p><strong>Conclusions: </strong>CAZ-AVI is expected to be a highly cost-effective second-line treatment compared with colistin + high-dose meropenem from the societal perspective in the Philippines.</p>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"50 ","pages":"101158"},"PeriodicalIF":1.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804930","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}
Pub Date : 2025-11-01Epub Date: 2025-08-07DOI: 10.1016/j.vhri.2025.101166
Raissa Allan Santos Domingues, Maria Regina Fernandes de Oliveira
Objectives: To estimate the direct and indirect costs of disseminated histoplasmosis in people living with HIV in Brazil in 2023.
Methods: The cost-of-illness study was conducted from the perspective of the Brazilian public health system and society. A hypothetical cohort was developed based on epidemiological data on HIV and histoplasmosis cases reported by the Brazilian Ministry of Health in 2023. Direct medical costs for diagnostic, treatment, and care provided to patients with disseminated histoplasmosis and HIV were calculated using the top-down approach. The indirect costs related to productivity loss due to premature mortality and morbidity were estimated using the human-capital method. A multivariate deterministic sensitivity analysis was performed because of uncertainties in some model parameters.
Results: The cohort began with reported cases of HIV, focusing on individuals estimated to develop symptoms of disseminated histoplasmosis requiring hospitalization. Cases were confirmed through clinical examinations and conventional laboratory methods. Treatment primarily involves amphotericin B. The analysis included patients who were discharged from the hospital, underwent secondary prophylaxis, potentially required treatment for reinfection or reactivation, necessitating additional hospitalization and who died. In 2023, the total cost of disseminated histoplasmosis in people living with HIV in Brazil was US dollars ($) 455 723 307.45, varying, according to the sensitivity analysis, from $283 862 967.76 to $635 305 985.67. Most costs (46%) were associated with indirect costs.
Conclusions: disseminated histoplasmosis represents a significant and costly health problem for both the Brazilian public health system and society, primarily because of productivity loss resulting from premature mortality.
{"title":"Disseminated Histoplasmosis in People Living With HIV: What Are the Care Costs for Brazil?","authors":"Raissa Allan Santos Domingues, Maria Regina Fernandes de Oliveira","doi":"10.1016/j.vhri.2025.101166","DOIUrl":"10.1016/j.vhri.2025.101166","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the direct and indirect costs of disseminated histoplasmosis in people living with HIV in Brazil in 2023.</p><p><strong>Methods: </strong>The cost-of-illness study was conducted from the perspective of the Brazilian public health system and society. A hypothetical cohort was developed based on epidemiological data on HIV and histoplasmosis cases reported by the Brazilian Ministry of Health in 2023. Direct medical costs for diagnostic, treatment, and care provided to patients with disseminated histoplasmosis and HIV were calculated using the top-down approach. The indirect costs related to productivity loss due to premature mortality and morbidity were estimated using the human-capital method. A multivariate deterministic sensitivity analysis was performed because of uncertainties in some model parameters.</p><p><strong>Results: </strong>The cohort began with reported cases of HIV, focusing on individuals estimated to develop symptoms of disseminated histoplasmosis requiring hospitalization. Cases were confirmed through clinical examinations and conventional laboratory methods. Treatment primarily involves amphotericin B. The analysis included patients who were discharged from the hospital, underwent secondary prophylaxis, potentially required treatment for reinfection or reactivation, necessitating additional hospitalization and who died. In 2023, the total cost of disseminated histoplasmosis in people living with HIV in Brazil was US dollars ($) 455 723 307.45, varying, according to the sensitivity analysis, from $283 862 967.76 to $635 305 985.67. Most costs (46%) were associated with indirect costs.</p><p><strong>Conclusions: </strong>disseminated histoplasmosis represents a significant and costly health problem for both the Brazilian public health system and society, primarily because of productivity loss resulting from premature mortality.</p>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"50 ","pages":"101166"},"PeriodicalIF":1.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804931","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}
Pub Date : 2025-10-29DOI: 10.1016/j.vhri.2025.101506
Nuraini Nazeha MPH , Sameera Senanayake PhD , Yiying Cai PhD , Mark J.A. Koh MD , Su Bing BS , Weiwei Hong MBBS , Nicholas Graves PhD , Sanjeewa Kularatna PhD
Objectives
The Children’s Dermatology Life Quality Index (CDLQI) assesses health-related quality of life in pediatric patients with atopic dermatitis. However, it cannot be used directly in economic evaluations. We developed algorithms to map CDLQI scores to EQ-5D-Y-3L health utility values, relevant for estimating quality-adjusted life-years.
Methods
Data were prospectively collected by recruiting pediatric patients with atopic dermatitis from a specialty children’s hospital in Singapore. Children aged 4 to 12 completed the EQ-5D-Y-3L and CDLQI questionnaires. For direct mapping approach, 3 model specifications were tested (CDLQI individual item scores, model 1; CDLQI domain scores, model 2; and CDLQI total score, model 3) using 4 regression techniques: ordinary least squares, general linear regression, multivariable fractional polynomials, and beta regression. A 4-fold cross-validation evaluated predictive performance using pooled root mean squared error and mean absolute error (MAE). For indirect response mapping, the ordered logit model predicted EQ-5D-Y-3L responses from CDLQI item scores.
Results
We extracted the data of 250 patients. Beta regression had the lowest MAE (0.0490) for item-based model 1, whereas ordinary least squares performed best for domain-based model 2 (MAE: 0.0499) and total score model 3 (MAE: 0.0532). However, the mapping algorithms overpredicted lower observed utility scores. The indirect mapping model achieved similar performance, with a MAE of 0.0452.
Conclusions
We mapped CDLQI to EQ-5D-Y-3L utilities using direct and indirect approaches with good predictive accuracy. These algorithms will allow studies with CDLQI data to calculate health utility estimates for use in atopic dermatitis-related economic evaluations.
{"title":"Mapping the Children’s Dermatology Life Quality Index Questionnaire to EQ-5D-Y-3L in Pediatric Patients With Atopic Dermatitis","authors":"Nuraini Nazeha MPH , Sameera Senanayake PhD , Yiying Cai PhD , Mark J.A. Koh MD , Su Bing BS , Weiwei Hong MBBS , Nicholas Graves PhD , Sanjeewa Kularatna PhD","doi":"10.1016/j.vhri.2025.101506","DOIUrl":"10.1016/j.vhri.2025.101506","url":null,"abstract":"<div><h3>Objectives</h3><div>The Children’s Dermatology Life Quality Index (CDLQI) assesses health-related quality of life in pediatric patients with atopic dermatitis. However, it cannot be used directly in economic evaluations. We developed algorithms to map CDLQI scores to EQ-5D-Y-3L health utility values, relevant for estimating quality-adjusted life-years.</div></div><div><h3>Methods</h3><div>Data were prospectively collected by recruiting pediatric patients with atopic dermatitis from a specialty children’s hospital in Singapore. Children aged 4 to 12 completed the EQ-5D-Y-3L and CDLQI questionnaires. For direct mapping approach, 3 model specifications were tested (CDLQI individual item scores, model 1; CDLQI domain scores, model 2; and CDLQI total score, model 3) using 4 regression techniques: ordinary least squares, general linear regression, multivariable fractional polynomials, and beta regression. A 4-fold cross-validation evaluated predictive performance using pooled root mean squared error and mean absolute error (MAE). For indirect response mapping, the ordered logit model predicted EQ-5D-Y-3L responses from CDLQI item scores.</div></div><div><h3>Results</h3><div>We extracted the data of 250 patients. Beta regression had the lowest MAE (0.0490) for item-based model 1, whereas ordinary least squares performed best for domain-based model 2 (MAE: 0.0499) and total score model 3 (MAE: 0.0532). However, the mapping algorithms overpredicted lower observed utility scores. The indirect mapping model achieved similar performance, with a MAE of 0.0452.</div></div><div><h3>Conclusions</h3><div>We mapped CDLQI to EQ-5D-Y-3L utilities using direct and indirect approaches with good predictive accuracy. These algorithms will allow studies with CDLQI data to calculate health utility estimates for use in atopic dermatitis-related economic evaluations.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"52 ","pages":"Article 101506"},"PeriodicalIF":1.5,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402118","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}
Pub Date : 2025-10-24DOI: 10.1016/j.vhri.2025.101510
Christos Melidis MSc , Sandrine Noblet PhD , Samuel Burg MD , Panagiotis Bamidis PhD , Ioannis Iakovou MD, PhD
Objectives
Access to positron emission tomography (PET) services is limited in many island regions because of dependence on externally produced radiopharmaceuticals and associated logistical constraints. This study provides a cost-minimization analysis of 3 alternative supply strategies, with the aim of improving access to these essential diagnostic examinations for underserved populations in remote island settings.
Methods
We conducted a cost-minimization analysis over a 20-year horizon, comparing 3 scenarios in 4 island regions (Corsica, Crete, Sardinia, and Cyprus): (A) full reliance on imported radiopharmaceuticals, (B) local PET-only production via small cyclotrons, and (C) full local production via hybrid cyclotrons. Total costs included investment, fixed, and variable components, and were adjusted using purchasing power parity. Sensitivity analyses explored the effects of transport costs and demand levels.
Results
For all regions, local production became the least costly option beyond an initial annual threshold of approximately 650 annual PET examinations. Hybrid cyclotrons were slightly more cost minimizing than PET-only systems, especially in larger populations. For 3 of the 4 islands, local production dominated by year 3 to 8; for Cyprus, this occurred later, depending on demand and transport assumptions.
Conclusions
Local radiopharmaceutical production can be a cost-minimization strategy for improving PET services accessibility in island regions. This analysis may also serve as a transferable decision-making framework for other remote or underserved areas, such as the Canary Islands, rural Australia, or similar settings worldwide.
{"title":"Improving Access to Nuclear Medicine in Island Regions: A Cost-Minimization Analysis of Radiopharmaceutical Supply Strategies","authors":"Christos Melidis MSc , Sandrine Noblet PhD , Samuel Burg MD , Panagiotis Bamidis PhD , Ioannis Iakovou MD, PhD","doi":"10.1016/j.vhri.2025.101510","DOIUrl":"10.1016/j.vhri.2025.101510","url":null,"abstract":"<div><h3>Objectives</h3><div>Access to positron emission tomography (PET) services is limited in many island regions because of dependence on externally produced radiopharmaceuticals and associated logistical constraints. This study provides a cost-minimization analysis of 3 alternative supply strategies, with the aim of improving access to these essential diagnostic examinations for underserved populations in remote island settings.</div></div><div><h3>Methods</h3><div>We conducted a cost-minimization analysis over a 20-year horizon, comparing 3 scenarios in 4 island regions (Corsica, Crete, Sardinia, and Cyprus): (A) full reliance on imported radiopharmaceuticals, (B) local PET-only production via small cyclotrons, and (C) full local production via hybrid cyclotrons. Total costs included investment, fixed, and variable components, and were adjusted using purchasing power parity. Sensitivity analyses explored the effects of transport costs and demand levels.</div></div><div><h3>Results</h3><div>For all regions, local production became the least costly option beyond an initial annual threshold of approximately 650 annual PET examinations. Hybrid cyclotrons were slightly more cost minimizing than PET-only systems, especially in larger populations. For 3 of the 4 islands, local production dominated by year 3 to 8; for Cyprus, this occurred later, depending on demand and transport assumptions.</div></div><div><h3>Conclusions</h3><div>Local radiopharmaceutical production can be a cost-minimization strategy for improving PET services accessibility in island regions. This analysis may also serve as a transferable decision-making framework for other remote or underserved areas, such as the Canary Islands, rural Australia, or similar settings worldwide.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"53 ","pages":"Article 101510"},"PeriodicalIF":1.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365170","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}
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