Value in health regional issues最新文献_第6页

Incremental Healthcare Costs of Diabetes Mellitus in a Middle-Income Country Using Administrative Healthcare Data 利用行政医疗保健数据计算中等收入国家糖尿病的增量医疗保健成本

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2024-05-06 DOI: 10.1016/j.vhri.2024.100992

Santiago Castro-Villarreal MSc , Sara Miksi MSc , Adriana Beltrán-Ostos MD, MSc , Carlos F. Valencia MSc, PhD

Objectives

To estimate the incremental medical cost of diabetes mellitus using information from administrative databases in Colombia.

Methods

We carried out a retrospective cohort study with administrative health databases from Colombian population affiliated in the contributory health insurance scheme. We used an operative definition to select the cohort with diabetes. Incremental cost and cost ratio of diabetes were estimated using an inverse probability weighting of treatment approach to find the causal effect of having the disease. Weights were calculated by a propensity score method using a Random Forest model. The flexibility of this machine learning algorithm allows to have a better specification and bias reduction. Additionally, we reported incremental costs and cost ratios with confidence intervals using bootstrapping and analyzed costs by age groups and complications associated with diabetes.

Results

The estimated prevalence of diabetes was 2834 per 100 000 cases, in 2018. The group with diabetes was comprised 634 015 people and the control group 1 524 808. The calculated annual direct medical cost was $860, for which the incremental cost was $493 and the cost ratio 2.34. The incremental annual cost for some type of complication ranges from $1239 to $2043, renal complication being the most expensive. Incremental cost by age groups ranges from $347 to $878, being higher in younger people.

Conclusions

Although the cost of diabetes in Colombia ranges among the global averages and is similar to other Latin-American countries, a greater incremental cost was found in patients with renal, circulatory, and neurologic complications.

目的利用哥伦比亚行政数据库中的信息估算糖尿病的增量医疗成本。方法我们利用行政健康数据库对参加缴费健康保险计划的哥伦比亚人口进行了一项回顾性队列研究。我们使用手术定义来选择糖尿病患者。我们采用反概率加权治疗法估算了糖尿病的增量成本和成本比，以找出患病的因果效应。权重是通过使用随机森林模型的倾向得分法计算得出的。这种机器学习算法具有灵活性，可以更好地规范和减少偏差。此外，我们还利用引导法报告了增量成本和成本比率及置信区间，并按年龄组和糖尿病相关并发症分析了成本。糖尿病患者组有 634 015 人，对照组有 1 524 808 人。计算得出的年度直接医疗成本为 860 美元，其中增量成本为 493 美元，成本比为 2.34。某种并发症的年增量成本从 1239 美元到 2043 美元不等，其中肾脏并发症的成本最高。结论虽然哥伦比亚的糖尿病费用处于全球平均水平，与其他拉美国家相似，但肾脏、循环系统和神经系统并发症患者的增量成本更高。

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引用次数: 0

Strategic Approaches to Reducing the Burden of Atopic Dermatitis in the Middle East and Africa Region 减轻中东和非洲地区特应性皮炎负担的战略方法

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2024-05-03 DOI: 10.1016/j.vhri.2024.100987

Baher Elezbawy MPH , Mohamed Farghaly PhD , Atlal Al Lafi PhD , Mary Gamal MSc , Mirna Metni PharmD , Willem Visser PhD , Hana Al-Abdulkarim MSc , Meriem Hedibel PharmD , Ahmad Nader Fasseeh PhD , Sherif Abaza MBA , Zoltán Kaló PhD

Objectives

Atopic dermatitis (AD) creates a significant burden on patients and society. This study proposes a set of health policy interventions that can reduce the burden of AD in the Middle East and Africa.

Methods

We conducted a scoping review to find relevant actions that have been implemented or recommended to decrease AD burden globally. An expert panel was conducted to discuss the review findings, then experts were surveyed to suggest the most efficient actions. Finally, survey results and recommendations were formulated into key actions to reduce the burden in the Middle East and Africa region.

Results

Recommended actions were related to 5 domains; capacity building, guidelines, research, public awareness, and patient support and education. Several actions related to each domain can help reduce the burden. One of the most advocated recommendations was investing in patient education through trained healthcare professionals. Understanding the disease and learning how to control it is a key cornerstone to treatment optimization and reducing the burden. Multidisciplinary care, publishing defined therapeutic guidelines, and investing in research were the most recommended actions based on the experts’ discussion and survey results.

Conclusions

Although the burden of AD is the highest among dermatological diseases, a well-grounded action plan has the potential to reduce the disease burden. Decision makers may develop a national AD action plan by selecting the most relevant items of this study based on their potential impact, feasibility, timeliness, and affordability.

目的特应性皮炎（AD）给患者和社会造成了沉重负担。本研究提出了一套可减轻中东和非洲地区过敏性皮炎负担的卫生政策干预措施。我们成立了一个专家小组来讨论审查结果，然后对专家进行调查，以提出最有效的行动建议。结果建议采取的行动涉及 5 个领域：能力建设、指南、研究、公众意识以及患者支持和教育。与每个领域相关的几项行动都有助于减轻负担。最受欢迎的建议之一是通过训练有素的医疗保健专业人员对患者教育进行投资。了解疾病并学会如何控制疾病是优化治疗和减轻负担的关键基石。根据专家讨论和调查结果，多学科护理、发布明确的治疗指南以及投资研究是最值得推荐的行动。决策者可以根据本研究的潜在影响、可行性、及时性和可负担性，选择最相关的项目来制定国家注意力缺失行动计划。

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引用次数: 0

Partial-Cost Analysis and Economic Impact of Ambulatory Coronary Angioplasty in a Private Hospital in the Caribbean 加勒比地区一家私立医院开展非住院冠状动脉血管成形术的部分成本分析和经济影响

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2024-05-02 DOI: 10.1016/j.vhri.2024.100988

Licurgo J. Cruz MD , Helio M. Grullón-Rodríguez MD , Yanely López-Bencosme MD , Sergio Gresse Jr. MPH , Yinny Cen Feng MD , Anthony Gutiérrez-Martínez MD, MSc

Objectives

This study aimed to assess direct costs of percutaneous coronary intervention (PCI) without hospital admission versus PCI with hospital admission longer than 24 hours in a private hospital-institutional perspective in the Dominican Republic in 2022.

Methods

This study has a comparative approach based on a prospective cross-sectional partial-cost analysis. We evaluated the direct costs of 10 patients from PCI without hospital admission approach and 10 patients from a hospital admission longer than 24 hours as a control group. We used a “first-come-first-served” approach from December 2021 to March 2022. The analysis used the electronic invoice generated for each patient.

Results

PCI without hospital admission approach represents $472.56 in patient savings, equivalent to a cost reduction of 12.5%. The subcosts analysis showed the pharmacy section as the main driver of the overall cost difference.

Conclusions

PCI without hospital admission was economically cost-saving compared with the control approach in direct costs in the Dominican perspective. The economic benefit is substantial and compliments the ease of use. This analysis may lead to improvements in institutional management of resources and can potentially be adapted to other health systems in the region.

本研究旨在评估 2022 年多米尼加共和国私立医院-机构视角下未经入院的经皮冠状动脉介入治疗 (PCI) 与入院时间超过 24 小时的 PCI 的直接成本。我们评估了 10 名未住院的 PCI 患者和 10 名住院超过 24 小时的对照组患者的直接成本。我们在 2021 年 12 月至 2022 年 3 月期间采用了 "先到先得 "的方法。分析使用了为每位患者生成的电子发票。结果不住院行冠脉介入治疗为患者节省了 472.56 美元，相当于降低了 12.5% 的成本。子成本分析表明，药房部分是造成总体成本差异的主要原因。结论从多米尼加的角度来看，与对照方法相比，不住院的 PCI 方法在直接成本方面节省了经济成本。经济效益显著，且易于使用。这项分析可能会改善机构对资源的管理，并有可能应用于该地区的其他医疗系统。

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引用次数: 0

Tiered Pricing and Alternative Mechanisms for Equitative Access to Vaccines in Latin America: A Narrative Review of the Literature 拉丁美洲疫苗平等获取的分级定价和替代机制：文献综述

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2024-04-27 DOI: 10.1016/j.vhri.2024.01.003

Adriana Arango-Luque DMD, MSE , Daniela Yucumá MD, MPH , Camilo E. Castañeda MD (Neurologist) , Jaime Espin LLB, MHE, PhD in Economics , Francisco Becerra-Posada MD, MPH, DrPH

Objectives

To review and describe alternative strategies for the supply of vaccines in Latin America.

Methods

We conducted a narrative review to explore and describe alternatives for equitable vaccine access in Latin America. We searched and considered the main access strategies reported in the literature through PubMed, Science Direct, and Google Scholar. Additionally, we reviewed the web sites of key stakeholders. The search was conducted using the following keywords: (“access” or “availability” or “acquisition” or “affordability” or “tiered pricing”) and (“vaccine”). Subsequently, documents that met the inclusion criteria were selected. Finally, findings were grouped by means of a thematic analysis and an interpretative synthesis.

Results

Twenty-four publications were included. We identified 5 main topics: current supply strategies, challenges for the acquisition of vaccines, vaccine prices equity, alternative supply strategies, and the advantages and impact of a tiered pricing strategy.

Conclusions

Our review suggests that tiered pricing can be an tool for accelerating the process of introducing vaccines in low-income countries at affordable prices and for countries that do not adhere to the current procurement mechanisms or are not eligible for Vaccine Alliance because giving countries prices for vaccines that reflect their ability to pay can result in better programmatic and financial planning for the purchase of these vaccines, and in return, vaccine manufacturers can gain access to wider markets However, this model has not been z improve access to vaccines that are aimed only at developing countries, mainly because the market in these countries is not profitable for producers.

方法我们进行了一项叙述性综述，以探索和描述拉丁美洲公平获取疫苗的替代方案。我们通过 PubMed、Science Direct 和 Google Scholar 搜索并研究了文献中报道的主要获取策略。此外，我们还浏览了主要利益相关者的网站。搜索时使用了以下关键词：（"获取 "或 "可用性 "或 "获得 "或 "可负担性 "或 "分级定价"）和（"疫苗"）。随后，筛选出符合纳入标准的文件。最后，通过专题分析和解释性综述对研究结果进行了分组。我们确定了 5 个主要议题：当前的供应策略、疫苗采购面临的挑战、疫苗价格公平性、替代供应策略以及分级定价策略的优势和影响。结论我们的综述表明，分级定价可作为一种工具，加快低收入国家以可承受的价格引进疫苗的进程，并适用于不遵守现行采购机制或不符合疫苗联盟条件的国家，因为给予各国反映其支付能力的疫苗价格可使购买这些疫苗的计划和财务规划更加完善，而作为回报，疫苗生产商可获得更广泛的市场。

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引用次数: 0

Electronic Decision-Making Tool for Smoking Cessation (Pare de Fumar Conosco) Versus Standard of Care: A Cost-Effectiveness Analysis 戒烟电子决策工具 (Pare de Fumar Conosco) 与标准护理的对比：成本效益分析

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2024-04-26 DOI: 10.1016/j.vhri.2024.01.002

Roberta S. Teixeira PhD , Arise G.S. Galil PhD , Ana Paula Cupertino PhD , Francisco Cartujano-Barrera MD , Fernando A.B. Colugnati PhD

Objectives

The study aimed to evaluate the cost-effectiveness of the Pare de Fumar Conosco software compared with the standard of care adopted in Brazil for the treatment of smoking cessation.

Methods

In the cohort of smokers with multiple chronic conditions, we developed an decision tree model for the benefit measures of smoking cessation. We adopted the perspectives of the Brazilian Unified Health System and the service provider. Resources and costs were measured by primary and secondary sources and effectiveness by a randomized clinical trial. The incremental cost-effectiveness ratio (ICER) was calculated, followed by deterministic and probabilistic sensitivity analyses and deterministic and probabilistic sensitivity analyses. No willingness to pay threshold was adopted.

Results

The software had a lower cost and greater effectiveness than its comparator. The ICER was dominant in all of the benefits examined (−R$2 585 178.29 to −R$325 001.20). The cost of the standard of care followed by that of the electronic tool affected the ICER of the benefit measures. In all probabilistic analyses, the software was superior to the standard of care (53.6%-82.5%).

Conclusion

The Pare de Fumar Conosco software is a technology that results in cost savings in treating smoking cessation.

研究旨在评估 Pare de Fumar Conosco 软件与巴西采用的标准戒烟治疗方法相比的成本效益。我们采用了巴西统一卫生系统和服务提供者的观点。资源和成本通过第一手和第二手资料进行测算，有效性通过随机临床试验进行测算。我们计算了增量成本效益比（ICER），然后进行了确定性和概率敏感性分析以及确定性和概率敏感性分析。没有采用支付意愿阈值。ICER 在所有研究效益中均占优势（-2 585 178.29 至-325 001.20 美元）。标准护理的成本和电子工具的成本影响了效益指标的 ICER。结论 Pare de Fumar Conosco 软件是一种可节省戒烟治疗成本的技术。

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引用次数: 0

Cost-Effectiveness of Technologies for the Treatment of Spinal Muscular Atrophy: A Systematic Review of Economic Studies 脊髓肌肉萎缩症治疗技术的成本效益：经济研究系统回顾

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2024-04-26 DOI: 10.1016/j.vhri.2024.02.002

André Motta-Santos PhD , Kenya Noronha PhD , Carla Reis MSc , Daniela Freitas PhD , Lélia Carvalho MSc , Mônica Andrade PhD

Objectives

This study aims to systematically collect data on cost-effectiveness analyses that assess technologies to treat type I and II spinal muscular atrophy and evaluate their recommendations.

Methods

A structured electronic search was conducted in 4 databases. Additionally, a complementary manual search was conducted. Complete economic studies that evaluated nusinersen, risdiplam, onasemnogene abeparvovec (OA), and the best support therapy (BST) from the health system’s perspective were selected. The incremental cost-effectiveness ratios were compared with various thresholds for the analysis. The review was registered a priori in PROSPERO (CRD42022365391).

Results

Twenty studies were included in the analyses. They were all published between 2017 and 2022 and represent the recommendations in 8 countries. Most studies adopted 5, 6, or 10-state Markov models. Some authors took part in multiple studies. Four technologies were evaluated: BST (N = 14), nusinersen (N = 19), risdiplam (N = 5), and OA (N = 9). OA, risdiplam, and nusinersen were considered inefficient compared with the BST. Risdiplam and OA were generally regarded as cost-effective when compared with nusinersen. Because nusinersen is not a cost-effective drug, no recommendation can be derived from this result. Risdiplam and OA were compared in 2 studies that presented opposite results.

Conclusions

Nusinersen, risdiplam, and OA are being adopted worldwide as a treatment for spinal muscular atrophy. Despite that, the pharmacoeconomic analyses show that the technologies are not cost-effective compared with the BST. The lack of controlled studies for risdiplam and OA hamper any conclusions about their face-to-face comparison.

本研究旨在系统地收集有关评估 I 型和 II 型脊髓性肌萎缩症治疗技术的成本效益分析数据，并对其建议进行评估。此外，还进行了补充性人工检索。选择了从医疗系统的角度对诺西能森、利地普兰、onasemnogene abeparvovec（OA）和最佳支持疗法（BST）进行评估的完整经济学研究。在进行分析时，比较了不同阈值下的增量成本效益比。该综述已事先在 PROSPERO（CRD42022365391）中注册。这些研究均发表于 2017 年至 2022 年，代表了 8 个国家的建议。大多数研究采用了 5、6 或 10 状态马尔可夫模型。一些作者参与了多项研究。对四种技术进行了评估：BST（N = 14）、nusinersen（N = 19）、risdiplam（N = 5）和 OA（N = 9）。与 BST 相比，OA、Risdiplam 和 Nusinersen 被认为效率较低。与 Nusinersen 相比，Risdiplam 和 OA 被普遍认为具有成本效益。由于 Nusinersen 不是一种具有成本效益的药物，因此无法从这一结果中得出任何建议。结论Nusinersen、risdiplam和OA正在全球范围内被用作脊髓性肌萎缩症的治疗药物。尽管如此，药物经济学分析表明，与 BST 相比，这些技术并不具有成本效益。由于缺乏对利地普仑和OA的对照研究，因此无法就其面对面比较得出结论。

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引用次数: 0

A Microcost Analysis of the Use of Personal Protective Equipment During and Before the COVID-19 Pandemic From a Hospital Perspective 从医院角度对 COVID-19 大流行期间和之前个人防护设备使用情况的微观成本分析

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2024-04-25 DOI: 10.1016/j.vhri.2024.01.005

Mariana Andrades Fiorini Monteiro Novo MS , Lukas Fernando De Oliveira Silva MD , Daniela Fernanda dos Santos Alves PhD , Patrick Alexander Wachholz MD, PhD , Vania dos Santos Nunes-Nogueira MD, PhD

Objectives

To calculate the direct cost of personal protective equipment (PPE) used during the COVID-19 pandemic from the perspective of a Brazilian tertiary public hospital.

Methods

We evaluated the cost of PPE during the pandemic to the cost before (2021 vs 2019, respectively) using the microcosting method. Cost estimates were converted into US dollars in 2023, taking inflation into account and using purchasing power parity conversion rates. Our expenses included gloves, disposable gowns, head coverings, masks, N95 respirators, and eye protection. The number of PPE used was determined by the hospital’s usual protocol, the total number of hospitalized patients, and the number of days of hospitalization. We used the following variables for uncertainty analysis: PPE adherence, an interquartile range of median length of hospitalization, and variance in the cost of each PPE.

Results

In 2021, 26 618 individuals were hospitalized compared with 31 948 in 2019. The median length of stay was 6 and 4 days, respectively. The total and per-patient direct cost of PPE were projected to be 2 939 935.47 US dollar (USD) and 110.45 USD, respectively, during the pandemic, and 1 570 124.08 USD and 49.15 USD, respectively, before the pandemic. The individual cost of PPE was the most influential cost variable.

Conclusions

According to the hospital’s perspective, the total estimated direct cost of PPE during the COVID-19 pandemic was nearly twice as high as the previous year. This difference might be explained by the 3-fold increase in PPE in the treatment of patients with COVID-19 compared with patients without isolation precautions.

目标从巴西一家三级公立医院的角度计算 COVID-19 大流行期间使用的个人防护设备 (PPE) 的直接成本。方法我们使用微观成本法评估了大流行期间与之前（分别为 2021 年与 2019 年）的个人防护设备成本。考虑到通货膨胀和购买力平价换算率，成本估算值被换算成 2023 年的美元。我们的支出包括手套、一次性工作服、头罩、口罩、N95 呼吸器和护眼设备。个人防护设备的使用数量由医院的常规方案、住院患者总数和住院天数决定。我们使用以下变量进行不确定性分析：结果 2021 年有 26 618 人住院，而 2019 年为 31 948 人。住院时间中位数分别为 6 天和 4 天。预计在大流行期间，PPE 的总成本和每位患者的直接成本分别为 2 939 935.47 美元和 110.45 美元，而在大流行之前分别为 1 570 124.08 美元和 49.15 美元。结论从医院的角度来看，COVID-19 大流行期间个人防护设备的估计直接成本总额几乎是前一年的两倍。出现这种差异的原因可能是，与未采取隔离预防措施的患者相比，治疗 COVID-19 患者的个人防护设备费用增加了 3 倍。

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引用次数: 0

Cost-effectiveness Analysis of Pharmacological Treatment for Adult Kidney Transplant Recipients in Colombia 哥伦比亚成年肾移植受者药物治疗的成本效益分析

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2024-04-25 DOI: 10.1016/j.vhri.2024.02.001

Daysi Sanmartin MSc , Camilo Tamayo MSc , Luis Esteban Orozco MSc , Angélica Ordóñez MSc , Juliana Huertas BSc , Diego Ávila MSc , Johanna Echeverry MSc , Mónica Caicedo MSc , Paola García NEP

Objectives

To evaluate cost-effective pharmacological treatment in adult kidney transplant recipients from the perspective of the Colombian health system.

Methods

A decision tree model for the induction phase and a Markov model for the maintenance phase were built. A review of the clinical literature was conducted to extract probabilities, and the life-years were used as the outcome. Costs were calculated using the administrative databases. The evaluating treatment schemes are organized by groups of evidence with direct comparisons.

Results

In the induction phase, anti-thymocyte immunoglobulin+ methylprednisolone is dominant, more effective, and less expensive, compared with basiliximab+methylprednisolone. In the maintenance phase, azathioprine (AZA) is dominant in contrast to mycophenolate mofetil (MFM) both with cyclosporine (CIC)+ corticosteroids (CE); CIC is dominant relative to sirolimus (SIR) and tacrolimus (TAC) (both with MFM+CE or AZA+CE), and TAC is dominant compared with SIR (in addition with MFM+CE or mycophenolate sodium [MFS]+CE); MFM is dominant in relation to MFS and everolimus, and SIR is more effective MFM but it does not exceed the threshold (in sum with TAC+CE); MFS and MFM are dominant relative to everolimus, and SIR is more effective than MFM, but it does not exceed the threshold (in addiction with CIC+CE); MFM is dominant in relation to TAC (in sum with SIR+CE), and CIC+AZA+CE is dominant in relation to TAC+MFM+CE.

Conclusions

The base-case results for all evidence groups are consistent with the different sensitivity analyses.

方法建立了诱导阶段的决策树模型和维持阶段的马尔可夫模型。对临床文献进行回顾以提取概率，并将寿命年数作为结果。成本则通过行政数据库进行计算。结果在诱导阶段，抗胸腺细胞免疫球蛋白+甲基强的松龙与巴利昔单抗+甲基强的松龙相比占优势、更有效、费用更低。在维持治疗阶段，硫唑嘌呤（AZA）与霉酚酸酯（MFM）相比，在环孢素（CIC）+皮质类固醇（CE）的情况下，硫唑嘌呤（AZA）占主导地位；与西罗莫司（SIR）和他克莫司（TAC）相比，西罗莫司（CIC）占主导地位（MFM+CE 或 AZA+CE）；与 SIR 相比，TAC 占主导地位（此外还有 MFM+CE 或霉酚酸钠[MFS]+CE）；与 MFS 和依维莫司相比，MFM 占优，SIR 比 MFM 更有效，但未超过阈值（与 TAC+CE 相加）；与依维莫司相比，MFS 和 MFM 占优，SIR 比 MFM 更有效，但未超过阈值（与 CIC+CE 相加）；与 TAC 相比，MFM 占优（与 SIR+CE 相加），与 TAC+MFM+CE 相比，CIC+AZA+CE 占优。结论所有证据组的基本情况结果与不同的敏感性分析结果一致。

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引用次数: 0

Cost-effectiveness Analysis of Triptorelin, Goserelin, and Leuprolide in the Treatment of Patients with Metastatic Prostate Cancer: A Societal Perspective 治疗转移性前列腺癌患者的曲普瑞林、戈舍瑞林和亮丙瑞林的成本效益分析：社会视角

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2024-04-24 DOI: 10.1016/j.vhri.2024.01.004

Mehdi Rezaee MSc , Iman Karimzadeh Pharm D, PhD , Amir Hashemi-Meshkini PhD , Shahryar Zeighami MD , Mohammad Bazyar Pharm D , Farhad Lotfi PhD , Khosro Keshavarz PhD

Objectives

Metastatic prostate cancer is the most common malignant cancer and the second leading cause of death due to various types of cancer among men after lung cancer. This study aimed to analyze the cost-effectiveness of triptorelin, goserelin, and leuprolide in the treatment of the patients with metastatic prostate cancer from the societal perspective in Iran in 2020.

Methods

This is a cost-effectiveness study in which a 20-year Markov transition modeling was applied. In this study, local cost and quality-of-life data of each health state were gathered from cohort of patients. The TreeAge pro 2020 and Microsoft Excel 2016 software were used to simulate cost-effectiveness of each treatment in the long term. The one-way and probabilistic sensitivity analyses were also performed to measure robustness of the model outputs.

Results

The findings indicated that the mean costs and utility gained over a 20-year horizon for goserelin, triptorelin, and leuprolide treatments were $ 13 539.13 and 6.365 quality-adjusted life-years (QALY), $ 18 124.75 and 6.658 QALY, and $ 26 006.92 and 6.856 QALY, respectively. Goserelin was considered as a superior treatment option, given the estimated incremental cost-effectiveness ratio. The one-way and probabilistic sensitivity analyses confirmed the robustness of the study outcomes.

Conclusions

According to the results of the present study, goserelin was the most effective and cost-effective strategy versus 2 other options. It could be recommended to policy makers of the Iran healthcare system to prioritize it in clinical guidelines and reimbursement policies.

目标转移性前列腺癌是最常见的恶性肿瘤，也是仅次于肺癌的导致男性死亡的第二大癌症。本研究旨在从伊朗社会角度分析 2020 年曲普瑞林、戈舍瑞林和利优普瑞治疗转移性前列腺癌患者的成本效益。在这项研究中，从患者队列中收集了各健康状态下的当地成本和生活质量数据。使用 TreeAge pro 2020 和 Microsoft Excel 2016 软件模拟了每种治疗方法的长期成本效益。结果研究结果表明，戈舍瑞林、曲普瑞林和利优普瑞治疗 20 年的平均成本和效用分别为 13 539.13 美元和 6.365 质量调整生命年（QALY）、18 124.75 美元和 6.658 QALY 以及 26 006.92 美元和 6.856 QALY。根据估计的增量成本效益比，戈舍瑞林被认为是一种更优的治疗方案。单向和概率敏感性分析证实了研究结果的稳健性。结论根据本研究的结果，戈舍瑞林与其他两种方案相比是最有效、最具成本效益的策略。建议伊朗医疗系统的政策制定者在临床指南和报销政策中优先考虑戈舍瑞林。

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引用次数: 0

Peripherally Inserted Central Catheter Versus Centrally Inserted Central Catheter for In-Hospital Infusion Therapy: A Cost-Effectiveness Analysis 用于院内输液治疗的外周置入中心导管与中心置入中心导管：成本效益分析

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2024-02-23 DOI: 10.1016/j.vhri.2023.12.006

Simone de Souza Fantin RN, MSc, ScD , Marina Scherer dos Santos RN , Eduarda Bordini Ferro RN , Vania Naomi Hirakata MSc , André Ferreira de Azeredo da Silva MD, PhD , Eneida Rejane Rabelo-Silva RN, MSc, ScD

Objectives

To evaluate the comparative effectiveness and cost-effectiveness of peripherally inserted central catheters (PICCs) compared with centrally inserted central catheters (CICCs).

Methods

Prospective cohort study was followed by an economic analysis over a 30-day time horizon. Propensity score matching was used to select hospitalized adults with similar indications for PICC or CICC. The composite outcome was device removal or replacement because of complications before the end of treatment. The economic evaluation was based on a decision tree model for cost-effectiveness analysis, with calculation of the incremental cost-effectiveness ratio (ICER) per catheter removal avoided. All costs are presented in Brazilian reais (BRL) (1 BRL = 0.1870 US dollar).

Results

A total of 217 patients were followed in each group; 172 (79.3%) of those receiving a PICC and 135 (62.2%) of those receiving a CICC had no device-related complication, respectively. When comparing the events leading to device removal, the risk of composite endpoint was significantly higher in the CICC group (hazard ratio 0.20; 95% CI 0.11-0.35). The cost of PICC placement was BRL 1290.98 versus BRL 467.16 for a CICC. In the base case, the ICER for placing a PICC instead of a CICC was BRL 3349.91 per removal or replacement avoided. On univariate sensitivity analyses, the model proved to be robust within an ICER range of 2500.00 to 4800.00 BRL.

Conclusions

PICC placement was associated with a lower risk of complications than CICC placement. Although the cost of a PICC is higher, its use avoided complications and need for catheter replacement before the end of treatment.

目的评估外周置入中心导管（PICC）与中心置入中心导管（CICC）的比较效果和成本效益。方法进行前瞻性队列研究，然后在 30 天的时间跨度内进行经济分析。采用倾向评分匹配法选择具有类似 PICC 或 CICC 适应症的住院成人。综合结果是在治疗结束前因并发症而移除或更换装置。经济评估采用决策树模型进行成本效益分析，计算每次避免拔除导管的增量成本效益比 (ICER)。所有成本均以巴西雷亚尔（BRL）表示（1 雷亚尔 = 0.1870 美元）。结果每组共有 217 名患者接受了随访；在接受 PICC 和 CICC 的患者中，分别有 172 人（79.3%）和 135 人（62.2%）未发生与设备相关的并发症。在比较导致装置移除的事件时，CICC 组的复合终点风险明显更高（危险比为 0.20；95% CI 为 0.11-0.35）。PICC 置入成本为 1290.98 BRL，而 CICC 为 467.16 BRL。在基础病例中，放置 PICC 而不是 CICC 每避免一次移除或更换的 ICER 为 3349.91 BRL。在单变量敏感性分析中，该模型在 2500.00 至 4800.00 BRL 的 ICER 范围内证明是稳健的。虽然 PICC 的费用较高，但使用 PICC 可以避免并发症和在治疗结束前更换导管的需要。

{"title":"Peripherally Inserted Central Catheter Versus Centrally Inserted Central Catheter for In-Hospital Infusion Therapy: A Cost-Effectiveness Analysis","authors":"Simone de Souza Fantin RN, MSc, ScD , Marina Scherer dos Santos RN , Eduarda Bordini Ferro RN , Vania Naomi Hirakata MSc , André Ferreira de Azeredo da Silva MD, PhD , Eneida Rejane Rabelo-Silva RN, MSc, ScD","doi":"10.1016/j.vhri.2023.12.006","DOIUrl":"https://doi.org/10.1016/j.vhri.2023.12.006","url":null,"abstract":"<div><h3>Objectives</h3><p>To evaluate the comparative effectiveness and cost-effectiveness of peripherally inserted central catheters (PICCs) compared with centrally inserted central catheters (CICCs).</p></div><div><h3>Methods</h3><p>Prospective cohort study was followed by an economic analysis over a 30-day time horizon. Propensity score matching was used to select hospitalized adults with similar indications for PICC or CICC. The composite outcome was device removal or replacement because of complications before the end of treatment. The economic evaluation was based on a decision tree model for cost-effectiveness analysis, with calculation of the incremental cost-effectiveness ratio (ICER) per catheter removal avoided. All costs are presented in Brazilian reais (BRL) (1 BRL = 0.1870 US dollar).</p></div><div><h3>Results</h3><p>A total of 217 patients were followed in each group; 172 (79.3%) of those receiving a PICC and 135 (62.2%) of those receiving a CICC had no device-related complication, respectively. When comparing the events leading to device removal, the risk of composite endpoint was significantly higher in the CICC group (hazard ratio 0.20; 95% CI 0.11-0.35). The cost of PICC placement was BRL 1290.98 versus BRL 467.16 for a CICC. In the base case, the ICER for placing a PICC instead of a CICC was BRL 3349.91 per removal or replacement avoided. On univariate sensitivity analyses, the model proved to be robust within an ICER range of 2500.00 to 4800.00 BRL.</p></div><div><h3>Conclusions</h3><p>PICC placement was associated with a lower risk of complications than CICC placement. Although the cost of a PICC is higher, its use avoided complications and need for catheter replacement before the end of treatment.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139941594","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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