Value in health regional issues最新文献

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IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-01

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IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-01

引用次数: 0

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-01

引用次数: 0

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-01

引用次数: 0

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-01

引用次数: 0

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-01

引用次数: 0

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2026-01-01

引用次数: 0

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

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

Pub Date : 2025-12-27 DOI: 10.1016/j.vhri.2025.101566

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

Objectives

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

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

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

Objectives

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues

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

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

Objectives

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

Methods

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

Results

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

Conclusions

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

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

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