Value in health regional issues最新文献_第9页

Estimating the Costs of End-of-Life Care in Patients With Advanced Cancer From the Perspective of an Insurance Organization: A Cross-Sectional Study in Iran 从保险机构的角度估算晚期癌症患者临终关怀的成本：伊朗横断面研究

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-12-27 DOI: 10.1016/j.vhri.2023.11.006

Ali Zafari MD , Parisa Mehdizadeh PhD , Mohammadkarim Bahadori PhD , Nooredin Dopeykar MSc , Ehsan Teymourzadeh PhD , Ramin Ravangard PhD

Objectives

Cancers are significant medical conditions that contribute to the rising costs of healthcare systems and chronic diseases. This study aimed to estimate the average costs of medical services provided to patients with advanced cancers at the end of life (EOL).

Methods

We analyzed data from the Sata insurance claim database and the Health Information System of Baqiyatallah hospital in Iran. The study included all adult decedents who had advanced cancer without comorbidities, died between March 2020 and September 2020, and had a history of hospitalization in the hospital. We calculated the average total cost of healthcare services per patient during the EOL period, including both cancer-related and noncancer-related costs.

Results

A total of 220 patients met the inclusion criteria. The average duration of the EOL period for these patients was 178 days, with an average total cost of $8278 (SD $5698) for men and $9396 (SD $6593) for women. Cancer-related costs accounted for 64.42% of the total costs, including inpatient and outpatient services. Among these costs, hospitalization was the primary cost driver and had the greatest impact on EOL costs. This observation was supported by the multiple linear regression model, which suggested that hospitalization in the final days of life could potentially drive costs in these patients. Notably, no specialized palliative care was provided to the patients included in this study.

Conclusions

The results demonstrate that there is a significant rise in costs of care in patients receiving routine cancer care rather than optimized EOL care.

目标：癌症是导致医疗系统和慢性病成本上升的重要疾病。本研究旨在估算晚期癌症患者在生命末期（EOL）所需医疗服务的平均成本：我们分析了来自伊朗 Sata 保险索赔数据库和 Baqiyatallah 医院健康信息系统的数据。研究对象包括所有患有晚期癌症且无合并症、在 2020 年 3 月至 2020 年 9 月期间死亡并有住院史的成年死者。我们计算了每位患者在临终前的平均医疗服务总成本，包括癌症相关成本和非癌症相关成本：共有 220 名患者符合纳入标准。这些患者的临终关怀期平均为 178 天，男性患者的平均总费用为 8278 美元（标准差为 5698 美元），女性患者的平均总费用为 9396 美元（标准差为 6593 美元）。癌症相关费用占总费用的 64.42%，包括住院和门诊服务费用。在这些成本中，住院是主要的成本驱动因素，对生命周期成本的影响最大。多元线性回归模型证实了这一观点，该模型表明，生命最后几天的住院治疗可能会增加这些患者的费用。值得注意的是，本研究中没有为患者提供专门的姑息治疗：研究结果表明，接受常规癌症护理而非优化生命末期护理的患者的护理成本会显著增加。

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引用次数: 0

Economic Evaluation of Neoadjuvant Versus Adjuvant Chemotherapy in Cancer Treatment: A Systematic Review and Meta-Analysis 癌症治疗中新辅助化疗与辅助化疗的经济评估：系统回顾与元分析》。

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-12-27 DOI: 10.1016/j.vhri.2023.11.005

Dongdong Wu PhD , Na Wang PhD , Rufu Xu PhD , Guoqiong Huang PhD , Ying Li PhD , Chunji Huang PhD

Objectives

In the absence of evidence on whether neoadjuvant (NAC) or adjuvant chemotherapy (AC) is more beneficial for various tumor treatments, economic evaluation (EE) can assist medical decision making. There is limited evidence on their cost-effectiveness and their prospective evaluation is less likely in the future. Therefore, a systematic review and meta-analysis about EE for NAC versus AC in solid tumor help compare these therapies from various perspectives.

Methods

Various databases were searched for studies published from inception to 2021. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and economic-specific guidelines. The data were pooled using a random effects model when possible.

Results

The retrieval identified 15 EE studies of NAC versus AC in 8 types of cancer. NAC is the dominant strategy for pancreatic, head and neck, rectal, prostate cancers and colorectal liver metastases. For ovarian cancer, NAC is cost-effective with a lower cost and higher or similar quality-adjusted life-year. There were no significant differences in cost and outcomes for lung cancer. For stage IV or high-risk patients with ovarian or prostate cancer, NAC was cost-effective but not for patients who were not high risk.

Conclusions

The EEs results for NAC versus AC were inconsistent because of their different model structures, assumptions, cost inclusions, and a shortage of studies. There are multiple sources of heterogeneity across EEs evidence synthesis. More high-quality EE studies on NAC versus AC in initial cancer treatment are necessary.

目的：在没有证据表明新辅助化疗（NAC）或辅助化疗（AC）对各种肿瘤治疗更有利的情况下，经济评估（EE）可以帮助医疗决策。目前，有关新辅助化疗和辅助化疗成本效益的证据有限，未来对其进行前瞻性评估的可能性也较小。因此，对 NAC 和 AC 治疗实体瘤的经济效益进行系统回顾和荟萃分析有助于从不同角度比较这些疗法：方法：在各种数据库中检索从开始到 2021 年发表的研究。本研究遵循《系统综述和荟萃分析首选报告项目》报告指南和经济学特定指南。尽可能使用随机效应模型对数据进行汇总：检索发现了 15 项关于 8 种癌症中 NAC 与 AC 的 EE 研究。NAC是治疗胰腺癌、头颈癌、直肠癌、前列腺癌和结直肠肝转移的主要策略。就卵巢癌而言，NAC具有较低的成本效益和较高或相似的质量调整生命年。肺癌的成本和疗效没有明显差异。对于 IV 期或高危卵巢癌或前列腺癌患者，NAC 具有成本效益，但对于非高危患者则不具成本效益：NAC 与 AC 的 EEs 结果不一致，这是因为它们的模型结构、假设、成本内含物不同，而且缺乏研究。EEs 证据综述的异质性有多种来源。在癌症初期治疗中，有必要对 NAC 与 AC 进行更多高质量的 EE 研究。

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引用次数: 0

Financial Toxicity Experiences of Patients With Cancer in Indonesia: An Interpretive Phenomenological Analysis 印度尼西亚癌症患者的经济毒性经历：诠释现象学分析》。

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-12-27 DOI: 10.1016/j.vhri.2023.11.007

Stevanus Pangestu MBA , Enggar Putri Harjanti MA , Ika Hana Pertiwi MA , Fanni Rencz MD, PhD , F.A. Nurdiyanto MA

Objectives

Financial toxicity (FT) is an important adverse effect of cancer. Recent systematic reviews have shown that FT may lead to treatment nonadherence and impaired health-related quality of life, both of which may adversely influence the survival rates of patients. However, less is known about how patients endure FT, particularly in low- and middle-income countries. The purpose of this study was to explore how patients with cancer experience and cope with FT in Indonesia.

Methods

Semistructured in-depth interviews were conducted to explore the experiences of Indonesian patients with cancer. Qualitative data were analyzed using interpretive phenomenological analysis approach. We purposefully recruited 8 patients undergoing active treatment (aged 27-69 years) who had been diagnosed of cancer over 5 years before and possessed health insurance at the time of diagnosis.

Results

We identified 2 main themes: (1) the experienced financial burden, with subthemes underinsurance, out-of-pocket nonhealthcare cancer-related costs, and negative income effect from employment disruption, and (2) the financial coping strategies, with subthemes reallocating household budget, seeking family support, rationalizing treatment decisions, and topping up insurance for family members.

Conclusions

This is the first interpretive phenomenological study on FT in the literature and the first qualitative FT study in Indonesia. Our findings provide insight into the occurrence of FT and coping strategies used by Indonesian patients with cancer. The subjective experiences of patients may be considered to further improve oncology care, support the need for measurement of FT, and provide mitigation programs for patients.

目的：经济毒性（FT）是癌症的一个重要不良反应。最近的系统综述显示，经济毒性可能导致不坚持治疗和健康相关生活质量受损，这两者都可能对患者的生存率产生不利影响。然而，人们对患者如何忍受 FT 却知之甚少，尤其是在中低收入国家。本研究旨在探讨印度尼西亚的癌症患者如何经历和应对 FT：方法：对印尼癌症患者进行了半结构化深度访谈，以探讨他们的经历。采用解释现象学分析方法对定性数据进行分析。我们有目的地招募了 8 名正在接受积极治疗的患者（年龄在 27-69 岁之间），他们在 5 年前被诊断出患有癌症，并且在诊断时拥有医疗保险：我们确定了两大主题：(1) 所经历的经济负担，包括保险不足、自付非医疗癌症相关费用和就业中断带来的负收入影响等副主题；(2) 经济应对策略，包括重新分配家庭预算、寻求家庭支持、合理化治疗决定和为家庭成员补充保险等副主题：这是文献中第一项关于家庭治疗的解释性现象学研究，也是印度尼西亚的第一项家庭治疗定性研究。我们的研究结果让我们深入了解了印尼癌症患者的家庭困境发生情况和应对策略。患者的主观体验可用于进一步改善肿瘤治疗，支持对FT进行测量的必要性，并为患者提供缓解方案。

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引用次数: 0

Looking to the Future: A Vision for Value in Health Regional Issues 展望未来：卫生领域的价值愿景地区问题

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-12-15 DOI: 10.1016/j.vhri.2023.11.008

Manuel A. Espinoza MD, MSc, PhD

引用次数: 0

Cost-Effectiveness of Comprehensive Genomic Profiling in Patients With Non–Small Cell Lung Cancer for the Colombian Health System 哥伦比亚卫生系统对非小细胞肺癌患者进行综合基因组分析的成本效益分析

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-12-14 DOI: 10.1016/j.vhri.2023.08.006

Oscar Gamboa MD, MSc , Carlos Eduardo Bonilla MD , David Quitian MSc , Gabriel Fernando Torres MD, MSc , Giancarlo Buitrago MD, MSc, PhD , Andrés F. Cardona MD, MSc, PhD, MBA

Introduction

The use of comprehensive genomic profiling (CGP) and target therapies is associated with substantial improvements in clinical outcomes among patients with non–small cell lung cancer (NSCLC). However, the costs of CGP may increase the financial pressures of NSCLC on health systems worldwide, especially in low- and middle-income countries. This study aimed to estimate the cost-effectiveness of CGP compared with current genomic tests in patients with NSCLC from the perspective of the Colombian Health System.

Methods

To estimate the costs and benefits of CGP and its comparators, we developed a 2-stage cohort model with a lifetime horizon. In the first stage, we made up a decision tree that calculated the probability of receiving each therapy as result of identifying a specific, actionable target. In the second stage, we developed a partitioned survival model that estimated the time spent at each health state. Incremental cost-effectiveness ratios were calculated for life-years (LYs) and quality-adjusted LYs gained. All costs were expressed in 2019 international dollars (INT$).

Results

CGP is associated with gains of 0.06 LYs and 0.04 quality-adjusted LYs compared with current genomic tests. Incremental cost-effectiveness ratios for CGP ranged from INT$861 to INT$7848, depending on the outcome and the comparator. Sensitivity analyses show that the cost-effectiveness decision was sensitive to prices of CGP above INT$7170 per test. These results are robust to most deterministic and probabilistic sensitivity analyses.

Conclusions

CGP may be cost-effective in patients with NSCLC from the perspective of the Colombian Health System (societal willingness-to-pay threshold of INT$15 630 to INT$46 890).

综合基因组谱分析(CGP)和靶向治疗的使用与非小细胞肺癌(NSCLC)患者临床结果的显著改善相关。然而，CGP的费用可能会增加非小细胞肺癌对全球卫生系统的财政压力，特别是在低收入和中等收入国家。本研究旨在从哥伦比亚卫生系统的角度评估CGP与当前非小细胞肺癌患者基因组检测的成本效益。方法为了评估CGP及其比较物的成本和收益，我们开发了一个具有生命周期的两阶段队列模型。在第一阶段，我们制作了一个决策树，通过确定一个具体的、可操作的目标来计算接受每种治疗的概率。在第二阶段，我们开发了一个分区生存模型，用于估计在每个健康状态下花费的时间。计算寿命年(LYs)和获得的质量调整LYs的增量成本-效果比。所有费用均以2019年国际元(INT$)表示。结果与目前的基因组检测相比，scgp与0.06个LYs和0.04个质量调整LYs相关。CGP的增量成本效益比从861至7848 INT$不等，取决于结果和比较国。敏感性分析表明，成本效益决策对每次检测的CGP价格高于7170 INT$很敏感。这些结果对大多数确定性和概率敏感性分析都是稳健的。从哥伦比亚卫生系统的角度来看，scgp在非小细胞肺癌患者中可能具有成本效益(社会支付意愿阈值为15630 - 46890 INT)。

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引用次数: 0

Central America and the Dominican Republic at Crossroads: The Importance of Regional Cooperation and Health Economic Research to Address Current Health Challenges 处于十字路口的中美洲和多米尼加共和国：区域合作和卫生经济研究对应对当前卫生挑战的重要性

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-12-11 DOI: 10.1016/j.vhri.2023.11.001

Jose Miranda PhD , Oscar Morales Barahona PhD , Alejandro Barahona Krüger MSc , Pilar Lagos MSc , Rodrigo Moreno-Serra PhD

Objectives

We discuss key health challenges currently faced by countries in the Central America and Dominican Republic region after the COVID-19 pandemic. We highlight the influence of socioeconomic determinants for the challenging public health dynamics observed and the crucial roles that regional cooperation and health economic research can have for tackling such challenges.

Methods

We present a descriptive overview of the current situation of public finances and its effect on government capacity to improve social expenditure. We also discuss the impact of the COVID-19 pandemic crisis on social dynamics and living conditions in the region.

Results

Our analysis suggests that the interplay between all these factors is likely to have important consequences for health systems and population health in the post-pandemic period. Previous examples of successful cross-country cooperation in the region indicate the great potential that these initiatives have for supporting health system resilience against current challenges. Technical cooperation must be informed by (currently unavailable) research evidence that can guide decision making, especially health economic research to support national health resource allocation policies. Areas identified as priorities for applied health economic research include both macro and microeconomic analyses.

Conclusions

Central America and the Dominican Republic face significant health challenges post-pandemic. Our article emphasizes the great potential that regional technical cooperation, informed by further health economic research, has to improve public policies and health governance in the region.

目标我们讨论了 COVID-19 大流行后中美洲和多米尼加共和国地区各国目前面临的主要卫生挑战。我们强调了社会经济决定因素对所观察到的具有挑战性的公共卫生动态的影响，以及区域合作和卫生经济研究在应对这些挑战方面可以发挥的关键作用。方法我们对公共财政现状及其对政府改善社会支出能力的影响进行了描述性概述。我们还讨论了 COVID-19 大流行危机对该地区社会动态和生活条件的影响。结果我们的分析表明，所有这些因素之间的相互作用可能会对大流行后时期的卫生系统和人口健康产生重要影响。该地区以往跨国合作的成功范例表明，这些举措在支持卫生系统抵御当前挑战方面具有巨大潜力。技术合作必须以（目前尚未获得的）能够指导决策的研究证据为依据，特别是卫生经济研究，以支持国家卫生资源分配政策。被确定为应用卫生经济研究的优先领域包括宏观和微观经济分析。结论中美洲和多米尼加共和国面临大流行病后的重大卫生挑战。我们的文章强调，在进一步开展卫生经济研究的基础上，区域技术合作在改善该地区公共政策和卫生治理方面具有巨大潜力。

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引用次数: 0

Forging Partnership Between Health Economics Researchers and Policy Makers: Better Methods, Better Policy, Better Health 在卫生经济学研究人员和政策制定者之间建立伙伴关系：更好的方法、更好的政策、更好的健康

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-12-07 DOI: 10.1016/j.vhri.2023.11.002

Paul Revill MSc , Manuel A. Espinoza MD, MSc, PhD

引用次数: 0

Scoping Review of Health Economics Research on Refugee Health in Sub-Saharan Africa 关于撒哈拉以南非洲难民健康的卫生经济学研究范围审查

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-12-07 DOI: 10.1016/j.vhri.2023.10.008

Wiktoria Tafesse PhD , Julie Jemutai PhD , Chrispus Mayora PhD , Federica Margini MSc Public Health

Objectives

Most refugees and internally displaced people (IDP) stay in low- and middle-income settings. A substantial proportion are hosted by countries in sub-Saharan African (SSA), which puts significant pressure on limited government healthcare budgets. As health economics may guide more optimal healthcare decision making, we scope the health economics literature on forcibly displaced populations in SSA to identify the nature and range of health economics evidence.

Methods

We conducted a scoping review of peer-reviewed and gray literature in English published from 2000 to 2021. Our search terms comprised a combination of keywords related to refugees, SSA, and health economics. We followed a stepwise methodology consisting of the identification and selection of studies, extraction and charting of data.

Results

We identified 29 health economics studies on refugees and IDPs in SSA covering different providers, interventions, and delivery platforms. Twenty-one articles studied the determinants of health, followed by 5 on the supply of healthcare and 2 concerned with economic evaluation and the demand for healthcare, respectively. We found an equal division of articles focusing on refugees and IDPs, as well as by settlement type. Mental health was the most frequently studied health area and Uganda was the most studied destination country.

Conclusions

The health economics literature on refugees in SSA remains limited. Our scoping review encourages future research to study a larger variety of healthcare systems and health economic topics such as economic evaluations, health financing and whole health systems to support resource allocation decisions and sustainable long-term solutions.

目标大多数难民和境内流离失所者（IDP）都居住在中低收入地区。撒哈拉以南非洲（SSA）国家收容了很大一部分难民和境内流离失所者，这给有限的政府医疗预算带来了巨大压力。由于卫生经济学可以指导更优化的医疗决策，我们对撒哈拉以南非洲被迫流离失所人口的卫生经济学文献进行了范围界定，以确定卫生经济学证据的性质和范围。我们的搜索条件包括与难民、撒南非洲和卫生经济学相关的关键词组合。我们采用了一种循序渐进的方法，包括识别和选择研究、提取数据并绘制图表。结果我们发现了29篇关于SSA难民和国内流离失所者的卫生经济学研究，涵盖了不同的提供者、干预措施和交付平台。21 篇文章研究了健康的决定因素，其次是 5 篇关于医疗供应的文章，还有 2 篇分别涉及经济评估和医疗需求。我们发现，关注难民和境内流离失所者以及定居点类型的文章数量相当。心理健康是研究最多的健康领域，乌干达是研究最多的目的地国家。我们的范围综述鼓励未来的研究对更多的医疗保健系统和卫生经济学主题进行研究，如经济评估、卫生融资和整个卫生系统，以支持资源分配决策和可持续的长期解决方案。

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引用次数: 1

A Vulnerability Index for Mitigation and Prevention of Diabetes Growth in India: A Disaggregated Analysis 印度缓解和预防糖尿病增长的脆弱性指数：分类分析

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-12-06 DOI: 10.1016/j.vhri.2023.09.009

Sujata Sujata PhD , Gayathri B. PhD , Ramna Thakur PhD

Objectives

This study aimed to provide a vulnerability index (VI) for identifying vulnerable regions in different states of India, which may serve as a tool for state- and district-level planning for mitigation and prevention of diabetes growth in the country.

Methods

Using data on 13 indicators under 4 domains, we generated domain-specific and overall VIs at state (36 states/union territories) and district levels (640 districts) using the percentile ranking method. The association of diabetes with individuals’ socioeconomic status at different levels of regional vulnerability has also been observed through multivariable logistic regression models.

Results

On a scale of 0 to 1, there are 13 states with an overall VI of >0.70, of which 5 states are from southern regions of India. A low VI has been achieved by socioeconomically backward states. We observed that prevalence rates and vulnerability levels for most of the top and bottom 11 states are in the same line. District-level analysis showed that the 20 most vulnerable and least vulnerable districts are mostly from coastal and socioeconomically backward states of the country, respectively. Furthermore, logistic regression revealed that rural adults and females are less likely to be diabetic in all vulnerability quartiles. The oldest, Muslims, wealthiest, widowed/deserted/separated, and those with schooling ≤12 years are significantly more likely to be diabetic than their counterparts.

Conclusion

The constructed VI is vital for identifying vulnerable areas and planners and policy-makers may use this comprehensive index and domain-specific VIs to prioritize resource allocation.

方法利用 4 个领域 13 个指标的数据，我们采用百分位数排名法生成了邦（36 个邦/中央直辖区）和区（640 个区）层面的特定领域和总体脆弱性指数。通过多变量逻辑回归模型，我们还观察了不同地区脆弱性水平下糖尿病与个人社会经济地位的关联。社会经济落后的邦的 VI 值较低。我们注意到，在排名前 11 个邦和排名后 11 个邦中，大多数邦的流行率和脆弱程度处于同一水平线上。地区层面的分析表明，20 个最脆弱和最不脆弱的地区分别来自该国的沿海和社会经济落后的州。此外，逻辑回归显示，在所有弱势四分位数中，农村成年人和女性患糖尿病的可能性较低。最年长者、穆斯林、最富有者、丧偶/荒漠/离散者以及受教育时间≤12 年者患糖尿病的可能性明显高于同类人群。

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引用次数: 0

Cost-Utility Analysis of Continuous Positive Airway Pressure Therapy Compared With Usual Care for Obstructive Sleep Apnea in the Public Health System in Brazil 巴西公共卫生系统中阻塞性睡眠呼吸暂停患者持续气道正压治疗与常规治疗的成本-效用分析

IF 2 Q2 Pharmacology, Toxicology and Pharmaceutics

Value in health regional issues

Pub Date : 2023-12-05 DOI: 10.1016/j.vhri.2023.10.006

Daniela V. Pachito PhD , Alan L. Eckeli PhD , Luciano F. Drager PhD

Objectives

This study aimed to conduct a cost-utility analysis of continuous positive airway pressure (CPAP) therapy compared with usual care as treatment of moderate to severe cases of obstructive sleep apnea (OSA) in Brazil, where decentralized policies of CPAP provision are in place.

Methods

Markov cohort model comparing CPAP therapy with usual care, that is, no specific treatment for OSA, for moderate to severe cases was used. The payer perspective from the Unified Health System, Brazil, was adopted. Effectiveness parameters and costs related to health states were informed by literature review. Resource use related to CPAP therapy was defined by specialists and costs informed by recent purchase and leasing contracts. Incremental cost-effectiveness ratios were generated for purchase and leasing contracts to reflect current practices. A conservative willingness-to-pay threshold was set at 1 gross domestic product per capita per quality-adjusted life-year (QALY) (Brazilian reais [BRL] 40 712/QALY). Uncertainties were explored in deterministic and probabilistic sensitivity analyses.

Results

Incremental cost-effectiveness ratio for the purchase modality was 8303 BRL/QALY and for leasing 45 192 BRL/QALY. Considering the adopted willingness-to-pay threshold, provision of CPAP by the purchase modality was considered cost-effective but not the leasing modality. The parameter related to the greatest uncertainty was the reduction in the risk of having a stroke attributable to CPAP. Probabilistic analysis confirmed the robustness of results.

Conclusions

CPAP therapy is a cost-effective alternative compared with usual care for moderate to severe OSA for the purchase modality. These results should help underpinning the decision making related to a uniform policy of CPAP provision across the country.

目的:本研究旨在对巴西中重度阻塞性睡眠呼吸暂停(OSA)患者进行持续气道正压(CPAP)治疗与常规治疗的成本-效用分析，在巴西，CPAP提供的分散政策已经到位。方法:采用马尔可夫队列模型，对中重度OSA患者采用CPAP治疗与常规治疗(即无特异性治疗)进行比较。采用了巴西统一卫生系统的付款人观点。通过文献综述了解与健康状态相关的有效性参数和成本。与CPAP治疗相关的资源使用由专家定义，费用由最近的购买和租赁合同通知。为购买和租赁合同生成了增量成本效益比率，以反映当前的做法。保守的支付意愿阈值设定为每质量调整生命年(QALY)人均国内生产总值1(巴西雷亚尔[BRL] 40712 /QALY)。在确定性和概率敏感性分析中探讨了不确定性。结果:购买模式的增量成本-效果比为8303 BRL/QALY，租赁模式的增量成本-效果比为45 192 BRL/QALY。考虑到采用的支付意愿阈值，以购买方式提供CPAP被认为是具有成本效益的，而不是租赁方式。与最大不确定性相关的参数是CPAP导致卒中风险的降低。概率分析证实了结果的稳健性。结论:与常规治疗相比，CPAP治疗是治疗中重度OSA的一种经济有效的选择。这些结果应该有助于支持与全国统一的CPAP提供政策相关的决策。

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引用次数: 0