Health Economics Review最新文献

Background: The ASCENT and OptiTROP-Breast01 trials indicated that sacituzumab govitecan and sacituzumab tirumotecan significantly improved clinical benefits in metastatic triple-negative breast cancer (TNBC). This study evaluated the cost-effectiveness of trophoblast cell-surface antigen 2 (TROP2)-targeted antibody-drug conjugate (ADC) from the Chinese healthcare system perspective.

Methods: A partitioned survival model with 21-day cycles was developed to simulate total costs, life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER) over 10-year time horizons. Clinical data was extracted from the ASCENT and OptiTROP-Breast01 trial, costs and utilities were estimated from public bid-winning databases, local charges and published literature. The willingness-to-pay (WTP) threshold was three times gross domestic product per capita in 2024 ($40,334.05). In scenario analysis, models were constructed employing network meta-analyses based on chemotherapy as the reference arm. One-way and probabilistic sensitivity analyses were implemented to examine the robustness of the model.

Results: In the base-case, the ICERs were $92,593.65/LY and $122,486.54/QALY for sacituzumab tirumotecan, and $348,005.00/LY and $409,219.27/QALY for sacituzumab govitecan compared with chemotherapy. Sacituzumab tirumotecan was dominant versus sacituzumab govitecan by virtue of lower costs and higher QALYs. When the unit costs of sacituzumab tirumotecan and sacituzumab govitecan were lower than $475.12 per 200 mg and $141.54 per 180 mg, they would be cost-effective over chemotherapy. The utility value of progression-free survival state was the most critical role on the base-case result. Probabilistic sensitivity analyses revealed that substantial price reductions for sacituzumab tirumotecan and sacituzumab govitecan could dramatically increase the probabilities of becoming cost-effective.

Conclusion: Sacituzumab tirumotecan and sacituzumab govitecan were unlikely to be cost-effective in previously treated metastatic TNBC. Sacituzumab tirumotecan was the preferred TROP2-targeted ADC in China.

Objective: To evaluate the total societal costs of postoperative antibiotic use compared to non-use in patients undergoing surgery for high horseshoe anal fistula (HHAF), based on a randomized controlled trial.

Methods: We conducted a single-blinded randomized controlled trial in 90 patients with HHAF treated using a standardized loose combined cutting seton (LCCS) procedure at the Department of Colorectal Surgery, China-Japan Friendship Hospital, between January and October 2023. Participants were randomly assigned to either a postoperative Antibiotic group or a No Antibiotic groups. The primary outcome was total societal cost. Clinical outcomes, including wound healing time and early recurrence, were assessed as secondary measures A societal cost-minimization analysis (CMA) was performed, encompassing direct medical costs, outpatient visit costs, and indirect costs due to lost productivity. Patient follow-up was completed by December 2024.

Results: Ninety patients were randomized equally (45 per group) with comparable baseline data. The Antibiotic group showed significantly higher hospitalization costs (¥13,202 ± 3,054 vs. ¥9,322 ± 1,205; p < 0.001) and longer stays (12.5 ± 5.8 vs. 7.9 ± 2.4 days; p < 0.001), without differences in wound healing (p = 0.490). Regression confirmed that both incision number (β = 1735.18, p = 0.020) and antibiotic use (β = 3287.06, p < 0.001) independently increased cost, with a significant interaction (β = 3641.00, p = 0.010). Antibiotic use also led to more outpatient visits (5.25 vs. 2.75; p = 0.013) and higher total societal costs (¥9,802 vs. ¥7,931; p = 0.014). Sensitivity analyses under multiple scenarios consistently confirmed higher overall costs in the Antibiotic group.

Conclusion: Routine postoperative antibiotics showed no significant additional clinical benefit in terms of wound healing or recurrence in HHAF patients treated with LCCS, yet significantly increase societal costs and postoperative burdens. A selective, evidence-based approach to antibiotic use should be adopted in the surgical management of complex anal fistulas.

Trial registration: This study was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2400093477) on December 5, 2024, after the enrollment of participants began in January 2023. The retrospective registration is in accordance with the journal's editorial policy for studies involving healthcare interventions in human participants.

Objectives: Nepalese students in Japan surged from under 1,000 in 2008 to over 29,000 by 2019, driven by Japan's strategy of using student visas to fill unskilled labor gaps. This study examined the cost and benefit impact of the introduction of pre-entry tuberculosis (TB) screening policy, including testing and treatment for Japan and Nepal from 2014 to 2018.

Methods: This study used anonymous data of TB statistics of diagnosis and treatment from the Nepal Demographic and Health Survey and from Japan's Legal Affairs Bureau and Tuberculosis Surveillance Center. We used social cost-benefit analysis to examine the effect of the pre-entry TB screening policy on visas of Nepalese workers and students to Japan. Total cost, total benefit and net benefit for both countries were compared for the policy scenarios "With" and "Without", using net present value (NPV). In order to address parameter differences for uncertainty, we conducted sensitivity analysis using the Monte Carlo simulation with secondary transmission rate.

Results: Between 2014 and 2018 in Japan, net present value (NPV) of Nepalese students increased from USD 1.9 million to USD 3.1 million; likewise, NPV of Nepalese workers grew from USD 1.1 million to USD 3.2 million. From the perspective of Japan, the increase in NPV was greater than zero, meaning that the implementation of the policy could produce a benefit for Japan regarding prevention of an increase in new TB cases. The total NPV was USD -51.6 million, as pre-entry screening and treatment costs are incurred by both emigrants and the national health system.

Conclusions: Implementing a pre-entry TB screening policy for foreign migrants from high-burden countries such as Nepal could yield cost savings by reducing the incidence of newly diagnosed and potentially transmissible TB cases. Strong collaboration could ensure the follow-up and incentive for burden sharing of the implementation cost.

Risk adjustment formulas are essential in health insurance markets, as they mitigate risk selection incentives by aligning revenues with expected healthcare expenses based on enrollee characteristics. However, current formulas can underpredict spending for certain groups, leading to under-compensation for insurers and potentially affecting fairness, quality, and access to care. Many countries are exploring the addition of new variables to improve accuracy, but this can also weaken incentives for cost control. This paper illustrates a methodology approach to risk adjuster selection by using a penalized regression framework that explicitly incorporates the potential downsides of including specific variables. Drawing on a large dataset of over 10 million Colombian health insurance enrollees, we combine statistical estimation with expert assessment of each variable's susceptibility to gaming to construct a specification that limits gaming and maintains predictive accuracy.