Cost Effectiveness and Resource Allocation最新文献

Background: The EVER-132-002 trial demonstrated the significant efficacy and manageable safety of sacituzumab govitecan in hormone receptor-positive human epidermal growth factor receptor 2-negative (HR + HER2-) metastatic breast cancer. This study evaluated the cost-effectiveness of sacituzumab govitecan compared with chemotherapy from the Chinese healthcare system perspective.

Methods: A partitioned survival model at 21-day intervals over a 10-year time horizon was developed to evaluate the total cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) at willingness-to-pay (WTP) threshold of 3 times gross domestic product per capita ($38,042.49 per QALY). Clinical data were extracted from the EVER-132-002 trial; direct medical costs and utility values were obtained from public bid-winning databases, local charges or published literature. To determine the model's robustness, scenario, one-way, two-way and probabilistic sensitivity analyses were performed.

Results: Compared with chemotherapy, sacituzumab govitecan generated an additional cost of $91,273.72, with an additional QALY of 0.43, resulted in an ICER of $211,948.62 per QALY. Patient weight was the most influential parameter on base-case results, and variations in each parameter did not substantially alter the conclusion. Probabilistic sensitivity analysis demonstrated that the probability of sacituzumab govitecan to be cost-effective was zero at the WTP threshold of $38,042.49 per QALY. Scenario analysis indicated that sacituzumab govitecan would be cost-effective versus chemotherapy only if its cost was reduced by 83% ($202.65 per unit) or more.

Conclusions: Sacituzumab govitecan might not be cost-effective compared with chemotherapy in the treatment for HR + HER2- metastatic breast cancer in China.

Background: Financial risk protection is one of the main goals of healthcare systems worldwide and prepayment system plays an important role to achieve it. There are some prepayment schemes, and Individual voluntary private health insurance (IVPHI) as a way can be affected by some variables.

Objective: This study aimed to investigates the factors affecting the purchase and selection of IVPHI coverage in Iran.

Methods: This study used secondary data from a private insurance company in Iran, collected in 2023. Data were retrospectively gathered via an online questionnaire covering demographics, health status, and lifestyle factors used to assess risk for voluntary health insurance plans. Individuals with high-risk profiles were referred to the company's physician for a clinical examination, after which they were categorized into high-risk or low-risk groups. The insurer then decided whether to approve the purchase of individual supplementary health insurance (ISHI). After data extraction and cleaning, a multivariate logistic regression model was used to identify determinants of voluntary health insurance purchase.

Results: Most ISHI sales occurred in low-deprivation provinces (71%), with women (64%) and those aged 26-49 (70%) more likely to purchase. Higher coverage (Plan 4) was preferred across all age groups. Key factors influencing ISHI purchase included health status, basic insurance, and region, with moderate deprivation areas showing higher demand for higher coverage plans.

Conclusion: The findings emphasize regional, demographic, and health status disparities in ISHI purchases. Policymakers should focus on improving access to higher coverage plans, especially in more deprived areas, to ensure equitable insurance distribution.

Background: Renal insufficiency is one of the most common complications in the treatment of multiple myeloma (MM). The administration of isatuximab showed improved patient outcome regarding the occurrence of renal insufficiency. Building on the results of the ICARIA-MM study, the aim of this study was to quantify the potential cost savings due to a prevented progress of renal insufficiency.

Methods: Real-life accounting data of the University Hospital Cologne (Germany) of inpatients with MM between 2016 and 2020 were analyzed regarding the presence of renal insufficiency. The health-economic impact of a less severe renal insufficiency due to improved renal filtration on German Diagnosis-Related Groups (G-DRG) tariffs was modelled.

Results: The analysis revealed a total of 74 hospital cases with MM. The vast majority (n = 64; 86.5%) were allocated to the G-DRG code R61, summarizing patients with "lymphoma and non-acute leukemia". Based on a reduction of stage 3 renal failure to stage 2, the model showed cost saving potential in patients with acute renal failure ranging from € 3,101 to € 4,642 per case.

Conclusion: The analysis quantifies for the first time the economic saving potential of improved renal function in patients with relapsed/refractory multiple myeloma in the German healthcare system through the administration of isatuximab.

Background: Nirmatrelvir/ritonavir is indicated for the treatment of COVID-19 in symptomatic adults with increased risk for severe illness, not requiring supplemental oxygen yet. From a Dutch societal perspective, a cost-utility assessment of nirmatrelvir/ritonavir versus best supportive care (BSC) was conducted in three patient groups: (a) immunocompromised patients, (b) patients aged at least 60 years with one comorbidity, (c) patients aged at least 70 years. Groups were selected considering their relevance as high-risk groups, as described in Dutch and international guidelines and recommendations.

Methods: A one-year decision-tree, estimating costs and outcomes associated with a COVID-19 infection was coupled to a lifetime two-state Markov component simulating subsequent life-time survival and quality of life. Effectiveness estimates, informing the intervention preventing hospital admission or death, were based on real-world evidence by Lewnard and colleagues (2023) in a vaccinated population during a timeframe with predominance of the Omicron variant. Epidemiology relies on publicly available data, primarily sourced during the Omicron variant's era. In the decision tree, clinically relevant event-related disutilities per disease course were applied to adjusted age-dependent Dutch-specific utility levels. In the Markov component, a disutility was considered for post-ICU patients. Costs rely on Dutch pharmacoeconomic guidelines and public data sources. The incremental cost-effectiveness ratio (ICER) was analysed as the main outcome, with a positive ICER indicating the cost associated with each additional quality-adjusted life year (QALY) gained by adopting the intervention.

Results: Nirmatrelvir/ritonavir was associated with an ICER of € 395 in the immunocompromised group (per patient: + 0.125 QALYs gained; + 0.130 life-years [LYs] gained; € 49 incremental cost), with an ICER of € 8700 in 60-plus patients with comorbidity (+ 0.054 QALYs; + 0.055 LYs; € 474 incremental cost), and with an ICER of € 13,021 among 70-plus patients (+ 0.053 QALYs; + 0.045 LYs; € 689 incremental cost). Results were most sensitive to the baseline hospitalization rates among high-risk individuals. Probabilistic sensitivity analyses indicate a high probability of being cost-effective (100, 94, 85% respectively), considering a willingness-to-pay threshold of € 20,000 per QALY.

Conclusions: From a Dutch societal perspective, over a lifetime horizon, nirmatrelvir/ritonavir is cost-effective versus BSC in the three groups analysed.

Background: As health expenditure continues to rise due to income growth, technological advancements, and an aging population, it has become increasingly important to accurately measure and improve the efficiency of health systems. This is because financial resources are limited, and the allocation of resources can significantly influence the quality of health systems and health outcomes.

Methods: This study applies machine learning techniques-Efficiency Analysis Trees (EAT) and Random Forest for Efficiency Analysis Trees (RFEAT)-to evaluate the efficiency of health systems in 36 OECD countries, comparing the results with those from the traditional free disposal hull (FDH) method.

Results: Analysis shows high discrimination power in the order of RFEAT, EAT, and FDH. The correlation in efficiency rankings shows more than 80% similarity between RFEAT and EAT, while both show less than 80% similarity with FDH. According to RFEAT estimates, the countries with the highest efficiency are South Korea, Switzerland, and Costa Rica, whereas the United States, Lithuania, and Latvia are identified as the least efficient. The group-level analysis reveals that Asian countries, on average, perform more efficiently followed by Oceania, Europe, and the Americas. The groups with higher out-of-pocket healthcare expenditures per capita tend to show slightly better efficiency and the group with the smallest elderly population proportion exhibits the highest average health system efficiency.

Conclusion: Traditional methods like FDH are prone to inefficiency underestimation, especially in small samples with multiple variables. This study demonstrates the potential of machine learning approaches like EAT and RFEAT to provide more reliable efficiency estimates. These methods can help policymakers make better resource allocation decisions by mitigating inefficiency underestimation and offering greater discrimination power.

Background: Inherited metabolic disorders (IMDs) are a significant cause of morbidity and death among children. To determine the cost-effectiveness of newborn screening for IMDs using tandem mass spectrometry (MS/MS) compared to the non-screened group in China.

Methods: We constructed a decision tree screening model based on the Chinese clinical path of tandem MS/MS screening for inherited metabolic disorders (IMDs) from the medical health system. This model simulated the mechanism of screening in the prevention and treatment of IMDs. The IMDs screening data was collected from Children's Hospital of Shanghai between 2010 and 2021. The Quality-adjusted life years (QALYs) and life expectancy were obtained from literature, while cost data was mainly sourced from hospital records and literature.

Results: In the base-case analysis, the total lifetime cost per patient was higher for the MS/MS screened group at 1,000,452 Chinese Yuan (CNY) (USD 143,515), compared to 157,303 CNY (USD 22,565) for the non-screened group. The QALYs gained were 16.47 and 3.97 for the screened and non-screened groups, respectively. The incremental cost-effectiveness ratio (ICER) of the MS/MS screened group compared to the non-screened group was 67,417 CNY (USD 9,671) per QALY gained, which is under the threshold of 3 times per capita GDP of China in 2022 (242,928 CNY, USD 34,848). The benefit-cost ratio (BCR) was 4.23, which means that for every 1 CNY (USD 0.1434506) invested, a return of 4.23 CNY (USD 0.57) can be obtained. The probability of cost-effectiveness was 100% in the MS/MS screened group compared to the non-screened group, indicating that the results of the base case analysis were robust.

Conclusion: Compared to the non-screened group, the MS/MS screened group incurs higher costs but also yields significantly greater QALY gains. Considering both the costs and benefits, the MS/MS screened group is an attractive cost-effective option at the current willingness-to-pay threshold for IMDs screening in China.

Background: Changes in the demand behavior for primary care during the covid-19 pandemic may translate into changes in the overall public health situation in Iran with the increase in the prevalence of non-communicable diseases.

Objective: The present study aimed to investigate the impact of the Covid-19 pandemic on the primary health care utilization and cost in Fars province of Iran.

Methods: Monthly utilization and cost of primary health care was extracted from the data base of Fars province branch of Iran Health Insurance Organization (IHIO) in Iran. The interrupted time series analysis (ITSA) was used to investigate the short-term and long-term effects of Covid-19 on the utilization and cost of primary health care.

Results: The mean difference test showed that the monthly utilization and cost of primary health care after Covid-19 has decreased significantly (64307 for utilization and 11581 US dollars for cost). The ITSA estimates showed that the number of monthly primary health care visits after Covid-19 has decreased significantly by 53,003 in the short term and 2,330 in the long term. Moreover, the cost of primary health care shows a significant decrease of $24,722 and $3,822 per month in the short term and in the long term, respectively.

Conclusion: It found a significant reduction in the utilization of primary health care. Considering the role of primary care in controlling the burden of chronic diseases, planning for active follow-up of patients with chronic conditions should be on the agenda.

Background: Childhood cancer is not a high priority in health care financing for many countries, including in Ghana. Delayed care seeking and treatment abandonment, often due to the financial burden of care seeking to families, are common reasons for a relatively low overall survival (OS) in low-and middle-income countries. In this study, we analyzed the cost-effectiveness of extending health insurance coverage to children with Burkitt lymphoma (BL) in Ghana.

Methods: We developed a Markov model in Microsoft Excel to estimate the costs and effects of BL treatment when National Health Insurance Scheme (NHIS) was provided compared to the status quo where NHIS does not cover care for childhood cancer. The analysis was undertaken from the societal and health system (payer) perspective. Both costs (measured in $) and effects, measured using disability adjusted life years (DALYs), were discounted at a rate of 3%. The time horizon was a lifetime. Probabilistic sensitivity analysis was done to assess uncertainty in the measurement of the incremental cost-effectiveness ratio (ICER). A budget impact analysis was undertaken from the perspective of the NHIS.

Results: In the base-case analysis, the intervention (NHIS reimbursed treatment) was less costly than current practice ($8,302 vs $9,558). The intervention was also more effective with less DALYs per patient than the standard of care (17.6 vs 23.33). The ICER was -$219 per DALY averted from societal perspective and $113 per DALY averted from health system perspective. The probabilistic sensitivity analysis showed that the intervention is likely to be both less costly and more effective than current practice in 100% of the 1,000 simulations undertaken.

Conclusion: Providing health insurance coverage to children with BL is potentially cost-effective. The effectiveness and cost-savings relating to this strategy is driven by its positive impact on treatment initiation and retention. Based on this evidence, there has been a policy change where Ghana's NHIS has prioritized financing for cancer treatment in children.

Background: The PECUNIA Project was funded by the H2020 programme in which 10 partners from six countries participated. The aim was to develop standardized, harmonized and validated methods and tools to calculate costs in different sectors (such as health and social care, education among others), with the purpose of facilitating comparability of economic evaluations of health technologies across European countries. In this paper we report the first validation of the developed reference unit cost templates in Spain.

Methods: The evaluation of the PECUNIA Reference Unit Cost (RUC) Templates involved usability, transferability and feasibility assessment. Applicability tests were performed to estimate the cost of a selection of 15 resource items by means of the RUC templates in Spain and in four Spanish regions. External validation involved comparison with existing unit costs.

Results: It was possible to estimate the cost of five services (dental care and general practitioner in the Canary Islands, general practitioner in Spain [tariffs], health-related day care centre and education services provided in a special education school in the Basque Country), car vandalism as an example of potential health-related consequences, and informal care in Spain. The templates were feasible although data completeness depended on the type of data needed to estimate the costs. The templates are transferable across countries although comparability depends on the services available in each jurisdiction.

Conclusions: The PECUNIA RUC Templates are free and feasible tools to estimate comparable reference unit costs across countries. Although more validation exercises are needed, they seem useful tools to perform robust multi-national economic evaluations and increase the transferability of cost-effectiveness studies of health technologies in Europe. However, they cannot compensate for the lack of data across jurisdictions.

Background: The cost accounting of medical service projects forms the basis for disease cost accounting and DRG (Diagnosis-Related Groups) cost accounting. Among the various costs involved, human resources represent a significant portion and are highly complex, making their accurate accounting a critical and challenging aspect of cost accounting for medical service projects.

Methods: This paper introduces the itemized point cost (IPC) method, a novel cost accounting approach based on the RBRVS (Resource-Based Relative Value Scale) theory. It outlines the core concepts of "points" and "process steps" within the IPC framework and details its application in human cost accounting. An example of impacted tooth extraction in the stomatology department of Hospital A is used to illustrate the IPC method's implementation process.

Findings: A comparative analysis with activity-based costing and time-estimation costing methods shows that the IPC method is concise, practical, and operable. It is also aligned with the principles of cost-effectiveness.

Conclusions: The paper proposes strategies to promote the IPC method, including leveraging information technology, enhancing top-level design, and standardizing processes, to improve its adoption and effectiveness in medical cost accounting.