Cost Effectiveness and Resource Allocation最新文献

Background: Hepatitis C virus (HCV) causes significant global morbidity and mortality, and combating it is a global health priority. Pakistan has a particularly high burden of HCV, including cases that remain undetected and untreated.

Methods: In 2019, a pilot workplace health screening program for chronic diseases, including HCV, was launched at Aga Khan University in Pakistan. We performed an economic evaluation to determine its cost-effectiveness in screening for HCV, inform resource allocation decisions, and advance evidence in this field. Over the course of the screening pilot, 1,809 employees completed enrollment, blood tests, assessment, and consultation. Cost-effectiveness modeling was conducted using a combination of decision-tree and Markov approaches. Univariate and multivariate probabilistic sensitivity analyses were performed.

Results: The median final ICER was $307.39 per DALY averted. Uncertainty around the health status of those lost to follow-up produced a large confidence interval, from $167.92 to $1601.22 per DALY averted, depending on the assumptions made. This screening is estimated to save anywhere from 1 to 14 lives by preventing HCV-induced liver failure, depending on the burden of HCV in the lost to follow-up group, out of a total of 25 HCV-induced liver failure deaths in the control group, between a 44% and a 4% reduction.

Conclusions: Our findings support that employee screening for HCV is cost-effective in high-prevalence areas such as Pakistan and a wise investment of health resources. The findings also point to programmatic improvements that could maximize the health benefits and improve the cost-effectiveness of other similar programs.

Background: Sustainable procurement is gaining attention across the world. In Ghana, interest is growing, even though a comprehensive sustainable procurement policy is yet to be implemented. This study explores the driving factors of sustainable procurement in the health sector using the case of two of the oldest teaching hospitals in Ghana.

Methods: The study used an exploratory qualitative case study to conduct key informant interviews (KIIs) mainly from Komfo Anokye and Korle-Bu Teaching Hospitals. Nineteen key informants from the two hospitals and four from three regulatory bodies were interviewed. Interviews were conducted from May 2019 to December 2019. The interviews were analysed thematically to find the main drivers.

Results: Both hospitals shared several drivers. These include resource conservation, following legal rules, avoiding legal cases, client satisfaction, health concerns, cost savings, and value for money. Komfo Anokye Teaching Hospital also showed context-specific drivers like societal pressure, profit-making, professional and personal ethics, and influence from donors and global groups. On the other hand, Korle-Bu Teaching Hospital has specific drivers such as cultural awareness, protecting public funds, making services affordable, using modern technology, and choosing long-lasting equipment.

Conclusions: The study shows that both local and global issues influence sustainable procurement in Ghana. Shared drivers reflect global goals. Context-specific drivers show that each institution also responds to its own needs. These findings show the need to link environmental goals with local social and economic needs in health care.

Background: Dialysis patients are at high risk for hepatitis B virus (HBV) infection. Intramuscular administration of HBV vaccination has shown limited responsiveness and durability of seroprotection in dialysis patients. Intradermal (ID) HBV Sci-B-Vac vaccination with imiquimod (Toll-like receptor 7 agonist) pretreatment was reported to be safe and improve seroprotection. This study aimed to evaluate the cost-effectiveness of ID administration of HBV Sci-B-Vac with pre-treatment imiquimod cream in dialysis patients from the perspective of US healthcare providers.

Methods: A lifetime Markov model was used to estimate outcomes in a hypothetical cohort of serologically negative dialysis patients with: (1) HBV Sci-B-Vac administered intradermally with pre-treatment imiquimod (IMQ) cream (IMQ + ID group), (2) HBV Sci-B-Vac by intradermal injection alone (ID group), and (3) HBV Sci-B-Vac by intramuscular injection alone (IM group). Main results included direct medical costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER).

Results: QALYs in the IMQ + ID group (2.9763) were the highest, followed by the ID group (2.9751) and the IM group (2.9740). The ID group (more costly and totals less QALYs versus IMQ + ID) was strongly dominated by the IMQ + ID group, and was eliminated from the cost-effectiveness analysis. The ICER of the IMQ + ID group versus the IM group (17,032 USD/QALY) was lower than the willingness-to-pay (WTP) threshold (50,000 USD/QALY) and remained lower than the WTP threshold in the one-way sensitivity analysis. The probabilities of IMQ + ID, IM, and ID groups to be cost-effective at a WTP of 50,000 USD/QALY were 85.06%, 14.86%, and 0.08%, respectively.

Conclusion: ID administration of HBV Sci-B-Vac with pre-treatment IMQ cream in serologically negative dialysis patients was the cost-effective strategy.

Background: Sports injuries are becoming increasingly prevalent worldwide as sports and physical activities gain popularity. These injuries impose a significant burden on individuals and society. However, a limited understanding of the cost analysis of sports injuries in Southeast China exists.

Objective: The objective is to explore the medical costs associated with sports injury surgery and related healthcare policies from a hospital perspective.

Methods: We conducted a prospective analysis of inpatient costs for sports injury surgeries at the First Affiliated Hospital of Jinan University from 2015 to 2022. The total expenditure was categorized into various components: general medical service, nursing service, imaging, rehabilitation, etc. These were analyzed based on the International Classification of Function, Disability, and Health (ICF) system, surgical type, year category, and age. Furthermore, we accessed authoritative economic data, such as standardized occupational salaries and cost estimations, to comprehensively depict the economic burden. We employed a generalized linear model to identify factors influencing costs and performed statistical comparisons across different demographic and clinical categories.

Findings: All values are expressed in 2022 Chinese Yuan (¥). A total of 8,804 hospitalized patients were registered. The median total expenditure is ¥38,691 (19680, 49640) (≈ 5749 US dollars), of which the S730 is the lowest ¥23,250 (8627, 31364) (≈ 3455 USD), and the S710 is the highest ¥61,626 (25990, 77122) (≈ 9157 USD). Grouped by year, the median in 2019-2020 was the highest at ¥42,008 (23095, 53281) (≈ 6242 USD), and the lowest in 2015-2016 was ¥30,903 (11517, 42954) (≈ 4592 USD). In terms of surgery type, Shoulder Arthroscopy has the highest median cost of ¥51,550 (40703, 60028) (≈ 7660 USD), and Ankle arthroscopy has the lowest median cost of ¥34,177 (29194, 38209) (≈ 5078 USD). In terms of age, the highest median cost was ¥44,306 (27807, 55588) (≈ 6583 USD) for > 65 years, and the lowest was ¥13,671 (5182, 15899) (≈ 2031 USD) for 1-12 years. Different age groups, genders, years of admission, ICF categories, surgical grades, occupation types, and arthroscopic surgery types significantly affect hospitalization costs.

Conclusion: This study examined various aspects of surgery for sports injuries in Southeast China. Shoulder arthroscopy was the costliest procedure, with disposable medical materials being the primary expense. These findings offer valuable insights into expenditure patterns in this context.

Clinical trial number: Not applicable.