Cost Effectiveness and Resource Allocation最新文献

While COVID-19 vaccines became available in late 2020, low-income countries (LICs) faced challenging COVID-19 vaccine distribution efforts in terms of both a delayed and scarce vaccine supply and barriers reaching the target populations. The cost of delivering COVID-19 vaccines in LICs is uncertain, which complicates planning and budgeting for country leadership as well as major funders. In the absence of such data, a global model was developed by the COVAX Working Group on Delivery Costing using data on the costs of similar immunization campaigns and assumptions. This study has two objectives, firstly to estimate the costs of delivering COVID-19 vaccine delivery using primary data collected in Malawi, and secondly comparing these estimates to modeled estimates based on secondary data, to contribute to a growing evidence base on the cost of the COVID-19 vaccination delivery in LICs.This retrospective study used a bottom-up method to estimate the financial and economic costs. Data were collected from health facilities and health posts via a COVID-19 cost survey. The data sources included existing records and interviews with relevant districts and facility staff. Twenty representative vaccine delivery sites were purposively selected across four districts. We focused on major cost drivers that contributed to the highest proportion and variability in delivery costs.The total financial cost of COVID-19 vaccine delivery in 20 facilities across four districts in Malawi (from April 1, 2021-March 31, 2022) was US$ 322,786. During that period, the 20 facilities delivered 70,947 vaccines. The financial cost per dose delivered was US$ 4.55. Considering the reallocation of existing staff time toward COVID-19 vaccination, volunteer opportunity costs, and donated vehicles, the economic cost per dose delivered was nearly four times greater at US$ 16.15. The economic cost of labor was estimated at US$ 10.75 per dose delivered and accounts for two-thirds of the total economic cost.This study is the first to provide evidence on the cost of COVID-19 vaccine delivery in Malawi. The financial cost of delivering the COVID-19 vaccine in twenty health facilities across 4 districts in Malawi, at US$ 4.55 [US$ 3.23- US$ 6.33] per dose delivered. We observed a large amount of labor reallocation towards COVID-19 vaccination.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, associated with significant morbidity, mortality, and economic burden due to thromboembolic events. In Chile, acenocoumarol is the most widely used anticoagulant, while access to direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, and apixaban remains limited for AF patients. Among DOACs, dabigatran is the only one with an approved specific reversal agent (idarucizumab) available in the Chilean public system. Evaluating the cost-effectiveness of these alternatives is critical for informing resource allocation.

Aims: To evaluate the cost-effectiveness of dabigatran compared to acenocoumarol, rivaroxaban and apixaban, for thromboembolic events prevention in atrial fibrillation (AF) patients, from the Chilean public health payer perspective.

Methods: A Markov cohort model was used to represent the natural history of AF in terms of ischemic and hemorrhagic complications. Direct costs were obtained from local official sources and converted to US dollars (1 USD = 710.9 CLP at 2022). Data about major events and utilities were obtained from the literature. We applied an undifferentiated discount rate of 3% for costs and outcomes over a lifetime time horizon. Uncertainty was characterized through deterministic and probabilistic sensitivity analysis. We also examined the use of idarucizumab and prothrombin-complexes-concentrate (PCC) as reversal agents in an emergency setting as an additional scenario-analysis.

Results: Dabigatran was the most (cost-)effective among all alternatives (8.53 QALYs). Considering the Chilean cost-effectiveness threshold of USD 17,200 (1 GDP per capita), dabigatran was cost-effective (USD 11,042 per QALY gained), while both rivaroxaban and apixaban were dominated by dabigatran. Regarding the second-order uncertainty, at the suggested threshold, dabigatran exhibit the highest probability of being cost-effective (approximately 60%). In the reversal agent scenario, dabigatran plus idarucizumab was also found to be cost-effective in the Chilean context.

Conclusion: Dabigatran is cost-effective and dominates both rivaroxaban and apixaban at current publicly available prices in Chile. In addition, we expect dabigatran-idarucizumab is also expected to be cost-effective for Chilean health system when is compared against acenocoumarol-PCC as reversal agents.

Objectives: The prevalence of chronic diseases is rising globally along with the consumption of nutraceuticals. It is documented that 80% of the deaths due to chronic illnesses occur in low and middle-income countries, including India. In addition, chronic diseases not only affect the patients but also their family income. Besides Southeast Asia is also the fastest-growing market for nutraceuticals with less stringent cost regulation. Hence, this research primarily focuses on the financial impact of the drug treatment for chronic illness, extensively comparing the therapeutic and non-therapeutic drug (nutraceutical) costs.

Methods: This was a retrospective, cross-sectional study with a sample size of 7877 prescriptions of medicine outpatient clinic, extracted from the hospital information system after 5 level screening for their inclusion in the study. The cost of drugs prescribed to the patient for chronic illness was calculated per month and its impact on the monthly family income was evaluated. The data analysis was stratified into the cost of therapeutic drug treatment and non-therapeutic drug treatment which was correlated with various chronic diseases and demographic parameters.

Results: A total of 465 patients were enrolled after screening and a high prescription rate of 88% for non-therapeutic treatment was reported. The total average monthly cost of chronic illness treatment was INR 1879 (22.42 USD), with therapeutic drug treatment of INR 1319 (15.74 USD) and non-therapeutic drug treatment of INR 560 (6.68 USD). Comprising 36% of patients, males spent higher amount on therapeutic drug treatment (INR 1780 or USD 21.26), while women spent higher on non-therapeutic drug treatment (INR 593 or USD 7.08). A catastrophic 11% of patients from 'lower' socioeconomic spent ≥ 10% of family income on non-therapeutic treatment.

Conclusion: Our study highlights the financial strain that chronic illnesses impose on families, emphasizing the need for policymakers to improve access to specialized care and cost capping of nutraceuticals.

Background: The number of published cost-effectiveness analyses in dental medicine has substantially increased in recent years. A key methodological issue in these analyses is how to address uncertainty in costs and effects, which also impacts uncertainty around the expected cost-effectiveness ratio. The cost-effectiveness acceptability curve has become the standard method to summarize uncertainty in probabilistic cost-effectiveness analyses. However, it does not inform decision-makers about budget impact or account for the fact that they are often risk-averse. The cost-effectiveness affordability curve and the cost-effectiveness risk-aversion curve have been proposed to address these limitations. In this systematic review, we assess how uncertainty has been handled in cost-effectiveness analyses in dental medicine, with a particular focus on affordability and risk-aversion.

Methods: We conducted a systematic literature search across electronic databases (MEDLINE, Web of Science, Cochrane Library, EconLit, Embase) on April 18, 2025, and performed manual searches of selected references. Articles published after January 1, 2021, were included. From each study, we extracted information on the first author, year of publication, country, intervention evaluated, study design (model-based, trial-based, or combined), use of deterministic and/or probabilistic sensitivity analysis, and whether budget impact and risk-aversion were considered.

Results: From a total of 57 published cost-effectiveness analyses, 49 (85%) used a deterministic sensitivity analysis and 37 (65%) used a probabilistic sensitivity analysis. Budget impact analysis was performed in five studies (9%), and only one study formally applied both the cost-effectiveness affordability curve and the cost-effectiveness risk-aversion curve.

Conclusion: The use of methods to address uncertainty related to budget constraints and risk-aversion remains limited in dental medicine. As decision-makers often operate within budget constraints and health is considered the most valuable good, incorporating methods that address affordability and risk-aversion could enhance the relevance and impact of cost-effectiveness analyses in dental care.

Background: The outpatient prescription service at UNS Hospital has traditionally relied on paper-based prescriptions. The outpatient prescription service at UNS Hospital is transitioning from paper-based to electronic prescription systems (EPSs). While existing literature highlights EPS benefits, gaps remain in understanding healthcare professionals' subjective experiences during implementation. This qualitative study explores doctors' and pharmacists' perceptions regarding the motivations, benefits, challenges, readiness, and system development suggestions for EPS implementation in outpatient services at UNS Hospital.

Methods: In-depth interviews were conducted with six doctors and four pharmacists between January and April 2024. The study participants were prescription doctors and pharmacists at UNS Hospital. The data were analyzed using thematic analysis techniques. Thematic analysis was used to identify the themes that emerged from the interviews.

Results: Five themes emerged: (1) Motivations centered on reducing medication errors and enhancing operational efficiency; (2) Benefits included improved communication, cost control, and streamlined workflows; (3) Readiness revealed pharmacists' enthusiasm versus doctors' cautious adaptation. (4) System suggestions emphasized real-time drug stock integration and advanced search features. (5)Electronic Prescription System Features included Information on adverse drug reaction.

Conclusion: While healthcare professionals perceive EPS as beneficial for safety and efficiency, addressing challenges like user training and system interoperability is critical for successful adoption. Implementing participant-driven suggestions, such as real-time inventory alerts, could optimize EPS effectiveness. These insights provide actionable strategies for hospitals transitioning to digital prescribing systems.

Introduction: Health system reforms are essential. In Iran, some of the most significant changes include the implementation of the Family Physician Program (FPP) and the Health Transformation Plan (HTP). The aim of this study was to assess the impact of these programs on the cost and use of services.

Methods: This quasi-experiment targeted insured individuals under the Iranian Health Insurance Organization in Fars province from 2010 to 2021. ANOVA, T-tests, and interrupted time-series analysis were used to investigate the impacts of FPP and HTP on service utilization and cost changes before and after the introduction of these programs.

Results: FPP decreased specialist visits, drug utilization, and drug expenditure in the short run. But eventually, it resulted in more general practitioner (GP) consultations, laboratory services, and imaging, hospitalization, and drug spending. The HTP first resulted in more GP consultations, laboratory services, drug use, and hospitalization but less use of imaging services and more total service spending. Eventually, the HTP resulted in more GP consultations, fewer GP prescriptions, and less laboratory test and imaging service spending.

Conclusion: FPP was successful in achieving some initial goals, such as decreasing expenditure and service usage through a referral system. It was finally unsuccessful in the long run due to the dissolution of this system and lack of proper supervision. At the beginning, the HTP imposed significant costs to insurance providers; however, it ultimately led to a reduction in the cost for particular services over a prolonged interval.

Objectives: Recently, NRG-GY018 clinical trial demonstrated that adding pembrolizumab to chemotherapy led to significantly longer progression-free survival than chemotherapy alone in the first-line treatment of advanced or recurrent endometrial cancer (a/rEC). This analysis aimed to estimate the cost-effectiveness of pembrolizumab plus paclitaxel plus carboplatin chemotherapy (PC) as the first-line treatment for a/rEC in the US and China.

Methods: A Markov model based on the clinical data from NRG-GY018 trial was established to estimate the cost and efficacy of PC and paclitaxel plus carboplatin groups for a/rEC in mismatch repair-proficient (pMMR) and mismatch repair-deficient (dMMR) populations. Direct medical costs and utility values were collected from the government databases, local databases, and published literatures. The main outcomes were incremental cost-effectiveness ratios (ICERs), incremental monetary benefit (INMB), and incremental net-health benefit (INHB). The robustness of the model was assessed using one-way and probabilistic sensitivity analyses.

Results: With the 5-year time horizon, treatment with PC gained an additional 0.87 QALYs (1.34 LYs) in pMMR and 4.17 QALYs (5.14 LYs) in the dMMR population. In the US, the ICERs of PC compared to chemotherapy were 404,575 $/QALY in pMMR and 124,406 $/QALY in dMMR patients, respectively. In China, the ICERs of PC compared to chemotherapy were 220,259 $/QALY and 70,207 $/QALY in pMMR and dMMR populations, respectively. The results of sensitivity analyses supported the robustness of our models.

Conclusions: For patients with a/rEC, PC was cost-effective compared with chemotherapy in the first-line treatment for dMMR populations in the US. However, the combination of pembrolizumab with chemotherapy was not a cost-effective strategy for pMMR a/rEC in the US and a/rEC in China regardless of the MMR status, a price reduction process is required to reach the traditional cost-effectiveness threshold.

Background: Idiopathic epilepsy is a serious neurological disorder that can lead to premature death and severe disability. We aimed to assess the global burden of idiopathic epilepsy, to provide a comprehensive understanding of the current dynamics and trends in idiopathic epilepsy, and to gain insight into its epidemiological attributes.

Methods: This study assessed the global, regional, and national impact of idiopathic epilepsy through incidence and disability-adjusted life year (DALY) based on the Global Burden of Disease Study 2021 (GBD 2021). After statistically summarizing the global incidence rates and disability-adjusted life years (DALYs), we performed Estimating Average Percent Change (EAPC) correlation analyses and Joinpoint regression analyses to further derive global trends in idiopathic epilepsy incidence rates and DALYs. Furthermore, through decomposition analysis, we determined which factors significantly influence the change in incidence and DALYs and the extent of their contribution. In addition, this study quantified the disparities in the burden of idiopathic epilepsy across countries through cross-country social inequality analyses, and finally predicted the future burden of idiopathic epilepsy based on Bayesian Age-Period-Cohort Model (BAPC).

Results: From 1990 to 2021, the incidence of idiopathic epilepsy increased generally, whereas DALY decreased. In terms of age and gender, the burden of idiopathic epilepsy is more severe in children and older age groups, with males bearing a higher burden than females. In terms of geographical distribution, the incidence was significantly higher in high Socio-Demographic Index (SDI) regions, while the burden of idiopathic epilepsy was heavier in low SDI areas. Decomposition analyses showed that the increase in incidence of idiopathic epilepsy and DALY in high SDI regions was mainly driven by epidemiological changes, whereas the increase in low SDI areas was more due to population growth. Cross-country social inequality analyses showed that despite improvements in the burden of idiopathic epilepsy, the burden and inequalities in low SDI countries remains significant. Projections indicated an increase in the incidence of idiopathic epilepsy globally, particularly in the 85 + age group, while global DALY was anticipated to continue declining.

Conclusions: Although global health is improving in line with population growth and age structure, the burden of idiopathic epilepsy remains significant. This study provides an important basis for prevention and care strategies for idiopathic epilepsy in different regions. Future work should focus on integrating idiopathic epilepsy into public health priorities, promoting effective measures, and narrowing treatment gaps.

Background: Health Technology Assessment in India (HTAIn) carries evidence-based decision making in improving health care. This study was done to assess cost-effectiveness of the laparoscopic IPOM technique compared to open VHR from health system perspective of India.

Methods: A Meta-analysis of outcomes of both procedures was carried out whereas cost estimates were obtained from national health system costing database.

Results: A meta-analysis of Randomized Control Trials (RCTs) showed similar risk in hernia recurrence rates between laparoscopic IPOM and open technique (RR: 1.28 95% C.I: 0.81, 2.04) but with significantly less risk for wound infections (RR: 0.31 95% C.I: 0.18, 0.54). Estimated cost from National Health System Costing Database (NHSCD) per VHR was high for laparoscopic IPOM (INR 58,872) compared to open hernioplasty (INR 36,166) with estimated Incremental Cost-Effective Ratio of INR 5,023 per wound infection averted.

Conclusions: Laparoscopic IPOM was not clinically effective in hernia recurrence and less likely to be cost-effective.