Cost Effectiveness and Resource Allocation最新文献

Introduction: Allergic rhinitis (AR) is highly prevalent worldwide, often leading to substantial healthcare costs and diminished patient quality of life. Although guidelines frequently recommend intranasal corticosteroids, oral second-generation antihistamines remain commonly used in many low- and middle-income countries. We performed a cost-utility analysis of newer-generation oral H1 antihistamines for adults with intermittent AR in Colombia.

Materials and methods: A 28-day decision-tree model compared multiple antihistamines' costs and quality-adjusted life years (QALYs). Inputs included clinical effectiveness and adverse-event probabilities from systematic reviews and network meta-analyses. All costs, expressed in 2024 US dollars (1 USD = 4,400 COP), were adjusted for inflation. Net monetary benefits (NMB) were calculated using willingness-to-pay thresholds for Colombia (US$ 5130). Probabilistic sensitivity analyses were conducted to assess uncertainty in key parameters.

Results: Cetirizine 10 mg and fexofenadine 180 mg were the only undominated strategies, exhibiting higher NMB values than other antihistamines. Deterministic analysis showed that cetirizine had a lower total cost (22.15 USD) and an ICER of 349.62 USD per QALY gained. In contrast, fexofenadine provided a slight gain in effectiveness at a modest incremental cost. Probabilistic analysis confirmed fexofenadine as cost-effective option across a wide range of thresholds, with cetirizine remaining a strong contender at lower thresholds.

Conclusion: In this cost-utility analysis of oral H1 antihistamines for adults with intermittent allergic rhinitis in Colombia, cetirizine 10 mg and fexofenadine 180 mg emerged as the cost-effective options, offering high net monetary benefits and remaining undominated in deterministic and probabilistic analyses.

Background: Maternal sensitivity is a crucial factor in fostering infants' resilience and healthy development. Parent-Infant Psychotherapy (PIP) interventions focus on the improvement of maternal or paternal sensitivity, among other outcomes. Little is known about their cost-effectiveness. This study aimed to evaluate the cost-effectiveness of a short-term PIP compared to care as usual (CAU) in Germany.

Methods: Cost-effectiveness analyses were conducted in two randomized controlled trials (RCTs) of the SKKIPPI project, which investigated the efficacy of a six-week PIP program compared to CAU. PIP aimed to support the establishment and maintenance of healthy parent-infant relationships. The first RCT (RCT-M) focused on mothers with postpartum mental disorders and their infants, while the second (RCT-I) examined children aged 0-36 months with regulatory problems and their mothers. Maternal sensitivity was assessed using the sensitivity subscale of the Emotional Availability Scale (EAS) at baseline, six weeks (primary endpoint), and twelve months, with scores ranging from 1 to 7 (Likert Scale) and higher values showing better sensitivity. Group differences were evaluated using ANCOVAs, adjusted for baseline values and treatment settings (inpatient/outpatient). Health care resource utilization was self-reported via questionnaires at baseline and after twelve months. Costs were estimated using standardized unit costs, and gamma-distributed generalized linear models with log link functions were applied to evaluate cost differences between groups from enrollment to twelve months from a payer's perspective. Incremental Cost-Effectiveness Ratio (ICER) was calculated if applicable.

Results: Between 2019 and 2021, 51 participants (25 PIP) of RCT-M, and 70 participants (38 PIP) of RCT-I could be included in our analyses. In RCT-M, adjusted EAS scores were slightly lower in the PIP group after twelve months (Δ -0.22, 95% CI -0.55 to 0.11), with higher adjusted costs in the PIP group (Δ €5,603). In RCT-I, the PIP group showed slightly higher adjusted EAS scores (Δ 0.12, 95% CI -0.13 to 0.36), resulting in an ICER of €29,600 per EAS unit gained. Results remained robust in sensitivity analyses.

Conclusion: Cost-effectiveness of the evaluated PIP in improving maternal sensitivity was unlikely in both trials. Future research could focus on mothers with more severe maternal sensitivity problems and alternative effectiveness measures.

Trial registration: German Register for Clinical Trials, ID: DRKS00016353 (RCT-M) and ID: DRKS00017008 (RCT-I).

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.