Cost Effectiveness and Resource Allocation最新文献

Background: Understanding insurance preferences for mental health services can help provide appropriate service demand and insurance coverage for such services.

Objectives: The present research aimed to investigate the preferences and willingness to pay of the people of Tehran for mental health insurance services using the discrete experiment method.

Methods: Quantitative methods were used in this applied research and it was conducted on 420 individuals (210 patients with mental disorders and 210 healthy people) using a discrete choice experiment. The data analysis was performed using the conditional regression model as well.

Results: The final model in this study included 6 attributes. The findings of the present research showed a statistically significant relationship (P < .001) between the odds ratios (OR) of choosing health insurance at all levels of insurance coverage except the service limit and the amount of insurance premium. Along with the increase in the cost coverage levels, the likelihood of choosing health insurance for the benefits of inpatient services at 70% and 90% levels (P < .001, OR = 1.96 and P < .001, OR = 2.28), outpatient services at 70% and 90% levels (P < .001, OR = 1.53 and P < .001, OR = 1.64), service delivery location (P < .001, OR = 1.54), and the use of online services (P < .001, OR = 0.84) increased significantly.

Conclusions: The findings showed that the people of Tehran had the highest preference and willingness to pay for the coverage of inpatient services. The results of this study can be provided to health managers and policy makers to predict the welfare effects and people's reactions to changes in mental health insurance policies so that they would be able to plan better to provide higher-quality services with the participation of people.

Background: Hip spica cast, plate and screw fixation, elastic nail fixation and external fixation are used to manage femoral fractures in children. Currently, there is still lacking evidence of the full economic evaluation for various treatments of pediatric femoral shaft fractures. This study was aimed to determine the cost-utility for the pediatric femoral shaft fracture treatment methods.

Methods: A bidirectional cohort study included children aged 2-11 years old with femoral shaft fracture at the university hospital between January 2001 and December 2021. Direct medical and non-medical costs were retrieved from medical records and telephone interview, while quality adjusted life year (QALY) was derived from EQ-5D-5L questionnaire. Considering both hospital and societal perspective, cost-utility analysis was assessed by incremental cost-effective ratio (ICER). The one-way sensitivity analysis was done according to varying parameters, and a Tornado diagram was generated.

Results: Twelve patients were included with mean age 7.6 ± 3.1 years, and 7 females (58.3%). Treatment distributions were 3 (25%) hip spica (HS), 8 (66.7%) plate and screws (PS), and one (8.3%) external fixation (EF). Regarding HS vs. PS, QALY was 0.981 vs. 0.958 (P = 0.393), and the leg length discrepancy was 8.3 mm vs. 8.0 mm (P = 0.903). Direct medical cost was 28,465 vs. 37,277 Baht (P = 0.047), and direct non-medical cost was 100,000 vs. 97,250 Baht (P = 0.570). When compared to PS, HS had lower ICER for hospital perspective - 383,152 Baht/QALY and for societal perspective - 263,587 Baht/QALY. Admission, and PS operation cost mostly contributed to cost-utility pattern.

Conclusion: HS provides cost-utility advantages for the treatment of pediatric femoral shaft fractures when compared to PS. Small samples for each treatment, especially EF, comes up with insufficient power to detect significant difference between groups. Further comprehensive study including other operations with adequate sample size is required.

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).