Cost Effectiveness and Resource Allocation最新文献

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.

Background: The contradictions between the insufficient supply of health services and the growing healthcare demand in China is still prominent. It is necessary to study the changes of China's main health resource individual and allocation efficiencies in recent years for improving the health services in China.

Methods: Data were collected from the National Data published on the website of the National Bureau of Statistics of the People's Republic of China and the Statistical Bulletin on the Development of Healthcare in China. The "Proportion Weight Method (PWM)" was used to establish some simple models of health resource efficiency under the multi-input and multi-output conditions for analyzing the health resource efficiencies. PWM is an objective valuation method to determine the weight of the indicators based on their own values. It means that the weight of one indicator is equal to the proportion of this indicator's value in all related indicators' values. If one indicator has larger proportion in all, it shows that this indicator plays a more important and effective role than others in representing or distinguishing its unit among all decision making units (DMUs).

Results: It was found that the efficiency of health institution of China showed an increasing trend from 0.77 in 2008 to 0.91 in 2021, with the largest value of 1.0 in 2019 and an average of 0.89, while the efficiencies of health personnel, health expenditure and health institution beds all showed downward trends from 1.0 in 2008 to 0.71, 0.26, 0.58 in 2021 respectively, with averages of 0.89, 0.54 and 0.79. The health resource allocation efficiency showed a slight downward trend from 0.99 in 2008 to 0.92 in 2021, with the average of 0.95.

Conclusion: The health resource allocation efficiency in China is overall at a high level with a downward trend, which is mainly due to the rapid declines of health expenditure efficiency and health institution bed efficiency. The models of health resource individual and allocation efficiencies established in this study are simple and practical, which are convenient to adopt targeted measures to upgrade the efficiency of resource allocation.

Background: This paper presents the rationale and plan for a cost-effectiveness analysis conducted alongside an open-label, prospective, randomized, two-arm, multicenter, non-inferiority study by the Consortium for Advancing the Prevention and Management of Cancer in People with HIV (AMC) in sub-Saharan Africa. The study compares two commonly used chemotherapy agents, paclitaxel (PTX) and pegylated liposomal doxorubicin (PLD), administered intravenously with concomitant antiretroviral therapy (ART) for the treatment of adult persons living with Human Immunodeficiency Virus (HIV) (PLWH) with severe Kaposi sarcoma (KS) according to WHO guidelines. The two regimens are commonly used in high-resource settings but have not been formally compared in lower-resource settings.

Methods: This study uses a decision-tree model to evaluate the cost-effectiveness of PTX versus PLD for treating severe KS in adults living with HIV. A health system perspective and a two-year time horizon will be applied. Costs, including medications, labs, and hospitalizations, will be estimated using micro-costing and time-and-motion analyses. Health outcomes will be measured in Quality Adjusted Life years using PROMIS 29 + 2 utility scores. Sensitivity analyses will include Daily adjusted life years and Years of Life Lost.

Discussion: This research will provide valuable insights into the cost-effectiveness of these treatments in managing KS. The results of this analysis will have important implications for healthcare providers and policymakers, offering guidance on the optimal treatment approach for HIV-infected individuals with KS.

Trial registration: This study (NCT05411237) is registered on ClinicalTrials.gov, sponsored by the Consortium for Advancing the Prevention and Management of Cancer in People with HIV. It was first posted on June 9, 2022, with the latest update on January 29, 2025. The trial was prospectively registered before participant enrollment. Estimated primary completion is December 2027, with full completion in September 2028.

Introduction: Lipid-lowering therapy is central to cardiovascular disease (CVD) management. Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) inhibitors (alirocumab, evolocumab) and inclisiran offer greater low-density lipoprotein cholesterol (LDL-C) reduction and improved outcomes beyond statins and ezetimibe, but high costs raise affordability concerns in low- and middle-income countries. This study reviews their cost-effectiveness in developing settings.

Methods: PubMed, Scopus, Web of Science, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to March 1, 2024. Studies were assessed for Quality-Adjusted Life Years (QALYs), Life Years Gained (LYGs), costs, and "Incremental Cost-Effectiveness Ratios" (ICERs). Quality and bias were evaluated using the "Integrated Health Economic Evaluation Reporting Standards" (CHEERS) and ECOBIAS checklists, following "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines.

Results: Of 580 records, 13 studies (2019-2024) from China (n = 8), Thailand, Mexico, Taiwan, Qatar, and Saudi Arabia met inclusion criteria, mostly evaluating evolocumab for primary and secondary prevention using Markov models (Time horizon: 2 years -lifetime, Discount rates: 3-5%). Studies were generally from a healthcare perspective. Evolocumab was not cost-effective in Chinese post-myocardial infarction (MI) patients (ICERs up to $281,762/QALY) but favorable in familial hypercholesterolemia(FH) ($57,018/QALY), and when evolocumab added to statins was cost-effective in patients with acute MI ($7,819 to $61,242 per QALY) and acute coronary syndrome (ACS) (vs. ezetimibe + statins) ($26,110/QALY) and atherosclerotic cardiovascular disease (ASCVD) (vs. placebo + statins)($4,268/QALY). Alirocumab ($490,198/QALY) and inclisiran ($335,404.88/QALY) were not cost-effective, while ezetimibe was ($22,965/QALY). In Thailand, PCSK9 inhibitors ($1,496,139/QALY), and ezetimibe ($33,246/QALY) exceeded thresholds. Evolocumab was cost-effective in Mexico ($37,925/QALY-$44,346/QALY) and Saudi Arabia ($49,502/QALY-$71,968/QALY) but not in Qatar. Sensitivity analyses identified drug prices, event risks, and utilities as key ICER drivers, with probabilistic analyses showing low cost-effectiveness in China (~ 2%) but higher in high-risk groups or at elevated thresholds.

Conclusion: Cost-effectiveness of PCSK9 inhibitors and inclisiran varies across developing countries, driven by drug prices, WTP thresholds, and healthcare perspectives. Evolocumab may be cost-effective in high-risk subgroups or in Mexico and Saudi Arabia but remains largely unaffordable elsewhere. Ezetimibe was consistently more favorable. Price reductions, tiered pricing, pooled procurement, and context-specific thresholds are essential to improve access and equity.