Cost Effectiveness and Resource Allocation最新文献

Introduction: Opioid poisoning in children under 12 years of age is a serious health problem in Iran that can lead to mortality and increase the economic burden on the health system. Given the increasing access of children to opioids, a more accurate understanding of the economic dimensions of these poisonings is necessary to develop effective strategies to prevent the costs imposed on families and the health sector.

Methods: This cross-sectional descriptive study was conducted on 45 children hospitalized with opioid poisoning in Motahari Hospital, Urmia during 2022. Demographic information of children and parents, type of substance consumed, type of health insurance, length of hospitalization, and direct medical costs were collected and analyzed using SPSS version 27 software.

Results: The mean age of the children was 5.08 ± 1.96 years, and 57.8% of them were boys. The most commonly used substance was methadone (40%). A total of 62.2% of the parents had less than a diploma, 17.8% had a history of addiction, and 6.7% of the children died due to poisoning. The estimated economic burden of pediatric opioid poisoning in Iran was $318,306 in 2022.

Conclusion: Opioid poisonings in young children occurred more frequently in boys, with methadone identified as the most common cause of poisoning. Low parental education levels and a history of addiction in the family were the main risk factors. Increasing parental awareness, controlling access to opioids, and strengthening support services can be effective in reducing poisoning cases and preventing unnecessary costs.

Background and objectives: In India, the burden of respiratory diseases has brought about a need for the use of inhalational bronchodilators, which often pose a financial strain for a significant portion of the underprivileged population. Hence Jan Aushadhi initiative makes available quality drugs at affordable prices through dedicated stores through-out India. The objective of this study was to perform a cost comparison study of generic inhalational bronchodilators provided through Jan Aushadi pharmacies versus their branded counterparts.

Methods: The cost of Jan Aushadi drugs and the cost of the most expensive and cheapest marketed branded drugs for the same molecule and dose were ascertained and presented in Indian rupees. The cost difference, cost ratio and cost variance were calculated by comparing the price of Jan Aushadi generic drugs with the most expensive and cheapest branded drugs in the same category.

Results: Compared to branded drugs, all the Jan Aushadi generic drugs were cheaper, except one (SALMETROL). The highest cost difference was observed for Tiotropium Bromide, while the least was observed for Salmetrol (25mcg). The highest cost ratio (5.55) and cost variance (455.454) were observed for Tiotropium Bromide (9 mcg).

Interpretation and conclusions: The current study compares the cost difference between the branded Inhalational bronchodilators on the market and Jan Aushadhi generic inhalational bronchodilators. Replacing the costly branded bronchodilators with Jan Aushadhi generic drugs can result in substantial cost savings. By conducting a cost comparison, decision makers can gain insights into the financial implications.

Objective: To test the cost effectiveness of an implementation strategy to promote evidence-based practice for low back pain in the emergency department.

Methods: An economic evaluation was conducted alongside a stepped-wedge cluster-randomised controlled trial. The trial aimed to evaluate a strategy to implement a guideline-endorsed model of care in four emergency departments in New South Wales, Australia. The intervention targeted emergency clinicians and was compared to usual emergency care. The main trial outcomes were healthcare use that aligns with the main principles of the model of care. The outcomes explored in this economic evaluation were lumbar imaging referrals, opioid use, and hospital admissions for low back pain. Costs related to implementation development, delivery and healthcare utilisation were included. Bivariate linear multilevel regression analyses were conducted, adjusting for clustering, time and the correlation between cost and outcome to calculate incremental cost and effects and incremental cost-effectiveness ratios. Non-parametric bootstrapping with 5,000 replications of incremental cost and effect pairs was carried out and plotted on cost-effectiveness planes for each of the outcomes. Cost-effectiveness acceptability curves were generated to explore the probability of being cost-effective based on a range of willingness to pay thresholds for each of the outcomes. Sensitivity analyses were carried out to determine to what extent the decision to exclude episodes of care missing healthcare costs and including inpatients costs impacted the results.

Results: The implementation was more effective but more costly when considering the three key outcomes. The implementation was cost-effective in reducing opioid use with an incremental cost-effectiveness ratio of $3,574.29 per episode of care where opioids were avoided. The incremental cost effectiveness ratios for avoiding imaging and hospitalisation were $26,298.50 and $49,290.00 per episode of care, respectively. The first sensitivity analysis highlighted uncertainty with the hospital admission result and the second sensitivity analysis found that the implementation was more likely to be cost-effective when considering emergency department costs only.

Conclusion: This implementation of the model of care may be cost-effective for reducing opioid use in patients who present to emergency with low back pain, however more research into willingness to pay to avoid opioid use in emergency departments is required.

The construction of key medical disciplines plays a crucial role in enhancing the capacity of medical services, cultivating high-level medical professionals, and advancing the development of medical technology. However, there is a relative insufficiency in assessing the efficiency of constructing these key disciplines. Most existing evaluations focus primarily on health services. To address this gap, the present study evaluates the construction efficiency of key medical disciplines within Tianjin and identifies critical factors that significantly influence this efficiency, thereby providing strategies for optimization. This research employs a three-stage data envelopment analysis (DEA) model to measure the construction efficiency of key medical disciplines. The super-efficient non-expected SBM model is utilized to analyze both the first and third stages of this three-stage DEA framework. In the second stage, adjustments are made to input variables based on results from Stochastic Frontier Analysis (SFA). Furthermore, Tobit regression analysis is conducted to examine factors influencing efficiency. The findings reveal that the average technical efficiency of key medical disciplines stands at 0.18, with only 8.57% classified as DEA efficient. The Tobit regression analysis indicates a significant positive impact from the proportion of doctoral personnel, material costs and travel costs on construction efficiency. It is essential to allocate resources rationally for developing key medical disciplines while implementing various measures aimed at optimizing both educational structures within discipline teams and financial resource allocation in order to enhance overall construction efficiency.

Video-EEG monitoring (VEM) is an obligatory step in drug-resistant epilepsy (DRE) management. The common way of VEM is in-hospital VEM (IVEM), which is limited by the need to admit the patient to the epilepsy monitoring unit. Prolonged intermittent home VEM (PIHVEM) can be a more available alternative. Since reducing antiseizure medication at home is impossible, PIHVEM can be associated with long monitoring and, therefore, relatively high cost. To regulate the parameters of PIHVEM (the patient selection criteria and length of PIHVEM), we introduce the cost-availability model (CAM), which balances the VEM availability and VEM cost, considering the ratio between the annual number of VEM studies performed for DRE and annual DRE incidence (VEM DRE/VEM incidence). The lowest CAM value corresponds to the most optimal parameters of PIHVEM. CAM value decreases with longer PIHVEM. With a lower VEM DRE/VEM incidence ratio, CAM value reduction can be achieved by including patients with lower seizure frequency in PIHVEM. In such a situation, the considerations of VEM availability outweigh the VEM cost. With the increase in VEM DRE/VEM incidence ratio, the influence of VEM cost increases relative to VEM availability. The conclusions: PIHVEM can increase VEM availability without increasing the cost, and CAM can estimate the optimal PIHVEM parameters.

Background: Evidence suggests that community pharmacist-led interventions in managing type 2 diabetes mellitus (T2DM) can improve clinical outcomes such as glycated hemoglobin (HbA1c), blood pressure, and lipid profiles, thereby reducing the risk of cardiovascular complications. However, limited research has evaluated the economic value of such interventions, particularly in the context of Iran.

Objective: Given the absence of well-designed studies assessing the cost-effectiveness of community pharmacist-based interventions in preventing cardiovascular complications among patients with T2DM in Iran, this study aimed to evaluate the economic and clinical impact of such an intervention. Standard care provided by community pharmacists served as the comparator.

Methods: This study was conducted over 12 months in a community pharmacy setting. A total of 110 patients with T2DM were enrolled, with 55 receiving usual care (comparator group) and 55 receiving a structured pharmacist-led intervention. The intervention included medication optimization, lifestyle counseling, and dietary guidance, with a focus on reducing cardiovascular risk. Economic evaluation was performed from the healthcare system perspective using a Markov model over a 10-year time horizon. Outcomes included life years gained (LYG) and reduction in the 10-year risk of cardiovascular events. Direct medical costs for both the intervention and comparator groups were considered.

Results: Pharmacist-led interventions significantly reduced average HbA1c levels (p = 0.009), improved HDL cholesterol (p = 0.016), and lowered LDL cholesterol (p = 0.05) in the intervention group compared to the comparator. SBP also showed a statistically significant improvement in the intervention group (p = 0.003), while the comparator group experienced an increase in SBP. The estimated 10-year risks for coronary heart disease (CHD) and stroke, both fatal and nonfatal, were lower in the intervention group. The cost-effectiveness analysis revealed that the intervention resulted in a cost saving of -1469.02 USD and an additional 0.045 life years gained compared to usual care.

Conclusion: The findings suggest that community pharmacist-led interventions targeting cardiovascular risk reduction in patients with T2DM are both clinically effective and cost-efficient. Incorporating pharmacists into diabetes care programs may significantly improve cardiovascular outcomes while reducing long-term healthcare costs in Iran.

Background: Hypertension is a prevalent global health issue with far-reaching consequences. It impacts millions of individuals worldwide and poses significant risks to overall health. We aimed to explore and compare the cost-effectiveness and clinical efficacy of single, dual, and triple antihypertensive therapies in the management of blood pressure.

Method: This retrospective observational study evaluated the cost effectiveness of antihypertensive therapy from the inpatient records of hypertensive urgency patients from January 2022 to December 2022. Data was extracted from the medical records including crucial information such as MR number, name, gender, weight, dates of admission and discharge, co-morbidities, therapy type, prescribed drugs and doses, and blood pressure readings. Employing standard costing techniques, the study calculated direct medical costs associated with the patient's stay, medical care, nursing, and medication charges, considering the timeframe of August 2023. Data was analyzed using SPSS and Microsoft Excel. Mann Whitney and Kruskall Walis test was performed for statistical analysis.

Results: Out of 120 patients, the majority were male 55% and between the age group 61-80 years i.e., 45%. The analysis revealed a statistically significant impact on systolic blood pressure across the different therapies. Monotherapy resulted in a higher median systolic BP (140.0 mmHg [IQR 6.27]) compared to dual therapy (136.7 mmHg [IQR 6.7]) and triple therapy (133.3 mmHg [IQR 10.0]), with a significant difference (p = 0.000). In terms of cost-effectiveness, triple therapy demonstrated the lowest average cost-effectiveness ratio (ACER) for systolic BP control PKR 1803, while dual therapy was the most cost-effective for diastolic BP management with PKR 2438.

Conclusion: The study concluded triple therapy as the most cost effective strategy for reducing systolic blood pressure, demonstrating its efficacy in blood pressure management. Conversely, dual therapy proved optimal for controlling diastolic blood pressure.

Registration: IRB # 0126 - 23 Dated: 24 July 2023.

Background: Respiratory syncytial virus (RSV) causes a large burden of illness among infants and young children, accounting for 50,000 hospitalizations annually in U.S. children under two years of age. RSV-related illness can require outpatient, emergency department, and hospitalized medical care contributing to significant medical and nonmedical economic burden. Further, the symptoms associated with RSV can reduce quality of life in children and their caregivers. Presently, the economic burden of RSV illness for children and their caregivers is largely unresearched. The objective of this study was to estimate the financial, time, and quality of life burdens associated with pediatric RSV illness for children and their caregivers.

Methods: Surveys were developed to measure the out-of-pocket costs, time costs, and caregiver quality of life associated with medically attended RSV illness. Caregivers of pediatric (age 0-17 years) patients with RSV illness seen at Michigan Medicine were invited by email and text message between October 2022 and June 2023 to complete the online surveys.

Results: Mean out-of-pocket medical costs for outpatient and emergency department (ED) visits were more than $500 per case. Mean out-of-pocket medical costs associated with hospitalizations, with an average length of stay of 6 days, were $1290 per case. Non-medical costs ranged from $83-$267 depending on health care service utilized. Mean time spent traveling, waiting, and receiving care in outpatient and ED settings was 9 h per case. Caregivers spent an average of 3.5 days caring for their non-hospitalized child with RSV illness and 11.6 days caring for their child who was hospitalized. Quality-adjusted life years (QALYs) lost for caregivers was 0.011-0.019. QALYs lost per episode for the sick child ranged between 0.0161 and 0.087 for outpatient episodes of illness and hospitalization, respectively.

Conclusions: This study demonstrated the high financial burden and consequences to quality of life experienced by children with RSV illness and their caregivers, especially when the child was hospitalized due to their illness. Use of these findings will be valuable for evaluating the cost effectiveness of treatments and preventative measures from the perspective of caregivers, and understanding the complete economic burden of RSV illness.

Background: The prevalence of smoking among Jordanian females has risen significantly from 10.1% in 2000 to 12.8% in 2022. (Who smokes more, men or women? - Our World in Data), it is imperative to recognize the global scope of this issue, which encompasses both genders. Furthermore, it is vital to discern potential sex-specific variations in the health and economic consequences of smoking cessation. This study aims to investigate the cost-effectiveness of smoking cessation interventions specifically tailored for Jordanian women.

Methodology: This study employs a pharmacoeconomic analysis to evaluate the potential cost effectiveness of JFDA-approved smoking cessation medications within the context of Jordanian women. The analysis focused primarily on a comparative assessment of two registered medications in Jordan, varenicline and nicotine replacement therapy (NRT), encompassing nicotine patches and lozenges. These interventions are juxtaposed against a control group representing the current standard practice of medical counseling with no medication use from the Ministry of Health's payer perspective.

Results: For a cohort comprising 82,512 Jordanian female smokers seeking to quit, the varenicline regimen yielded a gain of 13,151 life years compared with the 7,265 life years gained with the NRT regimen compared with the no-intervention scenario. The cost per life-year gained was found to be JD 1,689.50 ($ 2383.3) for varenicline and JD 1,892.48. ($2669.63) for NRT. The sensitivity analysis confirmed the robustness of the findings.

Discussion: The notably high cost-effectiveness of smoking cessation interventions in females underscores the importance of tailoring approaches to address the needs of female smokers who express an intention to quit. This research highlights the imperative of offering smoking cessation aids to facilitate efforts to quit smoking.