Cost Effectiveness and Resource Allocation最新文献

Objectives: New antiviral medications for hepatitis C can significantly reduce liver disease risk, and decrease mortality rates and associated costs. The cost-effectiveness of Glecaprevir/Pibrentasvir (GLE/PIB) has not yet been compared with other treatments in Iran, although it has demonstrated effectiveness and cost-effectiveness in other countries such as Japan and Brazil. Therefore, this study aimed to determine the cost-effectiveness of Glecaprevir/Pibrentasvir compared with Sofosbuvir/Daclatasvir (SOF/DCV) and Sofosbuvir/Velpatasvir (SOF/VEL) in Iran.

Matherial and methods: The analysis was conducted using a Markov model with a one-year cycle in a lifetime horizon from the perspective of the Ministry of Health. Effectiveness was calculated based on Quality-Adjusted Life Years (QALY). Costs were based on the direct medical costs (DMC) of Hepatitis C Virus treatment in Iran in 2024. The extraction of effectiveness was based on the results of published valid studies. The extraction of costs was done based on micro-costing and local costing. A cost-effectiveness comparison of the three investigated medication regimens was conducted through incremental cost-effectiveness ratio (ICER) and Incremental net benefit (INB). Finally, one-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to evaluate the uncertainty of the model parameters.

Results: The study showed that the direct medical costs (DMC) and Quality-Adjusted Life Years (QALYs) for GLE/PIB, SOF/DCV, and SOF/VEL were $7505, $5493, $5443, and 21.053, 20.806, and 20.898 QALYs, respectively. The ICER of GLE/PIB compared with SOF/DCV and SOF/VEL was $8138 and 13,282, respectively. The ICER was below the national willingness-to-pay threshold of 18,261 PPP$ (one time the GDP per capita for 2022), indicating that GLE/PIB was a cost-effective treatment. In the sensitivity analysis, the model was most sensitive to some parameters such as the cost of Chronic Hepatitis C (CHC) state for GLE/PIB, the cost of CHC for SOF/VEL, and the Utility of CHC for GLE/PIB and SOF/VEL. In the probabilistic sensitivity analysis, the probability of GLE/PIB being cost-effective compared to SOF/DCV was 56% and compared with SOF/VEL was 53.7%. The acceptability curve also showed that GLE/PIB was the superior choice in 40.6% of simulations based on differential willingness to pay.

Conclusion: The results showed that GLE/PIB is cost-effective compared with the two common medication regimens in Iran, SOF/DCV and SOF/VEL, consistent with Iran's national willingness-to-pay threshold based on one time the GDP per capita, making it a good treatment option for patients with hepatitis C.

Introduction: Nutritional support is an integral part of treating critically ill children in paediatric intensive care units (PICUs). Early enteral nutrition (EEN) in the PICU has been shown to have greater benefits compared to delayed enteral nutrition (DEN) in reducing PICU and hospital stays and lowering mortality. In this study, we conducted a cost comparison and cost-effectiveness analysis of early versus delayed enteral nutrition during PICU and hospital stays for children aged 1 month to 12 years in Malawi.

Methods: We used primary and secondary data to cost PICU and hospital admissions from a payer perspective. We developed a stochastic model that assumed that equal cohorts of 500 critically ill children were admitted to the PICU and provided with EEN and DEN. Using the average length of stay in the PICU and hospital and cost data, we estimated total cohort costs and the average cost per patient for each strategy. We estimated disability-adjusted life years (DALYs) and used the total hospital costs to estimate the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the results.

Results: The total cohort cost for EEN in the PICU was lower, $479,850, than that for DEN, $515,623. The total cohort costs for the hospital stay were also lower for EEN, $564,290, than for DEN, $613,902. The average cost per patient for EEN in the PICU was lower at $960 than $1031 for DEN. The average cost per patient for the hospital was also lower for EEN, $1129, than for DEN, $1228. EEN dominated DEN and the ICER was estimated as -$39.47/DALY averted. Probabilistic sensitivity analysis showed that EEN had a greater probability of being cost-effective, for a capacity to pay or cost-effectiveness threshold range of 0$-2000$/DALY averted, than DEN. Scaling up the implementation of EEN led to higher net monetary and health benefits.

Conclusion: EEN in children aged 1 month to 12 years was found to be less costly and more cost-effective than DEN in Malawi.

Background: The MONARCH 3 trial has demonstrated that Anastrozole combined with Abemaciclib is safe and effective for the treatment of postmenopausal hormone receptor-positive advanced breast cancer. However, its cost-effectiveness for long-term use has not been investigated yet. This study aims to evaluate the cost-effectiveness of Anastrozole combined with Abemaciclib versus Anastrozole used alone for patients in China.

Methods: Based on MONARCH 3 trial data, we constructed a Markov model using Treeage Pro 2022 software. The model cycle was set at 1 month over a period of 20- year time horizon, and the annual discount rate was set at 5%. The cost-utility analysis was used to assess the cost-effectiveness of Anastrozole combined with Abemaciclib for the treatment of postmenopausal hormone receptor-positive advanced breast cancer. The output indexes of the model were cost and quality-adjusted life year (QALY), and the model evaluation index was incremental cost-effectiveness ratio (ICER). The willingness to pay (WTP) threshold was set at 3 times the per-capita gross domestic product (GDP) of China in 2023 (¥268,074/QALY). Meanwhile, one-way sensitivity analysis and probabilistic sensitivity analysis were used to explore the uncertainties of the model and parameters.

Results: Anastrozole combined with Abemaciclib provided more health benefits than Anastrozole used alone, however, the total cost was higher. The incremental utility and incremental cost were 0.01 QALYs and ¥1075.51, respectively. And the ICER of the two regimens was ¥93,940.83/QALY, which was less than 3 times the per-capita GDP of China in 2023 (¥268,074). The results of the sensitivity analysis attested that the study results were robust.

Conclusions: Anastrozole combined with Abemaciclib is more cost-effective than Anastrozole used alone for the treatment of postmenopausal hormone receptor-positive advanced breast cancer.

Background: The United Arab Emirates (UAE) pharmaceutical market is estimated to reach 4.7 billion by 2025. Although several price reduction initiatives have been implemented, no prior study has systematically compared UAE medicine prices with those of a developed country. This study aimed to compare the pharmaceutical prices between UAE and Australia.

Methods: Retail medicine price data were obtained from publicly available database sources: Australian Pharmaceutical Benefits Scheme (PBS) and UAE Ministry of Health and Prevention. Medicines in the UAE that cost more than twice their Australian counterparts were further assessed for their therapeutic benefit using the France Haute Autorite de Sante Amélioration du Service Médical Rendu (ASMR) rating. Price ratios were calculated, log-transformed, and analysed using linear regression to examine associations with ASMR rating, drug class, and drug category (originator, biosimilar, generic).

Results: Price data were analyzed for 301 medicines (286 originators, 14 biosimilars, one generic). 3.7% of the drugs were cheaper, 12.0% were similarly priced or up to double, and 84.4% were more than double the cost in Australia. ASMR distribution showed 2.3% as ASMR I, 5.6% as ASMR III, 11.0% as ASMR IV, and 43.9% as ASMR V. Prices in the UAE remained substantially higher than in Australia, even after purchasing power parity adjustment. Originators drove the largest disparities, while biosimilars were over twice Australian benchmarks. Higher therapeutic benefit was not consistently associated with smaller price gaps.

Conclusions: Medicine prices in the UAE were substantially higher than in Australia, largely driven by low-benefit drugs. Findings highlight a persistent misalignment between therapeutic value and pricing, underscoring the need for stronger value-based pricing and affordability policies benefits.

Background: Early cancer diagnosis is crucial in improving the survival. The main goal in NHS in cancer diagnosis is detection rate of 75% by 2028. Our study presents the economic analysis of impact of early versus late-cancer diagnosis on healthcare resources use and costs within our Trust also exploring the influence of deprivation index.

Methods: We retrospectively analyse the cost-of-care and patient-level data for 4596 patients across nine cancer groups who fully completed their cancer pathway between April 2020 and September 2024. Costs were compared between early (stage 1 and 2) versus late (stage 3 and 4) diagnosis.

Results: Significant variations in costs were determine across cancer types, with colorectal and haematological malignancies being most costly. Early-stage diagnosis averaged £11,2K, significantly lower than late- stage £23,8K with largest differences seen in haematological, colorectal and breast cancers. A hypothetical 75% early detection rate could save the trust £14.7 million over four years. Successful treatment yielded an average 10.74 years of healthy life expectancy, further increased by early detection.

Conclusions: Late cancer diagnosis dramatically increases healthcare costs underscoring the importance of early detection and advanced screening methods. Extrapolating a 75% early detection rate across the NHS could yield substantial financial savings, highlighting its impact on healthcare efficiency.

Introduction: Breast cancer is an evolving non-communicable disease and a global disease burden, which accounts for a momentous portion of worldwide mortality and morbidity with significant economic impacts. In low- and middle-income countries like Ethiopia, the most common problem with cancer treatment is scarcity of medical resources, and financial supply, for providing care, which includes expensive medical costs, cost of service provision, and medical equipment. In Ethiopia, the cost of breast cancer care increased and imposed an enormous financial burden on healthcare providers and the healthcare system. The study aimed to estimate the annual total direct medical cost of breast cancer and identify the cost drivers of breast cancer treatment at Jimma University Medical Center (JUMC).

Methods: A facility-based retrospective medical record review was employed using the provider's perspective. Both mixed bottoms-up and top-down costing approaches were used to estimate the cost. Medical records of 130 breast cancer patients who were diagnosed between September 2022 and August 2023 were reviewed retrospectively.

Results: The mean age of patients was 41.9 (SD + 10.4) years. The total direct medical cost incurred at the hospital per patient to treat breast cancer across all stages was US$24,727 at JUMC. The total median cost per patient at the hospital to treat breast cancer at stages I, II, III, and IV could have been US$218.6, US$638.7, US$846.2, and US$753.4 respectively. At JUMC, the major cost drivers were the cost of drugs for chemotherapy accounts for 47.2%, followed by laboratory tests at 14.8%, and radiotherapy at 14.2%.

Conclusion: The hospital's direct medical costs associated with breast cancer disease were extensive. The highest medical cost was incurred in stage III of the disease. The main cost drivers at JUMC were drugs for chemotherapy, laboratory tests, and radiotherapy (radiologic imaging) added higher direct medical costs followed by surgery and pathology. The stage-specific cost analysis study focused on cost identification and valuation that provides profound information related to the estimation of direct medical cost, and the main cost drivers of the disease, and helps to encourage the treatment and diagnosis of breast cancer at an early stage of the disease.