Cost Effectiveness and Resource Allocation最新文献

Background: Sustainable procurement is gaining attention across the world. In Ghana, interest is growing, even though a comprehensive sustainable procurement policy is yet to be implemented. This study explores the driving factors of sustainable procurement in the health sector using the case of two of the oldest teaching hospitals in Ghana.

Methods: The study used an exploratory qualitative case study to conduct key informant interviews (KIIs) mainly from Komfo Anokye and Korle-Bu Teaching Hospitals. Nineteen key informants from the two hospitals and four from three regulatory bodies were interviewed. Interviews were conducted from May 2019 to December 2019. The interviews were analysed thematically to find the main drivers.

Results: Both hospitals shared several drivers. These include resource conservation, following legal rules, avoiding legal cases, client satisfaction, health concerns, cost savings, and value for money. Komfo Anokye Teaching Hospital also showed context-specific drivers like societal pressure, profit-making, professional and personal ethics, and influence from donors and global groups. On the other hand, Korle-Bu Teaching Hospital has specific drivers such as cultural awareness, protecting public funds, making services affordable, using modern technology, and choosing long-lasting equipment.

Conclusions: The study shows that both local and global issues influence sustainable procurement in Ghana. Shared drivers reflect global goals. Context-specific drivers show that each institution also responds to its own needs. These findings show the need to link environmental goals with local social and economic needs in health care.

Background: Dialysis patients are at high risk for hepatitis B virus (HBV) infection. Intramuscular administration of HBV vaccination has shown limited responsiveness and durability of seroprotection in dialysis patients. Intradermal (ID) HBV Sci-B-Vac vaccination with imiquimod (Toll-like receptor 7 agonist) pretreatment was reported to be safe and improve seroprotection. This study aimed to evaluate the cost-effectiveness of ID administration of HBV Sci-B-Vac with pre-treatment imiquimod cream in dialysis patients from the perspective of US healthcare providers.

Methods: A lifetime Markov model was used to estimate outcomes in a hypothetical cohort of serologically negative dialysis patients with: (1) HBV Sci-B-Vac administered intradermally with pre-treatment imiquimod (IMQ) cream (IMQ + ID group), (2) HBV Sci-B-Vac by intradermal injection alone (ID group), and (3) HBV Sci-B-Vac by intramuscular injection alone (IM group). Main results included direct medical costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER).

Results: QALYs in the IMQ + ID group (2.9763) were the highest, followed by the ID group (2.9751) and the IM group (2.9740). The ID group (more costly and totals less QALYs versus IMQ + ID) was strongly dominated by the IMQ + ID group, and was eliminated from the cost-effectiveness analysis. The ICER of the IMQ + ID group versus the IM group (17,032 USD/QALY) was lower than the willingness-to-pay (WTP) threshold (50,000 USD/QALY) and remained lower than the WTP threshold in the one-way sensitivity analysis. The probabilities of IMQ + ID, IM, and ID groups to be cost-effective at a WTP of 50,000 USD/QALY were 85.06%, 14.86%, and 0.08%, respectively.

Conclusion: ID administration of HBV Sci-B-Vac with pre-treatment IMQ cream in serologically negative dialysis patients was the cost-effective strategy.

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.