Cost Effectiveness and Resource Allocation最新文献

Background: Increased appropriate use of self-care for minor conditions can reduce the number of healthcare professional appointments and, hence, provide opportunity cost savings to the National Health Service (NHS). The receipt of over-the-counter medications can lead to faster access to treatment, improved health-related quality of life, and fewer education and work days lost.

Methods: A model was developed to evaluate the economic impact of a change in the proportion of people using self-care with ibuprofen to manage three conditions (dysmenorrhoea, migraine and acute rhinosinusitis) on preventable healthcare resource use from the perspective of the NHS and Personal Social Services (PSS). The total number of appointments for each condition was estimated from NHS Digital and was based on the number of primary (n = 230,298,091) and secondary (n = 22,839,832) care visits, and the proportion of visits due to each condition (informed by clinical opinion). Work and school days lost were also modelled to estimate the wider indirect costs associated with preventable absences due to delays in receiving treatment. Deterministic sensitivity and scenario analyses were also conducted to estimate the uncertainty associated with the analysis.

Results: The use of self-care with ibuprofen was increased by 5% in the base case analysis. The results indicate that this increase could prevent 409,243 appointments in the United Kingdom over a one-year time horizon. 882,875 and 117,114 work and school hours lost could also be prevented, respectively. Sensitivity analysis suggests the magnitude of change in self-care, average working hours/pay and appointment waiting times are the main drivers of the model results.

Conclusion: Self-care with ibuprofen provides opportunity cost-savings to the NHS and frees up the capacity of healthcare professionals so that they can focus on more severe conditions.

Introduction: The rapid evolution of technology has reshaped the insurance industry, with artificial intelligence (AI) taking center stage as a key driver of innovation. This paper examines the transformative impact of AI in health insurance, focusing on its applications and potential to revolutionize the sector.

Method: This scoping review examines literature published between 2000 and 2024, focusing on the application of AI in health insurance. We used relevant keywords related to artificial intelligence and health insurance to search the PubMed, Scopus, and Web of Science databases.

Findings: AI presents numerous opportunities in health insurance, including contributions to shaping international and national agendas, such as aligning goals, establishing indicators, and achieving objectives, financial management, fraud detection, monitoring capabilities, diagnostics and medical innovations, private insurance applications, risk management, technical analysis, and value creation. However, there are ethical challenges that must be addressed if AI is to be effectively implemented.

Conclusion: Policies for AI applications in health insurance should prioritize the protection of personal health and medical data, address ethical concerns, and ensure robust data privacy and security. Additionally, these policies should promote the use of AI to enhance customer experiences, optimize risk selection, and generate revenue for both insurers and policyholders.

Objectives: Endometriosis-related dysmenorrhea and pelvic pain impose significant economic and quality-of-life burdens. This study evaluated the cost-effectiveness of dienogest compared to gonadotropin-releasing hormone agonists (GnRH-a) for managing dysmenorrhea and pelvic pain in Vietnam.

Design: The cost-effectiveness analysis using a Markov model was conducted from a healthcare payer perspective. Model input parameters were obtained from meta-analyses, published literature, and local data sources. One-way sensitivity, and probabilistic sensitivity analyses (PSA) were performed to assess the robustness of the findings.

Setting: Vietnamese healthcare system context.

Participants: Hypothetical cohort of women with endometriosis experiencing dysmenorrhea or pelvic pain.

Interventions: Dienogest compared with GnRH-a therapies (triptorelin, leuprorelin, goserelin).

Main outcome measures: Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated over two years.

Results: Dienogest was the dominant treatment for dysmenorrhea, with the lowest cost ($363.3) and highest QALYs (1.74) compared to triptorelin ($739.3; 1.62 QALYs; ICER -$3,292/QALY) and leuprorelin ($744.0; 1.70 QALYs; ICER -$11,454/QALY). For pelvic pain, dienogest ($381.5, 1.64 QALYs) also dominated triptorelin ($720.4; 1.60 QALYs; ICER -$10,919/QALY), leuprorelin ($773.4; 1.54 QALYs; ICER -$4,300/QALY), and goserelin ($753.1; 1.49 QALYs; ICER -$2,609/QALY).One-way sensitivity analysis identified the probability of symptom resolution and utility values as key drivers of cost-effectiveness. PSA confirmed dienogest's high probability (≥ 99%) of being cost-effective at a willingness-to-pay threshold of one GDP per capita.

Conclusion: Dienogest is a cost-effective alternative to GnRH-a drugs for treating dysmenorrhea and pelvic pain in Vietnam, offering improved health outcomes at a lower cost. These findings support its broader adoption in clinical practice and healthcare policy.

Background: Out-of-pocket (OOP) expenditure is one of the most common payment strategies for hospitalization care in Bangladesh, and the share of OOP expenditure has been increasing at an alarming rate. This study aimed to investigate the OOP costs of hospitalization care, the impact of OOP on catastrophic healthcare expenditure (CHE) and financial distress, and the associated factors.

Methods: We used data from the most recent nationally representative dataset, the Bangladesh Household Income and Expenditure Survey 2022. A total of 14,395 households were surveyed, with 1973 household members hospitalized due to various illnesses. Respondents were asked to provide information regarding hospitalization care for the year preceding the survey. Households were considered to have CHE if they spent at least 25% of their total consumption expenditure or 40% of their non-food consumption expenditure on healthcare. Distress financing was defined as covering OOP healthcare costs by selling assets, borrowing money, or receiving financial assistance from friends or relatives. Multivariate logistic regression models were used to identify the determinants of CHE and distress financing.

Results: The annual average OOP cost of hospitalization was USD 418, with the OOP cost nearly twice as high in private facilities compared to public ones (USD 538 vs. USD 283). The highest OOP costs were observed for cancer treatment (USD 2365), followed by COVID-19 (USD 1391). Overall, 6.72% and 9.03% of hospitalized patients experienced CHE at 25% of total expenditure and 40% of non-food expenditure, respectively, while about 61% of patients faced distress financing due to hospitalization.

Conclusion: Financial hardship due to hospitalization remains high in Bangladesh. These findings will help policymakers adopt more effective healthcare financing strategies and improve the efficiency of public health investments.

Objective: This study assessed the cost-effectiveness of three domestic bevacizumab biosimilars (IBI305, LY01008, and QL1101) and an originator (Avastin) as first-line treatments for nonsquamous NSCLC in China.

Methods: A network meta-analysis (NMA) using the fractional polynomial (FP) method was used to determine hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) without relying on the proportional hazards (PH) assumption. Adjusted OS and PFS curves were used to compare effects. A partitioned survival model was used to evaluate the cost-effectiveness of the biosimilars plus chemotherapy versus the originator plus chemotherapy. The model included cost, utility parameters, scale, and shape determined from previous studies. Probabilistic sensitivity analysis (PSA) and one-way deterministic sensitivity analysis (DSA) were used to assess uncertainty.

Results: In a baseline study, LY01008 + chemotherapy, QL1101 + chemotherapy, and bevacizumab + chemotherapy were less effective than IBI305 + chemotherapy. Treatment with LY01008 achieved an additional 0.23 quality-adjusted life-years (QALYs), with a higher cost of $817, leading to an incremental cost-effectiveness ratio (ICER) of $3,552/QALY when compared with that of QL1101. All three biosimilars showed better cost-effectiveness than the originator. The DSA results revealed that the HR-related parameters from the NMA and drug price were the primary sources of uncertainty surrounding incremental net monetary benefits (INMBs). PSA showed that the IBI305 was most likely to be cost-effective when the WTP was 1-3 times the per capita GDP of China in 2022. Sensitivity and scenario analysis confirmed the reliability of the fundamental analysis results.

Conclusions: Domestic bevacizumab biosimilars are cost-effective alternatives to first-line treatment for nonsquamous NSCLC in China. IBI305 exhibited the most significant cost-effective advantage among the domestic biosimilars.

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.