Cost Effectiveness and Resource Allocation最新文献

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.

Background: Afghanistan as a low-income country suffers from the heavy burden of Communicable Diseases (CDs) and their significant economic consequences. Therefore, this research is aimed to strategically analyze the financing system of CDs management in Afghanistan and provide effective solutions.

Methods: We conducted the qualitative research using interpretative phenomenological analysis (IPA). An interview guide was used to conduct the semi- structured interviews with 49 experts from the Afghanistan health system. We used the framework analysis method to analyze the results.

Results: In this research, we found 12 strengths, 16 weaknesses, 9 opportunities, 21 threats, and 47 solutions. The main strength was diverse international funding sources for CDs control. The weakest points were the lack of a health insurance system, limited government budget allocation for health, high out-of-pocket expenditure (OOPE), fragmented donor's funds, poor managerial capacity, and donor-dependent health system. The main opportunity was the commitment and interest of donors to eradicate CDs. Lack of political commitment, cut of donors' aids, brain drain, low health literacy of people, and lack of drinkable water and sewage systems were the main threats. Increasing the government budget allocation, establishing health insurance system, implementing employees' retention strategies, integrating all CDs funds, strategic purchasing, strengthening public-private partnership (PPP), implementing appropriate user fees, and raising public awareness about CDs were the most important solutions.

Conclusion: The financing system of CDs management should be strengthened in such a way that it collects scattered financial resources, aggregates and transparently manages them. Then, they should be used to provide CDs control services that will reduce the CDs burden, improve people's health and protect from financial risks.

Introduction: Hospitals provide essential health services, focusing on quality, safety, and patient-centered care. The rising prevalence of communicable and non-communicable diseases in Indonesia has led to increased National Health Insurance (NHI) costs, with communicable diseases representing a significant burden despite global progress in disease control. Tuberculosis remains a major global health concern, causing 1.25 million deaths in 2023, while Indonesia ranks second globally for tuberculosis burden, accounting for 10% of global TB cases with an estimated 969,000 cases annually. Despite efforts to improve quality, Haji and Labuang Baji Hospitals face challenges, including financial losses and suboptimal patient outcomes. This study aims to assess the impact of an Integrated Clinical Pathway (ICP)-based Professional Nursing Practice Model on clinical outcomes, hospital costs, and patient satisfaction at these hospitals.

Methods: This study employed action research methodology by developing, implementing, and evaluating the clinical guidelines and ICP for 10 diseases that were categorized as high volume, high risk, and high cost based on secondary data analysis using the NHI databases. Data was collected through observation of the ICP implementation on 40 patients and interviews of Professional Care Providers (PCPs) and was analyzed using IBM SPSS Statistics version 28.

Results: A total of 40 patients from Haji Hospital (n = 20) and from Labuang Baji Hospital (n = 20) with diagnoses of pulmonary tuberculosis, pneumonia, dyspepsia, typhoid fever, normal delivery, and COPD were included and analyzed. Compliance with ICPs in both hospitals was quite low: 50.02% in Haji Hospital and 44.46% in Labuang Baji Hospital. However, the length of patients' stays (LOS) generally complied with ICP standards, although some cases exceeded the benchmarks. Hospital costs varied across different disease diagnoses, impacting overall financial outcomes. Patient satisfaction improved across all diagnostic categories.

Conclusion: The implementation of ICP at both hospitals showed that all indicators of patient clinical outcomes improved according to the time specified in ICP, resulting in patients' LOS being shorter than stipulated in ICP and an increase in patient satisfaction. ICP implementation has also led to hospitals earning different profits in almost all diagnoses.

Background: Chronic spontaneous urticaria (CSU) is a common inflammatory immune skin disease. It has a serious impact on the patients' quality of life and imposes a serious financial burden on patients. The standard therapy for CSU (using antihistamines), while less costly, has limited efficacy and no longer adequately meets the clinical needs of CSU patients. Omalizumab is the world's first and currently the only biologic approved for the treatment of CSU. Several studies have confirmed the efficacy and safety of omalizumab for CSU. However, the economics of omalizumab treatment relative to standard therapies remains unknown in China.

Objective: The purpose of this study was to analyze the cost-effectiveness of omalizumab versus standard treatments for CSU after omalizumab's inclusion in the National Drug Insurance List from the patient's perspective.

Methods: We developed a Markov model based on the Urticaria Activity Score over 7 days (UAS7). The modeling period was 4 weeks. The time horizon was 10 years. The willingness-to-pay threshold (WTP) of 1-3 times gross domestic product (GDP) per capita was selected. Incremental cost-effectiveness ratio (ICER) was calculated from the base-case analysis, and one-way sensitivity analysis and probabilistic sensitivity analysis were performed.

Results: The ICER of omalizumab treatment relative to standard treatment was ¥160,411/QALY, which was between 1 and 3 times GDP per capita. Sensitivity analyses illustrated that the direct cost of omalizumab had a significant effect on the ICER and demonstrated the stability of the results.

Conclusions: Omalizumab treatment is a cost-effective regimen compared with standard therapy under certain circumstances. This demonstrates the important role that health insurance policies play in reducing the burden on CSU patients. However, the limitations of applying foreign clinical data in this paper and the uncertainty of cost-effectiveness at a low WTP threshold are two aspects that cannot be ignored, and subsequent related studies are needed. This study will help patients to make decisions about treatment options, and will be a reference to relevant healthcare organizations.

While COVID-19 vaccines became available in late 2020, low-income countries (LICs) faced challenging COVID-19 vaccine distribution efforts in terms of both a delayed and scarce vaccine supply and barriers reaching the target populations. The cost of delivering COVID-19 vaccines in LICs is uncertain, which complicates planning and budgeting for country leadership as well as major funders. In the absence of such data, a global model was developed by the COVAX Working Group on Delivery Costing using data on the costs of similar immunization campaigns and assumptions. This study has two objectives, firstly to estimate the costs of delivering COVID-19 vaccine delivery using primary data collected in Malawi, and secondly comparing these estimates to modeled estimates based on secondary data, to contribute to a growing evidence base on the cost of the COVID-19 vaccination delivery in LICs.This retrospective study used a bottom-up method to estimate the financial and economic costs. Data were collected from health facilities and health posts via a COVID-19 cost survey. The data sources included existing records and interviews with relevant districts and facility staff. Twenty representative vaccine delivery sites were purposively selected across four districts. We focused on major cost drivers that contributed to the highest proportion and variability in delivery costs.The total financial cost of COVID-19 vaccine delivery in 20 facilities across four districts in Malawi (from April 1, 2021-March 31, 2022) was US$ 322,786. During that period, the 20 facilities delivered 70,947 vaccines. The financial cost per dose delivered was US$ 4.55. Considering the reallocation of existing staff time toward COVID-19 vaccination, volunteer opportunity costs, and donated vehicles, the economic cost per dose delivered was nearly four times greater at US$ 16.15. The economic cost of labor was estimated at US$ 10.75 per dose delivered and accounts for two-thirds of the total economic cost.This study is the first to provide evidence on the cost of COVID-19 vaccine delivery in Malawi. The financial cost of delivering the COVID-19 vaccine in twenty health facilities across 4 districts in Malawi, at US$ 4.55 [US$ 3.23- US$ 6.33] per dose delivered. We observed a large amount of labor reallocation towards COVID-19 vaccination.