Cost Effectiveness and Resource Allocation最新文献

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.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, associated with significant morbidity, mortality, and economic burden due to thromboembolic events. In Chile, acenocoumarol is the most widely used anticoagulant, while access to direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, and apixaban remains limited for AF patients. Among DOACs, dabigatran is the only one with an approved specific reversal agent (idarucizumab) available in the Chilean public system. Evaluating the cost-effectiveness of these alternatives is critical for informing resource allocation.

Aims: To evaluate the cost-effectiveness of dabigatran compared to acenocoumarol, rivaroxaban and apixaban, for thromboembolic events prevention in atrial fibrillation (AF) patients, from the Chilean public health payer perspective.

Methods: A Markov cohort model was used to represent the natural history of AF in terms of ischemic and hemorrhagic complications. Direct costs were obtained from local official sources and converted to US dollars (1 USD = 710.9 CLP at 2022). Data about major events and utilities were obtained from the literature. We applied an undifferentiated discount rate of 3% for costs and outcomes over a lifetime time horizon. Uncertainty was characterized through deterministic and probabilistic sensitivity analysis. We also examined the use of idarucizumab and prothrombin-complexes-concentrate (PCC) as reversal agents in an emergency setting as an additional scenario-analysis.

Results: Dabigatran was the most (cost-)effective among all alternatives (8.53 QALYs). Considering the Chilean cost-effectiveness threshold of USD 17,200 (1 GDP per capita), dabigatran was cost-effective (USD 11,042 per QALY gained), while both rivaroxaban and apixaban were dominated by dabigatran. Regarding the second-order uncertainty, at the suggested threshold, dabigatran exhibit the highest probability of being cost-effective (approximately 60%). In the reversal agent scenario, dabigatran plus idarucizumab was also found to be cost-effective in the Chilean context.

Conclusion: Dabigatran is cost-effective and dominates both rivaroxaban and apixaban at current publicly available prices in Chile. In addition, we expect dabigatran-idarucizumab is also expected to be cost-effective for Chilean health system when is compared against acenocoumarol-PCC as reversal agents.

Objectives: The prevalence of chronic diseases is rising globally along with the consumption of nutraceuticals. It is documented that 80% of the deaths due to chronic illnesses occur in low and middle-income countries, including India. In addition, chronic diseases not only affect the patients but also their family income. Besides Southeast Asia is also the fastest-growing market for nutraceuticals with less stringent cost regulation. Hence, this research primarily focuses on the financial impact of the drug treatment for chronic illness, extensively comparing the therapeutic and non-therapeutic drug (nutraceutical) costs.

Methods: This was a retrospective, cross-sectional study with a sample size of 7877 prescriptions of medicine outpatient clinic, extracted from the hospital information system after 5 level screening for their inclusion in the study. The cost of drugs prescribed to the patient for chronic illness was calculated per month and its impact on the monthly family income was evaluated. The data analysis was stratified into the cost of therapeutic drug treatment and non-therapeutic drug treatment which was correlated with various chronic diseases and demographic parameters.

Results: A total of 465 patients were enrolled after screening and a high prescription rate of 88% for non-therapeutic treatment was reported. The total average monthly cost of chronic illness treatment was INR 1879 (22.42 USD), with therapeutic drug treatment of INR 1319 (15.74 USD) and non-therapeutic drug treatment of INR 560 (6.68 USD). Comprising 36% of patients, males spent higher amount on therapeutic drug treatment (INR 1780 or USD 21.26), while women spent higher on non-therapeutic drug treatment (INR 593 or USD 7.08). A catastrophic 11% of patients from 'lower' socioeconomic spent ≥ 10% of family income on non-therapeutic treatment.

Conclusion: Our study highlights the financial strain that chronic illnesses impose on families, emphasizing the need for policymakers to improve access to specialized care and cost capping of nutraceuticals.