ClinicoEconomics and Outcomes Research最新文献

Background and objectives: Limited information is available regarding the distribution of increasing pharmaceutical expenditures within large representative samples of national populations globally. The aim was to investigate the distribution of pharmaceutical costs in outpatient treatment and analyze the primary characteristics of users of expensive drugs within the healthcare system of Kazakhstan.

Methods: This study utilized data from the Information System for Outpatient Drug Supply, which includes nationally representative data from all regions of Kazakhstan, covering both rural and urban populations. The key explanatory variables in this study included age, gender, number of prescribed medications, disease categories based on ICD-10 codes, and insurance coverage status. These variables were selected to capture demographic, clinical, and healthcare access factors influencing prescription drug costs. In total, 2.2 million people, who were prescribed outpatient medications were included. High-cost users (HCUs) were characterized as individuals whose prescription drug expenses ranked within the highest 5%.

Results: The distribution of pharmaceutical costs exhibits significant discrepancy, with 5% of the population receiving prescription drugs covered by the state budget and social medical insurance fund contributing to nearly three-quarters of all costs. Notably, these HCUs tended to be younger than low-cost drug users. HCUs, on average, consumed a greater quantity of medications compared to non-HCUs. Among children, the top diseases contributing to high costs were rare hereditary diseases and malignancies, while in adults, cancer and diabetes were the primary cost drivers.

Conclusion: There is a concentration of public drug program spending within a small percentage of beneficiaries with high drug costs in Kazakhstan. This discovery offers valuable insights for shaping policies tailored to this specific population, aiming to mitigate escalating costs and enhance the optimal use of medications.

Purpose: To analyze the costs of high thromboembolic risk patients who require low molecular weight heparins (LMWHs) as a thromboprophylaxis strategy.

Methods: Cost analysis was conducted to assess LMWHs (enoxaparin versus comparators: nadroparin and dalteparin) as thromboprophylaxis for hospitalized patients with high thromboembolic risk in Oncology, General or Orthopedic Surgery, and Internal Medicine services from the healthcare provider's perspective in Colombia. A decision tree was developed, and the health outcomes considered in the analysis were deep vein thrombosis, major bleeding, pulmonary thromboembolism, and chronic pulmonary hypertension. Clinical inputs were obtained from a systematic review of the literature and the economic parameters from micro-costing. Inputs were validated by three clinical experts. Costs were expressed in 2020 US dollars (USD).

Results: In a hypothetical cohort of 10,000 patients with a thromboprophylaxis use rate of 40%, the use of enoxaparin was less costly than that of dalteparin in Oncology (difference of USD 624,669), Orthopedic Surgery (difference of USD 275,829), and Internal Medicine (difference of USD 109,119) patients. For these services, using enoxaparin was more efficient than using nadroparin (cost differences of USD 654,069, USD 416,927, and USD 92,070, respectively). Sensitivity analysis showed an important influence of the number of patients undergoing thromboprophylaxis, as well as the unit cost, and the risk of events (DVT, PTE, and CTEPH).

Conclusion: Enoxaparin is the least expensive health technology for thromboprophylaxis in most of the medical contexts analyzed in Colombia due to its efficacy and the lower risk of complications than dalteparin and nadroparin.

Background: Icodec, once-weekly basal insulin, aims to simplify therapy management by reducing injection frequency for diabetic patients. The efficacy and safety of icodec were evaluated in the ONWARDS clinical development program. This study evaluates icodec economic and quality of life impact from the Italian National Healthcare System (NHS) perspective.

Materials and methods: A pharmacoeconomic study was developed to assess the once-weekly insulin icodec value, highlighting its potential to decrease needle use while improving adherence and quality of life. In the base case, a differential cost and cost-utility analysis over one year compared to once-daily insulin degludec were developed. Based on the comparison with degludec, a scenario analysis was planned between icodec and the mix of basal insulins available on the market. Economic evaluations included drug and administration costs, needles, and impact on adherence. The cost-utility analysis measured the utility associated with the weekly injection compared to the daily ones, resulting in an incremental cost-effectiveness ratio (ICER), measured as Δ€/ΔQALY (Quality Adjusted Life Years). To assess the robustness of the results, a deterministic one-way sensitivity analysis and a probabilistic sensitivity analysis were carried out.

Results: At an annual cost 25% higher than degludec, considering the economic benefits generated by the needle use reduction (-€51.10) and adherence improvement (-€54.85), once-weekly icodec grants no incremental cost and even potential savings per patient. Furthermore, icodec reported a utility advantage (0.023). It achieved a dominant incremental cost-effectiveness ratio (ICER) compared to degludec. The comparison with the mix of basal insulins also reported a cost-effectiveness profile. Sensitivity tests conducted confirmed the robustness of the findings, highlighting the key drivers of the analysis.

Conclusion: Icodec represents a new therapeutic option to simplify basal insulin treatment. It also improves the patient's management and his quality of life, without increasing the economic burden for the Italian NHS, while guaranteeing an excellent cost-effectiveness profile.

Objective: Management of advanced type 2 diabetes (T2D) typically involves daily insulin therapy alongside frequent blood glucose monitoring, as treatments such as oral antidiabetic agents are therapeutically insufficient. Real-time continuous glucose monitoring (rt-CGM) has been shown to facilitate greater reductions in glycated hemoglobin (HbA1c) levels and improvements in patient satisfaction relative to self-monitoring of blood glucose (SMBG). This study aimed to investigate the cost-utility of rt-CGM versus SMBG in Spanish patients with insulin-treated T2D..

Methods: The analysis was conducted using the IQVIA Core Diabetes Model (CDM V9.5). Baseline characteristics of the simulated patient cohort and treatment efficacy data were sourced from a large-scale, United States-based retrospective cohort study. Costs were obtained from Spanish sources and inflated to 2022 Euros (EUR) where required. A remaining lifetime horizon (maximum 50 years) was used, alongside an annual discount rate of 3% for future costs and health effects. A willingness-to-pay (WTP) threshold of EUR 30,000 per quality-adjusted life year (QALY) was adopted, based on precedent across previous cost-effectiveness studies set in Spain. A Spanish payer perspective was adopted.

Results: Over patient lifetimes, rt-CGM yielded 9.933 QALYs, versus 8.997 QALYs with SMBG, corresponding to a 0.937 QALY gain with rt-CGM. Total costs in the rt-CGM arm were EUR 2347 higher with rt-CGM versus SMBG (EUR 125,365 versus EUR 123,017). The base case incremental cost-utility ratio was therefore EUR 2506 per QALY gained, substantially lower than the WTP threshold of EUR 30,000 per QALY. The analysis also projected a reduction in cumulative incidence of ophthalmic, renal, neurological, and cardiovascular events in rt-CGM users, with reductions of 16.03%, 13.07%, 7.34%, and 9.09%, respectively.

Conclusion: Compared to SMBG, rt-CGM is highly likely to be a cost-effective intervention for patients living with insulin-treated T2D in Spain.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a multisystem condition destined to become pandemic in the coming decades. This study aimed at evaluating the economic impact of MASLD in the Italian population from the Italian National Healthcare Service (NHS) perspective.

Methods: The economic impact of the MASLD was assessed by developing a calculation model in Microsoft Excel^® from the Italian NHS perspective, considering healthcare resources and direct costs. The target population was based on the prevalence data. Through a literature search, complications of MASLD were identified, including MASH, with relative risk of evolution into CC, DCC, HCC, T2DM, cardiovascular diseases, in particular AMI and stroke, CKD, and CRC. The differential impact between complication development in the population with MASLD and the same sample size population without-MASLD was evaluated. Differential risk data, mortality rates, and event unit costs were drawn from the published international literature. Frequency and cost data were applied to the total target population, the total annual costs and mortality data, referring to the two arms, were then calculated, and the differential value was obtained.

Results: Based on an estimated 11,546,370 MASLD target population, an annual illness impact of €12,251,631,822 was calculated, corresponding to a difference of €7,731,674,054 compared with the same sample size without MASLD. Moreover, the MASLD population is expected to experience 13,438 additional deaths annually.

Conclusion: The growing epidemiological impact of MASLD and its complications represent a huge economic burden for healthcare services worldwide. An integrated approach, including changes in lifestyle behaviors, will be the first step. Specific drugs for MASLD are not yet available; however, studies are underway, and combined pharmaceutical therapies may be an inevitable choice to achieve adequate control of MASLD and its complications.

Purpose: This study aimed to estimate the costs associated with adverse events (AEs) in advanced lung cancer patients treated with first-line therapies.

Subjects and methods: All patients with advanced lung cancer diagnosed between 2011 and 2019 were identified from the Taiwan National Cancer Registry. First-line treatment was defined as a therapy that began within 30 days before and 90 days after the diagnosis. We defined a newly-developed AE as one established after first-line treatment had commenced, with the contingency that the patient had not been diagnosed with the AE within one year prior to the outset of therapy. One patient with a specific AE was matched on age, sex, and regimens with four patients without the AE. Payments incurred over the same period of time in the two groups were compared to estimate the AE-related costs.

Results: A total of 27,376 patients receiving first-line targeted therapy, immunotherapy, or chemotherapy were identified. Clinical characteristics of 15,454 treatment episodes with a specific AE and 61,816 treatment episodes without the AE were well balanced. The costliest AEs of any severity were sepsis/septicemia, neuropathy, and acute kidney injury, with the respective average incremental costs of 10101, 9982, and 7839 USD. The costliest severe AEs requiring hospitalization were sepsis/septicemia, interstitial lung disease/pneumonitis, and neuropathy, with mean incremental costs of 22483, 10645, and 10120 USD, respectively.

Conclusion: Costs associated with AEs in advanced lung cancer patients treated with first-line therapies were substantial. These estimates could be adopted for future cost-effectiveness analyses of new lung cancer treatments.

Background: Bilateral hip arthroplasty is a common surgical intervention for patients with bilateral hip disease. The decision between simultaneous versus staged procedures remains debated, primarily due to concerns over cost, postoperative recovery, and complication rates. This study aimed to evaluate the economic burden and clinical outcomes of simultaneous versus staged bilateral hip arthroplasty.

Methods: In this single-center, prospective study, patients who underwent bilateral hip replacement at XXX between 2021 and 2022 were included. Participants were divided into groups based on the surgical approach: simultaneous bilateral hip arthroplasty or staged bilateral hip arthroplasty. Data on costs, operation times, hospital stay lengths, and postoperative outcomes were collected and analyzed.

Results: A total of 57 patients were studied, with 45 undergoing simultaneous and 12 staged surgeries. The total cost for staged procedures was significantly higher, with a mean difference of 63,967.54 yuan compared to simultaneous procedures. No significant difference was found in prosthesis costs between the groups. Operation times and hospital stays did not significantly differ, with averages closely aligned between the simultaneous (operation time: 3.2 hours, hospital stay: 5 days) and staged groups (operation time: 3.4 hours, hospital stay: 5.2 days). The obesity rate was higher in the simultaneous group (P < 0.05).

Conclusion: Simultaneous bilateral hip arthroplasty appears to be an economically favorable option, with comparable perioperative and immediate postoperative outcomes to staged procedures. These insights have significant implications for clinical practice and policy-making, suggesting that simultaneous procedures can be safely implemented for appropriate patients, potentially optimizing healthcare resources.

Over 40,000 patients in the United States (US) require hospitalization for burns annually. The treatment regimen can cost more than $6,000 a day and requires the use of numerous supplies to ensure the graft takes for successful wound healing. Irrigation of the wound is a critical step for burn treatment, yet little is known about the cost-effectiveness of different irrigation modalities. In a recent study, pure hypochlorous acid preserved wound cleanser (pHA) was shown to be safe and effective compared to mafenide. This study estimated the associated costs of two common wound irrigation modalities, pHA and mafenide solution, for the treatment of patients with burns. In this study, a patient-level Monte Carlo simulation model using data from a randomized control trial (RCT) was used to conduct the cost analysis from the US Hospital perspective. Based upon 100,000 simulated patients, pHA was expected to save $133 ($123 to $144, 10^th to 90^th percentile) for the hospital compared to using a mafenide solution over 14 days. Adoption of pHA should be considered a cost-saving strategy when treating patients with burns.