ClinicoEconomics and Outcomes Research最新文献

Background: Non-small cell lung cancer (NSCLC) treatment costs significantly impact healthcare systems. This study analyzes direct costs and cost drivers of perioperative and adjuvant systemic treatments for stage I-II NSCLC from Jordanian healthcare providers' perspective using micro-costing methodology.

Methods: We employed micro-costing to analyze direct medical expenses including drug acquisition, preparation, administration, pre/post-medications, diagnostics, labor, and wastage costs for perioperative regimens used in stage I-II NSCLC. International guidelines defined therapeutic regimens, while drug prices were extracted from Jordan Food and Drug Administration's database. Published data and surveys quantified micro-costs.

Results: Among 26 assessed regimens (2 targeted therapy, 10 chemotherapy, 10 chemo-immunotherapy, 4 immunotherapy), targeted/immunotherapy agents significantly increased costs. Chemotherapy regimen cost differences ranged from $633.68 (squamous) to $1,763.91 (non-squamous) per cycle. Antineoplastic agents were primary cost drivers, highest for Durvalumab (98.72% of cycle cost). Laboratory costs comprised up to 50.73% in chemotherapy and 7.24% in immunotherapy regimens. Wastage contributed up to 10.36% of total cycle costs. Average administration cost was $35 per cycle. Maximum cycle costs were: targeted therapy (Osimertinib) $7,206.44, immunotherapy (Durvalumab) $9,057.71, immune-chemotherapy (Durvalumab-Carboplatin-Pemetrexed) $11,358.43, and chemotherapy (Carboplatin-Pemetrexed) $2,300.72.

Conclusion: Our results highlight the substantial economic impact and cost variability among treatment regimens. This variability presents opportunities for cost reduction through careful selection of therapeutically equivalent regimens based on pricing and toxicity profiles. The findings emphasize the need for comprehensive and precise cost analysis to inform healthcare policies and clinical practices. Future research should focus on cost-effectiveness analyses of these expensive agents to ensure value for money, support evidence-based decision-making, and strengthen price negotiations with suppliers.

Background: Epilepsy is a lifelong diagnosis, often requiring pharmacologic management. Despite the chronicity of this disorder, there has been a rise in medication cost over the years. To address this, Mark Cuban Cost Plus Drug Company (MCCPDC) has created a more affordable option to obtain patients' prescriptions. Focusing on epileptic medication, this study examines the potential cost saving benefit of MCCPDC compared to Medicare Part D plans.

Methods: We conducted a cross-sectional review identifying the prices of anticonvulsants available on MCCPDC compared to the 2021 Medicare Part D spending data. Prices for dispensing and shipping fees were recorded for the minimum quantity (30ct) and maximum quantity (90ct). We compared standardized unit prices for 30 and 90-day periods between Medicare and MCCPDC drugs.

Results: Of the 16 anti-seizure medications shared between MCCPDC and Medicare, Medicare spending reached nearly $1 billion. Analyzing 30ct prescriptions, we found potential savings in 60% of the drugs, amounting to $172 million when comparing individual drug costs on MCCPDC to Medicare. However, when averaged across all 30ct drugs, MCCPDC prices were 14.85% higher than Medicare, indicating that higher costs for certain drugs offset the savings from others. For 90ct prescriptions, savings were $373 million in 80% of drugs, a 31.63% reduction compared to Medicare prices.

Conclusion: Our study highlights the potential savings with MCCPDC, especially among the 90ct medications, demonstrating that a cheaper alternative to chronic medications is possible if the pricing of MCCPDC is used. We recommend that physicians educate patients on MCCPDC and their specific medications to find more accessible pricing. MCCPDC could alleviate financial burdens and enhance access to essential medications for patients, especially in the context of the Medicare-enrolled population.

Objective: Currently, there is no specific characterization of the economic burden of Diabetic Peripheral Neuropathic Pain (DPNP) in most Asian countries. The purpose of this study was to understand the economic burden of DPNP in China from a healthcare system perspective.

Methods: The analysis was conducted using the SuValue^® database, a large electronic medical record (EMR) database which covers 182 hospitals across 22 provinces in China. A 12-month baseline and 12-month follow-up period were used to compare healthcare resource utilization and costs before and after the initial diagnosis of DPNP.

Results: A total of 7373 adult patients with DPNP were identified and 4220 (57.24%) patients were treated. Analgesics (n=2044, 48.44%) and anti-inflammatory drugs (n=1990, 47.16%) were the most used treatments. Among DPNP treated patients, the mean (SD) total all-cause healthcare costs during follow-up period were 8980.83 (17,721.48) CNY, with a 4446.48 CNY increase (p-value < 0.001) from 4534.35 (9791.93) CNY at baseline. The cost increase was primarily driven by an increase in hospitalization and medication costs after the DPNP diagnosis. A similar trend in the treatment pattern and total cost increase after DPNP diagnosis was also found in a sensitivity analysis when excluding over-the-counter (OTC) products from the analysis.

Conclusion: DPNP is associated with significantly increased utilization of healthcare services and costs for patients in China.

Objective: To estimate the social cost of nasal sequelae in patients with cleft lip and palate (CL/P) treated in a Peruvian university dental clinic.

Methods: This is a cross-sectional study. The sample consisted of thirty patients over 18 years of age with nasal sequelae due to CL/P. This study conducted a partial economic analysis from a social perspective, by using the following questionnaires: ENAHO-Peru to assess sociodemographic variables, the Instituto de Salud del Niño - San Borja care guidelines and its tariff schedule to estimate health care costs, the Rhinoplasty Outcome Evaluation (ROE) scale to assess quality of life about the nasal sequela, and the "willingness to pay" (WTP) technique to calculate the monetary cost of the sequela from the patients' perspective. Costs in soles, where the exchange rate was: 1 USD = S/3.878.

Results: A total of 30 CL/P patients, who agreed to participate, were evaluated. Most of the patients were male (70.0%), aged 18-39 years (73.0%), single (93.4%), students (73.4%), and had secondary education (50.0%). Additionally, most were attended with Seguro Integral de Salud (46.7%), most had no daily income (50.0%), and the average quality of life score was 8.1. The highest direct cost reported was dental treatment (S/5756.89 ± S/359.22) and hospitalization (S/5013.60 ± S/880.15), statistically significant (p<0.05). The highest indirect cost was reported for absenteeism with a mean of 5288.6 ± 1280.23 (p<0.05). Regarding direct, indirect, and intangible costs in the treatment of nasal sequelae due to CL/P, the lowest median (S/6000.00) was found in intangible costs, with significant differences (p<0.05).

Conclusion: About half of the social cost (12,000 Peruvian soles = 3094 US dollars) was assumed by the patients, a prohibitive cost considering that most of them come from low socio-economic backgrounds.

Introduction: Time-driven activity-based costing (TDABC) is a highly accurate method for determining the true cost of delivering a healthcare service. However, TDABC is most often applied to a singular phase of care such as an outpatient visit or a surgical event. Here we broaden the scope by using TDABC to estimate the costs of surgically treating cervical myelopathy - from the moment of surgical scheduling until post-operative hospital discharge.

Methods: In a single-center retrospective study at a large tertiary academic institution, TDABC was employed to measure pre-operative, intra-operative, and post-operative (inpatient) costs for 63 patients undergoing elective surgery for cervical myelopathy. Cost patterns among different surgical approaches (anterior, posterior, anterior/posterior) were analyzed using generalized linear models and the Kruskal-Wallis test.

Results: 63 consecutive patients who underwent elective surgery for cervical myelopathy were examined (anterior approach: 36.5%, n=23; posterior approach: 54.0%, n=34; anterior/posterior approach: 9.5%, n=6). The average pre-operative, intraoperative, and postoperative costs were $352.83 ± $205, $10,809.09 ± $6052.69, and $5327.07 ± $5114.78, respectively. The average total episode cost for all cases was $16,488.99 ± $8,181,777. Kruskal-Wallis analysis revealed that total episode cost for the anterior-posterior approach was significantly higher than for both the anterior (p<0.001) and posterior approaches (p<0.05), while the total episode cost for the anterior approach was significantly less than that of the posterior (p<0.001).

Conclusion: We have demonstrated the feasibility of TDABC for estimating a large fraction of total episode costs for the surgical treatment of cervical myelopathy. This may also be the first attempt at understanding episode costs across multiple surgical options for a given spinal diagnosis, which will be relevant as condition-based bundled payments emerge. As expected, anterior cervical surgeries incurred lower costs than posterior surgeries, which incurred lower costs than anterior-posterior surgeries.

Purpose: Investments in antiretroviral therapy (ART) have shown to improve outcomes for those living with human immunodeficiency virus (HIV) and reduce exposure to and transmission of the virus. In the current work, we assess the impact of ART on government public accounts since its introduction in 1987.

Methods: National HIV epidemiological data from 1987 to 2023 were compared to a hypothetical no ART treatment scenario. This scenario was based on time series analysis, and on a transmission equation based on the effectiveness of ART. In the absence of historical epidemiological data, trend extrapolations were considered. The model assumes that individuals on ART are virally suppressed and, conservatively, excludes the impact of pre-exposure prophylaxis. The resulting differences in the number of HIV infections, acquired immunodeficiency syndrome (AIDS) cases and HIV-related deaths per year, were then considered to evaluate the impact on the labor market and on healthcare costs, based on the literature. The impact on employment was then used to estimate tax revenue and social benefits transfers. Results are presented separately with and without longevity effects.

Results: The investment in ART from 1987 to 2023 was estimated to prevent millions of new infections and AIDS cases and to avoid HIV-related deaths. This investment was estimated to provide a return of US$2.11 trillion from 1987 to 2023; each US$1 spent on ART was estimated to create a revenue of US$4.3 to the public sector in the USA. Results remained positive when longevity effects were included. One-way sensitivity analysis showed results were robust.

Conclusion: The analysis illustrates the broader economic benefits to the government attributed to public and private investments to develop and make ART available. The fiscal analysis of investing in ART shows a fourfold gain for the US government. This broader analysis is crucial to help shape health policy and funding decisions.

Purpose: This study aims to evaluate the economic value of Bictegravir/emtricitabine/tenofovir (B/F/TAF) as a first-line treatment for HIV-1 infection in China, where such evaluations are currently lacking.

Patients and methods: We developed a monthly-cycle Markov model to evaluate the economics of B/F/TAF versus dolutegravir/lamivudine (DTG/3TC) as a first-line ART for adult HIV-1 patients over a lifelong time. The social costs, quality-adjusted life years (QALYs), incremental net monetary benefit (INMB), and incremental cost-effectiveness ratio (ICER) have been analyzed using health economic methods. Sensitivity analyses were conducted for the result validation. Taking into account the transmissibility of HIV, we have developed a scenario within a dynamic model across the entire population in China, to conduct a health economic evaluation of the two drugs over 30 years. Model precision was tested using relative standard deviation (RSD).

Results: In the Markov model, B/F/TAF had higher per-person costs compared to DTG/3TC ($44,381.33 vs $42,160.13), but also resulted in greater QALYs (11.6771 vs 11.5389), leading to a per-person INMB of $3072.26 (WTP = 3GDP) and an ICER of $16,052.42 per QALY. Uncertainty analyses confirmed the robustness of these results. The dynamic model further indicated that B/F/TAF was both cost-benefit and cost-effective, with a per-person INMB of $7.33 (WTP = 3GDP) and an ICER of $7,953.72 per QALY, although it exhibited a higher RSD.

Conclusion: After adopting the B/F/TAF regimen in China, the cost-benefit and cost-effectiveness of HIV prevention and treatment have significantly improved. We should advocate for B/F/TAF as the first-line treatment to enhance HIV management.

Purpose: In the wake of ever-increasing health care costs, solutions are sought to make health care more affordable, such as moving hospital outpatient procedures to office-based laboratory (OBL) settings. A budget impact model was constructed to estimate the health plan cost benefit of moving 50% of yttrium-90 resin microspheres (Y-90) selective internal radiation therapy (SIRT) procedures for unresectable liver metastases associated with primary colorectal cancer (CRC) from a traditional hospital outpatient setting (HOPPS) to an OBL setting.

Methods: The eligible population was estimated using an incidence-based approach for a hypothetical health plan with 1 million covered lives. Modeled costs were based on 2024 Medicare reimbursement rates. Three treatment scenarios were considered: 1) base case HOPPS, 2) hybrid (HOPPS/OBL), and 3) OBL settings. Budget impacts were estimated as the differences in annual total cost of treatment after switching 50% of Y-90 SIRTs from HOPPS to the hybrid (HOPPS/OBL) or OBL setting. Per-member-per-month (PMPM) budget impacts were also calculated. Sensitivity analyses were conducted by varying the proportions of patients shifting settings and the treatment setting they were shifting into.

Results: Annually, 28 patients were estimated to have metastatic CRC and unresectable liver metastases in a health plan of 1 million members. Average estimated per-patient cost savings would be $8,791 by switching one patient to a hybrid setting and $17,697 for a patient switched to the OBL. Switching 50% of eligible procedures resulted in PMPM cost benefits to the plan of $0.0102 for hybrid setting and $0.0206 for OBL. In sensitivity analyses, annual cost savings for the health plan were affected by both the proportion of patients shifted and the setting they were shifted into.

Conclusion: Shifting a percentage of the treatment of unresectable liver metastases with Y-90 SIRT to the OBL setting results in modest cost benefits for US health plans.

Objective: Out-of-Hospital Cardiac Arrest (OHCA) is a significant public health issue in Poland, with only an 8.4% survival rate to hospital discharge. Early initiation of Basic Life Support and defibrillation through a Community First Responder (CFR) system can markedly improve survival rates and neurological outcomes.

Methods: A decision tree and Markov model compared the cost-effectiveness of three scenarios against standard care by estimating costs and quality-adjusted life years (QALYs). Scenario 1 involved raising public awareness and educating on the 30:2 CPR protocol. Scenario 2 added equipping blue-light service vehicles with Automated External Defibrillators (AEDs) and training personnel. Scenario 3 implemented a full CFR system with integrated AEDs, dispatch centers, and trained citizen responders. The analysis included survival to hospital discharge, with sensitivity analyses assessing robustness.

Results: The incremental cost-effectiveness ratios (ICERs) were €15,221 for Scenario 1, €30,659 for Scenario 2, and €16,205 for Scenario 3 per QALY gained-all below the threshold of €50,197. Improvements were observed in all stages, including survival to hospital discharge and neurologically intact survival. Probabilistic sensitivity analyses confirmed the robustness of the results.

Conclusion: Implementing a CFR system in Poland is a cost-effective strategy that enhances survival rates after OHCA at an acceptable cost per QALY. The study emphasizes the importance of AED accessibility, trained CFRs, and streamlined emergency responses to improve survival and quality of life for OHCA patients. These findings support policy development and resource allocation to strengthen Poland's emergency medical response to OHCA.

Purpose: Rheumatoid arthritis (RA) affects approximately 0.3 to 1.2% of the world's population. The objective of this study was to identify the existing literature on economic evaluations of RA in Latin America.

Patients and methods: Studies of economic evaluations of patients with RA from 2000 to 2023 were analyzed using the databases PubMed, Scopus, Web of Science, Embase, Cochrane, and the Virtual Health Library following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Study quality was assessed using the Joanna Briggs Institute (JBI) tool, and qualitative analysis was done (following SwiM guidelines).

Results: A total of 851 articles were identified. Following the application of inclusion criteria to titles and abstracts, 117 articles were initially considered eligible. Of these, 42 were excluded due to population or outcome-based errors, leaving 27 articles and 48 abstracts for analysis. Duplicates were removed prior to this process. The included studies involved various designs: cross-sectional, longitudinal, prospective, and retrospective. Brazil accounted for the highest proportion of publications (33.3%), followed by Colombia and Mexico, each contributing 26%. Most economic studies focused on cost analysis (86%), while cost-effectiveness studies and cost-utility studies represented 7.4% and 3.3%, respectively. Predominant perspectives included third-party payer 26%, insurers 14.8%, social providers 7.4%, and mixed providers 3.7%. In terms of publications of abstracts, Colombia leaded at 35.4%. The predominant perspective was that of the provider 66.6%, including the general perspective (37.5%), private (34.3%), public (22%), and mixed (6.2%) and the perspective of third-party payers (33.3%).

Conclusion: Economic evaluations of rheumatoid arthritis in Latin America remain limited, with most studies focusing on cost analysis. Brazil, Colombia, and Mexico lead in publications, primarily from a provider perspective. Greater emphasis on cost-effectiveness and broader economic evaluations is needed to guide health policy in the region.