ClinicoEconomics and Outcomes Research最新文献

Purpose: Evaluate the costs related to the pediatric haplo-SCT and adult and pediatric geno-SCT at the CNGMO in order to establish a tailored reimbursement package by the Tunisian Health Insurance Fund.

Patients and methods: This pharmaco-economic study compared the cost of pediatric haplo-SCT to adult and pediatric geno identical hematopoietic stem cell transplantation (geno-SCT) using the activity-based costing method. The cost assessment was conducted from the hospital's perspective and considered direct medical and non-medical costs.

Results: The cost assessment indicated that pediatric patients incurred higher expenses than adult patients. Furthermore, haplo-SCT was more expensive than geno-SCT for pediatric patients. The conditioning regimens used before haplo-SCT are more intensive than other preparative regimens and typically require longer inpatient therefore resulting in more costs. Complications, such as infections during the early phase of neutropenia and late-onset issues following hematopoietic stem cell transplantation (HSCT), particularly graft-versus-host disease (GVHD) and cytomegalovirus (CMV) reactivation, significantly contribute to increased procedural costs.

Conclusion: This study sets the standards for new specific packages for haplo-SCT and geno-SCT in pediatric patients.

Introduction: This study aimed to identify major determinants of the cost of road traffic (RT) injuries, rank their importance, and assess their effects on different quantiles of cost distribution.

Methods: This study analyzed data collected from 1372 Canadian RT survivors from July 2018 to March 2020. Costs, including healthcare and lost productivity costs over a year following RT injury, were estimated for each participant in 2023 Canadian dollars. Productivity loss was measured using the Institute for Medical Technology Assessment Productivity Cost Questionnaire. We considered 24 potential determinants of costs, which were grouped into five domains: sociodemographic, psychological, health, crash, and injury factors assessed during baseline interview. We employed a quantile regression forests machine learning approach alongside classical quantile regression to analyze costs. These methods were selected to capture heterogeneous effects across cost distribution, which are overlooked by traditional mean-based models, and to inform policy decisions targeting high-cost subgroup.

Results: The results showed that the 10th, 50th, and 90th quantiles of costs were $1,141.9, $7,403.1, and $49,537.5, respectively. ISS, GCS, and age were the top three influential variables among low-cost, medium-cost, and high-cost patients. ISS, GCS, age, sex, employment status, and living situation were common major determinants at all quantiles. Ethnicity was selected as an important determinant at the 50th and 90th quantiles. Education level, years lived in Canada, somatic symptoms severity, psychological distress, HRQoL, road user type, and head, torso, spine/back, and lower extremity injuries were selected only for high-cost patients (90th quantile). Classical quantile regression showed that selected major predictors disproportionately affected low-cost, middle-cost and high-cost patients.

Conclusion: High-cost patients were more likely to be older, retired, less educated, and have worse clinical and psychological indicators. These insights can guide targeted prevention and resource allocation strategies to reduce the economic burden of RT injuries.

Introduction: Terlipressin is the only Food and Drug Administration-approved medication for adults with hepatorenal syndrome-acute kidney injury (HRS-AKI) with rapid reduction in kidney function. Treatment with terlipressin, particularly in patients with lower serum creatinine (SCr) at diagnosis, improves outcomes. Despite evidence suggesting that treating HRS-AKI at lower SCr thresholds may improve clinical outcomes, the impact on healthcare resource utilization (HCRU) and medical costs of an earlier intervention strategy remains unquantified. This model-based analysis was conducted from a United States hospital perspective to project the clinical and economic impact of early HRS-AKI diagnosis and treatment with terlipressin among adults.

Methods: A decision-analytic model compared two SCr level-based scenarios and projected the outcomes for both scenarios. For current clinical practice, patient distribution was based on the CONFIRM trial (SCr <3 mg/dL: 45% and ≥3 to <5 mg/dL: 55%). For early diagnosis and treatment, distribution was based on the HRS medical chart review study (<3 mg/dL: 85% and ≥3 to <5 mg/dL: 15%). Terlipressin HRS reversal rate for the on-label population (SCr <5 mg/dL and acute-on-chronic liver failure grade 0-2) was 52.2% for SCr <3 mg/dL and 33.3% for SCr ≥3 to <5 mg/dL. An annual HRS incidence of 50,000 was assumed.

Results: Based on the modeled projections, early diagnosis and treatment with terlipressin versus current practice yielded an additional 3040 HRS reversals and consequently led to a reduction in hospital days and intensive care unit days. Early intervention resulted in 960 fewer patients requiring renal replacement therapy during hospitalization and 1200 more patients with 90-day transplant-free survival. Early intervention is projected to save $11,504 per patient, with total national savings of $460.2 million annually.

Conclusion: Based on the modeled projections using data from clinical trial, earlier HRS diagnosis and treatment with terlipressin may improve clinical outcomes, reduce HCRU, and save costs versus current clinical practice.

Purpose: The COVID-19 pandemic disrupted healthcare services globally, necessitating innovative care delivery models for non-communicable diseases. Remote healthcare pathways, including telehealth with pharmacy at home (PAH) and deferred care (DC), emerged as potential solutions for managing stable hypertension (HT) and diabetes mellitus (DM) patients. This study aims to estimate the budget impact of implementing PAH and DC compared to usual care (UC) for HT and DM patients in Thai tertiary care hospitals from the government perspective.

Methods:  A retrospective budget impact analysis was conducted using data from July-December 2021 (COVID-19 period) and July-December 2022 (new normal period). The study included stable patients from 35 tertiary care hospitals in Thailand. Direct medical costs were obtained from administrative databases and national costing studies. Multivariate log-linear regression models estimated conditional costs, controlling for patient characteristics. The analysis compared baseline scenario (UC only) versus alternative scenario (UC+PAH+DC). Sensitivity analyses were performed using 95% confidence intervals and ±20% population variations.

Results:  The alternative scenario demonstrated lower total budgets in both periods. During COVID-19, total costs were 12.23 versus 12.94 million USD (baseline), yielding 0.71 million USD in savings. In the new normal, costs were 11.93 versus 12.54 million USD (baseline), generating 0.61 million USD in savings. Cost-saving ratios were 0.06 USD and 0.05 USD per dollar allocated during the COVID-19 and new normal periods, respectively. Sensitivity analyses confirmed robustness across parameter variations.

Conclusion: PAH and DC pathways represent economically advantageous alternatives, demonstrating cost savings from the government perspective. These findings support implementing remote healthcare delivery in resource-constrained settings, though comprehensive evaluations incorporating societal and patient perspectives are warranted. The findings are based on extrapolation-based results and should be interpreted with caution due to variability in parameters including adoption rates of PAH/DC, unit costs applied, patient numbers, retrospective design, bundled interventions, and the savings ratio.

Background: Current treatment guidelines recommend consideration of neurostimulators and other alternative treatments to antiseizure medications in patients with drug-resistant epilepsy (DRE). This study assessed patterns of utilization and cost of healthcare services and prescription pharmacotherapies during the 2-year period before neurostimulator implantation among Medicaid enrollees with DRE.

Methods: This retrospective, observational cohort study used healthcare claims and enrollment data obtained from the US Centers for Medicare and Medicaid Services. Medicaid enrollees who met study selection criteria (ie, evidence of DRE and neurostimulator implantation) between January 1, 2011, and December 31, 2020, were included. Those without antiseizure medication (ASM) dispenses within 12 months of their implantation date or continuous enrollment for the 24-month period before this date were excluded. Demographic/clinical characteristics, utilization and cost of healthcare services, and prescription pharmacotherapies were assessed over the 2-year period before implantation. Care was designated as all-cause or epilepsy-related; the latter was defined as all ASM dispenses and all claims for medical care (ie, inpatient or outpatient) with a diagnosis code (any position) of epilepsy.

Results: In total, 2469 patients met the selection criteria. Mean age at implantation was 20.8 years. Comorbidities were common. Over the 2-year period before implantation, patients were prescribed a mean of 4.4 unique ASMs. Fifty-seven percent had at least one all-cause hospital admission, and 82.9% had at least one all-cause emergency department visit; corresponding epilepsy-related values were 55.3% and 66.1%. Less than half of patients received specific cranial imaging, including video electroencephalographs. Total mean all-cause healthcare costs were $117,013; epilepsy-related healthcare costs accounted for $48,169 (41.2%).

Conclusion: Medicaid enrollees with DRE experience high use and cost of healthcare services and pharmacotherapy over the 2 years before neurostimulator implantation. Further research is needed to understand the impacts associated with broader access to specialized epilepsy care, such as cranial imaging and neurostimulators.

Introduction: The Ethiopian health system is largely financed through household out-of-pocket payments and external donor support, increasing the risk of catastrophic health expenditures. To address these challenges, the government introduced two health insurance schemes: Community-Based Health Insurance (CBHI) targeting the informal sector and a still to be implemented Social Health Insurance (SHI) scheme for the formal sector. Although designed to operate separately, the long-term goal is to integrate them into a unified national risk pool. Achieving this integration requires cross-group solidarity, especially as formal sector employees may subsidize CBHI. This study investigates the willingness of formal sector workers to support CBHI, which is critical for long-term financial sustainability in the Ethiopian health insurance landscape.

Methods: The paper is based on a survey of 1,919 formal sector workers and pensioners in major administrative regions of Ethiopia. A survey-based experiment was used to elicit support for CBHI. Respondents were randomly assigned to one of five cases that varied by the information provided on CBHI subsidies and benefits. Descriptive statistics and logit models were used to analyze willingness to support CBHI.

Results: There is strong support from urban formal sector employees for the CBHI. Regardless of the scenario presented, after adjusting for non-response, at least 66% of participants supported the scheme. Regional variations were observed, and knowledge of health insurance was positively associated with support. Existing access to formal insurance was linked with lower support.

Discussion: Strong evidence of solidarity among formal sector workers bodes well for further expansion of the CBHI. Despite supporting CBHI, formal sector employees are resisting SHI due to cost concerns and skepticism about its benefits, unlike CBHI's known outcomes. SHI resistance signals the need for targeted communication and trust-building as the country moves toward achieving universal health coverage.

Purpose: Major depressive disorder (MDD) is a disabling condition that may require adjunctive treatment with atypical antipsychotics (AAs). However, little is known about how different adjunctive AAs impact disability outcomes. This analysis compared disability events, days, and costs among patients with MDD before and after initiating adjunctive treatment with cariprazine, brexpiprazole, or aripiprazole, which all belong to a class of AAs known as dopamine partial agonists.

Patients and methods: The Merative^TM MarketScan^® Commercial Database and the Health and Productivity Management Database (1/1/2015-12/31/2022) were used to identify adults with MDD and ≥2 dispensings of cariprazine, brexpiprazole, or aripiprazole (first dispensing=index) adjunctive to antidepressant therapy. Baseline characteristics between cohorts were balanced using inverse probability of treatment weighting. Changes (post-index minus pre-index) in all-cause and mental health (MH)-related disability claim rates, days, and costs were compared for cariprazine vs brexpiprazole and cariprazine vs aripiprazole via a difference-in-difference analysis; 95% CIs were generated using nonparametric bootstrap procedures. P-values <0.05 were considered statistically significant.

Results: In the cariprazine (n=224) vs brexpiprazole (n=643) analysis, the cariprazine cohort had significantly greater reductions in all-cause disability claims, days, and costs vs the brexpiprazole cohort (between-cohort difference: -0.23 claims [P<0.05], -25.27 days [P<0.001], -$4577.08 [P<0.01], respectively). The cariprazine cohort also had a significantly greater reduction in MH-related disability days (-12.07 [P<0.05]); reductions in MH-related disability claims and mean costs vs brexpiprazole were similar. In the cariprazine (n=174) vs aripiprazole (n=2931) analysis, a significantly greater reduction for cariprazine vs aripiprazole was observed for all-cause and MH-related disability costs (all-cause: -$3275.91 [P<0.01]; MH-related: -$2196.36 [P<0.05]); reductions in all-cause and MH-related disability claims and days were similar.

Conclusion: In this real-world analysis of patients with MDD using AAs adjunctively to antidepressants, significantly greater reductions were observed in disability claims and days for cariprazine vs brexpiprazole and in disability costs for cariprazine vs aripiprazole. These results suggest that adjunctive cariprazine may have beneficial effects on disability outcomes for patients with MDD.

Objective: To determine the challenges requiring psychosocial and economic support faced by children living with HIV, to describe the interventions in place and to explore the experience of professionals providing services in a health district in the city of Lubumbashi in the DRC.

Methods: A descriptive case study using the phenomenological qualitative approach was conducted in the Katuba health district. Over the course of eight months (June 1, 2024 - February 8, 2025), with data collection from July 1 and August 1, 2024. HIV focal points participated in in-depth, semi-structured interviews, and case managers participated in focus groups. ATLAS.ti (version 12) was used to conduct the thematic analysis.

Results: On average, the participants had 15.5 ± 11.43 years of experience, and 50% were senior nurses. The average age of the sample was 44.21 ± 9.40 years, and 57% of participants were female. Significant obstacles included the daily stresses of therapy, difficulties with adherence (especially when symptoms were not obvious), and experiences of discrimination, stigma, and exclusion within families, schools, and wider society. These issues adversely impacted education, work, and interpersonal connections. Children people also experienced financial difficulties, limited access to job opportunities and vocational training, and anxiety about an uncertain future. While psychosocial support was universally accepted, economic assistance was considered only partially beneficial due to funding delays and resource limitations. The recommendations focused on increasing government financing, improving access to medical and emotional support services, raising awareness of prevention measures, and strengthening human and material resources.

Conclusion: This research highlights the challenges faced by children living with HIV and underlines the importance of early identification and effective management of these problems to improve their quality of life. Current interventions are deemed effective, but could be improved by strengthening the support system, particularly in terms of human and organisational resources.

Purpose: Robotic platforms are commonly used for sleeve gastrectomy, despite the high capital costs and little understanding of the roles of platform-specific consumables and standard surgical alternatives in clinical outcomes and healthcare resource utilization. This study evaluates the trend, the effectiveness (outcomes) and efficiency (resource utilization) of different types of surgical staplers used in robotic sleeve gastrectomy (RSG).

Patients and methods: This was a retrospective observational cohort study analyzing data from the PINC AI™ Healthcare Data database. Patients were included if they underwent elective, inpatient, primary sleeve gastrectomy performed using the Intuitive Surgical robotic system (Sunnyvale, CA) with either a bedside stapler (BS, Signia™, Endo-GIA™, or Tri-staple™) or a robotic stapler (RS, Sureform™). The primary outcome measures included inpatient costs, complications, operating room time (ORT), length of stay (LOS), and intensive care unit visits. Outcomes were analyzed using bivariate analyses, multivariable generalized linear models (GLM), and propensity-score matching (PSM).

Results: Of 18,892 total RSG procedures that met eligibility criteria, robotic staplers were used in 15,152 procedures (80.2%) and bedside staplers were used in 3740 (19.8%). While RSG increased dramatically during the period, RS were shown to be associated with a greater risk of blood transfusion compared to bedside staplers both in a GLM [0.5% (BS) vs 0.7% (RS); Odds ratio (OR): 1.55; 95% confidence interval (CI): 1.02-2.36; p = 0.04] and after PSM [0.3% (BS) vs 0.9% (RS); OR: 3.02; 95% CI: 1.35-6.73; p = 0.007]. Bedside staplers were associated with total costs reduction [mean cost savings: $3084; 95% CI: $2860 - $3309; p < 0.001] and shorter ORT (21 minutes; 95% CI: 18.6-23.5; p < 0.001) compared to robotic staplers. Difference in LOS was not clinically significant.

Conclusion: When used during RSG, bedside staplers are cost-saving, with equivalent or better clinical outcomes and reduced resource utilization compared to robotic staplers.

Purpose: Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) are rare chronic autoimmune diseases, potentially fatal, with frequent relapses. They are associated with vital organ damage, especially renal, often resulting in end-stage renal disease. While current standard of care with immunosuppressants has improved renal function and survival, the main risks for patients under life-long immunosuppression are infections and other concomitant diseases. This study evaluated the burden of AAV using patient-level data from a disease-specific registry.

Patients and methods: The cohort of incident AVV patients (2013-2022) in the REDCap registry in a university hospital in Spain was studied. Patients with Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) and Eosinophilic Granulomatosis with Polyangiitis (EGPA) with at least one year of follow-up (or deceased during the period) were included. Clinical outcomes, including Birmingham Vasculitis Activity Score (BVAS) and healthcare resource consumption were analysed for the first year after diagnosis. Mean annual costs were calculated using unitary costs from the hospital accounting department.

Results: Seventy-five patients (12% EGPA, 32% GPA, and 56% MPA) were included. Fifty-two percent were women. Mean age at diagnosis was 65.20±14.70 years. At baseline, mean BVAS was 17.35±5.70, 93.33% of patients showed renal affectation, mean estimated glomerular filtration rate was 33.32±29.93mL/min/1.73m². As induction treatment, 62.67% received methylprednisolone, 37.33% rituximab, 25.33% cyclophosphamide, 14.67% rituximab plus cyclophosphamide, 34.67% plasmapheresis. During the first year after diagnosis, 17.33% relapsed and 78.67% had at least 1 hospitalisation; 97.33% received steroids; 13.33% were on dialysis at some point; one patient received a kidney transplant; 46.67% presented infections and 28% suffered corticosteroid-associated complications; 4 patients died, being 50% of deaths treatment-related. The highest observed mean cost per patient for the first year was €11,647.95 for hospital care.

Conclusion: This study revealed a considerable burden of AAV, as evidenced by high rates of hospitalisation, relapses, and the need for intensive medical interventions.