ClinicoEconomics and Outcomes Research最新文献

Background: Metabolic bariatric surgery (MBS) is an effective and relatively safe intervention for managing obesity. This study aimed to evaluate the cost-utility of MBS compared with the standard treatment-lifestyle modification plus liraglutide-in the Kingdom of Saudi Arabia (KSA).

Methods: A Markov model was developed to estimate the lifetime costs and outcomes of MBS. Costs and outcomes were discounted at an annual rate of 3%. The analysis was conducted from societal and healthcare system perspectives, using a willingness-to-pay (WTP) threshold of one to three times the gross domestic product (GDP) per capita per quality-adjusted life years (QALY) gained. Direct medical and nonmedical costs were obtained from hospital records and patient surveys, respectively. Transitional probabilities and utility values were obtained from published literature and primary data collection in the KSA. One-way and probabilistic sensitivity analyses were performed to assess parameter uncertainty.

Results: Over a lifetime horizon, MBS yielded 0.38 incremental QALY and US$ 11,975 (Saudi Riyal [SAR] 44,905; purchasing power parity [PPP] 23,911) incremental costs, leading to an incremental cost-effectiveness ratio (ICER) of US$ 31,909 (SAR 119,660; PPP 63,717) per QALY gained from a societal perspective and US$ 36,353 (SAR 136,324); PPP 72,590) from a healthcare system perspective. The model was most sensitive to the discount rates of costs and outcomes and the direct medical costs associated with MBS. At a WTP threshold of one GDP per capita (US$ 30,436; SAR 114,135; PPP 60,775), the standard treatment had a 63% probability of being cost-effective. However, at a threshold of approximately 1.8 GDP per capita (US$ 56,000; SAR 210,000; PPP 111,821), MBS was cost-effective in 100% of the iterations.

Conclusion: MBS is a cost-effective intervention compared with standard treatment in the context of the KSA. Efforts should be made to expand earlier and equitable access to MBS for individuals with a BMI > 40 kg/m² without comorbidities across the country.

Purpose: To estimate the economic impact of implementing smart infusion pump interoperability for a hypothetical health system in the United States (US).

Patients and methods: An economic model was developed to assess the financial impact of implementing smart infusion pump interoperability with electronic health records (EHRs) for a health system. The model perspective was that of a moderately-large hypothetical US heath-system consisting of 6 hospitals, with 1,500 staffed beds and 50,000 discharges annually. The main outcomes of interest in this model were patient safety and outpatient intravenous (IV) administration charge capture. The impact of interoperability on patient safety was assessed by measuring the estimated reduction in preventable adverse drug events (pADEs). The impact on outpatient charge capture was assessed by estimating the reduction in lost charges due to the implementation of interoperability. All model parameters and inputs were derived and supported by peer-reviewed literature.

Results: In the base-case analysis, the implementation of smart infusion pump interoperability resulted in an annual reduction of 56 pADEs, saving the health system $531,891 in associated pADE treatment costs. This equates to a total reduction of 281 pADEs over the 5-year time-horizon, with a cumulative cost savings of $2,659,457. Additionally, the implementation of interoperability recouped $2,419,673 in outpatient infusion administration charges annually, which is equivalent to $12,098,363 in recouped charges over five years.

Conclusion: The implementation of smart infusion pump interoperability has the potential to enhance patient safety by reducing pADEs and improving outpatient administration charge capture. However, it is important to note that while the model is based on peer-reviewed model inputs, the model itself is theoretical in nature without real-world data validation and does not account for investment costs. Health systems should carefully evaluate the safety and economic implications of smart infusion pump interoperability when deciding whether to invest in this technology.

Purpose: This analysis sought to characterize patients with relapsed or refractory multiple myeloma (RRMM) on triplet therapy with immunomodulatory agents/proteasome inhibitors/monoclonal antibodies combined with dexamethasone, describing their demographic and clinical features, therapeutic pathways and the related healthcare costs for the Italian National Health Service (NHS).

Patients and methods: A retrospective observational analysis was conducted on administrative databases of Italian healthcare entities, covering about 3.6 million health-assisted residents. From 2017 to 2020, patients receiving at least one triplet combination reimbursed by the Italian NHS for the treatment of RRMM were included. RRMM treatment pathways were evaluated in terms of duration of therapy and treatment lines. Healthcare costs per patient were assessed on monthly basis during the therapy period by computing expenditures for drugs, hospitalizations and outpatient specialist services.

Results: A total of 209 RRMM patients on triplet combinations were identified, with a mean age of 67.4 years, 56% males and mild-to-moderate comorbidity profile, with heart disease and renal disease as the most common coexisting conditions (respectively, 13.4% and 7.7% of patients). KRd (carfilzomib/lenalidomide/dexamethasone) was the triplet administrated to the largest proportion of patients (44%), then DaraRd (daratumumab/lenalidomide/dexamethasone) triplet (24%). Treatment duration was on average 7 months for overall patients, 7.7 months for 118 patients with triplet as second line at inclusion, and 6 months for 91 patients with triplet as third or further line at inclusion. The monthly overall costs were € 9,517, with drug expenses accounting for 93% of total expenditures. Progressing to later treatment lines, cost analysis showed comparable trends, being drugs as the most impactive item.

Conclusion: This analysis on RRMM patients under triplet medication in real-life Italian clinical practice confirmed the complex multifaceted profile of this frail population, highlighting a challenging clinical management for the oncologists and a major economic burden for the NHS.

Objective: Tolvaptan is used as an add-on therapy for heart failure (HF) patients with volume overload, particularly those with hyponatremia (HN), but its cost raises concern. This study aimed to estimate the budget impact of adding 30 mg of tolvaptan to standard treatment compared to standard treatment alone in hospitalized HF patients with HN in Thailand.

Methods: A budget impact analysis (BIA) model was developed in accordance with Thai Health Technology Assessment guidelines from the payer's perspective. Epidemiological data on HF in Thailand were used to estimate the target population. Clinical effectiveness data were derived from the EVEREST trial. Cost components included tolvaptan acquisition and HF-related hospitalization costs. Cost data were sourced from the National Health Security Office. The net budget impact (NBI) was calculated as the difference in total budget between standard care with tolvaptan and standard care alone. Deterministic sensitivity analysis was performed to explore the impact of key variables.

Results: The total budget without tolvaptan was 201 million THB (5,802,973 USD), increasing to 221 million THB (6,365,607 USD) with tolvaptan, resulting in an NBI of 19.5 million THB (562,634 USD) or 1117 THB (32 USD) per member. Despite higher drug costs, tolvaptan use reduced hospitalization costs (4.2 million USD vs 5.8 million USD) due to fewer HF hospitalization days and length of stay reduction. A lower tolvaptan dose, reduced HN risk, or a daily cost reduction of at least 25.5% could result in a negative NBI.

Conclusion: Although tolvaptan reduced hospital length of stay, its use at 30 mg daily still led to a positive NBI. These findings are relevant for Thailand and similar healthcare systems considering tolvaptan adoption.

Background: Diabetes mellitus (DM) is a chronic non-communicable disease (NCD) that imposes a significant economic burden on healthcare systems and households. This study aimed to estimate the direct medical costs associated with diabetes care from a hospital perspective in Hail, Saudi Arabia.

Methods: A retrospective, hospital-based study was conducted using data from hospital records of diabetic patients treated at King Khalid Hospital (KKH) and King Salman Specialized Hospital (KSSH) in Hail. The study employed a top-down approach to estimate direct medical costs, including consultation, lab tests, medications, admissions, and annual check-ups. Costs were adjusted to US dollars (1 USD = 3.75 SAR). Ethical approval was obtained from the Hail Health Cluster (IRB Log Number: 2023-44).

Results: A total of 377 diabetic patients were included in the study. The mean age was 58.02 years (SD = 18.80), with 53.3% male and 46.7% female patients. The average total annual cost per patient was US$6689.1 (±3450.1), with admission costs being the highest contributor (US$2686.0 ± 3373.0). The total estimated cost for all patients combined was approximately US$2.52 million. Older age, female gender, DM complications, and treatment at KSSH were significantly associated with higher direct costs.

Conclusion: The economic burden of diabetes is substantial and continues to rise annually. Policymakers should prioritize cost-effective interventions and improve data collection across hospitals to better understand and mitigate the financial impact of diabetes.

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.