ClinicoEconomics and Outcomes Research最新文献

Background: Ethiopia introduced a social health insurance (SHI) scheme for the formal sector that will cost 3% of the monthly salary as a premium and provide universal health coverage. Since health care professionals (HCP) are the primary front-line service providers, their willingness to pay (WTP) for SHI may have a direct or indirect impact on how the programme is implemented. However, little is known about WTP for SHI among HCP.

Objective: To assess WTP for SHI and associated factors among government employee HCP in the North Wollo Zone, Northeast Ethiopia.

Methods: Using the contingent valuation method, a mixed approach and cross-sectional study design were applied. For the qualitative study design, in-depth interviews were performed with focal persons and officers of health insurance. Multistage systematic random sampling was used to select 636 healthcare professionals. Logistic regression analysis was used to determine independent predictors of WTP for SHI. Qualitative data were analyzed using thematic analysis.

Results: A response rate of 92.45% was achieved among the 636 participants, with 588 healthcare professionals completing the interview. The majority (61.7%) of participants were willing to join and pay the suggested SHI premium. Participants' WTP was significantly positively associated with the presence of under five years of children but their willingness to pay was significantly negatively associated with the female gender and increasing monthly salary. On the other hand, on the qualitative side, the amount of premium contribution, benefits package, and quality of service were the major factors affecting their WTP.

Conclusion: The majority of healthcare professionals were willing to pay for the SHI scheme, almost as much as the premium set by the government. This suggests proof that healthcare financing reform is feasible, particularly for the implementation of the SHI system.

Purpose: The aim of this study was to estimate health-care resources utilization, costs and cost-effectiveness associated with the treatment with CNIC-Polypill as secondary prevention of atherosclerotic cardiovascular disease (ASCVD) compared to other treatments, in clinical practice in Spain.

Patients and methods: An observational, retrospective study was performed using medical records (economic results [healthcare perspective], NEPTUNO-study; BIG-PAC-database) of patients who initiated secondary prevention between 2015 and 2018. Patients were followed up to 2 years (maximum). Four cohorts were balanced with a propensity-score-matching (PSM): 1) CNIC-Polypill (aspirin+atorvastatin+ramipril), 2) Monocomponents (same separate drugs), 3) Equipotent (equipotent drugs) and 4) Other therapies ([OT], other cardiovascular drugs). Incidence of cardiovascular events, health-care resources utilization and healthcare and non-healthcare costs (2020 Euros) were compared. Incremental cost-effectiveness ratios per cardiovascular event avoided were estimated.

Results: After PSM, 1614 patients were recruited in each study cohort. The accumulated incidence of cardiovascular events during the 24-month follow-up was lower in the CNIC-Polypill cohort vs the other cohorts (19.8% vs Monocomponents: 23.3%, Equipotent: 25.5% and OT: 26.8%; p<0.01). During the follow-up period, the CNIC-Polypill cohort also reduced the health-care resources utilization per patient compared to the other cohorts, particularly primary care visits (16.6 vs Monocomponents: 18.7, Equipotent: 18.9 and OT: 21.0; p<0.001) and hospitalization days (2.3 vs Monocomponents: 3.4, Equipotent: 3.7 and OT: 4.0; p<0.001). The treatment cost in the CNIC-Polypill cohort was lower than that in the other cohorts (€4668 vs Monocomponents: €5587; Equipotent: €5682 and OT: €6016; p<0.001) (Difference: -€919, -€1014 and -€1348, respectively). Due to the reduction of cardiovascular events and costs, the CNIC-Polypill is a dominant alternative compared to the other treatments.

Conclusion: CNIC-Polypill reduces recurrent major cardiovascular events and costs, being a cost-saving strategy as secondary prevention of ASCVD.

Introduction: The availability and affordability of safe, effective, accessible, and high-quality essential medicines is a critical benchmark for achieving the right to good health, and it is also one of the goals of the global health development agenda. To that end, it is critical to conduct rigorous studies to identify the major challenges confronting developing countries, particularly those in Africa.

Objective: The purpose of this review was to identify the major challenges that Africans face in obtaining reasonably priced and readily available essential medicines.

Methods: Generally the Boolean operators "AND" and "OR" were employed. Making progress also involves using duplicate checks, field definitions, and comparisons of articles and criteria. The analysis included all English-language papers published in any African country between 2005 and 2022, depending on the year of publication. The technique searches electronic databases for key phrases related to essential medication availability and affordability, such as PubMed, Web of Science, Scopus, Science Direct, Plos Medicine, and Google Scholar.

Results: A total of 91 articles; by using search engines and handpicking including duplicates, were primarily searched. The electronic database search earned 78 articles while only eleven studies met the criteria for review and were reviewed of which 5 (50%) were from East African countries. Inadequate human resources, financial constraints, high cost of available medications on the market, poor inventory management, manual consumption forecasting, inefficiencies in drug registration, and trade-related aspects of intellectual property rights agreement regulations are all obstacles to the availability of essential medicines in African nations.

Conclusion: This review revealed that in Africa, the availability and affordability of essential medicines face numerous challenges. The primary challenge, according to the review research, is a lack of adequate financing to pay for an appropriate set of essential medications, which account for a significant portion of household spending.

Background: Atrial fibrillation (AF) is associated with considerable morbidity and mortality. Timely management and treatment is critical in alleviating AF disease burden. Variation in treatment by race and ethnic and sex could lead to inequities in health outcomes.

Objective: To identify racial and ethnic and sex differences in rhythm treatment for patients with incident AF.

Methods: Using 2010-2019 Optum Clinformatics database, an administrative claims data for commercially insured patients in the United States (US), incident AF patients ≥20 years old who were continuously enrolled 12-months pre- and post-index diagnosis were identified. Rhythm control treatment (ablation, antiarrhythmic drugs [AAD], and cardioversion) for AF were compared by patient race and ethnicity (Asian, Hispanic, Black vs White) and sex (female vs male). Multivariable regression analysis was used to examine the relationship of race and ethnicity and sex with rhythm control AF treatment.

Results: A total of 77,932 patients were identified with incident AF. Black and Hispanic female patients had the highest CHA₂DS₂VASc scores (4.3 ± 1.8) and Elixhauser scores (4.1 ± 2.8 and 4.0 ± 6.7), respectively. Black males were less likely to receive AAD treatment (adjusted odds ratio [aOR] 0.87; 95% confidence interval [CI], 0.79-0.96) or ablation (aOR, 0.72; 95% CI, 0.58-0.90). Compared to White males, all groups had lower likelihood of receiving cardioversion with Asian females having the lowest [aOR, 0.48; 95% CI, (0.37-0.63)].

Conclusion: Black patients were less likely to receive pharmacologic and procedural rhythm control therapies. Further research is needed to understand the drivers of undertreatment among racial and ethnic groups and females with AF.

Service design and in particular co-design are approaches able to align with the need of healthcare contexts of value-based and patient-centered processing through a participatory design of services. The purpose of this study is to identify the characteristics of co-design and its applicability to the reengineering of healthcare services, as well as to detect the peculiarities of the application of this approach in different geographical contexts. The methodology applied for the review, Systematic Literature Network Analysis (SLNA), combines qualitative and quantitative perspectives. In detail, the analysis applied the paper citation networks and the co-word network analysis to detect the main research trends over time and to identify the most relevant publications. The results of the analysis highlight the backbone of literature on the application of co-design in healthcare as well as the advantages and the critical factors of the approach. Three main literature streams emerged concerning the integration of the approach at meso and micro level, the implementation of co-design at mega and macro level, and the impacts on non-clinical related outcomes. Moreover, the findings underline differences in co-design in terms of impacts and success factors in developed countries and economies in transition or developing countries. The analysis shows the potentially added value of the application of a participatory approach to the design and redesign of healthcare services both at different levels of the healthcare organization and in the contexts of developed countries and economies in transition or developing countries. The evidence also highlights potentialities and critical success factors of the application of co-design in healthcare services redesign.

Introduction: Achieving and maintaining glycemic control is the cornerstone of type 1 diabetes management, with the aim of reducing the incidence of diabetes-related complications over the long term. However, many individuals fail to reach glycemic targets. The present study evaluated the clinical and economic burden associated with poor glycemic control in people with type 1 diabetes in the Netherlands, and the improvements in outcomes that can be achieved by improving treatment.

Methods: Immediate glycemic control, defined as achieving a glycated hemoglobin (HbA1c) target of 7.0% at the start of the analysis, was compared with delays in achieving control of 1, 3 and 7 years, with outcomes projected using the IQVIA CORE Diabetes Model. Projections of life expectancy, quality-adjusted life expectancy, and direct and indirect costs (expressed in 2021 euros [EUR]) were made at a patient level and extrapolated to the population level.

Results: Improving HbA1c from 8.0% to 7.0% and 9.0% to 7.0% resulted in gains of up to 0.66 and 1.37 quality-adjusted life years (QALYs) per patient over a lifetime, respectively. At a population level, achieving immediate glycemic control was associated with gains of 9438, 27,171 and 72,717 QALYs and cost savings of up to EUR 224 million, EUR 556 million and EUR 1.3 billion compared with remaining in poor control for 1, 3 and 7 years, respectively.

Conclusion: The clinical and economic burden of poor glycemic control in people with type 1 diabetes in the Netherlands was projected to be substantial, but considerable gains in quality-adjusted life expectancy and cost savings could be achieved through early and effective treatment.

Background: This paper explores the use of blockchain technology and smart contracts in the Internet of Medical Things (IoMT). It aims to identify the challenges and benefits of implementing smart contracts based on blockchain technology in the IoMT. It provides solutions and evaluates the IoMT uses in e-healthcare performance.

Methods: A quantitative approach used an online survey from public and private hospital administrative departments in Dubai, United Arab Emirates (UAE). ANOVA, t-test, correlation, and regression analysis were performed to assess the e-healthcare performance with and without IoMT (smart contract based on blockchain).

Patients and methods: A mixed method was used in this research, a quantitative approach for data analysis utilizing online surveys from public and private hospitals' administrative departments in Dubai, UAE. A correlation, regression through ANOVA, and independent two-sample t-test were performed to assess the e-healthcare performance with and without IoMT (smart contract based on blockchain).

Results: Blockchain application in smart contracts has proven to be significant in the healthcare sector. Results highlight the importance of integrating smart contracts and blockchain technology in the IoMT infrastructure to improve efficiency, transparency, and security. The study provides empirical evidence to support the implementation of smart contracts in the e-healthcare sector and suggests improved e-healthcare performance through this transition.

Conclusion: The emergence of e-healthcare systems with upgraded smart contracts and blockchain technology brings continuous health monitoring, time-effective operations, and cost-effectiveness to the healthcare sector.

Purpose: To demonstrate a need for improved health insurance coverage for anti-obesity medications (AOMs) by comparing clinical and economic benefits of obesity treatments to covered medications for selected therapeutic areas.

Methods: Using a grey literature search, we identified and prioritized therapeutic areas and treatment analogues for comparison to obesity. A targeted literature review identified clinical and economic outcomes research across the therapeutic area analogues. Associated comorbidities, clinical evidence, indirect costs (ie, absenteeism and productivity loss), and direct medical costs were evaluated to determine the relative value of treating obesity.

Results: Four therapeutic areas/treatment analogues were selected for comparison to obesity: smoking cessation (varenicline), daytime sleepiness (modafinil), migraines (erenumab), and fibromyalgia (pregabalin). Obesity was associated with 17 comorbidities, more than migraine (9), smoking (8), daytime sleepiness (5), and fibromyalgia (2). Economic burden was greatest for obesity, followed by smoking, with yearly indirect and direct medical costs totaling $676 and $345 billion, respectively. AOMs resulted in cost savings of $2586 in direct medical costs per patient per year (PPPY), greater than that for varenicline at $930 PPPY, modafinil at $1045 PPPY, and erenumab at $468 PPPY; pregabalin utilization increased costs by $924 PPPY. AOMs were covered by 10-16% of United States health insurance plans, compared to 45-59% for the four comparators.

Conclusion: Compared to four therapeutic analogues, obesity represented the highest economic burden and was associated with more comorbidities. AOMs provide greater cost savings compared to selected analogues. However, AOMs have limited formulary coverage. Improved coverage of AOMs may increase access to these treatments and may help address the clinical and economic burden associated with obesity and its comorbidities.

Purpose: Asthma is a common, chronic respiratory disorder associated with substantial societal and economic burden globally, despite the availability of different treatment modalities. GSK has developed a once-daily single-inhaler triple therapy (SITT), comprised of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI); a combination of inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting β₂-agonist for patients with uncontrolled asthma. A budget impact analysis was conducted to determine the financial impact of introducing FF/UMEC/VI SITT from the perspective of the Dubai Academic Healthcare Corporation (DAHC).

Methods: A budget impact model was constructed using an epidemiology-based approach and used to estimate the expected 5-year budget impact of including FF/UMEC/VI for the treatment of eligible patients within the DAHC in the United Arab Emirates (UAE). The model included both pharmacy and efficacy-related costs. The perspective of the DAHC healthcare payer was adopted, thus only direct payer costs were included in the analysis. A one-way sensitivity analysis was conducted to test the robustness of the model structure, assumptions, and input parameters.

Results: The total budget impact was estimated to save 1 million United States Dollars (USD) over 5 years, with budget impacts of 0.08 million USD in Year 1; 0.14 million USD in Year 2; 0.22 million USD in Year 3; 0.28 million USD in Year 4; and 0.33 million USD in Year 5. The overall budget impact per patient was estimated to save 12.2 USD over 5 years. In one-way sensitivity analyses, the budget impact was most sensitive to changes in the market uptake of FF/UMEC/VI.

Conclusion: Healthcare payers may consider FF/UMEC/VI in the management of uncontrolled asthma which would save costs and reduce healthcare resource use in the UAE.

Introduction: In the midst of the COVID-19 crisis, it might be difficult to provide the most vulnerable people with access to essential services. The main objective of this article is to lay the foundation for future solutions by collecting the results of previous published articles.

Methods: This study used a systematic and integrated method that began by searching relevant literature in professional and generally published journal databases from March 2019- December 2021.

Results: According to the results of the review, COVID-19 has had a significant effect on real and forecasted key macroeconomic variables such as economic growth, unemployment, inflation, poverty levels, and fiscal and monetary policy. In addition, this review reflects the sectorial effect of COVID-19 on health, factor productivity, domestic trade, exports, tourism, international aviation, remittances, the education sector, foreign direct investment, and the Ethiopian economy.

Conclusion: While appropriate social distance and personal protective equipment strategies exist in all types of markets across the country, the government should take precautions against the recurrence of Covid-19 by disseminating credible information. Finally, fiscal optimization should be seen as a broader intervention in the economy as a whole.