Pub Date : 2024-08-07DOI: 10.1101/2024.08.06.24311489
Helen Mitchell, Qian Xin, Jack Hide, Clement Halin, Swarali Sunil Tadwalkar, Sabera Hashim, Richard Hudson
Background National Institute for Health and Care Excellence (NICE) data regarding manufacturer driven terminations indicate that some patients in the United Kingdom (UK) are unable to access treatments that are available in other European countries, which may result in reduced survival and quality of life (QoL). This study aims to quantify the health impact of NICE appraisals for multi-indication products terminated for reasons not related to clinical trial failure on the UK population. Methods Terminated NICE appraisals (2014 to 2023) for multi-indication products were identified and a targeted literature search was conducted to identify data on the health impact of the interventions. The potential incremental quality-adjusted life year (QALY) loss and impact on overall survival (OS), progression-free survival (PFS), and QoL was calculated. Results Over 16,000 QALYs/year were potentially lost (with one QALY equal to one year of life in perfect health) across approximately 829,000 patients in the UK due to NICE appraisals for multi-indication products being terminated for reasons not related to clinical trial failure. Across oncology indications (approximately 18,900 patients), OS and PFS may have been reduced by over 9,400 years and 9,000 years, respectively. The potential impact of the treatments for non-oncology indications for which NICE appraisals were terminated on QoL was an incremental improvement of 13% (weighted average). Conclusions Due to the increasing number of NICE terminations for multi-indication products, patients cannot access therapies that could lengthen their lives and increase their QoL. As the UK uniform pricing policy is likely to influence manufacturer-driven terminations, introducing alternative reimbursement arrangements such as indication-based pricing (IBP) agreements to ensure that prices remain commensurate with therapeutic value could improve access to therapies in the UK, thereby improving public health.
{"title":"Is the United Kingdom (UK) medicines pricing policy failing patients? The impact of terminated National Institute for Health and Care Excellence (NICE) appraisals for multi-indication products on patients","authors":"Helen Mitchell, Qian Xin, Jack Hide, Clement Halin, Swarali Sunil Tadwalkar, Sabera Hashim, Richard Hudson","doi":"10.1101/2024.08.06.24311489","DOIUrl":"https://doi.org/10.1101/2024.08.06.24311489","url":null,"abstract":"Background\u0000National Institute for Health and Care Excellence (NICE) data regarding manufacturer driven terminations indicate that some patients in the United Kingdom (UK) are unable to access treatments that are available in other European countries, which may result in reduced survival and quality of life (QoL). This study aims to quantify the health impact of NICE appraisals for multi-indication products terminated for reasons not related to clinical trial failure on the UK population. Methods\u0000Terminated NICE appraisals (2014 to 2023) for multi-indication products were identified and a targeted literature search was conducted to identify data on the health impact of the interventions. The potential incremental quality-adjusted life year (QALY) loss and impact on overall survival (OS), progression-free survival (PFS), and QoL was calculated. Results\u0000Over 16,000 QALYs/year were potentially lost (with one QALY equal to one year of life in perfect health) across approximately 829,000 patients in the UK due to NICE appraisals for multi-indication products being terminated for reasons not related to clinical trial failure. Across oncology indications (approximately 18,900 patients), OS and PFS may have been reduced by over 9,400 years and 9,000 years, respectively. The potential impact of the treatments for non-oncology indications for which NICE appraisals were terminated on QoL was an incremental improvement of 13% (weighted average). Conclusions\u0000Due to the increasing number of NICE terminations for multi-indication products, patients cannot access therapies that could lengthen their lives and increase their QoL. As the UK uniform pricing policy is likely to influence manufacturer-driven terminations, introducing alternative reimbursement arrangements such as indication-based pricing (IBP) agreements to ensure that prices remain commensurate with therapeutic value could improve access to therapies in the UK, thereby improving public health.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141946020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-03DOI: 10.1101/2024.07.31.24311315
Mary Chriselda Antony Oliver, Matthew Graham, Ioanna Manolopoulou, Graham Medley, Lorenzo Pellis, Koen B Pouwels, Matthew Thorpe, Deirdre Hollingsworth
Cost-effectiveness analyses (CEA) typically involve comparing effectiveness and costs of one or more interventions compared to standard of care, to determine which intervention should be optimally implemented to maximise population health within the constraints of the healthcare budget. Traditionally, cost-effectiveness evaluations are expressed using incremental cost-effectiveness ratios (ICERs), which are compared with a fixed willingness-to-pay (WTP) threshold. Due to the existing uncertainty in costs for interventions and the overall burden of disease, particularly with regard to diseases in populations that are difficult to study, it becomes important to consider uncertainty quantification whilst estimating ICERs. To tackle the challenges of uncertainty quantification in CEA, we propose an alternative paradigm utilizing the Linear Wasserstein framework combined with Linear Discriminant Analysis (LDA) using a demonstrative example of lymphatic filariasis (LF). This approach uses geometric embeddings of the overall costs for treatment and surveillance, disability-adjusted lifeyears (DALYs) averted for morbidity by quantifying the burden of disease due to the years lived with disability, and probabilities of local elimination over a time-horizon of 20 years to evaluate the cost-effectiveness of lowering the stopping thresholds for post-surveillance determination of LF elimination as a public health problem. Our findings suggest that reducing the stopping threshold from <1% to <0.5% microfilaria (mf) prevalence for adults aged 20 years and above, under various treatment coverages and baseline prevalences, is cost-effective. When validated on 20% of test data, for 65% treatment coverage, a government expenditure of WTP ranging from $500 to $3,000 per 1% increase in local elimination probability justifies the switch to the lower threshold as cost-effective. Stochastic model simulations often lead to parameter and structural uncertainty in CEA. Uncertainty may impact the decisions taken, and this study underscores the necessity of better uncertainty quantification techniques within CEA for making informed decisions.
{"title":"Uncertainty Quantification in Cost-effectiveness Analysis for Stochastic-based Infectious Disease Models: Insights from Surveillance on Lymphatic Filariasis","authors":"Mary Chriselda Antony Oliver, Matthew Graham, Ioanna Manolopoulou, Graham Medley, Lorenzo Pellis, Koen B Pouwels, Matthew Thorpe, Deirdre Hollingsworth","doi":"10.1101/2024.07.31.24311315","DOIUrl":"https://doi.org/10.1101/2024.07.31.24311315","url":null,"abstract":"Cost-effectiveness analyses (CEA) typically involve comparing effectiveness and costs of one or more interventions compared to standard of care, to determine which intervention should be optimally implemented to maximise population health within the constraints of the healthcare budget. Traditionally, cost-effectiveness evaluations are expressed using incremental cost-effectiveness ratios (ICERs), which are compared with a fixed willingness-to-pay (WTP) threshold. Due to the existing uncertainty in costs for interventions and the overall burden of disease, particularly with regard to diseases in populations that are difficult to study, it becomes important to consider uncertainty quantification whilst estimating ICERs. To tackle the challenges of uncertainty quantification in CEA, we propose an alternative paradigm utilizing the Linear Wasserstein framework combined with Linear Discriminant Analysis (LDA) using a demonstrative example of lymphatic filariasis (LF). This approach uses geometric embeddings of the overall costs for treatment and surveillance, disability-adjusted lifeyears (DALYs) averted for morbidity by quantifying the burden of disease due to the years lived with disability, and probabilities of local elimination over a time-horizon of 20 years to evaluate the cost-effectiveness of lowering the stopping thresholds for post-surveillance determination of LF elimination as a public health problem. Our findings suggest that reducing the stopping threshold from <1% to <0.5% microfilaria (mf) prevalence for adults aged 20 years and above, under various treatment coverages and baseline prevalences, is cost-effective. When validated on 20% of test data, for 65% treatment coverage, a government expenditure of WTP ranging from $500 to $3,000 per 1% increase in local elimination probability justifies the switch to the lower threshold as cost-effective. Stochastic model simulations often lead to parameter and structural uncertainty in CEA. Uncertainty may impact the decisions taken, and this study underscores the necessity of better uncertainty quantification techniques within CEA for making informed decisions.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141946015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-26DOI: 10.1101/2024.07.24.24310952
Noel Namuhani, Angela Kisakye, Suzanne N Kiwanuka
Background Access to health care remains a challenge, especially among the informal sector workers in most low-income countries, due to high out-of-pocket (OOP) expenditures, with Uganda spending over 28.0% out of pocket on health care. In response, Uganda has proposed a national health insurance scheme (NHI). However, the willingness and ability to pay for the proposed NHI scheme within the informal sector have not yet been explored in Uganda. This study assessed the willingness and perceived ability to pay for the proposed NHI scheme and its determinants among the informal sector workers in Iganga and Mayuge districts, Uganda. Methodology A cross-sectional study was conducted in Iganga and Mayuge districts in April and May 2019. A contingent valuation method using the bidding game technique was used to elicit the willingness to pay (WTP). A total of 853 informal sector workers, including farmers, commercial motorists, fishermen, and traders, were randomly sampled. Seven focus group discussions (FGD) were also conducted. Logistic regression was done to identify the determinants of willingness to pay for the proposed NHI scheme. Qualitative data was analyzed thematically. Results The majority 695/853, (81.5%) of the respondents were willing to pay for NHI; the median WTP was UGX 25,000 (USD 6.8) annually; and 633/853, (74.2%) of the respondents believed that they were able to pay for the health insurance. Willingness to Pay was significantly associated with being a fisher folk (AOR: 1.70 95%CI: 1.04-2.79, P = 0.035), being in the fourth wealth quintile (AOR: 2.98, 95% CI: 1.56–5.65), not hearing about health insurance (AOR: 0.50 95%CI: 0.23-0.86, P = 0.032), and not having saving group membership (AOR: 0.51, 95%CI: 0.34-0.76, P<0.001). Most of the FGD participants were willing to pay for the proposed scheme; however, some of the participants doubted their ability to pay for the scheme given their high poverty levels and their unstable income. Conclusion The willingness to pay for health insurance in the informal sector is high. Therefore, it is viable for the government to extend NHI to the informal sector. However, awareness building and due consideration of high poverty levels in setting appropriate premiums should be a priority.
{"title":"Willingness and Perceived ability to pay for Uganda’s Proposed National Health Insurance Scheme among Informal Sector workers in Iganga and Mayuge districts, Uganda: A Contingent Valuation Method.","authors":"Noel Namuhani, Angela Kisakye, Suzanne N Kiwanuka","doi":"10.1101/2024.07.24.24310952","DOIUrl":"https://doi.org/10.1101/2024.07.24.24310952","url":null,"abstract":"Background Access to health care remains a challenge, especially among the informal sector workers in most low-income countries, due to high out-of-pocket (OOP) expenditures, with Uganda spending over 28.0% out of pocket on health care. In response, Uganda has proposed a national health insurance scheme (NHI). However, the willingness and ability to pay for the proposed NHI scheme within the informal sector have not yet been explored in Uganda. This study assessed the willingness and perceived ability to pay for the proposed NHI scheme and its determinants among the informal sector workers in Iganga and Mayuge districts, Uganda. Methodology A cross-sectional study was conducted in Iganga and Mayuge districts in April and May 2019. A contingent valuation method using the bidding game technique was used to elicit the willingness to pay (WTP). A total of 853 informal sector workers, including farmers, commercial motorists, fishermen, and traders, were randomly sampled. Seven focus group discussions (FGD) were also conducted. Logistic regression was done to identify the determinants of willingness to pay for the proposed NHI scheme. Qualitative data was analyzed thematically. Results The majority 695/853, (81.5%) of the respondents were willing to pay for NHI; the median WTP was UGX 25,000 (USD 6.8) annually; and 633/853, (74.2%) of the respondents believed that they were able to pay for the health insurance. Willingness to Pay was significantly associated with being a fisher folk (AOR: 1.70 95%CI: 1.04-2.79, P = 0.035), being in the fourth wealth quintile (AOR: 2.98, 95% CI: 1.56–5.65), not hearing about health insurance (AOR: 0.50 95%CI: 0.23-0.86, P = 0.032), and not having saving group membership (AOR: 0.51, 95%CI: 0.34-0.76, P<0.001). Most of the FGD participants were willing to pay for the proposed scheme; however, some of the participants doubted their ability to pay for the scheme given their high poverty levels and their unstable income. Conclusion The willingness to pay for health insurance in the informal sector is high. Therefore, it is viable for the government to extend NHI to the informal sector. However, awareness building and due consideration of high poverty levels in setting appropriate premiums should be a priority.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141772162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-11DOI: 10.1101/2024.07.11.24310267
F Zhang, A Shen, Waqas Ahmed, Richard F Pollock
Aims: Intravenous (IV) iron is the recommended treatment for patients with iron deficiency anemia (IDA) who are unresponsive to oral iron treatment or require rapid iron replenishment. Ferric derisomaltose (FDI) and ferric carboxymaltose (FCM) are high-dose, rapid infusion, IV iron formulations that have recently been compared in three head-to-head randomized controlled trials (RCTs), which showed significantly higher incidence of hypophosphatemia after administration of FCM than FDI. The present study objective was to evaluate the cost-utility of FDI versus FCM in a population of Chinese patients with IDA. Materials and methods: A previously-published patient-level simulation model was used to model the cost-utility of FDI versus FCM in China. The number of infusions of FDI and FCM was modeled based on the approved posology of the respective formulations using simplified tables of iron need in a population of patients with bodyweight and hemoglobin levels informed by a Chinese RCT of FCM. Data on the incidence of hypophosphatemia was obtained from the PHOSPHARE-IDA RCT, while data on disease-related quality of life was obtained from SF-36v2 data from the PHOSPHARE-IBD RCT. Results: Over the five-year time horizon, patients received 3.98 courses of iron treatment on average, requiring 0.90 fewer infusions of FDI than FCM (7.69 versus 6.79). This resulted in iron procurement and administration cost savings of RMB 206 with FDI (RMB 3,519 versus RMB 3,312). Reduced incidence of hypophosphatemia resulted in an increase of 0.07 quality-adjusted life years and further cost savings of RMB 782 over five years, driven by reduced need for phosphate testing and replenishment. FDI was therefore the dominant intervention. Conclusions: Results showed that FDI would improve patient quality of life and reduce direct healthcare expenditure versus FCM in patients with IDA in China.
{"title":"A Cost-utility Analysis of Ferric Derisomaltose versus Ferric Carboxymaltose in Patients with Iron Deficiency Anemia in China","authors":"F Zhang, A Shen, Waqas Ahmed, Richard F Pollock","doi":"10.1101/2024.07.11.24310267","DOIUrl":"https://doi.org/10.1101/2024.07.11.24310267","url":null,"abstract":"Aims: Intravenous (IV) iron is the recommended treatment for patients with iron deficiency anemia (IDA) who are unresponsive to oral iron treatment or require rapid iron replenishment. Ferric derisomaltose (FDI) and ferric carboxymaltose (FCM) are high-dose, rapid infusion, IV iron formulations that have recently been compared in three head-to-head randomized controlled trials (RCTs), which showed significantly higher incidence of hypophosphatemia after administration of FCM than FDI. The present study objective was to evaluate the cost-utility of FDI versus FCM in a population of Chinese patients with IDA.\u0000Materials and methods: A previously-published patient-level simulation model was used to model the cost-utility of FDI versus FCM in China. The number of infusions of FDI and FCM was modeled based on the approved posology of the respective formulations using simplified tables of iron need in a population of patients with bodyweight and hemoglobin levels informed by a Chinese RCT of FCM. Data on the incidence of hypophosphatemia was obtained from the PHOSPHARE-IDA RCT, while data on disease-related quality of life was obtained from SF-36v2 data from the PHOSPHARE-IBD RCT. Results: Over the five-year time horizon, patients received 3.98 courses of iron treatment on average, requiring 0.90 fewer infusions of FDI than FCM (7.69 versus 6.79). This resulted in iron procurement and administration cost savings of RMB 206 with FDI (RMB 3,519 versus RMB 3,312). Reduced incidence of hypophosphatemia resulted in an increase of 0.07 quality-adjusted life years and further cost savings of RMB 782 over five years, driven by reduced need for phosphate testing and replenishment. FDI was therefore the dominant intervention.\u0000Conclusions: Results showed that FDI would improve patient quality of life and reduce direct healthcare expenditure versus FCM in patients with IDA in China.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141612332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-05DOI: 10.1101/2024.07.01.24309774
Donald S. Shepard, Samantha R. Lee, Yara A. Halasa-Rappel, Carlos Willian Rincon Perez, Arturo Harker Roa
Background and Aims Wolbachia are bacteria that inhibit dengue virus replication within the mosquito. A cluster-randomized trial found Wolbachia reduced virologically-confirmed dengue cases by 77% and previous models predicted Wolbachia to be highly cost-effective in Indonesia, Vietnam, and Brazil. in Colombia, Wolbachia was introduced in the Aburrá Valley in 2015 and Cali in 2020. To inform decisions about future extensions, we performed economic evaluations of the potential expansion of Wolbachia deployments to 11 target Colombian cities. Methods We assembled quantities and the distribution by severity of reported dengue cases from Colombia’s national disease surveillance system and the health service provision registry (RIPS). An epidemiological panel of three experts estimated the shares of non-medical cases and adjustments for under-reporting and misclassifications. We determined costs (in 2020 US dollars) of treating dengue illness from the benchmark insurance tariff, RIPS data on treatment services per symptomatic dengue case, and the national government database for establishing insurance premiums. A cluster randomized trial quantified the effectiveness of Wolbachia against symptomatic dengue cases. Results Projecting impact over 10 years for Cali, we estimated a net health-sector savings of USD4.95 per person. We also estimated averting 369 disability-adjusted life years (DALYs) per 100,000 population. From a societal perspective, at 10 years Wolbachia deployment is expected to have highly favorable benefit-cost ratios, with benefits per dollar invested of $5.50 in Cali and USD4.68 over all target cities. Conclusions Over 10 years, Wolbachia is highly beneficial on economic grounds, and almost universally cost saving. That is, Wolbachia’s savings in health care costs alone would more than offset deployment costs nationally and in 9 target cities (those with adjusted annual dengue incidence at least 50/100,000 population). In these 9 target cities, Wolbachia would generate at least USD3.00 in benefits per dollar invested, giving substantial confidence that Wolbachia deployment would be cost-beneficial in Colombia.
{"title":"Economic evaluation of Wolbachia deployment in Colombia: A modeling study","authors":"Donald S. Shepard, Samantha R. Lee, Yara A. Halasa-Rappel, Carlos Willian Rincon Perez, Arturo Harker Roa","doi":"10.1101/2024.07.01.24309774","DOIUrl":"https://doi.org/10.1101/2024.07.01.24309774","url":null,"abstract":"Background and Aims\u0000Wolbachia are bacteria that inhibit dengue virus replication within the mosquito. A cluster-randomized trial found Wolbachia reduced virologically-confirmed dengue cases by 77% and previous models predicted Wolbachia to be highly cost-effective in Indonesia, Vietnam, and Brazil. in Colombia, Wolbachia was introduced in the Aburrá Valley in 2015 and Cali in 2020. To inform decisions about future extensions, we performed economic evaluations of the potential expansion of Wolbachia deployments to 11 target Colombian cities.\u0000Methods\u0000We assembled quantities and the distribution by severity of reported dengue cases from Colombia’s national disease surveillance system and the health service provision registry (RIPS). An epidemiological panel of three experts estimated the shares of non-medical cases and adjustments for under-reporting and misclassifications. We determined costs (in 2020 US dollars) of treating dengue illness from the benchmark insurance tariff, RIPS data on treatment services per symptomatic dengue case, and the national government database for establishing insurance premiums. A cluster randomized trial quantified the effectiveness of Wolbachia against symptomatic dengue cases.\u0000Results\u0000Projecting impact over 10 years for Cali, we estimated a net health-sector savings of USD4.95 per person. We also estimated averting 369 disability-adjusted life years (DALYs) per 100,000 population. From a societal perspective, at 10 years Wolbachia deployment is expected to have highly favorable benefit-cost ratios, with benefits per dollar invested of $5.50 in Cali and USD4.68 over all target cities.\u0000Conclusions\u0000Over 10 years, Wolbachia is highly beneficial on economic grounds, and almost universally cost saving. That is, Wolbachia’s savings in health care costs alone would more than offset deployment costs nationally and in 9 target cities (those with adjusted annual dengue incidence at least 50/100,000 population). In these 9 target cities, Wolbachia would generate at least USD3.00 in benefits per dollar invested, giving substantial confidence that Wolbachia deployment would be cost-beneficial in Colombia.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141547056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-04DOI: 10.1101/2024.07.03.24309664
Heesoo Joo, Brian A. Maskery, Louise K. Francois Watkins, Joohyun Park, Kristina M Angelo, Eric S Halsey
In the United States, typhoid vaccination is recommended for international travelers to areas with a recognized risk of typhoid exposure. Using MarketScan Commercial Database from 2016 through 2022, we estimated typhoid vaccination costs by route (injectable vs. oral) and provider setting (clinic vs. pharmacy). Of 165,930 vaccinated individuals, 99,471 received injectable and 66,459 received oral typhoid vaccines, with 88% and 17% respectively administered at clinics. Average costs for injectable vaccination were $132.91 per person [95% confidence interval (CI): $132.68-$133.13], with clinic and pharmacy costs at $136.38 [95% CI: $136.14-$136.63], and $107.45 [95% CI: $107.13-$107.77] respectively. Oral vaccination costs averaged $81.23 per person [95% CI: $81.14-$81.33], encompassing $86.61 [95% CI: $86.13-$87.10] at clinics and $80.14 [95% CI: $80.09-$80.19] at pharmacies. Out-of-pocket costs comprised 21% and 33% of total costs for injectable and oral vaccinations. These findings may inform clinical decision-making to protect international travelers' health.
{"title":"Costs of typhoid vaccination for international travelers from the United States","authors":"Heesoo Joo, Brian A. Maskery, Louise K. Francois Watkins, Joohyun Park, Kristina M Angelo, Eric S Halsey","doi":"10.1101/2024.07.03.24309664","DOIUrl":"https://doi.org/10.1101/2024.07.03.24309664","url":null,"abstract":"In the United States, typhoid vaccination is recommended for international travelers to areas with a recognized risk of typhoid exposure. Using MarketScan Commercial Database from 2016 through 2022, we estimated typhoid vaccination costs by route (injectable vs. oral) and provider setting (clinic vs. pharmacy). Of 165,930 vaccinated individuals, 99,471 received injectable and 66,459 received oral typhoid vaccines, with 88% and 17% respectively administered at clinics. Average costs for injectable vaccination were $132.91 per person [95% confidence interval (CI): $132.68-$133.13], with clinic and pharmacy costs at $136.38 [95% CI: $136.14-$136.63], and $107.45 [95% CI: $107.13-$107.77] respectively. Oral vaccination costs averaged $81.23 per person [95% CI: $81.14-$81.33], encompassing $86.61 [95% CI: $86.13-$87.10] at clinics and $80.14 [95% CI: $80.09-$80.19] at pharmacies. Out-of-pocket costs comprised 21% and 33% of total costs for injectable and oral vaccinations. These findings may inform clinical decision-making to protect international travelers' health.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141547057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.1101/2024.07.02.24309862
Linlin Han, Feng Yang, Jinxiang Yu
Releasing the consumption potential of rural residents and narrowing the consumption gap is crucial for expanding domestic demand and enhancing social equity. This study leverages data from the China Family Panel Studies (CFPS) spanning the years 2012 to 2018 to analyze the impact of the rural-urban health insurance integration policy on consumption inequality in rural areas and its underlying mechanisms. Employing a staggered difference-in-differences (DID) approach, the analysis reveals that the policy significantly raises consumption levels among middle and high-income groups while concurrently reducing expenditures for the lowest-income bracket, thereby exacerbating consumption inequality. Heterogeneity analysis indicates that the impact of rural-urban health insurance integration on rural consumption inequality is manifested in both consumption structure and life-cycle effects, with the most significant disparities observed in subsistence and enjoyment consumption, particularly among middle-aged and older age groups. Mechanism analysis identifies increased utilization of medical services, the release of precautionary savings among middle and high-income cohorts, and variations in health insurance funding modalities as key drivers of the widening consumption inequality gap. The study concludes with recommendations to progressively advance the establishment of parity in rural-urban integrated health insurance and to prioritize policy support for vulnerable groups, especially the elderly and impoverished households.
{"title":"Unequal Benefits: The Effects of Health Insurance Integration on Consumption Inequality in Rural China","authors":"Linlin Han, Feng Yang, Jinxiang Yu","doi":"10.1101/2024.07.02.24309862","DOIUrl":"https://doi.org/10.1101/2024.07.02.24309862","url":null,"abstract":"Releasing the consumption potential of rural residents and narrowing the consumption gap is crucial for expanding domestic demand and enhancing social equity. This study leverages data from the China Family Panel Studies (CFPS) spanning the years 2012 to 2018 to analyze the impact of the rural-urban health insurance integration policy on consumption inequality in rural areas and its underlying mechanisms. Employing a staggered difference-in-differences (DID) approach, the analysis reveals that the policy significantly raises consumption levels among middle and high-income groups while concurrently reducing expenditures for the lowest-income bracket, thereby exacerbating consumption inequality. Heterogeneity analysis indicates that the impact of rural-urban health insurance integration on rural consumption inequality is manifested in both consumption structure and life-cycle effects, with the most significant disparities observed in subsistence and enjoyment consumption, particularly among middle-aged and older age groups. Mechanism analysis identifies increased utilization of medical services, the release of precautionary savings among middle and high-income cohorts, and variations in health insurance funding modalities as key drivers of the widening consumption inequality gap. The study concludes with recommendations to progressively advance the establishment of parity in rural-urban integrated health insurance and to prioritize policy support for vulnerable groups, especially the elderly and impoverished households.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141547059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.1101/2024.07.02.24309857
Tayla Taynan Romão, Everton Nunes da Silva, Monica Kayo, Raíssa Mansilla, Lucas Ferraz, Isabella D’Andrea
Background: This study aimed to evaluate the direct and indirect annual costs of epilepsy from the perspective of patients with epilepsy treated at a public tertiary center situated in Rio de Janeiro, Brazil. Methods: A cross-sectional cost-of-illness study was conducted, using a bottom-up approach based on interviews and records of 166 outpatients with confirmed diagnoses of epilepsy. Direct costs included expenses related to treatment, and transportation, while indirect costs encompassed productivity losses due to morbidity and mortality, assessed through the human capital approach and caregivers. Results: The majority of patients in the sample had refractory epilepsy (68.1%) and were on polytherapy (43.98%). The average per capita income of the sample was USD 434,90 per month, and 28.3% of the individuals were unemployed. The total costs amounted to USD 8,243.10 per patient per year, with 76.95% attributed to indirect costs, 23.05% to direct medical costs, and 2.31% to non-medical costs. The primary cost contributors included unemployment (30.42%), caregiver expenses (22.41%), and antiseizure medications (20.30%). The majority of patients reported purchasing all their medications (62.43%). The total out-of-pocket health expenses amounted to USD 2,090.10 per patient per year, with medications accounting for 90.89% of the expenses and transportation for 9.11%. Conclusions: In addition to unemployment as the main cost driver, the patients incurred catastrophic spending on medications. Even though treated in a public service, out-of-pocket health expenses made up 40.04% of the average per capita income of the sample and 12.85% of the Brazilian GDP per capita in 2021. The significant patient expenditures may contribute to poor adherence to epilepsy treatment, which can exacerbate the disease and lead to increased seizure frequency. This, in turn, reduces their ability to earn income, contributing to the rise in indirect and intangible costs.
{"title":"Epilepsy Socioeconomic Impact in a Tertiary Center in Brazil From the Patient Perspective","authors":"Tayla Taynan Romão, Everton Nunes da Silva, Monica Kayo, Raíssa Mansilla, Lucas Ferraz, Isabella D’Andrea","doi":"10.1101/2024.07.02.24309857","DOIUrl":"https://doi.org/10.1101/2024.07.02.24309857","url":null,"abstract":"Background: This study aimed to evaluate the direct and indirect annual costs of epilepsy from the perspective of patients with epilepsy treated at a public tertiary center situated in Rio de Janeiro, Brazil.\u0000Methods: A cross-sectional cost-of-illness study was conducted, using a bottom-up approach based on interviews and records of 166 outpatients with confirmed diagnoses of epilepsy. Direct costs included expenses related to treatment, and transportation, while indirect costs encompassed productivity losses due to morbidity and mortality, assessed through the human capital approach and caregivers.\u0000Results: The majority of patients in the sample had refractory epilepsy (68.1%) and were on polytherapy (43.98%). The average per capita income of the sample was USD 434,90 per month, and 28.3% of the individuals were unemployed. The total costs amounted to USD 8,243.10 per patient per year, with 76.95% attributed to indirect costs, 23.05% to direct medical costs, and 2.31% to non-medical costs. The primary cost contributors included unemployment (30.42%), caregiver expenses (22.41%), and antiseizure medications (20.30%). The majority of patients reported purchasing all their medications (62.43%). The total out-of-pocket health expenses amounted to USD 2,090.10 per patient per year, with medications accounting for 90.89% of the expenses and transportation for 9.11%.\u0000Conclusions: In addition to unemployment as the main cost driver, the patients incurred catastrophic spending on medications. Even though treated in a public service, out-of-pocket health expenses made up 40.04% of the average per capita income of the sample and 12.85% of the Brazilian GDP per capita in 2021. The significant patient expenditures may contribute to poor adherence to epilepsy treatment, which can exacerbate the disease and lead to increased seizure frequency. This, in turn, reduces their ability to earn income, contributing to the rise in indirect and intangible costs.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141547060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.1101/2024.07.02.24309854
xiange wang, Wenhuan Tan, Kaitlyn Martinez, Benjamin H. McMahon, Jean C. Beckham, Nathan A. Kimbrel, Silvia Crivelli
Importance Social and environmental determinants of health (SDOH and EDOH) may contribute significantly to suicide rates among U.S. veterans. Objective To identify key predictive variables for assessing suicide related death rates (SRR), which include suicide deaths, suicide firearm deaths, and suicide nonfirearm deaths and vulnerability areas. Design, Setting, and Participants This case control study utilized Electronic Health Record (EHR) data, which included demographic and mental health information spanning from January 1, 2006, to December 31, 2016. The base cohort considered all veterans from the VHA outpatient database during the above period. Patients from the base cohort who died by suicide were identified through the National Death Index and considered as cases. Given the significantly larger number of alive patients compared to deceased patients, which caused the dataset to be extremely unbalanced and potentially biased, control participants were selected at a ratio of 4 controls to 1 case from those who were still alive. Cases of suicide related death were matched with four controls based on birth year, cohort entry date, sex, and follow up duration. Comprehensive data on social determinants (SDOH), geographic and gun related factors, quality of access to healthcare, environmental determinants (EDOH), and food insecurity were gathered from various sources at the midpoint of the study in 2011. Data analysis was carried out from January 2023 to January 2024. Exposures Suicide related deaths associated with SDOH and EDOH. Main Outcomes and Measures A hierarchical clustering method was employed to downselect the large number of variables, while Cox regression models were used to identify key predictive variables for SRR and areas of vulnerability. Results Out of a total of 9,819,080 veterans, 28,302 were identified as having died by suicide. These cases were matched with 113,208 control participants. The majority of the cohort was male (137,264 [97%]) and White (101,533 [72%]), with a significant portion being Black veterans (18,450 [13.12%]). The average age (SD) was 64.77 (17.56) years. We found that Social Determinants of Health (SDOH) and Environmental Determinants of Health (EDOH) were significantly associated with an increased risk of suicide. By incorporating SDOH and EDOH into the model, the performance (AUC) improved from 0.70 to 0.73. Conclusions and Relevance In this study, veterans who died by suicide using firearms exhibited distinct characteristics based on SDOH and EDOH, particularly in gun related variables, compared to those who died by nonfirearm methods. Our analysis indicated that veterans living in areas with more social issues, higher temperatures, and higher altitudes are at a higher risk of all means suicide. Furthermore, regions such as Montana, Wyoming, West Virgina and Arkansas, characterized by
{"title":"Association between social and environmental determinants of health with suicide-related death among veterans","authors":"xiange wang, Wenhuan Tan, Kaitlyn Martinez, Benjamin H. McMahon, Jean C. Beckham, Nathan A. Kimbrel, Silvia Crivelli","doi":"10.1101/2024.07.02.24309854","DOIUrl":"https://doi.org/10.1101/2024.07.02.24309854","url":null,"abstract":"<strong>Importance</strong> Social and environmental determinants of health (SDOH and EDOH) may contribute significantly to suicide rates among U.S. veterans. <strong>Objective</strong> To identify key predictive variables for assessing suicide related death rates (SRR), which include suicide deaths, suicide firearm deaths, and suicide nonfirearm deaths and vulnerability areas. <strong>Design, Setting, and Participants</strong> This case control study utilized Electronic Health Record (EHR) data, which included demographic and mental health information spanning from January 1, 2006, to December 31, 2016. The base cohort considered all veterans from the VHA outpatient database during the above period. Patients from the base cohort who died by suicide were identified through the National Death Index and considered as cases. Given the significantly larger number of alive patients compared to deceased patients, which caused the dataset to be extremely unbalanced and potentially biased, control participants were selected at a ratio of 4 controls to 1 case from those who were still alive. Cases of suicide related death were matched with four controls based on birth year, cohort entry date, sex, and follow up duration. Comprehensive data on social determinants (SDOH), geographic and gun related factors, quality of access to healthcare, environmental determinants (EDOH), and food insecurity were gathered from various sources at the midpoint of the study in 2011. Data analysis was carried out from January 2023 to January 2024.\u0000<strong>Exposures</strong> Suicide related deaths associated with SDOH and EDOH.\u0000<strong>Main Outcomes and Measures</strong> A hierarchical clustering method was employed to downselect the large number of variables, while Cox regression models were used to identify key predictive variables for SRR and areas of vulnerability.\u0000<strong>Results</strong> Out of a total of 9,819,080 veterans, 28,302 were identified as having died by suicide. These cases were matched with 113,208 control participants. The majority of the cohort was male (137,264 [97%]) and White (101,533 [72%]), with a significant portion being Black veterans (18,450 [13.12%]). The average age (SD) was 64.77 (17.56) years. We found that Social Determinants of Health (SDOH) and Environmental Determinants of Health (EDOH) were significantly associated with an increased risk of suicide. By incorporating SDOH and EDOH into the model, the performance (AUC) improved from 0.70 to 0.73. <strong>Conclusions and Relevance</strong> In this study, veterans who died by suicide using firearms exhibited distinct characteristics based on SDOH and EDOH, particularly in gun related variables, compared to those who died by nonfirearm methods. Our analysis indicated that veterans living in areas with more social issues, higher temperatures, and higher altitudes are at a higher risk of all means suicide. Furthermore, regions such as Montana, Wyoming, West Virgina and Arkansas, characterized by","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141547058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-28DOI: 10.1101/2024.06.27.24309582
Claudia Geue, Giorgio Ciminata, Govardhan Reddy Mukka, Daniel F Mackay, Jim Lewsey, Jocelyn M Friday, Ruth Dundas, Tran Quoc Bao Tran, Denise Brown, Frederick Ho, Claire Hastie, Michael Fleming, Alan Stevenson, Clea DuToit, Sandosh Padmanabhan, Jill P Pell
People living in care homes often have multiple morbidities and complex healthcare needs, potentially leading to more frequent healthcare utilisation (planned and unplanned) and increased costs. Unscheduled hospital attendance from a care home setting is often regarded as system failure, futile and inefficient in terms of resource use. However, there is a lack of evidence on the costs associated with these attendances. This retrospective cohort study aims to estimate these costs and provides a comparison by usual place of residence. Data were obtained from NHS Greater Glasgow and Clyde Safe Haven reference datasets. Individual-level record linkage between Trak ED, recording emergency admissions, and other routine healthcare datasets was carried out. Healthcare costs were estimated using a two-part model. The first part used a probit model to estimate the probability of positive healthcare resource utilisation, and the second part used a GLM to estimate costs, conditional on costs being positive. Annual mean costs were higher for care home residents than community-dwellers overall and in both men and women and all deprivation quintiles. No significant difference in costs was observed for care home residents who were younger than 65 years and those with no comorbidity. Our results indicate a notable increase in healthcare expenditure for individuals residing in care homes compared to those living in the community following unplanned acute care incidents, emphasising the importance of developing interventions that are specifically designed to meet the unique requirements of this demographic.
住在护理院的人往往有多种疾病和复杂的医疗保健需求，这可能会导致更频繁地使用医疗保健服务（计划内和计划外），并增加成本。从资源使用的角度来看，从护理院环境出发的计划外医院就诊通常被视为系统故障、徒劳无益且效率低下。然而，目前还缺乏与这些就诊相关的成本方面的证据。这项回顾性队列研究旨在估算这些成本，并按常住地进行比较。数据来自英国国家医疗服务系统（NHS）大格拉斯哥和克莱德地区安全港参考数据集。在记录急诊入院情况的 Trak ED 和其他常规医疗数据集之间建立了个人层面的记录链接。医疗成本采用两部分模型进行估算。第一部分使用 probit 模型估算医疗资源利用率为正的概率，第二部分使用 GLM 估算成本，条件是成本为正。总体而言，护理院居民的年平均成本高于社区居民，而且在男性和女性以及所有贫困五分位数中都是如此。年龄小于 65 岁和无合并症的护理院居民在成本上没有明显差异。我们的研究结果表明，与社区居民相比，居住在护理院的居民在发生意外急症护理事件后的医疗支出明显增加，这强调了针对这一人群的独特需求制定干预措施的重要性。
{"title":"Cost comparison of unplanned hospital admissions from care home and community settings: A retrospective cohort study using routinely collected linked data","authors":"Claudia Geue, Giorgio Ciminata, Govardhan Reddy Mukka, Daniel F Mackay, Jim Lewsey, Jocelyn M Friday, Ruth Dundas, Tran Quoc Bao Tran, Denise Brown, Frederick Ho, Claire Hastie, Michael Fleming, Alan Stevenson, Clea DuToit, Sandosh Padmanabhan, Jill P Pell","doi":"10.1101/2024.06.27.24309582","DOIUrl":"https://doi.org/10.1101/2024.06.27.24309582","url":null,"abstract":"People living in care homes often have multiple morbidities and complex healthcare needs, potentially leading to more frequent healthcare utilisation (planned and unplanned) and increased costs. Unscheduled hospital attendance from a care home setting is often regarded as system failure, futile and inefficient in terms of resource use. However, there is a lack of evidence on the costs associated with these attendances. This retrospective cohort study aims to estimate these costs and provides a comparison by usual place of residence. Data were obtained from NHS Greater Glasgow and Clyde Safe Haven reference datasets. Individual-level record linkage between Trak ED, recording emergency admissions, and other routine healthcare datasets was carried out. Healthcare costs were estimated using a two-part model. The first part used a probit model to estimate the probability of positive healthcare resource utilisation, and the second part used a GLM to estimate costs, conditional on costs being positive. Annual mean costs were higher for care home residents than community-dwellers overall and in both men and women and all deprivation quintiles. No significant difference in costs was observed for care home residents who were younger than 65 years and those with no comorbidity. Our results indicate a notable increase in healthcare expenditure for individuals residing in care homes compared to those living in the community following unplanned acute care incidents, emphasising the importance of developing interventions that are specifically designed to meet the unique requirements of this demographic.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141503200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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