European Journal of Health Economics最新文献

Introduction and objectives: Influenza is a widespread acute respiratory illness which represents a significant public health challenge from both the National Health Service (NHS) and societal perspective, especially in the older adults. The aim of this study was to assess the cost-effectiveness of influenza vaccination with a high-dose quadrivalent vaccine (HD-QIV) versus a standard dose quadrivalent vaccine (SD-QIV) in the older adults in Spain.

Methods: We assessed the public health and economic benefits of various alternatives using a decision-tree model. This model considered factors such as influenza cases, visits to general practitioners (GP), emergency department (ED) visits, hospitalizations due to cardiorespiratory events, and influenza-related mortality. To address uncertainties deriving from both epidemiological and economic sources, we conducted deterministic and probabilistic sensitivity analyses.

Results: From a societal perspective, HD-QIV compared to SD-QIV prevented during an influenza season 54,039 influenza cases, 7,733 GP consultations, 1,585 ED visits, 30,772 episodes of hospitalization due to cardiorespiratory events over a single influenza season and 1,203 deaths when vaccinating adults ≥ 65 years old in Spain, resulting in 14,316 LYs and 12,545 QALYs gained over a lifetime horizon. The reduction in health outcomes outweighed the increase in vaccination costs, translating to a reduction in total costs with HD-QIV compared to SD-QIV. Therefore, vaccinating older adults in Spain with HD-QIV instead of SD-QIV was a dominant strategy when evaluating hospitalizations due to cardiorespiratory events. HD-QIV remained dominant from an NHS perspective. Sensitivity analyses confirmed the robustness of the model.

Conclusions: This analysis showed that vaccinating older adults in Spain with HD-QIV instead of SD-QIV would reduce cases of influenza, GP and ED visits, hospitalizations, deaths, and associated costs, and thus it should be the strategy of choice in a situation of budgetary constraints from either a societal or an NHS perspective.

Background: This study comprehensively evaluated the cost-effectiveness of pembrolizumab, atezolizumab, and nivolumab plus ipilimumab compared with platinum-based doublet chemotherapy as the first-line treatment for advanced NSCLC with PD-L1 TPS ≥ 50% in Japan, incorporating recent Japan-specific clinical trial data and real-world cost estimates from a nationwide administrative database.

Methods: A Markov model was developed to conduct the cost-effectiveness comparison. The model simulated patient transitions between progression-free status, progressed disease, and death over a lifetime horizon using a six-week cycle. Clinical effectiveness data were obtained from pivotal trials, with transition probabilities adjusted using Japanese-specific survival data. Health state utilities were derived from published literature using the EQ-5D questionnaire. Costs were derived from the Diagnosis Procedure Combination database. The analysis was conducted from the Japanese health care payer's perspective, using quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). One-way deterministic and probabilistic sensitivity analyses were performed.

Results: Pembrolizumab had the most favorable cost-effectiveness profile, with an ICER of USD 13,423/QALY, well within Japan's willingness-to-pay threshold of USD 35,000/QALY. Nivolumab plus ipilimumab had an ICER of USD 31,150/QALY, whereas atezolizumab had the highest ICER at USD 44,281/QALY. Sensitivity analyses identified key ICER drivers. Results from probabilistic sensitivity analyses were consistent with those of the primary analyses.

Conclusions: Pembrolizumab is a cost-effective first-line treatment for advanced NSCLC with PD-L1 TPS ≥ 50% in Japan. Nivolumab plus ipilimumab is also a viable option. Atezolizumab is the least cost-effective.

Promoting the use of mobile money seems to be an important way of improving financial inclusion and households ability to cope with health shocks. This study aims to analyze the impact of mobile money usage on households ability to respond to health shocks in Madagascar. We also investigated the differential impact for disadvantaged groups such as female, less educated and rural people. FinScope database on financial inclusion is used. Employing an instrumental probit model, the results reveal that the use of mobile money increases households' ability to respond to health shocks by about 44.8%. The mains coping mechanisms include used of savings and assistance from friends/family. Results also reveal that the use of mobile money favors households in urban area compared to those in rural area. Women benefited more compared to men. Overall, these findings could inform policy makers on how to improve financial inclusion for disadvantaged groups and reduce vulnerability to health shocks in Africa.

Objectives: Letermovir has demonstrated efficacy and tolerability as prophylaxis against clinically significant cytomegalovirus infection (csCMVi) in CMV-seropositive adult patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) compared to alternative antivirals. Despite these advantages, associated costs remain substantial. This study addresses the evidence gap by evaluating the health economic impact of CMV prophylaxis with letermovir in a real-world setting for alloHCT patients.

Methods: This retrospective, multi-centre case-control study was conducted at six German tertiary care centres. A micro-costing approach evaluated hospitalisation and anti-CMV drug acquisition costs over a 48-week follow-up period post-alloHCT. The analysis included patients surviving at least 100 days following alloHCT, comparing individuals receiving letermovir prophylaxis (cases) with those who did not (controls) between January 2018 and April 2021.

Results: The incidence of csCMVi was significantly higher in the control than in the letermovir group (56%, n = 98 vs. 34%, n = 63, p < 0.001). Median hospital length of stay was significantly longer in the control group (45 days, IQR 36-66) compared to the letermovir group (39 days, IQR 32-55; p < 0.001). Hospitalisation costs were comparable (p = 0.865), while anti-CMV drug acquisition and overall direct treatment costs were significantly higher in the letermovir group (€21,844, 95% CI 19,247 - 25,107 vs. €7,711, 95% CI 12,692 - 25,107, p < 0.001; 81,871, 95% CI 76,721 - 87,021 vs. 67,161, 95% CI 61,693 - 72,629, p < 0.001). Besides letermovir, cost drivers post-alloHCT were rehospitalisation and csCMVi.

Conclusions: Our study demonstrated higher anti-CMV drug acquisition costs and overall direct treatment costs in patients receiving letermovir prophylaxis compared to controls. However, these higher costs are accompanied by significantly improved clinical outcomes.

Bevacizumab, originally developed by Genentech under the brand name Avastin^® as an anti-cancer drug, has gained widespread off-label use in ophthalmology due to its similar mechanism of action to other anti-VEGF treatments and its significantly lower cost compared to available on label alternatives for ophthalmological indications. While off-label bevacizumab has been standard in clinical practice for over a decade, recently, a repurposed formulation (brand name: Lytenava^®, Outlook Therapeutics Ltd), developed specifically for vascular retinal conditions, received marketing approval from the European Medicines Agency. This raises questions about what the price for a repurposed formulation should reasonably be, reflecting the efforts to obtain regulatory approval. This paper examines potential cost-based-plus pricing for such a repurposed formulation of bevacizumab using a novel pricing framework across four scenarios. By evaluating the pricing structure through an analysis of critical cost components, including, among others, research and development expenditures, manufacturing costs, and cost-of-capital, the study proposes a price range of €73 to €177 per injection. The explicit breakdown of these cost components provides valuable insights into the economic structure of repurposed biosimilars like bevacizumab, emphasizing how a cost-based-plus pricing model can support more transparent and informed negotiations between pharmaceutical companies and healthcare payers. Ultimately, this approach contributes to the development of pricing strategies that balance affordability for healthcare systems with sustainable returns for manufacturers while fostering the broader development of repurposed treatments. The findings of this paper aim to advance the dialogue on equitable pricing for repurposed therapies.