Background: Alzheimer's disease (AD) affects tens of millions of individuals and their families in the world. As AD progresses, the effectiveness of treatment declines, making a timely diagnosis crucial. One promising approach for timely diagnosis is testing biofluid biomarkers in patients' blood and cerebrospinal fluid (CSF). However, a comprehensive evaluation of whether these tests are cost-effective is missing. Here, we conducted a systematic review to assess the cost-effectiveness of testing biofluid biomarkers to diagnose AD.
Method: We searched PubMed, Embase, Cochrane Library, and Web of Science for studies published until October 2024. Studies were included if published in English, conducted an economic evaluation of CSF or blood biomarker testing to diagnose AD, and provided economic outcomes. We assessed the quality of studies using the CHEERS 2022 criteria.
Results: Nine studies were included: six evaluated CSF biomarker tests and three on blood biomarker tests. All studies used model-based simulations (decision trees or Markov models) rather than trial-based evaluations. CSF biomarker tests were mostly cost-effective compared to neurocognitive assessments or neuroimaging, while blood biomarker tests showed mixed results. Key cost-effectiveness contributors included AD prevalence, diagnostic accuracy, and treatment effectiveness. Studies met ~ 80% of the CHEERS criteria, with missing information on patient engagement.
Conclusion: Our review supports that biofluid biomarker testing could be cost-effective to diagnose AD. Given the lack of trial-based economic evaluations, model-based studies are a valuable starting point. Future evaluations should incorporate patient-centered outcomes and consider the emotional value and other socio-economic factors that affect patients and families suffering from AD.
Introduction: Non-randomized clinical trial has shown that Magnetic Resonance guided High-intensity focused ultrasound (MR-HIFU) leads to faster pain relief compared to the current standard of care External Beam Radiotherapy (EBRT).
Objective: To evaluate the cost-utility of 'early MR-HIFU' (with optional EBRT afterwards) or 'delayed MR-HIFU' (i.e., MR-HIFU after failed EBRT) versus EBRT (with optional re-irradiation with EBRT) from the societal perspective in the Netherlands METHODS: A lifelong patient-level simulation model was developed. After a treatment with either MR-HIFU or EBRT, a patient could have: (i) complete pain relief, (ii) partial pain relief, (iii) persistent pain and (iv) death. We also accounted for the event of a pathological fracture. Model outputs were costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICER). The net monetary benefit was calculated considering the willingness-to-pay threshold of €80,000 per QALY gained, adjusted by the Dutch disease severity index. Deterministic and probabilistic sensitivity analyses were conducted.
Results: The strategy 'delayed MR-HIFU' costs €706 more than EBRT, whilst 'early MR-HIFU' costs €1,875 more than EBRT.'Early MR-HIFU' adds 0,15 more QALYs than EBRT, resulting in an ICER of €12.755 per QALY and an incremental net monetary benefit of €8,631. At a threshold of 80,000€ per QALY there is a 77% probability that 'early MR-HIFU' is the most cost-effective option.
Conclusion: Although there are still uncertainties relating to implementation of MR-HIFU in patient care, our modelling study shows that offering MR-HIFU as an early treatment would be the most cost-effective option in the Netherlands.
Objective: To evaluate the comparative performance of SF-6Dv2 and EQ-5D-5L in the general population of Quebec (Canada), Tehran (Iran), and Japan.
Methods: Data on SF-6Dv2 and EQ-5D-5L were collected in the three countries. Descriptive differences in utility values between SF-6Dv2 and EQ-5D-5L were assessed using t-tests, as well as ceiling effects were evaluated based on the percentage of "no problem" levels reported. The known-group validity of both measures was assessed by comparing utility scores across health and demographic subgroups using t-tests or ANOVA and by calculating effect sizes across known groups. The area under the receiver operating characteristic curve (AUROC) analysis and F-statistic ratios were used to further validate the findings from the known-group validity analyses. Convergent validity for both instruments was assessed using Spearman's rank correlation coefficient. The agreement between instruments was evaluated using intraclass correlation coefficients (ICC) and Bland-Altman plots.
Results: A total of 2,378 respondents for Quebec, 3,061 for Tehran, and 3,933 for Japan were included. Differences in utility values between SF-6Dv2 and EQ-5D-5L were statistically significant, with SF-6Dv2 generally yielding lower utility scores. Both instruments demonstrated strong known-group validity, effectively distinguishing between diseased and healthy groups as well as various demographic characteristics. However, EQ-5D-5L outperformed SF-6Dv2 for most demographic characteristics based on AUROC analysis and F-statistic ratios. In contrast, their performance in distinguishing between healthy and diseased groups did not favor a particular instrument. Convergent validity analyses indicated strong associations between SF-6Dv2 and EQ-5D-5L utility values in Quebec (0.760) and Tehran (0.737). The agreement between SF-6Dv2 and EQ-5D-5L utility values was moderate in Quebec (0.69) and strong in Tehran (0.837). Bland-Altman plots indicated that differences between the two instruments tended to increase as the average score decreased.
Conclusion: Both EQ-5D-5L and SF-6Dv2 demonstrated favorable psychometric performance in terms of known-group validity and convergent validity. These findings suggest that both instruments are valid tools for health utility measurement for use in general population.
Background: Children with disabilities and special healthcare needs can considerably affect parental employment and family financial stability. This study aims to investigate the effects of children's disabilities, special healthcare needs, and their coexistence on parental employment in Australia.
Methods: This study utilised data from the nationally representative Baby (B) and Kindergarten (K) cohorts, spanning Waves 1 to 8 of the Longitudinal Study of Australian Children (LSAC). Fixed-effects logistic regression was employed to examine the relationship between children's disability, special healthcare needs, and parental (for both mothers and fathers) employment status.
Results: The findings show that within the same family, children's disability (adjusted odds ratio [aOR] = 0.81, 95% confidence interval [CI]: 0.70-0.94, p = 0.006) and having a child with special healthcare needs (aOR = 0.87, 95% CI: 0.76-0.99, p = 0.038) reduces the likelihood of a mother being employed. Furthermore, the results indicate that the interaction between disability and special healthcare needs (aOR = 0.69, 95% CI: 0.56-0.87, p = 0.001) significantly reduces the likelihood of mothers' participation in employment. Similarly, the findings show that within the same family, having a child with a disability (aOR = 0.60, 95% CI: 0.45-0.78, p < 0.001) results in a 40% decrease in the odds of paternal employment.
Conclusion: Children with disabilities and special healthcare needs significantly reduce maternal employment participation within the same family, while only disabilities are associated with reduced employment for fathers. These findings offer vital evidence for policymakers to improve support systems for families with children who have disabilities and special healthcare needs. Such support may include access to essential services and resources, leading to improved parental employment outcomes and enhanced overall family well-being.
Background: Rapid and abnormal weight gain resulting in severe persistent obesity due to physical, tumor- and/or treatment-related damage to the hypothalamus, is called acquired hypothalamic obesity (aHO), and is often linked to craniopharyngioma and/or sellar/suprasellar tumors. Here, we examine the healthcare resource use (HCRU) and costs of aHO following treatment of these tumors.
Methods: We used a retrospective matched cohort design with German statutory health insurance data on 5.42 million people from 2010 to 2021. We applied a novel three-step approach using diagnostic and prescription data to identify patients with treatment- or tumor-related (TTR)-aHO. We measured HCRU and costs across hospitalizations, outpatient visits, visits per specialist group, and outpatient prescription medications.
Results: Compared to non-HO obesity, TTR-aHO is associated with increased hospitalizations, increased outpatient physician visits, and increased prescription use in the two years after incident tumor surgery/radiotherapy. Excess costs of TTR-aHO are €19,900 per patient in the first year and €10,700 in the second, driven by inpatient costs. Cost-intensive hormone replacement therapies like somatropin lead to a sharp increase in prescription costs in the second year.
Conclusions: This study provides the first real-world analysis of TTR-aHO economics, emphasizing the importance of HCRU and costs for decision-making. Previously, economic evaluations have been missing due to the lack of a standard method to identify patients with aHO in retrospective studies. Using a new identification approach, the study reveals that TTR-aHO poses a significant burden in extensive treatment requirements for patients and high related costs for the healthcare system.
Objective: Distal radius fractures are commonly seen at the Emergency Department. In the Netherlands, non- or minimally displaced fractures are immobilized for 3-5 weeks. However, evidence suggests shorter immobilization yields similar or better functional outcome. There is a lack of cost-effectiveness studies investigating shorter duration of cast immobilization. This study investigates the cost-effectiveness of one week of plaster cast immobilization versus three to five weeks.
Methods: Cost-effectiveness data was collected as part of the Cast-OFF 2 study which started the 1st of January 2022. A randomized stepped wedge cluster design was used with 11 hospitals, and 10 clusters, including patients with an isolated non- or minimally displaced distal radius fracture without fracture reduction. Costs on medical consumption, and productivity were scored with the local Electronical Patient Record, and questionnaires at week one, six, month six, and twelve. Cost-effectiveness was reported per Quality-Adjusted Life Year (QALY).
Results: A total of 402 patients were included (control n = 197 vs intervention n = 205). No differences in QALY were observed (+ 0.02, CI [-0.02, 0.06]). Cost savings for the intervention group ranged from €31.94 to €322.41 depending on different scenarios. The future perspective scenario with reduction of one outpatient clinic visit showed a significant cost saving of €254.27 (CI [-467.33, -41.21]). No significant differences were observed in baseline characteristics.
Conclusion: One week of plaster cast immobilization for non- or minimally displaced distal radius fractures results in comparable or better cost savings compared to usual care. Adopting one week of cast immobilization as the new standard-of-care could reduce healthcare costs.
Trial registration: Netherlands Trial Register NL9278. CMO: 2-21-7308.
The relationship between poverty, income inequality, and health outcomes has been extensively explored in the literature, primarily focusing on cross-country comparisons. However, findings from within-country analyses have yielded inconsistent results. This study investigates the association between poverty risk, income inequality, and health outcomes using Finnish municipality-level data from 1990 to 2023. Fixed-effect models are used to reveal a concerning interplay between these factors by utilizing measures of poverty risk, income inequality, and their synergistic effect, alongside a comprehensive set of health outcome indicators. The findings reveal a significant strong association between both poverty risk and income inequality with various health indicators. Moreover, the analysis also demonstrates a strong combined influence of poverty and inequality, indicating that their combined effect on negative health outcomes is more pronounced. These findings suggest that policies promoting social mobility and reducing income inequality may lead to a healthier Finnish population, particularly low-income residents, with a lower burden of chronic diseases and mortality.
This study aims to economically evaluate three preventive interventions for dental caries among Australian children from low household income. The interventions included: (1) anticipatory guidance provided by oral health therapists via 1a) home visits or 1b) telehealth consultations; (2) school-based dental screening and fluoride varnish program delivered by 2a) dental practitioners or 2b) non-dental health professionals (no screening); and (3) school-based fissure sealant program. The base-case scenario included intervention and dental treatment costs, with six-year (1a and 1b) and two-year (2a, 2b and 3) time horizons. Sensitivity analysis included other healthcare costs (e.g. pulp therapy, extractions, etc.). Additionally, extrapolation modelling extended the 12-year time horizon (all interventions). Probability for cost-effectiveness applied AUD$50,000 per disability-adjusted life year (DALY) averted, and AUD$28,033 per quality-adjusted life year (QALY) gained willingness-to-pay thresholds. Under the base-case scenario, none of the interventions were cost-effective. Cost-effectiveness results were sensitive when including other healthcare costs and the 12-year time horizon. Probability for cost-effectiveness (DALYs averted/QALYs gained) with extrapolation modelling in order of ranking were: (1) 91.5%/94.7% for fluoride varnish, (2) 43.9%/48.6% for dental screening and fluoride varnish, (3) 28.7%/29.8% for anticipatory guidance via telehealth, (4) 17.1%/20.0% for fissure sealant, and (5) 2.2%/2.2% for anticipatory guidance via home visits.
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