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Background: This health-economic evaluation assessed the cost-effectiveness of an exercise referral scheme (ERS) versus doing nothing in the Flemish region (Belgium), with a particular focus on the impact of several scenarios. Methods: A 14-state Markov model was applied to compare the expected costs and quality-adjusted life years (QALYs) of 2 alternatives: the Flemish ERS (2019 data, mean age 52 y, 69.1% women) and doing nothing. A health care payer perspective was adopted and a lifetime time horizon was applied. A set of 18 scenario analyses is presented. In addition, univariate and probabilistic sensitivity analyses were performed. Results: Under the assumptions selected for the base-case analysis, the Flemish ERS is moderately cost-effective compared with doing nothing, with an incremental cost-utility ratio of €28,609/QALY. Based on the scenario analyses, the results largely depend on the assumptions regarding the continuation of the intervention effect and the frequency with which the intervention is repeated. The greatest health gains can be made when a sustainable behavioral change is achieved among participants. The probabilistic sensitivity analysis confirmed that the cost-effectiveness results were not robust. Conclusions: If it is possible to induce a sustainable behavioral change with an intervention delivered at 2- or 5-year intervals, then the Flemish ERS is potentially cost-effective compared with doing nothing (given a €40,000/QALY threshold). These results suggest the importance of repeated implementation of the program together with careful monitoring of the adherence and the sustainability of the observed effects in a real-world setting. [ABSTRACT FROM AUTHOR]

Objective: AIDS Drug Assistance Programs (ADAPs) are state-administered programs that pay for medical care and medication for people living with HIV (PLWH) in the United States. In October 2021, the federal policy requiring that clients recertify for the program every 6 months was repealed, giving states the authority to set their own recertification policies. However, little data exist on the costs and health effects of alternative recertification schedules. We assessed the cost of changing the legacy 6-month recertification to a 12-month schedule in Washington State to inform policy decisions on recertification. Methods: We used a Markov model to simulate the population of PLWH in Washington State who are eligible or enrolled in ADAP. We obtained model inputs and validation data from the Washington State Ryan White database. We estimated the cost of 12-month and 6-month criteria over a 5-year time horizon. Model outputs included annual program costs, population sizes, and number of people virally suppressed, by scenario. Results: Under a continuation of the legacy 6-month recertification criteria, the annual cost of Washington ADAP would be $37 663 000 (95% CI, $34 570 000-$41 686 000) during the next 5 years, with a per-client cost of $7966 (95% CI, $7478-$8494). Under 12-month criteria, the annual cost would be $40 217 000 (95% CI, $36 243 000-$44 401 000) and the per-client cost would be $7543 (95% CI, $7084-$8042). Under the 12-month scenario, 245 more people will have been virally suppressed by the end of 2025. Conclusions: Switching to a less frequent recertification process may improve health outcomes at a modest increase in cost in Washington State. [ABSTRACT FROM AUTHOR]

Aims: The direct cost of diabetes to the UK health system was estimated at around £10 billion in 2012. This analysis updates that estimate using more recent and accurate data sources. Methods: A pragmatic review of relevant data sources for UK nations was conducted, including population‐level data sets and published literature, to generate estimates of costs separately for Type 1, Type 2 and gestational diabetes. A comprehensive cost framework, developed in collaboration with experts, was used to create a population‐based cost of illness model. The key driver of the analysis was prevalence of diabetes and its complications. Estimates were made of the excess costs of diagnosis, treatment and diabetes‐related complications compared with the general UK population. Estimates of the indirect costs of diabetes focused on productivity losses due to absenteeism and premature mortality. Results: The direct costs of diabetes in 2021/22 for the UK were estimated at £10.7 billion, of which just over 40% related to diagnosis and treatment, with the rest relating to the excess costs of complications. Indirect costs were estimated at £3.3 billion. Conclusions: Diabetes remains a considerable cost burden in the UK, and the majority of those costs are still spent on potentially preventable complications. Although rates of some complications are reducing, prevalence continues to increase and effective approaches to primary and secondary prevention continue to be needed. Improvements in data capture, data quality and reporting, and further research on the human and financial implications of increasing incidence of Type 2 diabetes in younger people are recommended. [ABSTRACT FROM AUTHOR]

Aims: To assess the cost–utility of the FreeStyle Libre flash continuous glucose monitoring (CGM) system from an Italian healthcare system perspective, when compared with self‐monitoring of blood glucose (SMBG) in people living with type 2 diabetes mellitus (T2DM) receiving basal insulin. Materials and Methods: A patient‐level microsimulation model was run using Microsoft Excel for 10 000 patients over a lifetime horizon, with 3.0% discounting for costs and utilities. Inputs were based on clinical trials and real‐world evidence, with patient characteristics reflecting Italian population data. The effect of flash CGM was modelled as a persistent 0.8% reduction in glycated haemoglobin versus SMBG. Costs (€ 2023) and disutilities were applied to glucose monitoring, diabetes complications, severe hypoglycaemia, and diabetic ketoacidosis. The health outcome was measured as quality‐adjusted life‐years (QALYs). Results: Direct costs were €5338 higher with flash CGM than with SMBG. Flash CGM was associated with 0.51 more QALYs than SMBG, giving an incremental cost‐effectiveness ratio (ICER) of €10 556/QALY. Scenario analysis ICERs ranged from €3825/QALY to €26 737/QALY. In probabilistic analysis, flash CGM was 100% likely to be cost effective at willingness‐to‐pay thresholds > €20 000/QALY. Conclusions: From an Italian healthcare system perspective, flash CGM is cost effective compared with SMBG for people living with T2DM on basal insulin. [ABSTRACT FROM AUTHOR]

In 2015, the United Nations (UN) proposed the 2030 Agenda, a resolution that outlines the global goals for sustainable development. This report focuses on promoting health and well-being, emphasizing the importance of primary healthcare (PHC). However, Brazil faces challenges in managing its healthcare system, exacerbated by fiscal policy changes that have reduced public sector expenditures after 2015. This study was motivated by these recent changes in Brazil's fiscal policy. We evaluated potential fluctuations in total factor productivity (TFP) in 5,524 Brazilian municipalities' primary healthcare from 2015 to 2019. TFP, a measure of efficiency and production technology in PHC, was computed using the bootstrapping Malmquist productivity index (MPI) derived from the Data Envelopment Analysis (DEA) algorithm. This study focused on the economic recession and austerity measures initiated in 2015. Moreover, it's essential to highlight that the SARS-CoV-2 pandemic in Brazil in 2020 brought significant changes to the country's economic, social, and health dynamics. Therefore, this research intentionally concentrated on the pre-pandemic period. Our results revealed that TFP in the PHC sector in Brazil decreased between 2015 and 2019. It was possible to note that three out of every four Brazilian municipalities experienced either stagnation or a decline in the TFP of primary healthcare, with more pronounced challenges in the Midwest and Northeast regions. Looking at the TFP elements, we could see a continuous drop in technical efficiency everywhere in the country, markedly in the Midwest and Northeast. Conversely, there was a considerable uptick in Brazil's technological component. These results implied that there might have been advancements in PHC's technological infrastructure, preventing even less favorable outcomes in the TFP indicator. We concluded that the productivity of primary healthcare in Brazil declined when the 2015 fiscal ceiling was implemented. This decrease in performance was evident in the sluggish growth rate of primary healthcare inputs, a diminution in vaccination coverage indicators, and an increase in hospitalizations for preventable causes. Given that health is a crucial component of social well-being, it is vital to highlight the need for comprehensive efforts to guarantee the effective operation and advancement of primary healthcare services, even during economic downturns. [ABSTRACT FROM AUTHOR]

Huntington’s disease (HD) exerts significant impacts on individuals and families worldwide. Nevertheless, data on its economic burden in Brazil are scarce, revealing a critical gap in understanding the associated healthcare costs.This study was conducted at a tertiary neurology outpatient clinic in Brazil with the aim of assessing annual healthcare service utilization and associated costs for HD patients.We conducted a cross-sectional observational study involving 34 HD patients. A structured questionnaire was applied to collect data on direct medical costs (outpatient services, medications), non-medical direct costs (complementary therapies, mobility aids, home adaptations), and indirect costs (lost productivity, caregiver costs, government benefits) over one year.Significant economic impacts were observed, with average annual direct medical costs of $4686.82 per HD patient. Non-medical direct and indirect costs increased the financial burden, highlighting extensive resource utilization beyond healthcare services. Thirty-three out of 34 HD patients were unemployed or retired, and 16 relied on government benefits, reflecting broader socioeconomic implications. Despite the dataset’s limitations, it provides crucial insights into the economic impact of HD on patients and the Brazilian public health system.The findings underscore the urgent need for a more comprehensive evaluation of the costs to inform governmental policies related to HD. Future research is needed to expand the data pool and develop a nuanced understanding of the economic burdens of HD to help formulate effective healthcare strategies for patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Clinical use of vascular stents involves high medical costs, but it may also bring long-term benefits in reducing cardiovascular events and improving the quality of life in patients. Economics evaluation can help decision makers better understand the balance between the cost and benefit of treatment. OBJECTIVE: To analyze the related articles of health economics and discuss the hot spots in the study of the effect and problems of vascular stents in medical quality management. METHODS: The articles concerning health economics evaluation of vascular stents were retrieved from the core set of the Web of Science. The VOSviewer_1.6.19 software was used to make a visualization analysis of the annual publication volume, institutions, countries, keywords, etc. Finally, the research hot spots on the effects and problems of vascular stents were analyzed from the perspective of health economics and medical quality management. RESULTS AND CONCLUSION: (1) 120 articles in English were finally included. In the past 10 years, the highest number of articles published in this field was in 2019, with 10 articles. The institution with the largest number of articles published was Harvard University in the United States with 20 articles, and the country with the largest number of articles published was the United States with 58 articles. (2) Keyword cluster analysis demonstrated that the cost-effectiveness analysis of bare metal stents and drug-eluting stents in coronary disease, the cost-effectiveness analysis of angioplasty stent intervention, and the effect of coronary stents in percutaneous coronary intervention are the research hot spots in the field of health economics evaluation of vascular stent research. (3) In the context of medical quality management, the paper further summarized the research hot spots on the therapeutic effect of vascular stents as follows: long-term effect of vascular stents, safety, drug release mechanism research, personalized therapy, restenosis problems, and stent insertion technology. (4) The results of highly cited literature analysis exhibited that drug-eluting stents release drugs to reduce the risk of vascular restenosis, and the restenosis rate is lower than that of bare metal stents, but the cost is usually higher. Biodegradable stents combine the advantages of bare metal stents and drug-eluting stents, that is, avoiding long-term stent existence and reducing the risk of restenosis, but their cost may be higher, and there may be some complications in the short term, and they are not widely used at present. (5) In addition to the direct stent cost, factors that need to be considered when comparing the cost-effectiveness of vascular stents include the risk and cost of stent re-intervention, the risk and cost of complications, the duration and cost of drug therapy, and the quality of life of patients. Therefore, while the initial cost of drug-eluting and biodegradable stents may be higher than bare metal stents, they may lead to better clinical outcomes in the long term, resulting in a more favorable cost effect. (6) Future research directions should focus on making personalized vascular stent treatment decisions, observing the long-term effect of stent treatment, the impact of the stent on patients’ quality of life, formulating health policies, rational allocation of medical resources, and the establishment of long-term follow-up mechanisms. [ABSTRACT FROM AUTHOR]

Aim Method Results Conclusion Incorporating health‐related quality of life (HRQoL) measures into health economic analyses can help to provide evidence to inform decisions about how to improve patient outcomes in the most cost‐effective manner. The aim of this narrative review was to assess which HRQoL instruments have been used in economic evaluations of type 2 diabetes management including in Indigenous communities.MEDLINE (Ovid), Embase (Ovid) and Cochrane were searched from inception to June 2022. Studies included patients with type 2 diabetes; economic evaluations, derived scores from direct questioning of individuals; and were in English. Records were assessed for bias using the JBI critical appraisal tools.A total of 3737 records were identified, with 22 publications meeting the criteria for inclusion. Across those 22 articles, nine HRQoL instruments had been utilised. Generic tools were most frequently used to measure HRQoL, including EQ‐5D (−3 L and −5 L) (n = 10, 38%); SF‐12 (n = 5, 19%); and SF‐36 (n = 4, 15%). Two tools addressing the specific stressors faced by people with type 2 diabetes were utilised: Problem Areas In Diabetes tool (n = 1, 4%) and Diabetes Distress Scale (n = 1, 4%). Two publications reported whether the study population included Indigenous peoples.A wide range of HRQoL instruments are used in economic evaluations of type 2 diabetes management, with the most frequent being varying forms of the EQ‐5D. Few economic evaluations noted whether Indigenous peoples were featured in the study population. More research into HRQoL in people living with type 2 diabetes is urgently needed to improve evidence on effectiveness and cost‐effectiveness of interventions. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions To explore the utilization of permanent residential aged care (PRAC), healthcare costs, and mortality for frail compared with non‐frail individuals following their first assessment by an aged care assessment team (ACAT) for a government‐funded home care package.The study involved people aged 65 years and over who completed their first ACAT assessment in 2013 and were followed for up to 36 months. Frail and non‐frail study participants were matched through caliper matching without replacement to adjust for potential unobserved confounders. Poisson regression estimated the impact of frailty on PRAC admission and mortality rates. Healthcare costs, encompassing hospital admissions, emergency department presentations, primary care consultations, and pharmaceutical use, from ACAT assessment to end of follow‐up, PRAC entry or death were summarized monthly by frailty status.13 315 non‐frail controls were matched with up to three frail individuals (52 678 total). Frail individuals experienced higher mortality (incidence rate ratio [IRR] = 1.76; 95% confidence interval [CI] 1.70–1.83) and greater likelihood of entering PRAC (IRR = 1.73; 95% CI 1.67–1.79) compared with non‐frail individuals. Total healthcare costs over the 3‐year post‐assessment period for 39 363 frail individuals were $1 277 659 900, compared with expected costs of $885 322 522 had they not been frail. The primary contributor to the mean monthly excess cost per frail individual (mean = $457, SD = 3192) was hospital admissions ($345; 75%).Frailty is associated with higher rates of mortality and of entering PRAC, and excess costs of frailty are substantial and sustained over time. These findings emphasize the potential economic value of providing home care for older people before they become frail. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

The Human Genome Project, completed in 2003, heralded a new era in precision medicine. Somewhat tempering the excitement of the elucidation of the human genome is the emerging recognition that there are fewer single gene disorders than first anticipated, with most diseases predicted to be polygenic or at least gene-environment modified. Hereditary haemochromatosis (HH) is an inherited iron overload disorder, for which the vast majority of affected individuals (>90%) have homozygosity for a single pathogenic variant in the HFE gene, resulting in p.Cys282Tyr. Further, there is significant benefit to an individual in identifying the genetic risk of HH, since the condition evolves over decades, and the opportunity to intervene and prevent disease is both simple and highly effective through regular venesection. Add to that the immediate benefit to society of an increased pool of ready blood donors (blood obtained from HH venesections can generally be used for donation), and the case for population screening to identify those genetically at risk for HH becomes more cogent. Concerns about genetic discrimination, creating a cohort of "worried well", antipathy to acting on medical advice to undertake preventive venesection or simply not understanding the genetic risk of the condition adequately have all been allayed by a number of investigations. So why then has HH population genetic screening not been routinely implemented anywhere in the world? The answer is complex, but in this article we explore the pros and cons of screening for HH and the different views regarding whether it should be phenotypic (screening for iron overload by serum ferritin and/or transferrin saturation) or genotypic (testing for HFE p.Cys282Tyr). We argue that now is the time to give this poster child for population genetic screening the due consideration required to benefit the millions of individuals at risk of HFE-related iron overload. [ABSTRACT FROM AUTHOR]

Purpose: For cervical nerve root compression, anterior cervical discectomy with fusion (anterior surgery) or posterior foraminotomy (posterior surgery) are safe and effective options. Posterior surgery might have a more beneficial economic profile compared to anterior surgery. The purpose of this study was to analyse if posterior surgery is cost-effective compared to anterior surgery. Methods: An economic evaluation was performed as part of a multicentre, noninferiority randomised clinical trial (Foraminotomy ACDF Cost-effectiveness Trial) with a follow-up of 2 years. Primary outcomes were cost-effectiveness based on arm pain (Visual Analogue Scale (VAS; 0–100)) and cost-utility (quality adjusted life years (QALYs)). Missing values were estimated with multiple imputations and bootstrap simulations were used to obtain confidence intervals (CIs). Results: In total, 265 patients were randomised and 243 included in the analyses. The pooled mean decrease in VAS arm at 2-year follow-up was 44.2 in the posterior and 40.0 in the anterior group (mean difference, 4.2; 95% CI, − 4.7 to 12.9). Pooled mean QALYs were 1.58 (posterior) and 1.56 (anterior) (mean difference, 0.02; 95% CI, − 0.05 to 0.08). Societal costs were €28,046 for posterior and €30,086 for the anterior group, with lower health care costs for posterior (€12,248) versus anterior (€16,055). Bootstrapped results demonstrated similar effectiveness between groups with in general lower costs associated with posterior surgery. Conclusion: In patients with cervical radiculopathy, arm pain and QALYs were similar between posterior and anterior surgery. Posterior surgery was associated with lower costs and is therefore likely to be cost-effective compared with anterior surgery. [ABSTRACT FROM AUTHOR]

Summary: The refracture rate after major trauma is approximately half (57%) the refracture rate after a minimal trauma injury. Extending Fracture Liaison Service activity to include major trauma patients creates significant additional direct cost, but remains essentially cost neutral if notional savings through refracture risk reduction are taken into account. Purpose: To compare the 3-year refracture rate following minimal trauma (MT) and non-minimal trauma (non-MT) injuries and evaluate the cost of extending fracture liaison service (FLS) operations to non-MT presentations. Methods: Patients aged 50, or above presenting to the John Hunter Hospital with a fracture in calendar year 2018 were identified through the Integrated Patient Management System (IPMS) of the Hunter New England Health Service's (HNEHS), and re-presentation to any HNEHS facility over the following 3 years monitored. The refracture rate of MT and non-MT presentations was compared and analysed using Cox proportional hazards regression models. The cost of including non-MT patients was estimated through the use of a previously conducted micro-costing analysis. The operational fidelity of the FLS to the previous estimate was confirmed by comparing the 3-year refracture rate of MT presentations in the two studies. Results: The 3-year refracture rate following a MT injury was 8% and after non-MT injury 4.5%. Extension of FLS activities to include non-MT patients in 2022 would have cost an additional $198,326 AUD with a notional loss/saving of $ − 26,625/ + 26,913 AUD through refracture risk reduction. No clinically available characteristic at presentation predictive of increased refracture risk was identified. Conclusion: The 3-year refracture after a non-MT injury is about half (57%) that of the refracture rate after a MT injury. Extending FLS activity to non-MT patients incurs a significant additional direct cost but remains cost neutral if notional savings gained through reduction in refracture risk are taken into account. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the societal costs of untreated perinatal mood and anxiety disorders (PMADs) in Vermont for the 2018–2020 average annual birth cohort from conception through five years postpartum. Methods: We developed a cost analysis model to calculate the excess cases of outcomes attributed to PMADs in the state of Vermont. Then, we modeled the associated costs of each outcome incurred by birthing parents and their children, projected five years for birthing parents who do not achieve remission by the end of the first year postpartum. Results: We estimated that the total societal cost of untreated PMADs in Vermont could reach $48 million for an annual birth cohort from conception to five years postpartum, amounting to $35,910 in excess societal costs per birthing parent with an untreated PMAD and their child. Conclusion: Our model provides evidence of the high costs of untreated PMADs for birthing parents and their children in Vermont. Our estimates for Vermont are slightly higher but comparable to national estimates, which are $35,500 per birthing parent–child pair, adjusted to 2021 US dollars. Investing in perinatal mental health prevention and treatment could improve health outcomes and reduce economic burden of PMADs on individuals, families, employers, and the state. [ABSTRACT FROM AUTHOR]

Even though a well-functioning primary care system is widely acknowledged as critical to population health, the number of primary care physicians (PCPs) practicing in the United States has steadily declined, and PCPs are in short supply. The reasons are multiple and include inadequate income relative to other specialties, excessive administrative demands on PCPs and the lack of respect given to primary care specialties during medical school and residency. Advanced practice nurses can augment the services of primary care physicians but cannot substitute for them. To change this situation, we need action on several fronts. Medical schools should give preference to students who are more likely to enter the primary care specialties. The income gap between primary care and other specialties should be narrowed. The administrative load placed on PCPs, including cumbersome electronic medical records, must be lessened. Insurers, including Medicare and Medicaid, must provide the resources to allow primary care physicians to act as leaders of multidisciplinary teams. [ABSTRACT FROM AUTHOR]

Objectives: In many countries, obesity treatments are not fully reimbursed by healthcare systems. People living with obesity (PwO) often pay out‐of‐pocket (OOP) for pharmacological and non‐pharmacological interventions, placing them in a position of financial risk to manage their condition. This study sought to understand the OOP expenditures and non‐financial costs incurred by PwO to manage weight. Methods: A 25‐min cross‐sectional online survey was conducted with PwO between ages 18–60 in Italy, Japan, India, Brazil, Spain and South Korea. Respondents were recruited using proprietary vendor panels and non‐probability sampling. N = 600 participants completed the survey (n = 100 per country). Results: The mean annual OOP expenditure related to weight loss/management was $7,351, accounting for nearly 17% of annual household income. Costs generally increased by BMI. Half or more of the respondents agreed that obesity affected multiple aspects of their lives (outside activities, running a household, social life, work, family life, traveling). 46% agreed that obesity limited their job prospects. Conclusion: PwO spend a notable amount of their income paying OOP expenditures related to managing their weight. Quantifying the individual economic burden of living with obesity can inform the understanding of the resources required and policy changes needed to treat obesity as a disease. [ABSTRACT FROM AUTHOR]

Background: Enhanced recovery after surgery (ERAS) protocols have been shown to reduce length of stay (LOS) and complications. The impact of ERAS protocols on the cost of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has not been studied. Patients and Methods: We performed a retrospective cohort analysis of patients undergoing CRS-HIPEC from 2016–2022 at a single quaternary center. Propensity score matching was used to create pre-and post-ERAS cohorts. Cost, overall and serious complications, and intensive care unit (ICU) length of stay (LOS) between the two cohorts were compared using the Mann–Whitney U-test for continuous variables and χ2 test for categorical variables. Results: Our final matched cohort consisted of 100 patients, with 50 patients in both the pre- and post-ERAS groups. After adjusting for patient complexity and inflation, the median total cost [$75,932 ($67,166–102,645) versus $92,992 ($80,720–116,710), p = 0.02] and operating room cost [$26,817 ($23,378–33,121) versus $34,434 ($28,085-$41,379), p < 0.001] were significantly higher in the post-ERAS cohort. Overall morbidity (n = 22, 44% versus n = 17, 34%, p = 0.40) and ICU length of stay [2 days (IQR 1–3) versus 2 days (IQR 1–4), p = 0.70] were similar between the two cohorts. A total cost increase of $22,393 [SE $13,047, 95% CI (−$3178 to $47,965), p = 0.086] was estimated after implementation of ERAS, with operating room cost significantly contributing to this increase [$8419, SE $1628, 95% CI ($5228–11,609), p < 0.001]. Conclusions: CRS-HIPEC ERAS protocols were associated with higher total costs due to increased operating room costs at a single institution. There was no significant difference in ICU LOS and complications after the implementation of the ERAS protocol. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions To assess the cost‐effectiveness of a digital diabetes prevention programme (d‐DPP) compared with a diabetes prevention programme (DPP) for preventing type 2 diabetes (T2D) in individuals with prediabetes in the United States.A Markov cohort model was constructed, simulating a 10‐year period starting at the age of 45 years, with a societal and healthcare sector perspective. The effectiveness of the d‐DPP intervention was evaluated using a meta‐analysis, with that of the DPP as the comparator. The initial cycle represented the treatment period, and transition probabilities for the post‐treatment period were derived from a long‐term lifestyle intervention meta‐analysis. The onset of T2D complications was estimated using microsimulation. Quality‐adjusted life years (QALYs) were calculated based on health utility measured by short form (SF)‐12 scores, and a willingness‐to‐pay threshold of $100 000 per QALY gained was applied.The d‐DPP intervention resulted in cost savings of $3,672 from a societal perspective and $2,990 from a healthcare sector perspective and a gain of 0.08 QALYs compared with the DPP. The dropout rate was identified as a significant factor influencing the results. Probabilistic sensitivity analysis showed that the d‐DPP intervention was preferred in 85.8% in the societal perspective and 85.2% in the healthcare sector perspective.The d‐DPP is a cost‐effective alternative to in‐person lifestyle interventions for preventing the development of T2D among individuals with prediabetes in the United States. [ABSTRACT FROM AUTHOR]

This systematic review explores the cost of illness (COI) studies on breast cancer in low- to middle-income countries (LMICs). Studies in Cochrane, Proquest Thesis, PubMed and Scopus were considered. The reporting criteria were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 statement. Studies must (1) be peer-reviewed, (2) report cost data, and (3) be full-text articles. Non-English articles were excluded. Twelve studies were included. The identified costs were made constant to 2022 USD values for reporting and comparison across studies. Annual costs per patient varied from $195 to $11,866 direct medical costs, $201 to $2233 direct non-medical costs and $332 to $26,390 productivity losses were reported. Cost differences were due to the cost types and components in each study. Only three COI studies reported sensitivity analysis and discount rates. Hence, it is recommended that future COI studies include an analysis of correlation between cost components and other variables. Highlights: Direct medical costs with hospitalisation were reported as the highest cost of breast cancer among the LMICs. Direct non-medical costs and productivity losses added to the financial burden of breast cancer patients. COI studies without sensitivity analysis cannot predict breast cancer outcomes. Correlation analysis between cost components and other variables in future COI studies could provide more information for decisions on healthcare resource allocation and planning. [ABSTRACT FROM AUTHOR]

Severe acute malnutrition (SAM) is a high-fatality condition that affected 13.7 million children under five years of age worldwide in 2022, with complicated cases requiring extensive inpatient stay with an accompanying caregiver. Our objective was to assess the costs of inpatient treatment for complicated SAM in children aged 6 to 59 months in Northern Senegal and identify cost predictors. We performed a retrospective cost analysis, including 140 children hospitalized from January to December 2020 in five SAM inpatient treatment facilities. We adopted a societal perspective, including direct medical and non-medical costs and indirect costs. We extracted patients' sociodemographic and clinical data from medical records and conducted semi-structured interviews with healthcare staff to capture information on time allocation and care management. A multivariable generalized linear model with gamma family and a log link was used to investigate the factors associated with direct costs. Costs are expressed in 2020 international USD using purchasing power parity. Mean length of stay was 5.3 (SD = 3.2) days and diarrhoea was the cause of the admission in 55.7% of cases. Mean total cost was USD 431.9 (SD = 203.9), with personnel being the largest cost item (33% of the total). Households' out-of-pocket expenses represented 45.3% of total costs and amounted to USD 195.6 (SD = 103.6). Costs were significantly associated with gender (20.3% lower in boys), diarrhoea (27% increase), anaemia (49.4% increase), inpatient death (44.9% decrease), and type of facility (26% higher in hospitals vs. health centre). Our study highlights the financial burden of complicated SAM in Senegal in particular for families. This underscores the need for tailored prevention and social policies to protect families from the disease's financial burden and improve treatment adherence, both in Senegal and similar contexts. [ABSTRACT FROM AUTHOR]

Background: The burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective. Methods: We included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model. Results: Among 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD. Conclusion: The total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions. [ABSTRACT FROM AUTHOR]

This review explores the benefits of yoga during pregnancy and considers its implications for working pregnant women, focusing on safety, future directions, and limitations. The physical and psychological changes experienced during pregnancy can lead to increased stress and discomfort, impacting both maternal and fetal health, which may be further augmented by work stress during pregnancy. To address these challenges, various interventions such as yoga, relaxation techniques, and meditation have been proposed. Although there is evidence to support the benefits of yoga at both physical and psychological levels, there is a lack of proper strategies and guidelines for the implications of these interventions among working pregnant women. Incorporating yoga as a safe and cost‐effective intervention for managing work‐related distress during pregnancy can have significant benefits for both maternal and fetal health. However, careful consideration of safety guidelines, further research on working pregnant women, and exploring optimal implementation strategies are essential to fully harness the potential of yoga in this context. This review aims to provide a comprehensive overview of the current evidence for the benefits and safety of yoga during pregnancy, with a specific focus on working pregnant women. To ensure the scientific rigor of this review, we conducted a systematic search of the PubMed database for high‐quality research studies published in peer‐reviewed journals. [ABSTRACT FROM AUTHOR]

Health authorities use value-based pricing models to determine the value of innovative drugs and to establish a price. Pharmaceutical companies prefer value-based pricing over cost-based pricing. It is ambiguous whether valuebased pricing has the same meaning to these stakeholders. We aimed to identify the elements that attribute to value-based pricing of innovative drugs from a pharmaceutical industry's perspective and as possible starting point for (valuebased) contracting of drugs. We performed a scoping review of publications available in scientific databases with terms such as 'value-based pricing', 'pharmacoeconomics', 'drug cost', 'innovative drug' and 'drug therapy'. We included 31 publications, covering value elements of innovative drugs from a pharmaceutical industry's perspective. Overall, all found elements of value-based pricing were congruent with the elements of value-based pricing from a health authority's perspective. However, the emphasis placed on the elements differed. The most frequently mentioned elements in our review were economic considerations and cost aspects. Least mentioned were elements regarding cost-effectiveness, disease characteristics and patient characteristics. Although all elements in the drug value framework were present which indicate congruity, there seems controversy on the importance of cost-effectiveness as an element of value. Consequently, establishing a coherent and to all stakeholders' acceptable framework to value and price innovative drugs seems complicated. Mutual understanding can be found in the value elements societal considerations and healthcare process benefits. Our results supported the importance of economic and cost aspects regarding determination of prices of innovative drugs. Further research is required to quantify the weights of all relevant elements in the drug value framework, observe their possible interlinkages, and to weigh them over time. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori screening with eradication reduces gastric cancer (GC) development. However, it was unknown at what age the H. pylori screening should be implemented to achieve the greatest benefits at the least cost. This study aimed to determine the optimal age of H. pylori screening for primary GC prevention. Materials and Methods: A state transition model for a hypothetical cohort of 15‐year‐olds from a healthcare payer perspective on a lifetime horizon was developed. Nine ages for H. pylori testing were considered: 15, 18, 20, 30, 40, 50, 60, 70, and 80 years. H. pylori screening was compared with no screening and annual, biennial, and triennial endoscopies starting at age 50. The main outcomes were costs, quality‐adjusted life‐years (QALYs), life expectancy life‐years (LYs), incremental cost‐effectiveness ratios, GC cases, stage I GC cases, and GC‐related deaths. One‐way, two‐way, and probabilistic sensitivity analyses were performed to assess the uncertainty of the parameters. Results: All H. pylori screenings at ages 15–80 were more cost‐effective than all endoscopies and no screening. H. pylori screening at age 15 yielded the greatest cost‐saving and benefits. The cost‐effectiveness was sensitive to the adherence rate of H. pylori screening at age 15. Cost‐effectiveness acceptability curves showed that H. pylori screening at age 15 was 99.6% cost‐effective at a willingness‐to‐pay threshold of US$50,000 per QALY gained. Compared with no screening and biennial endoscopy in 15.6 million 15‐year‐olds from 2022 to 2037, respectively, H. pylori screening at age 15 saves US$9.70 million and US$2.39 billion, increases 1.26 million QALYs with 1312 LYs and 651 LYs, prevents 436 GC cases with 254 stage I GC cases and 305 stage I GC cases, and avoids 176 GC‐related deaths and 72 GC‐related deaths. Conclusions: The optimal age for population‐based H. pylori screening at ages 15–80 is the youngest, 15 years old. Shifting population‐based H. pylori screening to younger people will reduce GC morbidity and mortality worldwide, along with a detailed investigation of the feasibility and long‐term consequences of H. pylori eradication at a young age. [ABSTRACT FROM AUTHOR]

Background: Uncertainty about disproportionate impact on health care budgets limits implementation of early highly effective treatment (EHT) in multiple sclerosis (MS). Objective: To estimate cost-effectiveness of escalation versus EHT disease-modifying treatment (DMT) sequences. Methods: Using a health-economic approach, we analysed health benefits (relapse rate reduction, disability prevention), direct/indirect DMT and societal costs of escalation versus EHT DMT sequences. In scenario analyses, we allowed (1) earlier use of alemtuzumab (ALE) and (2) a single retreatment with cladribine (CLA). Results: In our model, we showed that the ratio between costs and quality-adjusted life years (QALYs) for the most cost-effective EHT and escalation sequence results into a similar net health benefit with higher costs and also higher QALYs associated with an EHT versus escalation strategy. Earlier use of ALE is more cost-effective than in later lines, even when aggravating the impact of its side-effects tenfold. Retreatment with CLA was more cost-effective in both escalation and EHT sequences. Conclusions: Certain EHT sequences are equally cost-effective to escalation sequences and are likely to result in more health at uncertain additional costs. The favourable cost–benefit ratio of CLA and ALE suggests that a wider application of affordable highly effective therapies could promote the cost-effectiveness both EHT and escalation approaches. [ABSTRACT FROM AUTHOR]

This article discusses the need for a comprehensive and efficient cost tool to measure the financial burden of food allergy on households. The current tool, the Food Allergy Economic Questionnaire (FA-EcoQ), has limitations such as its length and lack of questions on economic precarity. To address these limitations, the authors propose conducting a scoping review to evaluate and compare different questionnaires assessing the household financial costs of food allergy. The review will include studies that focus on the development, validation, reliability, or applicability of questionnaires specifically designed to measure the household cost of food allergy. The findings from this review will help inform the selection of a food allergy cost questionnaire and highlight gaps and limitations in existing cost measures. [Extracted from the article]

Background: Chronic nausea and vomiting syndromes (CNVS), gastroparesis and functional dyspepsia (FD) are complex disorders. Body Surface Gastric Mapping (BSGM), a new test of gastric function, using Gastric Alimetry® (Alimetry, New Zealand) may be useful for de-escalating healthcare utilisation. This study aimed to define healthcare costs and estimate health economic impacts of implementing this test in patients with chronic gastroduodenal symptoms. Methods: Consecutive patients at a tertiary referral centre evaluated with Gastric Alimetry were included. Frequency and cost data relating to medical investigations, hospital and outpatient presentations were evaluated. Costs of healthcare utilisation were calculated, and the potential cost savings of implementing Gastric Alimetry within a diagnostic decision-tree model were estimated. Results: Overall, 31 consecutive patients (mean age 36.1 years; 83.9% female; predominant symptoms: nausea [83.9%], pain [61.3%], vomiting [67.7%] and bloating [35.5%]) completed Gastric Alimetry testing. Repeat gastroscopy and abdominal CT rates were 29% (8/28) and 85% (11/13), respectively. Gastric Alimetry testing identified spectral abnormalities in 45.2% of patients, and symptom profiling classified a further 29.1% of patients. Median annualised cost difference after test introduction was NZ$-12,032. Estimated reductions in investigation-related costs when incorporating Gastric Alimetry into the diagnostic workflow model were approximately NZ$1,300 per patient. Conclusions: Healthcare utilisation and confirmatory testing rates remain high in nausea and vomiting syndromes. This study presents real-world data, together with a decision-tree analysis, showing Gastric Alimetry can streamline clinical care pathways, resulting in reduced healthcare utilisation and cost. [ABSTRACT FROM AUTHOR]

Current cost-effectiveness analyses (CEA) emphasize drug costs as the differentiator between NICE recommended anti-VEGF treatments but may neglect real-world non-drug costs of running nAMD services in the UK. To address this, this study identified real-world non-drug service cost items relevant to UK NHS nAMD clinics, including costs arising from operational strain (demand exceeding capacity). Cost items were identified by a structured literature review of peer-reviewed and grey literature, and an expert panel of 10 UK-based ophthalmologists with relevance to real-world practice. These items underwent meta-synthesis and were then determined in a consensus exercise. Of 237 cost items identified, 217 (91.6%) met the consensus threshold of >0.51 and were included in the nAMD Service Non-Drug Cost Instrument (nAS). Sensitivity of cost items taken from UK Health Technology Assessment (HTA) using the nAS as the reference standard was low (HTAmin: 1.84%, 95% CI 0.50–4.65%; HTAmax: 70.51%, 95% CI 63.96–76.49%). False negative rates showed variable likelihood of misclassifying a service by cost burden depending on prevalence. Scenario analysis using cost magnitudes estimated annual per-patient clinic cost at £845 (within capacity) to £13,960 (under strain) compared to an HTAmin estimate of £210. Accounting for cost of strain under an assumed 50% increase in health resource utilization influenced cost-effectiveness in a hypothetical genericisation scenario. Findings suggested that HTA underestimates UK NHS nAMD clinic cost burden with cost of strain contributing substantial additional unmeasured expense with impact on CEA. Given potential undertreatment due to strain, durability is suggested as one of the relevant factors in CEA of nAMD anti-VEGF treatments due to robustness under limited capacity conditions affecting UK ophthalmology services. When considering how well treatments work versus how much they cost, the focus is usually only on the price of the medicine itself. However, other real-world costs exist. In the UK, when treating certain eye problems such as neovascular age-related macular degeneration (nAMD), there are additional expenses related to running clinics and managing treatments that often go unnoticed. To get a better understanding of these hidden costs, the study examined factors like clinic workload and the extra expenses that come with it. Ten eye doctors in the UK were consulted for their expert opinions and numerous research papers were reviewed to identify these additional costs. The study grouped different costs in a tool called the nAMD Service Non-Drug Cost Instrument (nAS). When the findings of the nAS tool were compared to the usual methods of calculating costs, it was found that the conventional approach overlooked many of the actual expenses. Busy clinics face unique challenges, such as higher operational costs associated with staffing for extended hours, emergency appointments, extended waiting times and the potential to miss optimal treatment windows. This can lead to disease progression and the onset of comorbidities, which require more complex and costly treatments. Recognizing these real costs is crucial when making decisions about treatments, especially when treatments require more frequent visits to eye clinics. This study emphasizes the importance of considering all expenses, not just the obvious ones like medication and doctor visits when determining the most effective way to manage eye conditions like nAMD in the UK. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is a highly prevalent and potentially severe medical condition. Challenges regarding TBI management are related to accurate diagnostics, defining its severity, and establishing prompt interventions to affect outcomes. Among the health care components in the TBI handling strategy is intracranial pressure (ICP) monitoring, which is fundamental to therapy decisions. However, ICP monitoring is an Achilles tendon, imposing a significant financial burden on health care systems, particularly in middle and low-income communities. This article arises from the understanding from the authors that there is insufficient scientific evidence about the potential economic impacts from the use of noninvasive technologies in the monitoring of TBI. Based on personal experience, as well as from reading other, clinically focused studies, the thesis is that the use of such technologies could greatly affect the health care system and this article seeks to address this lack of literature, show ways in which such systems could be evaluated, and show estimations of possible results from these investigations. This review primarily investigates the economic burden of TBI and whether new technologies are suitable to reduce its health care costs without compromising the quality of care, according to the levels of evidence available. The objective is to stimulate more research and attention in the area. For this narrative review, a PubMed search was conducted for articles discussing TBI health care costs, as well as monitoring technologies (tomography, magnetic resonance imaging, optic nerve sheath diameter, transcranial Doppler, pupillometry, and noninvasive ICP waveform) and their application in managing TBI. Strategies were first evaluated from a medical noninferiority perspective before calculating the average savings of each selected strategy. All applicable studies were analyzed for quality using the Consolidated Health Economic Evaluation Reporting Standards 2022 Statement117 and this article was written to conform as much as possible with it. The review included 109 references and showed a consistent potential in noninvasive technologies to reduce costs and maintain or improve the quality of care. TBI prevalence has increased with a disproportionate health care burden in the last decades. Noninvasive monitoring techniques seem to be effective in reducing TBI health care costs, with few limitations, especially the need for more supporting scientific evidence. The undeniable clinical and financial potential of these techniques is compelling to further investigate their role in TBI management, as well as the creation of more comprehensive monitoring models to the understanding of complex phenomena occurring in the injured brain. [ABSTRACT FROM AUTHOR]

Purpose: Readmission indicators are used around the world to assess the quality of hospital care. We aimed to assess the relevance of this type of indicator in oncology, especially for socially deprived patients. Our objectives were (1) to assess the proportion of unplanned hospitalizations (UHs) in cancer patients, (2) to assess the proportion of UHs that were avoidable, i.e., related to poor care quality, and (3) to analyze cancer patients the effect of patients’ deprivation level on the type of UH (avoidable UHs vs. unavoidable UHs). Methods: In a French university hospital, we selected all hospitalizations over a year for a random sample of cancer patients. Based on medical records, we identified those among UHs due to avoidable health problems. We assessed the association between social deprivation, home-to-hospital distance, or home-to-general practitioner with the type of UH (avoidable vs. unavoidable) via a multivariate binary logit estimation. Results: Among 2349 hospitalizations (355 patients), there were 383 UHs (16 %), among which 38% were avoidable. Among UHs, the European Deprivation Index was significantly associated with the risk of avoidable UHs, with a lower risk of avoidable UH for patients with medium or high social deprivation. Conclusion: Our results suggest that the use of UHs rate as a quality indicator is questionable in oncology. Indeed, the majority of UHs were not avoidable. Furthermore, within UHs, those involving patients with medium or high social deprivation are more often unavoidable in comparison with other patients. [ABSTRACT FROM AUTHOR]

To evaluate the cost-effectiveness of repetitive transcranial magnetic stimulation (rTMS) as an adjunct to standard care from an Australian health sector perspective, compared to standard care alone for adults with treatment-resistant bipolar depression (TRBD). An economic model was developed to estimate the cost per disability-adjusted life-year (DALY) averted and quality-adjusted life-year (QALY) gained for rTMS added to standard care compared to standard care alone, for adults with TRBD. The model simulated the time in three health states (mania, depression, residual) over one year. Response to rTMS was sourced from a meta-analysis, converted to a relative risk and used to modify the time in the depressed state. Uncertainty and sensitivity tested the robustness of results. Base-case incremental cost-effectiveness ratios (ICERs) were $72,299 per DALY averted (95 % Uncertainty Interval (UI): $60,915 to $86,668) and $46,623 per QALY gained (95 % UI: $39,676 - $55,161). At a willingness to pay (WTP) threshold of $96,000 per DALY averted, the base-case had a 100 % probability of being marginally cost-effective. At a WTP threshold of $64,000 per QALY gained, the base-case had a 100 % probability of being cost-effective. Sensitivity analyses decreasing the number of sessions provided, increasing the disability weight or the time spent in the depression state for standard care improved the ICERs for rTMS. Dependent on the outcome measure utilised and assumptions, rTMS would be considered a very cost-effective or marginally cost-effective adjunct to standard care for TRBD compared to standard care alone. • The cost-effectiveness of repetitive transcranial magnetic stimulation (rTMS) added to standard care for treatment resistant bipolar depression (TRBD) was estimated. • The economic model used the available efficacy data on rTMS and standard care for TRBD. • rTMS was estimated to decrease morbidity at an additional cost. • rTMS was considered cost-effective for TRBD. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) screening is highly effective but underused. Blood-based biomarkers (liquid biopsy) could improve screening participation. Using our established Markov model, screening every 3 years with a blood-based test that meets minimum Centers for Medicare & Medicaid Services' thresholds (CMS min) (CRC sensitivity 74%, specificity 90%) was compared with established alternatives. Test attributes were varied in sensitivity analyses. CMS min reduced CRC incidence by 40% and CRC mortality by 52% vs no screening. These reductions were less profound than the 68%–79% and 73%–81%, respectively, achieved with multi-target stool DNA (Cologuard; Exact Sciences) every 3 years, annual fecal immunochemical testing (FIT), or colonoscopy every 10 years. Assuming the same cost as multi-target stool DNA, CMS min cost $28,500/quality-adjusted life-year gained vs no screening, but FIT, colonoscopy, and multi-target stool DNA were less costly and more effective. CMS min would match FIT's clinical outcomes if it achieved 1.4- to 1.8-fold FIT's participation rate. Advanced precancerous lesion (APL) sensitivity was a key determinant of a test's effectiveness. A paradigm-changing blood-based test (sensitivity >90% for CRC and 80% for APL; 90% specificity; cost ≤$120–$140) would be cost-effective vs FIT at comparable participation. CMS min could contribute to CRC control by achieving screening in those who will not use established methods. Substituting blood-based testing for established effective CRC screening methods will require higher CRC and APL sensitivities that deliver programmatic benefits matching those of FIT. High APL sensitivity, which can result in CRC prevention, should be a top priority for screening test developers. APL detection should not be penalized by a definition of test specificity that focuses on CRC only. [Display omitted] Blood tests to screen for colorectal cancer could be effective in people who decline stool tests or colonoscopy, but they should not substitute for established methods unless they achieve high detection rates for colorectal cancer and its precursors. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to demonstrate a practical framework that can be applied to estimate the health impact of changes in waiting times across a range of elective procedures in the National Health Service (NHS) in England. We apply this framework by modeling 2 procedures: coronary artery bypass graft (CABG) and total hip replacement (THR). Methods: We built a Markov model capturing health pre- and postprocedure, including the possibility of exiting preprocedure to acute NHS care or self-funded private care. We estimate the change in quality-adjusted life-years (QALYs) over a lifetime horizon for 10 subgroups defined by sex and Index of Multiple Deprivation quintile groups and for 7 alternative scenarios. We include 18 wk as a baseline waiting time consistent with current NHS policy. The model was populated with data from routinely collected data sets where possible (Hospital Episode Statistics, Patient-Reported Outcome Measures, and Office for National Statistics Mortality records), supplemented by the academic literature. Results: Compared with 18 wk, increasing the wait time to 36 wk resulted in a mean discounted QALY loss in the range of 0.034 to 0.043 for CABG and 0.193 to 0.291 for THR. The QALY impact of longer NHS waits was greater for those living in more deprived areas, partly as fewer patients switch to private care. Discussion/Conclusion: The proposed framework was applied to 2 different procedures and patient populations. If applied to an expanded group of procedures, it could provide decision makers with information to inform prioritization of waiting lists. There are a number of limitations in routine data on waiting for elective procedures, primarily the lack of information on people still waiting. Highlights: We present a modeling framework that allows for an estimation of the health impact (measured in quality-adjusted life-years) of waiting for elective procedures in the NHS in England. We apply our model to waiting for coronary artery bypass graft (CABG) and total hip replacement (THR). Increasing the wait for THR results in a larger health loss than an equivalent increase in wait for CABG. This model could potentially be used to estimate the impact across an expanded group of procedures to inform prioritization of activities to reduce waiting times. [ABSTRACT FROM AUTHOR]

Background: A risk-stratified breast screening program could offer low-risk women less screening than is currently offered by the National Health Service. The acceptability of this approach may be enhanced if it corresponds to UK women's screening preferences and values. Objectives: To elicit and quantify preferences for low-risk screening options. Methods: Women aged 40 to 70 y with no history of breast cancer took part in an online discrete choice experiment. We generated 32 hypothetical low-risk screening programs defined by 5 attributes (start age, end age, screening interval, risk of dying from breast cancer, and risk of overdiagnosis), the levels of which were systematically varied between the programs. Respondents were presented with 8 choice sets and asked to choose between 2 screening alternatives or no screening. Preference data were analyzed using conditional logit regression models. The relative importance of attributes and the mean predicted probability of choosing each program were estimated. Results: Participants (N = 502) preferred all screening programs over no screening. An older starting age of screening, younger end age of screening, longer intervals between screening, and increased risk of dying had a negative impact on support for screening programs (P < 0.01). Although the risk of overdiagnosis was of low relative importance, a decreased risk of this harm had a small positive impact on screening choices. The mean predicted probabilities that risk-adapted screening programs would be supported relative to current guidelines were low (range, 0.18 to 0.52). Conclusions: A deintensified screening pathway for women at low risk of breast cancer, especially one that recommends a later screening start age, would run counter to women's breast screening preferences. Further research is needed to enhance the acceptability of offering less screening to those at low risk of breast cancer. Highlights: Risk-based breast screening may involve the deintensification of screening for women at low risk of breast cancer. Low-risk screening pathways run counter to women's screening preferences and values. Longer screening intervals may be preferable to a later start age. Work is needed to enhance the acceptability of a low-risk screening pathway. [ABSTRACT FROM AUTHOR]

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The rising costs of cancer care and subsequent medical financial hardship for cancer survivors and families are well documented in the United States. Less attention has been paid to employment disruptions and loss of household income after a cancer diagnosis and during treatment, potentially resulting in lasting financial hardship, particularly for working‐age adults not yet age‐eligible for Medicare coverage and their families. In this article, the authors use a composite patient case to illustrate the adverse consequences of cancer diagnosis and treatment for employment, health insurance coverage, household income, and other aspects of financial hardship. They summarize existing research and provide nationally representative estimates of multiple aspects of financial hardship and health insurance coverage, benefit design, and employee benefits, such as paid sick leave, among working‐age adults with a history of cancer and compare them with estimates among working‐age adults without a history of cancer from the most recently available years of the National Health Interview Survey (2019–2021). Then, the authors identify opportunities for addressing employment and health insurance coverage challenges at multiple levels, including federal, state, and local policies; employers; cancer care delivery organizations; and nonprofit organizations. These efforts, when informed by research to identify best practices, can potentially help mitigate the financial hardship associated with cancer. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Treatment of chronic hepatitis B (CHB) with nucelos(t)ide analogues (NA) can improve outcomes, but NA treatment is expensive for insurance plans. Materials and Methods: The Centers for Medicare & Medicaid Services database was assessed from 2012 to 2021 to assess the use of NA for CHB in patients on Medicaid. Data extracted included the number of claims, units, and costs of each agent stratified by originator and generic. Results: Over the study period, 1.9 billion USD was spent on NA, with spending peaking in 2016 at $289 million US, which has subsequently decreased. Lower expenditures since 2016 have been associated with increased use of generics. The use of generic tenofovir or entecavir led to savings of $669 million US over the study period. Conclusions: Increased generic use has significantly reduced expenditures for NA drugs; policy shifts towards generic drug use may help with sustainability. [ABSTRACT FROM AUTHOR]

Many children do not receive a full schedule of childhood vaccines, yet there is limited evidence on the cost-effectiveness of strategies for improving vaccination coverage. Evidence is even scarcer on the cost-effectiveness of strategies for reaching 'zero-dose children', who have not received any routine vaccines. We evaluated the cost-effectiveness of periodic intensification of routine immunization (PIRI), a widely applied strategy for increasing vaccination coverage. We focused on Intensified Mission Indradhanush (IMI), a large-scale PIRI intervention implemented in India in 2017–2018. In 40 sampled districts, we measured the incremental economic cost of IMI using primary data, and used controlled interrupted time-series regression to estimate the incremental vaccination doses delivered. We estimated deaths and disability-adjusted life years (DALYs) averted using the Lives Saved Tool and reported cost-effectiveness from immunization programme and societal perspectives. We found that, in sampled districts, IMI had an estimated incremental cost of 2021US$13.7 (95% uncertainty interval: 10.6 to 17.4) million from an immunization programme perspective and increased vaccine delivery by an estimated 2.2 (−0.5 to 4.8) million doses over a 12-month period, averting an estimated 1413 (−350 to 3129) deaths. The incremental cost from a programme perspective was $6.21 per dose ($2.80 to dominated), $82.99 per zero-dose child reached ($39.85 to dominated), $327.63 ($147.65 to dominated) per DALY averted, $360.72 ($162.56 to dominated) per life-year saved and $9701.35 ($4372.01 to dominated) per under-5 death averted. At a cost-effectiveness threshold of 1× per-capita GDP per DALY averted, IMI was estimated to be cost-effective with 90% probability. This evidence suggests IMI was both impactful and cost-effective for improving vaccination coverage, though there is a high degree of uncertainty in the results. As vaccination programmes expand coverage, unit costs may increase due to the higher costs of reaching currently unvaccinated children. [ABSTRACT FROM AUTHOR]

目的 评估脑心共患疾病在共治与分治两种模式下的卫生经济学效益，以确定更优的医疗策略，提高治疗效率与经济效益。 方法 本研究采用回顾性分析方法，收集2019年1月—2023年12月在首都医科大学附属北京天坛医院心血管内科、神经内科、神经外科、心血管外科和介入放射科等治疗的，符合中国疾病诊断相关分组（Chinese diagnosis related groups，CN-DRG）中神经系统疾病及功能障碍合并循环系统疾病及功能障碍患者的病历资料，记录患者的人口学特征、总住院天数、各类医疗费用以及病例组合指数（case mix index，CMI）和权重（relative weight，RW）。将患者分为共治组（一次住院期间对患者的脑心共患疾病进行统筹规划和综合治疗）与分治组（不同住院期间分别进行神经系统和心血管系统疾病的治疗），比较两组的基线特点及总住院天数、费用等经济学指标。 结果 共纳入442例患者数据。共治组总住院天数低于分治组（6 d vs. 14 d，P

Umberto Restelli,1 Jacopo Vitale,2 Edoardo Croce,3 Susan Bernareggi,3 Stefania Guida,3 Sofia Silvola,1,4 Giuseppe Banfi,3,5 Luigi Zagra3 1LIUC University, Castellanza, Italy; 2Schulthess Klinik, Zürich, Switzerland; 3IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; 4Department of Public Health Medicine, School of Health System & Public Health, Faculty of Health Science, University of Pretoria, Pretoria, South Africa; 5Vita-Salute San Raffaele University, Milan, ItalyCorrespondence: Umberto Restelli, Email urestelli@liuc.itObjective: The objective of the analysis presented is to assess the efficacy of a fast-track pathway for elective hip and knee arthroplasty, compared to the traditional approach, adopted within a research hospital located in Milan (Italy), in terms of length of stay reduction and related direct medical costs.Methods: A monocentric observational retrospective study was implemented considering adult subjects who underwent elective primary total hip or knee replacement, with a diagnosis of primary or secondary osteoarthritis. Exclusion criteria were subjects admitted via emergency department, subjects undergoing knee or hip replacement because of fractures or prosthesis revision. The analysis compared the length of stay and the direct medical costs, assuming the hospital perspective, of subjects admitted in the pre-fast-track period (years 2016/2017) and during the fast-track period (years 2018/2019).Results: Knee replacement mean costs are 5,599 € (± 1,158.3 €) in the pre-fast-track period and 4,487 € (± 978.4 €) in the fast-track period (− 1,112 €; − 19.9%). Hip replacement mean costs in the pre-fast-track period are 5,364 € (± 1,037.2 €) and 4,450 € (± 843.7 €) in the fast-track period (− 914 €; − 17.0%). The adoption of fast-track pathway led to a statistically significant decrease of days of hospitalization of − 2.8 (− 37.6%) in knee replacement and of − 2.9 (− 39.2%) in hip replacement.Conclusion: The fast-track pathway adopted proved to be effective, reducing patients’ length of stay, and sustainable and efficient, reducing direct medical costs, for both elective hip and knee replacement surgeries.Keywords: health economics, direct medical costs, observational, hip replacement, knee replacement

David Eisenstein,1 Ghadear H Shukr,2 John J Carlow,3 Laura Kemp,4 Steve Yu5 1Department of Urology, Trinity/IHA Medical Group, Detroit, MI, USA; 2Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa Bay, FL, USA; 3Discovery Statistics, Laguna Niguel, CA, USA; 4Kemp Clinical Consulting Co LLC, Carlsbad, CA, USA; 5Department of Urology, Hoag Hospital, Newport Beach, CA, USACorrespondence: John J Carlow, Discovery Statistics, 31434 West Nine Drive, Laguna Niguel, CA, 92677, USA, Tel/Fax +1 760-519-7395, Email jcarlow.discovery@gmail.comPurpose: To describe two-year post-operative outcomes, and healthcare utilization of three uterus-sparing interventions used to treat women with intramural and/or subserosal uterine fibroids.Subjects and Methods: This was a post-market, randomized, prospective, multi-center, longitudinal, interventional, and comparative clinical study to evaluate the costs and health outcomes of LAP-RFA vs the standard uterine conserving technologies (myomectomy and UAE) for the treatment of symptomatic uterine fibroids in women who desire uterine conservation. For this RCT study, 54 subjects were randomized on a 1:1 ratio across the three procedures and followed out to two years. Their results were compared to retrospective US insurance claims from the IBM MarketScan® Commercial Database from 2017– 2020 for 96,854 women who underwent a uterus-sparing procedure for fibroids.Results: Mean ambulatory surgical center costs and the mean out-patient hospital costs were lowest for LAP-RFA (&dollar;13,134 and &dollar;14,428) and highest for UAE (&dollar;28,214 and &dollar;19,131). The total two-year re-intervention rate of any subsequent procedure (AM, LM, LAP-RFA, or UAE) was lowest in AM group (0%) followed by LM (4.2%), LAP-RFA (11%), and UAE (33%). Mean peri-operative reintervention costs and the mean reintervention total costs were &dollar;2429 and &dollar;5939 for LAP-RFA, &dollar;2122 and &dollar;8368 for LM, &dollar;4410 and &dollar;11,942 for AM, and &dollar;8113 and &dollar;46,692 for UAE subjects. In the RCT study, the average length of hospital stay was significantly less for the LAP-RFA group subjects (8.2 hours) in contrast to both the laparoscopic myomectomy group subjects (16.0 hours) and the abdominal myomectomy group subjects (33.6 hours). Despite the small numbers, two-year reintervention rates followed a similar pattern as the IBM MarketScan data.Conclusion: In comparing these three non-invasive approaches, LAP-RFA was associated with the lowest peri-operative cost, and UAE was associated with the highest peri-operative cost. Further studies are needed to assess the cost, effectiveness, and subject satisfaction with each procedure.Keywords: health economics, leiomyomas, interventional, cost/burden

Abstract This systematic review explores the cost of illness (COI) studies on breast cancer in low- to middle-income countries (LMICs). Studies in Cochrane, Proquest Thesis, PubMed and Scopus were considered. The reporting criteria were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 statement. Studies must (1) be peer-reviewed, (2) report cost data, and (3) be full-text articles. Non-English articles were excluded. Twelve studies were included. The identified costs were made constant to 2022 USD values for reporting and comparison across studies. Annual costs per patient varied from $195 to $11,866 direct medical costs, $201 to $2233 direct non-medical costs and $332 to $26,390 productivity losses were reported. Cost differences were due to the cost types and components in each study. Only three COI studies reported sensitivity analysis and discount rates. Hence, it is recommended that future COI studies include an analysis of correlation between cost components and other variables.

Abstract Background The burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective. Methods We included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model. Results Among 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p

Globally, providing evidence on the economic burden of chronic obstructive pulmonary disease (COPD) is becoming essential as it assists the health authorities to efficiently allocate resources. This study aimed to summarize the literature on economic burden evidence for COPD from 1990 to 2019. This study examined the economic burden of COPD through a systematic review of studies from 1990 to 2019. A search was done in online databases, including Web of Science, PubMed/Medline, Scopus, and the Cochrane Library. After screening 12,734 studies, 43 articles that met the inclusion criteria were identified. General study information and data on direct, indirect, and intangible costs were extracted and converted to 2018 international dollars (Int$). Findings revealed that the total direct costs ranged from Int$ 52.08 (India) to Int$ 13,776.33 (Canada) across 16 studies, with drug costs rannging from Int$ 70.07 (Vietnam) to Int$ 8,706.9 (China) in 11 studies. Eight studies explored indirect costs, while one highlighted caregivers’ direct costs at approximately Int$ 1,207.8 (Greece). This study underscores the limited research on COPD caregivers’ economic burdens, particularly in developing countries, emphasizing the importance of increased research support, particularly in high-resource settings. This study provides information about the demographics and economic burden of COPD from 1990 to 2019. More strategies to reduce the frequency of hospital admissions and acute care services should be implemented to improve the quality of COPD patients’ lives and reduce the disease’s rising economic burden.

BackgroundLaminectomy with fusion (LF) and laminoplasty (LP) are common posterior decompression procedures used to treat multilevel degenerative cervical myelopathy (DCM). There is debate on their relative efficacy and safety for treatment of DCM. The goal of this study is to examine outcomes and costs of LF and LP procedures for DCM.MethodsThis is a retrospective review of adult patients (.05). Patients were successfully weaned off opioids at similar rates (LF: 88%, LP: 86%). Fixed and variable costs respectively with LF cases hospital were higher, 15.7% and 25.7% compared to LP cases (p=.03 and p

OBJECTIVES: To investigate the impact of no cost sharing on paediatric care on usage and health outcomes, and whether the effect varies by household income levels. DESIGN: Regression discontinuity design. SETTING: Nationwide medical claims database in Japan. PARTICIPANTS: Children aged younger than 20 years from April 2018 to March 2022. EXPOSURE: Co-insurance rate that increases sharply from 0% to 30% at a certain age threshold (the threshold age varies between 6 and 20 years depending on region). PRIMARY OUTCOME MEASURES: The outpatient care usage (outpatient visit days and healthcare spending for outpatient care) and inpatient care (experience of any hospitalisation and healthcare spending for inpatient care). RESULTS: Of 244 549 children, 49 556 participants were in the bandwidth and thus included in our analyses. Results from the regression discontinuity analysis indicate that no cost sharing was associated with a significant increase in the number of outpatient visit days (+5.26 days; 95% CI, +4.89 to +5.82; p

ABSTRACTBackground A bivalent human papillomavirus vaccine (2vHPV) is currently used in the Netherlands; a nonavalent vaccine (9vHPV) is also licensed.Research design and methods We compared the public health and economic benefits of 2vHPV- and 9vHPV-based vaccination strategies in the Netherlands over 100 years using a validated deterministic dynamic transmission metapopulation model.Results Compared to 2vHPV, the 9vHPV strategy averted an additional 3,245 cases of and 825 deaths from 9vHPV-strain-attributable cancers, 4,247 cases of and 190 deaths from recurrent respiratory papillomatosis (RRP), and 1,009,637 cases of anogenital warts (AGWs), with an incremental cost-effectiveness ratio (ICER) of €4,975 per quality-adjusted life year (QALY) gained. The ICER increased in a scenario with increased HPV vaccination coverage rates and was relatively robust to one-way deterministic sensitivity analyses, with variation in the disease utility parameter having the most impact. When catch-up vaccination for individuals ≤26 years of age was added to the model, vaccinating with 9vHPV averted additional cancers and AGWs compared to 2vHPV vaccination.Conclusion Our analyses predict that transitioning from a 2vHPV- to a 9vHPV-based vaccination strategy would be cost-effective in the Netherlands.

Abstract Background The organisational care needs involved in accessing kidney transplant have not been described in the literature and therefore a detailed analysis thereof could help to establish a framework (including appropriate timing, investment, and costs) for the management of this population. The main objective of this study is to analyse the profile and care needs of kidney transplant candidates in a tertiary hospital and the direct costs of studying them. Methods A descriptive, cross-sectional study was conducted using data on a range of variables (sociodemographic and clinical characteristics, study duration, and investment in visits and supplementary tests) from 489 kidney transplant candidates evaluated in 2020. Results The comorbidity index was high (> 4 in 64.3%), with a mean of 5.6 ± 2.4. Part of the study population had certain characteristics that could hinder their access a kidney transplant: physical dependence (9.4%), emotional distress (33.5%), non-adherent behaviours (25.2%), or language barriers (9.4%). The median study duration was 6.6[3.4;14] months. The ratio of required visits to patients was 5.97:1, meaning an investment of €237.10 per patient, and the ratio of supplementary tests to patients was 3.5:1, meaning an investment of €402.96 per patient. Conclusions The study population can be characterised as complex due to their profile and their investment in terms of time, visits, supplementary tests, and direct costs. Management based on our results involves designing work-adaptation strategies to the needs of the study population, which can lead to increased patient satisfaction, shorter waiting times, and reduced costs.

Abstract This survey investigates the development of day surgery in China, and analyzes the national policy support, medical service management model, disease types of day surgery, medical insurance payment methods, and the medical service capacity, efficiency, quality and safety, health economics indicators, and patient satisfaction after the implementation of day surgery in a tertiary eye hospital. After more than 20 years of development, China’s day surgery has shown a good development trend. The implementation of day surgery in eye hospitals accounts for more than 70% of elective surgery, and patients, medical institutions, and medical insurance institutions have all achieved good social benefits.