PharmacoEconomics Open最新文献

{"title":"Cost-Effectiveness of Ultrasound Renal Denervation for Resistant Hypertension in Belgium, France and The Netherlands.","authors":"Rod S Taylor, Kaylie Metcalfe, Antoine Cremer, Sofie Brouwers, Joost Daemen, Sam Carter, Kieran Murphy, Marie-Claude Morice, Isabelle Durand-Zaleski, Linh Ngo, Michel Azizi, Ajay J Kirtane","doi":"10.1007/s41669-025-00574-2","DOIUrl":"https://doi.org/10.1007/s41669-025-00574-2","url":null,"abstract":"<p><strong>Background: </strong>Endovascular ultrasound renal denervation (uRDN) with the Paradise System has emerged as an adjunctive treatment option for the management of uncontrolled resistant hypertension (rHTN). This study assesses the cost-effectiveness of uRDN for rHTN across three European countries-Belgium, France and the Netherlands.</p><p><strong>Methods: </strong>On the basis of a previously developed state-transition Markov model, we projected costs, life years (LYs) and quality adjusted life years (QALYs) with the addition of uRDN to standard of care (SoC) compared with SoC alone over patient lifetime. Analyses were based on the RADIANCE-HTN TRIO trial, which demonstrated a mean reduction in office systolic blood pressure from a baseline of 8.5 mmHg at 2 months post-uRDN among patients with rHTN. Mortality and costs data were separately sourced and applied for each country independently. Country-specific discount rates were applied to both cost and outcomes. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty surrounding the model inputs and sensitivity of the model results to changes in parameter inputs. Results were reported as incremental cost-effectiveness ratios (ICERs).</p><p><strong>Results: </strong>The base-case analyses of the models for all three countries show uRDN plus SoC results in improvement in both LYs and QALYs per patient and higher costs compared with SoC alone. The mean ICERs for each country model fall well below the respective country-specific willingness-to-pay thresholds (WTPs)-Belgium: WTP €40,000 and ICER €4426/QALY gained; France: WTP €50,000 and ICER €6261/QALY gained; and the Netherlands: WTP €20,000 and ICER €1654/QALY gained. Results were robust across scenarios and sensitivity analyses.</p><p><strong>Conclusions: </strong>The addition of endovascular uRDN offers clinicians and payers a cost-effective adjunctive treatment approach alongside hypertensive medication for the management of rHTN in the healthcare systems of Belgium, France and the Netherlands.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Validation of Estimation of Health Utility Values in Alopecia Areata.","authors":"Caleb Dixon, Thomas Price, Elin Gruffydd, Andrew Lloyd, Ernest H Law","doi":"10.1007/s41669-025-00576-0","DOIUrl":"https://doi.org/10.1007/s41669-025-00576-0","url":null,"abstract":"<p><strong>Background: </strong>Current patient-reported burden measures, which guide decision-making, may not be sensitive to pertinent impacts of alopecia areata (AA). The UK public previously valued patient/caregiver vignettes using the time trade-off (TTO) method in interviews; however, the public may not fully understand the impact of AA. Therefore, this study aimed to evaluate the content validity of the vignettes using TTO interviews with patients with AA and to compare patient-derived utilities for each health state with the utilities derived from the UK public.</p><p><strong>Methods: </strong>To understand their perspective surrounding trade-offs between quantity and quality of life, and to confirm the UK public's utility values, adult participants in the UK with AA currently experiencing scalp hair loss or with no scalp hair loss but experiencing hair loss in the last 12 months were recruited. In total, five AA vignettes that described health states by hair loss and its impacts and one caregiver vignette describing caring for an adolescent patient (aged 12-17 years) with AA were presented to participants in interviewer-guided sessions. Participants imagined themselves in the health state or as a caregiver, then valued each state using a visual analog scale (VAS) and traded time from 10 years in full health in 6-month increments to avoid living in each health state to evaluate the TTO utilities (0 [dead] to 1 [full health]).</p><p><strong>Results: </strong>Among participants (N = 50), mean VAS scores (Severity of Alopecia Tool [SALT] 0-10: 74.3; SALT 11-20: 59.0; SALT 21-49: 39.4; SALT 50-100: 29.6; SALT 50-100 [no eyebrows/eyelashes]: 26.0; and caregiver [adolescent SALT 50-100]: 58.6) and TTO utility values (SALT 0-10: 0.93; SALT 11-20: 0.87; SALT 21-49: 0.67; SALT 50-100: 0.54; SALT 50-100 [no eyebrows/eyelashes]: 0.45; and caregiver [adolescent SALT 50-100]: 0.81) were lower for states with greater hair loss, similar to the mean UK public utility values. Over a 10-year time horizon, the average patient with AA was willing to trade approximately 5 years of life (mean TTO utility, 0.537 [standard deviation, 0.448]) to avoid impacts associated with 50-100% scalp hair loss.</p><p><strong>Conclusions: </strong>This is the first known study to evaluate how patients with AA would make trade-offs between quantity of life and disease-specific quality of life. A high willingness to trade off duration of life was observed, consistent with the UK public study and supporting a high disease burden of AA.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Diabetic Retinopathy Screening at Primary Health Centres in India: A Cost-Effectiveness Analysis.","authors":"Neha Purohit, Parul Chawla Gupta, Sandeep Buttan, Akashdeep Singh Chauhan, Ranjan Kumar Choudhury, Vishali Gupta, Atul Kotwal, Shankar Prinja","doi":"10.1007/s41669-025-00572-4","DOIUrl":"https://doi.org/10.1007/s41669-025-00572-4","url":null,"abstract":"<p><strong>Background: </strong>The eye care package under the Ayushman Bharat comprehensive primary healthcare programme includes annual population-based screening for diabetic retinopathy (DR) using non-mydriatic fundus cameras at the primary health centres (PHCs) in India. However, there can be several implementation models for introduction of a systematic screening programme for DR.</p><p><strong>Objectives: </strong>This study aims to assess the cost effectiveness of screening for DR in comparison with the usual-care scenario without a DR screening programme, and to determine cost-effective approaches for implementation of annual population-based screening for DR by optometrists at PHCs in India in terms of screening modalities (face-to-face vs tele-supported screening [screening followed by transfer and remote grading of images by ophthalmologists] vs artificial intelligence [AI]-supported screening) and target population groups for screening.</p><p><strong>Methods: </strong>A mathematical model comprising a decision tree and Markov model was developed. An extensive review of published literature was undertaken to obtain model parameters. Primary data collection was done to derive quality-of-life values. We used a lifetime horizon, abridged societal perspective, and discounted future costs and consequences at an annual rate of 3%. The incremental cost-effectiveness ratio (ICER) was computed for alternative screening strategies. A willingness-to-pay equal to gross domestic product per capita equal to ₹171,498 (US$2182) was used to determine the cost-effective choice. Sensitivity analyses were performed to assess the impact of variation in input parameters on the ICER values.</p><p><strong>Results: </strong>All the annual screening strategies were found to have lower ICERs relative to usual care. Among the screening strategies, annual tele-supported screening in the population with diabetes duration ≥5 years was the most cost-effective strategy with an ICER value of ₹57,408 (US$730) per quality-adjusted life year (QALY) gained. At the national level, this strategy is likely to reduce the annual incidence of vision-threatening DR and blindness by 17.3%, and 38.5%, respectively, and would result in higher benefits in Indian states with higher epidemiological transition. Sensitivity analyses showed that if adequate glycaemic control is achieved in 79% of the diabetic population, annual AI-supported screening in individuals with a diabetes' duration of 10 years or more becomes the most cost-effective strategy.</p><p><strong>Conclusion: </strong>The results of the study suggest the prioritization of an annual tele-supported DR screening programme in India. They also highlight the importance of the adoption of an integrated approach and functional linkage between eye care and diabetes care, to intensify efforts directed at improving glycaemic control, and to facilitate early DR detection and management.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Using Conditional Economic Incentives to Improve Pre-exposure Prophylaxis Adherence Among Male Sex Workers.","authors":"Carlos Chivardi, Alejandro Zamudio-Sosa, Marta Wilson-Barthes, Fernando Alarid-Escudero, Monica Gandhi, Kenneth H Mayer, Don Operario, Omar Galárraga","doi":"10.1007/s41669-025-00569-z","DOIUrl":"https://doi.org/10.1007/s41669-025-00569-z","url":null,"abstract":"<p><strong>Introduction: </strong>Conditional economic incentives can improve medication-taking behaviors among populations at risk of contracting human immunodeficiency virus (HIV). However, there are no data on the cost-effectiveness of incentive programs for improving pre-exposure prophylaxis (PrEP) adherence among male sex workers (MSWs) who have one of the highest HIV acquisition rates. Our objective was to assess the cost-effectiveness of incentive programs to improve adherence to pre-exposure prophylaxis (PrEP) among male sex workers METHODS: We conducted an economic evaluation of the PrEP Seguro randomized pilot trial in Mexico (ClinicalTrials.gov: NCT03674983). Among n = 110 MSWs, those randomized to the intervention received tiered incentives based on PrEP drug levels in scalp hair measured at three clinic visits over 6 months. The intervention led to a 28.7% increase in scalp hair PrEP concentration, consistent with increased adherence (p = 0.05). Here we use a micro-costing approach from the health system perspective to calculate costs. Quality-adjusted life years (QALYs) were estimated from the number of HIV infections averted through sufficient PrEP adherence (tenofovir concentration > 0.011 ng/mg corresponding to greater than or equal to three weekly doses). Incremental cost-effectiveness ratios (ICERs) estimated the cost/QALY gained owing to the intervention.</p><p><strong>Results: </strong>The mean cost per patient was US $165.53 and $179.55 among standard care and incentive patients, respectively. Over 6 months of follow-up, 62% of standard care patients and 78% of incentive recipients were PrEP adherent. After the program, the lifetime average QALYs gained per infection avoided were 9.17 (minimum, maximum: 7.5, 10.8) and 9.84 (minimum, maximum: 8.05, 11.6) among standard care and incentive patients, respectively. The 6-month ICER was US $20.92/QALY gained by the intervention, which was highly cost-effective at a willingness-to-pay of US $8655 (Mexico's 2020 per capita gross domestic product (GDP)).</p><p><strong>Discussion: </strong>Using behavioral economics approaches for enhancing adherence to HIV prevention may offer health and fiscal benefits through reduced HIV incidence. Fully powered implementation trials can determine future cost-effectiveness of scaling up incentives for PrEP adherence among high-risk populations.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring the Socioeconomic Impact of Cancer: A Systematic Review and Standardized Assessment of Patient-Reported Outcomes (PRO) Instruments.","authors":"Phu Duy Pham, Jasper Ubels, Rachel Eckford, Michael Schlander","doi":"10.1007/s41669-025-00568-0","DOIUrl":"https://doi.org/10.1007/s41669-025-00568-0","url":null,"abstract":"<p><strong>Background: </strong>A number of instruments have been developed to measure the socioeconomic impact (SEI) of cancer. A standardized comparison of the quality and content validity of these instruments is lacking. This study aimed to (1) conduct a standardized assessment of the quality of SEI instruments and (2) assess the content validity of these instruments using the conceptual framework developed by the Organization of European Cancer Institutes (OECI) for SEI analysis.</p><p><strong>Method: </strong>We identified articles measuring the SEI of cancer with ad hoc and/or validated instruments from an existing database. These articles were the initial pearls in a systematic review of published articles that applied and validated these instruments using the pearl-growing search strategy in PubMed, Web of Science, and Google Scholar databases. The Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool was utilized to provide quantitative assessment and comparison of the quality of identified instruments. To examine content validity, we allocated each instrument's items against the themes and sub-themes of the established conceptual framework for SEI analysis.</p><p><strong>Results: </strong>We identified and investigated 21 validation studies using nine original instruments. The number of articles varied significantly among the identified instruments. The COmprehensive Score for financial Toxicity (COST) instrument was the most frequently used, validated in ten different settings, whereas some newer instruments have not been applied yet. This variation resulted in significant differences in EMPRO overall scores among these instruments. Regarding content validity, we found that not all themes of the OECI framework were covered by the content of the instruments.</p><p><strong>Conclusion: </strong>The quality and the application of instruments measuring the SEI of cancer varied significantly. The content of the instruments seems not to cover all related themes of the applied OECI framework in this study. Further studies are warranted to confirm the quality and content validity of the instruments measuring the SEI of cancer.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Benefit Analysis of the Enhancing Men's Awareness of Testicular diseases (E-MAT) Feasibility Trial: A Virtual Reality Experience to Increase Testicular Knowledge and Self-Examination among Male Athletes.","authors":"Aileen Murphy, Ann Kirby, Federica De Blasio, Megan McCarthy, Frances Shiely, Josephine Hegarty, Martin P Davoren, Janas M Harrington, Gillian W Shorter, David Murphy, Billy O'Mahony, Eoghan Cooke, Michael J Rovito, Steve Robertson, Serena FitzGerald, Alan O Connor, Mícheál O Riordan, Mohamad M Saab","doi":"10.1007/s41669-025-00571-5","DOIUrl":"https://doi.org/10.1007/s41669-025-00571-5","url":null,"abstract":"<p><strong>Background: </strong>Virtual reality (VR) is potentially effective in raising awareness of testicular diseases, promoting self-examination and early help-seeking among men. This paper presents an early economic evaluation exploring the potential cost-effectiveness of Enhancing Men's Awareness of Testicular diseases (E-MAT)_VR, a VR interactive experience compared with E-MAT_E, electronic information, among male athletes Results from this economic evaluation will inform and support the design of a future randomized controlled trial (RCT).</p><p><strong>Methods: </strong>Results from an Irish feasibility trial (ClinicalTrials.gov identifier: NCT05146466) with 74 participants conducted in 2022 were employed. Benefits were measured in monetary units whereby the contingent valuation method was used to elicit participants' preferences through willingness-to-pay measures. A micro-cost analysis estimated the costs of the intervention and comparator and subsequent resource use. The costs and benefits of E-MAT_VR and E-MAT_E were compared to determine the net benefit. Sensitivity analyses were also conducted.</p><p><strong>Results: </strong>Base case analysis suggests participants were willing to pay €21.88 for E-MAT_VR and €11.16 for E-MAT_E. The total cost of E-MAT_VR was €104.09 and of E-MAT_E was €22.75 per participant. These estimates include capital and delivery costs, of which delivery costs were €25.02 and €22.40 for E-MAT_VR and E-MAT_E, respectively. A negative net benefit indicates E-MAT_VR was not cost-beneficial as delivered in the feasibility trial. Scenario analyses demonstrated reducing costs via delivery modifications increased the probability of E-MAT_VR being considered cost-effective. The cost-benefit analysis was feasible, response rates were acceptable, and willingness-to-pay estimates were stable.</p><p><strong>Conclusions: </strong>Economic evaluations alongside feasibility trials enable early economic evaluations, informing the design and conduct of a future RCT. E-MAT_VR had higher expected benefits (WTP) and costs than E-MAT_E, yielding a negative net benefit. Given the high cost of digital health interventions, investigating their cost-effectiveness early is important to inform and optimize resource allocation decisions. We present a series of scenarios to demonstrate how delivery modifications to reduce costs could improve the likelihood of E-MAT_VR being considered cost-effective.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Generic Entry on Market Shares and Prices of Originator Drugs: Evidence from Chinese Pharmaceutical Market.","authors":"Weimiao Li, Xiaoyu Li, Yaoguang He, Luwen Shi, Jing Chen","doi":"10.1007/s41669-025-00570-6","DOIUrl":"https://doi.org/10.1007/s41669-025-00570-6","url":null,"abstract":"<p><strong>Objectives: </strong>This article analyzes how market shares and prices for brand-name drugs are affected by generic competition in China.</p><p><strong>Methods: </strong>Data were collected for originator drugs that experienced initial generic entry between 2006 and 2016 from China Medicine Economic Information (CMEI), a large database of drug procurement records covering 699 tertiary hospitals across 28 provinces in mainland China. Quarterly utilization and expenditure data were collected. We compared the change of market share and price of originator drugs eight quarters after the first generic entry. General linear regression was performed to analyze the factors that influence the market share and price of originator drugs.</p><p><strong>Results: </strong>A total of 15 of 27 originator drugs maintained over 70% market share eight quarters after the first generic entry. In addition, 24 brand-name companies lowered prices with an average price decrease of 3% eight quarters after the first generic competitor appeared; prices for 3 drugs rose by an average of 0.62%. The median price ratio between originator and generic drugs was 1.76 when the first generic substitution entered, and the ratio became 2.00 eight quarters later. Regression showed that the number of generic manufacturers and time interval since the first generic entry exhibited a negative relation with the market share of originator drugs (P < 0.01; P < 0.01), and no relation with the prices of originator drugs (P = 0.61; P = 0.42).</p><p><strong>Conclusions: </strong>Generic medicines in China had only modest market penetration and little effect on originator drugs' prices eight quarters after first generic entry.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Expenditure Trajectories in the Last 5 Years of Life: A Retrospective Cohort Study of Decedents with Advanced Cancer and End-Stage Organ Diseases.","authors":"Sheryl Hui-Xian Ng, Palvinder Kaur, Laurence Lean Chin Tan, Mervyn Yong Hwang Koh, Andy Hau Yan Ho, Allyn Hum, Woan Shin Tan","doi":"10.1007/s41669-025-00573-3","DOIUrl":"https://doi.org/10.1007/s41669-025-00573-3","url":null,"abstract":"<p><strong>Background: </strong>Patients with nonmalignant end-stage organ diseases often incur healthcare costs in the last year of life that are disproportionately higher than in the period prior. Studies on healthcare expenditure (HCE) trends in these patients have largely focused on the final year of life, and examining a longer-term trajectory could better support healthcare professionals to target the timing and methods of care management. In this study, we aim to describe the HCE trajectories of end-stage organ disease (ESOD) over the last 5 years of life, compared against advanced cancer (AC).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study to profile decedents who had either a primary or secondary diagnosis of AC, advanced dementia, severe liver disease, as well as heart failure (HF), end-stage renal failure (ESRF), or respiratory failure (RF) in the last 5 years of their lives using a regional health system database in Singapore. Hospital-based HCE and utilization for each diagnosis group was reported cumulatively for 5 years, by year and by month. The proportion of the 5-year HCE incurred in each year was also reported.</p><p><strong>Results: </strong>Across all conditions, monthly HCE started to increase rapidly around 3 years prior to death, with 80% of the 5-year expenditure incurred in the same period. Expenditure among patients with ESODs other than dementia was £12,787 to £21,019 higher in comparison with patients with AC. Patients with RF incurred the highest 5-year HCE, driven by inpatient admissions.</p><p><strong>Conclusions: </strong>Our findings highlight the importance of examining HCE trends in ESOD and their cost drivers over multiple years prior to the last year of life to inform healthcare policy and to review care processes to ensure appropriate and efficient end-of-life (EOL) care.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Utility Analysis of LifeVest® in Post-Myocardial Infarction Patients at Risk of Sudden Cardiac Death in England.","authors":"Vasileios Kontogiannis, Farai Goromonzi, Brigitte Both, Frank Semrau, Michael Branagan-Harris, Jowan Atkinson, Paul R Roberts, Mehdi Javanbakht","doi":"10.1007/s41669-024-00553-z","DOIUrl":"10.1007/s41669-024-00553-z","url":null,"abstract":"<p><strong>Background: </strong>Patients with a left ventricular ejection fraction ≤ 35% are at increased risk of sudden cardiac death (SCD) within the first months after a myocardial infarction (MI). The wearable cardioverter defibrillator (WCD) is an established, safe and effective solution which can protect patients from SCD during the first months after an MI, when the risk of SCD is at its peak. This study aimed to evaluate the cost-effectiveness of WCD combined with guideline-directed medical therapy (GDMT) compared to GDMT alone, after MI in the English National Health Service (NHS).</p><p><strong>Methods: </strong>A multi-state Markov model, with a hypothetical cohort of 1000 patients, was developed to evaluate WCD + GDMT compared with GDMT alone, over a lifetime time horizon. Model input parameters were obtained from the pivotal randomised controlled trial and literature. The outcomes were costs and quality-adjusted life-years (QALYs), discounted at 3.5% annually, with overall results presented as an incremental cost-effectiveness ratio (ICER).</p><p><strong>Results: </strong>The cost-effectiveness analysis demonstrated that WCD + GDMT is potentially a cost-effective option with an ICER of £23,024 per QALY gained, which is in the acceptable willingness to pay threshold (WTP) range of £20,000-£30,000 set by the National Institute for Health and Care Excellence (NICE) in England. Results of probabilistic sensitivity analysis (PSA) indicated that WCD + GDMT has 89.3% and 23% probability of being cost-effective at WTP thresholds of £30,000 and £20,000, respectively.</p><p><strong>Conclusions: </strong>Implementation of WCD in patients post-MI is potentially a cost-effective use of resources for the NHS and improves clinical outcomes amongst adherent patients and in circumstances where implantable cardioverter defibrillators are not indicated by the guidelines.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":"301-312"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-Economic Modelling of Improved Behavior in Insulin Injection Technique in Belgium.","authors":"Kristof Theys, Sofie Vermander, Lieven Annemans, Christophe De Block, Michel P Hermans, Imke Matthys, Frank Nobels, Trung Nguyen, Vanessa Preumont, Katerina Zakrzewska, Frank Vanderdonck","doi":"10.1007/s41669-024-00547-x","DOIUrl":"10.1007/s41669-024-00547-x","url":null,"abstract":"<p><strong>Background: </strong>Adequate insulin injection technique (IIT) is crucial to optimize the efficacy of diabetes therapy. Widespread non-practice of injection-site rotation and frequent reuse of insulin pen needles (PN) promote high rates of lipohypertrophy (LH) among people living with diabetes (PwD). LH is associated with increased insulin requirement and suboptimal insulin absorption leading to worsened glycemic control and increased risk for hypoglycemia. Avoiding out-of-the-pocket patient costs of PN could reduce PN reuse, thereby limiting its contribution to LH occurrence.</p><p><strong>Objectives: </strong>A model was developed to compute the impact of a behavior shift in reuse on clinical and economic outcomes for type 1 and insulin-treated type 2 diabetes populations in Belgium.</p><p><strong>Methods: </strong>Patient populations were characterized by treatment-specific characteristics and grouped by their frequency of PN replacement. The intervention was modelled to cause a change in reuse frequency, with the effects propagating downstream of the model. Model and input parameters were based on literature research and expert opinions from a Delphi panel, since available data was found to be limited, incomplete or inconsistent and assumptions were needed.</p><p><strong>Results: </strong>Using the current situation as comparator, this analysis showed a reduction of healthcare expenditures following an improvement in IIT. Considering a 5-year time horizon, this study yields potential savings of 52.6 million euros (28.1-77.9 million euros) when 55% of PwD improve PN reuse behavior.</p><p><strong>Conclusion: </strong>Our model shows that even in an era of technological advances and established diabetes care, lack of adherence to correct IIT has an important impact on economic and health outcomes of PwD in Belgium.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":"259-270"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}