Value in health regional issues最新文献

{"title":"Cost-Effectiveness of Comprehensive Genomic Profiling in Patients With Non–Small Cell Lung Cancer for the Colombian Health System","authors":"Oscar Gamboa MD, MSc ,&nbsp;Carlos Eduardo Bonilla MD ,&nbsp;David Quitian MSc ,&nbsp;Gabriel Fernando Torres MD, MSc ,&nbsp;Giancarlo Buitrago MD, MSc, PhD ,&nbsp;Andrés F. Cardona MD, MSc, PhD, MBA","doi":"10.1016/j.vhri.2023.08.006","DOIUrl":"https://doi.org/10.1016/j.vhri.2023.08.006","url":null,"abstract":"<div><h3>Introduction</h3><p>The use of comprehensive genomic profiling (CGP) and target therapies is associated with substantial improvements in clinical outcomes among patients with non–small cell lung cancer (NSCLC). However, the costs of CGP may increase the financial pressures of NSCLC on health systems worldwide, especially in low- and middle-income countries. This study aimed to estimate the cost-effectiveness of CGP compared with current genomic tests in patients with NSCLC from the perspective of the Colombian Health System.</p></div><div><h3>Methods</h3><p>To estimate the costs and benefits of CGP and its comparators, we developed a 2-stage cohort model with a lifetime horizon. In the first stage, we made up a decision tree that calculated the probability of receiving each therapy as result of identifying a specific, actionable target. In the second stage, we developed a partitioned survival model that estimated the time spent at each health state. Incremental cost-effectiveness ratios were calculated for life-years (LYs) and quality-adjusted LYs gained. All costs were expressed in 2019 international dollars (INT$).</p></div><div><h3>Results</h3><p>CGP is associated with gains of 0.06 LYs and 0.04 quality-adjusted LYs compared with current genomic tests. Incremental cost-effectiveness ratios for CGP ranged from INT$861 to INT$7848, depending on the outcome and the comparator. Sensitivity analyses show that the cost-effectiveness decision was sensitive to prices of CGP above INT$7170 per test. These results are robust to most deterministic and probabilistic sensitivity analyses.</p></div><div><h3>Conclusions</h3><p>CGP may be cost-effective in patients with NSCLC from the perspective of the Colombian Health System (societal willingness-to-pay threshold of INT$15 630 to INT$46 890).</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"39 ","pages":"Pages 115-125"},"PeriodicalIF":2.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212109923000833/pdfft?md5=2525e36a2908ad4c914d869b62f44145&pid=1-s2.0-S2212109923000833-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138657140","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":"Central America and the Dominican Republic at Crossroads: The Importance of Regional Cooperation and Health Economic Research to Address Current Health Challenges","authors":"Jose Miranda PhD ,&nbsp;Oscar Morales Barahona PhD ,&nbsp;Alejandro Barahona Krüger MSc ,&nbsp;Pilar Lagos MSc ,&nbsp;Rodrigo Moreno-Serra PhD","doi":"10.1016/j.vhri.2023.11.001","DOIUrl":"https://doi.org/10.1016/j.vhri.2023.11.001","url":null,"abstract":"<div><h3>Objectives</h3><p>We discuss key health challenges currently faced by countries in the Central America and Dominican Republic region after the COVID-19 pandemic. We highlight the influence of socioeconomic determinants for the challenging public health dynamics observed and the crucial roles that regional cooperation and health economic research can have for tackling such challenges.</p></div><div><h3>Methods</h3><p>We present a descriptive overview of the current situation of public finances and its effect on government capacity to improve social expenditure. We also discuss the impact of the COVID-19 pandemic crisis on social dynamics and living conditions in the region.</p></div><div><h3>Results</h3><p>Our analysis suggests that the interplay between all these factors is likely to have important consequences for health systems and population health in the post-pandemic period. Previous examples of successful cross-country cooperation in the region indicate the great potential that these initiatives have for supporting health system resilience against current challenges. Technical cooperation must be informed by (currently unavailable) research evidence that can guide decision making, especially health economic research to support national health resource allocation policies. Areas identified as priorities for applied health economic research include both macro and microeconomic analyses.</p></div><div><h3>Conclusions</h3><p>Central America and the Dominican Republic face significant health challenges post-pandemic. Our article emphasizes the great potential that regional technical cooperation, informed by further health economic research, has to improve public policies and health governance in the region.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"39 ","pages":"Pages 107-114"},"PeriodicalIF":2.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S221210992300122X/pdfft?md5=a09a54c0e13bec7e1b73d4196bd00f7c&pid=1-s2.0-S221210992300122X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138570299","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":"Forging Partnership Between Health Economics Researchers and Policy Makers: Better Methods, Better Policy, Better Health","authors":"Paul Revill MSc ,&nbsp;Manuel A. Espinoza MD, MSc, PhD","doi":"10.1016/j.vhri.2023.11.002","DOIUrl":"https://doi.org/10.1016/j.vhri.2023.11.002","url":null,"abstract":"","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"39 ","pages":"Pages 95-97"},"PeriodicalIF":2.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212109923001231/pdfft?md5=7aece29777c5c25cda6a2cb167ad4019&pid=1-s2.0-S2212109923001231-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138548837","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":"Scoping Review of Health Economics Research on Refugee Health in Sub-Saharan Africa","authors":"Wiktoria Tafesse PhD ,&nbsp;Julie Jemutai PhD ,&nbsp;Chrispus Mayora PhD ,&nbsp;Federica Margini MSc Public Health","doi":"10.1016/j.vhri.2023.10.008","DOIUrl":"https://doi.org/10.1016/j.vhri.2023.10.008","url":null,"abstract":"<div><h3>Objectives</h3><p>Most refugees and internally displaced people (IDP) stay in low- and middle-income settings. A substantial proportion are hosted by countries in sub-Saharan African (SSA), which puts significant pressure on limited government healthcare budgets. As health economics may guide more optimal healthcare decision making, we scope the health economics literature on forcibly displaced populations in SSA to identify the nature and range of health economics evidence.</p></div><div><h3>Methods</h3><p>We conducted a scoping review of peer-reviewed and gray literature in English published from 2000 to 2021. Our search terms comprised a combination of keywords related to refugees, SSA, and health economics. We followed a stepwise methodology consisting of the identification and selection of studies, extraction and charting of data.</p></div><div><h3>Results</h3><p>We identified 29 health economics studies on refugees and IDPs in SSA covering different providers, interventions, and delivery platforms. Twenty-one articles studied the determinants of health, followed by 5 on the supply of healthcare and 2 concerned with economic evaluation and the demand for healthcare, respectively. We found an equal division of articles focusing on refugees and IDPs, as well as by settlement type. Mental health was the most frequently studied health area and Uganda was the most studied destination country.</p></div><div><h3>Conclusions</h3><p>The health economics literature on refugees in SSA remains limited. Our scoping review encourages future research to study a larger variety of healthcare systems and health economic topics such as economic evaluations, health financing and whole health systems to support resource allocation decisions and sustainable long-term solutions.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"39 ","pages":"Pages 98-106"},"PeriodicalIF":2.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212109923001218/pdfft?md5=e5280509f1669d3fcc1b544f2fbb262d&pid=1-s2.0-S2212109923001218-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138549986","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":"A Vulnerability Index for Mitigation and Prevention of Diabetes Growth in India: A Disaggregated Analysis","authors":"Sujata Sujata PhD ,&nbsp;Gayathri B. PhD ,&nbsp;Ramna Thakur PhD","doi":"10.1016/j.vhri.2023.09.009","DOIUrl":"https://doi.org/10.1016/j.vhri.2023.09.009","url":null,"abstract":"<div><h3>Objectives</h3><p>This study aimed to provide a vulnerability index (VI) for identifying vulnerable regions in different states of India, which may serve as a tool for state- and district-level planning for mitigation and prevention of diabetes growth in the country.</p></div><div><h3>Methods</h3><p>Using data on 13 indicators under 4 domains, we generated domain-specific and overall VIs at state (36 states/union territories) and district levels (640 districts) using the percentile ranking method. The association of diabetes with individuals’ socioeconomic status at different levels of regional vulnerability has also been observed through multivariable logistic regression models.</p></div><div><h3>Results</h3><p>On a scale of 0 to 1, there are 13 states with an overall VI of &gt;0.70, of which 5 states are from southern regions of India. A low VI has been achieved by socioeconomically backward states. We observed that prevalence rates and vulnerability levels for most of the top and bottom 11 states are in the same line. District-level analysis showed that the 20 most vulnerable and least vulnerable districts are mostly from coastal and socioeconomically backward states of the country, respectively. Furthermore, logistic regression revealed that rural adults and females are less likely to be diabetic in all vulnerability quartiles. The oldest, Muslims, wealthiest, widowed/deserted/separated, and those with schooling ≤12 years are significantly more likely to be diabetic than their counterparts.</p></div><div><h3>Conclusion</h3><p>The constructed VI is vital for identifying vulnerable areas and planners and policy-makers may use this comprehensive index and domain-specific VIs to prioritize resource allocation.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"40 ","pages":"Pages 89-99"},"PeriodicalIF":2.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138548838","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 Continuous Positive Airway Pressure Therapy Compared With Usual Care for Obstructive Sleep Apnea in the Public Health System in Brazil","authors":"Daniela V. Pachito PhD ,&nbsp;Alan L. Eckeli PhD ,&nbsp;Luciano F. Drager PhD","doi":"10.1016/j.vhri.2023.10.006","DOIUrl":"10.1016/j.vhri.2023.10.006","url":null,"abstract":"<div><h3>Objectives</h3><p>This study aimed to conduct a cost-utility analysis of continuous positive airway pressure (CPAP) therapy compared with usual care as treatment of moderate to severe cases of obstructive sleep apnea (OSA) in Brazil, where decentralized policies of CPAP provision are in place.</p></div><div><h3>Methods</h3><p>Markov cohort model comparing CPAP therapy with usual care, that is, no specific treatment for OSA, for moderate to severe cases was used. The payer perspective from the Unified Health System, Brazil, was adopted. Effectiveness parameters and costs related to health states were informed by literature review. Resource use related to CPAP therapy was defined by specialists and costs informed by recent purchase and leasing contracts. Incremental cost-effectiveness ratios were generated for purchase and leasing contracts to reflect current practices. A conservative willingness-to-pay threshold was set at 1 gross domestic product per capita per quality-adjusted life-year (QALY) (Brazilian reais [BRL] 40 712/QALY). Uncertainties were explored in deterministic and probabilistic sensitivity analyses.</p></div><div><h3>Results</h3><p>Incremental cost-effectiveness ratio for the purchase modality was 8303 BRL/QALY and for leasing 45 192 BRL/QALY. Considering the adopted willingness-to-pay threshold, provision of CPAP by the purchase modality was considered cost-effective but not the leasing modality. The parameter related to the greatest uncertainty was the reduction in the risk of having a stroke attributable to CPAP. Probabilistic analysis confirmed the robustness of results.</p></div><div><h3>Conclusions</h3><p>CPAP therapy is a cost-effective alternative compared with usual care for moderate to severe OSA for the purchase modality. These results should help underpinning the decision making related to a uniform policy of CPAP provision across the country.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"40 ","pages":"Pages 81-88"},"PeriodicalIF":2.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212109923001152/pdfft?md5=4f792c3eb3609947978b28df0890629f&pid=1-s2.0-S2212109923001152-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499486","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":"Revision of Malawi’s Health Benefits Package: A Critical Analysis of Policy Formulation and Implementation","authors":"Emilia Connolly DO, MPH ,&nbsp;Sakshi Mohan MS ,&nbsp;Pakwanja Twea BA ,&nbsp;Thulasoni Msuku MS ,&nbsp;Andreas Kees MS ,&nbsp;Lalit Sharma BA ,&nbsp;Stephanie Heung BA ,&nbsp;Dominic Nkhoma PhD ,&nbsp;Gerald Manthalu PhD","doi":"10.1016/j.vhri.2023.10.007","DOIUrl":"https://doi.org/10.1016/j.vhri.2023.10.007","url":null,"abstract":"<div><h3>Objectives</h3><p>Health benefits packages (HBPs), which define specific health services that can be offered for free or at a reduced cost to fit within public revenues, have been recommended for over 30 years to maximize population health in resource-limited settings. However, there remain gaps in defining and operationalizing HBPs. We propose a combination of design and prioritization methods along with practical strategies to improve the implementation of future iterations of the HBP in Malawi.</p></div><div><h3>Methods</h3><p>For HBP development for Malawi’s Third Health Sector Strategic Plan, we combined cost-effectiveness analysis with a quantitative, consultative multicriteria decision analysis. Throughout the process of development, we documented challenges and opportunities to improve HBP design and application.</p></div><div><h3>Results</h3><p>The primary and secondary HBP included 115 interventions. However, the definition of an HBP is just one step toward focusing limited resources, with functional operationalization as the most critical component. Full implementation of previous HBPs has been limited by challenges in aid coordination with the misalignment of nonfungible vertical donor funding for the HBP without accounting for the complexity and interconnectedness of the health system. Opportunities for improved application include creation of a complementary minimum health service package to guide overall resource inputs through an integrative approach.</p></div><div><h3>Conclusions</h3><p>We believe that expanded participatory HBP methods that consider value, equity, and social considerations, along with a shift to providing integrated health service packages at all levels of care, will improve the efficiency of using scarce resources along the journey to universal health coverage.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"39 ","pages":"Pages 84-94"},"PeriodicalIF":2.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212109923001206/pdfft?md5=841d8919d6713cdd5c482d5313f5bfb0&pid=1-s2.0-S2212109923001206-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138472441","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":"Demands for Intersectoral Actions to Meet Health Challenges in East and Southern Africa and Methods for Their Evaluation","authors":"Francesco Ramponi PhD ,&nbsp;Aloysius Ssennyonjo MSc ,&nbsp;Stephen Banda MSc ,&nbsp;Tom Aliti PhD ,&nbsp;Dominic Nkhoma PhD ,&nbsp;Oliver Kaonga PhD ,&nbsp;Susan Griffin PhD ,&nbsp;Paul Revill MSc ,&nbsp;Edward Kataika MA ,&nbsp;Juliet Nabyonga-Orem PhD","doi":"10.1016/j.vhri.2023.09.001","DOIUrl":"https://doi.org/10.1016/j.vhri.2023.09.001","url":null,"abstract":"<div><h3>Objectives</h3><p>Focusing on the East, Central, and Southern African region, this study examines both regional and country-level initiatives aimed at promoting multisectoral collaboration to improve population health and the methods for their economic evaluation.</p></div><div><h3>Methods</h3><p>We explored the interventions that necessitate cooperation among policymakers from diverse sectors and the mechanisms that facilitate effective collaboration and coordination across these sectors. To gain insights into the demand for multisectoral collaboration in the East, Central, and Southern African region, we presented 3 country briefs, highlighting policy areas and initiatives that have successfully incorporated health-promoting actions from outside the health sector in Zimbabwe, Uganda, and Malawi. Additionally, we showcased initiatives undertaken by the Ministry of Health in each country to foster coordination with national and international stakeholders, along with existing coordination mechanisms established for intersectoral collaboration. Drawing on these examples, we identified the primary challenges in the economic evaluation of multisectoral programs aimed at improving health in the region.</p></div><div><h3>Results</h3><p>We illustrated how decision making in reality differs from the traditional single-sector and single-decision-maker perspective commonly used in cost-effectiveness analyses. To ensure economic evaluations can inform decision making in diverse settings and facilitate regional collaboration, we highlighted 3 fundamental principles: identifying policy objectives, defining the perspective of the analysis, and considering opportunity costs. We emphasized the importance of adopting a flexible and context-specific approach to economic evaluation.</p></div><div><h3>Conclusions</h3><p>Through this work, we contribute to bridging the gap between theory and practice in the context of intersectoral activities aimed at improving health outcomes.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"39 ","pages":"Pages 74-83"},"PeriodicalIF":2.0,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212109923000870/pdfft?md5=ebc240833e7b3e50a02a2c2a55eaf084&pid=1-s2.0-S2212109923000870-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138437814","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":"Breast Cancer Screening in Georgia: Choosing the Most Optimal and Cost-Effective Strategy","authors":"Abyan Irzaldy MD, MSc ,&nbsp;Rema Gvamichava MD, PhD ,&nbsp;Tina Beruchashvili PhD ,&nbsp;Lela Sturua MD, PhD ,&nbsp;Nicolien T. van Ravesteyn PhD ,&nbsp;Harry J. de Koning MD, PhD ,&nbsp;Eveline A.M. Heijnsdijk PhD","doi":"10.1016/j.vhri.2023.09.002","DOIUrl":"10.1016/j.vhri.2023.09.002","url":null,"abstract":"<div><h3>Objectives</h3><p>To define the optimal and cost-effective breast cancer screening strategy for Georgia.</p></div><div><h3>Methods</h3><p>We used the Microsimulation Screening Analysis-Breast (MISCAN-Breast) model that has been adapted to the Georgian situation to evaluate 736 mammography screening strategies varied by interval (biennial and triennial), starting ages (40-60 years), stopping ages (64-84 years), and screening modality (with and without clinical breast examination [CBE]). Quality-adjusted life-years (QALYs) and additional cost (healthcare perspective) compared with no screening per 1000 women were calculated with 3% discount. Major uncertainties (eg, costs) are addressed as sensitivity analyses.</p></div><div><h3>Results</h3><p>Strategies using a combination of mammography and CBE yielded in substantially higher costs with minimal differences in outcomes compared with mammography-only strategies. The current screening strategy, biennial mammography screening from the age of 40 until 70 years with CBE, is close to the frontier line but requires high additional cost given the QALY gains (€16 218/QALY), well above the willingness-to-pay threshold of €12 720. The optimal strategy in Georgia would be triennial mammography-only screening from age 45 to 66 years with an incremental cost-effectiveness ratio of €12 507.</p></div><div><h3>Conclusions</h3><p>Biennial screening strategies are resource-intensive strategies and may not be feasible for Georgia. By switching to triennial mammography-only strategy from the age of 45 until 66 years, it is possible to offer screening to more eligible women while still gaining substantial screening benefits. This is to address capacity issues which is a common barrier for many Eastern European countries.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"39 ","pages":"Pages 66-73"},"PeriodicalIF":2.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212109923000882/pdfft?md5=c5fd1da873e11da76e8d0ecf55fc1e23&pid=1-s2.0-S2212109923000882-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138296125","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":"Cost-Utility Model of Nirmatrelvir/Ritonavir in Brazil: Analysis of a Vaccinated Population","authors":"Ricardo R.A. Fernandes PhD ,&nbsp;Bruno M. Barros MSc ,&nbsp;Milene R. da Costa PhD ,&nbsp;Carlos A.S. Magliano PhD ,&nbsp;Bernardo R. Tura PhD ,&nbsp;Quenia Cristina D. Morais MSc ,&nbsp;Marisa Santos PhD","doi":"10.1016/j.vhri.2023.09.005","DOIUrl":"10.1016/j.vhri.2023.09.005","url":null,"abstract":"<div><h3>Objectives</h3><p>The aim of this study is to conduct a cost-utility analysis of the use of the antiviral nirmatrelvir/ritonavir, applied to a vaccinated Brazilian population against COVID-19, from the perspective of the Brazilian Public Health System (SUS).</p></div><div><h3>Methods</h3><p>A microsimulation model was created with individual-level data and daily cycles, with a 1-year time horizon, to compare the current scenario of standard care with a scenario in which nirmatrelvir/ritonavir is offered to the population. Adults of any age group that received ≥2 doses of the COVID-19 vaccine formed the investigated population. Direct medical costs of the outpatients and inpatients admitted to the ward or intensive care unit were included. The effectiveness of the model was measured in quality-adjusted life-years (QALYs).</p></div><div><h3>Results</h3><p>In all simulations, the use of nirmatrelvir/ritonavir resulted in incremental costs per patient of US dollar (USD)245.86 and incremental effectiveness of 0.009 QALY, over a year. The incremental cost-utility ratio was USD27 220.70/QALY. The relative risk of the vaccinated population was the factor that affected the outcome most, according to the univariate sensitivity analysis. The probabilistic sensitivity analysis resulted in 100% of the simulations being more costly and effective, but that only 4% of them were below the established cost-effectiveness threshold of USD24 000.00/QALY. In the scenario considering only the population over 60 years old and immunosuppressed (of any age), the incremental cost-utility ratio was USD7589.37/QALY.</p></div><div><h3>Conclusions</h3><p>The use of nirmatrelvir/ritonavir in the treatment of COVID-19 in a vaccinated population was cost-effective only for immunosuppressed individuals and people over 60 years of age.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"40 ","pages":"Pages 74-80"},"PeriodicalIF":2.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300180","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}