Value in health regional issues最新文献

{"title":"Breast Cancer Screening Using Clinical Breast Examination: A Cost-Effectiveness Analysis for South Africa","authors":"Sithabiso D. Masuku MSc ,&nbsp;Olena Mandrik PhD ,&nbsp;Noreen D. Mdege PhD ,&nbsp;Gauravi Mishra MD ,&nbsp;Richard Muwonge PhD ,&nbsp;Gesine Meyer-Rath PhD ,&nbsp;Naomi Lince-Deroche PhD ,&nbsp;Alan Brennan PhD","doi":"10.1016/j.vhri.2025.101127","DOIUrl":"10.1016/j.vhri.2025.101127","url":null,"abstract":"<div><h3>Objectives</h3><div>The World Health Organization emphasizes screening and early diagnosis to reduce advanced cancer incidence and mortality. In low-to-middle-income countries, breast cancer (BC) survival rates are low because of late detection. South Africa’s policy recommends twice-yearly clinical breast examinations (CBEs) for asymptomatic women aged 40 to 69. We assessed the impact of scaling up CBE screening on mortality and cost-effectiveness.</div></div><div><h3>Methods</h3><div>Using trial data on downstaging, we compared the current baseline (5% coverage) with scenario 1 (25% coverage by year 5 [ie, 5% increase annually]) and scenario 2 (75% coverage by year 5, [ie, 17.5% increase annually]). A cohort model tracked women from screening to diagnosis, estimating downstaging’s impact on BC cases over their lifetime. Costs from the healthcare payer’s perspective are presented in 2022 US dollars.</div></div><div><h3>Results</h3><div>Five-year screen detection rates were 2.39 and 2.08 per 1000 women screened for scenarios 1 and 2, respectively. Scenario 1 reduced BC mortality by 0.7% and scenario 2 by 2.3%. Compared with no screening, the current baseline screening program averts 1645 disability-adjusted life years (DALYs) at $20 341/DALY averted. Scenario 1 averted 3823 DALYs with economic efficiency improving to $17 776/DALY averted, whereas scenario 2 averted 12 165 DALYs at $19 552/DALY averted.</div></div><div><h3>Conclusions</h3><div>CBE scale-up effectively saves life years but is not cost-effective under the country’s opportunity cost-derived threshold of $3015/DALY averted. However, decisions on the best screening policy are not solely based on cost-effectiveness. They involve careful consideration of budgetary constraints and competing healthcare priorities. Scale-up should consider system capacity, minimum care standards and cost-effective early detection strategies.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"49 ","pages":"Article 101127"},"PeriodicalIF":1.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154510","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":"Evaluating the Cost-Effectiveness of Pharmacological Therapy in Alzheimer Disease in Brazil","authors":"Price Udo Price PhD ,&nbsp;Robert Heggie PhD ,&nbsp;Julio Cesar Moriguti PhD ,&nbsp;Leonardo Regis Leira Pereira PhD","doi":"10.1016/j.vhri.2025.101130","DOIUrl":"10.1016/j.vhri.2025.101130","url":null,"abstract":"<div><h3>Objectives</h3><div>Alzheimer disease (AD) is a worsening neurodegenerative disorder and the leading cause of dementia, accounting for 60% to 70% of cases. It contributes significantly to disability, caregiver reliance, and is the eighth leading cause of death. AD is one of the most expensive diseases to treat, creating an economic burden for the healthcare system and families of patients. Dementia care costs in Brazil are projected to reach $49.2 billion by 2030, $63.5 billion by 2040, and $77.3 billion by 2050. This study evaluated the cost-effectiveness of acetylcholinesterase inhibitors (standard of care [SoC]) in slowing disease progression compared with no pharmacological therapy (best supportive care [BSC]), lecanemab, and donanemab in mild AD patients.</div></div><div><h3>Methods</h3><div>We developed a decision-analytic model to simulate AD progression, using cost and health utility data specific to Brazil, supplemented with data from the literature when necessary. The model covers a 20-year horizon from both the Brazilian national healthcare system and societal perspectives. Costs and quality-adjusted life years (QALYs) were discounted at 3.5% per year to reflect their present value. Costs in local currencies were converted to US dollars (US$) and inflation-adjusted to 2024 values.</div></div><div><h3>Results</h3><div>In the base-case analysis from the healthcare perspective, SoC was more clinically effective than BSC with a cost per QALY of $5211. For lecanemab versus SoC, the cost per QALY gained was $2 098 225, whereas donanemab versus lecanemab was $1 460 400.</div></div><div><h3>Conclusions</h3><div>The SoC is a cost-effective pharmacological intervention for AD, offering the lowest cost per QALY gains over a 20-year period.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"49 ","pages":"Article 101130"},"PeriodicalIF":1.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154511","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 20-Valent Pneumococcal Conjugate Vaccine in Adults Aged ≥18 Years in Singapore","authors":"Jingwen Zhang PhD ,&nbsp;Jeffrey Vietri PhD ,&nbsp;Ahuva Averin MPP ,&nbsp;Dhwani Hariharan PhD ,&nbsp;Mark Atwood MS ,&nbsp;Liping Huang MD","doi":"10.1016/j.vhri.2025.101136","DOIUrl":"10.1016/j.vhri.2025.101136","url":null,"abstract":"<div><h3>Objectives</h3><div>The Singapore Ministry of Health recommends vaccination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults aged 18 to 64 years with chronic medical conditions (“at risk”), 13-valent pneumococcal conjugate vaccine (PCV13) followed by PPSV23 (PCV13 → PPSV23) with PPSV23 revaccination in adults aged 18 to 64 years with immunocompromising conditions (“high risk”), and PCV13 → PPSV23 in all adults aged ≥65 years. We conducted a cost-effectiveness analysis of the newly licensed 20-valent PCV (PCV20) versus current recommendations.</div></div><div><h3>Methods</h3><div>Risks and costs of invasive pneumococcal disease, all-cause nonbacteremic pneumonia, and the expected impact of vaccination were projected over a lifetime modeling horizon using a probabilistic cohort model. Model inputs were based on local data, as available. Cost per quality-adjusted life year (QALY) gained with PCV20 (vs current recommendations) was assessed overall and among subgroups of the target population from a healthcare system perspective (discounting, 3%/year). Sensitivity analyses were also conducted.</div></div><div><h3>Results</h3><div>PCV20 was estimated to reduce invasive pneumococcal disease cases by 41, nonbacteremic pneumonia cases by 4335, and deaths by 196 among the model population (<em>N</em> = 1.6M). Net costs (vaccination + medical) and QALYs increased by S$0.3 million and 2693, respectively, yielding a cost/QALY of S$105 for PCV20. PCV20 was dominant among high-risk adults aged 18 to 64 years and all adults 65 to 99 years; among at-risk adults aged 18 to 64 years, cost/QALY for PCV20 was S$2081. PCV20 remained cost saving or highly cost-effective in sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>Cost-effectiveness analysis suggests use of PCV20—in lieu of current Singapore Ministry of Health recommendations for adult pneumococcal vaccination—would represent a cost-effective use of scarce healthcare resources.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"49 ","pages":"Article 101136"},"PeriodicalIF":1.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116911","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 an Enhanced Patient Care Intervention for Improving Viral Suppression Among Kenyan Adults Living With HIV","authors":"Jenna Fritz MPH ,&nbsp;Juddy Wachira PhD ,&nbsp;Marta Wilson-Barthes MSPH ,&nbsp;Catherine Kafu PhD ,&nbsp;Diana Chemtai BS ,&nbsp;Becky Genberg PhD ,&nbsp;Omar Galárraga PhD","doi":"10.1016/j.vhri.2025.101129","DOIUrl":"10.1016/j.vhri.2025.101129","url":null,"abstract":"<div><h3>Objectives</h3><div>Patient-centered interventions can improve care engagement and treatment adherence for people living with HIV (PLWH). Yet, evidence on their cost-effectiveness remains sparse, hindering their prioritization over alternative models. This study estimated the cost-effectiveness of a patient-centered intervention for improving viral suppression among PLWH in western Kenya.</div></div><div><h3>Methods</h3><div>We analyzed the cost-effectiveness of an enhanced patient-centered (EPC) intervention via a randomized pilot trial among 328 PLWH in 2 rural clinics. The EPC arm included clinician-patient continuity, treatment dialogue, and flexible scheduling. The provider-patient communication (PPC) arm provided training on motivational interviewing. The standard of care arm provided patient-specific interventions to promote viral suppression. Costs were aggregated across the 2 clinics and measured from a societal perspective, including patient time, transportation, and medication. The incremental cost per disability-adjusted life year averted was calculated based on patient virologic failure risk, HIV transmissions averted, and life expectancy. Key parameters were varied by ±25% to examine uncertainty in incremental cost-effectiveness ratios.</div></div><div><h3>Results</h3><div>Compared with standard HIV care, both the EPC intervention and PPC training alone were more cost-effective at various willingness-to-pay thresholds. Providing PPC training alone was the dominant strategy (more effective and less costly) compared with the EPC intervention at $97.72 per HIV infection averted and $4.44 per disability-adjusted life year averted. Both interventions were cost savings when factoring in lifetime HIV treatment cost averted.</div></div><div><h3>Conclusions</h3><div>Patient-centered care models may be highly cost-effective for improving treatment outcomes among PLWH. These encouraging results warrant further testing in fully powered clinical trials.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"49 ","pages":"Article 101129"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105620","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":"Erratum to ‘Cost-Utility Analysis and Efficiency Frontier of Drugs Available in Brazil for the Treatment of Relapsing-Remitting Multiple Sclerosis’","authors":"","doi":"10.1016/j.vhri.2025.101141","DOIUrl":"10.1016/j.vhri.2025.101141","url":null,"abstract":"","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"48 ","pages":"Article 101141"},"PeriodicalIF":1.4,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090384","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":"Author Reply: Savings Through Telemedicine: Initial Data From a Hospital-at-Home Program","authors":"Angus Jun Jie Ng BSc ,&nbsp;Chong Yau Ong MMed","doi":"10.1016/j.vhri.2025.101134","DOIUrl":"10.1016/j.vhri.2025.101134","url":null,"abstract":"","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"49 ","pages":"Article 101134"},"PeriodicalIF":1.4,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071806","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":"Comment on “Savings Through Telemedicine”: Addressing Hidden Costs and Quality Concerns","authors":"Baifeng Zheng BS","doi":"10.1016/j.vhri.2025.101135","DOIUrl":"10.1016/j.vhri.2025.101135","url":null,"abstract":"","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"49 ","pages":"Article 101135"},"PeriodicalIF":1.4,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071798","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":"Health-Related Quality of Life in Patients With Alzheimer Disease in Malaysia: Evidence from EQ-5D and QOL-AD","authors":"Lyn Xuan Tay PhD ,&nbsp;Siew Chin Ong PhD ,&nbsp;Hui Ming Ong MRCP ,&nbsp;Ewe Eow Teh MMed ,&nbsp;Alan Swee Hock Ch’ng MMed ,&nbsp;Ing Khieng Tiong MRCP ,&nbsp;Rizah Mazzuin Razali MIntMed ,&nbsp;Thaigarajan Parumasivam PhD","doi":"10.1016/j.vhri.2025.101122","DOIUrl":"10.1016/j.vhri.2025.101122","url":null,"abstract":"<div><h3>Objectives</h3><div>There were only a few studies that assessed health-related quality of life (HRQoL) of patients with Alzheimer disease (AD) in Malaysia. This cross-sectional study was to investigate the HRQoL scores of patients with AD in Malaysia using 2 HRQoL instruments and to identify predictors of patients’ HRQoL.</div></div><div><h3>Methods</h3><div>Informal caregivers of patients with AD were recruited in 4 tertiary hospitals during outpatient visits. Patients’ HRQoL was assessed using proxy-rated generic (EQ-5D-5L and EQ-VAS), and disease-specific (Quality-of-life Alzheimer’s Disease [QoL-AD]) assessment instruments were utilized to obtain proxy HRQoL scores of patients with AD from caregivers via structured interviews. The difference between HRQoL scores and other variables was tested using analysis of variance. Pearson correlation test was conducted between the 2 instruments, whereas a multivariable linear regression model was utilized to identify predictors of HRQoL in patients with AD.</div></div><div><h3>Results</h3><div>The mean EQ-5D-5L index, EQ-VAS, and QoL-AD score of patients with AD were 0.63 ± 0.30, 61.05 ± 20.48, and 26.69 ± 6.83, respectively, via proxy ratings. In terms of correlation, EQ-5D was weakly correlated with QoL-AD (r = 0.36, <em>P</em> &lt; .01). EQ-5D index and QoL-AD score reduced significantly as AD advanced (<em>P</em> &lt; .05). Besides, cognitive decline, presence of behavioral symptoms, female caregiver gender, and nonmarried status were associated with lower patients’ HRQoL in multivariable models with EQ-5D index (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Low HRQoL of patients with AD requires attention from healthcare providers and stakeholders in optimal resource allocation and decision making. Such health utility values are useful in future economic evaluations in investigating the cost-effectiveness of new interventions or disease-modifying therapies.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"48 ","pages":"Article 101122"},"PeriodicalIF":1.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071747","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":"Making the Investment Case for Mental Health in Low- and Middle-Income Countries","authors":"Dan Chisholm PhD ,&nbsp;Yong Yi Lee PhD ,&nbsp;Filip Meheus PhD ,&nbsp;Alexey Kulikov MD, PhD","doi":"10.1016/j.vhri.2025.101132","DOIUrl":"10.1016/j.vhri.2025.101132","url":null,"abstract":"","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"48 ","pages":"Article 101132"},"PeriodicalIF":1.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068194","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":"Lifetime Cost-Effectiveness of Using the Chinese Diabetes Risk Score for Prediabetes Screening in China","authors":"Song Li MB ,&nbsp;Jingjing Hao MSc ,&nbsp;Zhicheng Su MB ,&nbsp;Haichang Chen MB ,&nbsp;Zhaoyan Chen MSc ,&nbsp;Qiang Yao PhD ,&nbsp;Cairong Zhu PhD","doi":"10.1016/j.vhri.2025.101124","DOIUrl":"10.1016/j.vhri.2025.101124","url":null,"abstract":"<div><h3>Objectives</h3><div>To more comprehensively evaluate the lifetime cost-effectiveness of different prediabetes screening strategies based on the Chinese Diabetes Risk Score (CDRS) from a societal perspective and to explore the impact of different CDRS cutoff values on the evaluation.</div></div><div><h3>Methods</h3><div>A Markov model encompassing the complete natural history of type 2 diabetes was developed to compare costs, cumulative prevalence of type 2 diabetes complications, mortality rates, and quality-adjusted life years of 3 screening strategies: (1) the control group, the current screening strategy; (2) strategy 1, CDRS screening for all adults; and (3) strategy 2, supplemental CDRS screening for adults without annual health checkups. It was assumed that the individual exited the model upon reaching 80 years old or death in the model. The robustness of results was assessed through sensitivity analyses.</div></div><div><h3>Results</h3><div>Compared with the control group and strategy 2, strategy 1 saved $583.07 and $233.12 per capita, respectively, reduced the cumulative prevalence of type 2 diabetes complications by 8.47% and 1.64%, respectively, reduced mortality rates by 1.47% and 0.25%, respectively, and increased quality-adjusted life years by 0.07 and 0.01 per capita, respectively. At the cutoff value of 24, strategy 1 achieved the lowest cost and the highest health benefits.</div></div><div><h3>Conclusions</h3><div>Compared with the control group and strategy 2, strategy 1—implementing prediabetes screening in all adults via CDRS—was absolutely dominant when modeling the complete natural history of diabetes. The CDRS screening strategies demonstrated better cost-effectiveness when the cutoff value was set at 24.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"49 ","pages":"Article 101124"},"PeriodicalIF":1.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068064","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}