Value in health regional issues最新文献

{"title":"Health-Related Quality of Life And Economic Analysis of Olanzapine Versus Aprepitant in Preventing Chemotherapy-Induced Nausea and Vomiting in Patients Receiving Highly Emetogenic Chemotherapy in Malaysia","authors":"Nurul Suhaida Badarudin PhD ,&nbsp;Noraida Mohamed Shah PhD ,&nbsp;Nurul Ain Mohd Tahir PhD ,&nbsp;Azmi Nor Mohd Farez Ahmat PhD ,&nbsp;Fuad Ismail MBBS ,&nbsp;Farida Islahudin PhD ,&nbsp;Suhana Yusak MCO ,&nbsp;Syahir Muhammad MBBS ,&nbsp;Kamarun Neasa Begam Mohd Kassim MClinPharm","doi":"10.1016/j.vhri.2024.101028","DOIUrl":"10.1016/j.vhri.2024.101028","url":null,"abstract":"<div><h3>Objectives</h3><p>Olanzapine has been shown to be effective in preventing chemotherapy-induced nausea and vomiting (CINV) after highly emetogenic chemotherapy (HEC); however, there is limited work on the impact of CINV on health-related quality of life (HRQoL) and the comparative cost-effectiveness of CINV prophylaxis in the Malaysian context. Therefore, this study was conducted to determine the HRQoL using EQ-5D-5L and the cost-effectiveness of olanzapine compared with aprepitant for CINV prophylaxis in Malaysia using data from a local study.</p></div><div><h3>Methods</h3><p>Fifty-nine chemo-naive patients receiving either olanzapine or aprepitant were randomly recruited and completed the EQ-5D-5L before and day 5 after HEC. HRQoL utility scores were analyzed according to the Malaysian valuation set. The economic evaluation was conducted from a healthcare payer perspective with a 5-day time horizon. Quality-adjusted life days (QALD) and the rate of successfully treated patients were used to measure health effects. The incremental cost-effectiveness ratio is assessed as the mean difference between groups’ costs per mean difference in health effects. A one-way sensitivity analysis was performed to assess variations that might affect outcomes.</p></div><div><h3>Results</h3><p>Aprepitant and olanzapine arms’ patients had comparable baseline mean HRQoL utility scores of 0.920 (SD = 0.097) and 0.930 (SD = 0.117), respectively; however, on day 5, a significant difference (<em>P</em> value = .006) was observed with mean score of 0.778 (SD = 0.168) for aprepitant and 0.889 (SD = 0.133) for olanzapine. The cost per successfully treated patient in the aprepitant arm was 60 times greater than in the olanzapine arm (Malaysian Ringgit [MYR] 927 vs MYR 14.83). Likewise, the cost per QALD gain in the aprepitant arm was 36 times higher than in the olanzapine arm (MYR 57.05 vs MYR 1.57). Incremental cost-effectiveness ratio of MYR −937.00 (USD −200.98) per successfully treated patient and MYR −391.84 (USD −85.43) per QALD gained for olanzapine compared with the aprepitant-based regimen.</p></div><div><h3>Conclusions</h3><p>An olanzapine-based regimen is a cost-effective therapeutic substitution in patients receiving HEC in Malaysia.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"44 ","pages":"Article 101028"},"PeriodicalIF":1.4,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789130","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":"Societal Preferences in Health Technology Assessments for Rare Diseases and Orphan Drugs: A Systematic Literature Review of New Analytic Approaches","authors":"Paola Vásquez MPH ,&nbsp;Lisa Hall PhD ,&nbsp;Gregory Merlo PhD","doi":"10.1016/j.vhri.2024.101026","DOIUrl":"10.1016/j.vhri.2024.101026","url":null,"abstract":"<div><h3>Objectives</h3><p>This systematic literature review aimed to explore experiences worldwide of societal preferences integration into health technology assessments (HTAs) for rare diseases (RDs) and orphan drugs (ODs) through the implementation of multicriteria decision analysis (MCDA), discrete choice experiments (DCEs), and person trade-off (PTO) methods, among others.</p></div><div><h3>Methods</h3><p>A systematic search of the literature was conducted in April 2021 using PubMed, Cochrane, Embase, and Scopus databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was used for the review phases. Finally, the Promoting Action on Research Implementation in Health Services framework was used to discuss the implementation of these instruments in the RD context.</p></div><div><h3>Results</h3><p>A total of 33 articles met the inclusion criteria. The studies measured societal preferences for RD and OD as part of HTA using MCDA (n = 17), DCE (n = 8), and PTO (n = 4), among other methods (n = 4). These found that patients and clinicians do not prioritize funding based on rarity. The public is willing to allocate funds only if the OD demonstrates effectiveness and improves the quality of life, considering as relevant factors disease severity, unmet health needs, and quality of life. Conversely, HTA agency experts preferred their current approach, placing more weight on cost-effectiveness and evidence quality, even though they expressed concern about the fairness of the drug review process.</p></div><div><h3>Conclusions</h3><p>MCDA, PTO, and DCE are helpful and transparent methods for assessing societal preferences in HTA for RD and OD. However, their methodological limitations, such as arbitrary criteria selection, subjective scoring methods, framing effects, weighting adaptation, and value measurement models, could make implementation challenging.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"44 ","pages":"Article 101026"},"PeriodicalIF":1.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212109924000591/pdfft?md5=d36df0f011b66bacf9f5fbef4f2c4c67&pid=1-s2.0-S2212109924000591-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767439","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-Related Quality of Life in Chronic Pain Treated With Tapentadol Versus Oxycodone/Naloxone and Its Determinants: A Real-World, Single-Center Retrospective Cohort Study in Spain","authors":"Ana M. Peiró PhD ,&nbsp;Anna Grimby-Ekman PhD ,&nbsp;Jordi Barrachina PhD ,&nbsp;Mónica Escorial PhD ,&nbsp;César Margarit PhD ,&nbsp;Carmen Selva-Sevilla PhD ,&nbsp;Manuel Gerónimo-Pardo PhD","doi":"10.1016/j.vhri.2024.101013","DOIUrl":"10.1016/j.vhri.2024.101013","url":null,"abstract":"<div><h3>Objectives</h3><p>A substantial proportion of patients with chronic noncancer pain (CNCP) are treated with tapentadol (TAP) or oxycodone/naloxone (OXN) to improve their perceived physical and mental health over time.</p></div><div><h3>Methods</h3><p>A cross-sectional study was conducted in 135 CNCP outpatients with usual prescribing (TAP: n = 58, OXN: n = 77) at a tertiary-care Spanish Hospital to compare health-related quality-of-life (HRQoL) records. Health utility was derived from the EQ-5D-3L. Regression models were performed to search for other HRQoL determinants. Pain intensity, relief, analgesic prescription, adverse events, inpatient stays, emergency department visits, and change to painkiller prescriptions were registered from electronic records.</p></div><div><h3>Results</h3><p>Health utility (0.43 ± 0.24 scores, from −0.654 to 1) was similar for both opioids, although TAP showed a significantly low daily opioid dose requirement, neuromodulators use, and constipation side effect compared with OXN. After multivariable adjustment, the significant predictors of impaired HRQoL were pain intensity (β = −0.227, 95% CI −0-035 to −0.005), number of adverse events (β = −0.201, 95% CI −0.024 to −0.004), and opioid daily dose (β = −0.175, 95% CI −0.097 to −0.012). Male sex (β = −0.044) and pain relief (β = 0.158) should be taken into account for future studies.</p></div><div><h3>Conclusions</h3><p>HRQoL was similar for TAP and OXN in real-world patients with CNCP, albeit with a TAP opioid-sparing effect. More work is needed to explore HRQoL determinants in relation to long-term opioid use in CNCP.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"44 ","pages":"Article 101013"},"PeriodicalIF":1.4,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564510","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 the Recombinant Zoster Vaccine Among People Living With HIV in Japan","authors":"So Sato MD ,&nbsp;Takaaki Konishi MD, PhD ,&nbsp;Hiroyuki Ohbe MD, PhD ,&nbsp;Hideo Yasunaga MD, PhD","doi":"10.1016/j.vhri.2024.101025","DOIUrl":"https://doi.org/10.1016/j.vhri.2024.101025","url":null,"abstract":"<div><h3>Objectives</h3><p>People living with HIV (PLWHIV) are susceptible to opportunistic infections including herpes zoster (HZ) and postherpetic neuralgia (PHN). The recombinant zoster vaccine (RZV) (Shingrix) is available in some countries. However, the cost-effectiveness for PLWHIV remains unknown. This study aimed to analyze the cost-effectiveness of RZV for PLWHIV ≥50 years old.</p></div><div><h3>Methods</h3><p>A Markov model was developed to compare the cost-effectiveness of the 2-dose RZV immunization program with no RZV immunization for PLWHIV aged ≥50 years. We built the model with a yearly cycle over a 30-year period and 6 health conditions: HZ free, HZ, PHN, HZ/PHN recovery, HZ recurrence, and death. The parameters in the model were based on previous studies and a nationwide administrative claims database in Japan. The incremental cost-effectiveness ratio (ICER), expressed as Japanese yen (JPY) per the quality-adjusted life-years (QALYs), was estimated from a societal perspective. We conducted a one-way deterministic sensitivity analysis, probabilistic sensitivity analysis with Monte Carlo simulations of 10 000 samples, and scenario analyses.</p></div><div><h3>Results</h3><p>The ICER of the 2-dose RZV immunization program over no RZV immunization was 78 777 774 JPY (approximately 600 000 US dollars)/QALY. The one-way deterministic sensitivity analysis showed that HZ-related utility was the most significant for ICER. All estimates in the probabilistic sensitivity analysis were located above the willingness-to-pay threshold of 5 million JPY/QALY.</p></div><div><h3>Conclusions</h3><p>Our study revealed that no RZV immunization was more cost-effective than the 2-dose RZV immunization program for PLWHIV aged ≥50 years. This may be useful in evidence-based policy making.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"44 ","pages":"Article 101025"},"PeriodicalIF":1.4,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S221210992400058X/pdfft?md5=3839de3a86d79b6f66ce89cc1c0fb988&pid=1-s2.0-S221210992400058X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141543267","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":"The 30-Billion-Dollar Distribution Markups and Taxes of Pharmaceuticals in Latin American Countries: Impact, Options, and Trade-Offs","authors":"Giovanny Leon MBA ,&nbsp;Eduardo Gonzalez-Pier PhD ,&nbsp;Panos Kanavos PhD ,&nbsp;Eva Maria Ruiz de Castilla PhD ,&nbsp;Gerardo Machinicki PhD","doi":"10.1016/j.vhri.2024.101015","DOIUrl":"https://doi.org/10.1016/j.vhri.2024.101015","url":null,"abstract":"<div><h3>Objectives</h3><p>The World Health Organization provides 10 specific guidelines for managing the prices of pharmaceutical products. Many of those are widely known and used such as reference pricing, value-based pricing, price transparency, and tendering. Less attention and knowledge is concentrated in markup regulation across the pharmaceutical supply chain and distribution and in tax exemptions or reductions. This article quantifies the impact of these price components in the Latin American (LatAm) region and places the findings in the context of economic theory and international policy experiences.</p></div><div><h3>Methods</h3><p>2020 retail pharmaceutical sales data from 8 major LatAm markets covered in the IQVIA database were decomposed into ex-factory, distributor markups, and taxes using price build up information and the Price Decipher Methodology developed by the Novartis Global Pricing Governance and Negotiation team. The findings were reviewed by an international panel representing academia, health policy, health economics, patient, and industry.</p></div><div><h3>Results</h3><p>The ex-factory market value of the analyzed markets was $49 billion. Distribution markups added $20 billion and taxes a further $10.5 billion. This represented a 63% increase over ex-factory prices, considered high if compared with 24% for an international benchmark of 35 ex-LatAm countries. Reducing markups for these LatAm countries to 24% would represent up to $19 billion in savings for payers and patients.</p></div><div><h3>Conclusions</h3><p>There is potential for significant cost reductions associated with tax and distribution markup refinements in the LatAm retail pharmaceutical market. National policies should be informed by additional context-specific research for effective implementation.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"44 ","pages":"Article 101015"},"PeriodicalIF":1.4,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141543268","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 Maintenance Pemetrexed Plus Best Supportive Care Compared With Best Supportive Care Alone in Treating Patients With Non–Small Cell Lung Cancer in Jordan","authors":"Abeer Al Rabayah BPharm, MBA, MSc ,&nbsp;Rawan Al Froukh MSc ,&nbsp;Razan Sawalha MSc ,&nbsp;Maali Al Shnekat PharmD ,&nbsp;Beate Jahn PhD ,&nbsp;Uwe Siebert ScD ,&nbsp;Saad M. Jaddoua BPharm, RPh","doi":"10.1016/j.vhri.2024.101004","DOIUrl":"10.1016/j.vhri.2024.101004","url":null,"abstract":"<div><h3>Objectives</h3><p>To assess the cost-effectiveness of maintenance pemetrexed plus best supportive care (BSC) in non–small cell lung cancer patients from a Jordanian healthcare system perspective.</p></div><div><h3>Methods</h3><p>A Markov model with 4 health states was developed to estimate life years, quality-adjusted life-years (QALY), costs, and the incremental cost-utility ratio of pemetrexed plus BSC versus BSC. A lifelong time horizon was used in the base-case analysis. The transition probabilities were estimated from the PARAMOUNT trial, the utility weights were taken from published literature, and costs were based on data and unit costs at King Hussein Cancer Center and the Jordan Food and Drug Administration. Both costs and outcomes were discounted using a 3%. The parameter uncertainty was tested using deterministic and probabilistic sensitivity analyses.</p></div><div><h3>Results</h3><p>The base-case analysis showed that pemetrexed plus BSC increased QALYs and cost compared with BSC. Pemetrexed plus BSC leads to incremental 0.255 QALYs and incremental costs of US $30 826, resulting in an incremental cost-utility ratio of US $120 886/QALY.</p><p>The results were sensitive to changes in the utility estimates during the progression-free health state, the progression health state, and the cost of postprogression medications The probabilistic sensitivity analysis showed that the probability of pemetrexed plus BSC being a cost-effective option compared with BSC is 0 at a threshold of $56 000.</p></div><div><h3>Conclusions</h3><p>Maintenance pemetrexed for non–small cell lung cancer is not a cost-effective option compared with BSC from a healthcare system perspective based on the listed price at a threshold of $56 000/QALY.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"43 ","pages":"Article 101004"},"PeriodicalIF":1.4,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471061","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":"The Impact of Generic Entry of Pharmaceuticals in Australia","authors":"Arun M. Jones MSc ,&nbsp;Victoria Serra-Sastre PhD ,&nbsp;Hansoo Kim PhD","doi":"10.1016/j.vhri.2024.101008","DOIUrl":"10.1016/j.vhri.2024.101008","url":null,"abstract":"<div><h3>Objectives</h3><p>In this article, we estimate the initial and temporal impacts of generic entry on benchmark drug prices as reimbursed through the Pharmaceutical Benefits Scheme of Australia and the degree to which further generic competition affects these prices under the current regulatory framework.</p></div><div><h3>Methods</h3><p>We construct a panel data set consisting of 781 Pharmaceutical Benefits Scheme listed drugs over a 95-month time period and use fixed-effect regressions. The dynamic price effects of generic competition are investigated by implementing panel methods.</p></div><div><h3>Results</h3><p>Our results suggest that generic entry into the Australian pharmaceutical market causes significant initial price reductions of approximately 31% and that successive generic entrants also act to further reduce drug prices. Through subgroup analyses, we identify that the effect of generic competition varies significantly according to the drug’s therapeutic group and mode of drug administration and the dynamic analysis indicates that generic entry results in continuous price reductions even after large initial drops.</p></div><div><h3>Conclusions</h3><p>Generic competition reduces reimbursed drug prices in Australia to a greater extent than previous research has identified, although the average price effects can vary significantly depending on a drug’s therapeutic group or mode of drug administration. Prices generally continue to fall significantly over time under the price disclosure mechanism.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"43 ","pages":"Article 101008"},"PeriodicalIF":1.4,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212109924000414/pdfft?md5=e2ad804df53b75000f8b051e8d09ecac&pid=1-s2.0-S2212109924000414-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141459543","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":"Custo Direto do Tratamento do Acidente Vascular Cerebral Isquêmico na Perspectiva de um Hospital Público Terciário (Direct Cost of Treating Ischemic Stroke From the Perspective of a Tertiary Public Hospital)","authors":"Juliana Tereza Coneglian de Almeida MS ,&nbsp;Rodrigo Bazan MD, PhD ,&nbsp;Sarah Nascimento Silva PhD ,&nbsp;Lukas Fernando Silva MD ,&nbsp;Juliana Machado Rugolo PhD ,&nbsp;Mônica Aparecida de Paula de Sordi MS ,&nbsp;Carlos Clayton Macedo de Freitas MD, PhD ,&nbsp;Vania dos Santos Nunes-Nogueira MD, PhD","doi":"10.1016/j.vhri.2024.101019","DOIUrl":"10.1016/j.vhri.2024.101019","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objetivo&lt;/h3&gt;&lt;p&gt;mensurar o custo direto médico do tratamento do Acidente Vascular Isquêmico agudo (AVCi) na perspectiva de um hospital público (HCFMB) e compará-lo com o repasse pelo Sistema Único de Saúde (SUS), por meio do Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos, Órteses/Próteses e Materiais Especiais do Sistema Único de Saúde (SIGTAP).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Metodologia&lt;/h3&gt;&lt;p&gt;trata-se de um estudo de microcusteio, a partir da quantidade de pacientes internados por AVCi no ano de 2019 foram computados o custo do hospital e o faturamento SIGTAP para os cenários: padrão (1); alteplase (2); alteplase e trombectomia mecânica (3); trombectomia mecânica (4). Os custos do hospital foram ajustados pela inflação do período por meio do &lt;em&gt;CCEMG-EPPI-Centre Cost Converter.&lt;/em&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Resultados&lt;/h3&gt;&lt;p&gt;em 2019 foram hospitalizados 258 pacientes devido AVCi, 89,5% no cenário 1, 8% no cenário 2, 1,5% no cenário 3, 1% no cenário 4. Na perspectiva do hospital o custo por paciente foi estimado em R$7.780,13, R$15.741,23, R$28.988,49, R$25.739,79, para os cenários 1, 2 ,3 e 4, respectivamente. O valor faturado pelo SIGTAP foi estimado em R$3.079,87, R$5.417,21, R$10.901,92, R$10.286,28, respectivamente. Se a trombectomia mecânica tivesse sido incluída neste repasse, os dois últimos faturamentos seriam R$ 25.393,34 e R$24.248,89.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusão&lt;/h3&gt;&lt;p&gt;o custo do tratamento do AVCi para o hospital em 2019 foi estimado em R$2.295.209, o repasse SUS em R$889.391,54. Com a inclusão da trombectomia mecânica ao faturamento SIGTAP, este repasse seria de R$975.282,44, e o desfalque do custo HCFMB por paciente em relação ao faturado pelo SUS é maior nos cenários sem este procedimento.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;p&gt;To measure the direct cost of treating acute ischemic stroke (IS) from the perspective of a public hospital in Brazil (HCFMB) and compare it with the reimbursement by the Unified Health System (SUS), through the Procedure Table Management System, Medicines, Orthoses/Prostheses and Special Materials of the Unified Health System (SIGTAP).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;We performed a micro-costing study; four scenarios were evaluated: standard (1); alteplase (2); alteplase and mechanical thrombectomy (3); mechanical thrombectomy (4). Based on the number of patients hospitalized for ischemic stroke in 2019, hospital cost, and SUS billing were calculated for each scenario. Hospital costs were adjusted for inflation using CCEMG-EPPI-Centre Cost Converter.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;In 2019, 258 patients were hospitalized due to IS, 89.5% in scenario 1, 8% in scenario 2, 1.5% in scenario 3, 1% in scenario 4. From the hospital's perspective, the cost per patient was estimated at R$7780.13, R$15 741.23, R$28 988.49, R$25 739.79, for scenarios 1, 2, 3 and 4, respectively. The reimbursement by SIGTAP was estimated at R$3079.87, R$5417.21, R$10 901.92, R$10 286.28, respectively. If thrombectomy had been","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"44 ","pages":"Article 101019"},"PeriodicalIF":1.4,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141459544","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":"Treatment Cost and Psychological Impact of Burkitt Lymphoma on Ghanaian Families and Caregivers","authors":"Winifred E. Owusu PhD ,&nbsp;Johanita R. Burger PhD ,&nbsp;Martie S. Lubbe PhD ,&nbsp;Rianda Joubert PhD","doi":"10.1016/j.vhri.2024.101016","DOIUrl":"10.1016/j.vhri.2024.101016","url":null,"abstract":"<div><h3>Objective</h3><p>Before June 2022, the treatment cost of Burkitt lymphoma (BL) in Ghana was mainly borne by the child’s family or caregiver. We determined the treatment cost of BL in children and its psychological impact on parents and caregivers.</p></div><div><h3>Method</h3><p>This prospective observational study assessed the direct medical and nonmedical costs (US dollars [USD]) incurred during the treatment of a child with BL for 6 consecutive months using a cost diary. Productivity losses and the psychological impact on parents and caregivers were assessed using a self-administered questionnaire and the Caregiver Quality of Life Index-Cancer (CQOLC).</p></div><div><h3>Results</h3><p>Of the 25 participants, 7 abandoned the treatment of their children, and 4 withdrew because the children passed away. The median (Q1, Q3) cost for treating BL per child for caregivers/parents (N = 12) was USD 947.42 (USD 763.03, USD 1953.05). Direct medical costs formed 71% (USD 11 458.97) of total treatment costs. Working hours of parents before the child’s cancer diagnosis decreased from a median (Q1, Q3) of 44.00 (20.00, 66.00) hours to 1.50 (0, 20.00) hours after the diagnosis. The mean (SD) CQOLC score was 107.92 (15.89), with higher scores in men (111.00 [17.26]), married participants (111.26 [17.29]), Higher National Diploma certificate holders (113.00 [1.41]), and participants earning a monthly income more than USD 84.60.</p></div><div><h3>Conclusion</h3><p>Treatment costs reduced the overall household income of 5 families. Parents and caregivers experienced reduced work hours and loss of employment. CQOLC scores were higher in married participants, those with a higher educational background, and those with higher income.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"44 ","pages":"Article 101016"},"PeriodicalIF":1.4,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212109924000499/pdfft?md5=176ef4039bb4e134d6217d394db1de05&pid=1-s2.0-S2212109924000499-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451636","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-Effectiveness of Dolutegravir Compared With Efavirenz for Prevention of Perinatal Transmission in Women Presenting With HIV in Late Pregnancy in Uganda","authors":"Elly Nuwamanya MSc ,&nbsp;Sylvia Cornelia Nassiwa MD ,&nbsp;Andreas Kuznik PhD ,&nbsp;Catriona Waitt PhD ,&nbsp;Thokozile Malaba PhD ,&nbsp;Landon Myer PhD ,&nbsp;Angela Colbers PhD ,&nbsp;Jim Read ,&nbsp;Duolao Wang PhD ,&nbsp;Mohammed Lamorde PhD","doi":"10.1016/j.vhri.2024.101017","DOIUrl":"https://doi.org/10.1016/j.vhri.2024.101017","url":null,"abstract":"<div><h3>Objectives</h3><p>Dolutegravir (DTG) has proved to be more efficacious, tolerable, and safer than efavirenz (EFV) among mothers living with HIV and their infants in Uganda. This study assessed the cost-effectiveness of the DTG-based antiretroviral therapy (ART) compared with the standard of care for preventing perinatal transmissions among pregnant women initiating ART in late pregnancy in Uganda.</p></div><div><h3>Methods</h3><p>We used data from a randomized open-label trial (DolPHIN-2) and a 2-part cost-effectiveness model composed of a short-term decision tree to estimate the perinatal transmission rate and costs and an individual-based 3-state Markov model (HIV, advanced HIV, dead) to estimate the long-term costs and health outcomes from the Ugandan payer perspective using a lifetime horizon and a 1-year Markov cycle. The main outcomes were the mean annual costs in US dollars ($), disability-adjusted life-years (DALYs), and incremental cost-effectiveness ratio. Both the deterministic and probabilistic sensitivity analyses were conducted to assess the effect of parameter uncertainties on the ultimate results and the model’s robustness.</p></div><div><h3>Results</h3><p>Compared with the EFV-based ART, the DTG-based ART was associated with fewer mean annual costs ($43.58 vs $68.44) and DALYs (0.33 vs 0.56), leading to cost savings of $110 per DALY averted. In the incremental analysis, the DTG-based ART dominated the EFV-based ART; that is, it was less costly and more effective. These results were robust to deterministic and probabilistic sensitivity analyses.</p></div><div><h3>Conclusion</h3><p>The DTG-based ART is a highly cost-effective strategy compared with the EFV-based ART among women initiating treatment in the third trimester of pregnancy in a low-income setting.</p></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"44 ","pages":"Article 101017"},"PeriodicalIF":1.4,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141434858","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}