Value in health regional issues最新文献

{"title":"Understanding What Matters: Stakeholder Views on Decision Criteria for Cancer Drug Selection in the Public Sector in Malaysia","authors":"Haarathi Chandriah MPharm (Clin) ,&nbsp;Asrul Akmal Shafie PhD ,&nbsp;Muthukkumaran Thiagarajan MD, MClinOncol","doi":"10.1016/j.vhri.2024.101052","DOIUrl":"10.1016/j.vhri.2024.101052","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to determine stakeholders’ decision criteria preferences for formulary decisions of cancer drugs in the Ministry of Health. The secondary objective was to identify the outcome measures of interest for assessment of clinical benefits for cancer drugs.</div></div><div><h3>Methods</h3><div>A survey questionnaire was administered online and as hard copy using purposive sampling to 32 healthcare facilities providing cancer services and the Formulary Management Branch in the Ministry of Health. Respondents reported whether a criterion “will be considered” and weighted its relative importance on a 5-point scale. The choice of safety and efficacy/effectiveness outcomes were ranked from 1 to 5, and the minimum value of benefit for the efficacy/effectiveness outcome ranked 1 was provided. Trade-offs between survival and quality of life were also explored. Inferential statistics were used to explore difference in responses.</div></div><div><h3>Results</h3><div>A total of 316 healthcare professionals responded to the survey. The most important criteria for value assessment of cancer drug were safety and effectiveness. Other criteria deemed important were quality of evidence, disease severity, and patient-reported outcomes. There was no difference in the criteria preference and weights across the various respondent groups. Overall survival was the most preferred clinical benefit outcome. Overall, willingness to pay was higher for life-prolonging treatment than treatment that improved quality of life.</div></div><div><h3>Conclusions</h3><div>This study revealed that a wide range of criteria beyond the traditional decision-making criteria of efficacy, safety, and cost-effectiveness are important for value assessment of cancer drugs for the purpose of formulary decisions.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101052"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584405","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":"Exploring the Potential Health and Economic Benefits of Optimized Low-Density Lipoprotein Cholesterol Management in Malaysia’s Atherosclerotic Cardiovascular Disease Population: A Model-Based Analysis","authors":"Chee Yoong Foo MBBS, PhD ,&nbsp;Nurul Azwani Nadia Mansor BEng ,&nbsp;Thurston Erng MBBS, MRCP ,&nbsp;Mohd Sapawi Mohamed MD, MMed ,&nbsp;Gurudevan Mahadevan MBBS, MRCP ,&nbsp;Glendon Lau MBBS, MRCP ,&nbsp;Asri Ranga MD, MMed ,&nbsp;Tiong Kiam Ong MBBS, MRCP","doi":"10.1016/j.vhri.2024.101059","DOIUrl":"10.1016/j.vhri.2024.101059","url":null,"abstract":"<div><h3>Objectives</h3><div>This study quantified the health and economic benefits of improving low-density lipoprotein cholesterol (LDL-C) control in Malaysian patients with established atherosclerotic cardiovascular disease (ASCVD). It aimed to inform policy discussions and healthcare planning for effective ASCVD management.</div></div><div><h3>Methods</h3><div>A deterministic, prevalence-based model was used to project the annual health burden and direct medical costs associated with recurrent ASCVD events over a 10-year horizon. The target population included adults (≥30 years) with established ASCVD and uncontrolled LDL-C levels (&gt;1.8 mmol/L). The model comprised 3 modules: population size projection, recurrent ASCVD risk calculation (by means of the Secondary Manifestations of ARTerial disease [SMART] risk model), and direct medical and productivity cost estimation. The current status quo and a scenario with a 50% improvement in mean LDL-C were compared.</div></div><div><h3>Results</h3><div>We projected over 800 000 adults with established ASCVD in 2023, increasing to approximately 1.4 million by 2032. Under the status quo, about 55 000 recurrent ASCVD events were expected within 10 years, with significant direct medical costs and productivity losses. Improved LDL-C control could potentially reduce recurrent events by 7000 cases (13% reduction), prevent 2100 premature deaths, and save approximately 32 400 years of life. Economically, this could lead to a reduction of approximately 72 million MYR in direct medical costs and a gain of approximately 132.4 million MYR in productivity over a decade.</div></div><div><h3>Conclusions</h3><div>Optimizing LDL-C control in high-risk patients with ASCVD presents a critical opportunity to reduce health and economic burdens in Malaysia.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101059"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711054","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 a Slovak Representative Sample: A Validation Study of the Short Form-8 Scale","authors":"Dana Purova MSc ,&nbsp;Jana Furstova MSc, PhD ,&nbsp;Natalia Kascakova MD, PhD ,&nbsp;Alena Dobrotkova MSc, PhD ,&nbsp;Dagmar Sigmundova MSc, PhD ,&nbsp;Jozef Hasto MD, PhD ,&nbsp;Peter Tavel MSc","doi":"10.1016/j.vhri.2024.101058","DOIUrl":"10.1016/j.vhri.2024.101058","url":null,"abstract":"<div><h3>Objectives</h3><div>The Short Form-8 (SF-8) is a widely used 8-item tool for health-related quality of life assessment. This study aimed to evaluate the psychometric properties of the Slovak version of the SF-8 in a population sample.</div></div><div><h3>Methods</h3><div>A cross-sectional survey on a Slovak representative sample (n = 1018; mean age 46.24 ± 16.56 years; 51.3% women) monitoring health and well-being was performed in 2019. Exploratory network analysis and confirmatory factor analysis were used to assess the construct validity of the scale. Reliability and sociodemographic differences were evaluated.</div></div><div><h3>Results</h3><div>A 2-factor model had an adequate fit to the data [χ²(19) = 186.2, <em>P</em> &lt; .001, comparative fit index = 0.998, Tucker-Lewis index = 0.997, root mean square error of approximation = 0.093, standardized root mean of residuals = 0.039], with high reliability (α = 0.93, ω = 0.95). The physical component score and mental component score (MCS) were negatively associated with the presence of chronic health conditions. Lower physical component score and MCS were associated with higher age (<em>P</em> &lt; .001), and lower MCS were associated with female gender (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>The Slovak version of the SF-8 represents a valuable tool for measuring health-related quality of life in the Slovak population in both practice and research.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101058"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711055","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 Analysis of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin Chemotherapy Regimen in Comparison With Gemcitabine and Cisplatin Chemotherapy Regimen in the Treatment of Patients With Muscle Invasive Bladder Cancer in Iran","authors":"Sadra Nadimi Parashkouhi PharmD ,&nbsp;Iman Karimzadeh PhD ,&nbsp;Alireza Rezvani MD ,&nbsp;Hadi Abbasian PhD ,&nbsp;Leila Zarei PhD","doi":"10.1016/j.vhri.2024.101051","DOIUrl":"10.1016/j.vhri.2024.101051","url":null,"abstract":"<div><h3>Objectives</h3><div>Bladder cancer incurs the highest lifetime treatment cost per patient among various cancers. Current guidelines endorse several cisplatin-based regimens as neoadjuvant chemotherapy. This cost-utility analysis aimed to compare 2 primary neoadjuvant chemotherapy regimens—dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) and gemcitabine and cisplatin (GC)—for patients with muscle-invasive bladder cancer, providing economic evidence to inform treatment guidelines in Iran.</div></div><div><h3>Methods</h3><div>A Markov decision model was constructed, incorporating 4 states: after radical cystectomy without recurrence, no radical cystectomy, recurrence, and death over a lifetime horizon. Clinical outcomes were derived from the VESPER (French Genito-Urinary Tumor Group and French Association of Urology V05) phase 3 randomized controlled trial, whereas costs were obtained from local Iranian data. The main result involved determining an incremental cost-effectiveness ratio within the simulated population, with a willingness-to-pay threshold of 1656 USD (equivalent to Iran’s gross domestic product per capita in 2023). Costs and benefits were discounted at 5.8% per annum, and probabilistic and univariate deterministic sensitivity analyses were conducted.</div></div><div><h3>Results</h3><div>From the perspective of the Iranian healthcare payer, 6 cycles of dd-MVAC yielded 0.02 greater quality-adjusted life-years compared with 4 cycles of GC, resulting in a cost saving of 1 173 491 USD and an incremental cost-effectiveness ratio of −78 708 870. Consequently, dd-MVAC emerged as the dominant option over a lifetime horizon (23 years). The model proved most sensitive to variations in recurrence and toxicity probabilities during treatment.</div></div><div><h3>Conclusions</h3><div>Based on this study’s results, dd-MVAC represents a cost-saving treatment regimen per patient in the Iranian health system compared with GC, with superior utility.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101051"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547768","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 High Cost of the Legal Route in Public Health: The Impact of the Judicialization of Medicines in the Municipal Unified Health System in Campinas","authors":"Stefane Cristina Paixão Oliveira MSc ,&nbsp;Dyego Carlos Souza Anacleto de Araújo PhD ,&nbsp;Patricia Moriel PhD ,&nbsp;Marília Berlofa Visacri PhD","doi":"10.1016/j.vhri.2024.101050","DOIUrl":"10.1016/j.vhri.2024.101050","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to assess the costs and factors associated with the judicialization of medicines for the municipal Unified Health System in Campinas, São Paulo, Brazil, from 2017 to 2021.</div></div><div><h3>Methods</h3><div>This cross-sectional study used data provided by the Municipal Health Department of Campinas and the Court of Justice of the State of São Paulo.</div></div><div><h3>Results</h3><div>The sample comprised 506 medicines (322 active substances) and 493 legal cases. Of the US$9.270 million disbursed, 67.3% were allocated to purchase medicines. On average, 28.8% of the pharmaceuticals were listed on the National List of Essential Medicines (Rename), of which 52.3% were listed in the specialized component. Expenditures on nonincorporated and oncological medicines accounted for 76% of the total value. Acquisition of brand-specific medicines was predominant (53.7%), of which 75.5% had therapeutic equivalents. ABC curve shows that only 28 active substances corresponded to 79.8% of the expenses incurred to serve 573 plaintiffs. Four factors, when present in legal actions, prevented the rational use of public resources: assumption of responsibilities of other federative entities, acquisition of medicines not incorporated in Rename and oncological drugs, trademark determination, and the requirement to supply the medicine for an indefinite period. Costs associated with these factors caused an increase in expenditure, even with a decrease in legal demands filed against the municipality.</div></div><div><h3>Conclusions</h3><div>Judicialization of medicines in Campinas from 2017 to 2021 required an allocation of US$6.2 million, aimed at treating only 0.068% of the population. Associated factors include legal requirements and internal management challenges that have increased costs.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101050"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508904","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":"Quality of Life of Older Adults Living With Dementia and Caregiver Strain in Benin","authors":"Angeladine Kenne Malaha MPH, PhD ,&nbsp;Clémence Thébaut PhD ,&nbsp;Sem Harris Ahouantchede MSc ,&nbsp;Dismand Stephan Houinato MD, PhD ,&nbsp;Dieu donné Gnonlonfoun MD, PhD ,&nbsp;Thierry Adoukonou MD, PhD ,&nbsp;Grégoire Magloire Gansou MD ,&nbsp;Pierre-Marie Preux MD, PhD ,&nbsp;Maëlenn Guerchet PhD","doi":"10.1016/j.vhri.2025.101080","DOIUrl":"10.1016/j.vhri.2025.101080","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed at assessing the quality of life (QoL) of older adults living with dementia and caregiver strain in Benin, a West African country.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted from October to November 2021, recruiting participants aged 60 and over and their caregivers from health facilities and a rural community in Benin. QoL of older adults and caregiver burden were collected using standardized instruments, namely the World Health Organization’s dementia QoL and Zarit Burden Interview, respectively.</div></div><div><h3>Results</h3><div>A total of 114 older adults (mean age 73 ± 10 years, 51% female) and their primary caregivers (mean age 49 ± 16 years, 70% female) participated, of whom 73 were recruited from health facilities and 41 from rural communities. Fifty percent of older adults were diagnosed with mild to severe dementia. The overall QoL was good, with rural participants scoring higher in daily life and urban participants scoring higher in emotion. Factors associated with decreased QoL were higher disability levels and greater caregiver burden. The mean caregiver burden score was 17 ± 13, with higher scores among those caring for older men. Increased disability in older adults and lower socioeconomic status were linked to higher caregiver strain, whereas better QoL in older adults and higher socioeconomic status reduced caregiver burden.</div></div><div><h3>Conclusion</h3><div>Enhancing access to healthcare, strengthening social support systems, and providing caregiver training and support are crucial for improving the well-being and care of individuals living with dementia in Benin.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"47 ","pages":"Article 101080"},"PeriodicalIF":1.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510191","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":"Matching-Adjusted Indirect Comparison Studies in Oncology: A Scoping Review Focused on Reporting Quality","authors":"Cecília Menezes Farinasso MSc ,&nbsp;Vinícius Lins Ferreira PhD ,&nbsp;Flávia Cordeiro Medeiros PhD ,&nbsp;Aline Pereira da Rocha PhD ,&nbsp;Patrícia do Carmo Silva Parreira PhD ,&nbsp;Layssa Andrade Oliveira MSc ,&nbsp;Lays Pires Marra PhD ,&nbsp;Rosa Camila Lucchetta PhD ,&nbsp;Haliton Alves de Oliveira Jr. PhD","doi":"10.1016/j.vhri.2025.101088","DOIUrl":"10.1016/j.vhri.2025.101088","url":null,"abstract":"<div><h3>Objectives</h3><div>Matching-adjusted indirect comparisons (MAICs) can be used in case of cross-trial heterogeneity or availability of only single-arm trials. Although the National Institute for Health and Care Excellence (NICE) provides MAIC-development orientation, many still do not adhere to it. Our goal was to map MAIC oncology studies and whether NICE recommendations were observed.</div></div><div><h3>Methods</h3><div>We included MAIC studies comparing treatments in oncology from 2010. We searched PubMed, Embase, and the Cochrane Library up to October 1, 2024. We analyzed MAIC characteristics such as previous systematic reviews, whether the analysis was anchored or unanchored, selection of variables, and individual patient data (IPD) reporting. We adopted NICE recommendations for the assessment of MAIC studies.</div></div><div><h3>Results</h3><div>We included 117 MAIC studies, which often explored multiple myeloma (n = 19%) and non–small cell lung cancer (17%) more frequently. Most MAICs were unanchored (72%), with an average of 1.9 comparisons per study. MAIC studies generally reported using pseudo-IPD (69%) but did not report the source of IPD (78%). In general, MAICs did not conduct systematic reviews to select trials for inclusion (66%). The average sample size reduction, in comparison with the original trials, was 44.9%. Only 3 MAICs fulfilled all NICE recommendations. The least reported aspects were the adjustment for all effect modifiers and prognostic variables (for unanchored MAICs), evidence of effect modifier status, and distribution of weights.</div></div><div><h3>Conclusions</h3><div>Most MAIC models did not follow NICE recommendations. Our review highlights the importance of rigorous methodological standards and thorough reporting of MAIC studies to enhance their credibility.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"47 ","pages":"Article 101088"},"PeriodicalIF":1.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480514","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 Analysis and Efficiency Frontier of Drugs Available in Brazil for the Treatment of Relapsing-Remitting Multiple Sclerosis","authors":"Bruno M. Barros MSc ,&nbsp;Marcelo G. Correia MSc ,&nbsp;Bernardo R. Tura PhD ,&nbsp;Carlos S. Magliano PhD","doi":"10.1016/j.vhri.2025.101092","DOIUrl":"10.1016/j.vhri.2025.101092","url":null,"abstract":"<div><h3>Objectives</h3><div>In the Brazilian Public Health System (SUS), the different drugs for the treatment of relapsing-remitting multiple sclerosis (RRMS) are used in an escalating approach, through therapeutic lines from lowest to highest efficacy. Early intensive treatment, indicating the use of more effective drugs for the first symptoms of the disease, has been advocated by some specialists; however, the clinical and economic impact of this strategy is unknown. The aim of this study was to conduct cost-utility, net benefit, and efficiency frontier (EF) analyses for all drugs approved in Brazil for RRMS.</div></div><div><h3>Methods</h3><div>A Markov model was constructed from the SUS perspective to conduct economic analyses. The outcomes of the annualized relapse rate and sustained disability progression were modeled, considering disease progression according to changes in levels on the Expanded Disability Status Scale. Net benefit and EF analyses were also conducted.</div></div><div><h3>Results</h3><div>In the cost-utility assessment, 12 of the 14 drugs were dominated by alemtuzumab and teriflunomide. An EF was established between the 2 drugs with an incremental cost-effectiveness ratio of $8231.87/quality-adjusted life-years. Teriflunomide obtained the best results in the net benefit assessment. Most drugs had an incremental cost-effectiveness ratio below the cost-utility threshold ($8000.00/quality-adjusted life-years) in the probabilistic sensitivity analysis.</div></div><div><h3>Conclusions</h3><div>Early intensive treatment of EF may modify the current RRMS treatment paradigm, and the results presented may help define the cost utility of new entrants to the SUS.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"48 ","pages":"Article 101092"},"PeriodicalIF":1.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445198","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 Analysis of Idursulfase for the Long-Term Treatment of Hunter Syndrome Using a Partitioned-Survival Model Approach in R","authors":"Khairu Hazwan Mustaffa MSc ,&nbsp;Asrul Akmal Shafie PhD ,&nbsp;Lock-Hock Ngu MBBS ,&nbsp;Rowani Mohd-Rawi MBBS","doi":"10.1016/j.vhri.2025.101089","DOIUrl":"10.1016/j.vhri.2025.101089","url":null,"abstract":"<div><h3>Objectives</h3><div>Hunter syndrome is among the costliest life-long genetic conditions associated with a substantial burden-of-illness and a significant impact on the health systems, families, and society. We estimated the cost-effectiveness of long-term enzyme replacement therapy with idursulfase versus the standard of care from a societal perspective using a streamlined modeling strategy in R.</div></div><div><h3>Methods</h3><div>A de novo 4-state partitioned survival model was developed to compare lifetime cost and outcomes of 2 care models operationalized in R. The disease progression was based on independent survival modeling of relevant Kaplan-Meier data. The healthcare and out-of-pocket costs were drawn from the local setting. The quality of life was measured using the EQ5D5L and the time trade-off valuation of health-state vignettes that match the states in the model. Probabilistic and deterministic sensitivity analyses were conducted to test the uncertainty around the model results.</div></div><div><h3>Results</h3><div>The lifetime incremental quality-adjusted life years were 4.1 years (95% CI, 2.37-5.68). Incremental costs were estimated to be $9.5 million (95% CI, 9.0 million-10.0 million), which primarily consists of drug costs (99%). The incremental costs per quality-adjusted life year were estimated to be approximately $2.4 million (95% CI, 1.7 million-3.8 million). Sensitivity analyses showed that the key drivers of incremental cost-effectiveness ratio were quality of life in the preprogression state and differential discounting approach, besides the acquisition cost of enzyme replacement therapy of idursulfase.</div></div><div><h3>Conclusions</h3><div>The incremental cost-effectiveness ratios were beyond any conventionally used cost-effectiveness threshold in all cases. At the current price, there is a significant discrepancy between the therapy’s funding decision and the cost-effectiveness assessment as a basis for guiding healthcare prioritization in Malaysia.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101089"},"PeriodicalIF":1.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437615","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":"Budget Impact Analysis of Intravitreal Injections Used to Treat Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema in the Dubai Healthcare System","authors":"Sara Al Dallal MSc ,&nbsp;Ahmed El Khashab ,&nbsp;Rao Prasan ,&nbsp;Amar Safar ,&nbsp;Mahmoud Wael MEc ,&nbsp;Fadwa Abdellatif MSc ,&nbsp;Ahmed Ibrahim","doi":"10.1016/j.vhri.2025.101083","DOIUrl":"10.1016/j.vhri.2025.101083","url":null,"abstract":"<div><h3>Objectives</h3><div>With the rising prevalence of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), this study assesses the budget impact of current intravitreal injections (faricimab, brolucizumab, ranibizumab, and aflibercept) on Dubai’s private sector. The aim is to identify the most cost-effective intervention by evaluating utilization costs based on injection frequencies and direct acquisition expenses.</div></div><div><h3>Methods</h3><div>An Excel-based budget impact model, aligned with the current standard of care, incorporates direct medical costs only, acquisition prices of the 4 interventions, procedure costs, optical coherence tomography diagnosis and consultation visit costs, and average administration costs in Dubai’s healthcare system. Local experts’ opinions shape the clinical approach and costs. The model spans a 5-year horizon, considering a complete replacement or gradual increase in faricimab uptake. One-way sensitivity analysis ensures outcome robustness.</div></div><div><h3>Results</h3><div>The model, based on an estimated prevalence of 722 nAMD patients and 14 885 DME patients, projects faricimab’s growing market share yielding estimated total savings of 402 908 275 Arab Emirates Dirham over 5 years compared with current market shares. The savings stem from faricimab’s lower injection frequency and acquisition cost in managing DME and nAMD in Dubai’s healthcare system.</div></div><div><h3>Conclusions</h3><div>Increasing faricimab uptake promises substantial budget savings. Decision makers in Ophthalmology Care in the United Arab Emirates can efficiently allocate resources by endorsing faricimab as the primary treatment for nAMD and DME based on these findings.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101083"},"PeriodicalIF":1.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444422","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}