Value in health regional issues最新文献

{"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}

{"title":"Comparing the Measurement Properties of the Preliminary Version of the EuroQol Health and Well-Being and EQ-5D-5L in Patients, Healthy General Public, and Caregivers","authors":"Guangjie Zhang MSc ,&nbsp;Zhihao Yang PhD ,&nbsp;Nan Luo PhD ,&nbsp;Jan Busschbach PhD","doi":"10.1016/j.vhri.2025.101081","DOIUrl":"10.1016/j.vhri.2025.101081","url":null,"abstract":"<div><h3>Objectives</h3><div>The EuroQol Health and Well-Being (EQ-HWB) is a new generic quality of life (QOL) questionnaire to capture broader aspects of health and well-being than EQ-5D-5L. This study examined the measurement properties of the preliminary EQ-HWB version in patients, healthy individuals, and healthy caregivers.</div></div><div><h3>Methods</h3><div>Respondents (1) with or without caregiver tasks, (2) with different diseases, or (3) in full health were recruited online. Ceiling effects, convergent and divergent validity, known disease, and caregiver group differences were explored, and an exploratory factor analysis was used.</div></div><div><h3>Results</h3><div>A total of 500 respondents were recruited, including 100 healthy individuals (excluding 40 healthy caregivers), 122 with chronic hepatitis B, 101 with HIV/AIDS, 107 with depression, and 90 with generalized anxiety disorder. The EQ-HWB activities dimension correlated most highly with the EQ-5D-5L mobility, self-care, and usual activities dimensions, whereas EQ-HWB physical sensation dimension was strongly related to the EQ-5D-5L pain/discomfort dimension. Additional EQ-HWB dimensions (self-identity, cognition, autonomy, feelings and emotions, and relationships) aligned most closely with the EQ-5D-5L anxiety/depression dimension. Both instruments differentiated disease burden across healthy individuals and patients and identified caregiving roles. The EQ-5D-5L revealed 3 factors in exploratory factor analysis, whereas the EQ-HWB included 2 additional factors (F1 cognition, F2 physical activity, F3 feelings and emotions, F4 positive items, and F5 physical sensation).</div></div><div><h3>Conclusions</h3><div>EQ-HWB is able to measure health-related QOL in healthy people, patients, and caregivers given that it shares the same conceptual structure with EQ-5D. EQ-HWB is more sensitive in patients with mental health conditions than the EQ-5D. These results support that EQ-HWB captures well-being alongside health-related QOL.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"47 ","pages":"Article 101081"},"PeriodicalIF":1.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419443","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 Upadacitinib in Patients With Moderately to Severely Active Ulcerative Colitis in Greece","authors":"Charalampos Tzanetakos MSc ,&nbsp;Marina Psarra MSc ,&nbsp;Ilias Kotsis MSc ,&nbsp;George Gourzoulidis MSc","doi":"10.1016/j.vhri.2025.101091","DOIUrl":"10.1016/j.vhri.2025.101091","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate the cost-effectiveness of upadacitinib in patients with moderately to severely active ulcerative colitis (UC), who have had an inadequate response, lost response, or were intolerant to either conventional therapy (bio-naïve) or a biologic agent (bio-exposed), in Greece.</div></div><div><h3>Methods</h3><div>A cost-effectiveness model, consisting of an 8-week decision tree model (induction period) and a long-term Markov state-transition model with a 4-week cycle length (maintenance period), was locally adapted from a public payer perspective over the patient’s lifetime. Upadacitinib was compared with other UC marketed biologics and small molecule agents in Greece. Clinical and utility data were retrieved from published literature. Direct costs pertaining to drug acquisition, administration, disease management, and adverse events were considered in the analysis. All cost inputs were indexed to 2023 euros. Model outcomes were patients’ quality-adjusted life-years (QALYs), total costs, and incremental cost-effectiveness ratios (ICERs).</div></div><div><h3>Results</h3><div>In the bio-naïve population, compared with adalimumab, golimumab, infliximab, ozanimod, tofacitinib, ustekinumab, and vedolizumab, upadacitinib was found to be more effective (QALY gains: 0.833, 0.670, 0.671, 0.783, 0.314, 0.577, and 0.522, respectively) and cost-effective (ICERs: €18 618, €21 682, €17 864, €15 637, €30 061, €12 776, and €16 263, respectively). In the bio-exposed population, compared with adalimumab, ozanimod, tofacitinib, ustekinumab, and vedolizumab, upadacitinib demonstrated again a more effective (QALY gains: 0.784, 0.697, 0.514, 0.723, and 0.719, respectively) and cost-effective profile (ICERs: €16 396, €13 661, €17 074, €10 975, and €13 881, respectively).</div></div><div><h3>Conclusions</h3><div>Upadacitinib was estimated to be the most effective and cost-effective treatment among all advanced treatments for moderately to severely active UC in Greece.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101091"},"PeriodicalIF":1.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419610","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 Mineralocorticoid Receptor Antagonists in Ischemic and Nonischemic Heart Failure With Reduced Ejection Fraction: Perspective From a Universal Healthcare System","authors":"Cristiane Koeche BPharm, MSc ,&nbsp;Ana Claudia Cavalcante Nogueira MD, MSc ,&nbsp;Giselle Pinto da Silva Amaral MD ,&nbsp;Adriana J.B.A. Guimarães MD, PhD ,&nbsp;Yasmim Botelho Neiva ,&nbsp;Alexandre Magno Oliveira de Souza ,&nbsp;Marta Duran Fernandez MSc ,&nbsp;Luís Eduardo Rohde MD, PhD ,&nbsp;Andrei C. Sposito MD, PhD ,&nbsp;Luiz Sérgio F. de Carvalho MD, PhD","doi":"10.1016/j.vhri.2025.101084","DOIUrl":"10.1016/j.vhri.2025.101084","url":null,"abstract":"<div><h3>Objectives</h3><div>Mineralocorticoid receptor antagonists (MRAs) are cornerstones in the management of heart failure (HF) with reduced ejection fraction (HFrEF). New MRAs with improved safety profile, such as finerenone and eplerenone, were recently introduced. However, because of typical budget restrictions in middle-income countries, evaluating their cost-effectiveness is essential for optimizing treatment strategies.</div></div><div><h3>Methods</h3><div>We used a Bayesian network and Markov influence diagrams to estimate the incremental cost-effectiveness ratios (ICERs) in international dollars (Int$) per quality-adjusted life-year (QALY). Our model was fed by a systematic review and a network meta-analysis to compare MRAs effectiveness and used data from a cohort of 1066 Brazilian individuals with HFrEF (36% with ischemic and 64% with nonischemic disease).</div></div><div><h3>Results</h3><div>Over a 10-year time horizon, the treatment with spironolactone, eplerenone, and finerenone compared with no MRA utilization yielded discounted QALY per person of 0.072, 0.111, and 0.034, respectively. The ICERs were Int$7955, Int$6460, and Int$109 840 per QALY gained, respectively. Compared with spironolactone, eplerenone showed an ICER of Int$6178 per QALY gained. Assuming a willingness-to-pay threshold of 1 Brazilian per capita gross domestic product (Int$17 589) per QALY gained, the probabilistic sensitivity analyses suggest that spironolactone and eplerenone were cost-effective, respectively, in 87% and 92% of iterations. The 95% CIs were Int$2282 to Int$13 149 for spironolactone and Int$1795 to Int$12 351 for eplerenone per QALY gained. These findings were consistent across several scenarios including ischemic/nonischemic HF.</div></div><div><h3>Conclusions</h3><div>Eplerenone is likely the most cost-effective MRA in Brazil considering individuals with both ischemic and nonischemic HFrEF.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"47 ","pages":"Article 101084"},"PeriodicalIF":1.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394897","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":"Valuing an Index of Sanitation-Related Quality of Life in Urban Mozambique: A Discrete Choice Experiment","authors":"Patrick V. Katana MSc ,&nbsp;Neiva Banze MD ,&nbsp;Cremildo Manhiça BSc ,&nbsp;Catildo Cubai BSc ,&nbsp;Lucia Viera MD ,&nbsp;Edi Fulai MD ,&nbsp;Oliver Cumming MSc ,&nbsp;Edna Viegas PhD ,&nbsp;Igor Capitine PhD ,&nbsp;Ian Ross PhD","doi":"10.1016/j.vhri.2025.101087","DOIUrl":"10.1016/j.vhri.2025.101087","url":null,"abstract":"<div><h3>Objectives</h3><div>A total of 1.5 billion people live without basic sanitation. A 5-attribute index of sanitation-related quality of life (SanQoL-5) has been applied in 9 countries. SanQoL-5 attributes and their levels require weighting (valuation), with the resulting index ranging from 0 to 1. To date, SanQoL-5 valuation applied simple methods such as rank sum, not robust methods such as discrete choice experiment (DCE). We aimed to value SanQoL-5 using a DCE in urban Mozambique.</div></div><div><h3>Methods</h3><div>We enrolled 601 adults in the cities of Maputo and Dondo, sampling women and men equally. The DCE task was a choice of which was “better” among 2 combinations of SanQoL-5 attribute levels (always, sometimes, never). Each respondent completed 10 tasks and a dominance test. After fitting a mixed logit model, we rescaled coefficients to derive the index.</div></div><div><h3>Results</h3><div>The highest-valued attribute was disgust (“never feel disgusted while using the toilet”) at 0.25. The other attributes had similar values (ranging 0.18-0.19). People valued “sometimes” levels at approximately 60% of “never” levels. Therefore, moving from the middle level to the worst involves a larger decrement than moving from the best to the middle. Mean SanQoL-5 by toilet type followed a gradient with Sustainable Development Goal 6 categories: “open defecation” 0.30, “unimproved” 0.45, “limited” 0.60, and “at least basic” 0.70.</div></div><div><h3>Conclusions</h3><div>To our knowledge, this is the first DCE-based valuation of any index of sanitation-related quality of life, enabling SanQoL-5 to be used in economic evaluation. Identifying sanitation service transitions associated with the greatest quality of life gains could inform more efficient resource allocation.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"47 ","pages":"Article 101087"},"PeriodicalIF":1.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387548","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}