Value in Health最新文献

{"title":"Paid and Unpaid Productivity Losses Associated with Musculoskeletal Conditions: Longitudinal Evidence from Australia.","authors":"Nanati Legese Alemu, Anthony Niu, Jennifer J Watts, Suzanne Robinson, Gang Chen, Lan Gao","doi":"10.1016/j.jval.2026.04.007","DOIUrl":"https://doi.org/10.1016/j.jval.2026.04.007","url":null,"abstract":"<p><strong>Objective: </strong>To examine the impact of musculoskeletal conditions on paid and unpaid productivity using longitudinal Australian data.</p><p><strong>Methods: </strong>Data were drawn from four waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey. MSCs were identified from self-reported arthritis or osteoporosis, with prescription medication as an indicator of symptom severity. Functional limitation severity was classified using tertiles of the SF-36 Physical Functioning subscale. Correlated random-effects models estimated within- and between-person associations between MSCs and weekly paid, unpaid, and total productivity, adjusting for demographic, socioeconomic, and lifestyle covariates.</p><p><strong>Results: </strong>Overall, 36% of respondents reported an MSC in at least one wave. Individuals with MSCs worked 3.2 fewer paid hours per week (95% CI -3.9 to -2.4) but performed 3.1 more unpaid hours (95% CI 2.1 to 4.2), leaving total productivity largely unchanged. Respondents with MSCs but no medication worked 4.7 fewer paid hours (95% CI -5.8 to -3.5) and 4.7 more unpaid hours (95% CI 2.9 to 6.5), whereas those using medication worked 6.8 fewer paid hours (95% CI -7.8 to -5.9) and 3.0 more unpaid hours (95% CI 1.4 to 4.7). At lower physical functioning levels, paid (-12.8 hours) and total productivity (-13.2 hours) declined sharply. Paid-work losses were larger for men, consistent with significant sex differences in the CRE models.</p><p><strong>Conclusions: </strong>MSCs substantially reduce paid work and partly redirect time into unpaid work. Policies that support labour-force retention-such as early management of functional decline-and recognition of the unpaid role are essential to address the broader productivity burden.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can LLMs Predict Patient Treatment Choices? A Discrete Choice Experiment Framework.","authors":"Tina Cheng, Juan Marcos Gonzalez, Matthew M Engelhard, Shelby Reed, Semra Ozdemir","doi":"10.1016/j.jval.2026.04.006","DOIUrl":"https://doi.org/10.1016/j.jval.2026.04.006","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluated the viability of large-language-models (LLMs), specifically GPT-4, in predicting patient health preference-consistent choices using a discrete choice experiment (DCE) framework.</p><p><strong>Methods: </strong>Synthetic data were generated from real DCE responses by patients with a history of cancer. Analytical data included 50 synthetic patients, each answering 48 two-alternative treatment choice questions varying in expected survival, chance of long-term survival, health limitations, and out-of-pocket cost. GPT-4's predictive performance was assessed across four experiments. In Experiments 1 and 2, GPT-4 predicted 20 hold-out questions (i.e., new choice questions) leveraging 28 fixed (Experiment 1) or random selected (Experiment 2) sample questions. Experiment 3 varied the number of sample questions to examine prediction accuracy and prediction confidence. Experiment 4 evaluated how characteristics of the hold-out questions influenced prediction accuracy.</p><p><strong>Results: </strong>GPT-4 achieved an average prediction accuracy of 70.5% (95% confidence interval [CI]: 68.3%-72.7%) in Experiment 1 and 69.9% (95% CI: 66.9%-72.9%) in Experiment 2, with greater variability when sample questions were randomized. Experiment 3 revealed a learning curve, where accuracy improved from 53% with 5 sample questions to 64% with 10, after which performance plateaued. Experiment 4 showed higher prediction accuracy for questions with more salient attribute differences.</p><p><strong>Conclusions: </strong>GPT-4 demonstrated the ability to infer patient preferences from limited samples, achieving accuracy levels comparable to surrogate decision-makers. Its performance remained consistent across randomized input sequences and improved as the number of sample questions increased, eventually reaching a plateau where additional training yielded diminishing returns.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What \"Human-in-the-Loop\" Means in the AI Era of Health Economics and Outcomes Research.","authors":"Grammati Sarri, Ipek Ozer Stillman","doi":"10.1016/j.jval.2026.02.019","DOIUrl":"https://doi.org/10.1016/j.jval.2026.02.019","url":null,"abstract":"","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Carbon Emission Impact of Semaglutide in Patients with Type 2 Diabetes in the United Kingdom using an Innovative Modelling Approach.","authors":"Niels Lund, Andreas Rasche, Matthew Taylor, Barrie Chubb, Weiwei Xu, Loveleen Taneja, Anamaria-Vera Olivieri, Yuvraj Sharma","doi":"10.1016/j.jval.2026.03.2249","DOIUrl":"https://doi.org/10.1016/j.jval.2026.03.2249","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the carbon footprint and clinical outcomes of once-weekly subcutaneous semaglutide in patients with type 2 diabetes mellitus (T2DM) in the United Kingdom.</p><p><strong>Methods: </strong>Using the IQVIA Core Diabetes Model, environmental and clinical impacts were projected over a lifetime horizon from the National Health Services perspective. Data from the SUSTAIN-2 (patients with T2DM) and SUSTAIN-6 (patients with T2DM and established cardiovascular [CV] risk) trials were used to compare semaglutide with sitagliptin and placebo, respectively. Outcomes included life expectancy measured in life-years (LYs), and quality-adjusted life expectancy measured in quality-adjusted life-years (QALYs) gained; incidence of diabetes-related complications and adverse events; carbon emissions; and incremental carbon footprint effectiveness ratios (ICFERs).</p><p><strong>Results: </strong>In patients with T2DM, semaglutide dominates sitagliptin, with higher discounted LYs (0.096) and QALYs (0.095) gains, a 6.9% reduction in diabetes-related complications and adverse events, and reduced lifetime carbon emissions by 9.3% (13,899 kg carbon dioxide equivalent emissions [CO₂e] versus 15,319 kg CO₂e). Similarly, in patients with T2DM and established CV risk, semaglutide showed higher discounted LYs (0.206) and QALYs (0.164), with reductions in all complications except heart failure-related hospitalizations versus placebo. Lifetime carbon emissions were 5.2% lower with semaglutide (14,546 kg CO₂e versus 15,341 kg CO₂e), again with a dominant ICFER. The reduction in CO₂ was mainly driven by reduced complications and treatment needs. Sensitivity analyses supported the robustness of the results.</p><p><strong>Conclusion: </strong>Semaglutide offers environmental advantages over sitagliptin for patients with T2DM overall and over standard of care for those with established CV risk.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modelling Approaches to the Economic Evaluation of Micro-Elimination strategies for HCV in High-Risk Populations: A Systematic Review.","authors":"Ying Chen, Yun Bao, Yueting Chen, Mengxia Yan, Kaijie Yao, Wen Li, Bin Wu","doi":"10.1016/j.jval.2026.03.2248","DOIUrl":"https://doi.org/10.1016/j.jval.2026.03.2248","url":null,"abstract":"<p><strong>Background and objective: </strong>Mathematical models inform hepatitis C virus (HCV) micro-elimination strategies in high-risk groups, but their reliability depends on underlying methodological choices. We systematically appraised the modeling methods used in economic evaluations of HCV micro-elimination published between 2015 and 2026.</p><p><strong>Methods: </strong>Following PRISMA guidelines (PROSPERO: CRD420251185978), we searched PubMed/MEDLINE, Embase, and Web of Science for original studies using mathematical models to assess the cost-effectiveness of HCV interventions in high-risk populations. Using a structured extraction tool aligned with modeling best practices, we evaluated model conceptualization, structure, uncertainty handling, and validation. Reporting quality was assessed using the CHEERS 2022 checklist.</p><p><strong>Results: </strong>Fifty-five studies met the inclusion criteria. Most relied on aggregate-level frameworks, comprising dynamic compartmental models (n=25) and static Markov/decision-tree structures (n=18), while 12 employed individual-based models. People who inject drugs (PWID) were the primary cohort in 30 evaluations. A pervasive limitation across the literature was the omission of endogenous behavioral feedback, with only two models allowing risk behaviors or service uptake to dynamically respond to intervention outcomes. Approximately half of the models (n=28) synthesized parameters without a formal calibration process. While parameter uncertainty was universally explored, external validation against real-world data was uncommon (n=12) and, under our operational definition of distributional equity characterization, no study reported this assessment.</p><p><strong>Conclusion: </strong>Current economic models for HCV micro-elimination are technically sophisticated but frequently rely on structural simplifications-particularly the lack of dynamic behavioral feedback and network-based transmission-that may limit their real-world policy utility. Future efforts should prioritize data-driven network structures, rigorous external validation, and equity-informative frameworks to better support global elimination targets.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do QALY-based CEAs discriminate against disabled patients? A theoretical and empirical analysis.","authors":"Yue Ma, Peter J Neumann, David J Vanness, Hongchao Li, Feng Xie","doi":"10.1016/j.jval.2026.04.005","DOIUrl":"10.1016/j.jval.2026.04.005","url":null,"abstract":"<p><strong>Background: </strong>Quality-adjusted life years (QALYs) have been widely used in cost-effectiveness analyses (CEAs). Nonetheless, critics argue that this measure may inherently discriminate against people with disabilities.</p><p><strong>Objectives: </strong>To investigate whether the use of QALYs disadvantages disabled populations through combining theoretical analysis with examination of empirical evidence.</p><p><strong>Methods: </strong>For the theoretical analysis, we constructed five scenarios to compare incremental QALYs between disabled and non-disabled patients reflecting different treatment effects on health-related quality of life or survival. We then searched the Tufts CEA Registry to identify published CEAs for selected chronic diseases including rheumatoid arthritis, type 2 diabetes, and chronic kidney disease to match published evidence with these scenarios.</p><p><strong>Results: </strong>Across five scenarios, the differences in incremental QALYs between disabled and non-disabled groups were driven by relative changes in utility and life years, rather than indicating a systematic bias. In 9 of 11 published CEAs, the disabled subgroup achieved greater incremental QALY, lower (more favorable) ICERs, or dominant results.</p><p><strong>Conclusions: </strong>These findings suggest that, within the theoretical scenarios and empirical contexts examined, QALY-based CEAs do not appear to inherently disadvantage patients with disabilities.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Methods and Measures for Equity Informative Evaluations.","authors":"Susan Griffin, Sabine E Grimm, Julia F Slejko","doi":"10.1016/j.jval.2026.04.004","DOIUrl":"https://doi.org/10.1016/j.jval.2026.04.004","url":null,"abstract":"","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Technology Promotion and Geographic Health Equity: Breakthrough and Reflection on Evaluation Methods.","authors":"Liangzhe Wang, Mengyi Li, Sanglin Zhao","doi":"10.1016/j.jval.2026.03.2247","DOIUrl":"https://doi.org/10.1016/j.jval.2026.03.2247","url":null,"abstract":"","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Item-Level Convergent and Structural Validity of the EQ-HWB-9 in US Informal Caregivers Compared with ASCOT-Carer, CarerQoL, and EQ-5D-5L.","authors":"Soumana C Nasser, A Simon Pickard, Maja Kuharić","doi":"10.1016/j.jval.2026.04.003","DOIUrl":"https://doi.org/10.1016/j.jval.2026.04.003","url":null,"abstract":"<p><strong>Objectives: </strong>To examine convergent validity and factorial structure of the EQ-HWB-9 among US caregivers relative to caregiver-specific (CarerQoL, ASCOT-Carer) and generic (EQ-5D-5L) measures.</p><p><strong>Methods: </strong>Cross-sectional data from 504 informal caregivers were collected via online survey (2022-2023). Convergent validity was assessed using Spearman correlations with a priori hypotheses of strong correlations (r_s>0.50) between conceptually similar items. Exploratory factor analysis using unweighted least squares extraction and oblique rotation with parallel analysis examined dimensional structure across all instruments.</p><p><strong>Results: </strong>Convergent validity hypotheses were supported. Strong correlations emerged for physical dimensions (EQ-HWB mobility with EQ-5D mobility, r_s=0.57; EQ-HWB daily activities with EQ-5D usual activities, r_s=0.55) and emotional dimensions (EQ-HWB sadness/depression with EQ-5D anxiety/depression, r_s=0.67). For caregiver-specific measures, strong correlations included EQ-HWB sadness/depression with CarerQoL mental health (r_s=0.56) and EQ-HWB control with both ASCOT-Carer control (r_s=0.51) and ASCOT-Carer occupation/spend time (r_s=0.51). Weaker correlations between theoretically distinct constructs supported discriminant validity (r_s=0.02-0.45). A 4-factor solution explained 100% of common variance with minimal cross-loading: social care-related quality of life (ASCOT-Carer items exclusively), mental/emotional well-being (primarily EQ-HWB and EQ-5D emotional items), physical functioning (EQ-5D and EQ-HWB physical items), and care-related burden (CarerQoL items). The 100% of common variance explained reflects the common factor model's extraction of shared variance only, excluding unique variance.</p><p><strong>Conclusion: </strong>EQ-HWB-9 demonstrated strong convergent validity with clear factorial distinction from caregiver-specific measures, capturing general health constructs complementary to unique care-related domains assessed by ASCOT-Carer and CarerQoL. These findings support EQ-HWB-9 as a valid measure of general health and wellbeing in caregiver populations, while indicating that comprehensive caregiver assessment may benefit from combining generic and caregiver-specific instruments depending on study objectives.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Preferences, Perceptions, and Influencing Factors in Weight Loss Pharmacotherapy and Bariatric Surgery: A Systematic Literature Review.","authors":"Kenechukwu C Ben-Umeh, Chia Jie Tan, Juliana S Simonetti, Joseph F Levy, Daniel M Witt, T Joseph Mattingly","doi":"10.1016/j.jval.2026.04.001","DOIUrl":"https://doi.org/10.1016/j.jval.2026.04.001","url":null,"abstract":"<p><strong>Objectives: </strong>Understanding features of weight loss treatments that matter most to patients can inform clinical, reimbursement, and policy decisions. This systematic review synthesizes qualitative and quantitative evidence to characterize treatment attributes patients consider most important in weight loss pharmacotherapy and bariatric surgery.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, Embase, and the Cochrane Library. Studies were included if they assessed patient perspectives or preferences for weight loss pharmacotherapy or bariatric surgery among adults with overweight or obesity. Data extraction covered study characteristics, methodological features, and key findings. A narrative synthesis was conducted due to methodological heterogeneity. Study quality was assessed using three validated tools.</p><p><strong>Results: </strong>Of 965 articles identified, 14 met inclusion criteria (5 discrete choice experiments (DCEs), 4 surveys, 5 qualitative studies) from 9 countries. Most were published after 2017. Sample sizes ranged from 10 to 2,500. Treatment effectiveness (e.g., percentage weight loss, comorbidity resolution) consistently emerged as the most valued attribute, followed by cost and safety (notably gastrointestinal adverse effects). Willingness-to-pay estimates from DCEs showed patients were willing to pay more for greater weight loss, fewer adverse effects, and improved comorbidity outcomes. However, DCE methodologies varied considerably in design and analysis. Qualitative and survey studies further highlighted the influence of social support, stigma, and long-term risk perceptions.</p><p><strong>Conclusions: </strong>Patients prioritize effectiveness, cost, and safety in weight management and are willing to make meaningful trade-offs among these attributes. As the obesity treatment landscape evolves, preference studies using more standardized methods are critical for advancing patient-centered weight management.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}