Value in Health最新文献_第2页

Direct and Indirect Mapping of Assessment of Quality of Life - 6 Dimensions (AQoL-6D) Onto EQ-5D-5L Utilities Using Data From a Multicenter, Cross-Sectional Study of Malaysians With Chronic Heart Failure. 利用马来西亚慢性心力衰竭患者的多中心横断面研究数据，将 AQoL-6D 直接和间接映射到 EQ-5D-5L 工具。

IF 4.9 2区医学

Value in Health Pub Date : 2024-08-09 DOI: 10.1016/j.jval.2024.07.016

Yi Jing Tan, Siew Chin Ong

{"title":"Direct and Indirect Mapping of Assessment of Quality of Life - 6 Dimensions (AQoL-6D) Onto EQ-5D-5L Utilities Using Data From a Multicenter, Cross-Sectional Study of Malaysians With Chronic Heart Failure.","authors":"Yi Jing Tan, Siew Chin Ong","doi":"10.1016/j.jval.2024.07.016","DOIUrl":"10.1016/j.jval.2024.07.016","url":null,"abstract":"<p><strong>Objectives: </strong>The Assessment of Quality of Life - 6 Dimensions (AQoL-6D), a generic preference-based measure, is an appealing alternative to EQ-5D-5L for assessing health status in patients with chronic heart failure (HF), given its expanded scope. However, without a Malaysian value set, the AQoL-6D cannot generate health state utility values (HSUVs) to support local economic evaluations. This study intended to develop algorithms for predicting EQ-5D-5L HSUVs from AQoL-6D in an HF population.</p><p><strong>Methods: </strong>Cross-sectional data from a multicenter cohort of 419 HF outpatients were used. Both direct and indirect mapping approaches were attempted using 5 sets of explanatory variables and 8 models (ordinary least squares, Tobit, censored least absolute deviations, generalized linear model, 2-part model [TPM], beta regression-based model, adjusted limited dependent variable mixture model, and multinomial ordinal regression [MLOGIT]). The models' predictive performance was assessed through 10-fold cross-validated mean absolute error [MAE] and root mean squared error [RMSE]). Potential prediction bias was also examined graphically. The best-performing models, with the lowest RMSE and no bias, were then identified.</p><p><strong>Results: </strong>Among the models evaluated, TPM, which included age, sex, and 5 AQoL-6D dimension scores as predictors, appears to be the best-performing model for directly predicting EQ-5D-5L HSUVs from AQoL-6D. TPM yielded the lowest MAE (0.0802) and RMSE (0.1116), and demonstrated predictive accuracy for HSUVs >0.2 without significant bias. A MLOGIT model developed for response mapping had suboptimal predictive accuracy.</p><p><strong>Conclusions: </strong>This study developed potentially useful mapping algorithms for generating Malaysian EQ-5D-5L HSUVs from AQoL-6D responses among patients with HF when direct EQ-5D-5L data are unavailable.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914157","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}

引用次数: 0

Cost-Utility Analysis of Antipsychotic Reduction and Discontinuation in Patients with Long-term Schizophrenia and Psychosis in English Mental Health Trusts: The RADAR Study. 英国精神卫生信托基金中长期精神分裂症和精神病患者减少和停用抗精神病药物的成本效用分析：RADAR 研究》。

IF 4.9 2区医学

Value in Health Pub Date : 2024-08-08 DOI: 10.1016/j.jval.2024.07.017

George Bray, Joanna Moncrieff, Stefan Priebe, Louise Marston, Glyn Lewis, Nadia Haynes, Vanessa Pinfold, Sonia Johnson, Rachael Maree Hunter

{"title":"Cost-Utility Analysis of Antipsychotic Reduction and Discontinuation in Patients with Long-term Schizophrenia and Psychosis in English Mental Health Trusts: The RADAR Study.","authors":"George Bray, Joanna Moncrieff, Stefan Priebe, Louise Marston, Glyn Lewis, Nadia Haynes, Vanessa Pinfold, Sonia Johnson, Rachael Maree Hunter","doi":"10.1016/j.jval.2024.07.017","DOIUrl":"https://doi.org/10.1016/j.jval.2024.07.017","url":null,"abstract":"<p><strong>Objectives: </strong>The current recommended treatment for patients with recurrent episodes of schizophrenia and related conditions is antipsychotic medication. However, many antipsychotic users remain functionally impaired and experience serious physical and mental side effects. This study aims to assess the cost-effectiveness of a gradual antipsychotic reduction and discontinuation strategy compared to maintenance treatment over 24 months from a mental health services, health and social care, and societal perspectives.</p><p><strong>Methods: </strong>Nineteen mental health trusts recruited patients to the RADAR randomised controlled trial. Quality adjusted life years (QALYs) were calculated from patient-reported EQ-5D-5L, with years of full capability (YFCs) calculated from the patient-reported ICECAP-A. Mental health services use and medication was collected from medical records. Other resource use and productivity loss was collected using self-completed questionnaires. Costs were calculated from published sources.</p><p><strong>Results: </strong>253 participants were randomised: 126 assigned to antipsychotic dose reduction and 127 to maintenance. There were no significant differences between arms in total costs for any perspectives. There were no significant difference in QALYs (-0.035; 95% CI: -0.123 to 0.052), whereas YFCs were significantly lower in the reduction arm compared to the maintenance arm (baseline-adjusted difference: -0.103; 95% CI: -0.192 to -0.014). The reduction strategy was dominated by maintenance for all analyses and was not likely to be cost-effective.</p><p><strong>Conclusions: </strong>It is unlikely that gradual antipsychotic reduction and discontinuation strategy is cost-effective compared with maintenance over two-years for patients with schizophrenia and other recurrent psychotic disorders who are on long-term antipsychotics.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914156","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}

引用次数: 0

Does real option value influence oncologists' treatment recommendations? A survey of U.S. oncologists. 实际期权价值会影响肿瘤学家的治疗建议吗？对美国肿瘤学家的调查。

IF 4.9 2区医学

Value in Health Pub Date : 2024-08-08 DOI: 10.1016/j.jval.2024.07.021

Meng Li, Zizi Elsisi, William Wong, Stacey Kowal, David L Veenstra, Louis P Garrison

{"title":"Does real option value influence oncologists' treatment recommendations? A survey of U.S. oncologists.","authors":"Meng Li, Zizi Elsisi, William Wong, Stacey Kowal, David L Veenstra, Louis P Garrison","doi":"10.1016/j.jval.2024.07.021","DOIUrl":"https://doi.org/10.1016/j.jval.2024.07.021","url":null,"abstract":"<p><strong>Objectives: </strong>Survival benefit from anticancer treatments, even if modest, improves a patient's chances of accessing future innovations, thereby creating real option value (ROV). There is no empirical evidence on the impact of potential future innovations on oncologists' treatment recommendations.</p><p><strong>Methods: </strong>We conducted a national online survey of practicing medical and hematological oncologists. We presented a hypothetical metastatic cancer patient with median survival of 6 months under four decision-making scenarios with varying expected efficacy and time to arrival of future innovations. We assessed the likelihood of discussing future innovations with their patients and the likelihood that future innovations would influence their current treatment recommendation, as well as factors associated with these 2 outcomes using multivariate logistic regressions.</p><p><strong>Results: </strong>201 oncologists completed the survey. When future innovations were expected to improve survival by 6 months and be available in 6 months, 76% of oncologists were likely or very likely to discuss the innovations with their patients, and 68% reported they would influence their current treatment recommendations. A one-month increase in the expected survival improvement of future innovation was associated with a 1.17 (95% CI: 1.1-1.25) greater odds of reporting likely or very likely to discuss future innovations with their patients, while a one-month increase in the expected time to arrival was associated with a 0.91 (95% CI: 0.88-0.94) lower odds.</p><p><strong>Conclusions: </strong>As potential future innovations appear to influence oncologists' treatments recommendations, evidence to inform clinical guidelines and value assessments should consider data on ROV impacts to support informed treatment decision-making.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914158","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}

引用次数: 0

Cost-effectiveness of HCC Surveillance Strategies in Patients With Compensated Liver Cirrhosis in the United Kingdom. 英国补偿性肝硬化患者 HCC 监控策略的成本效益。

IF 4.9 2区医学

Value in Health Pub Date : 2024-08-08 DOI: 10.1016/j.jval.2024.07.015

Osvaldo Ulises Garay, Louisa Elena Ambühl, Thomas G Bird, Eleanor Barnes, William L Irving, Ryan Walkley, Ian A Rowe

{"title":"Cost-effectiveness of HCC Surveillance Strategies in Patients With Compensated Liver Cirrhosis in the United Kingdom.","authors":"Osvaldo Ulises Garay, Louisa Elena Ambühl, Thomas G Bird, Eleanor Barnes, William L Irving, Ryan Walkley, Ian A Rowe","doi":"10.1016/j.jval.2024.07.015","DOIUrl":"https://doi.org/10.1016/j.jval.2024.07.015","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the cost-effectiveness (CE) of four hepatocellular carcinoma (HCC) surveillance strategies in the UK, the GAAD algorithm, which combines gender (biological sex) and age with Elecsys® biomarker assays, alpha-fetoprotein (AFP) and protein induced by vitamin K absence-II (PIVKA-II), ultrasound (US), US+AFP and GAAD+US.</p><p><strong>Methods: </strong>A de novo micro-simulation state-transition Markov model was developed in Microsoft Excel® from the perspective of the UK National Health Service to calculate life years, quality-adjusted life-years (QALYs), costs, incremental CE ratios, and net monetary benefits. Parameters were sourced from peer-reviewed published literature, national guidelines, and public cost databases. Sensitivity and scenario analyses were performed to evaluate the impact of parameter and structural uncertainty on the results.</p><p><strong>Results: </strong>In a simulated cohort of 100,000 patients, discounted costs and QALYs per patient were £8,663 and 6·066 for US, £9,095 and 6·076 for US+AFP, £8,719 and 6·078 for GAAD alone, and £9,114 and 6·086 for GAAD+US. At a CE threshold of £20,000/QALY, GAAD was the most cost-effective strategy; however, although most costly, GAAD+US was the most clinically effective. Sensitivity and scenario analyses indicated that HCC incidence along with costs associated with diagnostic performance influence CE.</p><p><strong>Conclusion: </strong>Considering the cost of US and low incidence of HCC in the UK, this study suggests that GAAD alone or in combination with US are cost-effective surveillance strategies compared with US and US+AFP. Whilst GAAD+US showed the highest QALY increase, GAAD alone is considered preferable regarding CE; however, better performance estimates for GAAD+US are needed to confirm.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914154","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}

引用次数: 0

Assessing the Health and Welfare Benefits of Interventions Using the Wider Societal Impacts Framework. 利用更广泛的社会影响框架评估干预措施的健康和福利效益。

IF 4.9 2区医学

Value in Health Pub Date : 2024-08-02 DOI: 10.1016/j.jval.2024.07.014

Shainur Premji, Susan Griffin

{"title":"Assessing the Health and Welfare Benefits of Interventions Using the Wider Societal Impacts Framework.","authors":"Shainur Premji, Susan Griffin","doi":"10.1016/j.jval.2024.07.014","DOIUrl":"10.1016/j.jval.2024.07.014","url":null,"abstract":"<p><strong>Objectives: </strong>Health technology assessment bodies advocate capturing the value of interventions in terms of their benefits to health and broader welfare. The wider societal impacts (WSI) framework considers how changes in health alter a person's net contribution to society-that is, what they produce minus what they consume. In this research, we review this framework and explore the scope to differentiate WSI by equity-relevant sociodemographic characteristics.</p><p><strong>Methods: </strong>This research updates previous calculations using publicly available data from population-based surveys in the United Kingdom. We then estimate for 199 chronic conditions: (1) WSI for the average person with the condition and (2) gain in WSI for an improvement of 0.1 in health-related quality of life score.</p><p><strong>Results: </strong>The nature and availability of information varied across population-based surveys and precluded analyses to examine WSI by population subgroup. Our updated estimates mirrored earlier findings that consideration of the broader societal impacts of health would reprioritize interventions compared with assessment on health alone. For example, for the same improvement in health, a woman experiencing diseases of the circulatory system has the highest potential gain in WSI (£354/month) whereas a man experiencing HIV has the lowest potential gain (£233/month).</p><p><strong>Conclusions: </strong>The WSI framework provides a simple, indirect method to inform resource allocation decisions. Understanding the equity implications of this approach was hindered by differences in the information collected across population-based surveys. Findings demonstrate the potential reprioritization that may occur if the broader welfare benefits of health interventions were used to inform coverage decisions.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890236","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}

引用次数: 0

Cost-Effectiveness of Axicabtagene Ciloleucel for Adult Patients With Relapsed or Refractory Follicular Lymphoma in the United States 美国治疗复发或难治性滤泡性淋巴瘤成人患者的阿昔单抗西乐葆的成本效益。

IF 4.9 2区医学

Value in Health Pub Date : 2024-08-01 DOI: 10.1016/j.jval.2024.04.003

{"title":"Cost-Effectiveness of Axicabtagene Ciloleucel for Adult Patients With Relapsed or Refractory Follicular Lymphoma in the United States","authors":"","doi":"10.1016/j.jval.2024.04.003","DOIUrl":"10.1016/j.jval.2024.04.003","url":null,"abstract":"<div><h3>Objectives</h3><p>The results of a recent single-arm trial (ZUMA-5) of axicabtagene ciloleucel<span> (axi-cel) for relapsed/refractory (r/r) follicular lymphoma (FL) demonstrated high rates of durable response and tolerable toxicity among treated patients. To quantify the value of axi-cel compared with standard of care (SOC) to manage r/r FL patients who have had at least 2 prior lines of systemic therapy (3L+), a cost-effectiveness model was developed from a US third-party payer perspective.</span></p></div><div><h3>Methods</h3><p>A 3-state partitioned-survival cost-effectiveness model was developed with a lifetime horizon. Patient-level analyses of the 36-month ZUMA-5 (axi-cel) and SCHOLAR-5 (SOC) studies were used to extrapolate progression-free and overall survivals. After 5 years of survival, an estimated 40% of the modeled population was assumed to experience long-term remission based on literature. Results include the incremental cost-effectiveness ratio (ICER) measured as incremental cost per quality-adjusted life year (QALY) gained. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analyses were performed. All outcomes were discounted 3% per year.</p></div><div><h3>Results</h3><p>Axi-cel led to an increase of 4.28 life-years, 3.64 QALYs, and a total cost increase of $321 192 relative to SOC, resulting in an ICER of $88 300 per QALY. Across all parameters varied in the one-way sensitivity analysis, the ICER varied between $133 030 and $67 277. In the probabilistic sensitivity analysis, axi-cel had a 99% probability of being cost-effective across 5000 iterations using a $150 000 willingness-to-pay threshold.</p></div><div><h3>Conclusions</h3><p>Given the robustness of the model results and sensitivity analyses, axi-cel is expected to be a cost-effective treatment in 3L+ r/r FL.</p></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140757067","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}

引用次数: 0

The Long COVID Symptoms and Severity Score: Development, Validation, and Application 长冠状病毒病（COVID）症状和严重程度评分：开发、验证和应用。

IF 4.9 2区医学

Value in Health Pub Date : 2024-08-01 DOI: 10.1016/j.jval.2024.04.009

{"title":"The Long COVID Symptoms and Severity Score: Development, Validation, and Application","authors":"","doi":"10.1016/j.jval.2024.04.009","DOIUrl":"10.1016/j.jval.2024.04.009","url":null,"abstract":"<div><h3>Objectives</h3><p>The primary focus of this research is the proposition of a methodological framework for the clinical application of the long COVID symptoms and severity score (LC-SSS). This tool is not just a self-reported assessment instrument developed and validated but serves as a standardized, quantifiable means to monitor the diverse and persistent symptoms frequently observed in individuals with long COVID.</p></div><div><h3>Methods</h3><p>A 3-stage process was used to develop, validate, and establish scoring standards for the LC-SSS. Validation measures included correlations with other patient-reported measures, confirmatory factor analysis, Cronbach’s α for internal consistency, and test-retest reliability. Scoring standards were determined using K-means clustering, with comparative assessments made against hierarchical clustering and the Gaussian Mixture Model.</p></div><div><h3>Results</h3><p>The LC-SSS showed correlations with EuroQol 5-Dimension 5-Level (r<sub>s</sub> = −0.55), EuroQol visual analog scale (r<sub>s</sub> = −0.368), Patient Health Questionnaire-9 (r<sub>s</sub> = 0.538), Beck Anxiety Inventory (r<sub>s</sub> = 0.689), and Insomnia Severity Index (r<sub>s</sub> = 0.516), confirming its construct validity. Structural validity was good with a comparative fit index of 0.969, with Cronbach’s α of 0.93 indicating excellent internal consistency. Test-retest reliability was also satisfactory (intraclass correlation coefficient 0.732). K-means clustering identified 3 distinct severity categories in individuals living with long COVID, providing a basis for personalized treatment strategies.</p></div><div><h3>Conclusions</h3><p>The LC-SSS provides a robust and valid tool for assessing long COVID. The severity categories established via K-means clustering demonstrate significant variation in symptom severity, informing personalized treatment and improving care quality for patients with long COVID.</p></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1098301524023416/pdfft?md5=86160a63dcd23c8386405b2f4c4a4dfc&pid=1-s2.0-S1098301524023416-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140791012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How Do the Institute for Clinical and Economic Review’s Assessments of Comparative Effectiveness Compare With the German Federal Joint Committee’s Assessments of Added Benefit? A Qualitative Study 临床与经济审查研究所的比较效益评估与德国联邦联合委员会的附加效益评估相比如何？定性研究。

IF 4.9 2区医学

Value in Health Pub Date : 2024-08-01 DOI: 10.1016/j.jval.2024.04.015

{"title":"How Do the Institute for Clinical and Economic Review’s Assessments of Comparative Effectiveness Compare With the German Federal Joint Committee’s Assessments of Added Benefit? A Qualitative Study","authors":"","doi":"10.1016/j.jval.2024.04.015","DOIUrl":"10.1016/j.jval.2024.04.015","url":null,"abstract":"<div><h3>Objectives</h3><p>We compared the Institute for Clinical and Economic Review’s (ICER) ratings of comparative clinical effectiveness with the German Federal Joint Committee’s (G-BA) added benefit ratings, and explored what factors may explain the disagreement between the 2 organizations.</p></div><div><h3>Methods</h3><p>We included drugs if they were assessed by ICER under its 2020 to 2023 Value Assessment Framework and had a corresponding assessment by G-BA as of January 2024 for the same indication, patient population, and comparator drug. To compare assessments, we modified ICER’s proposed crosswalk between G-BA and ICER benefit ratings to account for G-BA’s certainty ratings. We also determined whether each pair was based on similar evidence. Assessment pairs exhibiting disagreement based on the modified crosswalk despite a similar evidence base were qualitatively analyzed to identify reasons for disagreement.</p></div><div><h3>Results</h3><p>Out of 15 drug assessment pairs matched on indication, patient subgroup, and comparator, none showed agreement in their assessments when based on similar evidence. Disagreement was attributed to differences in evidence evaluation, including evaluations of safety, generalizability, and study design, as well as G-BA’s rejection of the available evidence in 4 cases as unsuitable.</p></div><div><h3>Conclusions</h3><p>The findings demonstrate that even under conditions where populations and comparators are identical and the evidence base is consistent, different assessors may arrive at divergent conclusions about comparative effectiveness, thus underscoring the presence of value judgments within assessments of clinical effectiveness. To support initiatives that seek to facilitate the exchange of value assessments between countries, these value judgments should always be transparently presented and justified in assessment summaries.</p></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860425","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}

引用次数: 0

Estimating the Allocation of the Economic Value Generated by Utilization of All-Oral Direct-Acting Antivirals for Hepatitis C in the United States, 2015 to 2019 估算 2015-2019 年美国使用全口服直接作用抗病毒药物治疗丙型肝炎所产生的经济价值分配。

IF 4.9 2区医学

Value in Health Pub Date : 2024-08-01 DOI: 10.1016/j.jval.2024.04.011

{"title":"Estimating the Allocation of the Economic Value Generated by Utilization of All-Oral Direct-Acting Antivirals for Hepatitis C in the United States, 2015 to 2019","authors":"","doi":"10.1016/j.jval.2024.04.011","DOIUrl":"10.1016/j.jval.2024.04.011","url":null,"abstract":"<div><h3>Objectives</h3><p>Between 2013 to 2019, several all-oral direct-acting antivirals (DAAs) were launched with the potential to cure patients with hepatitis C virus (HCV). They generated economic value in terms of the health gains for patients and cost-savings for the US healthcare system. We estimated the share of this value allocated to 4 manufacturers vs society.</p></div><div><h3>Methods</h3><p>For 2015 to 2019, we estimated the incremental impact of DAAs on HCV health outcomes and costs. We used the Center for Disease Analysis Foundation Polaris Observatory database to estimate utilization. Per-patient projections of lifetime quality-adjusted life-years (QALYs) gained and medical costs avoided were based on a standard 9-state HCV disease-progression model for DAA treatment vs alternatives. Annual QALY gains were valued at $114 000 per QALY. Outcomes and costs were discounted at 3%. Estimated revenues were based on reported sales.</p></div><div><h3>Results</h3><p>An estimated 1 080 000 patients received DAAs: 81.5% would not have received the pre-DAA standard of care. On average, these patients were projected to gain 4.4 QALYs and save $104 400 in lifetime healthcare costs, generating $531.8 billion in value. Those who would have received treatment gained 1.7 QALYs and saved $41 500 in lifetime costs, generating $47.4 billion in economic value. As treatment costs fell nearly 75%, the 4 manufacturers reported $37.4 billion from DAA sales—an allocation of 6.5% of the total value.</p></div><div><h3>Conclusions</h3><p>The significant majority (∼90%) of the economic value of curing HCV with DAAs were health benefits to patients and net cost-savings to society. DAA manufacturers received a minority share (6.5%) of the aggregate economic value generated.</p></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S109830152402343X/pdfft?md5=30bfecad282596af1a8bdaadf2258d75&pid=1-s2.0-S109830152402343X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Health Fluctuations in Dementia and its Impact on the Assessment of Health-Related Quality of Life Using the EQ-5D-5L 痴呆症患者的健康波动及其对使用 EQ-5D-5L 评估健康相关生活质量的影响。

IF 4.9 2区医学

Value in Health Pub Date : 2024-08-01 DOI: 10.1016/j.jval.2024.04.010

{"title":"Health Fluctuations in Dementia and its Impact on the Assessment of Health-Related Quality of Life Using the EQ-5D-5L","authors":"","doi":"10.1016/j.jval.2024.04.010","DOIUrl":"10.1016/j.jval.2024.04.010","url":null,"abstract":"<div><h3>Objectives</h3><p>To quantify health fluctuations, identify affected health-related quality of life (HRQoL) dimensions, and evaluate if fluctuations affect the HRQoL instruments recall period adherence in people living with dementia (PlwD).</p></div><div><h3>Methods</h3><p>Caregivers of PlwD completed a daily diary for 14 days, documenting if PlwD’s health was better or worse than the day before and the affected HRQoL dimensions. Health fluctuation was categorized into low (0-4 fluctuations in 14 days), moderate (5-8), and high (9-14). Also, caregivers and PlwD completed the EQ-5D-5L (proxy- and self-reported) on days 1, 7, and 14. Subsequently, caregivers were interviewed to determine whether recurrent fluctuations were considered in the EQ-5D-5L assessment of today’s health (recall period adherence).</p></div><div><h3>Results</h3><p>Fluctuations were reported for 96% of PlwD, on average, for 7 of the 14 days. Dimensions most frequently triggering fluctuations included memory, mobility, concentration, sleep, pain, and usual activities. Fluctuations were associated with higher EQ-5D-5L health-states variation and nonadherence to the EQ-5D-5L recall period “today.” PlwD with moderate to high fluctuation had the highest EQ-5D-5L utility change between day 1 and 14 (0.157 and 0.134) and recall period nonadherence (31% and 26%) compared with PlwD with low fluctuation (0.010; 17%). Recall period nonadherence was higher in PlwD with improved compared with those with deteriorated health in the diary (37% vs 9%).</p></div><div><h3>Conclusions</h3><p>Health fluctuations frequently occur in dementia and strongly affect HRQoL assessments. Further research is needed to evaluate if more extended recall periods and multiple, consecutive assessments could capture health fluctuations more appropriately in dementia.</p></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1098301524023428/pdfft?md5=b32743f1c93ee5cfb36816ffebf1bf17&pid=1-s2.0-S1098301524023428-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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