Value in Health最新文献

{"title":"Eliciting a Conceptual Model for a New Patient-Reported Outcome Measure to Assess Patients’ Perception of Treatment Goal Achievement in Interdisciplinary Multimodal Pain Treatment","authors":"Stefan Hager MPH,&nbsp;Hendrik Berth PhD,&nbsp;Leonie Manzke MSc,&nbsp;Jan-Michael Hengel MD,&nbsp;Annekathrin Juliane Rätsch MSc,&nbsp;Anja Küchler-Köbe MSc,&nbsp;Elisa König MSc,&nbsp;Kristin Braun MSc,&nbsp;Ulrike Kaiser PhD","doi":"10.1016/j.jval.2026.05.014","DOIUrl":"10.1016/j.jval.2026.05.014","url":null,"abstract":"<div><h3>Objectives</h3><div>The study aimed to develop a content-valid conceptual model to capture patients’ perceptions of therapy goal achievement within interdisciplinary multimodal pain treatment (IMPT) programs. This model serves as the theoretical foundation for a new patient-reported outcome measure designed to evaluate IMPT effectiveness from the patient perspective.</div></div><div><h3>Methods</h3><div>Concept elicitation followed the concept mapping approach, combining qualitative and quantitative techniques. A total of 61 patients with primary chronic pain participated in focus groups and online surveys. Patient-generated treatment goals were collected, categorized, and analyzed by the multidimensional scaling method and a subsequent hierarchical cluster analysis. Finally, the data were validated by an interdisciplinary expert panel to ensure conceptual accuracy and relevance for the conceptual model.</div></div><div><h3>Results</h3><div>A total of 210 therapy goals were collected. Of these, 127 were retained for the final model after a reduction process. Fifteen coherent clusters emerged from the analysis, representing 3 overarching domains: functional restoration, therapy-related competence development, and psychological growth. This multidimensional structure reflects the biopsychosocial complexity of chronic pain and emphasizes that successful therapy is perceived as enhanced autonomy, regained participation, and self-empowerment rather than mere pain reduction.</div></div><div><h3>Conclusions</h3><div>The developed conceptual model provides a content-valid, patient-centered basis for assessing treatment goal achievement in IMPT. By integrating functional, cognitive, and emotional dimensions, it enables a differentiated assessment of patient-relevant treatment outcomes. Future work should focus on developing a conceptual framework and item generation, cognitive debriefing and validation, and psychometric evaluation in larger and more diverse samples ensuring reliability, validity, and applicability of the final patient-reported outcome measure across clinical and research settings.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"29 10","pages":"Pages 1857-1868"},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296569","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}

{"title":"Estimating the Wider Societal Impact of Semaglutide Across Multiple Indications in Canada: an Economic Evaluation.","authors":"Don Husereau, Marc Evans, Julie Hviid Hahn-Pedersen, Robert King, Jamie Kettle, Bejamin D Bray, Marina Berger, Maria Luckevich, Christopher Lübker, Soeren Mattke","doi":"10.1016/j.jval.2026.09.3116","DOIUrl":"https://doi.org/10.1016/j.jval.2026.09.3116","url":null,"abstract":"<p><strong>Introduction: </strong>Medical treatments may deliver individual, healthcare and societal impact across multiple indications. Assessing impact is challenging due to a focus on individual-level and indication-specific costs/benefits using narrow healthcare perspectives. A multi-indication model was developed for Canada to evaluate the wider societal impacts of semaglutide.</p><p><strong>Method: </strong>A population-level analysis estimated the 5-year (2025-2029) impact of semaglutide in a hypothetical population of 1,000,000 eligible treated Canadians with T2D, CV disease, MASH and/or CKD. Baseline prevalence and overlaps were estimated from published data. Treatment effects were derived from clinical trial comparisons of semaglutide vs standard care. Health care resource use reduction and cost-converted environmental impact was calculated from prevalence differences in control and treatment groups. Productivity was quantified using a US-based quality-of-life driven model.</p><p><strong>Results: </strong>Among treated individuals, 50% had 1 condition, 27% had 2, and 23% had ≥3 at baseline. Model analysis projected up to 235,000 fewer obesity cases and prevention by 2029 of 650 T2D cases, 8,400 CV events, 1,100 CV deaths, 5,300 MASH stage 3-4 cases, 2,200 stage 4 CKD/end-stage renal disease cases, and 48,800 obesity- and T2D-related complications, although 21,200 gastrointestinal adverse events were estimated to occur. Treatment with semaglutide was estimated to avoid 22,200 hospitalisations and 330kt CO2e, with estimated HCRU cost reductions of CAD 2.0billion and modelled productivity gains of CAD 19.9billion, offsetting CAD 20.4billion semaglutide (1mg, 2.4mg) treatment costs. Results were most sensitive to baseline utility values.</p><p><strong>Conclusion: </strong>Modelled 5-year impacts of semaglutide treatment suggest potential wide-ranging individual, healthcare and societal benefits across cardiometabolic comorbidities that are not captured in traditional narrow healthcare perspectives.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082054","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":"Recommendations on the Implementation of Performance Outcome Assessments in Clinical Trials: A Good Practices Report of an ISPOR Task Force.","authors":"Elizabeth Nicki Bush, Chris J Edgar, Heather Adams, Alexandra Atkins, Bill Byrom, Michelle Campbell, Heather Dickerson, Sonya Eremenco, Naomi Knoble, Fiona McDougall, Elektra Papadopoulos, Ashley F Slagle","doi":"10.1016/j.jval.2026.08.013","DOIUrl":"https://doi.org/10.1016/j.jval.2026.08.013","url":null,"abstract":"<p><p>Performance outcome (PerfO) assessments are standardized, task-based clinical outcome assessments (COAs) used to evaluate patients' physical, cognitive, sensory, and functional abilities in clinical trials. Building on the first ISPOR PerfO Task Force report, which addressed selection, development, and modification of PerfO instruments, this second task force report focuses on clinical trial implementation considerations that are especially relevant to PerfO assessments, when compared to other clinical outcome assessment types. Examples of PerfO Assessments related to specific aspects of function (sensory, motor, cognitive, daily, ambulatory, and neurodevelopmental) are presented. Practical considerations related to clinical trial design, standardized documentation, administrator training, data collection and use of digital health technologies to enable reliable data collection are provided. Factors that jeopardize validity (including disease progression, learning effects, encouragement effects, and sensory or cognitive limitations) are identified alongside targeted mitigation strategies. As no analytic technique can compensate for inconsistent PerfO assessment implementation, careful planning and consistent monitoring of data collection is foundational to ensuring data are valid and interpretable.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075978","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":"Barriers and facilitators to implementing patient-reported outcome and experience measures (PROMs/PREMs) in health systems: a comprehensive overview of systematic reviews.","authors":"Guillaume Fontaine, Meagan Mooney, Joshua Ramos, Laura Crump, Marie-Eve Perron, Marie-Eve Poitras, Maxime Sasseville, Rachael Laritz, Lydia Ould Brahim, Sylvie D Lambert","doi":"10.1016/j.jval.2026.09.3113","DOIUrl":"https://doi.org/10.1016/j.jval.2026.09.3113","url":null,"abstract":"<p><strong>Objectives: </strong>Patient-reported outcome measures and experience measures (PROMs/PREMs) are central to person-centred, value-based healthcare. We synthesized barriers and facilitators influencing the implementation of PROMs and PREMs to identify priorities for health system action and research.</p><p><strong>Methods: </strong>We conducted an overview of systematic reviews adhering to JBI and PRIOR guidelines. Databases were searched in June 2023, with hand-searching to March 2026. Two reviewers performed screening, quality appraisal, and factor coding using the Consolidated Framework for Implementation Research (CFIR). Data synthesis included thematic analysis by CFIR construct.</p><p><strong>Results: </strong>Thirty-two reviews contributed 1,326 factor mentions across 44 of 48 CFIR constructs and spanned diverse clinical populations and settings. The five most salient barriers (40.2% of mentions) were patients' difficulty completing measures because of literacy, language, illness, disability, or limited digital access; poor integration into clinical workflows and information systems; lengthy, inaccessible, or difficult-to-use measures and platforms; complex administration, interpretation, and response processes; and clinicians' limited motivation to collect or use results. The five leading facilitators (34.7% of mentions) were user-centred measure and platform design; visible clinical benefits over usual care; reliable and interoperable IT infrastructure; workflows embedding completion, timely review, and follow-up; and patients' belief that measures addressed meaningful needs and improved communication. Evidence was concentrated in oncology and high-income settings, with limited PREM-specific coverage.</p><p><strong>Conclusions: </strong>PROM and PREM programmes should prioritize workflow and IT integration, inclusive design of measures and platforms, clear ownership, and support for patients and clinicians. This review can guide implementation investment, local pre-implementation work, and evaluations.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075992","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":"Symptoms of Major Depressive Disorder Scale: Performance of a Novel Patient-Reported Symptom MeasureValue Health. 2019;22(8):906-915.","authors":"Donald M Bushnell, Kelly P McCarrier, Elizabeth Nicole Bush, Lucy Abraham, Carol Jamieson, Fiona McDougall, Madhukar H Trivedi, Michael E Thase, Linda Carpenter, Stephen Joel Coons","doi":"10.1016/j.jval.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.jval.2026.09.002","url":null,"abstract":"","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064620","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":"Signaling Demand with Cost-Effectiveness Analysis: A Case Study of PCSK9 Inhibitors.","authors":"Ciaran N Kohli-Lynch, Yina M Quique, Andrew H Briggs","doi":"10.1016/j.jval.2026.09.3114","DOIUrl":"https://doi.org/10.1016/j.jval.2026.09.3114","url":null,"abstract":"<p><strong>Objectives: </strong>Healthcare decision-makers increasingly account for heterogeneity in cost-effectiveness across patient populations. We aimed to characterize the demand curve implied by this heterogeneity. This framework was applied in an analysis of proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9-I) therapy for Scottish adults with familial hypercholesterolemia (FH).</p><p><strong>Methods: </strong>We showed how individual and subgroup level treatment value can be estimated by combining incremental health benefits and non-drug costs with a cost-effectiveness threshold, then annualized to obtain value-based prices. Ordering individuals or subgroups by value-based price generates a demand curve that maps treatment price to the proportion of the population that is cost-effective to treat. The framework was applied to PCSK9-I therapy for Scottish adults with FH. The Scottish CVD Policy Model, a previously published decision-analytic model, estimated quality-adjusted life years and healthcare costs. Uncertainty was explored with probabilistic sensitivity analysis.</p><p><strong>Results: </strong>At the current list price of £4,410 per year, PCSK9-I therapy is not cost-effective for Scottish adults with FH (ICER: £350,000/QALY). A decision-maker should treat approximately 10% of the prospective patient population at an annual price of £612 (95% UI: £438-£888) and 50% of the patient population at a price of £276 (95% UI: £200-£390).</p><p><strong>Conclusions: </strong>We developed a framework that characterizes the demand curve implied by heterogeneity in cost-effectiveness and demonstrates how treatment recommendations can be used to signal demand to manufacturers. Applied to PCSK9-I therapy, the framework characterized the relationship between treatment price and eligibility and its implications for treatment access, surplus distribution, and value-based pricing.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064600","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":"Sources of the utilities used in paediatric cost-utility analyses in children aged under 5 years, and the methods used in their elicitation: a systematic review.","authors":"Alexander van Heusden, Ashwini De Silva, Sophie Ten Dam, Vercancy Wu, Wendy J Ungar, Nancy Devlin, Kim Dalziel","doi":"10.1016/j.jval.2026.08.012","DOIUrl":"https://doi.org/10.1016/j.jval.2026.08.012","url":null,"abstract":"<p><strong>Objectives: </strong>Few multi-attribute utility instruments (MAUIs) have been developed and validated for children under five years, limiting the evidence on health-related quality of life used to inform resource allocation decisions. This systematic review aimed to characterize utilities used in cost-utility analyses (CUAs) involving children aged 0-5 years published between 2012 and 2023, their sources, and the methods used to obtain them.</p><p><strong>Methods: </strong>Studies were identified from the Paediatric Economic Database Evaluation (PEDE) Project. Eligible studies were CUAs reporting quality-adjusted life years (QALYs) with at least one health state for children aged 0-5 years. Descriptive analyses were conducted to summarise study characteristics, sources of utilities, and methods used to obtain utilities. Changes over time were explored by comparing studies published in 2012-2017 with 2018-2023.</p><p><strong>Results: </strong>Of the 1,098 studies screened, 162 met inclusion criteria. Of these, 87 (53.7%) had health states exclusively in the 0-5 years age-group, 16 (9.9%) included states also in the 5-18 years age-group, and 59 (36.4%) included states also in adulthood. Two-thirds of CUAs evaluated were preventative interventions. Seventy percent of studies clearly reported their utility sources. Among studies that obtained utilities from the literature (82.2%), most used MAUIs, with the adult EQ-5D-3L valued using the UK tariff being most common (33%).</p><p><strong>Conclusions: </strong>CUAs involving children under five years have increased; but the methods for obtaining utilities remain varied and underreported. The frequent reliance on adult MAUIs and utilities underscores the need for validated age-appropriate instruments to improve the validity of QALY estimates in this age group.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040897","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":"Cost-Effectiveness and Clinical Utility of a Retinal Cardiovascular AI-Guided Strategy for Statin Initiation: A South Korean Multicenter Prospective Study.","authors":"Dongjin Nam, Man S Kim, Hwan-Cheol Park, Lei Liu, Si Nae Oh, Youngmin Park, Jae Yong Han, Kwanghyun Lee, Jung Hyun Kim, Sunjin Hwang","doi":"10.1016/j.jval.2026.08.011","DOIUrl":"https://doi.org/10.1016/j.jval.2026.08.011","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the clinical utility and long-term cost-effectiveness of artificial intelligence (AI)-guided retinal cardiovascular risk assessment, compared with standard of care (SOC), for guiding statin therapy in primary cardiovascular disease prevention in South Korea.</p><p><strong>Methods: </strong>In this multicenter study, 274 prospectively enrolled AI-guided participants were compared with 274 propensity score-matched retrospective SOC controls; guideline concordance was adjudicated by an independent evaluator. Long-term cost-effectiveness was assessed from a healthcare-system perspective using a decision tree and lifetime Markov microsimulation of 10,000 hypothetical individuals aged 63 years. Costs and quality-adjusted life-years (QALYs) were discounted at 4.5%; deterministic and probabilistic sensitivity analyses included 10,000 Monte Carlo iterations.</p><p><strong>Results: </strong>AI-guided care was associated with higher guideline compliance (82.8% vs 61.3%) and appropriate statin initiation (53.3% vs 4.7%) and lower inappropriate non-initiation (11.7% vs 35.8%; all P<.001), which were directly observed decision-level outcomes. In the model, the AI-guided strategy was projected to be dominant, yielding more QALYs (12.57 vs 11.39) at lower lifetime cost ($123,271 vs $140,865) and an incremental cost-effectiveness ratio of -$14,972/QALY. Incremental net monetary benefit was $43,389 at 30,000,000 KRW/QALY ($21,952), and the strategy was cost-effective in every probabilistic iteration and all examined sensitivity analyses, including sex-stratified analyses.</p><p><strong>Conclusions: </strong>Linking retinal cardiovascular AI outputs to guideline-based preventive care was associated with more guideline-concordant statin decisions and, in a lifetime model, was projected to be economically dominant over usual care. Long-term outcomes were projected, not observed, and require confirmation in other settings.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040812","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":"CONFIRMATORY VALIDATION AND CLUSTER CLASSIFICATION OF THE IRRITABLE BOWEL SYNDROME SYMPTOM SEVERITY SCALE (IBS-SSS).","authors":"Pragalathan Apputhurai, Olafur S Palsson, Shrikant I Bangdiwala, Ami D Sperber, Antonina Mikocka-Walus, Simon R Knowles","doi":"10.1016/j.jval.2026.08.010","DOIUrl":"https://doi.org/10.1016/j.jval.2026.08.010","url":null,"abstract":"<p><strong>Background: </strong>Irritable Bowel Syndrome (IBS) affects about 4% of the global population and is associated with high psychological distress. The IBS Symptom Severity Scale (IBS-SSS) is the most widely used patient reported outcome measure for IBS, but its psychometric properties are under-studied. Using the largest and most globally representative IBS sample, this study provides a comprehensive psychometric evaluation of the IBS-SSS.</p><p><strong>Aim: </strong>To examine the factor structure of the IBS-SSS and identify symptom profiles using the Rome IV Global Epidemiology Survey.</p><p><strong>Methods: </strong>A cross-sectional sample of individuals with IBS (N = 1512) completed the IBS-SSS. Confirmatory factor analyses compared one- and two-factor models across the total sample, IBS subtypes, and IBS status (with vs. without additional Disorders of Gut-Brain Interaction (DGBI)). Latent profile analyses identified symptom profiles, and their associations with IBS subtypes were examined. MANOVA tested differences in IBS-SSS domains across profiles.</p><p><strong>Results: </strong>A two-factor model showed the best fit. Three profiles were identified: high (12.5%), moderate (42.7%), and low severity (44.8%). Profile membership showed weak associations with IBS subtypes, whereas IBS subtypes differed strongly across symptom domains (Wilks' Λ = 0.02, p < .001, partial η² = .98). ROC analysis supported severity cut-offs based on the total IBS-SSS score (≤ 274 mild, 275-354 moderate, ≥ 355 severe) with 83% accuracy.</p><p><strong>Conclusions: </strong>The IBS-SSS demonstrates strong psychometric validity and effectively distinguishes symptom severity. Findings highlight the heterogeneity of IBS and support symptom-based, personalised approaches over subtype-based classification.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031391","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":"Cost-Effectiveness Analysis of the Five First-line Treatment Regimens for ALK-positive NSCLC in China: An Economic Evaluation Based on Network Meta-Analysis.","authors":"Hui Zhang, Shuangshuang Hu, Yuhang Liu, Jing Ou, Bikun Cai, Guihao Zeng","doi":"10.1016/j.jval.2026.08.008","DOIUrl":"https://doi.org/10.1016/j.jval.2026.08.008","url":null,"abstract":"<p><strong>Background: </strong>With multiple first-line treatment options now available for advanced ALK-positive non-small cell lung cancer (NSCLC), clinicians and patients face significant challenges in selecting the optimal therapeutic strategy. This study aims to evaluate the cost-effectiveness of five tyrosine kinase inhibitors (TKIs) as first-line therapies from the perspective of the Chinese healthcare system.</p><p><strong>Methods: </strong>Using crizotinib as a common comparator, we performed indirect comparisons across five ALK-TKIs by reconstructing survival data and applying fractional polynomial models to estimate time-varying hazard ratios. A partitioned survival model was developed to assess cost-effectiveness. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were conducted to evaluate model robustness. Primary outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). The willingness-to-pay (WTP) threshold was set at $27,906.00/QALY.</p><p><strong>Results: </strong>Compared to crizotinib, the ICERs for lorlatinib, alectinib, ensartinib, brigatinib, and iruplinalkib were $4,674.43/QALY, $5,361.28/QALY, $199,751.00/QALY, -$29,623.06/QALY, and $4,652.70/QALY, respectively. Iruplinalkib yielded the highest QALY gain, while brigatinib was associated with the lowest total cost. DSA identified utility values and drug prices as key drivers of the ICERs. At a WTP threshold of $27,906/QALY, PSA indicated that iruplinalkib had the highest probability (75.70%) of being cost-effective.</p><p><strong>Conclusion: </strong>For patients with advanced ALK-positive NSCLC in China, lorlatinib, alectinib, brigatinib, and iruplinalkib are cost-effective compared to crizotinib, with the exception of ensartinib. Among these, iruplinalkib is the most cost-effective TKI for first-line treatment, followed by lorlatinib.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017589","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}