Cost Effectiveness and Resource Allocation最新文献

{"title":"Towards meaningful outcome measures for health economic evaluations in skin cancer : A decision matrix to guide transparent outcome selection in skin cancer health economic evaluations, supporting more informed decision-making.","authors":"Annick Meertens, Lieven Annemans, Floor Verstraete, Isabelle Hoorens, Nick Verhaeghe","doi":"10.1186/s12962-026-00855-5","DOIUrl":"10.1186/s12962-026-00855-5","url":null,"abstract":"<p><p>Healthcare systems are facing increasing resource constraints, so robust health economic evaluations (HEE) are essential to inform evidence-based decision-making, also in skin cancer care. Selecting incomplete or inappropriate outcomes in HEE may under- or overestimate benefits for patients, misrepresent trade-offs between costs and outcomes and lead to suboptimal resource allocation. This comment discusses key considerations in selecting outcome measures for skin cancer HEE and proposes a conceptual decision matrix to guide meaningful outcome selection. Informed by methodological guidance and a targeted literature search, outcome domains applied in skin cancer HEE were categorized into quality of life based outcomes and clinical outcomes (hard and intermediate endpoints). These were assessed against predefined criteria covering measurement properties (e.g. sensitivity & validity), model integration (e.g. economic translatability & compatibility), decision relevance (e.g. interpretability for health technology assessment (HTA) & patient burden) and feasibility (e.g. data availability & generalizability). A qualitative scoring approach was used to make trade-offs between outcomes explicit. Generic quality of life outcomes facilitate comparability and interpretability for HTA but may lack sensitivity. Disease-specific outcomes better reflect patient-relevant domains but raise challenges regarding comparability. Intermediate clinical outcomes align closely with intervention mechanisms but require additional assumptions. The decision matrix highlights that no single outcome measure performs well across all criteria. Overall, the findings support selecting complementary outcome measures that reflect the intervention mechanisms, patient- preferences and burden and decision context. The proposed decision matrix provides a structured framework to support transparent and meaningful outcome selection.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of iStent-based trabecular micro-bypass stenting combined with cataract surgery in mild-to-moderate open-angle glaucoma: a systematic review of analytic perspectives and time horizons.","authors":"Dan Drobin","doi":"10.1186/s12962-026-00846-6","DOIUrl":"10.1186/s12962-026-00846-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Glaucoma remains a major cause of irreversible blindness and was estimated to affect 64.3 million people worldwide in 2013. Despite growing clinical use of minimally invasive glaucoma surgery (MIGS), reimbursement and uptake remain constrained by uncertainty about long-term cost-effectiveness. iStent-based trabecular micro-bypass implantation is commonly performed at the time of cataract surgery in patients with mild-to-moderate open-angle glaucoma, yet its economic value has not been synthesised systematically across healthcare systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the cost-effectiveness of iStent trabecular micro-bypass implantation performed concurrently with cataract surgery for mild-to-moderate open-angle glaucoma, and to examine how the analytic perspective and time horizon adopted in the underlying models relate to the decision the evidence is intended to inform.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review was performed of published model-based economic evaluations. Eligible studies used a formal decision-analytic model, reported quality-adjusted life years (QALYs), and evaluated an iStent device implanted concurrently with cataract surgery. PubMed, Embase, the Cochrane Library and Web of Science were searched on 27 July 2026 without date, language or publication-type restriction. Incremental cost-effectiveness ratios (ICERs), QALYs, analytic perspectives, time horizons, discount rates and probabilistic results were extracted with a page reference for each value. Reporting was appraised item-by-item against CHEERS 2022. Findings were synthesised narratively; no quantitative pooling was attempted. Reporting followed PRISMA 2020.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 418 records identified and 293 after de-duplication, eight economic evaluations from eight countries met the eligibility criteria. All eight compared the device added to cataract surgery against cataract surgery alone; seven used a cohort Markov model and one an individual-patient microsimulation. Six adopted a payer or health-system perspective and two a societal perspective; five used a lifetime horizon, one 35 years and two 15 years. No evaluation adopted a provider perspective or a base-case horizon shorter than 15 years. All eight reported a favourable base-case result in the mild-to-moderate target population: reported ratios included €1,154 per QALY in France, €12,676 in Spain, €13,037 in Italy, €10,955 to €15,673 in Germany, JPY 1,430,647 in Japan and A$2,430 in Australia, together with two instances of dominance. Six of the eight were funded by the device manufacturer. Incremental QALY gains were small throughout, between approximately 0.005 and 0.17, so the reported ratios are highly sensitive to small changes in the denominator. One study did not report a price year and for a second it could not be verified; no study reported a pre-specified health economic analysis plan, and none modelled long-term structural chan","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of early empagliflozin initiation after acute myocardial infarction: a German statutory health insurance perspective.","authors":"Priyanka Boettger, Eleni Nakou, Thomas Kinsley, Michael Buerke, Eva-Maria Wild, Samuel Sossalla","doi":"10.1186/s12962-026-00830-0","DOIUrl":"https://doi.org/10.1186/s12962-026-00830-0","url":null,"abstract":"<p><strong>Background and objective: </strong>Empagliflozin reduced heart failure (HF) hospitalizations after acute myocardial infarction (MI) in EMPACT-MI without a mortality benefit. We assessed whether HF morbidity prevention generates long-term economic value from the German statutory health insurance perspective.</p><p><strong>Methods: </strong>We developed a monthly cohort Markov model over a lifetime horizon comparing early empagliflozin plus standard care with standard care in post-MI patients at increased HF risk. The base case applied the EMPACT-MI hazard ratio of 0.77 for first HF hospitalization, assumed no direct mortality benefit, and modelled 24 months of treatment. Costs were in 2026 euros. The primary analysis covered 17.9 months; exploratory lifetime outcomes included quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs).</p><p><strong>Results: </strong>Early empagliflozin gained 0.0315 QALYs at €1,418 incremental cost (ICER €45,100/QALY) and avoided 52.0 lifetime HF hospitalizations per 1000 patients. The probability of cost-effectiveness was 16.2%, 55.2%, and 79.7% at €30,000, €50,000, and €80,000/QALY, respectively. Price reductions of 25% and 50% lowered the ICER to €32,300/QALY and €19,500/QALY. The maximum annual price compatible with €30,000/QALY was €607. Results were most sensitive to the HF hospitalization effect, drug price, and baseline HF risk. A trial-anchored analysis using the EMPACT-MI placebo event and mortality rates yielded a similar ICER (€47,200/QALY).</p><p><strong>Conclusions: </strong>Early empagliflozin generated modest projected QALY gains, predominantly through modelled indirect survival gains, at higher lifetime costs.Economic value was conditional, depending on willingness-to-pay, net price, and absolute HF risk, with the most favorable profile at lower net prices and in HF-risk-enriched patients.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient medical costs and their composition among patients with stomach cancer who underwent surgery by tumor location: a hospital-based retrospective study in China.","authors":"Zeng-Bao Hu, Shang-Qi Chen, Stuart McDonald, Meng-Meng Chen, Hua Yu, Yi Lin","doi":"10.1186/s12962-026-00837-7","DOIUrl":"https://doi.org/10.1186/s12962-026-00837-7","url":null,"abstract":"<p><strong>Background: </strong>Stomach cancer (SC), the third leading cause of cancer-related death in China, poses a considerable challenge to the Chinese healthcare system. Evidence on inpatient medical costs and cost composition among patients with SC who underwent surgery in China remains limited. Using hospitalization billing data from Ningbo, China, this study estimates the total medical costs and cost composition of SC to gain insights into the economic burden due to SC in China.</p><p><strong>Methods: </strong>A hospital-based retrospective observational study was conducted using data from a tertiary hospital in Ningbo, China. SC-related medical expenditure and the sociodemographic and clinicopathologic characteristics of inpatients were obtained from the hospital billing system and inpatient medical records. Patients aged ≥ 18 years, with a primarily diagnosis of SC who underwent surgery between 2020 and 2023 were included in the study. The proportional breakdown of SC medical expenditure was analyzed by separating the expenditure into five major categories: materials, medications, surgery, examinations, and hospital services. All expenditure data were converted to 2020 Chinese Yuan.</p><p><strong>Results: </strong>A total of 1,102 inpatients were included, where 69.51% were male, 69.06% were at stages I and II, and 58.89% had tumors in the lower part of the stomach. Inpatient medical costs were generally higher among older patients and patients with more advanced tumor stage. Materials, medications, and examinations were the major cost drivers of SC medical costs, jointly accounting for 73-74% of total costs across tumor sites.</p><p><strong>Conclusions: </strong>Medical costs among SC inpatients were substantial and varied across patients' sociodemographic and clinicopathological characteristics, particularly by age, tumor stage, and tumor site. These findings provide contemporary cost estimates that may inform hospital budgeting, procurement of medical materials and medications, and the refinement of reimbursement arrangements for SC hospitalization. They may also provide insights for future economic evaluations of SC prevention and treatment strategies.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resource allocation efficiency in Ethiopian hospitals: technology utilization as mediator and staff competency as moderator.","authors":"Sintayehu Assefa Yirga","doi":"10.1186/s12962-026-00828-8","DOIUrl":"https://doi.org/10.1186/s12962-026-00828-8","url":null,"abstract":"<p><strong>Background: </strong>Efficient resource allocation remains a major challenge for hospitals in low-resource healthcare systems, where increasing service demand often exceeds the availability of financial, technological, and human resources. Understanding how organizational capabilities improve resource allocation efficiency is therefore essential. This study examined the effects of resource availability, process efficiency, and patient-centered care on resource allocation efficiency in Ethiopian hospitals, while investigating the mediating role of technology utilization and the moderating role of staff competency.</p><p><strong>Methods: </strong>A quantitative cross-sectional survey was conducted among healthcare professionals working in public and private hospitals in Ethiopia. Data were analyzed using partial least squares structural equation modeling (PLS-SEM) to assess the direct, mediating, and moderating relationships among the study variables. The measurement model was evaluated for reliability and validity, while the structural model was assessed using standardized path coefficients, coefficients of determination (R²), effect sizes (f²), predictive relevance (Q²), and bootstrapping procedures.</p><p><strong>Results: </strong>The findings indicated that resource availability, process efficiency, and patient-centered care positively and significantly influenced resource allocation efficiency. Technology utilization partially mediated these relationships, demonstrating that greater adoption of digital technologies enhances the efficient use of hospital resources by improving coordination and reducing operational inefficiencies. Staff competency also significantly moderated the relationship between technology utilization and resource allocation efficiency, indicating that the benefits of technology are strengthened when healthcare professionals possess higher levels of knowledge and skills. Overall, the structural model demonstrated substantial explanatory and predictive power for resource allocation efficiency.</p><p><strong>Conclusion: </strong>The findings suggest that improving resource allocation efficiency requires a balanced investment in both technological capabilities and workforce competency. Hospitals should prioritize digital transformation alongside continuous staff training to maximize the effective utilization of limited healthcare resources. This study extends the healthcare management literature by integrating the Resource-Based View, Socio-Technical Systems Theory, and Dynamic Capabilities Theory to explain how organizational resources, technological capability, and human competency jointly improve resource allocation efficiency in hospitals within a resource-constrained setting.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequality in hospital bed supply and utilization across regions and departments: evidence from China.","authors":"Yuheng Zhang, Jiyun Cui, Juan Li, Yan Song, Yin Shi","doi":"10.1186/s12962-026-00827-9","DOIUrl":"10.1186/s12962-026-00827-9","url":null,"abstract":"<p><strong>Background: </strong>Adequate hospital bed capacity is fundamental to health-care accessibility. However, increasing beds per capita may mask inequalities across regions and departments, not only in supply but also in how available capacity and utilization patterns vary across regions and departments. This study examined spatiotemporal patterns and inequalities in hospital bed supply and utilization across regions and departments in China from 2009 to 2024 to inform more targeted bed planning and resource allocation.</p><p><strong>Methods: </strong>Using data on hospital beds, inpatient discharges, and population for 15 hospital departments across 31 provincial-level regions in mainland China, we measured supply as beds per 10,000 population and utilization as the bed turnover rate. Spatial analysis, kernel density estimation, and Markov chains characterized distributional patterns and dynamics, while GE(1) measured interprovincial inequality within departments and interdepartmental inequality within provinces.</p><p><strong>Results: </strong>National bed supply increased from 23.56 to 57.74 beds per 10,000 population, substantially outpacing growth in the bed turnover rate, which rose from 27.09 to 31.25. Markov analysis showed a clear upward shift in bed supply. Provinces in the lower-middle and upper-middle states moved to the next-higher state with probabilities of 0.71 and 0.51, respectively, while the high state had a persistence probability of 0.98. The low and high bed-turnover states were relatively stable, but no consistent upward shift emerged. GE(1) showed that interprovincial inequality in overall bed supply declined from 0.03 to 0.01, whereas inequality in bed turnover rates remained at approximately 0.01. However, bed-supply inequality increased in obstetrics and gynecology, infectious diseases, and traditional medicine. Within provinces, interdepartmental inequality in bed supply declined from 0.55 to 0.49 but remained substantially greater than that in bed turnover rates.</p><p><strong>Conclusions: </strong>Expansion of total bed capacity and the narrowing of interprovincial disparities did not eliminate persistent disparities across departments. Hospital-bed planning should manage new capacity and reallocate existing beds based on region- and department-specific assessments of supply, utilization, and need.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of linezolid versus vancomycin in the treatment of adult hospital-acquired and ventilator-associated methicillin-resistant staphylococcus Aureus Pneumonia (a systematic review).","authors":"Efat Mohebi Moghadam, Reza Jahangiri, Mohamad Hadian","doi":"10.1186/s12962-026-00781-6","DOIUrl":"10.1186/s12962-026-00781-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ventilator-Associated Pneumonia (VAP) is defined as pneumonia that occurs 48 to 72 h following endotracheal intubation and frequently involves pathogens demonstrating significant antibiotic resistance. Methicillin-Resistant Staphylococcus Aureus (MRSA) is the most common pathogen associated with pneumonia. The treatment of MRSA VAP is challenging and is associated with high rates of morbidity, mortality, and overall hospital costs. The selection of an appropriate therapeutic option serves to reduce mortality and overall healthcare expenses. Given the increasing emphasis on monitoring antibiotic consumption and the optimal utilization of limited resources, decision-makers are encouraged to employ economic evaluations to select a cost-effective treatment option and optimize outcomes based on available resources.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The main objective of this study is to identify and review the economic evaluations conducted regarding the treatment of MRSA VAP patients with linezolid, vancomycin, and teicoplanin, and to summarize the evidence and assess the methodologies employed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search strategy was initiated by formulating the PICOS question and based on the designed protocol, data were extracted from PubMed, Web of Science, Scopus, and Google Scholar databases up to June 8, 2025. The retrieved documents were limited to English and Persian languages. To maximize document retrieval, no restrictions were placed on the time frame or document type. Inclusion and exclusion criteria were applied for screening studies, and eligible studies were identified and their reporting quality was assessed with the CHEERS and Philips checklists.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;The search yielded 1378 records, from which ten studies were ultimately utilized. Only three of ten studies were conducted within the MRSA VAP patient population, while the remaining were conducted within the patients with MRSA-related Hospital-Acquired Pneumonia (HAP). All ten included studies compared linezolid and vancomycin; teicoplanin was not discussed in any of the identified studies. Two studies also considered the duration of empirical antibiotic treatment. Nine studies were conducted using the cost-effectiveness method and one study using the cost-utility method. All studies utilized the decision tree analytical model. The majority of the studies have considered a short-term time horizon, and only two studies have utilized a lifetime horizon. All but one study assessed the robustness of their results through sensitivity analyses. The findings indicated that despite the high cost of the linezolid drug, its superior clinical efficacy, higher survival rates, and lower rates of adverse events and mortality make it cost-effective compared to vancomycin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of community-based interventions for type 2 diabetes management in Indonesia: a time-horizon sensitivity analysis.","authors":"Aalbrecht A Irawan, Nursanti Anggriani, Yudhie Andriyana, Rizky Abdulah","doi":"10.1186/s12962-026-00812-2","DOIUrl":"10.1186/s12962-026-00812-2","url":null,"abstract":"<p><strong>Background: </strong>Type 2 Diabetes Mellitus (T2DM) imposes a severe economic burden on Indonesia's Social Health Insurance Administration Body (BPJS Kesehatan), driven predominantly by expensive late-stage complications. While the Prolanis program offers community-based prevention, a lack of long-term economic forecasting hinders optimal resource allocation among its core interventions. To address this gap, this study aims to evaluate community-based intervention strategies to determine which approach is the most cost-effective for long-term T2DM management in Indonesia.</p><p><strong>Methods: </strong>We developed a deterministic linear compartmental state-transition model to forecast the 25-year epidemiological and economic impacts of six intervention strategies derived from three Prolanis pillars: health education, physical activity, and lifestyle modification. The model integrated an economic resource allocation framework, Indonesian epidemiology data, and a 3.8-fold complication cost penalty multiplier for complication states. Cost-effectiveness was evaluated from a healthcare payer perspective using the Incremental Cost-Effectiveness Ratio (ICER) and Time-Horizon Sensitivity Analysis.</p><p><strong>Results: </strong>Over 25 years, the Lifestyle Modification intervention emerged as the dominant strategy compared to baseline care. It generated the highest increase in the managed T2DM population while incurring the lowest total systemic cost. ICER analyses demonstrated that Lifestyle Modification strictly dominated individual and combined promotive activities, which were subject to severe budgetary restrictions due to their high delivery cost-weights. Furthermore, temporal analysis confirmed that Lifestyle Modification achieves systemic net savings rapidly by Year 5. By Year 25, it resulted in projected cumulative net savings of 19.22 trillion IDR under the 3% base-case discount rate, with sensitivity analyses confirming robust dominance across 0% (27.61 trillion IDR savings) and 5% (15.48 trillion IDR savings) discount rates.</p><p><strong>Conclusion: </strong>Lifestyle Modification is the most economically dominant community-based intervention for managing T2DM in Indonesia. To avert the financial penalties of downstream complications, policymakers should strategically rebalance the Prolanis capitation budget to prioritize proactive, monitoring-driven lifestyle interventions.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health commodity resource allocation formula to achieve universal health coverage in Tanzania: a policy perspective.","authors":"Frida N Ngalesoni, George M Ruhago, Aneth W Mutatina, Elias M Katani, James T Kengia, Abdallah A Mushi, Daudi I Msasi, Mavere A Tukai","doi":"10.1186/s12962-026-00800-6","DOIUrl":"https://doi.org/10.1186/s12962-026-00800-6","url":null,"abstract":"<p><strong>Background: </strong>Capitation formula funding is increasingly being adopted in low- and middle-income countries (LMICs) including Tanzania. The approach can address health system objectives of equity and efficiency especially when relevant risk adjustments to the capitation funding are made. This paper aimed at documenting the formula review process, identifying variables explaining current pharmaceutical expenditure by health facilities in Tanzania, and assessing their usefulness in allocating prospective health commodities funds.</p><p><strong>Methods: </strong>We followed a six phased approach. First, the desk review determined possible variables and evaluated criteria for their selection. Second, stakeholders' meetings reviewed the current allocation formula and risk adjusters for the new proposed formula. Third, Pearson's correlation and multiple regression analysis assessed the usefulness of the proposed variables in allocating health commodities funds. Fourth, the stakeholder consensus and data-driven weighting were used to rank the relative importance of the variables. Fifth, scenario analysis using data from national health information system was done to test the functionality and implications of the new proposed formula. Finally, validation meetings were conducted with decision makers.</p><p><strong>Results: </strong>A total of eight risk adjusters were chosen out of the probable 18 identified. Analysis indicated a significant robust correlation (P < 0.01) between per capita health commodities expenditure and all selected variables except antenatal care, which was moderately correlated. The variables explained 77% and 74% of the variation in per capita health commodities expenditure for the model with all primary health facilities (dispensaries, health centre and district hospitals) (PHC model, n = 145) and for the model with health centres and district hospitals (HC/DH model, n = 45), respectively.</p><p><strong>Conclusion: </strong>Resource allocation formula review is a complex process especially in data constrained settings. Nevertheless, we demonstrated the extent to which data driven risk adjusters and basic methodologies can be applied to inform the process. Further analysis to compare funding level from the allocation formula to actual pharmaceutical expenditure would be useful.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149275593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of empirical ceftazidime-avibactam for hospital-acquired urinary tract infections: a modeling study identifying key beneficiary subgroups.","authors":"Bing-Syun Wu, Yun-Yi Chang, Ssu-Chi Chen, Chung-Hsu Lai, Chun-Kai Huang, Chia-Ta Tsai, Wei-Ru Lin, Hsing-Chun Chung, I-Fan Lin","doi":"10.1186/s12962-026-00805-1","DOIUrl":"https://doi.org/10.1186/s12962-026-00805-1","url":null,"abstract":"<p><strong>Background: </strong>Hospital-acquired urinary tract infections (HAUTIs) caused by Gram-negative bacilli are increasingly difficult to manage owing to rising carbapenem resistance. The novel antibiotic ceftazidime-avibactam (CAZ-AVI) is a potential alternative, but its cost-effectiveness in this setting is unknown. This study evaluated the cost-effectiveness of empirical CAZ-AVI versus a meropenem-first strategy for treating HAUTIs.</p><p><strong>Methods: </strong>Using a patient-level decision-tree model, we simulated adult patients with HAUTIs in general ward and intensive care unit (ICU) settings in Taiwan, drawing on local pathogen distribution and antimicrobial susceptibility data. The model compared total costs and quality-adjusted life-years (QALYs); in the meropenem arm, pathogen-susceptible cases underwent antibiotic de-escalation once culture-guided susceptibility results were available. Clinical outcomes, utility weights, and costs were obtained from secondary sources of published studies, with all costs expressed in 2024 U.S. Dollars (USD) and future QALYs discounted at 3% annually. The primary outcome was the incremental cost-effectiveness ratio (ICER) per QALY gained, evaluated against a willingness-to-pay (WTP) threshold equal to Taiwan's 2024 GDP per capita ($33,983/QALY). Uncertainty was assessed with one-way, probabilistic, and scenario sensitivity analyses.</p><p><strong>Results: </strong>In the base case, CAZ-AVI was cost-effective in both settings. Incremental cost-effectiveness ratios (ICERs) were $12,049/QALY (Ward) and $21,396/QALY (ICU), both below the WTP threshold. At Taiwan's WTP threshold, the probability that CAZ-AVI was cost-effective was 93.8% (Ward) and 76.9% (ICU). The 50% cost-effectiveness threshold was approximately $12,500/QALY (Ward) and $22,500/QALY (ICU). In scenario analysis, CAZ-AVI was dominant (more effective and cost-saving) for patients with end-stage renal disease (ESRD).</p><p><strong>Conclusion: </strong>Empirical CAZ-AVI is cost-effective compared with meropenem for HAUTIs in both ward and ICU settings in Taiwan, with benefits most pronounced in critically ill patients and those with severe renal impairment. These findings support CAZ-AVI as a first-line empirical option in select patient populations, particularly in institutions with elevated rates of meropenem-resistant pathogens and may inform local antimicrobial stewardship policy.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149275534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}