Cost Effectiveness and Resource Allocation最新文献

{"title":"Analysis of costs in implementing the HEARTS hypertension program in Nigerian primary care.","authors":"Emmanuel Ndenor Sambo, Muhammad Jami Husain, Soumava Basu, Malau Mangai Toma, Sunday Victor Eze, Kufor Osi, Nanlop Ogbureke, Okeoma Erojikwe, Bolanle Banigbe, Andrew E Moran, Deliana Kostova","doi":"10.1186/s12962-025-00626-8","DOIUrl":"10.1186/s12962-025-00626-8","url":null,"abstract":"<p><strong>Background: </strong>The Nigeria Hypertension Control Initiative (NHCI) program, launched in 2020, integrates hypertension care into primary healthcare using the HEARTS technical package, which includes screening, health counselling, and standardized hypertension treatment protocols. This package has been piloted through NHCI in Kano and Ogun States and in the Federal Capital Territory (FCT) Abuja, as part of the Hypertension Treatment in Nigeria (HTN) project.</p><p><strong>Objective: </strong>To assess the costs of scaling up the HEARTS hypertension control package and compare these costs with those of usual care.</p><p><strong>Methods: </strong>Data on the costs of implementing the HEARTS program were collected from 15 purposively sampled primary health facilities in Kano, Ogun, and FCT Abuja between February and April 2024. Costs included training, medicines, provider time, and administrative expenses. We used the HEARTS costing tool, an Excel-based instrument, to collect and analyze the annual costs from a health system perspective, using an activity-based approach.</p><p><strong>Results: </strong>The estimated annual cost of implementing HEARTS was USD 16 per adult primary care user (PCU), with variations across the three locations: USD 21 in Abuja, USD 11 in Kano, and USD 16 in Ogun. Average annual medication costs per patient treated under HEARTS also varied by location, amounting to USD 28 in Abuja, USD 27 in Ogun, and USD 16 in Kano. Under usual care, annual medication costs per patient were estimated at USD 32 in Kano and USD 16 in Ogun (data for Abuja were unavailable). Major cost drivers for the HEARTS package included provider time (49%) and medication (47%), compared to usual care, where medication alone accounted for 80% of costs. Implementing HEARTS requires a full-time equivalent of 0.45 doctors, 1.59 nurses, and 5.21 community health workers per 10,000 primary care users.</p><p><strong>Conclusions: </strong>In the Nigerian primary care setting, provider time costs and medication costs emerge as major considerations in scaling up hypertension services. Policy options could consider reducing follow-up visit frequency for well-controlled patients to decrease provider time costs. Additionally, medication costs may be reduced by prioritizing first-line treatments and volume-driven purchasing as program scale-up continues.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"23"},"PeriodicalIF":1.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162888","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":"The effect of hospital budgeting system on physician-executives' budget cognitive consciousness and medical decision making.","authors":"Wen-Hsin Huang, Cheng-Tsung Lu","doi":"10.1186/s12962-025-00629-5","DOIUrl":"10.1186/s12962-025-00629-5","url":null,"abstract":"<p><strong>Background and objective: </strong>This study adopts social cognitive theory to comprehensively explore how hospital budgeting systems influence physician-executives' budget cognitions (budget usefulness, relevance, and cost control consciousness) and how these cognitions subsequently affect medical decision-making within the context of a global budget payment system.</p><p><strong>Methods: </strong>Data was collected through questionnaire survey method. Before distributing the formal questionnaire, researchers interviewed the hospital director to discuss the questionnaire items that matched the current medical organization situation. Subsequently, the formal questionnaire was mailed directly to physician-executives in teaching hospitals (National Health Insurance contracted). We used the Structural Equation Model to examine the causal relationships among research variables.</p><p><strong>Results: </strong>Hospital budgeting systems with communication, control, and forecasting characteristics positively impact physician-executives' cognitions of the relevance and usefulness of budget information. Both physician-executives' cognition of budget quality (relevance and usefulness) and budgeting systems characteristics positively impact the establishment of physician-executives' cost control consciousness. This heightened cost control consciousness significantly influences physician-executives' subsequent medical decisions. This study confirmed that when considerations of limited medical resources and costs under a global budget payment system, physician-executives tend to adopt cost control medical decision-making behaviors.</p><p><strong>Conclusions: </strong>The empirical findings of this study indicate that when physician-executives possess cost control consciousness or budget-related cognitive concepts, it may influence their adoption of cost control medical decisions. Therefore, in a highly competitive medical environment with limited resources under a global budget payment system, striking a balance between the rational allocation of budgetary resources and ensuring adequate medical care for the public becomes a critical issue. These findings provide valuable insights for both the medical industry and government in formulating future health insurance policies. Moreover, they offer hospitals useful references for designing and implementing effective budgeting systems.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"22"},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121197","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":"Estimation of economic burden of high salt intake in cardiovascular disease attributed to hypertension in Iran.","authors":"Sirous Pourkhajoei, Reza Goudarzi, Mohammadreza Amiresmaeili, Nouzar Nakhaee, Vahid Yazdi-Feyzabadi","doi":"10.1186/s12962-025-00631-x","DOIUrl":"10.1186/s12962-025-00631-x","url":null,"abstract":"<p><strong>Background: </strong>Excessive salt consumption is a significant risk factor for the development of cardiovascular disease (CVD) attributed to hypertension, major contributors to mortality in Iran. This study aims to estimate the economic burden of high salt consumption on CVD attributed to hypertension in Iran in 2022.</p><p><strong>Methods: </strong>The cross-sectional research was conducted in public and private hospitals in the southeast of Iran. The costs of CVD patients attributed to hypertension (ICD I10-I15) were estimated using a prevalence-based and bottom-up approach from society's perspective classifying costs into direct and social Costs of disease management. The indirect costs of productivity losses were quantified using the human capital approach. Sensitivity analysis was employed to investigate the effect of uncertain parameters.</p><p><strong>Results: </strong>The mean cost per CVD patient was US$1392.48, with an estimated total economic burden of US$980.61 million in Iran. Direct costs constituted 44.47% of the total disease burden, while social costs accounted for 55.53%. The results were robust, with a 20% variation in the average unit price of all direct medical and non-medical costs.</p><p><strong>Conclusion: </strong>The study highlights the substantial economic burden of high salt consumption on CVD attributable to hypertension in Iran, amounting to 3.25 times current health expenditures per capita and 0.27 times GDP per capita in 2022. Indirect costs, including productivity losses, surpass direct costs, underscoring the broader societal impact. Sensitivity analysis confirms the robustness of results, emphasizing the urgent need for preventive measures and resource allocation. Policymakers are encouraged to prioritize salt reduction programs to mitigate costs, enhance patient care, and promote long-term economic and health benefits.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"21"},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112240","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":"Optimizing strategy for cervical cancer prevention in china: a comprehensive modeling analysis.","authors":"Dachuang Zhou, Di Zhang, Yi Wang, Kejia Zhou, Wenxi Tang","doi":"10.1186/s12962-025-00630-y","DOIUrl":"https://doi.org/10.1186/s12962-025-00630-y","url":null,"abstract":"<p><strong>Background: </strong>With the first domestic 9-valent human papillomavirus (HPV) vaccine soon to be introduced in China, alongside advancements in cervical cancer screening technologies, we aimed to evaluate and identify effective, cost-effective, and affordable cervical cancer prevention strategies suitable for China.</p><p><strong>Methods: </strong>We developed a Markov model from the healthcare system perspective, comprising 18 ages strata and 9 health states, to predict the effectiveness, cost-effectiveness, and affordability of 38 different cervical cancer prevention strategies over the next 30 years, compared with no intervention. The model parameters were calibrated using least-squares fitting against real-world data and simulation results for the no-intervention scenario. Strategies were assessed and selected based on the World Health Organization's (WHO) cervical cancer elimination target (incidence < 4 per 100,000), cost-effectiveness threshold (Incremental cost effectiveness ratio [ICER] < one-time China's 2023 per capita GDP), and current cervical cancer prevention budget in China. We conducted one-way and probabilistic sensitivity analyses, and considered potential price reductions from centralized procurement to assess the robustness of the results.</p><p><strong>Results: </strong>Compared with no intervention, 16 strategies could achieve cervical cancer elimination by 2050, 29 were highly cost-effective, and 11 were affordable. Overall, only screening women aged 35-64 using visual inspection with acetic acid (VIA) combined with bivalent vaccination for girls aged 9-14 met all criteria. This strategy could achieve cervical cancer elimination by 2041, with an ICER of US$2,543.91 per quality-adjusted life-year (QALY), and was deemed affordable. Sensitivity analysis indicated the results were robust. If price reductions from centralized procurement were considered, CareHPV, PAP, and 9-valent HPV vaccination could become attractive alternatives.</p><p><strong>Conclusion: </strong>Screening women aged 35-64 with VIA and vaccinating girls aged 9-14 with the bivalent HPV vaccine is currently the most suitable cervical cancer prevention strategy for China. In scenarios with larger budgets, more accurate screening methods and the 9-valent HPV vaccine could be introduced. Our study provides crucial evidence for cervical cancer prevention and control policy in China.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"20"},"PeriodicalIF":1.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081357","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":"Effectiveness analysis and value incommensurability.","authors":"Anders Herlitz","doi":"10.1186/s12962-025-00624-w","DOIUrl":"https://doi.org/10.1186/s12962-025-00624-w","url":null,"abstract":"<p><p>This paper argues that in many contexts where effectiveness analysis such as benefit-cost analysis and cost-effectiveness analysis is used, we have good reason to think that some benefits or costs are incommensurable in value such that neither can be determined to be better than the other, although they cannot be determined to be equally good either. Two responses to such value incommensurability are outlined: abandoning conventional ways of measuring benefits and costs and replacing one-dimensional measures with multi-dimensional measures or sticking to conventional ways of measuring benefits and costs and accepting that whatever valuation one comes up with, it will fail to reflect the actual values and value relations between benefits and costs. Both responses are argued to be problematic.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"19"},"PeriodicalIF":1.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018061","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":"Impact of China's diagnosis-intervention packet payment reform on pediatric pneumonia hospitalization costs: an interrupted time series analysis.","authors":"Liang Zhao, Kun Zeng, Feijia Chen, Wei Li, Jun Zhao","doi":"10.1186/s12962-025-00623-x","DOIUrl":"https://doi.org/10.1186/s12962-025-00623-x","url":null,"abstract":"<p><strong>Background: </strong>Pediatric pneumonia remains a major cause of morbidity and mortality, imposing substantial financial burdens on healthcare systems and families. This study evaluates the impact of China's diagnosis-intervention packet (DIP) payment reform on hospitalization costs and care quality for pediatric pneumonia.</p><p><strong>Methods: </strong>We retrospectively analyzed hospitalization cost data from a pilot hospital for DIP reform, between January 2019 and December 2023. Cases were categorized into re-reform and post-reform phases based on DIP implementation. Interrupted time series regressions assessed immediate and long-term cost trends and clinical outcomes.</p><p><strong>Results: </strong>A total of 13,133 pediatric pneumonia hospitalizations were included (4,053 pre-reform; 9,080 post-reform). Median hospitalization costs decreased from 4,150.7 RMB to 3,853.3 RMB, with the most notable reductions in medication costs (261.1 RMB) and comprehensive service fees (103.9 RMB). Interrupted time series analysis showed significant immediate reductions in comprehensive service costs (23.2%, P < 0.001) and medication costs (15.8%, P = 0.031), followed by sustained monthly declines in all types of hospitalization costs. Concurrently, clinical outcomes improved: cure rates increased significantly from 87.0 to 90.6% (P < 0.001) without increased ICU transfers (3.5% vs. 4.6%, P = 0.478).</p><p><strong>Conclusion: </strong>The implementation of DIP payment reform was associated with significant reductions in hospitalization costs for pediatric pneumonia while maintaining key quality indicators such as cure rates and ICU transfer frequencies. The observed cost reductions were primarily driven by lower medication expenses and reduced use of unnecessary diagnostic services, reflecting a shift towards value-based care. These findings underscore the potential of DIP reform to enhance hospital efficiency and financial sustainability without compromising patient care.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"18"},"PeriodicalIF":1.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002469","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":"Out-of-pocket pharmaceutical expenditure and potential misuse of public resources - analysis in the Italian context.","authors":"Leonarda Maurmo, Federico Ruta, Grazia Dicuonzo, Vincenzo Signoretta, Cosimo Gennari, Vincenzo Dicuonzo, Donato Suma, Mariarosaria D'Ambrosio, Cataldo Procacci","doi":"10.1186/s12962-025-00619-7","DOIUrl":"https://doi.org/10.1186/s12962-025-00619-7","url":null,"abstract":"<p><p>The increase in longevity determines a greater need to receive medical care and pharmacological treatments. The introduction of patient cost-sharing in pharmaceutical expenditures aims to finance the National/Regional Health System while simultaneously reducing excessive consumption of health services. However, in the context of national health insurance, decreasing drug expenditures can lead to increased hospitalization costs. This phenomenon highlights the complexity of healthcare financing, where measures intended to control spending in one area may inadvertently escalate costs in another, necessitating a careful evaluation of health policies and their broader implications on patient care and system sustainability. The main focus of the analysis is to examine drug expenditures and the private purchase of drugs. Specifically, the analysis investigates the spending on drug therapies across different regional macro-areas (the Italian regional macro-areas are geographical subdivisions used to organize activities and services, particularly in the context of healthcare and scientific research.). Moreover, it analized the variability in the use of AIFA (Italian Medicines Agency) notes, a regulatory tool used in Italy to define the reimbursement criteria and therapeutic indications for which a drug can be prescribed at the expense of the National Health Service (SSN), and the extent to which individuals resort to private purchasing for drugs that are in total Health Service reimbursement. Additionally, the analysis delves into the top 30 active substances that significantly impact pharmaceutical spending, as reported in the Osmed 2022 report. This research found heterogeneous use of AIFA notes for many drugs across Italy. Inappropriate use of restrictive notes at prescription indicates high patient out-of-pocket spending, constituting financial damage. Comparing regional ratios to national benchmarks reveals deviations in prescribing behavior and AIFA note use by GPs. Regions with highest inappropriate AIFA note use also have highest out-of-pocket spending and lowest incomes, suggesting cultural factors drive branded over generic drug choices when public reimbursement is available.There can be many causes, including a cultural nature, which push patients to purchase the originator drug by paying the excess amount.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"17"},"PeriodicalIF":1.7,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018062","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-utility analysis of olaparib assisted targeted therapy for BRCA mutation HER2-negative early breast cancer in China and in the United States.","authors":"Chenxia Xu, Jie Zhuang, Jianrong Shen, Hong Sun, Jiaqin Cai, Xiaoxia Wei","doi":"10.1186/s12962-025-00617-9","DOIUrl":"https://doi.org/10.1186/s12962-025-00617-9","url":null,"abstract":"<p><strong>Background: </strong>Olaparib, an inhibitor of poly (ADP-ribose) polymerase (PARP), has demonstrated promising outcomes in treating HER2-negative early-stage breast cancer with BRCA mutations. However, a comprehensive evaluation of its cost-effectiveness in the context of the United States and China has yet to be undertaken. This study seeks to fill this research void by performing a thorough cost-utility analysis.</p><p><strong>Methods: </strong>This investigation takes as its foundation the findings from the OlympiA trial. We obtained survival curves from this trial and used the Weibull distribution function to calculate transition probabilities. Relevant literature provided the necessary data on costs, utility values, and discount rates applicable to both the United States and China. We utilized TreeAge software to construct Markov models for each country, simulating the progression of early-stage breast cancer. These models underwent extensive examination through multi-way analysis, cost-utility analysis, Monte Carlo simulations, one-way and two-way sensitivity analyses, as well as probabilistic sensitivity analysis.</p><p><strong>Results: </strong>The cost-utility analysis of the Chinese Markov model revealed that the total expenditure for the Olaparib cohort amounted to 384,274.75 RMB, generating 6.41 QALYs. Conversely, the placebo group incurred a total cost of 60,264.10 RMB, resulting in 6.34 QALYs. The Incremental Cost-Utility Ratio (ICUR) between the two cohorts stood at 5,007,332.36 RMB/QALY, which is significantly higher than thrice the Gross Domestic Product (GDP) per capita of China in 2022, set at 257,094 RMB. As for the U.S. model, the Olaparib group had a total expenditure of 245,604.01 USD, yielding 7.53 QALYs, while the placebo cohort had a total cost of 93,019.92 USD, generating 7.45 QALYs. The ICUR for the two groups was calculated at 1,891,974.19 USD/QALY, substantially surpassing the U.S. Willingness-To-Pay (WTP) threshold of 150,000 USD/QALY.</p><p><strong>Conclusions: </strong>When evaluated in the context of healthcare economics in both China and the United States, the implementation of an Olaparib-based treatment strategy for early-stage HER2-negative breast cancer with BRCA mutations does not present a cost-effective solution in either nation.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"16"},"PeriodicalIF":1.7,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062639","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 nephroprotection programs for patients with type 2 diabetes mellitus in insurers in Colombia.","authors":"Cristian Alejandro González-Rojas, Sergio Augusto Cáceres-Maldonado, Luis Alberto Soler-Vanoy, Lizbeth Alexandra Acuña-Merchán","doi":"10.1186/s12962-025-00618-8","DOIUrl":"https://doi.org/10.1186/s12962-025-00618-8","url":null,"abstract":"<p><strong>Background: </strong>This research aimed to determine the cost-effectiveness of nephroprotection programs compared to no intervention in adults with type 2 diabetes mellitus (T2DM) in the Colombian national health system.</p><p><strong>Methods: </strong>A Markov analysis with 3 disease states (controlled, uncontrolled and death) was modeled using a 1-year cycle and a 10-year time horizon based on T2DM and chronic kidney disease (CKD) data in Colombia from 2020 to 2023 from the perspective of the health insurance system. Effectiveness was considered as the control of CKD progression, with a decrease of estimated glomerular filtration rate (eGFR using CKD-EPI) of less than 5 ml/min/1.73 m², and glycated hemoglobin (HBA1c) of less than or equal to 7%. Costs are expressed in 2023 $USD. Univariate and multivariate probabilistic sensitivity analyses were conducted using 1,000 Monte Carlo simulations.</p><p><strong>Results: </strong>Compared to no intervention, nephroprotection programs were found to be cost-effective, with a dominant incremental cost-effectiveness ratio (ICER). Furthermore, the sensitivity analysis results showed that having a nephroprotection program is a cost-effective strategy in 89.2% and dominant in 56.7% of the simulations.</p><p><strong>Conclusions: </strong>Nephroprotection programs result in better T2DM control and slower CKD progression, while also being lower in costs incurred during the year.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"14"},"PeriodicalIF":1.7,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056393","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 economic evaluation of trans-tibial prosthetic suspension systems: a protocol for a pilot using an observational study and synthetic cohort.","authors":"Leigh Clarke, Alan Shiell, Michael P Dillon","doi":"10.1186/s12962-025-00611-1","DOIUrl":"https://doi.org/10.1186/s12962-025-00611-1","url":null,"abstract":"<p><strong>Background: </strong>Health Economic Evaluations (HEEs) provide the necessary evidence of cost-benefit to inform policy and investment decisions. No HEEs have quantified the cost-benefit of passive suction (PS) vs vacuum assisted suction (VAS) suspension for trans-tibial prosthesis users. There are methodological challenges to conducting HEE in prosthetics given the benefit measures are not focused on the things most important to prosthesis users and funders, and the required time horizons are lengthy. To address these challenges, we propose a pilot study using two PROMIS instruments to measure benefits and trial the use of a Synthetic Cohort Method, to quantify the cost-effectiveness and cost-utility of PS and VAS suspension for people living with trans-tibial amputation.</p><p><strong>Methods: </strong>An observational study will measure the costs and benefits of PS and VAS suspension for trans-tibial prosthesis users using a Synthetic Cohort Method, a technique used in epidemiological modelling of life-time risks. Each intervention will include 3 sub-groups, representing prosthesis users in the first, second, or third year of the intervention since fitting. A prosthetic payor perspective will be taken, with data collected over a 1-year period and synthesised to reflect the costs and benefits over a 3-year time horizon. Benefits will be measured using two PROMIS instruments reported to best measure the benefits most important to prosthesis users and funders. Costs will be calculated from actual billable costs to the funder. Costs and benefits will be discounted at 4%. Cost-effectiveness and cost-utility will be calculated using the incremental costs and incremental benefits, with results presented as incremental cost-effectiveness and incremental cost-utility ratios. Bootstrapping will be undertaken to assess uncertainty, and discounting will be analysed through a one-way sensitivity analysis.</p><p><strong>Discussion: </strong>This pilot will make a novel contribution by trailing the use of a Synthetic Cohort Method to reduce the lengthy time horizons required in prosthetic HEE. The HEE will use a two-pronged approach whereby cost-utility and cost-effectiveness are simultaneously evaluated using the PROMIS instruments to inform a wide range of policy and investment decisions. Additionally, this pilot will be the first HEE of suction suspension systems for people with transtibial amputation and will therefore make an important contribution to the prosthetic evidence base.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"15"},"PeriodicalIF":1.7,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054105","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}