Cost Effectiveness and Resource Allocation最新文献

{"title":"The cost-effectiveness of second line diabetes medication added to standard therapy in preventing type 2 diabetes related nephropathy in Germany.","authors":"Hanni Hille, Wendelin Schramm, Ahmed Bounekkar","doi":"10.1186/s12962-026-00801-5","DOIUrl":"10.1186/s12962-026-00801-5","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes and its associated complications like nephropathy impose a serious burden on health systems. Several blood glucose-lowering medications have shown to be likely to provide nephroprotective properties, delaying or preventing the onset of kidney damage. Kidney-specific health-economic evaluations, comparing different agents, remain rare for Germany.</p><p><strong>Methods: </strong>A Markov-microsimulation model was developed to obtain the perspective of the German statutory health system regarding cost-effectiveness. The model consists of five health states representing varying degrees of kidney damage with transition probabilities, utilities and costs being taken from published literature. Patient age was set to 62.8 years in the primary cohort; an additional analysis scenario was created with a start age of 50 years. The model outcomes life expectancy, quality adjusted life years, costs and net monetary benefit were discounted at 3% at a willingness-to-pay threshold of 100,000€ per quality adjusted life year gained.</p><p><strong>Results: </strong>Quality adjusted life years increased from 10.28 years in standard care to 10.48 years with Empagliflozin, 10.58 years with Semaglutide and 10.75 years with Tirzepatide all added on top of standard care. Life expectancy increased from 13.36 years in the base case to 13.66 years, 13.76 years and 14.00 years with Empagliflozin, Semaglutide and Tirzepatide respectively. Total direct cost amounted to 66,343.64€ in the base case, 79,767.42€ with Empagliflozin, 84,328.59€ with Semaglutide and to 155,992.59€ with Tirzepatide. The net monetary benefit was calculated to be 961,445.98€ in the base case, 968,406.95€, 973,647.74€ and 919,972.95€ with Empagliflozin, Semaglutide and Tirzepatide respectively. Multiple one-way sensitivity analyses were performed. The most influencing factors on the cost-effectiveness were found to be quality of life in the type 2 diabetes state and intervention cost.</p><p><strong>Conclusion: </strong>In this study, the application of second-line glucose-lowering medication in type 2 diabetes patients led to relevant medical improvements regarding kidney damage at higher expenditures. At the chosen willingness-to-pay threshold Empagliflozin and Semaglutide remained cost-effective in all scenarios. Patient age and sex did not change the health-economic implications.</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":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608463","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":"Efficiency and productivity of Mongolian subnational public hospital systems, 2014-2023: annual DEA, global Malmquist and double-bootstrap analysis.","authors":"Buyantogtokh Batsukh, Ganzorig Batbaatar, Amarzaya Batchimed, Tumurbat Byamba, Gantsetseg Baljirsuren, Byambakhorloo Sukhbaatar, Byambatseren Boldbaatar, Dariimaa Ganbat","doi":"10.1186/s12962-026-00808-y","DOIUrl":"10.1186/s12962-026-00808-y","url":null,"abstract":"<p><strong>Background: </strong>Mongolia must organise public hospital capacity across regions that differ greatly in population and geography. We reanalysed subnational hospital efficiency after methodological review, using an auditable production set and inferential procedures tailored to estimated frontier measures.</p><p><strong>Methods: </strong>This retrospective longitudinal study included 22 aggregated regional public hospital systems from 2014 to 2023 (220 region-years). Inputs were beds, physicians and mid-level personnel; desirable outputs were inpatient admissions, operations and outpatient visits. Annual input-oriented constant- and variable-returns DEA described contemporaneous efficiency, with pooled DEA and a desirable-output-only slack-based measure as supplementary benchmarks. Productivity was estimated using an output-oriented global constant-returns Malmquist index. A 400-replicate smoothed trajectory frontier bootstrap generated pseudo outputs and re-estimated annual and global frontiers in every replicate. For contextual assessment, Simar-Wilson Algorithm 2 was applied to one decade-average observation per region (22 independent decision-making units), using standardised log population and log geographic area.</p><p><strong>Results: </strong>Mean annual variable-returns technical efficiency was 0.931 (annual range 0.909-0.950); mean pooled variable-returns efficiency was 0.845. Bias-corrected global productivity declined in 2014-2015 (0.933, 95% bootstrap CI 0.911-0.955), 2015-2016 (0.957, 0.927-0.985), 2016-2017 (0.955, 0.940-0.970) and 2019-2020 (0.940, 0.922-0.956), increased in 2020-2021 (1.105, 1.070-1.145), and increased again in 2022-2023 (1.038, 1.018-1.060). In the independent-region double-bootstrap model, neither log population (coefficient -0.007, 95% CI -0.107 to 0.094) nor log area (0.120, -0.093 to 0.201) had a clearly non-zero association with inefficiency.</p><p><strong>Conclusions: </strong>Mongolian regional public hospital systems showed high contemporaneous technical efficiency but several statistically supported periods of productivity decline, including 2019-2020, followed by recovery in 2020-2021. The revised independent-region analysis does not support a robust regression claim that geographic area predicts inefficiency. DEA results are relative production benchmarks, not cost-effectiveness estimates or incremental cost-effectiveness ratios, and should inform monitoring and further investigation rather than punitive rankings.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228975","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 economic impact of medical scribe provision on physician productivity in outpatient clinics: a scoping review.","authors":"Ashwag Al Dhuhaibat, Thomas Mason, Erik Koornneef","doi":"10.1186/s12962-026-00764-7","DOIUrl":"10.1186/s12962-026-00764-7","url":null,"abstract":"<p><strong>Background: </strong>Medical scribes are increasingly used in outpatient clinics in the United States to reduce physician documentation burden, but their economic and operational impact remains inconsistently characterized. This scoping review synthesized evidence on the impact of medical scribes in outpatient care in the United States, focusing on physician productivity, documentation efficiency, and financial outcomes.</p><p><strong>Methods: </strong>Nine databases were searched from January 2010 to September 2024 for English-language studies reporting economic or productivity outcomes of medical scribe use in outpatient settings. Two reviewers independently screened 1,945 unique records; data were charted using a piloted template and synthesized thematically.</p><p><strong>Results: </strong>Twenty United States-based studies met the inclusion criteria: nine pre-post evaluations, five controlled cohort studies, two randomized controlled trials (RCTs), two microsimulation models, and two systematic reviews. Scribes consistently improved physician productivity: 19 of 20 studies (95%) reported increased work relative value units (wRVUs), higher patient throughput, and reduced documentation time. Clinician satisfaction improved across 9 studies; patient experience remained stable. Economic outcomes varied: 13 of 20 studies attempted return on investment (ROI) analysis, but only 6 included comprehensive costs (wages, training, licensing, turnover). Cost neutrality was achievable in high-volume clinics with predictable scheduling and unutilized capacity, but financial returns depended heavily on specialty, baseline productivity, and cost accounting rigor.</p><p><strong>Conclusions: </strong>Medical scribes enhance operational efficiency and physician workflow in United States outpatient clinics, though economic value is context-dependent and incompletely documented. Standardised cost frameworks and controlled evaluations in non-United States health systems are needed to guide implementation decisions.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608546","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 molecular reflex testing-based targeted therapy in non-small cell lung cancer from a German healthcare payer perspective using a decision tree model.","authors":"Leonie Schumacher, Melina Sophie Kurte, Tabea Poos, Markus Thalheimer, Frank Griesinger, Florian Kron","doi":"10.1186/s12962-026-00803-3","DOIUrl":"10.1186/s12962-026-00803-3","url":null,"abstract":"<p><strong>Background: </strong>Reflex testing (RT) - pathologist-initiated molecular testing performed at non-small cell lung cancer (NSCLC) diagnosis - enables rapid identification of actionable genomic alterations for targeted therapy (TT) selection. Despite national and international guideline recommendations, approximately 15% of patients with advanced NSCLC in Germany remain untested for driver mutations. The portion of untested patients in early stages is likely to be even higher.</p><p><strong>Objective: </strong>This study simulated the clinical and economic impact of introducing RT for untested NSCLC patients under different implementation scenarios, using a decision-tree model from the German statutory health insurance (SHI) perspective.</p><p><strong>Methods: </strong>A decision-tree model simulated four RT cases (C): (C1) no molecular testing, (C2) testing per German S3 guideline recommendations, (C3) testing according to current TT approvals, and (C4) comprehensive panel testing (standard in Austria). PD-L1 expression was tested in all cases. The untested NSCLC population was projected for 2025 based on SHI demographics. Model inputs comprised RT sensitivity, mutation and stage distribution, drug acquisition costs (Lauer-Taxe, April 2025), and median overall/progression-free survival (mOS/mPFS) per therapeutic strategy. A scenario analysis was conducted assuming NGS test costs of €3,000 per panel to assess their potential influence on cost-effectiveness versus no testing.</p><p><strong>Results: </strong>All RT cases (C2-C4) substantially increased actionable mutation detection, enabling earlier TT initiation and lower mean treatment costs versus no molecular testing. C2-C4 were clinically dominant, driven by increased mOS by 5.48-5.47 months and mPFS by 4.89-5.42 months. Model yielded annual cost savings versus no testing of €740 (C2) and €535 (C3/C4) per patient (annual cost savings of €1,175 - €1,621 per life-year gained). When €3,000 next-generation sequencing (NGS) panel costs were included, annual costs per patient increased modestly (C2: €2,260; C3/C4: €2,465 versus no testing), at annual incremental costs of €4,946 - €5,409 per life-year gained.</p><p><strong>Conclusions: </strong>Reflex testing across implementation cases, by enabling earlier identification of actionable biomarkers and receipt of matched targeted therapy, improves clinical outcomes and is cost-effective for untested NSCLC patients from the German SHI perspective. Structured initiatives, such as national Network for Genomic Medicine (nNGM), could further expand equitable access to precision oncology in Germany.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585576","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":"A systematic review of medication costs associated with preterm infants.","authors":"Yunhao Xu, Kamran Khan, Nia Roberts, Sungwook Kim","doi":"10.1186/s12962-026-00802-4","DOIUrl":"10.1186/s12962-026-00802-4","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth significantly affects neonatal and child health through various severe complications, contributing to high neonatal and under-5 mortality rates globally. While the overall medical costs associated with preterm birth have been explored, comprehensive studies specifically focused on the medication costs related to health conditions arising from preterm birth remain limited.</p><p><strong>Methods: </strong>Systematic searches were conducted across MEDLINE, Embase, Web of Science, International HTA database and Pediatric Economic Database Evaluation Project using broad search terms for literature published before May 31, 2024. Included studies, published in English, reported the medication costs of preterm birth individuals from birth to age 17 using primary evidence, which were then categorised according to corresponding life stages. Collected medication costs were converted to U.S dollars for the financial year in which the costs were reported based on purchasing power parities and inflated to 2025 U.S. dollar values.</p><p><strong>Results: </strong>The literature search yielded 5,269 articles. Of these, 42 articles satisfied criteria and were incorporated into this systematic review. Among these articles, 38 papers reported medication costs in infancy (under age 1), 3 papers reported costs in childhood (age 1 to age 12) and 1 paper reported costs across infancy and childhood. The review found that medication costs for common complications varied widely, with higher costs associated with severe conditions and specific treatments. The highest medication cost in this study was observed in patients with chronic lung disease treated with nitric oxide for approximately 24 days, totalling $20,705 per patient (2025 USD). Additionally, costs during childhood showed variability influenced by gestational age at birth and respiratory disease history. In infancy, medication costs typically accounted for less than 15% of total healthcare expenditure in studies reporting both components; childhood evidence was limited and suggested a smaller share of total costs.</p><p><strong>Conclusions: </strong>This review documented wide variation in medication costs among preterm infants, with the highest costs linked to selected conditions and treatments. Childhood evidence was limited to three heterogeneous studies, and no adolescent data were identified. Future economic evaluations should derive medication-cost parameters from reliable primary sources.</p><p><strong>Prospero registration number: </strong>CRD42024599548.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221046","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-effective primary health-centre allocation in Himalayan terrain: a spatial and resource-allocation analysis of Chamoli and Rudraprayag districts, India.","authors":"Neelkamal Alomayan Kalita, Guru Vasishtha","doi":"10.1186/s12962-026-00778-1","DOIUrl":"10.1186/s12962-026-00778-1","url":null,"abstract":"<p><strong>Background: </strong>Primary Health Centre (PHC) coverage in Himalayan India is constrained by terrain, dispersed settlement and a population-based norm (one PHC per 20,000 in hilly areas) that treats elevation as exogenous. Existing accessibility analyses describe these gaps but rarely evaluate the resource-allocation trade-offs of closing them.</p><p><strong>Methods: </strong>Using village-level Census 2011 data and PHC locations from the Department of Medical Health and Family Welfare, Uttarakhand, we mapped catchment areas in Chamoli and Rudraprayag using Voronoi polygons and 5/10/15-km buffers, and recomputed coverage with attention to the limitations of Euclidean distance in mountainous terrain. We then built a resource-allocation model comparing four scenarios: status quo (S0); strict NHM compliance at one PHC per 20,000 population (S1); a coverage-optimised scenario that adds the minimum number of PHCs needed to bring the share of population beyond 15 km below 5% (S2); and an altitude-adjusted dynamic threshold (S3). Costs used Indian Public Health Standards-aligned parameters (capital ₹1.85 crore per new PHC; recurring ₹86 lakh per PHC per year, 2024 prices) discounted at 5% over a 10-year horizon, with one-way sensitivity analysis.</p><p><strong>Results: </strong>At baseline, 23% of Chamoli's population and 2% of Rudraprayag's lay beyond 15 km of any PHC (combined 83.7% coverage; ~94,000 people uncovered). Achieving strict NHM compliance (S1) required 18 additional PHCs at a 10-year present-value (PV) cost of ₹275 crore (incremental cost-effectiveness ratio ICER ₹19,671 per additional person covered). The coverage-optimised scenario S2 required only 6 additional PHCs, reached 96.0% coverage at ₹158 crore PV cost, and dominated all alternatives with an ICER of ₹8,373 per additional person covered. The altitude-adjusted scenario (S3) achieved near-complete coverage but at the highest cost (ICER ₹29,274). Results were most sensitive to the time horizon and recurring cost; capital cost had a small effect (±₹3 crore for ± 25% variation).</p><p><strong>Conclusions: </strong>A small, geographically targeted expansion of the PHC network in upper Chamoli yields the largest cost-effectiveness gains and accounts for most of the avoidable access gap. Population thresholds alone are an unreliable allocation rule in mountainous districts; explicit coverage-cost optimisation should inform Health and Wellness Centre placement under Ayushman Bharat in hill regions.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550703","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 bacterial vaginosis screening strategies in women attempting for natural conception.","authors":"Dengyan Qi, Hanyue Zheng, Mengjie Zhao, Lei Ba, Bei Wang, Xuening Zhang, Xiang Hong","doi":"10.1186/s12962-026-00798-x","DOIUrl":"10.1186/s12962-026-00798-x","url":null,"abstract":"<p><strong>Objectives: </strong>Bacterial vaginosis (BV) is associated with reduced fecundability in women. To address the limited accessibility and diagnostic sensitivity of current preconception BV screening in China, this study evaluated the cost-effectiveness of BV Blue, an accessible, self-administered rapid test.</p><p><strong>Methods: </strong>A decision tree model was constructed from a societal perspective to compare five screening strategies: No screening, Amsel criteria, BV Blue testing alone, sequential BV Blue-Nugent testing, and Nugent scoring alone. Effectiveness was defined as the number of pregnancies per 100,000 women over one year. Cost-effectiveness was evaluated using incremental cost-effectiveness ratios (ICERs), referenced against a willingness-to-pay (WTP) threshold based on China's per capita GDP. Sensitivity analyses were conducted to assess model robustness.</p><p><strong>Results: </strong>In a simulated cohort of 100,000 women, BV Blue testing yielded 842 additional pregnancies compared with no screening (ICER: CNY 2,827 per pregnancy), well below the WTP threshold of CNY 99,665. The sequential and Amsel strategies were absolutely dominated by BV Blue testing. Compared with BV Blue testing, Nugent strategy yielded 171 additional pregnancies (ICER: CNY 198,051 per pregnancy), remaining below the three-fold per capita GDP threshold (CNY 298,995). However, sensitivity analyses indicated that the cost-effectiveness of Nugent strategy was not robust, being highly sensitive to BV Blue testing's diagnostic sensitivity and pregnancy rates. On the cost-effectiveness acceptability curve, BV Blue testing consistently demonstrated the highest probability of being the optimal strategy.</p><p><strong>Conclusion: </strong>In the preconception period, all screening strategies yielded more pregnancies than no screening. Both BV Blue testing and Nugent scoring were cost-effective, whereas the Amsel and sequential strategies were not. BV Blue testing is a promising screening tool for preconception BV management. These findings may inform the selection of diagnostic pathways in China's national preconception screening program.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457255","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":"Unintended consequences of National centralized volume-based drug procurement policy in China: a game theory-based analytical approach for pharmaceutical quality and pricing.","authors":"Siyu Zhang, Jiaxue Li, Siming Li, Jun Li, Linjing Zhang, Rui Wang, Changsheng Chen, Liang Zhu","doi":"10.1186/s12962-026-00794-1","DOIUrl":"10.1186/s12962-026-00794-1","url":null,"abstract":"<p><strong>Background: </strong>The pharmaceutical industry plays a pivotal role in the healthcare economy, with drug quality and pricing being critical to consumer welfare. China's government has implemented National centralized volume-based drug procurement(NVBP) policy, aiming to reduce medication costs through bulk purchasing. While existing research confirms its price-reduction effects, unintended consequences regarding pharmaceutical quality incentives remain overlooked. This study investigates how the NVBP policy reshapes firms' quality-pricing strategies, addressing a critical gap in policy evaluation.</p><p><strong>Methods: </strong>Game-theoretical model is constructed to simulate interactions between two pharmaceutical firms with distinct technological capabilities before and after China's National volume-based procurement (NVBP) policy. Prior to the policy, the Hotelling model's spatial competition is reinterpreted as a quality-preference spectrum After the policy, drugs are standardized through consistency evaluation, and competition reduces to pure price competition as in the Bertrand model. Then a double-envelope bidding game is introduced where the government sets a minimum quality standard and firms bid on price. After winning the bid, firms need to decide the production strategy.</p><p><strong>Results: </strong>Before NVBP policy implementation, equal-quality price differences depend solely on technical parameters. Under endogenous quality, a firm's quality rises with its own technology; the technologically superior firm charges a higher price, but a weaker firm facing a superior rival lowers its price. After NVBP policy implementation, during the bidding time, if both firms pass consistency evaluation, the winning bid price falls, but quality may drop below pre-NVBP levels. If the low-tech firm fails, the high-tech firm gains monopoly pricing power and raises prices. During the production time, some unintended consequences may occur, such as quality risk and supply disruption risk.</p><p><strong>Conclusions: </strong>The implementation of NVBP policy could lower drug prices and improve access, but it may also generate unintended consequences. Low standards induce price competition and reduce quality investment, while high standards may create sole-supplier monopoly. Excessively low bids pose quality or supply risks. Policy should calibrate standards, use tiered incentives, and strengthen surveillance, but empirical validation remains needed.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437904","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 luseogliflozin for the management of type 2 diabetes mellitus in Vietnam: a Markov model analysis from the Vietnam social health insurance perspective.","authors":"The Due Ong, Anh Son Dao, Quoc Trung Ly, Thi Tuyet Mai Kieu, Hong Minh Le","doi":"10.1186/s12962-026-00797-y","DOIUrl":"10.1186/s12962-026-00797-y","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to assess the cost-utility of luseogliflozin compared with Standard of Care (SoC) for patients with T2DM in Vietnam, under two reimbursement scenarios by Vietnam Social Health Insurance (VSHI).</p><p><strong>Methods: </strong>A Markov model with five health states was developed to simulate lifetime disease progression. The analysis adopted the VSHI perspective, including only direct medical costs. Health outcomes were expressed as quality-adjusted life-years (QALYs), and cost-effectiveness was evaluated against a willingness-to-pay (WTP) threshold of 1 GDP per capita in Vietnam (USD 4,700 per QALY). Both costs and outcomes were discounted at 3% annually. One-way and probabilistic sensitivity analyses (10,000 iterations), as well as a scenario analysis reflecting the 70% reimbursement case (consistent with the reimbursement rate applied to other SGLT2 inhibitors) were conducted.</p><p><strong>Results: </strong>In the base case (100% reimbursement), luseogliflozin increased total costs by USD 535.38 and yielded 0.325 additional QALYs, resulting in an incremental cost-effectiveness ratio (ICER) of USD 1,649.34/QALY, which is well below the WTP used in this analysis. The probabilistic analysis showed a mean ICER of USD 1,661/QALY, with 100% of simulations confirming cost-effectiveness. In the 70% reimbursement scenario, the incremental cost decreased to USD 327.74, yielding an ICER of USD 1,010/QALY, further strengthening the conclusion of cost-effectiveness.</p><p><strong>Conclusion: </strong>From the VSHI perspective, luseogliflozin was cost-effective compared with SoC, and the results remained robust across all sensitivity and scenario analyses. As the first economic evaluation of luseogliflozin in Vietnam, these findings provide locally relevant evidence to inform reimbursement policy for diabetes treatment.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13483501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437921","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":"Real-world cost avoidance associated with bevacizumab biosimilar adoption in a tertiary public hospital in Ecuador: a cost-minimization and budget impact analysis.","authors":"Sara Rodríguez, Carla Arias, María Del Carmen Aynaguano, Carol Moreno, David Armas","doi":"10.1186/s12962-026-00799-w","DOIUrl":"10.1186/s12962-026-00799-w","url":null,"abstract":"<p><strong>Background: </strong>The increasing use of high-cost oncology therapies poses significant challenges for healthcare systems, particularly in low- and middle-income countries. The introduction of biosimilars offers a potential strategy to optimize pharmaceutical expenditure while maintaining clinical outcomes. However, real-world economic evidence from Latin American public healthcare settings remains limited.</p><p><strong>Objective: </strong>To evaluate the economic impact of bevacizumab biosimilar adoption in a tertiary public hospital in Ecuador through a cost-minimization analysis and a budget impact analysis based on real-world institutional data.</p><p><strong>Methods: </strong>A retrospective observational economic evaluation was conducted using institutional pharmacy data available from January 2019 to June 2, 2026. The database was extracted on June 2, 2026; therefore, data for 2026 represent year-to-date observations. A cost-minimization analysis (CMA) was performed under the assumption of clinical equivalence between originator bevacizumab and its biosimilar (MB02), focusing on direct drug acquisition costs. A budget impact assessment was conducted using an originator-only counterfactual scenario, comparing observed biosimilar expenditure with the hypothetical expenditure that would have occurred if the same number and presentation mix of biosimilar vials had been acquired at originator prices. Cost estimates included real expenditure, hypothetical originator costs, and mean acquisition cost per vial. Uncertainty was explored using bootstrap resampling techniques.</p><p><strong>Results: </strong>A total of 6,431 bevacizumab vials were dispensed during the study period, 91.9% of which corresponded to the biosimilar. Biosimilar acquisition costs were substantially lower than those of the originator product across both vial presentations. Under the originator-only counterfactual scenario, hypothetical expenditure was estimated at USD 5,462,097.60 compared with observed biosimilar expenditure of USD 1,963,376.00, resulting in estimated cost avoidance of USD 3,498,721.60 (64.1%). These findings demonstrate substantial cost avoidance and pharmaceutical expenditure containment associated with biosimilar adoption.</p><p><strong>Conclusion: </strong>The incorporation of a bevacizumab biosimilar in a tertiary public hospital in Ecuador was associated with substantial cost avoidance under an originator-only counterfactual scenario. These findings support the role of biosimilars as a strategy to improve efficiency and contribute to expenditure containment in in oncology pharmaceutical spending within resource-constrained healthcare settings.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424913","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}