Cost Effectiveness and Resource Allocation最新文献

{"title":"Understanding provider behavioral responses to capitation prepayment systems: an integrated mixed-methods approach.","authors":"Tao Zhang, Boyu Li, Jing Liu, Jiayue Li","doi":"10.1186/s12962-026-00790-5","DOIUrl":"10.1186/s12962-026-00790-5","url":null,"abstract":"<p><strong>Background: </strong>Provider payment mechanisms are critical policy tools for shaping healthcare delivery, yet their effectiveness is mediated by contextual and organizational factors. This study examines the implementation of capitation prepayment under China's Integrated County Healthcare Consortium (ICHC) system, aiming to elucidate the complex interplay of factors influencing provider behavioral responses and the resulting system dynamics.</p><p><strong>Methods: </strong>We conducted a mixed-methods study in Datong prefecture, China. Qualitative data from 63 semi-structured interviews with county hospital physicians and administrators were analyzed using Latent Dirichlet Allocation (LDA) to identify key influencing factors. Social Network Analysis (SNA) and Interpretative Structural Modeling (ISM) were employed to examine the interrelationships and hierarchical structure of these factors. A System Dynamics Model (SDM) was developed using longitudinal data (2015-2019) from 15 county hospitals to simulate the incentive mechanisms of capitation prepayment.</p><p><strong>Results: </strong>The analysis revealed four primary domains influencing provider behavior under capitation prepayment: (1) external environmental factors (population characteristics, economic conditions, market competition), (2) institutional resources (bed capacity, workforce, medical equipment), (3) management strategies (particularly cost-control measures), and (4) service delivery outcomes. Management strategies emerged as the most direct determinant of provider behavior, while environmental factors and institutional resources moderated the effects of payment incentives. The SDM simulations indicated potential unintended consequences, including cost-shifting from inpatient to outpatient services.</p><p><strong>Conclusion: </strong>The study demonstrates that provider responses to capitation prepayment are predominantly driven by institutional cost-control measures, mediated by contextual and resource factors. Policy implementation should address potential unintended consequences through strengthened referral mechanisms between county and tertiary hospitals and enhanced monitoring of service shifting. These findings contribute to the global understanding of payment reform implementation in resource-constrained settings and highlight the importance of contextual adaptation in payment system design.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340693","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":"Quantitative evaluation of the medical resource allocation policy in China: a PMC-index model approach.","authors":"Wanwen Jia, Yitian Shao","doi":"10.1186/s12962-026-00788-z","DOIUrl":"10.1186/s12962-026-00788-z","url":null,"abstract":"<p><strong>Background: </strong>A comprehensive policy framework constitutes a crucial institutional foundation for the sustainable development of healthcare systems and quantitative evaluation of public policies offers a scientific basis for policy refinement and optimization. Amid ongoing healthcare reform and profound shifts in the structure of demand for medical resources, systematically assessing the textual quality of national-level medical resource allocation policies, together with examining of their structural characteristics and evolutionary trajectories, carries considerable practical significance.</p><p><strong>Methods: </strong>Through a systematic screening process, 16 national-level policy documents on medical resource allocation were identified. Text-mining techniques were applied to extract high-frequency keywords and build a keyword co-occurrence network, after which the PMC-index model was then used to quantitatively assess the overall quality of these policies. Heterogeneity analyses were then conducted across policy quality grades and time periods to reveal structural differences and evolutionary patterns.</p><p><strong>Results: </strong>The average PMC-index across the 16 policies was 6.67, suggesting that China's medical resource allocation policies are generally of relatively high quality. However, the analysis revealed several structural weaknesses, including limited predictive and forward-looking content, insufficient medium- to long-term planning, and an under-supply of higher-level policy instruments. Temporal analysis showed that the PMC-index increased from the Exploration Stage to the Deepening Stage before declining modestly in the Focus Stage.</p><p><strong>Conclusions: </strong>China's medical resource allocation policies are of relatively high overall quality, yet further improvements remain necessary. Future policy efforts should focus on three priorities: optimizing the hierarchical structure of the policy system, strengthening policy predictability and medium- to long-term planning orientation, and refining policy content and implementation mechanisms. Together, these efforts would enhance the systematization, stability, and governance effectiveness of the policy framework.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333649","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 a prognostic risk assessment for early-stage 1-3b diabetic kidney disease patients in the United States.","authors":"Jacie T Cooper, John E Schneider, Thomas Mclain, Steven Coca, Michael J Donovan","doi":"10.1186/s12962-026-00775-4","DOIUrl":"10.1186/s12962-026-00775-4","url":null,"abstract":"<p><strong>Background: </strong>Diabetic kidney disease (DKD) accounts for 44% of new chronic kidney disease cases and is associated with significant morbidity and mortality. Although sodium-glucose co-transporter-2 inhibitors (SGLT2is) can reduce cardiorenal outcomes, current DKD staging relying on eGFR and albuminuria (KDIGO risk categories) leaves SGLT2is underutilized in clinical practice. A new biomarker-enriched, AI-enabled risk score (KidneyIntelX™; Renalytix, Inc.) was developed to predict a progressive decline in kidney function in patients with early-stage DKD. KidneyIntelX categorizes patients as low, intermediate, or high risk for disease progression, which can guide resource utilization, prescribing of drugs such as SGLT2is, and improvements in efficiency of care. We report a cost-effectiveness analysis comparing DKD patient stratification with KidneyIntelX to KDIGO by generating an incremental cost effectiveness ratio (ICER).</p><p><strong>Methods: </strong>The model adopted a U.S. Medicare perspective and consisted of patients with DKD in stages G1-3b using KidneyIntelX or KDIGO. A 10-state Markov state transition structure was employed over a lifetime horizon which includes DKD stages 1-5, dialysis, kidney transplant, cardiovascular (CV) death, and non-CV death. Transition probabilities and risk group distributions for KidneyIntelX and KDIGO were sourced from a KidneyIntelX validation study. Evaluation resulting from KidneyIntelX or KDIGO informed SGLT2i use in the model. Cost inputs included testing, medications, and office visit costs, as well as annual costs for each DKD stage, dialysis, and kidney transplant. Quality of life for each disease state was captured as utility values informed by literature.</p><p><strong>Results: </strong>The modeled use of SGLT2i directed by KidneyIntelX led to a reduction in kidney disease progression (ESKD) and CV events, as well as dialysis starts, dialysis crashes, and kidney transplants compared to KDIGO-guided treatment. KidneyIntelX patients also spent less time in DKD stages 4 and 5 and more time in 1 through 3b. KidneyIntelX led to cost savings of about $514 per patient and quality-adjusted life year (QALY) gains of 0.028, resulting in a negative ICER. Combining SGLT2i with MRA's further increased per patient cost savings to $530 for Medicare participants.</p><p><strong>Conclusions: </strong>Wide deployment of KidneyIntelX in Medicare patients with DKD G1-3b is expected to be cost-effective compared to KDIGO from the Medicare perspective, with a negative, dominant ICER.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309875","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":"From out-of-pocket to prepaid financing? projected health expenditure and financing mix in Egypt, 1995-2050.","authors":"Moaz Elsayed Abouelmagd, Nereen A Almosilhy, Asmaa Zakria Alnajjar, Marwa Biltagy","doi":"10.1186/s12962-026-00766-5","DOIUrl":"10.1186/s12962-026-00766-5","url":null,"abstract":"<p><strong>Background: </strong>Egypt's health financing is characterised by persistently high out-of-pocket (OOP) payments exceeding 50% of total health expenditure and a declining government share, threatening financial protection and universal health coverage (UHC). Despite the 2018 Universal Health Insurance Law, whether current trends can achieve Egypt's OOP reduction targets by 2030 remains unknown. We aim to quantify levels, composition, and temporal dynamics of Egypt's health spending (1995-2050) and identify historical inflexion points.</p><p><strong>Methods: </strong>Country-level synthesis of Global Burden of Disease (GBD) Health Financing estimates (1995-2021) and projections (2022-2050).</p><p><strong>Outcomes: </strong>total health expenditure (THE), government health expenditure (GHES), prepaid private (PPP), out-of-pocket (OOP), and development assistance for health (DAH), in constant 2022 USD, per capita terms, and % of GDP. Historical trends (1995-2021) were modelled using segmented log-linear (joinpoint) regression with Newey-West heteroscedasticity- and autocorrelation-consistent (HAC) standard errors, reporting segment APCs, 95% CIs, and AAPCs. Long-run change summarised with CAGRs for 1995-2021 and 1995-2050. A pre-COVID Alternative scenario was trained with machine-learning ARIMA models on 1995-2017 to assess robustness.</p><p><strong>Results: </strong>In 1995, THE was 7.37 billion USD (GHES 34.2%, PPP 1.7%, OOP 62.1%). By 2021, THE reached USD 20.71 billion (GHES 37.2%, PPP 6.0%, OOP 54.6%). Historically, THE grew 4.06%/yr (1995-2021); full-period CAGR 3.62% (1995-2050). Joinpoint analysis showed accelerations in 1995-2001 and 2010-2017, followed by a flat 2017-2021 segment; PPP was the fastest-growing component (AAPC = 8.8%), with OOP remaining the largest despite a modest share decline. GBD projections indicate USD 52.04 billion by 2050, with GHES 26.6%, PPP 19.1%, OOP 53.8%, DAH 0.6%; per-capita THE rises to USD 319, while THE/GDP = 0.05%. The pre-COVID Alternative scenario (1995-2017) projected PPP rising to 65.9%, GHES declining to 12.7%, and OOP to 21.2%.</p><p><strong>Conclusions: </strong>Egypt's health spending will more than double by 2050. Both GBD and pre-COVID scenarios project a retreat of public financing and a growing reliance on prepaid private mechanisms. While dependence on PPP may help mitigate the burden of OOP, it may undermine equity and financial protection without a corrective policy.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273374","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":"Exploring trends of cost-effectiveness thresholds in South Korea: systematic review of pharmacoeconomic evaluations since introduction of the positive list system.","authors":"Hyun-Ji Kim, Kyung-Ae Nam, Suk-Chan Jang, Kyung Ah Ban, Eui-Kyung Lee, Sun-Kyeong Park","doi":"10.1186/s12962-026-00787-0","DOIUrl":"10.1186/s12962-026-00787-0","url":null,"abstract":"<p><strong>Background: </strong>Pharmacoeconomic evaluations are critical for healthcare decision-making, especially as South Korea has emphasized cost-effectiveness since the 2006 positive list system. However, no official cost-effectiveness threshold (CET) has been established. This study aimed to systematically review cost-utility analyses (CUAs) conducted in South Korea since 2007 and to describe how CET values have been reported and applied in published pharmacoeconomic studies.</p><p><strong>Methods: </strong>We conducted this systematic review following the PRISMA guidelines. We searched five databases, including PubMed and KoreaMed, for CUAs published after 2007. We included CUAs of medications conducted in South Korea that reported CET. Data on baseline year, outcome measures, CET values, drug type (anticancer drugs, vaccines, and other treatments), and funding sources were extracted. We assessed the association between CETs and categorical variables using the chi-square tests or Fisher's exact tests, as appropriate.</p><p><strong>Results: </strong>A total of 8,510 studies were initially identified, of which 53 met the inclusion criteria after screening. Median CETs showed an increasing trend over time. GDP per capita-based references were more frequently used than WTP-based approaches (60.4% vs. 37.7%). Anticancer drugs consistently demonstrated higher CET values than other treatment categories, and drug type was significantly associated with CET levels (p < 0.05). In contrast, other study characteristics, including funding source, were not significantly associated in categorical analyses.</p><p><strong>Conclusion: </strong>This study provides an overview of CET trends in South Korea, highlighting differences by drug type. As the number of high-cost drugs and healthcare demands increase, CETs are expected to play a key role in balancing financial sustainability and patient access. These findings offer insights into how CET values have been applied in the literature and may inform ongoing discussions on the use of CETs in health economic evaluations.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266614","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 PET-guided BrECADD with chemotherapy in advanced-stage, classical Hodgkin lymphoma.","authors":"Guihao Zeng, Bikun Cai, Hui Zhang, Yuhang Liu, Haonan Li","doi":"10.1186/s12962-026-00757-6","DOIUrl":"10.1186/s12962-026-00757-6","url":null,"abstract":"<p><strong>Objective: </strong>The HD21 trial demonstrated efficacy and safety of brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone (BrECADD) vs. bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) as frontline therapy for advanced-stage, classical Hodgkin lymphoma. This analysis evaluated the cost-effectiveness of BrECADD from a US healthcare payer perspective.</p><p><strong>Methods: </strong>Building upon a multicenter, randomized, open-label phase 3 HD21 trial (NCT02661503) that evaluated BrECADD versus eBEACOPP in advanced-stage, classical Hodgkin lymphoma patients, we constructed a Markov model with 3-week cycles over a 50-year horizon. The model's primary outcomes encompassed total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios, with all economic parameters discounted at 3.0% annually. Cost-utility analyses employed a willingness-to-pay threshold of $100,000 per QALY, supplemented by comprehensive sensitivity and scenario analyses to verify model robustness.</p><p><strong>Results: </strong>Economic evaluation demonstrated that compared to eBEACOPP, the BrECADD regimen yielded an additional 2.24 QALYs at an incremental cost of $113,134.17, producing an ICER of $50,411.69/QALY, substantially below the $100,000 WTP threshold. One-way sensitivity analysis identified BrECADD drug acquisition costs and health state utility values as the predominant model drivers; all ICERs remained below the $100,000 WTP threshold across the plausible ranges of all parameters. Probabilistic sensitivity analysis indicated that at a willingness-to-pay threshold of $100,000 per QALY, BrECADD was cost-effective compared to eBEACOPP in 100% of 1000 Monte Carlo iterations. The cost-effectiveness acceptability curve demonstrated that BrECADD achieved a greater than 50% probability of being cost-effective at WTP thresholds above approximately $55,000 per QALY.</p><p><strong>Conclusions: </strong>BrECADD can be considered a cost-effective treatment versus eBEACOPP in treating advanced-stage, classical Hodgkin lymphoma in America.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266446","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 a community-based dementia support model: evidence from a real-world economic evaluation.","authors":"Rachel L King, Stuart Warren, Elizabeth Vass, Benjamin T Sharpe, Kian Beaumont, Stewart Seymour, Samuel Bell, Rosana Pacella, Antonina Pereira","doi":"10.1186/s12962-026-00782-5","DOIUrl":"10.1186/s12962-026-00782-5","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of dementia is currently set to rise to 1.7 million by 2040, with associated costs estimated at £90 billion. Given its substantial impact on quality of life (QoL) and the growing societal and financial burden, identifying efficient approaches to dementia support is a key policy priority. Current policy direction emphasises a shift toward community-based models of care; however, economic evidence is required to determine whether such approaches can improve outcomes while representing cost-effective use of limited healthcare resources. This study presents a cost-effectiveness analysis of the Sage House Model, a community-based dementia support intervention integrating NHS diagnostic services, third-sector provision, and local partnerships within a single hub.</p><p><strong>Methods: </strong>A preliminary cost-effectiveness analysis was conducted using a natural experimental design comparing individuals with dementia accessing the Sage House Model (n = 65) to those receiving usual care (n = 153). Health-Related Quality of Life (HRQoL) was assessed using a single measure, alongside health and social care utilisation, over a three-month period. Resource use was valued from a health and social care perspective. Incremental costs and outcomes were estimated to assess cost-effectiveness.</p><p><strong>Results: </strong>The Sage House Model was associated with lower incremental costs and higher incremental QALYs compared to usual care over the three-month time horizon and was likely to be cost-effective, with a 72.2% probability at a £20,000 willingness-to-pay threshold and 74.7% at £30,000 per QALY.</p><p><strong>Conclusions: </strong>These findings provide preliminary evidence that community-based dementia support approaches, such as the Sage House Model, may represent a promising strategy for improving outcomes alongside more efficient use of health and social care resources, and therefore warrants larger scale investigation.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266583","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 non-surgical periodontal treatment to prevent strokes and myocardial infarctions in the United Kingdom.","authors":"Edward Coote, Nitesh Patel, Rajesh Vijayanarayanan","doi":"10.1186/s12962-026-00786-1","DOIUrl":"10.1186/s12962-026-00786-1","url":null,"abstract":"<p><strong>Background: </strong>Periodontal disease (PD) is common in the UK and is associated with higher risks of stroke and myocardial infarction (MI). Non-surgical periodontal treatment (NSPT) may therefore generate downstream cardiovascular benefits, but its value for money as a CVD-prevention strategy for the NHS is unclear.</p><p><strong>Methods: </strong>A Markov cohort model simulated 65-year-olds with severe PD and no prior CVD over 10 years (with a 25-year scenario). Eight health states captured acute and chronic phases of stroke, MI, combined events, and death. Baseline CVD risks were derived from published sources; NSPT effects (stroke HR 0.55, MI HR 0.70) were taken from large international cohort studies. Costs (2024 € , NHS payer perspective) and QALYs (EQ-5D) were discounted at 3.5%. Deterministic and probabilistic sensitivity analyses assessed parameter and structural uncertainty and identified effect sizes required to meet NICE thresholds.</p><p><strong>Results: </strong>Over a 25-year horizon, NSPT increased costs by € 9,755 and QALYs by 0.50 per patient (ICER € 19,322 per QALY). NSPT reduced non-fatal stroke and MI by 41% and 22%, respectively, with 22% of treated individuals event-free at 25 years and a 12% reduction in cumulative mortality. Probabilistic analysis resulted in a PSA mean ICER of € 19,129. The 10-year scenario produced an ICER of € 49,847, and a five-year scenario produced an ICER of € 197,614, demonstrating that NSPT is an intervention with a long payback period.</p><p><strong>Conclusions: </strong>Using a lifetime horizon and given current available evidence, NSPT potentially provides cost-effective prevention against CVD events at current NICE thresholds. Conclusions are sensitive to the magnitude of NSPT's cardiovascular effect, which is the main source of parameter uncertainty. We advocate for high-quality UK longitudinal evidence on NSPT's effect on hard CVD endpoints.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220240","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 a real-time screening strategy for bacterial vaginosis using qPCR to prevent preterm birth: results from a randomized prospective multicenter study.","authors":"Sandrine Loubiere, Anderson Loundou, Jean-François Cocallemen, Florence Fenollar, Florence Bretelle","doi":"10.1186/s12962-026-00780-7","DOIUrl":"10.1186/s12962-026-00780-7","url":null,"abstract":"<p><strong>Objective: </strong>Conventional diagnosis tests for vaginal flora abnormalities in pregnant women are heterogeneous and not easily reproducible, and treatments have been shown insufficient if not combined with screening for recurrence. This paper investigates, alongside a randomised controlled trial, the cost-effectiveness of testing pregnant women for bacterial vaginosis with a point-of-care polymerase chain reaction screening combined with treatment and screening for recurrence (S&T) vs. standard of care.</p><p><strong>Methods: </strong>Clinical and costs data of 6,671 pregnant women were collected from the AuTop trial. Administrative databases were used to fulfill resource utilization data. The perspective of the French health insurance was adopted, using national tariffs schedules when existed, such as for qPCR. The time horizon was less than one year, corresponding to the follow-up of the trial. The reduction in preterm birth rate was used as primary outcome and subgroup analyses were performed based on risk level.</p><p><strong>Results: </strong>Compared to standard of care, S&T reduced the rate of preterm births (3.8% vs. 4.6%) while the mean costs were higher, leading to a ratio of €13,730 per preterm birth averted. For multiparous women at low-risk of preterm birth, S&T was less effective and more costly than standard care. For nulliparous women, S&T appeared to be both more effective and less costly (-€4,663 per preterm birth averted). Probabilistic sensitivity analyses confirmed this dominance.</p><p><strong>Conclusions: </strong>Our findings suggest that S&T with a point-of-care molecular test for bacterial vaginosis offers benefits in terms of preterm birth avoided among nulliparous pregnant women and is also expected to result in cost savings in this subgroup compared to standard care.</p><p><strong>Trial registry: </strong>ClinicalTrials.gov, NCT02288832. 7th October 2014.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200611","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 an interdisciplinary care pathway for older patients with vertigo, dizziness and balance disorders in primary care (MobilE-PHY2) - a cluster-randomised trial.","authors":"Viola Zimmer, Caren Horstmannshoff, Petra Bauer, Peggy Borchers, Sandy Scheibe, Karen Voigt, Martin Müller, Juliane Köberlein-Neu","doi":"10.1186/s12962-026-00779-0","DOIUrl":"10.1186/s12962-026-00779-0","url":null,"abstract":"<p><strong>Background: </strong>Vertigo, dizziness and balance disorders affect over half of adults aged 65 and older. The MobilE-PHY2 study, conducted in Germany, evaluated the effectiveness of an evidence-based, multidisciplinary care pathway for this population. From a health economic perspective, the intervention was expected to increase outpatient and physiotherapy costs while reducing resource utilisation in other healthcare areas and improving patient-relevant outcomes.</p><p><strong>Objective: </strong>This health economic evaluation examined the cost-effectiveness of the care pathway compared to optimised routine care. Incremental costs were related to incremental changes in both quality-adjusted life years (QALYs) and the Dizziness Handicap Inventory (DHI) as a disease-specific outcome; expressed as incremental cost-effectiveness ratios (ICER).</p><p><strong>Methods: </strong>The study was a multicentre, cluster-randomised controlled trial with six -month follow-up. The health economic evaluation was conducted from a societal perspective. Cost-effectiveness was determined via incremental cost-utility ratios (ICURs) and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed using cost-effectiveness acceptability and net-monetary-benefit curves. Missing data were handled using Multiple Imputation by Chained Equations. Sensitivity analyses excluded informal care costs and focused on a subgroup with reduced imputation uncertainty.</p><p><strong>Results: </strong>The ICER was 81,246.85€ per additional patient achieving a clinically relevant DHI improvement. Indicating that if the willingness-to-pay threshold were €50,000 per additional patient achieving a clinically relevant DHI improvement, the intervention would be cost-effective with 71% probability. The ICUR was negative (-121,847.54€/QALY), meaning optimised routine care dominated the intervention. From a payer perspective, the intervention was less costly, though with lower QALYs. Findings were robust in sensitivity analyses.</p><p><strong>Conclusion: </strong>The care pathway shows potential for cost-effectiveness among patients achieving DHI improvements, supporting cautious, targeted implementation in routine care. Future research should address the economic burden on informal caregivers.</p><p><strong>Trial registration: </strong>DRKS00028524 retrospectively registered on March 24, 2022.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13244986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164975","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}