Cost Effectiveness and Resource Allocation最新文献

{"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}

{"title":"A systematic review of the current application status of decision-analytical models in the pharmacoeconomic evaluation of targeted therapies for pulmonary arterial hypertension.","authors":"Wenxing Dong, Zhe Zhang, Xiaodan Wang, Xiaolong Ma, Mingming Chu, Yulian Li, Xing Xiang, Cheng Peng, Rong Zhang","doi":"10.1186/s12962-025-00621-z","DOIUrl":"https://doi.org/10.1186/s12962-025-00621-z","url":null,"abstract":"<p><strong>Background: </strong>The implementation of targeted drug therapy results in a significant improvement in both survival rates and quality of life among patients diagnosed with pulmonary arterial hypertension (PAH), concurrently imposing a greater financial burden on them. The use of pharmacoeconomic evaluation based on decision-analytical models is extensively employed in the rational allocation of healthcare resources.</p><p><strong>Objectives: </strong>The present study conducted a systematic review of the literature on the pharmacoeconomic evaluation of drugs for treating PAH, with a focus on summarizing the composition and sources of parameters in decision-analytical models. This study aims to provide methodological guidance for future economic research.</p><p><strong>Methods: </strong>The review was conducted across six databases (PubMed, Embase, the Cochrane Library, CNKI, VIP, WanFang Data) and two health technology assessment agency websites (NHS EED, INAHTA). The characteristics of each study and the compositional details of the decision-analytical models are extracted.</p><p><strong>Results: </strong>In total, 13 published studies were included. The pharmacoeconomic evaluation methods employed in the studies included cost-effectiveness analysis (CEA) and cost-utility analysis (CUA). The decision analysis models employed in all 13 studies were Markov models. The models were all constructed on the basis of the World Health Organization (WHO) functional class, with variations in parameter settings and sources.</p><p><strong>Conclusions: </strong>All 13 Markov models provided useful insight into PAH modeling. Future research in this field can employ these research methods according to diverse research objectives. The utility values were derived from a single source; therefore, future studies should evaluate the quality of life in patients with PAH across varying disease severities.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"13"},"PeriodicalIF":1.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034851","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":"Willingness to join community-based health insurance and associated factors among households in Ethiopian: a systematic review and meta-analysis.","authors":"Abdene Weya Kaso, Berhanu Gidisa Debela, Habtamu Endashaw Hareru, Helen Ali Ewune, Mary Abera Debisa, Daniel Sisay, Alemayehu Hailu","doi":"10.1186/s12962-025-00620-0","DOIUrl":"https://doi.org/10.1186/s12962-025-00620-0","url":null,"abstract":"<p><strong>Background: </strong>In Ethiopia, out-of-pocket medical expenses make up one-third of all medical expenses, which makes it difficult for households to obtain and utilize healthcare. One of the prepayment mechanisms that shield low-income households from unaffordable medical bills is the community-based health insurance (CBHI) program. This systematic review and meta-analysis aimed to estimate the pooled willingness to join Community-based Health Insurance schemes and its associated factors among households in Ethiopia.</p><p><strong>Methods: </strong>Articles were searched from PubMed, Google Scholar, Web of Science, Scopus, Science Direct, and Ethiopian Universities' repositories for grey literature. The study used the modified PRISMA guidelines for rewriting and reviewing the literature. The quality of studies was assessed using Joanna Briggs Institute Critical Appraisal tools. Data was extracted using Microsoft Excel and exported to STATA version 16 software for analysis. Cochran's Q statistic and I² tests were utilized to determine the heterogeneity between studies. Studies publication bias was determined using a funnel plot and Egger's test. Subgroup analysis was conducted to demonstrate variations of the effect sizes across study regions. Finally, we utilized a random-effect model to compute the overall willingness to join the CBHI scheme and its determinants among households in Ethiopia.</p><p><strong>Result: </strong>We included thirty studies to determine the pooled prevalence of willingness to join the CBHI scheme and its determinants. The pooled magnitude of households' willingness to join the CBHI scheme was 60.42% (95% CI: 51.45%, 69.38%). Old aged (AOR = 2.17, [95% CI: 1.37, 3.44], I2 = 82.33%), formal educational status(AOR = 2.74, [95% CI: 2.10, 3.56], I² = 59.85%), Rich wealth index (AOR = 2.51, [95% CI: 1.99, 3.18], I² = 48.25%), good knowledge/awareness of CBHI scheme(AOR = 4.21, [95% CI: 3.01, 5.88], I² = 66.0%), experienced illness in the last three months (AOR = 3.42, [95% CI: 2.19, 5.35], I² = 71.15%), and large family size (AOR = 2.36, [95% CI: 1.95, 2.87], I² = 50.81%) were determinants of willingness to join the CBHI scheme. In addition, affordability of CBHI premium (AOR = 3.12, [95% CI: 2.34, 4.14], I² = 10.35%), poor health status (AOR = 3.23, [95% CI: 2.57, 4.06], I² = 35.97%), trust in scheme (AOR = 4.38, [95% CI: 1.91, 10.06], I² = 88.35%), chronic diseases (AOR = 3.24, [95% CI: 2.40, 4.37], I2 = 67.15%) and good quality of healthcare services (AOR = 2.91, [95%CI:2.08, 4.09], I² = 65.40%) were also predictors of willingness to join the CBHI program.</p><p><strong>Conclusion: </strong>The pooled prevalence of willingness to join the CBHI scheme was low and below the national target of 80%. Age, family size, educational status, wealth status, illnesses in last three months, presence of chronic illn","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"12"},"PeriodicalIF":1.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015386","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":"Association between medical insurance and life satisfaction among middle-aged and older adults in China: the mediating role of depression.","authors":"Jian Sun, Peter C Coyte, Yujiang Liu, Qianqiang Wang","doi":"10.1186/s12962-024-00584-7","DOIUrl":"10.1186/s12962-024-00584-7","url":null,"abstract":"<p><strong>Background: </strong>While studies have reported a positive association between medical insurance and life satisfaction, there is a lack of studies assessing the underlying impact mechanism. The present study aims to investigate the association between Urban and Rural Resident Basic Medical Insurance (URRBMI) and life satisfaction in China, focusing on the mediating role of depression.</p><p><strong>Methods: </strong>Using 2018 wave of China Health and Retirement Longitudinal Study, we employed ordered logit regression models to examine the correlation between URRBMI and life satisfaction. Causal mediation analysis was used to analyze the mediating effect of depression on this association.</p><p><strong>Results: </strong>URRBMI participation was related to greater life satisfaction (p < 0.01). Depression mediated the correlation between URRBMI and life satisfaction, and the percentage of total effect mediated was 18.20%.</p><p><strong>Discussion: </strong>Middle-aged and older adults covered by URRBMI were more likely to have greater life satisfaction than their counterparts because insurance relieved depression.</p><p><strong>Conclusion: </strong>Our study highlighted many policy suggestions, such as improving its coverage, establishing a unified information platform, and mobilizing social forces to provide better life services.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"10"},"PeriodicalIF":1.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11983981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054137","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":"Operationalizing game-theoretic weighting in public hospital cost control: an implementation framework from Chinese tertiary hospitals.","authors":"Zhihao Yu, Guangning Sun, Shuaijun Lin, Haoqian Hu, Jing Xu","doi":"10.1186/s12962-025-00616-w","DOIUrl":"10.1186/s12962-025-00616-w","url":null,"abstract":"<p><strong>Objective: </strong>In the current cost management model of public hospitals, decision-making heavily relies on the subjective judgment of managers, resulting in a 12.9% cost overrun compared to the budget in 2020 at a tertiary hospital in Eastern China. To address the systemic issues in the hospital's cost control practices, this study introduced a decision-making framework based on the Game-Theoretic combination weighting method into the hospital's cost management system. By harmonizing expert subjective judgments with objective data dispersion, the framework aims to mitigate subjective biases in hospital cost control, address deficiencies in the top-level design of existing public hospital cost control strategies, and provide a more scientific and systematic cost management approach for public hospitals.</p><p><strong>Method: </strong>Utilizing a literature review and the Delphi method, we established a Cost Control Evaluation Index System specifically tailored for the case hospitals. By employing the Analytic Hierarchy Process (AHP) and the Entropy Weight Method (EWM), we discerned subjective and objective weights for each index. These weights were then amalgamated using a game theory-based combined weighting method. Based on the calculations of weighting in game theory, a cost control optimization scheme for public hospitals was designed and implemented in the case hospital for a duration of three years. Ultimately, the improvement effects before and after the implementation of the optimization scheme were assessed using the fuzzy comprehensive evaluation method.</p><p><strong>Results: </strong>Research indicates previous studies underestimated the importance of indicators such as Logistics Supplies, Utilities (Water, Electricity, Heating), and Disposal Phase, while overemphasizing Salaries, Bonuses, and Maintenance Phase. This study recalibrated indicator weights and optimized strategies accordingly. Three years after implementing this plan, the case hospital demonstrated significant improvements in personnel expenses, material costs, drug costs, administrative expenses, and capital expenditures, with its overall satisfaction score increasing from 79.5656 to 90.2492. Notably, the most substantial improvements occurred in areas where weights were significantly increased, yielding higher returns.</p><p><strong>Conclusion: </strong>During the implementation at the case hospital, the game theory-based combined weighting method proved effective in optimizing cost control strategies for public hospitals. It facilitated more targeted interventions in weak areas of cost management and helped reduce decision-making biases. Additionally, this method enhanced the rigor and efficiency of cost control while providing a systematic framework to support decision-making in the medical field.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"11"},"PeriodicalIF":1.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754983","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 cost-utility analysis of long-acting insulin analogues (detemir, glargine and degludec) for the treatment of adult type 1 diabetes in South Africa.","authors":"Mark T Verryn, Susan Cleary","doi":"10.1186/s12962-025-00615-x","DOIUrl":"10.1186/s12962-025-00615-x","url":null,"abstract":"<p><strong>Background: </strong>Type 1 Diabetes Mellitus (T1DM) is a life-threatening condition that is managed with administered insulin. Intermediate- to long-acting insulin represents the basal insulin constituent of the total insulin used in treating T1DM. In South Africa, intermediate-acting Neutral Protamine Hagedorn (NPH) insulin has been the mainstay basal insulin recommended in the public sector, despite the availability of newer (ultra) long-acting insulin analogues. A cost-utility analysis of the newer long-acting insulin analogues insulins degludec, glargine U100, glargine U300 and detemir in comparison to current practice (NPH insulin) has yet to be performed in the South African public health sector context.</p><p><strong>Methods: </strong>A cost-utility analysis was carried out utilising Markov modelling. Long-acting insulins degludec, glargine and detemir were compared to NPH insulin in the model. For each comparator, two Markov states were created, one in which no complications occurred and another representing severe nocturnal hypoglycaemic events. Quality-Adjusted Life Years (QALYs) gained per patient year was the health outcome assessed over a one-year time horizon.</p><p><strong>Results: </strong>NPH insulin was the least costly and least effective; while Determir and Glargine U100 were extended and absolutely dominated respectively. The ICER for Glargine U300 in comparison to NPH was USD 40,104.91 per QALY gained, while Degludec was USD 64,831.20 per QALY gained in comparison to Glargine U300.</p><p><strong>Conclusions: </strong>The ICERs of long acting insulins were considerably higher than South Africa's indicative cost-effectiveness threshold. The status quo of NPH insulin in the management of T1DM in adults remains the most cost-effective option for the South African public health sector.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"9"},"PeriodicalIF":1.7,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693644","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}