Cost Effectiveness and Resource Allocation最新文献

{"title":"Cost-utility analysis of prenatal diagnosis of congenital cardiac diseases using deep learning.","authors":"Gary M Ginsberg, Lior Drukker, Uri Pollak, Mayer Brezis","doi":"10.1186/s12962-024-00550-3","DOIUrl":"10.1186/s12962-024-00550-3","url":null,"abstract":"<p><strong>Background: </strong>Deep learning (DL) is a new technology that can assist prenatal ultrasound (US) in the detection of congenital heart disease (CHD) at the prenatal stage. Hence, an economic-epidemiologic evaluation (aka Cost-Utility Analysis) is required to assist policymakers in deciding whether to adopt the new technology.</p><p><strong>Methods: </strong>The incremental cost-utility ratios (CUR), of adding DL assisted ultrasound (DL-US) to the current provision of US plus pulse oximetry (POX), was calculated by building a spreadsheet model that integrated demographic, economic epidemiological, health service utilization, screening performance, survival and lifetime quality of life data based on the standard formula: <math><mrow><mi>CUR</mi> <mo>=</mo> <mfrac> <mrow><mrow><mtext>Increase in Intervention Costs</mtext></mrow> <mo>-</mo> <mrow><mtext>Decrease in Treatment costs</mtext></mrow> </mrow> <mrow><mrow><mtext>Averted QALY losses of adding DL to US</mtext></mrow> <mspace></mspace> <mo>&</mo> <mspace></mspace> <mi>POX</mi></mrow> </mfrac> </mrow> </math> US screening data were based on real-world operational routine reports (as opposed to research studies). The DL screening cost of 145 USD was based on Israeli US costs plus 20.54 USD for reading and recording screens.</p><p><strong>Results: </strong>The addition of DL assisted US, which is associated with increased sensitivity (95% vs 58.1%), resulted in far fewer undiagnosed infants (16 vs 102 [or 2.9% vs 15.4%] of the 560 and 659 births, respectively). Adoption of DL-US will add 1,204 QALYs. with increased screening costs 22.5 million USD largely offset by decreased treatment costs (20.4 million USD). Therefore, the new DL-US technology is considered \"very cost-effective\", costing only 1,720 USD per QALY. For most performance combinations (sensitivity > 80%, specificity > 90%), the adoption of DL-US is either cost effective or very cost effective. For specificities greater than 98% (with sensitivities above 94%), DL-US (& POX) is said to \"dominate\" US (& POX) by providing more QALYs at a lower cost.</p><p><strong>Conclusion: </strong>Our exploratory CUA calculations indicate the feasibility of DL-US as being at least cost-effective.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"44"},"PeriodicalIF":2.3,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11110271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076940","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 TB diagnostic technologies in Ethiopia: a modelling study.","authors":"Lelisa Fekadu Assebe, Andargachew Kumsa Erena, Lemmessa Fikadu, Bizuneh Alemu, Yirgalem Shibiru Baruda, Boshen Jiao","doi":"10.1186/s12962-024-00544-1","DOIUrl":"10.1186/s12962-024-00544-1","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) is a major threat to public health, particularly in countries where the disease is highly prevalent, such as Ethiopia. Early diagnosis and treatment are the main components of TB prevention and control. Although the national TB guideline recommends the primary use of rapid TB diagnostics whenever feasible, there is limited evidence available that assess the efficiency of deploying various diagnostic tools in the country. Hence, this study aims to evaluate the cost-effectiveness of rapid TB/MDR-TB diagnostic tools in Ethiopia.</p><p><strong>Methods: </strong>A hybrid Markov model for a hypothetical adult cohort of presumptive TB cases was constructed. The following TB diagnostic tools were evaluated: X-pert MTB/RIF, Truenat, chest X-ray screening followed by an X-pert MTB/RIF, TB-LAMP, and smear microscopy. Cost-effectiveness was determined based on incremental costs ($) per Disability-adjusted Life Years (DALY) averted, using a threshold of one times Gross Domestic Product (GDP) per capita ($856). Data on starting and transition probabilities, costs, and health state utilities were derived from secondary sources. The analysis is conducted from the health system perspective, and a probabilistic sensitivity analysis is performed.</p><p><strong>Result: </strong>The incremental cost-effectiveness ratio for X-pert MTB/RIF, compared to the next best alternative, is $276 per DALY averted, making it a highly cost-effective diagnostic tool. Additionally, chest X-ray screening followed an X-pert MTB/RIF test is less cost-effective, with an ICER of $1666 per DALY averted. Introducing X-pert MTB/RIF testing would enhance TB detection and prevent 9600 DALYs in a cohort of 10,000 TB patients, with a total cost of $3,816,000.</p><p><strong>Conclusion: </strong>The X-pert MTB/RIF test is the most cost-effective diagnostic tool compared to other alternatives. The use of this diagnostic tool improves the early detection and treatment of TB cases. Increased funding for this diagnostic tool will enhance access, reduce the TB detection gaps, and improve treatment outcomes.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"43"},"PeriodicalIF":2.3,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11106958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076933","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":"Hyperkalemia in chronic kidney disease patients with and without heart failure: an Italian economic modelling study.","authors":"Ewa Stawowczyk, Thomas Ward, Ernesto Paoletti, Michele Senni, Antonio Ramirez de Arellano","doi":"10.1186/s12962-024-00547-y","DOIUrl":"10.1186/s12962-024-00547-y","url":null,"abstract":"<p><strong>Background: </strong>Hyperkalemia (HK) is frequently present in chronic kidney disease (CKD). Risk factors for HK among CKD patients include comorbidities and renin-angiotensin-aldosterone system inhibitor (RAASi) treatment. Current standard of care (SoC) often necessitates RAASi down-titration or discontinuation, resulting in poorer cardiorenal outcomes, hospitalization and mortality. This study evaluates the cost-effectiveness of patiromer for HK in CKD patients with and without heart failure (HF) in an Italian setting.</p><p><strong>Methods: </strong>A lifetime Markov cohort model was developed based on OPAL-HK to assess the health economic impact of patiromer therapy in comparison to SoC after accounting for the effects of HK and RAASi use on clinical events. Outcomes included accumulated clinical events, number needed to treat (NNT) and the incremental cost-effectiveness ratio (ICER). Subgroup analysis was conducted in CKD patients with and without HF.</p><p><strong>Results: </strong>Patiromer was associated with an incremental discounted cost of €4,660 and 0.194 quality adjusted life years (QALYs), yielding an ICER of €24,004. Per 1000 patients, patiromer treatment prevented 275 moderate/severe HK events, 54 major adverse cardiovascular event, 246 RAASi discontinuation and 213 RAASi up-titration/restart. Subgroup analysis showed patiromer was more effective in preventing clinical events in CKD patients with HF compared to those without; QALY gains were greater in CKD patients without HF versus those with HF (0.267 versus 0.092, respectively). Scenario analysis and sensitivity analysis results support base-case conclusions.</p><p><strong>Conclusion: </strong>Patiromer is associated with QALY gains in CKD patients with and without HF compared to SoC in Italy. Patiromer prevented HK events, enabled RAASi therapy maintenance and reduced cardiovascular event risk.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"42"},"PeriodicalIF":2.3,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11106859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141070771","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":"An overview of the perspectives used in health economic evaluations.","authors":"Manit Sittimart, Waranya Rattanavipapong, Andrew J Mirelman, Trinh Manh Hung, Saudamini Dabak, Laura E Downey, Mark Jit, Yot Teerawattananon, Hugo C Turner","doi":"10.1186/s12962-024-00552-1","DOIUrl":"10.1186/s12962-024-00552-1","url":null,"abstract":"<p><p>The term 'perspective' in the context of economic evaluations and costing studies in healthcare refers to the viewpoint that an analyst has adopted to define the types of costs and outcomes to consider in their studies. However, there are currently notable variations in terms of methodological recommendations, definitions, and applications of different perspectives, depending on the objective or intended user of the study. This can make it a complex area for stakeholders when interpreting these studies. Consequently, there is a need for a comprehensive overview regarding the different types of perspectives employed in such analyses, along with the corresponding implications of their use. This is particularly important, in the context of low-and-middle-income countries (LMICs), where practical guidelines may be less well-established and infrastructure for conducting economic evaluations may be more limited. This article addresses this gap by summarising the main types of perspectives commonly found in the literature to a broad audience (namely the patient, payer, health care providers, healthcare sector, health system, and societal perspectives), providing their most established definitions and outlining the corresponding implications of their uses in health economic studies, with examples particularly from LMIC settings. We then discuss important considerations when selecting the perspective and present key arguments to consider when deciding whether the societal perspective should be used. We conclude that there is no one-size-fits-all answer to what perspective should be used and the perspective chosen will be influenced by the context, policymakers'/stakeholders' viewpoints, resource/data availability, and intended use of the analysis. Moving forward, considering the ongoing issues regarding the variation in terminology and practice in this area, we urge that more standardised definitions of the different perspectives and the boundaries between them are further developed to support future studies and guidelines, as well as to improve the interpretation and comparison of health economic evidence.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"41"},"PeriodicalIF":1.7,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11092188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917255","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 and decision analysis for national airport screening options to reduce risk of COVID-19 introduction in Uganda, 2020.","authors":"Geofrey Amanya, Michael L Washington, Daniel Kadobera, Migisha Richard, Alex Ndyabakiira, Julie Harris","doi":"10.1186/s12962-024-00548-x","DOIUrl":"10.1186/s12962-024-00548-x","url":null,"abstract":"<p><strong>Introduction: </strong>Early during the COVID-19 outbreak, various approaches were utilized to prevent COVID-19 introductions from incoming airport travellers. However, the costs and effectiveness of airport-specific interventions have not been evaluated.</p><p><strong>Methods: </strong>We evaluated policy options for COVID-19-specific interventions at Entebbe International Airport for costs and impact on COVID-19 case counts, we took the government payer perspective. Policy options included; (1)no screening, testing, or mandatory quarantine for any incoming traveller; (2)mandatory symptom screening for all incoming travellers with RT-PCR testing only for the symptomatic and isolation of positives; and (3)mandatory 14-day quarantine and one-time testing for all, with 10-day isolation of persons testing positive. We calculated incremental cost-effectiveness ratios (ICERs) in US$ per additional case averted.</p><p><strong>Results: </strong>Expected costs per incoming traveller were $0 (Option 1), $19 (Option 2), and $766 (Option 3). ICERs per case averted were $257 for Option 2 (which averted 4,948 cases), and $10,139 for Option 3 (which averted 5,097 cases) compared with Option I. Two-week costs were $0 for Option 1, $1,271,431 Option 2, and $51,684,999 Option 3. The per-case ICER decreased with increase in prevalence. The cost-effectiveness of our interventions was modestly sensitive to the prevalence of COVID-19, diagnostic test sensitivity, and testing costs.</p><p><strong>Conclusion: </strong>Screening all incoming travellers, testing symptomatic persons, and isolating positives (Option 2) was the most cost-effective option. A higher COVID-19 prevalence among incoming travellers increased cost-effectiveness of airport-specific interventions. This model could be used to evaluate prevention options at the airport for COVID-19 and other infectious diseases with similar requirements for control.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"40"},"PeriodicalIF":2.3,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11089758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913097","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":"Fetoscopic laser versus amnioreduction, septostomy, and expected management for the treatment of twin-twin transfusion syndrome (TTTS): an economic evaluation analysis in Iran.","authors":"Zhila Najafpour, Kamran Shayanfard, Negar Aghighi, Najmieh Saadati","doi":"10.1186/s12962-024-00551-2","DOIUrl":"10.1186/s12962-024-00551-2","url":null,"abstract":"<p><strong>Background: </strong>Twin-twin transfusion syndrome (TTTS) affects 10-15% of monochorionic twin pregnancies. Without treatment, their mortality rates would be considerable. There are differences in survival rate between different therapeutic modalities. This study aims to compare the cost-effectiveness of Fetoscopic laser versus amnioreduction, septostomy, and expected management in the treatment of twin-to-twin transfusion syndrome (TTTS).</p><p><strong>Methods: </strong>This is a cost-effectiveness analysis of the treatment strategies in patients with TTTS. A decision tree model was used to estimate the clinical and economic outcomes with a pregnancy period time horizon. Medical direct costs were extracted in a quantitative study, and survival rates were determined as effectiveness measures based on a review. A probabilistic sensitivity analysis was used to measure the effects of uncertainty in the model parameters. The TreeAge, Excel and R software were used for analyzing data.</p><p><strong>Results: </strong>In the first phase, 75 studies were included in the review. Based on the meta-analysis, a total of 7183 women treated with Fetoscopic laser, the perinatal survival of at least one twin-based pregnancy was 69%. In the second phase, the results showed that expected management and amnioreduction have the lowest (791.6$) and highest cost (2020.8$), respectively. Based on the decision model analysis, expected management had the lowest cost ($791.67) and the highest rate in at least one survival (89%), it was used only in early stages of TTTS. Fetoscopic laser surgery, with the mean cost 871.46$ and an overall survival rate of 0.69 considered the most cost-effectiveness strategy in other stages of TTTS.</p><p><strong>Conclusion: </strong>Our model found Fetoscopic laser surgery in all stages of TTTS to be the most cost-effective therapy for patients with TTTS. Fetoscopic laser surgery thus should be considered a reasonable treatment option for TTTS.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"39"},"PeriodicalIF":2.3,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11080211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899879","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 effectiveness of a new powered stapling system with gripping surface technology on the intraoperative clinical and economic outcomes of gastrectomy for gastric cancer.","authors":"Honghai Guo, Tao Zheng, Yecheng Lin, Tiange Tang, Zhidong Zhang, Dong Wang, Xuefeng Zhao, Yu Liu, Bibo Tan, Peigang Yang, Yuan Tian, Yong Li, Qun Zhao","doi":"10.1186/s12962-024-00534-3","DOIUrl":"10.1186/s12962-024-00534-3","url":null,"abstract":"<p><strong>Background: </strong>Surgical staplers have been widely used to facilitate surgeries, and this study aimed to examine the real-world effectiveness of a new powered stapling system with Gripping Surface Technology (GST) on intraoperative outcomes of gastrectomy for gastric cancer.</p><p><strong>Method: </strong>The data were extracted from the Fourth Hospital of Hebei Medical University's (FHHMU) medical records system. Participants (N = 121 patients) were classified into the GST (n = 59) or non-GST group (n = 62), based on the use of the GST system. The intraoperative outcomes such as bleeding were assessed by reviewing video records. T-tests, Chi-square tests, and Mann-Whitney-U tests were used to compare the baseline characteristics between groups. Multivariate logistic regression was conducted for adjusting outcomes to study the effect of variables.</p><p><strong>Results: </strong>Compared with the non-GST group, the GST group had significantly lower risks for intraoperative bleeding, intraoperative anastomosis intervention rate, intraoperative suture, and intraoperative pression (aORs: 0.0853 (p < 0.0001), 0.076 (p = 0.0003), 0.167 (p = 0.0012), and 0.221 (p = 0.0107), respectively). The GST group also consumed one fewer cartridge than the non-GST group (GST:5 vs non-GST: 6, p = 0.0241).</p><p><strong>Conclusion: </strong>The use of the GST system was associated with better intraoperative outcomes and lower cartridge consumption in Chinese real-world settings.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"38"},"PeriodicalIF":2.3,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11071198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866564","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-benefit analysis of mass prostate cancer screening.","authors":"Hiro Farabi, Najmeh Moradi, Aziz Ahmadzadeh, Seyed Mohammad Kazem Aghamir, Abdolreza Mohammadi, Aziz Rezapour","doi":"10.1186/s12962-024-00553-0","DOIUrl":"10.1186/s12962-024-00553-0","url":null,"abstract":"<p><strong>Background: </strong>Prostate cancer (PCa) causes a substantial health and financial burden worldwide, underscoring the need for efficient mass screening approaches. This study attempts to evaluate the Net Cost-Benefit Index (NCBI) of PCa screening in Iran to offer insights for informed decision-making and resource allocation.</p><p><strong>Method: </strong>The Net Cost-Benefit Index (NCBI) was calculated for four age groups (40 years and above) using a decision-analysis model. Two screening strategies, prostate-specific antigen (PSA) solely and PSA with Digital Rectal Examination (DRE), were evaluated from the health system perspective. A retrospective assessment of 1402 prostate cancer (PCa) patients' profiles were conducted, and direct medical and non-medical costs were calculated based on the 2021 official tariff rates, patient records, and interviews. The monetary value of mass screening was determined through Willingness to Pay (WTP) assessments, which served as a measure for the benefit aspect.</p><p><strong>Result: </strong>The combined PSA and DRE strategy of screening is cost-effective, yields up to $3 saving in costs per case and emerges as the dominant strategy over PSA alone. Screening for men aged 70 and above does not meet economic justification, indicated by a negative Net Cost-Benefit Index (NCBI). The 40-49 age group exhibits the highest net benefit, $13.81 based on basic information and $13.54 based on comprehensive information. Sensitivity analysis strongly supports the cost-effectiveness of the combined screening approach.</p><p><strong>Conclusion: </strong>This study advocates prostate cancer screening with PSA and DRE, is economically justified for men aged 40-69. The results of the study recommend that policymakers prioritize resource allocation for PCa screening programs based on age and budget constraints. Men's willingness to pay, especially for the 40-49 age group which had the highest net benefit, leverages their financial participation in screening services. Additionally, screening services for other age groups, such as 50-54 or 55-59, can be provided either for free or at a reduced cost.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"37"},"PeriodicalIF":2.3,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11071254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866877","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 burden of health expenditure on household impoverishment in Ethiopia: a systematic review and meta-analysis.","authors":"Yawkal Tsega, Abel Endawkie, Shimels Derso Kebede, Natnael Kebede, Mengistu Mera Mihiretu, Ermias Bekele, Kokeb Ayele, Lakew Asmare, Fekade Demeke Bayou, Mastewal Arefaynie","doi":"10.1186/s12962-024-00543-2","DOIUrl":"https://doi.org/10.1186/s12962-024-00543-2","url":null,"abstract":"<p><strong>Background: </strong>Ethiopia, like many low-income countries, faces significant challenges in providing accessible and affordable healthcare to its population. Health expenditure is a critical factor in determining the quality and accessibility of healthcare. However, high health expenditure can also have detrimental effects on households, potentially leading to impoverishment. To the best knowledge of investigators, no similar study has been conducted in Ethiopia. Therefore, this systematic review and meta-analysis aimed to determine the pooled burden of health expenditure on household impoverishment in Ethiopia.</p><p><strong>Methods: </strong>This systematic review and meta-analysis used the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. PubMed, Cochrane Library, HINARI, Google Scholar and Epistemonikos electronic databases were searched systematically. Moreover, direct manual searching through google was conducted. The analysis was performed using STATA version 17 software. Heterogeneity and publication bias were assessed using I² statistics and Egger's test, respectively. The trim and fill method was also performed to adjust the pooled estimate. Forest plots were used to present the pooled incidence with a 95% confidence interval of meta-analysis using the random effect model.</p><p><strong>Results: </strong>This systematic review and meta-analysis included a total of 12 studies with a sample size of 66344 participants. The pooled incidence of impoverishment, among households, attributed to health expenditure in Ethiopia was 5.20% (95% CI: 4.30%, 6.20%). Moreover, there was significant heterogeneity between the studies (I² = 98.25%, P = 0.000). As a result, a random effect model was employed.</p><p><strong>Conclusion: </strong>The pooled incidence of impoverishment of households attributed to their health expenditure in Ethiopia was higher than the incidence of impoverishment reported by the world health organization in 2023.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"36"},"PeriodicalIF":2.3,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11069253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872655","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":"Rapid cost-effectiveness analysis: hemodialysis versus peritoneal dialysis for patients with acute kidney injury in Rwanda.","authors":"Cassandra Nemzoff, Nurilign Ahmed, Tolulope Olufiranye, Grace Igiraneza, Ina Kalisa, Sukrit Chadha, Solange Hakiba, Alexis Rulisa, Matiko Riro, Kalipso Chalkidou, Francis Ruiz","doi":"10.1186/s12962-024-00545-0","DOIUrl":"10.1186/s12962-024-00545-0","url":null,"abstract":"<p><strong>Background: </strong>To ensure the long-term sustainability of its Community-Based Health Insurance scheme, the Government of Rwanda is working on using Health Technology Assessment (HTA) to prioritize its resources for health. The objectives of the study were to rapidly assess (1) the cost-effectiveness and (2) the budget impact of providing PD versus HD for patients with acute kidney injury (AKI) in the tertiary care setting in Rwanda.</p><p><strong>Methods: </strong>A rapid cost-effectiveness analysis for patients with AKI was conducted to support prioritization. An 'adaptive' HTA approach was undertaken by adjusting the international Decision Support Initiative reference case for time and data constraints. Available local and international data were used to analyze the cost-effectiveness and budget impact of peritoneal dialysis (PD) compared with hemodialysis (HD) in the tertiary hospital setting.</p><p><strong>Results: </strong>The analysis found that HD was slightly more effective and slightly more expensive in the payer perspective for most patients with AKI (aged 15-49). HD appeared to be cost-effective when only comparing these two dialysis strategies with an incremental cost-effectiveness ratio of 378,174 Rwandan francs (RWF) or 367 United States dollars (US$), at a threshold of 0.5 × gross domestic product per capita (RWF 444,074 or US$431). Sensitivity analysis found that reducing the cost of HD kits would make HD even more cost-effective. Uncertainty regarding PD costs remains. Budget impact analysis demonstrated that reducing the cost of the biggest cost driver, HD kits, could produce significantly more savings in five years than switching to PD. Thus, price negotiations could significantly improve the efficiency of HD provision.</p><p><strong>Conclusion: </strong>Dialysis is costly and covered by insurance in many countries for the financial protection of patients. This analysis enabled policymakers to make evidence-based decisions to improve the efficiency of dialysis provision.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"35"},"PeriodicalIF":1.7,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11059575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872960","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}