Applied Health Economics and Health Policy最新文献

{"title":"Rationing in an Era of Multiple Tight Constraints: Is Cost-Utility Analysis Still Fit for Purpose?","authors":"Helen Dakin,&nbsp;Apostolos Tsiachristas","doi":"10.1007/s40258-023-00858-w","DOIUrl":"10.1007/s40258-023-00858-w","url":null,"abstract":"<div><p>Cost-utility analysis may not be sufficient to support reimbursement decisions when the assessed health intervention requires a large proportion of the healthcare budget or when the monetary healthcare budget is not the only resource constraint. Such cases include joint replacement, coronavirus disease 2019 (COVID-19) interventions and settings where all resources are constrained (e.g. post-COVID-19 or in low/middle-income countries). Using literature on health technology assessment, rationing and reimbursement in healthcare, we identified seven alternative frameworks for simultaneous decisions about (dis)investment and proposed modifications to deal with multiple resource constraints. These frameworks comprised constrained optimisation; cost-effectiveness league table; ‘step-in-the-right-direction’ approach; heuristics based on effective gradients; weighted cost-effectiveness ratios; multicriteria decision analysis (MCDA); and programme budgeting and marginal analysis (PBMA). We used numerical examples to demonstrate how five of these alternative frameworks would operate. The modified frameworks we propose could be used in local commissioning and/or health technology assessment to supplement standard cost-utility analysis for interventions that have large budget impact and/or are subject to additional constraints.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 3","pages":"315 - 329"},"PeriodicalIF":3.1,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7615833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139701671","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":"Evidence Synthesis and Linkage for Modelling the Cost-Effectiveness of Diagnostic Tests: Preliminary Good Practice Recommendations","authors":"Bethany Shinkins,&nbsp;A. Joy Allen,&nbsp;James Karichu,&nbsp;Louis P. Garrison,&nbsp;Brigitta U. Monz","doi":"10.1007/s40258-023-00855-z","DOIUrl":"10.1007/s40258-023-00855-z","url":null,"abstract":"<div><h3>Objectives</h3><p>To develop preliminary good practice recommendations for synthesising and linking evidence of treatment effectiveness when modelling the cost-effectiveness of diagnostic tests.</p><h3>Methods</h3><p>We conducted a targeted review of guidance from key Health Technology Assessment (HTA) bodies to summarise current recommendations on synthesis and linkage of treatment effectiveness evidence within economic evaluations of diagnostic tests. We then focused on a specific case study, the cost-effectiveness of troponin for the diagnosis of myocardial infarction, and reviewed the approach taken to synthesise and link treatment effectiveness evidence in different modelling studies.</p><h3>Results</h3><p>The Australian and UK HTA bodies provided advice for synthesising and linking treatment effectiveness in diagnostic models, acknowledging that linking test results to treatment options and their outcomes is common. Across all reviewed models for the case study, uniform test-directed treatment decision making was assumed, i.e., all those who tested positive were treated. Treatment outcome data from a variety of sources, including expert opinion, were utilised for linked clinical outcomes. Preliminary good practice recommendations for data identification, integration and description are proposed.</p><h3>Conclusion</h3><p>Modelling the cost-effectiveness of diagnostic tests poses unique challenges in linking evidence on test accuracy to treatment effectiveness data to understand how a test impacts patient outcomes and costs. Upfront consideration of how a test and its results will likely be incorporated into patient diagnostic pathways is key to exploring the optimal design of such models. We propose some preliminary good practice recommendations to improve the quality of cost-effectiveness evaluations of diagnostics tests going forward.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 2","pages":"131 - 144"},"PeriodicalIF":3.1,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10864520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139691052","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":"What Interventions are Cost Effective in Reducing Violence Against Women? A Scoping Review","authors":"Lauren Sheppard,&nbsp;Moosa Alsubhi,&nbsp;Vicki Brown,&nbsp;Ha Le,&nbsp;Kim Robinson,&nbsp;Marj Moodie","doi":"10.1007/s40258-023-00870-0","DOIUrl":"10.1007/s40258-023-00870-0","url":null,"abstract":"<div><h3>Purpose</h3><p>To systematically summarise the recent literature on the cost and cost effectiveness of interventions implemented to reduce violence against women (VAW) and decision frameworks guiding resource allocation.</p><h3>Method</h3><p>A scoping review of scholarly and grey literature on the cost-effectiveness and/or resource allocation for interventions addressing intimate partner violence (IPV), dating violence and non-partner sexual violence perpetrated against women aged 15 years and over. All settings and contexts were eligible, with papers published in English between 2010 and March 2023 included.</p><h3>Results</h3><p>Nineteen papers fulfilled the inclusion criteria reporting the cost, cost savings and/or cost effectiveness of 24 interventions to prevent IPV and to a lesser extent, other forms of interpersonal violence. Among the 16 economic evaluation studies reviewed, four types of interventions were cost effective in multiple settings or studies, including community activism (Uganda, Ghana), gender transformative interventions with couples and individuals (Ethiopia, Rwanda), specific justice and law enforcement measures (USA) and a combined personnel training, support, and referral programme in General Practice in the UK. Other interventions were cost effective in a single study or had conflicting evidence. Three remaining papers conducted a partial evaluation or cost appraisal providing limited information on the cost or cost-savings of other implemented interventions. No frameworks on resource allocation for the prevention of VAW were identified.</p><h3>Conclusion</h3><p>While there is some evidence of cost effectiveness emerging for interventions implemented in specific contexts, overall, we find the recent evidence on costs and cost effectiveness of interventions for the prevention of VAW to be limited. Embedding economic evaluation in future effectiveness trials will build critical evidence needed to inform policy and resource allocation decisions based on the value-for-money of interventions. Modelling the benefits and costs of interventions to better understand the societal impacts of programmes at scale is a further research opportunity.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 3","pages":"283 - 296"},"PeriodicalIF":3.1,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11021229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139569284","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 Interventions May Have Divergent Impacts on Health and Economic Equity: A Case Study of the Community-Based Hypertension Improvement Project in Ghana","authors":"Yizhi Liang,&nbsp;Yuqian Lin,&nbsp;Boshen Jiao","doi":"10.1007/s40258-024-00871-7","DOIUrl":"10.1007/s40258-024-00871-7","url":null,"abstract":"<div><h3>Background and Objective</h3><p>Improving health and economic equity are key objectives in priority setting, particularly in low-income and middle-income countries. This study aims to assess the distributional impacts of the Community-based Hypertension Improvement Project (ComHIP) on health and economic outcomes across wealth quintiles in Ghana.</p><h3>Methods</h3><p>We developed a decision analytical model to simulate a 30 million cohort of Ghanaians aged 15–49 years. The study specified health outcomes as the prevention of stroke cases and averting deaths among those with hypertension. Furthermore, we explored economic impacts, including savings in out-of-pocket costs for stroke patients and government spending. Financial risk protection against catastrophic and impoverishing health expenditures was also examined. We assessed these outcomes across wealth quintiles, and the corresponding concentration indexes (CIXs) were determined.</p><h3>Results</h3><p>It was estimated that ComHIP could prevent 1450 stroke cases and 564 related deaths annually. Health benefits were observed to be more significant among the wealthier quintiles (CIX 0.217), mainly attributed to a higher occurrence of hypertension within these groups. ComHIP was also projected to result in an annual saving of USD 49,885 in individuals’ out-of-pocket costs (CIX 0.262) and USD 37,578 in government spending (CIX 0.146). These savings correspond to the prevention of 335 catastrophic health expenditure cases (CIX − 0.239) and 11 impoverishing health expenditure cases (CIX − 0.600).</p><h3>Conclusions</h3><p>While ComHIP provides greater health benefits to wealthier groups, it offers substantial financial risk protection for the less wealthy. This study highlights the importance of considering equity in both health and financial risk when making priority-setting decisions.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 3","pages":"353 - 362"},"PeriodicalIF":3.1,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139545394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Preferences for Disease Profiles: A Discrete Choice Experiment from a US Societal Perspective","authors":"Karissa M. Johnston,&nbsp;Ivana F. Audhya,&nbsp;Jessica Dunne,&nbsp;David Feeny,&nbsp;Peter Neumann,&nbsp;Daniel C. Malone,&nbsp;Shelagh M. Szabo,&nbsp;Katherine L. Gooch","doi":"10.1007/s40258-023-00869-7","DOIUrl":"10.1007/s40258-023-00869-7","url":null,"abstract":"<div><h3>Objectives</h3><p>There is increasing interest in expanding the elements of value to be considered when making health policy decisions. To help inform value frameworks, this study quantified preferences for disease attributes in a general public sample and examined which combination of attributes (disease profiles) are considered most important for research and treatment.</p><h3>Methods</h3><p>A discrete choice experiment (DCE) was conducted in a US general population sample, recruited through online consumer panels. Respondents were asked to select one of a set of health conditions they believed to be most important, characterized by attributes defined by a previous qualitative study: onset age; cause of disease; life expectancy; caregiver requirement; symptom burden (characterized by the Health Utilities Index with varying levels of ambulation independence, dexterity limitations, and degree of pain and discomfort); and disease prevalence. A fractional factorial DCE design was implemented using R, and 60 choice sets were generated (separated into blocks of 10 per participant). Data were analyzed using a mixed-logit regression model, and results used to assess the likelihood of preferring disease profiles. Based on individual attribute preferences, overall preferences for disease profiles, including a profile aligned with Duchenne muscular dystrophy (DMD), were compared.</p><h3>Results</h3><p>Fifty-two percent of respondents (<i>n</i> = 537) were female, and 70.6% were aged 18–54 years. Attributes considered most important were those related to life expectancy (odds ratio [OR], 95% confidence interval [CI] 1.88 [1.56–2.27] for a 50% reduction in remaining life expectancy vs no impact), and symptom burden (OR [95% CI] 1.84 [1.47–2.31] for severe vs mild burden). Greater importance was also found for pediatric onset, caregiver requirement, and diseases affecting more people. As an example of disease profile preferences, a DMD-like pediatric inherited disease with 50% reduction in life expectancy, extensive caregiver requirement, severe symptom burden, and 1:5000 prevalence had 2.37-fold higher odds of being selected as important versus an equivalent disease with adult onset and no life expectancy reduction.</p><h3>Conclusions</h3><p>Of disease attributes included in this DCE, respondents valued higher prevalence of disease, life expectancy and symptom burden as most important for prioritizing research and treatment. Based on expressed attribute preferences, a case study of an inherited pediatric disease involving substantial reductions to length and quality of life and requiring caregiver support has relatively high odds of being identified as important compared to diseases reflecting differing attribute profiles. These findings can help inform expansions of value frameworks by identifying important attributes from the societal perspective.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 3","pages":"343 - 352"},"PeriodicalIF":3.1,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11021240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519571","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":"Estimating Transition Probabilities for Modeling Major Depression in Adolescents by Sex and Race or Ethnicity Combinations in the USA","authors":"Tran T. Doan,&nbsp;David W. Hutton,&nbsp;Davene R. Wright,&nbsp;Lisa A. Prosser","doi":"10.1007/s40258-024-00872-6","DOIUrl":"10.1007/s40258-024-00872-6","url":null,"abstract":"<div><h3>Objective</h3><p>About one-fifth of US adolescents experienced major depressive symptoms, but few studies have examined longitudinal trends of adolescents developing depression or recovering by demographic factors. We estimated new transition probability inputs, and then used them in a simulation model to project the epidemiologic burden and trajectory of depression of diverse adolescents by sex and race or ethnicity combinations.</p><h3>Methods</h3><p>Transition probabilities were first derived using parametric survival analysis of data from the National Longitudinal Study of Adolescent to Adult Health and then calibrated to cross-sectional data from the National Survey on Drug Use and Health. We developed a cohort state-transition model to simulate age-specific depression outcomes of US adolescents. A hypothetical adolescent cohort was modeled from 12−22 years with annual transitions. Model outcomes included proportions of youth experiencing depression, recovery, or depression-free cases and were reported for a US adolescent population by sex, race or ethnicity, and sex and race or ethnicity combinations.</p><h3>Results</h3><p>At 22 years of age, approximately 16% of adolescents had depression, 12% were in recovery, and 72% had never developed depression. Depression prevalence peaked around 16–17 years-old. Adolescents of multiracial or other race or ethnicity, White, American Indian or Alaska Native, and Hispanic, Latino, or Spanish descent were more likely to experience depression than other racial or ethnic groups. Depression trajectories generated by the model matched well with historical observational studies by sex and race or ethnicity, except for individuals from American Indian or Alaska Native and multiracial or other race or ethnicity backgrounds.</p><h3>Conclusions</h3><p>This study validated new transition probabilities for future use in decision models evaluating adolescent depression policies or interventions. Different sets of transition parameters by demographic factors (sex and race or ethnicity combinations) were generated to support future health equity research, including distributional cost-effectiveness analysis. Further data disaggregated with respect to race, ethnicity, religion, income, geography, gender identity, sexual orientation, and disability would be helpful to project accurate estimates for historically minoritized communities.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 3","pages":"375 - 390"},"PeriodicalIF":3.1,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Web-Based Valuation Surveys for Preference-Based Measures as Reliable as Face-to-Face Surveys? TTO, DCE and DCE with Duration","authors":"Takeru Shiroiwa,&nbsp;Takashi Fukuda","doi":"10.1007/s40258-023-00865-x","DOIUrl":"10.1007/s40258-023-00865-x","url":null,"abstract":"<div><h3>Background</h3><p>Valuation surveys of preference-based measures are typically conducted face-to-face or on web panels. In this survey, we considered whether face-to-face and online surveys were reliable using three tasks: composite time trade-off (cTTO), discrete choice experiment (DCE), and DCE with duration.</p><h3>Methods</h3><p>Respondents (aged 20–69 years) for both face-to-face (<i>N</i> = 1000, target sample size) and web surveys were selected through quota sampling by sex and age from each panel of the general population in Japan. They were then allocated to one of the three tasks and divided into six groups (two survey modes × three tasks, <i>N</i> = 334 per group). For the cTTO, respondents were asked to rate ten health states described by the EQ-5D-5L. For the DCE and DCE with duration surveys, respondents were asked about 15 health–state pairs. For all participants, as in the second-stage survey, a similar process was repeated two weeks after the first survey. Reliability was evaluated by calculating the percentage of agreement and intraclass correlation coefficients.</p><h3>Results</h3><p>The cTTO scores of the face-to-face and web surveys were systematically different. Between the face-to-face and web surveys, the agreement of the TTO survey was not good. The intraclass correlation coefficient (ICC) was 0.37 for the face-to-face test-test and 0.59 for the web test-retest. Discrete choice experiment (DCE) and DCE with duration had similarly good agreement (more than 70%), regardless of face-to-face or web surveys. However, between the first and second surveys (test-retest) of DCE and DCE with duration, the agreement depends on whether the positions of the two cards (health states) are identical.</p><h3>Conclusion</h3><p>If the face-to-face cTTO score is the gold standard, a web-based survey of cTTO is not recommended regardless of the ICC. If a DCE survey is performed, positioning effects should be considered.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 3","pages":"391 - 400"},"PeriodicalIF":3.1,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-023-00865-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139463117","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 Review of Current Approaches to Evaluating and Reimbursing New Medicines in a Subset of OECD Countries","authors":"Néboa Zozaya,&nbsp;Javier Villaseca,&nbsp;Irene Fernández,&nbsp;Fernando Abdalla,&nbsp;Benito Cadenas-Noreña,&nbsp;Miguel Ángel Calleja,&nbsp;Pedro Gómez-Pajuelo,&nbsp;Jorge Mestre-Ferrándiz,&nbsp;Juan Oliva-Moreno,&nbsp;José Luis Trillo,&nbsp;Álvaro Hidalgo-Vega","doi":"10.1007/s40258-023-00867-9","DOIUrl":"10.1007/s40258-023-00867-9","url":null,"abstract":"<div><h3>Objectives</h3><p>The aim of this study was to review the current evaluation and funding processes for new drugs in different developed countries, to provide a comparative framework with detailed, homogeneous, and up-to-date information.</p><h3>Methods</h3><p>Scientific publications, reports and websites were reviewed between July and December 2021 using PubMed, Google Scholar, and grey literature sources. The main items searched were actors and processes, including timelines, characteristics of clinical and economic evaluations, participation of stakeholders, elements of price and reimbursement decisions, cost-effectiveness thresholds and specific funds. The analysed 13 countries were Australia, Canada, England, France, Germany, Italy, Japan, the Netherlands, Portugal, Scotland, South Korea, Spain and Sweden.</p><h3>Results</h3><p>Eight countries perform the assessment process separated from the pricing decision. Countries measure each drug’s added therapeutic value through multi-attribute value scales, algorithms, non-prescriptive lists of criteria, or quality-adjusted life years (QALYs). Health technology assessment (HTA) methodologies differ in their outcome measures, elicitation techniques, comparators, and perspectives. The criteria used for pricing and reimbursement include humanistic, clinical, and economic aspects. Only Scotland, England, the Netherlands, Canada and Portugal use explicit efficiency thresholds. Health care professionals participate in all assessment committees, and patients are becoming increasingly involved in most countries. The official time from marketing authorisation to the completion of the evaluation and pricing processes varied from 126 to 540 days.</p><h3>Conclusions</h3><p>Most analysed countries show a trend towards value-based approaches that consider value for money to society, but also other economic, clinical, and humanistic criteria. Good practices included robustness, transparency, independence, and participation.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 3","pages":"297 - 313"},"PeriodicalIF":3.1,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139428263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance","authors":"Jake T. W. Williams,&nbsp;Katy J. L. Bell,&nbsp;Rachael L. Morton,&nbsp;Mbathio Dieng","doi":"10.1007/s40258-023-00868-8","DOIUrl":"10.1007/s40258-023-00868-8","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 2","pages":"271 - 272"},"PeriodicalIF":3.1,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10864505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139428249","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 Systemic Therapy for Intensification of Treatment in Metastatic Hormone-Sensitive Prostate Cancer in India","authors":"Nidhi Gupta,&nbsp;Dharna Gupta,&nbsp;Kiran Gopal Vaska,&nbsp;Shankar Prinja","doi":"10.1007/s40258-023-00866-w","DOIUrl":"10.1007/s40258-023-00866-w","url":null,"abstract":"<div><h3>Background and Objective</h3><p>Androgen-deprivation therapy is the mainstay of treatment for patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC). However, the intensification of treatment with either docetaxel or novel anti-androgens (abiraterone-acetate plus prednisone [AAP], enzalutamide, and apalutamide) is being recommended based on the improved clinical outcomes and quality of life among patients. This study aimed to determine the most cost-effective drug for treatment intensification for patients with mHSPC in India.</p><h3>Methods</h3><p>A Markov model was developed with four health states: progression-free survival, progressive disease, best supportive care, and death. Lifetime costs and consequences were estimated for four treatment sequences: AAP-first, enzalutamide-first, apalutamide-first, and docetaxel-first. Incremental cost per quality-adjusted life-year (QALY) gained with a given treatment option was compared against the next best alternative and assessed for cost effectiveness using a willingness to pay threshold of 1 × per capita gross domestic product in India.</p><h3>Results</h3><p>We estimated that the total lifetime cost per patient was ₹1,367,454 (US$17,487), ₹2,168,885 (US$27,735), ₹7,678,501 (US$98,190), and ₹1,358,746 (US$17,375) in the AAP-first, enzalutamide-first, apalutamide-first, and docetaxel-first treatment sequence, respectively. The mean quality-adjusted life-years lived per patient were 4.78, 5.03, 3.22, and 2.61, respectively. The AAP-first sequence incurs an incremental cost of ₹4014 (US$51) per quality-adjusted life-year gained as compared with the docetaxel-first sequence, with a 87% probability of being cost effective at the willingness-to-pay threshold of 1 × per-capita gross domestic product of India. The use of AAP-first also incurs an incremental net monetary benefit of ₹396,491 (US$5070) as compared with the docetaxel-first treatment sequence. Nearly a 48% reduction in the price of enzalutamide is required to make it a cost-effective treatment sequence as compared with AAP-first in India.</p><h3>Conclusions</h3><p>We concur with the inclusion of standard-dose AAP in India’s publicly financed health insurance scheme for the intensification of treatment in mHSPC as it is the only cost-effective sequence among the various novel anti-androgens when compared with the docetaxel-first treatment sequence. Furthermore, a systematic reduction in the price of enzalutamide would further help to improve clinical outcomes among patients with mHSPC.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 3","pages":"415 - 426"},"PeriodicalIF":3.1,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139401554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}