Applied Health Economics and Health Policy最新文献

{"title":"Public Preference for Off-Label Use of Drugs for Cancer Treatment and Relative Importance of Associated Adverse Events: A Discrete Choice Experiment and Best-Worst Scaling","authors":"Kailu Wang,&nbsp;Ho-Man Shum,&nbsp;Carrie Ho-Kwan Yam,&nbsp;Yushan Wu,&nbsp;Eliza Lai-Yi Wong,&nbsp;Eng-Kiong Yeoh","doi":"10.1007/s40258-024-00912-1","DOIUrl":"10.1007/s40258-024-00912-1","url":null,"abstract":"<div><h3>Background and Objective</h3><p>Patients may get more treatment options with off-label use of drugs while exposed to unknown risks of adverse events. Little is known about the public or demand-side perspective on off-label drug use, which is important to understand how to use off-label treatment and devise financial assistance. This study aimed to quantify public preference for off-label cancer treatment outcomes, process, and costs, and perceived importance of associated adverse events.</p><h3>Methods</h3><p>A discrete choice experiment and a best-worst scaling were conducted in Hong Kong in December 2022. Quota sampling was used to randomly select the study sample from a territory-wide panel of working-age adults. Preferences and willingness to pay (WTP) for treatment effectiveness, risk of adverse events, mode of drug administration, and availability of off-label treatment guidelines were estimated using a random parameter logit model and latent class model. The relative importance of different adverse events was elicited using Case 1 best-worst scaling.</p><h3>Results</h3><p>A total of 435 respondents provided valid responses. In the discrete choice experiment, the respondents indicated that extra overall survival as treatment effectiveness (WTP: HK$448,000/US$57,400 for 12-month vs 3-month extra survival) was the most important attribute for off-label drugs, followed by the risk of adverse events (WTP: HK$318,000/US$40,800 for 10% chance to have adverse event vs 55%), mode of drug administration (WTP: HK$42,000/US$5300 for oral intake vs injection), and availability of guidelines (WTP: HK$31,000/US$4000 for available versus not available). Four groups with distinct preferences were identified, including effectiveness oriented, off-label use refusal, oral intake oriented, and adverse event risk aversion. In the best-worse scaling, hypothyroidism, nausea/vomiting, and arthralgia/joint pain were the three most important adverse events based on the perceptions of respondents. Risk-averse respondents, who were identified from the discrete choice experiment, had different perceived importance of the adverse events compared with those with other preferences.</p><h3>Conclusions</h3><p>Knowing the preference and WTP for cancer treatment-related characteristics from a societal perspective facilitates doctors’ communications with patients on decision making and treatment goal-setting for off-label treatment, and enables devising financial assistance for related treatments. This study also provides important insight to inform evaluations of public acceptance and information dissemination in drug development as well as future economic evaluations.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 6","pages":"849 - 860"},"PeriodicalIF":3.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-024-00912-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279690","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":"Are Drug Novelty Characteristics Associated With Greater Health Benefits?","authors":"A. Alex Levine,&nbsp;Daniel E. Enright,&nbsp;Katherine A. Clifford,&nbsp;Stacey Kowal,&nbsp;James D. Chambers","doi":"10.1007/s40258-024-00910-3","DOIUrl":"10.1007/s40258-024-00910-3","url":null,"abstract":"<div><h3>Objective</h3><p>The aim of this study was to examine the association between characteristics of novel drugs and incremental health gains relative to standard of care, in terms of quality-adjusted life-years (QALYs).</p><h3>Methods</h3><p>This study’s unit of analysis is the drug–indication pair. For pairs approved by the US FDA from 1999 to 2018, we quantified incremental health gains using QALYs from the published literature and characterized each pair’s novelty in terms of a series of six binary (yes/no) characteristics of novel drugs given special consideration by Health Technology Assessment agencies: <i>Novel mechanism of action</i>, <i>Indicated for a rare disease</i>, <i>Indicated for a pediatric population</i>, <i>Treats a serious condition</i>, <i>Offers meaningful improvement over available therapies</i>, and <i>Potential to address unmet clinical needs</i>. We analyzed measures of bivariate association (Mann-Whitney U and Kolmogorov-Smirnov tests) and multivariable regression, accounting for the influence of multiple novelty characteristics simultaneously.</p><h3>Results</h3><p>Our sample of 146 drugs represents 21% of drugs approved the FDA in the time period (1999–2018). Median and mean QALY gains for ‘novel’ drug–indication pairs exceeded corresponding QALY gains for non-novel drug–indication pairs. For most comparisons, the bivariate relationships between QALY gains and novelty characteristics were significant at <i>p </i>&lt; 0.05 except for <i>novel mechanism of action</i> (Kolmogorov-Smirnov test) and <i>pediatric indication</i> (both bivariate tests). Multivariable models revealed an independent association between novelty characteristics and QALY gain except for <i>unmet clinical need</i> and <i>indicated for a rare disease</i>.</p><h3>Conclusions</h3><p>Drugs with novelty characteristics conferred larger health gains than drugs without these characteristics in bivariate analysis, multivariable models, or both. Future research should examine other aspects of drug novelty, such as patient and health system costs and equitable access.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 6","pages":"827 - 832"},"PeriodicalIF":3.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118841","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":"Measures of Performance and Clinical Superiority Thresholds for ‘Test-and-treat’ Predictive Biomarkers","authors":"Neil Hawkins,&nbsp;Janet Bouttell,&nbsp;Dmitry Ponomarev","doi":"10.1007/s40258-024-00906-z","DOIUrl":"10.1007/s40258-024-00906-z","url":null,"abstract":"<div><h3>Background</h3><p>Predictive biomarkers are intended to predict an individual’s expected response to specific treatments. These are an important component of precision medicine. We explore measures of biomarker performance that are based on the expected probability of response to individual treatment conditional on biomarker status. We show how these measures can be used to establish thresholds at which testing strategies will be clinically superior.</p><h3>Methods</h3><p>We used a decision model to compare expected probabilities of response of treat-all and test-and-treat strategies. Based on this, R-Shiny-based apps were developed which produce plots of the threshold positive and negative predictive values or sensitivities and specificities above which a ‘test-and-treat’ strategy will outperform a ‘treat-all’ strategy. We present a case study using data on the use of RAS status to predict response to panitumumab in metastatic colorectal cancer.</p><h3>Results</h3><p>Where a companion diagnostic is predictive of response to one of the treatments being compared, it is possible to estimate threshold sensitivities and specificities above which a testing strategy will outperform a treat-all strategy, based only on the odds ratio of response. Where negative and positive predictive values were used, the threshold depended on the prevalence of the biomarker-positive patients.</p><h3>Discussion</h3><p>These intuitive performance measures for predictive biomarkers, based on expected response to individual treatments, can be used to identify promising candidate companion diagnostic tests and indicate the potential magnitude of the net benefit of testing.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 1","pages":"65 - 74"},"PeriodicalIF":3.1,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103753","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":"Impact of Government-Funded Health Insurance on Out-of-Pocket Expenditure and Quality of Hospital-Based Care in Indian States of Madhya Pradesh and Maharashtra","authors":"Samir Garg,&nbsp;Kirtti Kumar Bebarta,&nbsp;Narayan Tripathi,&nbsp;Vikash Ranjan Keshri","doi":"10.1007/s40258-024-00911-2","DOIUrl":"10.1007/s40258-024-00911-2","url":null,"abstract":"<div><h3>Background</h3><p>With its clear focus on financial protection, government-funded health insurance (GFHI) stands out among the strategies for universal health coverage (UHC) implemented by low-to-middle income countries globally. Since 2018, India has implemented a GFHI programme called the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which covers 500 million individuals. The current study aims to evaluate the performance of GFHI in meeting its key objectives of improving access, quality and financial protection for hospital-based care in two large central Indian states: Madhya Pradesh and Maharashtra.</p><h3>Methods</h3><p>The study measures access in terms of utilisation of inpatient care. Financial protection was measured in terms of catastrophic health expenditure which was defined as the incidence of out-of-pocket expenditure (OOPE) above thresholds of 10% and 25% of annual household expenditure. Patient-satisfaction with care was taken as an indicator of quality. A household survey was conducted in 2023, covering a multi-stage sample of 11,569 and 12,384 individuals in Madhya Pradesh and Maharashtra, respectively. Multi-variate analyses were conducted to find the effect of GFHI-enrolment on the desired outcomes. The instrumental variable method was applied to address potential endogeneity in insurance enrolment. Additionally, propensity score matching was done to ensure robustness.</p><h3>Results</h3><p>Around 71% and 63% of surveyed individuals were enrolled under GFHI in Madhya Pradesh and Maharashtra, respectively. The hospitalisation rate did not differ much between the GFHI-enrolled and non-enrolled population. The average OOPE on hospitalisation was similar for the GFHI-enrolled and non-enrolled patients. The OOPE and catastrophic health expenditure in private hospitals remained very high, irrespective of GFHI enrolment. The pattern was similar in both states. Multi-variate adjusted models showed that GFHI had no significant effect on utilisation, quality, OOPE and catastrophic health expenditure. The above results were confirmed by propensity score matching.</p><h3>Conclusions</h3><p>Coverage by GFHI enrolment was ineffective in improving access, quality or financial protection for inpatient hospital care despite 5 years of implementation of the programme. Long-standing supply-side gaps and poor regulation of private providers continue to hamper the effectiveness of GFHI in India.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 6","pages":"815 - 825"},"PeriodicalIF":3.1,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054752","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":"A Contingent Valuation Study for Use in Valuing Public Goods with Health Externalities: The Case of Street Pianos","authors":"Aikaterini Papadopoulou,&nbsp;Helen Mason,&nbsp;Cam Donaldson","doi":"10.1007/s40258-024-00909-w","DOIUrl":"10.1007/s40258-024-00909-w","url":null,"abstract":"<div><h3>Background</h3><p>Clinical healthcare is not the only way to improve an individual’s health. Community-based interventions can have health and wellbeing impacts as well; however, the nature of these interventions, which have public good characteristics, poses challenges for the typical ways in which we value outcomes for use in (health) economic evaluations. The approaches to valuation of these type of interventions should allow for the incorporation of all types of values including option value, externalities and individual use-value.</p><h3>Objective</h3><p>This is a feasibility study with the objective to re-consider the importance of health externalities when valuing public health interventions that are treated as public goods from an economic perspective.</p><h3>Methods</h3><p>A contingent valuation (CV) survey was designed to elicit individual willingness to pay (WTP) for the public piano programme (PPP). Five different scenarios were designed; three scenarios focussed on individual use–value, while the other two (scenarios 4 and 5) covered option values and externalities. An online survey was conducted with a sample of 105 people.</p><h3>Results</h3><p>Preferences differed across the different scenarios. The mean WTP for scenario 1 was £0.81, for scenario 2 £3.65, for scenario 3 £3.07, for scenario 4 £7.26 and for scenario 5 £6.02. The WTP results for each scenario are presented and discussed regarding the nature of the good, user and non-user perspectives, payment vehicles and individual characteristics.</p><h3>Conclusion</h3><p>This study provides evidence that all types of use are necessary for inclusion in an economic evaluation, especially when the good in question is a public good where its benefits can be obtained from all community members.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 6","pages":"871 - 883"},"PeriodicalIF":3.1,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003460","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":"Economic Epidemiology: A Framework to Study Interactions of Epidemics and the Economy","authors":"Aditya Goenka,&nbsp;Lin Liu","doi":"10.1007/s40258-024-00907-y","DOIUrl":"10.1007/s40258-024-00907-y","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 6","pages":"767 - 769"},"PeriodicalIF":3.1,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974985","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":"Utilising Health Technology Assessment to Develop Managed Access Protocols to Facilitate Drug Reimbursement in Ireland","authors":"Claire Gorry,&nbsp;Maria Daly,&nbsp;Rosealeen Barrett,&nbsp;Karen Finnigan,&nbsp;Amelia Smith,&nbsp;Stephen Doran,&nbsp;Bernard Duggan,&nbsp;Sarah Clarke,&nbsp;Michael Barry","doi":"10.1007/s40258-024-00904-1","DOIUrl":"10.1007/s40258-024-00904-1","url":null,"abstract":"<div><p>The Health Service Executive, responsible for operating the Irish health service, has introduced health technology management (HTM) initiatives to manage expenditure on medicines. One such approach is managed access protocols (MAPs) to support access to high-cost medicines, while providing oversight, governance and budgetary certainty to the payer. Herein we describe the development and operation of MAPs, using case studies of liraglutide (Saxenda^®), dupilumab (Dupixent^®) and calcitonin gene-related peptide monoclonal antibodies. A MAP imposes the eligibility criteria attached to reimbursement support of a medicine. Criteria applied include controls on prescribing authority, clinical diagnostic and severity criteria, previous lines of treatment, concomitant treatments, outcome data collection, and validations within the reimbursement claims system. The choice of criteria are specific to each medicine, dictated by the areas of uncertainty highlighted in the health technology assessment report, such as the place in treatment, population, duration of treatment, etc., the commercial arrangements reached with the marketing authorisation holder, and specific recommendations made by the decision maker. By December 2023, there were 28 medicines reimbursed subject to a MAP in Ireland. Across the three case studies outlined, over 3000 patients were accessing novel treatments for chronic illnesses in September 2023. Managed access protocols can provide some cost certainty for the payer by aligning utilisation and expenditure with committed funds, while enabling access where unmet need is highest. Managed access protocols are now established in the drug reimbursement process in Ireland, meeting the needs of both payers, patients and industry, and are likely to remain a feature of the reimbursement landscape.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 6","pages":"771 - 781"},"PeriodicalIF":3.1,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-024-00904-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915984","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 Development of a New Approach for the Harmonized Multi-Sectoral and Multi-Country Cost Valuation of Services: The PECUNIA Reference Unit Cost (RUC) Templates","authors":"Susanne Mayer,&nbsp;Michael Berger,&nbsp;Nataša Perić,&nbsp;Claudia Fischer,&nbsp;Alexander Konnopka,&nbsp;Valentin Brodszky,&nbsp;Silvia M. A. A. Evers,&nbsp;Leona Hakkaart-van Roijen,&nbsp;Mencia Ruiz Guitérrez Colosia,&nbsp;Luis Salvador-Carulla,&nbsp;A-La Park,&nbsp;Joanna Thorn,&nbsp;Lidia García-Pérez,&nbsp;Judit Simon","doi":"10.1007/s40258-024-00905-0","DOIUrl":"10.1007/s40258-024-00905-0","url":null,"abstract":"<div><h3>Background</h3><p>Increasing healthcare costs require evidence-based resource use allocation for which assessing costs rigorously and comparably is crucial. Harmonized cross-country costing methods for evaluating interventions from a societal perspective are lacking. This study presents the development process and content of the service costing templates developed as part of the European project PECUNIA.</p><h3>Methods</h3><p>The six developmental steps towards technological readiness of the templates included (1) a common conceptual costing framework and review of methodological costing issues, (2) harmonization strategy formulation, (3) proof-of-concept with expert feedback, (4) piloting, (5) validation, and (6) demonstration in six European countries.</p><h3>Results</h3><p>The PECUNIA Reference Unit Cost (RUC) Templates for service costing are three new self-completion tools to be used with secondary or primary data for top-down micro-costing or top-down gross-costing approaches. Complementary data collection and unit cost aggregation/weighting templates are available. The applications leading to the final versions including (4) piloting through calculation of 15-unit costs, (5) validation within a Health Technology Assessment framework, and (6) RUC calculations mostly based on secondary data demonstrated the templates’ general feasibility, with feedback for improved usability incorporated and a supplementary user guide developed.</p><h3>Conclusion</h3><p>The validated PECUNIA RUC Templates for multi-sectoral and multi-country service costing allow for harmonized RUC development while incorporating flexibility and transparency in the choice of costing approaches, data sources and magnitude of remaining heterogeneity. The templates are expected to significantly improve the quality, comparability and availability of unit costs for economic evaluations, and promote the transferability of service cost information across Europe.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 6","pages":"783 - 796"},"PeriodicalIF":3.1,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-024-00905-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900755","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":"Financial Literacy and Mental Health: Empirical Evidence from China","authors":"Naijie Guan,&nbsp;Alessandra Guariglia,&nbsp;Patrick Moore,&nbsp;Hareth Al-Janabi","doi":"10.1007/s40258-024-00899-9","DOIUrl":"10.1007/s40258-024-00899-9","url":null,"abstract":"<div><h3>Background and Objective</h3><p>While financial literacy is a plausible determinant of mental health, there are relatively few studies exploring the relationship between financial literacy and mental health, and the existing literature focuses on a single construct of financial literacy in high-income settings. Our study addresses this by investigating whether there is an association between financial knowledge, attitudes, and behaviours and mental health in Chinese adults.</p><h3>Methods</h3><p>We use data from the China Family Panel Studies, a nationally representative longitudinal survey. Mental health is measured using the Kessler Psychological Distress Scale (K6) and financial literacy is assessed using a unique module on financial literacy covering financial knowledge, financial attitudes and financial behaviours.</p><h3>Results</h3><p>We found that overall financial literacy and two of its dimensions (financial attitudes and financial behaviours) are always positively associated with mental health. A positive association between basic financial knowledge and mental health is also apparent but is mediated by households’ finances. Our results are robust to using different outcome variables and estimation methods. Finally, we found that compared with their counterparts without debt, indebted respondents show a stronger sensitivity of mental health to basic financial knowledge, as well as a significant association between advanced financial knowledge and mental health, which persist when we control for households’ finances.</p><h3>Conclusions</h3><p>Our findings suggest that investments in financial education might significantly benefit mental health in Chinese adults. This is especially the case among indebted adults.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 6","pages":"833 - 847"},"PeriodicalIF":3.1,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791756","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":"Sedaconda ACD-S for Sedation with Volatile Anaesthetics in Intensive Care: A NICE Medical Technologies Guidance","authors":"Michal Pruski,&nbsp;Susan O’Connell,&nbsp;Laura Knight,&nbsp;Rhys Morris","doi":"10.1007/s40258-024-00903-2","DOIUrl":"10.1007/s40258-024-00903-2","url":null,"abstract":"<div><p>Intensive care unit (ICU) patients receive highly complex care and often require sedation as part of their management. ICU sedation has traditionally been delivered using intravenous (IV) agents due to the impractical use of anaesthetic machines in this setting, which are used to deliver volatile sedation. Sedaconda anaesthetic conserving device (ACD)-S (previously known as AnaConDa-S) is a device which allows for the delivery of volatile sedation via the majority of mechanical ventilators by being inserted in the breathing circuit where the heat and moisture exchanger is normally placed. The National Institute of Health and Care Excellence (NICE), as part of the Medical Technologies Evaluation Programme, considered the potential benefits of using Sedaconda ACD-S compared to standard IV sedation in ICU patients. Here we describe the evidence evaluation undertaken by NICE on this technology, supported by CEDAR. CEDAR considered the evidence present in 21 publications that compared the clinical outcomes of patients receiving Sedaconda ACD-S-delivered sedation and IV sedation, and critiqued the economic model provided by the manufacturer. Clinical expert input during the evaluation process was used extensively to ensure that the relevant clinical evidence was captured and that the economic model was suitable for the UK setting. Due to the uncertainty of the evidence, sensitivity analysis was carried out on the key economic inputs to ensure the reliability of the results. Economic modelling has shown that Sedaconda ACD-S–delivered isoflurane sedation is cost saving on a 30-day horizon compared to IV sedation by £3833.76 per adult patient and by £2837.41 per paediatric patient. Clinical evidence indicated that Sedaconda ACD-S-delivered isoflurane sedation is associated with faster patient wake-up times than standard of care. Consequently, NICE recommended Sedaconda ACD-S as an option for delivering sedation in the ICU setting, but noted that further research should inform whether Sedaconda ACD-S–delivered sedation is of benefit to any particular subgroup of patients.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"22 6","pages":"805 - 813"},"PeriodicalIF":3.1,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141764931","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}