The combination of lenvatinib and pembrolizumab (LP) for advanced or recurrent endometrial carcinoma has demonstrated improved survival in a clinical study and has been endorsed by the European Society for Medical Oncology. However, the LP regimen is currently not covered by Taiwan’s National Health Insurance (NHI). This study aimed to evaluate the cost-effectiveness of LP as a second-line treatment for advanced endometrial carcinoma (aEC) under Taiwan’s NHI. A 3-state partitioned survival model was used to analyze a hypothetical population of patients with aEC over 20 years. The overall and progression-free survival curves were obtained from the updated results of the phase III trial 309/KEYNOTE-775 and extrapolated using a hybrid method. The pricing of the LP was based on the NHI fee schedule for other cancer treatments. Health state utilities and disutilities related to adverse events were obtained from the published literature. The willingness-to-pay (WTP) threshold was three times the GDP per capita in 2022 (NT$2,917,650). Quality-adjusted life-years (QALYs) and costs were discounted at 3%. Scenario analyses included LP price reductions and time horizon adjustments. Deterministic sensitivity, probabilistic sensitivity, and value of information analyses were performed to assess the uncertainty. LP provided an incremental gain of 0.92 QALYs at an incremental cost of NT$2,929,046, resulting in an incremental cost-effectiveness ratio of NT$3,197,177, which exceeded the WTP threshold. The major factors causing uncertainty were the time horizon and cost of the LP. LP is not a cost-effective second-line therapy for aEC unless its price is reduced by more than 20%.

Advanced diabetic retinopathy (DR), including proliferative DR and diabetic macular edema (DME), demands costly interventions like anti-VEGF therapy, laser treatment, and vitrectomy. Despite global data on its economic burden, cost-of-illness studies in Iraq—particularly those covering public spending, out-of-pocket costs, and non-medical expenses—are limited. To evaluate the direct medical and non-medical cost of illness associated with diabetic retinopathy (DR) in Iraq from the Ministry of Health (MOH) and patient perspectives. A cost-of-illness analysis using the bottom-up method of micro-costing was conducted at large Teaching Eye Hospital in Baghdad, Iraq. Data was collected retrospectively between October 2024 and March 2025. Direct medical costs were assessed from the MOH perspective, while direct medical and direct non-medical costs were analyzed from patient perspectives. Data was obtained from patient interviews, hospital records, and national medicine procurement databases. From the MOH perspective, direct medical costs include anti-VEGF injections, healthcare practitioner labor, hospital operations and supplies, examination equipment, laser therapy, and vitrectomy procedures. Statistical comparisons between disease stages were performed using ANOVA and a Tukey post-hoc test. The study included 603 patients with 994 eyes affected by DR. From the Ministry of Health (MOH) perspective, total annual treatment costs reached 790,043,475 IQD (US$678,393.70), averaging 2,920,896 IQD (US$2,212.80) per eye annually and 300,894 IQD (US$227.95) per visit. Anti-VEGF therapy (bevacizumab, aflibercept) accounted for 82.36% of the total cost. In comparison, direct medical costs from patient perspective were mainly attributed to private treatments and anti-VEGF injections, accounting for 36.94% of patient expenditures (US$ 96,598.48). Non-medical expenses—mainly transportation and accommodation—constituted the largest financial burden for patients, accounting for 58.37% of total costs (US$161,109.84), with annual per-eye costs averaging 213,945.6 IQD (US$162.08). Managing DME imposed significantly higher financial burden than other DR stages. This study highlights the considerable financial burden of DR management, particularly in advanced disease stages that necessitate intravitreal anti-VEGF therapy. The Iraqi government spends approximately six times more on direct medical costs for treating DR in public hospitals than individual patients do out of pocket. It emphasizes the need for health policy interventions, improved access to cost-effective therapies, and caregiver support programs to reduce the financial impact on affected individuals and families.

BackgroundIn recent years, new treatment options for chronic lymphocytic leukemia (CLL) have shown great potential. In China, the large CLL patient base translates into considerable clinical and economic burden, factors such as cost-effectiveness will be of significant importance in guiding government decision-making.ObjectiveIn this study, a cost-effectiveness analysis was conducted to assess the health economic value of two important first-line treatment options for CLL.MethodsThis study developed a partitioned survival model with three health states to analyze the cost-effectiveness (CE) of Venetoclax (Ven) + Obinutuzumab (Obi) and Chlorambucil (Chl) + Obi as first-line treatments for adult CLL. The transition probabilities were calculated using data from a clinical trial. Healthcare resource utilization and costs were obtained from publicly available data and expert interviews. The tool used to calculate quality-adjusted life years (QALYs) was derived from clinical trials and literature reviews. The primary outcome measure was the incremental cost-effectiveness ratio (ICER), expressed as cost per QALYs gained.We adopted a willingness-to-pay threshold of CNY 266,203 per QALY(China, 2022).ResultsIn the base case, the Ven + Obi group obtained 1.29 QALYs more than the Chl + Obi group, with a cost reduction of 152,877.43¥. Sensitivity analysis and scenario analysis results showed that even when the main parameters in the model changed within plausible ranges, the ICER of the Ven + Obi group remained cost-effective. In probabilistic sensitivity analysis, 99% of the iterations were cost-effective under the threshold.ConclusionThis study demonstrates that, the combination of Ven + Obi as a frontline treatment for CLL is superior to Chl + Obi in terms of cost-effectiveness. Sensitivity analysis indicates that treatment costs will significantly decrease after the patent protection period of these drugs expires.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12962-025-00705-w.

Health economics is crucial for optimizing resource allocation and achieving equitable health outcomes in Africa. This study reviewed the historical evolution and current state of health economics in Africa, focusing on healthcare financing mechanisms, resource allocation strategies, and policy interventions. Data from peer-reviewed articles, research reports, and grey literature were synthesized from databases like PubMed, Scopus, Google Scholar and African Journals Online (AJOL). While healthcare financing dominated the literature, this review also covers resource allocation and broader health economics, highlighting key gaps in African research. Findings highlight significant challenges such as low public expenditure, high out-of-pocket costs, and inadequate insurance coverage. Out-of-pocket payments constitute over 40% of total health expenditure in half of the studied countries, while public health expenditure remains between $8 and $129 per capita annually, far below the $4,000 per capita in high-income countries. Only three African countries have met the Abuja Declaration target of allocating 15% of government budgets to health. Innovative financing mechanisms, such as community-based health insurance schemes and public-private partnerships, show promise in expanding coverage and improving service delivery. However, challenges in implementation, financial sustainability, and socio-cultural barriers persist. Technological innovations, including digital health solutions and telemedicine, could enhance efficiency by up to 15% by 2030. Primary challenges in Africa's health resource allocation include insufficient funding, inadequate human resources, inefficient management, poor data quality, and lack of political commitment. Policy recommendations include increasing public investment in health, improving resource allocation efficiency, and fostering sustainable financing through private sector and international donor partnerships.

Improving medical resource utilization is a significant global challenge. In China, the hospital grading system serves as a key policy to promote collaboration and division of labor among institutions of different grades, with the goal of enhancing the overall performance. However, the medical resource utilization in China remains suboptimal. This study examines the relationship between the hospital grading system and medical resource utilization, offering insights for advancing the healthcare system. Using data from 31 provinces in China spanning 2010 to 2019, this study applies a dynamic panel data model to analyze the relationship between the hospital grading system and medical resource utilization. In addition, a mechanism analysis explores how the hospital grading system may influence utilization through the structure of resource allocation. The hospital grading system demonstrates a significant negative association with the utilization of both outpatient and inpatient medical resources, with the impact varying across regions and levels of resource endowment. Furthermore, disparities in the allocation of resources between hospitals and primary healthcare institutions constitute a key mechanism through which the hospital grading system undermines overall utilization. This study finds that the hospital grading system is associated with a reduction in medical resource utilization in China. The results provide evidence to inform reforms aimed at revising hospital grading system standards, optimizing medical resource allocation and improving overall system performance in China, while also offering potential lessons for other countries facing similar healthcare challenges.

Diabetic foot is a severe complication of diabetes mellitus, with a significant impact on patients’ quality of life. The traditional treatment has been amputation, but its high mortality rate has prompted a search for alternatives, such as the resection of non-viable tissue and limb stabilization using external fixation. This study evaluates the cost-effectiveness relationship between these two strategies. An assessment was made of the incremental cost-effectiveness ratio (ICER), calculated over a ten-year time horizon, of both amputation and external fixation. The analysis was based on clinical and cost data obtained from a previous study and used a discrete event simulation model. The mean ten-year quality-adjusted life expectancy for amputated patients was 2.641 ± 1.64 quality-adjusted life years (QALYs) as compared with 6.627 ± 1.46 QALYs for patients treated with external fixation (p < 0.001). The average cost-effectiveness ratio (CER) was estimated at €29,717/QALY for amputation and €15,360/QALY for external fixation. A comparison between both options resulted in an ICER of €5,847/QALY. Sensitivity analyses found ICER values ranging between €5,847/QALY and €12,296/QALY. A budget impact analysis revealed that the incorporation of the new treatment alternative into the Spanish National Health System would lead to a budget increase of €528.2 million over a ten-year horizon. The use of external fixation in the treatment of ulcerated diabetic foot was shown to be a cost-effective option compared to major amputations.