Stroke continues to impose a substantial economic burden globally. To mitigate escalating healthcare costs and enhance financial protection for patients, diagnosis-related group (DRG) payment systems have been widely implemented in China. Neurointerventional stroke care, characterized by its complexity and high costs, represents a critical area for evaluating the impact of such payment reforms. This study investigates the effects of the DRG payment system on hospitalization costs and patient out-of-pocket expenditures (OOPE) for neurointerventional stroke patients in a leading neurological hospital in China. We conducted a retrospective cohort study using 2024 administrative data from Beijing Tiantan Hospital, China. The study included 5,205 inpatient stroke patients who underwent neurointerventional procedures (BE2 codes). Patients were categorized into a DRG payment group (Beijing residents, 18.87%) and a Fee-For-Service (FFS) payment group (non-Beijing residents, 81.13%) based on their medical insurance payment method. Pearson χ² tests and Mann-Whitney U tests were employed to compare total direct hospitalization costs (TDHC) and OOPE between the two groups. Quantile regression analysis further explored the impact of DRG payment across different expenditure levels to assess the heterogeneity of its financial protective effects. Compared to the FFS group, patients in the DRG payment group demonstrated significantly lower median TDHC (RMB 86,268 vs. RMB 102,885; p < 0.001), representing a 16.15% reduction. Similarly, the median OOPE for DRG patients was significantly lower (RMB 19,851 vs. RMB 30,266; p < 0.001), a 34.41% reduction. Quantile regression analysis confirmed consistent cost reductions across all expenditure quantiles (TDHC: 3.84%-5.16%; OOPE: 14.49%-36.32%), with more pronounced financial protection for patients with higher OOPE levels. Notably, centrally procured medical supplies were associated with increased costs, while higher insurance reimbursement, non-centrally procured medications, ICU transfers, and prolonged length of stay independently predicted higher expenditures. This single-center study demonstrates a significant association between the DRG payment system and effective cost containment and enhanced patient financial protection for neurointerventional stroke care in a large Chinese neurological center. These findings underscore the necessity for future DRG payment policy development to include specialty-adjusted DRG weights and to ensure coordinated integration between payment reforms and medical supply procurement policies. Due to its single-center nature and reliance on single-year data, caution is warranted when generalizing these results to other institutions and policy contexts.

Primary insomnia is a highly prevalent sleep disorder that significantly affects quality of life. Acupoint injection (AJ), a traditional therapy that combines pharmacological and acupuncture effects, has been increasingly applied in clinical practice. However, evidence of its efficacy and economic value is lacking. This study determined the clinical effectiveness of AJ and established the relative ranks of AJ-related therapies for the treatment of primary insomnia. The clinical effectiveness and cost-effectiveness of AJ-related therapies for primary insomnia were evaluated through a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs). We searched 11 electronic databases for relevant studies published up to June 10, 2025. The Pittsburgh Sleep Quality Index (PSQI) and effective rate were used as outcome measures. The quality of included studies was assessed using the Risk of Bias 2.0 tool. Pairwise meta-analysis and NMA were performed using RevMan 5.4 and R, respectively. The cost-effectiveness of the interventions was subsequently determined based on regional intervention costs. Twenty-four randomized controlled trials involving 1,851 participants were included in the meta-analysis. AJ combined with manual acupuncture (MA) significantly reduced PSQI scores based on the results of the pairwise meta-analysis and was among the most effective interventions based on the results of the network meta-analysis. The cost-effectiveness analysis revealed that AJ combined with MA was associated with better outcomes at modest additional costs, as indicated by the favorable incremental cost-effectiveness ratio (ICER) values for PSQI improvement and additional responders. This study is the first to comprehensively synthesize evidence on the clinical effectiveness and cost-effectiveness of acupoint injection for primary insomnia. AJ combined with MA significantly improves sleep quality and may be a cost-effective and safe adjunctive therapy within the context of traditional medicine practice. It may be a feasible treatment option for primary insomnia. However, this conclusion should be validated through future studies due to the limitations of the quality of the literature. Further high-quality RCTs with standardized economic evaluations are warranted to confirm these findings.

Widespread adoption of single-use intermittent catheters for bladder drainage has led to increased costs and environmental waste. Reusable catheters could reduce both. The MultICath study showed that combined reusable and single-use catheters (Mixed-use) was non-inferior to single-use catheters for urinary tract infection and quality of life, but the economic impact is unknown. We aim to determine whether Mixed-use is cost-effective compared to Single-use only. Cost-utility and cost-consequence analyses were conducted alongside MultICath. The analysis took the United Kingdom payer perspective, using individual patient-level data of the 578 randomised (1:1) trial participants over 12 months. Costs included catheter and cleaning costs, antibiotic costs, and health-related visit costs. Outcomes were measured in quality adjusted life years (QALYs), estimated from EQ-5D-5L data. Incremental, sensitivity, and scenario analyses were conducted. Mixed-use participants used on average 902 (95% CI 755.13; 1049.31) fewer single-use catheters per annum than Single-use participants. Mixed-use was cost-effective in all analyses. Base-case annual incremental cost savings were -£1348.82 (95% CI -1939.98; -757.65) whilst incremental QALYs were negligible (-0.001; [-0.026; 0.024]). These estimates produced a positive net monetary benefit of £1328.82 at a willingness-to-pay threshold of £20,000. The probability of Mixed-use being cost-effective was never below 96.6%. The primary limitation was differential withdrawal rates between groups, accounted for in sensitivity analyses. Mixed-use is cost-effective for the UK National Health Service, and provision of reusable catheters should be considered. These findings are also relevant for other health services worldwide with high single-use catheter costs.

This study aimed to evaluate the cost-effectiveness of Optical Coherence Tomography (OCT)-guided versus coronary angiography-guided Percutaneous Coronary Intervention (PCI) within the Chinese healthcare system, exploring its economic value for patients with complex coronary artery lesions. A Markov model simulated a cohort of 10,000 patients aged 65 with coronary heart disease over a lifetime horizon (20 years). Adopting a healthcare system perspective, the study compared OCT-guided versus angiography-guided PCI strategies. Model parameters integrated 2-year follow-up data from the OCCUPI trial, clinical parameters from a meta-analysis of 6 RCTs, the Chinese National Reimbursement Drug List (2025), and health utility values for the Chinese population. A 5% discount rate was applied for the cost-utility analysis. The primary outcome was the Incremental Cost-Effectiveness Ratio (ICER). This study compared the cost-effectiveness of OCT-guided versus angiography guided PCI over short-term (within-trial) and long-term (20 years) horizons. In the short term (1 year), the ICER for OCT versus angiography was substantially high at 2,154,501.65 CNY/QALY, indicating a lack of cost-effectiveness advantage. However, in the lifetime simulation, OCT demonstrated significant cost-effectiveness. When using transition probabilities from the OCCUPI trial, the ICER markedly decreased to 6,815.47 CNY/QALY, indicating strong cost-effectiveness. When using transition probabilities from the meta-analysis incorporating multiple studies, the ICER was 42,374.86 CNY/QALY, below the willingness-to-pay threshold of one times China's per capita GDP (99,665 CNY), also demonstrating cost-effectiveness. Subgroup analyses revealed that the economic advantage of OCT was more pronounced in patients with diabetes, unprotected left main disease, small vessel disease, and multivessel disease. Sensitivity analyses confirmed the robustness of these findings. The results indicate that OCT-guided PCI exhibits a typical "high initial investment, long-term significant benefit" profile, representing a cost-effective interventional strategy over a lifetime horizon. Within the Chinese healthcare system, OCT-guided PCI demonstrates favorable cost-effectiveness for patients with complex coronary artery lesions. Its higher initial costs are offset by long-term health gains, supporting its value for broader adoption.

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a mechanical life support modality used in patients with severe respiratory failure. Despite rising case numbers worldwide, costs are substantial, while patient-centered outcomes, particularly survival and quality-adjusted life years (QALYs), remain uncertain. High complication and mortality rates also persist. Limited financial budgets, human resources, and treatment capacities in healthcare systems require critical evaluation of whether continued use of this resource-intensive intervention at the current scale is sustainable and ethically justifiable. This study aims to provide further insight into this issue and to support healthcare decision-making by offering a structured economic and ethical framework for evaluating VV-ECMO, particularly regarding resource allocation, proportionality of costs, and the justification of its use in high-cost intensive care. This mixed-methods study consists of two parts. Part A includes two systematic literature reviews. The first examines total and daily in-hospital costs per patient, as well as outcomes measured in QALYs for adult patients supported with VV-ECMO across multiple countries between 2005 and 2024. The second aim is to identify established interventions with confirmed QALY gain that can subsequently be used as comparators for VV-ECMO. Part B evaluates the results according to the principles of medical ethics: beneficence, non-maleficence, autonomy, and justice. Given limited financial, personnel, and treatment capacities in healthcare systems, the question of how highly resource-intensive interventions such as VV-ECMO can be justified has increasing clinical, economic, and ethical relevance. By linking cost-related outcomes with a structured ethical evaluation, this study aims to contribute to a more differentiated discussion of whether and under which conditions VV-ECMO may be considered proportionate and justifiable within resource-constrained healthcare settings. Expected challenges include data availability and quality, differences in reported charges versus costs, and variation in healthcare systems, reimbursement structures, and national decision-making frameworks. These factors represent inherent limitations of international comparisons. The analysis is therefore intended as a comparative and contextual assessment rather than a formal cost-effectiveness evaluation within a single national reimbursement framework, particularly as no officially established uniform willingness-to-pay threshold per QALY exists in Germany. Not applicable. This study does not involve interventional clinical research. The protocol was registered on the Open Science Framework ( https://osf.io/24ky5 ).

Precision medical tests play a critical role in tailoring treatment plans to individual patients and optimizing medical resource utilization. This paper establishes a quantitative model to analyze the relationship between the accuracy of a precision medical test and its cost-effectiveness. Two theoretical lower bounds on test accuracy are proposed to be required for a testing strategy to be considered cost-effective. The first bound ensures that the intervention matched to a test result remains locally optimal for the reported patient class, thereby satisfying a local efficiency criterion. The second bound ensures that the testing strategy yields a higher expected net monetary benefit for the entire population compared to no testing, satisfying a global efficiency criterion. A special case analyzing sensitivity and specificity for binary test results illustrates these thresholds intuitively. Numerical simulations support these theoretical findings. The results illustrate how accuracy requirements depend on class prevalence, treatment benefits, and test costs, and may serve as a preliminary screening criterion for further evaluation.

Many Emergency Departments (EDs) front-load investigations, which can cause unnecessary over-investigation in ambulatory patients and has environmental and financial impacts. Coagulation screens often contribute little to patients' management and NHS England guidelines already exist regarding coagulation screening in the ED. Literature has demonstrated successful reductions in coagulation screening but have often lacked balancing measures. The number of coagulation and Full Blood Count (FBC) tests performed on ambulatory patients attending a multi-site Trust with 2 Emergency Departments were collected from 2023 to 2025. Total number of coagulation screens and coagulation: FBC ratio were measured and a proxy for repeat venepuncture measured. Interventions were introduced at the John Radcliffe, Oxford, a Major Trauma Centre and at the Horton General Hospital, a District General Hospital. Interventions were implemented through PDSA cycles, including posters, moving the location of the coagulation bottles, other specialty involvement and a survey to highlight educational needs. The project was highlighted at regular nursing and medical meetings. The decrease in the number of coagulation screens and the coagulation: FBC ratio was gradual and sustained: at 28 weeks, there was a decrease of 26.97% and 28.51%, respectively with no increase in the proxy measure for repeat coagulation or D-Dimer sampling, but there was an increase in the number of patients who had a D-Dimer retrospectively added to their previous sample. Projected annual cost savings were £81,700 - £86,400 and ~ 250kg CO₂2 per annum. Environmental and financial savings can be made by reducing coagulation screening in Major Trauma Centres and across EDs within the same Trust, in keeping with existing literature. This did not appear to be associated with increases in repeat phlebotomy.