Additional Life Years Research Articles

Aging Well? Exploring Self-Reported Quality of Life in the Older Austrian Population Based on Repeated Cross-Sectional Data

ABSTRACT Increase in life expectancy around the world puts aging societies with all their challenges on the Global Public Health agenda. In Austria, additional years of life gained are not spent in good health, as healthy life expectancy is far below the European average. Using repeated cross-sectional data from three waves of the Austrian Health Interview Survey (2006, 2014 and 2019), including a total of 10,056 participants aged 65 years and above, this study examined the change in self-reported quality-of-life (QoL) over time and explored associated factors. QoL, estimated by domain scores of the WHOQOL-BREF questionnaire, increased over time but decreased with age in all survey waves. Observed mean scores were significantly higher in males than in females in all QoL domains except the social domain but sex differences disappeared in most domains in the multivariable regression analyses. Instead, factors associated with significantly higher QoL scores included younger age, higher socioeconomic status, living in Western Austria and having no chronic conditions. Statistically significant observed sex differences in QoL in the older-aged Austrian population disappeared when adjusting for income and education. Strategies and measures to increase financial capabilities may have a significant impact on QoL and well-being in this age group.

Health and Economic Outcomes of Offering Buprenorphine in Homeless Shelters in Massachusetts

Overdose is the leading cause of death among people experiencing homelessness (PEH), but engagement in medication treatment is low in this population. Shelter-based buprenorphine may be a strategy for increasing initiation and retention on lifesaving medications. To estimate clinical outcomes and conduct an economic analysis of statewide shelter-based opioid treatment in Massachusetts. This economic evaluation study in Massachusetts used a cohort state-transition simulation model. Two cohorts were modeled starting in 2013, including (1) a closed cohort of a fixed population of PEH with history of high-risk opioid use over their lifetimes and (2) an open cohort in which membership could change over time, allowing assessment of population-level trends over a 10-year period. Data analysis occurred from January 2023 to April 2024. Model exposures included (1) no shelter-based buprenorphine (status quo) and (2) offering buprenorphine in shelters statewide. Outcomes included overdose deaths, quality-adjusted life-years (QALYs) gained, and health care and modified societal perspective costs. Sensitivity analyses were conducted on key parameters. In the closed cohort analysis of 13 800 PEH (mean [SD] age, 40.4 [13.1] years; 8749 male [63.4%]), shelter-based buprenorphine was associated with an additional 65.4 person-weeks taking buprenorphine over an individual's lifetime compared with status quo. Shelter-based buprenorphine was cost saving when compared with the status quo, with a discounted lifetime cost savings from the health sector perspective of $1300 per person, and 0.2 additional discounted QALYs per person and 0.9 additional life-years per person. In the population-level simulation, 254 overdose deaths were averted over the 10-year period with the shelter-based buprenorphine strategy compared with the status quo (a 9.2% reduction of overdose deaths among PEH in Massachusetts). Overdose-related and other health care utilization undiscounted costs decreased by $3.0 million and $66.4 million, respectively. Shelter-based opioid treatment generated $44.7 million in additional medication and clinical costs, but saved $69.4 million in overdose and other health costs. In this economic evaluation of clinical and economic outcomes among PEH, shelter-based buprenorphine was associated with fewer overdose deaths and was cost saving. These findings suggest that broad rollout of shelter-based buprenorphine may be an important tool in addressing the overdose crisis.

Clinical and economic analysis of the use of dapagliflozin in patients with chronic heart failure with reduced left ventricular ejection fraction in various subgroups of standard therapy in the Russian Federation

To evaluate the clinical and economic effectiveness of dapagliflozin in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction (HFrEF) in the Russian Federation in various subgroups of standard therapy for CHF. A clinical and economic analysis of the use of the drug dapagliflozin in addition to standard therapy was carried out in comparison with standard therapy in various subgroups of standard therapy for HFrEF using a modeling method. Cost calculations were carried out in a mathematical model adapted to the healthcare conditions of the Russian Federation by using Russian cost indicators and characteristics of the patient population. The present study demonstrates that the addition of dapagliflozin is beneficial in terms of clinical and cost-effectiveness, regardless of the initial regimen (angiotensin receptor-neprilysin inhibitors [ARNI] or angiotensin-converting enzyme inhibitors [ACEi]/angiotensin II receptor blockers [ARB]) of standard drug therapy for HFrEF and in all cases leads to an increase in life expectancy, a decrease in the number of hospitalizations and emergency visits due to CHF, as well as cardiovascular mortality. The obtained values of added value per additional year of life in all cases are significantly lower than the willingness-to-pay threshold, which indicates the clinical and economic effectiveness of the strategy of prescribing dapagliflozin as part of standard therapy for patients with HFrEF. In the case of adding dapagliflozin the values of the additional cost of an added year of life in the 3 considered standard therapy options (ARNI or ACEi/ARB, only ACEi/ARB and only ARNI) were 291,256, 279,571 and 338,374 rubles respectively. Thus, the scenario of using dapagliflozin with standard therapy, which included only ACEi/ARB, is characterized by the lowest additional cost and has the best clinical and economic characteristics. At the same time the scenario of use with standard therapy, which included only ARNI, is characterized by the highest value of the additional value of the added year of life.

The Broader Effects of Delayed Progression to End-Stage Kidney Disease: Delaying the Inevitable or a Meaningful Change?

A global rise in the prevalence of patients with chronic kidney disease (CKD) with end-stage kidney disease (ESKD) has led to a considerable and increasing burden to health systems, patients, and society. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are proven to reduce incidence of cardio-renal outcomes, including onset of ESKD. Recent post hoc analyses of SGLT2 inhibitor trials extrapolate substantial delays in the average time to ESKD over a patient's lifetime. In this article, we explore the possible real-world effects of such a delay by considering the available evidence reporting outcomes following onset of ESKD. From the patient perspective, a delay in reaching ESKD could substantially improve health-related quality of life and result in additional life years without the need for kidney replacement therapies, a target relevant to all CKD subpopulations. Furthermore, should a patient initiate dialysis at an older age as a result of CKD progression, the time spent in receipt of dialysis, and therefore associated healthcare costs, may also be reduced. A delay in progression may also lead to changes in the management of ESKD, such as increased election of conservative care in preference to dialysis, particularly in elderly populations. For younger patients with CKD, those who reach ESKD while employed face considerable work impairment and productivity loss, as may families and care partners of working age. Therefore, a delay to the onset of ESKD will reduce the proportion of their working lives affected by productivity losses or unemployment due to medical reasons. In conclusion, optimised treatment of CKD may lead to a shift in treatment options, but proper and timely implementation is essential for the realisation of improved outcomes.

Contribution of severe mental disorders to fatally harmful effects of physical disorders: national cohort study.

It remains unknown whether severe mental disorders contribute to fatally harmful effects of physical illness. To investigate the risk of all-cause death and loss of life-years following the onset of a wide range of physical health conditions in people with severe mental disorders compared with matched counterparts who had only these physical health conditions, and to assess whether these associations can be fully explained by this patient group having more clinically recorded physical illness. Using Czech national in-patient register data, we identified individuals with 28 physical health conditions recorded between 1999 and 2017, separately for each condition. In these people, we identified individuals who had severe mental disorders recorded before the physical health condition and exactly matched them with up to five counterparts who had no recorded prior severe mental disorders. We estimated the risk of all-cause death and lost life-years following each of the physical health conditions in people with pre-existing severe mental disorders compared with matched counterparts without severe mental disorders. People with severe mental disorders had an elevated risk of all-cause death following the onset of 7 out of 9 broadly defined and 14 out of 19 specific physical health conditions. People with severe mental disorders lost additional life-years following the onset of 8 out 9 broadly defined and 13 out of 19 specific physical health conditions. The vast majority of results remained robust after considering the potentially confounding role of somatic multimorbidity and other clinical and sociodemographic factors. A wide range of physical illnesses are more likely to result in all-cause death in people with pre-existing severe mental disorders. This premature mortality cannot be fully explained by having more clinically recorded physical illness, suggesting that physical disorders are more likely to be fatally harmful in this patient group.

Evaluation of Risk Factors Associated with Recurrence and Death in Patients with Thyroid Cancer From 2008 to 2023 in the West of Iran.

Thyroid carcinoma (TC) is a global clinical concern, and its incidence has progressively increased worldwide. Early detection of TC and subsequently decreased age at the diagnosis seem to result from extensive employment of imaging modalities, biopsy techniques, and improvements in the healthcare system. Study Design: A retrospective cohort study. Overall, 400 patients diagnosed with TC following thyroidectomy in the Endocrinology Clinic, who were followed for fifteen years, were investigated in this study. The checklist included patients' demographic characteristics, clinical information, and response to treatment, recurrence, and death. There were 19.25% men and 80.75% women. The mean age was 41.005±15.58 years. The risk of death and recurrence was significantly higher in men, patients>65 years, smokers, patients with a family history of TC, undifferentiated cancer, multifocality, and stages III and IV (P<0.001). Each additional year of life was associated with a 21% increase in the risk of death (P<0.001). Smoking was associated with a 4.36-fold increase in the risk of death (P=0.05). For each additional year of life, the probability of recurrence increased by 3% (P=0.009). Men were 4.73 times more likely to recur (P<0.001) than women. To employ the proper therapeutic intervention and perform meticulous postoperative surveillance, it is crucial to consider the predictive influence of pertinent elements. Diagnosing TC in its early stages is essential for the healthcare system because of the increased incidence, younger age at diagnosis, and overall favorable prognosis of TC.

Unravelling Elements of Value of Healthcare and Assessing their Importance Using Evidence from Two Discrete-Choice Experiments in England.

Health systems are moving towards value-based care, implementing new care models that allegedly aim beyond patient outcomes. Therefore, a policy and academic debate is underway regarding the definition of value in healthcare, the inclusion of costs in value metrics, and the importance of each value element. This study aimed to define healthcare value elements and assess their relative importance (RI) to the public in England. Using data from 26 semi-structured interviews and a literature review, and applying decision-theory axioms, we selected a comprehensive and applicable set of value-based elements. Their RI was determined using two discrete choice experiments (DCEs) based on Bayesian D-efficient DCE designs, with one DCE incorporating healthcare costs expressed as income tax rise. Respondent preferences were analysed using mixed logit models. Six value elements were identified: additional life-years, health-related quality of life, patient experience, target population size, equity, and cost. The DCE surveys were completed by 402 participants. All utility coefficients had the expected signs and were statistically significant (p<0.05). Additional life-years (25.3%; 95% confidence interval [CI] 22.5-28.6%) and patient experience (25.2%; 95% CI 21.6-28.9%) received the highest RI, followed by target population size (22.4%; 95% CI 19.1-25.6%) and quality of life (17.6%; 95% CI 15.0-20.3%). Equity had the lowest RI (9.6%; 95% CI 6.4-12.1%), decreasing by 8.8 percentage points with cost inclusion. A similar reduction was observed in the RI of quality of life when cost was included. The public prioritizes value elements not captured by conventional metrics, such as quality-adjusted life-years. Although cost inclusion did not alter the preference ranking, its inclusion in the value metric warrants careful consideration.

Cost-effectiveness of seasonal influenza vaccination in WHO-defined high-risk populations in Bangladesh.

Bangladesh carries a substantial health and economic burden of seasonal influenza, particularly among the World Health Organization (WHO)-defined high-risk populations. We implemented a modelling study to determine the cost-effectiveness of influenza vaccination in each of five high-risk groups (pregnant women, children under five years of age, adults with underlying health conditions, older adults (≥60 years), and healthcare personnel) to inform policy decisions on risk group prioritisation for influenza vaccination in Bangladesh. We implemented a Markov decision-analytic model to estimate the impact of influenza vaccination for each target risk group. We obtained model inputs from hospital-based influenza surveillance data, unpublished surveys, and published literature (preferentially from studies in Bangladesh, followed by regional and global ones). We used quality-adjusted life years (QALY) as the health outcome of interest. We also estimated incremental cost-effectiveness ratios (ICERs) for each risk group by comparing the costs and QALY of vaccinating compared to not vaccinating each group, where the ICER represents the additional cost needed to achieve one year of additional QALY from a given intervention. We considered a willingness-to-pay threshold (ICER) of less than one gross domestic product (GDP) per capita as highly cost-effective and of one to three times GDP per capita as cost-effective (per WHO standard). For Bangladesh, this threshold ranges between USD 2462 and USD 7386. The estimated ICERs were USD -99, USD -87, USD -4, USD 792, and USD 229 per QALY gained for healthcare personnel, older adults (≥60), children aged less than five years, adults with comorbid conditions, and pregnant women, respectively. For all risk groups, ICERs were below the WHO willingness-to-pay threshold for Bangladesh. Vaccinating pregnant women and adults with comorbid conditions was highly cost-effective per additional life year gained, while vaccinating healthcare personnel, older adults (≥60), and children under five years were cost-saving per additional life year gained. Influenza vaccination to all target risk groups in Bangladesh would be either cost-saving or cost-effective, per WHO guidelines of GDP-based thresholds.

Prevalence and Correlates of Frailty Among Older Adults Living With HIV in the CHANGE HIV Cohort.

Advancements in treatment have resulted in improved survival among people living with HIV. However, additional years of life are not necessarily spent in good health, as frailty tends to develop at a younger age among people living with HIV. We set out to examine the prevalence of frailty and its correlates among older adults living with HIV in Canada, with a primary interest in nadir CD4 count. We performed a cross-sectional analysis of the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, a Canadian cohort of people living with HIV aged 65 years or older. Participants were assessed using the Fried Frailty Phenotype at cohort entry, and those meeting ≥3 criteria were characterized as frail. We used Poisson regression with robust standard errors to estimate the association between nadir CD4 count and frailty, as well as age, gender, time since HIV diagnosis, comorbidities, marital status, and loneliness. Among 439 participants included in this analysis (median age 69 years, interquartile ranges 67-73), prevalence of frailty was 16.6%. Frailty was not associated with nadir CD4 count. Not being in a relationship (aRR 2.09, 95% CI 1.01 to 4.30) and greater degree of loneliness (aRR 1.25 per 10 point increase on UCLA loneliness scale, 95% CI 1.09 to 1.44) were associated with frailty. Frailty occurred in 16.6% of older adults living with HIV in this cohort. While nadir CD4 count did not correlate with frailty, being single and lonely did, highlighting the importance of recognizing and addressing these social vulnerabilities among people aging with HIV.

Association of Life’s Simple 7 lifestyle metric with cardiometabolic disease-free life expectancy in older British men

BackgroundCardiometabolic diseases (CMD), including myocardial infarction, stroke, and type 2 diabetes, are leading causes of disability and mortality globally, particularly for people at an older age. The impact of adhering to the Life’s Simple 7 (LS7) on the number of years an individual will live without CMD in older adults remains less studied.MethodsThis study included a cohort of 2662 British men aged 60–79 years free of CMD at baseline from the British Regional Heart Study (BRHS). Each LS7 factor (BMI, blood pressure, blood glucose, total cholesterol, smoking, physical activity, and diet) was categorized as poor, intermediate, or ideal, and a composite LS7 adherence was determined by summing the number of LS7 ideal levels achieved. Flexible parametric Royston–Parmar proportional-hazards model was applied to estimate CMD-free life expectancy.ResultsHere we show that compared to men with the lowest LS7 adherence [with 18.42 years (95% CI: 16.93, 19.90) of CMD-free life at age 60], men having an ideal LS7 adherence are estimated to gain an additional 4.37 years (95% CI: 2.95, 5.79) of CMD-free life. The CMD-free life gain benefits are consistent across social class groups of manual and non-manual workers. Among LS7 factors, achieving an ideal physical activity provides the largest CMD-free survival benefit: 4.84 years (95% CI: 3.37, 6.32) of additional CMD-free life compared with the physically inactive group.ConclusionsOur study quantifies and highlights the benefits of adhering to the LS7 ideal levels for living a longer life without CMD in older adults.

Regional differences and trends in healthy life expectancy in Germany

Against the background of increasing life expectancy, the question arises in which state of health the additional years of life are spent. The aim of this study is to assess for the first time regional differences in healthy life expectancy for Germany. The concept of healthy life expectancy allows for the combination of regional differences in health status and mortality in asingle measure. This article uses the concept of partial healthy life expectancy. We use official data on deaths and population numbers to calculate abridged life tables. Data from the Socio-Economic Panel (SOEP) are used to determine the age- and sex-specific prevalences of health status. Regional differences are analyzed from 2002 to 2019 by dividing Germany into four regions (North, South, East, West). The regional differences in healthy life expectancy in Germany are greater than differences in life expectancy, and trends in healthy life expectancy partly differ from the corresponding trends in mortality. These differences over time also vary according to age: while healthy life expectancy has tended to stagnate and, in some cases, decline among the population aged between 20and 64, the number and proportion of years in good health has increased among older adults up to the age of79. There are striking regional differences and trends in the distribution of expected years in good health in Germany. The timely identification of regionally divergent developments could facilitate the implementation of targeted health-promoting measures.

One-time screening for abdominal aortic aneurysm in Ontario, Canada: a model-based cost-utility analysis.

Screening programs for abdominal aortic aneurysm (AAA) are not available in Canada. We sought to determine the effectiveness and costutility of AAA screening in Ontario. We compared one-time ultrasonography-based AAA screening for people aged 65 years to no screening using a fully probabilistic Markov model with a lifetime horizon. We estimated life-years, quality-adjusted life-years (QALYs), AAA-related deaths, number needed to screen to prevent 1 AAA-related death and costs (in Canadian dollars) from the perspective of the Ontario Ministry of Health. We retrieved model inputs from literature, Statistics Canada, and the Ontario Case Costing Initiative. Screening reduced AAA-related deaths by 84.9% among males and 81.0% among females. Compared with no screening, screening resulted in 0.04 (18.96 v. 18.92) additional life-years and 0.04 (14.95 v. 14.91) additional QALYs at an incremental cost of $80 per person among males. Among females, screening resulted in 0.02 (21.25 v. 21.23) additional life-years and 0.01 (16.20 v. 16.19) additional QALYs at an incremental cost of $11 per person. At a willingness-to-pay of $50 000 per year, screening was cost-effective in 84% (males) and 90% (females) of model iterations. Screening was increasingly cost-effective with higher AAA prevalence. Screening for AAA among people aged 65 years in Ontario was associated with fewer AAA-related deaths and favourable cost-effectiveness. To maximize QALY gains per dollar spent and AAA-related deaths prevented, AAA screening programs should be designed to ensure that populations with high prevalence of AAA participate.

Estimating the clinical and budgetary impact of using angiotensin receptor neprilysin inhibitor as first line therapy in patients with HFrEF.

Recent updates of international treatment guidelines for heart failure with reduced ejection fraction (HFrEF) differ regarding the use of angiotensin receptor neprilysin inhibitor (ARNI) as first-line treatment. The American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) 2022 guidelines gives ARNI a Class IA recommendation for HFrEF patients while the European Society of Cardiology's guidelines are less clear when ARNI could be considered as first line treatment option in de novo patients. This study aimed to model the clinical and budgetary outcomes of implementing these guidelines, comparing conservative ARNI prescription patterns with less conservative in Sweden and in the United Kingdom. A health economic model was developed to compare different treatment patterns for HFrEF. Incident cohorts were included on an annual basis and followed over 10years. The model included treatment specific all-cause mortality and hospitalization rates, as well as drug acquisition, monitoring, and hospitalization costs. Increasing the use of ARNI could lead to about 7000-12300 life years gained and 2600-4600 hospitalizations prevented in Sweden. These health benefits come with an additional cost of 112-195 million euros. Similar results were estimated for the United Kingdom, albeit on a larger population. Increasing the proportion of patients receiving ARNI instead of angiotensin converting enzyme inhibitors as first-line treatment of HFrEF will lead to a considerable number of additional life years gained and prevented hospitalizations but with additional cost in terms of health care expenditure in Sweden and in the United Kingdom.

Data and Trends in Assisted Suicide and Euthanasia, and Some Related Demographic Issues

AbstractAlthough considerable gains in survival have been observed in developed countries, particularly in the last stretch of life, part of these additional years of life are lived in bad health. In this context, a number of actions/inactions that limit or may limit life span are becoming increasingly common. Demography and quantitative sociology are well‐positioned to make a significant contribution to the measurement of the consistency of different end‐of‐life interventions, to the examination of differences over time, space and among different social groups, and to the analysis of the behaviors and attitudes of different stakeholders (the sufferers, their relatives, health care personnel, public opinion). We focus here on euthanasia and assisted suicide (EAS). First, we discuss changes in public opinion on EAS in developed countries. Second, we analyze the diffusion and temporal trends of EAS, with a particular focus on Switzerland, the Netherlands, and Belgium; three countries for which it is also possible to consider the connections between the diffusion of EAS and palliative care. Third, we consider several differential aspects of the spread of EAS (mainly by sex, age, and cause of death).

Live longer, work longer? An investigation of the health capacity to work at older ages in Denmark using combined register and survey data

Publicly funded pension systems are facing the challenge of remaining financially sustainable without lowering pensions. Raising the statutory retirement age gradually in line with the increase in life expectancy has been a key measure to solve the problem. The implicit assumption is that the additional years of life are lived in good health, or as a minimum that health status is compatible with work. However, some individuals may not have the ability to work. Furthermore, a uniform retirement age ignores the different exposures to morbidity and mortality risks across social groups. Consequently, it is important to examine whether the health of older individuals will allow them to continue working and whether there is significant heterogeneity in the ability to work. Combining the Survey of Health, Ageing and Retirement in Europe (SHARE) with data from the Danish registers enables us to create a composite health index that includes an extensive range of health indicators. Utilising the health capacity to work approach, we estimate the health capacity to work among Danes aged 55 and above. We divide health capacity into physical and mental health. We investigate heterogeneity in health capacity across educational and occupational attainment. Substantial additional work capacity is found for older Danes. Depending on the type of health index applied, the health capacrk varies. There is evidence of a socio-economic gradient in work capacity. Results thereby show that policies that intend to utilise the additional work capacity should consider heterogeneity in health.HighlightsWe provide new evidence of the health capacity work in Denmark.The combination of survey and register data allow for comprehensive health indices.There is substantial additional health capacity to work.There is variation across health indices.There is variation across educational and occupational attainment.

The impact of modifiable risk factor reduction on future dementia burden: a microsimulation modeling study

AbstractBackgroundForty percent of dementia cases could potentially be prevented through modifiable risk factors. However, the effect of risk factor reductions might be partially offset by individuals living longer and developing dementia later. Using a microsimulation model, we determined the effect of reductions in smoking and hypertension prevalence on the future dementia burden.MethodThe microsimulation model ‘MISCAN‐Dementia’ was used to simulate life histories and dementia development of 10 million individuals. We modelled mid‐life (40‐59 years) hypertension and late‐life (65+ years) smoking as risk factors (Figure 1), simulating four risk groups: (1) neither risk factor, (2) smoking only, (3) hypertension only, and (4) both risk factors. Sex‐specific population data were used to determine risk factor prevalence. Based on prior literature, smoking and hypertension were each set to a 1.6‐fold increase in dementia risk, and a loss of life expectancy of 4 and 2 years, respectively. Reductions in risk factor prevalence of 100% (i.e. elimination), 50%, 25% and 10% were modeled and evaluated in terms of life years (LYs) without dementia gained, LYs with dementia averted and incident dementia cases averted.ResultCompared to no reduction, for the lifetime of 1000 individuals, elimination of hypertension results in 360 LYs without dementia gained, 40 LYs with dementia averted and 4 incident cases averted. Although smoking elimination results in 600 LYs without dementia gained, it also causes 75 more dementia LYs and 10 more incident cases. These additional LYs with dementia occur primarily at older ages, due to relatively high life expectancy gains compared to moderate reductions in dementia risk (Figure 2). Reductions of 50%, 25% and 10% result in similar findings at lower magnitudes.ConclusionReductions in prevalence of hypertension and smoking result in a gain in life years free of dementia. However, for smoking this coincides with a (smaller) increase in life years with dementia at older ages. These findings suggest that treatment or prevention of dementia risk factors will generally result in a larger number of cognitively healthy life years, but potentially at the cost of minor increases in years with dementia for risk factors with large effects on survival.

OP60 Community Funding Prioritization Of Drug Treatments: A Discrete Choice Experiment

IntroductionAllocating government resources for drug treatments continues to be a challenge in health care, particularly given the increasing number of high-cost personalized drug treatments, finite resources, and aging population. Since taxpayers fund government health budgets, it is important to understand how they think funding should be distributed, considering attributes such as cost of drug treatments, risk of dying, commonality of medical conditions, and quality of life changes with drug treatments. The aim of this study was to understand what attributes of a medical condition and treatment determine a community’s willingness to fund new drug treatments. Two decision-making contexts were explored: the allocation of funds from a health budget and a willingness-to-pay (WTP) perspective.MethodsA representative sample of 500 Australian adults completed an online survey. The survey comprised two discrete choice experiments (DCEs) with different framing: an allocation of government funds and a WTP for drug treatments. The government allocation DCE allowed a choice between two hypothetical alternatives, each describing the medical condition and the drug treatment, while the WTP for funding showed one hypothetical alternative with an option to not fund the drug treatment. Seven DCE attributes, informed by a literature review, were displayed in each choice set relating to the medical condition (risk of dying, prevalence, and ages affected) and to the drug treatment (change in quality of life, additional life-years, availability of other drug treatments, and cost to the government and the taxpayer).ResultsThe resulting DCE model will establish the funding prioritization choices made by the general community. We expect changes in quality of life and risk of dying to be very important attributes. Of key interest for this study is how the difference in the decision-making context impacts preferences. We expect taxpayers to employ a stricter rule set in funding decisions when paying out of pocket (WTP exercise).ConclusionsThe findings from this research have implications for decision makers when aligning funding decisions with community preferences and values.

Cost-Effectiveness of Pharmacist Prescribing for Managing Hypertension in the United States

Pharmacist-led interventions can significantly improve blood pressure (BP) control. The long-term cost-effectiveness of pharmacist-prescribing interventions implemented on a large scale in the US remains unclear. To estimate the cost-effectiveness of implementing a pharmacist-prescribing intervention to improve BP control in the US. This economic evaluation included a 5-state Markov model based on the pharmacist-prescribing intervention used in The Alberta Clinical Trial in Optimizing Hypertension (or RxACTION) (2009 to 2013). In the trial, control group patients received an active intervention, including a BP wallet card, education, and usual care. Data were analyzed from January to June 2023. Cardiovascular (CV) events, end-stage kidney disease events, life years, quality-adjusted life years (QALYs), lifetime costs, and lifetime incremental cost-effectiveness ratio (ICER). CV risk was calculated using Framingham risk equations. Costs were based on the reimbursement rate for level 1 encounters, medication costs from published literature, and event costs from national surveys and pricing data sets. Quality of life was determined using a published catalog of EQ-5D utility values. One-way sensitivity analyses were used to assess alternative reimbursement values, a reduced time horizon of 5 years, alternative assumptions for BP reduction, and the assumption of no benefit to the intervention after 10 years. The model was expanded to the US population to estimate population-level cost and health impacts. Assumed demographics were mean (SD) age, 64 (12.5) years, 121 (49%) male, and a mean (SD) baseline BP of 150/84 (13.9/11.5) mm Hg. Over a 30-year time horizon, the pharmacist-prescribing intervention yielded 2100 fewer cases of CV disease and 8 fewer cases of kidney disease per 10 000 patients. The intervention was also associated with 0.34 (2.5th-97.5th percentiles, 0.23-0.45) additional life years and 0.62 (2.5th-97.5th percentiles, 0.53-0.73) additional QALYs. The cost savings were $10 162 (2.5th-97.5th percentiles, $6636-$13 581) per person due to fewer CV events with the pharmacist-prescribing intervention, even after the cost of the visits and medication adjustments. The intervention continued to produce benefits in more conservative analyses despite increased costs as the ICER ranged from $2093 to $24 076. At the population level, a 50% intervention uptake was associated with a $1.137 trillion in cost savings and would save an estimated 30.2 million life years over 30 years. These findings suggest that a pharmacist-prescribing intervention to improve BP control may provide high economic value. The necessary tools and resources are readily available to implement pharmacist-prescribing interventions across the US; however, reimbursement limitations remain a barrier.

A clinical and economic analysis of the use of dapagliflozin in patients with chronic heart failure in the entire spectrum of left ventricular ejection fraction in the Russian Federation

To estimate the cost-effectiveness of dapagliflozin across the range of ejection fraction in patients with heart failure (HF) in Russian Federation. Cost-effectiveness model was developed for estimate the use of dapagliflozin as part of standard therapy in patients with HF regardless of ejection fraction is unknown. The calculation of costs was carried out in a mathematical model adapted to the conditions of Russian healthcare system by using Russian costs inputs and patient population characteristics. In the model, dapagliflozin therapy yielded a mean of 0.209 additional life-years compared with standard of care in 10 years horizon. The incremental cost of 1 additional life-year was 665,715 RUB, which does not exceed the threshold of willingness to pay 2,235,202 RUB. Thus, the intensification of chronic HF therapy with dapagliflozin is cost effective. The use of dapagliflozin in a cohort of 1000 target patients over 10 years will avoid 146 hospitalizations and 39 emergency visits due to HF, as well as prevent 32 deaths from cardiovascular diseases.

Cost-effectiveness of use of 20-valent pneumococcal conjugate vaccine among adults in Germany

ABSTRACTObjectivesDespite national recommendations for use of pneumococcal vaccines, rates of community-acquired pneumonia (CAP) and invasive pneumococcal disease (IPD) remain high in Germany. New pneumococcal conjugate vaccines (PCVs) with expanded coverage have the potential to reduce the pneumococcal disease burden among adults.MethodsUsing a Markov model, we evaluated the lifetime outcomes/costs comparing 20-valent PCV (PCV20) with standard of care (SC) vaccinations for prevention of CAP and IPD among adults aged ≥60 years and at-risk adults aged 18–59 years in Germany. PCV20 also was compared with sequential vaccination with 15-valent PCV (PCV15) followed by PPSV23 in a scenario analysis.ResultsOver the course of a lifetime (82 years), use of PCV20vs. SC would prevent 54,333 hospitalizations, 26368 outpatient CAP cases, 10946 disease-related deaths yield 74,694 additional life-years (LYs), while lowering total medical costs by 363.2 M €. PCV20 remained cost saving (i.e. dominant) versus SC even in numerous sensitivity analyses, including a sensitivity analysis assuming moderate effectiveness of the SC pneumococcal polysaccharide vaccine against noninvasive pneumococcal CAP. In several scenario analyses and a probabilistic sensitivity analysis, PCV20 was also cost-saving compared toPCV15 PPSV23 vaccination.ConclusionsOne dose of PCV20 among adults aged ≥60 years and adults aged 18–59 years with moderate- and high-risk conditions wouldsubstantially reduce pneumococcal disease, save lives, and be cost saving compared with SC.