Good Value For Money Research Articles

Modelling the cost-effectiveness of essential and advanced critical care for COVID-19 patients in Kenya

BackgroundCase management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care (ACC) needed for the...

The cost-effectiveness of B-type natriuretic peptide-guided care in compared to standard clinical assessment in outpatients with heart failure in Tehran, Iran

BackgroundB-type natriuretic peptide (BNP) is commonly used as a diagnostic method for patients with heart failure. This study was designed to evaluate the cost-effectiveness of BNP compared to standard clinical assessment in outpatients with heart failure with reduced ejection fraction (HFrEF) in Tehran, Iran.MethodsThis study was a cost-effectiveness analysis carried on 400 HFrEF outpatients > 45 years who were admitted to Rasoul Akram General Hospital of Tehran, Iran. A Markov model with a lifetime horizon was developed to evaluate economic and clinical outcomes for BNP and standard clinical assessment. Quality-adjusted life-years (QALYs), direct, and indirect costs collected from the patients.ResultsThe results of this study indicated that mean QALYs and cost were estimated to be 2.18 QALYs and $1835 for BNP and 2.07 and $2376 for standard clinical assessment, respectively. In terms of reducing costs and increasing QALYs, BNP was dominant compared to standard clinical assessment. Also, BNP had an 85% probability of being cost-effective versus standard clinical assessment if the willingness to pay threshold is higher than $20,800/QALY gained.ConclusionBased on the results of the present study, measuring BNP levels represents good value for money, decreasing costs and increasing QALYs compared to standard clinical assessment. It is suggested that the costs of the BNP test be covered by insurance in Iran. The result of the current study has important implications for policymakers in developing clinical guidelines for the diagnosis of heart failure.

Protective peritoneal patch for arteries during pancreatoduodenectomy: good value for money.

This study proposes and details a simple and inexpensive protective technique of wrapping the hepatic and gastroduodenal artery stumps with a peritoneal patch during pancreatoduodenectomy (PD) in order to decrease post-pancreatectomy hemorrhage (PPH). Among the 85 patients who underwent PD between July 2020 and March 2021, 16 patients with high-risk pancreatic anastomosis received a peritoneal patch. The Updated Alternative Fistula Risk Score (ua-FRS) was calculated. Post-operative pancreatic fistula (POPF) and PPH were diagnosed and graded according to the International Study Group of Pancreatic Surgery. The mortality rate was calculated up to 90days after PD. The mean ua-FRS of the 16 patients was 43% (range: 21-63%). Among them, 6 (38%) experienced clinically relevant-POPF, and a PPH was observed in two patients (13%). In these two patients who required re-intervention, the peritoneal patch was remarkably intact, and neither the gastroduodenal stump nor hepatic artery was involved. None of the patients experienced 90-day mortality. Although the outcomes are encouraging, the evaluation of a larger series to assess the effectiveness of the peritoneal protective patch for arteries in a high-risk pancreatic anastomosis is ongoing.

Real-world cost-effectiveness of anti-VEGF monotherapy and combination therapy for the treatment of polypoidal choroidal vasculopathy.

For patients with polypoidal choroidal vasculopathy (PCV), intravitreal anti-vascular endothelial growth factor (anti-VEGF) combination therapy has been shown to be cost-saving relative to monotherapy in a clinical trial setting. However, whether this also applies to real-world settings is unclear. We aim to compare the real-world functional outcomes and cost-effectiveness of intravitreal anti-VEGF combination therapy relative to monotherapy, to investigate whether combination therapy is truly cost-saving. We used a Markov model to simulate a hypothetical cohort of PCV patients treated at Singapore National Eye Centre. Model parameters were informed by coarsened exact matched estimates of a two-year retrospective study of patients who initiated treatment in 2015. Treatment options included intravitreal aflibercept, bevacizumab, or ranibizumab, as monotherapy or in combination with full-fluence verteporfin photodynamic therapy. The two-year logMAR letters gains were significant for combination therapy ( + 10.6, P = 0.006) but not monotherapy (-2.2, P = 0.459). Over 20 years, a PCV patient would cost the health system SGD 48,790 under monotherapy and SGD 61,020 under combination therapy. Quality-adjusted life-years (QALYs) were estimated to be 7.41 for monotherapy and 7.80 for combination therapy. The incremental cost-effectiveness ratio of combination therapy was SGD 31,460/QALY, which is less than the common willingness-to-pay threshold of per capita gross domestic product of Singapore (SGD 88,990/QALY). Sensitivity analysis showed that combination therapy remained incrementally cost-effective, but not cost-saving. Our study shows that combination therapy is good value for money but is likely to increase costs when applied in real-world settings.

A Mixed-Methods Realist Evaluation of the Implementation and Impact of Community Forensic CAMHS to Manage Risk for Young People With Forensic and Mental Health Needs: Study Protocol.

Introduction: Young people in contact with forensic child and adolescent mental health services present with more complex needs than young people in the general population. Recent policy has led to the implementation of new workstreams and programmes to improve service provision for this cohort. This paper aims to present the protocol for a national study examining the impact and implementation of Community Forensic Child and Adolescent Mental Health Services (F:CAMHS).Methods and analysis: The study will use a mixed-methods Realist Evaluation design. Quantitative service activity and feedback data will be collected from all 13 sites, as well as questionnaires from staff. Non-participant observations and qualitative interviews will be conducted with staff, young people and parents/guardians from four focus study sites. An economic evaluation will examine whether Community F:CAMHS provides good value for money. The results will be triangulated to gain an in-depth understanding of young people's, parents/guardians' and staff experiences of the service.Ethics and dissemination: Ethical approval was granted by the Health Research Association and UCL Ethics. The results will be disseminated via project reports, feedback to sites, peer-reviewed journal publications and conference presentations.

Dapagliflozin good value for money for diabetic patients with reduced LVEF in the USA

Dapagliflozin good value for money for diabetic patients with reduced LVEF in the USA

Explaining consumer motives to purchase in the informal economy.

Usually, studies on the informal economy focus mainly upon those working in the informal economy (supply side). However, many exchanges in the informal economy are initiated by purchasers asking how much a good or service costs if paid cash in hand. Therefore, the aim of this paper is to advance understanding of who make purchases in the informal economy and the reasons of the consumers making these purchases (demand side). Two potential explanations are evaluated. Firstly, consumers are explained as rational economic actors seeking a more convenient deal or profit maximisation (i.e., lower price or better value for money), making purchases from the informal economy due to the lack of availability of the product or service they need on the formal market, or they make such purchases involuntarily, due to the lack of perfect information necessary to make a fully rational economic decision when purchasing. Secondly, the consumers are portrayed as social actors pursuing community help. Using a multilevel mixed-effects logistic regression analysis on a 2019 Eurobarometer interviews in 27 EU member states and the UK reveal how the prevalence of these motives significantly varies across populations and regions. The theoretical and policy implications of the findings are discussed in the concluding section.

Retrofit effectiveness: Evidence from a nationwide residential energy efficiency programme

Buildings in the EU are responsible for 40% of energy use, with approximately 75% of buildings classed as energy inefficient. Many energy efficiency technologies have failed to deliver on the promised savings. This paper measures the extent to which residential dwelling retrofit delivers real energy savings in Ireland using a unique dataset of whole-home energy use (n = 8,572 households) over a two-year period. It is one of the largest studies of retrofit using whole-home energy data for a general housing sample, who do not disproportionately experience fuel poverty. It uses whole-home energy data to capture potential fuel switching induced by retrofit. Finally, this study addresses concerns regarding self-selection issues associated with the decision to undergo a retrofit by comparing with a second control group of homes that received a retrofit prior to the observation period.Results following a generalised difference-in-difference methodology indicate that retrofits reduce energy use by 1,091 kWh/year, on average. However, the magnitude of savings depends on the measures installed. Further analysis suggests that retrofits represent better value for money when factoring in actual changes in energy use. This study highlights possible unintended consequences of retrofit policies that may hinder progress towards national energy efficiency targets.

Implementing opt-out hepatitis C virus (HCV) screening in Canadian provincial prisons: A model-based cost-effectiveness analysis.

Implementing opt-out hepatitis C virus (HCV) screening across Canadian provincial prisons is crucial to achieving micro-elimination. Given short incarceration lengths, the most cost-effective screening strategy remains unknown. We compared the cost-effectiveness of current standard of care (venipuncture-based HCV-antibody+HCV RNA) and 13 alternative strategies in Quebec's largest provincial prison. A prison cohort was simulated with a Markov micro-simulation model. Strategies differed in the biomarkers, sampling methods, and number of tests used. The model considered incarceration lengths, time to linkage to care (LTC), nursing costs, and tests' costs, performances, acceptability and turnaround times. Outcomes included costs (Canadian dollars, CAD$), number of true positives linked to care, and incremental cost-effectiveness ratios (ICERs, additional $/additional TP-L). A one-year time horizon and health-payer perspective were adopted. Across all analyses, three strategies consistently provided the best value for money: venipuncture-based HCV-antibody+HCV-core antigen, venipuncture-based HCV-core antigen (base-case ICER=~ $720), and point-of-care HCV-antibody+HCV RNA (base-case ICER=$4,310). However, these strategies linked only 23%-29% viremic individuals to care. Main drivers of cost-effectiveness were the seroprevalence, proportion viremic, and time to LTC. Alternative strategies would be more cost-effective than standard of care for implementing opt-out screening in provincial prisons. However, interventions to maximize LTC should be explored.

Cost-Effectiveness of the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Versus Lower-Valent Alternatives in Filipino Infants

IntroductionThe Philippines pediatric national immunization program (NIP) included the 13-valent pneumococcal conjugate vaccine manufactured by Pfizer (PCV13-PFE) since 2015. Uptake has been slow in particular regions, with coverage only reaching all regions in 2019. Given affordability challenges in the context of higher coverage, this study seeks to determine whether universal coverage across all regions of the Philippines with PCV13-PFE will provide good value for money compared with 10-valent PCV alternatives manufactured by GlaxoSmithKline (PCV10-GSK) or Serum Institute of India (PCV10-SII).MethodsA decision analytic model is adapted for this cost-effectiveness analysis in the Philippines. Clinical and economic input parameters are taken from published sources. Future disease is predicted using age-stratified and population-level observed serotype dynamics. Total cases of pneumococcal disease, deaths, direct and indirect healthcare costs, and quality-adjusted life years (QALYs) gained are discounted 7% annually and modeled for each PCV. Given clinical uncertainty, PCV10-SII outcomes are reported as ranges. Incremental cost-effectiveness ratios (ICERs) are calculated for PCV13-PFE versus lower-valent PCVs (PCV10-GSK or PCV10-SII) from a societal perspective over 10 years.ResultsNationwide PCV13-PFE use over 10 years is estimated to avert 375,831 more cases, save 53,189 additional lives, and gain 153,349 QALYs compared with PCV10-GSK. This equates to cost-savings of PHP 12.27 billion after vaccine costs are accounted for. Similarly, PCV13-PFE is more effective and cost-saving compared with PCV10-SII. Switching programs to PCV10-SII would result in more cases of disease (313,797 – 666,889), more deaths (22,759 – 72,435), and lost QALYs (108,061 – 266,108), equating to a net economic loss (PHP 359.82 million – 14.41 billion). PCV13-PFE remains cost-effective in the presence of parameter uncertainty.ConclusionPCV13-PFE would prevent exceedingly more cases and deaths compared with lower-valent PCVs. Additionally, the PCV13-PFE program is estimated to continue providing cost-savings, offering the best value for money to achieve universal PCV coverage in the Philippines.

In search of an appropriate mix of taxes and subsidies on nutrients and food: A modelling study of the effectiveness on health-related consumption and mortality

Taxes and subsidies on foods and nutrients have the potential to promote healthier diets and thereby reduce mortality. In this study, we examine the effects of such policy instruments on Swedish public health. Specifically, we estimate the effects of food and nutrient taxes and subsidies on mortality averted and postponed in Sweden, using both demand system estimations and simulation models. We evaluate different Value Added Tax (VAT) reforms. The VAT is raised on food products that are particularly rich in saturated fat or salt and lowered on fruit and vegetables. Our models predict that an increase in the current VAT of 12% on food, to 25% VAT on products rich in saturated fat plus a 0% VAT on fruits and vegetables would result in almost 1100 deaths (95% CI: −832; −1363) averted or postponed in a year in Sweden, while the combination of a 34.4% VAT on products rich in saturated fat and a −10.4% VAT (i.e. a subsidy) on fruits and vegetables would result in almost 2100 (95% CI: −1572; −2311) deaths averted or postponed corresponding to a 4.8% reduction in diet-related annual death. Most of the deaths averted or delayed from this reform would be deaths from coronary heart disease (−1,148, 95% CI: −728; −1586), followed by stroke −641 (95% CI: −408; −887) and diet-related cancer deaths (−288, 95% CI: −11; −435). We find that health-related food taxes and subsidies improve dietary habits as well as reduce the mortality of the Swedish population. However, the effect of these reforms on different socioeconomic classes and which reforms provide the best value for money, i.e., cost-effectiveness of these reforms needs to be established first before implementation.

Socioeconomic, Macroeconomic, and Sociopolitical Issues in Water PPP Failures

AbstractPublic–private partnerships (PPPs) have been used worldwide in infrastructure services to achieve better value for money. However, PPPs in the water sector have witnessed many failures in b...

Comparative assessment of the physicochemical properties of antacid suspensions available in the Ho Municipality of the Volta Region of Ghana

Antacids are over-the-counter medications that neutralize stomach acid and inhibit pepsin activity. They are used to relieve symptoms associated with some upper gastrointestinal disorders. Several antacids are available in Ghana; therefore, comparative data on dose volume, efficacy, and cost are needed. This study investigated the properties of antacid suspensions sold in Ghana. Fourteen antacid suspensions (A−N) were randomly selected from community pharmacies in the Ho Municipality of Ghana and visually inspected. Density, pH, flow time, viscosity, sedimentation rate over 12 days, and acid-neutralizing capacity (ANC) were determined. The minimum adult dose range for the products was 5−15 mL. The samples were produced in Italy (7.1%), the United Kingdom (14.3%), India (28.6%), and Ghana (50.0%). Five samples (36%) lacked dosing devices. The pH, relative density, flow time, viscosity, and sedimentation volume and rate ranges were 7.77 ± 0.03−10.78 ± 0.00, 1.05−1.21, 6.09 ± 0.15−131.00 ± 6.04 seconds, 36.33 ± 1.15−971.67 ± 0.58 cPs, 0.40−1, and 0.00−1.10 mL/day, respectively. Sediments were formed in magnesium trisilicate mixtures. No sediment was formed in four products (29%). ANCs ranged from 12.42 ± 0.33 mEq (product E) to 38.82 ± 2.46 mEq (product J). H and J contained the same active ingredients; however, H had an ANC of 38.25 ± 0.67 mEq at a lower volume and cost per dose, and contained more doses. Product E (imported) was the most expensive antacid (GH¢ 42.00/150 mL), whereas samples K, L, M, and N (locally manufactured) were the least expensive (GH¢ 3.00/200 mL). All ANCs were greater than the minimum recommended value. Product F had the best value for money. There was no link between ANC and product cost or origin. Expensive products were not necessarily better in the tests performed. Therefore, there is no justification for selecting expensive/imported liquid antacids over locally produced/cheaper ones.

The Evolution of AIFA Registries to Support Managed Entry Agreements for Orphan Medicinal Products in Italy.

Italy has a well-established prominent system of national registries to support managed entry agreements (MEAs), monitoring innovative medicinal products (MPs) with clinical as well as economic uncertainties to ensure appropriate use and best value for money. The technological architecture of the registries is funded by pharmaceutical companies, but fully governed by the national medicines agency (AIFA). A desktop analysis was undertaken of data over a 15-year timeframe of all AIFA indication-based registries and associated EMA information. The characteristics of registries were evaluated, comparing orphan MPs vs. all MPs exploring cancer and non-cancer indications. OMP (orphan medicinal product) registries’ type vs. AIFA innovation status and EMA approval was reviewed. Of the 283 registries, 182 are appropriateness registries (35.2% relate to OMPs, with an almost equal split of cancer vs. non-cancer for OMPs and MPs), 35 include financial-based agreements [20% OMPs (2 non-cancer, 5 cancer)], and 60 registries are payment by result agreements [23.3% OMPs (4 non-cancer, 10 cancer)]. Most OMPs (53/88) came through the normal regulatory route. With the strengthening of the system for evaluation of innovation, fewer outcomes-based registries have been instigated. AIFA has overcome many of the challenges experienced with MEA through developing an integrated national web-based data collection system: the challenge that remains for AIFA is to move from using the system for individual patient decisions about treatment to reviewing the wealth of data it now holds to optimize healthcare.

Vaccination against four preventable diseases in older adults good value for money in the US

Vaccination against four preventable diseases in older adults good value for money in the US

Does public long‐term care expenditure improve care‐related quality of life of service users in England?

Public long-term care (LTC) systems provide services to support people experiencing difficulties with their activities of daily living. This study investigates the marginal effect of changes in public LTC expenditure on care-related quality of life (CRQoL) of existing service users in England. The public LTC program for people aged 18 or older in England is called Adult Social Care (ASC) and it is provided and managed by local authorities. We collect data on the outcomes and characteristics of public ASC users, on public ASC expenditure, and on the characteristics of local authorities across England in 2017/18. We employ an instrumental variable approach using conditionally exogenous elements of the public funding system to estimate the effect of public ASC expenditure on user CRQoL. Our findings show that by increasing public ASC expenditure by £1000 per user, on average, local authorities increase user CRQoL by 0.0030. These results suggest that public ASC is effective in increasing users' quality of life but only to a relatively small extent. When combined with the other potential effects of LTC expenditure (e.g., on informal carers, mortality), this study can inform policy makers in the United Kingdom and internationally about whether social care provides good value for money.

Електронна система публічних закупівель в Україні: особливості функціонування та перспективи розвитку

Introduction. Information support of electronic procurement procedures occupies an important place in the system of contractual relations, ensuring competition at the stage of placing documentation, signing the contract, monitoring its implementation. On the one hand, a single information system is an integral part of the information space, based on the general principles of an open information society and legislation. On the other hand, the information component in the electronic platform management system is one of the blocks of analysis and obtaining optimal solutions, creating conditions for effective interaction of all participants in procurement. Purpose. The purpose of the study is to highlight the features of the electronic system of public procurement of Ukraine and outline the main organizational and technical areas of its improvement in the context of the studied experience of the functionality of the web portal of public procurement of the Republic of Kazakhstan. Results. As a result of the research it has been established that the only web portal of public procurement of the Republic of Kazakhstan is wider than the electronic procurement system of Ukraine in terms of information saturation and functionality. As a result of studying the experience of foreign countries, it has been found that the share of functions of the electronic procurement system is identical and aimed at achieving the main goal of public procurement - to meet the needs of the country with quality products, works and services. It has been determined that it is expedient for Ukraine to form official registers of unscrupulous suppliers, contracts, complaints. The reasons for the termination of electronic platforms and uniform requirements for them have been grouped. The main directions of improving the functioning of electronic platforms have been identified. The latter is directly related to the state of comprehensive control over the implementation of public procurement at all stages. The proposed areas of improvement will contribute to some optimization of the research issue. Conclusions. Further optimization of the e-procurement system should help to improve the conditions for competition by increasing the level of legality, openness and impartiality of the contracting process; ensuring better value for money; reduction of corruption cases; improving the management system; conducting marketing research on the demand and supply of goods or services in the market for clear and effective procurement planning and creating a competitive environment in the market; improving the professionalism of personnel involved in public procurement.

Critical success factors for development of public-private-partnership airports in India

Examining the interrelationships between critical success factors (CSFs) is of importance for the successful development of PPP airports. Many studies are available for the identification of CSFs for infrastructure projects, but very limited research have been conducted so far on investigating the interrelationships between the CSFs of PPP airports. The study is based on the institutional theory, which considers the exploration of the relationships between different institutional factors. The results show that Process Characteristics have comparatively more impact on Public Characteristics and, similarly, Cooperative Environment has more impact on Process Characteristics. However, Process Characteristics have a less significant impact on Private Characteristics. The study also revealed that to achieve high-quality services and the protection of public interest under a PPP mechanism, proper government supervision is required. Moreover, customers’ satisfaction and their opinion are also responsible for the achievement of high-quality services and better value for money.

Cost-Utility Analysis of Dapagliflozin as an Add-On to Standard Treatment for Patients with Type2 Diabetes and High Risk of Cardiovascular Disease in Thailand.

IntroductionDiabetes treatment has incurred financial burden. We examined the cost–utility of adding dapagliflozin to the standard treatment for treating type 2 diabetes (T2DM) with cardiovascular risk in a Thai context.MethodsA two-part model, decision tree and Markov models, was developed to capture the benefits in terms of heart failure (HF) and chronic kidney disease. The model was used to estimate the lifetime costs and outcomes from a societal perspective. Costs were based on local data while the transitional probabilities and utilities were derived from the DECLARE-TIMI 58 clinical trial and published studies. Future costs and outcomes were discounted at an annual rate of 3%. The results were reported as incremental cost-effectiveness ratios (ICER). One-way and probabilistic sensitivity analyses were performed to investigate parameter uncertainty.ResultsThe increased cost of adding dapagliflozin from 8707 USD to 14,455 USD was associated with an increase in quality-adjusted life years (QALYs) from 9.28 to 9.58, yielding an ICER of 18,988 USD/QALY. Compared with the standard treatment, the dapagliflozin group acquired more clinical benefits in terms of fewer HF hospitalizations and macroalbuminuria. Sensitivity analyses revealed that with high prevalence of diabetic nephropathy of 29.4–43.9%, the ICER would decline to 5591–8014 USD/QALY.ConclusionOn the basis of the DECLARE study with low incidence of T2DM complications and 4.2 years of median follow-up duration, the add-on dapagliflozin results in an ICER of 18,988 USD/QALY, which exceeds the local threshold of 5310 USD/QALY. Dapagliflozin would show better value for money in the context of high prevalence of T2DM complications.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01088-w.

PNS63 A Longitudinal Study to Identify Potentially Low-Value Clinical Procedures Using Hospital Episode Statistics Linked to Deprivation and Ethnicity in England, 2014/15-2018/19

It is important that surgery is effective and good value for money. Different methods have been used to identify ‘low value’ surgical procedures for which use should be reduced or stopped; for example, reviewing current evidence/guidelines, or stakeholder consultation. We investigated whether high geographical or temporal variation in surgery rates in England might indicate uncertainty about their effectiveness or cost-effectiveness, potentially identifying them as ‘low value’. Longitudinal observational study of surgical procedures in England using Hospital Episode Statistics, 2014/15-2018/19, adjusted for age, sex, deprivation, and ethnicity using indirect standardisation. Procedures were defined by 3-character OPCS-4 codes. We highlighted surgeries in the top 5% for growth in surgery rates (2014/15-2018/19) and/or systematic component of variation (2018/19) and conducted a literature review of the evidence supporting these procedures. High temporal or geographical variation was associated with uncertainty in the evidence base: In five cases, it was unclear whether surgery was more cost-effective than non-surgical interventions (e.g. radiofrequency denervation of the facet joint); for another five procedures there was evidence that surgery is effective, but the most cost-effective method was unclear (e.g. bariatric surgery for obesity). Deep brain stimulation was recommended by NICE in particular circumstances, and there was little evidence about pressure manometry. Some observed variation was due to coding anomalies, highlighting the limitations of the OPCS system for research. Most procedures had not been previously identified as potentially ‘low value’ by other methods. Exploring temporal and geographical variation is a potential method of identifying clinical uncertainty about surgery. This type of analysis could be carried out on a regular basis to quickly identify increasing use of uncertain procedures. Early recognition could facilitate better regulation (e.g. only in trials) to generate evidence on cost-effectiveness before potentially ‘low value’ procedures become established in clinical practice.