Budget Impact Research Articles (Page 1)

Anemia is a serious heath concern due to its high prevalence in the global population. Its occurrence in surgical patients varies greatly and correlates with worse outcomes. Higher costs and severe complications could also result from insufficient iron status. An effective way to mitigate the burden of iron deficiency could be the adoption of national patient blood management (PBM) programs. This study aimed to quantify the potential health economic benefits of implementing preoperative anemia management (the first pillar of PBM) with ferric carboxymaltose (FCM) in Romanian hospitals. An already published decision-tree-based health economic model was adapted and populated with Romanian cost and epidemiological data from 2019. Cardiac (coronary artery bypass grafting) and non-cardiac (hip and knee arthroplasty) elective surgery cases were analyzed. Costs of complications per discharged case were assessed on the basis of data from ten local hospitals. A total of 14,641 cases met the inclusion criteria. On the basis of our sample of ten hospitals, the complication costs per case ranged from €1067.43 (for stroke) to €2896.14 (for sepsis with pneumonia). The health economic model simulated two scenarios. In the first scenario, all cases with anemia received FCM treatment. The total savings at the national level total were at least €1,500,875. In the second scenario half of the cases with anemia received treatment, resulting in savings of €363,779. Our results suggest that introducing iron deficiency anemia treatment with FCM in case of elective surgical interventions results in considerable cost reduction for the healthcare system.

The inappropriate use of antibiotics is a key driver of antimicrobial resistance (AMR) and can lead to various adverse side effects. C-reactive protein (CRP) point-of-care testing (POCT) in primary care has shown potential as an effective strategy to reduce inappropriate antibiotic prescribing. This study evaluates the budget impact of introducing CRP POCT in Belgian primary care over a 5-year time horizon. A decision tree model was developed to compare the budget impact of implementing CRP POCT in primary care versus usual care (without CRP POCT) based on 712,102 acute cough patients annually. Cost and probability parameters were derived through literature review and primary data collection. The robustness of the findings was assessed using univariate and probabilistic sensitivity analyses. Additionally, alternative scenarios were explored by modifying key assumptions in the base-case scenario to evaluate the effect on the results. Over a 5-year period, implementing CRP POCT in Belgian primary care for the management of 712,102 acute cough patients annually is estimated to result in an incremental cost of approximately €12.8million (95% credible interval: 12,699,459to 12,924,898), primarily driven by capital expenditures for analysers and CRP test expenses. Scenario analyses showed substantial variation in budget impact depending on implementation choices, ranging from €13.6million to €39.6million, with the highest costs when general practitioners' (GPs') compensation was included. Reduced inappropriate antibiotic use, adverse side effects, and AMR rates would decrease costs, with these savings expected to grow over time as CRP POCT becomes more widely adopted. However, the proportion of these savings relative to total expenditure is limited. The implementation of CRP POCT entails a significant financial investment. Our scenario analyses indicate a substantial increase in budget impact when GPs' compensation was included. However, a well-designed implementation strategy with an appropriate GP compensation structure may be crucial to avoid inefficiencies from over- or underuse of CRP testing and achieve the anticipated health benefits.

There is limited evidence on the optimal frequency of mammogram surveillance. At 5-year follow-up, the Mammo-50 trial found that, in patients aged 50+ and 3 years post diagnosis, less frequent mammograms were non-inferior to annual mammograms for breast-cancer-specific-survival, recurrence-free interval and overall survival. A within-trial cost-effectiveness analysis compared annual versus less frequent mammogram surveillance over 5 years from healthcare and societal perspectives. Hospital Episodes Statistics captured hospital-based resource use. Health-related quality of life and other cost data were obtained via questionnaires at surveillance mammograms. A budget impact analysis estimated NHS savings. Less frequent surveillance led to cost savings of -£543.88 (-£1116; £26) and a small reduction in quality-adjusted life years (QALYs) of -0.02 (-0.095; 0.06) per patient. The incremental net monetary benefit at a £20,000/QALY threshold was £187 (-£1574; £2027). Including societal costs increased savings to £1543 per person (-£2416; -£669), and cost-effectiveness. Projected NHS savings were £185.87 million over 6 years. Less frequent mammogram surveillance is cost-effective. Uncertainty remains due to variability in costs and quality of life estimates, and missing data in the less frequent arm due to study design. Given the trial's non-inferiority findings, this strategy is recommended from healthcare and societal perspectives.

Dental caries remains a prevalent condition with significant health and economic repercussions. To address persistent oral health disparities and reduce the burden of dental caries among preschoolers in Sweden, this study aims to evaluate the clinical and economic impact of implementing a theory-based behavioural intervention delivered by health promoters in clinics serving children at elevated risk for caries. A retrospective cohort design was applied, comparing clinics using a theory-based behavioural intervention led by health promoters with clinics using the Recommended Programme for Caries Treatment (RPCT). The cohort were children aged 3-6 years identified as being at increased caries risk in Region Västra Götaland during 2021-2023. Three analytic approaches were employed: (1) budget impact analysis (BIA) to measure net costs and resource shifts; (2) difference-in-differences (DiD) to compare mean decayed, extracted or filled teeth (deft) in intervention versus control clinics; and (3) cost-effectiveness analysis (CEA) to estimate the incremental cost-effectiveness ratio (ICER). The BIA showed that the theory-based behavioural intervention led by health promoters incurred higher initial personnel costs than the RPCT but required fewer clinical hours - an opportunity cost that, if redeployed to clinical activity, could partially offset these expenses. The DiD showed that, over 3 years, clinics implementing the intervention achieved a statistically significant reduction of 0.26 deft among 6-year-olds. The CEA estimated the ICER to be 2142 SEK (199 EUR) per deft prevented, which improved to 513-810 SEK (48-75 EUR) when the economic value of the liberated work hours was included. A theory-based behavioural intervention led by health promoters reduced caries risk among high-risk preschoolers and may enable improved resource allocation, contingent on the redeployment of freed hours. Despite higher initial personnel costs, the approach demonstrated favourable cost-effectiveness over time, supporting its integration into public dental care systems.

ABSTRACT Background Low back pain (LBP) is a disabling condition affecting all age groups globally. Exercise is safe and cost-effective for managing LBP. Pilates is an effective exercise modality recommended for LBP but is not reimbursed by the Brazilian Public Health System. This study aimed to estimate the budget impact of implementing Pilates for LBP patients within the Brazilian public health system compared to usual care. Research design and methods A budget impact analysis (BIA) was conducted over a five-year horizon, from healthcare and societal perspectives. Costs were extracted in local currency and converted to international dollars using purchasing power parities. Deterministic sensitivity analyses were performed. Results Over five years, healthcare costs in the usual care were Int$860.8 million, while Pilates reached Int$958 million, resulting in an incremental impact of Int$97.2 million. From the societal perspective, the usual care cost was Int$4.32 billion, and the Pilates scenario was Int$4.15 billion, indicating savings of Int$172.2 million. The incremental budget impact was negative, meaning that Pilates would provide savings of Int$172,203,216. Conclusion Implementing a group-based Pilates program for LBP in the Brazilian public health system would increase healthcare costs by Int$97 million but generate societal savings of Int$172 million over five years.

Cost-effectiveness and budget impact of malaria, measles, and meningitis vaccines in Africa: a scoping review.

The effectiveness, cost-effectiveness, budget impact, and return on investment of scaling up tuberculosis screening and preventive treatment in Brazil, Georgia, Kenya, and South Africa: a modelling study.

The financial impact of implementation of a prehabilitation program for colorectal cancer patients in the Netherlands: A budget impact analysis.

ABSTRACT Integration of distributed generation (DG) units in distribution networks (DNs) has some benefits, such as improvement in voltage profile, decrease in power losses, and reduction in operation costs. In line with this concern, the achievement of these advantages, along with environmental benefits, can be further strengthened by the optimal placement and sizing of renewable‐based DGs. Reconfiguration is well known as another approach for optimizing the voltage profile and reducing energy losses in DNs. In this paper, a comprehensive model of simultaneous optimal reconfiguration and allocation of renewable energy DGs, including wind turbines (WTs) and biomass (BM) units in DNs, is presented, considering uncertainties of renewables and hourly load demands. In addition, environmental aspects of the proposed problem are taken into consideration by including emissions resulting from the use of other fossil fuel generations in the objective function. To cope with uncertainties in a robust framework, the information gap decision theory (IGDT) method is implemented. The proposed robust optimization model is examined on the IEEE‐33 node DN as a benchmark based on a discrete particle swarm optimization (DPSO) algorithm in MATLAB platform software. Various cases are considered to examine the impact of uncertainty budgets and robustness indices of different parameters on the results. The achieved simulation results are analyzed and compared with the other existing algorithms to verify the accuracy of the proposed method and its superiority over other algorithms in reducing costs and losses.

Formaldehyde variation in urban Beijing: Levels, sources, budget, and ozone impact

Budget impact analysis of a muscle-targeted nutritional intervention for sarcopenia.

Cost and Budget Impact of Layering Depression Care Onto Existing HIV and Noncommunicable Disease Care Services in Western Kenya.

Optimizing immunization through concurrent vaccination: a safety and cost analysis of PCV13 and rotavirus vaccines co-administration in Shanghai.

Aims Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections among older adults, leading to hospitalizations, higher healthcare costs, and mortality. In Sweden, the bivalent RSV prefusion F (RSVpreF) vaccine was approved in August 2023 for individuals aged 60 years and older, prompting a need for a health economical evaluation. We estimated the cost-effectiveness and budget impact of vaccinating older adults with RSVpreF versus no vaccination in Sweden. Methods We implemented a population-based, multicohort Markov model using a lifetime horizon. Costs included direct medical care, vaccination and its administration. Rates of medically attended RSV-related lower respiratory tract infection, case-fatality rates and vaccine effectiveness were estimated by age group, comorbidity profile, and care setting. Adults were characterized based on age (60–74, 75+ years) and comorbidity profile (high risk vs. low risk) and a 75% vaccine uptake was assumed in the base case. We calculated budget impact for a five-year time horizon. Results The cost-effectiveness model projected fewer RSV-related hospitalizations (-12,9%), outpatient visits (-7,5%), and deaths (-11,3%) with RSVpreF vaccination among high-risk adults aged 60-74 and all adults ≥75 years compared to no intervention, with most benefits within the first 4 years (46,3%, 26,6%, and 46,2% averted, respectively). These reductions lowered direct healthcare costs (-2,8%) and increased QALYs over a lifetime, making RSVpreF cost saving compared to no intervention. In the budget impact analysis, initial investment costs were offset by direct medical savings in year 3, yielding ≈1.76 billion Swedish kronor (approximately 187 million USD) in net savings over five years. Conclusion Introducing RSVpreF vaccination for older adults in Sweden has the potential to reduce RSV-related hospitalizations, deaths, and healthcare costs. Findings support the implementation of RSV vaccination to older adults and at-risk individuals as a cost-effective and budget-saving strategy in the short term.

Background/Objectives: Patients that undergo percutaneous coronary intervention (PCI) require effective antiplatelet therapies to minimize the risk of thrombotic cardiovascular events. Oral P2Y12 inhibitors are often utilized, however co-administered opioids may lead to gastric absorption issues in these patients, affecting the efficacy of oral inhibitors. Cangrelor is an intravenous, direct-acting, reversible P2Y12 inhibitor that could be explored as a potential treatment option for patients with gastric absorption issues during ST-elevation myocardial infarction. The objective was to estimate the UK budget impact of introducing cangrelor for ST-elevation myocardial infarction (STEMI) patients with gastric absorption issues undergoing PCI. Methods: A budget impact model was developed to calculate the impact of introducing cangrelor to treat STEMI patients with gastric absorption issues undergoing PCI, to the UK National Health Service and personal social services, over 5 years. Oral P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor), glycoprotein IIb/IIIa inhibitors (eptifibatide and tirofiban), and aspirin and heparin alone were included as base case comparators. Cangrelor uptake ranged from 10% to 30% in years 1–5. The cangrelor-eligible population was estimated at 10,903 patients per year. Results: Over 5 years, cangrelor leads to a small cost saving (0.29%), varying from −GBP 261,989 in year 1 to GBP 174,778 in year 5. The introduction of cangrelor is estimated to lead to 314 fewer hospital days and 190 clinical events avoided over 5 years. Conclusions: Introducing cangrelor to STEMI patients with gastric absorption issues undergoing PCI in the UK is estimated to generate a small cost saving and reduced length of stay for some patients.

Peritoneal dialysis (PD) is used in Italy for less than 10% of patients on dialysis, with considerable inter-regional variability. The ALTEMS research using HTA methodology set out to assess whether this is justified on economic grounds. Effectiveness measured in terms of Quality Adjusted Life Years (QALY) is 1.20 for PD compared to the 0.94 of hospital hemodialysis (HD). In terms of cost-utility analysis, PD is therefore "dominant" as it is more effective and less costly, and as a result is the treatment of choice from both clinical and economic points of view, as well as from both social and SSN perspectives. On Budget Impact Analysis (BIA), the real annual cost per patient from the social perspective is € 24,142 for PD and € 42,231 for HD. A hypothetical greater use of PD, with an annual increase of at least 5% of patients on PD, would result in savings over a 5-year period of close to 100 million euro.

BackgroundWhile the immune checkpoint inhibitor pembrolizumab has improved outcomes for non-small cell lung cancer (NSCLC), the leading cause of cancer death in China, its standard fixed-dose regimen is costly. Given that studies demonstrate comparable efficacy between fixed and weight-based dosing, we aimed to compare the economic impact of these two dosing regimens in China.MethodsWe conducted a one-year budget impact analysis from the Chinese payer perspective comparing fixed-dose (200 mg Q3W) versus weight-based (2 mg/kg Q3W) pembrolizumab regimens. Model parameters, including lung cancer epidemiology, treatment costs and market penetration rates, were derived from published studies and open-access databases. Scenarios with and without institutional vial dose-sharing were analyzed, and comprehensive one-way and probabilistic sensitivity analyses (PSA) were performed to assess model robustness.ResultsThe standard fixed-dose regimen was projected to have an annual cost of $6.67 billion. In a dose-sharing scenario, the weight-based regimen reduced annual drug consumption by 34.41%, resulting in a total saving of $2.29 billion. This lowered the annual cost per patient from $86,392 to $56,661. Without dose-sharing, the weight-based regimen still yielded an annual saving of $76.93 million. PSA confirmed the robustness of these findings, showing a 50% probability of achieving savings greater than $2.09 billion in the dose-sharing scenario.ConclusionAdopting a weight-based dosing strategy for pembrolizumab, especially when optimized with vial-sharing protocols, offers substantial and achievable annual cost savings for the Chinese healthcare system without compromising therapeutic efficacy. Therefore, this regimen should be considered as a potential first-line treatment option for patients with advanced NSCLC.

Summary: Introduction: Colorectal cancer (CRC) screening is a key tool for secondary prevention, whose eff ectiveness depends on population participation, accessibility of care, and quality of the examinations. Its impact is further determined by systematic data collection and analysis. High-quality data represent a fundamental pillar for monitoring ongoing screening, evaluating outcomes, and identifying weaknesses in the program. The aim is to demonstrate the benefi ts of data for optimizing the Czech program through two case studies. Methods: Data sources included the National Health Information System and the Database of Preventive Colonoscopies managed by the Institute of Health Information and Statistics of the Czech Republic, complemented with sociodemographic data from the Czech Statistical Offi ce. Evaluation was carried out using screening quality indicators and a budget impact analysis focused on the change of age limits in screening. Results: The fi rst case study shows a 33% decrease in CRC incidence and a 49% reduction in mortality since program implementation. Coverage of the target population has long remained around 30%. In 2020, a positive fecal occult blood test (FOBT) rose to 10%. The interval between a positive FOBT and fol low-up colonoscopy corresponds to 3 months. The uptake of fol low-up colonoscopy after a positive FOBT reaches 60%. The second case study revealed that expanding the eligible age range from 45– 74 years will initially lead to a 5– 6% increase in costs; however, from 2029 onwards, a reduction is expected. Discussion: The fi rst study demonstrates the success of screening in reducing incidence and mortality, while also highlighting challenges such as low coverage, high FOBT positives, long waiting times for fol low-up colonoscopy, and low uptake of fol low-up colonoscopy. The second study found that expanding the age range will be cost-eff ective. Data confi rm the benefi ts of screening for population health and indicate areas requiring further attention. Conclusion: Systematically collected and analyzed data are an essential component for evaluating and managing screening programs. The case studies illustrate their applicability in monitoring care quality and supporting health policy decisions. Key words: colorectal cancer – adenoma – screening – colonoscopy – fecal occult blood test – quality indicators – data – statistical analysis

Budget Impact of Vericiguat for Treating Chronic Heart Failure in Japan

ObjectiveSevere blepharospasm is a disabling neurological condition that significantly affects patients’ quality of life. Botulinum toxin type A (BoNT-A) is considered the standard treatment due to its targeted therapeutic effect and fewer systemic side effects compared to oral medications. However, its high cost poses a barrier to access within Thailand’s healthcare system. This study aimed to assess the budget impact of introducing BoNT-A treatment (Onabotulinumtoxin A and Abobotulinumtoxin A) compared with current oral medications for severe blepharospasm in Thailand.MethodsA budget impact model was developed from the perspective of Thailand’s healthcare system over a 5-year time horizon. The current scenario (oral medications use) was compared with a new scenario involving BoNT-A treatment. The costs considered included drug acquisition, outpatient visits, and accident-related injuries. The base-case assumed gradual uptake of BoNT-A (30% in year 1, 50% in year 2, and 100% from year 3). Sensitivity analyses explored full uptake from year 1, no dose sharing, and inclusion of injury-related costs.ResultsExcluding injury-related costs, the 5-year net budget impact (NBI) was 7.91 million THB (223,040 USD) for onabotulinumtoxin A and 7.27 million THB (205,064 USD) for abobotulinumtoxin A. Including injury-related costs reduced the NBI to 4.20 million THB (118,564 USD) and 3.57 million THB (100,588 USD), respectively. Without dose sharing, the NBI rose significantly, reaching 40.5 million THB (1.14 million USD) for abobotulinumtoxin A.ConclusionBoNT-A treatment increases healthcare costs, primarily due to drug costs. However, reduced injury costs and dose-sharing strategies may enhance affordability and support BoNT-A’s inclusion in Thailand’s National List of Essential Medicine.