Cost-effectiveness Approach Research Articles

Cost of Carbon in the Total Cost of a Healthcare Procedure: Example of Micro-Costing Study in a French Setting.

Economic evaluation aims to compare the costs and results of health strategies to inform public decision making. Although sometimes suggested, until now no national evaluation agency has recommended formally incorporating the cost of greenhouse gas (GHG) emissions generated by health interventions into the estimation of healthcare costs. The objective of this study was to test and discuss the feasibility of estimating and including the contribution of GHG emissions cost to the total cost of a surgical intervention, with the example of robot-assisted total knee arthroplasty (RTA), using a micro-costing approach. The study was conducted in June 2022 at the William Morey Hospital (France). Data regarding all of the resources (labor, medical equipment, consumables), as well as energy consumption, staff commuting and waste treatment were collected and valued from the hospital point of view. Greenhouse gas emissions were valued using a cost-effectiveness approach. Several sensitivity analyses were performed. The mean cost per patient of an RTA was estimated to be €4755.65, of which €152.64 (3.21 %) would be attributable to GHG emissions. The contribution of GHG emissions in the overall cost of a health intervention was highly dependent on the convention used for the price of carbon. Despite persistent theoretical and practical challenges, adding the estimation of GHG emission costs in the economic evaluation of health interventions may provide institutional decision makers with information that allows them to allocate the public healthcare resources more efficiently.

Direct Primary Care: Financial Analysis and Potential to Reshape the U.S. Healthcare Landscape.

As the United States faces a looming shortage of primary care physicians and escalating rates of clinician burnout, there is a pressing need to explore alternative models of primary care delivery. Direct Primary Care (DPC) is an emerging primary care model in which patients enroll in a membership plan and make direct monthly or yearly payments to a DPC practice for specific primary care services. Although DPC holds the potential to enhance patient care and mitigate clinician burnout, no published studies provide a financial analysis of DPC practices or compare them to traditional fee-for-service (FFS) primary care models. In this article, we present an evidence-based analysis of theoretical DPC and FFS primary care practices. We demonstrate that the DPC practice can yield upwards of $25,000 in annual cost savings over the FFS practice while also providing more personalized patient care. Thus, we argue that the cost-effectiveness and value-based approach of DPC positions the model as a transformative force in reshaping the American healthcare landscape towards a more patient-centric, accessible, and resilient future.

A fairness-based multi-objective distribution and restoration model for enhanced resilience of supply chain transportation networks

A fairness-based multi-objective distribution and restoration model for enhanced resilience of supply chain transportation networks

Is more always better? Effectiveness of constraint-induced movement therapy in children with high-risk or unilateral cerebral palsy (0-6 years): Systematic review and meta-analysis.

While constraint-induced movement therapy is strongly recommended as an intervention for infants with unilateral cerebral palsy, the optimal dosage remains undefined. This systematic review aims to identify the most effective level of intensity of constraint-induced movement therapy to enhance manual function in infants at high risk of asymmetric brain lesions or unilateral cerebral palsy diagnosis. This systematic review with meta-analysis encompassed a comprehensive search across four electronic databases to identify articles that met the following criteria: randomised controlled trials, children aged 0-6 with at high risk or with unilateral cerebral palsy, and treatment involving constraint-induced movement therapy for upper limb function. Studies with similar outcomes were pooled by calculating the standardised mean difference score for each subgroup, and subgroups were stratified every 30 h of total intervention dosage (30-60, 61-90, >90 h). Risk of bias was assessed with Cochrane Collaboration's tool. Seventeen studies were included. Meta-analyses revealed significant differences among subgroups. The 30-60 h subgroup showed a weak effect for spontaneous use of the affected upper limb during bimanual performance, grasp function, and parents' perception of how often children use their affected upper limb. Additionally, this subgroup demonstrated a moderate effect for the parents' perception of how effectively children use their affected upper limb. Using a dosage ranging from 30 to 60 h when applying a constraint-induced movement therapy protocol holds promise as the most age-appropriate and cost-effectiveness approach for improving upper limb functional outcomes and parent's perception.

Opportunistic Screening for Asymptomatic Left Ventricular Dysfunction With the Use of Electrocardiographic Artificial Intelligence: A Cost-Effectiveness Approach

The burden of asymptomatic left ventricular dysfunction (LVD) is greater than that of heart failure; however, a cost-effective tool for asymptomatic LVD screening has not been well validated. We aimed to prospectively validate an artificial intelligence (AI)-enabled electrocardiography (ECG) algorithm for asymptomatic LVD detection and evaluate its cost-effectiveness for opportunistic screening. In this prospective observational study, patients undergoing ECG at outpatient clinics or health check-ups were enrolled in 2 hospitals in Taiwan. Patients were stratified into LVD (left ventricular ejection fraction ≤ 40%) risk groups according to a previously developed ECG algorithm. The performance of AI-ECG was used to conduct a cost-effectiveness analysis of LVD screening compared with no screening. Incremental cost-effectiveness ratio (ICER) and sensitivity analyses were used to examine the cost-effectiveness and robustness of the results. Among the 29,137 patients, the algorithm demonstrated areas under the receiver operating characteristic curves of 0.984 and 0.945 for detecting LVD within 28 days in the 2 hospital cohorts. For patients not initially scheduled for ECG, the algorithm predicted future echocardiograms (high-risk, 46.2%; medium-risk, 31.4%; low-risk, 14.6%) and LVD (high-risk, 26.2%; medium-risk, 3.4%; low-risk, 0.1%) at 12 months. Opportunistic screening with AI-ECG could result in a negative ICER of-$7,439 for patients aged 65 years, with consistent cost-savings across age groups and particularly in men. Approximately 91.5% of the cases were found to be cost-effective at the willingness-to-pay threshold of $30,000 in the probabilistic analysis. The use of AI-ECG for asymptomatic LVD risk stratification is promising, and opportunistic screening in outpatient clinics has the potential to reduce costs.

The Cost-Effectiveness of Psychosocial Interventions Following Self-Harm in Australia.

Background: Psychosocial interventions following self-harm in adults, in particular cognitive behavioral therapy (CBT), can be effective in lowering the risk of repeated self-harm. Aims: To evaluate the cost-effectiveness of CBT for reducing repeated self-harm in the Australian context. Method: The current study adopted the accessing cost-effectiveness (ACE) approach using return-on-investment (ROI) analysis. Uncertainty and sensitivity analyses (Sas) tested the robustness of the model outputs to changes in three assumptions: general practitioner referral pathway (SA1), private setting intervention delivery (SA2), and training costs (SA3). Results: The intervention produced cost savings of A$ 46M (95% UI -223.7 to 73.3) and A$ 18.3M (95% UI -86.2 to 24.6), subject to the effect of intervention lasting 2- or 1-year follow-up. The ROI ratio reduced to 5.22 in SA1 (95% UI -10.1 to 27.9), 2.5 in SA2 (95% UI -4.8 to 13.3), and 5.1 in SA3 (95% UI -9.8 to 27.8). Limitations: We assumed that the effectiveness would reduce 50% within 5 years in the base case, and we used Australian data and a partial social perspective. Conclusions: The current study demonstrated cost-effectiveness of CBT for adults who have self-harmed with the return-on-investment ratio of A$ 2.3 to $6.0 for every A$ 1 invested.

Green synthesis of stretchable ethyl cellulose film plasticized with transesterified sunflower oil

Green synthesis of stretchable ethyl cellulose film plasticized with transesterified sunflower oil

Economic evaluation of acupuncture as an adjunctive treatment with usual care for mild-to-moderate knee osteoarthritis: A Markov model-based analysis

Collaborative care (CC), in which acupuncture is combined with usual care (UC), improves clinical outcomes and increases costs in knee osteoarthritis (KOA). We evaluated the economic feasibility of CC for Korean female patients with mild-to-moderate KOA by using a cost-effectiveness approach. Two alternatives for KOA (1. UC as a comparator; and 2. CC as an intervention) were defined based on clinical guidelines, official Korean statistics, and expert validation. Each alternative was simulated in a Markov model every 6 months for 10 years. Estimates of costs, utilities, and transition probabilities were obtained from official statistics and previous studies. The effectiveness of CC was synthesized from randomized controlled trials. A base-case analysis of a limited societal perspective, univariate sensitivity analysis, and probability sensitivity analysis were performed. An annual discount rate of 4.5% and threshold of 20,000 United States dollar per Quality-adjusted life year (USD/QALY) were applied. Every incremental cost-effectiveness ratio (ICER) of CC calculated from the analyses was sub-threshold. In the base-case analysis, with a limited societal perspective, the ICER was 11,085 USD/QALY. The ICERs from the univariate sensitivity analyses were -2,577-16,748 USD/QALY. The average ICER in the probability sensitivity analysis was 12,412 USD/QALY. When the threshold surpassed 8,000 USD/QALY, the cost-effectiveness of CC exceeded 50%. The probability was 70.27% when the threshold was 20,000 USD/QALY. CC for Korean female patients with mild-to-moderate KOA was generally cost-effective. Considering the limitations of the evidence, we propose a re-evaluation using further clinical studies in the future.

Cost-Effectiveness Rivaroxaban versus Enoxaparin for Prevention of Venous Thromboembolism after Knee Replacement Surgery in Iran.

The highest risk of developing venous thromboembolism (VTE) is seen in patients who have undergone orthopedic surgery. One of the most common methods to reduce the risk of thromboembolism in these patients is anticoagulant prophylaxis. Rivaroxaban is one of the anticoagulants that has a lower cost than other anticoagulants and has a significant effect on people's quality of life as it is edible. The study aimed to determine the cost-effectiveness of rivaroxaban as compared with enoxaparin for venous thromboembolism prophylaxis in knee replacement patients in Iran. It was a quantitative and economic evaluation study with a cost-effectiveness approach and an applied study because its results could be used directly for policy-making and decision-making in the health system. The study was conducted in 2019 and 2020. This study considered the health system perspective. The study population included all knee replacement patients. The sample included 203 patients referred to Shafa Yahyaeian Hospital and 300 patients referred to Rasoul Hospital in Tehran. The study was conducted in two steps. A systematic review of studies was conducted in the first step. The CHEERS checklist was used to evaluate the quality of the studies in the systematic review. The EQ-5D questionnaire was used in the second step to calculate the QALY, and the cost collection form was used to calculate the direct medical cost. The data were analyzed through a decision tree, and Stata and Tree age pro softwares were the analysis tools. Also, according to the per capita GDP index for Iran in 2018, the incremental cost-effectiveness threshold was considered to be $10,000. The results of this study showed that during the prophylaxis period, rivaroxaban was one and a half times less costly than enoxaparin. Quality of life in uncomplicated conditions were 0.85 QALY for rivaroxaban and 0.69 QALY for enoxaparin. Based on the results of this study, the cost of rivaroxaban during the prophylaxis was $ 160.97 and the quality of life was 0.85 QALY and the cost of enoxaparin was $ 276.07 and the quality of life was 0.69 QALY. The cost difference between the two interventions was $ 115.09 and the outcome difference was 0.16 QALY. The incremental cost-effectiveness ratio was $ 189.40 for rivaroxaban and $ 416.28 for enoxaparin. According to the results of this study, rivaroxaban reduced the duration of hospitalization by an average of 2 days in asymptomatic patients (prophylaxis period) compared to enoxaparin. Rivaroxaban, an oral medication, reduced costs and increased the quality of life in people undergoing knee replacement surgery compared with an enoxaparin injection vial. This drug was less costly for the patient and health systems and its use was cost-effective as a thromboprophylaxis drug following knee replacement surgery.

Comparative pharmacoeconomic analysis of the use of apixaban, rivaroxaban and dabigatran for prevention of stroke and embolism in the vessels of the systemic circulation in patients with non-valvular atrial fibrillation

Aim . To compare the effectiveness of direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (AF) for preventing stroke and systemic thromboembolism (embolism in the vessels of the systemic circulation, systemic embolism) in terms of pharmacoeconomic indicators. Materials and Methods . The economic assessment was carried out from the standpoint of the healthcare system of the Russian Federation. We used published data on the clinical efficacy and safety of DOACs, which were obtained earlier in clinical trials. The efficacy of therapy was assessed by the incidence of ischemic stroke (IS) of systemic embolism (SE), while the safety was assessed by the incidence of major bleeding (MB) and clinically signifi cant minor bleeding (CSNMB). The total cost of patient management for each alternative treatment option included both the cost of drug therapy and the cost of managing adverse events over a study horizon of 12 months. The conclusion about the most preferred alternative was made on the basis of the ratio of effectiveness and cost of treating the patient. Results . The use of apixaban to prevent IS or SE in patients with AF was accompanied by a decrease in the incidence of their development (HR 0.80, 95 % CI 0.73–0.89; HR 0.72, 95 % CI 0.60–0.85 — compared with rivaroxaban and dabigatran, respectively), as well as a decrease in the frequency of MB compared with other DOACs (HR 0.55, 95 % CI 0.53–0.59; HR 0.78, 95 % CI 0.70–0.87 — compared with rivaroxaban and dabigatran, respectively). Since apixaban was more effective and safer than rivaroxaban and dabigatran, a cost-effectiveness approach was applied in this study. The least expensive treatment regimen included apixaban, the direct cost was 33,263 roubles per patient. The advantage was achieved both due to the lower of therapy with apixaban (29.6–34.0 % lower than other DOACs) and the minimum cost of managing the adverse events: for MB and CSNMB, it was reduced by 20.7 % compared to dabigatran and by 44.7 % compared to rivaroxaban; for stroke/SE, it was reduced by 25.9 % and 20.6 %, respectively. Conclusion . In patients with AF, apixaban was more cost-effective compared with rivaroxaban or dabigatran for preventing IS and SE, as it led to higher clinical efficacy and safety while requiring less healthcare system costs.

Exploring trade-offs between cost and peak flow reduction toward identifying optimal LID designs combining green roof and permeable pavement

ABSTRACT This study aims to apply a cost-effectiveness approach to identify optimal Low Impact Development (LID) designs for peak flow management when two specific practices are simultaneously employed: Permeable Pavement (PP) and Green Roofs (GR). Four design parameters were considered, associated with coverage ratios and underlying layer thicknesses of the LIDs. The results showed that optimal costs and parameters were more affected by the level of peak flow reduction than by storms’ intensity and duration. The best settings occurred with permeable pavement treating 100% of the adjacent impervious area. In this case, the optimal designs were dominated by smaller coverage ratios (20 to 60%) and deeper (190 to 330 mm) storage layer of PP, combined with a very small or non-existent area of GR. The findings of the present study demonstrate how the optimization of design parameters may lead to more economic LID designs and provide additional guidance for LID practice implementation and to assist in the decision-making process for the most cost-effective and sustainable solutions.

Radiographic Analysis of Graft Dimensional Changes in Transcrestal Maxillary Sinus Augmentation: A Retrospective Study.

Background. The maxillary sinus lift is a popular and predictable technique associated with implant-supported rehabilitation of the severely atrophic maxilla. The aim of the present retrospective study was to investigate the effectiveness of transcrestal maxillary sinus augmentation and the graft resorption pattern using different heterologous bone substitutes. Methods. A total of 75 sinus-grafting procedures were performed and 89 implants were placed in 66 patients, 24 males and 42 females, with mean age 67.9 ± 10.64 years (range 43–84 years). Nineteen subjects were smokers. The mean follow-up period was 93.33 ± 54.71 months (range 14–240 months). Clinical and radiographical evaluations were performed. Graft height and width were measured at baseline and at the latest follow-up. Results. Mesiodistal and vertical resorption averaged 9.3 ± 20.7% (standard deviation), and 5.04 ± 9.9% of the postoperative size, respectively, considering the graft as the unit. Linear regression analysis showed that graft resorption in both the vertical and the mesiodistal dimension is independent of the follow-up time. Conversely, there was a trend for greater resorption when increasing the postoperative graft size, in both vertical (p = 0.001) and horizontal (p = 0.007) dimensions. When grouping the dimensional changes by graft particle size (only small (<300 μm) particles, combination of small and medium (>500 μm)/large (>1000 μm) particles, and only medium/large particles), there was a trend for greater resorption associated with smaller particles, but it was not significant; neither in the mesiodistal nor in the vertical dimension (p = 0.17 and p = 0.25, respectively). No implant was lost during the observation period. In conclusion, the transcrestal technique for maxillary sinus augmentation documented a high level of predictability. The low clinical morbidity and the contextual dental implant positioning is clinically useful in relation to a significant reduction of the time required for implant restoration, a consistent decrease of the number of surgical phases, and a cost-effectiveness approach for the rehabilitation. The graft resorption pattern in all cases was compatible with persistent implant protection and support.

Time is money: Examining the time cost and associated charges of common performance validity tests

Objective: This study presents data on the time cost and associated charges for common performance validity tests (PVTs). It also applies an approach from cost effectiveness research to comparison of tests that incorporates cost and classification accuracy. Method: A recent test usage survey was used to identify PVTs in common use among adult neuropsychologists. Data on test administration and scoring time were aggregated. Charges per test were calculated. A cost effectiveness approach was applied to compare pairs of tests from three studies using data on test administration time and classification accuracy operationalized as improvement in posterior probability beyond base rate. Charges per unit increase in posterior probability over base rate were calculated for base rates of invalidity ranging from 10 to 40%. Results: Ten commonly used PVTs measures showed a wide range in test administration and scoring time from 1 to 3 minutes to over 40 minutes with associated charge estimates from $4 to $284. Cost effectiveness comparisons illustrated the nuance in test selection and benefit of considering cost in relation to outcome rather than prioritizing time (i.e. cost minimization) classification accuracy alone. Conclusions: Findings extend recent research efforts to fill knowledge gaps related to the cost of neuropsychological evaluation. The cost effectiveness approach warrants further study in other samples with different neuropsychological and outcome measures.

Building Construction Clients’ Design Consultant and Contractor Selection Criteria Versus Post-Occupancy Satisfaction Levels

In today’s competitive building construction markets, achieving clients’ satisfaction is of utmost importance. The choice of a design consultant and a contractor for a building project has a crucial influence on the post-occupancy satisfaction of the client. Hence, this study provides insights into private building construction clients’ perceptions of a set of criteria contributing to their selections of design consultant and contractor together with the resulting post-occupancy overall client satisfaction levels eventually reached, by presenting survey findings of 330 clients in North Cyprus construction market. Unlike previous studies, the current study combined all the interrelated and vital stages of design consultant and contractor selection with post-occupancy client satisfaction levels. A further contribution is differentiating among various types of client groups’ behaviors in each of the three specified stages. Clients in different categories had distinct approach differences in selection stages, and different post-occupancy satisfaction values indicating that firms may benefit from market segmentation. “Residential” and “&lt;120,000£” type building clients were the least satisfied groups, while “project execution stage” and “functionality” emerged as major features creating dissatisfaction. The findings revealed the importance attached by the clients to “references about the firm” in the selection stages and low client satisfaction with the completed projects. Regression analysis findings revealed different design consultant and contractor selection factors predicting overall clients’ satisfaction while assigning high importance to the “cost-effectiveness approach of the firm” emerged as the only strong predictor of dissatisfaction. This study provides a guide for building construction clients to attain higher post-occupancy satisfaction and assists design consultants and contractors in adopting specific customer-focused strategies.

COST EFFECTIVENESS ANALYSIS (CEA) PENGGUNAAN GOLONGAN OBAT NEUROPROTEKTAN CITICOLINE INJEKSI DAN PIRACETAM INJEKSI PADA PASIEN STROKE DI RSU IMELDA PEKERJA INDONESIA MEDAN

Stroke is disease or functional disorder of the brain in the form of nerve paralysis (neurological deficit) due to obstruction of blood flow to the brain. One of the therapies given to stroke patients is by giving neuroprotectant drugs, namely citicoline injection and piracetam injection. The purpose of this study was to determine the effectiveness of therapy and cost effectiveness of stroke patients' therapy between the use of alternative citicoline injection and injection piracetam in a pharmacoeconomic manner with a Cost Effectiveness approach in RSU Imelda Pekerja Indonesia Medan. This study uses a retrospective Cohort Study method. The sample of this study consisted of 44 patients, namely 22 patients treated with citicoline injection and 22 patients treated with piracetam injection. The results of this study were obtained from the comparison of ACER (Average Cost Effectiveness Ratio) and ICER (Incremental Cost Effectiveness Ratio) values. The ACER value of citicoline injection is Rp. 11.949.- less than the ACER value of piracetam Rp. 15.474.- so that the Cost Effective ACER value which has the lowest ACER value is citicoline injection. The ICER value of the comparison of citicoline injection and injection piracetam is Rp. -32.661.- . which means the ICER result is negative or getting smaller, it is considered more effective and cheaper, in accordance with quadrant II the plant's cost-effectiveness decreases so that the neuroprotectant drug class therapy with the most Cost Effectiveness of stroke patients in RSU Imelda Pekerja Indonesian Medan is citicoline injection.

Impact of metabolic surgery on cost and long-term health outcome: acost-effectiveness approach.

The increase in obesity has become a major public health concern. Morbid obesity is associated with co-morbidities, reduced quality-of-life, and death. Metabolic surgery (MS) is the most effective treatment for obesity. The aim of this study was to evaluate the costs and outcomes of MS compared with no surgery in patients with a body mass index ≥30 kg/m2. Health care system, Austria METHODS: A total of 177 patients who underwent MS were documented retrospectively, based on the hospital records of 2 specialized centers in Austria, over a 1-year period. At baseline 26.0% of patients exhibited type 2 diabetes (T2D), 52.5% cardiovascular disease (CVD), 23.2% hyperlipidemia, and 23.7% depression. Following the observation period, a Markov chain simulation model was developed to analyze the long-term consequences of T2D, including diabetic complications, CVD, hyperlipidemia, depression, non-alcoholic steatohepatitis (NASH), myocardial infarction, and stroke, over a total of 20 years. Direct medical costs were expressed in 2017 euros from the payer's perspective. Quality-adjusted life years (QALYs), life years (LYs), and costs were discounted. MS led to costs of €40,427 and 9.58 QALYs (15.58 LYs) per patient over 20 years. No MS was associated with €64,819 and 6.33 QALYs (13.92 LYs). Total cost-savings amounted to €24,392, which offset the cost of the procedure including re-operations. Over 20 years MS saved -6.7 patient-years per patient with T2D, -5.8 patient-years with CVD, -1.5 patient-years with hyperlipidemia, -1.8 patient-years with depression, and -3.8 patient-years with NASH. MS is associated with substantial savings in long-term costs, expected health benefits, and reduced onset of complications. MS significantly increases quality of life.

Designing Fuel-Economy Standards in Light of Electric Vehicles

Electric vehicles are declining in cost so rapidly that they may claim a large share of the vehicle market by 2030. This paper examines a set of practical regulatory design considerations for fuel-economy standards or greenhouse gas standards in the context of highly uncertain electric vehicle costs in the next decade. The analysis takes a cost-effectiveness approach and uses analytical modeling and simulation to develop insight. I show that counting electric vehicles under a standard with a multiplier or assuming zero upstream emissions can reduce electric vehicle market share by weakening the standards. Furthermore, there are trade-offs from implementing a backstop conventional vehicle standard along with a second standard that also includes electric vehicles, but such a backstop offers the possibility of ensuring that low-cost conventional vehicle technologies are exploited.

Jatropha integerrima flower extract mediated phyto-fabrication and characterization of silver nanoparticles

Jatropha integerrima plant is well known for its antiplasmodial, antituberculosis, antimicrobial, and antioxidant properties. Current work reports the phyto-fabrication of silver nanoparticles (JI@AgNPs) using Jatropha integerrima flower extract (JIFE). This bio-synthesis route of nanoparticles substitutes chemical synthesis due to its cost-effectiveness, eco-friendly, and sustainable approach. Various analytical techniques such as UV–vis spectroscopy, X-ray Diffraction (XRD), Fourier Transform Infrared spectra (FTIR), Field Emission Scanning Electron Microscopy (FESEM), and High-Resolution Transmission Electron Microscopy (HRTEM), Selected Area Electron Diffraction (SAED), Energy-Dispersive X-ray Spectroscopy (EDS) were performoed to characterize the synthesized silver nanoparticles. Zeta potential measurements were done to determine the charge on the nanoparticles. The catalytic activity of JI@AgNPs towards the degradation of rhodamine-B (Rh-B) was evaluated. The reaction kinetics and effect of reaction parameters were also investigated.

Estimation of Seasonal Quality-Adjusted Life-Year Using Seemingly Unrelated Regression Equation Models With an Application to Orthopedic Data

The technological advancement in the field of orthopedics has initiated better healthcare service that equates to the need of cost-effectiveness approach. We propose a model for estimating the simultaneous effect of health and cost involved in an orthopedic surgery implants by using seemingly unrelated regression equations models. The simultaneous equations represent a relationship between the health status of a group of individuals and their expenditures related to the cost of surgical procedure/treatment undertaken in an orthopedic department of a hospital. We define model specification, estimation, and statistical tests in simultaneous equation models. This is further used to estimate the utility function that indeed helps in the computation of quality-adjusted life-year (QALY) values. Using the seemingly unrelated regression equation models for the seasonal data in 2018 and 2019, we have obtained the seasonal QALY values. Furthermore, the measurement of seasonal changes in QALY values is done by using a method of simple averages. We analyze the health conditions in orthopedics by the formation of health and expenditure relationship for the inpatients and outpatients undertaking a treatment. A framework has been setup for computing quality of life-year values by including the direct and the indirect costs. The patient-reported outcome measures are also useful in detecting the change in disease states and important difference in minimal clinical changes that further adds value to the computation of quality of life.

Use of simulation models in health economic evaluation studies of dietary salt-reduction policies for cardiovascular disease prevention

Objectives Social security costs related to the healthcare and long-term care of patients with cardiovascular diseases is a national burden that is expected to grow as Japan's population ages. Nutritional policies for improving the nation's diet could prevent cardiovascular diseases, but scientific evidence on their costs and outcomes is limited. This study gives an overview of health economic evaluation studies on population-wide dietary salt-reduction policies that have been instituted for the purposes of cardiovascular disease prevention. Thus, this study provides background information for the development of evaluation methods that can be utilized in Japan for analyzing the effects of nutritional policies on public health and social security cost containment.Methods We extracted representative health economic simulation models that are used for predicting the effects of cardiovascular disease-related interventions: Cardiovascular Disease Policy Model, IMPACT Coronary Heart Disease Policy and Prevention Model, US IMPACT Food Policy Model, Assessing Cost-Effectiveness (ACE) approach to priority-setting, and Prevention Impacts Simulation Model (PRISM). Next, we collected original articles on studies that used these models for assessing the costs and effects of national population-wide dietary salt-reduction policies. We then outlined the background, structure, and applied studies associated with each model.Results The five models utilized Markov cohort simulation, microsimulation, proportional multistate life tables, and system dynamics to predict the effect of dietary salt-reduction policies on blood pressure reduction and cardiovascular disease prevention. The models were applied to countries such as Australia, England, and the United States to simulate long-term (10 years to lifetime) costs and effects. These applied studies examined policies that included health promotion campaigns, sodium labels on the front of food packages, and mandatory or voluntary reformulation by the food industry to reduce the salt content of processed foods.Conclusion Health economic simulation modeling is actively being used to evaluate scientific evidence on the costs and outcomes of national dietary salt-reduction policies. Similarly, leveraging simulation modeling techniques could facilitate the evaluation and planning of dietary salt-reduction policies and other nutritional policies in Japan.