Cost-effectiveness Studies Research Articles

Affordability of an NGO-government partnership for community-based disability rehabilitation.

Tunafasi is a community-based rehabilitation (CBR) programme for persons with disability, implemented by a local non-governmental organisation in Uvira, Democratic Republic of Congo, in partnership with government. To assess affordability and support discussions with the government about continued financing and implementation, Tunafasi representatives commissioned a cost-effectiveness study of the programme's health component. This study aimed to estimate the programme's impacts, costs, cost per disability-adjusted life year (DALY) averted and affordability of the health component implemented from February 2019 to December 2021. Health-related improvements were assessed for a sample of 511 persons with disability and converted to DALYs averted. Total expenditure during the period February 2019 to December 2021 was estimated from audited financial statements. The cost per DALY averted was estimated by dividing total programme expenditure by the sum of DALYs averted and compared against newly generated, country-specific thresholds to assess affordability. The programme cost $55 729.00 to implement from February 2019 to December 2021 and averted 234 DALYs in 511 persons, at a cost per DALY averted of $224.00. This falls above the affordability threshold of $54.00 - $199.00. While the cost per DALY averted is higher than what thresholds consider affordable for Democratic Republic of Congo, improved engagement from CBR facilitators and greater possibilities for treatment in the post-pandemic era should improve results. This new CBR implementation modality offers a possibly affordable solution to African governments struggling to operationalise disability commitments such as United Nations Convention on the Rights of Persons with Disabilities.

Understanding context of violence against healthcare through citizen science and evaluating the effectiveness of a co-designed code of conduct and of a tailored de-escalation of violence training in Eastern Democratic Republic of Congo and Iraq: a study protocol for a stepped wedge randomized controlled trial

BackgroundViolence against health care workers (HCWs) is a multifaceted issue entwined with broader social, cultural, and economic contexts. While it is a global phenomenon, in crisis settings, HCWs are exposed to exceptionally high rates of violence. We hypothesize that the implementation of a training on de-escalation of violence and of a code of conduct informed through participatory citizen science research would reduce the incidence and severity of episodes of violence in primary healthcare settings of rural Democratic Republic of Congo (DRC) and large hospitals in Baghdad, Iraq.MethodsIn an initial formative research phase, the study will use a transdisciplinary citizen science approach to inform the re-adaptation of a violence de-escalation training for HCWs and the content of a code of conduct for both HCWs and clients. Qualitative and citizen science methods will explore motivations, causes, and contributing factors that lead to violence against HCWs. Preliminary findings will inform participatory meetings aimed at co-developing local rules of conduct through in-depth discussion and input from various stakeholders, followed by a validation and legitimization process. The effectiveness of the two interventions will be evaluated through a stepped-wedge randomized-cluster trial (SW-RCT) design with 11 arms, measuring the frequency and severity of violence, as well as secondary outcomes such as post-traumatic stress disorder (PTSD), job burnout, empathy, or HCWs’ quality of life at various points in time, alongside a cost-effectiveness study comparing the two strategies.DiscussionViolence against HCWs is a global issue, and it can be particularly severe in humanitarian contexts. However, there is limited evidence on effective and affordable approaches to address this problem. Understanding the context of community distrust and motivation for violence against HCWs will be critical for developing effective, tailored, and culturally appropriate responses, including a training on violence de-escalation and a community behavioral change approach to increase public trust in HCWs. This study aims therefore to compare the effectiveness and cost-effectiveness of different interventions to reduce violence against HCWs in two post-crisis settings, providing valuable evidence for future efforts to address this issue.Trial registrationClinicalTrial.gov Identifier NCT05419687. Prospectively registered on June 15, 2022.

The short-term cost-effectiveness of once-weekly semaglutide versus once-weekly dulaglutide for the treatment of type 2 diabetes mellitus in Colombian adults.

Type 2 Diabetes Mellitus (T2DM) is a highly prevalent disease worldwide and in Colombia, representing one of the main causes of death and placing a considerable burden on healthcare systems. 13 classes of drugs are approved for the treatment of T2DM, with Glucagon-like Peptide-1 (GLP-1) receptor agonists being a first-line treatment option for patients with or at high risk of certain cardiovascular diseases and chronic kidney disease. The objective of this study is to conduct a short-term cost-effectiveness analysis of once-weekly semaglutide versus once-weekly dulaglutide in Colombian adults with T2DM, from a third-party payer perspective. Numbers needed to treat were calculated for different single and composite endpoints of the SUSTAIN 7 trial, annual costs for once weekly semaglutide 1.0 mg and dulaglutide 1.5 mg were extracted from the public SISMED database. With these inputs a cost of control model was developed, to obtain the annual cost of bringing one T2DM patient to relevant clinical outcomes by using semaglutide or dulaglutide. Semaglutide was considered cost-effective compared to dulaglutide across all pre-specified endpoints, even in the different scenarios evaluated in the sensitivity analyses, and in a particularly pronounced manner for weight loss outcomes. Semaglutide at a dose of 1.0 mg once-weekly was cost-effective compared to dulaglutide 1.5 mg across all outcomes in the short-term, making it an appropriate first-line choice in the treatment of T2DM when deciding between these two GLP-1 receptor agonists. This is the first short-term cost-effectiveness study of semaglutide and dulaglutide in T2DM Colombian patients. Our modeled results suggest that once-weekly semaglutide represents a cost-effective option for treating individuals with T2DM in Colombia who are not achieving glycaemia control with metformin, and it would be expected to improve HbA1C, promote greater weight loss and reduce costs from a third-payer perspective compared with treatment with dulaglutide.

Critical care delivery across health care systems in low-income and low-middle-income country settings: A systematic review.

Prior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from critical illness than high-income countries (HICs). There is a pressing need for improved critical care delivery in LLMICs to reduce this inequity. This systematic review aimed to characterise the range of critical care interventions and services delivered within LLMIC health care systems as reported in the literature. A search strategy using terms related to critical care in LLMICs was implemented in multiple databases. We included English language articles with human subjects describing at least one critical care intervention or service in an LLMIC setting published between 1 January 2008 and 1 January 2020. A total of 1620 studies met the inclusion criteria. Among the included studies, 45% of studies reported on pediatric patients, 43% on adults, 23% on infants, 8.9% on geriatric patients and 4.2% on maternal patients. Most of the care described (94%) was delivered in-hospital, with the remainder (6.2%) taking place in out-of-hospital care settings. Overall, 49% of critical care described was delivered outside of a designated intensive care unit. Specialist physicians delivered critical care in 60% of the included studies. Additional critical care was delivered by general physicians (40%), as well as specialist physician trainees (22%), pharmacists (16%), advanced nursing or midlevel practitioners (8.9%), ambulance providers (3.3%) and respiratory therapists (3.1%). This review represents a comprehensive synthesis of critical care delivery in LLMIC settings. Approximately 50% of critical care interventions and services were delivered outside of a designated intensive care unit. Specialist physicians were the most common health care professionals involved in care delivery in the included studies, however generalist physicians were commonly reported to provide critical care interventions and services. This study additionally characterised the quality of the published evidence guiding critical care practice in LLMICs, demonstrating a paucity of interventional and cost-effectiveness studies. Future research is needed to understand better how to optimise critical care interventions, services, care delivery and costs in these settings. PROSPERO CRD42019146802.

Expert Opinion on Addressing the Gap in Injection Technique and Needle Reuse for People with Diabetes in Indonesia.

The use of insulin for patients with diabetes mellitus in Indonesia appears to be under expectation; moreover, there are gaps in knowledge regarding the proper injection technique and pen needle reuse by both healthcare professionals (HCPs) and patients. To address these issues, a scientific expert meeting was held with the participation of endocrinologists and public health specialist from many different organizations in Indonesia to identify the challenges and problem related to injection technique, high pen needle reuse rate, and the need of all stakeholders. The experts agreed that it is necessary to ensure physicians to start the initiation phase as early as indicated, continue optimizing its dosage to reach targeted blood sugar based on guideline, and involve all relevant stakeholders to improve insulin distribution and patient access in every primary care facility in order to optimize the use of insulin or other injectable diabetes medications in Indonesia. Additionally, the experts believed that education on proper injection technique and improved reuse rate of pen needle is necessary. To date, Indonesian Diabetes Educators Association (IDEA/PEDI) has established guideline on injection technique. There are also recommendations on injection technique and needle reuse from Indonesian Society of Endocrinology (PERKENI) and Forum for Injection Technique & Therapy: Expert Recommendations (FITTER); however, this guideline/recommendation should be disseminated more widely among HCPs. In addition, cost-effectiveness studies based on local data are needed to propose and convince the Payors and other stakeholders. This article can be used as a guidance for HCPs and policymakers to improve current practice on injection technique, pen needle reuse, needle prescription and reimbursement policy in Indonesia and elsewhere.

Enabling Adherence to Treatment (EAT): a pilot study of a combination intervention to improve HIV treatment outcomes among street-connected individuals in western Kenya

BackgroundStreet-connected individuals (SCI) in Kenya experience barriers to accessing HIV care. This pilot study provides proof-of-concept for Enabling Adherence to Treatment (EAT), a combination intervention providing modified directly observed therapy (mDOT), daily meals, and peer navigation services to SCI living with HIV or requiring therapy for other conditions (e.g. tuberculosis). The goal of the EAT intervention was to improve engagement in HIV care and viral suppression among SCI living with HIV in an urban setting in Kenya.MethodsThis pilot study used a single group, pre/post-test design, and enrolled a convenience sample of self-identified SCI of any age. Participants were able to access free hot meals, peer navigation services, and mDOT 6 days per week. We carried out descriptive statistics to characterize participants’ engagement in EAT and HIV treatment outcomes. We used McNemar’s chi-square test to calculate unadjusted differences in HIV outcomes pre- and post-intervention among participants enrolled in HIV care prior to EAT. We compared unadjusted time to initiation of antiretroviral therapy (ART) and first episode of viral load (VL) suppression among participants enrolled in HIV care prior to EAT vs. concurrently with EAT using the Wilcoxon rank sum test. Statistical significance was defined as p < 0.05. We calculated total, fixed, and variable costs of the intervention.ResultsBetween July 2018 and February 2020, EAT enrolled 87 participants: 46 (53%) female and 75 (86%) living with HIV. At baseline, 60 out of 75 participants living with HIV (80%) had previously enrolled in HIV care. Out of 60, 56 (93%) had initiated ART, 44 (73%) were active in care, and 25 (42%) were virally suppressed (VL < 1000 copies/mL) at their last VL measure in the 19 months before EAT. After 19 months of follow-up, all 75 participants living with HIV had enrolled in HIV care and initiated ART, 65 (87%) were active in care, and 44 (59%) were virally suppressed at their last VL measure. Among the participants who were enrolled in HIV care before EAT, there was a significant increase in the proportion who were active in HIV care and virally suppressed at their last VL measure during EAT enrollment compared to before EAT enrollment. Participants who enrolled in HIV care concurrently with EAT had a significantly shorter time to initiation of ART and first episode of viral suppression compared to participants who enrolled in HIV care prior to EAT. The total cost of the intervention over 19 months was USD $57,448.64. Fixed costs were USD $3623.04 and variable costs were USD $63.75/month/participant.ConclusionsThis pilot study provided proof of concept that EAT, a combination intervention providing mDOT, food, and peer navigation services, was feasible to implement and may support engagement in HIV care and achievement of viral suppression among SCI living with HIV in an urban setting in Kenya. Future work should focus on controlled trials of EAT, assessments of feasibility in other contexts, and cost-effectiveness studies.

The cost-effectiveness of tranexamic acid for preventing blood transfusions following reverse total shoulder arthroplasty: a break-even analysis

BackgroundThe administration of tranexamic acid (TXA) in patients undergoing shoulder arthroplasty is a safe and effective means of reducing blood loss and blood transfusions. Due to its low cost and ability to prevent costly complications, TXA’s use is thought to be a cost-saving practice. The purpose of this study was to determine the cost-effectiveness of TXA in preventing blood transfusions in patients undergoing reverse shoulder arthroplasty (RSA). MethodsThe cost of TXA ($5.22) and the cost of a blood transfusion ($299.31) from our institution, as well as baseline published blood transfusion rates following RSA (14.3%) without the administration of TXA, were included in a break-even model to calculate the absolute risk reduction (ARR) that the routine use of TXA would need to be considered economically justifiable. To account for variance in baseline transfusion rates, the cost of TXA, and the cost of blood transfusion across institutions, sensitivity analyses were conducted in which the break-even transfusion rate and ARR were calculated across a wide range for each variable. ResultsTXA is deemed cost-effective if it prevents one blood transfusion out of 57 RSAs (ARR = 1.74%). It is economically viable at varying drug costs ($1-$25), blood transfusion costs ($50-$5000), and baseline transfusion rates (2.00%-50.00%). ConclusionUsing the cost parameters at a single institution, the current study found that TXA would be cost-effective in preventing blood transfusion if its routine use achieves an ARR greater than 1.74% following RSA. As the ARR has been demonstrated in the literature to be greater than 1.74%, TXA can be considered cost-effective in preventing blood transfusion following RSA.

Predictive value of lung function measures for cardiovascular risk: a large prospective cohort study

IntroductionAlthough lung function measures are associated with cardiovascular disease (CVD), the added predictive values of these measures remain unclear.MethodsFrom the UK Biobank, 308 415 participants free of CVD with spirometry...

Quantifying Drug Wastage and Economic Loss of Chemotherapy Drugs at an Adult Oncology Care of a Tertiary Care Public Hospital in India.

Background and objective New drugs have revolutionized cancer care, but their high cost requires cost-effectiveness studies. However, these studies only consider optimal use, neglecting real-world wastage. We aim to assess chemotherapy drug wastage and financial loss in our adult oncology care. Methods A total of 100 adult patients attending daycare oncology were prospectively evaluated. The total dose of parenteral anticancer drug, the amount administered, and the amount of drug wasted were recorded for each patient. The economic loss estimation was done considering the unit cost for the drug. Results Our study evaluated 157 parenteral drug administrations of 10 different anticancer drugs in 100 enrolled patients. The most common diagnosis was breast cancer (39/100; 39%), and the most commonly prescribed drugs were paclitaxel (36/157; 23%) and cyclophosphamide (21/157; 13%). However, the wastage percentage varied from 6% to 35.06%, and the overall wastage estimated was 16,298 mg (20.06%) of the total drug procured. Notably, the highest proportion of drug wastage was observed for carboplatin (2,525/7200 mg; 35.06%), whereas oxaliplatin, gemcitabine, 5-FU, and cisplatin wastage were more than 20% of the ordered drug. The total cost of the chemotherapy drug procured was 7,26,005 INR (8,738.78 USD), and drug wastage amounted to 17.14% of the total drug cost, resulting in an economic loss of 1,24,485 INR (1,498.40 USD). Gemcitabine (542.86 USD), oxaliplatin (452.66 USD), and paclitaxel (286.15 USD) were responsible for the maximum cost of wastage. Conclusion Drug wastage and financial loss are significant for carboplatin, oxaliplatin, and gemcitabine, with small proportions of paclitaxel also contributing to economic loss. Possible solutions include planning pharmacy inventory for multiple vial sizes and drug-wise batching strategies to facilitate vial sharing. However, these approaches may present challenges. The pharmaceutical industry can consider initiatives such as providing varying packaging sizes to minimize drug wastage.

A Bayesian change-point detection approach to the economic evaluation of risky projects: an application to healthcare technology assessment

Abstract We propose a Bayesian hypothesis testing framework that allows for the assessment of evidence collected during a clinical trial about the cost-effectiveness of a healthcare technology. The model exploits a Bayesian updating rule that makes the link between the evidence collected in clinical research and the expected payoffs of adoption to the healthcare system. The framework takes into account the cost of decision errors in the payoff function, allowing the decision maker to compute the cost of taking a decision when evidence is far from the optimal decision triggers. We show, using a real-world cost-effectiveness study based on clinical trial evidence, how rules derived from a sequential adaptive design approach can lead to quicker decisions when compared to the value of information decision framework. Our application shows that a sequential approach has the potential to lead to quicker decisions, higher payoffs, and better health outcomes.

Cost-effectiveness study of septic tank management in rural communities

Cost-effectiveness study of septic tank management in rural communities

High-Efficiency Particulate Air Filters for Preventing Wildfire-related Asthma Complications: A Cost-Effectiveness Study.

Rationale: Air pollution caused by wildfire smoke is linked to adverse health outcomes, especially for people living with asthma. Objectives: To evaluate whether government rebates for high-efficiency particulate air (HEPA) filters, which reduce concentrations of smoke particles indoors, are cost effective in managing asthma and preventing exacerbations in British Columbia (BC), Canada. Methods: We used a Markov model to analyze health states for asthma control, exacerbation severity, and death over a retrospective time horizon of 5 years (2018-2022). Concentrations of wildfire smoke-derived particulate matter with an aerodynamic diameter ⩽2.5 μm (PM2.5) from the Canadian Optimized Statistical Smoke Exposure Model and relevant literature informed the model. The base-case analysis assumed continuous use of a HEPA filter. Costs and quality-adjusted life-years (QALYs) resulting from varying rebates were computed for each Health Service Delivery Area (HSDA). Measurements and Main Results: In the base-case analysis, HEPA filter use resulted in increased costs of $83.34 (SE, $1.03) and increased QALYs of 0.0011 (SE, 0.0001) per person. The average incremental cost-effectiveness ratio among BC HSDAs was $74,652/QALY (SE, $3,517), with incremental cost-effectiveness ratios ranging from $40,509 to $89,206 per QALY in HSDAs. Across the province, the intervention was projected to prevent 4,418 exacerbations requiring systemic corticosteroids, 643 emergency department visits, and 425 hospitalizations during the 5-year time horizon. A full rebate was cost effective in 1 of the 16 HSDAs across BC. The probability of cost-effectiveness ranged from 0.1% to 74.8% across HSDAs. A $100 rebate was cost effective in most HSDAs. Conclusions: The cost-effectiveness of HEPA filters in managing wildfire smoke-related asthma issues in BC varies by region. Government rebates up to two-thirds of the filter cost are generally cost effective, with a full rebate being cost effective only in Kootenay Boundary.

Clinical efficacy of robotic spine surgery: an updated systematic review of 20 randomized controlled trials

Purpose To determine whether using robots in spine surgery results in more clinical advantages and fewer adverse consequences. Methods Between October 1990 and October 2022, a computer-based search was conducted through the databases of PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, China Biology Medicine, VIP databases, and WAN FANG. The study only included randomized controlled trials (RCTs) comparing the clinical efficacy and safety of robot-assisted surgery with those of conventional spine surgery. The review was conducted following PRISMA 2020, and AMSTAR-2 was used to evaluate the methodological quality. R version 4.2.1 was used in the meta-analysis. The Cochrane Collaboration Tool was used for evaluating the risk of bias. Results This study analyzed 954 participants from 20 RCTs involving cervical spondylosis, lumbar degenerative disease, scoliosis, etc. The robot-assisted group outperformed the freehand group in terms of intraoperative blood loss, number of screws in grade A position, grade A + B position, radiation dose, and hospital stay. Operation duration, visual analog scale scores of low back pain, Oswestry disability index, and radiation exposure time did not significantly differ between the two groups. Conclusions Although robotic spine surgery is more accurate in pedicle screw placement than conventional methods, the robot group did not demonstrate an advantage in terms of clinical efficacy. Studies of complications and cost-effectiveness are still very rare.

«Mind the gap». Fundamentos de economía de la salud para una comunicación efectiva entre clínicos y gestores sanitarios

Health Economics is an unfriendly topic for most clinical cardiologists. However, if we want to bridge the gap between patients and healthcare management, it is essential that decisions regarding new drugs, procedures, and technologies involve clinical professionals. Our unique position allows us to provide valuable insights and expertise in our fields and bring added value for decision making in the health system as a whole. Equipping clinical cardiologists with basic knowledge and tools in Health Economics and Economic Evaluation (such as cost-effectiveness or cost-utility studies) is crucial to develop studies that accurately reflect the clinical impact of diseases, both for patients and the healthcare system. By getting involved, clinicians can play a vital role in shaping the future of healthcare systems and influencing the allocation of (usually scarce) resources to ensure optimal care for our patients.

Peer support for discharge from inpatient to community mental health care: the ENRICH research programme

Peer support for discharge from inpatient to community mental health care: the ENRICH research programme

Disease modifying therapies in multiple sclerosis: cost-effectiveness systematic review

ObjectiveTo identify and describe cost-effectiveness studies that evaluate disease modifying therapies in the context of relapsing-remitting multiple sclerosis. MethodA systematic review of the literature was carried out by searching MEDLINE, Embase, the Cochrane Library, LILACS, the Tufts Medical Center Cost-Effectiveness Analysis Registry, the National Health Service Economic Evaluation Database and Open Grey. The search was performed in January 2018 and covered articles published between January 2010 and December 2017 The studies reviewed were payer-perspective cost-effectiveness analyses for interferon beta-1a, interferon beta-1b, glatiramer acetate, teriflunomide, fingolimod, dimethyl fumarate, natalizumab, alemtuzumab and rituximab. The Quality of Health Economic Studies instrument was used to determine the quality of the studies reviewed. Risk of bias was assessed without a standardized tool. An analysis was made of direct costs, quality-adjusted life-years and the incremental cost-effectiveness ratio. Data extraction and evaluation of information were conducted separately by each author. ResultsFour hundred one references were found; nine studies were included. A great degree of variability was identified for several methodological aspects. Two studies that applied the incremental cost-effectiveness ratio (cost) showed no first-line therapy to be cost-effective. A third study demonstrated dominance of interferon beta-1 b over placebo (USD –315,109.45) and a fourth paper showed dominance of teriflunomide over interferons and glatiramer acetate (USD –121,840.37). As regards second-line therapies, dimethyl fumarate was cost-effective in a study that compared it to glatiramer acetate and interferon beta-1a and it was dominant in another study that compared it with glatiramer acetate (USD –158,89793) and fingolimod (USD –92,988.97). In the third line of treatment, one study showed natalizumab to be cost-effective as compared with fingolimod, and another study showed alemtuzumab to be dominant over fingolimod (USD –49,221). A third trial demonstrated alemtuzumab to be dominant over natalizumab (USD –1,656,266.07). Many of the trials have sponsorship bias. Eight of the trials received a high QHES score. ConclusionsThe present paper shows that cost-effectiveness studies have high levels of methodological variability, some of them reaching contradictory results. As a result, it is not possible to determine which disease-modifying therapy is really cost-effective in the context of relapsing-remitting multiple sclerosis.

Cost-effectiveness study of closed system transfer devices for the preparation of antineoplastic agents

Most cytostatic drugs cannot be administered directly to patients in their marketed presentation, but require previous reconstitution conducted in the Pharmacy Unit areas for cytostatic preparation.There are systems that allow drug reconstitution and transfer once it has been diluted, in order to protect staff from any potential contamination during handling. These are commonly known as Closed Systems, and generally have a piece for vial attachment and a syringe adapter with a built-in filter, that replace the traditional needles. Closed systems feature different characteristics and costs which is necessary to analyze in order to determine the most efficient one.

Cost-effectiveness study of closed system transfer devices for the preparation of antineoplastic agents

Most cytostatic drugs cannot be administered directly to patients in their marketed presentation, but require previous reconstitution conducted in the Pharmacy Unit areas for cytostatic preparation.There are systems that allow drug reconstitution and transfer once it has been diluted, in order to protect staff from any potential contamination during handling. These are commonly known as Closed Systems, and generally have a piece for vial attachment and a syringe adapter with a built-in filter, that replace the traditional needles. Closed systems feature different characteristics and costs which is necessary to analyze in order to determine the most efficient one.

Trends in medical care utilization in patients with cancer: An analysis of real-world data in a tertiary hospital in Korea, 2014-2019.

Rising costs of cancer treatments challenge even areas with universal health coverage. There's a need to assess current medical care utilization trends among patients with cancer to guide public health policy, resource allocation, and set informed healthcare goals. We analyzed the latest trends in medical care utilization by cancer patients in four areas-drugs, radiation therapy (RT), surgery, and diagnostic procedures-using clinical databases extracted from electronic medical records of a tertiary hospital in Korea between 2014 and 2019. Compound adjusted growth rates (CAGR) were computed to capture the annual growth over the study period. A total of 74,285 cancer patients were identified, with 40.3% (29,962), 14.2% (10,577), 31.1% (23,066), and 92.6% (68,849) of patients having received at least one anticancer agent, RT, surgery, and diagnostic procedure, respectively, over the period. We observed a 1.7-fold increase in the use of targeted · immune-oncology agents (from 6.8% to 11.6%) and a 21-fold increase (from 3.0% in 2014 to 65.7%) in intensity-modulated RT (IMRT) use over the period. In contrast, we observed a continuous decrease in the proportion of patients who underwent surgical treatment from 12.2% in 2014 to 10.9% in 2019. This decrease was particularly noticeable in patients with colon cancer (from 28.5% to 24.2%) and liver cancer (from 4.1% to 2.9%). From 2014 to 2019, there was a significant rise in the use of targeted· immune-oncology agents and IMRT, alongside a decline in surgeries. While targeted · immune-oncology agents and IMRT may offer promising outcomes, their financial impact and potential for overuse necessitate careful oversight and long-term cost-effectiveness studies.

A quantitative assessment of the consistency of projections from five mathematical models of the HIV epidemic in South Africa: a model comparison study

BackgroundMathematical models are increasingly used to inform HIV policy and planning. Comparing estimates obtained using different mathematical models can test the robustness of estimates and highlight research gaps. As part of a larger project aiming to determine the optimal allocation of funding for HIV services, in this study we compare projections from five mathematical models of the HIV epidemic in South Africa: EMOD-HIV, Goals, HIV-Synthesis, Optima, and Thembisa.MethodsThe five modelling groups produced estimates of the total population, HIV incidence, HIV prevalence, proportion of people living with HIV who are diagnosed, ART coverage, proportion of those on ART who are virally suppressed, AIDS-related deaths, total deaths, and the proportion of adult males who are circumcised. Estimates were made under a “status quo” scenario for the period 1990 to 2040. For each output variable we assessed the consistency of model estimates by calculating the coefficient of variation and examining the trend over time.ResultsFor most outputs there was significant inter-model variability between 1990 and 2005, when limited data was available for calibration, good consistency from 2005 to 2025, and increasing variability towards the end of the projection period. Estimates of HIV incidence, deaths in people living with HIV, and total deaths displayed the largest long-term variability, with standard deviations between 35 and 65% of the cross-model means. Despite this variability, all models predicted a gradual decline in HIV incidence in the long-term. Projections related to the UNAIDS 95–95-95 targets were more consistent, with the coefficients of variation below 0.1 for all groups except children.ConclusionsWhile models produced consistent estimates for several outputs, there are areas of variability that should be investigated. This is important if projections are to be used in subsequent cost-effectiveness studies.