Economic Evaluation Methods Research Articles

Cost minimization analysis of chronic kidney disease management: Evaluating economic strategies for early intervention and treatment optimization

Chronic kidney disease is a common global health condition characterized by progressive loss of kidney function and significant cost burden on the healthcare system worldwide. The disease often coexists with conditions such as diabetes and hypertension, further complicates its management and increasing associated costs. Effective economic management, particularly in the early stages of CKD, is crucial for reducing long-term healthcare expenses and improving patient outcomes. This review examines the utility of cost minimization analysis (CMA) as a strategic tool for evaluating economic options in CKD management. CMA is an economic evaluation method that compares the costs of different therapeutic interventions that have demonstrated equivalent clinical effectiveness, thereby aiding healthcare providers and policymakers in identifying the most cost-efficient options to optimize resource utilization. This review highlights the economic impact of CKD, focusing on the increasing costs linked to advanced disease management and the essential role of early diagnosis and intervention in reducing these costs and explores various cost-effective strategies for CKD management, including pharmacological treatments, lifestyle modifications, and patient education, to identify approaches that are both clinically and economically advantageous. Additionally, the broader implications of cost minimization for healthcare policy, clinical decision-making, and resource allocation are discussed for their significance in a resource-limited healthcare setting. Evidence indicates that prioritizing cost-effective CKD management through early intervention and preventive care can significantly lower healthcare expenditures, slow the disease progression, and enhance patient’s quality of life. By adopting such strategies, healthcare systems can achieve better clinical outcomes and ensure financial sustainability.

Assessing economic efficiency of driving behavior within traffic flow dynamics

The widespread adoption of electric vehicles has a positive impact on energy conservation and emission reduction, significantly contributing to sustainable development. This paper proposes an economic evaluation method for drivers’ driving behaviors based on actual operational data of pure electric vehicles. This method aims to eliminate the influence of traffic conditions on the evaluation results, ensuring that the outcomes solely reflect the economic efficiency level of drivers’ behaviors. Initially, short trips are identified and traffic conditions are classified and identified based on real vehicle data. A random forest identification model is established to recognize the traffic conditions of short trips in real-time. Subsequently, characteristic variables are selected and calculated. Pearson correlation analysis wand Spearman correlation analysis are utilized to identify variables strongly correlated with energy consumption and traffic conditions, which are then used as evaluation indicators. Finally, eco-scores are calculated using the energy consumption per unit mileage for short trip segments under different traffic conditions. A neural network model is established and trained between the evaluation indicators and eco-scores, enabling real-time evaluation of the economic efficiency of drivers’ driving behaviors. The evaluation method proposed in this paper can objectively assess the economic efficiency of driving behavior, facilitating drivers to improve their driving practices based on their evaluation results.

Economic Evaluations of Robotic-Assisted Surgery: Methods, Challenges and Opportunities.

The use of robotic-assisted surgery (RAS) is growing rapidly. However, economic evaluation of this technology is challenging. This study aims to identify and discuss the different economic evaluation methods which have been used to evaluate RAS. This scoping review systematically searched PubMed and Embase from 2015 to 2023. We included economic evaluation studies comparing RAS versus laparoscopic or open surgery. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to aid data extraction and was extended to cover additional features relevant to RAS, including learning curve, organisational impact, incremental innovation and dynamic pricing. A total of 50 economic evaluations of RAS were included. Cost-utility analysis (46%) was the most commonly applied economic evaluation method, followed by cost-consequence analysis (32%). The studies focused on the specialties of urology (42%), hepato-pancreato-biliary (20%), colorectal (14%) and gynaecology (6%). Distinctive features related to the assessment of RAS were under-addressed in economic evaluations. Only 40% of the included studies considered learning curve and organisational impact and less than 12% of the included studies reflected on incremental innovation and dynamic pricing. This review found that some studies have incorporated challenges specific to RAS in their evaluations. However, most studies still lack key aspects of importance. In particular, studies rarely considered the ability of RAS platforms to be shared across multiple specialities. Incorporating these distinctive features offers an opportunity for economic evaluation to provide decision-makers with a more realistic assessment of the cost-effectiveness of this technology and to ensure its optimal utilisation in clinical practice.

Thermo-economic and environmental analyses of supercritical carbon dioxide Brayton cycle for high temperature gas-cooled reactor

The supercritical carbon dioxide (sCO2) Brayton cycle demonstrates special advantages for the high temperature gas-cooled reactor (HTGR) delivered into commercial operation recently in China, with its high efficiency, compactness, flexibility, and safety compared to the conventional steam Rankine cycle. However, the large temperature rise of 500 °C for the HTGR brings new challenges for the design of sCO2 cycle. Here, we present the first study on the thermodynamic, economic, and environmental performance of the HTGR-sCO2 system using the energy, exergy, economic, and environmental (4E) evaluation method. The cascaded sCO2 cycle made up of two independent sCO2 cycles is proposed, which are arranged in series on the cold side of reactor heat exchanger. We show that the cascaded sCO2 cycle can utilize the heat absorption from HTGR effectively by optimizing the cycle configurations of top and bottom sub-cycles. The improved cascaded sCO2 cycle minimizes the exergy loss, and increases the thermal efficiency to 43.2% when compared to the steam Rankine cycle of HTGR demonstration power plant and the single recompression cycle. By balancing the fixed-capital investment cost with the net power, the levelized cost of electricity can be reduced to 0.0283$/kWh. The life-cycle GHG emission intensity of HTGR-sCO2 systems is about 6.5gCO2,eq/kWh, which is much smaller than that of coal-fired power plants, suggesting a great potential for decarbonization of the HTGR-sCO2 system. Our study may find implications for the advancement of the sCO2 Brayton cycle in next-generation nuclear power plant.

Low carbon operation and evaluation methods for integrated energy system counting EVs with whole life cycle considering demand response

The integrated energy system has gradually become an effective way of energy saving and emission reduction with the proposal of “dual carbon" target and the continuous promotion of low-carbon development. However, most of the existing studies on demand-side flexible loads only consider flexible power loads, and there are fewer studies on the controllability of thermal loads. This paper proposes a low-carbon and economic optimal scheduling model and evaluation method for integrated energy system considering demand-side response. With the goal of minimizing the total operating cost of the integrated energy system, and taking into account the transferable and curtailing characteristics of the electric and thermal flexible loads, we establish an optimal scheduling model of the integrated energy system considering the user-side flexible loads, and comprehensively evaluate the performance of the system in terms of economic performance, reliability, and environmental performance. The performance of the system is evaluated in terms of economic performance, reliability and environmental performance. The role of flexible loads in improving the economy of the combined supply system is investigated with examples, and the rationality and effectiveness of the study are verified through comparative analysis of different scenarios. The results show that the total cost of the system is reduced by 18.04 %, 9.1 %, 3.35 % and 7.03 % when carbon trading cost and demand-side flexible electric-heat load response are considered at the same time; and the total carbon emission of the system is reduced by 65.28 %, 20.63 %, 3.85 % and 18.03 %, respectively. Considering carbon trading costs and demand-side flexible electric and thermal load response can improve the reliability of the system. The overall reliability of the system is improved by 10 %, 15 %, 16.67 % and 20 % for the four scenarios, respectively.

Economic Evaluation of Conservation through Use of an Araucaria angustifolia Provenance and Progeny Test.

Araucaria angustifolia is a species known for its valuable wood and nuts, but it is threatened with extinction. The plantation of forests for genetic resource conservation is a complementary strategy designed to reduce the species' genetic variability loss. This study aimed to evaluate the technical and economic viability of A. angustifolia for genetic conservation through use. The analyzed provenance and progeny trial was established in 1982 in Itapeva, Brazil. It was structured using a compact family blocks design with 110 open-pollinated progenies from five natural populations, three replicates, ten plants per subplot, and 3.0 m × 2.0 m spacing. After 33 years, the trial was evaluated for total height, diameter at breast height, wood volume, and survival. The variance components and genetic parameter estimates were performed using Restricted Maximum Likelihood/Best Linear Unbiased Prediction methods (REML/BLUP) methods with the Selegen software (version 2014). The production and management scenarios were obtained using the SisAraucaria software (version 2003). Sensitivity analysis and economic parameter estimates were obtained through various economic evaluation methods using the Planin software (version 1995). In general, the genetic parameters indicated that the population has enough variability for both conservation and breeding purposes, suggesting technical viability for the establishment of a seed orchard. The economic parameters indicated that the commercialization of wood and araucaria nuts proved to be more profitable than wood production by itself. In conclusion, araucaria genetic conservation through use is a technically and economically viable ex situ conservation strategy.

The Knowledge and Application of Economics in Healthcare in a High-Income Country Today: The Case of Belgium.

Healthcare is a huge business sector in many countries, focusing on the social function of delivering quality health when people develop illness. The system is essentially financed by public funds based on the solidarity principle. With a large financial outlay, the sector must use economic evaluation methods to achieve better efficiency. The objective of our study was to evaluate and to understand how health economics is used today, taking Belgium as an example of a high-income country. The evaluation started with a historical view of healthcare development and ended with potential projections for its future. A literature review focused on country-specific evaluation reports to identify the health economic methods used, with a search for potential gaps. The first results indicated that Belgium in 2021 devoted 11% of its GDP, 17% of its total tax revenue, and 30% of the national Social Security Fund to health-related activities, totalizing EUR 55.5 billion spending. The main health economic method used was a cost-effectiveness analysis linked to budget impact, assigning reimbursable monetary values to new products becoming available. However, these evaluation methods only impacted at most 20% of the money circulating in healthcare. The remaining 80% was subject to financial regulations (70%) and budgeting (10%), which could use many other techniques of an economic analysis. The evaluation indicated two potentially important changes in health economic use in Belgium. One was an increased focus on budgeting with plans, time frames, and quantified treatment objectives on specific disease problems. Economic models with simulations are very supportive in those settings. The other was the application of constrained optimization methods, which may become the new standard of practice when switching from fee-for-service to pay-per-performance as promoted by value-based healthcare and value-based health management. This economic refocusing to a more constrained approach may help to keep the healthcare system sustainable and affordable in the face of the many future challenges including ageing, climate change, migration, pandemics, logistical limitations, and financial instability.

National Recommendations for Pharmacoeconomic Evaluations Reporting for Reimbursement and Procurement of New Pharmaceutical Applications in Egypt.

To improve resource allocation within our healthcare system, the Egyptian Authority for Unified Procurement, Medical Supply and the Management of Medical Technology (UPA) and Universal Health Insurance Authority (UHIA) established a joint economic evaluation process to support UHIA reimbursement decisions and UPA procurement decisions. The main objective of this study is to describe the developed national pharmacoeconomic guidelines in Egypt, especially for reimbursement and procurement for new pharmaceuticals. A focus group was formed as a national initiative activity by governmental authorities in Egypt. The aim of this focus group was to develop national pharmacoeconomic guidelines for the evaluation of innovative and high-budget pharmaceutical products. This group consisted of various stakeholders with experience in health economics, outcomes research, public health, and pharmacy practice. To develop our national pharmacoeconomic guidelines, three steps were taken. First, the focus group reviewed the European Network for Health Technology Assessment (EUnetHTA) methods for health economic evaluations for new pharmaceuticals as well as the Canadian Agency for Drugs and Technologies in Health (CADTH) guidelines and the Academy of Managed Care Pharmacy (AMCP) Format for Formulary Submissions. Second, the focus group used the EUnetHTA guideline as a reference and adapted it to our local context. The focus group added the value assessment component, using the CADTH and AMCP guidelines. Third, the focus group collected input and feedback from key stakeholders through a focus group by using the quasi-Delphi panel approach. The results of the focus group are a main structure of national pharmacoeconomic guidelines for the evaluation of innovative and high-budget pharmaceutical products, consisting of seven main topics. Economic evaluation is a core element of Health Technology Assessment, (HTA); therefore, the UHIA and UPA were encouraged to produce unified joint pharmacoeconomic guidelines for innovative products as an initial step in their commitment to implement the use of HTA in decision-making. This standardization of guidelines not only ensures transparency but also guarantees an accurate and transparent process to support evidence-based decision-making. These guidelines are expected to help decision-makers improve their process and attain better health outcomes for Egyptian patients.

The EQ-5D-3L valuation study for Bermuda: using an on-line EQ-VT protocol.

In many countries, methods of economic evaluation and Health Technology Assessment are used to inform healthcare resource allocation decisions. These approaches often require EQ-5D health outcomes measures. This study aimed to create an EQ-5D-3L value set for Bermuda from which EQ-5D-5L Crosswalk values could be obtained. Respondents in Bermuda were recruited locally. A team of Trinidad-based interviewers with prior EQ-5D-3L valuation experience conducted valuation interviews on-line using the EQ-VT protocol. Respondents completed composite time-trade off (cTTO) and discrete choice experiment (DCE) tasks. A hybrid model that included both the cTTO and DCE data was estimated. An EQ-5D-5L crosswalk value set was then created from the EQ-5D-3L index values. Coefficients in the resulting crosswalk model were compared with those of crosswalk and valuation studies from other countries. The valuation tasks were completed by a near-representative sample of 366 adult Bermuda citizens. Half of the respondents reported being in state 11111. The lowest EQ VAS and EQ-5D-3L index values were 20 and -0.120 respectively. The hybrid model produced all logically consistent and statistically significant coefficients that in turn produced index values that were very similar to those obtained in a preliminary model (MAD of 0.027). The on-line EQ-VT valuation study was successfully conducted in Bermuda and the values therein can now be used for economic analysis in Bermuda. The Bermuda values differed considerably from those of the other countries against which they were compared. Challenges were encountered with recruitment for an on-line survey in a small population.

Multihazard resilience and economic loss evaluation method for cable-stayed bridges under the combined effects of scour and earthquakes

Cable-stayed bridges (CSBs) commonly experience scour-induced foundation issues during their service life, impacting both structural seismic resilience and economic losses. Nonetheless, these aspects remain inadequately addressed in existing seismic codes. This paper presents a comprehensive probabilistic multihazard fragility, resilience, and economic loss evaluation method for CSBs influenced by scour and earthquakes. Numerical models with various scour depths considering epistemic uncertainties in loads, structural properties, and soil conditions are first established using the Latin-hypercube sampling (LHS) method. Incremental dynamic analyses (IDAs) are then conducted on these models in cases with near-fault and far-field bidirectional ground motions, yielding probabilistic multihazard demand models and component- and system-level multihazard fragility surfaces for diverse limit states. Subsequently, resilience and economic losses are comparatively evaluated by integrating damage probabilities with corresponding uncertain functional recovery functions. Eventually, a rapid bridge traffic capacity evaluation method based on the critical traffic capacity surface concept is devised to effectively assess CSB open patterns under various peak ground accelerations (PGAs), scour depths, and repair times. The numerical results show apparent shifts in the nonmonotonic seismic fragility, resilience, and economic loss of the case CSB due to scour effects, with the rates of change reaching 31.4 %, 34 %, and 24.8 %, respectively, associated with a critical scour depth of 12 m at IM = 0.8 g. The developed analysis framework provides a reference for the life-cycle design and maintenance of CSBs affected by multihazard scour and earthquakes.

Prescription drug, healthcare utilization, and lost earnings cost of behavioral interventions for fear of cancer recurrence in breast cancer survivors.

e24095 Background: Breast cancer survivors experience distress due to the fear of cancer recurrence. Acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) can treat the fear of cancer recurrence. However, no study has applied economic evaluation methods to estimate ACT and CBT behavioral intervention costs for breast cancer survivors. Methods: 384 adult stage I-IIIA breast cancer survivors with fear of cancer recurrence were randomly assigned to either the ACT (n = 128), CBT (n = 128), or enhanced usual care (EUC, n = 128) groups. Through micro-costing, we assessed the societal perspective cost of behavioral interventions using 2022 dollars. Per-capita drug costs, healthcare utilization, and lost productivity were calculated using participant survey data. Drug costs were estimated using Micromedex’s Red Book wholesale unit price. The 2022 Medicare Physician Fee Schedule for Indiana estimated healthcare utilization costs from outpatient, inpatient, and emergency visits. Lost productivity costs included work loss, productivity loss, and unpaid work loss, valued by Indiana's mean hourly wage. We assessed the cost differences between baseline (T1) and after the 6-week intervention period (T2). We evaluated between-group differences with Bonferroni's tests for each pairwise group comparison and within-group differences with a paired t-test at a p-value of < 0.05. Results: The mean total per-capita cost change from T1 to T2 in the ACT, CBT, and EUC groups was -$563, -$1622, and -$981, respectively (Table 1). This cost reduction stemmed from drug and healthcare utilization. There was no significant between-group difference in total cost at T1 or T2 and no significant between-group or within-group cost change from T1 to T2. Conclusions: Our cost estimates will be updated at 6 and 12 months of intervention and combined with changes in quality of life and mental health metrics to assess the cost-effectiveness of ACT and CBT for fear of breast cancer recurrence. Clinical trial information: NCT05364450 . [Table: see text]

Comparative Study on Economic Benefit Evaluation Methods for Power Transmission and Transformation Construction Projects Under DB Mode

By introducing and comparing the commonly used economic benefit evaluation methods for power transmission and transformation construction projects under the Design and Build(DB) mode, the paper investigates which method should be used for different purposes of economic benefit evaluation. On this basis, the advantages and disadvantages of these methods and their application conditions have been discussed in depth so as to provide useful references for the economic evaluation work.

РЕКОМЕНДАЦИИ ПО ОЦЕНКЕ ЭФФЕКТИВНОСТИ ИННОВАЦИОННЫХ ПРОЕКТОВ

Innovative projects involve a large amount of resources and time required to implement and achieve the required product parameters. Well-known methods of economic evaluation of the effectiveness of projects can provide an accurate analysis for the first few years, without taking into account all possible factors. Due to the importance of setting the effectiveness assessment as accurately as possible for the implementation of innovative projects, regardless of the duration, the methods currently used are insufficiently developed. The amount of resources required to create an innovative project can reach such levels of indicators, which will significantly affect the financial and economic performance of the enterprise. The proposed new method in the article, based on the calculation of the socio-physical potential of the project, takes into account both economic and non-economic factors, regardless of the duration of the project. Unlike other methods, it takes into account the parameters of the product being created, which allows you to get more correct estimates and ensure the correct allocation of resources during implementation. The method of using socio-physical potential allows us to find a new and more accurate approach to evaluating the effectiveness of innovative projects. The purpose of the study. The paper considers the issue of comparing the evaluation of the effectiveness of calculations using socio-physical potentials and existing approaches. It is stated that the effectiveness assessment should take into account diverse factors of a qualitative and quantitative nature. Based on the analysis of existing approaches, it is concluded that the reliability of the assessment is low. The inability to evaluate correctly leads to excessive costs that accompany the processes of product development and operation. Materials and methods. An efficiency assessment model based on the calculation of the socio-physical potential is presented. A model of the socio-physical potential is presented. The method of determining efficiency is described, the application of which is described in a comparative example of the analysis of the choice of the machine. Results. With the complexity of the implementation of innovative projects, the transition to assessment using socio-physical potential ensures a more efficient allocation of resources for project development. A method of using socio-physical potential for calculating the effectiveness of innovative projects was proposed and justified. Conclusion. In conclusion, it is concluded that in order to increase efficiency, it is necessary to carry out an assessment using the method of calculating socio-physical potentials, since the results are more accurate in comparison with known methods.

Cost-Effectiveness of the treatment protocols of pediatrics with Acute Lymphoblastic Leukemia (Decision tree modelling)

Background: Acute lymphoblastic leukemia (ALL) has a high prevalence at early age and in children and regard to life expectancy index this disease cause to losing many years of life in these patients. Two well-known European protocols called United Kingdom (UK-ALL) and Berlin-Frankfurt-Munster (BFM-ALL) protocols are used to treat the disease in most countries of the world and in Iran, so the objective of this study is modelling of the treatment process using both protocols to estimate more cost-effectiveness method. Methods: A decision tree model was applied to depict the real treatment process to calculate costs per quality-adjusted life-year (QALY). Total costs were included to the model. Results: The cost effectiveness ratio of UK-ALL is lower than BFM-ALL (1145.52 USD /3.87 QALY for UK-ALL and 1942.35 USD /3.02 QALY for BFM-ALL). Therefore, the UK-ALL is dominant and BFM-ALL is dominated. Conclusion: The modeling results showed a double difference between the two studied options so to better cancer management, policymakers and oncologist should advocate the economic evaluation methods and modeling to select a real option in the treatment of patients to save resources like UK-ALL.

Protocol for a trial-based economic evaluation analysis of a complex digital health intervention including a computerised decision support tool: the iFraP intervention

Background Digital health interventions (DHI) are associated with significant promise. In recent years, the need to assess the value of these healthcare technologies has motivated a debate regarding the suitability of existing economic evaluation methods in the context of DHI evaluation. Some have argued that robust economic evaluation methods may not be capable of capturing relevant DHI’s characteristics. Others consider that assessing the value of DHI might not be feasible. This protocol paper challenges that view. More specifically, it describes early Health Technology Assessments (HTA) methods to rigorously assess the value for money of a complex intervention including a digital decision support tool i.e., Improving uptake of Fracture Prevention drug treatments (iFraP) as a tracer intervention. iFraP is a complex intervention consisting of a computerised decision support tool, a clinician training package, and information resources to facilitate shared decision-making, increase informed medicine initiation and reduce levels of medicine discontinuation. iFraP’s development was motivated by a view that good quality shared decision-making conversations have the potential to improve levels of osteoporosis medicine uptake. Methods An early economic evaluation of the iFraP intervention was designed to identify, measure, and evaluate the costs and health benefits of iFraP compared to usual practice in Fracture Liaison Services (FLSs). A within-trial cost-effectiveness from the perspective of the National Health Service and Personal Social Service in England will be conducted using patient’s self-reported health related quality of life (HRQoL) and resource use from the iFraP randomised controlled trial. Microanalysis will be used to estimate iFraP’s intervention cost. Finally, Bayesian Value of Information analysis will allow us to estimate an upper bound for the potential health benefits gained from reducing uncertainty on the impact of the iFraP intervention to support uptake and adherence with osteoporosis medicines. Trial registration ISRCTN10606407 - https://doi.org/10.1186/ISRCTN10606407

Measuring national economic resilience through industrial portfolios

Even though the importance of economic resilience has increased as economic shocks have become more frequent in the world, there is still a knowledge gap on how to measure it. In search for effective ways to measure national resilience, this article identifies and mathematically proves the existence of direct correlation between resilience and competitiveness through time-specific global correlation rate. This research proposes an economic performance evaluation method that measures the competitiveness of countries facing economic shocks and recovering from them. A quantified method for identification of global economic shocks through industrial portfolio is proposed as well. The holistic approach internalises most externalities and a nation’s resilience is pared down to its ability to compete in the international trade, linking the main determinants of resilience to the basics of human behaviour. The proposed methodology can be used effectively for national and global economic performance estimations. It also opens a range of new possibilities for economic resilience studies.

A review on research and application of multi-energy complementary system containing high proportion of renewable energy based on different attributes

To better understand the latest development of renewable energy systems, recent studies on multi-energy complementary power systems with a high proportion of renewable energy are reviewed in this paper. The connection modes of power grids and economic system analysis are summarized and discussed respectively, putting forward some suggestions on the system design and operation optimization. Firstly, the characteristics and differences between an integrated system and an off-grid system are reviewed, concluding that an integrated system is more reliable and costeffective based on a few case studies. Secondly, the commonly used economic parameters and cost evaluation methods of the hybrid power system are reviewed. Those methods offer crucial tools to optimize the system, and they are able to analyze the system feasibility, enabling the most economical configuration. The results of several cases prove that the hybrid multi-energy system is more economical than the single-energy system. Finally, there are few articles focusing on technical details assessments and environmental impacts, which leaves room for future study.

The Limitations and Potentials of Evaluating Economic Aspects of Community-Based Health Promotion: A Critical Review.

Community-based health promotion (CBHP) interventions are promising approaches to address public health problems; however, their economic evaluation presents unique challenges. This review aims to explore the opportunities and limitations of evaluating economic aspects of CBHP, focusing on the assessment of intervention costs and outcomes, and the consideration of political-level changes and health equity. A systematic search of the PubMed, Web of Science and PsycInfo databases identified 24 CBHP interventions, the majority of which targeted disadvantaged communities. Only five interventions included a detailed cost/resource assessment. Outcomes at the operational level were mainly quantitative, related to sociodemographics and environment or health status, while outcomes at the political level were often qualitative, related to public policy, capacity building or networks/collaboration. The study highlights the limitations of traditional health economic evaluation methods in capturing the complexity of CBHP interventions. It proposes the use of cost-consequence analysis (CCA) as a more comprehensive approach, offering a flexible and multifaceted assessment of costs and outcomes. However, challenges remain in the measurement and valuation of outcomes, equity considerations, intersectoral costs and attribution of effects. While CCA is a promising starting point, further research and methodological advancements are needed to refine its application and improve decision making in CBHP.

The catastrophic cost of motorcycle road traffic injuries: Experience from a major reference centre in a lower-middle income country

BackgroundMotorcycle crashes are an increasing public health problem in low- and middle-income countries (LMICs). An accurate estimation of the economic burden of these crashes could be complex owing to a prevalent system of out-of-pocket (OOP) payment for health care services in these countries. Our study aims to objectively evaluate the cost implication of motorcycle Road Traffic Injuries (RTIs) among road crash victims managed at a major trauma reference hospital in Nigeria. Two economic evaluation methods were used to accurately reflect the cost-of-care (C-o-C) of each victim as well as for cross-validation. MethodThis is a prospective cohort study conducted between August 2020 and May 2021. All patients involved in motorcycle road traffic crashes presenting to the Emergency Department of the University College Hospital, Ibadan, Nigeria, were included in the study. For each patient, all medical expenses from the time of injury (T0) to 30 days after injury (T30) or Time to death (TD) – whichever occurred first, were valued in costs, and added (Activity-based costing or ABC), while also estimating overall cost-of-care (C-o-C) at T30 or TD, using the willingness-to-pay (WTP) method. Following the WHO definition, catastrophic expenditure was defined as expenditure > 25% of the patient's estimated annual household income. ResultsOf the 150 consecutively managed motorcycle crashes victims during the study period, 112 had complete data. The median monthly household income for the cohort was $121 with 75% of them earning less than $180. The median cost-of-care (C-o-C), by ABC, was $242 ($143 - 828). For individual care items, expenditure on surgical intervention(s) was the highest followed by prosthesis and implant procurement, and radiological investigations. On the other hand, the estimated medical cost was $2356 (IQR $938 - 6475) by WTP. Only 14% had health insurance coverage. The overall expenditure was catastrophic for 46% of the patients. Monthly household income of < $180 (AOR=9.2; 95% CI=2.6–32.8; p < 0.001), absence of health insurance coverage (AOR=10.7; 95% CI=1.1–101.6; p = 0.040), and prolonged hospital stay above 14 days (AOR=25.1; 95% CI=5.5 -115.1; p = 0.001) were predictors of catastrophic expenditure. There was a weak positive correlation between actual cost-of-care using the ABC method and WTP (r = 0.247; p = 0.102). ConclusionThe aggregate cost of motorcycle RTIs is catastrophic for nearly half of the victims attending the University College Hospital, Ibadan. The willingness-to-pay method, though less tedious is often less reliable in these settings owing to a prevalent OOP payment system. This study identified the need to implement effective financial protection mechanisms against the high OOP expenditure faced by motorcycle crash victims in LMICs.

Health economics in nursing research: what you need to know to include economic evaluation methodology in your research.

Due to limited resources and constant, ever-changing healthcare challenges, health economics is essential to support healthcare decisions while improving health outcomes. Economic evaluation methodology facilitates informed decision-making related to the efficient allocation of resources while positively impacting clinical practice. In this paper, we provide an overview of economic evaluation methods and a real-world example applying one method of economic evaluation (cost-utility analysis) in nursing research.