Incremental Cost Research Articles

Estimating the economic burden of mental and substance use disorders in Belgium

Abstract Mental and substance use disorders are the leading cause of disease burden (disability-adjusted life years, DALYs) in Belgium. Strong mental health policies are needed to reduce the burden, taking into account effectiveness and cost-effectiveness of possible interventions. Next to providing an overview of the economic burden of mental health conditions (what is), routine cost-of-illness studies also serve as a source of information for modelling the cost-effectiveness of policies and interventions to improve the mental health of populations (what could be). In the context of an extension of the Belgian Health Status Report and the Belgian National Burden of Disease Study, we calculated the direct medical costs of a range of health conditions, including mental health conditions such as depression. We used self-reported diagnostic data from the Belgian health Interview Survey linked with claims data to calculate the incremental costs attributable to mental health disorders with g-computation. We correct for confounders such as age and sex, and also look at uncertainty brought about by the data source and modelling. This presentation aims to share the experience of calculating the economic burden of mental ill-health in the context of a routine cost-of-illness study. We will present the results of the study and discuss alternative ways in which the costs of common mental health conditions such as depression could be estimated, for example based entirely on claims data using pharmaceutical cost groups.

Active surveillance for cardiac complications after major noncardiac surgery: implications on resource utilization and safety in high-risk patients

Abstract Background The 2022 ESC guidelines on cardiovascular assessment and management of patients undergoing noncardiac surgery recommend that high-risk patients should undergo active surveillance for cardiac complications, including perioperative myocardial infarction/injury (PMI), following major noncardiac surgery. Unfortunately, little is known about the resource use and safety of active surveillance compared to a control cohort (i.e. without active surveillance). Objective To quantify the impact of active surveillance for cardiac complications, by perioperative cardiac troponin (cTn) measurements and a systematic PMI work-up on working days, on resource usage and safety. Methods We did a retrospective comparison of non-randomised pre- vs post-implementation of an active surveillance program for cardiac complications in patients at elevated cardiovascular risk undergoing noncardiac surgery at two hospitals in Switzerland. The two cohorts' resource use and safety were compared. Resource use encompassed perioperative cTn measurements, ECGs, cardiac imaging, cardiology consultations as well as coronary angiography (CAG) and revascularisation procedures. Safety was assessed based on the number of "seemingly normal CAG" and complications arising from CAG and revascularisation procedures. Results A total of 13’147 patients, 10’346 in the active surveillance cohort and 2’805 in the standard-of-care (SOC) cohort, were eligible for this analysis. Patient characteristics between both cohorts were comparable (e.g. median age of 74 vs 73 and 44.8% vs 43% female, respectively). Patients in the active surveillance cohort underwent significantly more perioperative cTn measurements (86.4% vs 3.5%, respectively), postoperative ECGs (13.5% vs 5.7%), postoperative cardiac consultations (5.9% vs 2.4%), postoperative transthoracic echocardiogram (TTE) (7.5% vs 6.1%), postoperative myocardial perfusion imaging (MPI) (1.2% vs 0.6%), and postoperative CAG (0.8% vs 0.4%, all p <0.05). The increased resource use led to a substantial increase in detected cardiac complications within the first 48h after surgery: active surveillance 1’207 (12%) (95%CI 11%-12%) vs SOC 68 (2.4%) (95%CI 1.9%-3.1%). The active surveillance cohort generated an overall cardiac management cost of 236 Euros (95%CI 223–250) per patient vs 133 Euros (95%CI 110–160) per patient in the SOC cohort, resulting in an incremental cost for the active surveillance of 103 Euros (95%CI 110–160) per patient. Thereby the cost of detecting one additional cardiac complication within 48h was 989 Euros. Concerning safety, no significant differences in the number of "seemingly normal CAG" (6.4% vs 15%, p=0.1) and complications due to CAG and revascularisation (0.6% vs 5.1%, p=0.08) were observed. Conclusion The active surveillance for cardiac complications is safe when compared to a standard-of-care cohort while 989 Euros per additional detected cardiac complication seems reasonably priced.Resource-utilization tableOverview

Economic Burden of Treatment-Resistant Depression: Insights from Real-World Data

Background: Treatment-resistant depression (TRD) is a highly prevalent condition. It is generally referred to as the failure of at least two or more prior treatments with antidepressants or augmentation therapy with adequate dose and duration. TRD affects the individual's overall health and social life, in addition to the economic impact associated with the illness. Therefore, this review is focused on examining the financial burden of illness among patients with TRD across different countries and identifying the key drivers for the incremental costs and healthcare resource utilization (HRU). Methods: A literature search was carried out in the PubMed database using relevant MeSH terms. This review included relevant studies published between 2019 & 2024. Results: Overall, 22 studies were included in this review, with the majority based in the United States (n=15). The majority of the patients were females, ranging from 53.1% to 77%, and the mean age of patients with TRD ranged from 37.7±14.4 to 73.1±6.5 years. The mean annual all-cause healthcare cost per patient ranged from $3,190 to $40,040. The mean annual all-cause indirect costs per patient ranged from $4,199 to $6,342. Outpatient visits were the frequently utilized healthcare services, especially psychiatric visits and visits to general practitioners or family physicians. The incremental costs were primarily driven by worsening symptom severity, the presence of comorbidities, advancing age, and frequent visits to specialists. Conclusion: Regardless of the factors influencing the cost burden, TRD generally accounts for higher healthcare use and costs compared to individuals with major depressive disorder or without any mental illness. This underscores the need for fostering newer interventions and implementation of multidisciplinary approaches to lessen the cost burden of this condition, in addition to managing it effectively.

Estimating the Incremental Cost Per QALY Produced by the Spanish NHS: A Fixed-Effect Econometric Approach.

Knowing the health opportunity costs of funding decisions is crucial to assess whether the health gains associated with new interventions are larger than the health losses imposed by the displacement of resources. Empirical estimates based on the effect of health spending on health outcomes have been proposed in several countries, including Spain, as a proxy to capture these opportunity costs. However, there is a need to regularly update existing health opportunity cost estimates and to explore the role of omitted variable bias in these estimations. The aim of this paper is to provide an updated and refined estimate of the causal impact of health spending on health in Spain that can be translated into an estimate of the incremental cost per quality-adjusted life-year produced by the Spanish national health system. We applied fixed-effect models using data for 17 Spanish regions from 2002 until 2022 to estimate the impact of public health spending on health outcomes and explored the extent of omitted variable bias. Changes in these estimates over time were assessed and alternative specifications were tested. Based on fixed-effect models with control variables, the estimated spending elasticity was 0.061, which translated into an incremental cost per quality-adjusted life-year of approximately €34,000. The bias-corrected elasticity was 0.075, with a corresponding incremental cost per quality-adjusted life-year of €27,000. We found that the estimated impact of spending on health decreases when recent years of data are added, and that the extent of omitted variable bias appears to increase, particularly when adding the COVID-19 pandemic period. This study provides an updated estimation of the incremental cost per quality-adjusted life-year produced by the Spanish national health system. The estimates provided can be easily updatable as new data become accessible, and the methods applied might be transferable to other settings with similar available data.

Cost-effectiveness analysis of mindfulness-based cognitive therapy in patients with anxiety disorders in secondary mental health care settings alongside a randomized controlled trial

IntroductionAnxiety disorder is one of the most prevalent mental disorders. Mindfulness-based cognitive therapy (MBCT) is effective for treating anxiety disorders. However, no studies have investigated the cost-effectiveness of MBCT for anxiety disorders. We aimed to conduct a cost-effectiveness analysis alongside a randomized controlled trial (RCT) to clarify the cost-effectiveness of MBCT for anxiety disorders.MethodsA cost-effectiveness analysis alongside an RCT was conducted for 8 weeks in 40 patients with anxiety disorders at a university hospital. Patients (1) aged 20–75 years; (2) who were diagnosed with panic disorder/agoraphobia or social anxiety disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria; and (3) who provided written consent were analyzed. The participants were allocated randomly (1:1 ratio) to the augmented MBCT group (i.e., MBCT plus treatment as usual [TAU]) or TAU (waitlist control) group. The cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER), which is the ratio of the incremental costs divided by the incremental state-trait anxiety inventory- state (STAI-S), state-trait anxiety inventory- trait (STAI-T), and quality-adjusted life years (QALYs). The QALYs were estimated using The Japanese version of EuroQoL five-dimensional 3-level questionnaire. The unit cost data were derived from the government-regulated fees. This study was conducted from a public healthcare insurance perspective. No discount rates were considered.ResultsA total of 38 participants with complete data were included in the analysis. The MBCT was JPY 13,885 more than the cost of TAU and was associated with a STAI-S, STAI-T, and QALY increase of 10.13, 12.00, 0.009 respectively. The ICER were JPY 1,371 (USD13) per STAI-S, JPY 1,157 (USD 11) per STAI-T, and JPY 1,566,357 (USD 14,940) per QALY respectively. MBCT had an 77.5% probability of being cost-effective at a willingness to pay threshold in Japan (JPY 5,000,000 per QALY). The results of the four one-way sensitivity analyses supported the robustness of the base-case analysis findings.DiscussionAugmented MBCT for anxiety disorders is cost-effective compared with TAU post-treatment from a public healthcare insurance perspective. Future studies should include long-term observations, and analysis from a societal perspective.

Improving racial/ethnic health equity and naloxone access among people at risk for opioid overdose: A simulation modeling analysis of community-based naloxone distribution strategies in Massachusetts, United States.

During the COVID-19 pandemic, there was a surge in opioid overdose deaths (OODs) in Massachusetts, USA, particularly among Black and Hispanic/Latinx populations. Despite the increasing racial and ethnic disparities in OODs, there was no compensatory increase in naloxone distributed to these groups. We aimed to evaluate two community-based naloxone expansion strategies, with the objective of identifying approaches that could mitigate mortality and racial and ethnic disparities in OODs. Individual-based simulation model. We measured naloxone availability using naloxone kits per OOD and evaluated scenarios of achieving higher benchmarks for naloxone availability (i.e. 40, 60 and 80 kits per OOD) from 2022 levels (overall: 26.0, White: 28.8, Black: 17.3, Hispanic/Latinx: 18.9). We compared two naloxone distribution strategies: (1) proportional distribution: achieving the benchmark ratio at the overall population level while distributing additional kits proportional to the 2022 level for each racial/ethnic group (at 40 kits per OOD benchmark: overall: 40, White: 44.3, Black: 26.6, Hispanic/Latinx: 29.1), and (2) equity-focused distribution: achieving the benchmark ratio among each racial/ethnic group (at 40 kits per OOD benchmark: 40 for all groups). Massachusetts, United States. People at risk of OOD. Annual number and rate of OODs, total healthcare costs of increasing naloxone availability. Both naloxone distribution strategies yielded comparable predicted reductions in total OODs in 2025 and incurred similar incremental costs. However, the relative reduction in the rate of OODs differed across groups. For achieving an 80 kits per OOD benchmark, proportional distribution resulted in a projected 6.7%, 6.5% and 7.1% reduction in annual OODs in 2025 among White, Black and Hispanic/Latinx populations, respectively. In contrast, equity-focused distribution achieved a reduction of 5.7%, 11.3% and 10.2% in the respective groups. In all scenarios, the cost per OOD averted was lower than the generally accepted thresholds for cost per life saved. An equity-focused naloxone distribution strategy designed to reduce racial and ethnic disparities in naloxone availability could improve health equity among racial and ethnic groups while potentially improving overall population health at lower healthcare costs per opioid overdose death averted than a proportional distribution strategy.

Rationale and design of Healthy Kids Beyond the Bell: a 2x2 full factorial study evaluating the impact of summer and after-school programming on children’s body mass index and health behaviors

BackgroundThe Structured Days Hypothesis posits that structure protects children against obesogenic behaviors (e.g., physical inactivity, unhealthy dietary intake) and, ultimately, prevents the occurrence of excessive weight gain. The hours following school (i.e., 3–6 pm school days) and summer vacation are two “windows of vulnerability” when children may experience less structure. Programs that provide a healthy structured environment and may prevent BMI gain exist for both time periods (i.e., after-school programs and summer day camps). Unfortunately, these programs are cost prohibitive for children from low-income families to attend. This study will test the impact of providing vouchers to access existing, community-operated after-school and summer programs on BMI z-score, body composition, and obesogenic behaviors (i.e., physical activity, screen use, diet, and sleep) of children (5–12 years) from schools that primarily serve families with low income.MethodsThe study will employ a 2x2 factorial design. Participants (N = 480) attending 4 elementary schools in one school district will be randomly assigned to a no treatment control, after-school program voucher only, summer day camp voucher only, or after-school and summer day camp vouchers. Vouchers will cover the full cost of attending a pre-existing community-based after-school or summer camp program. The primary outcome (BMI z-score) will be measured at baseline (before end of school year, ~ May), 3-month follow-up (after summer, ~ August), and 12-month follow-up (end the following school year, ~ May). Secondary outcomes include body composition (i.e., whole-body fat mass, fat free mass, and percent body fat) and obesogenic behaviors (i.e., physical activity, sedentary time, sleep, screen-time, and diet). The study will also employ a rigorous process evaluation which will consider after-school and summer camp program attendance and content. Analyses will examine differences between the four groups in BMI z-score, body composition, and obesogenic behaviors. Incremental cost effectiveness ratios will determine the cost effectiveness of the intervention.DiscussionThe current study will provide critical information for researchers, practitioners, and policy makers seeking to combat the childhood obesity epidemic in children from families with low-income during the school year and summer.Trial registrationNCT05880901. Registered 27 May 2023.

Cost-Effectiveness Analysis Comparing Conventional and Digital Software Supported Management for Hypothyroidism.

Wearable devices can now leverage the established correlation between thyroid function and heart rate to monitor thyroid function alongside exercise levels and heart rate. The objective was to assess the cost-effectiveness of introducing a wearable/mobile-based thyroid function digital monitoring solution for the management of hypothyroidism compared to the conventional management approach. A decision-analytic Markov state-transition simulation model employed for utilizing a simulated cohort of 10,000 40-year-old patients with hypothyroidism to estimate costs and health outcomes. Cost-effectiveness from the healthcare sector perspective was evaluated using a 4.5% annual discount rate and the costs adjusted to 2022 levels, and lifetime outcomes were presented through incremental cost-effectiveness 49 ratios (ICERs). Deterministic and probabilistic sensitivity analyses evaluated the robustness of the results. The digital monitoring solution supported group yielded an additional 0.65 QALYs with an incremental cost of $11700.87, resulting in an ICER value of $17988.97 per QALY gained. Digital-powered software could be an optimal strategy in 99% of iterations against willingness-to-pay thresholds of $32,255/QALY gained. The ICER was most sensitive to the annual cost of a digital monitoring solution for hypothyroidism. The incorporation of the digital monitoring solution has demonstrated positive cost-effectiveness in hypothyroidism management when compared to the standard care. The cost of the digital monitoring solution and its sensitivity are key factors in determining cost-effectiveness. Striking a balance among the cost of digital monitoring support, the precision of hormonal level monitoring, and its effectiveness for the specific group of hypothyroid patients in real-world clinical practice is essential.

Universal Health Coverage of Opioid Agonist Treatment in Norway: An Equity-Adjusted Economic Evaluation.

Detailed information on the efficiency of health services targeting opioid use disorder (OUD) and treatment with opioid agonist treatment (OAT) is sparse. Many countries, including Norway, are still falling short of universal health coverage (UHC) of OAT. This study aims to evaluate the incremental lifetime costs and effects of treating OUD with OAT as compared to no OAT in Norway and scaling up the treatment to a universal coverage level using equity-adjusted health economic evaluations. We conducted cost-utility and budget impact analyses and constructed a two-state Markov model to compare the lifetime costs and outcomes among patients with OUD with and without OAT. Model inputs were derived from routine health information systems and the literature, with costs reported in 2023 Norwegian Kroner (NOK). The analyses were conducted from a Norwegian extended health-service and societal perspectives, with a lifetime time horizon. Quality-adjusted life years (QALYs) was the metric of health benefits. Outcomes were reported as incremental cost-effectiveness ratios (ICERs). The willingness-to-pay (WTP) threshold was equity-adjusted according to the future prognostic healthy life year loss method in Norway (severity of disease criterion), which is sensitive to the size of future undiscounted healthy life year loss due to the affected conditions. The WTP threshold is NOK 825,000 per QALY gained in Norwegian policy for conditions with undiscounted future QALY loss > 20. Uncertainty in the parameters and robustness of the results were assessed with one-way and probabilistic sensitivity analyses and scenario analyses. The mean results from probabilistic sensitivity analysis estimated that OAT was associated with 3.03 additional discounted QALYs gain and incremental lifetime discounted cost of NOK 1.45 million, leading to an ICER of NOK 479,099 per QALY gained when compared with not providing OAT, with the extended health-service perspective. From a societal perspective, OAT was cost-saving, i.e. OAT produced greater health benefits while resulting in lower overall societal costs compared to no OAT. The mean undiscounted future health loss was estimated to be 21.34 QALYs for the Norwegian patient group with OUD. A total 5-year budget increase of NOK 1.208 billion was estimated if OAT was going to be scaled up from the current coverage level of 70% to UHC. Compared with the current coverage, 100% coverage of OAT was associated with an additional lifetime cost of NOK 4.332 billion but also an additional 6760 QALYs gained. Our analysis suggests that OAT is cost-effective in Norway and has the potential to be cost-saving from a societal perspective. Therefore, Norwegian policy should consider scaling up treatment to extend the coverage of OAT.

Cost-effectiveness analysis of Tumor Treating Fields treatment in Chinese patients with metastatic non-small cell lung cancer.

The LUNAR trial demonstrated the significant efficacy and safety of Tumor Treating Fields (TTFields) plus standard-of-care (SOC) [immune checkpoint inhibitor (ICI) and docetaxel (DTX)] for patients with previously treated metastatic non-small cell lung cancer (mNSCLC). However, it remains uncertain as to whether the high costs are justified by the corresponding survival benefits. Here, the cost-effectiveness of using TTFields plus SOC for treating mNSCLC was evaluated from the perspective of the Chinese healthcare system. A Markov model with a 15-year time horizon was established and used to comparedeveloped to enable the simulation of treatment-associated costs and patient outcomes when comparing TTFields plus SOC to SOC alone. Primary outcomes for these analyses included total costs, life-years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratio (ICER) values. The impact of paramere uncertainty on model outcomes was evaluated through sensitivity analyses. Additional subgroup and scenario analyses were also performed to extend these results. While TTFields plus SOC exhibited a $74,688 increase in total costs relative to SOC ($96,092 vs. $21,404), it was associated with 0.38 additional QALYs (1.08 vs. 0.82 QALYs) for an ICER of $284,490/QALY. This value exceeded the $35,983/QALY willingness-to-pay (WTP) threshold selected for these analyses by a wide margin. Relative to ICI and DTX treatment, the incremental costs of TTFields plus ICI and TTFields plus DTX were $78,115 and $71,307, respectively, with corresponding gains of 0.42 and 0.13 QALYs, yielding ICERs of $187,434/QALY, and $546,386/QALY. The parameter that most strongly impacted the results of these analyses was the cost of TTFields. The results indicated that given current treatment costs, TTFields plus SOC was insufficiently cost-effective in treating patients with mNSCLC in China, although TTFields plus ICI yields substantial health benefits.

Atezolizumab plus bevacizumab and chemotherapy versus bevacizumab plus chemotherapy for metastatic cervical cancer: a cost-effectiveness analysis.

The objective of this study is to conduct a cost-effectiveness analysis in order to evaluate the economic advantages of incorporating atezolizumab into a standard bevacizumab plus platinum regimen for the treatment of metastatic cervical cancer from the Chinese medical system perspective. We developed a partitioned survival model based on data obtained from the recently published BEATcc clinical trial and economic cost data. Our model utilized a tree-based decision analysis approach to simulate two different treatment strategies for metastatic cervical cancer: the standard bevacizumab plus platinum regimen, and the addition of atezolizumab to the standard treatment regimen. The economic assessment data included the costs of the drugs, costs related to treatment-induced adverse events. The cost-effectiveness metrics used in the analysis were quality-adjusted life-year (QALY) and incremental cost-effectiveness ratio (ICER). The robustness of our model was assessed through sensitivity analysis. The total costs of the atezolizumab group were $128179.56, while the costs of chemotherapy group were $42065.89. The atezolizumab group gained 3.52 QALYs, whereas the chemotherapy group gained 2.35 QALY. The atezolizumab regimen resulted in an increase of 1.17 QALYs at an incremental cost of $86113.67. This led to an ICER of $73601.43, which exceeds the willingness-to-pay (WTP) threshold of $39855.79 in China. Sensitivity analysis demonstrated none of the parameters within a margin of ±25% result in significant alterations to the analysis findings. Atezolizumab plus bevacizumab and chemotherapy was not to be a cost-effective option for the treatment of metastatic cervical cancer compared to bevacizumab plus chemotherapy.

Sputum and tongue swab molecular testing for the in-home diagnosis of tuberculosis in unselected household contacts: a cost and cost-effectiveness analysis.

Delayed and missed diagnosis are a persistent barrier to tuberculosis control, partly driven by limitations associated with sputum collection and an unmet need for decentralized testing. Household contact investigation with point-of-care testing of non-invasive specimens like tongue swabs are hitherto undescribed and may be a cost-effective solution to enable community-based active case finding. In-home, molecular point-of-care testing was conducted using sputum and tongue specimens collected from all household contacts of confirmed tuberculosis cases. A health economic assessment was executed to estimate and compare the cost and cost-effectiveness of different in-home, point-of-care testing strategies. Incremental cost effectiveness ratios of strategies utilizing different combination testing algorithms using sputum and/or tongue swab specimens were compared. The total implementation cost of delivering the standard of care for a 2-year period was $84 962. Strategies integrating in-home point-of-care testing ranged between $87 844 - $93 969. The cost-per-test for in-home, POC testing of sputum was the highest at $20·08 per test. Two strategies, Point-of-Care Sputum Testing and Point-of-Care Combined Sputum and Individual Tongue Swab Testing were the most cost-effective with ICERs of $543·74 and $547·29 respectively, both below a $2,760 willingness-to-pay threshold. An in-home, point-of-care molecular testing strategy utilizing combination testing of tongue swabs and sputum specimens would incur an additional 10.6% program cost, compared to SOC, over a 2-year period. The increased sample yield from tongue swabs combined with immediate result notification following, in-home POC testing would increase the number of new TB cases detected and linked to care by more than 800%. Evidence before this study: We searched PubMed for original research published between January 1, 1950 and June 30, 2024 that evaluated the cost-effectiveness of in-home POC molecular testing, as part of HCI strategies for tuberculosis. PubMed search terms used included ["household contact investigation" OR "household contact tracing"] AND "tuberculosis" AND "cost-effectiveness". The search revealed 8 studies, of which one was removed as HCIs were leveraged for the provision of short course preventative therapy and not tuberculosis testing. None of the studies were conducted in South Africa. All seven remaining studies relied on a hub-and-spoke model of sputum collection and transportation with sputum tested at a centralized laboratory facility. Although active case finding strategies like HCIs are endorsed by the WHO to improve early case detection and treatment initiation, limited research has been done to assess its cost-effectiveness in low- and middle-income countries.Added value of this study: To our knowledge, this is the first example of in-home molecular point-of-care (POC) testing as part of HCI. The use of primary data to estimate and compare the incremental cost effectiveness of different combination, in-home testing strategies utilizing alternative sample types equips policy makers with a selection of strategy options to choose from. The tradeoff between sample types with high collection yield and those with increased accuracy becomes evident in the economic analysis, highlighting the need to consider both yield and accuracy in effective clinical decision making and use-case development. The success of in-home, POC tongue swab testing of all contacts, irrespective of symptom presentation shows great promise for universal testing programs.Implications of all available evidence: Results from our economic modeling provide evidence in support for the integration of in-home, POC tuberculosis (TB) testing during HCI. The use of less invasive tongue swab samples to increase sample yield in the absence of sputum expectoration highlights the value of combination testing strategies. Immediate result notification resulting from rapid, in-home POC testing shows great promise for increasing early case detection and improving treatment uptake. In-home, POC testing strategies, when incorporated into HCI could curb ongoing community transmission and reduce the overall burden of TB. Considerations for adopting novel POC testing strategies in future active case finding programs like HCI should strongly be considered. We evaluated the cost-effectiveness of in-home, point-of-care TB testing of household contacts. The findings indicate that combined testing strategies using tongue swab and sputum specimens could significantly increase TB case detection, with modest additional program costs.

Cost-effectiveness of universal esophageal cancer screening for newly diagnosed oral cancer patients.

Oral and esophageal cancers are globally prevalent, especially in East Asia. Over half of head and neck cancer patients developing second primary esophageal cancer (SPEC) were initially diagnosed with oral cavity cancer (OCC). This study assessed the cost-effectiveness of universal endoscopic screening for early SPEC prevention in newly diagnosed OCC patients at different stages. This study employed Markov cohort models to evaluate the cost-effectiveness of endoscopic SPEC screening post-OCC diagnosis (stages 0 to IV) between screened and non-screened groups. Four surveillance frequencies were assessed: (i) one time, (ii) annual for 3years, (iii) annual for 10years, and (iv) annual for life. A hypothetical cohort of 100000 cases across stages was compared for costs and quality-adjusted life-years (QALYs), discounted annually at 3%. All four screening strategies were beneficial for all OCC stages, especially for early-stage patients, resulting in higher QALYs. Lifetime/annual screening from the payer's perspective proved most favorable, with incremental QALYs of 1.23 at stage 0 and 0.06 at stage IV. Incremental costs for this strategy ranged from NTD 121331 (USD 4044) at stage 0 to NTD 13032 (USD 434) at stage IV. Both incremental costs and incremental cost-effectiveness ratio (ICER) values indicated cost savings from a societal perspective. The ICER values ranged from NTD -626440 (USD -20881) at stage 0 and NTD -475021 (USD -15834) at stage IV. Overall, our study provided cost-effectiveness evidences to understanding the cost-effectiveness of endoscopic screening in OCC patients, particularly emphasizing the benefits of early and consistent screening.

Cost-effectiveness of pembrolizumab as an adjuvant treatment of renal cell carcinoma post-nephrectomy in Switzerland

Aims Pembrolizumab has demonstrated significantly prolonged disease-free survival and overall survival (OS) among adult patients post-nephrectomy who have an intermediate-high risk, high-risk, or M1 stage with no evidence of disease (M1 NED) renal cell carcinoma (RCC) with clear cell component. The aim of this study was to evaluate the cost-effectiveness of pembrolizumab for patients with RCC post-nephrectomy versus observation in Switzerland. Materials and methods A previously published Markov model was adapted for the Swiss setting to estimate the cost-effectiveness of adjuvant pembrolizumab versus observation from the Swiss statutory health insurance perspective. Transition probabilities between model states were estimated using survival curves from KEYNOTE-564 (data cut-off: June 14, 2021). Outcomes included costs (2022 Swiss francs [CHF]), quality-adjusted life-years (QALYs), and life-years (LYs), measured over a lifetime horizon. Costs included drug acquisition and administration for adjuvant and subsequent therapy. Both costs and effectiveness were discounted at 3.0% annually. Cost-effectiveness was evaluated at a hypothetical willingness-to-pay (WTP) threshold of CHF 100,000 Sensitivity was assessed through scenario analyses as well as deterministic and probabilistic sensitivity analyses. Results Over a lifetime horizon, the total incremental cost for pembrolizumab versus observation was CHF 59,089, providing incremental gains of 0.90 QALYs (1.07 LYs); the incremental cost-effectiveness ratio was CHF 65,299/QALY. Pembrolizumab was deemed cost-effective versus observation, with a 69.9% probability of cost-effectiveness. Limitations A more recent interim analysis data cut from KEYNOTE-564 with median follow up of 57.2 months has since been published; however, these were not available at the time of analysis. It would likely have minimal impact on transition probabilities from disease-free, and the current approach remains conservative for predicting OS for pembrolizumab. Conclusions As an adjuvant treatment of RCC post-nephrectomy, pembrolizumab was found to be cost-effective versus observation in Switzerland at a WTP threshold of CHF 100,000/QALY. Policy makers should consider pembrolizumab as an adjuvant treatment for patients with RCC post-nephrectomy when making decisions regarding resource allocation.

The Challenge of Energy Efficiency in Social Housing: An Evaluation of Envelope's Improvements and their Economic Effects

Objective: This study aims to propose a combination of modifications to the envelope of a Social Housing (SH) project and evaluate their impacts on thermal load reduction and cost increase, staying within the budgetary constraints. Theoretical Framework: The Minha Casa Minha Vida Program (PMCMV) prioritizes architectural solutions focused on large-scale production and reduced unit costs, at the expense of environmental comfort and energy efficiency. However, efforts to raise the standards of habitability and quality of life are evident in the new 2023 program version and its regulations for new projects. Method: This case study assesses the envelope classification of an SH project applied to 20 sets of construction modifications and 4 deployment orientations, using the Inmetro Normative Instruction for Building Energy Efficiency (INI-R). Thermal load reduction and cost increment analysis will be performed. Results and Discussion: For each deployment orientation, the modifications that resulted in the greatest reduction in thermal load. This reduction ranged between 20% and 26.5% for the four orientations, with an additional cost ranging from 6% to 16%. Research Implications: Energy efficiency measures, even if they entail higher costs, may provide economic benefits during the operation and maintenance phases of the properties within PMCMV standards. Originality/Value: This study contributes to the dissemination of the simplified method of INI-R for envelope analysis in buildings and may influence improvements in public policies related to environmental quality in housing programs.

Faricimab versus bevacizumab for neovascular age-related macular degeneration: Cost analysis based on real-world data from the Swedish Macula Registry.

To analyse the impact on cost if faricimab is used as the first-line treatment for neovascular age-related macular degeneration (nAMD) compared to standard treatment with bevacizumab. Retrospective registry study including real-world data from the Swedish Macula Registry between 2017 and 2022. The observed number of injections and visits for bevacizumab during the first two years of treatment was used (n = 437 patients). Number of faricimab injections was obtained from published clinical trial data and unit costs mostly from publicly available Swedish sources. The provider cost included medication and visit cost and societal cost included additionally patient travel cost. Costs are presented in 2023 EUR. The incremental societal cost of faricimab was 277 EUR per patient compared to bevacizumab in the base case. Medication cost was higher (1516 EUR) while visit cost (-1183 EUR) and patient travel cost (-56 EUR) were lower due to longer injection intervals. Faricimab was of similar cost as bevacizumab for patients residing far from the clinic. The faricimab injection interval and the number of bevacizumab injections were major drivers of uncertainty in the results. Faricimab represents a cost-effective alternative to bevacizumab for patients with nAMD in Sweden. Its extended treatment interval is particularly beneficial for patients living far from clinics, and if the real-life faricimab injection interval extends beyond 12 weeks. Our findings emphasize faricimab's potential to free up healthcare staff to treat a larger patient population with existing clinic resources.

Cost of COVID-19 vaccine delivery in nine States in Nigeria via the U.S. Government Initiative for Global Vaccine Access

BackgroundIn 2022, the U.S. Centers for Disease Control and Prevention collaborated with implementing partners, African Field Epidemiology Network and Sydani Group, to support COVID-19 vaccination efforts in Nigeria. To characterize the costs of COVID-19 vaccination, this study evaluated financial costs per dose for activities implemented to support the intensification campaign for COVID-19 vaccination.MethodsThis retrospective evaluation collected secondary data from existing expenditure and programmatic records on resource utilization to roll out COVID-19 vaccination during 2022. The study included incremental financial costs of the activities implemented to support an intensification campaign for COVID-19 vaccination across nine states and six administrative levels in Nigeria from the perspective of the external donor (U.S. Government). Costs for vaccines and injection supplies, transport of vaccines, and any economic costs, including government in-kind contributions, were not included. All costs were converted from Nigerian Naira to 2022 U.S. Dollars (US$).ResultsThe estimated financial delivery cost of the COVID-19 vaccination intensification campaign was US$0.84 per dose (total expenditure of US$6.29 million to administer 7,461,971 doses). Most of the financial resources were used for fieldwork activities (86%), followed by monitoring and supervision activities (8%), coordination activities (5%), and training-related activities (1%). Labor (58%) and travel (37%) were the resource inputs that accounted for the majority of the cost, while shares of other resource inputs were marginal (1% for each). Most labor costs (79%) were spent on payments for mass vaccination campaign teams, including pay-for-performance incentives. By administrative level, the largest share of costs (46%) was for pay-for-performance incentives at the community, health facility, or campus levels combined, followed by local government area level (24%), community level only (15%), state level (9%), national level (3%), campus level only (1%), and health facility level only (< 1%).ConclusionsFindings from the evaluation can help to inform resources needed for vaccination activities to respond to future outbreaks and pandemics in resource-limited settings, particularly to reach new target populations not regularly included in routine childhood immunization delivery.

Outcomes and Cost-Effectiveness of an EHR-Embedded AI Screener for Identifying Hospitalized Adults at Risk for Opioid Use Disorder.

Hospitalized adults with opioid use disorder (OUD) are at high risk for adverse events and rehospitalizations. This pre-post quasi-experimental study evaluated whether an AI-driven OUD screener embedded in the electronic health record (EHR) was non-inferior to usual care in identifying patients for Addiction Medicine consults, aiming to provide a similarly effective but more scalable alternative to human-led ad hoc consultations. The AI screener analyzed EHR notes in real-time with a convolutional neural network to identify patients at risk and recommend consultation. The primary outcome was the proportion of patients receiving consults, comparing a 16-month pre-intervention period to an 8-month post-intervention period with the AI screener. Consults did not change between periods (1.35% vs 1.51%, p < 0.001 for non-inferiority). The AI screener was associated with a reduction in 30-day readmissions (OR: 0.53, 95% CI: 0.30-0.91, p = 0.02) with an incremental cost of $6,801 per readmission avoided, demonstrating its potential as a scalable, cost-effective solution for OUD care. ClinicalTrials.gov ID : NCT05745480.

VI-RADS followed by Photodynamic Transurethral Resection of Non-Muscle-Invasive Bladder Cancer vs White-Light Conventional and Second-resection: the 'CUT-less' Randomised Trial Protocol.

A second transurethral resection of bladder tumour (Re-TURBT) is recommended by European Association of Urology (EAU) Guidelines on non-muscle-invasive bladder cancers (NMIBCs) due to the risk of understaging and/or persistent disease following the primary resection. However, in many cases this may be unnecessary, potentially harmful, and significantly expensive constituting overtreatment. The CUT-less trial aims to combine the preoperative staging accuracy of Vesical Imaging-Reporting and Data System (VI-RADS) and the intraoperative enhanced ability of photodynamic diagnosis (PDD) to overcome the primary TURBT pitfalls thus potentially re-defining criteria for Re-TURBT indications. Single-centre, non-inferiority, phase IV, open-label, randomised controlled trial with 1:1 ratio. The primary endpoint is short-term BC recurrence between the study arms to assess whether patients preoperatively categorised as VI-RADS Score 1 and/or Score 2 (i.e., very-low and low likelihood of MIBC) could safely avoid Re-TURBT by undergoing primary PDD-TURBT. Secondary endpoints include mid- and long-term BC recurrences and progression (i-ii). Also, health-related quality of life (HRQoL) outcomes (iii) and health-economic cost-benefit analysis (iv) will be performed. All patients will undergo preoperative Multiparametric Magnetic Resonance Imaging of the bladder with VI-RADS score determination. A total of 327 patients with intermediate-/high-risk NMIBCs, candidate for Re-TURBT according to EAU Guidelines, will be enrolled over a 3-year period. Participants will be randomised (1:1 ratio) to either standard of care (SoC), comprising primary white-light (WL) TURBT followed by second WL Re-TURBT; or the Experimental arm, comprising primary PDD-TURBT and omitting Re-TURBT. Both groups will receive adjuvant intravesical therapy and surveillance according to risk-adjusted schedules. Measure of the primary outcome will be the relative proportion of BC recurrences between the SoC and Experimental arms within 4.5 months (i.e., any 'early' recurrence detected at first follow-up cystoscopy). Secondary outcomes measures will be the relative proportion of late BC recurrences and/or BC progression detected after 4.5 months follow-up. Additionally, we will compute the HRQoL variation from NMIBC questionnaires modelled over a patient lifetime horizon and the health-economic analyses including a short-term cost-benefit assessment of incremental costs per Re-TURBT avoided and a longer-term cost-utility per quality-adjusted life year gained using 2-year clinical outcomes to drive a lifetime model across the two arms of treatment. ClinicalTrial.gov identifier (ID): NCT05962541; European Union Drug Regulating Authorities Clinical Trials Database (EudraCT) ID: 2023-507307-64-00.

Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study

BackgroundCardiovascular disease (CVD) risk increases with age. Statins reduce cardiovascular risk but their effects are less certain at older ages. We assessed the long-term effects and cost-effectiveness of statin therapy...