Treatment Costs Research Articles

Mechanics-informed autoencoder enables automated detection and localization of unforeseen structural damage

Structural health monitoring ensures the safety and longevity of structures like buildings and bridges. As the volume and scale of structures and the impact of their failure continue to grow, there is a dire need for SHM techniques that are scalable, inexpensive, can operate passively without human intervention, and are customized for each mechanical structure without the need for complex baseline models. We present a novel “deploy-and-forget” approach for automated detection and localization of damage in structures. It is a synergistic integration of entirely passive measurements from inexpensive sensors, data compression, and a mechanics-informed autoencoder. Once deployed, the model continuously learns and adapts a bespoke baseline model for each structure, learning from its undamaged state’s response characteristics. After learning from just 3 hours of data, it can autonomously detect and localize different types of unforeseen damage. Results from numerical simulations and experiments indicate that incorporating the mechanical characteristics into the autoencoder allows for up to a 35% improvement in the detection and localization of minor damage over a standard autoencoder. Our approach holds significant promise for reducing human intervention and inspection costs while enabling proactive and preventive maintenance strategies. This will extend the lifespan, reliability, and sustainability of civil infrastructures.

The relationship between erectile dysfunction and serum adropin level in male patients with type 2 diabetes mellitus

Background: Diabetes Mellitus is a chronic, progressive disease with increasing worldwide prevalence and is a public health problem because of the high cost of treatment and complications. Adropin has been discovered in recent years, and it has been reported to be associated with glucose, lipid metabolism, and endothelial dysfunction. In this study, it was aimed to investigate the relationship between erectile dysfunction and Adropin level in Type 2 diabetic male patients. Methods: Forty patients with type 2 DM with erectile dysfunction and 25 patients with type 2 DM without erectile dysfunction, aged between 40 and 60, who applied to the internal medicine outpatient clinic between November 2019 and March 2020, were included in the prospective study. In addition to routine blood tests in the study groups, Adropin levels were measured using the ELISA method. Results: The study was conducted with 65 men aged 40 and 60 between November 2019 and February 2020. The mean age of the men was 52.71±6.04. The study used 40 (61.5%) Case groups and 25 (38.5%) Control groups. The case group consisted of 12 (18.5%) Mild ED, 20 (30.8%) Moderate ED, and 8 (12.8%) Severe ED, and the control group consisted of Type 2 Diabetes Mellitus Patients without erectile dysfunction. Conclusion: According to our results, serum Adropin levels in Mild ED, Moderate ED, and Severe ED groups were found to be higher than those in Type 2 Diabetes Mellitus patients without erectile dysfunction.

Фармакоэкономический анализ различных методов лечения акне у детей и подростков

Acne is a widespread dermatological disease affecting children and adolescents that requires the use of innovative approaches to its treatment with the purpose of not only improving the patient's condition but also to minimize the treatment costs. The purpose of this research was to analyze the clinical efficacy, safety and economic feasibility of the use of the cold atmospheric plasma (CAP) in the acne therapy. Materials and methods used: the study included 176 pediatric patients aged 10 to 18 y/o (ME 16 y/o, M:F gender ratio 1:1.2) who were divided into groups depending on the severity of acne as follows: G1 with mild acne, G2 with moderate acne, and randomized into subgroups depending on the treatment methods (TM) as follows: TM1 for monotherapy with a combined external drug containing 0.1% adapalene with 2.5% benzoyl peroxide in the form of a gel, TM2 for CAP monotherapy and TM3 for combined therapy consisting of external therapy with a gel containing 0.1% adapalene with 2.5% benzoyl peroxide and the CAP treatment. The severity of acne was assessed using the acne dermatological index (ADI) and the clinical efficacy was assessed by achieving ADI0, ADI75, and ADI50. Skin moisture and pH were measured in all patients both prior to and immediately after the treatment using the PH98110 pH meter (by Kelilong, China). Adverse events (AE) were assessed during the study. The incremental cost-effectiveness ratio (ICER) was used in the pharmacoeconomic analysis. Results: during treatment in the TM1 subgroups, the full clinical effect (DIA0) was achieved in 88.89% of cases with mild acne and in 61.76% of cases with moderate acne, in the TM2 s/g, the full clinical effect was achieved in 95.24% and 68.57% of cases and in the TM3 s/g in 100% and 88.24% of cases, respectively. After the treatment, the skin pH values in patients of the TM1 s/g, G1 and G2 became lower than the reference values, TM2 and TM3 s/gs of both groups returned to normal. Skin moisture after treatment decreased in the TM1 s/g of both groups, remained the same in the TM2 s/g and the TM3 s/g of G1 and approached to normal in the TM2, TM3 s/gs of G2. AEs (lichenification, erythema and/or burning sensation of the skin) were observed in patients of s/gs TM1 and TM3 and were mild (n=24) or moderate (n=25) in severity. The ICER coefficient for the TM1 v TM3 pairwise comparison was 324,254.55 Russian rubles for G1, 184,060.00 Russian rubles for G2, and for the TM2 v TM3 comparison 25,333.33 Russian rubles for G1, 12,800.00 Russian rubles for G2, which is statistically significant (p=0.001 and p=0.04, respectively) and indicates high economic feasibility of using the TM3. Conclusion: the use of CAP in the treatment of mild to moderate acne is effective, safe and cost-effective as well.

Estimated cost of VEGFR TKI associated adverse events in metastatic renal cell carcinoma patients

IntroductionThe majority of metastatic renal cell carcinoma (mRCC) patients receive one or more VEGFR TKI agents, alone or in combination with an immune-oncology (IO) agent or an mTOR inhibitor. To date, the cost of adverse events (AEs) common to VEGFR TKIs has not been quantified. This study estimated the potential impact of differences in VEGFR TKI AE profiles on treatment cost efficiency in the relapsed/refractory (R/R) setting.MethodsPatients with documented mRCC who were treated with VEGFR TKI therapies between Jan 2015 and Mar 2021 were identified using EMR. ICD-10 diagnosis codes were used to identify the first occurrence of each class effect AE. Patients were matched to 3rd party insurance claims, and costs associated to TKI AEs within 90 days of index event were captured. Average per patient AE cost data was calculated and applied to published incidence data to estimate regimen-specific AE total cost burden within a hypothetical commercial plan for mRCC patients undergoing treatment in the R/R setting.ResultsThe highest total cost for AE management was attributed to lenvatinib and everolimus use at $13,303, followed closely by sunitinib at $13,092. Tivozanib treatment was associated with the lowest total cost of AE management at $7,523, driven by the relatively lower incidence of certain high-cost AEs.ConclusionsThe estimated costs of managing VEGFR TKI class-effect AEs were lowest with tivozanib, and highest with lenvatinib and everolimus, indicating potentially differential healthcare resource burden by TKI regimen. The use of tivozanib in the 3 L + mRCC setting suggests potential costs offsets when compared to other TKI regimens.

The Health and Economic Benefits of United States Investments in Measles and Rubella Control and Elimination

Background: Prior to measles vaccine introduction in 1963, measles virus caused hundreds of thousands of annual reported cases, which led to substantial US morbidity, mortality, and costs. Similarly, congenital rubella syndrome (CRS) led to highly visible and tragic lifelong disability for thousands of Americans, before rubella vaccine introduction in 1969. The US certified national virus transmission elimination of indigenous measles in 2000 and rubella in 2004. Methods: Applying an existing integrated transmission and economic model, this analysis characterizes the net benefits of US investments in measles (1963–2030) and rubella (1969–2030) immunization assuming continued high routine immunization coverage. Due to importation risks, the US maintains two doses of both vaccines in its routine immunization schedule. Results: This analysis estimates total US costs of 8.1 billion (economics reported in 2023 US dollars) for measles immunization for 1963–2023 and 14.1 billion for rubella immunization for 1969–2023. The analysis estimates an additional approximately 1.2 billion for measles immunization and 1.5 billion for rubella immunization expected for 2024–2030. Historical and future US investments prevented an estimated approximately 237 million measles infections, 228,000 measles deaths, 193 million rubella infections, and 166,000 CRS cases. These investments imply net benefits (from avoided treatment costs minus immunization costs) of approximately 310 billion for measles and 430 billion for rubella and CRS, even without incorporating avoided productivity losses and intangible costs. Conclusions: US investments in measles and rubella immunization continue to provide enormous savings of human and financial costs and to prevent substantial mortality and morbidity.

Evaluating the Impact and Financial Implications of Immediate versus Delayed Stenting Strategies in High Thrombus Burden Acute Myocardial Infarction: A Propensity Score-Matched Analysis.

The efficacy of delayed stenting strategies in the management of high thrombus burden acute myocardial infarction remains uncertain. We aimed to compare the therapeutic effects and financial implications of immediate and delayed stenting strategies in patients with acute myocardial infarction and high thrombus burden treated at our institution. This was a retrospective analysis of 158 patients who underwent intracoronary thrombus aspiration for acute ST-elevation myocardial infarction (STEMI) at the Second Affiliated Hospital of Shantou University Medical College between 2013 and 2023. Patients were divided into two groups: immediate stenting (immediate group; n = 101) and delayed stenting (delayed group; n = 57), based on the timing of the stenting procedure. Propensity score matching was performed to minimize confounding bias. Therapeutic effects and cost of treatment were compared between the two groups. After propensity score matching (n = 52 for each group), there were no significant differences in terms of baseline clinical characteristics, characteristics of vascular lesions (number of diseased vessels, culprit vessels, thrombolysis in myocardial infarction (TIMI) thrombus grade, proximal coronary artery lesion), the incidence of no-reflow/slow flow during the first surgery, or the use of antiplatelet drugs, intraprocedural anticoagulants, intracoronary drugs, and tirofiban. There were no significant between-group differences in terms of in-hospital all-cause mortality, in-hospital major adverse cardiovascular events, or hospitalization costs. However, peak creatine kinase-myocardial band (CK-MB) levels were significantly lower in the delayed group. For patients with STEMI undergoing emergency thrombus aspiration, a delayed stenting strategy appears to be non-inferior to immediate stenting strategy in terms of clinical efficacy and hospitalization costs, and may reduce the extent of myocardial injury. Delayed stenting strategy may allow for a more individualized surgical approach based on assessment of thrombus burden and lesion complexity.

Artificial intelligence-enabled predictive planning for sewage treatment based on improved DNN and LSTM

Predictive planning is essential for sewage treatment, which ensures water security. In the context of Industry 4.0, new sensor technologies are generating large amounts of heterogeneous data from multiple sources in increasingly complex sewage treatment processes. This complexity renders traditional methods inadequate for the accurate and timely prognostication of data essential for predictive planning. To solve the challenge, this study proposes an architecture of artificial intelligence-enabled predictive planning to reduce cost and increase efficiency for sewage treatment. Within this architecture, a combination of a sparsely connected deep neural network model based on combined correlation analysis and an improved long short-term memory model based on periodicity is used to predict critical data for sewage treatment. Then, the proposed architecture is applied by using production data from the high-density pool unit of a sewage treatment plant. Results reveal that the accuracy of the data in predictive planning is 92.7 % compared with the actual data. Establishing this architecture for predictive planning provides a practical basis for the digital transformation of sewage treatment plants to automate processes, improve decision-making, reduce costs and increase operational efficiency.

Cardiodiabesity: Epidemiology, resource and economic impact

ObjectiveTo assess i) the epidemiology of cardiodiabesity, ii) its association with healthcare resource utilization and cost of care, as well as iii) provide recommendations for its management. MethodsA cohort study of insured adults with early-stage and/or active cardiodiabesity from January 2019 to December 2021 identified through a longitudinal, and de-identified medical and pharmacy claims database was conducted. All patients were followed for one year through December 2022. Conditions include cardiovascular disease, prediabetes, Type 2 diabetes (T2D), chronic kidney disease (CKD), overweight and/or obesity. Rates of progression from early-stage cardiodiabesity to active cardiodiabesity and/or advanced cardiodiabesity with complications; frequency of emergency department, inpatient and outpatient visits; as well as total cost of care over one year were analyzed. ResultsA total of 3,273,813 and 1,628,407 patients had at least one of the comorbid conditions for early-stage and active cardiodiabesity, respectively. Among those with all early-stage cardiodiabesity conditions, 27.4 % progressed to active cardiodiabesity, while 88.4 % of those with all active cardiodiabesity conditions progressed to complications within one year. Predictors of progression from early-stage to active cardiodiabesity were hypertension (OR: 2.31, 95 % CI: 2.29–2.33, p < 0.001), hyperlipidemia (OR: 1.77, 95 % CI: 1.76–1.79, p < 0.001), CKD stages 1 and 2 (OR: 1.74, 95 % CI: 1.69–1.79, p < 0.001), prediabetes (OR: 1.64, 95 % CI: 1.63–1.66, p < 0.001) and living in areas with very high social needs (OR: 1.25, 95 % CI: 1.23–1.26, p < 0.001). Significant predictors of progression from active cardiodiabesity to complications were T2D (OR: 1.88, 95 % CI: 1.81–1.96, p < 0.001), CVD (OR: 1.47, 95 % CI: 1.44–1.51, p < 0.001), CKD stages 3 and 4 (OR: 1.37, 95 % CI: 1.34–1.41, p < 0.001) and obesity (OR: 1.29, 95 % CI: 1.26–1.32, p < 0.001). Average total cost of care increased significantly among those who progressed from one disease phase to the next (p < 0.05). ConclusionsCardiodiabesity is deadly and rapidly progressive with substantial economic burden on the healthcare system. However, it is preventable. Innovative approaches to better understand the holistic impact of cardiodiabesity on total cost of care, early intervention or management to halt disease progression and promote equity, as well as decrease resource utilization are needed.

Transforming public health and economic outcomes by reducing risky behaviors: the potential for South Korea

South Korea faces a diminishing workforce driven by the world's lowest fertility rate, restrictive immigration, and low female labor participation. This paper explores reducing non-communicable diseases from risky behaviors as a solution. We investigate how many cases could be prevented if South Koreans changed risky consumption patterns, and the associated economic healthcare burden impact. Utilizing the Preventable Risk Integrated Model (PRIME), we model hypothetical 2022 reductions in tobacco, alcohol, and unhealthy diet risks to estimate disease case and economic cost impacts. We contrast actual 2022 consumption against a moderate harm reduction scenario. Findings reveal potentially preventing approximately 73,400 new non-communicable disease cases, 69% among working-age Koreans, benefiting the workforce. This reduction could save $13 billion from avoided treatment costs, absenteeism, and premature deaths, including $3.7 billion in 2022 and $9.3 billion in future economic losses. The study emphasizes needing a harm reduction regulatory approach balancing public health and societal realities. We advocate risk-proportionate taxation policies incentivizing consumers toward less harmful alternatives. Given government responsibilities preserving both public health and productivity, smart regulation of risky consumption is critical. This timely research quantifies the significant potential gains from strategic interventions on key risk factors, informing policymakers navigating health promotion and economic objectives.

Treatment of equine keratomycosis, part 1: selection of appropriate therapy based on clinical presentation and diagnostic testing improves clinical outcomes.

To determine clinical outcome, treatment costs, and hospitalization duration in horses treated for keratomycosis and identify ophthalmic examination and diagnostic results associated with these outcomes. This was a retrospective study of 126 equine keratomycosis cases between 2004 and 2020 with fungal infection confirmed on cytology, culture, and/or histopathology and a minimum of 1-month follow-up. Details of the ophthalmic examination, diagnostic test results, and treatment and cost outcomes were recorded. Outcomes of interest were analyzed by treatment type. The relationship of patient and diagnostic test variables to the outcomes of interest was determined via logistic and linear regression models. Globe retention and positive visual outcome occurred in 82.5% and 78.9% of medically and 88.4% and 85.5% of surgically treated cases, respectively. While not statistically significant, there were more positive clinical outcomes with surgery; in recent years, the globe and vision were preserved in 94.7% of cases following penetrating keratoplasty. The choice to pursue surgery was related to lesion depth. Medical treatment was associated with statistically shorter hospitalization times and lower total and hospitalization invoices compared to all surgical treatments. Diagnosis of stromal abscess was associated with higher total invoice and longer hospitalization times compared to ulcerative keratomycosis, although clinical outcomes were similar. Overall positive clinical outcomes were achieved despite the severity of the disease in many cases, highlighting the need for appropriate treatment selection based on clinical presentation. Expanding knowledge of clinical decision-making, treatment options, and associated clinical and financial outcomes may further improve outcomes for equine keratomycosis patients.

Sample Size Planning in the Design of Two-Level Randomized Cost-Effectiveness Trials

This study introduces recent advances in statistical power analysis methods and tools for designing and analyzing randomized cost-effectiveness trials (RCETs) to evaluate the causal effects and costs of social work interventions. The article focuses on two-level designs, where, for example, students are nested within schools, with interventions applied either at the school level (cluster design) or student level (multisite design). We explore three statistical modeling strategies—random-effects, constant-effects, and fixed-effects models—to assess the cost-effectiveness of interventions, and we develop corresponding power analysis methods and tools. Power is influenced by effect size, sample sizes, and design parameters. We developed a user-friendly tool, PowerUp!-CEA, to aid researchers in planning RCETs. When designing RCETs, it is crucial to consider cost variance, its nested effects, and the covariance between effectiveness and cost data, as neglecting these factors may lead to underestimated power.

Pembrolizumab (Keytruda)

Canada’s Drug Agency recommends that Keytruda should be reimbursed by public drug plans for the treatment of patients with locally advanced unresectable or metastatic human epidermal growth factor receptor 2 (HER2) negative gastric or gastroesophageal junction (GEJ) adenocarcinoma if certain conditions are met. Keytruda should only be covered to treat patients who have not received previous treatment for HER2-negative advanced or metastatic gastric or GEJ cancer and who have good performance status. Keytruda should only be reimbursed if prescribed in combination with fluoropyrimidine- and platinum-containing chemotherapy by a clinician with expertise and experience in treating gastric and GEJ cancer, and the cost of Keytruda in combination with chemotherapy is reduced so that it does not exceed the drug program cost of treatment with nivolumab in combination with chemotherapy.

A cost-utility analysis of single maintenance and reliever (SMART) therapy as compared to step 3 fixed-dose therapy in patients aged 12 years or more with uncontrolled asthma.

A significant percentage of patients with asthma appear to benefit from the addition of long-acting β2-agonists (LABAs) to ICS to achieve better control of their disease. The aim of the present study was to determine the cost-utility of single inhaler combination inhaled ICS/LABAs as both maintenance and reliever (SMART) versus remaining at the same treatment step with fixed-dose ICS-LABA maintenance with a short-acting β2-agonist (SABA) as reliever in patients aged 12 years or more with uncontrolled asthma. A Markov-type model was developed to estimate the costs and health outcomes of a simulated cohort of patients aged 12 years or more with uncontrolled asthma treated for 12 months. The effectiveness data and transition probabilities were obtained from a recent meta-analysis. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs). The base-case analysis showed that compared with remaining at the same GINA treatment step with ICS/LABA maintenance plus SABA reliever, ICS/LABAs as SMART was associated with lower costs, US$2,906.92 versus $4,462.02 average cost per patient, and the greatest gain in QALYs, 0.8540 versus 0.8258 QALYs on average per patient, thus leading to dominance. Compared with remaining at the same GINA treatment step with ICS/LABA maintenance plus SABA reliever, ICS/LABAs as SMART is more cost-effective in patients aged 12 years or more with uncontrolled asthma. This is because ICS/LABAs as SMART showed a greater gain in QALYs at lower total treatment costs.

The International Spinal Cord Injury Survey in Iran (InSCI-IR)

Background and Aim: Spinal cord injury patients are faced with many neglected side effects that threaten the health, wealth, and life of the patients and their families. For this purpose, the international spinal cord injury survey (InSCI) was conducted in 2017 by adding 22 countries to follow up the patients facing spinal cord injury. Iran as a developing country was added to the survey in 2022 focusing on the catastrophic health expenditures of spinal cord injury patients. The survey is named: The International spinal cord injury survey in Iran (InSCI -IR). Methods and Materials/Patients: This study will be performed in Guilan Province, Iran and the primary data of the patients will be gathered from the Poursina Hospital of Rasht and the Iranian National Registry of Spinal Cord Injury Patients. InSCI-IR contains two parts; the general questionnaire which gathers the data for the InSCI and the specific questionnaire which gathers data for calculating catastrophic expenditures. Results: It is estimated that 600 patients will participate in the study and more than 200 cases are faced with paraplegia or tetraplegia. The international questionnaire contains 11 sections on the living situation of patients with SCI, sociodemographic questions, injury characteristics, mental and physical health, feeling and work conditions, environmental factors, and access to health services. The catastrophic expenditure part contains questions about the cost of treatment, medication, caregiving, transportation, and household income loss related to spinal cord injury, wealth index, and household total income. Both parts will be edited in psychometrics processes.

Budget impact analysis on the use of Sysmex PA-100 AST system as a point of care for uncomplicated urinary tract infections detection and treatment in Spanish females

Objective Efficient diagnostic methods, such as the Sysmex PA-100, provide rapid antimicrobial susceptibility test results directly from urine samples with high sensitivity and specificity, and improve treatment recommendations. Our study analyzes the economic impact of integrating the Sysmex PA-100 to assess its potential benefits and cost implications for uncomplicated urinary tract infection (uUTI) management in Spain. Methodology A budget impact model was developed using a decision tree framework to compare current UTI management practices with a new scenario incorporating the Sysmex PA-100. The clinical inputs were extracted from published literature. The model, representing adult females with uUTIs, assessed direct medical and indirect costs over three years, including diagnostic procedures, treatment costs, staff time costs, and productivity loss. The cost data was captured from two Spanish hospitals. Two scenario analyses were conducted in the model: scenario A included costs for antimicrobial resistance (AMR) emergence in patients receiving unnecessary empirical antibiotics, whereas scenario B assumed no AMR costs. Results In scenario A, 100% implementation of PA-100 within various Spanish healthcare settings over one year resulted in total cost savings of EUR 323,657,712 (EUR 119.10 per patient per year). The total overall cost savings attributable to the implementation of PA-100 over three years were EUR 970,973,137. In scenario B, the total annual savings were EUR 4,254,795 (EUR 1.57 per patient per year), and the 3-year savings were EUR 12,764,385. Conclusion The adoption of this point-of-care system results in overall cost savings, driven by reductions in direct and indirect costs related to UTI management. The model highlights potential savings over three years owing to appropriate rapid management (reduction in time to diagnosis and treatment, which leads to fewer complications and secondary infections) and reduced staff time and productivity loss costs. These findings support the potential benefits of adopting the Sysmex PA-100 to enhance UTI management and allocate healthcare resource utilization in Spain.

The financial impact of participant attrition from randomised trials: a case-study from the Occupational Therapist Intervention Study (OTIS).

Loss to follow-up of participants can compromise the statistical validity of randomised trials. Moreover, it can have financial consequences for trial teams and funders. This study explores the Occupational Therapist Intervention Study (OTIS) where, despite a withdrawal rate of less than 10%, the trial team incurred opportunity costs related to participants who were initially recruited but subsequently decided to withdraw from the trial. To estimate the cost of participant losses to follow-up in the OTIS trial and thus introduce a costing framework to research teams on how they could estimate the opportunity costs of participant withdrawal from their randomised trials. The participants lost to follow-up are differentiated by (1) the time point at which they were lost to follow-up; (2) the treatment group they were allocated to; (3) their response patters to follow-up questionnaires; these elements were considered to identify the relevant types of attrition. Protocol-driven costs of trial materials, including administration, print, and shipping, were gathered. We calculated unit costs for each type of attrition by multiplying protocol-driven and intervention costs with the relevant number of participants. Summing up unit costs by type of loss to follow-up yields aggregate figures, enabling the estimation of aggregate and average opportunity costs of attrition. The average cost per participant loss to follow-up in the OTIS trial is £98.41. The aggregate cost of participant loss to follow-up is £10,234.90 from the economic perspective of the trial team. Therefore, 1.42% of the allocated funding has been misallocated because of participant loss to follow-up. Despite the low attrition rate of the OTIS trial, loss to follow-up has still generated considerable opportunity costs. It is recommended that decision makers focus on identifying strategies which could improve participant retention in randomised trials to optimise their budget.

Cost-Effectiveness Analysis of Topical Treatments for Actinic Keratosis in Italian National Health System.

Introduction: Actinic keratosis (AK) is a widespread pre-cancerous skin condition that may evolve to squamous cell carcinoma, a non-melanoma skin cancer, which is able to become locally invasive and metastatic. Thus, it is important to treat AK. Methods: We conducted a cost-effectiveness analysis for the field-directed therapeutic approaches: local application of drugs containing 5-fluorouracil, both alone at a 4% concentration and associated to 10% salicylic acid at a 0.5% concentration (0.5% 5-FU + 10% SA cut. sol.); diclofenac-hyaluronic acid gel; imiquimod, both at 3.75% and 5% (5% IMQ cream) concentrations; and tirbanibulin ointment. The effectiveness data were abstracted from the literature. The cost-effectiveness analysis was performed by considering the prices reported by Agenzia Italiana del Farmaco (AIFA) for each medicine. Results: We obtained the total cost for each treatment by computing the cost of a single treatment for its duration. Application of 0.5% 5-FU + 10% SA cut. sol. appeared as the most convenient approach, as it was more effective and less expensive than all treatments except for 5% IMQ cream. For this last option, the incremental cost/effectiveness ratio analysis showed that a modest gain in effectiveness has a cost of EUR 7.94, therefore making it less cost effective.

ASO Author Reflections: Understanding the Costs of Major Surgical Intervention.

ASO Author Reflections: Understanding the Costs of Major Surgical Intervention.

Cost of epilepsy in the Russian Federation

Background. Epilepsy underdiagnosis in Russia, population aging, innovative drugs and expensive treatment regimens, the introduction of additional and alternative methods such as neurosurgery, annually increase the cost for treatment of epilepsy patients. In this regard, an issue of maximizing benefits for the largest number of the population becomes relevant. Pharmacoeconomical research within the assessment of healthcare technologies helps to choose the most economically and medically effective treatment strategy among numerous alternatives.Objective: analysis of epilepsy-associated costs in the Russian Federation, aimed at supporting decision-making processes in the field of health policy and financing.Material and methods. The empirical study was based on collecting the data on a continuous sampling of 384 epilepsy outpatient records from subjects aged 19 to 79 years for the period 2019–2022. The issues related to all costs of epilepsy were discussed. While planning, conducting and analyzing these studies, the principles of strengthening the reporting of observational studies in epidemiology (STROBE) were taken into account.Results. The total annual per-patient expenditure on epilepsy treatment comprised a fifth of gross domestic product per capita. Indirect costs exceed direct cost savings. It was found out that the economic damage caused to society, family, and individual related to epilepsy is three times higher than the direct costs.Conclusion. The results obtained are consistent with other publications in which unemployment among epilepsy patients is one of the major cost-determining factors and illustrates a critical need to maintain employment for such patients or to find suitable alternative work through professional retraining.

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.