Healthcare Perspective Research Articles

Lifetime Cost-Effectiveness of Structured Education and Exercise Therapy for Knee Osteoarthritis in Australia.

Structured education and exercise therapy programs have been proposed to reduce reliance on total knee replacement (TKR) surgery and improve health care sustainability. The long-term cost-effectiveness of these programs is unclear. To estimate the lifetime cost-effectiveness of implementing a national structured education and exercise therapy program for individuals with knee osteoarthritis with the option for future TKR compared with usual care (TKR for all). This economic evaluation used a life table model in combination with a Markov model to compare costs and health outcomes of a national education and exercise therapy program vs usual care in the Australian health care system. Subgroup, deterministic, and probabilistic sensitivity analyses were completed. A hypothetical cohort of adults aged 45 to 84 years who would undergo TKR was created. Structured education and exercise therapy intervention provided by physiotherapists. The comparator was usual care where all people undergo TKR without accessing the program in the first year. Incremental net monetary benefit (INMB), with an incremental cost-effectiveness ratio threshold of 28 033 Australian dollars (A$) per quality-adjusted life-year (QALY) gained, was calculated from a health care perspective. Transition probabilities, costs, and utilities were estimated from national registries and a randomized clinical trial. The hypothetical cohort included 61 394 individuals (53.9% female; 93.6% aged ≥55 years). Implementation of an education and exercise therapy program resulted in a lifetime cost savings of A$498 307 942 (US $339 922 227), or A$7970 (US $5537) per individual, and resulted in fewer QALYs (0.43 per individual) compared with usual care. At a population level, education and exercise therapy was not cost-effective at the lifetime horizon (INMB, -A$4090 [-US $2841]). Subgroup analysis revealed that the intervention was cost-effective only for the first 9 years and over a lifetime only in individuals with no or mild pain at baseline (INMB, A$11 [US $8]). Results were robust to uncertainty around model inputs. In this economic evaluation of structured education and exercise therapy compared with usual care, the intervention was not cost-effective over the lifetime for all patients but was for the first 9 years and for those with minimal pain. These findings point to opportunities to invest early cost savings in additional care or prevention, including targeted implementation to specific subgroups.

A systematic review of cost-effectiveness analyses of gene therapy for hemophilia type A and B.

In 2022-2023, the US Food and Drug Administration approved 2 novel gene therapies, valoctocogene roxaparvovec and etranacogene dezaparavovec, for hemophilia A and B, respectively. These one-time-administered gene therapies have been marketed at prices that create financial challenges for payers and patients. Understanding the magnitude and uncertainties around the long-term value of these therapies and how they can potentially relate to managed care practices is of high interest to the payer and patient community. To conduct a systematic review of cost-effectiveness analysis (CEA) studies to assess (1) the long-term value of valoctocogene roxaparvovec and etranacogene dezaparavovec and (2) the relevance and validity of the underlying data and assumptions used in the CEA models and discuss how they relate to the challenges identified for CEAs of gene therapies. A systematic review of cost-effectiveness studies of novel hemophilia A and B gene therapy was conducted. PubMed and Embase were searched for published studies from inception to January 12, 2024. Original research articles published in English that conducted a CEA on gene therapy treatments for hemophilia A and B, with a comparison of incremental costs and health effects, were considered. Critical appraisal of the quality of reporting and the underlying modeling assumptions were conducted to assess the relevance and validity of the results. Two hundred thirty-eight studies were identified, of which 4 met the inclusion criteria. Three studies were conducted from a US health care perspective and 1 from a Dutch societal perspective. Despite the high upfront costs of the gene therapies, all included studies' (3 hemophilia A and 1 hemophilia B) modeled results showed that gene therapies had lower overall costs and better health outcomes compared with factor concentrate replacement therapies and emicizumab. The results were driven by the assumption that gene therapies will have a durable effect of at least 10 years and offset the high cost of the current standard of care. The modeled health improvements varied substantially across studies, showing that the long-term value is sensitive to varying clinical and economic assumptions. The novel hemophilia gene therapy treatments can potentially be a cost-effective use of treatment resources if the treatment effects are durable over time. To reduce the risk for payers while still facilitating patient access, outcomes-based agreements similar to what has recently been proposed by the Centers for Medicare & Medicaid Services for sickle-cell therapies are well supported.

National health and economic impact of a lifestyle program to prevent type 2 diabetes mellitus in Germany: a simulation study

IntroductionTo examine the long-term health and economic impact of a lifestyle diabetes prevention program in people with high risk of developing type 2 diabetes in Germany.Research design and methodsWe assessed...

Public mobile chronic obstructive pulmonary disease applications for self-management: Patients and healthcare professionals' perspectives.

Poorly controlled chronic obstructive pulmonary disease (COPD) can negatively impact quality of life but mobile applications (apps) are popular digital tools that may mitigate these support needs. However, it is unclear if public mobile COPD apps are acceptable to healthcare professionals and patients, people living with COPD. Objectives: The primary objective is to determine people with COPD and healthcare professionals' perspectives on the appropriateness of public mobile COPD apps for supporting individuals' needs. The secondary objectives were to identify the ideal features and styles of mobile COPD apps for COPD self-management; and to identify the facilitators, barriers and needs for future COPD app research and development. Methods: Public mobile COPD apps were rated by questionnaires administered before and after focus group meetings. Ratings were reported as medians with interquartile ranges and median scores were categorized into three levels of appropriateness: 1-3 for inappropriate; 4-6 for uncertain; and 7-9 for appropriate. Results: A total of 6 people with COPD (mean age 68.2 ± 4.8years) and 22 healthcare professionals (mean age 45 ± 8.3years) completed this study. People with COPD identified one and healthcare professionals identified three public mobile COPD apps to be appropriate. They had different preferences for features and engagement styles but similar preferences for facilitators and barriers to use. Stakeholders mutually rated one public mobile COPD app as appropriate for self-management and emphasized the need for apps to be supplementary and customizable, rather than replacements for clinical management.

Cost of care associated with utilization of telehealth in clinical trials

ObjectiveDue to COVID-19 pandemic restrictions, telehealth was incorporated into standard oncologic care and clinical trial operations. We sought to analyze whether telehealth changed cost of care compared to traditional clinical trial operations. MethodsWe conducted a retrospective cohort study of gynecologic oncology patients enrolled in therapeutic clinical trials at a National Cancer Institute designated center, comparing the cost of cancer care on trial pre-TELEhealth (9/30/2019 to 3/15/2020) versus during TELEhealth (3/16/2020 to 8/20/2020). Inclusion required trial participation during both study periods, ≥1 telehealth visit, and identifiable billing records. The analysis was from a healthcare sector perspective. Cost per patient per month on trial was calculated for scheduled (per protocol) and unscheduled (non-protocol) encounters using 2020 national Medicare reimbursement rates, not institution-specific prices. Pairwise t-tests between pre-TELE and TELE periods were performed. ResultsTwenty-eight patients were included in the study. The majority of patients (93 %) had ovarian cancer. One patient (4 %) had uterine and 1 (4 %) had concurrent ovarian/uterine cancer. Most patients had advanced-stage disease at diagnosis (93 %). Mean cost per patient per month was similar in pre-TELE and TELE periods ($3797 vs. $4720, p = 0.064). There were no cost differences among scheduled or unscheduled encounters, office or ED visits, admissions, outpatient procedures, nor those billed to study sponsors or patient’s insurer. ConclusionsIncorporating telehealth in gynecologic cancer clinical trials during the COVID-19 pandemic did not increase cost of care and may be a mechanism for decentralizing clinical trials, reducing barriers to trial participation, and improving the value of cancer care.

Cost-effectiveness analysis of COVID-19 booster doses and oral antivirals: Case studies in the Indo-Pacific.

Decision-makers in middle-income countries need evidence on the cost-effectiveness of COVID-19 booster doses and oral antivirals to appropriately prioritise these healthcare interventions. We used a dynamic transmission model to assess the cost-effectiveness of COVID-19 booster doses and oral antivirals in Fiji, Indonesia, Papua New Guinea, and Timor-Leste. We conducted cost-effectiveness analysis from both healthcare and societal perspectives using data collated from publicly available sources. We developed an interactive R Shiny which allows the user to vary key model assumptions, such as the choice of discounting rate, and view how these assumptions affect model results. Booster doses were cost saving and therefore cost-effective in all four middle-income settings from both healthcare and societal perspectives using 3% discounting. Providing oral antivirals was cost-effective from a healthcare perspective if procured at a low generic price (US$25) or middle-income reference price (US$250); however, their cost-effectiveness was strongly influenced by rates of wastage or misuse, and the ongoing costs of care for patients hospitalised with COVID-19. The cost or wastage of rapid antigen tests did not appear strongly influential over the cost-effectiveness of oral antivirals in any of the four study settings. Our results support that COVID-19 booster programs are cost-effective in middle-income settings. Oral antivirals demonstrate the potential to be cost-effective if procured at or below a middle-income reference price of US$250 per schedule. Further research should quantify the rates of wastage or misuse of oral COVID-19 antivirals in middle-income settings.

Prevalence of Painful Temporomandibular Disorder Symptoms Among Professional and Student Musicians: An Online Survey.

Within the fields of medicine and music, increasing attention is given to evidence indicating music performance being an occupational risk factor for temporo-mandibular disorders (TMD). Assessment of self-reported painful TMD symptoms among student and professional musicians. Using Survey Monkey software, the German version of the 'TMD-Pain-Screener' was distributed electronically to professional and student musicians in Europe. Supplementary questions addressed age, gender, daily playtime, instrument type and type of professional practice. Results are presented as median [interquartile range]. The TMD-pain-screener was completed by 492 participants. Among them, 96 (19.5%) reported painful TMD (Pain_pos) and 396 did not experience pain (80.5%, Pain_neg). Pain_pos participants were significantly younger (Pain_pos: 34 years [26; 46], Pain_neg: 44 years [30; 56], p = 0.0003), had less work experience (Pain_pos: 15.5 years [6; 25], Pain_neg: 20 years [10; 32], p = 0.009), had fewer performances/year (Pain_pos: 20/year [10; 45], Pain_neg: 30/year [12; 53.5], p = 0.03) and were predominantly female (OR = 3.22 [1.87, 5.74], p < 0.0001). Comparisons among music performance types revealed no statistical significance in the overall test (p = 0.13), although 'keyboard' (OR = 2.99 [0.58, 30.12]), 'upper string' (OR = 2.31 [0.43, 23.63]) and 'singer' (OR = 2.14 [0.44, 20.75]) stood out compared to the reference group 'lower string' (OR 1.00). Organ players formed the largest group and showed a comparatively low prevalence of Pain_pos (16%), compared to other keyboard instruments (Pain_pos 30.2%). Prevalence of TMD pain was highest among young inexperienced female musicians. Playing keyboard instruments (other than organ) or upper strings instruments were frequently associated with painful TMD screening. An improved understanding of causes, implementation of preventive measures, professional guidance and a biopsychosocial health care perspective may decrease this occupational risk while maintaining the health benefits of music.

Droplet Contact Line Dynamics after Impact on Solid Surface: Future Perspectives in Healthcare and Medicine

Droplet Contact Line Dynamics after Impact on Solid Surface: Future Perspectives in Healthcare and Medicine

Part I - Health Issues of Those Experiencing Trafficking: Background and Context for Dermatologists

Human trafficking is a global human rights violation affecting millions of individuals across diverse demographics with severe health consequences. Despite the frequent interactions that exploited individuals have with healthcare systems, many remain unrecognized, positioning healthcare providers, including dermatologists, as critical first responders. In the first part of this three-paper series, we discuss the current landscape of human trafficking from a healthcare perspective, emphasizing the role of dermatologists in recognizing and responding to this issue. This paper reviews the current understanding of trafficking, outlines the epidemiology and legal framework surrounding trafficking, and discusses gaps in training for healthcare providers and policy that may hinder effective identification and intervention. It also explores state and national efforts to incorporate human trafficking education into healthcare training, emphasizing the need for standardized, trauma-informed approaches within dermatology. By fostering awareness and advocacy within the dermatology community, this paper aims to contribute to the broader efforts to combat human trafficking and improve the care and support provided to this patient population.

Prospective healthcare students' perspectives and attitudes on pharmacy as a chosen career path

BackgroundWith the national increase in the number of colleges and schools of pharmacy as well as the decreased pharmacy school applicant pool in recent years, pharmacy school enrollment challenges are at the forefront of issues facing pharmacy programs today. Factors that can influence a candidate's likelihood to pursue pharmacy school are important to evaluate. Recent studies assessing factors that motivate potential pre-health candidates to pursue pharmacy school or other healthcare careers are limited. ObjectiveTo describe prospective candidates' perspectives and attitudes toward pharmacy as a career pathway and assess factors that motivate or deter them from pursuing pharmacy as a career and from considering a specific pharmacy school. MethodThe study was cross-sectional and used an online data collection form distributed via the Qualtrics platform from October 4, 2022 through October 12, 2022 using the social media platform Reddit. Reddit has hundreds of subcommunities known as subreddits, that allow for exchange of ideas and discussion regarding various topics. This social media platform is commonly used by pre-health students to discuss career options. The survey consisted of 28 items and two domains, demographics and prospective healthcare students' understanding of responsibilities of pharmacists and their overall perspective on pharmacy as a profession. The survey was targeted toward anyone with an intention of pursuing a health science degree or career. ResultFour hundred participants completed the survey. Participants were mainly Caucasian, male, and with a mean age of 25 years. This study assessed prospective candidates' perspectives and attitudes toward pharmacy as a career pathway, appealing and unappealing characteristics about pursuing a career in the field of pharmacy, and factors that motivate or deter candidates from pursuing pharmacy. While 68 % of the participants had heard that career choices are vast and vary in the field of pharmacy, most still had concerns about the pharmacy field being heavily saturated and lack of job opportunities after graduation. Almost 60 % of responders gained information about pharmacy programs through social media platforms. The North American Pharmacist Licensure Examination pass rate, postgraduate residencies/fellowships, program duration and program reputation were among the top factors in choosing a pharmacy program. ConclusionMany survey participants had heard that there are a variety of job opportunities in the field of pharmacy, but the majority had heard that the pharmacy field is heavily saturated and that there are lack of opportunities after graduation. Most responders gained information through social media platforms. For prospective pharmacy school candidates, NAPLEX pass rate, number of graduates matched with PGY1 residencies and fellowships, and duration and reputation of the program seems to be among the most important factors in choosing a pharmacy program. Factors that prospective candidates consider when selecting a pharmacy program and the means they use to research about programs can be important considerations for pharmacy programs recruitment. Awareness of the preferences and baseline knowledge of candidates about the field of pharmacy can aid in developing targeted recruitment strategies and informing decision-making in pharmacy programs and recruitment efforts.

Economic effects of next-generation sequencing diagnostics in unspecific sepsis patients - a budget impact analysis from the healthcare providers' perspective in Germany.

Next-generation sequencing (NGS) tools have clinical advantages over blood culture but are more expensive. This study assesses the budget impact and break-even point of NGS testing costs from a healthcare provider's perspective in Germany. The budget impact was calculated based on aggregated data of German post-operative surgery cases. Simulated cost savings were calculated based on a simulated reduction in hospital length of stay (LOS) of four or eight days with a positivity rate of 71% and compared to the costs of one (scenario A) or two tests (scenario B) per case. Furthermore, the break-even point of the cost of two tests compared to saved costs through shortened LOS was conducted. For 9,450 cases, an average budget impact for scenario A and scenario B of €1,290.41 [95% CI €1,119.64 - €1,461.19] and - €208.59 [95% CI - €379.36 - - €37.81] was identified for gastrointestinal and kidney surgery cases, and €1,355.58 [95% CI €1,049.62 - €1,661.55] and €18.72 [95% CI - €324.69 - €287.24] for vascular artery surgery cases, respectively. The break-even analysis showed that using two tests per case could achieve a minimum positive contribution margin with an average of 1.9 tests per case across the study population. The results revealed a positive budget impact for one NGS test and a slightly negative budget impact for two NGS tests per case. Findings suggest that largest cost savings are generated for more severe cases and are highly dependent on the patient population.

Igniting Awareness: Assessing Healthcare Providers' Understanding of Firefighter Cancer Risks

Firefighters are at increased risk for skin cancer from exposure to fireground carcinogens, UV radiation, and other occupational hazards. Despite known risk factors, agencies such as the US Preventive Services Task Force (USPSTF) do not include recommendations for routine skin cancer screenings in their general guidelines. Moreover, limited provider understanding of the unique health challenges firefighters encounter has resulted in a lack of awareness in the healthcare community regarding these increased skin cancer threats. This raises concern as providers are crucial in conducting skin cancer screenings and advocating for preventive measures for patients, especially firefighters. To better understand healthcare provider perspectives, the San Antonio Fire Department (SAFD) administered a questionnaire assessing healthcare providers’ knowledge of firefighter cancer, including rates, risks, and policies, to healthcare providers attending the second annual SAFD “Firefighter Cancer Prevention and Wellness Fair” in January and February 2024, sharing de-identified results with the research team. The results indicate a majority of healthcare providers have limited knowledge about skin cancer in firefighters and are unaware of the major risks affecting members of this occupation. Approximately 70 healthcare providers participated in the questionnaire; of those, 4% passed the basic firefighter cancer knowledge quiz (&gt;70% correct answers) and 18% scored higher than 50%. The mean score was 34%. While the SAFD skin cancer screenings revealed a smoldering knowledge gap among providers in understanding firefighter cancer risk, this study underscores the necessity of educating more healthcare professionals about the men and women who dedicate their lives to keeping ours safe.

Poor sample size reporting quality and insufficient sample size in economic evaluations conducted alongside pragmatic trials: a cross-sectional survey

ObjectivesEconomic evaluations based on well-designed and -conducted pragmatic randomized controlled trials (pRCTs) can provide valuable evidence on the cost-effectiveness of interventions, enhancing the relevance and applicability of findings to healthcare decision-making. However, economic evaluation outcomes are seldom taken into consideration during the process of sample size calculation in pragmatic trials. The reporting quality of sample size and information on its calculation in economic evaluations that are well-suited to pRCTs remain unknown. This study aims to assess the reporting quality of sample size and estimate the power values of economic evaluations in pRCTs. Study Design and SettingWe conducted a cross-sectional survey using data of pRCTs available from PubMed and OVID from 1 January 2010 to 24 April 2022. Two groups of independent reviewers identified articles; three groups of reviewers each extracted the data. Descriptive statistics presented the general characteristics of included studies. Statistical power analyses were performed on clinical and economic outcomes with sufficient data. ResultsThe electronic search identified 715 studies and 152 met the inclusion criteria. Of these, 26 were available for power analysis. Only 9 out of 152 trials (5.9%) considered economic outcomes when estimating sample size, and only one adjusted the sample size accordingly. Power values for trial-based economic evaluations and clinical trials ranged from 2.56% to 100% and 3.21%–100%, respectively. Regardless of the perspectives, in 14 out of the 26 studies (53.8%), the power values of economic evaluations for quality-adjusted life years (QALYs) were lower than those of clinical trials for primary endpoints (PEs). In 11 out of the 24 (45.8%) and in 8 out of the 13 (61.5%) studies, power values of economic evaluations for QALYs were lower than those of clinical trials for PEs from the healthcare and societal perspectives, respectively. Power values of economic evaluations for non-QALYs from the healthcare and societal perspectives were potentially higher than those of clinical trials in 3 out of the 4 studies (75%). The power values for economic outcomes in Q1 were not higher than those for other journal impact factor quartile categories. ConclusionTheoretically, pragmatic trials with concurrent economic evaluations can provide real-world evidence for healthcare decision makers. However, in pRCT-based economic evaluations, limited consideration, and inadequate reporting of sample-size calculations for economic outcomes could negatively affect the results’ reliability and generalisability. We thus recommend that future pragmatic trials with economic evaluations should report how sample sizes are determined or adjusted based on the economic outcomes in their protocols to enhance their transparency and evidence quality.

Inferred attractiveness gravity-based models for estimating realized access at rural hospitals

Operating obstetric units in rural America is financially challenging in part due to low birth volume. Birth volume at a hospital decreases when birthers bypass it to go to a farther hospital. Beyond financial considerations, it is important from a healthcare equity perspective for hospitals to know whether certain subgroups of birthers avoid utilizing the hospital’s services. This can better inform resource allocation decisions targeting those subgroups. In this paper, we use a nonlinear programming optimization model, inferred attractiveness gravity-based model (GBM), to estimate realized access to obstetric care at hospitals in Montana. We compare three variations of GBM and benchmark our results to a regression-based conditional logit model. Results indicate that hospital attractiveness varies across the level of obstetric care provided and depends on the subgroup of birthers considered. While all GBMs produced smaller errors for hospitals with higher birth volumes, our novel variant was more accurate for low-volume hospitals. Bootstrapping analyses and resolving the models for population subgroups indicated large variations in hospital attractiveness. Research findings contribute to new knowledge about equity in access to obstetric care, the importance of considering population heterogeneity in GBMs, and the benefit of using hospital demand-based thresholds for GBMs in rural settings.

Is a 1-year course of methotrexate in patients with arthralgia at-risk for rheumatoid arthritis cost-effective? A cost-effectiveness analysis of the randomised, placebo-controlled TREAT EARLIER trial

ObjectivesRheumatoid arthritis (RA) has a considerable disease burden with life-long physical limitations, reduced work productivity and high societal costs. Trials on arthralgia at-risk for RA are therefore conducted, aiming to...

Cost-effectiveness of proton beam therapy vs. conventional radiotherapy for patients with brain tumors in Sweden: results from a non-randomized prospective multicenter study

BackgroundThis study assessed the cost-effectiveness of proton beam therapy (PBT) compared to conventional radiotherapy (CRT) for treating patients with brain tumors in Sweden.MethodsData from a longitudinal non-randomized study performed between 2015 and 2020 was used, and included adult patients with brain tumors, followed during treatment and through a one-year follow-up. Clinical and demographic data were sourced from the longitudinal study and linked to Swedish national registers to get information on healthcare resource use. A cost-utility framework was used to evaluate the cost-effectiveness of PBT vs. CRT. Patients in PBT group (n = 310) were matched with patients in CRT group (n = 40) on relevant observables using propensity score matching with replacement. Costs were estimated from a healthcare perspective and included costs related to inpatient and specialized outpatient care, and prescribed medications. The health outcome was quality-adjusted life-years (QALYs), derived from the EORTC-QLQ-C30. Generalized linear models (GLM) and two-part models were used to estimate differences in costs and QALYs.ResultsPBT yielded higher total costs, 14,639 US$, than CRT, 13,308 US$, with a difference of 1,372 US$ (95% CI, -4,914–7,659) over a 58 weeks’ time horizon. Further, PBT resulted in non-significantly lower QALYs, 0.746 compared to CRT, 0.774, with a difference of -0.049 (95% CI, -0.195–0.097). The probability of PBT being cost-effective was < 30% at any willingness to pay.ConclusionsThese results suggest that PBT cannot be considered a cost-effective treatment for brain tumours, compared to CRT.Trial registrationNot applicable.

Exploring medication self-management in polypharmacy: a qualitative systematic review of patients and healthcare providers perspectives.

Purpose: Polypharmacy presents many challenges to patient medication self-management. This study aims to explore the self-management processes of medication in polypharmacy from the perspectives of both patients and healthcare providers, which can help identify barriers and facilitators to effective management. Methods: A systematic review of qualitative studies was performed by searching seven databases: PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, and MEDLINE, from their establishment until August 2024. The Critical Appraisal Skills Programme (CASP) tool was employed to evaluate the quality of the studies included. The extracted data were then analysed thematically and integrated into The Taxonomy of Everyday Self-management Strategies (TEDSS) framework. Results: A total of 16 studies were included, involving 403 patients and 119 healthcare providers. Patient management measures were mapped into TEDSS framework, including categories such as medical management, support-oriented domains, and emotional and role management. Conclusion: Enhancing patients' proactive health awareness, improving medication literacy, balancing lifestyle adjustments with medication therapy, dynamically reviewing and optimizing medications, strengthening patients' social support networks, and helping patients integrate medication management into their daily life are the key elements that can effectively assist patients in self-managing their medications. Future interventions to improve patient medication self-management ability should be designed for these issues. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024524742.

REPRODUCTIVE HEALTH IN TRANS AND GENDER DIVERSE PATIENTS: Mind the gap: a nationwide audit of LGBTQ+ inclusion in fertility care providers in the United Kingdom.

We describe a first-of-its-kind audit of LGBTQ+ inclusivity in fertility care providers across the United Kingdom. Despite efforts being made to improve LGBTQ+ inclusion in fertility care, our results paint a picture of widespread gaps in clinical and cultural expertise alongside significant barriers to LGBTQ+ inclusion. LGBTQ+ patients comprise one of the fastest-growing user demographics in fertility care, yet they remain under-represented in fertility research, practice, and discourse. Existing studies have revealed significant systemic barriers, including cisheteronormativity, discrimination, and gaps in clinical expertise. In this article, we present a checklist of measures that clinics can take to improve LGBTQ+ inclusion in fertility care, co-created with members of the LGBTQ+ community. This checklist focuses on three key areas: cultural competence, clinical considerations, and online presence. The cultural competence criteria encompass inclusive communication practices, a broad understanding of LGBTQ+ healthcare needs, and knowledge of treatment options suitable for LGBTQ+ individuals. Clinical considerations include awareness of alternative examination and gamete collection techniques for transgender and gender diverse patients, the existence of specific clinical pathways for LGBTQ+ patients, and sensitivity to the psychological aspects of fertility care unique to this demographic. The online presence criteria evaluate provider websites for the use of inclusive language and the availability of LGBTQ+-relevant information. The checklist was used as the foundation for an audit of fertility care providers across the UK in early 2024. Our audit identified a widespread lack of LGBTQ+ inclusion, particularly for transgender and gender diverse patients, highlighting deficiencies in clinical knowledge and cultural competence. Our work calls attention to the need for further efforts to understand the barriers to inclusive and competent LGBTQ+ fertility care from both healthcare provider and patient perspectives.

Effect of long-term care insurance on medical expenditure and health status: National cohort study

BackgroundLong-term care insurance (LTCI) was implemented in China to solve the elderly care problems caused by the aging population. It is crucial to evaluate the effectiveness of LTCI implementation from the perspective of value-based healthcare.ObjectiveThis study aimed to investigate the impact of LTCI on medical care expenditure and health status in China.MethodsWe used staggered difference-in-differences (DID) analysis to analyze the effect of LTCI policy on medical expenditure and health status based on China Health and Retirement Longitudinal Study data from 2011 to 2018.ResultsOur findings confirmed the positive contribution of LTCI policies to medical expenditures and health status. We found that the implementation of LTCI significantly reduced inpatient and outpatient expenditure, scores of self-report of health, and CESD scores by 26.3%, 12.3%, 0.103, and 0.538, respectively. It also decreased ADL scores, but the decrease was not significant. The impact of LTCI on reducing inpatient expenditure was greater for individuals aged between 65 and 80 and those residing in urban areas and eastern cities. In terms of outpatient costs, the effect of LTCI was more pronounced among median and high-income people and people living in central and eastern cities. The impact of LTCI on self-report of health is stronger for rural populations, individuals under 80, and those in central and eastern cities. For ADL scores, LTCI affected those aged 65–80 the most. About the CESD scores, LTCI had a greater impact on rural populations, people aged 45–65, median income groups, and those in eastern cities.ConclusionsOur study underscored LTCI’s effectiveness in curbing medical expenditures and enhancing health status, offering valuable insights for future LTCI development in China and beyond. Accelerating the development of LTCI is conducive to improving the quality of life of the disabled elderly, enhancing the well-being of people’s livelihoods, and realizing the goal of value-based healthcare.

Cost-effectiveness of ace inhibitors versus ARBs in heart failure management.

Heart failure is a chronic condition that imposes a significant burden on healthcare systems worldwide. Effective management is crucial for improving patient outcomes and reducing costs. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are widely used to manage heart failure by reducing cardiac strain and preventing disease progression. Despite their common use, ACE inhibitors and ARBs differ in mechanisms, cost, and potential side effects. ACE inhibitors have long been the standard treatment, while ARBs are often prescribed to patients intolerant to ACE inhibitors, particularly due to side effects like cough. Given these differences, evaluating the cost-effectiveness of these treatments is essential. This study compares the cost-effectiveness of ACE inhibitors and ARBs from a healthcare system perspective, considering both direct medical costs and health outcomes. A cost-effectiveness analysis was conducted using a decision-analytic Markov model to simulate heart failure progression in a hypothetical cohort. Data inputs included clinical trial outcomes, real-world effectiveness data, direct medical costs (medications, hospitalizations, monitoring), and utility values for quality of life. The primary outcome measures were the cost per quality-adjusted life year gained and the incremental cost-effectiveness ratio. Sensitivity analyses tested the robustness of results, and subgroup analyses were conducted based on age and disease severity. The base-case analysis showed that ACE inhibitors were associated with lower overall costs and slightly higher quality-adjusted life years than ARBs. Sensitivity analyses revealed that variations in key parameters, such as transition probabilities, mortality rates, and healthcare expenses, had limited impact on the overall cost-effectiveness conclusions. Subgroup analyses indicated that ACE inhibitors and ARBs exhibited similar cost-effectiveness profiles for patients aged <65 and ≥65 years. However, among patients with severe heart failure, ARBs demonstrated a higher incremental cost-effectiveness ratio compared with ACE inhibitors, suggesting reduced cost-effectiveness in this subgroup. ACE inhibitors are likely a more cost-effective option for managing heart failure than ARBs, particularly from a healthcare system perspective. The findings underscore the importance of tailoring treatment decisions to individual patient factors, preferences, and clinical conditions, providing valuable insights for healthcare policy and practice, particularly regarding cost-effectiveness across patient subgroups.