Societal Perspective Research Articles

Cost-effectiveness analysis of screening three-year old for social-emotional problems

Abstract Aim To assesses the long-term cost-effectiveness of a population-based screening to detect social-emotional problems at 3-years-old combined with an evidence-based intervention to prevent mental health problems. Methods A decision-analytic Markov model compares two alternatives 1) all 3-years-old get screened for social-emotional problems, and parents for children at a high risk receive a generic targeting parenting intervention 2) no screening and no intervention. The cohort of 3-year-old is modeled until they are 19 years old. The screening test is the ASQ:SE and the intervention was given to children with scores that suggest social-emotional problems. The model considered development of anxiety, conduct problems, and ADHD, over the 16 years. The analyses were done from a societal and healthcare perspectives. Health outcomes were assessed with DALYs averted. Results Results suggest that the probability of population-based screening for social-emotional problems combined with the parenting intervention to high risk-children being cost-effective is high, adopting a societal and healthcare perspective, 98% and 97% each. From a societal perspective, the likelihood of cost saving is high, 85 %. The combination of screening and intervention strongly dominated the comparator. Conclusions The findings align with previous research; prevention aimed at children’s mental health disorders will likely yield high investment returns. Successful implementation of population-based screening for social-emotional problems combined with an effective evidence-based parenting intervention might be an important way to contribute to sustainable and efficient mental health care. Key messages • The impact of combining population-based screening with intervention is encouraging when considering a long-term view. • Prevention aimed at children’s mental health will likely yield high investment return.

The future of screening and early detection in the Netherlands: a foresight study to support new screening policy strategies

Abstract The Dutch government provides several population screening programmes intended for early detection of diseases so that prompt treatment can be provided. These include population screenings for various forms of cancer and screenings for specific diseases in unborn and newborn children. The future provision of these screenings is influenced by various developments, including the ageing population, economic fluctuations and technological advancements. To understand these developments and their potential impacts on the future of screening and early detection, RIVM has conducted a foresight study based upon a systematic six-step approach. Important steps in this process are building a conceptual framework, identifying important developments via horizon scanning, selecting scenario logics and making scenarios in order to select important challenges and opportunities for the future. The final output of the foresight study consists of a broad horizon scan, two simple future scenarios and four societal perspectives on screening and early detection. In this foresight study, there was special attention for the role of different societal perspectives and the variation in desirable futures that these perspectives entail. These perspectives were presented to the Ministry and other important stakeholders in the future strategy planning, by playing a serious role game. The results of the foresight study and the experience of looking to the future through various perspectives forms the input for the Dutch Ministry of Health, Welfare and Sport in formulating a strategy for the future of screening and early detection and making informed decisions about potential actions. The presentation will focus on how the foresight process was done and how this has informed the Ministry of Health in order for them to follow the next steps in setting future goals and ambitions and planning for a future policy strategy.

Economic evaluation of Polygenic Risk Scores in healthcare interventions: a systematic review

Abstract Background Polygenic Risk Scores (PRS) quantify genetic susceptibility to diseases, promising personalized healthcare. This review explores current evidence regarding the economic evaluation of strategies based on PRS or other polygenic risk stratification approaches, scrutinizing their methodologies. Methods The study protocol was registered in PROSPERO (CRD42023442780). A systematic search in PubMed, Scopus, and Web of Science identified full economic evaluations of intervention based on polygenic risk stratification strategies. The quality of the included articles was assessed using the Drummond checklist. This study was supported by the EC and MUR under PNRR - M4C2-I1.3 Project PE_00000019 ‘HEAL ITALIA”. Results Nineteen articles were included in the analysis, with oncological conditions being the most frequently investigated (13), followed by cardiovascular conditions (3). In nearly 80% of the studies, PRS was employed for screening interventions, with the general population being the primary target in 14 out of the 19 studies. All the economic analysis models investigated cost-utility in terms of QALYs, with Markov models and microsimulations being the most common structures. The majority of these models were based on simulated cohorts derived mostly from North American or European data, with 9 adopting a healthcare system perspective and 6 a societal perspective. Although delivery strategies for PRS testing were rarely addressed, PRS costs were included in nearly all studies. Indirect costs were examined in fewer than half of the studies. In 12 out of 19 studies, the conclusions claimed the cost utility of PRS involving strategies. Conclusions Despite the technique’s potential, evaluations of various strategies based on PRS approaches yield heterogeneous conclusions regarding cost-utility. Our study highlights the factors contributing to this heterogeneity and underscores the need for further exploration, ideally prioritizing real-world data. Key messages • PRS strategies evaluations vary in cost-utility conclusions, highlighting the need for further investigation. • Real-world data and practical implications should be prioritised in PRS research.

Economic cost of a case of diarrhoea in Uvira, Democratic Republic of the Congo: A cost of illness study.

Diarrhoea is one of the leading causes of disability-adjusted life years (DALYs) among children below five years, though the proportion of the burden occurring amongst those aged over 70 is increasing. The cost of treating and managing diarrhoea can place a burden on individuals, their households, and society in general. The cost can be high but is often undocumented, and many studies focus on children or hospitalised patients only. This study aimed to estimate the economic cost per case of diarrhoea amongst individuals of any age in Uvira, Democratic Republic of the Congo. The study was cross-sectional and retrospective, and based on a household survey approximately representative of the city undertaken in September 2021. Data on quantities and prices of resources were collected in the survey, as well as from interviews with staff at the Cholera Treatment Centre in the Uvira general hospital and their records on resource use and patient numbers. Direct and indirect costs were measured from the societal perspective, and generalised linear regression used to identify factors associated with higher costs. Of 2,820 members of the 528 households surveyed, 175 people (6.2%) were reported to have had diarrhoea in the previous seven days. The majority sought care (91%) of which most (64%) visited a pharmacy. The average economic cost of illness (COI) for an episode of diarrhoea was 33,816 Congolese Francs (CDF) (US$ 17.0) in 2021 prices. The median was CDF 14,000 (US$ 7.0). The average out of pocket COI to patients was CDF 15,579 (US$ 7.8), representing 9% of the estimated average monthly income of households. On average caregivers and patients lost 4 days per episode. A concentration index suggested a lower economic COI among poorer households (p=0.099). A regression analysis identified that being older than 5 years (p=0.001) or being water insecure (p=0.032) were associated with higher COI. Households in Uvira experience many diarrhoeal episodes per year, and the COI is an important burden for them and society. These costs could be avoided if diarrhoea were prevented through public health interventions to reduce prevalence and care-seeking was better managed to avert this public health burden.

Health economics and services research in symbiosis: STREAMLINEing mental health services in Austria

Abstract Objectives The cost of mental diseases exceeds 4% of GDP in Europe. In Austria, every 5th person lives with mental ill-health (MIH). Ongoing epidemiological, demographic and societal changes increase the need for easily accessible, better integrated and good value services. In STREAMLINE, we combine, harmonize and implement the latest methods in human service mapping and economic costing to optimize future service provision and financing for MIH in Austria. Methods We comprehensively assess the availability, activity and affordability of human services targeting MIH in Vienna within the health and social care, education, labour and justice sectors based on a conceptual mind map. We identify services through extensive literature, document and web searches plus expert consultations. Services are mapped and costed according to the European PECUNIA methods: classification of the main service types using the international DESDE taxonomy of human services; development of Reference Unit Costs using the PECUNIA RUC templates with primary data; validation of the results with secondary data; compilation of a comprehensive multi-sectoral service catalogue; and synthesis for spatial and policy analyses. Results We identified 756 sources, 75% individual organisations, 5% multi-organisations and 20% existing provider lists. 84% relate to health and social care, 10% labour, and 3% education and justice sectors each. 58% deliver care to adults, 37% to children & adolescents, and 5% support carers. Further service mapping and RUCs will be presented. Discussion STREAMLINE pioneers in coordinated public mental health services and economics research at scale. Assessed levels of fragmentation call for better integration, improved transition, reduced spatial inequity and increased support for carers. Results increase the feasibility of service evaluations from a societal perspective. Planned public service atlas facilitates information and access for service users and carers. Funding: WWTF Key messages • New methods for harmonized health services and economics research allow comprehensive information for optimized future mental health service planning and financing. • Assessed levels of fragmentation highlight the need for better integration, improved transition, reduced spatial inequity and increased support for carers.

Economic burden of suicide in Sweden in 2022

Abstract Background Suicide and suicidal behaviors bring massive human, social and economic impacts. Estimates of the cost of suicide can give some guidance as to where research on developing new interventions might be focused to give the greatest potential gain. The aim of the study is to quantify the economic cost of suicide in Sweden in 2022. Methods Incidence of suicide attempts and mortality due to suicide, intentional and undetermined (ICD10 X60-X84 and Y10-Y34) were sourced from the Swedish National Board of Health and Welfare databases for 2022. Cost were estimated from a societal perspective, including costs for inpatient and outpatient care, medication, police and justice activities as well as productivity losses due to early mortality. Results In 2022, a total of 1,569 suicide death were registered in Sweden (1,102 men and 467 women). The incidence rate remains stable during the last ten years, 17 death per 100 000. In total, 18,854 patients (10, 359 women and 8,459 men) were treated in inpatient and outpatient hospital care with suicide-related diagnoses, generated 32,843 days in inpatient care and 11,471 outpatient care visits. Direct costs for suicide death including forensic examination, emergency services, police investigation and property damage were estimated as €6,02 million, while indirect costs for productivity losses totaled €690 million. Direct healthcare costs for suicide related treatment were estimated at €54.3 million. Overall, suicide and suicide attempts cost around €750 million per year to society. Conclusions Estimates of the economic burden of suicide are needed for the Swedish setting, and these amounted to €60.3 million in direct costs and €690 million in indirect costs in 2022. The cost might be underestimated because the societal cost of suicide bereaved persons was not considered. These cost estimates can provide useful inputs to a cost-effectiveness analysis of a specific preventive intervention, and to its subsequent evaluation. Key messages • Economic burden of suicide is substantial for society. • Public health policies aimed at the prevention of suicide should be increased.

6.P. Scientific session: Economic evaluation of health impacts for better decision choices

Abstract The strategy of Health in All Policies (HiAP) pursues to analyse the wider determinants of health affected by the decision-making process of traditionally non-health sectors, seeking to enhance population health benefits while avoiding health inequalities. This usually involves the use of health impact assessment (HIA) or health lens analysis to any policy, program, plan or project (PPPP), preferably prior to its implementation. On the other hand, decision-makers from a wide range of public and private sectors also demand a better insight of the meaning of the health impacts quantified under HIA. Assuming the (ubiquitous) situation of limited resources and budgets, decisions need to be based on cost effectiveness criteria and, whenever possible, direct and indirect health costs should be part of the impact assessment. Economic appraisal attempts to define whether a proposal makes a net contribution to social welfare, quantifying and valuing changes to individuals’ utility from the societal perspective, taking into account the impact of health on the individual, their family, employers, healthcare providers and the state. This approach can incorporate different components of the welfare costs of illness, including direct medical and paid care expenses, indirect lost opportunity costs such as productivity and the value of informal care time, as well as a value that monetises the disutility or pain and suffering associated with disease. The range of methods and estimated benefits can make it challenging to identify a best practice approach. The present session aims to address certain methodological aspects related to the economic evaluation of health impacts, which still generate some controversy and debate, with particular emphasis on the following topics: • Approaches for synthesizing evidence on health impact pathways and economic evaluation of health impacts for a better decision choice; • Health metrics: influence on the conclusions of economic analysis within HIA; • Sources of metrics used for economic analysis; • Uncertainties inherent to economic valuation of health outcomes: how to deal with it. Key messages • The economic analysis of health impacts can help prioritizing aspects with the greatest impact on population health, facilitating a more effective use of human and economic resources. • The economic analysis within HIA can improve decision-making but requires careful consideration of health metrics, sourcing of data, and management of uncertainties.

Cost-effectiveness analysis of the digital fall preventive intervention Safe Step among community-dwelling older people aged 70 and older

Falls are the most common cause of injury in older people, with consequences for the individual and society. With an increasing population of older people, falls and related costs are expected to increase. It is crucial to identify scalable and cost-effective interventions and subsequently reduce fall-related costs. The aim was to evaluate the cost-effectiveness of the Safe Step digital fall preventive exercise intervention over a period of 12 years and, in addition, to evaluate the impact of increased recruitment cost and decreased intervention effect. The intervention was evaluated in an observational study in a municipality context targeting community-dwelling older people of age 70 + . A Markov model with five states was used to model the cost-effectiveness of the Safe Step intervention and evaluate quality-adjusted life years (QALYs) and fall-related costs from a societal perspective. By using data from a meta-analysis as basis for the estimated intervention effect, the Safe Step intervention was compared with a no-intervention alternative. The results showed that the Safe Step intervention dominated no intervention. In the sensitivity analysis with the most conservative estimate of intervention effect, the ICER was €7 616 per QALY gained. Hence, Safe Step showed to be a cost-saving fall preventive intervention in older people at risk of falling and potentially cost-effective even with a low estimated intervention effect. Future studies on efficacy of fall preventive digital interventions will contribute in precising effect estimates and enhance the validity of these cost-effectiveness results.

A Clinical and Economic Comparison of Cell-Based Versus Recombinant Influenza Vaccines in Adults 18–64 Years in the United States

Background: This analysis compares the cost-effectiveness of a cell-based influenza vaccine to a recombinant influenza vaccine, and each to no vaccination. The analysis is based on United States (US) commercial and societal perspectives. Methods: A Susceptible–Exposed–Infectious–Recovered (SEIR) transmission model of the total US population followed with a cost-effectiveness model for 18–64-year-olds was used to estimate the clinical and economic impact of vaccination over one influenza season (2018–2019). Deterministic and probabilistic sensitivity analyses were conducted. Results: Both enhanced vaccines prevented a substantial number of influenza cases and influenza-related deaths compared to no vaccination. The cell-based vaccine was associated with higher quality-adjusted life years (QALYs) gained compared to the recombinant vaccine or no vaccination. The cell-based vaccine had a 36% lower vaccination cost, amounting to $2.8 billion in cost savings, compared to the recombinant vaccine. The incremental cost-effectiveness ratios (ICERs) for the cell-based vaccine, compared to the recombinant vaccine or no vaccination, were dominant from all payer perspectives, regardless of risk groups. Conclusions: Overall, the cell-based vaccine was cost-saving compared to the recombinant vaccine for subjects aged 18–64 years in the US, achieving comparable health outcomes with a significant reduction in associated costs.

Cost-utility analysis of adapted problem adaptation therapy for depression in mild-to-moderate dementia caused by Alzheimer's disease: PATHFINDER randomised controlled trial.

Depression is common in people with dementia, and negatively affects quality of life. This paper aims to evaluate the cost-effectiveness of an intervention for depression in mild and moderate dementia caused by Alzheimer's disease over 12 months (PATHFINDER trial), from both the health and social care and societal perspectives. A total of 336 participants were randomised to receive the adapted PATH intervention in addition to treatment as usual (TAU) (n = 168) or TAU alone (n = 168). Health and social care resource use were collected with the Client Service Receipt Inventory and health-related quality-of-life data with the EQ-5D-5L instrument at baseline and 3-, 6- and 12-month follow-up points. Principal analysis comprised quality-adjusted life-years (QALYs) calculated from the participant responses to the EQ-5D-5L instrument. The mean cost of the adapted PATH intervention was estimated at £1141 per PATHFINDER participant. From a health and social care perspective, the mean difference in costs between the adapted PATH and control arm at 12 months was -£74 (95% CI -£1942 to £1793), and from the societal perspective was -£671 (95% CI -£9144 to £7801). The mean difference in QALYs was 0.027 (95% CI -0.004 to 0.059). At £20 000 per QALY gained threshold, there were 74 and 68% probabilities of adapted PATH being cost-effective from the health and social care and societal perspective, respectively. The addition of the adapted PATH intervention to TAU for people with dementia and depression generated cost savings alongside a higher quality of life compared with TAU alone; however, the improvements in costs and QALYs were not statistically significant.

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.

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.

Economic burden of knee joint replacement in Iran

BackgroundThe knee is the most commonly afflicted weight-bearing joint. Osteoarthritis of the knee is regarded as one of the most commonly diagnosed causes of disability in the elderly. Knee joint replacement can be regarded as a final solution for Osteoarthritis of the knee in which the joint is worn out, accompanied by clinical symptoms such as pain, deformity, and limited movement.Aimthis study sought to estimate the economic burden of knee joint replacement procedures carried out in Iran.MethodThis cross-sectional descriptive study utilized the Incidence-based approach to assess the economic burden of knee joint replacement surgeries conducted in Iran during 2022, estimating the costs of the disease from a societal perspective. The sampling method employed was random sampling, and the sample size consisted of 300 patients. Direct costs were calculated employing the top-down approach, while indirect costs were estimated using the human capital approach. Microsoft Excel was employed for data analysis.ResultThe average direct medical costs of the knee replacement procedure per patient were $10,076.87 and $13,099.93 in the public and private sectors, respectively. The average direct non-medical costs of knee joint replacement surgery are $1123.64, with companion costs constituting most of the direct non-medical costs. Finally, the economic burden of the knee joint replacement surgery was estimated at $67340417.28.ConclusionDespite insurance coverage, knee joint replacement surgery in Iran incurs substantial costs. With the anticipated rise in the elderly population, the frequency of these procedures is expected to increase, amplifying the economic burden on the Iranian public.

Gender as biology, discourse, and construct: The form of space in The Tenant of Wildfell Hall as a subversion of the fairy tale “Blue-Beard”

The gendered prescriptions that permeate fairy tales can shape societal structures and perspectives. However, just as literature plays a role in reinforcing societal constructs, it can be used to challenge and subvert them. This paper looks at the form of space in The Tenant of Wildfell Hall by Anne Brontë (1848) as a subversion of “Blue-Beard” by Charles Perrault (1697) and its relation to understanding gender as biology, discourse, and construct.

The basic income for care leavers in Wales pilot evaluation: Protocol of a quasi-experimental evaluation.

This study will evaluate the Basic Income for Care Leavers in Wales pilot (BIP), which is the most generous basic income scheme in the world. A cohort of care-experienced young people who become aged 18 during a 12-month enrolment period (July 2022-June 2023) are receiving £1,600 (before tax) per month for two years, and the Welsh Government intends this to have a range of benefits. This evaluation will examine the impact of BIP, the implementation of the pilot and how it is experienced, and its value for money. The study is a theory-based quasi-experimental evaluation, and the design and methods are informed by ongoing co-production with care-experienced young people. We will estimate the impact of BIP on participants using self-reported survey data and routinely collected administrative data. This will include outcomes across a range of domains, including psychological wellbeing, physical and mental health, financial impact, education, training and volunteering. Comparisons between temporal (Welsh) and geographical (English, using administrative data) controls will be done using coarsened exact matching and difference in differences analysis. The process evaluation will examine how BIP is implemented and experienced, primarily through monitoring data (quantitative) and interview, observational, and focus group data (qualitative). The economic evaluation will take a public sector and a societal perspective to identify, measure and value the costs and outcomes of BIP, and to synthesise the evidence to inform a social cost-benefit analysis at 24 months post-intervention. BIP is unusual in that it targets a wide range of outcomes and is available to an entire national cohort of participants. The evaluation also has several practical constraints. Therefore, the study will use a range of methods and triangulate between different analyses to assess how successful it is. Findings will inform policy in relation to care leavers, social security and basic income studies worldwide.

Cost-effectiveness of prophylactic ramosetron in the prevention of postoperative nausea and vomiting.

This study was conducted to assess the cost-effectiveness of prophylactic use of ramosetron compared to no antiemetic medications for the prevention of postoperative nausea and vomiting (PONV) from the healthcare payer and societal perspectives in South Korea. A decision analytic model was constructed to assess the cost-effectiveness of prophylactic ramosetron use versus no antiemetic therapy at 24-hour and 48-hour periods post-surgery over a 5-day duration. The model was populated using costs and utility parameters from published studies as well as from surveys of an expert panel of physicians using structured questionnaires. The cost parameters included the costs of drugs, treatment, patient time, productivity loss, and transportation. Effectiveness was measured using quality adjusted life years (QALYs). The study outcome was the incremental cost-effectiveness ratio (ICER). The parameter uncertainties were addressed using deterministic and probabilistic scenario analyses. The base-case analysis showed that, on average, patients treated with prophylactic ramosetron had lower costs from both the healthcare payer (US$16.88 vs US$17.33) and societal (US$16.89 vs US$18.72) perspectives and higher QALYs (0.0121 vs 0.0114) over the 5-day study duration compared to patients without any antiemetic medications. Deterministic and probabilistic sensitivity analyses were conducted to examine the robustness of results for the parameters included in the model. The acceptability curve probability showed that treating patients with ramosetron compared to no antiemetic medications was more than 99% cost-effective at a willingness-to pay threshold of US$5,000/QALY from both payer and societal perspectives. The results demonstrated that prophylactic use of ramosetron compared to no antiemetic therapy is highly cost-effective to prevent PONV for patients undergoing surgery from both healthcare payer and societal perspectives. The cost effectiveness is the result of the decrease in the incidence of PONV and the direct treatment costs of severe PONV with improved patient quality of life.

The same but different: A cross‐country comparison of national earthquake policies and societal perspectives of seismic risk in Israel and Switzerland

AbstractNational earthquake policies aim to mitigate earthquake risk by minimizing the potential damage to lives, property, and infrastructure and by preparing the population to carry out recommended behaviors when an earthquake is felt or a warning is heard. In this research, we compare two earthquake‐prone countries, Israel and Switzerland, to examine if and how their policies to mitigate seismic risk differ, and how citizens react to the national earthquake policies in terms of their perceived risk of earthquakes and their preparedness. We examine and compare four national‐level earthquake policy components—risk assessment, mitigation regulation, early warning system, and risk communication with the public. We find that centralized national‐level policy in Israel, which includes regulated building codes, a nationwide early warning system, and national awareness campaigns, does lead to higher levels of reported awareness and preparedness. Similarly, in high‐risk cantons in Switzerland, which apply these policies (except for the warning system), citizens were also more prepared than in low‐risk cantons. However, given learning from both countries' policies, we suggest that earthquake policies should include collaboration with local authorities and the population through a more decentralized and localized approach, which includes drills, training, and information dissemination.

Cost-Effectiveness of Teduglutide for Pediatric Patients with Short Bowel Syndrome in Japan, Including Caregiver Burden.

Short bowel syndrome (SBS) is associated with a significant mental and physical burden for patients and caregivers. Standard of care (SOC) for SBS includes parenteral support (PS) to optimize intestinal function. Teduglutide, a recombinant human glucagon-like peptide2 analogue, reduces the need for PS in patients with SBS. In this study, we assessed the cost-effectiveness of teduglutide in pediatric patients with SBS from multiple perspectives, considering the caregiver's burden. A Markov model was used to evaluate cost (Japanese yen, JPY) and effectiveness (quality-adjusted life years, QALYs) of teduglutide compared with SOC for pediatric patients with SBS in Japan. We conducted a base-case analysis and selected sensitivity and scenario analyses from three perspectives: (1) the public healthcare payer, (2) the public healthcare and long-term care payer, and (3) society. In the base-case analysis, the incremental cost-effectiveness ratio (ICER) was 9,533,412 JPY per QALY from the public healthcare payer perspective, 6,335,980 JPY per QALY from the public healthcare and long-term care payer perspective, and 3,510,371 JPY per QALY from the societal perspective. The probability that cost-effectiveness of teduglutide is favorable from a societal perspective was 59.3%. In all scenario analyses, consistent with the base-case analysis, ICERs for teduglutide compared with SOC were different depending on whether caregiver utility and productivity loss were considered. Incorporating the caregiver's burden in the cost-effectiveness analysis of teduglutide for pediatric patients with SBS provided a more comprehensive assessment of the value of teduglutide for patients, their families, and society. This approach enhances our understanding of the overall value of a treatment, especially for diseases with significant caregiver burden.

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.

Health and Economic Outcomes of Offering Buprenorphine in Homeless Shelters in Massachusetts

Overdose is the leading cause of death among people experiencing homelessness (PEH), but engagement in medication treatment is low in this population. Shelter-based buprenorphine may be a strategy for increasing initiation and retention on lifesaving medications. To estimate clinical outcomes and conduct an economic analysis of statewide shelter-based opioid treatment in Massachusetts. This economic evaluation study in Massachusetts used a cohort state-transition simulation model. Two cohorts were modeled starting in 2013, including (1) a closed cohort of a fixed population of PEH with history of high-risk opioid use over their lifetimes and (2) an open cohort in which membership could change over time, allowing assessment of population-level trends over a 10-year period. Data analysis occurred from January 2023 to April 2024. Model exposures included (1) no shelter-based buprenorphine (status quo) and (2) offering buprenorphine in shelters statewide. Outcomes included overdose deaths, quality-adjusted life-years (QALYs) gained, and health care and modified societal perspective costs. Sensitivity analyses were conducted on key parameters. In the closed cohort analysis of 13 800 PEH (mean [SD] age, 40.4 [13.1] years; 8749 male [63.4%]), shelter-based buprenorphine was associated with an additional 65.4 person-weeks taking buprenorphine over an individual's lifetime compared with status quo. Shelter-based buprenorphine was cost saving when compared with the status quo, with a discounted lifetime cost savings from the health sector perspective of $1300 per person, and 0.2 additional discounted QALYs per person and 0.9 additional life-years per person. In the population-level simulation, 254 overdose deaths were averted over the 10-year period with the shelter-based buprenorphine strategy compared with the status quo (a 9.2% reduction of overdose deaths among PEH in Massachusetts). Overdose-related and other health care utilization undiscounted costs decreased by $3.0 million and $66.4 million, respectively. Shelter-based opioid treatment generated $44.7 million in additional medication and clinical costs, but saved $69.4 million in overdose and other health costs. In this economic evaluation of clinical and economic outcomes among PEH, shelter-based buprenorphine was associated with fewer overdose deaths and was cost saving. These findings suggest that broad rollout of shelter-based buprenorphine may be an important tool in addressing the overdose crisis.