Societal Perspective Research Articles

The Case of Paris and Helen Through Time, Society, and Anti-Aging Medicine.

This study revisits the myth of Paris and Helen through the interdisciplinary lenses of classical chronology, social norms, and modern aesthetic medicine. By reconstructing key generational markers from Greek myth, the paper estimates that Helen was ~28 to 33 years old and Paris 45 to 55 years old at the time of her abduction to Troy-revealing a significant 12 to 25 year age gap often overlooked in popular portrayals. Although Helen, a married mother, would have been considered a matron in Bronze Age society, Paris-already mature at the time of the Judgment of Paris-would be seen as a romance-gray figure, well beyond the ideal warrior age. This pairing disrupts conventional notions of youthful love, reflecting an age-defying dynamic that mirrors contemporary relationships. From a societal perspective, their affair challenges ancient gendered age norms that favored youthful brides and heroic young men. From the standpoint of modern aesthetic medicine, both Helen and Paris fall within age groups now targeted for anti-aging interventions: early neuromodulation and skin tightening for women in their 30s, and jawline refinement or hair restoration for men in their 50s. Their myth, therefore, not only captures divine manipulation and political consequences but also illustrates the enduring relevance of desire beyond youth. The case of Paris and Helen ultimately questions cultural limits on love and beauty, past and present, and suggests that the boundaries of erotic legitimacy may be more fluid-and more socially constructed-than timeless.

Economic evaluation of type 2 diabetes mellitus T2DM pharmaceutical treatment compared to an alternative, conducted alongside randomized controlled trials: A scoping review

Abstract Objective Diabetes mellitus is recognized as one of the most challenging health conditions facing all healthcare systems around the world and poses a high burden on individuals and society. Prevention of type 2 diabetes via screening programs and accessible, safe, and effective treatments would benefit people who might otherwise suffer decades of drug therapy and disease-related complications, leading to premature mortality, preventable morbidity, and significant economic burden. This study aimed to systematically map existing research on the cost-effectiveness of T2DM pharmaceutical treatment conducted alongside randomized controlled trials (RCT). Method This scoping review was carried out according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews" and "Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) " checklists. Medline, Health & Medical Complete (ProQuest), Cochrane Central Register of Controlled Trials (CENTRAL), and Tufts Global Health Cost Effectiveness Analysis (GH CEA) Registries were searched from January 2010 to January 2023. Results 205 records were initially identified, and 21 records were selected for full-text review, resulting in the extraction and analysis of data from 13 articles, including 15 studies. Of the included studies, 53% of economic evaluations have been carried out in Europe (Spain, United Kingdom, Sweden and the Netherlands), 27% United States and 20% in China. Two-thirds of included studies used the payer’s perspective, three studies adopted a healthcare system perspective, one study used a societal perspective and one did not provide information on the perspective chosen. With the exception of three studies, the remaining investigations were predicated upon a lifetime model.13 studies identify the relevant pharmaceutical treatments are cost-effective. In contrast, one study’s result showed that the insulin degludec/liraglutide versus its monotherapy is not cost-effective, and one study deduced that the short-term cost-effectiveness of one-daily liraglutide vs once-weekly exenatide highly depends on the selected source of the clinical data. Among the 12 studies that conducted a sensitivity analysis, three studies employed probabilistic sensitivity analysis, three studies utilized univariate sensitivity analysis, and six studies employed both approaches. The medication cost emerged as the most frequently identified key driver of the outcome. Conclusion This review may help inform decisions about investment, research, and development of type 2 diabetes pharmaceutical treatment. However, it also clearly demonstrates significant gaps in local evidence in this area and could be used to support ongoing research on this topic.

Cost-Utility and Budget Impact Analyses of Herpes Zoster Vaccines in Patients With Human Immunodeficiency Virus in Thailand.

Cost-Utility and Budget Impact Analyses of Herpes Zoster Vaccines in Patients With Human Immunodeficiency Virus in Thailand.

Borderline personality disorder Athens study: a quasi-experimental pragmatic trial for the assessment of a public, psychodynamic, stepped care service for borderline personality disorder patients

BackgroundBorderline personality disorder (BPD) is a common mental disorder that severely impairs patients’ psychosocial functioning and quality of life and results in prolonged use of health services. Although psychotherapy is recommended as the most effective treatment for patients with BPD, their complex emotional needs can be met in everyday clinical practice by developing integrative, holistic, personalized mental health services tailored to their needs.Aim and hypothesisThe aim of our study was to evaluate the effectiveness of a specialized psychodynamic stepped-care service for BPD patients. Our hypothesis is that patients receiving this specialized health-care service will show greater improvement in clinical, functional and quality of life than patients receiving a treatment as usual (TAU) service. In addition, specialized health-care services will prove to be more cost effective.Method and designA quasi-experimental clinical trial will be conducted. The study is designed to include 212 BPD patients who will be non-randomly assigned to specialized health care services and to two TAU centers. Patients will be recruited at each site following the routine clinical pathways of referral at each center. The primary outcome measures are BPD severity, suicide attempts and hospital admissions. The secondary outcome measures will include measures of general psychopathology, psychosocial functioning, quality of life and retention in treatment. In addition. An economic evaluation from a societal perspective will be conducted.DiscussionThe development of complex individualized stepped-whole care public interventions for BPD patients requires extended research in everyday clinical practice conditions. In this study, we describe the design and implementation of a pragmatic trial to evaluate this type of health service for BPD patients, and we discuss the strengths as well as the problems and how these can be mitigated.Trial registrationClinical Trials gov.: ClinicalTrials.gov ID: NCT06392139 (Protocol ID No. 404/06-07-202).

Economic Burden of Obesity in Iran University of Medical Sciences: A Cost Analysis Using the Cost of Illness Framework.

Obesity is a multifaceted health issue that significantly elevates the risk of various chronic diseases and can lead to a reduction in life expectancy by 5-20 years. This study aimed to estimate both the direct and indirect costs associated with obesity among the population served by Iran University of Medical Sciences in 2023. This study employed a cost of illness (COI) framework, utilizing a prevalence-based approach from a societal perspective, specifically targeting the obese demographic. Subsequently, using prevalence and cost data, we calculated the expenses related to each obesity-associated disease, categorizing them into direct medical, direct nonmedical, and indirect costs. The costs for each disease were then adjusted based on the attributable fraction of the obese population, and the total costs associated with obesity-related diseases were aggregated. The economic burden of obesity-attributable to six specific diseases within the population covered by Iran University of Medical Sciences was estimated at approximately $PPP 2452 million, representing 31% of the total economic burden of these six chronic diseases, which amounts to $PPP 7804 million. Of the total economic burden due to obesity, direct medical costs accounted for $PPP 1362 million (56%), direct nonmedical costs were $PPP 76 million (3%), and indirect costs reached $PPP 1014 million (41%). The financial implications of obesity, particularly in relation to certain diseases, are substantial. There is an urgent need for cost-effective preventive measures aimed at controlling and reducing the prevalence of overweight and obesity, thereby mitigating their adverse health impacts and economic consequences.

DOMESTIC VIOLENCE AGAINST MEN IN ACEH: AN ANALYSIS OF CAUSES AND IMPACTS

Domestic violence is a topic that is frequently debated and discussed, even widely reported on social media, where most husbands or men are portrayed as perpetrators of domestic violence and wives as the victims. However, it is known that within the household, anyone has a significant potential to become a perpetrator. Men as victims of domestic violence are often overlooked in social and legal discourses. This study aims to analyze the causes and impacts of domestic violence against men. The research methodology used is a qualitative approach with data collection techniques including observation, documentation, and interviews. This research was conducted in Aceh Besar District and Banda Aceh City. The study found that power dynamics in relationships, economic imbalance, and rigid gender roles contribute to the worsening condition of male victims. The impacts experienced by men who are subjected to domestic violence tend to include feelings of shame, stigma, and difficulty in accessing help due to social constructs that expect men to be strong and not show weakness. This study provides insight into the need for greater attention to men as victims of domestic violence and emphasizes the importance of changing societal perspectives and policies to create a more inclusive and responsive system for victims of all genders.

The cost-effectiveness of an AI-based population-wide screening program for primary open-angle glaucoma in the Netherlands.

The cost-effectiveness of an AI-based population-wide screening program for primary open-angle glaucoma in the Netherlands.

Cost-effectiveness of treatment with finerenone in mild to advanced stage chronic kidney disease patients with type 2 diabetes from a societal perspective

ABSTRACTIntroductionOne in three patients with type 2 diabetes (T2D) suffers from any stage of chronic kidney disease (CKD), a chronic illness associated with a high global burden that impacts not only the healthcare system but also societal costs. Addition of finerenone to the standard of care (SoC) for patients with advanced CKD and T2D has been shown to be cost-effective by reducing healthcare and societal costs. This analysis explores the cost-effectiveness of finerenone in patients with CKD (stages 1–4 with albuminuria) associated with T2D from a societal perspective, as broader societal costs are a crucial consideration in managing chronic illnesses.Research design and methodsThe validated FINE-CKD model was populated with data from the pooled FIDELITY analysis (ie, a patient population with early-to-late stage CKD associated with T2D) to investigate the cost-effectiveness of the addition of finerenone to SoC compared with SoC alone, from a Dutch societal perspective. Sensitivity analyses were conducted to evaluate the impact of parameter uncertainty on the robustness of the model.ResultsOur analysis shows that by adding finerenone to SoC, patients with mild to severe stage CKD and T2D gain 0.14 quality-adjusted life years (QALYs) compared with SoC alone, mainly due to a reduction in renal and cardiovascular events. The societal costs of these events are considerable (ie, €8481 and €9799 per patient over a lifetime in the finerenone and SoC arm, respectively), showing the relevance of a societal perspective in chronic diseases. Overall, finerenone leads to savings of €2713 per patient over a lifetime. Therefore, the addition of finerenone to SoC emerges as the dominant treatment option when compared with SoC alone. The sensitivity analysis shows that finerenone has a 62.3% chance to be dominant and an 83.8% chance to be cost-effective, considering a willingness-to-pay threshold of €20 000/QALY.ConclusionsThis study highlights the burden that chronic diseases impose on healthcare systems and society, emphasising the relevance of incorporating a societal perspective in cost-effectiveness analyses. The analysis estimates that adding finerenone to SoC treatment for patients with mild to advanced CKD associated with is cost-effective from a healthcare and societal perspective.

Civic Cyber Defence / Resilience: A Review of Approaches

Cyber defence / security is a critical component of civic resilience, ensuring the protection and continuity of essential services and infrastructure in the face of cyber threats. As societies become increasingly digital, the potential for cyber attacks on public systems, such as utilities, healthcare, transportation, and government services, grows. These attacks can disrupt daily life, compromise sensitive data, and undermine public trust. But what happens in a national emergency? How is cyber security and disinformation considered from a civic cyber resilience perspective? What are the expectations of citizens in the first 72 hours of a national emergency? The paper will evaluate cyber advice offered to the citizens of a number of European countries. The evaluation will focus on the national advice offered from a technological, legal, and societal perspective. The analysis will focus on the different approaches of six European countries and what can be learned from these different approaches regarding Civic Defence and Resilience.

Cost-effectiveness of immunization strategies to protect infants against respiratory syncytial virus in the Netherlands

ABSTRACT The European Medicines Agency has authorized two interventions to prevent lower respiratory tract disease due to respiratory syncytial virus (RSV-LRTD) in infants: nirsevimab, a monoclonal antibody, and bivalent stabilized prefusion F subunit maternal vaccine (RSVpreF). In the Netherlands, RSV-LRTD protection is recommended for all infants with nirsevimab given preferential recommendation over RSVpreF. We evaluated cost-effectiveness of various intervention strategies to prevent RSV in the Netherlands. We employed a cohort model to evaluate clinical and economic outcomes associated with RSV-LRTD during the first year of life among infants receiving RSVpreF with complementary nirsevimab and, alternatively, nirsevimab alone versus no intervention. Model inputs, based principally on Dutch data, include rates of disease, case-fatality, general mortality; disutility; and costs of interventions, medical care, treatment-related travel, and disease-associated work loss. Uptake of interventions assumed 70%; effectiveness was based on a published study using Phase III trial data. Analyses were conducted from the societal perspective using 2023 EUR; annual discount rates were 3% for costs and 1.5% for quality-adjusted life-years (QALYs). With no intervention, there were 10,482 RSV-LRTD cases with total associated costs of € 17.4M. Nirsevimab alone prevented 4,905 cases, yielding 100 QALYs; total costs increased by € 59.3M due to high intervention costs and cost-effectiveness was € 592,404/QALY (vs. no intervention). RSVpreF with complementary nirsevimab for infants prevented 4,723 cases, yielding 108 QALYs; total costs increased by € 35.5M and cost-effectiveness was € 329,187/QALY (vs. no intervention). Maternal RSVpreF with complementary nirsevimab was more cost-effective than nirsevimab alone.

1057-P: Cost Analysis of Freestyle Libre Systems in Patients with Type 2 Diabetes Receiving Basal Insulin and Poor Glycemic Control (HbA1c >8%)—A Societal Perspective in Spain

Introduction and Objective: This cost analysis compared FreeStyle Libre® systems (FSL) vs self-monitoring of blood glucose (SMBG) in T2D patients on basal insulin and poorly controlled (HbA1c > 8%), from a societal perspective in Spain. Methods: A model compared costs (€2024) of FSL and SMBG in a cohort of 1,000 T2D patients. The inputs, validated by local experts, derived from literature. Acute events in SMBG were modeled by event frequency and costs/patient-year (events/year-patient [cost]: mild hypoglycemia [MH] = 17.0 [€17]; severe hypoglycemia events [SHE] = 2.5 [€2,509]; DKA = 0.03 [€2,071]). Chronic complications were modeled by frequency and 1% decrease in HbA1c-related risk reduction (% events [% risk reduction / cost]: AMI = 7.4 [14.0 / €1,214]; angina pectoris = 8.6 [9.9 / €670]; HF = 6.3 [16.0 / €1,482]; stroke = 3.6 [12.0 / €3,101]; transitory ischemic disease = 3.6 [12.0 / €2,774]; neuropathy = 5.3 [37.0 / €3,961]; retinopathy = 8.1 [19.0 / €3,845]; peripheric angiopathy = 5.0 [16.7 / €1,086]; nephropathy = 8.6 [21.9 / €1,884]; ESRD = 5.9 [21.9 / €41,593]). Absenteeism in employed patients (26.5%) was determined by an absenteeism rate of 18.5% (64.6 days lost/patient-year, average earnings €26,700/year). Daily SMBG use included 2.5 strips (€0.55/unit) and 2.5 lancets (€0.14/unit). FSL reduced acute events (MH/SHE by 58%; DKA by 68%), HbA1c levels (1.1%), absenteeism (58.4%), and strip/lancet use (83%). Results: Annual cost/patient was €7,085 for SMBG and €5,172 for FSL. For 1,000 patients, FSL averted 9,872 MHs, 1,450 SHEs, 2 DKAs, 124 chronic complications, and 1,850 absenteeism days. Total savings were €1,913,489 (€135,200 from reduced absenteeism). Sensitivity analyses confirmed cost savings. Conclusion: Compared to SMBG, FSL reduce diabetic complications and absenteeism in poorly controlled T2D patients on basal insulin, generating cost savings for the Spanish healthcare system and society. Disclosure F. Ampudia Blasco: Consultant; Abbott. Speaker's Bureau; Abbott. I. Oyagüez: None. P. Mezquita-Raya: Consultant; Abbott. A. Hernández Martínez: Consultant; Abbott. A. Cebrian: None. J. Carretero Gomez: None. V. Bellido: Speaker's Bureau; Novo Nordisk, Lilly Diabetes, Sanofi, AstraZeneca, Abbott. Consultant; Novo Nordisk, Sanofi, Abbott. Research Support; Novo Nordisk, Sanofi, Lilly Diabetes. F. Gomez-Peralta: Speaker's Bureau; Abbott. Advisory Panel; Novo Nordisk. Speaker's Bureau; Lilly Diabetes, Sanofi, Menarini.

Public health impact and cost-effectiveness of implementing gender-neutral vaccination with a 9-valent HPV vaccine in Japan: a modeling study

Aims This study aimed to assess the public health impact and cost-effectiveness of gender-neutral vaccination (GNV) using a nonavalent vaccine (9vHPV) in Japan. Methods We used a published, validated dynamic transmission model to estimate the cases of, deaths from, quality-adjusted life years (QALYs) lost to, and costs of diseases associated with HPV genotypes included in the 9vHPV vaccine. These outcomes were modeled over a 100-year time horizon under different GNV and female-only vaccination (FOV) strategies. The primary analysis compared GNV to FOV at a female vaccination coverage rate (VCR) of 30% and male VCR of 15%. Scenario analyses assessed the effects of varying these VCRs, the age at vaccination, and the discount rate. Results In the base case, GNV averted an additional 2,070 female and 1,773 male deaths from HPV-associated cancers compared to FOV and was cost effective, with an incremental cost-effectiveness ratio (ICER) of 4,798,537 ¥/QALY from the payer perspective (direct medical costs) and 4,248,586 ¥/QALY from the societal perspective (including costs of lost work productivity). The ICER of GNV versus FOV was higher in scenarios with higher VCRs. However, the ICER could be reduced compared to the base case by implementing vaccination at <15 years of age to reduce the number of vaccine doses required or by reducing the discount rate to assign greater value to the long-term cancer prevention benefits of HPV vaccination. Limitations This study may be limited by inaccuracies in the model’s input data and assumptions, as well as the exclusion of some societal costs, which may have underestimated cost-effectiveness. Conclusions Including boys and men in Japan’s HPV vaccination strategy is predicted to provide additional public health benefits compared to FOV and to be cost effective, particularly while the female VCR remains low and if the full vaccine series is completed before age 15.

Cost-Utility Analysis of Acupuncture for the Prevention of Episodic Migraine from a Lifetime Canadian Health System and Societal Perspective

Cost-Utility Analysis of Acupuncture for the Prevention of Episodic Migraine from a Lifetime Canadian Health System and Societal Perspective

Cost-Effectiveness of an Interdisciplinary, Internet-Based Transgender Health Care Program in Germany: Economic Evaluation Alongside a Randomized Controlled Trial

BackgroundThe provision of specialized, professionally coordinated, and interdisciplinary care is relevant for the care of transgender and gender diverse (TGD) people diagnosed with gender incongruence or gender dysphoria. In remote areas outside the metropolitan regions, however, transgender health care structures are rarely adequate or within reach. In order to improve transgender health care for TGD people, an interdisciplinary, internet-based transgender health care program (i²TransHealth) has been developed.ObjectiveThe aim of this study was to determine the cost-effectiveness of i²TransHealth for TGD people from remote areas with no or insufficient transgender health care structures either exploring their gender identity or being in an early phase of transition from a societal perspective.MethodsThis study was conducted alongside a randomized controlled trial comparing the effectiveness of i²TransHealth with a waiting list. The i²TransHealth intervention consisted of a telehealth-based eHealth intervention including one-to-one chat conversations with study therapists in combination with office-based regular care provided by general physicians and psychiatrists when needed. As health effect measures, quality-adjusted life years (QALYs) were calculated based on the EuroQol 5-dimension 5-level index, and reliable improvement on the Global Severity Index of the Brief Symptom Inventory-18 (BSI-18 GSI) was used. Health care service usage was assessed using service receipt inventories. The cost-effectiveness of i²TransHealth compared with a waiting list was assessed using the adjusted incremental cost-effectiveness ratio (ICER) based on seemingly unrelated regressions. Furthermore, the uncertainty of the ICER was assessed using cost-effectiveness planes and cost-effectiveness acceptability curves.ResultsParticipants in the intervention group (IG; n=88) and the control group (CG; n=80) were on average aged 26 and 27 years, respectively. The mean QALYs of participants in the IG and CG were both 0.28 (SE 0.00) during the 4-month follow-up period. With 23.02%, participants in the IG had statistically significantly higher reliable improvement on the BSI-18 GSI compared with participants in the CG (9.21%, P=.01). The mean 4-month total costs were statistically significantly higher among the participants in the IG (+€1390, P=.002; a currency exchange rate of €1=US $1.14 was applicable as of December 31, 2020). The corresponding ICER of i²TransHealth was €254,021 per additional QALY, and €10,786 per additional reliable improvement on the BSI-18 GSI, respectively. The corresponding probability of cost-effectiveness of i²TransHealth was 20% at a willingness-to-pay (WTP) of €150,000 per additional QALY and 75% at a WTP of €15,000 per additional reliable improvement on the BSI-18 GSI.ConclusionsFrom a societal perspective, i²TransHealth was unlikely to be cost-effective, even at high WTP per additional QALY. However, the comparison of i²TransHealth with a waiting list could have led to a distortion of the results with regard to health care service usage. When considering additional reliable improvement on the BSI-18 GSI as health effect measure, the probability of cost-effectiveness of i²TransHealth is unclear depending on the WTP.

Relevance of the Frankfurt Triangle for Critical Media Literacy and Digital Citizenship

The paper examines the ambivalence of digital capitalism, contrasting the economic dominance of big tech giants with the promise of diverse digital literacy experiences. Using digital citizenship education as a case study, the paper introduces the Frankfurt Triangle model, a framework that encourages a multi-perspective approach to the phenomena of digitality. This model broadens traditional technological perspectives by incorporating cultural, societal, and interactional aspects, aiming to address the lack of media-cultural, societal, and usage-related perspectives in educational discourses on digitality.

Vaccination strategies, public health impact and cost-effectiveness of dengue vaccine TAK-003: A modeling case study in Thailand

BackgroundDengue is an increasing global problem associated with negative health and economic impacts. Vaccination is an important measure to reduce the significant public health and economic burden caused by dengue. Our study assesses the public health impact and cost-effectiveness of a new dengue vaccine, TAK-003, using Thailand as a case study.Methods and findingsWe developed a dynamic transmission model with both host and vector populations, 4 serotype-specific infections, seasonality, and other key elements of dengue natural history. We estimated efficacy of TAK-003 from the DEN-301 trial. We first used the model to determine the optimal cohort age for different vaccination strategies with TAK-003, based on Thai dengue epidemiology. Secondly, we assessed the public health impact of a pragmatic strategy integrating TAK-003 into an existing national immunization program in Thailand. Cost-effectiveness was evaluated from a societal perspective using disability-adjusted life-years (DALYs) over a 20-year horizon.TAK-003 is estimated to prevent 41%−57% of symptomatic cases and 47%−70% of hospitalizations, with the greatest impact observed when routinely vaccinating children aged 6 years with 10 additional catch-up cohorts. This strategy resulted in 104,415 fewer DALYs and savings of US$1,786 million. If introduced into the national immunization program at 11 years of age (alongside the existing human papillomavirus vaccine), TAK-003 is estimated to prevent 44% of symptomatic cases and 53% of hospitalizations. This strategy prevented 87,715 DALYs and saved US$1,346 million. Sensitivity analyses demonstrated that the results were robust. The main limitations were inherent to the assumptions and simplifications made in the model, which are unavoidable when approximating the impact of vaccination in the real world.ConclusionsTAK-003 can considerably reduce dengue burden and lead to cost savings in Thailand. These benefits can be maximized by identifying optimal age cohorts for vaccination and adding catch-up programs. Our model can be used to assess the vaccination impact in other dengue-endemic countries.

Vestibular Rehabilitation in Multiple Sclerosis: Randomized Controlled Trial and Cost-Effectiveness Analysis Comparing Customized With Booklet Based Vestibular Rehabilitation for Vestibulopathy.

Vestibular dysfunction occurs in 30% to 70% of cases with multiple sclerosis (MS). To compare the clinical and cost-effectiveness of a customized vestibular rehabilitation (VR) program with a generic booklet-based VR intervention in people with MS with clinical signs of vestibulopathy. People with MS and symptoms of vertigo and/or imbalance were screened for vestibulopathy (n = 73). Seventy recruited participants were randomly allocated to a 12-week generic booklet-based home program with telephone support (n = 35) or a 12-week customized VR program (n = 35, 12 face-to-face sessions and a home exercise program). The primary clinical outcome was the Dizziness Handicap Inventory (DHI) at 26 weeks post-randomization. The primary economic endpoint was quality-adjusted life-years (QALYs). Secondary outcomes included vertigo severity, balance, gait, and perceived impact of physical symptoms in MS. There was no significant between-group difference in the DHI: mean reduction -1.76 (95% confidence interval -10.02, 6.50) at week 26 in favor of the customized group (P = .670). There were significant differences in favor of the customized group for vertigo symptom score, balance confidence, walking, and perceived impact of MS. Primary cost-effectiveness analysis showed customized VR to be less costly and more effective. However, removal of 2 cost outliers in sensitivity analysis resulted in a mean cost-per-QALY of £30 147. Customized VR was also cost-effective from a societal perspective. Impairment level improvements did not translate into functional improvements as measured by the DHI perhaps reflecting that vestibular dysfunction is one of several impairments in MS. The findings indicate the potential cost-effectiveness of the customized program. ISRCTN27374299.

Health and economic impact of 20-valent pneumococcal conjugate vaccine for adults aged 66–84 years in Japan and shiga prefecture

ABSTRACT Background The Japanese National Immunization Program against pneumococcal disease (PD) includes 23-valent pneumococcal polysaccharide vaccine (PPSV23) but does not provide vaccination for adults aged ≥66 years. We evaluated the cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) in adults aged 66–84 years with no history of PPSV23 vaccination in Japan and assessed the potential economic and health impact of introducing PCV20 on the local government (specifically, Shiga prefecture). Research design and methods Using a Markov model, we assessed lifetime costs, quality-adjusted life-years (QALYs), and number of prevented cases and deaths caused by PD. Results In national-level analysis, PCV20 was cost-effective compared with no vaccination under incremental cost-effectiveness ratio threshold of Japanese yen (JPY) 5,000,000/QALY, i.e. JPY1,677,401/QALY and JPY1,351,811/QALY from payer and societal perspectives, respectively. PCV20 was dominant (less costly and more effective) compared with PPSV23. In local-level analysis, the introduction of PCV20 required initial costs but resulted in greater cost savings related to medical expenses (-JPY424 and -JPY430 per person) and nursing care (-JPY560 and -JPY575 per person) compared to PPSV23 and no vaccination, respectively. Conclusions PCV20 is cost-effective compared with PPSV23 and no vaccination in adults aged 66–84 years, which could reduce the future healthcare burden in Japan.

Abstract PS19-04: Exploring the broad societal value of pembrolizumab in triple-negative breast cancer in Canada

Abstract Background: The impact of breast cancer is multifaceted; for each patient there are personal, social, and financial consequences which have wider societal and economic consequences. Cost-effectiveness analyses for health technology assessment (HTA) purposes are predominantly conducted from the traditional payer perspective and often do not capture these wider impacts. Pembrolizumab, a programmed death receptor-1 (PD-1)-blocking antibody indicated for the treatment of triple-negative breast cancer (TNBC), has demonstrated substantial survival benefits to patients. Our study analyzes the traditional societal and broader societal net monetary benefit (NMB) of pembrolizumab-based therapies for early TNBC (eTNBC) and metastatic TNBC (mTNBC) in a Canadian setting. We incorporate novel elements of value described in the third ISPOR Special Task Force Report alongside new elements considered relevant to the disease. METHODS: Two validated and HTA approved cost-effectiveness models for pembrolizumab in eTNBC and mTNBC were expanded to include elements constituting the broad societal perspective. For the traditional societal perspective, this included productivity. For the broad societal perspective, the additional elements included caregiver burden, insurance value, value of hope, real option value, severity of disease, out-of-pocket expenses, and fertility treatment costs. A targeted literature review was conducted to identify inputs for each element. A standard of care comparator, consisting of chemotherapy, was generated for each indication; formed of a weighted average of the various chemotherapy comparators by indication based on market share. Canadian list prices were used for all treatment acquisition costs. An overall NMB was generated across indications by weighting individual results by prevalence and using a willingness to pay threshold of CAD$100,000. Probabilistic sensitivity analysis (PSA) and scenario analyses were implemented to analyze the robustness of results to plausible variation. Results: The results showed that adopting a broad societal perspective resulted in more favourable cost-effectiveness results. Specifically, the overall broad societal NMB was CAD$1,113,858, almost four times greater than the traditional payer (CAD$282,644) and traditional societal NMB (CAD$279,534). For mTNBC, the NMB was positive for the broad societal perspective whereas the two traditional perspectives yielded a negative NMB. For eTNBC, pembrolizumab consistently resulted in a positive NMB for all three perspectives, however the broad societal perspective resulted in a substantially higher NMB. This was largely driven by the substantial insurance value impact on quality-adjusted life years. The next most influential element was the value of hope. PSA was consistent with deterministic results. Scenario analysis demonstrated that the choice of input source used to inform the broad elements of value had a substantial impact on NMB. Discussion: The inclusion of broader societal elements of value resulted in a significantly higher NMB than the traditional payer perspective for both indications, indicating that society as a whole may place a substantially greater value on access to treatment than suggested from a traditional payer perspective. However, the paucity of disease-specific input data and the uncertain estimation of some of the broad societal perspective elements of value result in challenges with interpretation. Overall, the research highlights the importance of considering alternative and broader perspectives of analysis in health technology evaluation, but more research is needed to robustly parameterize novel elements of value. Notably, this study indicates that the traditional payer and societal perspectives commonly used for HTA may be missing key elements of value, and thus underestimate the value that general societal places on access to innovative therapies. Citation Format: Kate Young Brook E, Madin-Warburton M; Wijenayake N; Mishkin K; Meilleur M-C; Davies A. Exploring the broad societal value of pembrolizumab in triple-negative breast cancer in Canada [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr PS19-04.

Health and economic benefits of improving pre-hospital identification of stroke in Australian women: a modelling study.

To estimate the long term gains in life years and quality-adjusted life years (QALYs) and the cost savings that could be achieved if ischaemic stroke was identified in women with the same level of accuracy received by men, versus the status quo. Decision tree and Markov model decision analysis. Two arms including 5513 women aged under 70 years: a hypothetical scenario, in which women receive the same level of accuracy of stroke identification as men (yet experienced symptoms relevant to women); and the status quo. Transitions between post-stroke health states, recurrent stroke and death were made in 1-year cycles over 50 years from a societal perspective. Years of life lived, QALYs and costs per patient in the hypothetical scenario relative to the status quo. Results were extrapolated to the national level based on the annual number of ischaemic stroke hospitalisations among women across Australia in the financial year 2020-21. Compared with the status quo, the hypothetical arm gained 0.14 years of life, gained 0.08 QALYs and saved $2984 per patient. At the national level, for the financial year 2020-21, this equates to 252 life years and 144 QALYs gained, and cost savings of $5.4 million. Outcomes were most sensitive to the probability of an accurate assessment of stroke, short term treatment costs, patient age, and transition probabilities to 90-day post-stroke health states. Enhancing the timely and accurate identification of ischaemic stroke among Australian women in the pre-hospital setting would yield significant health benefits and cost savings to Australian society as a whole.