Moderate acute malnutrition (MAM) affects 33 million children annually. Investments in formulations of corn-soy blended flours and lipid-based nutrient supplements have effectively improved MAM ...recovery rates. Information costs and cost-effectiveness differences are still needed.
We assessed recovery and sustained recovery rates of MAM children receiving a supplementary food: ready-to-use supplementary food (RUSF), corn soy whey blend with fortified vegetable oil (CSWB w/oil), or Super Cereal Plus with amylase (SC + A) compared to Corn Soy Blend Plus with fortified vegetable oil (CSB+ w/oil). We also estimated differences in costs and cost effectiveness of each supplement.
In Sierra Leone, we randomly assigned 29 health centers to provide a supplement containing 550 kcal/d for ∼12 wk to 2691 children with MAM aged 6–59 mo. We calculated cost per enrollee, cost per child who recovered, and cost per child who sustained recovery each from 2 perspectives: program perspective and caregiver perspective, combined.
Of 2653 MAM children (98.6%) with complete data, 1676 children (63%) recovered. There were no significant differences in the odds of recovery compared to CSB+ w/oil 0.83 (95% CI: 0.64–1.08) for CSWB w/oil, 1.01 (95% CI: 0.78–1.3) for SC + A, 1.05 (95% CI: 0.82–1.34) for RUSF. The odds of sustaining recovery were significantly lower for RUSF (0.7; 95% CI 0.49–0.99) but not CSWB w/oil or SC + A 1.08 (95% CI: 0.73–1.6) and 0.96 (95% CI: 0.67–1.4), respectively when compared to CSB+ w/oil. Costs per enrollee US dollars (USD)/child ranged from $105/child in RUSF to $112/child in SC + A and costs per recovered child (USD/child) ranged from $163/child in RUSF to $179/child in CSWB w/oil, with overlapping uncertainty ranges. Costs were highest per sustained recovery (USD/child), ranging from $214/child with the CSB+ w/oil to $226/child with the SC + A, with overlapping uncertainty ranges.
The 4 supplements performed similarly across recovery (but not sustained recovery) and costed measures. Analyses of posttreatment outcomes are necessary to estimate the full cost of MAM treatment. This trial was registered at clinicaltrials.gov as NCT03146897.
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•Currently, nasopharyngeal carcinoma(NPC) stands as a significant cancer posing a threat to human health, with approximately three-quarters of cases being diagnosed at the locally advanced ...stage.•While multiple treatment options exist for locally advanced NPC, the determination of the most clinically beneficial and cost-effective approach remains unclear.•The objective of this study is to construct Network Meta-Analysis (NMA) and Cost-Effectiveness Analysis (CEA) models to assess which treatment strategy yields the maximum benefit.•Our research team specializes in clinical diagnosis, treatment, and efficacy prediction for NPC, with notable achievements in pharmacoeconomics.•Through this study, we aim to provide a therapeutic guidance for clinical practitioners by evaluating the comparative benefits of different treatment modalities. The ultimate goal is to contribute valuable insights for healthcare professionals in the field.
The aim of this study is to evaluate the efficacy and cost-effectiveness of various induction chemotherapy (IC) regimens as first-line treatment for Locoregionally advanced nasopharyngeal carcinoma (LA-NPC), aiming to provide clinicians and patients with informed insights to aid in treatment decision-making.
We conducted a network meta-analysis (NMA) and cost-effectiveness analysis (CEA) based on data from 10 clinical trials investigating IC regimens for the treatment of LA-NPC. A Bayesian NMA was performed, with the primary outcomes being hazard ratios (HRs) for disease-free survival (DFS) and overall survival (OS). To model the disease progression of LA-NPC, we developed a dynamic partitioned survival model consisting of three disease states: progression-free survival (PFS), progression disease (PD), and death. The model was run on a 3-week cycle for a research period of 10 years, with quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) serving as outcome measures.
According to the surface under the cumulative ranking curve (SUCRA) estimates derived from the NMA, TPC and TP, as IC regimens, appear to exhibit superior efficacy compared to other treatment modalities. In terms of CEA, concurrent chemoradiotherapy (CCRT), TPF + CCRT, and GP + CCRT were found to be dominated (more costs and less QALYs). Comparatively, TPC + CCRT emerged as a cost-effective option with an ICER of $1260.57/QALY when compared to PF + CCRT. However, TP + CCRT demonstrated even greater cost-effectiveness than TPC + CCRT, with an associated increase in costs of $3300.83 and an increment of 0.1578 QALYs per patient compared to TPC + CCRT, resulting in an ICER of $20917.62/QALY.
Based on considerations of efficacy and cost-effectiveness, the TP + CCRT treatment regimen may emerge as the most favorable first-line therapeutic approach for patients with LA-NPC.
To evaluate cost-effectiveness of a novel screening strategy using a microRNA (miRNA) blood test as a screen, followed by endoscopy for diagnosis confirmation in a 3-yearly population screening ...program for gastric cancer.
A Markov cohort model has been developed in Microsoft Excel 2016 for the population identified to be at intermediate risk (Singaporean men, aged 50-75 years with Chinese ethnicity). The interventions compared were (1) initial screening using miRNA test followed by endoscopy for test-positive individuals and a 3-yearly follow-up screening for test-negative individuals (proposed strategy), and (2) no screening with gastric cancer being diagnosed clinically (current practice). The model was evaluated for 25 years with a healthcare perspective and accounted for test characteristics, compliance, disease progression, cancer recurrence, costs, utilities, and mortality. The outcomes measured included incremental cost-effectiveness ratios, cancer stage at diagnosis, and thresholds for significant variables.
The miRNA-based screening was found to be cost-effective with an incremental cost-effectiveness ratio of $40 971/quality-adjusted life-year. Key drivers included test costs, test accuracy, cancer incidence, and recurrence risk. Threshold analysis highlights the need for high accuracy of miRNA tests (threshold sensitivity: 68%; threshold specificity: 77%). A perfect compliance to screening would double the cancer diagnosis in early stages compared to the current practice. Probabilistic sensitivity analysis reported the miRNA-based screening to be cost-effective in >95% of iterations for a willingness to pay of $70 000/quality-adjusted life-year (approximately equivalent to 1 gross domestic product/capita)
The miRNA-based screening intervention was found to be cost-effective and is expected to contribute immensely in early diagnosis of cancer by improving screening compliance.
•Biomarker testing can offer effective cancer screening, enabling early diagnosis, but poses a risk of high testing costs and missed cases. Recently GastroClear, an in vitro test for gastric cancer–related microRNA, has been approved by the Singapore government. Nevertheless, there is a need to evaluate the cost-effectiveness of its implementation for population screening. This study addresses this evidence gap by:•Evaluating the cost-effectiveness of screening population every 3-years for the population at intermediate risk•Identifying the impact of screening on early diagnosis, significance of compliance, test accuracy, and testing costs•Studying outcomes to enable identification of the drivers/limitations that are crucial to achieve cost-effectiveness
Background
Recent developments in nutrition intervention indicated clinical effectiveness for pressure ulcer (PU) prevention and treatment, but it is important to assess whether they are ...cost‐effective. The aims of this systematic review are to determine the cost‐effectiveness and clinical outcomes of nutrition support in PU prevention and treatment.
Methods
A systematic search of randomized controlled trials, observational studies, and statistical models that investigated cost‐effectiveness and economic outcomes for prevention and/or treatment of PUs were performed using standard literature and electronic databases.
Results
Fourteen studies met the inclusion criteria, which included 3 randomized controlled trials with their companion economic evaluations, 4 model‐based, 2 cohort, 1 pre and post, and 1 prospective controlled trial. Risk of bias assessment for all of the uncontrolled or observational trials revealed high or serious risk of bias. Interventions that incorporated specialized nursing care appeared to be more effective in prevention and treatment of PUs, compared with single intervention studies. There is a trend of improved PU healing when additional energy/protein are provided. PU prevention ($250–$9,800) was less expensive than treatment ($2,500–$16,000). Nutrition intervention for PU prevention was cost‐effective in 87.0%–99.99% of the simulation models.
Conclusions
There is potential cost‐saving and/or cost‐effectiveness of nutrition support in the long term, as predicted by the model‐based PU prevention studies in the review. Prevention of PU also appears to be more cost‐effective than treatment. A multidisciplinary approach to managing PU is more likely to be cost‐effective.
The efficacy of biologics in psoriasis treatment is clinically proven; however, biologics are expensive. In this study, we assessed the real‐world cost‐effectiveness of biologics for psoriasis ...treatment by evaluating the relationship between biologic drug survival (DS) and total medical‐treatment costs from a pharmacoeconomic viewpoint. Furthermore, the effects of patient factors on cost‐effectiveness were investigated. We retrospectively reviewed the medical records of 135 cases who received either a tumor necrosis factor‐alpha (TNF‐α) monoclonal antibody (TNF‐mab), interleukin (IL)‐17 mab, or IL23p19‐mab for psoriasis from January 2010 to June 2020 at Yamaguchi University Hospital. We compared the monthly medical‐treatment costs according to biologic classification and found that costs of medical services, tests, and external preparations required for the treatment process were significantly higher in the TNF‐mab group than in the other groups, and the total medical costs associated with TNF‐mab treatment were significantly higher than those of IL17‐mab treatment. The total monthly cost of medical care was lower in the long‐term DS group than in the short‐term group. The number of prescriptions for external preparations, comprising Vitamin D3 and corticosteroid, was significantly higher in the long‐term DS group than in the short‐term group; in the TNF‐mab group, the proportion of patients without smoking habits was significantly higher in the long‐term group as well. Our study indicated that when costly biologics are used for psoriasis treatment, the maintenance of long‐term DS and appropriate patient guidance might improve the quality of medical care, thus allowing cost‐effective medical care.
Objectives
Although the efficacy of the addition of ipratropium bromide (IB) to short‐acting β2‐agonists (SABAs) for treating children with moderate to severe asthma exacerbations has been ...demonstrated, evidence of its cost‐effectiveness is scarce. The aim of the present study was to evaluate the cost‐effectiveness of treatment with a combination of SABAs and IB compared with SABAs alone for the treatment of children with moderate to severe asthma exacerbations.
Methods
To achieve the objectives of the study, a decision‐analysis model was adapted. Effectiveness parameters were obtained from a systematic review of the literature with meta‐analysis. Cost data were obtained from hospital bills and from the national manual of drug prices in Colombia. The study was carried out from the perspective of the national healthcare system in Colombia. The main outcome of the model was avoidance of hospital admission.
Results
In children with moderate to severe asthma exacerbations, the base‐case analysis showed that compared to SABAs alone, treatment with a combination of SABAs and IB was associated with lower overall treatment costs (US$126.24 vs. US$170.69 mean cost per patient) and a higher probability of hospital admission avoided (0.7999 vs. 0.7100), thus leading to dominance. For children with severe asthma exacerbations, these values were US$132.99 versus US$170.69 and 0.7883 versus 0.7100, respectively.
Conclusions
In Colombia, when compared to therapy with SABAs alone, therapy with a combination of SABAs and IB for treating pediatric patients with moderate to severe asthma exacerbations involves a lower probability of hospital admission at lower treatment costs.
Objective
This systematic review updates an existing review examining the cost‐effectiveness of interventions to prevent and treat eating disorders (EDs).
Method
Literature search was conducted in ...Academic Search Complete, MEDLINE, CINAHL, PsycINFO, EconLit, Global Health, ERIC, Health Business Elite, and Health Policy Reference Center electronic databases, capturing studies published between March 2017 to April 2023. Hand‐searching was conducted as supplementary including gray literature search. Included articles were (1) full economic evaluations or return‐on‐investment studies, (2) in English and (3) aimed at prevention and treatment of any ED. Included studies were added and synthesized with previously reviewed studies. Screening and extraction followed PRISMA guidelines. Quality assessment was conducted using the Drummond checklist. PROSPERO registration CRD42021287464.
Results
A total of 28 studies were identified, including 15 published after the previous review. There were nine prevention, seven anorexia nervosa (AN) treatment, five bulimia nervosa (BN) treatment, four binge‐eating disorder (BED), and three non‐specific ED treatment studies. Findings indicate value‐for‐money evidence supporting all interventions. Quality assessment showed studies were fair‐to‐good quality.
Discussion
There has been significant growth in cost‐effectiveness studies over the last 5 years. Findings suggest that interventions to prevent and treat ED offer value for money. Interventions such as Featback (ED prevention and non‐specific ED treatment); focal psychodynamic therapy, enhanced cognitive behavioral therapy, and high‐calorie refeeding (AN treatment); stepped‐care with assisted self‐help and internet‐based cognitive behavioral therapy (BN treatment); and cognitive behavioral therapy guided self‐help intervention (BED treatment) have good quality economic evidence. Further research in implementation of interventions is required.
Public Significance Statement
The increasing prevalence of ED globally has significant impact on healthcare systems, families, and society. This review is showcasing the value for money of interventions of eating disorders prevention and treatment. This review found that existing interventions offers positive economic benefit for the healthcare system.
Resumen
Objetivo
Esta revisión sistemática actualiza una revisión existente que examina la rentabilidad de las intervenciones para prevenir y tratar los trastornos de la conducta alimentaria (TCA).
Método
Se realizó una búsqueda bibliográfica en las bases de datos electrónicas Academic Search Complete, MEDLINE, CINAHL, PsycINFO, EconLit, Global Health, ERIC, Health Business Elite y Health Policy Reference Center, abarcando estudios publicados entre marzo de 2017 y abril de 2023. Se realizó una búsqueda manual como complemento, incluyendo la búsqueda de literatura gris. Los artículos incluidos eran (1) evaluaciones económicas completas o estudios de retorno de inversión, (2) en inglés y (3) dirigidos a la prevención y tratamiento de cualquier TCA. Los estudios incluidos se añadieron y sintetizaron con estudios previamente revisados. El cribado y la extracción siguieron las pautas PRISMA. La evaluación de la calidad se realizó utilizando la lista de verificación de Drummond. Registro en PROSPERO CRD42021287464.
Resultados
Se identificaron 28 estudios, incluyendo 15 publicados después de la revisión anterior. Hubo nueve estudios de prevención, siete de tratamiento de anorexia nerviosa (AN), cinco de tratamiento de bulimia nerviosa (BN), cuatro de trastorno por atracón (TpA) y tres de tratamiento de TCA no especificados. Los hallazgos indican evidencia de valor por dinero que respalda todas las intervenciones. La evaluación de la calidad mostró que los estudios eran de calidad aceptable a buena.
Discusión
Ha habido un crecimiento significativo en los estudios de rentabilidad en los últimos cinco años. Los hallazgos sugieren que las intervenciones para prevenir y tratar los TCA ofrecen valor por dinero. Intervenciones como Featback (prevención de TCA y tratamiento de TCA no específicos); terapia psicodinámica focal, terapia cognitivo‐conductual mejorada y rehabilitación nutricional con alto contenido calórico (tratamiento de AN); atención escalonada con autoayuda asistida y terapia cognitivo‐conductual en línea (tratamiento de BN); y terapia cognitivo‐conductual guiada de autoayuda (tratamiento de TpA) tienen una buena evidencia económica de calidad. Se requiere más investigación en la implementación de intervenciones.
Objective
We previously showed that intermittently scanned continuous glucose monitoring (isCGM) reduces HbA1c at 24 weeks compared with self‐monitoring of blood glucose with finger pricking (SMBG) ...in adults with type 1 diabetes and high HbA1c levels (58–97 mmol/mol 7.5%–11%). We aim to assess the economic impact of isCGM compared with SMBG.
Methods
Participant‐level baseline and follow‐up health status (EQ‐5D‐5L) and within‐trial healthcare resource‐use data were collected. Quality‐adjusted life‐years (QALYs) were derived at 24 weeks, adjusting for baseline EQ‐5D‐5L. Participant‐level costs were generated. Using the IQVIA CORE Diabetes Model, economic analysis was performed from the National Health Service perspective over a lifetime horizon, discounted at 3.5%.
Results
Within‐trial EQ‐5D‐5L showed non‐significant adjusted incremental QALY gain of 0.006 (95% CI: −0.007 to 0.019) for isCGM compared with SMBG and an adjusted cost increase of £548 (95% CI: 381–714) per participant. The lifetime projected incremental cost (95% CI) of isCGM was £1954 (−5108 to 8904) with an incremental QALY (95% CI) gain of 0.436 (0.195–0.652) resulting in an incremental cost‐per‐QALY of £4477. In all subgroups, isCGM had an incremental cost‐per‐QALY better than £20,000 compared with SMBG; for people with baseline HbA1c >75 mmol/mol (9.0%), it was cost‐saving. Sensitivity analysis suggested that isCGM remains cost‐effective if its effectiveness lasts for at least 7 years.
Conclusion
While isCGM is associated with increased short‐term costs, compared with SMBG, its benefits in lowering HbA1c will lead to sufficient long‐term health‐gains and cost‐savings to justify costs, so long as the effect lasts into the medium term.
New technologies in hip and knee arthroplasty are commonly evaluated using cost-effectiveness analyses and similar economic assessments. There is a wide variation in the methodology of these studies, ...introducing the potential for bias. The purpose of this study was to evaluate associations between potential financial conflicts of interest (COI) and the outcomes of economic analyses. We hypothesized that authors’ COI and industry funding would be associated with conclusions favorable to a new technology.
Economic analyses making cost-effectiveness or economic implementation claims on patient-specific instrumentation, robotics, and implants used in hip and knee arthroplasty published from 2010 to 2022 were identified. Papers were evaluated to determine if conclusions were favorable to the new technology being studied. Fisher’s exact test was utilized to determine the relationship between the presence of COI and an article’s conclusions.
Of 43 eligible articles, 76.7% were cost-effectiveness analyses, 23.2% were cost analyses, and 67.4% of articles had conclusions favorable to a technology. Of the 29 articles with favorable conclusions, 26 had an author with a financial COI (89.7%), and 14 had industry funding (48.3%). Of the 33 articles with a financial COI, 26 (78.8%) had favorable conclusions, and of the 16 articles with industry funding, 14 (87.5%) had favorable conclusions. Fisher’s exact test revealed a statistically significant association between an article having favorable conclusions and the presence of an author’s COI or industry funding (odds ratio, 13.5; 95% CI confidence interval, 2.3 to 79.9; P = .003).
Financial COIs were present in 79.1% of lower extremity arthroplasty economic analyses on technologies and were associated with an article having conclusions favorable to the new technology. Surgeons and decision-makers should be aware of the variability and assumptions in these studies and the potential bias of the conclusions.
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