The study of DESTINY-Lung01 and DESTINY-Lung02 demonstrated the favorable efficacy and optimal dosage of trastuzumab deruxtecan (T-DXd) in managing the human epidermal growth factor receptor 2 (HER2)-mutant non-small cell lung cancer (NSCLC) patients who had received previous treatment. The study sought to assess the cost-effectiveness of T-DXd in both the United States (US) and Chinese healthcare systems. Markov models were developed to evaluate the overall cost, incremental cost-effectiveness ratio (ICER), quality-adjusted life years (QALYs), and life years (LYs) of treatment with T-DXd compared with docetaxel, nivolumab, and pyrotinib for patients in the US and China. The level of willingness-to-pay (WTP) in the US and China is 150,000/QALYs and 32,517/QALYs, respectively. Sensitivity analyses were carried out to ensure the precision of the model. T-DXd yielded additional QALYs of 0.63 and 0.06 with an ICER of $338997.84 and $1437258.33 per QALY, respectively, in the US compared to the docetaxel and nivolumab regimens. And T-DXd yielded additional QALYs of 0.63, 0.06, and 0.13 with an ICER of $137959.45, $623805.93, and $515447.12 per QALY, respectively, in China compared to the docetaxel, nivolumab, and pyrotinib regimens. Sensitivity analysis showed that the cost of drugs is the most influential factor. T-DXd provides substantial therapeutic benefit for NSCLC patients with HER2 mutations who have had previous treatment but is not deemed cost-effective in either the US or China when compared to docetaxel, nivolumab, and pyrotinib. Price reduction is perhaps the main way to make T-DXd cost-effective.

The Republic of Srpska (RS), as a part of the Western Balkans (WB) region, has a higher diabetes prevalence than the EU. This study aims to assess the cost-effectiveness of early treatment of high-risk patients with pre-diabetes and undiagnosed diabetes in our setting. We designed a Markov chain Monte Carlo (MCMC) model which reflects the current International Diabetes Federation (IDF) three-step plan for the prevention of T2DM in those at increased risk. The model captures the evolution of the disease in FINDRISC high-risk patients from normal glucose tolerance (NGT) to impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) and then to T2DM and its complications. We developed two MCMC models, in order to follow the progression of the disease in high-risk cases, ie, when early treatment is undertaken or when it is not undertaken. The health costs and quality adjusted life years (QALY) were discounted at an annual rate of 3%. The key model parameters were varied in one-way and probabilistic sensitivity analysis. Early treatment resulted in increased life expectancy, postponement of the onset of diabetes and increased QALY for all patients. The discounted incremental cost-effectiveness-ratios (ICER) in NGT, IFG, IGT, and T2DM patients were -289.9, 9724.03, -1478.59 and 4084.67 €. In high-risk IGT patients, ICER was the most favorable, being both a cost saving and QALY gaining, with the consistent results confirmed by the sensitivity analysis. The results recommend the acceptance of a new health policy of identifying IGT patients with the use of FINDRISC questionnaire and plasma glucose measurements; providing them with a lifestyle change program; and implementing intensive diabetes treatment, as their disease progresses. Our results are especially significant for the Western Balkan countries, since this was the first cost-effectiveness study of T2DM prevention in this region.

Expanding malaria community case management (mCCM) to all ages could shift the point-of-care to the community leading to improved healthcare access in underserved populations. This study assesses the economic viability of such an expansion in Farafangana district, Madagascar.

A cluster-randomized trial was conducted across 30 health centres and the 502 community health workers (CHW) in their catchment areas, with the intervention arm implementing the age-expanded mCCM intervention. CHWs across both arms received training, supplies, and supervision to manage malaria. An economic evaluation assessed cost-effectiveness from health sector and societal perspectives, measuring outcomes in disability-adjusted life years (DALYs) averted. The impact of CHW compensation and economic risks were evaluated using sensitivity analyses.

Without CHW compensation, annual costs were $794,000, primarily for antimalarials and diagnostic tests. Incremental cost-effectiveness ratios (ICERs) per DALY averted ranged from -$21.86 to $212.42. From a societal perspective, the ICER was -$135.64, and -$243.29 including mortality benefits, meaning the intervention was cost-saving. The programme could avert 99.6 deaths and 3,721.7 DALYs annually, yielding $1,172,283 in net economic benefits. Sensitivity analyses supported these findings.

Age-expanded mCCM is highly cost-effective and can enhance malaria treatment access in resource-limited settings.

In the setting of high hepatitis B virus (HBV) endemicity, we studied the cost-effectiveness of universal HBV screen-and-treat strategies for averting HBV-related morbidity and mortality in Hong Kong, where diagnosis and treatment coverages are low. An age-sex-specific compartmental model for 2000-2040 was developed, with the incorporation of population-based screening strategies targeting different age groups. With a one-time HBV screening programme in 2025-2029, 3.6%-8.9% of HBV-related deaths could be averted. We evaluated the cost-effectiveness of the screening strategies with primary-care-based management in different scenarios with components of annual drug cost levels, screening programme duration, starting year and targeted age groups. Incremental cost-effectiveness ratio (ICER) was calculated, with the willingness-to-pay (WTP) threshold set at USD100,000/quality-adjusted life years (QALY). At the standard drug cost level, only the screening strategy targeting the 40-49 years old is cost-saving. When drug cost decreases to a low level, the strategy targeting the 35-49 years old (ICER USD97,042/QALY gained) is likely to be cost-effective and screening 35-59 years old is marginally cost-effective. In probabilistic sensitivity analysis, screening 40-49 years old (50%) and 35-59 years old (42%) have a half-half probability of being the most cost-effective at USD100,000/QALY WTP threshold, but increased to 93% for screening 35-59 years old at USD150,000/QALY threshold. From scenario analysis, deferred initiation of screening and unlimited programme duration would increase the ICER. Universal HBV screening targeting individuals aged 35-59 years or 40-49 years in the general population, with an earlier start and limited duration of the programme, is likely to be cost-effective.

Children aged 5-14 years who are household contacts (HHCs) of index people with active TB disease (PWTB) have limited coverage for TB preventive therapy (TPT) due to variable uptake of the national guideline recommendations in the Philippines. We conducted a cost-effectiveness analysis evaluating the expansion of TB infection (TBI) testing and treatment among pediatric (5-14 years) HHCs of index PWTB in the Philippines to assist the National TB program in choosing the most cost-effective testing and treatment strategy for TBI among HHCs of index PWTB.

Using a Markov state transition model, eligible HHCs age 5-14 years are screened for TBI with either the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Those who test positive are then simulated to receive one of the following TPT strategies: 6 months of daily isoniazid (6H), 3 months of weekly isoniazid and rifapentine (3HP), 3 months of daily isoniazid plus rifampicin (3HR) and the current practice of no testing or treatment for TBI (NTT). The analysis assesses the projected cost and quality-adjusted life years (QALY) gained for every strategy from the perspective of the Philippines public healthcare system over a time horizon of 20 years. The total cost and gain in QALYs are presented as an incremental cost-effectiveness ratio (ICER) comparing cost per QALY gained for each strategy over NTT.

Our model estimates that expanding TPT coverage to HHCs aged 5-14 years would be cost-effective with incremental cost-effectiveness ratios (ICERs) ranging from 1,024 $/QALY gained when using TST and 6H (Uncertainty range: 497---2,334) to 2,293 $/QALY gained when IGRA and 3HR are used (Uncertainty range: 1,140 - 5,203). These findings were robust to sensitivity analyses over a wide range of parameter values.

Expanding TPT coverage to HHCs aged 5-14 years is cost-effective when using TST and 6H closely followed by a strategy combining TST and 3HP.

Since 2015, the National Institute for Health and Care Excellence (NICE) guidelines have recommended antenatal magnesium sulfate (MgSO4) for mothers in preterm labour (<30 weeks' gestation) to reduce the risk of cerebral palsy (CP) in the preterm baby. However, the implementation of this guideline in clinical practice was slow, and MgSO4 use varied between maternity units. In 2018, the PRrevention of Cerebral palsy in PreTerm labour (PReCePT) programme, an evidence-based quality improvement (QI) intervention to improve use of MgSO4, was rolled out across England. Earlier evaluation found this programme to be effective and cost-effective over the first 12 months. We extended the original evaluation to determine the programme's longer-term impact over 4 years, its impact in later preterm births, the impact of the COVID-19 pandemic, and to compare MgSO4 use in England (where PReCePT was implemented) to Scotland and Wales (where it was not).

Quasi-experimental longitudinal study using data from the National Neonatal Research Database on babies born <30 weeks' gestation and admitted to a National Health Service neonatal unit. Primary outcome was the percentage of eligible mothers receiving MgSO4, aggregated to the national level. Impact of PReCePT on MgSO4 use was estimated using multivariable linear regression. The net monetary benefit (NMB) of the programme was estimated.

MgSO4 administration rose from 65.8% in 2017 to 85.5% in 2022 in England. PReCePT was associated with a 5.8 percentage points improvement in uptake (95% CI 2.69 to 8.86, p<0.001). Improvement was greater when including older preterm births (<34 weeks' gestation, 8.67 percentage points, 95% CI 6.38 to 10.96, p<0.001). Most gains occurred in the first 2 years following implementation. PReCePT had a NMB of £597 000 with 89% probability of being cost-effective. Following implementation, English uptake appeared to accelerate compared with Scotland and Wales. There was some decline in use coinciding with the onset of the pandemic.

The PReCePT QI programme cost-effectively improved use of antenatal MgSO4, with anticipated benefits to the babies who have been protected from CP.

The NAPOLI 3 trial demonstrated that compared to the nab-paclitaxel and gemcitabine (GemNab) regimen, the NALIRIFOX (5-fluorouracil, leucovorin, liposomal irinotecan, oxaliplatin) regimen can significantly improve patients' overall survival (OS) and progression-free survival (PFS), and the safety of this regimen is generally controllable. To ensure the appropriateness of the chosen treatment, economic evaluation is essential. Thus, from the perspective of American healthcare systems, we explored the cost-effectiveness comparison between NALIRIFOX or GemNab in treating patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) who had not previously received treatment.

A three-state partitioned survival model was developed, incorporating a lifetime horizon with a 4-week cycle length. The efficacy data were sourced from the NAPOLI 3 study, while treatment costs, health state utilities, and adverse events (AEs) were obtained from public databases and literature. Applying an annual discount rate of 3%, the analysis focused on total cost, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) as primary outcomes. Conducted within a US healthcare system perspective over a 13-year lifetime horizon, the analysis set willingness-to-pay (WTP) thresholds of $50,000, $100,000 and $150,000 per QALY. Sensitivity analyses were performed to assess the robustness of the model's findings.

In our base-case analysis, NALIRIFOX group was estimated to achieve an incremental gain of 0.13 QALYs. Compared to the GemNab group, treatment with NALIRIFOX resulted in higher costs ($150,437 vs $130,683). The ICER for NALIRIFOX therapy was calculated to be $155,602.83/QALYs. Sensitivity analysis revealed the model's robustness across a range of parameters. Through probabilistic sensitivity analysis applying Monte Carlo simulation with 1000 iterations, NALIRIFOX therapy was identified as the cost-effective regimen in 45.7% of all iterations at a WTP threshold of $150,000/QALYs.

Treatment with NALIRIFOX strategy was estimated to provide a significant clinical advantage over GemNab. According to the model outcomes, NALIRIFOX therapy is borderline cost-effective for treatment-naive patients with mPDAC, slightly exceeding the highest conventional US willingness-to-pay threshold of 150,000/QALY. However, at lower thresholds, such as 100,000/QALY, NALIRIFOX fails to demonstrate cost-effectiveness in all simulations. In addition, NALIRIFOX therapy emerges as a cost-effective treatment strategy at higher willingness-to-pay thresholds or when the drug price is significantly reduced.

The necessity of pre-exposure prophylaxis (PrEP) for ending the global AIDS epidemic by 2030 remains controversial. In Taiwan, the HIV epidemic predominantly affects young, sexually active men who have sex with men (MSM). This study aimed to model the impact and cost-effectiveness of a high-coverage oral emtricitabine/tenofovir PrEP program in Taiwan from an HIV elimination perspective.

We applied stochastic and risk/age-structured deterministic modeling to assess the impact of PrEP scale-up on the basic reproduction number (R0) and the trajectory of the HIV epidemic in Taiwan, respectively. Both models were parameterized using the national HIV registry and cascade data. Cost-effectiveness was evaluated from a societal perspective.

Here we show that an intensive HIV test-and-treat strategy targeting HIV-positive individuals alone would substantially decrease HIV transmission but is not sufficient to eliminate the HIV epidemic among MSM at the estimated mixing level. In contrast, a PrEP program covering 50% of young, sexually active, high-risk, HIV-negative MSM would suppress HIV's R0 below 1, facilitating its elimination. It would also reduce HIV incidence to levels below the World Health Organization's HIV elimination threshold (1/1000 person-years) by 2030 and is highly cost-saving, yielding a benefit-cost ratio of 7.16. The program's effectiveness and cost-effectiveness remain robust even under conditions of risk compensation (i.e., no condom use among PrEP users), imperfect adherence (75%), or low-level emtricitabine/tenofovir resistance (1%).

Our findings strongly support scaling up PrEP for young, sexually active, high-risk, HIV-negative MSM as a critical strategy to end the HIV epidemic in Taiwan and globally.

Background/Objectives: As life expectancy rises and the epidemiological landscape of chronic diseases evolves, the necessity to assess and improve the overall health status of the population becomes increasingly fundamental. Therefore, evaluating health gains is a crucial challenge for modern health systems, particularly in the context of limited resources and increasing demand for services. The aim of this study is to assess health gains and their costs, with data provided by a private Italian clinic. Methods: We conducted a retrospective study on 129 patients admitted between June 2020 and August 2023 in a solvent ward for short-term planned hospitalization. The patients completed the EQ-5D-5L questionnaire at both admission and discharge. Quality-Adjusted Life Years (QALYs) were estimated based on the difference in EQ-5D-5L scores between discharge and admission, assuming that health gains persist up to two years post-discharge. Through QALYs value and hospitalization cost, a cost-utility analysis was performed. Descriptive and statistical analyses were carried out using STATA SE/14.0 software. Results: Of the studied sample, 55% was female, the median age was 81 [11] years old, and the median length of stay (LoS) was 16 [16] days. The patients gained, in median, 0.33 [0.38] in QALY, which was higher for males (0.35 [0.34]) than females (0.29 [0.45]). The QALY gained was greater for the non-geriatric patients (0.41 [0.42]) than geriatric ones (0.32 [0.38]) (p > 0.05). Those with a longer LoS showed a higher gain in QALY (0.35 [0.42]) than those with a shorter one (0.23 [0.29]) (p < 0.05). The cost per QALY gained was, in median, EUR 14,337, which was lower in males (EUR 13,803), in non-geriatric patients (EUR 13,743), and in patients with a shorter LoS (EUR 10,670) (p > 0.05). Conclusions: Although QALY gains differed among the groups, the median cost per QALY remained consistent. These results highlight the need for targeted interventions to optimize resource allocation, both by integrating data into allocation strategies and by employing a multidisciplinary approach to tailor interventions.

Immunotherapy has made significant advancements in cervical cancer (CC) treatment; however, its efficacy remains limited in programmed death ligand 1 (PD-L1)-negative patients. Cadonilimab, the first bispecific antibody targeting both programmed death 1 (PD-1) and cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), demonstrated superior efficacy and manageable safety as a first-line treatment for persistent, recurrent, or metastatic CC (p/r/m CC) in the phase III COMPASSION-16 trial. Notably, it showed significant survival benefits in PD-L1-negative patients. This study aimed to evaluate its cost-effectiveness from the perspective of the Chinese healthcare system.

A partitioned survival model was developed based on data derived from the COMPASSION-16 trial. The model utilized a 3-week cycle length and a 10-year time horizon. The primary outcomes included costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net monetary benefit (INMB), and incremental net health benefit (INHB). Additionally, sensitivity analyses, scenario analyses, and subgroup analyses were performed.

The cadonilimab plus chemotherapy regimen provided an additional 0.61 QALYs compared to chemotherapy alone, at an incremental cost of $42,486.54. This yielded an ICER of $70,220.88/QALY, exceeding the willingness-to-pay threshold of $38,042/QALY. The corresponding INMB and INHB were -$19,469.55 and -0.51 QALYs, respectively. Consequently, cadonilimab plus chemotherapy was not deemed to be cost-effective. Sensitivity analyses showed that the results remained consistent when each parameter varied within the predetermined range, indicating the model's robustness. Subgroup analyses demonstrated no significant positive correlation between economic outcomes and PD-L1 expression levels. Notably, in the subgroup of patients who did not receive bevacizumab, cadonilimab plus chemotherapy emerged as a cost-effective alternative.

In China, cadonilimab plus chemotherapy is not considered cost-effective compared to standard chemotherapy as a first-line treatment for the general p/r/m CC population. However, it represents a cost-effective option for patients ineligible for bevacizumab therapy.

Empirical evidence regarding temporal trends in cost per quality-adjusted life year (QALY) gained remains limited. This study investigates the evolution of cost-effectiveness for diabetes mellitus treatments over time.

We analyzed cost-effectiveness analyses of anti-diabetic pharmaceuticals extracted from the Tufts Medical Center Cost-Effectiveness Analysis Registry (CEAR). Incremental cost-effectiveness ratios (ICERs) were normalized by GDP per capita and categorized into four threshold-based groups. In addition, we examined temporal trends in incremental QALYs. Analyses stratified by Organisation for Economic Co-operation and Development (OECD) membership were also conducted.

Among 239 eligible studies, the proportion of highly cost-effective interventions in OECD countries decreased from 62.50% (1999-2005) to 35.48% (2021-2023), while interventions exceeding 3хGDP per capita/QALY increased from 12.50% to 54.84%. This trend was less pronounced in non-OECD countries. Mean incremental QALYs remained stable (range: 0.19-0.47) across periods and between OECD and non-OECD countries, suggesting that rising costs rather than diminishing health benefits drive the declining cost-effectiveness.

The cost-effectiveness of anti-diabetic medications has deteriorated substantially over time, particularly in OECD countries, despite stable therapeutic benefits. These findings highlight the need for dynamic approaches to cost-effectiveness thresholds and robust price negotiations to ensure sustainable access to innovative therapies.

The cost of healthcare spending in foot and ankle surgery continues to rise. Several recent studies about cost effectiveness have been published. These may be difficult to understand and analyze without a background in business and healthcare economics. The goal of this narrative review is to provide the fundamentals for understanding and interpreting healthcare economic studies by defining key terminology and providing examples in the field of foot and ankle surgery. Foot and ankle surgeons should be familiar with the elements that comprise cost-effectiveness for providers, clinicians, researchers, and economists in caring for patients and making healthcare-related decisions.

An M1/M2 macrophage-regulating treatment, ON101 cream, has shown its superior healing efficacy for diabetic foot ulcers (DFUs) versus standard absorbent dressing, according to a phase III trial. Given its high cost, corroborating the economic value of ON101 treatment can facilitate clinical and policy decision-makings. This study sought to evaluate the cost-effectiveness of ON101 versus an absorbent dressing for patients with DFUs from Taiwan's healthcare sector perspective. This economic evaluation utilized effectiveness and cost data (in 2022 USD) from a randomized controlled trial of ON101, published literature, and Taiwan's National Health Insurance program. Incremental cost-effectiveness ratio (ICER) against willingness-to-pay (WTP) threshold was estimated to determine the cost-effectiveness of treatment. Over a mean follow-up of 12.69 weeks in the full analysis set of patients (n = 236), 6 patients would need to be treated with ON101 versus the absorbent dressing to obtain a case of complete healing, which costed US$21,128 per complete-healing case gained. This ICER value was below WTP threshold of US$32,788. Cost-effective findings were consistent across sensitivity analyses, and more remarkable for patients with Wagner grade 2 ulcers, HbA1c >7%, and plantar ulcers. All these results were similar in modified intention-to-treat set. The high upfront drug cost of ON101 could be offset by its superior healing efficacy. Considering key prognostic factors for DFUs while optimizing the allocation of limited healthcare budgets, ON101 should be prioritized for severe cases with poor ulcer prognosis.

In 2022, the World Health Organization extended their guidelines for perennial malaria chemoprevention (PMC) from infants to children up to 24 months old. However, evidence for PMC's public health impact is primarily limited to children under 15 months. Further research is needed to assess the public health impact and cost-effectiveness of PMC, and the added benefit of further age-expansion. We integrated an individual-based model of malaria with pharmacological models of drug action to address these questions for PMC and a proposed age-expanded schedule (referred as PMC+, for children 03-36 months). Across malaria prevalence settings of 5-70% and different drug sensitivity assumptions, we predicted PMC and PMC+'s median efficacy (interquartile range) of 18.6% (12.2-25.0%) and 21.9% (14.3-29.5%) against clinical disease and 9.0% (2.0-16.0%) and 10.8% (3.2-18.4%) against severe malaria, respectively, in children under three years. PMC's total impact outweighed the risk of delayed malaria in children up to age five and remained cost-effective across currently recommended transmission intensities (over 10% prevalence) when delivered through the existing Expanded Program on Immunization channels. Further empirical evidence of likely added benefit, operational feasibility and sustainability of age-expanded PMC will be essential to complement our model-based findings.

Multiple micronutrient deficiencies might increase the adverse outcome during pregnancy and after birth. Considering the WHO recommendations since 2016 and scientific evidence from previous studies that multiple-micronutrient supplementation (MMS) is more effective than iron folic acid (IFA) in improving pregnant women's health, it is imperative to conduct an economic evaluation to assess the cost-effectiveness of MMS compared with IFA.

We conducted a systematic review from PubMed and Scopus to identify the cost-effectiveness analyses of MMS compared to IFA for pregnant women up to January 2024. Data extraction included specific study characteristics, input parameters, cost elements, cost-effectiveness results, and key drivers of uncertainty. This systematic review adhered to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

After removing 111 duplicates and following the screening process on the title and abstract of 1201 records, resulting in 125 full-text articles assessed for eligibility, a total of 5 studies fulfilled the inclusion criteria and were included in the review. All included studies were from low- and middle-income countries and demonstrated that MMS compared to IFA for pregnant women is cost-effective and even very cost-effective in some countries. All included studies implemented cost-effectiveness analysis (CEA) and estimated its cost-effectiveness using incremental cost-effectiveness ratio (ICER) per disability-adjusted life years (DALY) averted. Results suggested that the transition from IFA to MMS was cost-effective. The range of ICER per DALY averted in this study is USD 3.62 to USD 1024, depending on the scenario. Overall, the main determinant influencing cost-effectiveness was the cost of MMS procurement.

Our findings highlight that transitioning from IFA to MMS in certain conditions has been proven cost-effective, emphasizing this intervention's economic viability. MMS price and micronutrient deficiency-related disease burden are important determinants in assessing cost-effectiveness.

PROSPERO CRD42022319470.

The benefits of Interdisciplinary Rehabilitation in an Outpatient Specialised Unit (IROSU) have not been determined.

To compare the effects of IROSU and physiotherapy in the community on impairment, function and Quality Of Life (QoL) in people with Multiple Sclerosis (pwMS) and to determine the medico-economic impact.

Pragmatic, multicentre, parallel, randomized (centralised computer-generated randomisation) controlled trial. 148 pwMS were analysed (73 in the IROSU group, 75 in the community group). IROSU included balance, stretching, walking, resistance and endurance training. The 6-Minute Walk Test (6MWT) was the primary outcome. Secondary outcomes were speed over 10 m, Timed Up and Go and Stair test, balance (Berg Balance Scale, posturology), knee extensor and flexor strength (isokinetic dynamometer), peak power output (cycling test), fatigue (Fatigue Severity Scale, Modified Fatigue Impact Scale), QoL (EuroQol EQ5D3 L, SEP59), anxiety and depression (Hospital Anxiety and Depression scale) and Multiple Sclerosis Impact Scale. Evaluations were performed before, after 4 weeks of training and 3 and 6 months after the start by therapists blinded to group allocation. Linear mixed effect models were used (intention-to-treat analysis). Cost-effectiveness and cost-utility ratios were analysed.

6MWT increased similarly in both groups from baseline to M1 (423.8 (126.7) m to 476.0 (119) m IROSU, 404.4 (99.3) m to 440.5 (112.1) m community, P < 0.001), to M3 (P < 0.001) and to M6 (P = 0.001). Knee extensor strength, power output and QoL-physical health improved significantly more in IROSU group (P < 0.05, effect size 0.25-0.61). Many improvements were maintained at the 6-month follow-up. Gain in quality adjusted life years and cost-utility ratios were in favour of IROSU.

Walking distance improved similarly in both groups but this was underpowered. The larger improvements in secondary outcomes and quality-adjusted life years after IROSU, maintained at the 6-month follow-up, suggest pwMS should have access to this program each year.

NCT01871818.

To describe the characteristics of the demands for health technologies submitted to the Brazilian Government.

A descriptive analysis was carried out by surveying the reports produced by the National Committee for the Incorporation of Health Technologies since its creation in Brazil until 2023. The extracted data were tabulated in 3 domains: identification of demand, epidemiological profile of the disease, and clinical evidence and economic assessment.

A total of 778 among 813 reports were included (95.7%), of which 266 (34.2%) were related to rare diseases. Of these, 86 (32.3%) were related to oncology, for 73.3% of which there were requests for the incorporation of medicines, 51.0% from external demand, 48.2% related to public entities, and 58.7% had the recommendation as a final opinion. The total and average incremental budgetary impact of the incorporated technologies was R$36 683 014 441.02 and R$1 111 606 498.20 and the total and average incremental cost-effectiveness ratio was R$1 024 897.50/QALY and R$68 326.50/QALY, whereas for nonincorporated technologies it was R$3 055 888 437.38; R$ 127 328 684.89; R$ 952 263.85/QALY and; R$52 903.54/QALY, respectively.

The oncology area had greater representation among the demands evaluated, with rare cancers representing the largest portion of health technologies demanded, and the decision to incorporate was the majority. The incremental budgetary impact and incremental cost-effectiveness ratio were greater for the incorporated technologies, 2 among them exceeded the cost-effectiveness threshold adopted by the National Committee for the Incorporation of Health Technologies.

This study assessed the cost-effectiveness of nivolumab plus ipilimumab (NIVO+IPI) versus platinum-doublet chemotherapy (chemo) in untreated metastatic non-small cell lung cancer (NSCLC) using mixture-cure modelling, an approach used to analyse immuno-oncology treatments due to their underlying methods depicting delayed but durable response in some patients.

A mixture-cure economic model was developed from a US third-party payer perspective to assess the lifetime costs and benefits of NIVO+IPI versus chemo using data from Part 1 of the phase III CheckMate 227 trial with 5 years of follow-up. The model consisted of four health states: progression-free without long-term response (non-LTR), progression-free with long-term response (LTR), post-progression, and death. The primary outcomes were the incremental cost per life-year (LY) and quality-adjusted life-year (QALY) gained for NIVO+IPI versus chemo over a patient's lifetime time horizon. Model uncertainty was evaluated using one-way sensitivity analyses and probabilistic sensitivity analysis.

NIVO+IPI treatment showed a significant improvement in overall survival versus chemo; mean gain 1.69 LYs and 1.42 QALYs. The majority of the 4.04 LYs accrued by NIVO+IPI were in the LTR state (2.27 years). The incremental cost of NIVO+IPI versus chemo was US$125,321, resulting in an incremental cost/QALY gained of US$88,219.

This study suggests NIVO+IPI may be a cost-effective first-line treatment when compared with chemo in a US setting given a threshold of US$150,000 per QALY. The cost-effectiveness analysis used a mixture-cure approach, which may offer a more appropriate modelling method in immuno-oncology given LTR, by more accurately capturing the potential treatment benefit.

Smoking is the leading preventable cause of death and disability in the United States. A 2019 randomized controlled trial found e-cigarettes are more effective than nicotine replacement therapy (NRT) in achieving abstinence when both are combined with behavioral counseling. Few cost-effectiveness studies have been performed regarding e-cigarettes as an adjunct to cessation efforts, and none in a U.S. context. This study evaluated the cost-effectiveness of e-cigarettes compared to NRT, both with counseling, and as cessation aids for Medicaid smokers in California.

A cost-effectiveness analysis from a U.S. societal perspective comparing e-cigarettes with NRT was constructed. Using a lifetime horizon, smokers were followed to different health states to their expected lifespan. Costs were expressed in 2020 U.S. dollars and health outcomes in quality-adjusted life years (QALY). All costs and outcomes were discounted at a 3% annual rate and model findings were assessed with a series of sensitivity analyses.

Using U.S. willingness-to-pay thresholds, e-cigarettes were more cost-effective than NRT, with an incremental cost-effectiveness ratio of $11 454 per additional QALY gained over smokers' lifetimes. Results were sensitive to smokers' healthcare costs, model start ages, discount rates, and QALY weights.

E-cigarettes used as a cessation treatment by smokers are more cost-effective relative to NRT. However, e-cigarettes as a treatment are currently unapproved by the Food and Drug Administration (FDA). Despite the lack of FDA approval, e-cigarettes are a popular choice among smokers trying to quit. Policymakers should consider whether providing financial support for e-cigarettes as a harm reduction strategy is worth pursuing.

As e-cigarettes grow in popularity and are an increasingly preferred choice of smoking cessation aid among smokers attempting to quit, it is important to examine the inclusion of these products in tobacco policy, research, and practice. Several countries have now adopted or are in the process of adopting e-cigarettes as a medically licensed and regulated smoking cessation aid. Future smoking cessation strategies by U.S. policymakers may consider the adoption of e-cigarettes as a cost-effective harm reduction tool for use by current smokers seeking to quit.

The isocitrate dehydrogenase (IDH) inhibitor, vorasidenib, may offer a promising new treatment option for patients with IDH-mutant gliomas. However, the indefinite nature of this targeted therapy raises significant financial concerns. High costs of targeted cancer therapies, often exceeding $150 000 annually, contribute to financial toxicity, characterized by medical debt, income loss, and psychological stress, and place stress on health systems. This review analyzes the drug approval and pricing mechanisms in various countries and their impact on healthcare costs and patient access, focusing specifically on the impacts in neuro-oncology. The United States employs a market-driven approach resulting in higher drug prices, while most countries, such as the United Kingdom, Germany, France, Italy, Japan, South Africa, and Brazil, use negotiated pricing and health technology assessment to manage costs. The financial burden of expensive medications affects patient adherence and quality of life, with many cancer patients facing substantial out-of-pocket expenses and potential treatment abandonment, and many more unable to access these drugs altogether. Vorasidenib's introduction, while potentially improving patient outcomes, may exacerbate financial toxicity unless mitigated by patient access programs and cost-management strategies. As neuro-oncology treatment paradigms evolve, understanding the economic implications of new therapies is essential to ensure equitable access and optimize patient care.

Given the high disease and cost burden of ischemic stroke, evaluating the clinical efficacy and cost-effectiveness of new approaches to prevent and treat ischemic stroke is critical. Effective ischemic stroke management depends on timely administration of thrombolytics after stroke onset. This study evaluates the cost-effectiveness associated with the use of mobile stroke units (MSUs) to expedite tissue plasminogen activator (tPA) administration, as compared with standard management through emergency medical services (EMS).

This study is a prospective, multicenter, alternating-week, cluster-controlled trial of MSU versus EMS. One-year and life-time cost-effectiveness analyses, using the incremental cost-effectiveness ratio (ICER) method, were performed from the perspective of CMS's Medicare. Quality-adjusted life years (QALYs) estimated using patient-reported EQ-5D-5L data were used as the effectiveness measure. Health care utilizations were converted to costs using average national Medicare reimbursements. ICERs excluding patients with pre-existing disability, and limited to stroke-related costs were also calculated.

The first-year ICER for all tPA-eligible patients using total cost differences between MSU and EMS groups was $238,873/QALY; for patients without pre-existing disability was $61,199/QALY. The lifetime ICERs for all tPA-eligible patients and for those without pre-existing disability were $94,710 and $31,259/QALY, respectively. All ICERs were lower when restricted to stroke-related costs and were highly dependent on the number of patients treated per year in an MSU.

MSUs' cost-effectiveness is borderline if we consider total first-year costs and outcomes in all tPA-eligible patients. MSUs are cost-effective to highly cost-effective when calculations are based on patients without pre-existing disability, patients' lifetime horizon, stroke-related costs, and more patients treated per year in an MSU. ANN NEUROL 2025;97:209-221.

Robot-assisted physical rehabilitation offers promising benefits for patients, yet its adoption among therapists remains a complex challenge. This study investigates the acceptance of robot-assisted physical rehabilitation technology among therapists in Vietnam, a middle-income country with a growing demand for rehabilitation services. Drawing on the Technology Acceptance Model 2 (TAM2) and the Theory of Planned Behaviour (TPB), an online survey and semi-structured interviews were conducted to explore therapists' attitudes and intentions towards using this technology. The results show that Vietnamese therapists recognised its potential benefits and expressed a willingness to use it. Although having similar acceptance patterns compared to developed regions, they demonstrated significantly higher levels of agreement across acceptance constructs. This may be attributed to factors such as the novelty effect, cultural perceptions of robots, and the high workload of therapists in Vietnam. Gender and location were found to influence two acceptance constructs-subjective norms and image, respectively-highlighting the need for tailored strategies in technology implementation. The study underscores the importance of considering socio-cultural factors in the adoption of technology and provides insights for enhancing the acceptance and effectiveness of robot-assisted physical rehabilitation in Vietnam. This contributes to the global understanding of therapist acceptance of technology in this field.

To evaluate the economic burden and cost-effectiveness of interventions and management of non-infectious uveitis (NIU).

A comprehensive search was conducted across Medline, Embase, and Scopus databases from inception to March 2023. Risk of bias assessments were conducted using the Joanna Briggs Institute critical appraisal tools.

A total of 24 articles consisting of 16 economic burden studies (67%) and 9 cost-effectiveness or cost-utility studies (38%) met the inclusion criteria. Annual direct medical costs ranged from $16,428 to $134,135 USD 2023, with costs being 4.3 times higher for those with blindness compared to those without vision loss. Direct medical costs for corticosteroid, immunosuppressive, and biologic therapies were $19,497, $29.979, and $45,830, respectively. Indirect costs ranged from $806 to $57,170, with costs being 2.1 times higher for persistent NIU and 2.3 times higher for those with blindness. Annual medication and intervention costs ranged from $345 to $13,134, with prescription drug costs being 60% higher for blind patients compared to those with moderate vision loss. Overall, cost-effectiveness analyses show promise for treatments like adalimumab and certain implants, though the extent of economic benefit depends on price reductions and healthcare system variations. Varying parameters like willingness-to-pay (WTP) thresholds and input parameters further complicated comparability.

NIU poses a significant economic impact, particularly in patients with blindness and those on advanced therapies. While evidence is growing in Western countries like the US and UK, further research in non-westernized countries is warranted for a comprehensive, global understanding of the disease's economic burden.

Atrial fibrillation (AF) screening identifies undiagnosed patients who can benefit from anticoagulant therapy, thereby reducing the risk of ischemic stroke. However, the long-term outcomes and costs related to population screening for this purpose in the Asian elderly remain unknown.

This study aimed to evaluate the cost-effectiveness of population screening for AF in the elderly in Taiwan and explore the optimal screening strategy from the health care sector's perspective.

Using a Markov decision-analytic model, we simulated lifetime outcomes and costs of AF screening in a cohort of 10,000 individuals aged 75. Comparative analyses with a nonscreening approach assessed prevented ischemic strokes, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to address model uncertainty, while scenario analyses were performed to determine the optimal age and frequency of screening.

One-time population screening for AF among 75-year-olds prevented 45 ischemic strokes and gained 47.42 QALYs, with an additional cost of $592,450 (ICER: $12,493 per QALY gained). The cost-effectiveness of screening remained robust in sensitivity analyses, with anticoagulant effectiveness in ischemic stroke prevention being the most influential factor. Similar ICERs were observed for individuals aged 65 to 80 years. Implementing annual screening for individuals aged 65 to 80 years yielded an ICER of approximately $18,000 per QALY gained.

Both one-time and annual population screening for AF in individuals aged 65 to 80 years appear to be cost-effective. Further research is needed to assess budgetary and feasibility aspects to establish an optimal screening program.

The Phase 3 RATIONALE-312 trial (NCT04005716) showed that tislelizumab plus chemotherapy led to a noteworthy enhancement resulted in a significant improvement in overall survival among patients diagnosed with extensive-stage small-cell lung cancer (ES-SCLC) compared to chemotherapy alone. The treatment also had an acceptable level of safety. Nevertheless, the debate over the efficacy of implementing several treatment plans in competition continues due to the significant expenses involved. Therefore, we aimed to evaluate the potential efficacy and cost of tislelizumab treatment as a first-line treatment for the ES-SCLC patient population in China. The study assessed primary health outcomes by measuring life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). This was done using a Markov model considering three health states with a 15-year horizon. To assess its model resilience, we conducted one-way sensitivity analyses with probability. In addition, subgroup analyses of some pre-specified patients was performed. Compared to chemotherapy alone, tislelizumab plus chemotherapy resulted in an additional 0.34 ($8,028) QALYs, leading to an ICER of $23,553 per QALY for the overall patient population. The ICER was lower than the assumed willingness-to-pay threshold of $35,367 per QALY. Approximately 60% of simulations suggested that tislelizumab in combination with chemotherapy was cost-effective, while 40% suggested that chemotherapy alone was cost-effective. The subsequent sensitivity analyses revealed that the health utility value associated with the disease progression parameter had the greatest influence on ICER. Tislelizumab plus chemotherapy was a preferable treatment option for regimens for patients with ES-SCLC in China. This finding is important in guiding the Chinese healthcare system.

This study was aimed to evaluate the cost-effectiveness of pembrolizumab with chemotherapy (pembrolizumab combination therapy) and compare it with standard-of-care platinum-based chemotherapy (chemotherapy alone) as a first-line treatment for metastatic nonsquamous NSCLC from the perspective of Taiwan's third-party-payer public health-care system. We used a partitioned survival model with an estimated time horizon of 10 years. The partitioned survival model uses Kaplan-Meier estimates of progression-free and overall survival from the KEYNOTE-189 clinical trial. The quality-adjusted life-year (QALY) values were based on utility values by progression status calculated from the KEYNOTE-189 trial. This study examined costs related to treatment regimens, disease management, second-line therapy, end-of-life care, and adverse event management. Cost and utility were discounted at 3% per year. Probabilistic and deterministic sensitivity analyses were performed to test the robustness of the results. The willingness-to-pay threshold was set at 3 × Taiwan's gross domestic product (GDP), equivalent to NT$2,788,290. In the base-case scenario, pembrolizumab combination therapy resulted in an expected gain of 0.89 QALYs and an incremental cost of NT$2,201,203 relative to chemotherapy alone. The ICER was NT$2,478,601/QALY. In the analysis of the PD-L1 tumor proportion score (TPS) ≥ 50% subgroup, the patients who received pembrolizumab combination therapy gained 1.12 QALYs more than those who received chemotherapy alone, and the incremental cost was NT$2,522,528. Therefore, the ICER for this subset of patients was NT$2,258,358/QALY. In conclusion, pembrolizumab combination therapy is a cost-effective option for first-line treatment of metastatic nonsquamous NSCLC. The relative cost-effectiveness of pembrolizumab combination therapy is greatest for patients with PD-L1 TPS ≥50%.

China faces the dual challenge of high air pollution and an increasing burden of cardiovascular disease (CVD). We aimed to estimate the healthcare costs associated with CVD and the quality-adjusted life years (QALYs) under scenarios of improved air quality in China.

A health prediction model was developed to estimate 10-year CVD-related costs and QALY associated with PM2.5 levels in 2015, as well as two hypothetical improved air quality scenarios: (1) the China national PM2.5 target of 35 µg/m³, and (2) the World Health Organization's (WHO) PM2.5 guideline of 5 µg/m³. Population CVD risks were estimated from the 2015 China Health and Retirement Longitudinal Study. Hazard ratios from WHO risk curves were subsequently applied to baseline cardiovascular risks to predict national 10-year estimates of ischaemic stroke and coronary heart disease-related healthcare expenditures and QALYs for individuals aged 45-85 under the three air quality scenarios.

Under PM2.5 levels in 2015, we estimated a cumulative 10-year incidence of 35.40 million CVD events, resulting in healthcare costs of US$96.12 billion and 4.44 billion QALYs. Under the national target of 35 µg/m³, the projected 10-year CVD incidence was 31.92 million cases, resulting in cost savings of US$9.29 billion and 3.43 million QALY gains compared with 2015 levels. If PM2.5 concentration levels meet the WHO's guideline of 5 µg/m³, the projected number of CVD events would decrease to 24.18 million, translating to cost savings of approximately US$30.10 billion and gains of 11.29 million QALYs.

Our findings indicate that achieving the WHO recommended PM2.5 concentration level of 5 µg/m³ could lead to over threefold greater health and economic benefits than those achievable under national standards of 35 µg/m³. This underscores the potential need for stricter future national PM2.5 standards. Our findings also inform other low- and middle-income countries in establishing effective long-term PM2.5 targets.

The Government of Kerala initiated a pilot screening programme for diabetic retinopathy in 16 Family Health Centres in Thiruvananthapuram district in 2019 in collaboration with the ORNATE India project. The evaluation of this pilot included a study of its costs and cost-effectiveness to inform decisions about extending the programme throughout Kerala.

The participants comprise all 5307 people who were screened for diabetic retinopathy under the pilot programme for whom data could be collected.

The costs of the pilot programme are estimated at INR 11.3 million (including INR 1.9 million costs to individuals) and the benefits at 514 QALYs, slightly over one QALY per person treated. The cost per QALY was INR 22,000, which is well below India's Gross National Income per person.

Kerala's 2019 pilot screening programme for diabetic retinopathy was highly cost-effective.

Breast cancer (BC) remains a global health challenge, devastatingly impacting women's lives. Low-and-middle-income countries (LMIC), such as India, experience a concerning upward trend in BC incidence, necessitating the implementation of cost-effective screening methods. While mammography, ultrasonography, and magnetic resonance imaging are preferred screening modalities in resource-rich settings, limited resources in LMICs make clinical breast examination (CBE) the method of choice. This review explores the merits of CBE, its coverage, barriers, and facilitators in the Indian context for developing strategies in resource-constrained settings. CBE has shown significant down-staging and cost-effectiveness. Performed by trained health workers in minutes, CBE offers an opportunity for education about BC. Various individual and health system barriers, such as stigma, financial constraints, and the absence of opportunistic screening hinder CBE coverage. Promising facilitators include awareness programs, capacity building, and integrating CBE through universal health care. No healthcare provider must miss any screening opportunity through CBE.

This study aimed to compare the efficacy and cost-utility of unilateral biportal endoscopy (UBE) versus percutaneous endoscopic interlaminar discectomy (PEID) for the treatment of single-level lumbar disc herniation (LDH).

A retrospective analysis was conducted on 99 patients who underwent either UBE (n = 33) or PEID (n = 66) between July 2022 and December 2023 at the Second Xiangya Hospital. Patients were matched 1:2 based on age, sex, and surgery level to ensure comparability. Clinical outcomes were assessed using Visual Analog Scale (VAS), European Quality of Life-5 Dimensions (EQ-5D), and Oswestry Disability Index (ODI) scores, with quality-adjusted life years (QALYs) calculated for cost-utility analysis. Hospitalization costs were analyzed, and the incremental cost-utility ratio (ICER) was determined.

Both UBE and PEID groups demonstrated significant postoperative improvements in VAS, EQ-5D, and ODI scores (p < 0.05). The operative time, blood loss and nursing cost were significantly higher for UBE compared to PEID (p < 0.05). UBE has higher gained QALY and overall costs, but the differences are not statistically significant (p = 0.643 for QALY, p = 0.327 for costs). The Incremental Cost-Effectiveness Ratio (ICER) for UBE compared to PEID was calculated to be $354.5 per QALY gained, indicating that for each additional QALY gained through UBE, an additional cost of $354.5 is incurred compared to PEID.

In our single-center study conducted in China, both the UBE and PEID procedures have demonstrated comparable short-term efficacy in alleviating pain and improving functional ability in patients with single-level LDH. UBE procedure demonstrates greater cost-utility than the PEID procedure in cost-utility analysis, despite its longer operative time, higher nursing costs and greater blood loss.

Mobile stroke units have been shown to deliver faster patient care and improve clinical outcomes. However, costs associated with staffing limit their use to densely populated cities. Using the Melbourne mobile stroke unit, we aim to evaluate the safety, timeliness, and resource efficiency of a telemedicine model, where the neurologist assesses a patient remotely, via telemedicine, compared with an onboard neurologist model. We hypothesize that, without compromising patient safety, the telemedicine model will provide timely care and superior resource efficiency.

Using a prospective, randomized, blinded end-point controlled design, 270 participants consecutively assessed on the Melbourne mobile stroke unit over ≈12 months will be assigned into 2 arms: (1) telemedicine neurologist assessment (intervention) versus (2) onboard assessment (comparator). Enrollment is based on prospectively designated randomized days of neurologist review onboard versus telemedicine. The primary outcome will be the odds that a randomly selected participant in the telemedicine arm will have a better outcome than a randomly selected participant in the onboard arm, measured using a desirability-of-outcome ranking, an outcome measure that includes, in order of importance: (1) safety, (2) scene-to-treatment-decision time metrics, and (3) resource usage. All participants within each arm will be compared with those in the other, resulting in a "win/tie/loss" distribution for telemedicine compared with the onboard model.

The study will establish whether use of a telemedicine neurologist delivers superior resource efficiency without compromising patient care. This would enable the broader use of mobile stroke units, particularly relevant to regions with limited access to neurologists, thus improving equity in access to time-critical, lifesaving stroke care.

URL: clinicaltrials.gov; Unique Identifier: NCT05991310.

The article offers a comparative analysis of the influence of cost-effectiveness thresholds in the decision-making processes in financing policies, coverage, and price regulation of health technologies in nine countries. We investigated whether countries used cost-effectiveness thresholds for public health policy decision making and found that few countries have adopted the cost-effectiveness threshold as an official criterion for financing, reimbursement, or pricing. However, in countries where it is applied, such as Thailand, the results have been very favorable in terms of minimizing health technology prices and ensuring the financial sustainability of the health system. Although the cost-effectiveness threshold has opportunities for improvement, particularly in certain institutional contexts and with adequate participation of the different strategic actors in the formulation of public policy, its potential use and added value are significant in various aspects.

Air pollution is one of the main causes of global disease burden, especially in low-income and middle-income countries. Estimation of the current situation and prediction of the future health effects of death and incidence of stroke and coronary heart disease (CHD) attributed to PM2.5 were done using BenMAP-CE software. Estimating and forecasting the economic burden of these diseases were done in 4 scenarios: Stability of the current PM2.5 concentration, annual 10 % reduction of PM2.5 concentration, reduction to 5 µg/m3, and reduction to 12 µg/m3, with three approaches for calculating the economic burden in mortality costs, including the human capital(HC), years of life lost(YLL) and value of statistical life(VSL) was performed. With the stability of the PM2.5 concentration, the economic burden of stroke attributed to PM2.5 with the approach of calculating the cost of death with the HC, the YLL, and VSL will reach from 64, 82 and 172 million USD in 2020-849, 1120 and 2703 million USD in 2030 and these costs for CHD in the mentioned approaches of calculating the cost of death will reach respectively from 499, 568 and 898 million USD in 2020-7096, 8088, and 13,621 million USD in 2030. We find that the morbidity economic burden (including direct, indirect, and intangible costs) of stroke compared to the cost of death with the HC, and YLL approaches are 67.58 times, 3.15 times respectively, and in the VSL approach is 47.32 % of stroke death cost. Also, the costs of CHD morbidity economic burden compared to the cost of death in the method of calculating the cost of death with the HC, YLL, and VSL approaches are 42.09, 7.25, and 1.16 times, respectively. This study provides comprehensive baseline information for health policymakers to understand the benefits of air pollution control policies globally, especially in LMICs.

Treatment outcomes for acute malnutrition can be improved by integrating treatment into community case management (iCCM). However, little is known about the cost-effectiveness of this integrated nutrition intervention. The present study investigates the cost-effectiveness of treating moderate acute malnutrition (MAM) through community health volunteer (CHV) and integrating it with routine iCCM. A cost-effectiveness model compared the costs and effects of CHV sites plus health facility-based treatment (intervention) with the routine health facility-based treatment strategy alone (control). The costing assessments combined both provider and patient costs. The cost per DALY averted was the primary metric for the comparison, on which sensitivity analysis was performed. Additionally, the integrated strategy's relative value for money was evaluated using the most recent country-specific gross domestic product threshold metrics. The intervention dominated the health facility-based strategy alone on all computed cost-effectiveness outcomes. MAM treatment by CHVs plus health facilities was estimated to yield a cost per death and DALY averted of US$ 8743 and US$ 397, respectively, as opposed to US$ 13,846 and US$ 637 in the control group. The findings also showed that the intervention group spent less per child treated and recovered than the control group: US$ 214 versus US$ 270 and US$ 306 versus US$ 485, respectively. Compared with facility-based treatment, treating MAM by CHVs and health facilities was a cost-effective intervention. Additional gains could be achieved if more children with MAM are enrolled and treated.

Decision-makers in middle-income countries need evidence on the cost-effectiveness of COVID-19 booster doses and oral antivirals to appropriately prioritise these healthcare interventions.

We used a dynamic transmission model to assess the cost-effectiveness of COVID-19 booster doses and oral antivirals in Fiji, Indonesia, Papua New Guinea, and Timor-Leste. We conducted cost-effectiveness analysis from both healthcare and societal perspectives using data collated from publicly available sources. We developed an interactive R Shiny which allows the user to vary key model assumptions, such as the choice of discounting rate, and view how these assumptions affect model results.

Booster doses were cost saving and therefore cost-effective in all four middle-income settings from both healthcare and societal perspectives using 3% discounting. Providing oral antivirals was cost-effective from a healthcare perspective if procured at a low generic price (US$25) or middle-income reference price (US$250); however, their cost-effectiveness was strongly influenced by rates of wastage or misuse, and the ongoing costs of care for patients hospitalised with COVID-19. The cost or wastage of rapid antigen tests did not appear strongly influential over the cost-effectiveness of oral antivirals in any of the four study settings.

Our results support that COVID-19 booster programs are cost-effective in middle-income settings. Oral antivirals demonstrate the potential to be cost-effective if procured at or below a middle-income reference price of US$250 per schedule. Further research should quantify the rates of wastage or misuse of oral COVID-19 antivirals in middle-income settings.

The Chinese Society of Clinical Oncology (CSCO) has recommended sintilimab plus chemotherapy (SINT + Chemo) as a standard first-line therapy for advanced gastric cancer or gastroesophageal junction cancer (GC/GEJC), based on the proven effectiveness and safety in the ORINT-16 trail. Its cost-effectiveness, however, remains to be evaluated.

We established a partitioned survival approach (PartSA) model with a 10-year time horizon to determine whether SINT + Chemo (vs. chemotherapy) was more cost-effective as a first-line treatment for unresectable advanced or metastatic GC/GEJC. Survival data was generated from the ORIENT-16 trail. Cost calculation was limited to direct medical costs. Database of Hunan Public Resources Trading Service Platform was used as the source for obtaining drug prices. Other cost and utility values were gathered from established literature. Incremental cost-effectiveness ratio (ICER) was the primary output. Additionally, we conducted sensitivity analysis, subgroup analysis, and scenario analysis.

In the base-case analysis, group SINT + Chemo showed an increase in utility value by 0.32 quality-adjusted life-years (QALYs) at an extra cost of $7988.43, resulting in an ICER of $25239.29/QALY, below the Chinese cost-effective willingness-to-pay (WTP) threshold of $38223.34. Upon further subgroup analysis according to patients' programmed death 1 ligand (PD-L1) combined positive score (CPS), the ICERs were $26341.01/QALY for patients highly expressing PD-L1 (CPS ≥5) and $17658.26/QALY for patients lowly expressing PD-L1 (CPS <5). Based on the sensitivity analysis, we found the PFS utility was the parameter that had the most significant impact on the model's outcomes. Moreover, in scenario analysis, the results remained consistent despite variations in the model's time frame.

In China, SINT + Chemo is a more cost-effective option (vs. chemotherapy) as a first-line therapy for unresectable advanced or metastatic GC/GEJC, irrespective of PD-L1 expression levels.

This study aimed to assess the cost-effectiveness of durvalumab as a treatment option for patients with inoperable stage III non-small cell lung cancer (NSCLC) from healthcare and partial societal perspectives in Vietnam.

A lifetime partitioned survival model was used to evaluate the costs and quality-adjusted life years (QALYs) associated with consolidation durvalumab in comparison with the standard of care alone. Local costs and utilities were incorporated into the model. In the base-case analysis, no discount was applied to the acquisition cost of durvalumab. Scenario-based, one-way and probabilistic-sensitivity analyses were conducted.

The base-case analysis revealed that the intervention resulted in an increase of 1.38 life years or 1.08 QALYs for patients, but the intervention was not deemed cost-effective from either perspective in the base-case analysis. However, with a 70% reduction in the durvalumab acquisition cost, the intervention was observed to be cost-effective when evaluated from a healthcare perspective and when examining the undiscounted results from a partial societal standpoint.

This study provides evidence regarding the cost-effectiveness of durvalumab for the treatment of inoperable stage III NSCLC in Vietnam for various scenarios. The intervention was not cost-effective at full acquisition cost, but it is important to acknowledge that cost-effectiveness arguments alone cannot solely guide decision-makers in Vietnam; other criteria, such as budget impact and ethical concerns, are crucial factors to consider in decision-making processes.