Objectives Surgical site and community-acquired osteoarticular infections cause prolonged hospitalization, high costs, and health system burden. Although early intravenous-to-oral (IV-to-PO) antibiotic switch is internationally established, adoption remains limited in Brazil. Objective To evaluate the effectiveness and direct medical costs of a structured IV-to-PO switch protocol targeting ≤5 days of IV therapy for these infections. Methods Quasi-experimental before-after study in a public tertiary hospital in southern Brazil. Microbiologically confirmed adult patients were included in retrospective control (January-October 2023; n = 60) or prospective intervention cohort (December 2023-May 2024; n = 29) after protocol implementation by infectious disease specialists and clinical pharmacists. Primary outcome: therapeutic success (clinical improvement, declining inflammatory markers, oral tolerance). Antimicrobial costs were estimated from public health system perspective using microcosting (2024 Brazilian reais [BRL]). Results Median hospital length of stay decreased from 12 days (IQR 8-17) to 8 days (IQR 6-13; P = .019). IV antibiotic duration was halved—from 10 days (IQR 7-14) to 5 days (IQR 4-8; P < .001), with increased oral use (P = .007). Therapeutic success was numerically higher in the intervention group (88.9% vs 71.7%; P = .140). Median antimicrobial costs declined from BRL 707.32 (IQR 438.25-1141.92) to BRL 351.40 (IQR 193.82-588.34; P < .001). A 4-day stay reduction may yield significant savings because bed-days are the primary cost of complex infections in public health system. Conclusions A structured ≤5-day IV-to-PO protocol in a Brazilian public hospital safely reduced stays and costs without compromising outcomes, supporting stewardship in resource-constrained settings. Future studies should include hospital bed-day costs beyond antimicrobial expenses.
Objectives To evaluate the cost-effectiveness of ribociclib plus letrozole as first-line therapy for premenopausal or perimenopausal women with hormone receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer in Thailand. Methods We developed a state-transition (Markov) model with 5 health states and 2 tunnel states, using 28-day cycles over a lifetime horizon from the public healthcare perspective. First-line progression-free survival was reconstructed from MONALEESA-7 Kaplan-Meier curves and fitted using log-normal parametric survival models. Transition probabilities incorporated progression and death as competing risks. Utilities came from Thai EuroQol 5-Dimension (EQ-5D) data, and direct medical costs were estimated based on primary data collection from tertiary hospitals (2025 US$). Outcomes included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Uncertainty was assessed using 1-way and probabilistic sensitivity analyses, whereas scenario analyses varied drug prices and incorporated Asian subgroup efficacy. Results Ribociclib plus letrozole yielded 5.42 QALYs at US$75 324, compared with 4.06 QALYs at US$9020 for letrozole alone, with an ICER of US$48 753 per QALY, which is above Thailand’s willingness-to-pay threshold of US$4842 per QALY. The ICER was most sensitive to first-line progression-free utility, ribociclib acquisition cost, and the discount rate. Applying MONALEESA-7 Asian subgroup efficacy and a 75% ribociclib price reduction reduced the ICER to US$11 621 per QALY. Sensitivity analyses confirmed the robustness of the ICERs across all scenarios. Conclusions Despite clinical benefits, ribociclib plus letrozole is not cost-effective in Thailand at the current price. Price negotiation and alternative financing or risk-sharing mechanisms are warranted to expand access while preserving budget sustainability.
OBJECTIVES:To develop and psychometrically validate the TF-Col, a patient- and caregiver-reported outcome measure to assess financial toxicity in adult and pediatric oncology populations in a middle-income Latin American context. METHODS:A multicenter study following Consensus-based Standards for the Selection of Health Measurement Instruments recommendations and guided by an evidence-centered design framework was conducted. The final 20-item scale was administered to 348 participants (200 adult cancer patients and 148 caregivers of pediatric patients). Psychometric evaluation included internal consistency, exploratory and confirmatory factor analyses using polychoric correlations, bifactor modeling, and item response theory analyses. Construct and convergent validity were examined using Spearman correlations with the Comprehensive Score for Financial Toxicity and the Pediatric Quality-of-Life Inventory. RESULTS:The TF-Col showed excellent internal consistency for the total score (α = 0.957) and both domains. Exploratory analyses supported a dominant underlying dimension, whereas confirmatory factor analysis demonstrated superior fit for a correlated 2-factor model (CFI = 0.984; root mean square error of approximation = 0.043). A bifactor analysis supported the total score as the primary interpretive index (ωh = 0.700; Explained Common Variance = 0.694), with domain scores retaining descriptive value. item response theory analyses indicated adequate to high item discrimination and greatest measurement precision at low to moderate levels. Strong negative correlations were observed with the Comprehensive Score for Financial Toxicity (ρ = -0.785), and moderate negative correlations with caregiver-reported Pediatric Quality-of-Life Inventory scores. CONCLUSION:The TF-Col demonstrated strong reliability, evidence of internal structure, and convergent validity in adult cancer patients and caregivers of children with cancer. These findings support its intended use as a contextually relevant measure for clinical assessment, outcomes research, and health system evaluation in oncology care.
Objectives Dolutegravir-based therapy (tenofovir/lamivudine/dolutegravir [TLD]) is recommended by the World Health Organization as the preferred first-line regimen for HIV treatment due to its superior efficacy and safety profile. However, local economic evidence supporting this recommendation in Indonesia remains limited. This study evaluated the cost utility of TLD compared with efavirenz-based therapy (tenofovir/lamivudine/efavirenz [TLE]) using real-world data from primary healthcare settings. Methods A Markov model was developed to estimate lifetime costs and health outcomes of TLD and TLE from the healthcare payer’s perspective. The model included 3 mutually exclusive health states: suppressed, unsuppressed, and death. Primary data on treatment outcomes were collected from multiple primary healthcare facilities in Bandung, Indonesia. Costs included drug acquisition and routine monitoring based on national tariffs. Costs and outcomes were discounted at 3% annually. Deterministic, probabilistic, and scenario analyses were conducted to assess uncertainty. Results In the base case, TLD was less costly and more effective than TLE, indicating dominance. Probabilistic sensitivity analysis demonstrated decision uncertainty, with simulations distributed across cost-effectiveness quadrants, although TLD was favored in most iterations. The cost-effectiveness acceptability curve showed a probability exceeding 90% across commonly used thresholds. Scenario analysis incorporating resistance-related switching produced consistent findings, with TLD remaining economically favorable. Results were most sensitive to treatment costs and baseline viral suppression. At a benchmark of approximately 1 × gross domestic product per capita (≈IDR 83 to 84 million per quality-adjusted life-years), TLD remained economically favorable. Conclusion TLD is likely to be cost-effective for HIV management in Indonesia, while acknowledging decision uncertainty.
OBJECTIVES:Malaysia's National Thalassemia Screening Program uses multivisit sequential testing (protocol 1), with a dropout rate of 20%, disproportionately affecting rural and underserved populations in Sabah and Sarawak. Protocol 2 proposes 3-tier testing from a single retained blood sample, eliminating visit-based dropout. Previous deterministic evaluation demonstrated favorable incremental cost per carrier detected but did not quantify parameter uncertainty. METHODS:Probabilistic sensitivity analysis was conducted using 2018 administrative data covering 65 990 students in Sabah and Sarawak. Monte Carlo simulations (10 000 iterations) assigned probability distributions to all parameters: gamma distributions for costs (15% coefficient of variation) and beta-binomial for dropout rates. Cost-effectiveness acceptability curves estimated probabilities across willingness-to-pay thresholds of MYR 10-50 per additional carrier detected. Scenario analyses tested protocol 2 dropout rates ranging from 0.5% (base case) to 5% (pessimistic). RESULTS:Mean probabilistic incremental cost-effectiveness ratios matched deterministic estimates (Sabah: MYR 20.8; Sarawak: MYR 10.3) with narrow 95% credible intervals (Sabah: 18.7-23.2; Sarawak: 9.2-11.5). At MYR 25-50 thresholds, protocol 2 has a > 91% probability of cost-effectiveness in Sabah and ∼100% in Sarawak. Under pessimistic 5% dropout scenarios, probabilities remained ≥70%, indicating substantial implementation tolerance. CONCLUSION:Probabilistic sensitivity analysis demonstrated that protocol 2 maintained favorable screening cascade efficiency across plausible operational scenarios. The lower incremental cost-effectiveness ratio in Sarawak suggests potential equity advantages in higher dropout settings. Illustrative willingness-to-pay thresholds of MYR 10-50 per additional carrier detected were explored for scenario interpretation rather than as normative policy thresholds. These findings support future prospective pilot evaluations and health technology assessment to inform screening implementation decisions.
OBJECTIVES:Global information on the costs of the autism spectrum disorder (ASD) diagnostic process is limited. No previous research has been conducted in Thailand. This study aimed to determine the societal costs of the ASD diagnostic process after the patients visited 7 tertiary hospitals in the Northern, Central, Northeast, and Southern regions of Thailand. METHODS:A total of 155 children diagnosed with ASD were included from January to December 2022. The societal costs consisted of the patient costs, and service provider costs. Government reimbursement and labor costs were also evaluated. The patient perspective costs were calculated from direct nonmedical costs plus nonreimbursable direct medical costs. Direct nonmedical costs were collected by parent questionnaires. Nonreimbursable direct medical costs and the government reimbursement were acquired from each hospital's financial database. Service provider perspective costs were gathered from the Human Resources Unit hospital database. RESULTS:The median of societal, service provider, patient, labor costs, and government reimbursement for the ASD diagnostic process were 3578.6 (2433.7-5412.8), 259.5 (259.5-314.7), 3319.0 (2169.0-5138.1), 559.6 (488.8-795.6), and 200 (0-300) Thai Bahts (THB)/child, respectively. The caregiver productivity loss was the largest proportion among the total patient perspective costs. The median societal costs by region sorted by descending order were Northeast, Central, North, and South, which were 5197.6 (3248.5-6802.3), 3578.6 (2688.8-5412.8), 3028.6 (2286.7-4905.7), and 2198.9 (1686.8-3483.9) THB/child, respectively. CONCLUSION:The societal costs of the ASD diagnostic process were 3578.6 THB/child. The Northeast region demonstrated the highest costs. The caregiver productivity loss was the largest proportion of the total societal costs.
OBJECTIVES:Colorectal cancer is a major public health concern with a high mortality rate. Fecal immunochemical tests (FIT) and total colonoscopy (TCS) are recommended screening methods; however, their cost-effectiveness varies by country. This study addressed the lack of comprehensive cost-effectiveness analyses comparing TCS with the current FIT-based screening in Japan. METHODS:We developed a microsimulation-based decision analytic model to compare FIT-based screening (current practice) with TCS-based screening (alternative) in a hypothetical cohort of 10 000 Japanese adults over a 60-year period. The analysis was conducted from the healthcare payer perspective, with both costs and health outcomes discounted annually by 2%. We adhered to the 2022 Consolidated Health Economic Evaluation Reporting Standards reporting guidelines and incorporated Japan-specific data on costs, participation rates, and disease progression. RESULTS:In the base-case analysis, FIT-based screening was more cost-effective than TCS-based screening. TCS-based screening also yielded fewer quality-adjusted life-years, making it the less favorable approach. Sensitivity analyses showed that FIT remained the dominant screening across most parameter variations. CONCLUSIONS:In Japan, the current FIT-based colorectal cancer screening is more cost-effective than TCS-based screening. Efforts should focus on improving FIT program participation to achieve greater public health benefits, rather than transitioning to a costlier and less effective alternative.
OBJECTIVES:Millions of people rely on humanitarian organizations for medical care. We characterized the complexity and economic value of care provided by a humanitarian relief organization for displaced persons at the Mexico-US border. METHODS:We conducted a cross-sectional study of clinical encounters by a humanitarian relief organization in Tamaulipas, México, near US ports of entry from 2020 to 2022. We used records from a sample of medical encounters to assign ICD-10 and Current Procedural Terminology (CPT) billing codes for each encounter, procedure, or service. We derived an estimate of economic value for these encounters in 2020 US dollars by mapping the CPT billing codes to Medicaid reimbursement rates in Texas, and we compared these with a locally derived estimate using a fee schedule from the Instituto Mexicano del Seguro Social. We stratified economic value estimates by demographics, site of care, and type of medical service. RESULTS:From 23 339 clinical encounters representing 13 963 unique patients (59.5% female; median age 30 years), the most common codes were office visits: CPT 99202 ("office visit with a history") comprised 43.9% of all encounters. The most common procedure was obstetric ultrasound, present in 341 (1.5%) of all clinical encounters. The value of care was $39.18 per encounter, which was within 5% of the locally derived estimate. Evaluation and management services accounted for 95.4% of the value. CONCLUSION:This approach of assigning diagnosis and billing codes to clinical encounters provides an estimate for the value and complexity of clinical services provided by humanitarian relief organizations at the México-US border.
OBJECTIVES:To conduct a cost-utility analysis comparing sentinel node biopsy (SNB) with selective neck dissection (SND) for clinically node-negative early-stage oral cancer from the Indian healthcare system perspective. METHODS:A hybrid decision-tree-Markov model compared SNB with SND over a 10-year horizon, incorporating 18 clinical pathways, time-trade-off utilities from an Indian population, and costs from Indian settings. Model and R code construction were assisted by a large language model (Claude-3.5-Sonnet) with author verification. Effectiveness was measured in quality-adjusted life-years (QALYs). Deterministic and probabilistic sensitivity analyses were conducted. The primary outcome was net monetary benefit at the India-specific willingness-to-pay threshold of INR 212 307/QALY. RESULTS:SNB yielded 6.145 QALYs versus 6.032 for SND (incremental 0.114) at INR 332 865 versus INR 336 433 (incremental -INR 3568). SNB dominated SND in the deterministic base case. Under probabilistic sensitivity analysis, SNB was cost-effective in 78.5% of iterations at the India-specific threshold (mean incremental net monetary benefit INR 15 944; 95% CrI -INR 22 141 to INR 54 287) and 81.8% at 1× gross domestic product per capita (INR 245 000/QALY). A lifetime-horizon scenario (cohort age 55-100; 45 cycles) confirmed SNB dominance with incremental cost -INR 5466 and incremental QALYs 0.1767. Results were robust across deterministic and scenario analyses. CONCLUSIONS:SNB is a cost-effective alternative to SND for clinically node-negative early-stage oral cancer in Indian tertiary cancer centers with appropriate technical expertise, dominating in the deterministic base case and remaining cost-effective in 78.5% of probabilistic iterations at the India-specific threshold. These findings support adoption of SNB as the preferred staging strategy at such centers.
OBJECTIVES:We aimed to identify drivers and solutions to overcome the barriers of the effective use of real-world data (RWD) and real-world evidence (RWE) in Central and Eastern Europe. METHODS:First, a targeted literature review was followed by an experts' workshop aiming to refine and complement the identification of current barriers and drivers. Next, we performed a gap analysis on the barriers based on their importance and actionability. The scores of importance and actionability for each barrier were determined through a questionnaire completed by the experts. Finally, a second experts' workshop was held to develop recommendations to overcome the most important actionable barriers and to collect case studies of RWD/RWE utilization. RESULTS:A total of 22 publications were included in the data extraction phase of the targeted literature review. After the first experts' workshop, 16 barriers and 9 drivers were identified. At the second workshop 9 solutions were proposed in 4 main intervention areas. In addition, 13 case studies were provided from the 4 countries, where RWD/RWE was used effectively. CONCLUSIONS:The effective use of RWD/RWE in health-policy decision making still faces several barriers in Czechia, Hungary, Poland, and Slovakia. This research highlighted the most important barriers and collected recommendations by key experts on how to improve the utilization of RWD/RWE. In addition, we have identified several drivers for the use of RWD/RWE, alongside with 13 case studies, in which RWD/RWE was used effectively.
OBJECTIVES:To evaluate the cost-effectiveness of blinatumomab compared with consolidation chemotherapy in pediatric patients with high-risk relapsed B-cell acute lymphoblastic leukemia from the perspective of the Brazilian Unified Health System. METHODS:A partitioned survival model with 3 health states (event-free survival, postevent survival, and death) was developed over a lifetime horizon. Parametric survival models were fitted to clinical trial data from Locatelli et al, and treatment effects were incorporated using hazard ratios under the proportional hazards assumption. Real-world data from a retrospective cohort of pediatric patients treated at a tertiary public hospital were used to inform cost inputs, resource utilization, and dosing assumptions. Health-state utility values were obtained from published literature. Costs and outcomes were discounted at an annual rate of 5%. Parameter uncertainty was assessed through deterministic and probabilistic sensitivity analyses (5000 Monte Carlo simulations). RESULTS:Blinatumomab was associated with higher costs and improved outcomes compared with consolidation chemotherapy. Patients treated with blinatumomab achieved 11.73 life-years and 9.96 quality-adjusted life-years (QALYs), compared with 8.36 life-years and 6.74 QALYs with chemotherapy, resulting in incremental gains of 3.37 life-years and 3.22 QALYs. The incremental cost was R$ 340 490.07, yielding an incremental cost-effectiveness ratio of R$ 101 035.63 per life-year gained and an incremental cost-utility ratio of R$ 105 742.26 per QALY gained. Sensitivity analyses confirmed the robustness of these findings, with most probabilistic simulations falling below the willingness-to-pay threshold. CONCLUSIONS:Blinatumomab is associated with improved clinical outcomes and represents a cost-effective alternative to consolidation chemotherapy for pediatric patients with high-risk relapsed B-cell ALL within the Brazilian Unified Health System under commonly referenced willingness-to-pay thresholds.
Objectives Severe malaria in childhood causes long-term cognitive and behavioral problems; however, its impact on health-related quality of life (HRQoL) remains understudied. We assessed HRQoL 4 to 20 years after cerebral malaria (CM), severe malarial anemia (SMA), or other severe malaria (OSM) in Uganda. Methods Participants from 3 longitudinal cohorts with CM, SMA, or OSM were included. Asymptomatic community children (CC) served as the reference group. HRQoL was assessed with a mean (SD) duration of 10.0 (3.3) years after enrollment using the EuroQol 5-Dimension 3-Level instrument (EQ-5D-3L) (age ≥12 years) and EQ-5D-Y-3L (age 8 to 11 years). Model-predicted EQ-5D-3L index and visual analog scale (VAS) scores (children ≥12 years) and EQ-5D-Y-3L VAS scores (children 8 to 11 years) were compared across groups using adjusted 2-part models with log transformation. Results Among the 479 study participants aged ≥12 years (187 CM, 133 SMA, and 159 CC), model-predicted EQ-5D-3L index and VAS scores were significantly lower in children with CM than SMA or CC, and VAS scores were higher in children with SMA than CC. Among the 313 children aged 8 to 11 years (39 CM, 76 SMA, 130 OSM, and 68 CC), model-predicted EQ-5D-Y-3L VAS scores were significantly lower in children with CM than in those with SMA, OSM, or CC and also lower in children with SMA than OSM or CC. Conclusions CM and, to a lesser extent, SMA in childhood are associated with long-term reduction in HRQoL. The chronic effects extend beyond cognition and behavior to affect overall HRQoL.
OBJECTIVES:This cross-sectional concept elicitation study aimed to evaluate herpes zoster (HZ) and postherpetic neuralgia (PHN) impact on health-related quality of life (HRQoL) in patients aged ≥50 years in East Asia, in relation to local cultural/contextual factors, and qualitatively validate a published Canadian conceptual model. METHODS:One-to-one semi-structured interviews were conducted among HZ/PHN patients aged ≥50 years in selected East Asia locales (Hong Kong/Mainland China/South Korea/Taiwan) in September 2022 to February 2023. Convenience sampling and snowballing were used for recruitment. RESULTS:104 patients were interviewed (52 HZ/52 PHN; each: Hong Kong [n = 4]/Mainland China [n = 36]/South Korea [n = 6]/Taiwan [n = 6]). All patients described physical and emotional effects of HZ. The most common symptoms were pain (100%) and rash (86%). The main reason for seeking diagnosis was rash (72%). Pain was the most bothersome symptom (89%); 83% of patients reported their worst pain level as ≥8 (scale 0-10 [most painful]). The most affected HRQoL domains were sleep (100%), emotional functioning (90%), and activities of daily living (89%). Concept saturation was reached. Unmet needs throughout the patient journey included low patient awareness of HZ, poor physician-patient communication on vaccination (eg, benefits and risks), and lack of community support. Patients with comorbidities, including end-stage renal disease, reported additional burden due to HZ. Sixty-nine percent of patients reported HZ vaccination willingness. CONCLUSION:Understanding the patient experience helps to meet healthcare needs (eg, informing healthcare decision making to prevent HZ). The East Asian HZ conceptual model was consistent with the Canadian model, validating it to the East Asia context.
OBJECTIVES:Cerebral palsy (CP) causes lifelong functional impairment and societal burden. In Thailand, botulinum toxin type A (BoNT-A) is not reimbursed for CP-related focal spasticity. This study evaluated the cost-utility and budget impact of adding abobotulinumtoxinA (aboBoNT-A) or onabotulinumtoxinA (onaBoNT-A) to standard care (SoC) versus SoC alone. METHODS:A Markov model (societal perspective; lifetime horizon; 3% annual discount) was used to estimate costs and outcomes for SoC+aboBoNT-A and SoC+onaBoNT-A compared with SoC. Direct medical and nonmedical costs, utility, and transitional probabilities were collected from tertiary hospitals. Treatment efficacies were derived from a network meta-analysis. Deterministic and probabilistic sensitivity analyses were conducted. Lifetime cost, life-years, quality-adjusted life-years (QALYs), and an incremental cost-effectiveness ratio were estimated and assessed against a Thai threshold of 160 000 (US $4468) THB per QALY. A budget impact analysis was conducted using epidemiological estimates and projected uptake rates (30% in year 1, 50% in year 2, and up to 100% thereafter; alternative scenario: 80% from year 3 onward). RESULTS:SoC + aboBoNT-A and SoC + onaBoNT-A elicited 0.0033 and 0.0026 QALYs gained with additional costs of US $20 and US $29, yielding incremental cost-effectiveness ratios of US $6003 and US $11 147 per QALY, respectively. Results were most sensitive to direct nonmedical costs among nonresponders. The 5-year budget impact was US $228 961 to $284 805, with similar estimates under conservative uptake. CONCLUSION:Neither SoC + BoNT-A therapy was cost-effective, although both improved spasticity-related quality of life. A 14% price reduction for aboBoNT-A could improve cost-effectiveness. The projected 5-year budget impact was modest across uptake scenarios.
OBJECTIVES:The study aimed to assess the provider-side financial viability of antiamyloid disease-modifying therapies for early Alzheimer's disease in Japan, we developed a linear hospital-provider model that separates a short inpatient diagnostic phase from an outpatient infusion phase. METHODS:Using public National Health Insurance tariffs, official 2025 drug prices, and workflow-based labor costing with time-driven activity-based costing, we estimated per-case outpatient margins and program-level break-even case volumes. Scenarios examined fee-for-service versus diagnosis procedure combination/per-diem payment system hospitals, magnetic resonance imaging surveillance intensity, purchase discounts, wage growth, routine-workflow staff time, and the scheduled 15% lecanemab price reduction effective November 1, 2025. RESULTS:At 1.5 T with no assumed wage growth, donanemab yielded positive outpatient margins from + 37,670JPY at no purchase discount to + ¥110 777 at a 2.6% discount. Lecanemab at 50 kg yielded -¥9048 at no discount and broke even at a discount of 0.304% before the scheduled price reduction and 0.358% after it. At 55 to 60 kg, the equal-discount threshold at which lecanemab overtook donanemab shifted from about 6.2% before the price reduction to 20.9% after it. Sensitivity analyses showed purchase discounts were the dominant driver, whereas labor and workflow inputs affected lecanemab more because it requires more infusions per year. CONCLUSIONS:Under Japan's fee schedule, both therapies were financially viable across typical purchase-discount ranges in scenario analyses, but findings should be interpreted as provider-margin estimates rather than comparative clinical judgments.
OBJECTIVES:To determine the socioeconomic burden of cancer in South Korea during the period 2015 to 2019, with specific attention to variations across sex, age groups, and cancer types. METHODS:Using real-world data on the entire population of cancer patients (ICD-10 codes C00-C97) from 2015 to 2019, this study estimated the socioeconomic burden of cancer. Direct medical costs encompassing expenses for treatment, hospitalizations, and outpatient visits were calculated suing the cost-of-illness approach, whereas direct nonmedical costs (transportation, caregiver expenses) were estimated based on healthcare utilization frequency. The Human Capital Approach was used to estimate indirect costs, specifically quantifying productivity losses due to both absenteeism and premature mortality using national census income and employment data. All costs are presented in US$2020 values to ensure temporal comparability. RESULTS:In 2015, the total socioeconomic cost amounted to US$15.6 billion, and it increased to US$23.8 billion in 2019, with a compound annual growth rate of 11.2%. The cancer types with the highest total socioeconomic costs were, in order: lung (US$3.8 billion), liver (US$3.1 billion), colon and rectum (US$2.6 billion), stomach (US$2.4 billion), and breast (US$1.8 billion). CONCLUSIONS:To ensure the efficient allocation of limited healthcare resources, there is an increasing need to develop robust evidence and data to inform cancer-related health policy.
OBJECTIVES:To assess how province-level healthcare resource configuration relates to in-hospital management and outcomes for acute ischemic stroke in China. METHODS:We conducted a cross-sectional study of 1 055 971 adults with acute ischemic stroke treated at 1456 secondary and tertiary hospitals in the Chinese Stroke Center Alliance, 2015 to 2019. Hospital-level management and outcome measures were linked to province-level resource indicators from the China Health Statistics Yearbook, including physician:nurse ratio, nurse:bed ratio, density of medical institutions, and total health expenditure. Associations were estimated using patient-number-weighted linear regression models adjusted for hospital level, provincial gross regional product per capita, admission timing, and year, with cluster-robust standard errors at the province level. RESULTS:Substantial interprovincial variation was observed. Most healthcare resource indicators were not significantly associated with composite adherence, although physician:nurse ratio showed a borderline positive association (β = 0.018 per 0.1 increase, 95% CI, -0.0004 to 0.036). Secondary prevention adherence was positively associated with health expenditure (β = 0.007; 95% CI, 0.0003-0.014). For thrombolysis within 4.5 hours, physician:nurse ratio was negatively associated (β = -0.062; 95% CI, -0.119 to -0.006), whereas nurse:bed ratio was positively associated (β = 1.232; 95% CI, 0.066-2.397). In contrast, healthcare resource indicators were not clearly associated with in-hospital outcomes. CONCLUSIONS:Healthcare resource configuration showed modest associations with stroke management but limited associations with in-hospital outcomes, suggesting that resource availability alone may not fully explain variation in stroke outcomes.
Objectives Health equity considerations are not yet regularly incorporated into value-based and policy decision making. Previous research has examined health equity as an integral element of value in policy making and health technology assessments (HTA), as well as barriers to the widespread adoption of health equity in these settings. This study identified and compared current frameworks addressing health equity in policy and healthcare decision making. Methods An environmental scan was conducted in January 2024 (updated in August 2025) of MEDLINE (Ovid) and Embase databases and relevant HTA websites for frameworks and guidance documents (past 10 years) providing recommendations for incorporating health equity considerations into healthcare decision making. Recommendations were compared across 3 key aspects—planning, impact/incentives, and data quality/integrated analysis—based on the 2024 Advancing Health Equity and Whole-Person Care in the Centers for Medicare and Medicaid Services National Quality Strategy plan. Results Ten peer-reviewed articles and 8 reports from HTA agencies were included, representing frameworks and guidance documents from 10 countries. Themes emerging from the identified references included the need for planning for health equity incorporation at the planning level, which was unanimously recommended, followed by ensuring data representativeness and quality (as referred to by 11 documents); providing incentives was referenced by 5 frameworks. Conclusions Existing frameworks identified in this environmental scan promote the expansion of value elements in technologies’ assessment and provide structured guidance on the study design and outline the analytical capabilities and technical elements required to allow routine incorporation of health equity in decision making.
