Cost-effectiveness Analysis of Insulin Degludec and Liraglutide Injection in the Treatment of Type 2 Diabetes

Objective To analyze the cost-effectiveness of insulin degludec and liraglutide injection(IDegLira)compared with insulin glargine plus insulin aspart(IGar plus IAsp)in the treatment of type 2 diabetes mellitus(T2DM)based on the price of IDegLira before and after it was successfully admitted to the National Reimbursable Drug List(NRDL).Methods Cost and effectiveness parameters were obtained through systematic retrieval from PubMed,ScienceDirect,CNKI,and Wanfang database.A cost-effectiveness analysis(CEA)model was established to analyze the economics using IDegLira for T2DM patients with 1 to 5 years of medication.Results and Conclusion Before IDegLira was admitted to NRDL,its economic advantages over the IGlar plus Iasp regimen became more significant as patients’medication time prolonged.After being admitted to NRDL,with 1 year of medication,the medical cost of IDegLira decreased by 2853.91 yuan and the quality adjusted life years(QALY)increased by 0.12055 than IGar plus IAsp.The sensitivity analysis was highly consistent with the results of the baseline result.After being admitted to NRDL,for patients with T2DM who have poor blood glucose control,IDegLira is absolutely an economic advantage scheme compared with IGar plus IAsp.

The Cost-effectiveness Analysis of Percutaneous Transhepatic Metal Versus Plastic Biliary Stent Implantation for Treating Malignant Biliary Obstruction (Multiple Center Investigation)

Objective: To compare metal versus plastic biliary stent implantation for treatment of malignant biliary obstruction in cost-effectiveness ratio (CER). Methods: Percutaneous transhepatic self-expandable metal stent (MS, n=61) or 10F plastic stent (PS, n=34) implantation was performed in 95 patients with malignant biliary obstruction in three hospitals of Guangdong province. All patients were followed up until death or at least one year after the procedure. Kaplan-Meier analysis was used to compare the survival and stent patency rates of the patients in the two groups. CERs of two groups were calculated. The main indexes were CERsurvival period (total cost/median survival period), CERpatency period (total cost/median patency period). Results: The total costs of treatment were 53177±3139 yuan (RMB) in MS group and 42564±4950 yuan (RMB) in PS group respectively (P>0.05). CER in MS group was superior to that in PS group (CERsurvival period was 237.4 yuan /d vs 452.6 yuan /d, respectively; CERpatency period was 231.2 yuan /d vs 472.9 yuan /d, respectively). Conclusion: The metal stent implantation is superior to the plastic stent in the CER for treatment of malignant biliary obstruction.

High-resolution microendoscopy for esophageal cancer screening in China: A cost-effectiveness analysis

AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separate model analyses were conducted for cohorts consisting of an averagerisk population or a high-risk population in China.Hypothetical 50-year-old individuals were followed until age 80 or death.We compared three different strategies for both cohorts:(1)no screening;(2)standard endoscopic screening with Lugol’s iodine staining;and(3)endoscopic screening with Lugol’s iodine staining and an HRME.Model parameters were estimated from the literature as well as from GLOBOCAN,the Cancer Incidence and Mortality Worldwide cancer database.Health states in the model included non-neoplasia,mild dysplasia,moderate dysplasia,high-grade dysplasia,intramucosal carcinoma,operable cancer,inoperable cancer,and death.Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations.Costs in Chinese currency were converted to international dollars(I$)and were adjusted to 2012dollars using the Consumer Price Index.RESULTS:The main outcome measurements for this study were quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER).For the average-risk population,the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646,resulting in an ICER of I$11808 per QALY gained.Standard endoscopic screening was weakly dominated.Among the high-risk population,when the HRME screening strategy was compared with the standard screening strategy,the ICER was I$8173 per QALY.For both the high-risk and average-risk screening populations,the HRME screening strategy appeared to be the most cost-effective strategy,producing ICERs below the willingness-topay threshold,I$23500 per QALY.One-way sensitivity analysis showed that,for the average-risk population,higher specificity of Lugol’s iodine(>40%)and lower specificity of HRME(<70%)could make Lugol’s iodine screening cost-effective.For the high-risk population,the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening,Lugol’s iodine test characteristics(sensitivity and specificity),or HRME specificity.CONCLUSION:The incorporation of HRME into an ESCC screening program could be cost-effective in China.Larger studies of HRME performance are needed to confirm these findings.

Cost-effectiveness analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening

AIM: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma(HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography(AUS).METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per lifeyear gained with a 3% annual discount rate. RESULTS: The results show that the mass screening using AUS was associated with an incremental costeffectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening.CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.

Cost-effectiveness analysis of tele-retinopathy of prematurity screening in Iran

AIM:To conduct a cost-utility analysis of the teleretinopathy of prematurity(ROP)screening program against no screening.METHODS:A decision tree model was developed to identify and treat the infants with threshold ROP through the tele-screening system compared with no screening program from the societal perspective.We used the quality adjusted life years(QALY)index to measure the scenarios’effectiveness,which was discounted for the future years by 0.058.One hundred twenty-six randomly selected newborns with ROP required treatment were investigated to extract the treatment information.We considered the direct medical and non-medical costs in cost calculations analysed by the bottom-up approach.The figures of the model’s inputs were calculated using the Monte Carlo simulation that generated 1000 random iteration of the data,and a one-way sensitivity analysis was performed on the model to cope with the potential uncertainties.RESULTS:The total and per capita needed the budget to establish a tele-ROP screening system were estimated at over 1.5 million and 35.13 USD,respectively.The total cost of identifying and treating an ROP case in tele-screening and no screening strategies were obtained as 108.72 and 63.52 USD,respectively,and their lifetime discounted QALY gained were calculated as 15.39 and 15.11,respectively.Therefore,incremental cost-effectiveness ratio(ICER)of tele-screening strategy against the competitive strategy was achieved as 161.43 USD.CONCLUSION:Tele-ROP screening program is one of the most cost-effective interventions in the Iranian health system and has a high priority to receive a budget for implementation.

AN ANALYSIS OF THE COST-EFFECTIVENESS OF AIR DEFENSE SURVEILLANCE RADARS

This paper is a study of the quantitative evaluation on the cost-effectiveness of air defense surveillance radars. The composition of life cycle cost of the radar is analysed at first. Then the radar performance and effectiveness formulas are derived. By calculating the values of many radars' cost, performance and effectiveness, tendency curves are plotted. The application of cost-effectiveness calculation and the tendency curves in radar system analysis is discussed at last.

Cost-Effectiveness Analysis of Atezolizumab plus Pemetrexed and Platinum in First-Line Treatment of Non-Squamous Non-Small Cell Lung Cancer in China

Objective: To evaluate the cost-effectiveness of atezolizumab plus pemetrexed and platinum-based (APP) in the first-line treatment of non-squamous non- small cell lung cancer (NSCLC). Methods: A partitioned survival model (PSM) was constructed based on the IMpower132 clinical trial. Total cost, quality- adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER) were the main outputs of the model. Deterministic sensitivity analysis and probabilistic sensitivity analysis were adopted to test the uncertainty of the parameters. Results: The results of the base-case analysis illustrated that compared with PP, the incremental cost of APP was CNY 591040.94, the incremental utility was 0.46 QALY, and the ICER was CNY 1291414.83/QALY. Deterministic sensitivity analysis results illustrated that atezolizumab and other parameters have a greater impact on ICER. Probabilistic sensitivity analysis results show that no matter how each parameter changes, under the willingness to pay threshold of 3-times Chinese per capita GDP, the probability of APP has cost-effectiveness is 0. Conclusion: From the perspective of the Chinese health system, APP is not cost-effective for first-line treatment of non-squamous non-small cell lung cancer without sensitizing EGFR or ALK genetic alterations.

Cost-effectiveness analysis of different anesthesia strategies for transperineal MRI/US fusion prostate biopsy

This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies,namely chatting while under local anesthesia(Chat-LA),total intravenous anesthesia(TIVA),and general anesthesia with laryngeal mask airway(GA-LMA),employed in transperineal magnetic resonance imaging(MRI)/ultrasound(US)fusion prostate biopsy(TP-MUF-PB).A retrospective study was conducted involving 1202 patients who underwent TP-MUF-PB from June 2016 to April 2023 at The First Affiliated Hospital of Soochow University(Suzhou,China).Clinical data and outcomes,including total costs,complications,and quality-adjusted life years(QALYs),were compared.Probability sensitivity and subgroup analyses were also performed.Chat-LA was found to be the most cost-effective option,outperforming both TIVA and GA-LMA.However,subgroup analyses revealed that in younger patients(under 65 years old)and those with smaller prostate volumes(<40 ml),TIVA emerged as a more cost-effective strategy.While Chat-LA may generally be the most cost-effective and safer anesthesia method for TP-MUF-PB,personalization of anesthesia strategies is crucial,considering specific patient demographics such as age and prostate volume.

Analysis of a Community-based Intervention to Reduce Heat-related Illness during Heat Waves in Licheng,China:a Quasi-experimental Study

Objective To reduce health-related threats of heat waves, interventions have been implemented in many parts of the world. However, there is a lack of higher-level evidence concerning the intervention efficacy. This study aimed to determine the efficacy of an intervention to reduce the number of heat-related illnesses. Methods A quasi-experimental design was employed by two cross-sectional surveys in the year 2024 and 2015, including 2,240 participants and 2,356 participants, respectively. Each survey was designed to include one control group and one intervention group, which conducted in Licheng, China. A representative sample was selected using a multistage sampling method. Data, collected from questionnaires about heat waves in 2014 and 2015, were analyzed using a difference-in-difference analysis and cost effectiveness analysis. Outcomes included changes in the prevalence of heat-related illnesses and cost-effectiveness variables. Results Relative to the control participants, the prevalence of heat-related illness in the intervention participants decreased to a greater extent in rural areas than in urban areas （OR=0.495 vs. OR=2.282）. Moreover, the cost-effectiveness ratio in the intervention group was tess than that in the control group （usS25.06 vs. us$25.69 per participant）. Furthermore, to avoid one additional patient, the incremental cost-effectiveness ratio showed that an additional USS14.47 would be needed for the intervention compared to when no intervention was applied. Conclusion The intervention program may be considered a worthwhile investment for rural areas that are more likely to experience heat waves. Meanwhile, corresponding improving measures should be presented towards urban areas. Future research should examine whether the intervention strategies could be spread out in other domestic or international regions where heat waves are usually experienced.

Cost effectiveness analysis of population-based serology screening and ^(13)C-Urea breath test for Helicobacter pylori to prevent gastric cancer:A markov model

AIM:To compare the costs and effectiveness of no screening and no eradication therapy, the population- based Helicobacter pylori (H pylori) serology screening with eradication therapy and 13C-Urea breath test (UBT) with eradication therapy. METHODS:A Markov model simulation was carried out in all 237 900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years (QALYs) gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses. RESULTS:Compared to no screening, the incremental cost-effectiveness ratio (ICER) was $16 166 per life year saved or $13 571 per QALY gained for the serology screening, and $38 792 per life year saved and $32 525 per QALY gained for the UBT. The ICER was $477 079 per life year saved or $390 337 per QALY gained for the UBT compared to the serology screening. The cost- effectiveness of serology screening over the UBT was robust to most parameters in the model. CONCLUSION:The population-based serologyscreening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.

Desalination and Alternative Water-Shortage Mitigation Options in Israel: A Comparative Cost Analysis

Costs for seawater desalination have dropped significantly over the past decade due to technological advances. This has increased the attractiveness of desalination to policy-makers as a means to address water supply shortages. Israel, a country that faces chronic water scarcity, is in the process of developing wide-scale desalination capacity that is projected to supply all of the nation's domestic water use within a few years. Two issues are often neglected, however, by policy-makers pursuing desalination. The first is that seawater desalination is associated with a number of external costs, consideration of which may influence the optimal scale and timing of desalination implementation. The second is that alternative measures for managing water scarcity, including conservation techniques, are often more cost-efficient. This study estimates the full cost of desalination in Israel, including externalities, and then compares this to the costs of several alternative options for addressing water scarcity, including both demand management and supply augmentation measures. We find that desalination, despite being the primary policy option pursued by Israel, is among the least cost-efficient of all the alternatives considered, even without taking into account the externalities involved.

Cost-effectiveness of enhanced liver fibrosis test to assess liver fibrosis in chronic hepatitis C virus and alcoholic liver disease patients

AIM To assess liver fibrosis(LF) in hepatitis C virus(HCV) and alcoholic liver disease(ALD), estimate health outcomes and costs of new noninvasive testing strategies METHODS A Markov model was developed to simulate LF progression in HCV and ALD for a cohort of 40-yearold men with abnormal levels of transaminases. Three different testing alternatives were studied: a single liver biopsy; annual Enhanced liver fibrosis(ELF?) followed by liver stiffness measurement(LSM) imaging as a confirmation test if the ELF test is positive; and annual ELF test without LSM. The analysis was performed from the perspective of a university hospital in Spain.Clinical data were obtained from published literature. Costs were sourced from administrative databases of the hospital. Deterministic and probabilistic sensitivity analyses were performed.RESULTS In HCV patients, annual sequential ELF test/LSM and annual ELF test alone prevented respectively 12.9 and 13.3 liver fibrosis-related deaths per 100 persons tested, compared to biopsy. The incremental costeffectiveness ratios(ICERs) were respectively €13400 and €11500 per quality-adjusted life year(QALY). In ALD, fibrosis-related deaths decreased by 11.7 and 22.1 per 100 persons tested respectively with sequential ELF test/LSM and annual ELF test alone. ICERs were €280 and €190 per QALY, respectively.CONCLUSION The use of the ELF test with or without a confirmation LSM are cost-effective options compared to a single liver biopsy for testing liver fibrosis in HCV and ALD patients in Spain.

Cost-Utility Analysis of Liraglutide in Type 2 Diabetes Patients in China after Chinese Reformation of Medical Care System

Objectives: The cost-utility analysis of Liraglutide is aimed at evaluating whether Liraglutide is cost-effective or not after Chinese reformation on medical insurance. The analysis is based on the results of clinical trial conducted in Asia. Methods: We applied a Markov model to estimate the quality-adjusted life years, medical cost and incidence of diabetes-related complications for patients receiving the Liraglutide as an add-on to the metformin treatment. Baseline characteristics were taken from a China’s study while the treatment effect is from an Asian study. The related medical cost and utility score were obtained from a local study in China. Having set 30 years’ simulations, the incremental cost-effectiveness ratio was calculated comparing with glimepiride treatment. The ratio would be compared with the willingness to pay for a quality-adjusted-life-year (QALY) which is three times of the GDP per capita in Beijing. Sensitivity analysis was also performed. Result: During a period of 30 years, the base-case analysis which takes discount rate at 3% shows that Liraglutide 1.8 mg results in an average incremental cost of CNY 82,671.49, an improvement in 0.12 QALYs and a reduction of incidence of diabetes-related complications comparing to glimepiride. The associated incremental cost-effectiveness ratio is CNY 688,929.08. Conclusion: Long-term project shows that taking Liraglutide as an add-on to the metformin treatment will lead to increasing quality-adjusted life years and reduction of incidence of diabetes-related complications. When the price of Liraglutide is reduced by 43 percent in China’s yuan, Liraglutide will be cost-effective in China from the healthcare system perspective taking three times of GDP per capita as our WTP threshold.

Cost-effectiveness of seasonal influenza vaccination of children in China:a modeling analysis

Background China has a high burden of influenza-associated illness among children.We aimed to evaluate the cost-effectiveness of introducing government-funded influenza vaccination to children in China(fully-funded policy)compared with the status quo(self-paid policy).Methods A decision tree model was developed to calculate the economic and health outcomes,from a societal perspective,using national-and provincial-level data.The incremental cost-effectiveness ratio(ICER)[incremental costs per quality-adjusted life year(QALY)gained]was used to compare the fully-funded policy with the self-paid policy under the willingness-to-pay threshold equivalent to national and provincial GDP per capita.Sensitivity analyses were performed and various scenarios were explored based on real-world conditions,including incorporating indirect effect into the analysis.Results Compared to the self-paid policy,implementation of a fully-funded policy could prevent 1,444,768[95%uncertainty range(UR):1,203,446-1,719,761]symptomatic cases,92,110(95%UR:66,953-122,226)influenza-related hospitalizations,and 6494(95%UR:4590-8962)influenza-related death per season.The fully-funded policy was cost-effective nationally(7964 USD per QALY gained)and provincially for 13 of 31 provincial-level administrative divisions(PLADs).The probability of a funded vaccination policy being cost-effective was 56.5%nationally,and the probability in 9 of 31 PLADs was above 75%.The result was most sensitive to the symptomatic influenza rate among children under 5 years[ICER ranging from−25,612(cost-saving)to 14,532 USD per QALY gained].The ICER of the fully-funded policy was substantially lower(becoming cost-saving)if the indirect effects of vaccination were considered.Conclusions Introducing a government-funded influenza policy for children is cost-effective in China nationally and in many PLADs.PLADs with high symptomatic influenza rate and influenza-associated mortality would benefit the most from a government-funded influenza vaccination program.

Considering the cost-effectiveness of statins in family practice in Turkey from a payer perspective

The percentage of mortality caused by cardio-vascular events in European Countries and European Union Countries is respectively 49% and 42% of all mortality causes. Our estimates about cardiovascular mortality in Turkey depend on TEKHARF (Hearth Disease and Risk Factors in Turkish Adults) which depended on a 12 year observation. It has been reported that cardio-vascular mortality rates for Turkey in men and women were 0.082% and 0.043% respectively. In Turkey, Atorvastatin, Fluvastatin, Pravastatin, Rosuvastatin and Simvastatin are the different alternatives found in the statin market. All stat-ins are reimbursed by insurance companies. The aim of this study is to determine the cost- effectiveness of statins. In conclusion, simvas-tatin and rosuvastatin comprised the optimal two statin alternatives.

Mathematical model and optimal control analysis of coffee berry borer with temperature and rainfall variability

This study focuses on a nonlinear deterministic mathematical model for coffee berry borer(Hypothenemus hampei)with temperature and rainfall variability.In the model analysis,CBB free and coexistence equilibria are computed.The basic reproduction numbers at a minimum and maximum temperature and rainfall are derived.The qualitative analysis of the model revealed the scenario for equilibria together with basic reproduction numbers.The local stability of equilibria is established through the Jacobian matrix and the Routh-Hurwitz criteria,while the global stability of equilibria is demonstrated using an appropriate Lyapunov function.The normalized sensitivity analysis has also been performed to observe the impact of different parameters on basic reproduction numbers.The proposed model is extended into an optimal control problem by incorporating two control variables,namely,the preventive measure variable based on the separation of susceptible coffee berries from contacting the pests based on biological control and an increase in the death rate of colonizing females of CBB based on chemical control.Optimal disease control analysis is examined using Pontryagin's minimum principle.Finally,the numerical simulations are performed based on analytical results and are discussed quantitatively.Furthermore,the cost-effectiveness of control strategies to determine the best approach to minimize the CBB burden was studied.The study is significant in providing reliable information on how one can use mathematical modeling to improve the roles of control strategies and prevention in CBB transmission in a coffee farm.The outcome of the study may guide public agriculture policymakers on optimal control strategies to control the pests.In particular,using chemical pesticides is very effective to combat pests with minimum costs.

Cost-Effectiveness Analysis of Combined Chinese Medicine and Western Medicine for Ischemic Stroke Patients

Objective： To evaluate the cost-effectiveness of combining Chinese medicine （CM） with Western medicine （WM） for ischemic stroke patients. Methods： Hospitalization summary reports between 2006 and 2010 from eight hospitals in Beijing were used to analyze the length of stay （LOS）, cost per stay （CPS）, and outcomes at discharge. Results： Among 12,009 patients （female, 36.44%; mean age, 69.98 ＋ 13.06 years old）, a substantial number of patients were treated by the WM_Chinese patent medicine （CPM）_Chinese herbal medicine （CHM） （38.90%）; followed by the WM_CPM （32.55%）, the WM （24.26%）, and the WM_CHM （4.15%）. With adjustment for confounding variables, LOS of the WM_CPM_CHM group was about 10 days longer than that of the WM group, and about 6 days longer than that of the WM_CPM group or the WM_CHM group （P〈0.01）; CPS of the WM_CPM_CHM group was United States dollar （USD） 1,288 more than that of the WM group, and about USD 600 more than that of the WM_CPM group or the WM_CHM group （P〈0.01）. Compared with the WM group, odd ratio （OR） of recovered and improved outcome of the WM_CPM CHM group was the highest [OR： 12.76, 95% confidence intervals （CI）： 9.23, 17.64, P〈0.01], OR of death outcome of the WM_CPM_CHM group was the lowest （OR： 0.08, 95% CI： 0.05, 0.12, P〈0.01）. There was no significant difference between LOS, CPS and OR of the WM_CPM group and those of the WM_CHM group （P〉0.05）. Cost/effectiveness and incremental cost- effectiveness ratio of the WM_CPM_CHM group were robustly higher than those of the WM group. Conclusion： Compared with WM alone, supplementing CPM and CHM to WM provides significant health benefits of improving the chance of recovered and improved outcome, and reducing the death rate, at an expense of longer LOS and higher CPS.

Cost-effectiveness analysis of tyrosine kinase inhibitors(erlotinib,gefitinib,afatinib and osimertinib)as first-line therapy for epidermal growth factor receptor-mutated advanced non-small cell lung cancer

Gefitinib,erlotinib,afatinib and osimertinib have been recommended as the first-line treatment for epidermal growth factor receptor(EGFR)-mutated advanced non-small cell lung cancer(NSCLC),whereas no studies have compared the cost-effectiveness of these four tyrosine kinase inhibitors(TKIs)simultaneously in China.In the present study,we aimed to estimate the cost-effectiveness of erlotinib,gefitinib,afatinib and osimertinib for untreated EGFR-mutated advanced NSCLC.A Markov model was constructed to compare the 10-year impact of four TKIs for patients with treatment-naive EGFR-mutated advanced NSCLC from the perspective of the Chinese medical system.Clinical data and utility values were derived from published literature,and costs were obtained from Chinese official websites.The primary output indicator was the incremental cost-effectiveness ratio(ICER).Sensitivity analyses were performed to test the robustness of the model.We found that afatinib was estimated to spend the lowest cost with minimum life-years(LYs),while osimertinib was the most expensive regimen with maximum LYs.The ICER of gefitinib versus afatinib was$732/quality-adjusted life-year(QALY),which was less than the willingness-to-pay(WTP)of$29382/QALY.Compared with gefitinib,erlotinib yielded a higher cost and a shorter lifetime,hence it was identified as a dominated strategy.Then,osimertinib was compared to gefitinib,which produced an ICER of$71330/QALY,exceeding the WTP.It suggested that gefitinib was the most cost-effective regimen as the first-line treatment for EGFR-mutated advanced NSCLC.Decreasing the osimertinib price or increasing the WTP threshold to$68558/QALY might enhance the favorability of the outcome,by which osimertinib might become more cost-effective.One-way sensitivity analysis manifested that the model was robust.

Cost-effectiveness analysis of malaria rapid diagnostic tests:a systematic review

Background:Rapid diagnostic tests(RDT)can effectively manage malaria cases and reduce excess costs brought by misdiagnosis.However,few studies have evaluated the economic value of this technology.The purpose of this study is to systematically review the economic value of RDT in malaria diagnosis.Main text:A detailed search strategy was developed to identify published economic evaluations that provide evidence regarding the cost-effectiveness of malaria RDT.Electronic databases including MEDLINE,EMBASE,Biosis Previews,Web of Science and Cochrane Library were searched from Jan 2007 to July 2018.Two researchers screened studies independently based on pre-specified inclusion and exclusion criteria.The Consolidated Health Economic Evaluation Reporting Standards(CHEERS)checklist was applied to evaluate the quality of the studies.Then cost and effectiveness data were extracted and summarized in a narrative way.Fifteen economic evaluations of RDT compared to other diagnostic methods were identified.The overall quality of studies varied greatly but most of them were scored to be of high or moderate quality.Ten of the fifteen studies reported that RDT was likely to be a cost-effective approach compared to its comparisons,but the results could be influenced by the alternatives,study perspectives,malaria prevalence,and the types of RDT.Conclusions:Based on available evidence,RDT had the potential to be more cost-effective than either microscopy or presumptive diagnosis.Further research is also required to draw a more robust conclusion.

Cost-effectiveness analysis of malaria rapid diagnostic test in the elimination setting

Background:As more and more countries approaching the goal of malaria elimination,malaria rapid diagnostic tests(RDT)was recomendated to be a diagnostic strategy to achieve and maintain the statute of malaria free,as it’s less requirments on equipment and experitise than microscopic examination.But there are very few economic evaluations to confirm whether RDT was cost-effective in the setting of malaria elimination.This research aimed to offer evidence for helping decision making on malaria diagnosis strategy.Methods:A cost-effectiveness analysis was conducted to compare RDT with microscopy examination for malaria diagnosis,by using a decision tree model.There were three strategies of malaria diagnostic testing evaluated in the model,1)microscopy,2)RDT,3)RDT followed by microscopy.The effect indicator was defined as the number of malaria cases treated appropriately.Based on the joint perspective of health sector and patient,costs data were collected from hospital information systems,key informant interviews,and patient surveys.Data collection was conducted in Jiangsu from September 2018 to January 2019.Epidemiological data were obtained from local malaria surveillance reports.A hypothetical cohort of 300000 febrile patients were simulated to calculate the total cost and effect of each strategy.One-way,two-way,and probabilistic sensitivity analysis were performed to test the robustness of the result.Results:The results showed that RDT strategy was the most effective(245 cases)but also the most costly(United States Dollar[USD]4.47 million)compared to using microscopy alone(238 cases,USD 3.63 million),and RDT followed by microscopy(221 cases,USD 2.75 million).There was no strategy dominated.One-way sensitivity analysis reflected that the result was sensitive to the change in labor cost and two-way sensitivity analysis indicated that the result was not sensitive to the proportion of falciparum malaria.The result of Monte Carlo simulation showed that RDT strategy had higher effects and higher cost than other strategies with a high probability.Conclusions:Compared to microscopy and RDT followed by microscopy,RDT strategy had higher effects and higher cost in the setting of malaria elimination.