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Cost effectiveness analysis (CEA) has been increasingly used to inform cancer treatment coverage policy making worldwide. The primary objective of this study was to assess the association between industry sponsorship and CEA results in oncology. All CEAs in oncology used incremental cost per quality-adjusted life year (QALY) as health effect identified from the Tufts CEA Registry since 1976 was analyzed. Descriptive analyses were performed to present and compare the characteristics of CEA funded by industry and non-industry. Robust logistic regression was performed to assess the relationship between the industry sponsorship and cost effective conclusion over a wide range of threshold values. A total of 1537 CEAs in oncology published from 1976 to 2021 were included. There were 387 (25.2%) with the industry sponsorship. CEAs sponsored by the industry were more likely to report ICERs below $50,000/QALY (adjusted odds ratio (OR), 1.91, 95% confidence interval (CI), 1.45-2.51, P < 0.001), $100,000/QALY (2.74, 1.98-3.79, P < 0.001), and $150,000/QALY (3.53, 2.37-5.27, P < 0.001) than studies without industry sponsorship. Our study suggests that there has been a significant sponsorship bias in CEAs in oncology. This bias could have a profound implication on drug pricing and coverage policy making.

BackgroundThis study aimed to evaluate the cost-effectiveness of nivolumab plus chemotherapy (NIVO + Chemo) compared with chemotherapy monotherapy (Chemo) for patients with advanced or metastatic HER2-negative gastric or gastroesophageal junction or esophageal adenocarcinoma (GC/GEJC/EAC) in Japan from the perspective of healthcare payer.MethodsA partitioned survival analysis model was developed to predict costs and quality-adjusted life years (QALYs) for NIVO + Chemo and Chemo. The time horizon of the model was set to 38 years. An annual discount rate of 2% for both costs and QALYs was applied. Data on overall survival and progression-free survival were derived from the CheckMate649 trial. Cost parameters were estimated from a Japanese medical claims database. The incremental cost-effectiveness ratio (ICER) of NIVO + Chemo compared with Chemo was estimated. A subgroup analysis on the level of PD-L1 CPS expression was conducted. In addition, sensitivity analysis was performed to assess the uncertainty in the parameter settings.ResultsThe incremental cost and QALY of NIVO + Chemo compared with Chemo were USD99,416 and 0.30 QALY, respectively. The ICER of NIVO + Chemo was estimated to be USD327,161 per QALY gained. The results of the subgroup analysis showed that ICER was USD247,403/QALY and USD302,183/QALY for PD-L1 CPS ≧ 5 and ≧ 1, respectively. Sensitivity analyses showed a relatively robust result that the ICER remained higher than the Japanese cancer threshold of USD75,000–150,000/QALY.ConclusionsApplying the Japanese cancer threshold of USD75,000–150,000/QALY, NIVO + Chemo was not cost-effective for patients with advanced or metastatic HER2-negative GC/GEJC/EAC in Japan from the perspective of healthcare payer.

To conduct a cost-effectiveness analysis from payers' perspectives of six treatments for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and to examine positioning of these modalities in the marketplace for the best use of health care funds and quality-of-life benefits for patients. The economic analysis was conducted with a Markov model to compare combination prescription drug therapy (ComboRx), minimally invasive therapies (MITs) including convective radiofrequency (RF) water vapor thermal therapy (Rezūm ), conductive RF thermal therapy (Prostiva ), and prostatic urethral lift (UroLift ), and invasive surgical procedures including photovaporization of the prostate (Greenlight PVP) and transurethral resection of the prostate (TURP). Effects assessed with International Prostate Symptom Score, adverse events, and re-treatment rates were estimated from medical literature; treatments effects were modeled using a common baseline score. Starting with each therapy, patients' transitions to more intensive therapies when symptoms returned were simulated in 6-month cycles over 2 years. Incremental cost-effectiveness ratios (ICERs) were calculated for pairs of treatments; uncertainty in ICERs was estimated with probabilistic sensitivity analyses. ComboRx was least effective and provided one-third of the symptom relief achieved with MITs. UroLift was similar in effectiveness to Prostiva and Rezūm but costs more than twice as much. The cheaper MITs were ~$900 more expensive than the cost of ComboRx generic drugs over 2 years. TURP and PVP provided slightly greater relief of LUTS than MITs at approximately twice the cost over 2 years; typically, they are reserved for treatment of more severe LUTS. The analysis evaluated the costs and symptom relief of six treatment options in the continuum of care from a common baseline of LUTS severity. Identification of treatments for LUTS/BPH that demonstrate cost-effectiveness and provide appreciable symptom relief is paramount as reimbursement for patient care moves from volume-based services to value-based services.

IntroductionPoverty, HIV and perinatal depression represent a triple threat to public health in sub-Saharan Africa because of their combined negative effects on parenting and child development. In the resource-constrained context of low-income and middle-income countries, a lay-counsellor-delivered intervention that combines a psychological and parenting intervention could offer the potential to mitigate the consequences of perinatal depression while also optimising scarce resources for healthcare.Measuring the cost-effectiveness of such a novel intervention will help decision-makers to better understand the relative costs and effects associated with replicating the intervention, thereby supporting evidence-based decision-making. This protocol sets out the methodological framework for analysing the cost-effectiveness of a cluster randomised controlled trial (RCT) that compares a combined intervention to enhanced standard of care when treating depressed, HIV-positive pregnant women and their infants in rural South Africa.Methods and analysisThis cost-effectiveness analysis (CEA) protocol complies with the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. A societal perspective will be chosen.The proposed methods will determine the cost and efficiency of implementing the intervention as per the randomised control trial protocol, as well as the cost of replicating the intervention in a non-research setting. The costs will be calculated using an appropriately adjusted version of the Standardised Early Childhood Development Costing Tool.Primary health outcomes will be used in combination with costs to determine the cost per improvement in maternal perinatal depression at 12 months postnatal and the cost per improvement in child cognitive development at 24 months of age. To facilitate priority setting, the incremental cost-effectiveness ratios for improvements in child cognitive development will be ranked against six other child cognitive-development interventions according to Verguet et al’s methodology (2022).A combination of activity-based and ingredient-based costing approaches will be used to identify, measure and value activities and inputs for all alternatives. Outcomes data will be sourced from the RCT team.Ethics and disseminationThe University of Oxford is the sponsor of the CEA. Ethics approval has been obtained from the Human Sciences Research Council (HSRC, #REC 5/23/08/17), South Africa and the Oxford Tropical Research Ethics Committee (OxTREC #31–17), UK.Consent for publication is not applicable since no participant data are used in this protocol.We plan to disseminate the CEA results to key policymakers and researchers in the form of a policy brief, meetings and academic papers.Trial registration detailsISRCTN registry #11 284 870 (14/11/2017) and SANCTR DOH-27-102020-9097 (17/11/2017).

Objectives To investigate the cost-effectiveness of supplemental short-protocol brain MRI after negative non-contrast CT for the detection of minor strokes in emergency patients with mild and unspecific neurological symptoms. Methods The economic evaluation was centered around a prospective single-center diagnostic accuracy study validating the use of short-protocol brain MRI in the emergency setting. A decision-analytic Markov model distinguished the strategies “no additional imaging” and “additional short-protocol MRI” for evaluation. Minor stroke was assumed to be missed in the initial evaluation in 40% of patients without short-protocol MRI. Specialized post-stroke care with immediate secondary prophylaxis was assumed for patients with detected minor stroke. Utilities and quality-of-life measures were estimated as quality-adjusted life years (QALYs). Input parameters were obtained from the literature. The Markov model simulated a follow-up period of up to 30 years. Willingness to pay was set to $100,000 per QALY. Cost-effectiveness was calculated and deterministic and probabilistic sensitivity analysis was performed. Results Additional short-protocol MRI was the dominant strategy with overall costs of $26,304 (CT only: $27,109). Cumulative calculated effectiveness in the CT-only group was 14.25 QALYs (short-protocol MRI group: 14.31 QALYs). In the deterministic sensitivity analysis, additional short-protocol MRI remained the dominant strategy in all investigated ranges. Probabilistic sensitivity analysis results from the base case analysis were confirmed, and additional short-protocol MRI resulted in lower costs and higher effectiveness. Conclusion Additional short-protocol MRI in emergency patients with mild and unspecific neurological symptoms enables timely secondary prophylaxis through detection of minor strokes, resulting in lower costs and higher cumulative QALYs. Key Points • Short-protocol brain MRI after negative head CT in selected emergency patients with mild and unspecific neurological symptoms allows for timely detection of minor strokes. • This strategy supports clinical decision-making with regard to immediate initiation of secondary prophylactic treatment, potentially preventing subsequent major strokes with associated high costs and reduced QALY. • According to the Markov model, additional short-protocol MRI remained the dominant strategy over wide variations of input parameters, even when assuming disproportionally high costs of the supplemental MRI scan.

Threats to biodiversity and the integrity of ecological systems are escalating globally, both within and outside of protected areas. Decision makers have inadequate resources to manage all threats and typically lack information on the likely outcomes and cost‐effectiveness of possible management strategies. Priority Threat Management (PTM) is an emerging approach designed to address this challenge, by defining and appraising cost‐effective strategies for mitigating threats to biodiversity across regions. The scientific and practical impacts of PTM are increasing, with a growing number of case study applications across the globe. Here, we provide guidance and resource material for conducting the PTM process based on our experience delivering six large‐scale projects across Australia and Canada. Our handbook describes the four stages of PTM: scoping and planning; defining and collecting key elements; analysing the cost‐effectiveness of strategies; and communicating and integrating recommendations. We summarise critical tips, strengths, and limitations and scope for possible enhancements of the approach. Priority Threat Management harnesses scientific and expert‐derived information to prioritise management strategies based on their benefit to biodiversity, management costs and feasibility. The approach involves collaboration with key experts and stakeholders in a region to improve knowledge sharing and conservation support. The PTM approach identifies sets of regional level strategies that together provide the greatest benefits for multiple species under a limited budget, which can be used to inform existing processes for decision‐making. The PTM approach applies some generalisations in management strategies and resolution, in order to address complex challenges. Further developments of the approach include testing in a greater range of socioecological systems with adaptations that cater for multiobjective decisions. Synthesis and applications. Priority Threat Management is a decision science approach that brings people together to define and prioritise strategies for managing threats to biodiversity across broad regions. It delivers a prospectus for investment in the biodiversity of a region that is transparent, repeatable, participatory, and based on the best available information. Our handbook provides the necessary guidance and resources for expanding the Priority Threat Management approach to new locations, contexts, and challenges. Priority Threat Management is a decision science approach that brings people together to define and prioritise strategies for managing threats to biodiversity across broad regions. It delivers a prospectus for investment in the biodiversity of a region that is transparent, repeatable, participatory, and based on the best available information. Our handbook provides the necessary guidance and resources for expanding the Priority Threat Management approach to new locations, contexts, and challenges.

Primary cervical screening with testing for human papillomavirus (HPV) brings increased detection of women with low-grade squamous intraepithelial lesion recommended for follow-up with colposcopy. This study evaluates whether co-testing (HPV + cytology) or testing for HPV alone can safely replace colposcopy as follow-up for histologically confirmed low-grade squamous intraepithelial lesions. It estimates these strategies' diagnostic performance in detecting histological high-grade squamous intraepithelial or more severe lesions at follow-up and analyzes their relative cost-effectiveness. This is a retrospective cohort study on follow-up data of women aged 23-70 with histological low-grade squamous intraepithelial lesion, diagnosed during 2017-2018, with an analysis of data from the Swedish National Cervical Screening Registry. Out of the 14 643 women with low-grade squamous intraepithelial lesions, 4213 women with complete data on HPV, cytology, and histology results were analyzed. The primary outcome was to estimate the diagnostic performance of the strategies of co-testing (HPV + cytology) and human papillomavirus-alone in detecting histological high-grade squamous intraepithelial or more severe lesions in the follow-up of histological low-grade squamous intraepithelial lesions. The secondary outcome was to perform a cost-effectiveness analysis of these strategies. Using co-testing as the primary follow-up and reserving colposcopy for women who tested positive for HPV or cytology results yielded a sensitivity of 96% for high-grade squamous intraepithelial or more severe lesions. HPV-alone testing had 88% sensitivity. Adding colposcopy to co-testing would require 1735 (70%) additional examinations to detect 14 (3.9%) more women with high-grade squamous intraepithelial or more severe lesions. No cancer cases were missed by co-testing or HPV-alone. The cost of detecting one extra high-grade squamous intraepithelial or more severe lesion by adding colposcopy to co-testing was 81 959 EUR. Histological low-grade squamous intraepithelial lesion follow-up can be safely managed with co-testing, considerably reducing the number of colposcopies and associated costs.

Over the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence‐based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost‐effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta‐analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high‐income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high‐income countries and spreading slowly to middle‐income countries. IPS is an evidence‐based practice for people with serious mental illness in high‐income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.