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Informal caregivers perform complex home-care tasks but often lack structured training, causing preventable safety risks and burden. Technology-enhanced simulation provides practice; psychoeducational programs that flag risky activities may strengthen safety behaviors and self-efficacy. Comparing costs guides scalable caregiver training. This study compared the cost-consequences of traditional and immersive digital simulation for home care, focusing on costs, errors avoided, and caregiver-burden reduction. This is a prospective observational comparative cohort study with secondary cost-consequence analysis and incremental cost-effectiveness ratios (ICERs) versus control, expressed in €/error avoided and €/burden point reduced. Costs are reported in euros. A prespecified synthesis of 3 coordinated studies yielded 3 active arms plus a control cohort, implemented independently between August 2023 and July 2025 under a shared core protocol in comparable Spanish home-care settings. Arms were psychoeducation, virtual reality (VR), 360° video training (360VT), and standard education as control. Outcomes were 3-month changes in self-reported errors and caregiver burden, measured with the Zarit Burden Interview-7 (ZBI-7; 0-28). Costing adopted a societal perspective and included staff time, caregiver time, and development costs amortized over 3 years at 200 participants/year. Downstream health care use was modeled by applying 1%-5% of follow-up incidents (base case 2%) to a €1,257 composite unit cost. Combined costs equaled direct plus downstream costs, with no discounting over 3 months. Costs and consequences were reported in natural units, including incremental and pairwise comparisons. A total of 282 caregivers were included (psychoeducational n=71, VR n=70, 360VT n=71, and control n=70). Incident changes over a 3-month period were: +0.44 (95% CI 0.06 to 0.82) for control, -0.51 (95% CI -0.89 to -0.13) for psychoeducational, -0.56 (95% CI -0.97 to -0.20) for VR, and -0.20 (95% CI -0.66 to 0.09) for 360VT. Combined cost/per participant (direct +2% downstream) was: €46.88 for control, €77.04 for psychoeducational, €105.60 for VR, and €42.97 for 360VT. ICERs versus control were: (1) for errors avoided, -€31.75/error (95% CI €19.78 to -€54.98) for psychoeducation, €58.72/error (95% CI €39.40 to -€97.89) for VR, and 360VT was dominant, saving €6.11 (95% CI €4.24 to -€10.63) per error avoided, with €3.91 (95% CI €3.52 to -€4.29) saved per participant; (2) for burden reduced (ZBI-7), -€55.85/point (95% CI €38.27 to -€98.68) for psychoeducational, €45.88/point (95% CI €32.12 to -€76.67) for VR, and 360VT was dominant, saving €6.41 (95% CI €4.42 to -€11.23) per point reduced, with €3.91 (95% CI €3.52 to -€4.29) saved per participant. Pairwise for burden were as follows: (1) VR versus psychoeducational, €38.59 (95% CI €26.89 to -€66.13) per extra point; (2) 360VT versus psychoeducational dominant; and (3) VR versus 360VT, €93.48 (95% CI €64.41 to -€163.85) per extra point. This real-world cost-consequence analysis innovatively compares immersive and nonimmersive training for informal caregivers from a societal perspective, using harmonized safety, burden, and downstream cost outcomes. Findings support stepped adoption: 360VT as a scalable default, VR for higher-risk tasks or caregivers with greater burden, and psychoeducation as a complementary low-cost strategy when resources are constrained.

Summary The FEMuR III economic evaluation presents costs and consequences of the intervention compared with usual care at 52-week follow-up. There was no evidence of clinical effectiveness in terms of improvement of quality of life, and the total health service costs were higher in the intervention group. Purpose To explore the costs and consequences of the new FEMuR III intervention compared to usual care after hip fractures. Methods This cost-consequence analysis accompanies the FEMuR III randomised controlled trial using a micro-costing approach. The main outcome measures in this economic evaluation were healthcare service use, costs, and quality of life over 12 months, from both National Health Service and wider societal perspectives. Quality of life was measured using the EuroQoL-5D-3L. Results The mean cost of delivering the intervention was £444 per participant. For participants with complete EQ-5D data ( n  = 142), both groups showed improvement in EQ-5D index score, moving scores closer to UK norms. Participants in the intervention group gained 0.02 (95% CI: − 0.036, 0.076) more quality-adjusted life years (QALYs) than the usual care group. However, this was not statistically significant ( p value = 0.312). For imputed cases, participants in the intervention group gained less QALYs than the usual care by 0.01 (95% CI: − 0.056, 0.030). For participants with complete cost data ( n  = 115), at 52-week follow-up, mean health service use costs were higher in the intervention group from both perspectives. Conclusions The mean health service use costs were higher in the intervention group due to longer inpatient stays. There was no significant difference in QALYs between both groups. The trial was affected by the COVID-19 pandemic, and this goes some way to explaining the large proportion of missing data (40%). Trial registration ISRCTN28376407.

Expenditures for physiotherapy and extended outpatient physiotherapy (EAP) are increasing within Germany's statutory accident insurance system (Berufsgenossenschaften), placing growing pressure on rehabilitation capacity and timely access to care. Digital health applications (DiGAs) are reimbursable nationwide and represent a novel component of routine rehabilitation pathways. However, their real-world system-level and economic effects in occupational rehabilitation remain insufficiently understood. This study aimed to evaluate how the integration of DiGAs into occupational rehabilitation pathways may influence costs, service capacity, and waiting times within routine care delivered by 5 German statutory accident insurance funds that cover 25.9 million insured individuals. Aggregated administrative data from 5 Berufsgenossenschaften (fiscal years 2023-2024) were analyzed using a multilevel simulation framework combining (1) probabilistic cost-consequence modeling with Monte Carlo simulation (10,000 iterations), (2) an adherence-based adoption funnel distinguishing long-term engaged users (15%) and short-term users (85%) based on German claims data, and (3) a calibrated M/M/1 queuing model validated through discrete event simulation to estimate the effects on waiting times and system capacity. Primary outcomes included net financial impact, break-even thresholds, and changes in access-related performance metrics. Combined physiotherapy and EAP expenditures reached €404 million (€1=US $1.18) in 2024, increasing by 10.1% year-over-year. The primary simulation (N=10,000 iterations) indicated mean annual net savings of €18.4 million (median €17.9 million) with a 90.7% probability of cost savings (95% uncertainty range: net cost of €8 million to net savings of €47.7 million). After incorporating adherence dynamics, the projected mean net savings were €16.2 million (95% CI €5-€29.8 million), corresponding to a 100% probability of positive financial impact within the modeled parameter space. Cost neutrality was maintained for DiGA prices up to €617.8 per prescription, nearly 40% above the base-case assumption of €450, indicating substantial economic robustness. Queuing analyses demonstrated that modest reductions in therapeutic demand decreased mean waiting times from 17.3 to 12.8 days (-26%), equivalent to approximately 120,000 cumulative patient waiting days saved annually across 26,705 EAP patients. The validation of discrete event simulation confirmed the magnitude and direction of analytic estimates. Under conservative assumptions, integrating digital therapeutics into occupational rehabilitation pathways is likely to generate both economic benefits and substantial system-level capacity gains. The break-even threshold of €617.80 per prescription provides a wide margin for pricing policy. Beyond cost effects, DiGAs may function as scalable capacity tools that alleviate systemic bottlenecks and improve timely access to rehabilitation services in capacity-constrained systems.

Background Natalizumab (NAT) is an established disease-modifying therapy (DMT) for highly active multiple sclerosis (MS). However, its use involves complex decision-making, often leading to initial use of lower efficacy therapies. Recently, the first biosimilar NAT was approved, enabling competitive pricing. This study assessed the societal implications of initiating NAT in various scenarios through a cost–consequence analysis. Methods A 10-year Markov model based on the Expanded Disability Status Scale (EDSS) was employed, with 11 health states, annual cycles, and half-cycle correction. The cohort had an initial age of 36 years and 70% females. NAT was compared to common initial therapies (glatiramer acetate, teriflunomide, dimethyl fumarate, and fingolimod). Scenarios included continuous use, early (after 1 year), and delayed (5 years) switch to NAT. Baseline characteristics and probabilities for clinical and economic outcomes were derived from clinical trial data, published literature, and other available sources. Results Continuous NAT use resulted in the highest time spent on low EDSS levels, fewer relapses, reduced years of life lost due to disability, and a higher employment rate over a 10-year period. Switching to NAT after 1 year yielded outcomes similar to continuous NAT use. Despite higher DMT costs, disease management costs, including indirect costs and non-DMT direct medical costs, were lower in continuous use and early switch to NAT. Late switching resulted in outcomes most comparable to continuous use of the initial DMT. Conclusion Continuous and early switch to NAT resulted in better clinical outcomes and lower societal economic burden compared to delayed NAT initiation, indicating potential long-term cost savings.

Background Few studies have examined costs of implementing evidence-based interventions (EBIs) as scale-up proceeds. Across four phases, we co-adapted and scaled up an effective EBI designed to promote older adults’ health (Choose to Move; CTM). Following formative evaluation (2015), Phases 1–2 (2016-17) comprised the CTM pilot and early scale-up. For Phase 3 (2018-20), we adapted CTM to establish “best fit” and support broad scale-up. In response to COVID-19 (2020), we adapted CTM for virtual delivery. For Phase 4 (2020-22), we adapted CTM to reduce resource use. We aimed to (1) identify, measure, and value costs of implementing CTM across four phases (7 years) of scale-up; and (2) analyze change in implementation costs alongside changes in intervention effect sizes to assess cost-consequence trends from Phases 1–2 through Phase 4. Methods We conducted a trial-based cost and cost-consequence analysis of CTM Phases 1–2 through Phase 4 from a program provider perspective. Program costs were identified, measured, and valued using micro-costing techniques; variation in program cost was explored using scenario analyses. We compared Phase 4 intervention effects against those of Phases 1–2 and Phase 3 to examine how changes in implementation costs corresponded with changes in effect size. Results For Phases 1–2, total cost ($CDN, 2024) of CTM implementation was $863,559 for 55 programs (534 participants; $1,617/participant). Phase 3 costs were $1,564,446 for 165 programs (1668 participants; $938/participant). Phase 4 costs were $760,983 for 135 programs (1278 participants; $595/participant), a reduction of 63% and 37% compared with Phases 1–2 and Phase 3, respectively. Compared with Phases 1–2, Phase 4 had a greater positive effect on social isolation but effect sizes for physical activity, mobility and loneliness were reduced. Phase 4 had a greater positive effect on physical activity and mobility in all participants, and loneliness among those < 75 years, compared with Phase 3. Conclusions Costs associated with broad scale-up of EBIs are rarely investigated. We sought innovative ways to maximize impact of a health-promoting EBI, while minimizing costs. Our analysis highlights how strategic adaptations can enhance cost efficiency while improving intervention outcomes; this represents an emergent application of economic analysis within scale-up science. Trial registration Retrospectively registered at ClinicalTrials.gov, NCT05678985 (CTM Phase 4) and NCT05497648 (CTM Phase 3).

Abstract Background Parkinson’s disease is a degenerative neurological condition causing multiple motor and non-motor symptoms that have a serious adverse effect on quality of life. Management is problematic due to the variable and fluctuating nature of symptoms, often hourly and daily. The PD_(M)anager mHealth platform aims to provide a continuous feed of data on symptoms to improve clinical understanding of the status of any individual patient and inform care planning. The objectives of this trial are to (1) assess patient (and family carer) perspectives of PD_(M)anager regarding comfort, acceptability and ease of use; (2) assess clinician views about the utility of the data generated by PD_(M)anager for clinical decision making and the acceptability of the system in clinical practice. Methods/design This trial is an unblinded, parallel, two-group, randomised controlled pilot study. A total of 200 persons with Parkinson’s disease (Hoehn and Yahr stage 3, experiencing motor fluctuations at least 2 h per day), with primary family carers, in three countries (110 Rome, 50 Venice, Italy; 20 each in Ioannina, Greece and Surrey, England) will be recruited. Following informed consent, baseline information will be gathered, including the following: age, gender, education, attitudes to technology (patient and carer); time since Parkinson’s diagnosis, symptom status and comorbidities (patient only). Randomisation will assign participants (1:1 in each country), to PD_(M)anager vs control, stratifying by age (1 ≤ 70 : 1 > 70) and gender (60% M: 40% F). The PD_(M)anager system captures continuous data on motor symptoms, sleep, activity, speech quality and emotional state using wearable devices (wristband, insoles) and a smartphone (with apps) for storing and transmitting the information. Control group participants will be asked to keep a symptom diary covering the same elements as PD_(M)anager records. After a minimum of two weeks, each participant will attend a consultation with a specialist doctor for review of the data gathered (by either means), and changes to management will be initiated as indicated. Patients, carers and clinicians will be asked for feedback on the acceptability and utility of the data collection methods. The PD_(M)anager intervention, compared to a symptom diary, will be evaluated in a cost-consequences framework. Discussion Information gathered will inform further development of the PD_(M)anager system and a larger effectiveness trial. Trial registration ISRCTN Registry, ISRCTN17396879. Registered on 15 March 2017.

We comment on the recent retrospective cohort by Moreira and colleagues evaluating intracranial-compliance-guided mean arterial pressure management. The adjusted multivariable logistic regression in the published analysis includes ten estimated coefficients against 22 ICU deaths, producing an adjusted odds ratio reported with a confidence interval spanning more than two orders of magnitude. We outline why these features are consistent with model instability rather than a precise causal estimate, identify a corroborating signal within the same model, and raise two secondary questions about control selection and the headline cost figure. We support the authors’ call for prospective evaluation while suggesting that the inferential claims of the present analysis warrant more cautious presentation.

Purpose To assess and compare clinical outcomes and costs, to the Italian healthcare system, of three therapeutic options approved in the management of adult patients with gastro-enteropancreatic neuroendocrine tumours (GEP-NETs). Methods We compared the efficacy, safety, and costs of [177Lu]Lu-DOTA-TATE, everolimus (both originator and generic products), and sunitinib in patients with advanced GEP-NETs (NET G1 and G2) that had progressed following treatment with somatostatin analogs (SSAs). A cost-consequence model was developed and validated by a panel of clinical experts from three NET reference centres in Italy. The clinical outcomes included in the model were median progression-free survival and the incidence of grade 3 or 4 adverse events (AEs), as reported in pivotal clinical trials. The costs for acquisition and administration of each treatment, and of managing AEs, were calculated from the perspective of the Italian national health service. Treatment costs per progression-free month were calculated separately for patients with NETs of pancreatic (PanNETs; all three treatments) and gastrointestinal (GI-NETs; [177Lu]Lu-DOTA-TATE and everolimus only) origin. Results In patients with PanNETs, total costs per progression-free month were €2989 for [177Lu]Lu-DOTA-TATE, €4975 for originator everolimus, €3472 for generic everolimus, and €5337 for sunitinib. In patients with GI-NETs, total costs per progression-free month were €3189 for [177Lu]Lu-DOTA-TATE, €4990 for originator everolimus, and €3483 for generic everolimus. Conclusions [177Lu]Lu-DOTA-TATE was associated with lower costs per progression-free month versus relevant treatment options in patients with GI-NETs or PanNETs (NET G1–G2; progressed following SSA treatment), although acquisition and administration costs are higher. These findings provide further economic arguments in the overall context of treatment decision-making.

Background Chronic wounds pose considerable financial challenges for healthcare systems globally, with most cases requiring hospital care and extended lengths of stay, particularly due to delayed access to treatment. To address this, Sydney Local Health District (LHD) in Australia launched the Wound Care Command Centre™ in 2023, utilising a digital application for timely access to wound care and to reduce the burden on hospitals. This study evaluates the cost consequences of this Centre by comparing healthcare service use under this new model of care compared to service use under standard clinical practice after one year of operation to determine savings to the health system. Methods Admitted patient, non-admitted and emergency department patient records relating to chronic wounds between 2018 and 2024 were analysed to determine service use costs, number of chronic wound admissions, length of stay, non-admitted services and emergency department presentations. Regression was used to control for patient mix, and records from a neighbouring LHD utilising the standard clinical care model was used as a control for this study. Results We estimated that with the Wound Care Command Centre™, in 2023 there were up to 97 chronic wound admissions prevented, 943 hospital days averted due to earlier discharges, 308 more non-admitted service events and 208 more emergency department presentations in Sydney LHD, compared to expected levels under standard clinical practice models. This was consistent with reduced prevalence of complex cellulitis admissions in Sydney LHD and partial shifting of care from admitted to outpatient settings. Reduced hospital admissions and earlier discharges were estimated to total between $3.2 M to $4.8 M and costs of non-admitted and emergency department services were estimated to total $264k. After accounting for $1.3 M operational costs for the Command Centre over 2023, net savings were between $1.7 M to $3.3 M. Conclusions The Wound Care Command Centre™ reduced hospital admissions by 97 individuals and shortened hospital length of stays by 1.1 day, resulting in savings up to $3.3 M for Sydney LHD. Additional benefits for patients included increased access to specialist advice through the Wound Care Command Centre™ and reduced face-to-face contact due to use of a digital platform minimising unnecessary hospital visits for patients.

Published evidence on health service interventions should inform decision-making in local health services, but primary effectiveness studies and cost-effectiveness analyses are unlikely to reflect contexts other than those in which the evaluations were undertaken. A ten-step framework was developed and applied to use published evidence as the basis for local-level economic evaluations that estimate the expected costs and effects of new service intervention options in specific local contexts. Working with a multidisciplinary group of local clinicians, the framework was applied to evaluate intervention options for preventing hospital-acquired hypoglycemia. The framework included: clinical audit and analyses of local health systems data to understand the local context and estimate baseline event rates; pragmatic literature review to identify evidence on relevant intervention options; expert elicitation to adjust published intervention effect estimates to reflect the local context; and modeling to synthesize and calibrate data derived from the disparate data sources. From forty-seven studies identified in the literature review, the working group selected three interventions for evaluation. The local-level economic evaluation generated estimates of intervention costs and a range of cost, capacity and patient outcome-related consequences, which informed working group recommendations to implement two of the interventions. The applied framework for modeled local-level economic evaluation was valued by local stakeholders, in particular the structured, formal approach to identifying and interpreting published evidence alongside local data. Key methodological issues included the handling of alternative reported outcomes and the elicitation of the expected intervention effects in the local context.