Journal round-up: Applied Health Economics and Health Policy 19(2)

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This issue of Applied Health Economics and Health Policy covered diverse topics on cost-effectiveness, price regulation, utility weights, and COVID-19 related studies.

A systematic review on the cost-effectiveness of kidney replacement therapy suggested kidney transplantation to be the most cost-effective therapy compared to hemodialysis and peritoneal dialysis. The authors highlighted the need for future economic evaluation from a societal perspective especially incorporating the indirect costs borne by patients and their families and productivity losses which can provide decision-makers with a comprehensive understanding of the cost-effectiveness of various interventions.

A cost-effectiveness analysis based on a discrete event simulation model compared 16 case detection strategies for chronic obstructive pulmonary disease (COPD). It suggested that an early diagnosis of COPD through implementing a regular screening questionnaire during routine primary care visits, accompanied by timely and appropriate care, is likely to be cost-effective compared to doing nothing. A study from India suggested a new contraceptive method, etonorgestrel implant, is cost-effective and recommended the Ministry of Health add it to the public health system.

An interesting study from the United States researched whether the choice of a cost-effectiveness threshold (CET) is independent of incremental cost-effectiveness ratio (ICER) results. Given that the US panel on cost-effectiveness did not recommend a universal CET, a CET usually depends on the researchers’ discretion. Scientifically, it should be hypothesized before the analysis. However, researchers could be cherry-picking the CET to make their results cost-effective. Based on their findings, they concluded that the choice of a CET may not be independent of the ICER.

The utility weights for the French version of Quality of Life Utility Measure-Core 10 Dimensions (QLU-C10D), a cancer-specific multi-attribute utility instrument based on the widely used Quality of Life Questionnaire-Core 30 (QLQ-C30), are now available. The utilities were elicited from the general population of France using a discrete choice experiment (DCE). This will enable researchers to use QLU-C10D for cost-utility analyses in oncology and improve the quality of economic evaluations by using cancer-specific multi-attribute utility instruments. However, future validation studies are required to show how the utilities obtained from this instrument will compare to the utilities generated from generic instruments such as EQ-5D or HUI3 in terms of sensitivity and meaningful clinical differences. Another article using DCE methodology explored and provided insights into the preferences of community pharmacists in New Zealand and discussed how they could be incorporated into future policies targeting pharmacist prescribing services in primary care. The DCE results signalled that community pharmacists see themselves as part of the prescribing team and highlighted a need to develop prescribing education programmes that are robust and attractive. This would encourage more pharmacists in primary care, solving the issue of inequity of access to prescribing services and sharing the increasing prescribing workload.

Another study provided insights into the development of recommendations for the NICE Medical Technologies Guidance (MTG) on using CurosTM disinfection caps for needleless connectors. The final guidance concluded that, while Curos could lead to cost savings by lowering bloodstream infections, there is some uncertainty in the clinical benefits. Further research is required to address this. In another paper, the authors assessed the impact of guidelines on medical technology diffusion using a Cardiac Resynchronization Therapy (CRT) case study in the UK. They took a distinctive approach of analyzing UK Google Trends data as a proxy of the CRT awareness and major changes in guidelines as the independent factor. They suggested that strong clinical evidence reflected by the strength of the guideline recommendation is an important factor for clinician response.

One interesting study explored the relationship between pharmaceutical price regulation and R&D intensity using the latest firm-level data of the top-10 pharmaceutical firms. The authors found that exposure to price regulation was negatively associated with R&D intensity, driven by the negative association of price regulation on cash flow and profitability. When including firm effects in the model, the negative association of price regulation on cash flow and profitability remained. However, price regulation did not have a statistically significant association with R&D intensity suggesting firm differences and strategies play an important role in explaining the relationship between price regulation and R&D intensity.

Other topics covered in this issue include the budget impact of microbial cell-free DNA testing strategies in immunocompromised patients, cost-effectiveness analysis of the number of intensive beds justifiable for hospital pandemic preparedness for COVID-19 in Germany, and prevention and control strategies of the Vatican City’s healthcare system against COVID-19.


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