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Journal round-up: PharmacoEconomics 40(1)

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The first 2022 issue of PharmacoEconomics covers a varied and thought-provoking range of topics. The issue begins with an acknowledgement to referees, which thanks authors and reviewers of articles from 2021. An editorial article celebrates 30 years of PharmacoEconomics, and I hope the journal felt better about turning 30 than I did. The editorial includes a helpful summary of the growth of relevant literature, as well as an overview of some key changes to how evidence bases and methods have evolved. Through my work with researchers in low- and middle-income countries, I was especially interested to see that the journal is interested in papers from a wider range of countries and mentions an interest in increasing the diversity of the editorial board.

Another editorial article offers some thoughts on productivity losses given the pandemic and the potential shift towards more home and hybrid working. The authors suggest some changes to the terminology used when discussing productivity losses, as well as adaptations to measurements in order to more accurately capture productivity considering nuances of remote working. Related to this topic, a research paper from the Netherlands investigated productivity changes related to paid work and time allocation (paid and unpaid work and leisure activities) related to home working during the pandemic. On average, participants reported spending less time on paid work and a reduction in productivity but, as would be expected, larger reductions in productivity were reported for people with young children, lower incomes, and those without separate home offices. It will be interesting to see how the evidence changes if home and hybrid working becomes the norm for more workers. Remember, PharmacoEconomics has a call for papers on productivity costs and non-health care consumptions costs (deadline for abstract submissions at the end of March).

One paper that caught my eye focused on incorporating equity concerns in cost-effectiveness analysis. The authors conducted a systematic review, identifying the various methodological approaches that have been used. They helpfully summarise and compare the approaches, including discussion on practical decisions. This paper is likely to be very useful for any researchers looking to reflect equity impacts in cost-effectiveness evaluation (including me!).

Dosing regimens of antipsychotics are often complex, and one paper compared the costs and effects of different dose regimens for long-acting injectables. The authors apply a pharmacokinetic model to simulate antipsychotic plasma concentration and minimum concentration. This links to a pharmacodynamic component to calculate the probability of relapse conditional on the plasma concentration of the antipsychotic agent. Finally, the authors used an economic model (Markov patient-level simulation) to calculate relapses and costs. I think this is a really interesting application that makes good use of the current evidence base. However, the model assumes complete adherence to medication and investigating the impact of adherence and discontinuation would be a useful step for future research.

Another paper focused on the impact of heterogeneous populations in survival modelling. Clinical trial data are often extrapolated using parametric models, but there is often limited focus on heterogeneity. The authors performed a simulation study across subgroup and complement populations, comparing modelled life-years (LYs) over a lifetime horizon. They found that in the presence of heterogeneity, LYs were underestimated, and subsequently suggest that NICE (and I assume decision-makers elsewhere) need to be cautious of the impact of heterogeneity on survival estimates. The effect of increasing trial sample size and accounting for subgroup interactions is also explored. Whilst I agree that a larger sample size is always helpful, I’m not sure how feasible this is depending on the indication and given the often limited health economics input into pharmaceutical trial design.

Other papers in this issue look at outcomes-based contracts in Europe and the challenges associated with these, methodological considerations related to estimating the marginal cost of health, preferences around antimicrobial resistance and the cost-effectiveness of preoperative intravenous iron.


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