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OBJECTIVE: Empirical estimates of the impact of healthcare expenditure on health outcome measures may inform the cost-effectiveness threshold (CET) for guiding funding decisions. This study aims to systematically review studies that estimated this, summarize and compare the estimates by country income level. METHODS: We searched PubMed, Scopus, York Research database, and [anonymized] for Reviews and Dissemination database from inception to 1 August 2023. For inclusion, a study had to be an original article, estimating the impact of healthcare expenditure on health outcome measures at a country level, and presented estimates, in terms of cost per quality-adjusted life year (QALY) or disability-adjusted life year (DALY). RESULTS: We included 18 studies with 385 estimates. The median (range) estimates were PPP$ 11,224 (PPP$ 223 - PPP$ 288,816) per QALY gained and PPP$ 5,963 (PPP$ 71 - PPP$ 165,629) per DALY averted. As ratios of Gross Domestic Product per capita (GDPPC), these estimates were 0.376 (0.041-182.840) and 0.318 (0.004-37.315) times of GDPPC, respectively. CONCLUSIONS: The commonly used CET of GDPPC seems to be too high for all countries, but especially low-to-middle-income countries where the potential health losses from misallocation of the same money are greater. REGISTRATION: The review protocol was published and registered in PROSPERO (CRD42020147276).
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Atención a la Salud , Gastos en Salud , Humanos , Análisis Costo-Beneficio , Años de Vida Ajustados por Calidad de VidaRESUMEN
OBJECTIVES: Although many reviews of the literature on cost-effectiveness thresholds (CETs) exist, the availability of new studies and the absence of a fully comprehensive analysis warrant a new review. This study systematically reviews demand-side methods for estimating the societal monetary value of health gain. METHODS: Several electronic databases were searched from inception to October 2019. To be included, a study had to be an original article in any language, with a clearly described method for estimating the societal monetary values of health gain and with all estimated values reported. Estimates were converted to US dollars ($), using purchasing power parity (PPP) exchange rates and the gross domestic product (GDP) per capita (2019). RESULTS: We included 53 studies; 45 used direct approach and 8 used indirect approach. Median estimates from the direct approach were PPP$ 24 942 (range 554-1 301 912) per quality-adjusted life-year (QALY), which were typically 0.53 (range 0.02-24.08) GDP per capita. Median estimates using the indirect approach were PPP$ 310 051 (range 36 402-7 574 870) per QALY, which accounted for 7.87 (range 0.68-116.95) GDP per capita. CONCLUSIONS: Our review found that the societal values of health gain or CETs were less than GDP per capita. The great variety in methods and estimates suggests that a more standardized and internationally agreed methodology for estimating CET is warranted. Multiple CETs may have a role when QALYs are not equally valued from a societal perspective (eg, QALYs accruing to people near death compared with equivalent QALYs to others).
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Análisis Costo-Beneficio/métodos , Años de Vida Ajustados por Calidad de Vida , HumanosRESUMEN
Introduction: Coronavirus disease 2019 (COVID-19) has significantly affected health care workers (HCWs), including their mental health. However, there has been limited evidence on this topic in the Vietnamese context. Therefore, this study aimed to explore COVID-19-related, psychological stress risk factors among HCWs, their concerns and demands for mental health support during the pandemic period. Methods: We employed a cross-sectional study design with convenience sampling. An online, self-administered questionnaire was used and distributed through social media among medical and non-medical HCWs from April 22 to May 12, 2020. HCWs were categorized either as frontline or non-frontline. We measured the prevalence of psychological stress using the Impact of Event Scale-Revised (IES-R) instrument. Multivariate binary logistic regression analysis was performed to identify risk factors associated with psychological stress among HCWs. Results: Among the 774 enrolled participants, 761 (98.3%) eligible subjects were included in the analysis. Most respondents were females (58.2%), between 31 and 40 years of age (37.1%), lived in areas where confirmed COVID-19 cases had been reported (61.9%), medical HCWs (59.9%) and practiced being at the frontline (46.3%). The prevalence of stress was 34.3%. We identified significant risk factors such as being frontline HCWs (odds ratio [OR] = 1.77 [95% confidence interval [CI]: 1.17-2.67]), perceiving worse well-being as compared to those before the COVID-19 outbreak [OR = 4.06 (95% CI: 2.15-7.67)], and experiencing chronic diseases [OR = 1.67 (95% CI: (1.01-2.77)]. Majority (73.9%) were concerned about testing positive for COVID-19 and exposing the infection to their families. Web-based psychological interventions that could provide knowledge on managing mental distress and consulting services were highly demanded among HCWs. Conclusion: The prevalence of psychological stress among HCWs in Vietnam during the COVID-19 pandemic was high. There were also significant risk factors associated with it. Psychological interventions involving web-based consulting services are highly recommended to provide mental health support among HCWs.
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COVID-19/psicología , Personal de Salud/psicología , Salud Mental , Estrés Laboral/epidemiología , Apoyo Social , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Pandemias , Factores de Riesgo , Encuestas y Cuestionarios , Vietnam , Adulto JovenRESUMEN
INTRODUCTION: As the availability of new economic evaluations (EE) on adjuvant trastuzumab therapy for early-stage breast cancer (EBC) with HER2-positive since last search and other EEs missed warrant a more extensive review, this study aimed to systematically review EEs of adjuvant trastuzumab compared with chemotherapy alone for HER2-positive EBC. AREA COVERED: The search was performed in February 2019 using MEDLINE and Scopus. Reviewers independently selected studies based on eligibility criteria, extracted data, assessed quality of reporting, and appraised quality of data sources. EXPERT OPINION: 22 studies were included which were from high-income (HICs) and upper-middle income countries (UMICs). Incremental cost-effectiveness ratios (ICERs) from HICs were within their cost-effectiveness thresholds and ranged from 6,018 to 78,929 USD per quality-adjusted life year (QALY) gained. ICERs from UMICs mostly exceeded their thresholds ranging from 3,526 to 174,901 USD per QALY gained. Evidence shows cost-effectiveness of trastuzumab for HER2-positive EBC in HICs. There were no methodological variations. The extent and adequacy of reporting were high. The quality of data sources was moderate to high. The quality of future EEs can be improved by enhancing the reporting quality, by using context-based data and real-world efficacy data, which would impact cost-effectiveness.