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Injury Oct 2023With the rise in global healthcare spending, medical decision-making is increasingly based on health economics outcomes. This narrative review aims to provide an... (Review)
Review
With the rise in global healthcare spending, medical decision-making is increasingly based on health economics outcomes. This narrative review aims to provide an overview of cost-effectiveness analysis (CEA) and cost-utility analysis (CUA), including their advantages and limitations, and outline practical aspects for implementing health economics in clinical trials for orthopaedic trauma. Both CEA and CUA offer several advantages. Firstly, they consider the costs as well as benefits of an intervention, providing a more comprehensive picture of its economic impact. Secondly, they provide a clear and straightforward metric for comparing interventions, which can help decision-makers make informed choices. However, there are methodological shortcomings that must be acknowledged, such as the lack of standardized instruments for assessing health utility measures, which can result in a wide range of cost-benefit ratios. In addition, a consensus on the willingness-to-pay threshold still needs to be reached to develop decision rules for cost-effectiveness similar to clinical effectiveness. Methods such as CEA and CUA should be incorporated into clinical trials in orthopaedic trauma research. Practical aspects for this include planning in advance, preferably in cooperation with a health economist. Selecting appropriate outcome measures is crucial, and both the medical effects of interventions and quality of life instruments should be carefully chosen to ensure comparability with previous studies. Additionally, the potential impact on clinical practice and healthcare policies should be considered. Direct as well as indirect costs should be assessed, and quality assurance with well-established checklists should be confirmed.
Topics: Humans; Quality of Life; Orthopedics; Cost-Benefit Analysis; Clinical Decision-Making; Treatment Outcome
PubMed: 37923505
DOI: 10.1016/j.injury.2023.110878 -
Trauma Surgery & Acute Care Open 2024Career shifts are a naturally occurring part of the trauma and acute care surgeon's profession. These transitions may occur at various timepoints throughout a surgeon's...
Career shifts are a naturally occurring part of the trauma and acute care surgeon's profession. These transitions may occur at various timepoints throughout a surgeon's career and each has their own specific challenges. Finding a good fit for your first job is critical for ensuring success as an early career surgeon. Equally, understanding how to navigate promotions or a change in job location mid-career can be fraught with uncertainty. As one progresses in their career, knowing when to take on a leadership position is oftentimes difficult as it may mean a change in priorities. Finally, navigating your path towards a fulfilling retirement is a complex discussion that is different for each surgeon. The American Association for the Surgery of Trauma (AAST) convened an expert panel of acute care surgeons in a virtual grand rounds session in August 2023 to address the aforementioned career transitions and highlight strategies for successfully navigating each shift. This was a collaboration between the AAST Associate Member Council (consisting of surgical resident, fellow and junior faculty members), the AAST Military Liaison Committee and the AAST Healthcare Economics Committee. Led by two moderators, the panel consisted of early, mid-career and senior surgeons, and recommendations are summarized below and in figure 1.
PubMed: 38616786
DOI: 10.1136/tsaco-2023-001334 -
Public Health Nov 2023The aim of this study was to systematically evaluate the current economic burden of coronary heart disease (CHD) in mainland China and provide a reference for the... (Review)
Review
OBJECTIVES
The aim of this study was to systematically evaluate the current economic burden of coronary heart disease (CHD) in mainland China and provide a reference for the formulation of policies to reduce the economic burden of CHD.
STUDY DESIGN
A systematic literature review was conducted of empirical studies on the economic burden of CHD over the past 20 years.
METHODS
PubMed, Web of Science, Embase, China Knowledge Resource Integrated Database and the WANFANG database were comprehensively searched for relevant articles published between 1 January 2000 and 22 December 2021. Content analysis was used to extract the data, and Stata 17.0 software was used for analysis. The median values were used to describe trends.
RESULTS
A total of 35 studies were included in this review. The annual median per-capita hospitalisation expense and the average expense per hospitalisation were $3544.40 ($891.64-$18,371.46) and $5407.34 ($1139.93-$8277.55), respectively. The median ratio on medical consumables expenses, drug expenses, medical examination expenses and treatment expenses were 41.59% (12.40%-63.73%), 26.90% (7.30%-60.00%), 9.45% (1.65%-33.40%) and 10.10% (2.36%-66.00%), respectively. The median per-capita hospitalisation expense in the eastern, central and western regions were $9374.45 ($2056.13-$18,371.46), $4751.5 ($2951.95-$8768.93) and $3251.25 ($891.64-$13,986.38), respectively. The median average expense per hospitalisation in the eastern and central regions were $6177.15 ($1679.15-$8277.55) and $1285.49 ($1239.93-$2197.36), respectively. The median average length of stay in the eastern, central and western regions were 9.3 days, 15.2 days and 16.1 days, respectively.
CONCLUSIONS
The economic burden of CHD is more severe in mainland China than in developed countries, especially in terms of the direct economic burden. In terms of the types of direct medical expenses, a proportion of medical examination expenses, treatment expenses and drug expenses were lowest in the eastern region, but medical consumables expenses were the highest in this region. This study provides guidance for the formulation of policies to reduce the economic burden of CHD in mainland China.
Topics: Humans; China; Coronary Disease; Cost of Illness; Hospitalization; Health Care Costs
PubMed: 37797560
DOI: 10.1016/j.puhe.2023.08.034 -
Zeitschrift Fur Orthopadie Und... Jun 2024
Topics: Humans; Germany; Ambulatory Care; Education, Medical, Continuing; Remuneration; National Health Programs; Quality of Health Care
PubMed: 38834076
DOI: 10.1055/a-2290-7605 -
Journal of the National Cancer Institute Aug 2023Real-world data studies usually consider biases related to measured confounders. We emulate a target trial implementing study design principles of randomized trials to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Real-world data studies usually consider biases related to measured confounders. We emulate a target trial implementing study design principles of randomized trials to observational studies; controlling biases related to selection, especially immortal time; and measured confounders.
METHODS
This comprehensive analysis emulating a randomized clinical trial compared overall survival in patients with HER2-negative metastatic breast cancer (MBC), receiving as first-line treatment, either paclitaxel alone or combined to bevacizumab. We used data from 5538 patients extracted from the Epidemiological Strategy and Medical Economics-MBC cohort to emulate a target trial using advanced statistical adjustment techniques including stabilized inverse-probability weighting and G-computation, dealing with missing data with multiple imputation, and performing a quantitative bias analysis for residual bias due to unmeasured confounders.
RESULTS
Emulation led to 3211 eligible patients, and overall survival estimates achieved with advanced statistical methods favored the combination therapy. Real-world effect sizes were close to that assessed in the existing E2100 randomized clinical trial (hazard ratio = 0.88, P = .16), but the increased sample size allowed to achieve a higher level of precision in real-world estimates (ie, reduced confidence intervals). Quantitative bias analysis confirmed the robustness of the results with respect to potential unmeasured confounding.
CONCLUSION
Target trial emulation with advanced statistical adjustment techniques is a promising approach to investigate long-term impact of innovative therapies in the French Epidemiological Strategy and Medical Economics-MBC cohort while minimizing biases and provides opportunities for comparative efficacy through the synthetic control arms provided.
DATABASE REGISTRATION
clinicaltrials.gov Identifier NCT03275311.
Topics: Humans; Female; Breast Neoplasms; Receptor, ErbB-2; Paclitaxel; Bevacizumab; Combined Modality Therapy
PubMed: 37220893
DOI: 10.1093/jnci/djad092 -
Journal of the American College of... Nov 2023Behavioral economics studies how external influences subconsciously affect decision making. Everyone is subject to a range of cognitive biases, which can affect the... (Review)
Review
Behavioral economics studies how external influences subconsciously affect decision making. Everyone is subject to a range of cognitive biases, which can affect the radiology training environment and can impact resident selection, resident education, feedback, workflow, and report composition. Understanding the cognitive sources of error and patterns of deviation can help faculty and trainees better engage in an optimal learning environment. This review focuses on the role of cognitive biases as they impact multiple facets of radiology education and training environments.
Topics: Economics, Behavioral; Radiology; Learning; Bias; Feedback; Internship and Residency
PubMed: 37634796
DOI: 10.1016/j.jacr.2023.06.039 -
Value in Health : the Journal of the... Dec 2023
Section 50 of the Inflation Reduction Act Drug Price Negotiation Program: Considerations for the Centers for Medicare & Medicaid Services, Manufacturers, and the Health Economics and Outcomes Research Community.
Topics: Aged; Humans; United States; Medicare; Medicaid; Negotiating; Economics, Medical; Inflation, Economic
PubMed: 37827492
DOI: 10.1016/j.jval.2023.09.2995 -
EMBO Reports Aug 2023The new biologics have great potential to help patients with hitherto uncurable diseases. But their exorbitant costs challenges the basis of health care systems based on...
The new biologics have great potential to help patients with hitherto uncurable diseases. But their exorbitant costs challenges the basis of health care systems based on equity.
Topics: Humans; Biological Products; Drug Costs
PubMed: 37341571
DOI: 10.15252/embr.202357637 -
JAMA Aug 2023
Topics: Drug Costs; Prescription Drugs; United States; Government Programs; Federal Government
PubMed: 37505512
DOI: 10.1001/jama.2023.11056 -
Annals of Internal Medicine Jun 2024The current U.S. health insurance "system" was not deliberately planned and constructed but has emerged piecemeal over the past half-century through a series of... (Review)
Review
The current U.S. health insurance "system" was not deliberately planned and constructed but has emerged piecemeal over the past half-century through a series of incremental and haphazard reforms. That policy history also reveals a clear but unfulfilled societal commitment to providing access to essential health care regardless of resources. To fulfill this obligation, the solution proposed in this article has 2 key elements: 1) universal coverage that is automatic, free, and basic, and 2) the option to buy supplemental coverage in a well-designed market. Such a system could, if desired, be created without raising taxes and without disrupting or changing the delivery of medical care.
Topics: United States; Health Care Reform; Universal Health Insurance; Humans; Insurance, Health; Health Services Accessibility; Patient Protection and Affordable Care Act
PubMed: 38739923
DOI: 10.7326/M24-0091