Search Results (291)

Background and aim: Advanced Therapy Medicinal Products (ATMPs) are innovative drugs based on genes, tissues, or cells that target rare and severe diseases. ATMPs have shown promising clinical outcomes but are associated with high costs, raising questions about cost-effectiveness. Hence, this systematic review aims to analyze the cost-effectiveness and cost-utility profiles of the European Medicines Agency-authorized ATMPs for treating rare diseases. Methods: A systematic review was conducted following PRISMA guidelines. Studies were identified by searching PubMed, Embase, Web of Science, and ProQuest scientific databases. Economic evaluations reporting incremental cost-effectiveness/utility ratios (ICERs/ICURs) for ATMPs were included. Costs were standardized to 2023 Euros, and a cost-effectiveness plane was constructed to evaluate the results against willingness-to-pay (WTP) thresholds of EUR 50,000, EUR 100,000, and EUR 150,000 per QALY, as part of a sensitivity analysis. Results: A total of 61 studies met the inclusion criteria. ATMPs for rare blood diseases, such as tisagenlecleucel and axicabtagene ciloleucel, were found to be cost-effective in a majority of studies, with incremental QALYs ranging from 1.5 to 10 per patient over lifetime horizon. Tisagenlecleucel demonstrated a positive cost-effectiveness profile in the treatment of acute lymphoblastic leukemia (58%), while axicabtagene ciloleucel showed a positive profile in the treatment of diffuse large B-cell lymphoma (85%). Onasemnogene abeparvovec for spinal muscular atrophy (SMA) showed uncertain cost-effectiveness results, and voretigene neparvovec for retinal diseases was not cost-effective in 40% of studies, with incremental QALYs around 1.3 and high costs exceeding the WTP threshold set. Conclusions: ATMPs in treating rare diseases show promising economic potential, but cost-effectiveness varies across indications. Policymakers must balance innovation with system sustainability, using refined models and the long-term impact on patient outcomes. Full article

Background: Adolescents in Ethiopia, particularly in rural areas, face significant barriers to accessing comprehensive sexual and reproductive health (SRH) services, resulting in poor health outcomes. The youth-friendly health services (YFHS) initiative addresses these challenges by training Health Extension Workers (HEWs) to deliver tailored, age-appropriate care at the primary care level. This study evaluates the cost-effectiveness of YFHS implementation in rural health posts in the Jimma Zone, Ethiopia. Methods: Using an ingredient-based costing approach, costs were analyzed across six health posts, three implementing YFHS and three offering routine services. Health outcomes were modeled using disability-adjusted life years (DALYs) averted, and incremental cost-effectiveness ratios (ICERs) were calculated. Results: Results showed that YFHS reached 9854 adolescents annually at a cost of USD 29,680, compared to 2012.5 adolescents and USD 7519 in control sites. The study showed the ICER of USD 25.50 per DALY averted. The intervention improved health outcomes, including a 27% increase in antenatal care uptake, a 34% rise in contraceptive use, and a 0.065% reduction in abortion-related mortality, averting 52.11 DALYs versus 26.42 in controls. Conclusions: The ICER was USD 25.50 per DALY averted, well below Ethiopia’s GDP per capita, making it highly cost-effective by WHO standards. Scaling YFHS through HEWs offers a transformative, cost-effective strategy to advance adolescent SRH equity and achieve universal health coverage in Ethiopia. Full article

Background: Endoscopic therapies for Crohn’s disease (CD) strictures, including endoscopic balloon dilation (EBD) and endoscopic stricturotomy (ESt), are less invasive interventions compared to surgery. ESt is advantageous for strictures that are longer, more fibrotic, or adjacent to anatomic structures requiring precision, and it has shown a high rate of surgery-free survival. Methods: We designed a microsimulation state-transition model comparing ESt to surgical resection for CD strictures. We calculated quality-adjusted life years (QALYs) over a 10-year time horizon; secondary outcomes included costs (in 2022 USD) and incremental cost-effectiveness ratios (ICERs). We used a societal perspective to compare our strategies at a willingness-to-pay (WTP) threshold of 100,000 USD/QALY. Sensitivity analyses, both deterministic and probabilistic, were performed. Results: The surgery strategy cost more than 2.5 times the ESt strategy, but resulted in nine more QALYs per 100 persons. The ICER for the surgery strategy was 308,787 USD/QALY; thus, the ESt strategy was determined more cost-effective. One-way sensitivity analyses showed that quality of life after ESt as compared to that after surgery, the likelihood of repeat intervention, and surgical mortality and cost were the most influential parameters shifting cost-effectiveness. Probabilistic sensitivity analyses favored ESt in most (65.5%) iterations. Conclusions: Our study finds endoscopic stricturotomy to be a cost-effective strategy to manage primary or anastomotic Crohn’s disease strictures. Post-intervention quality of life and probabilities of requiring repeated interventions exert most influence on cost-effectiveness. The decision between ESt and surgery should be made considering patient and stricture characteristics, preferences, and cost-effectiveness. Full article

Background: This study aims to evaluate the cost-effectiveness of providing the 23-valent pneumococcal polysaccharide vaccine (PPV23) free of charge versus self-paying vaccination among adults aged 60 years and older in Nanning, Guangxi, China. Methods: A decision tree–Markov model was developed to compare three strategies (government-funded free vaccination, self-funded vaccination, and no vaccination) over a 5-year time horizon. The model incorporated local epidemiological data and cost parameters, applying a 3% discount rate. Sensitivity analyses were conducted on key parameters, including vaccine effectiveness against pneumonia and pneumonia treatment costs. Results: The benefit–cost ratios for free and self-funded vaccination were 0.075 and 0.015, respectively, both below the cost-effectiveness threshold of 1. However, the free vaccination strategy resulted in a higher net benefit (USD 399,651.32) compared to the self-funded strategy (USD 222,594.14), along with a lower Incremental Cost-Effectiveness Ratio (ICER) (USD 1.47 per USD 0.14 of avoided disease cost). Although both strategies yielded benefit–cost ratios far below the conventional threshold of 1, the free strategy demonstrated relatively greater economic efficiency. Sensitivity analyses confirmed that vaccine effectiveness against pneumonia and treatment costs were key drivers of economic outcomes. Conclusions: While neither vaccination strategy achieved conventional cost-effectiveness benchmarks in this setting, the free PPV23 vaccination program demonstrated relatively greater economic efficiency compared to the self-funded approach; although neither strategy met the conventional cost-effectiveness thresholds, they should be considered for inclusion in regional health policy for older adults. Full article

X-linked adrenoleukodystrophy (ALD) is an inherited metabolic disorder that can cause adrenal insufficiency and cerebral ALD (cALD) in childhood. Early detection prevents adverse health outcomes and can be achieved by newborn screening (NBS) followed by monitoring disease progression. However, monitoring is associated with high costs. This study evaluates the cost–effectiveness of NBS for ALD in The Netherlands compared to no screening using a health economic model. A decision tree combined with a Markov model was developed to estimate societal costs, including screening costs, healthcare costs, and productivity losses of parents, and health outcomes over an 18-year time horizon. Model parameters were derived from the literature and expert opinion. A probabilistic sensitivity analysis (PSA) was performed to assess uncertainty. The screening costs of detecting one ALD case by NBS was EUR 40,630. Until the age of 18 years, the total societal cost per ALD case was EUR 120,779 for screening and EUR 62,914 for no screening. Screening gained an average of 1.7 QALYs compared with no screening. This resulted in an incremental cost–effectiveness ratio (ICER) of EUR 34,084 per QALY gained for screening compared to no screening. Although the results are sensitive to uncertainty surrounding costs and effectiveness due to limited data, NBS for ALD is likely to be cost–effective using a willingness-to-pay (WTP) threshold of EUR 50,000– EUR 80,000 per QALY gained. Full article

In Network-on-Chip (NoC) research, the task mapping problem has attracted considerable attention as a core issue influencing system performance. As an NP-hard problem, it remains challenging, and existing algorithms exhibit limitations in both mapping quality and computational efficiency. To address this, a method named ET (Enhanced Coati Optimization Algorithm) is proposed, which leverages the nature-inspired Coati Optimization Algorithm (COA) for task mapping. An incremental hill-climbing strategy is integrated to improve local search capabilities, and a dynamic mechanism for adjusting the exploration–exploitation ratio is designed to better balance global and local searches. Additionally, an initial mapping strategy based on spectral clustering is introduced, which utilizes inter-task communication strength to cluster tasks, thereby improving the quality of the initial population. To evaluate the effectiveness of the proposed algorithm, the performance of the ET algorithm is compared and analyzed against various existing algorithms in terms of communication cost, energy consumption, and latency, using both real benchmark task maps and randomly generated task maps. Experimental results demonstrate that the ET algorithm consistently outperforms the compared algorithms across all performance metrics, thereby confirming its superiority in addressing the NoC task mapping problem. Full article

Background/Objectives: Reducing waiting times for elective surgeries remains a critical global healthcare challenge that negatively impacts patient outcomes and economic productivity. This study develops an adaptable cost-utility modeling framework for assessing the cost-effectiveness (CE) of reducing waiting time for elective surgeries in data-limited environments. Methods: We evaluated the economic and health impacts of Egypt’s recent initiative aimed at decreasing surgical waiting lists. The study conducts a CE analysis of the initiative by estimating incremental costs (expressed in Egyptian Pounds—EGP) and outcomes (expressed in quality-adjusted life years—QALYs) before and after its implementation, performs a benefit–cost analysis to quantify the initiative’s return on investment, and employs a budget share method to evaluate catastrophic health expenditure (CHE). The analysis included five elective surgical interventions: open-heart surgery, cardiac catheterization, cochlear implantation, ophthalmic surgery, and orthopedic (joint replacement) surgery. Results: The main research outcomes of the study are as follows. The initiative resulted in incremental cost-effectiveness ratios of EGP 46,795 (societal perspective) and EGP 56,094 (payer perspective) per QALY, both within acceptable CE thresholds. Most of the evaluated interventions demonstrated substantial returns on the investment. Without public funding, more than 90% of patients faced CHE, indicating considerable financial barriers to elective surgeries. Conclusions: Egypt’s initiative to reduce waiting times was deemed cost-effective. Our adaptable modeling framework could be practical for similar evaluations in low/middle-income countries, especially where data is limited. Scaling up the initiative to include additional curative and preventive services and integrating it with broader health system reforms in Egypt is strongly recommended. Full article

Spasticity is a persistent and debilitating consequence of stroke and effective rehabilitation is a healthcare priority. Botulinum neurotoxin A (BoNT-A) with supportive therapy has increasingly been embedded within clinical practice for treatment of post-stroke spasticity. But the evidence for this approach has hitherto been limited to the findings of a limited number of small trials. The InTENSE trial was undertaken specifically to provide high-quality clinical trial evidence focusing on the effect of BoNT-A and adjunctive therapy on upper limb spasticity. While the clinical trial did not detect a significant impact upon clinical outcomes, there remains a need to evaluate any impact on the broader use of healthcare resources and overall cost-effectiveness. A detailed cost–utility analysis of the InTENSE trial was undertaken. The costs over the 12-month follow-up period were compared with quality-adjusted life years (QALY) gained using utilities generated from the EQ-5D three level (EQ-5D-3L) instrument. There were no significant differences in QALY gained between the intervention and control groups identified, or in the majority of health and community care costs. The Incremental Cost-Effectiveness Ratio per QALY gained was estimated at AU $63,947.11 (Australian dollars), which is well above accepted thresholds for cost-effectiveness in Australia. The study was unable to identify evidence for the cost-effectiveness of treatment approaches combining BoNT-A with adjunctive therapy. Full article

In this paper, we develop an HIV/AIDS epidemic model that incorporates a saturated incidence rate to reflect the limited transmission capacity and the impact of behavioral saturation in contact patterns. The model is formulated as a system of seven non-linear ordinary differential equations representing key population compartments. In addition to model formulation, we introduce an optimal control problem involving three control measures: educational campaigns, screening of unaware infected individuals, and antiretroviral treatment for aware infected individuals. We begin by establishing the positivity and boundedness of the model solutions under constant control inputs. The existence and local and global stability of both the disease-free and endemic equilibrium points are analyzed, depending on the effective reproduction number (${\mathcal{R}}_e$). Bifurcation analysis reveals that the model undergoes a forward bifurcation at ${\mathcal{R}}_e=1$. A local sensitivity analysis of ${\mathcal{R}}_e$ identifies the disease transmission rate as the most sensitive parameter. The optimal control problem is then formulated by incorporating the dynamics of infected subpopulations, control costs, and time-dependent controls. The existence of optimal control solutions is proven, and the necessary conditions for optimality are derived using Pontryagin’s Maximum Principle. Numerical simulations support the theoretical analysis and confirm the stability of the equilibrium points. The optimal control strategies, evaluated using the Incremental Cost-Effectiveness Ratio (ICER), indicate that implementing both screening and treatment (Strategy D) is the most cost-effective intervention. These results provide important insights for designing effective and economically sustainable HIV/AIDS intervention policies. Full article

Background/Objectives: Antibiotic management of hospitalized penicillin-allergic patients (PAPs) is associated with prolonged hospital stays, adverse reactions and treatment failure, resulting in increased healthcare costs. This study aimed to estimate the cost-effectiveness of beta-lactam desensitization (DES) in the management of PAPs. Methods: A cost-effectiveness analysis was performed using a probabilistic model with 1000 s-order Monte Carlo simulations. Hospital costs (in 2025 Euros) and effectiveness outcomes (cure and survival rates) were derived from a Spanish retrospective case–control study conducted between 2015 and 2022, which included 56 PAPs (14 in the desensitization group [DES] and 42 in the control group without DES [NDES]; ratio 1:3), and collected healthcare costs per patient. Results: The incremental cost of the DES group was EUR 37,805 (95% CI: EUR 2023–EUR 126,785), with a 100% probability of incurring additional costs compared to the NDES group. The cure rate was 16.5% higher in the DES group (95% CI: 13.3–20.0%), and the estimated gain in life-years per patient (LYG) was 1.42 (95% CI: 1.15–1.73) versus NDES. The cost per life-year gained (LYG) with DES versus NDES was EUR 24,618 ± EUR 19,535 (95% CI: EUR 1755–EUR 73,488). The probability that DES would be cost-effective (cost per LYG < EUR 25,000 and <EUR 30,000) was 61.1% and 100%, respectively. Conclusions: According to this analysis, DES appears to be a cost-effective option for managing PAPs. These findings should be confirmed in clinical studies with larger sample sizes. Full article

Visceral leishmaniasis (VL), a chronic disease caused by Leishmania infantum, is more prevalent in males than females. Control strategies that do not take this disparity into account can be suboptimal. We extended a sex-structured VL model by introducing four control variables: insecticide-treated bed nets, vector control, medical treatment, and animal culling. The study evaluates six intervention strategies and calculates the incremental cost-effectiveness ratio to assess their impact on disease transmission and cost-effectiveness. The analysis shows that, without interventions, the disease remains endemic with significant health and socioeconomic consequences. The proposed strategy, which applies all four controls, emerges as the most effective and cost-efficient strategy, leading to an exponential reduction in disease prevalence across human, vector, and animal populations. Strategies without animal culling and vector control followed in effectiveness. Moreover, it was found that applying up to 50% of the controls to females, compared to males, can still eliminate VL within the planning period. Full article

This study investigates optimal intervention strategies for controlling the spread of two co-circulating strains of SARS-CoV-2 within the Nigerian population. A newly formulated epidemiological model captures the transmission dynamics of the dual-strain system and incorporates three key control mechanisms: vaccination, non-pharmaceutical interventions (NPIs), and therapeutic treatment. To identify the most effective approach, Pontryagin’s Maximum Principle is employed, enabling the derivation of an optimal control function that minimizes both infection rates and associated implementation costs. Through numerical simulations, this study evaluates the performance of individual, paired, and combined intervention strategies. Additionally, a cost-effectiveness assessment based on the Incremental Cost-Effectiveness Ratio (ICER) framework highlights the most economically viable option, while results suggest that the combined application of vaccination and treatment strategies offers superior control over dual-strain transmission and implementing all three strategies together ensures the most robust suppression of the outbreak. Full article

The amendment to MARPOL Annex VI, which limits the sulfur content in marine fuels to a maximum of 0.5 wt.%, came into effect in January 2020. This includes reducing sulfur oxide (SO_X) emissions and establishing nitrogen oxide (NO_X) emission standards (Tiers I, II, and III) based on the ship’s engine type and construction date. Furthermore, the regulations require oil tankers to control volatile organic compound (VOC) emissions and prohibit the installation of new equipment containing ozone-depleting substances. After a four-year exploration phase, global shipping companies still lack consistent evaluation criteria for the selection and use of alternative fuels, resulting in divergence across the industry. According to the latest data, methanol can reduce NO_X, SO_X, and particulate matter (PM) emissions by approximately 80%, 99%, and 95%, respectively, compared to traditional heavy fuel oil. Furthermore, green methanol has the potential for near-zero greenhouse gas emissions and can meet the stringent standards of Emission Control Areas. Therefore, this study adopts a cost-benefit analysis method to evaluate the feasibility and implementation benefits of two promising strategies: methanol dual fuel and very low-sulfur fuel oil (VLSFO). A 6600-TEU container ship was selected as a representative case, and the evaluation was conducted by replacing an older ship with a newly built one. The reductions in total pollutants and CO₂-equivalent emissions of the container ship, as well as the cost-effectiveness of each specific strategy, were calculated. This study found that, in the first five years of operation, the total incremental cost of Vessel A, which uses 100% VLSFO, will be significantly lower than that of Vessel B, which uses a blend of 30% e-methanol + 70% VLSFO as fuel. Furthermore, compared to a scenario without any improvement strategies, the total incremental cost for Vessels A and B will increase by 69.90% and 178.15%, respectively, over five years. Vessel B effectively reduced the total greenhouse gas emission equivalent (CO₂e) of CO₂, CH_4, and N₂O by 24.72% over five years, while Vessel A reduced the CO₂e amount by 12.18%. Furthermore, the cost-benefit ratio (CBR) based on total pollutant emission reduction is higher for Vessel A than for Vessel B within five years of operation. However, in terms of the cost-effectiveness of CO₂e emission reduction, the CBR of Vessel A becomes lower than Vessel B after 4.7 years of operation. Therefore, Vessel A’s strategy should be considered a short-term option for reducing CO₂e within 4.7 years, whereas the strategy of Vessel B is more suitable as a long-term solution for more than 4.7 years. Full article

Objectives: To estimate the association between various indicators of obesity-related health risk and the incidence of rheumatoid arthritis (RA) in a large cohort of women. Methods: The UK Women’s Cohort Study is a prospective cohort of 35,372 middle-aged women (aged 35–69 at recruitment) initiated in 1995–1998. Obesity was assessed using body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), categorised according to WHO and NICE guidelines, as well as clothing size. Incident RA cases were identified via Hospital Episode Statistics (HES) linkage up to March 2019. Cox regression models were used to estimate RA risk, adjusting for demographics, reproductive factors, and lifestyle factors. Non-linear associations were examined using restricted cubic splines. Results: Among 27,968 eligible subjects with complete data linkage (625,269 person-years of follow-up), there were 255 incident RA cases. Obesity (≥30.0 kg/m²) was associated with increased RA risk (HR (95% CI) 1.48 (1.02, 2.17), as were abdominal obesity (WC > 88 cm: 1.58 (1.10, 2.27)), WHR ≥ 0.85 (1.56 (1.03, 2.36)), and WHtR ≥ 0.6 (2.25 (1.34, 3.80)). Each 2.5 kg/m² increase in BMI was associated with a 9% higher risk of RA; each 5 cm increase in WC with 6%; each 0.1 increase in WHR with 20%, and each 0.1 increase in WHtR with 27%. Larger clothing sizes were associated with a greater RA risk: for each onesize increment in blouse size and skirt size, the HRs were 1.13 (95% CI: 1.04, 1.22) and 1.13 (95% CI: 1.05, 1.22), respectively. Notably, skirt size ≥ 20 was associated with a 2.36-fold increased risk of RA. There was evidence of effect modification by weight change and menopausal status in obesity-related RA risk. Conclusions: Our findings suggest that managing obesity and central adiposity in middle-aged women may be associated with the risk of developing RA. WHtR may serve as a practical alternative to BMI in assessing RA risk. Clothing size, particularly skirt size, could provide a simple, cost-effective proxy for identifying at high risk of RA. Full article

The uncoordinated charging behaviors of electric vehicles (EVs) challenge the stable operation of the grid, e.g., increasing the peak-to-valley ratio of the grid and diminishing power supply reliability. A Monte Carlo sampling method is employed to develop a charging behavior model for EVs to solve the problems raised by random charge mode. The probability densities of daily driving distance, initial charging time, charging power, and charging duration are incorporated and analyzed. The proposed model enables multiple random sample values for EVs, considering varying weather conditions and time-of-use electricity prices. For charge and discharge optimization, an EV charge and discharge scheduling model is constructed, aiming to balance multiple objective functions, including battery degradation costs, user charging costs, grid load fluctuations, and peak-to-valley differences. The weighting method is applied to transform the multi-objective framework into a single-objective comprehensive solution, facilitating the identification of optimal charge and discharge strategies. Results demonstrate that the Monte Carlo sampling can satisfactorily generate datasets with realistic characteristics on the driving range and charging initiation time of the EVs. Furthermore, the load results achieved through multi-objective optimization demonstrate that the proposed strategy effectively mitigates peak-to-valley disparities. The peak load reduction and trough load increment are 27.6% and 160.1%, respectively. Through post-peak load balancing, the average costs of each EV for daily charging and battery degradation are reduced to be 7.58 yuan and 15.68 yuan, respectively. This approach can significantly enhance the grid stability, simultaneously address the economic interests of users, and extend battery lifespan. Full article