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BACKGROUND: The existing intravenous systemic anticancer therapy (SACT) pathway in pharmacies is operationally inefficient. Manual, paper-based workflows render the system prone to human error, and the need for time-consuming manual verification diverts pharmacy staff time. The introduction of an automated workflow solution for the intravenous SACT pathway could optimize treatment timeliness and improve oncological outcomes for patients, aligning with the National Health Service Long Term Plan for improved cancer care.
OBJECTIVE: This observational analysis aimed to assess the change in time, cost, and errors following the implementation of the Becton Dickinson (BD) Cato Pharmacy system in an aseptic unit producing intravenous SACT at Watford General Hospital.
METHODS: Data on compounding process times were collected manually by pharmacy staff before and after the implementation of the intravenous compounding software (BD Cato). The data were analyzed to estimate annual time savings, opportunity cost savings, and error reduction.
RESULTS: The intravenous compounding software produced a time saving of 18 (SD 9) minutes per drug, equating to 1034 hours saved per year (1034/2591, 39.9% reduction). If this time were repurposed to producing more intravenous SACT, Watford General Hospital could increase production by 66% (2298/3482) annually (2298 additional intravenous SACT). This represents an average cost saving of £11.29 (£1=US $1.273) per drug, equating to an annual opportunity cost saving of £39,246. The intravenous compounding software also decreased observed errors by 86% (43/50), a reduction of 43 errors over 2 months (approximately 258 fewer errors annually). Staff also preferred the intravenous compounding software to the manual system.
CONCLUSIONS: Implementing intravenous compounding software can save time, reduce costs, and lower errors in intravenous SACT preparation. This could improve timely treatment access for patients with cancer.
Health technology assessment (HTA) must increasingly incorporate environmental sustainability (ES) to ensure digital health technologies (DHTs) deliver true value for both population and planetary health. Existing HTA frameworks inadequately capture the upstream and downstream environmental implications of DHTs, overlooking critical factors such as energy consumption, data storage, water usage and electronic waste. Using a few examples on telehealth platforms, electronic health records and artificial intelligence (AI) driven diagnostic tools, we illustrate how these technologies can reduce carbon emissions and other pollutants by limiting patient travel and optimizing resource use. We review current HTA frameworks, identify ongoing initiatives, and highlight gaps and challenges in integrating ES into value assessment. Traditional HTA models provide limited guidance for incorporating broad environmental factors, risking underestimation of DHTs’ environmental impacts and potentially undermining health systems’ net-zero commitments by 2050. To address these issues, in this commentary, we propose for targeted investment in frameworks, streamlined environmental data collection, and stronger cross-sector collaboration. Systemic inclusion of ES can reduce inequalities, support ethical supply chains and incentivize developers to design lower-impact technologies, positioning HTA as a driver of sustainable digital health innovation. By embedding environmental metrics, health systems can better balance clinical benefits, economic efficiency and ecological responsibility, thereby advancing both human and planetary health.
BACKGROUND: Infections represent the most serious complication associated with cardiac implantable electronic devices (CIEDs). This can result in prolonged hospital stays, high morbidity and mortality, and a significant economic burden for healthcare systems.
OBJECTIVES: This study aimed to evaluate the cost-effectiveness of the TYRX absorbable antibacterial envelope for CIED infection prevention from the Spanish Healthcare System perspective.
METHODS: A decision tree model with a lifetime horizon was developed to compare standard antibiotic prophylaxis with its combination with TYRX, regardless of infection risk. The model incorporated infection incidence, mortality, and utility values up to 36 months, derived from REINFORCE, AdaptResponse, and WRAP-IT studies. Unit costs (2025 euros) included prevention strategies and infection management. Lifetime costs and quality-adjusted life-years (QALYs) were assigned to survivors beyond 36 months. The incremental cost-effectiveness ratio (ICER) was reported by CIED and weighted by implant distribution (permanent pacemaker [PPM, 76.5%], implantable cardioverter-defibrillator [ICD, 15.2%], cardiac resynchronization therapy with defibrillator [CRT-D, 5.4%], and pacemaker [CRT-P, 2.9%]). A subgroup analysis was performed in high-risk patients (PADIT≥7), modifying infection rates based on PADIT risk stratification, along with sensitivity analyses. Model inputs were validated by an expert panel.
RESULTS: TYRX was the dominant strategy (more effective and less costly) for CRT-D and ICD recipients and cost-effective for those receiving PPM (€17 740/QALY) or CRT-P (€14 647/QALY), considering a willingness-to-pay threshold of €25 000/QALY. Across the spectrum of CIEDs, the ICER was €11 709/QALY. TYRX remained cost-effective in 77% of sensitivity analysis simulations. In high-risk patients, TYRX was dominant for all CIEDs.
DISCUSSION: This study is believed to be the first economic evaluation of TYRX in Spain and provides novel evidence in a broad, unselected population. Previous cost-effectiveness analyses conducted across different healthcare systems have consistently shown that TYRX is cost-effective in patients at elevated risk for device-related infections. Although the populations and healthcare settings differ, our findings are consistent with this body of evidence.
CONCLUSIONS: TYRX represents a dominant strategy for infection prevention for CRT-D and ICD and is cost-effective for PPM and CRT-P, based on Spain’s willingness to pay.
BACKGROUND: Gastroesophageal reflux disease (GERD) affects 6.8 million individuals in Spain, incurring €56 million/year in healthcare costs. Standard-of-care treatment (SOC) in Spain includes medical management with proton pump inhibitors (PPIs) and laparoscopic Nissen fundoplication (LNF) in selected cases. The limitations of PPIs, including high rates of unresponsiveness, adverse events (AEs) associated with long-term use, and nonindicative misuse, increase the economic strain on European healthcare systems. The durability of LNF treatment is hindered by reoperation and postoperative complications. RefluxStop, a novel implantable device, restores the anti-reflux barrier without encircling the esophagus and confers long-term efficacy and safety in the treatment of GERD.
OBJECTIVE: This study assessed the cost-effectiveness of RefluxStop compared with medical (PPI-based) and surgical (LNF) SOC for refractory GERD in Spain.
METHODS: The cost-effectiveness of RefluxStop versus PPI-based medical management and LNF was assessed from the Spanish National Health System (SNS) perspective over a lifetime horizon (monthly cycles, 3.0% annual discount rate). A Markov model adapted from a published UK National Health Service (NHS) cost-effectiveness analysis of this device was used. Quality-adjusted life years (QALYs) and total costs were calculated for each intervention, while inter-arm differences were evaluated using incremental cost-effectiveness ratios (ICERs).
RESULTS: RefluxStop yielded ICERs of €557 and €2393 per QALY gained compared with medical management and LNF, respectively. At the cost-effectiveness threshold of €30,000 per QALY gained for Spain, the probability of RefluxStop being cost-effective was 100% compared with medical management and 93% compared with LNF. Over a lifetime horizon, the per-patient cost differences and QALY gains for RefluxStop were €1472 and 2.64 versus medical management and €2111 and 0.88 versus LNF, respectively. The model results remained robust to sensitivity analysis.
CONCLUSIONS: RefluxStop was estimated to be cost-effective relative to SOC in Spanish healthcare settings for the treatment of adult patients with refractory GERD, consistent with recently published findings in the UK, Switzerland, Sweden, and Norway. It is acknowledged that the model has limitations, including its reliance on single-arm trial data and indirect comparisons using heterogeneous literature sources, which limit the precision and generalizability of its findings.
INTRODUCTION: Integrating smoking cessation supports into lung cancer screening can improve abstinence rates. However, healthcare decision-makers need evidence of cost-effectiveness to understand the cost/benefit of adopting this approach.
METHODS: To evaluate the cost-effectiveness of smoking cessation interventions, and service delivery, we used a cohort-based Markov model, adapted from previous National Institute for Health and Care Excellence (NICE) guidelines on smoking cessation. This uses long-term epidemiological data to capture the prevalence of the smoking-related illnesses, updated through targeted literature searches as required from the core NICE model, with costs extracted from publicly recognised UK sources.
RESULTS: All smoking cessation interventions appeared cost-effective at a threshold of £20 000 per quality-adjusted life year, compared with no intervention or behavioural support alone. Offering immediate smoking cessation as part of lung cancer screening appointments, compared with usual care (onward referral to stop smoking services), was also estimated to be cost-effective with a net monetary benefit of £2198 per person, and a saving of between £34 and £79 per person in reduced workplace absenteeism among working age attendees. Estimated healthcare cost savings were more than four times greater in the most deprived quintile compared with the least deprived, alongside a fivefold increase in quality adjusted life years accrued.
CONCLUSIONS: Smoking cessation interventions within lung cancer screening are cost-effective and should be integrated, so that treatment is initiated during screening visits. This is likely to reduce overall costs to the health service, and wider integrated care systems, improve quality and length of life, and may lessen health inequalities.
BACKGROUND: Digital peer support apps can assist with mental ill health. We present an early economic evaluation of Tellmi, a related and novel app for children and young people (CYP).
METHODS: Tellmi users were surveyed; healthcare resource use over 3 months was captured. Data informed the development of an early cost-comparison model, capturing cost and resource use differences (CYP using Tellmi vs standard care). A 1-year time horizon was used, and the model was built from a National Health Service (NHS) perspective. Deterministic sensitivity analysis highlighted key driving parameters.
RESULTS: There were 283 responses. Tellmi use for more than 1 month resulted in significantly fewer accident and emergency, general practitioner and school nurses/counsellor visits (vs standard care). An early cost calculator model estimated that Tellmi use led to an NHS cost saving of £214 per person (excluding service cost).
CONCLUSIONS: Tellmi has the potential to be cost saving to the NHS. Further evidence is needed.
