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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.
BACKGROUND: Sjögren’s disease (SjD) is a multifaceted, systemic autoimmune disease with substantial clinical heterogeneity. The objective of this study was to conduct a qualitative expert opinion exercise to explore how SjD is assessed, evaluated and managed in international clinical practice.
METHODS: A qualitative research design was used to elicit the expert opinion of 8 clinicians. Two researchers interviewed each clinician individually. The results of the interviews were synthesised using thematic analysis, and draft definitions of key terms were prepared. A group workshop was held to discuss/validate the interview results and refine the working definitions.
RESULTS: The clinicians had extensive experience in managing SjD from different countries. Seven topics emerged as major themes: disease classification, disease activity, relevant subpopulations, disease severity, disease progression, disease remission, and unmet needs. For 4 of these topics, there was no consensus – particularly regarding definitions that could be used in a clinical setting. The terms “systemic involvement” and “extra-glandular symptoms” have similar meanings but lack consistent application between clinicians. There was a lack of consensus on what “severity” refers to – whether it is severity of disease damage, the nature of disease manifestations, the potential for irreversible damage, or level of symptoms. There were also conflicting opinions regarding whether patient perspectives should be incorporated in key definitions.
CONCLUSION: There is currently a lack of standard definitions specifically for daily practice, which may contribute to high variability in clinical assessment and management. The definitions proposed in this study represent initial working concepts and are intended as a first step to promote further discussion among SjD experts to facilitate a more unified routine evaluation of patients.
BACKGROUND: In 2024, the UK National Institute of Health and Care Excellence (NICE) recommended TriageHF alerts as an option for remote monitoring of patients with heart failure (HF) and a compatible cardiac implantable electronic device (CIED). Data on the cost-effectiveness of this approach has not been published. This research evaluates the cost-effectiveness of TriageHF Plus in public hospital settings, using data from the TriageHF Plus multicentre study (758 participants, NCT04177199).
METHODS: An economic model was developed to capture the lifetime cost and benefits of TriageHF Plus versus usual care, based on a site of 300 eligible patients. Analysis on individual patient-level data informed model efficacy and resource use parameters. EuroQol five-dimensional questionnaire data and unit costs were obtained from published, peer-reviewed literature and national databases respectively. Costs and benefits were discounted at 3.5% per annum to adjust future costs and benefits to present value.
RESULTS: In a site size of 300, TriageHF Plus was predicted to prevent 384 (363–405) hospitalisations over 5 years. In total, TriageHF Plus saved £3989 (£1812–£5563) per person-lifetime versus usual care and was more effective and cost-saving in 99.4% of simulations. Results were robust to changes in key input parameters. Modelling showed that to avoid one hospitalisation, 1.7 people would need lifetime access to TriageHF Plus.
CONCLUSION: The TriageHF Plus pathway is cost-effective for the remote monitoring of HF in patients with CIEDs.
Diabetes affects over 500 million people worldwide and contributes substantially to the environmental impact of health care, including carbon emissions and plastic waste. As healthcare systems globally aim to reduce their environmental footprint, there is a need to embed environmental sustainability into decision making and foster innovation in health and life sciences.
This commentary outlines the environmental sustainability challenges and opportunities across the diabetes care pathway, highlighting innovations that reduce the demand for healthcare resources and associated environmental impact. We discuss the current and potential role of health technology assessment (HTA) agencies in promoting more sustainable health systems, by incorporating environmental considerations into the value assessment of technologies. Several approaches, such as integrated and parallel evaluation, are emerging to support this aim, whereas HTA agencies increasingly consider parameters of environmental life cycle assessment (eLCA), a comprehensive framework for evaluating the environmental sustainability of technology. Although a framework is evolving, early implementation by HTA bodies, for example, in the United Kingdom, Thailand, Canada, and Italy, highlights growing momentum. Moreover, sustainability policies at government and health system levels are developing globally, signaling opportunities to incorporate environmental sustainability in HTA (ESHTA).
Given the scale of health care’s environmental footprint, large disease areas offer critical opportunities for sustainable action. Diabetes, with its growing global prevalence, presents a particularly suitable domain for piloting the integration of environmental sustainability into HTA.
BACKGROUND: English Local authorities are responsible for delivering the Healthy Child Programme (HCP), to improve the health and wellbeing of children. Despite the importance of prevention, economic evidence to guide investment is limited, particularly for school-aged children. This scoping review aimed to map UK-based economic evidence relevant to the HCP for children aged 5–19 years, to inform policy and highlight gaps in the evidence.
METHODS: We searched sixteen databases in December 2023 to January 2024, in addition to citation and key websites searching. Eligible studies included economic evaluations and return on investment analyses of interventions that could be potentially delivered by local authorities under the HCP. Two reviewers screened titles and abstracts, and extracted data on study characteristics, methods, and outcomes. We assessed risk of bias using the Economic Evaluation Bias (ECOBIAS) checklist, synthesised the available evidence descriptively, and presented findings using summary tables and an evidence gap map.
RESULTS: We included 39 economic analyses. The most commonly evaluated interventions focused on mental health (12 studies), followed by physical activity (9 studies), healthy eating (4 studies, of which 2 were in combination with physical activity), risk behaviours (4 studies), bullying (3 studies), obesity (2 studies), hearing or vision screening (2 studies), social workers in schools (2 studies) and sexual health, ADHD prevention and improving oral health (each one study). Ten studies reported an incremental cost-effectiveness ratio (ICER), five studies reported either a benefit–cost ratio (BCR) or incremental net monetary benefit (INMB), whilst others described quality-adjusted life years (QALYs), costs or willingness to pay.
In general, robust evidence of the value of these interventions was partial because the interventions and methods of analysis were heterogenous. School nurse delivered services were particularly underrepresented despite their central role in the HCP delivery.
CONCLUSIONS: This review highlights the diverse range of interventions available to local authorities and the lack of robust economic evidence to support prioritisation of investment as part of the HCP 5–19 years. Further research should focus on developing more robust evidence of the value of public health interventions in this age group, using economic analysis to enable priority-setting, and addressing the evidence gaps identified.
