Introduction:
Lung cancer is a leading cause of mortality globally, with EGFR-mutated metastatic non-small cell lung cancer (NSCLC) prevalent in the Asian population. EGFR-tyrosine kinase inhibitors (TKIs) are used for managing this condition. The FLAURA trial recently demonstrated the remarkable efficacy of osimertinib in the front-line setting. However, analyzing real-world effectiveness, safety, and pharmacoeconomic considerations is essential for patients to make informed treatment choices.
Aims:
This study aims to compare the clinical effectiveness and safety of osimertinib versus gefitinib/erlotinib in treating EGFR-mutated metastatic non-small cell lung cancer (NSCLC), along with a cost-effectiveness analysis.
Methods:
This prospective, single-center, open-label, parallel assignment, phase IV cohort study was conducted at a Clinical Oncology Center in the western region of India. Patients with EGFR-mutated metastatic NSCLC were recruited after obtaining informed consent and allocated into two cohorts. Cohort 1 received osimertinib, while cohort 2 received gefitinib/erlotinib. Patients were followed for 1 year. The response to EGFR-TKIs was assessed using objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and incidence of adverse events (AEs). Incremental cost-effectiveness ratio (ICER) was calculated through a cost-effectiveness analysis.
Results:
A total of 70 patients were enrolled, with 35 patients in each cohort. The ORR for cohorts I and II was 11.11% and 25.64% (p=0.142), respectively, and the DCR was 69.44% and 82.05% (p=0.28), respectively. Osimertinib and gefitinib/erlotinib had median PFS of 8.43 months and 10.68 months, respectively. The incidence of AEs for osimertinib and gefitinib/erlotinib was 1.94 and 2.49, respectively. The ICER between cohorts I and II was 454,848 INR.
Discussion:
Osimertinib was not found to be superior to gefitinib/erlotinib in terms of clinical effectiveness and direct medical costs, particularly in a developing nation like India. Although osimertinib demonstrated a better safety profile, the higher treatment cost compared to gefitinib/erlotinib is not justifiable.

Introduction:
Chronic kidney disease (CKD) imposes a substantial economic burden on many countries and patients' families due to its high morbidity and mortality rates.

Aims:
To analyze the impact of drug price changes on the economic burden of erythropoiesis-stimulating agents (ESAs) and roxadustat for treating anemia in CKD patients in China.

Methods:
We utilized national cohort data from Tianjin Inspur Healthcare Big Data. Patients with renal anemia aged over 18 who visited any hospital in Tianjin from January 2018 to June 2023 were included. Study indicators included changes in the average price of roxadustat and ESAs from 2019 to 2023, changes in drug utilization, and changes in patient costs.

Results:
A total of 130,863 patients with renal anemia were enrolled in the study cohort. The average price of traditional ESA drugs remained stable from 2019 to 2023, with minor fluctuations of less than $10. In contrast, roxadustat, a novel drug for renal anemia treatment, showed a consistent annual price decrease from $413.79 in 2019 to $134.28 in 2023. ESA usage decreased from 2019 to 2023: 727,136 (100%), 781,909 (94.8%), 74,727 (87.8%), 649,548 (77.7%), and 245,692 (72.5%). Meanwhile, roxadustat usage increased: 290 (0.0%), 42,856 (5.2%), 103,601 (12.2%), 185,982 (22.3%), and 93,328 (27.5%). Patient visit costs from 2019 to 2023 were $1.40 billion, $2.86 billion, $1.93 billion, $2.07 billion, and $1.19 billion, respectively.

Discussion:
No significant correlation was found between drug price changes and the overall financial burden of ESA and/or roxadustat for anemia in Chinese CKD patients.

Background: Pharmacogenomic testing has the potential to improve the efficacy and safety of antidepressant pharmacotherapy. This study aims to assess the cost-effectiveness of implementing a combinatorial pharmacogenomic testing (CPGx) approach to guide the prescription of antidepressants.
Methods: We developed a two-stage decision tree diagram of a short-term 6-week follow up, and a lifetime Markov model with 3-month cycles. The analysis compared the current standard of care (SoC) with the alternative strategy of CPGx testing in adult patients with major depressive disorder (MDD). Clinical outcomes and utilities were obtained from published studies, while healthcare costs were estimated based on data from Hamad Medical Corporation, Qatar. The short-term outcome measure was the incremental cost-effectiveness ratio (ICER) against treatment response without side effects and without relapse, as well as against treatment response with or without side effects and without relapse. The long-term outcome assessed the ICER against the quality-adjusted life year (QALY) gained, with a 3% annual discount rate. The study adopted a public hospital perspective. One-way, multivariate, and scenario sensitivity analyses were performed to evaluate the robustness of the model.
Results: Adopting the CPGx testing for adult patients with MDD in Qatar resulted in cost savings of Qatari Riyal (QAR) 2,289 (95% CI, -22,654-26,340) for the health system. In the short term, the CPGx testing was associated with higher response rates without side effects and without relapse (mean difference 0.10, 95% confidence interval (CI) 0.09-0.15) and higher response rates with or without side effects and without relapse (mean difference 0.05, 95% CI 0.04-0.06) compared to the SoC. For long term, the CPGx testing resulted in 0.06 QALYs gained, per person, along with cost savings of QAR 46,215 (95% CI -15,744-101,758).
Conclusion: Implementing pharmacogenomic testing to guide antidepressant use was found to improve population health outcomes, while also significantly reducing health system costs.

Introduction. Tackling cardiovascular disease (CVD) in type 2 diabetes (T2D) is a crucial priority. A novel measure called the productivity-adjusted life-year (PALY) has been developed to account for the productivity loss from diseases.
Aims. To use a 10-year dynamic modeling to examine the burden of CVD resulting from T2D in terms of PALYs among the working age population, and to explore the potential impact of interventions on the burden of CVD in T2D in Qatar, 2024-2033.
Methods. We designed models to quantify the productivity burden (using the PALY) of CVD in Qataris with T2D aged 40–65 years from 2024 to 2033. The base-case analysis was designed to quantify the burden of CVD in terms of PALYs experienced using real-world data from the Primary HealthCare Corporation (2020). The risk of first CVD events was estimated via the 2013 PCE-ASCVD. Afterward, three simulations were conducted under hypothetical scenarios to assess the potential productivity advantages resulting from enhanced control of risk factors. These scenarios included reductions in systolic blood pressure (SBP) by 17%, number of smokers by 19%, and incidence of T2D by 9.5%. To determine the productivity, we considered the absenteeism, presenteeism, and workforce dropouts.
Results. In the base-case, the estimated total PALYs were 2.18 million, contributing US$233.03 billion to the country's GDP. Reducing the incidence of T2D by 9.5% would project gains of 113,911 PALYs, accompanied by economic gains of US$12.44 billion. Additionally, if there were a 17% reduction in SBP and a 19% reduction in smoking numbers, there would be gains of 111,677 and 108,228 PALYs, respectively. These reductions would also result in economic gains of US$12.61 billion and US$12.21 billion, respectively.
Conclusion. CVD in T2D could have a significant impact on PALYs in Qatar. However, improved risk factors control has the potential to mitigate the impact of this condition.

Introduction. Lynch syndrome (LS), the most prevalent hereditary condition of colorectal cancer (CRC), accounts for 2-3% of all CRC cases. Recent US and European guidelines have recommended universal LS screening or routine screening of CRC patients up to 70 years old. However, despite the clear benefits of LS screening programs, there is a lack of economic evaluations of such programs in Vietnam, where the prevalence of CRC is rapidly increasing.
Aims. The primary objective of our study is to assess the cost-effectiveness of implementing universal screening for LS among patients with CRC from the perspective of a healthcare system. Additionally, we sought to identify critical parameters that may influence the cost-effectiveness of LS screening and warrant consideration by Vietnamese policy-makers.
Methods. In this study, we utilized a state-of-the-art decision-analytic model to assess the cost-effectiveness of LS screening from the perspective of the healthcare system in Vietnam. Our novel approach allowed us to compare two distinct testing strategies: sequencing of all MMR genes without prior tumor analysis (Strategy 1), sequential immunohistochemistry and germline testing analysis (Strategy 2), and no testing.
Results. Assuming a CRC incidence rate of 0.0168%, and a share of patients affected by LS equal to 6.25%, the model identified 801 newly LS diagnosed cases. Our analysis indicated that universal LS screening is highly cost-effective. Strategy 2 was the most sensitive strategy in identifying LS CRC patients (N = 801), followed by strategy 1 (N = 697). Strategy 1 was the most expensive, followed by Strategy 2. The ICERs relative to the “No Screening” strategy ranged from 3 154 USD/QALY in Strategy 2 to 8 026 USD/QALY in Strategy 1. The one-way sensitivity analysis results shown that the variables most influenced model outcomes in the both two strategies were the utility of alive after cancer and probability CRC for LS carriers.. The cost-effectiveness acceptability curves for two strategies compared to the “No Screening strategy”. Considering a threshold of 12.852 USD/QALY (3 times GDP per capita), strategy 2 had a 100% probability of being cost-effective as compared to “No Screening” and strategy 1 had around 70% probability of being cost-effective.
Discussion. This is the first comprehensive economic evaluation of LS testing strategies in Vietnam, and our results provide compelling evidence to support the introduction of cost-effective LS screening recommendations in the country.

Introduction: Chronic diseases pose a significant and growing burden on healthcare systems worldwide. Health-related quality of life (HRQoL) is a crucial measure reflecting the overall well-being of individuals affected by these conditions.

Aims: This study aimed to quantify the impact of various chronic diseases on individuals' HRQoL using a nationally representative survey database in Taiwan and to identify variations in HRQoL across different demographic groups and disease conditions.

Methods: We utilized data from the 2017 National Health Interview Survey, which included 15,765 individuals aged over 20 years. The study population was divided into two subgroups using age 65 as the cutoff for analysis. HRQoL was assessed using the EQ-5D-5L index, derived from EQ-5D-5L responses based on the Taiwanese value set (range -1.03~1), and the EQ-VAS (0~100). The impact of each chronic disease on HRQoL was measured using ordinary least squares regression.

Results: Overall, 7,844 individuals reported having at least one chronic disease. The average number of comorbidities was 0.70 (SD 1.09) for those under 65 and 2.19 (SD 1.79) for those over 65. Among the younger age group, individuals with stroke exhibited the worst HRQoL, with the lowest EQ-5D-5L index (mean ± SD: 0.7936 ± 0.3680) and EQ-VAS (65.23 ± 18.21). For the elderly over 65, those with Parkinson’s disease had the lowest EQ-5D-5L index (0.4859 ± 0.5449), while those with mental disorders had the lowest EQ-VAS (61.97 ± 19.28). Multivariable regression confirmed that these diseases contributed the most significant negative impact on individuals’ HRQoL when relevant demographic factors and the number of comorbidities were controlled.

Discussion: The study quantified the disease burden in Taiwan by evaluating HRQoL scores under different chronic conditions. However, significant variations were observed in the distribution of EQ-5D-5L index and EQ-VAS scores across various chronic diseases, highlighting the need for further investigation into the discrepancies.