Health Decision

Age priority in continuous coronavirus disease 2019 booster doses under China's new policy of free-will nucleic acid test: A dynamic model-based effectiveness and cost-effectiveness analysis

Dachuang Zhou — 2023-05-26

Background: The initial mass vaccination's effectiveness has diminished, necessitating accelerated immunization coverage scaling. China has shifted nucleic acid testing from large-scale to voluntary. This study assesses the effectiveness and cost-effectiveness of different booster vaccination strategies in China. Methods: A dynamic transmission model divided the population into three groups: 0-19, 20-59, and 60+ years. We evaluated the effectiveness and cost-effectiveness of three vaccination strategies based on previous studies and public databases. Three scenarios were modeled and compared to no-continuation-vaccination to calculate averted diseases, deaths, and net benefits. One-way sensitivity analysis and probabilistic sensitivity analysis assessed findings' stability. Results: COVID-19 vaccination had significant health benefits compared to no continuing vaccination. Strategy II (prioritizing vaccinated 20-59-year-olds, then vaccinated 60+ individuals, and finally 0-19-year-olds) was the most cost-effective. Strategy I (prioritizing unvaccinated 60+ individuals, then 20-59, and finally 0-19) prevented the most deaths. Strategy II was the most cost-effective, with a total cost of 93,995,223,462 USD and the highest net benefit of 3,054,475,908,551,960 USD. Strategy II resulted in the highest number of avoided cases across categories, including infected, asymptomatic, mild/moderate, severe, and critical cases. Each strategy's effects on preventing new cases and critical illness were comparable. Sensitivity analyses confirmed the results' reliability. Conclusion: Prioritizing vaccinated 20-59-year-olds, then vaccinated 60+ individuals, and finally 0-19-year-olds was the most effective prevention strategy. The vaccination strategy should be tailored to the pandemic situation and available medical resources for maximum health gains.

Different vaccination strategies for preventing coronavirus disease 2019 in Kenya: A dynamic modelling study of health impact and cost-effectiveness

Dachuang Zhou — 2023-04-26

Background: Vaccination can significantly reduce the health impact and economic burden of coronavirus disease 2019 (COVID-19), but vaccination levels for COVID-19 in most African countries lag far behind global averages. We assessed the cost-effectiveness of different COVID-19 vaccination strategies in Kenya and determined the optimal vaccination strategy. Methods: Using a dynamic transmission model, we divided the population into three groups: 0-18 years, 19-58 years and 58+ years. We assessed the effectiveness and cost-effectiveness of three vaccination strategies at different numbers of daily vaccinations based on previous studies and public databases. Nine scenarios were modeled and compared to no-continuation-vaccination to calculate the number of averted diseases, averted deaths, and net benefits of different vaccination strategies. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to assess the stability of our findings. Results: Compared to no-continuation-vaccination for various vaccination scenarios, all vaccination strategies were found to be effective and cost-saving. The incremental net benefit ranged from 0.235 billion USD to 2.305 billion USD, and prioritizing vaccination boosters for individuals aged 19-58 was identified as the most cost-effective option. On the other hand, prioritizing vaccination for the unvaccinated population aged 58 and above could potentially reduce COVID-19 related deaths by 1.59%-56.60%, which was the most effective approach in avoiding cause-specific deaths. However, all vaccination strategies were found to be ineffective in controlling the infection trend when compared to no intervention under different vaccination scenarios, with only 474,318-5,306,865 infections potentially being prevented. Conclusion: Timely and widespread vaccination against COVID-19 in Kenya is effective and cost-effective, a specific vaccination strategy should be selected based on decision-making needs. Priority vaccination for the elderly without vaccination may be more cost-effective compared with other vaccination strategies.

Cost effectiveness analysis of blonanserin versus ziprasidone as first-line treatment for patients with schizophrenia in China

Xin Guan — 2023-08-31

Background and Objectives: The aim of the study is to evaluate the cost-effectiveness of blonanserin compared with ziprasidone as first-line treatment for patients with schizophrenia in China. Methods: A 10-state Markov model was built to assess the long-term cost-effectiveness of blonanserin from China health care system perspective. A time horizon of 10 years with monthly cycle was chosen. Patients with schizophrenia will receive blonanserin or ziprasidone as first-line treatment and could switch to olanzapine or clozapine as second-line or third-line treatment when symptoms relapse happens. Efficacy and safety data were derived from network meta-analysis. Probabilities of experience recurrences were derived from a retrospective cohort study. The costs were obtained from real world data and local published resources. Costs and outcomes were both discounted at 5%. Sensitivity analysis were conducted to verify the robustness of the results. Results: Blonanserin generated 4.30 quality-adjusted life-years (QALYs) with cost of Chinese Yuan (CNY) 167,011, whereas ziprasidone generated 4.28 QALYs with cost of CNY 173,575. Compared with ziprasidone, blonanserin was seen as the dominant treatment. One-way sensitivity analysis demonstrated the robustness of the base case results. Probabilistic sensitivity analysis showed that blonanserin was a cost-effective strategy in more than 70% simulations under the local threshold compared with ziprasidone. Conclusions: Compared with ziprasidone, blonanserin is cost-effective as first-line treatment for patients with schizophrenia in China.

A Erratum on Cost effectiveness analysis of blonanserin versus ziprasidone as first-line treatment for patients with schizophrenia in China

Xin Guan — 2023-11-24

Traditional Chinese medicine in treating corona virus disease 2019: A systematic review and cost-effectiveness analysis

Taihang Shao — 2023-03-17

ABSTRACT

Background: Currently, corona virus disease 2019 (COVID-19) has infected 633,601,048 people worldwide according to World Health Organization, which leads to huge disease burden. A considerable number of trials of traditional Chinese medicine (TCM) have been carried out and have shown the efficacy of TCM in the treatment of COVID-19, but their cost-effectiveness has not been studied, especially in China. Therefore, we plan to perform a systematic review and cost-effectiveness analysis to explore the cost-effectiveness of using TCM in treating COVID-19.

Methods: A systematic review based on previously published secondary data from randomized controlled trials and observational studies which included TCM as one of the interventions for patients with COVID-19 will be performed. Patients with COVID-19 will be classified into five specific groups (patients without diagnosis; patients with mild, moderate, severe and critical symptoms). TCM versus western medicine on both effectiveness outcomes(cure rate and survival rate) and utility outcome(quality-adjusted life years) will be evaluated. A decision tree model will be established taking the perspective of Chinese health care system since the costs were paid by the Chinese government. Cumulative costs, Qalys, and incremental cost-effectiveness ratio will be selected as the outcome indicator. Sensitivity analysis will also be conducted to evaluate the impact of parameter uncertainty on the base-case analyses results. We will present results at various willingness-to-pay thresholds using a cost-effectiveness acceptability curve.

Discussion We hope to demonstrate the cost-effectiveness of TCM, see an improvement in the patients' quality of life, achieve a improvement in the cure rate and survival rate of COVID-19. If TCM is cost-effectiveness, it could be applied to clinical practice decision making.

Ethics and dissemination: Ethics approval is not required for the current study. Because the data used in this study is just the re-use of data which are already in the public domain. The results will be disseminated to general public, clinicians, academics and policy makers.

Registration number: CRD42021228887

Keywords: Traditional Chinese medicine; Corona Virus Disease 2019; decision tree model; systematic review; cost-effectiveness analysis

Traditional Chinese medicine provides new ideas for the treatment of coronavirus disease 2019

Jie Guan — 2023-02-10

Improving evidence and outcomes in health decision-making in Asia-Pacific

Aixia Ma — 2023-01-05