Shan Jiang

Introduction: Hereditary breast and ovarian cancer, linked to BRCA gene mutations, poses significant health risks. Australian breast and ovarian cancer mortality rates emphasize the public health importance of effective screening. This study evaluated the cost effectiveness of population-wide BRCA screening and its equity implications, focusing on reducing health disparities across socioeconomic groups through early detection and prevention strategies. Methods: A cost-effectiveness analysis was conducted comparing population-wide BRCA screening to family-history-based testing for Australian women aged 30 to 50 years. A decision-analytic model included a decision tree and two Markov models simulating outcomes over a lifetime horizon. Transition probabilities captured risk-reducing interventions. Outcomes included quality-adjusted life years (QALYs) and costs in 2024 AUD, discounted at five percent. Socioeconomic quintiles were defined using Socio-Economic Indexes for Areas, and distributional impacts were assessed with net health benefits and equally distributed equivalent health (EDEH) using the Atkinson index. Model inputs were derived from census data and empirical studies. Opportunity costs used UK data as a proxy. Results: Screening at the age of 30 years was cost saving (incremental cost-effectiveness ratio [ICER] −AUD8,331 [−USD5,482] per QALY), while screening at ages 35 and 40 years was cost effective (ICERs: AUD28,231 [USD18,577] and AUD40,086 [USD26,384] per QALY, respectively). Screening at ages 45 and 50 years exceeded the threshold (ICERs: AUD78,666 [USD51,778] and AUD155,937 [USD102,640] per QALY). Distributional analysis showed screening at the age of 30 years increased average quality-adjusted life expectancy and EDEH, reducing health inequality between socioeconomic groups. In contrast, screening at older ages resulted in diminished benefits and exacerbated inequalities, highlighting the importance of early intervention in achieving both cost-effectiveness and equity goals. Conclusions: Population-wide BRCA screening was cost effective for Australian women at younger ages, particularly at the age of 30 years, and reduced health inequalities. Policymakers should prioritize early screening to address hereditary breast and ovarian cancer, promote health equity, and alleviate disease burden. Further strategies to enhance access among disadvantaged groups could amplify these benefits, advancing a more equitable healthcare system.

To investigate the cost-effectiveness of toripalimab plus chemotherapy versus chemotherapy alone for advanced non-small cell lung cancer (NSCLC) patients from a societal perspective. A partitioned-survival model estimated the costs and cost-effectiveness of toripalimab plus chemotherapy versus standard chemotherapy for advanced NSCLC over 20 years. Clinical data were derived from the CHOICE-01 trial, and cost and utility inputs were gathered from Yaozh.com, expert interviews, and a nationwide hospital-based survey. Costs were reported in 2022 US dollars, and outcomes included quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs), with a 5% discount rate was applied. Sensitivity, subgroup, and scenario analyses verified the robustness of results. Toripalimab plus chemotherapy resulted in 3.052 QALYs and a total cost of $60,813, with an ICER of $19,066 per QALY, below China's 3 times GDP per capita threshold ($38,223). Robustness is confirmed through sensitivity, subgroup and scenario analyses. Toripalimab plus chemotherapy is a cost-effective option for treatment-naive advanced NSCLC compared to chemotherapy alone, providing valuable evidence for clinical and reimbursement decision-making.

Early diagnosis through genome sequencing can significantly transform clinical care for critically ill neonates. Traditional testing methods often fall short in

Background: Hereditary breast and ovarian cancers (HBOCs) pose significant health risks worldwide and are mitigated by prophylactic interventions. However, a meta-analysis of their efficacy and the impact of different genetic variants on their effectiveness is lacking. Methods: A systematic review and meta-analysis were conducted, adhering to Cochrane guidelines. The review encompassed studies that involved prophylactic interventions for healthy women with BRCA variants, focusing on cancer incidence and mortality outcomes. The Newcastle–Ottawa Scale was used for risk of bias assessment. We pooled the extracted outcomes using random effects models and conducted subgroup analyses stratified by intervention, variant, and cancer types. Results: A total of 21 studies met the inclusion criteria. The meta-analysis revealed that prophylactic interventions significantly reduced cancer risk and mortality. The subgroup analysis showed a greater protective effect for BRCA2 than BRCA1 variant carriers. Risk-reducing surgeries (RRS) were more effective than chemoprevention, with RRS notably reducing cancer risk by 56% compared to 39% for chemoprevention. Prophylactic oophorectomy significantly reduced HBOC risks, while the effect of prophylactic mastectomy and chemoprevention on mortality was less conclusive. Conclusions: Prophylactic interventions significantly reduce the risk of HBOC and associated mortality. This comprehensive analysis provides insights for future economic evaluations and clinical decision-making in HBOC interventions.

Background Familial hypercholesterolemia is a prevalent genetic disorder with global implications for severe cardiovascular diseases. As the scrutiny on evaluating its economic impact intensifies, an imperative arises for a worldwide synthesis of economic evidence related to familial hypercholesterolemia screening. This study aims to globally examine economic assessments of familial hypercholesterolemia, synthesize evidence, and present economic insights into the impact of familial hypercholesterolemia screening on population equity. Methods A comprehensive, systematic literature review was conducted to identify economic evaluations of familial hypercholesterolemia screening programs. The quality appraisal of literature was guided by the quality of health economic studies instrument and consolidated health economic evaluation reporting standards 2022. Meta-analysis techniques were applied to integrate findings from various studies, focusing on the total cost-effectiveness and total net health benefit associated with both cascade and universal screening programs for familial hypercholesterolemia. An aggregate distributional cost-effectiveness analysis was employed to determine the potential impact of screening programs on health equity across populations. Results The study results reveal significant differences in the economic evaluations of familial hypercholesterolemia across different countries, and we provide detailed descriptions of unique characteristics. The combined results of cost-effectiveness analyses indicate that 90% of screening for familial hypercholesterolemia is cost-effective. Meta-analysis synthesized the economic impacts of seven sets of cascade and universal screening across diverse health outcomes. Aggregate distributional cost-effectiveness analysis showed that the difference was positive across all six studies, indicating that familial hypercholesterolemia screening strategy has the potential to mitigate health inequalities. Conclusion This study provides a global perspective on familial hypercholesterolemia economic evaluation. Despite international variations, findings suggest that, in the majority of cases, familial hypercholesterolemia screening is cost-effective, improving health equity and overall population health. The study offers a positive outlook for future health decisions.

INTERNATIONAL REGISTERED REPORT RR2-10.2196/45747