https://hdl.handle.net/10419/76676 2026-09-14T01:48:12Z https://hdl.handle.net/10419/285303 Title: Transcatheter aortic valve implantation against conventional aortic valve replacement surgery in high-risk patients with aortic stenosis: A cost-effectiveness analysis Authors: Ghiasvand, Hesam; Khaleghparast, Shiva; Kachoueian, Naser; Tirgarfakheri, Kourosh; Mortazian, Meysam; Toloueitabar, Yaser; Gorjipour, Farhad; Naghdi, Seyran Abstract: Background: Aortic stenosis is a prevalent heart valvular disorder in Iran. Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) are two common procedures for treating the disease in the current clinical pathway. However, TAVI is an expensive procedure, and for Iran with severe limitations in fnancial resources, it is crucial to investigate the cost-efectiveness of the technology against other competing alternatives with the same purpose. This study aims to analyse the cost-efectiveness of TAVI vs SAVR in elderly patients who are at a higher risk of surgery. Methods: This study is a decision economic evaluation modeling, with a lifetime horizon and a healthcare payer (health insurer) perspective. The utility values are from a previous study, transitional probabilities come from an established clinical trial called PARTNER-1, and the unit costs are from Iran's national fee schedule for medical services. The probabilistic and one-way sensitivity analyses have been performed to mitigate the uncertainty. Results: The incremental cost, efectiveness, and cost-efectiveness ratio for the base case were: 368,180,101 Iranian Rial, (US$ 1,473), 0.37 QALY-per-patient, and, 995,081,354 Iranian Rial (US$ 3,980), respectively. The probabilistic sensitivity analysis yielded 981,765,302 I.R.I Rials (US$ 3,927) per patient for the ICER. The probability of being cost-efective at one and three times the country's Gross Domestic Production (GDP) is 0.31 and 0.83, respectively. Conclusions: TAVI does not seem a cost-efective procedure in comparison with SAVR at the current willingness to pay thresholds of the country. However, by increasing the WTP threshold to 3 times the GDP per capita the probability of being cost-efective will raise to 83%. 2023-01-01T00:00:00Z https://hdl.handle.net/10419/285305 Title: Incentivizing COVID-19 vaccination among racial/ethnic minority adults in the United States: $ 209 per dose could convince the hesitant Authors: Chen, Kevin; Wilson-Barthes, Marta; Harris, Jeffrey E.; Galarraga, Omar Abstract: Background: More than two years into the coronavirus disease (COVID-19) pandemic, it remains unclear whether fnancial incentives can reduce vaccine hesitancy and improve uptake among key unvaccinated populations. This study estimated the willingness of racial/ethnic minority adults in the United States to accept fnancial incentives for COVID-19 vaccination and the minimum amount needed to vaccinate a sufciently high percentage of this population. Methods: From August through September 2021, we conducted an online survey of 367 Black/African American and Hispanic patients, age=18 years, from 8 community health centers in Rhode Island. Contingent valuation questions assessed respondents' willingness-to-accept (WTA) incentives for COVID-19 vaccination using random-startingpoints and iterative incentive ofers of $5 to $50 per dose. Ordered logistic regression models examined associations between respondent characteristics and WTA. Predictive probabilities were modeled using both within-survey range and out-of-survey range incentive ofer amounts and compared against vaccination thresholds needed to reach herd immunity. Results: Less than 30% of unvaccinated survey respondents were WTA an incentive of $50/dose for vaccination. Mod- els using out-of-survey incentive ofer amounts greater than $50 suggested that 85% of respondents would agree $140/dose (95% CI: $43-$236) could convince other people to accept vaccination, while $209/dose (95% CI: -$91$509) would be needed for 85% of respondents to accept vaccination themselves. Conclusions: Findings from this analysis may inform the design of incentive schemes aiming to reduce racial/ethnic disparities in vaccine and booster uptake, which will continue to be important as new variants of SARS-CoV-2 emerge. 2023-01-01T00:00:00Z https://hdl.handle.net/10419/285306 Title: Approximating the influence of external factors on the technical efficiency score of hospital care: Evidence from the federal states of Germany Authors: Vrabková, Iveta; Lee, Sabrina Abstract: Background: A good health care system and, especially, the provision of efcient hospital care are the goals of national and regional health policies. However, the scope of general hospital care in the 16 federal states in Germany varies considerably from region to region. The objectives of this paper are to evaluate the technical efciencies of all general hospitals of the 16 federal states for the period from 2015 to 2020, to fnd out the relation between the exogenous factors and score of efciency, and also the infuence of the COVID-19 pandemic on the results of the technical efciency of hospital care in the German states. Methods: A two-step approach was used. First, an input-oriented Data Envelopment Analysis model with constant returns to scale and variable returns to scale was applied for the 6-year period from 2015 to 2020. The calculation of technical efciency according to the input-oriented DEA model contains the three components-total technical efciency (TTE), pure technical efciency (PTE) and scale efciency (SE). In the second stage, the infuence of exogenous variables on the previously determined technical efciency was evaluated by applying the tobit regression analysis. Results: Although the level of average technical efciency of about 90% is high, total technical efciency deteriorated steadily from 2015 to 2020. Its lowest point at around 78%, was in the year 2020. The deterioration of the average technical efciency is notably infuenced by the lower results in the years 2019 and 2020. The decomposition of technical efciency also revealed that the deterioration of overall average efciency was infuenced by both pure technical efciency (PTE) and scale efciency (SE). Based on the tobit regression analysis performed, it was possible to conclude that the change in the efciency score can be explained by the infuence of exogenous factors only from 6.4% for overall efciency and from 7.1% for scale efciency. Conclusions: The results of the analysis of the overall technical efciency reveal that the aggregated data of all general hospitals of all 16 federal states show a steadily worsening total technical efciency every year since 2015. Although, especially, the deterioration of the year 2020 with the occurrence of COVID-19 pandemic, contributes to a deteriorated efciency average, the deterioration of the efciency values, based on the analysis performed, is also observable between the years 2016 and 2019. Considering the output generated, for inefcient units and the relevant policy authorities in the hospital sector, it can be recommended that the number of beds and in particular the number of physicians, should be reduced as inputs. Based on this study, it is also recommended that decisions to increase the efciency of general hospitals should be made with consideration of exogenous factors such as the change in the number of general hospitals or the population density in the respective state, as these had explanatory value in connection with the increase in efciency values. Due to the wide variation in the size of the federal states, the recommendation is more appropriate for federal states with low population density. 2023-01-01T00:00:00Z https://hdl.handle.net/10419/285304 Title: The effect of altruism on COVID-19 vaccination rates Authors: Hierro, Luis Á.; Patiño, David; Atienza, Pedro; Garzón, Antonio J.; Cantarero, David Abstract: Background: After the emergence of the frst vaccines against the COVID-19, public health authorities have promoted mass vaccination in order to achieve herd immunity and reduce the efects of the disease. Vaccination rates have difered between countries, depending on supply (availability of resources) and demand (altruism and resistance to vaccination) factors. Methods: This work considers the hypothesis that individuals' health altruism has been an important factor to explain the diferent levels of vaccination between countries, using the number of transplants as a proxy for altruism. Taking European Union's countries to remove, as far as possible, supply factors that might afect vaccination, we carry out cross-sectional regressions for the most favorable date of the vaccination process (maximum vaccination speed) and for each month during the vaccination campaign. Results: Our fndings confrm that altruism has afected vaccination rates against the COVID-19. We fnd a direct relationship between transplants rates (proxy variable) and vaccination rates during periods in which the decision to be vaccinated depended on the individual's choice, without supply restrictions. The results show that other demand factors have worked against vaccination: political polarization and belonging to the group of countries of the former Eastern bloc. Conclusions: Altruism is a useful tool to defne future vaccination strategies, since it favors the individuals' awareness for vaccination. 2023-01-01T00:00:00Z