Chronic kidney disease (CKD) is a major global cause of morbidity and mortality. Recent nephroprotective therapies have improved CKD management, yet their cost effectiveness across settings remains uncertain. This review systematically identified and compared cost-effectiveness studies of novel CKD treatments for both broad CKD populations and disease-specific subgroups. A systematic search was conducted in PubMed and the Cochrane Library using terms related to "chronic kidney disease," "cost-effectiveness," "cost-utility," "health technology assessment," "SGLT2 inhibitor," and commercial and generic names of nephroprotective drugs approved since 2013. Eligible studies were full-length articles in English published between January 2015 and September 2025. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were extracted. All monetary values were standardized to 2025 US dollars. The search yielded 172 records, of which 26 met inclusion criteria. A supplementary search identified ten additional studies, resulting in 36 evaluations. Most studies assessed sodium-glucose cotransporter 2 inhibitors or finerenone. Across evaluations, these therapies consistently improved outcomes, with QALY gains reported in all studies (0.012-1.44 QALYs gained). Most concluded that the interventions were cost effective compared with standard of care, and 13 reported cost-saving results. Only three studies reported an incremental cost-efffectiveness ratio above $100,000 per QALY threshold. Cost effectiveness was observed in both general CKD and CKD with diabetes mellitus, although estimates varied by country, time horizon, and analytic perspective. Current evidence indicates that novel nephroprotective therapies for CKD are generally cost effective, and in some settings cost saving. These findings support their value in both general CKD and diabetic populations and highlight the importance of early treatment adoption to delay disease progression and reduce long-term healthcare costs.

Quality-adjusted life-years (QALYs) are the predominant health benefit measure used in health technology assessment. In response to legal and policy constraints on the use of QALYs in some jurisdictions, alternative outcome measures, such as equal value life-years and health years in total, have been proposed. However, there is limited illustration of how these alternative measures behave when applied to common health economic model structures. Three stylized oncology economic models, reflecting typical features of published cost-effectiveness analyses, were used to examine how alternative outcome measures re-express identical underlying survival and health-related quality-of-life inputs. Outcomes based on QALYs were compared with those based on life-years, equal value life-years, and health years in total for renal cell carcinoma, chronic myeloid leukemia, and non-small cell lung cancer. Incremental health years in total were consistently larger than incremental QALYs (13-46% higher). The relationship between life-years and QALYs varied across indications (from 63% lower to 43% higher). When applied to identical model inputs, alternative outcome measures primarily re-express existing information rather than incorporate additional dimensions of health benefit. Differences relative to QALYs reflect alternative weighting of survival and health-related quality-of-life effects and depend on the balance between these components. These findings highlight the need for careful interpretation of alternative measures when used alongside QALYs in economic evaluation.

Modelling the cost effectiveness of screening interventions presents unique challenges. These relate to a lack of knowledge about underlying health states and disease progression in the absence of screening, added costs arising from incidental findings, screening recall and follow-up diagnostics, imperfect uptake, potential harms to otherwise healthy people, and impacts on resource capacity and equity. No specific but generalisable advice currently exists to help guide health economic modellers working in this area. There is a need for tailored recommendations beyond the widely used, health economic modelling frameworks. We aimed to develop a set of recommendations for modelling the cost effectiveness of screening programmes. In our iterative process, we first drafted a conceptual document outlining key issues requiring recommendations. This framework was then expanded based on additional themes identified through a survey of screening modelling experts. Next, the draft recommendations were shared with a broader international expert group, which included modellers, health economists and policy specialists. Finally, the core concepts were refined and agreed upon during a virtual stakeholder meeting. A set of ten recommendations and a checklist are presented. The document provides guidance on critical methodological requirements for modelling screening interventions. These guidelines are intended to help health economic modellers and screening policy makers working to evaluate screening interventions across a wide range of diseases and jurisdictions with clarity, rigour and consistency.

Combination vaccines combine several components in a single dose administration. They offer programmatic and public health advantages, particularly as vaccine schedules become increasingly crowded. They are often more expensive to develop and produce, which discourages manufacturer investment without clear market signals. Hence their benefits need to be captured with existing health economic evaluation reference cases used by decision-makers to guide vaccine investments. We propose that the value of combination vaccines can be captured through at least four domains: (1) reductions in tangible and intangible costs to caregivers, (2) operational efficiencies to the health system, (3) opportunity costs of vaccine schedule slots, and (4) more streamlined vaccine schedules. We demonstrate the practicality of our framework by comparing the value of introducing a hypothetical vaccine to a crowded schedule as a standalone formulation, a replacement for a vaccine already in the schedule, or a combination product. The framework could also be applied to estimate the value of reducing the number of separate administrations needed for a standalone vaccine. Applying it in real-world situations could be facilitated by further data collection, particularly on collating results on the value of existing vaccines in the schedule and estimating willingness-to-pay for fewer vaccine administrations.

Collaborative engagement with individuals invested in or affected by health research, beyond researchers themselves, is advantageous and encouraged by major funding bodies. However, the degree of collaborative engagement in health state valuation is unclear. A scoping review was conducted to (i) identify recommendations on best practice in collaborative engagement in health economics and related literature; (ii) identify examples of collaborative engagement in valuation studies; and (iii) map (ii) onto (i) to identify current practice and future recommendations. Eight databases were searched in March-May 2024, with grey literature searches in August-September 2024. For objective (i), reports or manuscripts in health economics or patient-reported outcome measure development/evaluation of any date providing recommendations for collaborative engagement were included. For objective (ii), articles published since 2019 featuring health state valuation and collaborative engagement were included. Best practice recommendations were extracted and thematically synthesised. Examples of collaborative engagement were extracted and mapped against recommendations. Twenty-two records featuring recommendations and 15 valuation studies were included. A 15-item framework of emerging best practice recommendations for collaborative engagement was synthesised. Most examples of collaborative engagement involved patients and/or experts helping inform health states for valuation. There was no evidence for 9 out of 15 synthesised recommendations having been applied in any of the valuation studies and only minimal evidence was extracted for the remaining six. Collaborative engagement in health state valuation is underdeveloped and unaligned with literature recommendations. A 15-point framework has been developed as a strategic starting point for developing guidance to improve practice in the field.

This study examines the generalizability of foreign economic evaluations to the Spanish healthcare system. The research aims to describe the cross-country adaptation methods identified in a scoping review of multinational cost-utility analyses and to examine the probability of concordant funding decisions between Spanish and foreign results, as well as to identify factors influencing generalizability. First, a scoping review of multinational studies reporting cost-utility analyses for at least two countries, including Spain, was conducted using MEDLINE, PubMed, Embase and Web of Science in April 2025. Data related to transferability were extracted and a narrative synthesis was performed. Second, a dataset of case comparisons-each defined as a technology against a comparator in a specific population-was developed from the identified studies. Each foreign comparison was matched to its Spanish equivalent within the same study. Incremental cost-effectiveness ratios (ICERs) were converted to 2024 Spanish Euros and compared against a threshold of €30,000 per quality-adjusted life year (QALY). A multilevel logit model was used, with a binary variable indicating decision concordance between Spanish and foreign ICERs/dominance as the dependent variable. We also analysed the distances in the incremental costs and incremental QALYs between countries using a log-normal bivariate model. Country-specific and other study-related factors were considered as independent variables in both models. The review included 57 studies. Most were funded by drug manufacturers and conducted in Europe. The majority of authors did not specify their reasons for selecting countries. All but three studies attempted to use local costs, probabilities and/or epidemiological data. Twelve studies incorporated country-specific utilities. A total of 644 comparisons were analysed; 142 were Spanish results and 502 were foreign results with their Spanish equivalents. The cost-effectiveness plane quadrant of the foreign result matched the Spanish result in 84% of cases. Assuming a threshold of €30,000 per QALY, the funding decisions were the same in 93% of cases. The probability of decision concordance was higher when the study was conducted in a Eurozone country or in the United Kingdom. Sensitivity analysis showed the variability of decisions depending on the selected cost-effectiveness threshold. Similar variables were found as relevant factors explaining the distance in the incremental QALYs analysis. Foreign cost-effectiveness results of those studies analysing drugs from Eurozone countries such as France, Germany, Italy, or from the United Kingdom can often be generalizable and provide meaningful insights for decision making in Spain. However, these findings should not be used as a reason to avoid country-specific studies if they are feasible. Further research is needed to determine if these findings apply to other health technologies. Limitations of the study include the lack of a formal assessment of the methodological quality of the selected studies and the potential risks of bias.