Academic publishing is at a critical juncture. The challenges faced by the academics are mired in controversy. Among theseare three hotly debated concerns. First is the issue of whether technological innovations such as artificial intelligence (AI)improves research efficiency or if its use sacrifices research integrity.Another is the controversy between paywall publishingand open access. Lastly, adapting an appropriate business model for sustainability is a contentious issue and the choice betweena commercial or a university-based publishing platform is a difficult one.

Traditional models of scientific investigation relied on tedious intellectual calisthenics in all aspects of research —identifying research gaps, reviewing of published literature, devising valid methodology, collecting data, analysing results, and,finally, drawing conclusions. With the advent of powerful tools employing artificial intelligence, these heavy tasks are efficientlycarried out. The dilemma lies in determining which parts of the work can be attributed to the authors and which are ascribedto the output of large language models (LLMs) and other automated assistance employed.Despite requiring adequate vettingby experts of these AI-aided output, many in the scientific community still question these methods. Can research employingAI be considered honest work? Will full disclosure answer doubts as to the integrity of the scientific work?

Indeed, LLMs just gather information that is already out there, albeit more efficiently. After all, science progresses bystanding on the shoulder of giants. AI makes such work comprehensive and efficient. Standing on those proverbial shoulders,however, require access to prior work, hence our next challenge in academic publishing--open access versus paid access.Paywalls limit the benefits of valuable research to institutions and universities with the capacity to pay. Excluded from these arethose from low resourced countries, with nations from the global south being affected disproportionately. Additionally, whilenumerous authors appreciate the features of open access as it improves their impact and visibility, many feel unduly burdenedsince the cost of publishing in this format is passed on to them.

This brings us to our third issue: who bears the cost of academic publishing? Indeed, it is a lucrative industry, generatingan annual revenue of US$19 billion and an estimated 40 percent profit margin. Many, however, find fault in this businessmodel as concerns about the profit motives of the commercial publishers far overshadow their sustainability goals.

How do we navigate this landscape of controversies? We, at the ACTA, as part of the community of scholars, would needto clarify our mission. Our goals for this publication should be consistent with our values. These values, such as scientific rigor,integrity, and accountability, should be reflected in our policies. We should be cognizant of the role we play in national scientificdiscourse while we endeavor to make an impact in the global scene. We are accountable to our stakeholders — nurturingearly career scholars, supplying evidence to health policymakers, and being accountable to those who provide resources tosustain us. This stewardship is essential so that ACTA will stand shoulder to shoulder with the giants on which science buildsupon to benefit future generations.

Artificial Intelligence ; Commerce ; Costs And Cost Analysis ; Disclosure ; Drawing ; Efficiency ; Family Characteristics ; Forecasting ; Goals ; Gymnastics ; Health ; Health Resources ; Industry ; Intelligence ; Inventions ; Language ; Literature ; Methods ; Play And Playthings ; Policy ; Publications ; Publishing ; Research ; Residence Characteristics ; Role ; Science ; Shoulder ; Social Responsibility ; Universities ; Ursidae ; Volition ; Work ; World Health Organization

Walking through the wards of a crowded public hospital and seeing suffering and tragedy from easily preventable conditionsmakes one wonder what it takes for a facility to change the outcomes. The evidence is there, and guidelines have beendeveloped from it; yet practices remain difficult to change—whether in screening, prevention, treatment, or rehabilitation.

Recently, the Department of Health has put up a compendium of clinical practice guidelines (CPG) crafted accordingto the standards set by the Manual for Clinical Practice Guideline Development of DOH-Philhealth.Guidelines stipulatethat dissemination and implementation be considered, and applicability issues are discussed. The uptake of the guidelinesshould be evaluated, and facilitators and barriers should be identified. Thus, there is a need for implementation andapplicability studies to assess how effective guidelines are. For breast cancer, the Philippine Guidelines were published in 2022and updated in 2026.Identified as barriers against implementation are financial constraints and out-of-pocket costs. Actahas since responded to these concerns by publishing articles on financing cost assessment, and in this issue, by Mondragonand co-authors, an “Assessment of Out-of-Pocket Expenditure of HER2-Positive Breast Cancer Patients in a Tertiary CancerCenter and Private Clinics in the Philippines.”

These types of studies are necessary in the translation of evidence to practice, allowing organizations to adopt, scale,and sustain recommendations to real-world settings.

Where CPGs on malnutrition cite resource constraints as the only significant barrier for implementation, the article byde Luna and co-authors on the “A Qualitative Program Evaluation Study on the Perceived Impact of Health and NutritionPrograms among Beneficiaries of a Civil Society Organization in the Philippines” in this issue of the Acta add fear ofsustainability by families and competition from readily accessible instant food of poor nutritional value as barriers in implementingsuch programs.

These studies help us go beyond information dissemination of evidence-based practice to create pathways for impactfulintegration of recommended interventions. Implementation studies sharpen our analysis and focus our efforts on strategies thatcan help pilot, roll out, and scale up guidelines.

New modalities to carry out recommendations can also be part of how guidelines are implemented in the communitysetting. Where the Philippine Academy of Rehabilitation Medicine (PARM) recommends early home-based rehabilitation,the Stroke Society of the Philippines recommends telerehabilitation to augment the efforts of care providers.The articleby Laxamana and co-authors in this issue on “The Acceptance of Stroke Telerehabilitation among Rehabilitation Providersand Consumers in Two Tertiary Hospitals in the Philippines” not only identifies but also provides suggestions to addressimplementation barriers.

We support and encourage articles on implementation science. These works provide tools to convert evidence into outcomes.These transform organizations and help us accomplish meaningful, lasting structural change that should come withoutany delay to provide relief to our patients in our crowded public wards.

Practice Guideline ; Program Evaluation ; Evaluation Studies As Topic ; Costs And Cost Analysis ; Organizations ; Residence Characteristics ; Health Services Needs And Demand

BACKGROUND

The survival advantage of HER2-positive breast cancer from targeted treatment is commonly undermined by catastrophic health expenditure (CHE), particularly in resource-limited areas. Recognizing that financial catastrophe leads to non-adherence to treatment and dissaving practices, we examined the out-of-pocket (OOP) expenses of patients with HER2-positive breast cancer.

OBJECTIVE

The study aimed to estimate the median total per-cycle out-of-pocket expenditure of HER2-positive breast cancer treatment from the patient perspective, in public and private clinics, evaluate the association of catastrophic health expenditure with non-adherence to treatment, and describe dissaving practices.

METHODS

This was a cross-sectional micro-costing analysis of the treatment of HER2-positive breast cancer from the patient perspective from a tertiary cancer center and select private clinics in the Philippines. Random sampling of patients with HER2-positive breast cancer was done. Using a validated questionnaire, a guided interview was administered. Catastrophic health expenditure was estimated as having OOP of >20% of the household income. OOP costs were assessed retrospectively from the time of confirmed HER2 diagnosis up to the date of survey, while household income referred to the corresponding period. The proportion of patients experiencing catastrophic health expenditure was computed. Fisher's exact was used to assess for any association between CHE and non-adherence to treatment. Descriptive statistics were used to report dissaving practices. All statistical analyses were performed using Stata analytical software version 12.

RESULTS

A total of 101 patients participated in the study. The mean age of participants from the tertiary cancer center and private clinics were 52 and 58 years old respectively. Patients from the private clinics had a median total OOP expenditure of PhP 54,737.06 (IQR = PhP 102,670.00), compared with patients from tertiary cancer center who had a median total OOP expenditure of PhP 13,920.66 (IQR = PhP 20,830.00). The overall prevalence of CHE (90.9%, 95% CI 0.81, 0.95) and nonadherence to treatment with trastuzumab (79%, 95% CI 0.70, 0.87) were high, and similar in both groups. A number of dissaving practices such as resignation from work, borrowing money from friends, selling assets were observed.

CONCLUSION

The high rate of CHE and treatment delay among patients with HER2-positive breast cancer were not addressed by the existing cancer programs. Most OOP expenditure was for trastuzumab. Current cancer support programs have potential to address the financial impact of their treatment.

Human ; Therapeutics ; Survival ; Patients ; Neoplasms ; Philippines ; Health Expenditures ; Breast Neoplasms

BACKGROUND AND OBJECTIVES

Non-Hodgkin Lymphoma (NHL) ranks 11th in cancer incidence and mortality in the Philippines with the combination chemotherapy composed of Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP) being commonly used as treatment. However, the addition of Rituximab to CHOP (R-CHOP) has been shown to exhibit higher response rates and longer remissions, potentially improving quality of life. Currently, there is conflicting evidence on the cost-utility of CHOP versus R-CHOP. The study aimed to describe the patient- and country-specific factors, and treatment modalities used for NHL and systematically review cost-utility evidence of R-CHOP versus CHOP in adult NHL patients.

METHODS

A systematic literature search of cost-utility studies on R-CHOP versus CHOP for NHL treatment was performed on eight databases: PubMed/MEDLINE, Scopus, Web of Science, EBSCOHost, Cochrane, York Research Database, Centre for Reviews and Dissemination Database, and HERDIN, where 607 studies were identified. Upon screening using an eligibility criteria, 10 studies were included and critically assessed using four appraisal tools: CHEERS, Drummond, Cooper, and ECOBIAS. These were performed independently by two authors with a third author assisting to help reach a consensus.

RESULTS

All studies from high-income countries (HICs) (n=8) and low-middle-income country (LMIC) (n=1) suggested that R-CHOP was more cost-effective for NHL treatment than CHOP in terms of utility outcomes. The study conducted in a low-income country (LIC) (n=1) suggested the opposite, favoring CHOP over R-CHOP. Methodological differences such as perspective, discount rate, willingness-to-pay (WTP), time horizon, and economic model were observed. Methodological limitations include completeness of data reported and credibility of sources used.

CONCLUSION

The results of this review shall be interpreted with caution as those favoring R-CHOP over CHOP for NHL treatment in terms of cost-utility were concentrated in HICs. More economic evaluations from LICs, LMICs, and upper-middle income countries (UMICs) are needed for a robust conclusion. Additionally, establishing a universally recognized guideline for economic evaluations is essential to guide researchers effectively.

Cost-benefit Analysis ; Hodgkin Disease ; Lymphoma ; Systematic Review ; Lymphoma, Non-hodgkin

Walking through the wards of a crowded public hospital and seeing suffering and tragedy from easily preventable conditionsmakes one wonder what it takes for a facility to change the outcomes. The evidence is there, and guidelines have beendeveloped from it; yet practices remain difficult to change—whether in screening, prevention, treatment, or rehabilitation.

Recently, the Department of Health has put up a compendium of clinical practice guidelines (CPG) crafted accordingto the standards set by the Manual for Clinical Practice Guideline Development of DOH-Philhealth.Guidelines stipulatethat dissemination and implementation be considered, and applicability issues are discussed. The uptake of the guidelinesshould be evaluated, and facilitators and barriers should be identified. Thus, there is a need for implementation andapplicability studies to assess how effective guidelines are. For breast cancer, the Philippine Guidelines were published in 2022and updated in 2026.Identified as barriers against implementation are financial constraints and out-of-pocket costs. Actahas since responded to these concerns by publishing articles on financing cost assessment, and in this issue, by Mondragonand co-authors, an “Assessment of Out-of-Pocket Expenditure of HER2-Positive Breast Cancer Patients in a Tertiary CancerCenter and Private Clinics in the Philippines.”

These types of studies are necessary in the translation of evidence to practice, allowing organizations to adopt, scale,and sustain recommendations to real-world settings.

Where CPGs on malnutrition cite resource constraints as the only significant barrier for implementation, the article byde Luna and co-authors on the “A Qualitative Program Evaluation Study on the Perceived Impact of Health and NutritionPrograms among Beneficiaries of a Civil Society Organization in the Philippines” in this issue of the Acta add fear ofsustainability by families and competition from readily accessible instant food of poor nutritional value as barriers in implementingsuch programs.

These studies help us go beyond information dissemination of evidence-based practice to create pathways for impactfulintegration of recommended interventions. Implementation studies sharpen our analysis and focus our efforts on strategies thatcan help pilot, roll out, and scale up guidelines.

New modalities to carry out recommendations can also be part of how guidelines are implemented in the communitysetting. Where the Philippine Academy of Rehabilitation Medicine (PARM) recommends early home-based rehabilitation,the Stroke Society of the Philippines recommends telerehabilitation to augment the efforts of care providers.The articleby Laxamana and co-authors in this issue on “The Acceptance of Stroke Telerehabilitation among Rehabilitation Providersand Consumers in Two Tertiary Hospitals in the Philippines” not only identifies but also provides suggestions to addressimplementation barriers.

We support and encourage articles on implementation science. These works provide tools to convert evidence into outcomes.These transform organizations and help us accomplish meaningful, lasting structural change that should come withoutany delay to provide relief to our patients in our crowded public wards.

Practice Guideline ; Program Evaluation ; Evaluation Studies As Topic ; Costs And Cost Analysis ; Organizations ; Residence Characteristics ; Health Services Needs And Demand

BACKGROUND

The survival advantage of HER2-positive breast cancer from targeted treatment is commonly undermined by catastrophic health expenditure (CHE), particularly in resource-limited areas. Recognizing that financial catastrophe leads to non-adherence to treatment and dissaving practices, we examined the out-of-pocket (OOP) expenses of patients with HER2-positive breast cancer.

OBJECTIVE

The study aimed to estimate the median total per-cycle out-of-pocket expenditure of HER2-positive breast cancer treatment from the patient perspective, in public and private clinics, evaluate the association of catastrophic health expenditure with non-adherence to treatment, and describe dissaving practices.

METHODS

This was a cross-sectional micro-costing analysis of the treatment of HER2-positive breast cancer from the patient perspective from a tertiary cancer center and select private clinics in the Philippines. Random sampling of patients with HER2-positive breast cancer was done. Using a validated questionnaire, a guided interview was administered. Catastrophic health expenditure was estimated as having OOP of >20% of the household income. OOP costs were assessed retrospectively from the time of confirmed HER2 diagnosis up to the date of survey, while household income referred to the corresponding period. The proportion of patients experiencing catastrophic health expenditure was computed. Fisher's exact was used to assess for any association between CHE and non-adherence to treatment. Descriptive statistics were used to report dissaving practices. All statistical analyses were performed using Stata analytical software version 12.

RESULTS

A total of 101 patients participated in the study. The mean age of participants from the tertiary cancer center and private clinics were 52 and 58 years old respectively. Patients from the private clinics had a median total OOP expenditure of PhP 54,737.06 (IQR = PhP 102,670.00), compared with patients from tertiary cancer center who had a median total OOP expenditure of PhP 13,920.66 (IQR = PhP 20,830.00). The overall prevalence of CHE (90.9%, 95% CI 0.81, 0.95) and nonadherence to treatment with trastuzumab (79%, 95% CI 0.70, 0.87) were high, and similar in both groups. A number of dissaving practices such as resignation from work, borrowing money from friends, selling assets were observed.

CONCLUSION

The high rate of CHE and treatment delay among patients with HER2-positive breast cancer were not addressed by the existing cancer programs. Most OOP expenditure was for trastuzumab. Current cancer support programs have potential to address the financial impact of their treatment.

Human ; Therapeutics ; Survival ; Patients ; Neoplasms ; Philippines ; Health Expenditures ; Breast Neoplasms

OBJECTIVE

To perform a cost comparison of the 5-year total direct medical costs of iStent inject® W vs. trabeculectomy vs. glaucoma medications for the treatment of primary open-angle glaucoma, with and without phacoemulsification, from the perspective of Filipino patients.

METHODS

This cost-comparative analysis compared total private sector costs of surgery, post-operative care, and medication usage over 5 years on combined phacoemulsification (combined) or standalone (SA) procedures using iStent inject W, trabeculectomy, and glaucoma medications for the general population and senior citizens/individuals with disabilities. Data, including unit costs and frequencies, were obtained from published literature and local primary research. Scenario analysis consisted of three payment models: 100% out-of-pocket (OOP), coverage from PhilHealth public health insurance, and combined subsidies from both private and PhilHealth insurance.

RESULTS

iStent inject W was less costly than glaucoma medications in all scenarios and patient populations. When compared with trabeculectomy, iStent inject W, was less costly in all patient populations in the OOP scenario, providing savings of 5% for SA procedures and 5% to 6% for combined procedures. It was also less costly as a combined procedure in all populations in the combined private health and PhilHealth insurance scenario, offering 6% savings in the general population and 9% in elderly and disabled patients. However, it was costlier by 1% in the PhilHealth scenario. As an SA procedure, it was costlier vs. trabeculectomy in both populations in the PhilHealth and PhilHealth plus private health insurance scenarios by 18% to 22% and 101% to 109%, respectively. The highest incremental cost for iStent inject W was US$1,662 vs. trabeculectomy as an SA procedure in the general population under the combined private health and PhilHealth insurance scenario.

CONCLUSION

For Filipino glaucoma patients who are treated in the private sector, iStent inject W, whether combined or as an SA procedure, may be cost-saving compared with glaucoma medications over a 5-year period; however, it may be costlier compared with trabeculectomy depending on health insurance coverage scenarios.

Human ; Glaucoma ; Philippines ; Costs And Cost Analysis

Costs And Cost Analysis ; Delivery Of Health Care

OBJECTIVES

o demonstrate the utility of the supraclavicular artery island flap (SCAIF) as a viable alternative to free tissue transfer for reconstruction of large cervicofacial defects.

METHODS

Design:Case Report

Setting:Tertiary National University Hospital

Patient: One

RESULTS

A 43-year-old woman with a giant cavernous hemangioma measuring 21.43 x 9.91 x 20.75cm underwent tumor resection and immediate reconstruction using SCAIF. Following preoperative embolization and complete tumor excision, an 11 x 15cm cervicofacial defect was successfully reconstructed using SCAIF. The patient experienced post-operative complications including multiple wound dehiscences and hypertrophic scar formation but achieved significant functional and aesthetic improvement. At three months follow up, the patient reported cessation of bleeding episodes, improved feeding capacity, and enhanced quality of life despite persistent tracheostomy dependence. Plans for secondary surgery include scar revision, commissuroplasty, and intralesional steroid injections.

CONCLUSION

The supraclavicular artery island flap presents a practical, cost-effective alternative to free tissue transfer for extensive cervicofacial reconstruction, particularly in resource-limited environments or in patients where free tissue transfer is contraindicated. Advantages include good color match, wide arc of rotation, and ease of harvest. Despite potential complications, it offers excellent functional and aesthetic outcomes with acceptable donor site morbidity.

Human ; Female ; Young Adult: 19-24 Yrs Old ; Aids-related Complex ; Neoplasms ; Costs And Cost Analysis ; General Surgery ; Environment ; Research Report ; Steroids ; Tracheostomy ; Hospitals

BACKGROUND: Medical Aid (MA) beneficiaries, belonging to low-income and vulnerable groups, tend to utilize more healthcare services than patients covered by general health insurance. This study aimed to investigate shifts in medical expenses among South Korean MA beneficiaries from 2010 to 2020 in response to changes in health coverage. METHODS: This study was a retrospective cohort study that involved analyzing data from 354,289 MA beneficiaries aged 20 years and older as of 2010 whose healthcare utilization data could be tracked up to 2020. The impact of changes in health coverage of MA beneficiaries on the increase in medical expenses was analyzed with multiple logistic regression analysis. RESULTS: The findings revealed that the group maintaining their MA eligibility had a higher rate of increase in medical expenses compared to those transitioning from MA to National Health Insurance (NHI). Even after adjusting for covariates, the likelihood of an increase in total annual medical expenses was more than 1.4 times higher for the MA maintenance group. However, the group that maintained MA also had higher initial healthcare expenses, indicating poorer health status, compared to the group that transitioned to NHI. CONCLUSION In the public healthcare domain, such as MA, it is crucial to enhance access to necessary healthcare services while preventing unnecessary medical treatments. There is a need for systemic improvements to ensure that low-income, medically vulnerable groups can appropriately use the healthcare services they require to achieve high-value health outcomes.
Republic of Korea ; Humans ; Retrospective Studies ; Middle Aged ; Adult ; Female ; Poverty/statistics & numerical data* ; Male ; Vulnerable Populations/statistics & numerical data* ; Aged ; Health Expenditures/statistics & numerical data* ; Young Adult ; Medical Assistance/statistics & numerical data* ; Insurance Coverage/statistics & numerical data*