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

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

BACKGROUND AND OBJECTIVE

Non-communicable diseases (NCDs) are medical conditions that are associated with long durations, slow progress, and lifetime medications. This study aimed to assess the household out-of-pocket (OOP) expenditures on NCDs in a 4th class municipality.

METHODS

This cross-sectional study was conducted to determine the characteristics of the households and household heads, healthcare needs, expenditures on medicines, health, and household, and alternative coping strategies to avail healthcare needs.

RESULTS

This study surveyed 200 households from all ten barangays of Ternate, Cavite. Top NCDs recorded include hypertension, diabetes, heart diseases, and asthma, while top NCDs medicines recorded were Losartan, Amlodipine, Metformin, and Glimepiride. Blood tests were the most needed medical laboratory service, while X-ray was the most needed diagnostic imaging service. Although more than half of the households have a member with only one NCD— the most prevalent being hypertensive disease, diabetes mellitus and other metabolic diseases—it is also common to have household members taking medicines for two to three NCDs.

CONCLUSION

This study highlights the need to address issues with lack of access and availability of essential medicines for NCDs especially in the primary health care setting. This study provides evidence on the minimal financial risk protection provided for medicines with data suggesting that it is the primary cause of CHEs for NCDs. Households covered by the Primary Care Benefit Packages were excluded from the study, thus, the estimates derived from the sample may be an overestimate of the true prevalence of CHE in the municipality. Therefore, there is a need to have mechanisms in place to expand insurance coverage and increase government programs catering to certain population groups to reduce the financial burden of medicines for NCDs.

Human ; Noncommunicable Diseases ; Out-of-pocket Expenditures ; Health Expenditures ; Households ; Family Characteristics

BACKGROUND

The Division of Colorectal Surgery at the Philippine General Hospital (PGH) conducts hundreds of surgeries annually for benign and malignant colorectal conditions. Since 2019, the Division has implemented an Enhanced Recovery After Surgery (ERAS) program to improve patient outcomes. However, its impact on hospital costs—critical for a government hospital—has not yet been studied.

OBJECTIVE

This study aimed to evaluate the effect of ERAS on healthcare costs for elective colorectal surgeries performed at PGH in 2021.

METHODS

A retrospective observational study was conducted on adult patients who underwent elective colorectal surgeries under the ERAS protocol in 2021. Medical and billing records were retrieved using the hospital’s electronic medical records (EMR) system, excluding cases with incomplete data. Procedures were categorized by type [stoma closure, colonic or rectal resection, reversal of Hartmann’s, or cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)] and surgical approach (open, laparoscopic, or robotic). Costs were classified into diagnostics, facility fees, medications, surgery, and hospital supplies. ERAS compliance rates were extracted from the online ERAS Interactive Audit System (EIAS), and linear regression analysis was performed.

RESULTS

Among 114 elective colorectal surgeries, records for 90 cases were analyzed. Surgery-related expenses accounted for the highest mean hospital costs across all procedure types. An inverse correlation between ERAS compliance and total cost was observed for open surgeries, with statistically significant reductions in stoma closures and open colon resections (p-value: 0.0213 and 0.0134, respectively). However, minimally invasive surgeries (MIS) did not demonstrate cost reductions with increasing ERAS compliance, likely due to additional expenses associated with advanced equipment. Linear regression indicated that higher compliance rates generally led to decreased hospital costs.

CONCLUSION

Standardized care through ERAS has been associated with cost savings compared to traditional perioperative management. This study supports the conclusion that higher ERAS compliance can reduce hospital costs in open colorectal surgeries. However, the higher costs of MIS procedures, driven by equipmentrelated expenses, may offset potential savings from ERAS adherence. Further research is warranted to explore the cost implications of ERAS in MIS cases.

Costs And Cost Analysis ; Colorectal Surgery

BACKGROUND AND OBJECTIVE

Oral ivermectin is recommended as an alternative to topical permethrin in Japanese, European, and CDC-STI guidelines for treating classic scabies. The combination of oral ivermectin and topical permethrin is also used in some settings. Partial economic evaluations conducted in India and Egypt have conflicting results, and no cost-effectiveness analysis in the Philippines has compared ivermectin-based regimens to permethrin for scabies treatment. We aimed to determine the cost-effectiveness of oral ivermectin, alone or in combination with permethrin, compared to permethrin, in the treatment of Filipino adult patients with classic scabies.

METHODS

We used a decision tree model to estimate the cost-effectiveness of two regimens, oral ivermectin alone or in combination with permethrin, compared with permethrin to treat adults and children aged five years and older with classic scabies in the outpatient setting from the household perspective in the Philippines. We estimated total costs and disability-adjusted life years (DALYs) over a one-month follow-up. Input parameters were obtained from secondary data, such as effect estimates for probabilities of clinical outcomes from a network meta-analysis, DALYs from the Global Burden of Disease 2019, and prevailing market cost in the Philippines (DPRI 2022 with recommended markup by DOH, and leading drugstores) as of August 2022. We computed for incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) to determine which of the interventions are cost-effective. Univariate and probabilistic sensitivity analyses, and scenario analyses were conducted to assess the impact of parameter and structural uncertainty.

RESULTS

Ivermectin-based regimens are suggested to be likely cost-saving compared to permethrin in the Philippine outpatient setting. Base case analysis showed that oral ivermectin had higher cost-savings (change in cost, -1,039.31; change in DALYS, 0.00027), while combination oral ivermectin/permethrin had higher DALYs averted (change in cost, PhP -1,019.78; change in DALYs, 0.00045), compared to permethrin. Combination oral ivermectin/permethrin (56%) was the most cost-effective, followed by oral ivermectin (44%) compared to permethrin (0%) through probabilistic sensitivity analysis. Estimates for ivermectin were sensitive to risk of cure for ivermectin vs permethrin using 1-way deterministic sensitivity analysis. Oral ivermectin was favored over combination oral ivermectin/permethrin at all thresholds based on the cost-effectiveness acceptability curve.

CONCLUSION

Both ivermectin-based regimens seem to be cost-saving compared to permethrin in the treatment of classic scabies in the Philippine outpatient setting. Clinicians may consider oral ivermectin, alone or in combination with permethrin as an alternative first-line or second-line treatment depending on patient preference, adverse event risk profile, availability, and economic capacity. This needs to be confirmed using primary data from Filipino patients to enhance the robustness of the findings and support evidence-based local decision-making in different settings. Less uncertainty in modelled parameters can give greater confidence in the results, which can be adopted for budget impact analysis and allow more rational resource allocation. Value of information analysis can be done to determine whether the expense of future RCTs or surveys in Filipinos to collect primary data is worth it. The cost of reducing uncertainty, if deemed worth the cost of further studies, may facilitate population-level decision-making and budget planning. Findings may further inform practice guideline development, coverage decisions, and national control program planning by providing the most cost-effective scabies intervention.

Scabies ; Ivermectin ; Permethrin ; Cost-benefit Analysis ; Cost-effectiveness Analysis

Costs And Cost Analysis ; Delivery Of Health Care

OBJECTIVES

This study investigates the impact of the COVID-19 pandemic on social service accessibility for persons with disabilities in the Philippines, with a focus on disability related opportunity costs and out-of-pocket expenses.

METHODOLOGY

A mixed-methods approach was employed, combining both qualitative and quantitative data collection techniques. Focus group discussions (FGDs) and interviews were conducted to gather qualitative insights, while quantitative analysis, utilizing one-sample t-tests, was used to assess the impact of the pandemic on key areas such as income, access to essential goods, employment, healthcare, mental health, and social support.

RESULTS

Using a mixed-methods approach, data were collected from 141 participants. Qualitative insights highlighted that 89% of participants reported negative effects on daily living conditions due to rising costs and limited access to necessities. Parents of children with disabilities indicated that early childhood care and development services were adversely affected by school closures, and transitioning to online learning posed significant barriers, with 62% lacking access to training and resources. While many participants had access to healthcare, lockdowns exacerbated disability-related opportunity costs, complicating access to routine care. Quantitative data findings were analyzed through one-sample t-tests to assess the impact of COVID-19 on various aspects of daily life, including income, access to essential goods, employment status, healthcare access, mental health, and social support. Findings revealed significant challenges, with an average income decrease rating of 7.39, reflecting substantial financial loss. Ratings for access to essential goods and healthcare services also averaged 7.39, while employment status was rated at 7.82, indicating instability. Mental health impacts averaged 7.13, and social support was rated at 7.42, underscoring inadequacies during this crisis.

CONCLUSION

Overall, the study emphasizes the urgent need for targeted interventions and inclusive responses in emergency planning to mitigate the pandemic's disproportionate impact on this marginalized group in the Philippines.

Human ; Persons With Disabilities ; Out-of-pocket Costs ; Health Expenditures ; Philippines ; Social Service ; Social Work ; Covid-19