Journal of Health Economics and Outcomes Research最新文献

{"title":"Effect of Fresh Frozen Plasma Infusion on Hospital Length of Stay for Patients With Hereditary Angioedema.","authors":"Subhan Khalid, Alan T Hitch","doi":"10.36469/001c.141171","DOIUrl":"https://doi.org/10.36469/001c.141171","url":null,"abstract":"<p><p><b>Background:</b> Patients with hereditary angioedema treated with fresh frozen plasma (FFP) infusion face complications and risk of side effects. <b>Objective:</b> To study the effect of FFP infusion on hospital length of stay for patients with hereditary angioedema. <b>Methods:</b> Data from the 2021 Nationwide Inpatient Sample were used to identify hospitalized patients with hereditary angioedema. Patient demographics, comorbidities, and severity measures were analyzed, and a Bayesian additive regression tree model was used to assess factors contributing to length of stay. <b>Results:</b> FFP infusion was found to be associated with increased length of stay for patients with risk factors such as respiratory, cardiovascular disease, or urticaria. <b>Conclusions:</b> Caution is recommended when planning to use FFP, to ensure that underlying patient conditions and risk factors are thoroughly understood. The findings emphasize the need for personalized treatment plans based on individual risk factors, with a recommendation for prioritizing C1-inhibitor therapy over FFP.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 2","pages":"1-10"},"PeriodicalIF":2.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12251561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics, Treatment Patterns, Healthcare Resource Utilization, and Costs Among Patients with Multifocal Motor Neuropathy: A US Claims Database Cohort Study.","authors":"Nikhil Khandelwal, Marie Sanchirico, Ade Ajibade, Kiraat Munshi, Michelle Vu, Nicole Engel-Nitz, Christina Steiger, Amy J Anderson, Chafic Karam","doi":"10.36469/001c.140817","DOIUrl":"10.36469/001c.140817","url":null,"abstract":"<p><p><b>Background:</b> Multifocal motor neuropathy (MMN) is a rare, slowly progressive nerve disorder characterized by asymmetric limb weakness without sensory abnormalities. MMN is often misdiagnosed due to similarities in clinical symptoms with conditions including amyotrophic lateral sclerosis (ALS), making diagnosis and treatment challenging. <b>Objectives:</b> This study assessed patient characteristics, treatment patterns, and the economic burden of MMN in the United States. <b>Methods:</b> Using the Optum Research Database, this retrospective analysis included patients with ≥1 diagnostic or nondiagnostic medical claim with an MMN diagnosis code between 2016 and 2020 (date of first diagnosis-related claim =index date), and continuous enrollment for 12 months preindex and postindex. Patients with MMN within this group were identified using more specific criteria; ≥2 MMN nondiagnostic claims separated by ≥30 days, with no subsequent ALS diagnosis during follow-up. All patients who did not meet these criteria were included in the MMN-mimic cohort. Outcomes included treatment patterns, differential diagnoses, healthcare utilization, and costs. <b>Results:</b> Of 904 patients identified, 37% had MMN and 63% had an MMN-mimic condition. Patients with MMN were significantly younger than patients in the MMN-mimic cohort (mean, 64.9 vs 66.8 years; <i>P</i> = .047). At preindex, significantly more patients with MMN received MMN-related medications than patients in the MMN-mimic cohort (20.5% vs 9.0%, respectively; <i>P</i> < .001). Intravenous immunoglobulin (IVIG) was the most common MMN-related medication. At postindex, more patients with MMN used IVIG (28.0%) compared with preindex (16.4%). In the 12 months preindex and postindex, >70% of patients had ≥1 differential diagnosis. The MMN cohort had higher all-cause total costs than the MMN-mimic cohort (mean preindex, <math><mn>58</mn> <mrow><mo> </mo></mrow> <mn>974</mn> <mi>v</mi> <mi>s</mi></math> 48 132, respectively [<i>P</i> = .100]; mean postindex, <math><mn>74</mn> <mrow><mo> </mo></mrow> <mn>187</mn> <mi>v</mi> <mi>s</mi></math> 50 652 [P = .002]); they also had significantly higher MMN-related healthcare costs (mean preindex, <math><mn>23</mn> <mrow><mo> </mo></mrow> <mn>625</mn> <mi>v</mi> <mi>s</mi></math> 12 890 [<i>P</i> = .011]; mean postindex, <math><mn>39</mn> <mrow><mo> </mo></mrow> <mn>521</mn> <mi>v</mi> <mi>s</mi></math> 11 938 [<i>P</i> < .001]). <b>Discussion:</b> This study showed that most patients with initial MMN diagnoses had an alternative disorder after subsequent evaluation/follow-up, and patients with MMN incurred higher costs. Many patients with MMN did not receive IVIG, suggesting that undertreatment or misattribution of diagnosis codes are common. <b>Conclusions:</b> Further education is needed regarding accurate diagnosis of MMN to ensure patient access to guideline-recommended treatment.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 1","pages":"261-268"},"PeriodicalIF":2.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Size and Treatment Outcomes of HR+, HER2- Early Breast Cancer Population With High Risk of Recurrence: A Real-World Cohort Study With Danish Breast Cancer Cooperative Group Registry Data.","authors":"Heidi Loponen, Juha Mehtälä, Laila Mehkri, Astrid Torstensson, Anna Emde, Tero Ylisaukko-Oja, Walid Fakhouri","doi":"10.36469/001c.137277","DOIUrl":"10.36469/001c.137277","url":null,"abstract":"<p><p><b>Background:</b> While the prognosis is generally good for hormone receptor-positive (HR+), human epidermal growth factor-negative (HER2-) early breast cancer (EBC) patients, up to 30% of patients with high-risk clinical and/or pathologic features experience recurrence. <b>Objectives:</b> This retrospective cohort study was designed to estimate the proportion of BC patients meeting the high-risk criteria used in monarchE, a phase III study of abemaciclib, and to describe the characteristics, survival, and disease recurrence in a Danish patient population. <b>Methods:</b> The study cohort included all women with BC diagnosis registered in the Danish Breast Cancer Cooperative Group registry, and lumpectomy or mastectomy performed between January 1, 2010, and December 31, 2019. The patient characteristics and survival outcomes were compared between high-risk patients (≥4 positive lymph nodes or 1-3 positive nodes and grade 3 and/or primary tumor size ≥5 cm), low/moderate-risk patients, and patients with triple-negative EBC (TNBC). <b>Results:</b> A total of 13.0% of the HR+, HER2- EBC patients met the high-risk criteria. Five-year invasive disease-free survival (IDFS) and distant recurrence-free survival rates (DRFS) were significantly lower in the high-risk group (73.9% and 75.9%, respectively) and the TNBC group (73.0% and 76.5%, respectively), than the low/moderate-risk group (86.1% and 87.7%, respectively) (P < .0001). <b>Discussion:</b> This study is in line with earlier observations showing that HR+, HER2- is the most common subtype, accounting for over 70% of all BC cases. The size of the monarchE-like high-risk group aligns with previous evidence from large US cohort studies. We observed that the proportion of TNBC among all EBC patients showed a decreasing trend between 2010-2019, consistent with earlier reports. The 5-year IDFS and DRFS rates of high-risk patients observed in this study are in line with the evidence from a large US cohort study, however, slightly lower IDFS and DRFS rates at 5 years for the low/moderate-risk group were observed here. <b>Conclusion:</b> About 13.0% of the HR+, HER2- EBC patient population has a high risk of recurrence and would likely benefit from novel treatment strategies targeted for patients with a high risk of recurrence.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 1","pages":"252-260"},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12201145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Enhanced Behavioral Health Services on Total Healthcare Costs Among US Employers: A Site-Level Analysis of 19 Cohort Studies.","authors":"Matt Hawrilenko, Casey Smolka, Emily Ward, RuthAnne Kavelaars, Millard Brown, Adam M Chekroud","doi":"10.36469/001c.138634","DOIUrl":"10.36469/001c.138634","url":null,"abstract":"<p><p><b>Background:</b> The return on investment (ROI) of mental health care is a critical metric in an era of cost-conscious healthcare decision-making. However, selective reporting of positive study results may inflate ROI estimates. <b>Objective:</b> To quantify the mean and variation in employer-level ROI outcomes for a comprehensive behavioral health benefit program. <b>Methods:</b> Data were obtained from 19 employer-specific studies conducted between May 2023 and December 2024. Sources included medical claims data spanning 12 months pre- and post-program launch, and program billing records of clinical and nonclinical costs. Studies were included if they were conducted by a single behavioral health benefit where the full sample of studies was known. The population included 19 US employers where employees and dependents received up to 12 free psychotherapy or medication management sessions. All studies used the same inclusion and exclusion criteria, retrospective matched cohort design, and difference-in-differences analysis. Data were abstracted following PRISMA guidelines. ROI was estimated using a difference-in-differences model to control for baseline medical spending and pooled using inverse variance weighting with a random effects structure. The primary outcome was the ROI multiple, defined as the ratio of gross per-member-per-month savings to total program spending. <b>Results:</b> The meta-analysis included 42 148 participants (14 645 program users and 27 503 matched controls) across a range of employer sizes and industries. The pooled ROI multiple was 2.3 (95% CI, 1.9-2.8), corresponding to net savings of <math><mn>159</mn> <mi>p</mi> <mi>e</mi> <mi>r</mi> <mi>m</mi> <mi>e</mi> <mi>m</mi> <mi>b</mi> <mi>e</mi> <mi>r</mi> <mi>p</mi> <mi>e</mi> <mi>r</mi> <mi>m</mi> <mi>o</mi> <mi>n</mi> <mi>t</mi> <mi>h</mi> <mo>(</mo> <mn>95</mn></math> 111-$207). Significant heterogeneity was observed (I² = 67.8%; t² = 0.646; <i>P</i> < .001). A sensitivity analysis including nonclinical costs yielded a pooled ROI of 1.8. <b>Conclusion:</b> This meta-analysis, the largest of its kind, demonstrates that a centralized behavioral health benefit can consistently generate net savings across varied employer settings. These findings provide robust evidence to support the adoption of comprehensive mental health programs as an effective strategy for reducing overall medical spending in employer-sponsored health plans.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 1","pages":"246-251"},"PeriodicalIF":2.3,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Private Sector Hospitals' Response to Changes in Demand for Health Insurance in Arab Countries.","authors":"Vivian Nasiruddin","doi":"10.36469/001c.140416","DOIUrl":"10.36469/001c.140416","url":null,"abstract":"<p><p><b>Background:</b> Health insurance (HI) plays a vital role in providing health services, as it covers relevant healthcare costs to improve health outcomes. <b>Objectives:</b> The study aimed to analyze the extent to which private sector hospitals respond to changes in demand for HI in 3 Arab countries between 2006 and 2022. Methods: A structural equation model was used to evaluate the dynamic association between the variables. The study sample comprised the Kingdom of Saudi Arabia, the United Arab Emirates, and Jordan. <b>Results:</b> There were largely negative relationships between the demand for insurance and indicators of healthcare capacity, namely, the number of hospitals, hospital beds, and nurses. This suggests that publicly funded and organized healthcare systems limit private insurance demand. Furthermore, the panel vector autoregression Granger causality tests indicated a dynamic, 2-way Granger causal relationship between insurance demand and infrastructure. The policy implications of the study therefore suggest recommendations that healthcare planning be coordinated with insurance policy planning. <b>Discussion:</b> Regarding the number of hospitals, the coefficient for demand for HI was -0.169 (<i>P</i> = .032, indicating a negative but not significant relationship between HI and the number of hospitals. For beds, the coefficient for HI was 0.0000574 (<i>P</i> <  .001), suggesting a statistically significant negative relationship between HI and number of beds. Regarding the number of doctors, the coefficient for HI was -0.0000266 (<i>P</i>< .001), indicating a statistically significant negative relationship between HI and number of doctors. For the number of nurses, the coefficient for future insurance demand was -0.0000968 (<i>P</i> <  .001), reinforcing a negative relationship between HI and number of nurses. <b>Conclusions:</b> The study presents important insights into the intricate interplay between healthcare infrastructure and insurance demand in the private hospital markets of Saudi Arabia, the United Arab Emirates, and Jordan. These findings highlight the need for comprehensive health system planning in conjuction with insurance reforms, infrastructure development, and workforce reinforcement to maximize the sustainability and effectiveness of HI plans in the region.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 1","pages":"238-245"},"PeriodicalIF":2.3,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Pain Reduction and Functional Improvements Following a Noninvasive Biomechanical Intervention for Gait Rehabilitation on Healthcare Claims: An Observational Study.","authors":"William Vanderveer, Eric Freeman","doi":"10.36469/001c.140740","DOIUrl":"10.36469/001c.140740","url":null,"abstract":"<p><p><b>Background:</b> Musculoskeletal conditions substantially impact public health in the United States, affecting approximately 128 million adults and resulting in over $600 billion in annual socioeconomic costs. Low back pain and knee osteoarthritis are the most prevalent musculoskeletal disorders, with projections suggesting their incidence will increase markedly due to aging populations and rising obesity rates. <b>Objective:</b> The purpose of this study was to evaluate healthcare claims utilization (HCRU), clinical outcomes, and patient satisfaction for individuals with knee and back pain treated with a home-based, biomechanical intervention that aims to provide precision medicine for patients with musculoskeletal conditions. <b>Methods:</b> A retrospective analysis of claims data was conducted on 616 patients with knee and back pain who were treated with a noninvasive, home-based, biomechanical intervention (AposHealth) from October 2020 to October 2023. Eligibility was determined based on specific diagnostic criteria. The controls were 3576 patients with knee and back pain who were receiving the standard of care. HCRU, pain levels, functional disability, and patient satisfaction were captured. <b>Results:</b> Significant reductions in HCRU were noted, with significantly lower rates of minor and major surgeries compared with control groups. The economic analysis suggested substantial cost savings of approximately $9 million over 20 months, suggesting an 80% reduction in costs in those treated with the biomechanical intervention compared with controls. Pain levels decreased significantly by 32.5% and 57% at 3 and 6 months posttreatment for back pain, respectively. Patients with knee pain reported a significant decrease of 39% and 35% at 3 and 6 months, respectively. <b>Discussion:</b> The examined biomechanical intervention led to a significant reduction in pain and improvement in function, which presumably is a driving factor for a meaningful reduction in HCRU and potential cost savings. <b>Conclusions:</b> There is an urgent need for innovative strategies that alleviate the burden of musculoskeletal disorders on the healthcare system. The results of this study add to the evidence about the clinical effectiveness and cost-savings of this intervention in patients with knee and back pain, using real-world data.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 1","pages":"230-237"},"PeriodicalIF":2.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open Access to Antipsychotics in State Medicaid Programs: Effect on Healthcare Resource Utilization and Costs among Patients with Serious Mental Illness.","authors":"Rashmi Patel, Onur Baser, Heidi C Waters, Daniel Huang, Leigh Morrissey, Katarzyna Rodchenko, Gabriela Samayoa","doi":"10.36469/001c.137909","DOIUrl":"10.36469/001c.137909","url":null,"abstract":"<p><p><b>Background:</b> The restrictive consequences of Medicaid formulary restriction policies on antipsychotic medications may lead to higher healthcare utilization and costs among beneficiaries with serious mental illness (SMI). <b>Objectives:</b> This study compared outcomes among patients with SMI accessing antipsychotic medications through state Medicaid programs with open access (OA) policies (Michigan) vs 5 states without Medicaid OA policies (California, Colorado, Florida, Illinois, Wisconsin). <b>Methods:</b> A retrospective analysis was conducted using Kythera Labs Medicaid data (Jan. 1, 2016-Dec. 31, 2023). Outcomes were assessed for patients with SMI (>18 years of age, ≥1 antipsychotic medication claim during the identification period (Jan. 1, 2017-Dec. 31, 2022), ≥1 SMI claim in the 12-month baseline). Continuous medical and pharmacy benefits were required for 12 months pre- and post-index date. Outcomes included SMI-related hospital admissions, length of hospital stay, emergency department and outpatient visits, and associated costs. <b>Results:</b> A greater proportion of beneficiaries with SMI resided in Michigan than in the other states. After matching, significantly more antipsychotics users experienced SMI-related hospitalizations in California (18.25% vs 9.47%, P < .0001), Colorado (11.41% vs 7.33%, P  =.0004), Florida (19.70% vs 10.17%, P < .0001), Illinois (23.57% vs 8.79%, P < .0001), and Wisconsin (15.21% vs 10.02%, P = .0046) than in Michigan. Length of stay was lower in Michigan than in California, Colorado, and Illinois. Inpatient costs related to SMI were significantly lower in Michigan, yet pharmacy costs were higher. Total SMI-related costs were higher in all non-OA states than in Michigan, except Colorado. <b>Discussion:</b> State Medicaid programs without OA to antipsychotics were associated with higher rates of SMI-related resource utilization and costs vs Michigan. <b>Conclusions:</b> Policy makers should consider the potential downstream cost implications of restrictive access policies and evaluate whether OA could result in improved health outcomes for patients and savings for Medicaid programs.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 1","pages":"222-229"},"PeriodicalIF":2.3,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Upfront Treatment Patterns for Newly Initiated Patients With Pulmonary Arterial Hypertension in the United States.","authors":"Carly Paoli, Wenze Tang, Sumeet Panjabi, Ashwin Ravichandran","doi":"10.36469/001c.138006","DOIUrl":"10.36469/001c.138006","url":null,"abstract":"<p><p><b>Background:</b> The 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) pulmonary hypertension guidelines recommend initial combination of endothelin receptor antagonist (ERA) and phosphodiesterase type-5 inhibitor (PDE5i) in patients with pulmonary arterial hypertension (PAH) at low to intermediate risk without cardiopulmonary comorbidities. <b>Objective:</b> To examine US treatment patterns for newly diagnosed patients, including frequency of cardiopulmonary comorbidities. <b>Methods:</b> Treatment-naïve adults (≥18 years) initiating treatment, identified using claims data (IQVIA PharMetrics® Plus; April 2013-June 2023), were assigned dual therapy if initiating ERA/PDE5i within a treatment-determination period (3 months), or monotherapy if initiating ERA or PDE5i. Descriptive statistics captured 25th/75th percentiles, means (SD), and medians. <b>Results:</b> Of 2868 patients, 824 (28.7%) initiated dual therapy and 2044 (71.3%) monotherapy. In dual therapy, 461 (56.0%) initiated ERA first, 250 (30.3%) PDE5i first, and 113 (13.7%) both the same day. In monotherapy, 153 (7.5%) received ERA and 1891 (92.5%) PDE5i. For escalation to dual therapy, 330 (16.1%) monotherapy users initiated ERA (10.7%) or PDE5i (5.5%) during follow-up. Most had cardiopulmonary comorbidities (monotherapy: 86.8%; dual: 79.6%). Of the 824 on dual therapy, 20.4% started triple therapy during follow-up. Compared with monotherapy, dual therapy users were younger (54.9 vs 59.6 years) and mostly female (72.9% vs 60.9%). <b>Discussion:</b> This study found that in the United States, among newly diagnosed PAH patients, 71.3% initiated monotherapy and 28.7% dual therapy, with 16.1% of monotherapy patients eventually escalating to dual therapy. High rates of initial monotherapy may reflect the high proportion of patients with comorbidities and their possible intolerance of initial dual therapy. As these data mostly precede the 2022 guidelines, future research should include treatment post-guidelines, rationales behind decision making, differences between initial monotherapy and dual therapy users, and monotherapy overreliance and effects on morbidity and mortality. <b>Conclusions:</b> This analysis of real-world US treatment patterns for newly initiating PAH patients found low rates of upfront dual-therapy use with high rates of cardiopulmonary comorbidities.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 1","pages":"213-221"},"PeriodicalIF":2.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Costs and Consequences of Implementing an Optimization Process for Low-Complexity Emergency Care: The LINEA Program.","authors":"German Devia-Jaramillo, Nathalia Esmeral-Zuluaga, Juan Pablo Vargas-Gallo, Rafael Alfonso-Cristancho","doi":"10.36469/001c.130031","DOIUrl":"10.36469/001c.130031","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Introduction:&lt;/b&gt; Overcrowding is persistent in emergency departments (EDs) worldwide and can result in adverse patient outcomes and prolonged lengths of stay. Delays in care and unmet demand contribute to negative outcomes for patients awaiting treatment, including increased morbidity and mortality, prolonged hospital stays, and overall lower quality of medical care. Overcrowding in EDs not only diminishes patient satisfaction with the entire hospitalization experience, beyond the ED, but also significantly increases healthcare costs and contributes to a rise in medical errors. Therefore, developing strategies that optimize the limited resources available for emergency patient care, especially for those with low-complexity emergencies, is crucial. &lt;b&gt;Objective:&lt;/b&gt; To evaluate whether implementing a specific care strategy for patients with low-complexity emergencies can effectively reduce costs and improve clinical outcomes and patient-reported experiences compared with standard care practices. &lt;b&gt;Methods:&lt;/b&gt; A cost-consequence model was employed to separately evaluate the costs and outcomes of each alternative. The cost and outcome analyses were applied to healthcare services using the database of a tertiary-level ED, analyzed from the perspective of the healthcare service provider over a 2-year time horizon. To assess the perspective of the healthcare provider institution, the cost-consequence analysis was conducted using a decision tree model. &lt;b&gt;Results:&lt;/b&gt; The study included 43 268 patients. No significant differences were found in demographic variables between groups. A significant difference was found in total length of stay in minutes between groups: minimum (median interquartile range [IQR]), 534 (456-644) vs 494 (364-719) (&lt;i&gt;P&lt;/i&gt; &lt; .001). In addition, there was an improvement in the NPS value from 44 to 53 throughout the ED, with 0.005% mortality in the study group and 0.07 in the control group (&lt;i&gt;P&lt;/i&gt; &lt; .001). Finally, a significant difference was documented in the mean billing per patient, with a median (IQR) of Col &lt;math&gt;&lt;mn&gt;255&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;903&lt;/mn&gt; &lt;mo&gt;(&lt;/mo&gt; &lt;mi&gt;C&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt;&lt;/math&gt; 151 108-Col &lt;math&gt;&lt;mn&gt;658&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;585&lt;/mn&gt; &lt;mo&gt;)&lt;/mo&gt; &lt;mi&gt;v&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;h&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;c&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;p&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;g&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;p&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;C&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt;&lt;/math&gt; 283 922 (Col &lt;math&gt;&lt;mn&gt;125&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;998&lt;/mn&gt; &lt;mo&gt;-&lt;/mo&gt; &lt;mi&gt;C&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt;&lt;/math&gt; 776 097) (&lt;i&gt;P&lt;/i&gt; &lt; .018). &lt;b&gt;Conclusion:&lt;/b&gt; The implementation of a specialized unit for the care of patients with low-complexity emergencies within the ED has proven effective in improving total patient length of stay. This significantly contributes to reducing overcrowding, decreasing mortality, and reducing unmet ","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 1","pages":"207-212"},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the Secondary Care System Burden of Glycogen Storage Disease Type Ia (GSDIa) Using the Hospital Episode Statistics Database.","authors":"Eliza Kruger, Shreena Giblin","doi":"10.36469/001c.137126","DOIUrl":"10.36469/001c.137126","url":null,"abstract":"<p><p><b>Background:</b> Glycogen storage disease type Ia (GSDIa) is a rare, inherited metabolic disorder characterized by a deficiency in glucose 6-phosphatase. People living with GSDIa are at high risk for clinical manifestations (including hypoglycemia and hepatomegaly) and clinical complications (including hyperlipidemia, stunted growth, liver adenomas, and renal failure). Evaluating symptom management and secondary care burdens is vital to understanding the patient experience and optimizing care pathways. <b>Objective:</b> We sought to quantify the number of patients with GSDIa within secondary care settings across England and to evaluate the burden of disease associated with living with GSDIa. <b>Methods:</b> This study utilized the United Kingdom Hospital Episode Statistics (HES) database across a 69-month time period (April 2015-December 2020) to investigate National Health Service (NHS) resource use and GSDIa mortality. <b>Results:</b> Patients (N = 943) with GSDIa were identified. Frequent manifestations included anemia (n = 421; 45%), hypoglycemia (n = 185; 20%), and hepatomegaly (n = 152; 16%). On average, patients had a total of 8 events/year, including 2 elective events, 2 nonelective emergencies, 1 outpatient visit, and 3 daycase visits. In the entire HES population, there was approximately 1 (~60% elective, ~40% nonelective) event/year. The highest total number of events across the entire patient journey tracked within the HES occurred with adolescents (12-17 years) who had an average of 28.5 events. Average length of stay was greatest in the pediatric infantile (0-2 years) population with 4.6 days and 3.4 days for nonelective and elective events, respectively. When benchmarked against the general population, patients with GSDIa had a mortality rate of 4.3%, compared with 0.9% for the entire HES population. The average age at mortality was 14.3 years lower for patients with GSDIa vs the entire HES population (63.7 years vs 78.0 years). <b>Discussion:</b> This study demonstrates high burden associated with GSDIa. Complications are a key driver of NHS resource use. Mortality associated with GSDIa in hospitalized patients is higher than the general population. <b>Conclusions:</b> GSDIa imposes a large burden on the healthcare system. There is a clear unmet need for patients with GSDIa, and complications are a substantial driver of resource use and burden of disease.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 1","pages":"201-206"},"PeriodicalIF":2.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12124281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}