Journal of Health Economics and Outcomes Research最新文献

{"title":"Systematic Literature Reviews of Health-State Utility Values, Costs, and Healthcare Resource Use in Duchenne Muscular Dystrophy.","authors":"Chui-Ying Yip, Eric N Kemadjou, Daisy Stewart, Hannah Shapiro, Tom Macmillan","doi":"10.36469/001c.158537","DOIUrl":"https://doi.org/10.36469/001c.158537","url":null,"abstract":"<p><strong>Background: </strong>Duchenne muscular dystrophy (DMD) is a rare, X-linked inherited disorder starting in early childhood, characterized by progressive muscle loss and weakness, causing disability, loss of ambulation, and cardiopulmonary failure. Economic modeling is required to assess cost-effectiveness of new DMD therapies, but there are challenges from limitations and variations in currently available data.</p><p><strong>Objective: </strong>To assess the burden of DMD on patients, caregivers and healthcare systems, identifying inputs for cost-effectiveness models to inform economic assessments.</p><p><strong>Methods: </strong>Two systematic literature reviews (SLRs) were conducted. One SLR was performed to identify health state utility values (HSUV, original date 2019 with a 2023 update) and another to identify and cost data (original date 2023). Both SLRs were updated in 2024. Databases searched included Embase, MEDLINE, Centre for Reviews and Dissemination and EconLit, with additional hand-searching. PRISMA guidelines were followed. For each SLR, title/abstract and full-text screening were performed by two independent reviewers before data extraction. Validated quality assessment tools were used.</p><p><strong>Results: </strong>Across both SLRs, the burden increased as DMD progressed from early to late stages, indicated by decreasing HSUVs and increasing healthcare resource use and costs. The results highlighted large increases in burdens between early nonambulatory and late nonambulatory DMD in studies using the typical 4-state progression model. Recent publications using an 8-stage natural history model reported gradual increases in burden. There was heterogeneity between studies and a lack of long-term data in both SLRs.</p><p><strong>Discussion: </strong>The results highlighted the complex nature of progressive DMD, with heterogeneity and lack of long-term data across the studies. The findings suggest that HUI-3 may be the preferred tool for HSUV measurement in DMD, and the 8-stage natural history model may be preferable to typical 4-state models of DMD progression, to account for the observed heterogeneity and non-linear progression of this rare disease.</p><p><strong>Conclusions: </strong>These data indicate that the burden on patients, caregivers, and healthcare systems increases as DMD progresses. A wide range of inputs for economic modeling were identified, including insights into the way that the stages of DMD should be modeled to accurately reflect progression.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"140-154"},"PeriodicalIF":2.3,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13131909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816135","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":"Public Health Impact and Cost-Effectiveness of 2-Dose vs 1-Dose Human Papillomavirus Vaccination Regimen in Saudi Arabia.","authors":"Abdullah M Assiri, Carole Mamane, Dzhumber Ugrekhelidze, Laurie Lévy-Bachelot, Haleema A M Alserehi, Ghadah Albassam, Ahmed S Bassyouni, Tufail M Malik, Vincent Daniels","doi":"10.36469/001c.160028","DOIUrl":"https://doi.org/10.36469/001c.160028","url":null,"abstract":"<p><strong>Background: </strong>The Saudi Food and Drug Authority recently registered a 9-valent human papillomavirus (HPV) vaccine, which provides broader protection than the existing 4-valent vaccine against genital warts and various cancers. A single-dose protocol vs a 2-dose protocol has been considered as an option for girls aged 9 to 14 and 15 to 20 years in the Kingdom of Saudi Arabia (KSA).</p><p><strong>Objective: </strong>To assess cost-effectiveness and health outcomes associated with 2-dose vs 1-dose 9-valent HPV (9vHPV) vaccination in the KSA.</p><p><strong>Methods: </strong>A dynamic transmission model was used to assess public health impact and incremental cost-effectiveness ratio (ICER) of a 2-dose compared with a 1-dose 9vHPV program. Costs (2023 SAR) and quality-adjusted life-years (QALY) were discounted at 3%. Vaccination coverage was estimated using the Ministry of Health school-based program. Scenario analyses considered higher cervical cancer incidence and higher 1-dose vaccine effectiveness.</p><p><strong>Results: </strong>A 2-dose vs a 1-dose 9vHPV vaccine prevents 13 700 additional cases of HPV-related diseases over a time horizon of 100 years. Furthermore, the model yields an ICER of SAR 30 400/QALY gained. Under scenarios of higher cervical cancer incidence and higher 1-dose vaccine effectiveness, ICERs are SAR 17 400/QALY and SAR 83 200/QALY, respectively. For the scenario with higher cervical cancer incidence (ie, 6.1 per 100 000 women), the 2-dose program achieves cervical cancer elimination within a median time of 54 years, whereas the 1-dose program takes more than 100 years. In sensitivity analyses, the ICER remains below 1×GDP per capita (SAR 129 000).</p><p><strong>Conclusions: </strong>A 2-dose program shows a positive impact in terms of public health and cost-effectiveness compared with a 1-dose program.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"130-139"},"PeriodicalIF":2.3,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773471","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":"Peripheral Intravenous Catheters in Hospitalized Surgical Patients: A US Real-World Data Analysis.","authors":"Rena Moon, Julie Gayle, Stephanie Pitts, Joy David, Kristin Jacobs, Ning Rosenthal","doi":"10.36469/001c.156489","DOIUrl":"https://doi.org/10.36469/001c.156489","url":null,"abstract":"<p><strong>Background: </strong>Limited evidence exists to evaluate the clinical and economic burden of treating hospitalized surgical patients experiencing peripheral intravenous catheter (PIVC)-associated complications.</p><p><strong>Objective: </strong>To estimate the prevalence of PIVC-associated complications and compare the healthcare resource use and cost between surgical inpatients with and without a PIVC-associated complication.</p><p><strong>Methods: </strong>This retrospective cohort study used a large, geographically diverse, hospital-based US database (Premier Healthcare Database). Hospitalized adult (≥18 years) and pediatric (<18 years) patients undergoing a surgery between January 1, 2019, and December 31, 2023, without the use of central line access device were included.</p><p><strong>Results: </strong>The analysis included 6 992 120 adult and 159 256 pediatric patients. In the adult cohort, the prevalence of PIVC-associated complications was 0.7%. Patients with complications were older (mean, 64.2 vs 55.2 years) and more likely to be men (53.1% vs 36.6%) than those without complications (both P < .01). Patients with complications were 46% more likely to be readmitted for any reason (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.42-1.50), had longer length of stay (LOS) by 5.52 days, and incurred higher costs by $19 074 than patients without complications, after adjusting for covariates (all <i>P</i> < .01). In the pediatric cohort, the prevalence of PIVC-associated complications was 0.5%. Patients with complications were younger (mean, 8.6 vs 9.6 years) and more likely to be Black (19.9% vs 15.6%) than those without complications (both <i>P</i> < .01). Patients with complications were 115% more likely to be readmitted for any reason within 30 days after discharge (OR, 2.15; 95% CI, 1.73-2.67), had longer LOS by 4.50 days, and incurred higher costs by $16 052 than patients without complications, after adjusting for covariates (all <i>P</i> < .01).</p><p><strong>Discussion: </strong>While the overall prevalence of PIVC-associated complications is around 1%, this still amounts to a significant number of patients as most patients undergoing an inpatient surgical procedure would have a PIVC placed. The study results call for stakeholders to establish a process for decreasing complications related to PIVCs.</p><p><strong>Conclusions: </strong>In both adult and pediatric cohorts, patients with PIVC-associated complications had significantly higher total hospitalization cost, LOS, and 30-day readmission risks than those without complications.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"120-129"},"PeriodicalIF":2.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147673889","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":"Epidemiology, Patient Characteristics, Real-World Treatment Patterns, and Healthcare Utilization and Spending for Patients with Multifocal Motor Neuropathy: A US Claims-Based Analysis.","authors":"Nikhil Khandelwal, Caroline Geremakis, Faisal Riaz, Gina Ryan, Vishal Saundankar, Richard Sheer, Brandon Suehs","doi":"10.36469/001c.158137","DOIUrl":"https://doi.org/10.36469/001c.158137","url":null,"abstract":"<p><strong>Background: </strong>Multifocal motor neuropathy (MMN) is a rare, progressive neurological disease characterized by asymmetrical limb weakness. The real-world healthcare burden of MMN is not well established.</p><p><strong>Objectives: </strong>To characterize the epidemiology, diagnostic procedures, treatment patterns, healthcare resource utilization (HCRU), and healthcare spending associated with MMN in patients in the US.</p><p><strong>Methods: </strong>This retrospective, observational claims study extracted data from the Humana Healthcare Research Database, comprising US Medicare Advantage plan members. Eligible patients were aged 18-89 years, had ≥2 nondiagnostic medical claims (the first being the index date) associated with an MMN diagnosis code (January 1, 2017-June 30, 2022), and continuous enrollment for 12 months pre-index (baseline) and post-index (follow-up). Patients with amyotrophic lateral sclerosis, chronic inflammatory demyelinating neuropathy, or immunosuppressant use were excluded. Outcomes were assessed during the baseline and follow-up periods.</p><p><strong>Results: </strong>Deidentified data were extracted for 248 patients with MMN. Median (Q1, Q3) age at index was 70.0 (62.0, 77.0) years; most patients were male (53.6%) and White (78.2%). Diagnostic procedures included (baseline/follow-up periods) spinal magnetic resonance imaging (21.4%/18.1%), nerve conduction studies (19.8%/14.5%), and electromyography (17.7%/15.3%). Anticonvulsants, pain medications, corticosteroids, and central muscle relaxants were the most commonly used medications. Overall, 5.2% of patients had intravenous immunoglobulin (IVIG) during follow-up. Mean (standard deviation [SD]) time from index to IVIG initiation was 63.1 (52.2) days, with 6.5 (5.4) administrations, 28.7 (22.9) days between administrations, and 147.5 (133.9) days of total treatment. For all-cause HCRU, 23.8% of patients had ≥1 inpatient stay in the baseline period, with mean (SD) length of stay of 12.7 (14.5) days; during follow-up, 27.8% of patients had ≥1 inpatient stay (length of stay, 13.4 [16.2] days). During the baseline/follow-up periods, 43.1%/46.8% of patients had ≥1 emergency department visit, and 18.5%/28.6% used telehealth services. Median all-cause spending (baseline/follow-up) was <math><mn>11</mn> <mrow><mo> </mo></mrow> <mn>299</mn> <mrow><mo>/</mo></mrow> </math> 16 074 for total healthcare, <math><mn>6745</mn> <mrow><mo>/</mo></mrow> </math> 10 630 for medical resources, and <math><mn>1374</mn> <mrow><mo>/</mo></mrow> </math> 1701 for pharmacy.</p><p><strong>Discussion: </strong>Further studies are needed to enhance our understanding of the real-world diagnostic and treatment patterns associated with MMN and to determine long-term clinical outcomes.</p><p><strong>Conclusion: </strong>These real-world data highlighted the considerable burden associated with MMN on the healthcare system and patients.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"111-119"},"PeriodicalIF":2.3,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627992","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":"Modeling the Public Health Impact of Improved Antiretroviral Therapy Restart Patterns Among People with HIV Who Have Discontinued Treatment.","authors":"Hansel E Tookes, Cillian Copeland, Uche Mordi, James Jarrett, Rui Martins, Mark Connolly, Patrick S Sullivan","doi":"10.36469/001c.159112","DOIUrl":"10.36469/001c.159112","url":null,"abstract":"<p><strong>Background: </strong>Antiretroviral therapy (ART) has become a cornerstone of human immunodeficiency virus (HIV) management. However, a challenge in HIV care and policy is ensuring individuals remain engaged in care and on treatment over time. Discontinuation of ART is common for various reasons, and prolonged treatment interruptions can lead to worse health outcomes at the individual level and increased HIV transmissions at the public health level.</p><p><strong>Objective: </strong>A cost-consequence analysis was conducted to evaluate the economic and public health impact of reducing the interval to ART restart among people with HIV (PWH) who have disengaged from care.</p><p><strong>Methods: </strong>A state transition disease model was developed to calculate the economic benefits from improving treatment restart patterns from a United States healthcare payer perspective. Two hypothetical cohorts of 1000 PWH who discontinued ART were compared: a standard-of-care cohort where restart occurs 32 weeks after discontinuation, and a comparator cohort exploring the impact of reducing the time between ART discontinuation and restart to 12 weeks. Individuals were assigned to CD4-related health states, and rates of viral suppression were considered. Four outcomes, ART costs, CD4 health state costs, CD4-related mortality, and new HIV transmissions were calculated over a three-year time horizon. Cost savings from averted HIV cases were valued based on the lifetime excess healthcare costs for a PWH.</p><p><strong>Results: </strong>Increasing the proportion of individuals restarting ART and reducing time to restart was estimated to avert 88 HIV transmissions. This corresponds to a number needed to treat, defined as the number of PWH who would need to experience the earlier restart pattern of the comparator cohort, of 11 to avoid one new transmission, and $101 083 857 lifetime cost savings. Cost savings attributable to improved CD4 counts in the cohort were also found.</p><p><strong>Conclusion: </strong>Enhancing ART restart patterns improves health and provides considerable cost savings by improving individuals' CD4 counts and reducing new HIV transmissions from people who are viremic. Effective policies to promote care engagement and treatment adherence are predicted to improve the health of PWH and reduce new HIV cases.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"103-110"},"PeriodicalIF":2.3,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13032768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574231","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":"Clean Energy and Health Expenditure in an African Setting: A Socioeconomic Analysis of Household Costs and Willingness to Pay.","authors":"Davies Adeloye, Wale O Ogunleye, Boni M Ale, Olayemi O Akinnola, Alexander Iseolorunkanmi, Abimbola D Akinyosoye, Emmanuel Okafor, Amos A Olore, Akinyimika Sowunmi, Faatihah Niyi-Odumosu, Obianuju B Ozoh","doi":"10.36469/001c.158931","DOIUrl":"10.36469/001c.158931","url":null,"abstract":"<p><strong>Background: </strong>Climate vulnerability in sub-Saharan Africa, including Nigeria, has heightened concern about household energy transitions and associated health and economic impacts. Despite clean fuel initiatives, uncertainty remains regarding household expenditure patterns, health expenditures, and socioeconomic drivers of adoption.</p><p><strong>Objectives: </strong>To examine (1) household cooking-energy and respiratory healthcare expenditures, (2) descriptive expenditure ratios comparing energy costs with respiratory healthcare spending including benefits of transitioning to cleaner energy solutions, and (3) the socioeconomic determinants that influence households' willingness to transition to cleaner cooking practices.</p><p><strong>Methods: </strong>A cross-sectional household survey was conducted in Alimosho (Lagos State) and Ado-Odo Ota (Ogun State) in southwest Nigeria. Using a multistage cluster sampling approach, 292 respondents from 200 households were surveyed on cooking-energy expenditures, respiratory healthcare costs, and willingness to adopt clean fuels. Expenditure patterns were compared descriptively, and a model-based cost-utility analysis was performed to estimate the incremental cost-effectiveness ratio in US dollars per disability-adjusted life-years (DALYs) averted. A multivariable logistic regression model was used to examine socioeconomic predictors of willingness to adopt clean cooking.</p><p><strong>Results: </strong>Clean-fuel (liquefied petroleum gas or electricity) households reported higher annual cooking-energy expenditures than polluting-fuel households (US <math><mn>25.08</mn> <mi>v</mi> <mi>s</mi> <mi>U</mi> <mi>S</mi></math> 16.27), as well as higher respiratory healthcare expenditures (US <math><mn>112.50</mn> <mi>v</mi> <mi>s</mi> <mi>U</mi> <mi>S</mi></math> 50.64). The healthcare-to-energy expenditure ratio was also higher among clean-fuel users (4.48 vs 3.11). In adjusted analyses, tertiary education was associated with higher willingness to adopt clean cooking, while larger household size and urban residence were associated with lower willingness. In the model-based economic evaluation over a 1-year horizon, clean cooking was cost-saving (dominant) across plausible DALY-averted scenarios.</p><p><strong>Conclusions: </strong>Expenditure differences by fuel type likely reflect underlying socioeconomic conditions and variations in healthcare access, rather than causal effects of fuel choice. The model-based cost-utility analysis suggests that clean cooking could be cost-saving or highly cost-effective under plausible assumptions. Policies that address affordability and supply constraints, alongside stronger longitudinal evidence, are needed to support equitable and sustained clean-cooking transitions in Nigeria and across sub-Saharan Africa.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"93-102"},"PeriodicalIF":2.3,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13006001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504201","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":"Retrospective Analysis of Burden of Illness of Congenital Pulmonary Valve Disease in a Large, Commercially Insured US Population.","authors":"Tariku J Beyene, Vincent J Willey, Malvika Venkataraman, Katherine Wong, Eric Anderson, Sophie C Hofferberth","doi":"10.36469/001c.156168","DOIUrl":"https://doi.org/10.36469/001c.156168","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Babies born with congenital pulmonary valve disease (CPVD) face a lifetime burden of disease and significant medical expense beginning in their first year of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess costs and burden of care in patients with CPVD from birth through age 65.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study used administrative claims data to examine healthcare costs and utilization among commercially insured patients with ≥2 claims with CPVD diagnosis between January 1, 2006, and April 30, 2024; the earliest CPVD claim defined the index date. Per-patient-per-year costs were calculated by age category. Mean annual costs for each age group were multiplied by age category duration to estimate full age category period costs. Costs for each age category period were summed to estimate lifetime costs through 65 years of age. Sensitivity analyses were conducted in subgroups with continuous eligibility from birth through 60 months and 120 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among eligible patients (N = 22 751), 53.2% experienced an average of 1.8 CPVD-related inpatient admissions during their first year: mean (standard deviation) cumulative admission days, 50.2 (74.2); with &lt;math&gt;&lt;mn&gt;267&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;945&lt;/mn&gt; &lt;mo&gt;(&lt;/mo&gt; &lt;mn&gt;737&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;565&lt;/mn&gt; &lt;mo&gt;;&lt;/mo&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;,&lt;/mo&gt; &lt;mn&gt;6487&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;q&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;g&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mo&gt;(&lt;/mo&gt; &lt;mi&gt;I&lt;/mi&gt; &lt;mi&gt;Q&lt;/mi&gt; &lt;mi&gt;R&lt;/mi&gt; &lt;mo&gt;)&lt;/mo&gt; &lt;mo&gt;,&lt;/mo&gt; &lt;mn&gt;0&lt;/mn&gt; &lt;mo&gt;-&lt;/mo&gt; &lt;mn&gt;238&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;486&lt;/mn&gt; &lt;mo&gt;]&lt;/mo&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;c&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;e&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;s&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mo&gt;.&lt;/mo&gt; &lt;mi&gt;A&lt;/mi&gt; &lt;mi&gt;m&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;t&lt;/mi&gt; &lt;mi&gt;h&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;w&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;h&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;p&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;f&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;C&lt;/mi&gt; &lt;mi&gt;P&lt;/mi&gt; &lt;mi&gt;V&lt;/mi&gt; &lt;mi&gt;D&lt;/mi&gt; &lt;mo&gt;-&lt;/mo&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;p&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;c&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;g&lt;/mi&gt; &lt;mi&gt;c&lt;/mi&gt; &lt;mi&gt;h&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;h&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mo&gt;,&lt;/mo&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;v&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;g&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt; &lt;mi&gt;c&lt;/mi&gt; &lt;mi&gt;o&lt;","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"56-65"},"PeriodicalIF":2.3,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147498897","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 Fiscal Consequences for the Canadian Government of Efgartigimod in the Treatment of Generalized Myasthenia Gravis.","authors":"Ana Teresa Paquete, Mark P Connolly, Cynthia Qi, Hans Katzberg, Syed Raza, Charles Kassardjian, Zaeem A Siddiqi, Roger Kaprielian, Jason Locklin, Glenn A Phillips, Nikos Kotsopoulos","doi":"10.36469/001c.157709","DOIUrl":"https://doi.org/10.36469/001c.157709","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Generalized myasthenia gravis (gMG) severely impacts activities of daily living. Productivity losses and the need for care can impact household finances and consequently government public accounts. This study adopts a governmental perspective framework to assess the fiscal consequences of treating gMG that is inadequately controlled by standard therapy, beyond healthcare costs. Savings in tax revenue loss and benefit payments are considered. &lt;b&gt;Objectives:&lt;/b&gt; To value the fiscal consequences of treating adults with acetylcholine receptor-antibody positive (AChR-Ab+) gMG with efgartigimod vs current treatments. The lifetime impact on people living with gMG and their caregivers is considered from the perspective of Canada's public accounts. &lt;b&gt;Methods:&lt;/b&gt; A lifetime Markov cohort simulation following adults with gMG according to their Activities of Daily Living (MG-ADL) score was linked to labor and fiscal stages of both patients and care- givers. Based on the MyRealWorld MG study, MG-ADL scores defined the labor market characteristics of both individuals with gMG and their caregivers. National statistics data on sex- and age-specific labor outcomes were used to model patients with minimal symptoms. Benefit payments and tax revenue losses attributable to gMG were estimated and valued according to national official sources. Public healthcare costs were included. The difference between efgartigimod and current treatments was assessed by discounted lifetime incremental fiscal consequences. Sensitivity analyses were applied to the fiscal parameters. &lt;b&gt;Results:&lt;/b&gt; Without active treatments, the lifetime fiscal burden associated with individuals with gMG and their caregivers was estimated at CAD &lt;math&gt;&lt;mn&gt;1.24&lt;/mn&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;g&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;v&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;x&lt;/mi&gt; &lt;mi&gt;p&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mo&gt;.&lt;/mo&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;e&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;w&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;h&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;u&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;w&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;g&lt;/mi&gt; &lt;mi&gt;h&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;b&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;f&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;C&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mo&gt;,&lt;/mo&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;f&lt;/mi&gt; &lt;mi&gt;g&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;g&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;w&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;m","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"85-92"},"PeriodicalIF":2.3,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12986971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468272","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":"Modeling Financial Insolvency and Income Loss Insurance in Head and Neck Cancer.","authors":"Ana V Araujo, Murray J Bartho, Garren M I Low, Ryan J Li","doi":"10.36469/001c.155597","DOIUrl":"10.36469/001c.155597","url":null,"abstract":"<p><strong>Background: </strong>Head and neck cancer (HNC) carries high morbidity, and its treatment can be functionally devastating, impacting a patient's ability to work. While most patients have medical insurance benefits, studies on the impact of HNC on overall household finances have been limited.</p><p><strong>Objectives: </strong>This study explored the effect of HNC treatment on household finances and the feasibility of catastrophic income loss insurance.</p><p><strong>Methods: </strong>This cross-sectional study was based on a population-level survey of American adults. Participants, aged 35 to 64 years, were respondents to the US Federal Reserve 2023 Survey on Household Economics and Decisionmaking (SHED).</p><p><strong>Results: </strong>With total income loss, 16% of simulated HNC patients were insolvent after 3 months, rising to 49% at 6 months. With a 50% loss in income, 3% of patients were insolvent at 3 months, increasing to 5% at 6 months. If savings were liquid, 0.5% of patients were insolvent at 3 months, rising to 1.3% at 6 months.</p><p><strong>Discussion: </strong>Our findings underscore the substantial financial vulnerability faced by patients undergoing treatment for HNC. Even in a simulated model based on national economic data, nearly half of patients experiencing total income loss were insolvent by 6 months. Given the intensive and prolonged nature of HNC treatment, these financial challenges may compound physical and psychosocial stressors, affecting overall recovery and quality of life.</p><p><strong>Conclusion: </strong>The model suggested a need for more substantial income loss protection programs. Financial hardship applies to other cancer types and merits further study into the household financial impact of HNC and other cancers.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"80-84"},"PeriodicalIF":2.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377452","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":"Environmental Impact of Pentaspline Pulsed Field Ablation-Global Warming or Arctic Front?","authors":"Peter Calvert, Vishal Luther, Dhiraj Gupta","doi":"10.36469/001c.157672","DOIUrl":"https://doi.org/10.36469/001c.157672","url":null,"abstract":"","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"79"},"PeriodicalIF":2.3,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12944332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147325991","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}