Journal of Health Economics and Outcomes Research最新文献

{"title":"Comparative Effectiveness of Cytisinicline and Varenicline for Smoking Cessation: A Matching-Adjusted Indirect Comparison (MAIC).","authors":"Mark Rubinstein, David Rowe, Renee Perdok, Cindy Jacobs","doi":"10.36469/001c.160017","DOIUrl":"10.36469/001c.160017","url":null,"abstract":"<p><strong>Background: </strong>Pharmacologic options for supporting smoking cessation remain limited. Cytisinicline is a plant-based alkaloid that selectively binds to α4β2 nicotinic acetylcholine receptors, reducing nicotine craving and withdrawal symptoms, and has proven effective for smoking cessation in the phase III ORCA-2 and ORCA-3 trials, with a favorable safety profile. Using data from randomized clinical trials, we performed an indirect treatment comparison of varenicline, a guideline-recommended partial agonist of the nicotinic acetylcholine receptor used as first-line pharmacotherapy for tobacco cessation, vs cytisinicline for smoking cessation.</p><p><strong>Objectives: </strong>This analysis was designed to compare the efficacy and safety of cytisinicline vs varenicline using pooled data from the cytisinicline ORCA-2 and ORCA-3 trials, and the EAGLES trial of varenicline.</p><p><strong>Methods: </strong>ORCA-2 (conducted from October 2020 to December 2021), ORCA-3 (May 2023-March 2024), and EAGLES (November 2011-January 2015) enrolled adults who smoked at least 10 cigarettes daily and were motivated to quit. A matching-adjusted indirect treatment comparison was employed to adjust for patient population differences between the ORCA (cytisinicline) and EAGLES (varenicline) studies. Propensity score weighting was used to align patient characteristics, then efficacy outcomes, continuous smoking abstinence rate at Weeks 9-12 and Weeks 9-24, and safety outcomes, including treatment discontinuation due to adverse events, were assessed. Adjusted and unadjusted analyses (a standard Bucher and the Mantel-Haenszel approach) were performed.</p><p><strong>Results: </strong>There was no statistically significant difference in continuous abstinence between the cytisinicline and varenicline cohorts at the 9- to 12-week assessment (adjusted OR, 1.33; 95% CI, 0.86-2.05). Patients prescribed cytisinicline had higher odds of abstinence vs varenicline at the 9- to 24-week assessment (adjusted OR, 1.95; 95% CI, 1.13-3.34). Cytisinicline was associated with 82% lower odds of nausea vs varenicline (adjusted OR, 0.18; 95% CI, 0.10-0.31).</p><p><strong>Conclusion: </strong>Cytisinicline may be an effective and more tolerable alternative, especially for patients at risk of relapse or unable to tolerate varenicline.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"182-188"},"PeriodicalIF":2.5,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13196912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015926","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":"Estimated Cost of Adverse Event Management in Treatment Naïve Non-small Cell Lung Cancer Patients with Common EGFR Mutations Treated with Amivantamab Plus Lazertinib and Osimertinib Plus Chemotherapy.","authors":"Alexander Spira, Pratyusha Vadagam, Iris Lin, Courtney Longfield, Robert Musci, Lillian Wang, Denise Zou","doi":"10.36469/001c.161356","DOIUrl":"10.36469/001c.161356","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recent clinical trials have demonstrated improved efficacy of combination regimens, including amivantamab plus lazertinib and osimertinib plus platinum-based chemotherapy, compared with standard therapy in patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). As these regimens enter routine clinical use, understanding the economic implications of treatment-related adverse event (AE) management, including proactive therapy management (PTM), is important.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To estimate and compare grade 3 or 4 AE management costs associated with first-line amivantamab (intravenous [IV] or subcutaneous [SC]) plus lazertinib and osimertinib plus platinum-based chemotherapy in patients with EGFR-mutated locally advanced or metastatic NSCLC from a US Commercial and Medicare Advantage payer perspective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A descriptive cost modeling analysis used grade 3/4 AE incidence data from pivotal clinical trials of amivantamab (IV and SC) plus lazertinib and osimertinib plus platinum-based chemotherapy. AEs occurring in ≥5% of patients or deemed clinically significant were included. PTM strategies for dermatologic events, venous thromboembolism, and infusion-related reactions were modeled for amivantamab-based regimens using guideline-concordant practices and clinical trial evidence. As a conservative assumption, PTM for osimertinib plus platinum-based chemotherapy was not included. AE management costs were derived from national inpatient and physician fee schedules and inflated to 2025 US dollars. Total per-patient AE management and PTM costs were estimated for each treatment regimen. Scenario analyses evaluated expanded PTM assumptions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Across both payer perspectives, total AE management costs were estimated to be lower for amivantamab-based regimens than for osimertinib plus platinum-based chemotherapy. Under the Commercial perspective, modeled AE management costs were &lt;math&gt;&lt;mn&gt;2345&lt;/mn&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;a&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;v&lt;/mi&gt; &lt;mi&gt;a&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;m&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;b&lt;/mi&gt; &lt;mo&gt;(&lt;/mo&gt; &lt;mi&gt;S&lt;/mi&gt; &lt;mi&gt;C&lt;/mi&gt; &lt;mo&gt;)&lt;/mo&gt; &lt;mi&gt;p&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;z&lt;/mi&gt; &lt;mi&gt;e&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;n&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;b&lt;/mi&gt; &lt;mo&gt;,&lt;/mo&gt;&lt;/math&gt; 4321 for amivantamab (IV) plus lazertinib, and &lt;math&gt;&lt;mn&gt;8497&lt;/mn&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;o&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;e&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;n&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;b&lt;/mi&gt; &lt;mi&gt;p&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;p&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;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mo&gt;-&lt;/mo&gt; &lt;mi&gt;b&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;d&lt;/mi&gt; &lt;mi&gt;c&lt;/mi&gt; &lt;mi&gt;h&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;o&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;r&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;p&lt;/mi&gt; &lt;mi&gt;y&lt;/mi&gt; &lt;mo&gt;.&lt;/mo&gt; &lt;mi&gt;C&lt;","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"174-181"},"PeriodicalIF":2.5,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987808","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":"Managing High-Risk Root Caries with Silver Diamine Fluoride Application: A Markov Simulation Study.","authors":"Young S Kim, Ji W Yoo, Maryam Tabrizi, Jae-In Ryu, Yonsu Kim, Maria Teresa Chong, Dong-Hun Han, Jong Ho Won, Yoohwan Kim, Iulia Ioanitoaia-Chaudhry, Mark J Rosenberg, Marcia Loo, Claire S Lee, Anderson Penna","doi":"10.36469/001c.160210","DOIUrl":"10.36469/001c.160210","url":null,"abstract":"<p><strong>Background: </strong>Dental caries are common oral health conditions among Medicaid beneficiaries. Silver diamine fluoride (SDF) has been applied to manage dental caries.</p><p><strong>Objectives: </strong>To evaluate the cost-effectiveness of SDF application for managing high-risk root caries within the context of Medicaid, a Markov simulation model was adopted from a healthcare system perspective.</p><p><strong>Methods: </strong>A 45-year-old subject with 21 residual teeth was simulated for 19 years. Twice-yearly 38% SDF application on the tooth surface at risk for caries was compared with 5% sodium fluoride (NaF) varnish in terms of effectiveness and cost. Tooth-years free of extraction were set as the effect.</p><p><strong>Results: </strong>Compared with 5% NaF varnish, 38% SDF application was cost-effective, with a difference of 6.34 extraction-free tooth-years and an additional cost of <math><mn>7798</mn> <mo>(</mo> <mi>i</mi> <mi>n</mi> <mi>c</mi> <mi>r</mi> <mi>e</mi> <mi>m</mi> <mi>e</mi> <mi>n</mi> <mi>t</mi> <mi>a</mi> <mi>l</mi> <mi>c</mi> <mi>o</mi> <mi>s</mi> <mi>t</mi> <mo>-</mo> <mi>o</mi> <mi>f</mi> <mo>-</mo> <mi>e</mi> <mi>f</mi> <mi>f</mi> <mi>e</mi> <mi>c</mi> <mi>t</mi> <mi>i</mi> <mi>v</mi> <mi>e</mi> <mi>n</mi> <mi>e</mi> <mi>s</mi> <mi>s</mi> <mi>r</mi> <mi>a</mi> <mi>t</mi> <mi>i</mi> <mi>o</mi> <mo>,</mo></math> 1229 per extraction-free tooth-year gained; incremental net monetary benefit, $309 355). One-way sensitivity analyses on SDF and NaF costs confirmed cost-effectiveness of SDF application over NaF varnish.</p><p><strong>Conclusions: </strong>An integrated orosystemic care model is underscored to disseminate the benefits of SDF application as the Medicaid payment system shifts from fee-for-service to managed care. Semiannual 38% SDF application might reduce and delay tooth extraction due to root caries in statewide dental provider shortage areas, particularly \"dental deserts,\" where Medicaid-accepting dentists are not available.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"168-173"},"PeriodicalIF":2.5,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963752","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":"Short and Long-Term Outcomes in Kidney Transplant Recipients with Neutropenia or Leukopenia Following CMV Prophylaxis.","authors":"Vladimir Turzhitsky, Qinghua Li, Lei Ai, Murvin Jootun, Weijia Wang, Andrew Beyer, Pamela Moise, Irina Kolobova","doi":"10.36469/001c.159410","DOIUrl":"10.36469/001c.159410","url":null,"abstract":"<p><strong>Background: </strong>Neutropenia and leukopenia following kidney transplant are linked to poor transplant outcomes. One factor that can contribute to neutropenia or leukopenia following transplant is the use of valganciclovir as a cytomegalovirus prophylaxis.</p><p><strong>Objective: </strong>This study aimed to evaluate post-transplant neutropenia and leukopenia and the associated resource use and costs among kidney transplant recipients receiving valganciclovir prophylaxis.</p><p><strong>Methods: </strong>Adults receiving kidney transplant with a claim for valganciclovir 30 days post-transplant were included (Merative™ MarketScan® with Medicare supplemental database, January 2012-March 2021). Incidence of, and risk factors for, neutropenia and leukopenia were assessed 1 year post-transplant. Clinical outcomes, resource use, and costs were assessed through 5 years post-transplant.</p><p><strong>Results: </strong>A total of 3121 and 357 individuals were included for the 1-year and 5-year analyses, respectively. Cumulative incidence of neutropenia or leukopenia 1 year post-transplant was 32.5%. Resource use was greater among patients with myelotoxicities than those without, driven by emergency department and inpatient visits. Among those with resource use, the total unadjusted median cost was greater in patients with vs without myelotoxicities ( <math><mn>82</mn> <mrow><mo> </mo></mrow> <mn>536</mn> <mi>v</mi> <mi>s</mi></math> 68 652 per patient per year, respectively; <i>P</i> < .0001). A greater proportion of those with myelotoxicities experienced clinical complications and resource use 2 to 5 years post-transplant.</p><p><strong>Conclusions: </strong>Of kidney transplant recipients receiving valganciclovir prophylaxis, myelotoxicity claims were present in approximately one-third at 1 year post-transplant. Neutropenia or leukopenia in kidney transplant recipients is associated with high resource use and costs through 5 years post-transplant.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"13 1","pages":"155-167"},"PeriodicalIF":2.5,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13175152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963814","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":"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":"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":2.5,"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":"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":2.5,"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":"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":2.5,"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":"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":2.5,"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":2.5,"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":2.5,"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}