Journal of Medical Economics最新文献

{"title":"Health-economic impact of implementing continuous vital sign monitoring in post-surgical patients in five European countries.","authors":"Jasjit Syan, Tobias Muench, Carla Fernández-Barceló, Rhodri Saunders, Jonah Attebery, Marco Luchetti, Mary Erslon, John Beard, Sadia Khan","doi":"10.1080/13696998.2025.2602364","DOIUrl":"https://doi.org/10.1080/13696998.2025.2602364","url":null,"abstract":"<p><strong>Aims: </strong>Hospitals, in particular intensive care units (ICUs), account for a large proportion of healthcare costs and environmental burden. Preventing unexpected patient transfer to ICU <i>via</i> continuous vital sign monitoring (CVSM) may mitigate this burden. Country-specific evidence on the cost-effectiveness of CVSM is missing. This analysis explored the impact of CVSM versus intermittent monitoring in post-surgical patients across France, Germany, the Netherlands, Spain, and the UK.</p><p><strong>Materials and methods: </strong>A health-economic, decision-tree model was developed to compare CVSM versus intermittent monitoring for costs, resources, and environmental consequences up to 30 days after hospital discharge for a hypothetical, 100-patient cohort. Hospital data from the UK were used to populate the initial country model, while data were extracted from the literature for Netherlands, Germany, Spain, and France. Key outcomes were costs (in 2024 currency), days in hospital, and environmental impact (kg of CO_2eq and kg of waste). Robustness of results to changes in model inputs were assessed <i>via</i> 2,000 Monte Carlo simulations, results being presented reporting the 95% credible interval (95% CrI).</p><p><strong>Results: </strong>For 100 patients, the cost savings with use of CVSM ranged from -€111,381 (95% CrI = -35,164; -159,176) in the Netherlands to -€22,745 (95% CrI = -7,656; -44,134) in France. In no country did the range of the 95% CrI cross zero, indicating significant cost savings with CVSM. Cost savings mainly resulted from reductions of ICU days, which ranged from -25 (95% CrI = 8; -43) in Germany to -9 (95% CrI = -1; -28) in France. Changes in ICU days were not always significant. On average, 3,866 kg of CO_2eq and 247 kg of waste were saved per cohort and country.</p><p><strong>Limitations: </strong>Published data was limited and data was proxied across countries when unavailable.</p><p><strong>Conclusions: </strong>CVSM is expected to be a cost-saving, sustainable solution for most hospitals of the countries included.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"50-65"},"PeriodicalIF":3.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A five-year cost-consequence analysis of extended-use etonogestrel implant versus other contraceptives.","authors":"Vanessa Perez Patel, Kevin Collins, Klaas Heinemann, William Ngantung, Matia Saeedian","doi":"10.1080/13696998.2025.2606600","DOIUrl":"https://doi.org/10.1080/13696998.2025.2606600","url":null,"abstract":"<p><strong>Objective: </strong>While multiple reversible contraceptives are available, long-acting reversible contraception (LARC) offers multi-year protection with minimal user burden. The etonogestrel implant is the most effective LARC but carries higher upfront acquisition costs. This analysis evaluated whether the acquisition costs for the etonogestrel implant are offset <i>via</i> pregnancy prevention and pregnancy-related expenditures.</p><p><strong>Methods: </strong>A discrete Markov chain model with 5-year time horizon simulated pregnancy outcomes among 1,000 women 18-49 years initiating 1 of 8 hormonal contraceptive methods: branded or generic oral contraception (OC; progestin only and combined), medroxyprogesterone acetate injection, etonogestrel/ethinyl estradiol vaginal ring, norelgestromin/ethinyl estradiol transdermal patch, 3- or ≥5-year levonorgestrel IUD, and the etonogestrel implant. The model specified 28-day cycles. Contraceptive acquisition costs, typical-use failure rates, discontinuation rates, pregnancy outcomes and costs, and healthcare resource use were examined from a United States managed care perspective. Sensitivity analyses were also conducted.</p><p><strong>Results: </strong>The etonogestrel implant followed by IUDs were associated with the fewest pregnancies (60 [etonogestrel implant], 105 [3-year IUD], and 104 [≥5-year IUD], respectively) and the lowest per-woman costs ($3,428 [etonogestrel implant], $5,275 [3-year IUD], and $4,728 [≥5-year IUD], respectively). Cost offsets occurred in Year 1 and increased incrementally through Year 5. In comparison, branded and generic OC resulted in 299 and 323 pregnancies, respectively, and $8,477 and $8,678 per-woman costs; the vaginal ring, injection, and patch resulted in 328, 265, and 327 pregnancies, respectively, with per-woman costs ranging from $8,781 to $13,963. Discontinuation rates, not acquisition costs, were the primary driver impacting overall costs.</p><p><strong>Conclusions: </strong>The etonogestrel implant was the most cost-effective contraceptive option when modeled over a 5-year period, offering the fewest pregnancies and lowest associated healthcare costs. Policies and practices that support initiation and continuation of the etonogestrel implant can enhance both clinical outcomes and overall cost-effectiveness.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"66-76"},"PeriodicalIF":3.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs per responder for patients with relapsed or refractory multiple myeloma treated with Talquetamab compared with usual care.","authors":"Hans C Lee, Chelsey Yang, Yi-Hsuan Liu, Fan Mu, Jiamin Wang, Joseph Goble, Neel Patel, Xinke Zhang, Ariel F Grajales-Cruz, Tianze Jiao","doi":"10.1080/13696998.2025.2604457","DOIUrl":"https://doi.org/10.1080/13696998.2025.2604457","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate costs per responder for patients with triple-class exposed (TCE) relapsed or refractory multiple myeloma (RRMM) receiving talquetamab (Tal) on weekly (QW) and biweekly (Q2W) dosing schedules, compared with usual care from a United States commercial payer's perspective.</p><p><strong>Methods: </strong>A cost per responder model was developed over a 6-month time horizon, incorporating pre-progression and post-progression costs. For Tal QW and Tal Q2W, pre-progression costs included costs of drug acquisition, inpatient step-up doses (hospitalization, pre-medication, and tocilizumab), outpatient visits, and monitoring. Pre-progression costs for usual care were estimated based on a weighted average of the 10 most used regimens in a real-world LocoMMotion/MoMMent study, including costs of acquisition, administration, co-medication, and monitoring. Post-progression costs included subsequent treatment for a subset of patients and terminal care costs prior to death. All costs were reported in 2025 United States Dollars. Clinical data of overall response rate (ORR), progression-free survival, and overall survival were obtained from an indirect treatment comparison using MonumenTAL-1 (September 2024 data cut) and LocoMMotion/MoMMent (October 2022 and August 2023 data cuts) as data sources. Deterministic sensitivity analyses and scenario analyses were conducted to assess the robustness of model results.</p><p><strong>Results: </strong>Over the 6-month period, the total cost of care was $179,556 for usual care, $295,993 for Tal QW, and $315,135 for Tal Q2W. Despite higher costs, Tal demonstrated superior ORR, resulting in lower cost per responder: $575,962 for usual care, $405,470 for Tal QW, and $443,165 for Tal Q2W, representing a 23-30% reduction in cost per responder with Tal. Sensitivity and scenario analyses showed consistent findings.</p><p><strong>Conclusion: </strong>Although Tal QW and Q2W are associated with higher total per-patient costs compared with usual care, they offer improved clinical effectiveness, resulting in lower cost per responder. These findings suggest greater economic value for Tal in the treatment of TCE RRMM.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"93-105"},"PeriodicalIF":3.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A global model for symptomatic obstructive hypertrophic cardiomyopathy to assess the cost-effectiveness of mavacamten: results from a Dutch societal perspective.","authors":"Varun Ektare, Claire Simons, Kasper Johannesen, Taryn Krause, Carla L Zema, Leander R Buisman, Maarten Treur, Ana Moura, Manikanta Dasari, Melissa Verkaik, Gijs van de Wetering, Linde Pronk, Marjolein Pompen, Xiaoyan Li, Marta Contente, Christian Knackstedt, Michael Hurst","doi":"10.1080/13696998.2026.2675850","DOIUrl":"10.1080/13696998.2026.2675850","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the cost-effectiveness of mavacamten + beta-blocker/calcium channel blocker therapy (BB/CCB) versus BB/CCB monotherapy for the treatment of symptomatic obstructive hypertrophic cardiomyopathy (HCM).</p><p><strong>Materials and methods: </strong>A 5-state Markov model (New York Heart Association classes I-IV, death) that included treatment sequencing was developed. It used a Dutch societal perspective and lifetime horizon stratified into short-term (mavacamten + BB/CCB: 30 weeks; BB/CCB: 46 weeks) and long-term (i.e. post short-term) periods. The model population reflected the EXPLORER-HCM trial intention-to-treat population. Model parameters were aligned with 2016 Zorginstituut Nederland guidelines, including annual discount rates of 4.00% and 1.50% for costs and health outcomes. Costs (2022/2023 Euros), life-years (LYs) and quality-adjusted LYs (QALYs) per patient, incremental costs and LYs/QALYs, and incremental cost-utility ratios were estimated. Sensitivity and scenario analyses were conducted to evaluate the robustness of the results.</p><p><strong>Results: </strong>Treatment with mavacamten + BB/CCB resulted in an incremental discounted gain of 3.09 QALYs and 3.17 LYs versus the BB/CCB monotherapy strategy. Incremental discounted costs were €49,388 over a lifetime; the additional costs of mavacamten were driven by increased treatment acquisition costs but partly offset by savings in healthcare resource utilization and indirect costs, particularly informal care costs. Mavacamten + BB/CCB was cost-effective at a €50,000 per QALY threshold versus BB/CCB monotherapy at €15,961 per QALY gain. The deterministic and probabilistic sensitivity and scenario analyses supported the robustness of the model results.</p><p><strong>Conclusions: </strong>In the Netherlands, mavacamten + BB/CCB is a cost-effective treatment strategy for symptomatic obstructive HCM compared to BB/CCB monotherapy.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1595-1616"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of high body mass index on health state utilities: a time trade-off study in the general population of Japan.","authors":"Tomohiro Tanaka, Hideaki Kagitani, Taisuke Kojima, Zhihong Cai, Toshihiko Aranishi, Fujio Matsuyama, Tatsunori Murata, Yoko Yoshinaga","doi":"10.1080/13696998.2026.2684844","DOIUrl":"10.1080/13696998.2026.2684844","url":null,"abstract":"<p><strong>Aims: </strong>Given the increasing burden of patients with obesity disease, the impact of weight loss on health state utility needs to be reflected in cost-effectiveness analyses of new treatments. Equally important is that, health state utilities that reflect the preferences of the general population are of value for cost-effectiveness analyses. The aim of this time trade-off (TTO) study in the general population of Japan is to estimate the health state utilities of patients with obesity disease.</p><p><strong>Methods: </strong>Vignettes were generated for health states categorized by BMI (kg/m²), as follows: ≥25 to <30, ≥30 to <35, ≥25 to <35, or ≥35. The vignettes were validated by a medical expert and patients with obesity disease. A pilot survey examined the general population's comprehension of the vignettes before the main survey. Face-to-face interviews were conducted with the general population in both the pilot and main surveys by trained interviewers. Respondents were asked to imagine themselves in each vignette. Health state utilities were measured for each vignette using the TTO method.</p><p><strong>Results: </strong>The main survey and pilot survey included 240 adult respondents from the general population of Japan in total (female 50%; mean age, 44.5 years; and mean BMI, 22.4 kg/m²). The mean (95% confidence interval) health state utility tended to decrease as BMI category increased, as follows: 0.827 (0.804-0.849) for ≥25 to <30 kg/m², 0.604 (0.563-0.645) for ≥30 to <35 kg/m², 0.771 (0.741-0.800) for ≥25 to <35 kg/m², and 0.317 (0.255-0.380) for ≥ 35 kg/m².</p><p><strong>Conclusions: </strong>The results of this TTO study in the general population of Japan demonstrate that an increase in BMI from 25 kg/m² upward is associated with a decrease of health state utilities. These findings can be utilized to perform cost-effectiveness analyses of anti-obesity medications in Japan.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1688-1700"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and economic burden of medically attended influenza and influenza-like illness in Germany, 2016-2019.","authors":"Anna C Meyer, Julian Witte, Manuel Batram, José Bartelt-Hofer, Mathieu Bangert, Marie Schild, Ursula Marschall, Wolfgang Greiner, Jörg Schelling, Oliver Damm","doi":"10.1080/13696998.2026.2644765","DOIUrl":"10.1080/13696998.2026.2644765","url":null,"abstract":"<p><strong>Aims: </strong>Older adults and individuals with certain underlying conditions are at elevated risk of severe influenza complications. This study quantifies the burden of influenza and influenza-like illness (ILI) in Germany focusing on these high-risk groups.</p><p><strong>Methods: </strong>This cohort study is based on claims data of a large statutory health insurance fund. Influenza/ILI was identified through International Classification of Diseases version 10 (ICD-10) codes J09-J11. Among insured individuals, the incidence of medically attended influenza/ILI, hospitalizations, complications, and direct healthcare costs were estimated for three consecutive influenza seasons from 2016-2017 to 2018-2019. Healthcare resource use, complications, and costs attributable to influenza were estimated through comparison with a matched control group. Analyses were stratified by age and prevalence of underlying conditions.</p><p><strong>Results: </strong>Approximately 7 million individuals were included in each season. Influenza/ILI incidence decreased with age, but hospitalizations were most common among older adults. One in five cases aged 80+ years was hospitalized. In all age groups, individuals with underlying conditions had a higher incidence of influenza/ILI and of complications than those without underlying conditions. Direct costs per influenza/ILI case ranged from €133.28 (2016-2017) to €218.99 (2018-2019) and were higher in older adults and in individuals with underlying conditions.</p><p><strong>Limitations: </strong>Underdiagnosis and misclassification of influenza in administrative claims may occur, particularly in the outpatient setting. Only selected complications were examined; exclusion of cardiovascular and neurological consequences likely results in an underestimation of the influenza/ILI burden. Indirect costs, e.g. through productivity losses are not considered.</p><p><strong>Conclusions: </strong>Influenza/ILI significantly impacts the German healthcare system, with older adults and individuals with underlying conditions contributing disproportionately to the observed burden. Risks of severe outcomes and direct costs are highest in older adults, particularly those aged 80+ years, while children with underlying conditions also contribute substantially to the observed burden. These groups are important targets for preventive interventions.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"972-985"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs and benefits of whole-exome, whole-transcriptome sequencing versus 50-gene panels for genomic profiling in solid tumors.","authors":"Jesse D Ortendahl, Gebra Cuyun Carter, Eliza M Zantema, Jess R Hoag, Arthur Starodynov, Karen L White, Gargi D Basu, Anson Tharayanil, Jean-Paul De La O, David W Hall, Frederick L Baehner","doi":"10.1080/13696998.2026.2644108","DOIUrl":"10.1080/13696998.2026.2644108","url":null,"abstract":"<p><strong>Aims: </strong>The rapid development of therapies linked to molecular biomarkers has increased the importance of next-generation sequencing (NGS)-based tumor profiling to guide treatment decisions. Technology has enabled more comprehensive clinical testing; however, the optimal economic approach deserves investigation. This study evaluated the impact of testing using whole-exome, whole-transcriptome sequencing (WES/WTS) versus 50-gene panel tests from a US payer perspective.</p><p><strong>Materials and methods: </strong>A previously published Microsoft Excel-based model was used to compare WES/WTS and four 50-gene panels for testing within triple-negative breast cancer (TNBC), colorectal cancer (CRC), non-small cell lung cancer (NSCLC), and castrate resistant prostate cancer (CRPC). Genomic alteration prevalence and test sensitivity were based on a previous analysis of WES/WTS results in clinical samples. Model inputs related to the patient population, costs, clinical trial uptake, and market share were based on published literature. Results included the number of patients directed to a different therapy and the per-member per-month (PMPM) impact to a health plan when increasing utilization of WES/WTS testing.</p><p><strong>Results: </strong>In a one-million-member hypothetical plan, 858 patients were eligible for tumor profiling. Across the four 50-gene panel tests, the number of patients switching treatment when using WES/WTS testing was 1-2 (TNBC), 4-6 (CRC), 1-6 (NSCLC), and 3-5 (CRPC). PMPM cost differences when replacing use of 50-gene panels with WES/WTS testing ranged from a cost-savings of $0.0517 in NSCLC to a $0.0268 increase in CRPC. Per-patient costs when using WES/WTS testing were driven by medical and pharmacy costs, with testing representing only 1.1-2.1% of total costs.</p><p><strong>Limitations: </strong>Limitations include simplifications required in modeling and exclusion of recently approved therapeutic options due to the quickly evolving landscape.</p><p><strong>Conclusions: </strong>WES/WTS testing resulted in more patients directed to targeted therapies with a minimal budget impact and should be considered in clinical decision-making to improve patient outcomes.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1046-1058"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in drug price reduction trends during Japan's transition to an annualized revision environment: a comparative analysis using open data from the national claims database.","authors":"Koichi Tsuda, Asuka Suzuki, Yoshinori Nakata","doi":"10.1080/13696998.2026.2651056","DOIUrl":"10.1080/13696998.2026.2651056","url":null,"abstract":"<p><strong>Objective: </strong>To address the lack of evidence on the effects of Japan's transition to an annualized revision environment, this study quantified the net change in drug price reduction rates between the biennial and annualized revision periods, encompassing the introduction of off-year revisions and policy measures, and examined structural heterogeneity across drug types, dosage forms, and therapeutic categories.</p><p><strong>Methods: </strong>Longitudinal analysis was conducted using the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data. The study period was divided into Pre-period (2016-2019) and Post-period (2020-2023). Linear mixed-effects models (LMMs) were employed to estimate price change rates, adjusting for drug type, dosage form, therapeutic sub-categories, and log-transformed baseline price and prescription volume, with unique drug identifiers included as a random intercept.</p><p><strong>Results: </strong>The analysis included 4,448 drugs from 85 therapeutic sub-categories. Overall, the mean drug price reduction rate significantly accelerated in the Post-period, declining by an additional 4.46 percentage points (pp) compared with the Pre-period (<i>p</i> < 0.001). After covariate adjustment, the primary LMM estimate indicated a net acceleration of -6.65 pp (95% CI: -7.24 to -6.06; <i>p</i> < 0.001). The model also revealed pronounced bipolarization: oral drugs showed substantial acceleration in price reduction, with least squares (LS) means decreasing from -6.5% to -17.0% for brand-name drugs and from -15.6% to -27.3% for generics (<i>p</i> < 0.001 for both). Injection products showed divergent trajectories in the primary analysis. Severe price erosion occurred in antitumor agents (-13.3 pp), whereas high price resilience persisted in categories such as anticoagulants and hemodialysis solutions.</p><p><strong>Conclusions: </strong>Japan's annualized revision environment (2020-2023) was associated with an acceleration in pharmaceutical cost containment, but also with bipolarization across product segments. Marked price erosion in oral drugs, together with pronounced therapeutic heterogeneity, suggests that uniform reductions should be reconsidered to safeguard access and continuity of care.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1076-1088"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A system dynamics modelling protocol to evaluate the impact of a health financing mechanism for breast cancer pharmacotherapies in Malaysia.","authors":"Jing Sheng Lim, Weng Hong Fun, Kenneth Kwing Chin Lee, Renukha Sellappans","doi":"10.1080/13696998.2026.2660601","DOIUrl":"10.1080/13696998.2026.2660601","url":null,"abstract":"<p><strong>Introduction: </strong>The rising cost of targeted breast cancer therapies challenges financial sustainability and equitable access in dual-tier health systems. In Malaysia, public cancer care is highly subsidized but budget constrained, shifting patients toward private services that are typically financed through out-of-pocket payments, private health insurance or employer-sponsored insurance. Rakan KKM (MOH's Friend) is a fee-for service initiative in selected public hospitals designed to provide lower-cost private care, with revenues reinvested into the public system. However, its financial implications for breast cancer pharmacotherapy remain uncertain. This manuscript presents a methodological protocol for a system dynamics (SD) model developed to evaluate the financial implications of Rakan KKM for breast cancer pharmacotherapy in Malaysia.</p><p><strong>Methodology: </strong>A system dynamics model has been developed to model breast cancer disease progression across stages and patient movement between public, private and Rakan KKM care settings, integrating associated healthcare expenditures and revenue flows from the perspective of the Ministry of Health. An influence diagram was constructed through stakeholder engagement to identify key feedback mechanisms influencing access, affordability and system sustainability. Model parameterisation is complete, using national epidemiological data, published registries data, national drug acquisition cost estimates and expert elicitation from oncology clinicians and pharmacists. This protocol details the simulation framework where a status quo scenario is compared against intervention scenarios over a 10-year horizon. One-way sensitivity analysis and monte-carlo simulations address parameter and clinical uncertainties, while scenario analyses guided by the Diffusion of Innovation framework examine alternative uptake rates and capacity constraints.</p><p><strong>Conclusion: </strong>This protocol describes a transparent and adaptable SD modelling approach to assess the fiscal sustainability of financing high-cost breast cancer therapies in mixed public-private systems by projecting how patient switching influences pharmacotherapy expenditure and the net resources potentially available to support public service investment through Rakan KKM.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1279-1291"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of offering blood-based testing alongside existing modalities for colorectal cancer screening among those who previously declined screening: an economic evaluation.","authors":"Shaun P Forbes, Elifnur Yay Donderici, Nicole Zhang, Victoria M Raymond, Amar K Das, Peter S Liang","doi":"10.1080/13696998.2026.2633027","DOIUrl":"10.1080/13696998.2026.2633027","url":null,"abstract":"<p><strong>Aim: </strong>Inadequate adherence to colorectal cancer screening reduces individual and population level health benefits. Blood-based tests offer a new modality that may help patients overcome barriers, but there are concerns about the impact of patients switching from existing guideline-recommended screening modalities. This study estimates the population health outcomes and cost-effectiveness of offering blood-based testing using a validated individual-level simulation model based on patient preference evidence from randomized controlled trials.</p><p><strong>Materials and methods: </strong>In this study, a validated discrete-event simulation model was used to evaluate the performance of different combinations of colorectal cancer screening strategy preferences per 10,000 screened individuals beginning at age 45. Preferences for screening options were informed by randomized controlled trials of patients with and without the option of blood-based testing. Adherence to initial patient preferences over a simulated lifetime was modeled as: (1) assumed 100% adherence and (2) longitudinal using a calibrated model. Simulated outcomes included clinical outcomes and cost-effectiveness from a healthcare sector perspective. A strategy was deemed cost-effective at a willingness-to-pay threshold of $100,000 per quality-adjusted life-year gained.</p><p><strong>Results: </strong>The introduction of blood-based testing to an unscreened population with evidence from randomized controlled trials is projected to increase colorectal cancer deaths averted by 35% to 116% and from 68% to 247% relative to no screening, for stated preference and revealed preference scenarios, respectively. These outcomes are cost-effective, with incremental cost-effectiveness ratios ranging from $63,994 to $85,497 and from $30,464 to $54,764 across stated preference and revealed preference scenarios, respectively.</p><p><strong>Limitations: </strong>Given limited data, natural history and real-world longitudinal adherence to screening are based on evidence-informed assumptions.</p><p><strong>Conclusions: </strong>Using a simulation model to extrapolate data from two recent trials, we demonstrate that the introduction of blood-based tests has the potential to lead to cost-effective increases in the number of CRC deaths averted among the unscreened population.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"609-619"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}