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":"Enhanced patient outcomes and improved budget impact from increased PFO diagnostic testing in cryptogenic stroke workup: a US hospital perspective.","authors":"John J Volpi, Giorgia Tiozzo, Jet Neervoort, Timon Louwsma, Anne K Marti, Erik J Landaas, Mitesh Nakum, Ryan J Imhoff","doi":"10.1080/13696998.2026.2630603","DOIUrl":"10.1080/13696998.2026.2630603","url":null,"abstract":"<p><strong>Aim: </strong>Limited research exists on the hospital-level costs and reimbursement associated with PFO diagnostic testing. This study estimates the impact of fully implementing guideline-driven PFO diagnostic evaluation in patients with a history of cryptogenic stroke, from the perspective of an US hospital, focusing on costs, hospital reimbursement, and clinical outcomes.</p><p><strong>Methods: </strong>A budget impact analysis (BIA) was conducted from the perspective of a typical US hospital managing an average of 186 new cryptogenic stroke patients annually. Two scenarios were compared: the Current Diagnostic scenario, with a 54% testing rate, versus an Increased Testing scenario with a 100% testing rate. A hybrid decision tree combined with a Markov health state transition model was used to simulate costs and clinical outcomes over a one-year time horizon. Clinical and diagnostic input parameters were derived from the literature, while cost data were obtained from the Centers for Medicare and Medicaid Services (CMS) and other published sources.</p><p><strong>Results: </strong>Among a cohort of 186 cryptogenic stroke patients, testing 100% of eligible patients (compared to 54%) was expected to result in diagnosing an additional 21 PFO-related strokes (46 vs. 25), and with 8 more PFO closures (17 vs. 9) over a period of one year. This translated to a total expected reimbursement increase of $378,359 ($719,738 vs $1,098,097) over a one-year period. Most reimbursement increases came from PFO closure ($275,546), with contributions from diagnostics ($96,880) and adverse event management ($13,919). The total increase in contribution margin was $191,655 from improving PFO diagnostics.</p><p><strong>Conclusions: </strong>Increased diagnostic testing for PFO-associated stroke is expected to improve patient health outcomes and increase contribution margin from an US hospital perspective. This evidence supports improving PFO testing in US hospitals to reduce recurrent strokes and improve hospital efficiency.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"620-634"},"PeriodicalIF":3.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321584","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":3.0,"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}

{"title":"Healthcare burden of mixed aortic valve stenosis and insufficiency disease.","authors":"Ibrahim Sultan, Michael Ryan, Candace Gunnarsson, Godfred Marfo, Prashanth Vallabhajosyula","doi":"10.1080/13696998.2026.2635880","DOIUrl":"https://doi.org/10.1080/13696998.2026.2635880","url":null,"abstract":"<p><strong>Objective: </strong>To compare mortality, healthcare utilization, and costs between patients with symptomatic and asymptomatic mixed aortic valve disease (MAVD).</p><p><strong>Methods: </strong>We analyzed Optum United Health Care database for US patients with aortic insufficiency (AI) claims (2017-2024) and prior/concurrent aortic stenosis (AS) claims, requiring 12 months continuous enrollment. Patients with baseline aortic valve replacement (AVR) were excluded. Symptomatic MAVD (SMAVD) was defined as ≥2 baseline visits for heart failure, angina, dyspnea, or syncope. Outcomes included mortality, time to home health/skilled nursing facility (SNF), and annualized healthcare utilization and costs, analyzed using Cox proportional hazard and general linear models.</p><p><strong>Results: </strong>Among 132,361 MAVD patients, 73.62% (<i>n</i> = 97,448) were symptomatic at diagnosis. Of initially asymptomatic patients, 58.94% became symptomatic within 5 years. Only 22% received AVR within 5 years. SMAVD patients had higher mortality (HR 1.48, 95% CI 1.44-1.53), home health utilization (HR 1.32, 95% CI 1.30-1.35), SNF admissions (HR 1.38, 95% CI 1.35-1.41), and $11,120 higher annual costs.</p><p><strong>Conclusions: </strong>SMAVD patients experience significantly worse outcomes than asymptomatic patients. Early detection and timely interventions are critical to reducing MAVD's healthcare burden.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"761-771"},"PeriodicalIF":3.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377776","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":"https://doi.org/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":3.0,"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":"Loss of productivity among commercially insured patients with pulmonary arterial hypertension in the United States.","authors":"Anna Watzker, Christine Ferro, Gabriela Dieguez, Charmaine Girdish, Adnan Alsumali, Dominik Lautsch, Karim El-Kersh","doi":"10.1080/13696998.2026.2642553","DOIUrl":"https://doi.org/10.1080/13696998.2026.2642553","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in treatment, pulmonary arterial hypertension (PAH) remains a progressive condition with the onset of disease often in working-aged adults, leading to substantial economic burden and increased healthcare resource utilization despite the rarity of the disease. The aim of this study was to estimate productivity loss for patients with PAH.</p><p><strong>Methods: </strong>This was a retrospective cohort study of the Milliman Consolidated Health Cost Guidelines Source Data and the Merative MarketScan Commercial dataset between 01/01/2018 and 09/30/2023. Adult patients diagnosed and treated for PAH between 01/01/2019 and 08/31/2023 were identified and followed through the earliest of end of enrollment, or end of data. Outcomes were described as average workdays lost to receive healthcare services per-patient per-year (PPPY) and further assessed by healthcare setting. The cost of productivity loss was calculated based on the annual median household income.</p><p><strong>Results: </strong>The study included 1,588 commercially insured patients (mean age 52 years, 63% female). Between 2019-2023, the mean number of workdays lost ranged between 21 and 23 PPPY, equating to over 8% of annual workdays. The cost of loss of productivity ranged from $8,828 to $9,599 PPPY (in 2023 dollars). Across all study years, the largest proportion of workdays lost were attributed to emergency room (ER)/observation, followed by office visits, and outpatient facilities, altogether comprising two-thirds of total workdays lost. Inpatient hospitalization-related workday loss was approximately 11% of total workdays lost. Over the study period, the largest change in workdays lost was observed for ER/observation.</p><p><strong>Conclusion: </strong>This study demonstrates substantial workdays lost due to health services utilization among patients with PAH, further adding to the overall economic burden of PAH. Quantifying productivity loss in PAH patients provides critical insight into the broader societal costs of the disease, supporting the inclusion of indirect costs in future economic evaluations and healthcare policy decisions.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"909-918"},"PeriodicalIF":3.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491170","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":"https://doi.org/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":3.0,"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":"https://doi.org/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":3.0,"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}