Journal of Medical Economics最新文献

{"title":"Lost earnings among triptan non-responders in the general population of Denmark: a measure of disproportionate migraine-attributed burden and of unrecognised and unmet treatment need.","authors":"Messoud Ashina, Timothy J Steiner, Jakob Møller Hansen, Daniel Sloth Hauberg, Ulla Sofie Lønberg, Maria Spanggaard, Jens Olsen, Sandra Benkjer Stallknecht, Thomas Folkmann Hansen","doi":"10.1080/13696998.2025.2477342","DOIUrl":"10.1080/13696998.2025.2477342","url":null,"abstract":"<p><strong>Aims: </strong>Migraine leads to substantial healthcare utilization and associated costs. However, much higher costs are attributed to lost productivity. The impact of effective migraine treatment on these costs, at the individual level, has not been well established. Even less known is the impact of treatment failure. The objective of this study was to assess lost earnings as a measure of migraine-attributed burden among triptan non-responders in Denmark.</p><p><strong>Materials and methods: </strong>We used data from the Danish National Prescription Register and Danish Income Statistics Register over the 27-year period 1995-2021. We identified 4,979 triptan non-responders (85.9% female) and matched them for sex, age and region of residence with 14,292 continuing users of triptans (triptan responders) and 13,592 individuals from the background population (triptan never-users). We then estimated average annual individual earnings, and compared those among triptan non-responders, from 3 years prior to and 10 years after their last triptan redemption, with those among their matched triptan responders and triptan never-users over the same periods.</p><p><strong>Results: </strong>Triptan non-responders earned significantly less than both their matched triptan responders and their matched triptan never-users. The earnings gap was evident even 3 years prior to the last triptan prescription (€4,344 and €4,356 respectively). This gap widened substantially over time, so that average cumulative earnings over the 14-year period of follow-up for each triptan non-responder were €93,684 less than those of responders and €99,485 less than those of never-users.</p><p><strong>Limitations: </strong>There are uncertainties with regard to the reasons for triptan discontinuation (whether non-response or otherwise), and to lack of diagnostic confirmation of migraine.</p><p><strong>Conclusions: </strong>Triptan non-response represents failure of currently available acute treatment options. It is associated with substantial and cumulative lost earnings, highlighting a disproportionate economic burden. These findings underscore the potential economic benefit of recognizing, and rectifying, unmet treatment needs in migraine management.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"398-404"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572835","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":"Economic option value associated with surgical aortic valve replacement using a novel bioprosthetic and a future transcatheter aortic valve-in-valve procedure.","authors":"Eric L Keuffel, Matt Reifenberger, Andrew Pellegrini, Pradeep Yadav, Vinod H Thourani","doi":"10.1080/13696998.2025.2503664","DOIUrl":"https://doi.org/10.1080/13696998.2025.2503664","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal lifetime management of surgical aortic valve replacement (SAVR) patients should account for the expected clinical and economic value of the index procedure as well as the future trajectory of health outcomes. This study estimates the discounted per surgery \"total value\" (from the time of initial SAVR operation through 25 years post-surgery) and the option value (after reoperation) that mechanical SAVR patients forego by choosing a device that does not allow for valve-in-valve transcatheter aortic valve reoperation (ViV/TAVR).</p><p><strong>Methods: </strong>The model adopts a US payer perspective and tracks major health events, anti-coagulant monitoring, maintenance, and expenditures associated with these events following initial SAVR procedures, inclusive of costs before and after a potential reoperation. We compare the expected utilization and expenditures for tissue valve patients and mechanical valve patients over a 25-year period. The model also compares the experience of mechanical SAVR patients after reoperation to a counterfactual group receiving ViV/TAVR to estimate option value. Monte Carlo simulation, sensitivity analyses, scenario analyses, and break-even analyses were conducted to account for variation in inputs.</p><p><strong>Results: </strong>Novel SAVR treatment for aortic stenosis followed by ViV TAVR for reoperation reduces 25-year payer expenditures relative to mechanical valves by either $34,621 (95% CI: 17,426-52,218), $31,363 (95% CI: $19,871 -$43,399) or $23,303 (95% CI: $16,906-$30,075) depending on the age of initial SAVR operation. During this period, the \"option value\" share of overall savings ranges from 8-17% and generally is lower for older patients. Reoperation and anti-coagulant monitoring are important drivers of overall savings and option value.</p><p><strong>Conclusion: </strong>The deterministic and simulation models both demonstrate that novel SAVR tissue valves, followed by a ViV/TAVR, result in lower 25-year expected costs than a treatment strategy using mechanical SAVR valves, and option value is a component of these savings.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"28 1","pages":"778-787"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119705","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":"Real-world effectiveness of cariprazine in major depressive disorder and bipolar I disorder in the United States.","authors":"Roger S McIntyre, Mousam Parikh, Jamie Ta, Simranpreet Waraich, Chandra Cohen-Stavi, Carl Marci, Nadia Nabulsi","doi":"10.1080/13696998.2025.2513766","DOIUrl":"10.1080/13696998.2025.2513766","url":null,"abstract":"<p><strong>Aims: </strong>The efficacy of cariprazine for major depressive disorder (MDD) (adjunctive therapy) and bipolar I (BP-I) depression has been demonstrated in clinical trials. This study evaluated the real-world effectiveness of cariprazine in reducing depression severity among patients with moderate-to-severe MDD or BP-I depression.</p><p><strong>Methods: </strong>Medical/pharmacy claims and electronic medical records (EMRs) from specialty providers in the OM1 Real-World Data Cloud were used to identify adults with MDD or BP-I who initiated cariprazine (adjunctively for MDD) (first dispensing = index) and had ≥1 EMR and ≥1 claim during 12-month baseline and ≤12-month follow-up periods. Included patients had a baseline Patient Health Questionnaire (PHQ)-9 total score ≥10, reflecting at least moderate depressive symptoms. Follow-up continued until cariprazine discontinuation, alternate diagnosis (e.g. BP-I [MDD cohort] or MDD [BP-I cohort]), or 12 months post-index. Depression severity was assessed using PHQ-9 total scores that were observed or estimated from clinical notes using a previously validated machine learning algorithm. Analyses included mean change in PHQ-9 score from baseline to 2, 6, and 12 months of follow-up. A sensitivity analysis using only observed PHQ-9 scores was conducted.</p><p><strong>Results: </strong>Of 754 patients at baseline, 396 had MDD (mean PHQ-9 = 16.4) and 358 had BP-I (mean PHQ-9 = 16.9). For patients with MDD, mean reductions in PHQ-9 scores from baseline to 2, 6, and 12 months of adjunctive cariprazine treatment were 3.5 (95% CI: 2.7, 4.4; <i>n</i> = 127), 4.1 (2.9, 5.4; <i>n</i> = 87), and 3.7 (1.6, 5.8; <i>n</i> = 52), respectively. For patients with BP-I, mean reductions from baseline to 2, 6, and 12 months were 5.2 (95% CI: 4.2, 6.2; <i>n</i> = 121), 6.5 (5.2, 7.8; <i>n</i> = 90), and 6.9 (5.2, 8.5; <i>n</i> = 54), respectively. Greater improvements were observed in the sensitivity analysis.</p><p><strong>Conclusions: </strong>This real-world effectiveness study of cariprazine treatment for MDD (adjunctive use) or BP-I demonstrated clinically meaningful and sustained improvement in depression symptoms during short- and long-term follow-up.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"885-898"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187151","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":"Cost-utility analysis of isavuconazole compared with the standard of care as a first-line therapy for patients with invasive fungal infection prior to differential pathogen diagnosis in Japan.","authors":"Ataru Igarashi, Shun Inoue, Yasushi Onishi","doi":"10.1080/13696998.2025.2483098","DOIUrl":"10.1080/13696998.2025.2483098","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to evaluate the cost-effectiveness of isavuconazole compared with voriconazole as a first-line therapy for patients with invasive aspergillosis prior to differential pathogen diagnosis.</p><p><strong>Materials and methods: </strong>Using a state-transition model, a cost-utility analysis of isavuconazole compared with voriconazole was conducted in patients with presumptive invasive aspergillosis. The study population consisted of patients with hematological malignancies undergoing hematopoietic stem cell transplantation (HSCT) or chemotherapy who developed invasive fungal infections. The incremental cost-effectiveness ratio (ICER) was analyzed from the perspective of public healthcare. In patients with presumptive invasive aspergillosis, 6.6% were assumed to have mucormycosis. Efficacy data were sourced from the SECURE and VITAL trials, which included patients with invasive aspergillosis and mucormycosis. Expected survival was based on data for acute myeloid leukemia. The cost of voriconazole was based on its generic price. Different parameters were set for quality of life, expected survival period, and hospitalization costs in the HSCT and chemotherapy models, and the robustness of the model was evaluated using probabilistic and deterministic sensitivity analyses.</p><p><strong>Results: </strong>In the HSCT model, the base case showed an incremental quality-adjusted life-years (QALYs) of 0.37 and an incremental cost of JPY 918,682 for isavuconazole compared with voriconazole, with an ICER of JPY 2,515,813. In the chemotherapy model, the incremental QALYs was 0.16, and the incremental cost was JPY 723,111, with an ICER of JPY 4,411,564. The probability sensitivity analysis showed that the proportion of ICERs below JPY 5 million was 100.0% in the HSCT model and 79.1% in the chemotherapy model.</p><p><strong>Limitations: </strong>Reference efficacy data were obtained from non-Japanese clinical trials.</p><p><strong>Conclusions: </strong>Assuming a willingness-to-pay threshold of JPY 5 million for additional QALYs, isavuconazole was shown to be cost-effective compared with voriconazole in both the HSCT and chemotherapy models as a first-line therapy for patients with presumptive invasive aspergillosis.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"460-470"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692356","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":"Cost per remission for mirikizumab versus ustekinumab for moderately to severely active ulcerative colitis treatment from the United States commercial payer perspective.","authors":"Ankit Gulati, Neha Mittal, Sunanda Kane, Thomas Creveling, Nicholas Bires, Deborah A Fisher, Neha Chanan, Amit Kumar Koushik, Navneet Upadhyay","doi":"10.1080/13696998.2025.2503661","DOIUrl":"10.1080/13696998.2025.2503661","url":null,"abstract":"<p><strong>Introduction: </strong>Mirikizumab, approved for the treatment of moderately to severely active ulcerative colitis (UC), may be prescribed in a similar placement to ustekinumab in second-line settings. Payers may compare the economic value when making formulary decisions. This study estimated and compared the cost per remission of the second-line therapies mirikizumab versus ustekinumab in patients with UC.</p><p><strong>Methods: </strong>An Excel-based analytic model was developed to estimate the cost per additional patient achieving clinical remission at the end of one year in biologic/Janus kinase inhibitor (JAKi)-experienced patients (second-line therapy) with UC from a United States commercial payer perspective. A network meta-analysis of published pivotal randomized clinical trials was used to derive the number needed to treat (NNT) for clinical response, clinical remission, and endoscopic remission/endoscopic improvement/mucosal healing for ustekinumab and mirikizumab in the study population. The model included the treatment cost (wholesale acquisition costs [WAC] and treatment administration costs) during the induction and maintenance phases. A scenario involving the availability of a ustekinumab biosimilar was also evaluated, assuming the NNT remained the same as ustekinumab but with a WAC set at 50% lower than its current WAC.</p><p><strong>Results: </strong>The costs per patient achieving clinical remission for mirikizumab vs. ustekinumab as a second-line therapy were $461,096 vs. $67,273 during induction and $501,456 vs. $1,079,189 during maintenance. The cost per clinical remission in case of dose escalation during maintenance was lower for mirikizumab vs. ustekinumab ($501,456 vs. $1,569,127). Considering the ustekinumab 130 mg IV biosimilar, the scenario resulted in a lower cost per clinical remission for mirikizumab vs. a ustekinumab biosimilar during the maintenance phase ($501,456 vs. $539,594).</p><p><strong>Conclusion: </strong>Mirikizumab is projected to have a lower cost per remission during maintenance therapy than ustekinumab. Given the need for long-term treatment for this chronic condition, mirikizumab appears to be a cost-efficient treatment option.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"709-718"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969883","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":"Productivity loss associated with premature mortality due to human papillomavirus-related cancers in Poland.","authors":"Rafał Jaworski, Marcin Czech, Alicja Wójcik, Ugne Sabale, Jarosław Pinkas","doi":"10.1080/13696998.2025.2523161","DOIUrl":"https://doi.org/10.1080/13696998.2025.2523161","url":null,"abstract":"<p><strong>Introduction: </strong>Human papillomavirus (HPV) is among the leading infection-related causes of cancer mortality and lost productivity in Central and Eastern European countries, including Poland. The aim of this study was to assess productivity loss and indirect costs of premature mortality due to HPV-related cancers in Poland with focus on burden attributable to the 9-valent vaccine HPV genotypes.</p><p><strong>Methods: </strong>Previously published model using the human capital approach has been adapted to the Polish context by utilizing country-specific epidemiological and economic data from primary national sources. The number of HPV-related cancer deaths, Years of Life Lost (YLL), Years of Productive Life Lost (YPLL), and the Present Value of Future Lost Productivity (PVFLP) were estimated in 2010, 2015, 2019, and 2022. The PVFLP was estimated using either a gross domestic product (GDP) per employed person or average wage. Attributable fractions to HPV types were utilized to determine the percentage of deaths, YLL, YPLL, and PVFLP attributed to HPV.</p><p><strong>Results: </strong>The number of deaths, YLL, and YPLL due to cancers attributable to 9-valent HPV vaccine types in 2022 were estimated at 1,810, 25,747, and 5,665, respectively. This represented a decline of 14.7%, 28.2%, and 37.9%, respectively, from 2010. Cancers attributable to the 9-valent HPV vaccine accounted for 75% to 100% of all HPV-related cancers depending on cancer type. The PVFLP amounted to EUR 142.00 million in 2022, which represented an 11.5% increase from EUR 127.0 million in 2010. The PVFLP of cancers attributable to the 9-valent HPV vaccine genotypes accounted for 90% to 91% of all HPV-related cancers.</p><p><strong>Conclusions: </strong>HPV-related cancers continue to pose a substantial public health challenge. Expanding coverage rate for the 9 valent HPV vaccine creates the potential to reduce the burden of HPV-related diseases and avoid productivity loss due to the premature mortality from HPV-related cancers.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"28 1","pages":"1014-1022"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553757","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 resource utilization and costs among patients with metastatic castration-sensitive prostate cancer initiated on apalutamide or enzalutamide in the United States (2019-2023).","authors":"Mehmet A Bilen, Benjamin Lowentritt, Sabree Burbage, Frederic Kinkead, Ibrahim Khilfeh, Carmine Rossi, Shawn Du, Gordon Wong, Dominic Pilon, Kruti Joshi, Neal D Shore","doi":"10.1080/13696998.2025.2530865","DOIUrl":"10.1080/13696998.2025.2530865","url":null,"abstract":"<p><strong>Aims: </strong>This retrospective longitudinal cohort study compared healthcare resource utilization (HRU) and costs among patients with metastatic castration (hormone)-sensitive prostate cancer who initiated apalutamide or enzalutamide, two androgen receptor pathway inhibitors (ARPIs) that have demonstrated efficacy in the treatment of advanced prostate cancer in phase 3 clinical trials.</p><p><strong>Methods: </strong>Linked patient-level data from a practice-related clinical urology database and an administrative claims database in the United States (1 January 2016-31 December 2023) were used. Per-patient-per-month (PPPM) HRU and cost outcomes were compared between the apalutamide and enzalutamide cohorts during the observation period (i.e. from ARPI initiation until continuous insurance eligibility end) after inverse probability treatment weighting to balance differences in baseline characteristics.</p><p><strong>Results: </strong>Overall, 486 patients who initiated apalutamide (mean age 70.3 years, 53.5% white, 25.4% Black, 58.1% Medicare-insured) and 601 patients who initiated enzalutamide (mean age 70.5 years, 52.9% white, 25.5% Black, 58.8% Medicare-insured) were included. Duration of continuous treatment use was 9.6 months for apalutamide and 8.6 months for enzalutamide. Despite longer continuous ARPI use among patients treated with apalutamide relative to enzalutamide, the number of inpatient admissions (rate ratio [RR] = 0.58; 95% confidence interval [CI] = 0.37, 0.86; <i>p</i> = 0.012), number of admission days (RR = 0.58; 95% CI = 0.19, 0.70; <i>p</i> = 0.004), as well as all-cause medical costs (mean monthly cost difference = -$1,845; 95% CI = -$52, -$4,908; <i>p</i> = 0.044) were significantly lower in the apalutamide cohort than the enzalutamide cohort during the observation period. Mean monthly all-cause pharmacy costs between the cohorts was not significantly different ($2,121; 95% CI = -2,389, 5,703; <i>p</i> = 0.320).</p><p><strong>Limitations: </strong>This study relied on administrative claims and clinical data, which may contain coding inaccuracies or omissions. While linkages between the data sources are comprehensive, any mislinkages may have led to misclassification and information bias.</p><p><strong>Conclusion: </strong>The findings of this study suggest that apalutamide may result in better economic outcomes relative to enzalutamide.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1096-1109"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637235","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":"Treatment persistence among treatment-experienced people with HIV switching to integrase strand transfer inhibitor-based antiretroviral regimens.","authors":"Ching-Yi Chuo, Mary J Christoph, Woodie Zachry, Melanie de Boer, Megan Chen, Cassidy Trom","doi":"10.1080/13696998.2025.2536422","DOIUrl":"10.1080/13696998.2025.2536422","url":null,"abstract":"<p><strong>Aims: </strong>Low rates of persistence are associated with poor outcomes in people with HIV (PWH). This retrospective cohort study assessed treatment persistence as measured by time to treatment switch in treatment-experienced (TE) PWH initiating integrase strand transfer inhibitor (INSTI)-based regimens.</p><p><strong>Methods: </strong>United States prescription claims and medical history data from the IQVIA Longitudinal Access and Adjudication Dataset between January 1, 2018, and August 31, 2023, were analyzed. TE PWH with ≥1 prescription claim for initiation of an INSTI-based antiretroviral regimen during the index period (January 1, 2020, to December 31, 2022) were included. Descriptive analyses of demographic and comorbidity variables were performed, stratified by regimen. Kaplan-Meier analysis was used to evaluate time to subsequent treatment switch in the overall population and among PWH aged ≥50 years, those receiving Medicare, and those with mental health conditions or substance use disorders.</p><p><strong>Results: </strong>Overall, 29,348 TE PWH were included. The majority of INSTI-based regimen initiations were for bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) (61%; <i>n</i> = 17,917), followed by dolutegravir/lamivudine (27.4%; <i>n</i> = 8034) and cabotegravir + rilpivirine (7.4%; <i>n</i> = 2186). A subsequent switch occurred in 3341 (11.4%) PWH. Risk factors for switch included female sex, Medicare/Medicaid coverage, and higher Charlson Comorbidity Index scores. B/F/TAF was associated with the fewest subsequent switches (9.2%; <i>n</i> = 1656) and was significantly less likely than any other regimen to lead to a subsequent switch, either in the overall population or in the three at-risk subgroups.</p><p><strong>Limitations: </strong>No data are available to determine the underlying reasons for initial treatment choice or subsequent treatment switch.</p><p><strong>Conclusions: </strong>This study provides evidence for greater treatment persistence with B/F/TAF versus other INSTI-based regimens. Unlike prior studies that focused on treatment-naïve individuals, this analysis uniquely evaluates persistence among treatment-experienced PWH initiating newer INSTI-based regimens.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1241-1251"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659418","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":"Cost-effectiveness of CMR over MPS-SPECT: a systematic review of recent trends for diagnosing CAD.","authors":"Ben Kluge, James Harris, Irene Sánchez-Collado, Inés Pérez-Román, Molly Paffett, Sina Christophel, Cornelia Harz, Michael Blankenburg, John P Greenwood","doi":"10.1080/13696998.2025.2550331","DOIUrl":"10.1080/13696998.2025.2550331","url":null,"abstract":"<p><strong>Aims: </strong>The health economic impacts of cardiovascular magnetic resonance (CMR) imaging and myocardial perfusion scintigraphy by single photon emission computed tomography (MPS-SPECT) as diagnostic modalities are not well understood. This review is based on a wider systematic review and aims to compare CMR and MPS-SPECT as first-line, non-invasive modalities for the diagnosis of symptomatic individuals with a low-to-intermediate pre-test probability (PTP) of coronary artery disease (CAD).</p><p><strong>Materials and methods: </strong>We performed a systematic review of MEDLINE and Embase, MEDLINE In-process, the Cochrane Database of Systematic reviews and the Cochrane Central Register of Controlled Trials. Studies from January 1992 to January 2023 were included, if they were based in the UK, France, Germany, Italy, Japan, China, and/or the USA (published in any language). Risk of bias was assessed using the Drummond checklist.</p><p><strong>Results: </strong>Thirteen relevant reports were identified. In the USA, CMR was consistently cost-effective compared with MPS-SPECT for patients with a low-to-intermediate PTP of CAD; resource use and associated costs, as well as total costs, were lower. For patients with a low-to-intermediate PTP of CAD in Europe, CMR was cost-effective in Germany, while in the UK increases in quality-adjusted life-years were found but cost savings were mixed. This review found only 13 reports on the economic benefits of CMR over MPS-SPECT, with just three providing cost-effectiveness outcomes, highlighting the need for further research across different settings and perspectives.</p><p><strong>Conclusion: </strong>Overall, findings suggest that the cost savings from using CMR compared with MPS-SPECT for patients with a low-to-intermediate PTP of CAD support prioritized investment; however, confirmatory research is needed given the limited number of cost-effectiveness analyses identified in this review.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1451-1466"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957360","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":"Assessment of unmet clinical needs and healthcare resource use among statin-treated patients with or at risk of developing atherosclerotic cardiovascular disease.","authors":"Nancy Ortiz, Jacqueline Shehata, Jeremy Smart, Brian Leinwand, Ahan Ali, Dushyant Katariya, Mary R Dicklin, Andrew Hsieh","doi":"10.1080/13696998.2025.2558314","DOIUrl":"10.1080/13696998.2025.2558314","url":null,"abstract":"<p><strong>Aim: </strong>Atherosclerotic cardiovascular disease (ASCVD) imposes considerable clinical and economic burdens. ASCVD prevention seeks to control low-density lipoprotein cholesterol (LDL-C) using statins as first-line treatment. This retrospective US cohort study assessed unmet clinical needs and healthcare resource use among statin users in primary and secondary prevention.</p><p><strong>Materials and methods: </strong>MarketScan administrative claims 2017-2021 were leveraged and linked to laboratory data to identify patients with hypercholesterolemia followed for 2 years. Numbers of statin-treated hypercholesterolemia patients in primary prevention, very high-risk or not very high-risk secondary prevention, and their LDL-C goal achievement, were estimated and inflated to national estimates, along with annualized healthcare resource utilization and costs. Cardiovascular events according to LDL-C goal attainment were also assessed.</p><p><strong>Results: </strong>Almost 125,000 statin-treated patients did not meet LDL-C goals. Data inflated to US national estimates suggested approximately 72 million (M) patients have hypercholesterolemia: 43 M primary prevention (∼40% above goal), 9.8 M very high-risk secondary prevention (∼78% above goal), and 9.1 M not very high-risk secondary prevention (∼60% above goal) are treated with statins, and 9.5 M are untreated (∼84% above goal). Managing LDL-C to goal was associated with a 50% reduction in the proportion of patients with a cardiovascular event. Patients utilizing high-cost healthcare services and annualized healthcare costs increased from primary to secondary prevention, and from not very high- to very high-risk secondary prevention.</p><p><strong>Limitations and conclusions: </strong>Prevention is an essential component of any effort to improve population health and ultimately reduce spending. While some prevention efforts are cost-saving, some strategies that improve health will increase total spending. Nonetheless, millions of people in the US taking statins do not achieve LDL-C goals, indicating a significant clinical burden among those with, or at risk for, ASCVD, resulting in substantial healthcare resource use and costs.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1616-1625"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069769","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}