Journal of Medical Economics最新文献

{"title":"Management of moderate-to-highly exuding leg ulcers with polyacrylate superabsorbent wound dressings versus foam dressings in spanish settings: an early-stage cost-effectiveness and budget-impact analysis.","authors":"Vladica Veličković, Joan-Enric Torra I Bou, Francisco Cegri, Federico Palomar Llatas","doi":"10.1080/13696998.2026.2636435","DOIUrl":"10.1080/13696998.2026.2636435","url":null,"abstract":"<p><strong>Aim: </strong>This study evaluates the incremental cost‑effectiveness and budget impact of polyacrylate Superabsorbent (SAP) dressings compared with foam dressings for the management of moderate‑to‑highly exuding leg ulcers in the Spanish healthcare setting.</p><p><strong>Methods: </strong>We developed a weekly-cycle microsimulation state-transition model over 24 weeks from the Spanish National Health System perspective. Clinical effectiveness inputs for SAP dressings were derived from IPD from two observational clinical studies (<i>n</i> = 84, 2-week follow-up). Foam-dressing effectiveness was informed by a systematic review and meta-analysis of three eligible studies reporting 14-day wound-area reduction. The modelled cohort represented patients with moderate-to-highly exuding leg ulcers managed with compression therapy as standard of care; baseline severity was parameterised from the IPD (mean ulcer duration 15.1 months; baseline wound size 5,765 mm²).</p><p><strong>Results: </strong>This early-stage model predicts an absolute incremental improvement in healing rate of 2.41 percentage points, an absolute incremental gain of 0.135 quality‑adjusted life weeks (QALWs) over a 24‑week period, and an absolute per‑patient direct cost reduction of €729 when SAP dressings are compared with foam dressings. When these incremental results are extrapolated to a hypothetical scenario of 100% adoption, the Spanish National Health System could achieve annual cost savings of €55.557 million. These estimates should be interpreted cautiously given the early‑stage, non‑comparative nature of the underlying evidence.</p><p><strong>Limitations: </strong>Treatment‑effect estimates were derived from non‑randomized studies, which may introduce unmeasured confounding. As a result, the magnitude of the incremental effects is uncertain. To evaluate robustness, we conducted deterministic and probabilistic sensitivity analyses, both of which showed that the direction of the base‑case findings remained consistent across all plausible parameter ranges.</p><p><strong>Conclusions: </strong>Preliminary model predictions suggest that polyacrylate wound dressings may provide additional health benefits and potentially reduce costs compared with foam dressings within the Spanish Health Care System.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"712-725"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147348436","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 systematic review of acute and long-term outcomes in patients with non-transvenous implantable cardioverter-defibrillators.","authors":"Steven Zweibel, David Lanctin, Reece Holbrook, Sunil Kapur","doi":"10.1080/13696998.2026.2667706","DOIUrl":"10.1080/13696998.2026.2667706","url":null,"abstract":"<p><strong>Background: </strong>Non-transvenous implantable cardioverter-defibrillator (ICD) systems have been developed to address limitations of transvenous ICDs. This systematic literature review aimed to summarize periprocedural and long-term outcomes of non-transvenous ICD systems in adult patients with guideline-based indications for ICD therapy.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420261327618). Eligible studies enrolled adults (≥18 years) receiving a non-transvenous ICD for primary or secondary prevention. Outcomes included periprocedural and long-term endpoints and were summarized descriptively. The Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) checklist for case series were used to assess risk of bias.</p><p><strong>Results: </strong>Twenty-five publications representing 18 unique studies and 4,633 patients were included. Most studies were single-arm (<i>n</i> = 13), while 2 were randomized controlled trials and 3 were nonrandomized comparative studies. Procedural success ranged from 81%-100%, with rates ≥94% of patients in all but one early-phase study; defibrillation threshold testing success ranged from 89%-100% (≥96% in studies with <i>n</i> ≥ 100). Periprocedural complications were reported in 0%-5% of patients in most studies. Long-term complication rates ranged from 0%-8% at 0.5-1.5 years of follow-up and 1%-14% beyond 1.5 years. All-cause mortality ranged from 1%-5% within 6 months and increased to 16%-26% at 4-8 years. Clinical defibrillation success was consistently high (95%-100%). Incidence of inappropriate shock generally ranged from 7%-13% at 1 year and 2%-18% at later timepoints. Appropriate shock incidence ranged from 2% to 9% within 1 year and increased with longer follow-up. Risk of bias was predominantly moderate, with limited variation using NOS and greater discrimination observed with JBI.</p><p><strong>Conclusions: </strong>Non-transvenous ICD systems demonstrate favorable safety and effectiveness profiles, with high procedural and defibrillation success and acceptable complication and inappropriate shock rates across studies. Overall, the available evidence supports their use in appropriately selected adult patients with standard ICD indications.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1492-1509"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987952","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 analysis of rapid antimicrobial susceptibility testing as a point of care for patients with uncomplicated urinary tract infection in Japan","authors":"Hayato Niiro, Ayumu Yoshida, Fumiko Kino, Fujio Matsuyama, Naoki Tashiro, Tatsunori Murata, Norio Ohmagari","doi":"10.1080/13696998.2026.2659826","DOIUrl":"10.1080/13696998.2026.2659826","url":null,"abstract":"<p><strong>Background: </strong>Empirical antibiotic therapy for patients with urinary tract infections (UTIs) has contributed to the rise of overuse or use of inappropriate antibiotics, which is a significant public health concern. The introduction of point-of-care diagnostic tests (POCTs) for the rapid determination of antimicrobial susceptibility is predicted to help reduce unnecessary broad-spectrum antibiotic use and produce actionable information for an approach to antibiotic stewardship.</p><p><strong>Aims: </strong>To evaluate the cost-effectiveness of UTI diagnostic and treatment strategies, including a POCT in Japan.</p><p><strong>Methods: </strong>A decision tree model was constructed from a healthcare payer perspective to compare three diagnostic and treatment strategies for patients with uncomplicated UTIs visiting community clinics or hospital outpatient settings in Japan: (1) a POCT-guided strategy; (2) empirical broad-spectrum antibiotic treatment alone; and (3) empirical broad-spectrum antibiotic treatment with concurrent conventional culture. The study population was stratified into patients with cystitis and those with pyelonephritis. The time horizon was set at 30 days for cystitis and 60 days for pyelonephritis.</p><p><strong>Results: </strong>For patients with cystitis, the incremental cost-effectiveness ratio (ICER) for the POCT strategy was JPY 10,787,224 per quality-adjusted life year (QALY) gained compared with broad-spectrum antibiotic agents only, and JPY 1,552,864/QALY compared with broad-spectrum antibiotic agents plus culture. For patients with pyelonephritis, the ICERs for the POCT strategy were JPY 2,362,912/QALY versus broad-spectrum antibiotic agents only, and JPY 222,752/QALY versus broad-spectrum antibiotic agents plus culture.</p><p><strong>Conclusions: </strong>Compared with the broad-spectrum antibiotic agents plus culture strategy, which is common practice in Japan, the POCT strategy demonstrated potential cost-effectiveness for patients with cystitis and pyelonephritis. These results suggest that introducing POCTs for patients with UTIs in Japan may be a cost-effective approach.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1315-1326"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773668","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 analysis of atezolizumab and bevacizumab as first-line systemic therapy in unresectable hepatocellular carcinoma in Malaysia.","authors":"Yoke Fui Wong, Rosmawati Mohamed, Audi Adawiah Sulaiman Shah, Nathorn Chaiyakunapruk, Chanthawat Patikorn","doi":"10.1080/13696998.2026.2658448","DOIUrl":"10.1080/13696998.2026.2658448","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to evaluate the cost-effectiveness of atezolizumab plus bevacizumab as first-line systemic therapy for unresectable hepatocellular carcinoma (uHCC) in Malaysia, compared with the current standard treatments in the Malaysian Ministry of Health (MOH) to inform public healthcare decision‑making.</p><p><strong>Materials and methods: </strong>A cost-effectiveness analysis was conducted from the MOH perspective, following the national pharmacoeconomic guidelines (2019). The study compared atezolizumab plus bevacizumab with sorafenib and lenvatinib, respectively, using a partitioned survival model to project health outcomes and costs over a lifetime horizon. Clinical efficacy data were sourced from published trials and network meta-analyses. Cost inputs reflected local healthcare resource use and prices, using 2024 Malaysian Ringgit values inflated <i>via</i> the Consumer Price Index for Health. Costs and outcomes were discounted at 3% annually. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of key parameter uncertainties on the results.</p><p><strong>Results: </strong>Atezolizumab plus bevacizumab provided the highest quality-adjusted life years (QALYs) and life years compared to sorafenib and lenvatinib. Sorafenib was dominated by lenvatinib due to lower QALYs and higher costs and excluded from further analysis. Compared to lenvatinib, atezolizumab plus bevacizumab yielded 0.873 additional QALYs and RM 44,863 additional cost, resulting in an incremental cost-effectiveness ratio (ICER) of RM 51,399 per QALY gained (∼0.906 GDP/capita at Malaysia's 2024 GDP/capita RM 56,734).</p><p><strong>Conclusions: </strong>Atezolizumab plus bevacizumab is cost-effective compared to lenvatinib and sorafenib across willingness-to-pay (WTP) values of one to three times Malaysia's GDP per capita. These findings provide evidence to inform public health policy that expanding funding and adoption of atezolizumab plus bevacizumab is likely to improve health outcomes cost-effectively.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1327-1337"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773699","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":"Subcutaneous foslevodopa/foscarbidopa (LDp/CDp) in advanced Parkinson's disease (aPD): societal cost impact analysis for the UK, France, Germany, Spain, and Canada.","authors":"K Ray Chaudhuri, Juan Carlos Parra, Trishal Boodhna, Jonathan Belsey","doi":"10.1080/13696998.2026.2652780","DOIUrl":"10.1080/13696998.2026.2652780","url":null,"abstract":"<p><strong>Background: </strong>The costs associated with advanced Parkinson's disease (aPD) extend beyond direct medical expenditure. As symptoms become more severe, professional and informal personal care costs are likely to exceed those incurred for medical and pharmacological treatment. The objective of this analysis is to explore the impact of treatment with subcutaneous foslevodopa/foscarbidopa (LDp/CDp) on the societal cost impact in the UK, France, Germany, Spain, and Canada.</p><p><strong>Methods: </strong>A model was developed to aggregate expected costs incurred by a cohort with aPD over a 5-year time frame. Resource use for direct medical, non-medical, and informal care are estimated from a real world data source (Adelphi), mapped to the severity of disease as estimated by the extent of OFF-time experienced by patients. Indirect societal costs are estimated from published literature. Unit costs for each of the included countries are then applied to these resource use estimates. Symptom progression of individuals within the cohort are derived from a previously developed Markov model, which captures the differential effect on OFF-time of LDp/CDp versus best medical treatment (BMT).</p><p><strong>Results: </strong>Overall costs for aDP patients were shown to rise over the 5-year time horizon, as symptom progression occurred. The use of LDp/CDp incurred greater drug costs than BMT, but, by delaying exacerbation of OFF-time, this additional cost was more than offset by other savings - principally attributable to professional and informal care. Aggregated results showed a net cumulative saving of €96,273 per patient over the 5 year time horizon. Results for the five individual countries evaluated ranged from €50,297 to €135,208 per patient saving.</p><p><strong>Conclusion: </strong>LDp/CDp has been shown to significantly improve OFF-time burden in patients with aPD, compared with BMT. Once the costs of professional and informal care are taken into account, the additional acquisition costs of LDp/CDp are more than offset, yielding a net societal saving.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1230-1245"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773756","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":"Trends in industry-sponsored clinical trial activity since passage of the Inflation Reduction Act.","authors":"Genia Long","doi":"10.1080/13696998.2026.2646075","DOIUrl":"10.1080/13696998.2026.2646075","url":null,"abstract":"<p><strong>Background and objective: </strong>By shortening the time after U.S. drug approval when substantial revenue reductions typically occur, the Inflation Reduction Act's (IRA) Drug Price Negotiation Program (DPNP) alters investment incentives. Particular concerns include disincentives for post-approval clinical testing of new indications (begun after U.S. drug approval), and investment in small molecules relative to biologics. Post-approval development faces shortened times to earn returns; small molecule drugs are eligible to be selected for the DPNP four years earlier than biologics. The purpose of this study is to investigate these potential disincentives by quantifying trends in clinical trial starts, before and after IRA passage, for biologics and small molecules, further segmenting trials into those begun prior to U.S. drug approval and those begun later, seeking additional indications (pre-approval and post-approval trials, respectively).</p><p><strong>Methods: </strong>Combining data from Citeline Trialtrove and Pharmaprojects databases, a linear regression model estimated separately for trials beginning pre- and post-U.S. drug approval yielded best-fit estimates of trends and percentage changes in average monthly Phase I-III industry-sponsored interventional clinical trial starts for the periods before (January 2010-July 2022) and after (August 2022-December 2024) passage of the IRA, in biologic and small molecule drugs.</p><p><strong>Results: </strong>During the first twenty-nine months after IRA passage, the estimated number of small molecule drug clinical trials started monthly dropped by 25.2% (95% CI: -39.0% to -7.1%) and 29.5% (95% CI: -42.4% to -13.2%) for pre-approval trials for new drugs and post-approval trials, respectively. In comparison, for biologics, the model estimates non-significant decreases for pre-approval trials (-2.1%, 95% CI: -9.4% to +5.8%) and post-approval trials (-13.0%, 95% CI: -30.0% to +6.4%).</p><p><strong>Conclusions: </strong>While descriptive, this study offers early evidence of reductions in industry-sponsored new small molecule pre-approval and post-approval drug trials after IRA passage. These trends should be monitored as responses work their way through drug pipeline investment decisions.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"957-971"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512663","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":"Characterization of US patients with alpha-1 antitrypsin deficiency treated with an alpha-1 proteinase inhibitor.","authors":"Nikhil Khandelwal, Sally Higgins, Jimmy Hinson, Shahla Amin, Temitope Bello, James K Stoller","doi":"10.1080/13696998.2026.2705768","DOIUrl":"https://doi.org/10.1080/13696998.2026.2705768","url":null,"abstract":"<p><strong>Background and aim: </strong>Currently, specific therapy for alpha-1 antitrypsin deficiency (AATD) consists solely of augmentation therapy with alpha-1 proteinase inhibitors, including Glassia (Alpha₁-PI). The real-world experience and impact of Alpha₁-PI have not been well characterized. The aim of this retrospective cohort study was to describe the characteristics and healthcare resource utilization (HCRU) of patients with AATD receiving Alpha₁-PI.</p><p><strong>Method: </strong>De-identified records from adults with diagnosed AATD (aged ≥18 years) who had ≥2 in/outpatient claims and ≥12 months of continuous enrollment before and after the index date were evaluated as sub-cohorts, with analysis focusing primarily on patients receiving Alpha₁-PI. Outcomes included baseline demographics, clinical characteristics, AAT testing rates, treatment patterns, and HCRU, with descriptive statistics calculated for continuous variables and categorical measures.</p><p><strong>Results: </strong>249 patients were identified as Alpha₁-PI users, of which 159 (63.8%) were new users. At baseline, the most common comorbidities were any chronic pulmonary disease (95.2%), hypertension (59.4%), and emphysema (46.2%). AAT testing rates during the study period were 49.4% and 56.6% among anytime and new Alpha₁-PI users, respectively. During 12 months of follow-up, new Alpha₁-PI users achieved a mean of 22.3 (standard deviation, 16.2) prescription claims. In total, 103 (64.8%) patients adhered to treatment (proportion of days covered ≥80%). Seventy-four new users (46.5%) persisted in using Alpha₁-PI, whilst 45 (28.3%) discontinued and started another augmentation therapy. Most patients required outpatient visits (99.2%).</p><p><strong>Limitations: </strong>Claims-based adherence may be misclassified because an infusion claim does not confirm administration, and some Alpha₁-PI claims may bundle multiple infusions. As a result, proportion of days covered and observed treatment patterns may be overestimated and may reflect reimbursement patterns rather than actual use.</p><p><strong>Conclusion: </strong>Patients with AATD had a high burden of comorbidities, treatment discontinuations and switching, and HCRU, demonstrating an unmet need when utilizing Alpha₁-PI for augmentation therapy.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"2020-2030"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562270","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":"The healthcare resource utilization and costs associated with metabolic dysfunction-associated steatohepatitis among Medicare beneficiaries: a retrospective cohort study.","authors":"Husam Albarmawi, Anran Tan, Abdalla Aly, Anthony Hoovler, Caichen Zhong, Jamieson Vaccaro, Joanna Harton, Parvez Mantry","doi":"10.1080/13696998.2026.2630601","DOIUrl":"10.1080/13696998.2026.2630601","url":null,"abstract":"<p><strong>Aims: </strong>The main objective of this study was to estimate the incremental healthcare resource utilization (HCRU) and costs attributable to metabolic dysfunction-associated steatohepatitis (MASH) from a Medicare fee-for-service perspective by comparing beneficiaries diagnosed with MASH with those not diagnosed with MASH.</p><p><strong>Material and methods: </strong>This observational study used 100% Medicare fee-for-service claims data from January 1, 2016, through December 31, 2022. The study population was stratified in cohorts based on MASH status. In the main analysis, the MASH cohort included all beneficiaries diagnosed with MASH, while the non-MASH cohort comprised a random sample of beneficiaries without a MASH diagnosis, matched in size to the MASH cohort. To compare the 2 cohorts, stabilized inverse probability of treatment weighting (IPTW) was used to adjust for differences in baseline covariates, including selected cardiometabolic conditions. Reported outcomes included all-cause, cardiovascular-related, and liver-related HCRU and costs after IPTW.</p><p><strong>Results: </strong>The study included 128 622 beneficiaries in the MASH cohort and 128 579 beneficiaries in the non-MASH cohort. After IPTW, MASH was associated with higher all-cause HCRU rates, particularly for inpatient hospitalizations (rate ratio, 1.36; 95% CI, 1.33-1.39). This increase appeared to be driven by liver-related hospitalizations (rate ratio, 10.41; 95% CI, 9.40-11.42). Consistent with HCRU findings, mean total cost per patient per year was higher for MASH compared with non-MASH ($27 816 vs $25 666; mean cost difference, $2150; 95% CI, $1673-$2627).</p><p><strong>Limitations: </strong>The HCRU and cost attributed to MASH could be underestimated because of MASH underdiagnosis and underreporting, as well as potential overadjustment for MASH-driven comorbidities in the IPTW model.</p><p><strong>Conclusions: </strong>Among Medicare fee-for-service beneficiaries aged 66 years and older, MASH was associated with significantly greater HCRU and costs, even after adjustment for cardiometabolic and other comorbidities. The higher HCRU and costs are likely driven by the management of liver disease, which may include cirrhosis and hepatic decompensation.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"498-515"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258322","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 burden of advanced non-small cell lung cancer (NSCLC): a systematic literature review.","authors":"Nick Jovanoski, Gavneet Kaur, Hemlata Shukla, Neeti Chana, Saifuddin Kharawala","doi":"10.1080/13696998.2026.2623789","DOIUrl":"10.1080/13696998.2026.2623789","url":null,"abstract":"<p><strong>Aims: </strong>A systematic review of the economic burden of advanced non-small-cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>Articles from 2011 onwards reporting the economic burden of locally advanced (stage IIIB/C)/metastatic (stage IV) NSCLC were identified through systematic and supplementary searches. Outcomes included hospitalizations, emergency department (ED) and outpatient visits, and direct and indirect costs, amongst others.</p><p><strong>Results: </strong>Across 50 publications (43 studies), patients with advanced NSCLC had high rates of healthcare resource utilization (HCRU), with most reporting hospitalization (ranging from 13.0% to 98.2% of patients), ED visits (2.5% to 83.1%), outpatient visits (74.6% to 100.0%), and diagnostic or monitoring tests (45.9% to 92.0%). HCRU (hospitalizations, ED visits and pharmacy visits) appeared to be lower with immunotherapy as compared to chemotherapy. Brain/central nervous system (CNS) metastases were the major clinical factor influencing HCRU. Mean direct costs ranged from US$5,647 (Brazil) to US$158,908 (US) over 12-24 months, and were generally higher in the US, Korea, Germany, and the UK (vs. Brazil, France, and Italy). The main direct cost drivers were drug-related costs (9.5-76.0% of total), overall outpatient costs (39-70.6%), and inpatient costs (5.0-58.1%). Costs were higher for chemotherapy than for immunotherapy. In China, indirect medical costs were US$1,413 per case. In general, mean total healthcare costs were higher for metastatic disease. Disease severity/diagnosis, presence of brain/CNS metastases, targeted therapy and chemotherapy (vs. immunotherapy) and the presence of comorbidities were the main factors influencing higher costs.</p><p><strong>Limitations and conclusions: </strong>Patients with advanced NSCLC had high rates of HCRU, and costs were substantial, though varying greatly across countries. HCRU and costs were higher in patients with brain/CNS metastases. Since this was a qualitative review, no formal quantitative synthesis was attempted. Costs reported in different currencies and heterogeneity across studies limited comparability. Finally, a single reviewer extracted data.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"433-454"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271234","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":"The economic burden of moderate-to-severe rheumatoid arthritis in Spain: the CIARA study.","authors":"Lucía Silva-Fernández, Alejandro Balsa Criado, Raimon Sanmartí, José Javier Pérez Venegas, Ruth López-González, Manuel Castaño Sánchez, Rafael Cáliz Cáliz, Cristina Membrive Jiménez, Carlos Marras Fernández-Cid, Simón Ángel Sánchez-Fernández, Susana Gómez Castro, Nuria Vegas-Revenga, Francisca Sivera Mascaró, Natalia Mena Vázquez, Ángeles Belmonte, Miguel Ángel Ruiz Díaz, Javier Rejas-Gutiérrez, Alfonso De Lossada Juste, María Montoro Álvarez","doi":"10.1080/13696998.2026.2644119","DOIUrl":"10.1080/13696998.2026.2644119","url":null,"abstract":"<p><strong>Aims: </strong>The CIARA (Cost Impact Analysis in Rheumatoid Arthritis patients) study in Spain aimed to assess societal costs (€2022) associated with adult patients with moderate-to-severe rheumatoid arthritis (RA) starting advanced therapies after failing conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or a first biologics (bDMARD). Costs included those incurred by the Spanish National Health System, indirect costs due to productivity losses, and patient out-of-pocket expenses. Secondary objectives were to compare costs according to patients' disease activity and treatment subgroups, identify variables associated with costs, and conduct a cost-utility analysis (CUA) of switching strategies.</p><p><strong>Methods: </strong>This prospective, non-interventional, multicenter cohort included adults with active RA (Disease Activity Score in 28 joints with erythrocyte sedimentation rate ≥3.2) starting a bDMARD or a targeted synthetic DMARD (tsDMARD) and followed for 12 months. Total and disaggregated mean costs per patient were estimated across three periods: 6 months before, and 0-to-6 months and 6-to-12 months post-switch. Costs for the 6-month pre-switch were compared with those for the 6-to-12 post-switch.</p><p><strong>Results: </strong>A total of 118 patients (mean age: 54.9 years; 78% women) were included. Mean total cost per patient increased from €6,882 pre-switch to €9,927 at 6-12 months (+44.3%;<i>p</i> < 0.001), primarily driven by pharmacological costs (+191%), while out-of-pocket expenses (-55%;<i>p</i> = 0.001) and productivity losses (-25%;<i>p</i> = 0.394) decreased. Switching from a csDMARD was dominant vs. switching from a first bDMARD (-€11,281/quality-adjusted life year [QALY] gained). Patients who achieved remission at 12 months had lower costs than those with moderate-high activity. The Work Productivity and Activity Impairment (WPAI) productivity impairment subscale and patient satisfaction with care were independently associated with total costs.</p><p><strong>Limitations: </strong>Observational design, limited power for subgroups, official-actual price gap, and a 1-year horizon.</p><p><strong>Conclusions: </strong>Switching to advanced therapies reduced out-of-pocket expenses and productivity losses. Although this reduction did not offset higher pharmaceutical spending, it may reflect clinical improvements.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"994-1011"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581588","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}