Journal of Medical Economics最新文献

{"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":3.1,"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":"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":"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":3.1,"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":"Addressing the challenges of health economic modelling in the context of suboptimal evidence base - case study based on a comparison between photodynamic diagnosis and narrow band imaging in non-muscle invasive bladder cancer.","authors":"Jonathan Belsey, Wojciech Chrosny, Jane Lapon","doi":"10.1080/13696998.2026.2661553","DOIUrl":"10.1080/13696998.2026.2661553","url":null,"abstract":"<p><strong>Introduction: </strong>Standard economic models, which have been developed to reflect typical data availability for pharmaceutical products, often struggle with non-pharmaceutical interventions like diagnostics and medical devices, where clinical trial data is more likely to be short-term or non-comparative. This paper explores methodological challenges in evaluating Photodynamic Diagnosis (PDD) <i>via</i> blue light cystoscopy (BLC) versus Narrow Band Imaging (NBI) for non-muscle invasive bladder cancer (NMIBC).</p><p><strong>Methods: </strong>A semi-Markov state-transition cost-utility model was developed for a health technology appraisal (HTA) by the Danish Treatment Council. The basis of the model was a differential effect of the two technologies on the risk of early local cancer recurrence. Due to a lack of direct comparative trials, an indirect hazard-function-based approach was used. Using TreeAge Pro software, baseline hazard curves were derived from ten-year survival data for conventional white light cystoscopy. Hazard ratios (HRs) from meta-analyses were then applied to these curves to derive simulated time-to-event curves for BLC and NBI.</p><p><strong>Results: </strong>The base-case analysis yielded an incremental cost-effectiveness ratio (ICER) of DKK 70,707/QALY for BLC-TURBT versus NBI-TURBT. Sensitivity analyses confirmed results remained robust and well below the DKK 500,000/QALY willingness-to-pay threshold. The model was most sensitive to HRs for time to first recurrence. Scenario analyses, including traditional parametric extrapolation, yielded consistent ICERs between DKK 36,775 and DKK 215,965/QALY.</p><p><strong>Discussion: </strong>The hazard-based workflow effectively integrated survival data from disparate sources, using a software-based method was quicker, simpler and more intuitive to use than conventional statistical methods. The approach used is equally applicable to a partitioned survival structure. The alignment between hazard-based and traditional parametric methods suggests this is a valid, efficient alternative for developing models in the face of evidence gaps.</p><p><strong>Conclusions: </strong>A hazard-function approach provides a transparent, practical solution for building robust economic models when clinical data is limited or incompatible with standard approaches.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1341-1354"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773854","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":"Estimating the budget impact of introducing dostarlimab as first line in treating endometrial cancer in Saudi Arabia.","authors":"Mohamed Aseafan, Faisal Azam, Ahmed S Alanazi, Shaheed Alhumaid, Nawaf H Almalki, Mohamed Masoud, Zainab Alsharef, Hany Soliman, Mohamed El-Khedr Hassan","doi":"10.1080/13696998.2026.2706988","DOIUrl":"https://doi.org/10.1080/13696998.2026.2706988","url":null,"abstract":"<p><strong>Objective: </strong>The budget impact of introducing dostarlimab plus carboplatin-paclitaxel (CP) as a first-line treatment option for primary advanced or recurrent endometrial cancer (EC) in Saudi Arabia was evaluated from the perspective of the Saudi national payer.</p><p><strong>Methods: </strong>The budget impact model (BIM) utilized epidemiological, clinical, and cost and resource use inputs to evaluate the total costs associated with a market scenario without dostarlimab versus a market scenario with dostarlimab over a three-year time horizon (2026-2028). Currently available comparator treatments in Saudi Arabia were evaluated based on associated market share and relevance as comparable treatment regimens to dostarlimab plus CP. A one-way sensitivity analysis was performed to identify the sensitivity of the BIM to changes in input parameters.</p><p><strong>Results: </strong>Out of 250 eligible patients, 58 were estimated to receive dostarlimab plus CP as a first-line EC treatment during its first year on the market, increasing to 242 out of 569 eligible patients in the third year. The resulting annual budget impact was -$326,607 in the first year and -$668,830 in the third year of market availability, with a total cumulative budget impact of -$1,650,171 over the three-year time horizon. The mean annual budget impact per patient treated with dostarlimab plus CP was -$4,388.57, a decrease of -1.84% compared with the scenario without dostarlimab.</p><p><strong>Conclusions: </strong>The introduction of dostarlimab plus CP to healthcare settings for first-line treatment of primary advanced and recurrent EC was found to be budget neutral in this model, with lower treatment acquisition costs and decreased second-line subsequent treatment costs compared with the other currently available treatment options.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"2063-2075"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630613","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":"Italian policies and incentives introduced to tackle antimicrobial resistance: an emerging model.","authors":"Andrea Zovi","doi":"10.1080/13696998.2026.2708509","DOIUrl":"https://doi.org/10.1080/13696998.2026.2708509","url":null,"abstract":"","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"2086-2090"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630627","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":"Clinical and economic outcomes of cabazitaxel versus Lu-PSMA in mCRPC: a US perspective.","authors":"Braydon Nault, David Garcia, Heather Cameron, Andrew Revel, Kevin Steele, Kyle Flannery, Pedro Barata","doi":"10.1080/13696998.2026.2709297","DOIUrl":"https://doi.org/10.1080/13696998.2026.2709297","url":null,"abstract":"<p><strong>Background: </strong>The TheraP trial compared cabazitaxel to Lutetium-177-labeled PSMA-617 (Lu-PSMA) in metastatic castration-resistant prostate cancer (mCRPC) following docetaxel and an androgen receptor pathway inhibitor (ARPI). Lu-PSMA demonstrated improved PSA response (66% vs 37%; <i>p</i> < 0.0001) and progression-free survival (HR = 0.63; <i>p</i> = 0.0028), while overall survival (OS; median 16.4 vs. 19.4 months) and rates of Grade 3 (0.88 vs. 0.96 events/patient) and Grade 4 adverse events (AE; 0.11 vs. 0.08 events/patient) were comparable. The comparative economic implications of these two therapies in the United States (US) remain uncertain.</p><p><strong>Methods: </strong>A cost-consequence Excel model was developed from the US Medicare perspective to evaluate the direct cost outcomes for mCRPC patients receiving cabazitaxel or Lu-PSMA. Inputs were derived from TheraP, supplemented by literature and clinical expert validation. Costs included PSMA testing, drug acquisition and administration, supportive care, AE management, and end-of-life care. Outcomes (derived from TheraP inputs) included OS, progression-free survival (PFS), PSA-PFS, and radiographic-PFS (rPFS). An 18-month time horizon aligned with clinical follow-up. Costs were reported in 2025 USD.</p><p><strong>Results: </strong>At 18 months in the modeled cohort of 100 patients, cabazitaxel was associated with nine additional modeled survivors; this should be interpreted cautiously, as TheraP reported no statistically significant difference in OS between cabazitaxel and Lu-PSMA. In contrast, Lu-PSMA demonstrated improved PFS outcomes in the modeled cohort, with eight more patients remaining progression-free and 15 more radiographic progression-free. From the Medicare perspective, cabazitaxel was associated with a per-patient cost of $107,729, versus $303,338 per patient for Lu-PSMA (-$195,608). Cost differences were driven primarily by lower drug acquisition costs for cabazitaxel.</p><p><strong>Conclusions: </strong>Cabazitaxel provides a clinically validated and economically favorable treatment option post-docetaxel and ARPI, providing substantial cost savings across payer scenarios with no observed difference in OS. Lu-PSMA offers improved PSA-based outcomes and progression-related endpoints at higher treatment costs. These findings support clinical-economic trade-off considerations when sequencing therapies for mCRPC.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"2107-2120"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684911","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 pneumococcal vaccination of at-risk and high-risk adults aged 18-64 years in Switzerland using PCV21.","authors":"Muloongo Simuzingili, Zinan Yi, Andrea Favre-Bulle, Thomas Mutschler, Eleana Tsoumani, Kwame Owusu-Edusei","doi":"10.1080/13696998.2026.2726640","DOIUrl":"https://doi.org/10.1080/13696998.2026.2726640","url":null,"abstract":"<p><strong>Background: </strong>Pneumococcal disease (PD) is more common and severe among adults with underlying medical conditions. Pneumococcal vaccination is recommended but not reimbursed in Switzerland for adults 18-64 years with these risk factors.</p><p><strong>Objective: </strong>We estimated the cost-effectiveness of reimbursed vaccination for high-risk (immunocompromised) and at-risk (chronic medical condition) adults 18-64 years in Switzerland using 21-valent pneumococcal conjugate vaccine (PCV21).</p><p><strong>Methods: </strong>We updated a published state-transition Markov model to estimate lifetime health and economic outcomes for multiple adult cohorts, following individuals until death or age 100 years, from the Swiss payer perspective. Swiss demographic and health economic data were used where available and supplemented with proxy epidemiologic estimates from comparable international sources when Swiss-specific data were unavailable. Vaccination of 60% of the target population with PCV21 was compared with no pneumococcal vaccination. One-way and probabilistic sensitivity analyses assessed parameter uncertainty and model robustness.</p><p><strong>Results: </strong>Implementing PCV21 for at-risk and high-risk adults 18-64 years in Switzerland was predicted to avert 518 invasive pneumococcal disease cases, 12 post-meningitis sequelae cases, and 2,578 inpatient non-bacteremic pneumococcal pneumonia (NBPP) cases and 224 deaths. The CHF 21.4 M decrease in direct PD treatment costs partially offset the CHF 39.0 M vaccination costs, resulting in an incremental cost-effectiveness ratio (ICER) of 7,665 CHF/quality-adjusted life year (QALY) gained. The ICER was 1,750 CHF/QALY in a scenario analysis in which the proportions of adults with risk conditions increased with age. One-way sensitivity analysis found results were most sensitive to vaccine efficacy against NBPP in the at-risk group and discount rate. In probabilistic sensitivity analyses, the probability that PCV21 was cost-effective reached 100% at willingness-to-pay thresholds of approximately CHF 18,000 or higher.</p><p><strong>Conclusions: </strong>Vaccination of at-risk and high-risk adults 18-64 years of age in Switzerland using PCV21 is likely to be cost-effective.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"2283-2294"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930026","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":"Androgen receptor inhibitor double therapies in the management of metastatic castration-sensitive prostate cancer: a cost-effectiveness analysis.","authors":"William V Padula, Benjamin G Cohen, Paul Steel, Sreevalsa Appukkuttan, Bashir Kalayeh, Matthew Rettig","doi":"10.1080/13696998.2026.2733865","DOIUrl":"https://doi.org/10.1080/13696998.2026.2733865","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the cost-effectiveness of darolutamide plus androgen deprivation therapy (DARO+ADT) versus enzalutamide plus ADT (ENZA+ADT) and apalutamide plus ADT (APA+ADT) as first-line androgen receptor pathway inhibitor (ARPI) double therapies for metastatic castration-sensitive prostate cancer (mCSPC) from a US healthcare sector perspective.</p><p><strong>Methods: </strong>A partitioned survival model with three health states (progression-free mCSPC, progressed mCRPC, and death) projected lifetime costs and outcomes over a 30-year horizon with monthly cycles. DARO+ADT efficacy was derived from the ARANOTE trial; comparative efficacy for ENZA+ADT and APA+ADT was estimated <i>via</i> network meta-analysis-derived hazard ratios. Costs (drug acquisition, adverse event management, subsequent therapy, end-of-life care) and utilities were derived from trial data, published literature, and US cost sources. Costs and outcomes were discounted at 3% annually. Deterministic, probabilistic, and two-way sensitivity analyses assessed parameter uncertainty at a willingness-to-pay threshold of $150,000/QALY.</p><p><strong>Results: </strong>DARO+ADT generated 4.18 QALYs versus 4.03 (ENZA+ADT) and 3.99 (APA+ADT), driven by longer treatment persistence and lower adverse-event-related disutility. Versus ENZA+ADT, DARO+ADT yielded 0.15 incremental QALYs at $12,564 incremental cost (ICER: $85,108/QALY; net monetary benefit: $9,579). Versus APA+ADT, DARO+ADT was dominant (0.19 additional QALYs, $4,293 lower cost; net monetary benefit: $33,153). Two-way sensitivity analyses varying off-treatment utilities and post-discontinuation therapy costs showed that DARO+ADT remained cost-effective versus ENZA+ADT and dominant versus APA+ADT, respectively, across the parameter ranges tested. Probabilistic sensitivity analysis showed DARO+ADT was cost-effective in 51% and 52% of simulations versus ENZA+ADT and APA+ADT, respectively, which demonstrates uncertainty around the incremental findings.</p><p><strong>Limitations: </strong>The analysis relies on indirect comparisons and extrapolated modeling, factors that may limit the generalizability of the findings.</p><p><strong>Conclusions: </strong>DARO+ADT was cost-effective versus ENZA+ADT and dominant versus APA+ADT, driven by improved tolerability and treatment persistence, supporting its value as a first-line mCSPC option.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"2423-2436"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110841","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 Orca-T vs allo-HCT with conventional GVHD prophylaxis for the treatment of advanced hematologic malignancies in the United States.","authors":"Rawan Faramand, James Scott McClellan, Anna Pavlova, Rocio Manghani, Andrea Blank, Matia Saeedian, Shivani Yadav, Miguel-Angel Perales","doi":"10.1080/13696998.2026.2732644","DOIUrl":"10.1080/13696998.2026.2732644","url":null,"abstract":"<p><strong>Aims: </strong>Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative therapy for patients with hematologic malignancies, but its success is limited by graft‑versus‑host disease (GVHD), which carries considerable clinical and economic burden. A cost-effectiveness model was developed to evaluate whether the higher upfront costs of allogeneic regulatory T cell-based immunotherapy with HSPC and T cells-vldq (Tregzi [Orca-T; Orca Bio, Menlo Park, CA, USA]) are offset by reductions in GVHD and associated healthcare costs compared with conventional allo-HCT using TAC/MTX or PTCy.</p><p><strong>Methods: </strong>A three-state partitioned survival model (relapse-free, relapsed, and dead) with a lifetime horizon and monthly cycles was developed. Overall survival and relapse-free survival data from the Phase 3 Precision-T study (ClinicalTrials.gov Identifier NCT05316701) were incorporated using a cure-mixture modeling approach to estimate long-term survival, relapse status, and cure fraction for patients. Costs included transplant procedure, GVHD management, infection management, and terminal care. Outcomes included life-years, quality-adjusted life-years (QALYs), and direct healthcare costs. Both costs and outcomes were discounted at 3% annually. A scenario analysis was conducted to determine the cost-effectiveness of Orca-T vs allo-HCT with PTCy for GVHD prophylaxis, and sensitivity analyses were conducted to test the uncertainty of the model inputs.</p><p><strong>Results: </strong>Orca‑T was associated with lower lifetime costs ($1,026,856 vs $2,170,875) and higher QALYs (15.28 vs 13.00) than conventional allo‑HCT with TAC/MTX, yielding cost savings of $1,144,019 and a gain of 2.28 QALYs per patient. GVHD-related costs were substantially lower with Orca‑T ($495,447 vs $1,998,621). Compared with PTCy, Orca‑T remained dominant, with cost savings of $158,144, a gain of 2.85 QALYs, and lower GVHD-related costs ($476,448 vs $999,945).</p><p><strong>Conclusions: </strong>Orca‑T reduced costs and increased QALYs versus conventional allo‑HCT with TAC/MTX or PTCy, driven by lower GVHD and infection burden. These findings support Orca‑T as a high‑value treatment option.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"2386-2405"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074979","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":"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":3.1,"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}