Journal of Medical Economics最新文献

{"title":"Annual vaccination with BNT162b2 in Germany can avoid substantial clinical and economic burden of COVID-19 disease.","authors":"Amy Barber, Julie Roiz, Sam Greenall, Edward Church, Andrea Schmetz, Stefan Riebel, Jingyan Yang, Oliver Witzke, Afschin Gandjour","doi":"10.1080/13696998.2025.2604970","DOIUrl":"https://doi.org/10.1080/13696998.2025.2604970","url":null,"abstract":"<p><strong>Aims: </strong>To quantify the clinical and economic burden of Coronavirus disease 19 (COVID-19), and burden potentially avoided with annual vaccination, in German adults in an endemic setting.</p><p><strong>Materials and methods: </strong>A decision tree model was constructed to estimate the clinical and economic impact of COVID-19 and projected burden avoided with BNT162b2, a seasonally adapted mRNA vaccine against severe COVID-19 disease. The majority of cost inputs and clinical event probabilities were informed by German real-world evidence from seasons 2022/23 and 2023/24. Vaccine efficacy was derived from US and German studies. Long/Post COVID impact was assessed in scenario analysis.</p><p><strong>Results: </strong>The model estimated up to 20.8 million symptomatic infections per year in adults, including 7.5 million in people aged 60+, and 6.0 million in comorbid adults. This translates to an estimated 198,598 hospitalizations and 24,626 COVID-attributable deaths, with 93.6% of deaths occurring in people aged 60+. The total economic burden including productivity loss was estimated at €1.4 billion in people aged 60+, €2.0 billion in comorbid adults, and €3.9 billion in all working adults. Long/Post COVID increased the economic burden by 1.7 times.</p><p><p>Assuming vaccination of 100% of recommended groups, 11.0 million symptomatic infections could be prevented, with the greatest impact in people aged 60+ (estimated 110,362 hospitalizations and 13,685 deaths avoided). For people aged 60+, comorbid adults, and all working adults, the number needed to vaccinate to prevent one symptomatic infection was 7, 4, and 4 people; to prevent one hospitalization, 231, 2,363, and 4,549; and to avoid one death, 1,862, 19,055, and 36,683, respectively.</p><p><strong>Conclusion: </strong>COVID-19 imposes a substantial clinical and economic burden on the German population, which could be mitigated with an expanded COVID-19 vaccination program. Further research into Long/Post COVID is needed. Our study presents considerations highlighting the value of broad vaccination especially for working adults.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"16-28"},"PeriodicalIF":3.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846571","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 pasireotide long-acting release in acromegaly: a systematic literature review and methodology assessment.","authors":"Aleksandra Gilis-Januszewska, Małgorzata Bronikowska, Grzegorz Binowski, Michał Jachimowicz, Beatrice Gueron, Fabian Schmidt, Sika Dédé Kossi","doi":"10.1080/13696998.2025.2609506","DOIUrl":"10.1080/13696998.2025.2609506","url":null,"abstract":"<p><strong>Background: </strong>Acromegaly is a rare and progressive condition caused by excessive secretion of growth hormone and insulin-like growth factor type 1. Pasireotide long-acting release (LAR) is indicated as a second-line therapy for adults with acromegaly who are unsuitable for or unresponsive to surgery and inadequately controlled with first-generation somatostatin receptor ligands (FGSRLs). Although its efficacy and safety have already been established, its cost-effectiveness remains unclear. The primary objective of this study was to systematically assess the cost-effectiveness of pasireotide LAR compared to other second-line medical options, particularly pegvisomant.</p><p><strong>Methods: </strong>A systematic literature review was conducted in May 2024 in Medline, Medline In Process, Web of Science, and the Centre for Reviews and Dissemination (CRD), York. Studies were eligible if they were full or partial economic analyses of pasireotide LAR as a second-line pharmacological treatment for adult patients with acromegaly. Studies not available in English and publications prior to 2009 were excluded. Included articles were assessed for transparency using the appropriate checklists. Data extraction focused on costs, incremental cost-effectiveness ratios and quality-adjusted life years. Formal data synthesis of outcomes was not undertaken due to the small number of studies and notable heterogeneity between them. Methodological assessment involving the evaluation of model inputs, data sources, and their alignment with the evidence on the course of disease and clinical practice was performed to examine the main factors contributing to discrepancies in cost-effectiveness outcomes and assess the credibility of the results.</p><p><strong>Results: </strong>Of 160 records identified, six publications met the inclusion criteria. Their findings demonstrated variability. The critical assessment highlighted considerable variability in methodological rigor among the included studies.</p><p><strong>Conclusions: </strong>Evidence on pasireotide LAR's cost-effectiveness versus pegvisomant regimens remains inconclusive. Although two studies indicated that pegvisomant is more cost-effective, the study with the highest methodological credibility found that pasireotide LAR is a cost-effective alternative.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"135-154"},"PeriodicalIF":3.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949003","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 pembrolizumab as neoadjuvant therapy and in combination with standard of care (SOC) as adjuvant therapy for stage III-IVA resectable locally advanced head and neck squamous cell carcinoma (LA HNSCC) in Switzerland.","authors":"Claudine Bommer, Srushti Gotarkar, Burcu Akyol, Kian Farajkhah, Dzhumber Ugrekhelidze, Sarah Sharon Gabriel, Feng Qian","doi":"10.1080/13696998.2026.2712763","DOIUrl":"https://doi.org/10.1080/13696998.2026.2712763","url":null,"abstract":"<p><strong>Aims: </strong>KEYNOTE-689 trial results demonstrated that neoadjuvant pembrolizumab followed by adjuvant pembrolizumab plus standard of care (NP/AP + SOC) significantly improved event-free survival (EFS) versus SOC alone in patients with locoregionally advanced head and neck squamous cell carcinoma (LA HNSCC). This study evaluated the cost-effectiveness of NP/AP + SOC vs. SOC from the Swiss healthcare perspective.</p><p><strong>Materials and methods: </strong>A 4 mutually exclusive health state US-specific Markov cohort model was adapted to the Swiss healthcare perspective. Efficacy inputs were derived from patient-level KEYNOTE-689 data using parametric survival analysis. Healthcare resource utilisation and costs (2025 Swiss Franc [CHF]) were obtained from Swiss clinical experts and national tariffs. Health state utilities were derived from EuroQoL-5 dimension data collected in KEYNOTE-689. Outcomes included costs, quality-adjusted life-years (QALYs) and life-years (LYs), measured over a lifetime horizon. At the base-case, a 3.0% discount rate was applied to costs and effectiveness. Cost-effectiveness was evaluated as an incremental cost-effectiveness ratio (ICER) at a hypothetical willingness-to-pay (WTP) threshold of CHF 100,000/QALY gained. Deterministic, probabilistic, and scenario analyses were conducted for sensitivity.</p><p><strong>Results: </strong>NP/AP + SOC treatment extended life expectancy by 1.81 years compared to SOC, generating 1.42 incremental QALYs. Total costs were CHF 172,086 for NP/AP + SOC versus CHF 151,908 for SOC, resulting in incremental costs of CHF 20,178/patient. ICERs were CHF 14,227/QALY gained and CHF 11,130/LY gained. At a WTP of CHF 100,000/QALY gained, NP/AP + SOC had a 96% probability of being cost-effective.</p><p><strong>Limitations: </strong>Long-term follow-up data (median 3.2 years) required extrapolation; real-world Swiss cost data were unavailable necessitating expert opinion; Belgian utility values were used as Swiss-specific data were unavailable.</p><p><strong>Conclusion: </strong>NP/AP + SOC is cost-effective for LA HNSCC in Switzerland, supporting clinical implementation.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"2121-2134"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684685","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 productivity losses due to cancer mortality and morbidity in 13 Asia-Pacific geographies across 2010, 2015, 2019, and 2022.","authors":"Manoj Gambhir, Athar Hasan Siddiqui, Anne Meiwald, Chamath Perera, Aimee Fox, Sameer Gokhale","doi":"10.1080/13696998.2026.2663840","DOIUrl":"10.1080/13696998.2026.2663840","url":null,"abstract":"<p><strong>Background: </strong>Cancer is a major health and economic burden in the Asia-Pacific region, with significant disparities between countries. This study aimed to quantify productivity losses for the five cancers with high mortality and morbidity burden across 13 Asia-Pacific geographies.</p><p><strong>Methods: </strong>Productivity losses were calculated for high-income geographies (HIGs) and middle-income geographies (MIGs) for 2010, 2015, 2019, and 2022. Tracheal, bronchus, lung, stomach, colorectal, breast, and cervical cancer were included. HIGs comprised of Australia, Hong Kong, Japan, New Zealand, Singapore, South Korea, and Taiwan. MIGs included India, Indonesia, Malaysia, Philippines, Thailand, and Vietnam. Data on deaths, Years of Life Lost (YLL), and Years Lived with Disability (YLD) were sourced from the Institute for Health Metrics and Evaluation. Years of Productive Life Lost (YPLL), Present Value of Future Lost Productivity (PVFLP), Productive YLD (PYLD), and Value of YLD (VYLD) were estimated using retirement age, average wage, labor force participation, and unemployment rate. Linear regression evaluated temporal trends, and a deterministic sensitivity analysis assessed the impact of variations in model inputs.</p><p><strong>Results: </strong>In HIGs, cancer deaths increased from 2010 (411,651) to 2022 (468,480). YLLs remained steady with PVFLP dropping from $12.3 billion to $10.1 billion. YLD rose from 466,498 to 553,782, while VYLD was stable at $2.9 billion. In MIGs deaths increased from 753,961 to 1,113,815, YLL from 24,615,518 to 35,018,065, and YLD from 436,749 to 750,609. PVFLP rose from $2.6 billion to $3.2 billion, and VYLD from $238.1 million to $360.3 million. Regression analysis showed a decline in YLL per death across income categories. YLD per incidence case decreased in HIGs but increased in MIGs.</p><p><strong>Conclusion: </strong>Disparities between HIGs and MIGs are widening, with MIGs showing greater morbidity and productivity losses. Investment in prevention, early detection, and equitable treatment are needed.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1579-1594"},"PeriodicalIF":3.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143633","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":"Methodological opacity in Sword Health digital pelvic health: can superiority be claimed without defined interventions?","authors":"Laira Ramos","doi":"10.1080/13696998.2026.2673769","DOIUrl":"https://doi.org/10.1080/13696998.2026.2673769","url":null,"abstract":"","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1510-1512"},"PeriodicalIF":3.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973141","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 perioperative pembrolizumab plus enfortumab vedotin for cisplatin-ineligible or cisplatin-declining patients with muscle-invasive bladder cancer in the United States.","authors":"Daniel Hill-McManus, Yizhen Lai, Arielle G Bensimon, Joshua Young, Kelly Reeve, Anjela Tzontcheva, Patrick Squires, Haojie Li, Chethan Ramamurthy, Matthew Mossanen","doi":"10.1080/13696998.2026.2713865","DOIUrl":"https://doi.org/10.1080/13696998.2026.2713865","url":null,"abstract":"<p><strong>Aims: </strong>In the KEYNOTE 905/EV 303 study, perioperative enfortumab vedotin plus pembrolizumab (EV+Pem) improved event-free survival (EFS), overall survival (OS), and pathological complete response in a predominantly cisplatin-ineligible muscle-invasive bladder cancer (MIBC) population, compared with surgery alone with or without adjuvant nivolumab, as indicated (surgery ± adjuvant nivolumab). This study assessed the cost-effectiveness of perioperative EV+Pem for cisplatin-ineligible or declining patients with MIBC from a US third-party payer perspective.</p><p><strong>Methods: </strong>This cost-utility analysis used a state-transition Markov model with event-free (EF), progressed or recurrent disease (PRD), and death health states. The target population included cisplatin-ineligible or cisplatin-declining adults with MIBC. Transitions from EF were estimated using parametric multistate survival models based on trial data, with extrapolation beyond follow-up. Survival following PRD was modeled using a treatment-mix approach reflecting US clinical practice. Costs were derived from US sources, and utilities from KEYNOTE-905 EQ-5D-5L data. Scenario analyses explored alternative extrapolations and structural assumptions, and sensitivity analyses assessed parameter uncertainty.</p><p><strong>Results: </strong>In the base case, EV+Pem increased life-years by 3.08 (7.70 vs 4.62) and quality-adjusted life-years (QALYs) by 2.56 (6.19 vs 3.62) versus surgery ± adjuvant nivolumab. EV+Pem was associated with higher initial treatment costs, increasing total costs by $133,661 ($546,831 vs $413,171), partially offset by lower costs of treatment for PRD ($34,636 vs $129,813), yielding an incremental cost-effectiveness ratio (ICER) of $52,117 per QALY gained. Across scenario analyses, ICERs ranged from $50,363 to $69,703 per QALY gained. Probabilistic sensitivity analysis showed that EV+Pem had a 99.1% probability of being cost-effective at a $100,000 per QALY threshold.</p><p><strong>Limitations: </strong>Results are subject to uncertainty in long-term survival extrapolation and evolving treatment patterns following PRD.</p><p><strong>Conclusions: </strong>EV+Pem is cost-effective versus surgery ± adjuvant nivolumab for cisplatin-ineligible or cisplatin-declining patients with MIBC from a US third-party payer perspective at a willingness-to-pay threshold of $100,000 per QALY.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"2161-2176"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794233","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 financial impact of surgical interventions for benign prostatic hyperplasia within a single NHS trust.","authors":"Shiv Sarna, Sachinka Ranasinghe, Ranil Johann Boaz, Mark Rochester","doi":"10.1080/13696998.2026.2694880","DOIUrl":"https://doi.org/10.1080/13696998.2026.2694880","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the financial impact of surgical modalities for benign prostatic hyperplasia (BPH) from the perspective of an NHS Trust.</p><p><strong>Methods: </strong>A retrospective analysis of patients undergoing Aquablation, Holmium Laser Enucleation of the Prostate (HoLEP) and Transurethral Resection of the Prostate (TURP) was conducted at a single NHS teaching hospital between January 2023 and June 2025. Financial data was extracted from the patient-level information and costing system, including clinical income based on Healthcare Resource Group tariffs, direct and indirect costs, and overheads. Primary outcomes were median episode clinical income, total costs, and net surplus/deficit.</p><p><strong>Results: </strong>436 procedures were analysed (140 Aquablation, 160 HoLEP, 136 TURP). Mean operative time was shortest for Aquablation (61.8 ± 27.0 min), while HoLEP had the shortest length of stay (0.34 ± 1.18 days). Aquablation was the only procedure to yield a median net surplus (+£1,859, IQR +785 to +2,736), whereas both HoLEP (-£157, IQR -679 to +189) and TURP (-£852, IQR -1,716 to +84) resulted in median deficits (<i>p < 0.001</i>). Aquablation's financial advantage was driven by its robotic-assisted classification, attracting a higher median clinical income (£7,659) than HoLEP (£3,038) and TURP (£2,997) (<i>p < 0.001</i>). Surplus-generating episodes were more frequent for Aquablation (83.6%) than HoLEP (28.1%) or TURP (22.1%) (<i>p < 0.001</i>). Major individual losses were driven by complications and prolonged admissions across all cohorts.</p><p><strong>Limitations: </strong>This single-centre retrospective study focused on short-term hospital-level costs. It did not account for initial capital expenditure, long-term clinical outcomes, or Quality-Adjusted Life-Years.</p><p><strong>Conclusions: </strong>Under the current NHS Payment Scheme, Aquablation is the only financially sustainable surgical modality for the provider among those analysed. Its higher robotic-assisted tariff compensates for greater consumable costs. National tariff reviews may be warranted to ensure reimbursement reflects the true resource intensity of all surgical interventions. Establishing broader NHS cost-effectiveness will require long-term evaluation of clinical outcomes and retreatment rates.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1864-1874"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368663","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":"Budget impact model of nadofaragene firadenovec for the treatment of high-risk non-muscle-invasive bladder cancer that is unresponsive to Bacillus Calmette-Guérin immunotherapy.","authors":"Min Yang, Xinglei Chai, Dongni Ye, Angela Zhao, Ashton Moradi, Yair Lotan","doi":"10.1080/13696998.2026.2630599","DOIUrl":"10.1080/13696998.2026.2630599","url":null,"abstract":"<p><strong>Aims: </strong>To estimate the budget impact of adopting nadofaragene firadenovec for the treatment of adults with high-risk, Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) with carcinoma <i>in situ</i> with or without papillary tumors (CIS ± Ta/T1) from a US third-party payer's perspective.</p><p><strong>Methods: </strong>A budget impact model was developed to compare total healthcare costs under two scenarios: (1) with nadofaragene firadenovec included in the treatment mix, and (2) without it. The model simulated a hypothetical US health plan covering one million members over a 3-year time horizon. Costs assessed included drug acquisition and administration, surveillance and disease management, cystectomy, and treatment-related adverse events (AEs). Base-case inputs were informed by trial data, published literature, and real-world evidence. Scenario analyses explored alternative population definitions, epidemiology and clinical inputs; one-way sensitivity analyses tested parameter uncertainty.</p><p><strong>Results: </strong>In the base-case, the estimated per-member-per-month (PMPM) budget impact of adopting nadofaragene firadenovec ranged from $0.0010 in Year 1 to $0.0084 in Year 3. Increased drug and administration costs were partially offset by cost savings from reduced disease progression, fewer cystectomies, and lower AE rates. Scenario analyses demonstrated that even examining a broader population including papillary disease-only patients, the budget impact remained modest ($0.0064-$0.0548 PMPM from Years 1-3). Sensitivity analyses confirmed that results were most influenced by uptake rate, drug cost, and target population size.</p><p><strong>Limitations: </strong>Key limitations include reliance on projected market shares for nadofaragene firadenovec, omission of recently approved treatments (nogapendekin alfa inbakicept-pmln and TAR-200) due to the lack of publicly available market share data, and assumptions to derive clinical outcomes for certain treatments due to lack of reported data.</p><p><strong>Conclusions: </strong>Despite its higher acquisition cost, the inclusion of nadofaragene firadenovec resulted in a minimal budget impact as bladder-sparing option for patients with BCG-unresponsive NMIBC with CIS ± Ta/T1.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"672-687"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355392","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 indirect economic burden caused by premature mortality from lung cancer in Asia-Pacific countries; years of life lost and productivity costs.","authors":"Manoj Gambhir, Vishnu Subash, Deepak Alexander, Robert Hughes, Aimee Fox, Sameer Gokhale","doi":"10.1080/13696998.2026.2635297","DOIUrl":"10.1080/13696998.2026.2635297","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer caused 2.2 million new cases and 1.8 million deaths globally in 2020, accounting for 11.4% of global cancer. In the Asia-Pacific (AP) region, lung cancer is the leading cause of cancer mortality, contributing to 60% of global lung cancer deaths. This study assesses the economic impact of premature lung cancer deaths in 12 AP countries with different economic profiles by estimating productivity losses.</p><p><strong>Methods: </strong>The human capital approach was used to estimate productivity losses from premature lung cancer deaths (ICD-10 C33-34) across Singapore, Australia, Hong Kong, New Zealand, South Korea, Taiwan, Malaysia, Thailand, Indonesia, Philippines, Vietnam, and India. Years of productive life lost (YPLL) and the present value of future lost productivity (PVFLP) were calculated based on age-specific mortality, wage, and employment data. Results were analyzed by grouping countries into high- and middle-income categories.</p><p><strong>Findings: </strong>In 2019, 221,293 lung cancer deaths led to 617,574 YPLL and over $2.3 billion in productivity losses across the 12 AP countries. High-income countries experienced greater losses ($1.5 billion, $34,359 per death) compared to middle-income countries ($816 million, $4,660 per death).</p><p><strong>Limitations: </strong>The analysis excluded direct healthcare costs and productivity losses from morbidity and caregiver burden. Assumptions such as uniform labor force participation and mortality distribution may limit precision.</p><p><strong>Interpretation: </strong>Lung cancer imposes a significant burden across the AP region, with economic disparities between high- and middle-income countries. Findings highlight the need for continued investment in prevention, early detection, and equitable access to treatment, especially in middle-income nations.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"726-739"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365549","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":"Behind the counter: a time-driven activity-based costing analysis of community pharmacy dispensing services in Taiwan.","authors":"Peng-An Chen, Yen-Ming Huang, Yao-Hsing Wang, Hsun-Yu Chan, Yunn-Fang Ho","doi":"10.1080/13696998.2026.2689232","DOIUrl":"https://doi.org/10.1080/13696998.2026.2689232","url":null,"abstract":"<p><strong>Background: </strong>Sustainable financing of community pharmacy services requires reimbursement models that accurately reflect resource use. However, empirical cost data for dispensing services remain limited in many health systems, including Taiwan's single-payer National Health Insurance (NHI) program. This study estimated the cost of dispensing services in community pharmacies and assessed the extent to which current reimbursement reflects underlying resource utilization.</p><p><strong>Methods: </strong>A cost analysis was conducted from the healthcare provider perspective using a time-driven activity-based costing approach. Eight community pharmacies in Taiwan were included. Dispensing workflows were systematically mapped into six sequential steps, and time-and-motion data were collected across six simulated standardized dispensing scenarios designed to capture variation in medication number and type. Resource use included direct, indirect, and personnel-related cost components. Indirect costs were allocated using both space-based and revenue-based approaches. Personnel costs were calculated using capacity cost rates based on pharmacist salaries and practical working capacity. All costs were expressed in New Taiwan Dollars (NT$), and sensitivity analyses assessed robustness under alternative allocation assumptions.</p><p><strong>Results: </strong>Mean dispensing time ranged from 195 to 303 s per prescription and increased with prescription complexity. Total dispensing costs ranged from NT$30.82 to NT$61.21 per prescription. Each additional medication increased costs by NT$13-17, while controlled substances added NT$18-23 due to additional regulatory procedures. Personnel-related costs were the primary cost driver, and cognitive verification activities accounted for the largest share of workload. Compared with current NHI dispensing reimbursement of approximately NT$49-68 per prescription, reimbursement may inadequately reflect the resources required for more complex prescriptions. Cost patterns were consistent across allocation methods.</p><p><strong>Conclusions: </strong>Dispensing services are resource-intensive and vary with prescription complexity, yet current flat-fee reimbursement under Taiwan's NHI does not adequately reflect this variation. Complexity-adjusted reimbursement mechanisms, such as per-medication or controlled-substance modifiers, may better align payment with actual resource utilization and support sustainable community pharmacy services.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"29 1","pages":"1750-1763"},"PeriodicalIF":3.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271840","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}