Journal of Medical Economics最新文献

{"title":"Cost-effectiveness of a machine learning risk prediction model (LungFlag) in the selection of high-risk individuals for non-small cell lung cancer screening in Spain.","authors":"Juan Carlos Trujillo, Joan B Soriano, Mercè Marzo, Oliver Higuera, Luis Gorospe, Virginia Pajares, María Eugenia Olmedo, Natalia Arrabal, Andrés Flores, José Francisco García, María Crespo, David Carcedo, Carolina Heuser, Milan M S Obradović, Nicolò Olghi, Eran N Choman, Luis M Seijo","doi":"10.1080/13696998.2024.2444781","DOIUrl":"10.1080/13696998.2024.2444781","url":null,"abstract":"<p><strong>Objective: </strong>The LungFlag risk prediction model uses individualized clinical variables to identify individuals at high-risk of non-small cell lung cancer (NSCLC) for screening with low-dose computed tomography (LDCT). This study evaluates the cost-effectiveness of LungFlag implementation in the Spanish setting for the identification of individuals at high-risk of NSCLC.</p><p><strong>Methods: </strong>A model combining a decision-tree with a Markov model was adapted to the Spanish setting to calculate health outcomes and costs over a lifetime horizon, comparing two hypothetical scenarios: screening with LungFlag versus non-screening, and screening with LungFlag versus screening the entire population meeting 2013 US Preventive Services Task Force (USPSTF) criteria. Model inputs were obtained from the literature and the clinical practice of a multidisciplinary expert panel. Only direct costs (€of 2023), obtained from local sources, were considered. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of our results.</p><p><strong>Results: </strong>A cohort of 3,835,128 individuals meeting 2013 USPSTF criteria would require 2,147,672 LDCTs scans. However, using LungFlag would only require 232,120 LDCTs scans. Cost-effectiveness results showed that LungFlag was dominant versus non-screening scenario, and outperformed the scenario where the entire population were screened since the observed loss of effectiveness (-224,031 life years [LYs] and -97,612 quality-adjusted life years [QALYs]) was largely offset by the significant cost savings provided (€7,053 million). The resulting incremental cost-effectiveness ratio (ICER) for this strategy of screening the whole population versus using LungFlag was €72,000/QALY, showing that LungFlag is cost-effective. Various were described, such as the source of the efficacy or adherence rates, and other limitations inherent to cost-effectiveness analyses.</p><p><strong>Conclusions: </strong>Using LungFlag for the selection of high-risk individuals for NSCLC screening in Spain would be a cost-effective strategy over screening the entire population meeting USPSTF 2013 criteria and is dominant over non-screening.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"147-156"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854530","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":"Autologous skin cell suspension plus phototherapy in stable vitiligo: findings from a US economic model.","authors":"Jennifer Benner, Nicholas Adair, Brian Hitt, Vivien L Nguyen, Iltefat H Hamzavi, Matthew Sussman","doi":"10.1080/13696998.2025.2475674","DOIUrl":"10.1080/13696998.2025.2475674","url":null,"abstract":"<p><strong>Introduction: </strong>A cell harvesting device for preparing non-cultured autologous skin cell suspension (ASCS) at the point-of-care is FDA-approved for repigmentation of stable depigmented vitiligo lesions in patients 18 years and older. The pivotal RSVP trial showed ≥80% repigmentation at Week-24 in 36% of lesions treated with laser ablation, ASCS, and narrowband ultraviolet B phototherapy compared to 0% with phototherapy alone (<i>p</i> = 0.012). The objective of this analysis was to evaluate the potential economic impact of laser ablation plus ASCS with phototherapy versus phototherapy alone for repigmentation of stable vitiligo lesions from a US payer perspective.</p><p><strong>Methods: </strong>A 5-year decision-tree model was developed reflecting clinical pathways of adults with stable vitiligo lesions who had an inadequate response to prior topicals and phototherapy. Patients entering the model were treated with ASCS plus phototherapy or phototherapy alone and assessed for treatment response at Weeks-24 and 52 based on the RSVP trial's effectiveness endpoints. Durable response for Year-2 onwards was proxied by melanocyte-keratinocyte transplantation data. Model outcomes included per-patient total and incremental healthcare costs, treatment costs and total costs, cost per-patient per-month (PPPM), and cost per-patient per-year (PPPY). One-way sensitivity analyses assessed model result robustness.</p><p><strong>Results: </strong>The cumulative total per-patient cost for ASCS plus phototherapy increased from $28,177 to $92,779 between Year-1 and Year-5. Phototherapy alone increased from $21,146 to $101,518 over the same period. Compared to phototherapy alone, ASCS plus phototherapy incurred $7,030 more total per-patient cumulative costs in Year-1 and $8,738 less by Year-5 (-$146 PMPM; -$1,748 PPPY). Breakeven occurred between Years 2-3. Results were most sensitive to changes in ASCS response at Weeks-24 and 52 and healthcare costs.</p><p><strong>Conclusion: </strong>Among adults with stable vitiligo with prior inadequate response to topicals or phototherapy, ASCS treatment may lead to lower all-cause direct medical costs over 5 years compared to phototherapy alone.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"425-435"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556800","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-of-illness analysis of chronic kidney disease (CKD) management in the Philippines.","authors":"Anthony Russell Villanueva, Donnah de Leon, Patrick James Encarnacion, Elaine Cunanan, Amor Patrice Estabillo, Christianne Jade Gonzales, Miharu Jay Kimwell, Marizel Mallari-Catungal, Mary Joy Taneo, Dianne Danielle Tan-Lim, Richard Henry Perlas Tiongco, Jennifer Ivy Togonon-Leaño, Maria Rhodora De Lara-Valenzona, Danny Yu, Arlene Cabotaje Crisostomo, Precious Juzenda Montilla","doi":"10.1080/13696998.2025.2481766","DOIUrl":"10.1080/13696998.2025.2481766","url":null,"abstract":"<p><strong>Aims: </strong>To conduct the first comprehensive cost-of-illness analysis for chronic kidney disease (CKD) management in the Philippines, estimating direct medical, direct non-medical, and indirect costs across all disease stages and renal replacement therapies (RRT).</p><p><strong>Methods: </strong>A combined top-down and bottom-up quantitative approach was employed. Cost data were collected through facility surveys, literature reviews, and expert panel input. The analysis included cost estimated for both non-diabetic and diabetic CKD scenarios across all stages and RRT modalities. Direct medical costs, transportation costs, and productivity losses were calculated for each CKD stage and RRT option.</p><p><strong>Results: </strong>Annual costs for CKD management increased progressively with disease advancement, ranging from PHP 44,610.36 to PHP 116,590.24 for non-diabetic patients and PHP 46,451.88 to PHP 120,948.12 for diabetic patients, excluding complication-related expenses. Significant cost increases were observed between stages G2-G3a and G3b-G4. Analysis of RRT showed comparable annual direct medical costs across modalities (∼PHP 401,000-560,000), with differences primarily observed in annual direct non-medical and indirect costs, which were lower in transplant recipients compared to patients on maintenance dialysis (PHP 37,920-246,480 for dialysis; PHP 3,160 for KT recipients).</p><p><strong>Limitations: </strong>The study primarily focused on urban and semi-urban healthcare facilities, potentially limiting generalizability to rural areas. Long-term cost trajectories and quality-of-life measures were not captured due to the cross-sectional nature of the data.</p><p><strong>Conclusions: </strong>This analysis provides crucial evidence supporting early detection and intervention strategies in CKD management. It suggests the promotion of peritoneal dialysis as a cost-effective first-line therapy and highlights the long-term economic benefits of kidney transplantation. The findings have significant implications for health policy and clinical practice in the Philippines, offering a foundation for evidence-informed decision-making to improve CKD management sustainability and patient outcomes.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"494-507"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691834","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":"Patient and physician preferences for treatment of hepatitis C virus infection in Japan: a discrete choice experiment.","authors":"Daisuke Nakamoto, Yi Piao, Hajime Mizutani, Michael LoPresti, Yunosuke Chikamura, Dilip Makhija, Kyung Min Kwon, Jamie Zagorski, Masahisa Jinushi, Yuichiro Eguchi","doi":"10.1080/13696998.2025.2483572","DOIUrl":"10.1080/13696998.2025.2483572","url":null,"abstract":"<p><strong>Aims: </strong>This study was performed to evaluate patients' and physicians' preferences regarding hepatitis C virus (HCV) treatment in Japan, particularly focusing on direct-acting antivirals. Understanding these preferences is important for maintaining adherence to treatment necessary for achieving HCV elimination.</p><p><strong>Methods: </strong>A discrete choice experiment was conducted to identify patients' and physicians' preferences for HCV treatment in Japan. Eligible participants completed a preference survey <i>via</i> an online questionnaire. Eight attributes and their respective levels - pertaining to dosing regimen/schedule, safety, and out-of-pocket costs - were identified. The primary and secondary endpoints were the relative attribute importance (RAI) and utility value of attribute levels, which were compared between patients and physicians to highlight differences.</p><p><strong>Results: </strong>Both patients (<i>n</i> = 95) and physicians (<i>n</i> = 118) showed the greatest concern for total out-of-pocket treatment costs, followed by safety risks. While patients and physicians generally shared similar treatment preferences, patients placed a higher RAI on total out-of-pocket costs than did physicians (50.4% vs. 39.4%). Conversely, patients assigned lower RAI values to the risks of nasopharyngitis and pruritus (15.2% vs. 17.9% and 11.7% vs. 16.2%, respectively). The RAI for the number of tablets taken daily was higher than that for treatment duration among patients (11.6% vs. 0.2%), but nearly equal among physicians.</p><p><strong>Limitations: </strong>The study had potential non-response bias, physicians not being actual care providers for surveyed patients, a small sample size, reliance on predefined DCE attributes, and limited participant diversity from online panels.</p><p><strong>Conclusions: </strong>This study highlights the importance of patient-centered care in HCV treatment and the need to raise awareness of the public subsidy for hepatitis, and to ensure an effective access scheme for the patients. Simplifying regimens like once-daily pills and minimal monitoring may enhance treatment convenience. Improved patient-physician communication supports optimized strategies, aiding Japan's goal of HCV elimination by 2030.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"524-534"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692371","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 and public health impact of using high dose influenza vaccine in the Japanese older adults.","authors":"Caroline de Courville, Chiho Tadera, Takeshi Arashiro, Florence Bianic, Mafalda Costa, Mohit Joshi, Xinyu Wang","doi":"10.1080/13696998.2025.2488151","DOIUrl":"10.1080/13696998.2025.2488151","url":null,"abstract":"<p><strong>Background: </strong>High-dose (HD) influenza vaccine, which has demonstrated superior efficacy and acceptable safety compared to standard-dose (SD), has market authorization in many countries. This study evaluated the public-health impact and cost-effectiveness of HD versus SD in Japanese older-adults (OAs) from healthcare payer-perspective.</p><p><strong>Methods: </strong>Decision-tree model was employed assessing health outcomes for each vaccination strategy, simulating influenza cases, outpatient/emergency department (ED) visits, hospitalizations, and mortality, over one-year time-horizon. Incremental cost-effectiveness ratios (ICER) were assessed at Japanese willingness-to-pay (WTP) threshold. Base-case analysis considered influenza vaccines effective against influenza hospitalizations only, whereas complementary analyses reflected their efficacies against Pneumonia and Influenza (P&I), respiratory and cardiorespiratory hospitalizations possibly related to influenza among individuals ≥65 years. Scenario analysis extended target population to at-risk individuals aged 60-64 years. Uncertainty was assessed using sensitivity analyses.</p><p><strong>Results: </strong>In base-case, switching from SD to HD prevented 174,863 influenza cases, 121,084 outpatient and 614 ED visits, annually. Further, 5,777 influenza hospitalizations, and 2,406 deaths related to influenza were avoided with HD vaccine. The HD vaccine was found to be a cost-effective strategy at WTP threshold of ¥5,000,000/Quality-Adjusted-Life-Years (QALY) with ICER of ¥4,876,512/(QALY). Sensitivity analyses confirmed the robustness of these findings. Complementary analyses showed notably improved outcomes, in terms of public-health, economic impact, and ICERs, when considering efficacy of influenza vaccines against P&I, respiratory, and cardiorespiratory hospitalizations possibly related to influenza.</p><p><strong>Conclusion: </strong>These results indicate that HD vaccine has a high economic value in Japan compared to SD. Implementing HD vaccine could effectively alleviate the burden on healthcare facilities for Japanese OAs.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"544-555"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753161","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":"Prevalence, incidence, patient characteristics, and treatment trends of valvular heart disease using the national database of health insurance claims of Japan.","authors":"Ataru Igarashi, Tomomi Takeshima, Shoichi Irie, Kosuke Iwasaki","doi":"10.1080/13696998.2025.2474885","DOIUrl":"10.1080/13696998.2025.2474885","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study is to elucidate the prevalence, incidence, patient characteristics, and recent treatment trends of valvular heart disease (VHD) in Japan using a comprehensive claims database.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using the national database of health insurance claims in Japan (April 2009-June 2021), which contains data from the entire Japanese population, regardless of the type of medical facility. Descriptive analyses were conducted to examine the prevalence, incidence, and patient characteristics of each valve disease in 2020 based on diagnoses, and the treatment trends from 2009 to 2021.</p><p><strong>Results: </strong>We identified 28,366,924 patients with VHD over the entire data period, and 2,473,070 patients in 2020, including 711,876 newly diagnosed. The prevalence and annual incidence in the entire Japanese population were 1.96% (1.88% in men and 2.04% in women) and 0.56% (0.53 and 0.60%), respectively, and increased with age in adults. Among the 8 types of VHD in combination with a disordered valve (aortic, mitral, tricuspid, or pulmonic) and type of valve disease (stenosis or regurgitation), mitral regurgitation had the highest prevalence followed by aortic regurgitation and tricuspid regurgitation. Heart failure was diagnosed in ≥50% of patients with aortic, mitral, or tricuspid disease, with the highest rate in mitral stenosis. The number of open-heart surgeries remained constant, while the number of transcatheter surgeries increased over time, particularly between 2016 and 2021. Aortic stenosis prevalence in transcatheter surgeries rose to ≥60% in 2014 and ≥80% in 2016.</p><p><strong>Limitations: </strong>Diagnoses of VHD and comorbidity were based on claims data, so diagnostic criteria and disease severity are unknown, and misclassification of VHD types might have occurred. Incidence rates were based on the initial VHD diagnosis only, excluding any subsequent diagnoses of different VHD type. Conclusions: We presented basic information, which may provide an understanding of the clinical status of VHD in Japan.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"405-412"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531004","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":"Associations between procedural volume, costs, and outcomes of septal reduction therapies for obstructive hypertrophic cardiomyopathy in US hospitals.","authors":"Ervant J Maksabedian Hernandez, Shanthi Krishnaswami, Anandkumar Dubey, Nisha Singh, Anna G Jonkman, Zhun Cao, Manu Tyagi, Craig Lipkin, Andrew Wang","doi":"10.1080/13696998.2025.2468127","DOIUrl":"10.1080/13696998.2025.2468127","url":null,"abstract":"<p><strong>Aim: </strong>We assessed the relationship between hospital septal reduction therapy (SRT) procedural volume and clinical outcomes, healthcare resource utilization, and hospital costs.</p><p><strong>Methods: </strong>This cross-sectional study used 2012-2022 US hospital data from the PINC AI Healthcare Database for adults with hypertrophic cardiomyopathy (HCM) undergoing alcohol septal ablation (ASA) or septal myectomy (SM; with or without mitral valve repair or replacement [MVRR]). We categorized hospital procedural volume into tertiles according to the numbers of procedures performed and made pairwise comparisons of patient characteristics, clinical events, healthcare utilization, and hospital costs between tertiles. We conducted multivariable analyses (adjusted for patient, clinical, and hospital characteristics) for index hospitalization length of stay, cost, and 30-day readmission rates.</p><p><strong>Results: </strong>Overall, 3,068 patients with HCM (across 315 hospitals) underwent SRT (ASA: 1,400; SM: 1,668). Index visit in-hospital mortality was 1.1-1.5% among individuals undergoing ASA, 3.2-7.4% for SM with MVRR, and 2.8-3.8% for SM without MVRR. There were no significant differences in in-hospital mortality or stroke/transient ischemic attack at index visits between the hospital procedural volume tertiles for ASA or SM. Adjusted hospital length of stay, costs, and readmission rates were significantly greater in low-volume than high-volume hospitals for ASA (<i>p</i> < 0.001). Similar trends were reported for SM for length of stay and costs (<i>p</i> < 0.001).</p><p><strong>Limitations: </strong>This study relied upon accurate and complete reporting of diagnoses and procedures by hospitals. Patients were not randomly assigned, potentially leading to selection bias. Only in-hospital costs were evaluated. Follow-up events were only captured if they occurred in the same healthcare facility.</p><p><strong>Conclusions: </strong>Resource utilization and in-hospital costs for patients undergoing SRT are lower in high procedural volume hospitals than low procedural volume hospitals. SRT procedure volume remains low even in hospitals with the highest relative procedural volumes, highlighting a need for globally accessible therapies that improve outcomes.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"302-313"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458306","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 newborn screening for spinal muscular atrophy in Japan.","authors":"Akira Hata, Akihito Uda, Satoru Tanaka, Diana Weidlich, Walter Toro, Laetitia Schmitt, Ataru Igarashi, Matthias Bischof","doi":"10.1080/13696998.2024.2439734","DOIUrl":"10.1080/13696998.2024.2439734","url":null,"abstract":"<p><strong>Aims: </strong>Spinal muscular atrophy (SMA) is a rare genetic disorder characterized by progressive muscle weakness, atrophy, respiratory failure, and in severe cases, infantile death. Early detection and treatment before symptom onset may substantially improve outcomes, allowing patients to achieve age-appropriate motor milestones and longer survival. We assessed the cost-utility of newborn screening (NBS) for SMA in Japan.</p><p><strong>Materials and methods: </strong>A cost-utility model (decision tree and Markov model) compared lifetime health effects and costs between \"NBS\" for SMA (presymptomatic treatment) or \"no NBS\" (treatment initiated at symptom onset). Model inputs were sourced from literature, local data, and expert opinion. Sensitivity and scenario analyses were conducted to assess model robustness and data validity.</p><p><strong>Results: </strong>Based on the 1:10,000 SMA incidence, it was estimated that 43 newborns/year would have SMA, and a total of 39 patients with SMA would initiate presymptomatic treatment after NBS. An estimated 736 quality-adjusted life-years were gained per annual birth cohort with NBS. NBS for SMA was dominant compared with no NBS (i.e. less costly and more effective), with ¥8,856,960,096 reduced total costs with NBS versus no NBS (base-case). Sensitivity and scenario analyses supported cost effectiveness of NBS for SMA versus no NBS. A greater percentage of patients was estimated to enjoy longer survival and be without permanent assisted ventilation with NBS versus no NBS.</p><p><strong>Limitations: </strong>Real-world observations may differ from single-arm clinical trial outcomes. It was assumed that patients with SMA identified via NBS were asymptomatic and would receive treatment prior to symptoms. Best supportive care was not considered, and Japan-specific variations in gene replacement therapy protocol were not fully reflected.</p><p><strong>Conclusion: </strong>NBS for SMA allows for early identification of patients with SMA and treatment initiation before symptom onset, improving health outcomes and reducing total costs than without NBS.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"44-53"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785717","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 psoriasis treatment patterns and disease burden in Germany, with a focus on biologics and apremilast: data from a German statutory health insurance database.","authors":"Andreas Pinter, Marcus Schulte, Nils Kossack, Marc Pignot, Michael Schultze, Andrea Feldhus","doi":"10.1080/13696998.2025.2452054","DOIUrl":"10.1080/13696998.2025.2452054","url":null,"abstract":"<p><strong>Background: </strong>Psoriasis is a chronic, systemic, inflammatory skin disease, with increasing prevalence; however, few studies have reported real-world prescription patterns and healthcare burden.</p><p><strong>Objectives: </strong>This retrospective, observational cohort study used statutory health insurance claims data (January 2014-December 2019) to estimate prevalence/incidence of moderate-to-severe psoriasis in Germany. Patient characteristics, treatment patterns/compliance, and healthcare resource utilization (HCRU)/costs were evaluated, focusing on apremilast and anti-interleukin (IL), and anti-tumor necrosis factor (TNF) biologics.</p><p><strong>Methods: </strong>The epidemiology population included adults with psoriasis; 1-year prevalence/incidence rates were extrapolated to the statutory health insurance population. The HCRU/costs population included adults with psoriasis and a first prescription for a drug of interest (index date). Baseline periods were 12 or 48 months before the index date, with 12‑month follow-up.</p><p><strong>Results: </strong>In 2019, the estimated psoriasis prevalence/incidence was 2,672.9 per 100,000 individuals/508.7 per 100,000 person-years. Of 2,809 patients in the HCRU/costs population, 3.6% (<i>n</i> = 101) received index drug apremilast, 10.2% (<i>n</i> = 287) anti-IL, 6.8% (<i>n</i> = 191) anti-TNF, and 79.4% (<i>n</i> = 2,230) traditional/other systemic therapy. Patients initiating apremilast were older and were more often biologic-naïve than those initiating anti-IL/TNF biologics. Twelve months after treatment initiation, drug adherence (medication possession rate >80%) and persistence (<60 days between prescriptions/no switch) were lower for apremilast <i>vs.</i> anti-IL and anti-TNF groups (24.8% <i>vs.</i> 59.6% and 53.9%; 36.6% <i>vs.</i> 66.9% and 57.6%, respectively). During a 12-month baseline period, psoriasis-related hospitalization was lower for apremilast <i>vs.</i> anti-IL and anti-TNF groups (4.95% <i>vs.</i> 15.68% and 14.14%) and higher during 12 months' follow-up (5.94% <i>vs.</i> 2.44% and 3.14%). Adjusted index drug costs during follow-up were €4,105, €3,498, and €13,777 higher for adalimumab, other anti-TNF and anti-IL biologics <i>vs.</i> apremilast, respectively, and the main driver for lower overall apremilast costs.</p><p><strong>Conclusion: </strong>Given variation in treatment adherence/persistence, HCRU, and costs between apremilast and biologics, these findings could be key considerations during treatment selection.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"207-220"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978947","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":"Noninvasive tests and diagnostic pathways to MASH diagnosis in the United States: a retrospective observational study.","authors":"Semiu O Gbadamosi, Kristin A Evans, Brenna L Brady, Anthony Hoovler","doi":"10.1080/13696998.2025.2468582","DOIUrl":"10.1080/13696998.2025.2468582","url":null,"abstract":"<p><strong>Aim: </strong>Although liver biopsy is considered the most reliable diagnostic tool for metabolic dysfunction-associated steatohepatitis (MASH), it is invasive and can be costly. Clinicians are increasingly relying on routine biomarkers and other noninvasive tests (NITs) for diagnosis. We examined real-world diagnostic pathways for patients newly diagnosed with MASH with a primary focus on NITs.</p><p><strong>Materials and methods: </strong>This retrospective, observational study analyzed healthcare claims data (Merative MarketScan Commercial and Medicare Databases) from patients in the United States newly diagnosed with MASH from October 1, 2016, to March 31, 2023. Patients ≥18 years old with ≥12 months of continuous enrollment with medical and pharmacy benefits prior to diagnosis were included. Diagnostic pathways leading up to MASH diagnosis, including NITs (blood-based and imaging-based tests) and liver biopsies were assessed. Prevalence of comorbid conditions, MASH-associated medication use, and the diagnosing physician specialty were also examined.</p><p><strong>Results: </strong>A total of 18,396 patients were included in the analysis. Routine laboratory tests (alanine aminotransferase [ALT], albumin, aspartate aminotransferase [AST], cholesterol, complete blood count, and hemoglobin A1c) were performed among ≥70% of patients prior to MASH diagnosis, including 89% of patients with a liver enzyme test (ALT and/or AST). More than 75% of patients had necessary laboratory tests to calculate AST to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) scores. The most common imaging performed was ultrasound (62%); liver biopsy was only performed in 10% of patients. There was a high prevalence of cardio metabolic risk factors such as hyperlipidemia (66%), hypertension (62%), obesity (58%), type 2 diabetes (40%), and cardiovascular disease (21%). Nearly half of the patients (49%) were diagnosed by a primary care physician.</p><p><strong>Limitations and conclusions: </strong>This study highlights real-world diagnostic pathways among patients newly diagnosed with MASH, supporting previous findings that liver biopsies are infrequently used in favor of noninvasive methods.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"314-322"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440972","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}