Journal of Medical Economics最新文献

{"title":"Cost-effectiveness of perioperative nivolumab + neoadjuvant platinum doublet chemotherapy as treatment for resectable non-small cell lung cancer in the United States.","authors":"Benjamin White, Mack Harris, Reginald Villacorta, Ariel Sun, Sandra Milev, Stefano Lucherini","doi":"10.1080/13696998.2025.2494943","DOIUrl":"https://doi.org/10.1080/13696998.2025.2494943","url":null,"abstract":"<p><strong>Aims: </strong>CheckMate-77T demonstrated the clinical benefit of perioperative nivolumab plus neoadjuvant platinum-doublet chemotherapy (periNivo + neoCT). This study assessed the cost-effectiveness of periNivo + neoCT as treatment for non-metastatic (Stage IIA-IIIB), resectable non-small cell lung cancer (NSCLC) vs. relevant comparators in the US.</p><p><strong>Materials and methods: </strong>Following the natural history of non-metastatic NSCLC, a four-state Markov model was developed. Modeled health states were event-free survival, locoregional recurrence, distant metastasis, and death. CheckMate-77T informed time to progression estimates for periNivo + neoCT and neoCT; mortality estimates leveraged longer-term follow-up available from CheckMate-816. Indirect treatment comparison informed efficacy of comparator treatments not considered in CheckMate-77T. Comparators were neoadjuvant treatment strategies (neoadjuvant nivolumab + chemotherapy [neoNivo + CT], neoadjuvant chemotherapy [neoCT], and neoadjuvant chemoradiotherapy [neoCRT]), adjuvant chemotherapy (adjCT), and perioperative immuno-therapy (IO) strategies (perioperative durvalumab + neoadjuvant chemotherapy [periDurva + neoCT] and perioperative pembrolizumab + neoadjuvant chemotherapy [periPembro + neoCT]). Cost inputs were obtained from published literature and standard US sources and expressed in 2024 USD. The base-case analysis adopted the perspective of a commercial payer with a lifetime time horizon and discounted cost and health outcomes by 3% annually.</p><p><strong>Results: </strong>Model results showed that periNivo + neoCT is more effective and costly than comparators. Deterministic incremental cost-effectiveness ratios were $84,921, $153,557, $77,976, $60,826, $74,252, $32,069, and $21,974 vs. neoCT, neoNivo + CT, neoCRT, adjCT, surgery, periPembro + neoCT, and periDurva + neoCT, respectively. In probabilistic sensitivity analysis, periNivo + neoCT resulted in an ICER below $150,000/QALY in 93.3%, 58.2%, 82.4%, 95.1%, 98.3%, 69.9%, and 82.1% of iterations vs. neoCT, neoNivo + CT, neoCRT, adjCT, surgery only, periPembro + neoCT, and periDurva + neoCT, respectively.</p><p><strong>Limitations: </strong>Uncertainty in the survival extrapolations reflected the limited body of evidence informing the indirect treatment comparison. ICERs vs. perioperative IO treatment strategies were sensitive to small changes in predicted costs and QALYs, given low incremental base case costs and QALYs.</p><p><strong>Conclusion: </strong>PeriNivo + neoCT is a cost-effective treatment option for patients with resectable, non-metastatic NSCLC.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"28 1","pages":"625-637"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975663","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":"Unpacking the post-COVID association between unexpected births and excess deaths.","authors":"Les Coleman","doi":"10.1080/13696998.2025.2500825","DOIUrl":"10.1080/13696998.2025.2500825","url":null,"abstract":"<p><strong>Objective: </strong>Global fertility has halved since its 1960s peak to be little above the replacement rate, and lower in many developed countries. In addition it has been suggested that excess deaths since the onset of the COVID pandemic may have influenced fertility. Given the economic and social interest in declining fertility, this study seeks an explanation.</p><p><strong>Methods: </strong>We developed a sample for 18 mid-large industrialized countries of 30 variables covering vital statistics and health, social and economic data, and determined excess deaths during 2020-2022 and unexpected births during 2022-2024. Analysis estimated the link between COVID excess deaths and subsequent unexpected births; and estimated links between excess deaths and unexpected births and national parameters.</p><p><strong>Results: </strong>Countries' average birth rate during 2022-2023 was 5-6% below that expected from their trend and mean prior to the spread of COVID-19 in 2020. Birth rates were higher than expected after 2022 in countries which had high excess deaths during 2020-2022. Regression against national parameters traced reductions in post-COVID births to countries' strong economic measures (low unemployment, high GDP per capita), indicators of women's high economic capacity (years at school, female workforce participation), and weak religiosity. Similar analysis identified higher excess deaths in less wealthy countries, and those with weaker social measures and women's opportunities, and poor pre-existing health outcomes (high infant mortality, low life expectancy, fewer physicians).</p><p><strong>Conclusion: </strong>The association between unexpected births and excess deaths this decade is largely spurious because lower wealth and poor previous health outcomes drove excess deaths, while the opportunity cost of childbearing has accelerated declining births in wealthier countries post-COVID. Better understanding population effects of the pandemic is of broad social and economic interest given declining fertility rates; and change in trajectory of births could prove the pandemic's most serious socio-economic consequences.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"726-733"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006786","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":"Healthcare resource utilization of patients with lower-risk myelodysplastic syndromes treated with luspatercept versus erythropoiesis-stimulating agents: a United States healthcare claims database study.","authors":"Brian J Ball, Rui Song, Enrico Zanardo, Lynn Huynh, Manasi Mohan, Megan Pinaire, Derek Tang, Mihran Yenikomshian, Ashley Swanson, Svetlana Gavrilov, Samantha Slaff","doi":"10.1080/13696998.2025.2498852","DOIUrl":"10.1080/13696998.2025.2498852","url":null,"abstract":"<p><strong>Objective: </strong>This study compared the healthcare resource utilization (HRU) of patients with lower-risk myelodysplastic syndromes (LR-MDS) treated with luspatercept versus erythropoiesis-stimulating agents (ESAs).</p><p><strong>Methods: </strong>This real-world retrospective cohort study used claims data from the Symphony Health Integrated Dataverse, a large nationally representative United States database, to identify patients with LR-MDS who initiated luspatercept or ESA between May 1, 2020, and June 30, 2022. Index date was defined as the date of the first claim for luspatercept or ESA. The follow-up period was from the index date to the earliest of the end of clinical activity or end of data availability. All-cause and MDS-related HRU were evaluated for both treatment cohorts and compared using generalized estimating equations with Poisson distribution and robust variance estimator.</p><p><strong>Results: </strong>Overall, 243 and 3,515 patients were included in the luspatercept and ESA cohorts, respectively. Patients in both cohorts had a similar median (interquartile range [IQR]) age at index (luspatercept: 77.0 [70.0-79.0] years; ESA: 78.0 [72.0-79.0] years) and median (IQR) follow-up duration (luspatercept: 14.6 [10.4-22.6] months; ESA: 14.4 [9.5-20.9] months). Compared with patients treated with ESA, patients treated with luspatercept had a 26% lower rate of all-cause inpatient visits (adjusted incidence rate ratio [aIRR], 0.74; 95% confidence interval [CI], 0.58-0.93; <i>p</i> < .05) and a 31% lower rate of all-cause outpatient visits (aIRR, 0.69; 95% CI, 0.61-0.79; <i>p</i> < .001). The rate of MDS-related inpatient visits was also 25% lower among the patients treated with luspatercept versus ESA (aIRR, 0.75; 95% CI, 0.56-0.99; <i>p</i> < .05).</p><p><strong>Conclusion: </strong>This study showed that patients with LR-MDS treated with luspatercept required significantly less HRU than patients treated with ESA. Further research is warranted to evaluate the financial impact of this lower HRU burden.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"719-725"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970166","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 benefits of telehealth in promoting equity in blood cancer care - results of a multi-stakeholder forum and systematic literature review.","authors":"Joseph Mikhael, Deanna Darlington, Bethany Howell, Jay Hydren, Tricia Hernandez, Sally Werner, Tracey Iraca, Mary Arnett, Victor Gonzalez, Susan Peschin, Alan J Balch, Diane Moran, Roslyn Young-Daniels, Olamide Banjo, George Dennis Obeng, Benjamin Asiedu-Ayeh, Sampson Kawuo, Asmau Mohammed Tukur, Inusah Mohammed, Akosua Pokuaah Obeng, Marcell Csanádi, Thomas Lew, Mimi Choon-Quinones","doi":"10.1080/13696998.2024.2438561","DOIUrl":"10.1080/13696998.2024.2438561","url":null,"abstract":"<p><strong>Aims: </strong>Therapeutic advancements have significantly improved patient outcomes in blood cancers. However, racial and ethnic disparities persist in treatment and access to care. Telehealth offers a promising solution to these disparities by using electronic and telecommunication technologies to deliver healthcare remotely. Ensuring access to telehealth depends not just on the technologies, but on the broader enabling environment, especially policy harmonization, communications infrastructure, and skills. This paper aims to advocate for the expanded use of telehealth in blood cancer management, highlighting its potential to improve equity and outcomes.</p><p><strong>Materials and methods: </strong>An expert forum discussion results informed this systematic literature review which was performed to better understand the applied Telehealth solutions and the expected benefits. The forum discussion and the literature review findings were aggregated and reviewed by experts and patient advocates with personal experience in blood cancer.</p><p><strong>Results: </strong>Our review of the literature yielded 18 relevant papers. Studies included patients from various disease areas; some studies used broader definitions of cancer to include more patients (i.e. acute leukemias and malignant lymphomas), while others were more specific to a particular condition. The identified Telehealth solutions were classified into two groups: solutions focusing on electronic consultation (<i>n</i> = 10) and solutions focusing on a specific intervention to improve patients' health status (<i>n</i> = 8). A larger variety of outcomes were found in these studies, including quality of life, patient and clinicians' acceptance, adherence, costs, and resource use.</p><p><strong>Conclusions: </strong>Initial findings demonstrate that telehealth can potentially improve patient outcomes for people living with blood cancer, including improved patient quality of life, increased clinician acceptance, better adherence, and reduced costs and resource use to the health system. While evidence for virtual consultations show promising results, further research is needed due to the variety of study settings evaluated in this review. Providers and health systems need additional data on the positive economic impact of Telehealth related to the diagnostic journey and access to treatment.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"788-802"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004260","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":"Effects of liposomal bupivacaine (LB) and provider experience with LB on service utilization, clinical outcomes, and Medicare expenditures among fee-for-service (FFS) beneficiaries.","authors":"Sarmistha Pal, Michael Beins, Al Dobson, Sung Kim, Seung Kim, Steven Heath, Richa Zirath","doi":"10.1080/13696998.2025.2510814","DOIUrl":"10.1080/13696998.2025.2510814","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effects of Liposomal Bupivacaine (LB) and provider LB use rate for 6 months after discharge on service utilization, clinical outcomes, and Medicare expenditures among Fee for Service (FFS) beneficiaries who have undergone hospital outpatient department (HOPD) procedures.</p><p><strong>Methods: </strong>100% Medicare Research Identifiable Files data from 2019 to 2023 was utilized. Medicare FFS beneficiaries with the top 100 HOPD surgical procedures where LB was utilized were included in the study and divided into two cohorts: received LB (treatment) and did not receive LB (comparison) during the surgical procedure. An Inverse Probability Treatment Weighting Propensity Score model was estimated to balance treatment and control groups. We estimated Emergency Department (ED) admission, Short Term Acute Care Hospitals (STACH) admission, mortality, Opioid Use Disorder (OUD) and Opioid prescription fill events, and spending metrics.</p><p><strong>Results: </strong>LB use contributed to significant reductions in ED admission (9%; 23.28 vs. 25.69%), STACH admission (8%; 11.61 vs. 12.65%), mortality (39%; 0.67 vs. 1.1%) and opioid prescription fills (6%; 1.8 vs. 1.92) within 180-days post-discharge. Total Medicare expenditures (180-day episode) were $245 lower for the LB user ($9,645 vs. $9,891). For each 10-percentage point increase in provider LB use-rate, the likelihood of ED admission, STACH admission, mortality, and OUD decreased by 0.1, 0.15, 0.01 and 0.02 percentage points, respectively. Total Medicare expenditures (180-day episode) were reduced by $258 for every one percentage point increase in LB use-rate.</p><p><strong>Conclusion: </strong>Use of LB and provider LB use rate are associated with improved patient clinical, service utilization, and expenditure outcomes.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"848-858"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159284","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":"Development and validation of an advanced data analytics model to support strategic point-of-care testing utilization decisions in the emergency department.","authors":"Antonio Leon-Justel, Marta Jimenez-Barragan, Carmen Navarro-Bustos, Salomon Martin-Perez, Jose M Garrido-Castilla, Isabel M Morales-Barroso, Fernando Oltra-Hostalet, Maria F Fernandez-Gallardo, Ana Diaz-Luque, Antonia Eugenio-Pizarro, Antonio Luque-Cid, Catalina Sanchez-Mora","doi":"10.1080/13696998.2025.2508659","DOIUrl":"10.1080/13696998.2025.2508659","url":null,"abstract":"<p><strong>Aims: </strong>This study was carried out to address potential uncertainties about how point-of-care testing (POCT) improves patients' outcomes in emergency department (ED). The main aim was to develop and validate a model based on advanced data analytics to evaluate POCT's impact in patients' outcomes and ED patients' flow.</p><p><strong>Materials and methods: </strong>We built a discrete event model simulation (DEMS) to represent workflow of a Spanish ED. Historical data from ED, published evidence and expert estimates were used to support the model. Different scenarios of progressive utilization of POCT in patients' care triaged as Emergency Severity Index (ESI) level 3 were compared to standard-of-care (SoC) in terms of time-to-first medical intervention (TFMI), time-to-disposition decision (TDD), total length of stay (LoS) and patient workflow.</p><p><strong>Results: </strong>In POCT maximum utilization scenario (60% of ESI-3 patients), time savings reached 27.44, 14.58 and 13.96 min of TFMI, 55.77, 13.64 and 13.97 min of TDD and 89.60, 18.55 and 13.98 min of LoS (ESI-3, 4 and 5 patients, respectively). Statistically significant reductions were found for all time outcomes in every POCT scenario for ESI-3, 4 and 5 patients. Internal validation didn't show differences between model results and real data.</p><p><strong>Limitations: </strong>Simplifications were made due to theoretical nature of computer-simulation models. Some input data and assumptions regarding individual process times were derived from interviews. Theoretical distributions were assumed; other activities outside the ED were considered as a disruption to the system; finally, findings reflect experience of a single ED.</p><p><strong>Conclusions: </strong>Advanced data analytics has become a useful tool in analyzing lots of processes. Our study showed that advanced data analytics has become an exceptional tool in clinical laboratories and exemplifies how POCT incorporation in ED for care of ESI-3 patients reduces physicians' workload and waiting times of ESI-3, 4 and 5 patients, thus optimizing the patients' medical journey.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"871-884"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost per responder for teclistamab and elranatamab in relapsed or refractory multiple myeloma in the United States.","authors":"Lucio N Gordan, Arielle G Bensimon, Fan Mu, Nina Kim, Bingcao Wu, Dee Lin, Agne Paner, Jessica Fowler, Alex Marshall, Suzy Van Sanden, Eric Ammann, Joe Goble, Xinke Zhang, Hoa H Le, Elissa E Min, Louis P Garrison","doi":"10.1080/13696998.2025.2514909","DOIUrl":"10.1080/13696998.2025.2514909","url":null,"abstract":"<p><strong>Aims: </strong>Teclistamab and elranatamab are bispecific antibodies recently approved for the treatment of triple class-exposed relapsed/refractory multiple myeloma (RRMM). This study assessed the relative efficacy and economic value of teclistamab and elranatamab through a matching-adjusted indirect comparison (MAIC) and cost per responder analysis using data from the MajesTEC-1 (NCT03145181/NCT04557098) and MagnetisMM-3 (NCT04649359) trials.</p><p><strong>Materials and methods: </strong>The MAIC compared overall response rate (ORR) between the therapies after weighting individual patient data from MajesTEC-1 to match key baseline characteristics in MagnetisMM-3. Matched covariates included age, refractory status, prior lines of therapy, extramedullary disease, performance status, disease stage, and cytogenetic risk profile. Cost per responder was calculated based on estimated per-patient drug acquisition and administration cost (2024 United States dollars) over 6 months divided by ORR. One-way and probabilistic sensitivity analyses were conducted to characterize uncertainty.</p><p><strong>Results: </strong>The ORRs were 63.0% for teclistamab before matching (<i>N</i> = 165), 61.4% for teclistamab after matching (effective sample size = 92), and 61.0% for elranatamab (<i>N</i> = 123) (odds ratio after matching: 1.02; 95% confidence interval [CI]: 0.59, 1.77). Per-patient costs were estimated to be $231,435 for teclistamab and $285,201 for elranatamab (difference: -$53,766; 95% confidence interval [CI]: -$59,094, -$48,311), yielding costs per responder of $376,930 and $467,730, respectively (difference: --$90,800; 95% CI: -$183,680, $8,148).</p><p><strong>Limitations: </strong>Because MajesTEC-1 and MagnetisMM-3 are single-arm trials, the MAIC was unanchored and therefore susceptible to confounding from any unadjusted effect modifiers or prognostic variables.</p><p><strong>Conclusions: </strong>Teclistamab was associated with significantly lower treatment costs and numerically lower cost per responder than elranatamab in triple class-exposed RRMM.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"910-920"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266436","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":"Nationwide extrapolation of economic benefit of therapeutic innovation: a 10-year retrospective budget impact of direct oral anticoagulants introduction in France.","authors":"C Guilmet, H Lesage, F E Cotté, R Moreau, C Marant Micallef, M Née, D Guitard-Dehoux, M Belhassen, N Danchin","doi":"10.1080/13696998.2025.2514381","DOIUrl":"10.1080/13696998.2025.2514381","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with atrial fibrillation (AF) face increased risks of strokes and systemic thromboembolism (SE), traditionally managed with vitamin K antagonists (VKAs), which are associated with major bleeding (MB) risks. The nationwide real-life data-based NAXOS study, comparing Direct Oral Anticoagulants (DOACs: apixaban, dabigatran, rivaroxaban) to VKAs in over 400,000 AF patients in France, showed that DOACs are more effective, safer, and associated with lower total costs. This study evaluates the 10-year budget impact of DOACs in France, focusing on reductions in strokes/SE, MB, and monitoring costs (INRt).</p><p><strong>Methods: </strong>A retrospective budget impact model from 2014 to 2023 compared scenarios with and without DOACs, using clinical and cost data from the NAXOS study. The target population of DOAC-eligible patients ranged from 725,000 in 2014 to 1.4 million in 2023. Market shares trends were derived from the public national drugs database, indicating that VKAs' use decreased from 67% to 11%, while DOACs, especially apixaban, rose sharply (2% to 55%) over the same period. Costs included treatment acquisition, strokes/SE, MB, and international normalized ratio testing (INRt) for VKAs.</p><p><strong>Results: </strong>Over a 10-year horizon, the introduction of DOACs is estimated to have prevented 73,009 strokes, 97,234 major bleeding, and 19,567 stroke-related deaths among patients with NVAF. DOAC introduction increased treatment costs by €5.15 billion over 10 years, and reduced costs for strokes/SE (-€4.24 billion), MB (-€3.22 billion), and INRt (-€1.14 billion), leading to €3.45 billion of savings for National Insurance over 10 years, with apixaban contributing 55% of savings.</p><p><strong>Limitations: </strong>This analysis may not account for all contextual variables, such as indirect costs related to productivity losses.</p><p><strong>Conclusion: </strong>Over 10 years, the introduction of DOACs in France has generated substantial savings in AF-related costs, highlighting their clinical and economic benefits and the importance for authorities to valorise the external effects of therapeutic innovations.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"28 1","pages":"859-870"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234315","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}