Journal of Medical Economics最新文献

{"title":"Cost-effectiveness of outpatient COVID-19 antiviral treatment with nirmatrelvir/ritonavir versus usual care in Swedish patients with various risk factors.","authors":"Fredrik Nilsson, Martina Aldvén, Christian Gerdesköld Rappe, Tendai Mugwagwa","doi":"10.1080/13696998.2024.2444836","DOIUrl":"10.1080/13696998.2024.2444836","url":null,"abstract":"<p><strong>Aims: </strong>Nirmatrelvir/ritonavir (NMV/r) is an orally administered antiviral indicated for the outpatient treatment of adult patients with mild-to-moderate COVID-19 at high risk for disease progression to severe illness. We estimated the cost-effectiveness of NMV/r versus best supportive care for 54 patient cohorts, specified according to age, vaccination status and comorbidity burden.</p><p><strong>Materials and methods: </strong>A previously published and validated cost-effectiveness model was utilized and adapted to the Swedish setting. The model used a short-term decision-tree (1 year) followed by a lifetime 2-state Markov model. The short-term decision-tree captured costs and outcomes associated with the primary infection. Post-acute COVID-19 syndrome was only considered in terms of quality-of-life decrements for one year. Baseline hospitalization and mortality risks were taken from a Swedish, nationwide, uniquely granular, Omicron-era, real-world study. NMV/r effectiveness were taken from an Omicron-era US real-world study. Remaining inputs were informed by previous COVID-19 studies and publicly available Swedish sources.</p><p><strong>Results: </strong>The incremental cost-effectiveness ratios (ICERs) showed a large variation ranging from almost nine million SEK for some of the youngest cohorts to being dominant (i.e. cost-saving with higher gains in quality-of-life vs standard of care) for twelve elderly cohorts. In general, higher age in combination with non-recent (>180 days) or no vaccination led to lower ICERs. Specifically, NMV/r was cost-effective for all but one patient cohorts at least 70 years old, and for most patient cohorts 60-69 years old.</p><p><strong>Limitations: </strong>As the COVID-19 landscape changes, symptom burden and baseline risks constantly change. Thus, the cost-effectiveness of NMV/r will change with time. However, the future risks could be related to the risks in the current study, and thus remain useful for decision makers.</p><p><strong>Conclusions: </strong>This study shows that NMV/r is a cost-effective or even cost-saving treatment option for many patient cohorts, including most elderly and not-recently vaccinated patients with at least some comorbidity burden.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"186-195"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864541","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 finerenone therapy for patients with chronic kidney disease and type 2 diabetes in England & Wales: results of the FINE-CKD model.","authors":"David Cherney, Aleksandra Drzewiecka, Kerstin Folkerts, Pierre Levy, Aurélie Millier, Stephen Morris, Michał Pochopień, Prabir Roy-Chaudhury, Sean D Sullivan, Paul Mernagh","doi":"10.1080/13696998.2025.2451526","DOIUrl":"10.1080/13696998.2025.2451526","url":null,"abstract":"<p><strong>Objective: </strong>Chronic kidney disease (CKD) is the leading cause of kidney failure, end-stage kidney disease (ESKD), and cardiovascular (CV) events in patients with type 2 diabetes (T2D). The FIDELIO-DKD trial demonstrated that finerenone lowered the risk of renal and CV events in patients with CKD and T2D, regardless of cardiovascular disease history. This study evaluated the cost-effectiveness of finerenone added to background treatment (finerenone + BT) versus background treatment (BT) alone in patients with CKD and T2D from the perspective of the National Health Service in England and Wales.</p><p><strong>Methods: </strong>A lifetime Markov model assessed the indicated usage of finerenone for the treatment of stage 3 or 4 CKD with albuminuria associated with T2D in adults, as per the relevant marketing authorization. The model structure considered kidney disease progression and CV risk, with health states encompassing patients' kidney disease stage and CV event profiles, using patient-level data from the FIDELIO-DKD trial. Model outcomes were life years, quality-adjusted life years (QALYs), per-patient costs, incremental costs, and incremental cost-effectiveness ratio (ICER). Sensitivity and scenario analysis were performed, including an analysis exploring the impact of real-world data which suggests more frequent sodium-glucose co-transporter-2 (SGLT2) inhibitor use in the United Kingdom since FIDELIO-DKD.</p><p><strong>Results: </strong>Patients receiving finerenone experienced kidney and CV benefits, including reduced rates of nonfatal CV events and CV deaths, translating to improvements in survival and quality-adjusted life years (QALYs) of 6.11 and 5.97 per patient for finerenone + BT versus BT, respectively. Total discounted per-patient costs were £48,940 for finerenone + BT and £47,716 for BT alone, resulting in an incremental cost-effectiveness ratio of £8,808 per QALY gained for finerenone + BT versus BT.</p><p><strong>Conclusion: </strong>Sensitivity and scenario analyses, including more frequent SGLT2 inhibitor use consistent with real-world data, indicate a robust ICER that remains within the bounds of what is typically considered cost-effective.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"196-206"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the societal economic burden of food allergy in the United States.","authors":"Christopher Warren, Melanie D Whittington, Lucy Bilaver, David Kratochvil, Rongzhe Liu, Arpamas Seetasith, Stella Ko, Vincent Garmo, Stacey Kowal, Sachin Gupta, Ruchi Gupta","doi":"10.1080/13696998.2025.2563462","DOIUrl":"10.1080/13696998.2025.2563462","url":null,"abstract":"<p><strong>Aim: </strong>Food allergy (FA) imposes a large burden on patients/caregivers, but there is limited recent information on the societal economic burden of FA. We aimed to quantify this burden in the United States (US) using a health economic population cost exercise.</p><p><strong>Methods: </strong>A prevalence-based model was adopted to estimate the US population with FA and the annual societal/patient costs of FA (in 2024 US$). The Markov model consisted of 3 mutually exclusive health states: \"avoidance (with sensitivity),\" \"full tolerance,\" and death. Inputs included published data on epidemiology, clinical outcomes, and estimated costs. The model focuses on a comprehensive societal scenario. Scenario analyses utilized a conservative costing approach, determined if the estimated burden exhibited heterogeneity across underserved populations of race/ethnicity and household income, and assessed the impact of allergen desensitization on estimated costs.</p><p><strong>Results: </strong>The model estimated 16,678,832 people with ≥1 physician-diagnosed FA, an annual total societal cost of $370.8 billion, and an annual cost per patient of $22,234, which was higher for children and adolescents than adults. Societal cost was primarily attributed to indirect costs (92.7% of total cost). In the scenario analysis, conservative total societal cost was $39.6 billion; Hispanic, African American, and other races/multiracial patients had ∼3% increased cost relative to White patients; direct medical cost for the low-income group was 39.1% higher than for the high-income group; and total cost was reduced by ∼4% for each additional 10% of the population that entered the model as desensitized.</p><p><strong>Conclusions: </strong>Using a population cost exercise that incorporated a range of epidemiologically plausible explanations, we estimated the annual total societal cost of FA in the US may approach $370.8 billion, mostly from indirect costs borne by patients/caregivers during daily living. This assessment may assist population-level healthcare decision-makers in investing in measures that reduce economic burden, valuing interventions, and considering approaches to reduce economic/health disparities for underserved populations.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1669-1681"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075503","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 patterns among patients with Parkinson's disease psychosis and dementia: analysis of US Medicare beneficiaries treated with pimavanserin versus other-atypical antipsychotics or versus quetiapine.","authors":"Krithika Rajagopalan, Daksha Gopal, Lambros Chrones, Dilesh Doshi, Nazia Rashid","doi":"10.1080/13696998.2025.2487358","DOIUrl":"10.1080/13696998.2025.2487358","url":null,"abstract":"<p><strong>Background: </strong>Pimavanserin (PIM) is the only FDA approved atypical antipsychotic treatment (AAP) for hallucinations and delusions associated with Parkinson's disease psychosis (PDP) among patients with or without coexisting dementia; however, Other-AAPs (i.e. quetiapine (QUE), risperidone, olanzapine, aripiprazole) are commonly prescribed off-label. Healthcare resource utilization (HCRU) patterns among patients with PDP and coexisting dementia (PDP+D) who newly initiate PIM versus (vs.) Other-AAPs (i.e. other AAP-mix) or QUE in real-world settings is limited.</p><p><strong>Methods: </strong>A retrospective analysis of Parts A, B, and D claims from the 100% Medicare sample from 04/01/15 to 12/31/21 was conducted. AAP-naïve patients with PDP+D who initiated ≥12-month continuous monotherapy with PIM vs. Other-AAPs or vs. QUE during 04/01/16-12/31/20 were propensity score matched 1:1 on thirty-one variables (age, sex, race, region and 27 Elixhauser comorbidity characteristics). Adjusted log binomial regressions compared all-cause HCRU [(e.g. inpatient hospitalizations and by hospitalization-type [short-term stays (ST-stays), long-term stays (LT-stays), skilled nursing facility stays (SNF-stays)], and emergency room (ER) visits] risk between cohorts.</p><p><strong>Results: </strong>Of the 5,932 patients with PDP+D, matched cohorts (<i>n</i> = 1,294 in each) on continuous- monotherapy of PIM vs. Other-AAPs or QUE had similar demographics and comorbidities. Adjusted regression results showed those who initiated PIM vs. Other-AAPs had significantly lower relative risk (RR) of ≥1 all-cause inpatient hospitalizations (RR = 0.88, 95% CI: 0.80-0.97), ST-stays (RR = 0.86, 95% CI: 0.77-0.95), SNF-stays (RR = 0.79, 95% CI: 0.68-0.92), and ER visits (RR = 0.89, 95% CI: 0.84-0.94). PIM vs. QUE also experienced significantly lower RR for ≥1 all-cause IP hospitalizations (RR = 0.88, 95% CI: 0.80-0.96), ST-stays (RR = 0.85, 95% CI: 0.77-0.95), SNF-stays (RR = 0.81, 95% CI: 0.70-0.94), and ER visits (RR = 0.88, 95% CI: 0.83-0.94).</p><p><strong>Conclusions: </strong>Patients initiating PIM-monotherapy for PDP+D experienced 12% lower all-cause inpatient hospitalizations vs. Other-AAPs or QUE. These results are consistent with prior real-world research in PDP with or without dementia.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"556-566"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753163","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":"An Italian cost-utility analysis of 20-valent pneumococcal conjugate vaccine for routine vaccination in infants.","authors":"Michele Basile, Filippo Rumi, Agostino Fortunato, Debora Antonini, Roberto Di Virgilio, Giuseppe Novelli, Alessandra Pagliaro, Eugenio Di Brino","doi":"10.1080/13696998.2025.2495461","DOIUrl":"10.1080/13696998.2025.2495461","url":null,"abstract":"<p><strong>Background: </strong>Streptococcus pneumoniae represents a significant global public health threat, causing approximately 45 million lower respiratory tract infections and 350,000 deaths annually among children under 5 years of age. Conjugate pneumococcal vaccines (PCVs), such as PCV15 and PCV20, have been developed to mitigate this burden by providing protection against serotypes responsible for the disease. The present analysis aims to evaluate the cost-utility of PCV20 compared to PCV15 as a vaccination strategy for preventing pneumococcal diseases in children in Italy.</p><p><strong>Methods and materials: </strong>A cost-utility analysis (CUA) was conducted using a static Markov model adapted to the Italian context to simulate the economic and clinical effects of vaccination over a 10-year time horizon. The study adopted the perspective of the Italian National Health Service (NHS), considering only direct healthcare costs. Deterministic and probabilistic sensitivity analyses were performed to explore parameter uncertainty.</p><p><strong>Results: </strong>The model showed that PCV20 is a dominant strategy compared to PCV15, generating cost savings of €6.45 million and a gain of 101,708 QALYs (quality-adjusted life years). These benefits are attributed to PCV20's broader serotype coverage, which significantly reduces the incidence of invasive and non-invasive pneumococcal diseases. Vaccination with PCV20 offers substantial clinical and economic advantages over PCV15.</p><p><strong>Conclusions: </strong>The introduction of PCV20 as a vaccination strategy for children in Italy represents a cost-effective and clinically advantageous option. Its implementation can reduce the burden of pneumococcal disease and associated healthcare costs, improving public health outcomes and the economic efficiency of the healthcare system.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"674-687"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028778","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":"Bridging the gap in public healthcare services in developing countries: lessons from the family doctor contract services in China.","authors":"Mohammad Habibullah Pulok","doi":"10.1080/13696998.2025.2480479","DOIUrl":"10.1080/13696998.2025.2480479","url":null,"abstract":"","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"445-447"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649278","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":"U.S. payer budget impact of the Leva Pelvic Health System to improve pelvic floor muscle training as first-line treatment of female urinary incontinence compare to real-world clinical practice.","authors":"Evelyn Hall, Ayachi Sharma, Thomas F Goss, Kristin Hung","doi":"10.1080/13696998.2025.2494940","DOIUrl":"https://doi.org/10.1080/13696998.2025.2494940","url":null,"abstract":"<p><strong>Aim: </strong>Urinary incontinence (UI) is a common condition for adult women impacting over 60% of women with 9.8% experiencing daily symptoms and 32.4% experiencing monthly symptoms. It is associated with significant negative impacts on patients' quality of life, well-being, and social functioning, resulting in substantial healthcare costs to payers. The goal of this study was to analyze 24-month budget impact of treatment of urinary incontinence (UI) in adult women enrolled in a 1-million-member US commercial health plan by comparing clinical practice that includes the use of the Leva Pelvic Health System (CP with Leva) to current clinical practice without Leva (CCP).</p><p><strong>Methods: </strong>A budget-impact model compared 24-month costs associated with first-line pelvic floor muscle training (PFMT) in women seeking UI treatment in two cohorts: 85% receiving first-line CCP treatment/15% receiving the CP with Leva, compared to all patients treated with CCP. Medical spending per treated patient and per-member-per-month were calculated by summing 24-month UI treatment costs comparing CCP to CP with Leva. The treatment pathway was developed based on published guidelines and literature to obtain estimates of success and complications. Commercial payer costs were estimated by applying a 1.50× multiplier to published Medicare costs based on Congressional Budget Office data for Hospital and Physician Services.</p><p><strong>Results: </strong>In a 1-million-beneficiary US commercial health plan with 334,191 adult women, 31,438 (9.4%) adult women were treated for UI over a 24-month period. Total estimated 24-month cost per treated patient was $11,267 in the CCP and $10,447 in the CP with Leva groups, respectively. Estimated total health plan 24-month savings was $25,782,112, or $1.07 per-member-per-month.</p><p><strong>Limitations: </strong>The model may not capture all events in the care pathway for female UI patients seeking medical treatment, as there are significant variations in practice patterns; the rate of Leva adoption as a first-line therapy is based on estimates. The costs and savings calculated in this model may not be generalizable to every commercial health plan, given that actual costs routinely rely on specifically negotiated reimbursement rates.</p><p><strong>Conclusions: </strong>The model demonstrates that access to first-line Leva therapy can reduce two-year UI treatment costs compared to CCP.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"28 1","pages":"637-647"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029831","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 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":"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}