Journal of Medical Economics最新文献

{"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":"https://doi.org/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 -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 (n = 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":"1-14"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","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":"Artificial Intelligence in key pricing, reimbursement and market access (PRMA) processes: better, faster, cheaper - can you really pick two?","authors":"Eva Susanne Dietrich","doi":"10.1080/13696998.2025.2488154","DOIUrl":"https://doi.org/10.1080/13696998.2025.2488154","url":null,"abstract":"<p><p>The rapid evolution of large language models (LLMs) and machine learning (ML) presents both significant opportunities and challenges for market access processes. These sophisticated AI systems, built on transformer architectures and extensive datasets, offer potential to forecast claims and decisions of health technology assessment (HTA) agencies and streamline processes such as systematic literature reviews and HTA submissions. Furthermore, the analysis of real-world data - also for deriving causal relationships - is being discussed intensively. Despite notable advancements, their adoption in key PRMA processes is still limited at present, with only a small fraction of submissions to HTA bodies incorporating AI. Key barriers include stringent transparency requirements, the necessity of explainability and human oversight in data analyses, and the highly sensitive nature of text drafting - especially in cases where reimbursement decisions or pricing negotiations balance on a knife's edge. These requirements are often not met due to the immaturity of many AI applications, which still lack the necessary precision, reliability, and contextual understanding. Moreover, AI-generated evidence has yet to prove its validity before it can supplement or replace traditional study designs, such as randomized controlled trials (RCTs), which are critical for HTA decisions. Additionally, the environmental and financial costs of training LLMs require careful assessment. This paper explores various current AI applications, their limitations, and future prospects in key PRMA processes from a German perspective while also considering the broader implications of the EU Health Technology Assessment Regulation (HTAR). It concludes that while AI hold transformative potential, its integration into workflows must be approached cautiously, with incremental adoption, and close collaboration between industry, HTA agencies, and academia. Demonstrating robust, unbiased comparative evidence-showcasing superior performance and cost savings over traditional methods-could accelerate the adoption process.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1-19"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753158","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":"https://doi.org/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":"1-18"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","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":"A Swedish cost-utility analysis of ferric derisomaltose versus ferric carboxymaltose in the treatment of iron deficiency anemia in patients with inflammatory bowel disease.","authors":"Stefan C Lindgren, Hans Strid, Henrik Hjortswang, Bardh Manxhuka, Neesha Nanu, Richard F Pollock","doi":"10.1080/13696998.2025.2487359","DOIUrl":"https://doi.org/10.1080/13696998.2025.2487359","url":null,"abstract":"<p><strong>Objectives: </strong>Iron deficiency anemia (IDA) is a common extraintestinal manifestation of inflammatory bowel disease (IBD), driven by impaired iron absorption, inflammation of intestinal mucosa and blood loss due to intestinal bleeding. Exogenous iron is indicated to correct iron deficiency, with intravenous iron preferred in patients with malabsorption or intolerance of oral iron, active bleeding, systemic inflammation, or a need for rapid iron replenishment. The objective was to assess the cost-utility of two high-dose, rapid-infusion iron formulations - ferric derisomaltose (FDI) and ferric carboxymaltose (FCM) - in the treatment of patients with IBD and IDA in Sweden.</p><p><strong>Methods: </strong>The analysis used a previously-published micro-simulation model. Phosphate monitoring was modeled based on the product labelling, while iron need and disease-related quality of life (QoL) were modeled based on data from the PHOSPHARE-IBD randomized controlled trial. Cost-utility was evaluated from the national healthcare payer perspective over a five-year time horizon. Sensitivity and scenario analyses were performed.</p><p><strong>Results: </strong>For each iron treatment course, patients treated with FDI required 0.41 fewer infusions than those treated with FCM. The reduced number of infusions resulted in savings of SEK 9,876 over five years from iron administration costs alone (SEK 44,216 with FCM versus SEK 34,340 with FDI). Phosphate monitoring in patients treated with FCM cost SEK 2,776 over five years versus no monitoring costs with FDI. Total cost savings with FDI were SEK 14,962. FDI also resulted in a 0.076 quality-adjusted life year (QALY) improvement versus FCM driven primarily by the QoL improvements reported in PHOSPHARE-IBD, and FDI was therefore the dominant intervention.</p><p><strong>Limitations: </strong>The analysis did not capture costs or outcomes associated with hypophosphatemic osteomalacia or fractures.</p><p><strong>Conclusion: </strong>Relative to FCM, fewer infusions of FDI were required, there was no need for phosphate monitoring, and disease-related QoL was improved, while overall costs were reduced.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1-14"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753085","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":"All-cause healthcare resource utilization and costs among community-managed adults with long-COVID in France, 2020-2023.","authors":"Jingyan Yang, Cheikh Tamberou, Elise Arnee, Pierre-Alexandre Squara, Ayoub Boukhlal, Jennifer L Nguyen, Hannah R Volkman, Stéphane Fiévez, Marina Lepoutre-Bourguet, Jinma Ren, Haifa Ben Romdhane, Pascal Crépey, Olivier Robineau","doi":"10.1080/13696998.2025.2485626","DOIUrl":"https://doi.org/10.1080/13696998.2025.2485626","url":null,"abstract":"<p><strong>Background: </strong>The clinical and economic burden of long-COVID is poorly understood. We aim to assess all-cause healthcare resource utilization (HCRU) and costs in the primary care setting among adults with long-COVID in France.</p><p><strong>Methods: </strong>A retrospective cohort study using the electronic records of confirmed and/or probable COVID-19 patients from The Health Improvement Network (THIN) data between March 2020-December 2022 was conducted. Long-COVID was identified per World Health Organization (WHO) as suggestive symptoms present ≥3 months following acute SARS-CoV-2 infection. Patients' characteristics, HCRU, direct healthcare and indirect costs (National Health Insurance-based prices) were summarized. Costs between patients with previous SARS-CoV-2 infection who developed long-COVID, patients with previous SARS-CoV-2 infection who did not develop long-COVID (COVID only), and contemporaneous controls without SARS-CoV-2 infection were compared (Non-COVID).</p><p><strong>Results: </strong>Long COVID developed among 30,122 (11.6%) adults; mean (SD) age was 50 (17) years, 63.6% were female and 27.5% had a Charlson Comorbidity Index score >2. During the post-infection follow-up (mean = 13 months), 97.3% of patients had general practitioner consultations (GP) and 62.4% had nursing care. Costs were highest during the first post-diagnosis year with per patient per year costs of €2,443 (total cost of €52 million), including costs for GP (€208) and specialist (€170), outpatient procedures (€413), retail pharmacy use (€595), biological testing (€147), and medical device usage (€172). Patients with long COVID had additional costs of €163 and €176 when comparing to patients in the COVID only and Non-COVID cohorts, respectively.</p><p><strong>Limitations: </strong>Since the THIN database is generated from GP EHRs, there is the possibility of measurement/documentation errors and missing values which could compromise the validity and accuracy of certain results.</p><p><strong>Conclusion: </strong>Long COVID was associated with non-negligible HCRU, direct and indirect costs to the French healthcare system. These findings reinforce the importance of optimizing long-term resource allocation for patients infected with SARS-CoV-2.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1-17"},"PeriodicalIF":2.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Budget impact of introducing glofitamab for treatment of relapsed or refractory diffuse large B-cell lymphoma after two or more lines of systemic therapy in the United States.","authors":"Zahra Mahmoudjafari, Jia Li, Eric Bercaw, Helene Parise, Katalin Bognar, Si-Tien Wang, Anthony Masaquel","doi":"10.1080/13696998.2025.2486839","DOIUrl":"https://doi.org/10.1080/13696998.2025.2486839","url":null,"abstract":"<p><strong>Background: </strong>Glofitamab is a T-cell engaging bispecific monoclonal antibody that was granted accelerated approval from the United States Food and Drug Administration for adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), not otherwise specified or large B-cell lymphoma arising from follicular lymphoma, after ≥2 lines of systemic therapy (3L+).</p><p><strong>Methods: </strong>A budget impact model was developed fora hypothetical blended commercial/Medicare health plan with 1,000,000 members. Comparators were axicabtagene ciloleucel (Axi-cel), lisocabtagene maraleucel (Liso-cel), tisagenlecleucel (Tisa-cel), loncastuximab tesirine, polatuzumab vedotin + bendamustine + rituximab, rituximab + gemcitabine + oxaliplatin, tafasitamab + lenalidomide, and epcoritamab (Epcor). Total costs included those for drugs, wastage, administration, grade ≥3 adverse reactions and all-grade cytokine release syndrome) and routine care. Market shares were based on internal projections and expert opinions. Total and per-member per-month (PMPM) net budget impacts over 3 years were calculated.</p><p><strong>Results: </strong>Approximately nine patients were projected to be eligible for 3L + DLBCL treatment in a health plan of 1,000,000 members. The introduction of glofitamab as a treatment option resulted in estimated total and PMPM cost savings of $728,697 and -$0.0202, respectively, over 3 years. Costs were reduced across all cost categories but particularly in drug costs. Among the newer therapies, total 3-year cost per treated patient was lowest for glofitamab: $226,658 versus Tisa-cel = $564,113; Axi-cel = $540,002; Liso-cel = $516,272; and Epcor = $335,293. Across all sensitivity analyses, the inclusion of glofitamab had minimal PMPM budget impact, ranging from -$0.0256 to -$0.0108.</p><p><strong>Conclusions: </strong>With the lowest 3-year total cost per treated patient among the newer therapies, glofitamab being an available option in the 3L + DLBCL market is estimated to save a hypothetical 1,000,000-member health plan $728,697 in cumulative total costs and $0.0202 in PMPM costs over 3 years.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1-30"},"PeriodicalIF":2.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753159","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":"Characterizing the clinical and economic burden of COVID-19 among individuals with immunocompromising conditions in Ontario, Canada - a matched, population-based observational study.","authors":"Christina Qian, Karissa M Johnston, Maria Tinajero, M Lauren Voss, Austin Nam, Mackenzie A Hamilton","doi":"10.1080/13696998.2025.2482372","DOIUrl":"https://doi.org/10.1080/13696998.2025.2482372","url":null,"abstract":"<p><strong>Aims: </strong>Despite high vaccination rates, COVID-19 continues to be associated with substantial burden among immunocompromised patients (IC). This study aimed to describe and compare outcomes during and following COVID-19 hospitalizations among immunocompromised IC and non-immunocompromised patients (non-IC).</p><p><strong>Methods: </strong>Patients hospitalized with COVID-19 (01/2020-03/2023) were identified in Ontario health administrative claims databases. All eligible IC (≥1 of solid organ or stem cell transplant; hematological malignancy; rheumatoid arthritis; multiple sclerosis; or primary immunodeficiency) were matched (1:4) to eligible non-IC. Clinical burden, healthcare resource use, and costs were assessed during hospitalization and post-discharge. Multivariate regression models were used to estimate relative risks (RRi), rates (RRa), and corresponding 95% confidence intervals (CIs), adjusting for neighborhood deprivation, long-term care residency, baseline comorbidities, and COVID-19 vaccination status.</p><p><strong>Results: </strong>9,283 IC hospitalized with COVID-19 (mean age 68.7 years; 52.1% female) were matched to 37,127 non-IC. During index hospitalization, IC had greater risks of intensive care unit admission (RRi = 1.06[1.01-1.12]), receipt of ventilation (RRi = 1.27[1.19-1.36]), and all-cause mortality (RRi = 1.34[1.27-1.41]) compared to non-IC. Within 30-days post-discharge, IC had greater rates of all-cause readmission to hospital (RRa = 1.33[1.26-1.40]), admission to emergency departments (RRa = 1.13[1.08-1.18]), home oxygen use (RRi = 1.35[1.15-1.58]), and COVID-19-related rehabilitation (RRa = 1.52[1.22-1.89]), resulting in 21%(16%-25%) and 51%(45%-58%) greater costs in hospital and post-discharge, respectively. All-cause mortality remained approximately 5% higher for IC compared to non-IC at 30- and 60- days post-discharge (p < 0.001). Resource use rates remained elevated among IC with 57%(50%-64%) greater costs within 180 days post-discharge.</p><p><strong>Limitations: </strong>Unmeasured confounding remain; the use of treatments for COVID-19 were not adjusted due to a lack of in-hospital prescription data. Attribution of post-discharge resource use and costs to COVID-19 hospitalizations was subject to greater uncertainty further from the index hospitalization.</p><p><strong>Conclusion: </strong>IC experienced more severe COVID-19 outcomes in hospital and post-discharge compared to non-IC. COVID-mitigating policies and prophylactic treatments are needed to continue to protect immunocompromised populations.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1-21"},"PeriodicalIF":2.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753160","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 invasive pneumococcal disease, all-cause pneumonia, and all-cause otitis media among commercial-insured US children.","authors":"Ahuva Averin, Derek Weycker, Rotem Lapidot, Mark H Rozenbaum, Liping Huang, Jeffrey Vietri, Adriano Arguedas Mohs, Alejandro Cane, Alexander Lonshteyn, Stephen I Pelton","doi":"10.1080/13696998.2025.2484919","DOIUrl":"https://doi.org/10.1080/13696998.2025.2484919","url":null,"abstract":"<p><strong>Background: </strong>Invasive pneumococcal disease (IPD), pneumonia (PNE), and otitis media (OM) are significant causes of morbidity among children in the United States (US). While studies have evaluated the economic burden of these conditions, recent data on episodic costs of IPD, PNE, and OM requiring hospitalization or ambulatory care only among US children by age and comorbidity profile are currently not available. This study was undertaken to address this evidence gap.</p><p><strong>Methods: </strong>A retrospective observational cohort design and data (2015-2019) from Optum's de-identified Clinformatics® Data Mart Database were employed. Episodes of IPD, all-cause PNE, and all-cause OM were ascertained on a monthly basis during the follow-up period and stratified by care setting (hospital vs. ambulatory); all-cause OM was alternatively stratified by disease severity (acute, persistent, tympanostomy tube placement) and, for acute/persistent, by complexity (simple, complex). Mean episodic costs of disease were estimated for children aged <1, 1-<2, 2-<6, and 6-<18 years, respectively, overall and by comorbidity profile (with vs. without ≥1 medical condition).</p><p><strong>Results: </strong>Mean age-specific cost of IPD hospitalization ranged from $40,575-$95,607; IPD requiring care in an emergency department (ED), from $2,013-$5,606; and IPD requiring care in other ambulatory settings, from $619-$1,103. Mean cost of all-cause PNE ranged from $16,631-$21,429 for hospitalized cases; $2,462-$2,685 for ED cases; and $424-$473 for other ambulatory cases. Corresponding ranges for all-cause OM were $14,599-$16,341; $1,190-$2,083; and $253-$514. Children with (vs. without) comorbidities had higher mean costs of PNE episodes across all ages and care settings; mean cost of all-cause OM was largely invariant by comorbidity profile and was highest for episodes involving TTP.</p><p><strong>Conclusions: </strong>Costs of IPD, all-cause PNE, and all-cause OM are high, particularly in the hospital setting. All-cause PNE, one of the most common causes of hospitalization for children, is particularly costly for children with comorbidities.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730414","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":"Patterns of responses in time trade-off studies: A latent class analysis of health states worse than dead.","authors":"Adam B Smith, Stuart Mealing, Andria Joseph","doi":"10.1080/13696998.2025.2485627","DOIUrl":"https://doi.org/10.1080/13696998.2025.2485627","url":null,"abstract":"<p><strong>Aim: </strong>The study was to characterise participant responses in a time trade-off (TTO) task involving states worse than dead (WTD) to determine patterns of congruence and incongruence.</p><p><strong>Methods: </strong>The online TTO task involved 4 hypothetical health states describing a rare paediatric condition. Participants completed the task from a parental perspective with a 10-year time horizon. Mean health utilities were derived for the health states (HS). Congruence patterns were defined <i>a priori</i> as \"perfect\", i.e., completely logical sequence of health state utilities, \"incongruent\", reversal of the most and least severe HS utilities, and \"mixed\" congruence. A multinomial regression and latent class analysis (LCA) were applied to elucidate congruence patterns.</p><p><strong>Results: </strong>A total of 322 participants completed the TTO (49% females; average age 43 years). Perfect congruent response patterns were observed in only 11.5% (37) participants; 99 participants (30.8%) had incongruent response patterns and 186 (57.8%) a mixture. Two (most severe) HS were rated WTD by the \"mixed\", but not the \"perfect\" congruence group, who rated all HS better than dead. The multinomial regression identified age and gender as potential factors influencing congruence patterns; the most impactful factor was the number of stated rated WTD. The LCA was not able to identify a single class of perfectly congruent responders.</p><p><strong>Limitations: </strong>This online TTO did not allow further exploration of individual choices through post-task participant interviews.</p><p><strong>Conclusions: </strong>Facts of TTO tasks such as states WTD may introduce an additional cognitive burden on participants and impact on congruence. However, incongruence was observed even within ostensibly perfectly congruent responses; conversely incongruent response patterns showed some internal coherence. Removing the latter in favour of the former may therefore also introduce bias. A balance may need to be struck between sacrificing perfect congruence and the inclusion of some incongruence to achieve greater representativeness of health state utilities.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1-13"},"PeriodicalIF":2.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719851","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":"https://doi.org/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 via 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 (n = 95) and physicians (n = 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":"1-17"},"PeriodicalIF":2.9,"publicationDate":"2025-03-24","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}