Journal of Medical Economics最新文献

{"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":"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":"586-595"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","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":"Prevalence, incidence, patient characteristics, and treatment trends of valvular heart disease using the national database of health insurance claims of Japan.","authors":"Ataru Igarashi, Tomomi Takeshima, Shoichi Irie, Kosuke Iwasaki","doi":"10.1080/13696998.2025.2474885","DOIUrl":"10.1080/13696998.2025.2474885","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study is to elucidate the prevalence, incidence, patient characteristics, and recent treatment trends of valvular heart disease (VHD) in Japan using a comprehensive claims database.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using the national database of health insurance claims in Japan (April 2009-June 2021), which contains data from the entire Japanese population, regardless of the type of medical facility. Descriptive analyses were conducted to examine the prevalence, incidence, and patient characteristics of each valve disease in 2020 based on diagnoses, and the treatment trends from 2009 to 2021.</p><p><strong>Results: </strong>We identified 28,366,924 patients with VHD over the entire data period, and 2,473,070 patients in 2020, including 711,876 newly diagnosed. The prevalence and annual incidence in the entire Japanese population were 1.96% (1.88% in men and 2.04% in women) and 0.56% (0.53 and 0.60%), respectively, and increased with age in adults. Among the 8 types of VHD in combination with a disordered valve (aortic, mitral, tricuspid, or pulmonic) and type of valve disease (stenosis or regurgitation), mitral regurgitation had the highest prevalence followed by aortic regurgitation and tricuspid regurgitation. Heart failure was diagnosed in ≥50% of patients with aortic, mitral, or tricuspid disease, with the highest rate in mitral stenosis. The number of open-heart surgeries remained constant, while the number of transcatheter surgeries increased over time, particularly between 2016 and 2021. Aortic stenosis prevalence in transcatheter surgeries rose to ≥60% in 2014 and ≥80% in 2016.</p><p><strong>Limitations: </strong>Diagnoses of VHD and comorbidity were based on claims data, so diagnostic criteria and disease severity are unknown, and misclassification of VHD types might have occurred. Incidence rates were based on the initial VHD diagnosis only, excluding any subsequent diagnoses of different VHD type. Conclusions: We presented basic information, which may provide an understanding of the clinical status of VHD in Japan.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"405-412"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness and public health impact of using high dose influenza vaccine in the Japanese older adults.","authors":"Caroline de Courville, Chiho Tadera, Takeshi Arashiro, Florence Bianic, Mafalda Costa, Mohit Joshi, Xinyu Wang","doi":"10.1080/13696998.2025.2488151","DOIUrl":"10.1080/13696998.2025.2488151","url":null,"abstract":"<p><strong>Background: </strong>High-dose (HD) influenza vaccine, which has demonstrated superior efficacy and acceptable safety compared to standard-dose (SD), has market authorization in many countries. This study evaluated the public-health impact and cost-effectiveness of HD versus SD in Japanese older-adults (OAs) from healthcare payer-perspective.</p><p><strong>Methods: </strong>Decision-tree model was employed assessing health outcomes for each vaccination strategy, simulating influenza cases, outpatient/emergency department (ED) visits, hospitalizations, and mortality, over one-year time-horizon. Incremental cost-effectiveness ratios (ICER) were assessed at Japanese willingness-to-pay (WTP) threshold. Base-case analysis considered influenza vaccines effective against influenza hospitalizations only, whereas complementary analyses reflected their efficacies against Pneumonia and Influenza (P&I), respiratory and cardiorespiratory hospitalizations possibly related to influenza among individuals ≥65 years. Scenario analysis extended target population to at-risk individuals aged 60-64 years. Uncertainty was assessed using sensitivity analyses.</p><p><strong>Results: </strong>In base-case, switching from SD to HD prevented 174,863 influenza cases, 121,084 outpatient and 614 ED visits, annually. Further, 5,777 influenza hospitalizations, and 2,406 deaths related to influenza were avoided with HD vaccine. The HD vaccine was found to be a cost-effective strategy at WTP threshold of ¥5,000,000/Quality-Adjusted-Life-Years (QALY) with ICER of ¥4,876,512/(QALY). Sensitivity analyses confirmed the robustness of these findings. Complementary analyses showed notably improved outcomes, in terms of public-health, economic impact, and ICERs, when considering efficacy of influenza vaccines against P&I, respiratory, and cardiorespiratory hospitalizations possibly related to influenza.</p><p><strong>Conclusion: </strong>These results indicate that HD vaccine has a high economic value in Japan compared to SD. Implementing HD vaccine could effectively alleviate the burden on healthcare facilities for Japanese OAs.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"544-555"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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":"Economic burden of growth hormone deficiency among adults who are at risk for and who have confirmed growth hormone deficiency using US real-world data.","authors":"Andrew R Hoffman, Subhara Raveendran, Janna Manjelievskaia, Allison S Komirenko, Isabelle Winer, Jennifer Cheng, Jessamine P Winer-Jones, Machaon Bonafede, Paul Miner, Alden R Smith","doi":"10.1080/13696998.2025.2548741","DOIUrl":"10.1080/13696998.2025.2548741","url":null,"abstract":"<p><strong>Background: </strong>Underdiagnosis and the absence of a condition-specific diagnostic code have made the economic burden of adult growth hormone deficiency (AGHD) difficult to capture. This study measured all-cause and disease-specific healthcare utilization and costs of AGHD among individuals stratified by diagnosis status and receipt of growth hormone (GH) treatment.</p><p><strong>Methods: </strong>Adults meeting ≥1 of the following criteria (1/1/2017-12/31/2021): diagnosis of hypopituitarism or related condition, ≥3 pituitary hormone deficiencies, ≥3 pituitary hormone treatments, or ≥1 GH prescription were identified in the Veradigm Network EHR linked to claims. Individuals were stratified by GH level on or before the earliest qualifying event: confirmed (GH < 3 ng/mL), at-risk (no test result), ruled-out (GH ≥ 3 ng/mL). Confirmed and at-risk individuals were segmented by GH treatment. An age and gender-matched control cohort without AGHD was identified. Healthcare utilization and costs were measured in the 12-month post-index period. Multivariable modeling compared all-cause and AGHD-related healthcare costs, excluding cost of GH, among diagnosis- or treatment status-stratified cohorts while adjusting for baseline characteristics.</p><p><strong>Results: </strong>Among 54,310 individuals at risk for AGHD and 268 with confirmed AGHD, 3.1% and 9.7% received GH treatment, respectively. Study subjects were, on average, 50 years old and majority female. Adjusted all-cause healthcare costs were higher among at-risk individuals (cost ratio [95% confidence interval]: 2.37 [2.26-2.49]) and among confirmed individuals (2.11 [1.52-3.43]) compared to controls. Adjusted annual AGHD-related costs were lower among confirmed individuals compared to at-risk individuals (0.62 [0.52-0.76]) and among treated individuals compared to untreated individuals (0.55 [0.47-0.64]) for those initiating GH therapy.</p><p><strong>Conclusions: </strong>All-cause healthcare costs were higher among individuals with confirmed AGHD or at risk for AGHD than among adults without GHD. After excluding the cost of GH therapy, lower adjusted AGHD-related costs were associated with both a confirmed AGHD diagnosis and receipt of GH treatment.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1322-1333"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873580","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":"Safety and efficacy of an intrinsic antitachycardia pacing algorithm in patients from Japan and South Korea: results from a cardiac device registry in the Asia Pacific region.","authors":"Masahiko Goya, Seung-Jung Park, Kenji Ando, Reece Holbrook, Rowan Iskandar, Luke Jacobsen, Joseph D Mozingo, Boyoung Joung","doi":"10.1080/13696998.2025.2543213","DOIUrl":"10.1080/13696998.2025.2543213","url":null,"abstract":"<p><strong>Background: </strong>Antitachycardia pacing (ATP) therapy, available in modern implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRT-D), aims to terminate ventricular arrhythmias without administering high energy shocks. The intrinsic ATP (iATP) algorithm automates ATP programming in real-time, tailoring therapy based on previous ATP attempts. This study evaluated the safety, efficacy, and clinical outcomes of iATP in patients from Japan and South Korea.</p><p><strong>Methods: </strong>This study was a prospective, observational, multi-site registry that enrolled patients from Japan and South Korea implanted with an ICD or CRT-D device with the iATP algorithm. Patients were followed for a minimum of 12 months. Outcomes included ATP termination success, appropriate shocks, acceleration, arrhythmia-related syncope, and mortality. A post hoc unanchored matching-adjusted indirect comparison (uMAIC) was performed to compare iATP with standard ATP using published literature.</p><p><strong>Results: </strong>A total of 800 patients were enrolled. The iATP success rate for terminating all episodes was 89.2% (86.2% Generalized Estimating Equation [GEE] estimated) and 82.2% for episodes in the fast VT zone (80.9% GEE estimated). Acceleration occurred in 2.0% of episodes, and arrhythmia-related syncope was observed in 0.5% of patients. The 1-year survival rate was 96.1%, with no device-related deaths or abnormal battery depletions. The uMAIC showed iATP had higher termination efficacy across all episodes (88.1% vs. 79.3%, <i>p</i> < 0.001), a lower probability of appropriate shocks per episode (iATP 14.7% and ATP 31.3%, <i>p</i> < 0.001), and fewer accelerations per episode (2.1% vs. 4.8%, <i>p</i> = 0.02), with similar probability of arrhythmia-related syncope per patient (0.5% vs 0.9%, <i>p</i> = 0.35) and mortality (12-month Kaplan Meyer survival estimate iATP 95.4%, ATP 95.3%, <i>p</i> = 0.43).</p><p><strong>Conclusions: </strong>iATP exhibited a high ventricular arrhythmia termination efficacy and a favorable safety profile. Comparison of iATP to standard ATP provides initial evidence of higher termination success, lower incidence of accelerations and appropriate shocks, and similar rates of mortality and arrhythmia-related syncope.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT01524276; Japan Registry of Clinical Trials Identifier: jRCT1042200049.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1307-1318"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784534","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":"Quantifying all-cause healthcare resource utilization and costs of children with mild-to-moderate long COVID in France.","authors":"Jingyan Yang, Cheikh Tamberou, Elise Arnee, Pierre-Alexandre Squara, Ayoub Boukhlal, Jennifer L Nguyen, Hannah R Volkman, Stephane Fievez, Marina Lepoutre-Bourguet, Haifa Ben Romdhane, Charlotte Renaudat, Pascal Crépey, Olivier Robineau","doi":"10.1080/13696998.2025.2525002","DOIUrl":"10.1080/13696998.2025.2525002","url":null,"abstract":"<p><strong>Background: </strong>Although children are known to be at risk of developing long COVID, its economic burden is poorly described. We aimed to assess the all-cause healthcare resource utilization (HCRU) and associated direct medical costs of children with mild-to-moderate long COVID in France.</p><p><strong>Methods: </strong>This retrospective cohort study utilized The Health Improvement Network (THIN) primary care electronic health records to identify children aged <18 years with confirmed/probable COVID-19 diagnoses during March 2020 to December 2022 who developed long COVID, identified per the World Health Organization as suggestive symptoms present ≥3 months following SARS-CoV-2 infection. Patient characteristics, all-cause HCRU and direct healthcare costs from a national health insurance perspective were summarized. HCRU and costs were stratified into healthcare encounters, medical procedures, retail pharmacy usage, testing, caregiver sick leave, medical transport, and medical device usage.</p><p><strong>Results: </strong>Of 27,537 children diagnosed with acute COVID-19, 3,888 (14.1%) developed long COVID; mean age was 8.9 years, 49.2% were female and, among those with comorbidity, 24.5% had a Charlson Comorbidity Index score ≥1. During a mean post-diagnosis follow-up of 12.6 months, 93.6% of children had general practitioner consultations, 93.5% had pharmacy usage, and 61.0% had medical procedures. First-year costs were highest at €823 per patient per year; 4.3% of children required caregiver-related work absenteeism. Compared to children who did not develop long COVID, a long COVID diagnosis was associated with an incremental cost increase of €98 per patient per year.</p><p><strong>Limitations: </strong>Our findings only represent a national payer perspective. The true societal burden of long COVID in children is likely underestimated since long COVID-related indirect costs are not fully captured and access to care varies.</p><p><strong>Conclusion: </strong>Children living with long COVID managed in the community pose a non-neglectable burden on French health insurance, reinforcing the importance of managing long COVID with a multidisciplinary approach and optimizing resource allocation.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1002-1013"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505985","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}