Journal of Medical Economics最新文献

{"title":"The benefits of telehealth in promoting equity in blood cancer care - results of a multi-stakeholder forum and systematic literature review.","authors":"Joseph Mikhael, Deanna Darlington, Bethany Howell, Jay Hydren, Tricia Hernandez, Sally Werner, Tracey Iraca, Mary Arnett, Victor Gonzalez, Susan Peschin, Alan J Balch, Diane Moran, Roslyn Young-Daniels, Olamide Banjo, George Dennis Obeng, Benjamin Asiedu-Ayeh, Sampson Kawuo, Asmau Mohammed Tukur, Inusah Mohammed, Akosua Pokuaah Obeng, Marcell Csanádi, Thomas Lew, Mimi Choon-Quinones","doi":"10.1080/13696998.2024.2438561","DOIUrl":"10.1080/13696998.2024.2438561","url":null,"abstract":"<p><strong>Aims: </strong>Therapeutic advancements have significantly improved patient outcomes in blood cancers. However, racial and ethnic disparities persist in treatment and access to care. Telehealth offers a promising solution to these disparities by using electronic and telecommunication technologies to deliver healthcare remotely. Ensuring access to telehealth depends not just on the technologies, but on the broader enabling environment, especially policy harmonization, communications infrastructure, and skills. This paper aims to advocate for the expanded use of telehealth in blood cancer management, highlighting its potential to improve equity and outcomes.</p><p><strong>Materials and methods: </strong>An expert forum discussion results informed this systematic literature review which was performed to better understand the applied Telehealth solutions and the expected benefits. The forum discussion and the literature review findings were aggregated and reviewed by experts and patient advocates with personal experience in blood cancer.</p><p><strong>Results: </strong>Our review of the literature yielded 18 relevant papers. Studies included patients from various disease areas; some studies used broader definitions of cancer to include more patients (i.e. acute leukemias and malignant lymphomas), while others were more specific to a particular condition. The identified Telehealth solutions were classified into two groups: solutions focusing on electronic consultation (<i>n</i> = 10) and solutions focusing on a specific intervention to improve patients' health status (<i>n</i> = 8). A larger variety of outcomes were found in these studies, including quality of life, patient and clinicians' acceptance, adherence, costs, and resource use.</p><p><strong>Conclusions: </strong>Initial findings demonstrate that telehealth can potentially improve patient outcomes for people living with blood cancer, including improved patient quality of life, increased clinician acceptance, better adherence, and reduced costs and resource use to the health system. While evidence for virtual consultations show promising results, further research is needed due to the variety of study settings evaluated in this review. Providers and health systems need additional data on the positive economic impact of Telehealth related to the diagnostic journey and access to treatment.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"788-802"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of artificial intelligence (AI) in earlier detection of liver lesions in cirrhotic patients at risk of hepatocellular carcinoma in Italy.","authors":"L Maas, C Contreras-Meca, S Ghezzo, F Belmans, A Corsi, J Cant, W Vos, M Bobowicz, M Rygusik, D K Laski, L Annemans, M Hiligsmann","doi":"10.1080/13696998.2025.2525006","DOIUrl":"10.1080/13696998.2025.2525006","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer-related death. Cirrhosis is a major contributing factor, accounting for over 90% of HCC cases. With the high mortality rate of HCC, earlier detection of HCC is critical. When added to magnetic resonance imaging (MRI), artificial intelligence (AI) has been shown to improve HCC detection. Nonetheless, to date no cost-effectiveness analyses have been conducted on an AI tool to enhance earlier HCC detection. This study reports on the cost-effectiveness of detection of liver lesions with AI improved MRI in the surveillance for HCC in patients with a cirrhotic liver compared to usual care (UC).</p><p><strong>Methods: </strong>The model structure included a decision tree followed by a state-transition Markov model from an Italian healthcare perspective. Lifetime costs and quality-adjusted life years (QALY) were simulated in cirrhotic patients at risk of HCC. One-way sensitivity analyses and two-way sensitivity analyses were performed. Results were presented as incremental cost-effectiveness ratios (ICER).</p><p><strong>Results: </strong>For patients receiving UC, the average lifetime costs per 1,000 patients were €16,604,800 compared to €16,610,250 for patients receiving the AI approach. With a QALY gained of 0.55 and incremental costs of €5,000 for every 1,000 patients, the ICER was €9,888 per QALY gained, indicating cost-effectiveness with the willingness-to-pay threshold of €33,000/QALY gained. Main drivers of cost-effectiveness included the cost and performance (sensitivity and specificity) of the AI tool.</p><p><strong>Discussion: </strong>This study suggests that an AI-based approach to detect HCC earlier in cirrhotic patients can be cost-effective. By incorporating cost-effective AI-based approaches in clinical practice, patient outcomes and healthcare efficiency are improved.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1023-1036"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost per responder for teclistamab and elranatamab in relapsed or refractory multiple myeloma in the United States.","authors":"Lucio N Gordan, Arielle G Bensimon, Fan Mu, Nina Kim, Bingcao Wu, Dee Lin, Agne Paner, Jessica Fowler, Alex Marshall, Suzy Van Sanden, Eric Ammann, Joe Goble, Xinke Zhang, Hoa H Le, Elissa E Min, Louis P Garrison","doi":"10.1080/13696998.2025.2514909","DOIUrl":"10.1080/13696998.2025.2514909","url":null,"abstract":"<p><strong>Aims: </strong>Teclistamab and elranatamab are bispecific antibodies recently approved for the treatment of triple class-exposed relapsed/refractory multiple myeloma (RRMM). This study assessed the relative efficacy and economic value of teclistamab and elranatamab through a matching-adjusted indirect comparison (MAIC) and cost per responder analysis using data from the MajesTEC-1 (NCT03145181/NCT04557098) and MagnetisMM-3 (NCT04649359) trials.</p><p><strong>Materials and methods: </strong>The MAIC compared overall response rate (ORR) between the therapies after weighting individual patient data from MajesTEC-1 to match key baseline characteristics in MagnetisMM-3. Matched covariates included age, refractory status, prior lines of therapy, extramedullary disease, performance status, disease stage, and cytogenetic risk profile. Cost per responder was calculated based on estimated per-patient drug acquisition and administration cost (2024 United States dollars) over 6 months divided by ORR. One-way and probabilistic sensitivity analyses were conducted to characterize uncertainty.</p><p><strong>Results: </strong>The ORRs were 63.0% for teclistamab before matching (<i>N</i> = 165), 61.4% for teclistamab after matching (effective sample size = 92), and 61.0% for elranatamab (<i>N</i> = 123) (odds ratio after matching: 1.02; 95% confidence interval [CI]: 0.59, 1.77). Per-patient costs were estimated to be $231,435 for teclistamab and $285,201 for elranatamab (difference: -$53,766; 95% confidence interval [CI]: -$59,094, -$48,311), yielding costs per responder of $376,930 and $467,730, respectively (difference: --$90,800; 95% CI: -$183,680, $8,148).</p><p><strong>Limitations: </strong>Because MajesTEC-1 and MagnetisMM-3 are single-arm trials, the MAIC was unanchored and therefore susceptible to confounding from any unadjusted effect modifiers or prognostic variables.</p><p><strong>Conclusions: </strong>Teclistamab was associated with significantly lower treatment costs and numerically lower cost per responder than elranatamab in triple class-exposed RRMM.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"910-920"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of pembrolizumab as an adjuvant treatment of early-stage non-small cell lung cancer following complete resection and platinum-based chemotherapy in Canada.","authors":"Sylvi Nguyen, Elizabeth Wehler, Chloe Langevin, Arielle Bensimon, Natasha B Leighl, Sreetama Sarkar, Xiaohan Hu, Ruifeng Xu, Brian Matthew Lang, Diksha Vohra, Ashwini Arunachalam, Ralph P Insinga","doi":"10.1080/13696998.2025.2530862","DOIUrl":"10.1080/13696998.2025.2530862","url":null,"abstract":"<p><strong>Aim: </strong>To assess the cost-effectiveness of adjuvant pembrolizumab (Keytruda) versus routine observation of adult patients with stage IB (T2a ≥ 4 cm) -IIIA with programmed cell death ligand 1 (PD-L1) tumor proportion score (TPS) <50% who have undergone complete resection and platinum-based chemotherapy from the Canadian public healthcare payer perspective.</p><p><strong>Materials and methods: </strong>A Markov model was constructed to capture clinical and economic outcomes across four health states: disease-free (DF), local-regional recurrence (LR), distant metastases (DM), and death. Transition probabilities (TPs) from the DF state were populated using clinical trial data from KEYNOTE-091. TPs from the LR state were from real-world evidence (RWE). Clinical trial and network meta-analysis output populated transitions from DM. TPs from LR and DM were calibrated to fit the KEYNOTE-091 survival data. Costs were reported in 2023 Canadian dollars and utilities were based on data from KEYNOTE-091 and metastatic NSCLC clinical trials.</p><p><strong>Results: </strong>Pembrolizumab extended life years (LYs) (1.55) and quality-adjusted life years (QALYs) (1.19). Costs increased by $84,050, resulting in an incremental cost-effectiveness ratio (ICER) per additional LY of $54,219 and per additional QALY of $70,725, below the willingness-to-pay threshold of $100,000. Survival gains associated with pembrolizumab were attributed to more time spent in the DF health state. Higher costs for pembrolizumab were due to adjuvant treatment costs but were partially offset by lower subsequent treatment costs in downstream health states, reflecting a lower risk of recurrence associated with pembrolizumab. The model results remained robust across scenario and sensitivity analyses.</p><p><strong>Limitations: </strong>Due to lack of transition probabilities starting from the LR and DM states from the KEYNOTE-091 trial, TPs from the LR and DM states were estimated using non-trial sources.</p><p><strong>Conclusions: </strong>Adjuvant pembrolizumab was found to be cost-effective compared to routine observation from the public healthcare payer perspective in Canada.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1110-1131"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide extrapolation of economic benefit of therapeutic innovation: a 10-year retrospective budget impact of direct oral anticoagulants introduction in France.","authors":"C Guilmet, H Lesage, F E Cotté, R Moreau, C Marant Micallef, M Née, D Guitard-Dehoux, M Belhassen, N Danchin","doi":"10.1080/13696998.2025.2514381","DOIUrl":"10.1080/13696998.2025.2514381","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with atrial fibrillation (AF) face increased risks of strokes and systemic thromboembolism (SE), traditionally managed with vitamin K antagonists (VKAs), which are associated with major bleeding (MB) risks. The nationwide real-life data-based NAXOS study, comparing Direct Oral Anticoagulants (DOACs: apixaban, dabigatran, rivaroxaban) to VKAs in over 400,000 AF patients in France, showed that DOACs are more effective, safer, and associated with lower total costs. This study evaluates the 10-year budget impact of DOACs in France, focusing on reductions in strokes/SE, MB, and monitoring costs (INRt).</p><p><strong>Methods: </strong>A retrospective budget impact model from 2014 to 2023 compared scenarios with and without DOACs, using clinical and cost data from the NAXOS study. The target population of DOAC-eligible patients ranged from 725,000 in 2014 to 1.4 million in 2023. Market shares trends were derived from the public national drugs database, indicating that VKAs' use decreased from 67% to 11%, while DOACs, especially apixaban, rose sharply (2% to 55%) over the same period. Costs included treatment acquisition, strokes/SE, MB, and international normalized ratio testing (INRt) for VKAs.</p><p><strong>Results: </strong>Over a 10-year horizon, the introduction of DOACs is estimated to have prevented 73,009 strokes, 97,234 major bleeding, and 19,567 stroke-related deaths among patients with NVAF. DOAC introduction increased treatment costs by €5.15 billion over 10 years, and reduced costs for strokes/SE (-€4.24 billion), MB (-€3.22 billion), and INRt (-€1.14 billion), leading to €3.45 billion of savings for National Insurance over 10 years, with apixaban contributing 55% of savings.</p><p><strong>Limitations: </strong>This analysis may not account for all contextual variables, such as indirect costs related to productivity losses.</p><p><strong>Conclusion: </strong>Over 10 years, the introduction of DOACs in France has generated substantial savings in AF-related costs, highlighting their clinical and economic benefits and the importance for authorities to valorise the external effects of therapeutic innovations.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"28 1","pages":"859-870"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic impact of a digital tobacco cessation program: healthcare savings and productivity gains in a self-insured manufacturing company.","authors":"Matthew Brault, David B Rein, Amanda L Graham","doi":"10.1080/13696998.2025.2529721","DOIUrl":"10.1080/13696998.2025.2529721","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the return on investment of a digital tobacco cessation program from an employer perspective by analyzing healthcare cost savings and productivity gains in a real-world workplace setting.</p><p><strong>Methods: </strong>This quasi-experimental study analyzed medical claims data from a self-insured US manufacturing company, comparing healthcare costs between program enrollees (<i>n</i> = 153) and matched non-enrollees (<i>n</i> = 3,943) over a 12-month post-enrollment period. Exact and propensity score matching were used to address selection bias, followed by difference-in-differences analysis to control for temporal trends. The study population included employees and spouses continuously enrolled in the company health plan from November 2019 through December 2023. Administrative claims data captured all healthcare services, while productivity benefits were estimated through simulation modeling using published parameters and conservative assumptions for absenteeism reduction and presenteeism improvements. The analysis adopted an employer perspective with a 1-year time horizon, incorporating both direct medical cost savings and indirect productivity gains.</p><p><strong>Results: </strong>Program enrollees demonstrated $950 lower annual healthcare costs compared to matched non-enrollees within the first year of enrollment (95% CI = -$2,022-$122; <i>p</i> = 0.083 using difference-in-differences analysis). Productivity gains contributed an additional $960 per enrollee (95% CI = $446-$1,614), resulting from reduced absenteeism and improved workplace performance. Combined healthcare and productivity savings totaled $1,910 per participant (95% CI = $694-$3,158). At a program cost of $200 per participant, this yielded a return on investment of $9.55 for every dollar invested (95% CI = $3.47-$15.79). Sensitivity analyses confirmed robust positive returns across varying assumptions about abstinence rates and productivity parameters.</p><p><strong>Conclusions: </strong>Using rigorous econometric methods to minimize confounding bias, this analysis demonstrates substantial employer cost savings from implementing a digital tobacco cessation program. The nearly 10-fold return on investment, driven by both healthcare savings and productivity improvements, provides compelling economic evidence for employers evaluating digital health solutions in workplace wellness programs.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1061-1074"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unpacking the post-COVID association between unexpected births and excess deaths.","authors":"Les Coleman","doi":"10.1080/13696998.2025.2500825","DOIUrl":"10.1080/13696998.2025.2500825","url":null,"abstract":"<p><strong>Objective: </strong>Global fertility has halved since its 1960s peak to be little above the replacement rate, and lower in many developed countries. In addition it has been suggested that excess deaths since the onset of the COVID pandemic may have influenced fertility. Given the economic and social interest in declining fertility, this study seeks an explanation.</p><p><strong>Methods: </strong>We developed a sample for 18 mid-large industrialized countries of 30 variables covering vital statistics and health, social and economic data, and determined excess deaths during 2020-2022 and unexpected births during 2022-2024. Analysis estimated the link between COVID excess deaths and subsequent unexpected births; and estimated links between excess deaths and unexpected births and national parameters.</p><p><strong>Results: </strong>Countries' average birth rate during 2022-2023 was 5-6% below that expected from their trend and mean prior to the spread of COVID-19 in 2020. Birth rates were higher than expected after 2022 in countries which had high excess deaths during 2020-2022. Regression against national parameters traced reductions in post-COVID births to countries' strong economic measures (low unemployment, high GDP per capita), indicators of women's high economic capacity (years at school, female workforce participation), and weak religiosity. Similar analysis identified higher excess deaths in less wealthy countries, and those with weaker social measures and women's opportunities, and poor pre-existing health outcomes (high infant mortality, low life expectancy, fewer physicians).</p><p><strong>Conclusion: </strong>The association between unexpected births and excess deaths this decade is largely spurious because lower wealth and poor previous health outcomes drove excess deaths, while the opportunity cost of childbearing has accelerated declining births in wealthier countries post-COVID. Better understanding population effects of the pandemic is of broad social and economic interest given declining fertility rates; and change in trajectory of births could prove the pandemic's most serious socio-economic consequences.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"726-733"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-of-illness analysis of chronic kidney disease (CKD) management in the Philippines.","authors":"Anthony Russell Villanueva, Donnah de Leon, Patrick James Encarnacion, Elaine Cunanan, Amor Patrice Estabillo, Christianne Jade Gonzales, Miharu Jay Kimwell, Marizel Mallari-Catungal, Mary Joy Taneo, Dianne Danielle Tan-Lim, Richard Henry Perlas Tiongco, Jennifer Ivy Togonon-Leaño, Maria Rhodora De Lara-Valenzona, Danny Yu, Arlene Cabotaje Crisostomo, Precious Juzenda Montilla","doi":"10.1080/13696998.2025.2481766","DOIUrl":"10.1080/13696998.2025.2481766","url":null,"abstract":"<p><strong>Aims: </strong>To conduct the first comprehensive cost-of-illness analysis for chronic kidney disease (CKD) management in the Philippines, estimating direct medical, direct non-medical, and indirect costs across all disease stages and renal replacement therapies (RRT).</p><p><strong>Methods: </strong>A combined top-down and bottom-up quantitative approach was employed. Cost data were collected through facility surveys, literature reviews, and expert panel input. The analysis included cost estimated for both non-diabetic and diabetic CKD scenarios across all stages and RRT modalities. Direct medical costs, transportation costs, and productivity losses were calculated for each CKD stage and RRT option.</p><p><strong>Results: </strong>Annual costs for CKD management increased progressively with disease advancement, ranging from PHP 44,610.36 to PHP 116,590.24 for non-diabetic patients and PHP 46,451.88 to PHP 120,948.12 for diabetic patients, excluding complication-related expenses. Significant cost increases were observed between stages G2-G3a and G3b-G4. Analysis of RRT showed comparable annual direct medical costs across modalities (∼PHP 401,000-560,000), with differences primarily observed in annual direct non-medical and indirect costs, which were lower in transplant recipients compared to patients on maintenance dialysis (PHP 37,920-246,480 for dialysis; PHP 3,160 for KT recipients).</p><p><strong>Limitations: </strong>The study primarily focused on urban and semi-urban healthcare facilities, potentially limiting generalizability to rural areas. Long-term cost trajectories and quality-of-life measures were not captured due to the cross-sectional nature of the data.</p><p><strong>Conclusions: </strong>This analysis provides crucial evidence supporting early detection and intervention strategies in CKD management. It suggests the promotion of peritoneal dialysis as a cost-effective first-line therapy and highlights the long-term economic benefits of kidney transplantation. The findings have significant implications for health policy and clinical practice in the Philippines, offering a foundation for evidence-informed decision-making to improve CKD management sustainability and patient outcomes.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"494-507"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and physician preferences for treatment of hepatitis C virus infection in Japan: a discrete choice experiment.","authors":"Daisuke Nakamoto, Yi Piao, Hajime Mizutani, Michael LoPresti, Yunosuke Chikamura, Dilip Makhija, Kyung Min Kwon, Jamie Zagorski, Masahisa Jinushi, Yuichiro Eguchi","doi":"10.1080/13696998.2025.2483572","DOIUrl":"10.1080/13696998.2025.2483572","url":null,"abstract":"<p><strong>Aims: </strong>This study was performed to evaluate patients' and physicians' preferences regarding hepatitis C virus (HCV) treatment in Japan, particularly focusing on direct-acting antivirals. Understanding these preferences is important for maintaining adherence to treatment necessary for achieving HCV elimination.</p><p><strong>Methods: </strong>A discrete choice experiment was conducted to identify patients' and physicians' preferences for HCV treatment in Japan. Eligible participants completed a preference survey <i>via</i> an online questionnaire. Eight attributes and their respective levels - pertaining to dosing regimen/schedule, safety, and out-of-pocket costs - were identified. The primary and secondary endpoints were the relative attribute importance (RAI) and utility value of attribute levels, which were compared between patients and physicians to highlight differences.</p><p><strong>Results: </strong>Both patients (<i>n</i> = 95) and physicians (<i>n</i> = 118) showed the greatest concern for total out-of-pocket treatment costs, followed by safety risks. While patients and physicians generally shared similar treatment preferences, patients placed a higher RAI on total out-of-pocket costs than did physicians (50.4% vs. 39.4%). Conversely, patients assigned lower RAI values to the risks of nasopharyngitis and pruritus (15.2% vs. 17.9% and 11.7% vs. 16.2%, respectively). The RAI for the number of tablets taken daily was higher than that for treatment duration among patients (11.6% vs. 0.2%), but nearly equal among physicians.</p><p><strong>Limitations: </strong>The study had potential non-response bias, physicians not being actual care providers for surveyed patients, a small sample size, reliance on predefined DCE attributes, and limited participant diversity from online panels.</p><p><strong>Conclusions: </strong>This study highlights the importance of patient-centered care in HCV treatment and the need to raise awareness of the public subsidy for hepatitis, and to ensure an effective access scheme for the patients. Simplifying regimens like once-daily pills and minimal monitoring may enhance treatment convenience. Improved patient-physician communication supports optimized strategies, aiding Japan's goal of HCV elimination by 2030.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"524-534"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of drug utilization management strategies on the incidence and cost of clinical events in patients with non-valvular atrial fibrillation receiving DOACs in the US.","authors":"Rupesh Subash, Elisabeth Vodicka, Serina Deeba, Chloe Salter, Carissa Dickerson, Ewa Stawowczyk","doi":"10.1080/13696998.2025.2558449","DOIUrl":"10.1080/13696998.2025.2558449","url":null,"abstract":"<p><strong>Aims: </strong>Medicare plans employ drug utilization management strategies, including prior authorization (PA) and step therapy (ST), or formulary tier increases, to control spending. However, PA and ST can delay treatment access and encourage use of less effective/safe therapies, while formulary tier increases can lead to treatment switching/discontinuation due to higher patient out-of-pocket costs. This study modeled the impact of restricted access to direct oral anticoagulants (DOACs), and a tier increase for apixaban, on incidence and cost of clinical events in patients with non-valvular atrial fibrillation (NVAF) in the US.</p><p><strong>Materials and methods: </strong>Decision models were developed using hypothetical cohorts of 1,000,000 Medicare Fee-For-Service plan members to evaluate incidence and cost of clinical events of two utilization management strategies over one-year. Model 1 compared restricted access (PA or ST required) versus unrestricted access to DOACs; model 2 compared a formulary tier increase for apixaban (patients assumed to continue apixaban, switch (to any DOAC (primary analysis) or rivaroxaban (secondary analysis)), or discontinue at rates of 57.5%, 12.4%, and 30.1%, respectively) versus no tier increase (patients assumed to continue apixaban). Epidemiology, clinical, and cost inputs were sourced from literature and online databases and costs inflated to 2024 US dollars.</p><p><strong>Results: </strong>In the \"restricted access\" cohort (model 1; <i>n</i> = 67,984) patients experienced an additional 57 strokes, 61 major bleeds (MBs), 43 transient ischemic attacks, and 452 all-cause deaths versus the \"unrestricted access\" cohort, accruing additional annual costs of $8,008,860. A tier increase for apixaban (model 2; <i>n</i> = 47,036) resulted in an additional 330 (secondary analysis: 257) stroke/systemic embolisms, 58 (20) MBs and 32 (25) deaths versus the \"no tier increase\" cohort, costing an additional $6,542,373 ($4,656,305) annually.</p><p><strong>Conclusions: </strong>For patients with NVAF, PA/ST restrictions for DOACs and a formulary tier increase for apixaban resulted in additional clinical events and higher clinical event-related costs for US Medicare payers.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1602-1615"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006215","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}