Journal of Medical Economics最新文献

{"title":"Cost-effectiveness of semaglutide in people with obesity and cardiovascular disease without diabetes.","authors":"Phil McEwan, Martin Bøg, Mads Faurby, Volker Foos, Ildiko Lingvay, Christopher Lübker, Ryan Miller, Joshua C Toliver, Florian Yeates, A Michael Lincoff","doi":"10.1080/13696998.2025.2459529","DOIUrl":"10.1080/13696998.2025.2459529","url":null,"abstract":"<p><strong>Aims: </strong>The cardioprotective effects of semaglutide 2.4 mg reported in the SELECT cardiovascular (CV) outcomes trial (ClinicalTrials.gov NCT03574597) provide clinical benefit for subjects with overweight or obesity and established CV disease without type 2 diabetes (T2D). We assessed cost-effectiveness of semaglutide 2.4 mg in this population against the American College of Cardiology/American Heart Association value framework.</p><p><strong>Materials and methods: </strong>A cohort-level Markov-state cost-effectiveness model using trial-derived data with outcomes from a healthcare sector perspective measured over a lifetime horizon was developed. Treatment costs were based on US list prices; scenario analyses used literature-reported estimated rebates. Healthcare costs and benefits were discounted at 3.0%. A simulated cohort of 100,000 subjects was aligned to the SELECT trial population baseline characteristics and time-on-treatment. Subjects received either semaglutide 2.4 mg or placebo in addition to standard of care (SoC). Modelled outcomes included clinical events (CV events, progression to T2D, chronic kidney disease [CKD]) and health economic measures, including direct costs and quality-adjusted life years (QALYs).</p><p><strong>Results: </strong>Mean semaglutide 2.4 mg treatment duration was 2.79 years. Per 100,000 subjects, treatment avoided 2,791 non-fatal myocardial infarctions, 3,000 coronary revascularizations, 487 non-fatal strokes, and 115 CV deaths over the modeled lifetime horizon. Average per-subject lifetime treatment costs were $47,353; savings arose from avoided T2D ($14,431), CKD ($2,074), and CV events ($1,512). Semaglutide 2.4 mg was associated with increased lifetime costs ($29,767), additional QALYs gained (0.218) and an incremental cost-effectiveness ratio of $136,271/QALY at list price; a scenario using an empirically estimated 48% rebate predicted $32,219/QALY.</p><p><strong>Limitations: </strong>The generalizability of observations from SELECT to a broader US population is unknown. Our model does not capture all outcomes nor costs that may be affected by weight loss. Modeling assumptions may present limitations.</p><p><strong>Conclusions: </strong>Semaglutide 2.4 mg use as in SELECT is cost-effective at list price, using a $150,000/QALY willingness-to-pay threshold.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"268-278"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066159","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":"Validation of the IHE type 2 diabetes cohort model in the Japanese clinical setting.","authors":"Kristoffer Nilsson, Adam Fridhammar, Riku Ota, Morten Sall Jensen, Michael Willis, Sofie Persson","doi":"10.1080/13696998.2025.2517506","DOIUrl":"10.1080/13696998.2025.2517506","url":null,"abstract":"<p><strong>Aims: </strong>Economic simulation models, such as the IHE Type 2 Diabetes Cohort Model (IHE-DCM-T2), are used widely to inform resource allocation for Type 2 Diabetes (T2D) treatments. Recently, IHE-DCM-T2 was augmented with Japanese-specific risk equations to align with the Japanese healthcare context. This study extends prior model validation of IHE-DCM-T2 to cover the Japanese risk equations for applications in Japan's clinical setting and healthcare system.</p><p><strong>Materials and methods: </strong>Face validity was assessed through expert review of model assumptions and structure. Model programming was verified by code review and 728 stress tests. Predictive accuracy was tested by comparing model predictions to real-world outcomes from 28 Japanese studies, assessing concordance visually, with regression lines, and with mean absolute percentage error (MAPE), root mean square percentage error (RMSPE), mean squared logarithmic error (MSLE), and mean squared log-accuracy ratio (MSLAR). Subgroup analyses examined dependent and independent endpoints, along with mortality, microvascular, and macrovascular outcomes. Sensitivity analyses assessed robustness to variations in scale and sample size.</p><p><strong>Results: </strong>IHE-DCM-T2 demonstrated face validity and correct implementation. External validation against 120 endpoints showed good alignment between predicted and observed events, with regression line slope=0.96 and R²=0.98. Overall, prediction errors were: MAPE=0.83, RMSPE=1.21, MSLE=0.61, and MSLAR=0.53. Predictions were more accurate for dependent than independent endpoints. Among endpoint categories, macrovascular events had the lowest average errors, whereas mortality endpoints had the highest MAPE and RMSPE, and microvascular endpoints had highest MSLE and MSLAR. Predictive accuracy was consistent across alternative test specifications.</p><p><strong>Limitations: </strong>Limitations included gaps in validation data, and the requirement for long-term follow-up that inherently reflects past treatment patterns. Only studies with at least 1,000 patients were included, which may introduce selection bias.</p><p><strong>Conclusions: </strong>This comprehensive validation of the IHE-DCM-T2, augmented with Japanese-specific risk equations, demonstrated its suitability for health technology assessments and resource allocation decisions for T2D in the Japanese clinical setting and healthcare system.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"944-963"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275131","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":"Comparing pulsed field ablation and thermal energy catheter ablation for paroxysmal atrial fibrillation: a cost-effectiveness analysis of the ADVENT trial.","authors":"William V Padula, Alexandra Paffrath, Caroline M Jacobsen, Benjamin G Cohen, Rachel Nadboy, Brad S Sutton, Edward P Gerstenfeld, Moussa Mansour, Vivek Y Reddy","doi":"10.1080/13696998.2024.2441071","DOIUrl":"10.1080/13696998.2024.2441071","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) has emerged as an effective technology in the treatment of paroxysmal atrial fibrillation (AF).</p><p><strong>Objective: </strong>To evaluate the cost-effectiveness of PFA vs. thermal ablation from a US healthcare payer perspective using data from a randomized trial.</p><p><strong>Methods: </strong>A hybrid decision tree and Markov model was developed comparing patients receiving PFA to thermal ablation (either radiofrequency or cryoballoon ablation) from a US healthcare payer perspective at 5-, 10-, 20-, and 40-year time horizons. Direct medical costs (in 2024 US Dollars), quality-adjusted life years (QALYs), and the net monetary benefit were evaluated at a willingness-to-pay (WTP) threshold of $100,000/QALY. Univariate and probabilistic sensitivity analyses were performed to test model uncertainty. The budget impact for a standard US healthcare payer with 1 million beneficiaries was also assessed.</p><p><strong>Results: </strong>Over a 40-year time horizon, PFA resulted in an additional 0.044 QALYs at a lower cost of $2,871 compared to thermal ablation. PFA was cost-effective in 54.9% of simulations. Anticoagulation and ablation procedure costs had the largest impact on model uncertainty. The expected cost savings per member per month for a US healthcare payer adopting PFA were $0.00015, $0.0059, and $0.02343 in years 1, 4, and 6, respectively.</p><p><strong>Conclusions: </strong>PFA was at least as cost-effective as conventional thermal ablation modalities for treatment of paroxysmal AF and potentially reduces US healthcare payer costs. Providers and payers should consider designating PFA among the preferred first-line therapies for eligible patients.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"127-135"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854523","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 radiofrequency renal denervation for uncontrolled hypertension in Canada.","authors":"Philip A McFarlane, Mina Madan, Anne M Ryschon, Sheldon Tobe, Ernesto L Schiffrin, Raj S Padwal, Ross Feldman, George Dresser, Lindsay Machan, Hamid Sadri, Khoa N Cao, Jan B Pietzsch","doi":"10.1080/13696998.2024.2441072","DOIUrl":"10.1080/13696998.2024.2441072","url":null,"abstract":"<p><strong>Aims: </strong>Catheter-based radiofrequency renal denervation (RF RDN) is an interventional treatment for uncontrolled hypertension. This analysis explored the therapy's lifetime cost-effectiveness in a Canadian healthcare setting.</p><p><strong>Materials and methods: </strong>A decision-analytic Markov model was used to project health events, costs, and quality-adjusted life years over a lifetime horizon. Seven primary health states were modeled, including hypertension alone, stroke, myocardial infarction (MI), other symptomatic coronary artery disease, heart failure (HF), end-stage renal disease (ESRD), and death. Multivariate risk equations and a meta-regression of hypertension trials informed transition probabilities. Contemporary clinical evidence from the SPYRAL HTN-ON MED trial informed the base case treatment effect (-4.9 mmHg change in office systolic blood pressure (oSBP) observed vs. sham control). Costs were sourced from published literature. A 1.5% discount rate was applied to costs and effects, and the resulting incremental cost-effectiveness ratio (ICER) was evaluated against a willingness-to-pay threshold of $50,000 per QALY gained. Extensive scenario and sensitivity analyses were performed.</p><p><strong>Results: </strong>Over 10 years, RF RDN resulted in relative risk reduction in clinical events (0.80 for stroke, 0.88 for MI, and 0.72 for HF). Under the base case assumptions, RF RDN was found to add 0.51 (15.81 vs. 15.30) QALYs at an incremental cost of $6,031 ($73,971 vs. $67,040) over a lifetime, resulting in an ICER of $11,809 per QALY gained. Cost-effectiveness findings were found robust in sensitivity analyses, with the 95% confidence interval for the ICER based on 10,000 simulations ranging from $4,489 to $22,587 per QALY gained.</p><p><strong>Limitations and conclusion: </strong>Model projections suggest RF RDN, under assumed maintained treatment effect, is a cost-effective treatment strategy for uncontrolled hypertension in the Canadian healthcare system based on meaningful reductions in clinical events.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"70-80"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807145","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":"Lost earnings among triptan non-responders in the general population of Denmark: a measure of disproportionate migraine-attributed burden and of unrecognised and unmet treatment need.","authors":"Messoud Ashina, Timothy J Steiner, Jakob Møller Hansen, Daniel Sloth Hauberg, Ulla Sofie Lønberg, Maria Spanggaard, Jens Olsen, Sandra Benkjer Stallknecht, Thomas Folkmann Hansen","doi":"10.1080/13696998.2025.2477342","DOIUrl":"10.1080/13696998.2025.2477342","url":null,"abstract":"<p><strong>Aims: </strong>Migraine leads to substantial healthcare utilization and associated costs. However, much higher costs are attributed to lost productivity. The impact of effective migraine treatment on these costs, at the individual level, has not been well established. Even less known is the impact of treatment failure. The objective of this study was to assess lost earnings as a measure of migraine-attributed burden among triptan non-responders in Denmark.</p><p><strong>Materials and methods: </strong>We used data from the Danish National Prescription Register and Danish Income Statistics Register over the 27-year period 1995-2021. We identified 4,979 triptan non-responders (85.9% female) and matched them for sex, age and region of residence with 14,292 continuing users of triptans (triptan responders) and 13,592 individuals from the background population (triptan never-users). We then estimated average annual individual earnings, and compared those among triptan non-responders, from 3 years prior to and 10 years after their last triptan redemption, with those among their matched triptan responders and triptan never-users over the same periods.</p><p><strong>Results: </strong>Triptan non-responders earned significantly less than both their matched triptan responders and their matched triptan never-users. The earnings gap was evident even 3 years prior to the last triptan prescription (€4,344 and €4,356 respectively). This gap widened substantially over time, so that average cumulative earnings over the 14-year period of follow-up for each triptan non-responder were €93,684 less than those of responders and €99,485 less than those of never-users.</p><p><strong>Limitations: </strong>There are uncertainties with regard to the reasons for triptan discontinuation (whether non-response or otherwise), and to lack of diagnostic confirmation of migraine.</p><p><strong>Conclusions: </strong>Triptan non-response represents failure of currently available acute treatment options. It is associated with substantial and cumulative lost earnings, highlighting a disproportionate economic burden. These findings underscore the potential economic benefit of recognizing, and rectifying, unmet treatment needs in migraine management.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"398-404"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572835","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-utility analysis of isavuconazole compared with the standard of care as a first-line therapy for patients with invasive fungal infection prior to differential pathogen diagnosis in Japan.","authors":"Ataru Igarashi, Shun Inoue, Yasushi Onishi","doi":"10.1080/13696998.2025.2483098","DOIUrl":"10.1080/13696998.2025.2483098","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to evaluate the cost-effectiveness of isavuconazole compared with voriconazole as a first-line therapy for patients with invasive aspergillosis prior to differential pathogen diagnosis.</p><p><strong>Materials and methods: </strong>Using a state-transition model, a cost-utility analysis of isavuconazole compared with voriconazole was conducted in patients with presumptive invasive aspergillosis. The study population consisted of patients with hematological malignancies undergoing hematopoietic stem cell transplantation (HSCT) or chemotherapy who developed invasive fungal infections. The incremental cost-effectiveness ratio (ICER) was analyzed from the perspective of public healthcare. In patients with presumptive invasive aspergillosis, 6.6% were assumed to have mucormycosis. Efficacy data were sourced from the SECURE and VITAL trials, which included patients with invasive aspergillosis and mucormycosis. Expected survival was based on data for acute myeloid leukemia. The cost of voriconazole was based on its generic price. Different parameters were set for quality of life, expected survival period, and hospitalization costs in the HSCT and chemotherapy models, and the robustness of the model was evaluated using probabilistic and deterministic sensitivity analyses.</p><p><strong>Results: </strong>In the HSCT model, the base case showed an incremental quality-adjusted life-years (QALYs) of 0.37 and an incremental cost of JPY 918,682 for isavuconazole compared with voriconazole, with an ICER of JPY 2,515,813. In the chemotherapy model, the incremental QALYs was 0.16, and the incremental cost was JPY 723,111, with an ICER of JPY 4,411,564. The probability sensitivity analysis showed that the proportion of ICERs below JPY 5 million was 100.0% in the HSCT model and 79.1% in the chemotherapy model.</p><p><strong>Limitations: </strong>Reference efficacy data were obtained from non-Japanese clinical trials.</p><p><strong>Conclusions: </strong>Assuming a willingness-to-pay threshold of JPY 5 million for additional QALYs, isavuconazole was shown to be cost-effective compared with voriconazole in both the HSCT and chemotherapy models as a first-line therapy for patients with presumptive invasive aspergillosis.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"460-470"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost per remission for mirikizumab versus ustekinumab for moderately to severely active ulcerative colitis treatment from the United States commercial payer perspective.","authors":"Ankit Gulati, Neha Mittal, Sunanda Kane, Thomas Creveling, Nicholas Bires, Deborah A Fisher, Neha Chanan, Amit Kumar Koushik, Navneet Upadhyay","doi":"10.1080/13696998.2025.2503661","DOIUrl":"10.1080/13696998.2025.2503661","url":null,"abstract":"<p><strong>Introduction: </strong>Mirikizumab, approved for the treatment of moderately to severely active ulcerative colitis (UC), may be prescribed in a similar placement to ustekinumab in second-line settings. Payers may compare the economic value when making formulary decisions. This study estimated and compared the cost per remission of the second-line therapies mirikizumab versus ustekinumab in patients with UC.</p><p><strong>Methods: </strong>An Excel-based analytic model was developed to estimate the cost per additional patient achieving clinical remission at the end of one year in biologic/Janus kinase inhibitor (JAKi)-experienced patients (second-line therapy) with UC from a United States commercial payer perspective. A network meta-analysis of published pivotal randomized clinical trials was used to derive the number needed to treat (NNT) for clinical response, clinical remission, and endoscopic remission/endoscopic improvement/mucosal healing for ustekinumab and mirikizumab in the study population. The model included the treatment cost (wholesale acquisition costs [WAC] and treatment administration costs) during the induction and maintenance phases. A scenario involving the availability of a ustekinumab biosimilar was also evaluated, assuming the NNT remained the same as ustekinumab but with a WAC set at 50% lower than its current WAC.</p><p><strong>Results: </strong>The costs per patient achieving clinical remission for mirikizumab vs. ustekinumab as a second-line therapy were $461,096 vs. $67,273 during induction and $501,456 vs. $1,079,189 during maintenance. The cost per clinical remission in case of dose escalation during maintenance was lower for mirikizumab vs. ustekinumab ($501,456 vs. $1,569,127). Considering the ustekinumab 130 mg IV biosimilar, the scenario resulted in a lower cost per clinical remission for mirikizumab vs. a ustekinumab biosimilar during the maintenance phase ($501,456 vs. $539,594).</p><p><strong>Conclusion: </strong>Mirikizumab is projected to have a lower cost per remission during maintenance therapy than ustekinumab. Given the need for long-term treatment for this chronic condition, mirikizumab appears to be a cost-efficient treatment option.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"709-718"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969883","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 option value associated with surgical aortic valve replacement using a novel bioprosthetic and a future transcatheter aortic valve-in-valve procedure.","authors":"Eric L Keuffel, Matt Reifenberger, Andrew Pellegrini, Pradeep Yadav, Vinod H Thourani","doi":"10.1080/13696998.2025.2503664","DOIUrl":"https://doi.org/10.1080/13696998.2025.2503664","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal lifetime management of surgical aortic valve replacement (SAVR) patients should account for the expected clinical and economic value of the index procedure as well as the future trajectory of health outcomes. This study estimates the discounted per surgery \"total value\" (from the time of initial SAVR operation through 25 years post-surgery) and the option value (after reoperation) that mechanical SAVR patients forego by choosing a device that does not allow for valve-in-valve transcatheter aortic valve reoperation (ViV/TAVR).</p><p><strong>Methods: </strong>The model adopts a US payer perspective and tracks major health events, anti-coagulant monitoring, maintenance, and expenditures associated with these events following initial SAVR procedures, inclusive of costs before and after a potential reoperation. We compare the expected utilization and expenditures for tissue valve patients and mechanical valve patients over a 25-year period. The model also compares the experience of mechanical SAVR patients after reoperation to a counterfactual group receiving ViV/TAVR to estimate option value. Monte Carlo simulation, sensitivity analyses, scenario analyses, and break-even analyses were conducted to account for variation in inputs.</p><p><strong>Results: </strong>Novel SAVR treatment for aortic stenosis followed by ViV TAVR for reoperation reduces 25-year payer expenditures relative to mechanical valves by either $34,621 (95% CI: 17,426-52,218), $31,363 (95% CI: $19,871 -$43,399) or $23,303 (95% CI: $16,906-$30,075) depending on the age of initial SAVR operation. During this period, the \"option value\" share of overall savings ranges from 8-17% and generally is lower for older patients. Reoperation and anti-coagulant monitoring are important drivers of overall savings and option value.</p><p><strong>Conclusion: </strong>The deterministic and simulation models both demonstrate that novel SAVR tissue valves, followed by a ViV/TAVR, result in lower 25-year expected costs than a treatment strategy using mechanical SAVR valves, and option value is a component of these savings.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"28 1","pages":"778-787"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119705","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":"Real-world effectiveness of cariprazine in major depressive disorder and bipolar I disorder in the United States.","authors":"Roger S McIntyre, Mousam Parikh, Jamie Ta, Simranpreet Waraich, Chandra Cohen-Stavi, Carl Marci, Nadia Nabulsi","doi":"10.1080/13696998.2025.2513766","DOIUrl":"10.1080/13696998.2025.2513766","url":null,"abstract":"<p><strong>Aims: </strong>The efficacy of cariprazine for major depressive disorder (MDD) (adjunctive therapy) and bipolar I (BP-I) depression has been demonstrated in clinical trials. This study evaluated the real-world effectiveness of cariprazine in reducing depression severity among patients with moderate-to-severe MDD or BP-I depression.</p><p><strong>Methods: </strong>Medical/pharmacy claims and electronic medical records (EMRs) from specialty providers in the OM1 Real-World Data Cloud were used to identify adults with MDD or BP-I who initiated cariprazine (adjunctively for MDD) (first dispensing = index) and had ≥1 EMR and ≥1 claim during 12-month baseline and ≤12-month follow-up periods. Included patients had a baseline Patient Health Questionnaire (PHQ)-9 total score ≥10, reflecting at least moderate depressive symptoms. Follow-up continued until cariprazine discontinuation, alternate diagnosis (e.g. BP-I [MDD cohort] or MDD [BP-I cohort]), or 12 months post-index. Depression severity was assessed using PHQ-9 total scores that were observed or estimated from clinical notes using a previously validated machine learning algorithm. Analyses included mean change in PHQ-9 score from baseline to 2, 6, and 12 months of follow-up. A sensitivity analysis using only observed PHQ-9 scores was conducted.</p><p><strong>Results: </strong>Of 754 patients at baseline, 396 had MDD (mean PHQ-9 = 16.4) and 358 had BP-I (mean PHQ-9 = 16.9). For patients with MDD, mean reductions in PHQ-9 scores from baseline to 2, 6, and 12 months of adjunctive cariprazine treatment were 3.5 (95% CI: 2.7, 4.4; <i>n</i> = 127), 4.1 (2.9, 5.4; <i>n</i> = 87), and 3.7 (1.6, 5.8; <i>n</i> = 52), respectively. For patients with BP-I, mean reductions from baseline to 2, 6, and 12 months were 5.2 (95% CI: 4.2, 6.2; <i>n</i> = 121), 6.5 (5.2, 7.8; <i>n</i> = 90), and 6.9 (5.2, 8.5; <i>n</i> = 54), respectively. Greater improvements were observed in the sensitivity analysis.</p><p><strong>Conclusions: </strong>This real-world effectiveness study of cariprazine treatment for MDD (adjunctive use) or BP-I demonstrated clinically meaningful and sustained improvement in depression symptoms during short- and long-term follow-up.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"885-898"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187151","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":"Productivity loss associated with premature mortality due to human papillomavirus-related cancers in Poland.","authors":"Rafał Jaworski, Marcin Czech, Alicja Wójcik, Ugne Sabale, Jarosław Pinkas","doi":"10.1080/13696998.2025.2523161","DOIUrl":"https://doi.org/10.1080/13696998.2025.2523161","url":null,"abstract":"<p><strong>Introduction: </strong>Human papillomavirus (HPV) is among the leading infection-related causes of cancer mortality and lost productivity in Central and Eastern European countries, including Poland. The aim of this study was to assess productivity loss and indirect costs of premature mortality due to HPV-related cancers in Poland with focus on burden attributable to the 9-valent vaccine HPV genotypes.</p><p><strong>Methods: </strong>Previously published model using the human capital approach has been adapted to the Polish context by utilizing country-specific epidemiological and economic data from primary national sources. The number of HPV-related cancer deaths, Years of Life Lost (YLL), Years of Productive Life Lost (YPLL), and the Present Value of Future Lost Productivity (PVFLP) were estimated in 2010, 2015, 2019, and 2022. The PVFLP was estimated using either a gross domestic product (GDP) per employed person or average wage. Attributable fractions to HPV types were utilized to determine the percentage of deaths, YLL, YPLL, and PVFLP attributed to HPV.</p><p><strong>Results: </strong>The number of deaths, YLL, and YPLL due to cancers attributable to 9-valent HPV vaccine types in 2022 were estimated at 1,810, 25,747, and 5,665, respectively. This represented a decline of 14.7%, 28.2%, and 37.9%, respectively, from 2010. Cancers attributable to the 9-valent HPV vaccine accounted for 75% to 100% of all HPV-related cancers depending on cancer type. The PVFLP amounted to EUR 142.00 million in 2022, which represented an 11.5% increase from EUR 127.0 million in 2010. The PVFLP of cancers attributable to the 9-valent HPV vaccine genotypes accounted for 90% to 91% of all HPV-related cancers.</p><p><strong>Conclusions: </strong>HPV-related cancers continue to pose a substantial public health challenge. Expanding coverage rate for the 9 valent HPV vaccine creates the potential to reduce the burden of HPV-related diseases and avoid productivity loss due to the premature mortality from HPV-related cancers.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"28 1","pages":"1014-1022"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553757","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}