Journal of Medical Economics最新文献

{"title":"A strategic framework for synergizing managed entry agreement efforts to access pharmaceutical products in Saudi Arabia-results from a multi-stakeholder workshop.","authors":"Hussain Abdulrahman Al-Omar, Asma Abdulaziz Almuhsin, Lolwa Hamad Almudaiyan, Amal Hassan Al-Najjar, Laila Carolina Abu Esba, Hind Almodaimegh, Esraa S Altawil, Consuela Cheriece Yousef, Mansoor Ahmed Khan, Khalid AlYahya, Jehan Alamre, Fatma Maraiki, Jaime Espín, Rosanna Tarricone, Panos Kanavos","doi":"10.1080/13696998.2025.2506967","DOIUrl":"10.1080/13696998.2025.2506967","url":null,"abstract":"<p><strong>Background: </strong>Managed entry agreements (MEAs) between manufacturers and healthcare payers allow health systems to maximize patients' access to treatments while maintaining financial sustainability. However, to work efficiently, MEAs need to be integrated into a country's formal pricing, reimbursement, and market access processes. This study proposes a country-specific MEA framework for pharmaceutical products and sheds light on the key enablers of optimal implementation of MEAs in Saudi Arabia.</p><p><strong>Methods: </strong>This mixed-methods study was conducted through secondary data collection derived from systematic literature search followed by a half-day multi-stakeholder workshop hosted in Riyadh, Saudi Arabia including representatives from different governmental, quasi-governmental, and private sectors, all of whom had a job role related to pharmaceutical pricing, reimbursement, and market access. A predefined and validated set of questions was used to guide the workshop discussion with props and prompts to elicit more insights on MEAs design and framework from the participants. The workshop discussion and interactions were digitally recorded to enable verbatim transcription, followed by a thematic analysis.</p><p><strong>Results: </strong>Ten themes emerged from the workshop discussion with majority guided the framework design: (1) access to innovative medications; (2) stakeholder views about MEAs; (3) early dialogue; (4) prioritization of MEAs for pharmaceutical products; (5) the regulatory landscape; (6) designing a technical framework for MEAs; (7) innovative payment models; (8) health system governance; (9) challenges for successful implementation; and (10) stakeholder engagement.</p><p><strong>Conclusions: </strong>In Saudi Arabia, MEAs are perceived as strategic levers to enable health system to navigate the access paradox, particularly for innovative and high-cost therapies. Nevertheless, having in place a robust Saudi-specific framework and anchored regulations and policies is essential to ensure that MEAs enhance-rather than compromise-access, sustainability, and equity. As therapies grow more complex, Saudi Arabia must adopt agile, evidence-adaptive MEAs policy and structure to remain fit for purpose.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"753-765"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078212","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":"Willingness to pay for the effect of SARS-CoV-2 antivirals in preventing COVID-19 transmission to others in the Japanese population.","authors":"Ataru Igarashi, Kenji Kurazono, Naoya Itsumura, Tomomi Takeshima, Kosuke Iwasaki","doi":"10.1080/13696998.2025.2461897","DOIUrl":"10.1080/13696998.2025.2461897","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the willingness to pay (WTP) of the Japanese population for the transmission prevention function of SARS-CoV-2 antiviral treatments and identify the attributes associated with higher WTP.</p><p><strong>Methods: </strong>A web-based survey (registration number: UMIN000054955) was conducted from May 17 to June 1, 2024, targeting a general population using a survey company panel. We aimed to obtain around 3,000 valid responses. Respondents were randomly divided into two groups: one assuming a COVID-19 infection (infection-assumed group) and the other without this assumption (non-infection-assumed group). WTP was assessed using an open-ended question format, asking how much they would be willing to pay out-of-pocket for a hypothetical antiviral drug that reduces the risk of transmitting COVID-19 to others by half. The survey also collected demographic information, COVID-19 related attributes, empathy levels using the Multidimensional Empathy Scale (MES), and health literacy using the Communicative and Critical Health Literacy scale. The mean WTP for COVID-19 treatment was calculated for all respondents and for the infection-assumed and non-infection-assumed groups. Subgroup analyses examined the effects of respondent attributes on WTP. A linear regression model with stepwise selection identified factors associated with WTP.</p><p><strong>Results: </strong>Responses were obtained from 3,657 individuals, with 3,131 valid responses analyzed. The mean WTP among all respondents was JPY 3,205 (USD 20.85) (standard error: JPY 84 [USD 0.55]). The infection-assumed group showed a 21% higher WTP than the non-infection-assumed group (<i>p</i> < 0.001). Subgroup analyses indicated that WTP varied based on attributes such as co-residing children, occupation, empathy levels, and health literacy. Higher WTP was significantly associated with being aged 65 years and older, higher household income, absence of co-residing children, being a company employee, executive, or public servant, fear of COVID-19 infection, higher other-oriented emotional reactivity (a factor of MES), and higher health literacy.</p><p><strong>Conclusion: </strong>We presented the WTP of the Japanese population for the transmission prevention function of COVID-19 treatments as an actual monetary value. Factors such as empathy, health literacy, and some attributes were significantly associated with WTP. These findings might help inform policymakers in developing health policies based on the universal health insurance system in Japan.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"260-267"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066129","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 of heart failure with preserved and reduced ejection fraction in the Philippines.","authors":"John Añonuevo, Camilo Oliver Aquino, Elaine Cunanan, Patrick James Encarnacion, Elmer Jasper Llanes, Diana Dalisay Orolfo, Chito Permejo, Dante Salvador, Mary Joy Taneo, Anthony Russell Villanueva, Helen Ong-Garcia, Precious Juzenda Montilla","doi":"10.1080/13696998.2025.2504269","DOIUrl":"10.1080/13696998.2025.2504269","url":null,"abstract":"<p><strong>Aim: </strong>Heart Failure (HF) poses a significant clinical and economic burden globally. Due to its progressive and chronic nature, HF requires both continuous medical management and acute care related to hospitalization. This study aimed to estimate the economic burden of HF in the Philippines, covering both outpatient care and inpatient management.</p><p><strong>Methods: </strong>The study utilized a bottom-up micro-costing approach to determine the economic burden of heart failure with mildly reduced ejection fraction (HFmrEF)/heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) across all NYHA classifications using a societal perspective. Price data were gathered from clinical experts, public and private hospitals, while quantity and probability assumptions were derived from published literature, subsequently validated through clinical expert consensus.</p><p><strong>Results: </strong>In 2022, an estimated 914,892 individuals were diagnosed with HF in the Philippines, based on a prevalence rate of 0.82%. This equates to a total economic burden of PHP 80.9B (USD 1.5B). Direct costs accounted for 90% of the total burden at PHP 72.8B (USD 1.3B). Hospital and medication expenses represented 61% of the total cost-of-illness, amounting to PHP 49.2B (USD 887.6 M).</p><p><strong>Conclusions: </strong>HF management poses a significant burden-of-disease for Filipinos. The annual societal costs of HF management potentially expose Filipinos to catastrophic health spending and impoverishment, especially in a system where a substantial portion of healthcare expenses are paid out-of-pocket. These findings highlight the urgent need to prioritize preventive public health interventions and enhance financial risk protection for HF patients.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"814-822"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086237","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 psoriasis treatment patterns and disease burden in Germany, with a focus on biologics and apremilast: data from a German statutory health insurance database.","authors":"Andreas Pinter, Marcus Schulte, Nils Kossack, Marc Pignot, Michael Schultze, Andrea Feldhus","doi":"10.1080/13696998.2025.2452054","DOIUrl":"10.1080/13696998.2025.2452054","url":null,"abstract":"<p><strong>Background: </strong>Psoriasis is a chronic, systemic, inflammatory skin disease, with increasing prevalence; however, few studies have reported real-world prescription patterns and healthcare burden.</p><p><strong>Objectives: </strong>This retrospective, observational cohort study used statutory health insurance claims data (January 2014-December 2019) to estimate prevalence/incidence of moderate-to-severe psoriasis in Germany. Patient characteristics, treatment patterns/compliance, and healthcare resource utilization (HCRU)/costs were evaluated, focusing on apremilast and anti-interleukin (IL), and anti-tumor necrosis factor (TNF) biologics.</p><p><strong>Methods: </strong>The epidemiology population included adults with psoriasis; 1-year prevalence/incidence rates were extrapolated to the statutory health insurance population. The HCRU/costs population included adults with psoriasis and a first prescription for a drug of interest (index date). Baseline periods were 12 or 48 months before the index date, with 12‑month follow-up.</p><p><strong>Results: </strong>In 2019, the estimated psoriasis prevalence/incidence was 2,672.9 per 100,000 individuals/508.7 per 100,000 person-years. Of 2,809 patients in the HCRU/costs population, 3.6% (<i>n</i> = 101) received index drug apremilast, 10.2% (<i>n</i> = 287) anti-IL, 6.8% (<i>n</i> = 191) anti-TNF, and 79.4% (<i>n</i> = 2,230) traditional/other systemic therapy. Patients initiating apremilast were older and were more often biologic-naïve than those initiating anti-IL/TNF biologics. Twelve months after treatment initiation, drug adherence (medication possession rate >80%) and persistence (<60 days between prescriptions/no switch) were lower for apremilast <i>vs.</i> anti-IL and anti-TNF groups (24.8% <i>vs.</i> 59.6% and 53.9%; 36.6% <i>vs.</i> 66.9% and 57.6%, respectively). During a 12-month baseline period, psoriasis-related hospitalization was lower for apremilast <i>vs.</i> anti-IL and anti-TNF groups (4.95% <i>vs.</i> 15.68% and 14.14%) and higher during 12 months' follow-up (5.94% <i>vs.</i> 2.44% and 3.14%). Adjusted index drug costs during follow-up were €4,105, €3,498, and €13,777 higher for adalimumab, other anti-TNF and anti-IL biologics <i>vs.</i> apremilast, respectively, and the main driver for lower overall apremilast costs.</p><p><strong>Conclusion: </strong>Given variation in treatment adherence/persistence, HCRU, and costs between apremilast and biologics, these findings could be key considerations during treatment selection.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"207-220"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978947","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 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":"Budget impact analysis of Haemate-<i>P</i> as long-term prophylaxis and on-demand therapy for von Willebrand disease in Spain.","authors":"Michele R Wilson, Pablo Mendez, Cheryl L McDade, Laura Vidal Barrientos, Juan E Megías-Vericat, Gines Escolar, Korinna Karampampa, Marco Panebianco, Songkai Yan","doi":"10.1080/13696998.2025.2535232","DOIUrl":"10.1080/13696998.2025.2535232","url":null,"abstract":"<p><strong>Objectives: </strong>A decision-analytic model was developed to assess the Spanish healthcare system budget impact associated with increased use of Haemate-<i>P</i> in individuals with von Willebrand disease.</p><p><strong>Methods: </strong>The model considered long-term prophylaxis and on-demand treatment with each of three von Willebrand factor (vWF) replacement products (Haemate-<i>P</i>, Fanhdi, and Wilate). Two budget scenarios were considered: a status quo scenario (no changes in uptake of products/strategy) and an alternative scenario (increased Haemate-<i>P</i> uptake). The model estimated total product costs and other medical costs for each budget scenario annually over 3 years. Total budget impact was estimated by subtracting the costs for the status quo scenario from the costs for the alternative scenario.</p><p><strong>Results: </strong>The alternative Haemate-<i>P</i> uptake scenario was estimated to save the Spanish healthcare system €5.64 million over 3 years. Cost savings were driven primarily by a reduction in vWF product costs (-€5.62 million) resulting from a reduction in vWF product use (-€4.80 million) and bleed reductions (-€0.82 million). In univariate and multiway deterministic sensitivity analyses, the alternative scenario remained cost-saving.</p><p><strong>Conclusion: </strong>Haemate-<i>P</i> was found to be a cost-saving strategy, and increased use of Haemate-<i>P</i> over Fanhdi, and Wilate is expected to reduce overall costs to the healthcare system in Spain.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1183-1190"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659417","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":"Treatment patterns and outcomes in patients with lower-risk myelodysplastic syndromes treated with erythropoiesis-stimulating agents in a large US community oncology practice: a retrospective chart review.","authors":"Lucio N Gordan, Gustavo Fonseca, Amanda Warner, Aya Alajrash, Amy Ming, Derek Tang, Svetlana Gavrilov, Nisha Singh, Trevor Heritage, Ernest Griffin, Ashley Swanson, Samantha Slaff","doi":"10.1080/13696998.2025.2548739","DOIUrl":"https://doi.org/10.1080/13696998.2025.2548739","url":null,"abstract":"<p><strong>Background: </strong>Erythropoiesis-stimulating agents (ESAs) are an established treatment for lower-risk myelodysplastic syndromes (LR-MDS). However, real-world data on the outcomes of patients with LR-MDS treated with ESAs are limited. This study describes treatment patterns and clinical outcomes in this population.</p><p><strong>Methods: </strong>This is a retrospective review of electronic medical records compiled from Florida Cancer Specialists & Research Institute databases. Inclusion criteria were: LR-MDS diagnosis (between January 2018 through December 2022), initiation of ESA treatment, ≥18 years at diagnosis, availability of ≥6 months of data prior to diagnosis, and ≥1 year of follow-up data. Patients treated with luspatercept prior to ESAs or enrolled in clinical trials during the study period were excluded. Patients were followed for 1 year from the initial diagnosis until loss to follow-up/death. Outcomes included treatment patterns (occurrence of and time to ESA failure, and time on ESA treatment after failure), and clinical outcomes related to ESA failure (hematologic improvement and transfusion independence), with ESA failure defined as <i>a</i> < 1.5 g/dL rise in hemoglobin or no decrease in red blood cell transfusions by 6-8 weeks of treatment.</p><p><strong>Results: </strong>At baseline, of 359 eligible patients with LR-MDS most were male (65.2%), White (88.0%), non-transfusion dependent (74.9%), and had hemoglobin levels of 8-10 g/dL (56.3%) and ring sideroblasts <5% (59.3%). Most patients (68.0%) experienced ESA failure, with a median of 56.0 days from ESA initiation to failure, and a median of 466.5 days receiving ESA treatment after failure. Hematologic improvement was observed in 33.7% of patients.</p><p><strong>Conclusions: </strong>In this real-world evaluation of ESA treatment in a population with LR-MDS, only one-third of patients experienced hematologic improvement and two-thirds of patients remained on ESA treatment for ≥1 year after failure. These results demonstrate high rates of ESA failure and indicate patients in community oncology settings in the US may be continuing with ESA treatment despite failure.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"28 1","pages":"1357-1369"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957315","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}