Journal of Medical Economics最新文献

{"title":"Cost-effectiveness analysis of universal hypothyroidism screening in the general population aged 30-65 years in Spain.","authors":"Carles Zafón Llopis, Olga Vicente López, Mª Ángeles Cruz Martos, Heidi de Los Santos Real, Bleric Alcalá Revilla, Olga Ojeda Rife, Daniel Pérez Troncoso, Belén Citoler Berdala, José Manuel Cucalón Arenal","doi":"10.1080/13696998.2025.2563973","DOIUrl":"10.1080/13696998.2025.2563973","url":null,"abstract":"<p><strong>Aims: </strong>Hypothyroidism is an endocrine disorder that often begins in a subclinical form but can lead to non-specific symptoms and cardiovascular problems. Its prevalence is higher among women, and a significant proportion of cases remain undiagnosed. While previous studies assessed screening in specific populations (e.g. pregnant women, older adults), this study evaluates the cost-effectiveness of population-wide screening in adults aged 30-65 from the Spanish National Health System (NHS) perspective.</p><p><strong>Materials and methods: </strong>A cost-effectiveness Markov model was developed, simulating seven health states: subclinical hypothyroidism (undiagnosed and controlled), overt hypothyroidism (undiagnosed and controlled), euthyroid state, cardiovascular event, and death. Two strategies were compared: population-based screening <i>versus</i> no screening. Model inputs-transition probabilities, prevalence, costs, utilities, and screening effectiveness-were obtained from published literature. A panel of four clinical experts validated the model structure and assumptions. Lifetime costs and quality-adjusted life-years (QALYs) were estimated, and the incremental cost-effectiveness ratio (ICER) was calculated. Probabilistic, sensitivity, and scenario analyses were conducted.</p><p><strong>Results: </strong>Population-based screening for hypothyroidism in individuals aged 30-65 resulted in an incremental cost of €34.7 million and 6,037 QALYs gained over 35 years, yielding an ICER of €5,745/QALY, significantly below the Spanish willingness-to-pay threshold (€21,000/QALY). Screening also resulted in 33,215 additional diagnoses of subclinical hypothyroidism and 6,870 fewer cases of overt hypothyroidism. It was cost-effective in 99% of probabilistic simulations and under all tested screening intervals (1-5 years).</p><p><strong>Limitations and conclusions: </strong>Key limitations include the use of constant transition probabilities and some inputs from international sources. Nonetheless, expert validation supports the model's relevance. The analysis adopts a conservative approach, excluding potential additional benefits like hyperthyroidism detection or integration with routine bloodwork, which could improve cost-effectiveness. Overall, hypothyroidism screening is a cost-effective strategy for the Spanish NHS, improving early detection, preventing progression, and enhancing quality of life in a frequently underdiagnosed population.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1683-1695"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092186","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":"Economics of corneal cross-linking for keratoconus treatment.","authors":"Christopher J Rapuano, Richard L Lindstrom, Eric Donnenfeld, John P Berdahl, Vance Thompson, David Kratochvil, John Carter","doi":"10.1080/13696998.2025.2564576","DOIUrl":"10.1080/13696998.2025.2564576","url":null,"abstract":"<p><strong>Aim: </strong>To optimize the real-world applicability of a health economic model estimating the cost-effectiveness of corneal cross-linking for the treatment of keratoconus in the United States.</p><p><strong>Materials and methods: </strong>A previously reported discrete-event simulation (DES) model was adapted to reassess the cost-effectiveness of corneal cross-linking (CXL) from the US payer perspective. The simulation of keratoconus progression, which is a key driver of model outcomes, was remodeled to more accurately reflect the real-world relationship between age and the rate of disease progression. All costs were updated to reflect 2025 values. We simulated 4,000 eyes of 2,000 patients diagnosed with keratoconus to compare the lifetime cost and quality-adjusted life years (QALYs) of those treated with CXL vs conventional management.</p><p><strong>Results: </strong>Given updated cost and disease progression parameters, CXL resulted in lower direct medical costs of $38,897 and 2.97 incremental QALYs over a lifetime treatment horizon. Economically justifiable price (EJP) analysis demonstrated that CXL remained cost-effective up to a drug acquisition cost of $172,369 at a $100,000/QALY cost-effectiveness threshold and $246,549 at a $150,000/QALY cost-effectiveness threshold.</p><p><strong>Conclusions: </strong>After modeling a conservative cost of corneal transplantation and incorporating an age-dependent disease progression rate, our evaluation confirmed that CXL was the dominant (i.e. cost-saving and cost-effective) treatment strategy, primarily due to greatly improved patient outcomes (i.e. benefits strongly correlated with visual acuity). As novel and less invasive methods (e.g. transepithelial CXL) enter the market, it is expected that the demand for corneal cross-linking will increase given its significant clinical and economic value.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1696-1708"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A budget impact analysis of the Dario Diabetes Solution for type 2 diabetes mellitus in a US managed care population.","authors":"Laura Wilson, Coby Martin, Sandeep Tripathi, Harshit Dixit, Jared Miller, Ruihong Wang, Won Chan Lee","doi":"10.1080/13696998.2025.2564575","DOIUrl":"10.1080/13696998.2025.2564575","url":null,"abstract":"<p><strong>Aims: </strong>To estimate the potential budget impact following adoption of the Dario Diabetes Solution (DDS), a combined all-in-one smart glucose monitor with cloud-based app integration, in combination with standard of care (SoC) for patients with type 2 diabetes mellitus (T2D) versus SoC alone.</p><p><strong>Methods: </strong>Applying the findings of the retrospective cohort from real world data (RWD) studies of T2D patients' clinical outcomes and healthcare r251esource utilization (HCRU), a population-based budget impact model was developed. Budget impact was estimated with disaggregated costs calculated in categories, including medication, inpatient (IP) and emergency room (ER), office visit, and all-cause total costs. One-way sensitivity analysis (OWSA) was conducted to quantify the uncertainty in the model input parameters. Eight unique scenarios were analyzed, including the Medicare perspective, a two-year time horizon, and glycemic control.</p><p><strong>Results: </strong>Analysis of the base case (1-year, commercial perspective, inclusion of device, application, and costs pertaining to consumable, medication, and health care resource utilization) resulted in net cost savings of $9,652,498 in a plan population of 1 million. Net budget impact for scenarios ranged from savings of $39,216,721, for the Medicare-only perspective instead of commercial, to $251,554 when restricting the population to patients who moved from poor-to-good glycemic control (HbA1C ≥ 8% mg/dl to < 8%).</p><p><strong>Conclusions: </strong>Despite cost estimation using remittance data and a relatively short time horizon (one year), our budget impact analysis demonstrated substantial cost savings with the introduction of DDS, driven by reduced HCRU for patients using DDS, who displayed improved adherence and glycemic control.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"1721-1732"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191721","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 newborn screening for spinal muscular atrophy in Japan.","authors":"Akira Hata, Akihito Uda, Satoru Tanaka, Diana Weidlich, Walter Toro, Laetitia Schmitt, Ataru Igarashi, Matthias Bischof","doi":"10.1080/13696998.2024.2439734","DOIUrl":"10.1080/13696998.2024.2439734","url":null,"abstract":"<p><strong>Aims: </strong>Spinal muscular atrophy (SMA) is a rare genetic disorder characterized by progressive muscle weakness, atrophy, respiratory failure, and in severe cases, infantile death. Early detection and treatment before symptom onset may substantially improve outcomes, allowing patients to achieve age-appropriate motor milestones and longer survival. We assessed the cost-utility of newborn screening (NBS) for SMA in Japan.</p><p><strong>Materials and methods: </strong>A cost-utility model (decision tree and Markov model) compared lifetime health effects and costs between \"NBS\" for SMA (presymptomatic treatment) or \"no NBS\" (treatment initiated at symptom onset). Model inputs were sourced from literature, local data, and expert opinion. Sensitivity and scenario analyses were conducted to assess model robustness and data validity.</p><p><strong>Results: </strong>Based on the 1:10,000 SMA incidence, it was estimated that 43 newborns/year would have SMA, and a total of 39 patients with SMA would initiate presymptomatic treatment after NBS. An estimated 736 quality-adjusted life-years were gained per annual birth cohort with NBS. NBS for SMA was dominant compared with no NBS (i.e. less costly and more effective), with ¥8,856,960,096 reduced total costs with NBS versus no NBS (base-case). Sensitivity and scenario analyses supported cost effectiveness of NBS for SMA versus no NBS. A greater percentage of patients was estimated to enjoy longer survival and be without permanent assisted ventilation with NBS versus no NBS.</p><p><strong>Limitations: </strong>Real-world observations may differ from single-arm clinical trial outcomes. It was assumed that patients with SMA identified via NBS were asymptomatic and would receive treatment prior to symptoms. Best supportive care was not considered, and Japan-specific variations in gene replacement therapy protocol were not fully reflected.</p><p><strong>Conclusion: </strong>NBS for SMA allows for early identification of patients with SMA and treatment initiation before symptom onset, improving health outcomes and reducing total costs than without NBS.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"44-53"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785717","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":"Optimizing scan times in clinical neuroimaging: the potential of synthetic MRI.","authors":"Alexander von Hessling, Felix Stahl, Frauke Kellner-Weldon","doi":"10.1080/13696998.2025.2496065","DOIUrl":"https://doi.org/10.1080/13696998.2025.2496065","url":null,"abstract":"<p><strong>Aim: </strong>Synthetic Magnetic Resonance Imaging (SI) generates images from parametric maps of tissue properties and derives contrast weightings from the same acquisition. We aimed to evaluate the potential for scan time reduction using SI in patients with neurological indications in a tertiary care cantonal hospital.</p><p><strong>Methods: </strong>We searched our hospital database for head imaging performed between March 2020 and August 2022. Sequences were categorized as either fully replaceable (Scenario A) or potentially replaceable (Scenario B) if replacement would lead to limitations, such as resolution or contrast. We calculated the time used and potentially saved if all replaceable sequences and their respective planning were replaced by a 3-dimensional (3D) SI sequence lasting 3 or 5 min.</p><p><strong>Results: </strong>We identified 4,320 head examinations. Total examination time for replaceable sequence imaging in Scenario A was 656 h 54 min (minimum: 506 h 26 min; maximum: 982 h 53 min) and 778 h 38 min (minimum: 602 h 34 min; maximum: 1,223 h 34 min) for Scenario A & B. If 3D SI had been used, the estimated time required would have been 216 h for a 3-minute 3D SI and 360 h for a 5-minute 3D SI. The application of SI would have yielded an estimated reduction of 440 h 54 min (minimum: 290 h 26 min; maximum: 766 h 53 min) for Scenario A, and 562 h 38 min (minimum: 386 h 34 min; maximum: 907 h 34 min) for Scenario A & B.</p><p><strong>Conclusion: </strong>Reducing scan time with 3D SI is feasible and depends on the scan time of 3D SI, the type and frequency of performed protocols, and its ability to meet high-quality requirements. The effectiveness is most pronounced when 3D SI can replace traditional weighted images while maintaining diagnostic standards.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"28 1","pages":"649-655"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999706","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 evaluation of PCV21 in vaccine-naïve adults aged 19-64 years with underlying medical conditions in the United States.","authors":"Zinan Yi, Elamin H Elbasha, Kwame Owusu-Edusei","doi":"10.1080/13696998.2025.2496070","DOIUrl":"https://doi.org/10.1080/13696998.2025.2496070","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to estimate the incremental health and economic outcomes associated with the use of PCV21 (Capvaxive) in vaccine-naive adults aged 19-64 years with underlying medical conditions in the United States (US).</p><p><strong>Methods: </strong>A static multi-cohort state-transition Markov model was utilized, drawing on data from published literature and publicly available databases and reports, comparing PCV21 (intervention) versus PCV20 or PCV15 + PPSV23 (comparator) from a societal perspective with a lifetime horizon. The target population consisted of vaccine-naive adults aged 19-64 years classified as at-risk (AR) or high-risk (HR). Key outcome measures included undiscounted clinical cases: invasive pneumococcal disease (IPD), inpatient and outpatient non-bacteremic pneumococcal pneumonia (NBPP), post-meningitis sequelae (PMS), deaths from IPD and inpatient NBPP, as well as discounted quality-adjusted life years (QALYs), and total costs (in 2023 USD), with the incremental cost-effectiveness ratios (ICERs) reported as $/QALY gained. Costs and QALYs were discounted at 3% per year. Deterministic and probabilistic sensitivity analyses were conducted.</p><p><strong>Results: </strong>The analysis indicated that the V116 strategy prevented a substantial number of cases and deaths compared to the PCV20 or PCV15 + PPSV23 strategies among vaccine-naive AR/HR adults aged 19-49 and 50-64 years. For instance, the use of PCV21 was projected to reduce IPD cases by 1,450 and 4,232, respectively, in the two age groups when compared with PCV20. The estimated ICERs for both age groups were found to be cost-saving when compared to both PCV20 and PCV15 + PPSV23. Deterministic and probabilistic sensitivity analyses confirmed the robustness of these findings, with over 95% of simulations yielding cost-saving results and all estimated ICERs remaining below $10,000/QALY gained.</p><p><strong>Conclusions: </strong>The findings suggest that the use of PCV21 (Capvaxive) in adults aged 19-64 years with underlying medical conditions in the US can prevent a significant number of pneumococcal disease cases and deaths while demonstrating favorable economic outcomes across various scenarios.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":"28 1","pages":"665-673"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prospective cohort study estimating total pre-surgical healthcare costs before and two-year total societal costs after resective brain surgery, and quality of life of patients with drug-resistant epilepsy undergoing surgery.","authors":"L Maas, C B C M Peeters, M Hiligsmann, S M J van Kuijk, S Tousseyn, J Kellenaers, G A P G van Mastrigt, M C G Vlooswijk, S Klinkenberg, L Wagner, J Nelissen, O E M G Schijns, H J M Majoie, K Rijkers","doi":"10.1080/13696998.2025.2473745","DOIUrl":"10.1080/13696998.2025.2473745","url":null,"abstract":"<p><strong>Background: </strong>In contrast to clinical effectiveness of resective epilepsy surgery (RES) for patients with drug-resistant epilepsy, societal costs of RES is still unclear. The aim of this study was to report on total societal costs up until two years after surgery and analyse the trend of post-surgical costs over time. Secondary objectives included assessing quality of life (QoL) changes and identifying determinants of post-surgical costs.</p><p><strong>Methods: </strong>Data were derived from the patients' entire medical history based on hospital files and accompanied by validated questionnaires before and 3-, 6-, 12-, and 24-months post-surgery to additionally include medical consumption outside of the hospital, productivity losses and gains, and QoL. To explore the trend of post-surgical costs over time and identify determinants of post-surgical costs, linear mixed effects and linear regression models were performed.</p><p><strong>Results: </strong>The study included 44 patients. Mean complete costs from diagnostics and treatment strategies in the period before referral for pre-surgical evaluation up until two years after RES were €121,856 (Interquartile range = €76,058-€137,027). Post-surgical costs significantly decreased 12 months (mean 3-month difference = €-6,675, <i>p</i> = 0.000) and 24 months (mean 3-month difference = €-7,690, <i>p</i> = 0.000) after surgery compared to 3 months before surgery. Higher post-surgical costs were associated with a clinically relevant increase in disease-specific QoL after RES (<i>p</i> = 0.000), previous ketogenic diet (<i>p</i> = 0.005), RES in the left hemisphere (<i>p</i> = 0.014), previous RES (<i>p</i> = 0.007), and higher diagnostics and treatment strategies costs before referral for pre-surgical evaluation (<i>p</i> = 0.021). For disease-specific and generic QoL, 20 (45%) patients reached a clinically relevant QoL increase two years after surgery compared to before RES.</p><p><strong>Conclusion: </strong>In conclusion, RES leads to significant reduction in costs 2 years post-surgery. History of RES and ketogenic diet, clinically relevant disease-specific QoL increase, surgery in the left hemisphere, and higher costs of diagnostics and treatment strategies before referral for pre-surgical evaluation were significant determinants for higher post-surgical costs after RES.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"364-376"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523706","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":"Noninvasive tests and diagnostic pathways to MASH diagnosis in the United States: a retrospective observational study.","authors":"Semiu O Gbadamosi, Kristin A Evans, Brenna L Brady, Anthony Hoovler","doi":"10.1080/13696998.2025.2468582","DOIUrl":"10.1080/13696998.2025.2468582","url":null,"abstract":"<p><strong>Aim: </strong>Although liver biopsy is considered the most reliable diagnostic tool for metabolic dysfunction-associated steatohepatitis (MASH), it is invasive and can be costly. Clinicians are increasingly relying on routine biomarkers and other noninvasive tests (NITs) for diagnosis. We examined real-world diagnostic pathways for patients newly diagnosed with MASH with a primary focus on NITs.</p><p><strong>Materials and methods: </strong>This retrospective, observational study analyzed healthcare claims data (Merative MarketScan Commercial and Medicare Databases) from patients in the United States newly diagnosed with MASH from October 1, 2016, to March 31, 2023. Patients ≥18 years old with ≥12 months of continuous enrollment with medical and pharmacy benefits prior to diagnosis were included. Diagnostic pathways leading up to MASH diagnosis, including NITs (blood-based and imaging-based tests) and liver biopsies were assessed. Prevalence of comorbid conditions, MASH-associated medication use, and the diagnosing physician specialty were also examined.</p><p><strong>Results: </strong>A total of 18,396 patients were included in the analysis. Routine laboratory tests (alanine aminotransferase [ALT], albumin, aspartate aminotransferase [AST], cholesterol, complete blood count, and hemoglobin A1c) were performed among ≥70% of patients prior to MASH diagnosis, including 89% of patients with a liver enzyme test (ALT and/or AST). More than 75% of patients had necessary laboratory tests to calculate AST to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) scores. The most common imaging performed was ultrasound (62%); liver biopsy was only performed in 10% of patients. There was a high prevalence of cardio metabolic risk factors such as hyperlipidemia (66%), hypertension (62%), obesity (58%), type 2 diabetes (40%), and cardiovascular disease (21%). Nearly half of the patients (49%) were diagnosed by a primary care physician.</p><p><strong>Limitations and conclusions: </strong>This study highlights real-world diagnostic pathways among patients newly diagnosed with MASH, supporting previous findings that liver biopsies are infrequently used in favor of noninvasive methods.</p>","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":" ","pages":"314-322"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 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}