PharmacoEconomics Open最新文献

{"title":"Real-World Analysis of Healthcare Utilization, Treatment Patterns, and Economic Burden in Medicare Beneficiaries with Parkinson's Disease: Implications by Levodopa Formulation and Disease Severity.","authors":"Renée J G Arnold, Winona Tse, Kimberly Martin, Renee Kuan","doi":"10.1007/s41669-025-00588-w","DOIUrl":"https://doi.org/10.1007/s41669-025-00588-w","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate healthcare utilization, costs, and treatment patterns of Medicare beneficiaries with Parkinson's disease (PD) treated with different carbidopa-levodopa regimens.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using 100% fee-for-service Medicare research identifiable claims data from 2017 to 2019. The study population included 201,241 Medicare beneficiaries aged 65-90 years with PD who received at least one prescription for a carbidopa-levodopa-containing regimen. Treatment patterns, healthcare resource utilization, and costs were analyzed, stratified by medication regimen containing levodopa and levodopa equivalent daily dose (LEDD), the latter as a proxy for disease severity.</p><p><strong>Results: </strong>Immediate release (IR) carbidopa-levodopa was the most common initial prescription (83%). Extended release (ER) formulations had the highest mean daily dose (1140 mg, although the equivalent dose in a non-ER formulation is approximately 570 mg, in line with the other three primary regimens). Treatment persistence and cost generally increased with higher LEDD. Concomitant medication use, particularly dopamine agonists, also increased with higher LEDD. Total 3-year per patient healthcare costs were lower for patients prescribed controlled release (CR) carbidopa-levodopa (US $98,650); compared with US $116,394 for patients prescribed IR carbidopa-levodopa; US $123,650 for those prescribed CR + IR carbidopa-levodopa; and US $125,802 for ER carbidopa-levodopa. Costs tended to increase with higher LEDD, primarily driven by outpatient care and medications.</p><p><strong>Conclusions: </strong>This study provides comprehensive real-world evidence on carbidopa-levodopa use in Medicare beneficiaries with PD. Findings highlight the need for individualized treatment approaches, considering both symptom control and healthcare costs. Future research should focus on prospective studies to assess long-term outcomes and economic impact of different treatment strategies in PD, considering disease severity and quality of life.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimation of Lifetime Costs Among Insured Persons with HIV in the United States.","authors":"Joshua P Cohen, Vamshi Ruthwik Anupindi, Riddhi Doshi, Jason Yeaw, Xiaoyu Zhou, Mary J Christoph, Megan Chen, Paresh Chaudhari, Cassidy Trom, Woodie Zachry","doi":"10.1007/s41669-025-00584-0","DOIUrl":"https://doi.org/10.1007/s41669-025-00584-0","url":null,"abstract":"<p><strong>Background/objective: </strong>With recent advances in human immunodeficiency virus (HIV) management and prevention, it is critical to understand the lifetime costs (LTC) of HIV. The objective of the study was to evaluate all-cause LTC, annual costs and healthcare resource utilization (HCRU) among persons with HIV (PWH) versus a matched non-HIV cohort in the United States (US).</p><p><strong>Methods: </strong>This observational study included persons (≥ 18 years) with an HIV diagnosis, antiretroviral treatment (ART), and continuous enrollment (CE) within each year (2018-2023) in the PWH cohort, and with no HIV diagnosis/ART and CE in the non-HIV cohort, identified using a US commercial claims database (IQVIA PharMetrics^® Plus). Cohorts were matched 1:3 on age, sex, geographic region, and health plan. Undiscounted LTC, discounted LTC (95% confidence interval [CI]) and annual costs were computed in 2022 US dollars (USD) for ages 18-75 years. Annual inpatient, outpatient, emergency room, and outpatient pharmacy utilization and costs were compared.</p><p><strong>Results: </strong>Person counts ranged from 45,465 to 54,530 in the PWH cohort and 136,395 to 163,590 in the non-HIV cohort from 2018 to 2023. Mean undiscounted LTC were $2,895,020 (CI 2,847,453-2,947,867) and $482,522 (CI 453,114-513,44) for PWH and non-HIV cohorts, respectively, with an incremental cost difference of $2,412,498 (CI 2,354,674-2,474,024). Mean discounted LTC were $1,299,210 (CI 1,279,397-1,321,458) and $181,481 (CI 169,392-194,036) for PWH and non-HIV cohorts, respectively, with an incremental cost difference of $1,117,729 (CI 1,093,606-1,143,350). Mean annual total costs were six to seven times higher among PWH than the non-HIV cohort each year; with higher costs among older persons. HCRU was higher among PWH.</p><p><strong>Conclusions: </strong>Among a sample of primarily commercially insured US adults, HIV conferred an estimated incremental LTC difference of over $2.4 million (undiscounted) and $1.1 million (discounted), with annual costs being six to seven times higher for PWH compared to non-HIV persons.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Enhanced Retention Strategy to Prevent the Vertical Transmission of HIV in Uganda: A Budget Impact Analysis.","authors":"Elly Nuwamanya, Benjamin C Johnson, Stephen Okoboi, Ronald Galiwango, Diana Namuddu, Tabitha Ayabo, Joseph B Babigumira, Mohammed Lamorde","doi":"10.1007/s41669-025-00587-x","DOIUrl":"https://doi.org/10.1007/s41669-025-00587-x","url":null,"abstract":"<p><strong>Background: </strong>Novel retention strategies have the potential to reduce vertical transmission of HIV and improve patient outcomes for women living with HIV (WLHIV) and their infants. We estimated the budget impact of the enhanced retention strategy (ERS) compared with the Ministry of Health strategy/standard of care (SOC) approach for preventing vertical transmission of HIV among women initiating antiretroviral therapy (ART) in late pregnancy in Uganda.</p><p><strong>Methods: </strong>A budget impact analysis (BIA) was conducted from the payer (Uganda's Ministry of Health) perspective with a 5-year time horizon. A Microsoft Excel-based BIA model was populated with HIV epidemiological data and expenditures from the literature and the clinical trial of dolutegravir in pregnant HIV mothers and their neonates. These cost projections accounted for various programmatic inputs, disease progression, differences in mortality based on treatment status, and subsequent pregnancies. The eligible population included all HIV-positive pregnant women currently receiving prevention of vertical transmission services in Uganda. The primary outcomes of the analysis were incremental budget costs, and infections averted over 5 years.</p><p><strong>Results: </strong>Adopting the ERS would lead to a net cost increase of US$63.8 million over the next 5 years, or a net cost increase of US$12.7 million per year compared with the SOC. Newly enrolled WLHIV accounts for US$39.5 million of these marginal costs, while in-system patients account for US$24.2 million. Direct programmatic costs of the ERS only account for 13% of this additional cost, with 87% of the marginal increase coming from the cost of providing ART for WLHIV who would otherwise be lost to follow-up. The ERS would avert an additional 6933 infant infections compared with the SOC.</p><p><strong>Conclusion: </strong>Implementing the ERS would significantly increase the Ugandan Ministry of Health's budget, but most additional costs would be accrued from the resulting expansion of ART client volume. The ERS is a relatively low-cost intervention to reduce loss to follow-up rates among marginalized and hard-to-reach populations.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of a Methodological Manual for Economic Evaluations in Healthcare Decision-Making in Ecuador.","authors":"Ricardo Yajamín-Villamarín","doi":"10.1007/s41669-025-00585-z","DOIUrl":"https://doi.org/10.1007/s41669-025-00585-z","url":null,"abstract":"<p><p>This article provides an overview of Ecuador's Methodological Manual for Economic Evaluations of Health Technologies, emphasizing its importance, key methodological aspects, and relevance within the country's health technology assessment (HTA) framework. The manual establishes standardized guidelines for conducting economic evaluations, incorporating international best practices while adapting them to the national context. It outlines essential methodological components, including decision problem definition, economic evaluation types, cost estimation, use of decision models, and sensitivity analysis. Additionally, it highlights the role of quality-adjusted life years (QALYs) and cost-effectiveness thresholds in supporting evidence-based decision-making. Beyond its methodological contributions, the manual plays a crucial role in institutionalizing economic evaluations in Ecuador's healthcare system. By promoting transparency, consistency, and technical rigor, it strengthens the integration of economic evidence into policy decisions, ensuring efficient resource allocation. However, challenges persist, including limitations in technical capacity, data availability, and the need for further refinement of local cost-effectiveness thresholds and indirect cost valuation. This article also explores the broader policy implications of adopting the manual within Ecuador's HTA framework. Strengthening institutional capacity, improving data infrastructure, and fostering international collaboration will be essential to its successful implementation. By embedding economic evaluations into healthcare decision-making, Ecuador can enhance the sustainability of its health system, optimize expenditures, and improve access to cost-effective health technologies.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploratory Cost-Effectiveness of a Novel Bioprosthetic Valve for Surgical Aortic Valve Replacement in Spain.","authors":"María Ascaso, Daniel Pérez, Lourdes Montero, Jens Deckert, Andrea White, Paloma González, Marta Mengual, Seila Lorenzo-Herrero, Carlos Crespo, Sergio Cánovas","doi":"10.1007/s41669-025-00582-2","DOIUrl":"https://doi.org/10.1007/s41669-025-00582-2","url":null,"abstract":"<p><strong>Objectives: </strong>Limited information is available regarding the impact of valve choice for patients with aortic stenosis (AS) undergoing surgical aortic valve replacement (SAVR) in Spain. Herein, we aimed to explore the potential cost-effectiveness of a new bioprosthetic valve with RESILIA tissue versus mechanical alternatives from a Spanish healthcare perspective.</p><p><strong>Methods: </strong>Health outcomes, including quality-adjusted life years (QALYs), adverse events, and costs were estimated for two cohorts of patients with severe AS (aged ≥ 65 or 55-64 years) over a lifetime horizon employing a UK cost-effectiveness model adapted to Spanish clinical practice to compare a novel bioprosthesis versus mechanical alternatives. This model included a decision tree to describe short-term outcomes and a partitioned survival model to evaluate mortality and long-term outcomes. A panel of clinical experts validated the model methodology, including parameters and assumptions considered. Sensitivity analyses were performed to account for uncertainty.</p><p><strong>Results: </strong>The novel bioprosthetic valve led to cost savings for both cohorts (€6209/patient for age ≥ 65 years; €8289/patient for ages 55-64 years). These were mainly driven by a reduction in anticoagulation- and adverse event-associated resources, outweighing the costs derived from more reoperations estimated with the novel bioprosthetic valve. An observable increase in QALYs was detected in both age groups (0.0051 and 0.0191, respectively). Hence, the novel bioprosthetic valve is expected to be a dominant alternative for patients 55 years or older who are eligible for SAVR. It remained cost-effective in > 98% of sensitivity analyses.</p><p><strong>Conclusions: </strong>Our exploratory study indicates the novel RESILIA bioprosthetic valve as a potential alternative to mechanical valves for SAVR in patients 55 years or older can lead to budgetary cost savings and improved health outcomes in Spain.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness Analyses of Adolescent- and Young-Adult-Focused HIV Interventions Incorporating HIV Transmission: a Scoping Review of Modeling Methods and Proposed Guidance.","authors":"Wanyi Chen, Simeng Li, Carol Mita, Sarah E Rutstein, Audrey Pettifor, John Giardina, Kenneth Freedberg, Kimberly A Powers, Andrea Ciaranello, Anne M Neilan","doi":"10.1007/s41669-025-00583-1","DOIUrl":"https://doi.org/10.1007/s41669-025-00583-1","url":null,"abstract":"<p><strong>Background: </strong>Adolescents and young adults (AYA) are disproportionately affected by human immunodeficiency virus (HIV) globally, with high-burden population subgroups differing across regions. Cost-effectiveness modeling analyses of AYA-focused HIV interventions have provided vital information to policy makers by projecting long-term health and economic impacts of interventions' effects on reduced HIV transmission. To provide a broad overview of available modeling approaches and identify gaps in methods reporting, we evaluated modeling methodologies used in AYA-focused cost-effectiveness analyses incorporating HIV transmission.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and Web of Science for peer-reviewed articles that were published January 2006 to August 2023 and described models that considered HIV transmission in estimating cost-effectiveness of AYA-focused HIV prevention interventions. We extracted selected study characteristics, transmission model properties, and methods to estimate long-term health and economic outcomes. We assessed study quality using published guidelines.</p><p><strong>Results: </strong>Among 42 studies, 38% included individuals assigned male or female sex at birth, 19% included females only, and 43% included males only; 24% focused on AYA only; 88% were set in Africa; and 7% were restricted to certain population subgroups. The most common population subgroups examined were women who have transactional sex (24%) and men who have sex with men (17%). Most (88%) studied primary prevention interventions for people at risk of HIV; 29% examined secondary prevention interventions including treatment and testing. Most (98%) assessed incremental cost-effectiveness ratios (ICERs) were defined as incremental cost per incremental life year (either quality-adjusted or disability-adjusted), or cost per infection averted, or both. Of 24 different transmission models identified with distinct structures, 59% were dynamic. Of 20 studies that translated averted infections into long-term health benefit, 55% used their transmission models directly through assigning health utilities to modeled states. A total of 30 studies converted averted infections into long-term cost savings, among which, 73% used their transmission models directly by assigning costs to modeled states. Fewer than half captured age-specific sexual and care-engagement behaviors. Important gaps in quality included incomplete reporting of model validation and calibration results.</p><p><strong>Conclusions: </strong>We identified heterogeneous modeling approaches in cost-effectiveness analyses of AYA-focused HIV interventions incorporating transmission. Reporting of key elements could be improved. We propose additional criteria that could clarify choices around modeling approaches and strengthen the reporting of model validation and calibration results.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjusting Health State Utility Values for Multiple Conditions: Real-World EQ-5D-3L Data Modeling in Brazil.","authors":"Milene Rangel da Costa, Bráulio Dos Santos Júnior, Marisa da Silva Santos","doi":"10.1007/s41669-025-00586-y","DOIUrl":"https://doi.org/10.1007/s41669-025-00586-y","url":null,"abstract":"<p><strong>Background and objective: </strong>Decision analytical models are typically included in health economic evaluations to represent clinical pathways and enable the estimation of clinical and economic outcomes of health technologies. Clinical effects are frequently measured in terms of health-related quality of life and expressed as utility values. It is not rare that a health state in an analytical model simultaneously comprises more than one health condition. In this situation, the utility of each coexisting health condition could be combined using the additive, multiplicative, minimum, or adjusted decrement estimator (ADE) methods. However, there is no consensus about the best approach. This study aimed to compare different methods to estimate utility values for health states in which patients carry more than one health condition using data from the Brazilian population.</p><p><strong>Methods: </strong>Data were obtained from a multicentric cross-sectional evaluation study conducted in Brazil. Individuals completed the EQ-5D-3L questionnaire, a generic preference-based instrument that is used to obtain utility values, and were requested to disclose if they had any health conditions. Utilities were obtained according to the Brazilian value set. Four methods for adjusting joint utilities were tested: additive, multiplicative, minimum, and ADE. Observed and estimated utility values were compared for accuracy and bias.</p><p><strong>Results: </strong>A total of 5774 individuals were included in the analysis. The utility score (mean ± SE) was 0.8235 ± 0.1717. Lower utility scores were associated with an increased number of comorbidities, reaching 0.467 ± 0.192 for individuals with seven conditions. The minimum method produced accurate utility estimates for individuals with two simultaneous health conditions. For health states with more than two conditions, the multiplicative method presented more accurate estimates. Overall, fixing the baseline utility equal to the mean utility of healthy individuals produced less biased estimates compared with a baseline utility equal to 1.</p><p><strong>Conclusion: </strong>Depending on the utility data available and the number of concomitant conditions, different adjustment methods could be used that produce accurate estimates. For the adjustment of Brazilian utility values for health states with comorbidities, the minimum and multiplicative methods should be preferred if two or more than two conditions are present, respectively.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Evaluation of Patiromer in Patients with Concomitant Heart Failure and Chronic Kidney Disease in Italy.","authors":"M Senni, E Paoletti, Ewa Stawowczyk, M Hale, A Ramirez de Arellano","doi":"10.1007/s41669-025-00581-3","DOIUrl":"https://doi.org/10.1007/s41669-025-00581-3","url":null,"abstract":"<p><strong>Background: </strong>Hyperkalaemia (HK), in patients with heart failure (HF) with and without chronic kidney disease (CKD), is potentially life-threatening. Risk of HK is further heightened in those patients receiving renin-angiotensin-aldosterone system inhibitors (RAASi), used to reduce cardiovascular morbidity and mortality in HF. Patiromer, an oral potassium (K⁺) binder, has been shown to reduce the risk of HK and enable optimal RAASi dosing. We evaluated the cost-effectiveness of patiromer in HF patients with CKD in the Italian setting, utilising results from the recent DIAMOND clinical trial, which assessed long-term use of patiromer in HK management.</p><p><strong>Methods: </strong>An established Markov model was adapted to include data from DIAMOND using the National Health Service (NHS) perspective. In DIAMOND, patients received patiromer during a run-in period (up to 12 weeks) to achieve optimal RAASi without HK. However, this led to low mean K⁺ concentrations in the placebo arm, resulting from a legacy effect of patiromer in the run-in phase of the trial. Therefore, the DIAMOND population was adjusted to a real-world population to better represent the K⁺ levels in the standard of care (SoC) arm. Mean K⁺ concentration for baseline and the patiromer arm was calculated from the overall population at baseline (screening phase) and after treatment (end of run-in period), respectively. Lifetime trajectories were estimated for quality-adjusted life years (QALYs), life years (LYs) and costs.</p><p><strong>Results: </strong>The economic evaluation model calculated a discounted total average cost per patient of €109,900 for patiromer and €64,847 for SoC. Patiromer generated a gain of 1.97 LYs (1.55 QALYs) compared with SoC. The incremental cost-effectiveness ratio (ICER) for patiromer was €29,060/QALY gained versus SoC.</p><p><strong>Conclusion: </strong>Applying DIAMOND data, patiromer is deemed to be cost-effective at a willingness-to pay threshold of €40,000 per QALY gained in Italy.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs and Complications of Respiratory Syncytial Virus and Acute Respiratory Infections in the Adult Population: Analysis of a German Claims Database.","authors":"Pavo Marijic, Roman Kliemt, Martin Krammer, Nikolaus Kolb, Theo Last, Andreas Ambrosch, Santiago Ewig, Rembert Koczulla, Jörg Schelling, Claus Vogelmeier, Maria Waize, Manuela Stierl, Maria João Fonseca, Sara Pedron, Alen Marijam","doi":"10.1007/s41669-025-00565-3","DOIUrl":"10.1007/s41669-025-00565-3","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) infections pose health and economic burdens to adults. Using claims data, we estimated RSV-associated costs, healthcare resource utilization (HCRU), and complication rates from patients of a nationwide German health insurance database.</p><p><strong>Methods: </strong>We analyzed confirmed RSV, RSV-possible, and acute respiratory infection (ARI) cohorts, plus 1:1 matched control cohorts of individuals ≥ 18 years from 2010 to 2019. Matching was performed separately for patients 18-49, 50-59, and ≥ 60 years. Medical costs, HCRU, and sick leave were assessed for inpatients and outpatients. Complications were compared between cases and controls, and logistic regression assessed odds ratios (ORs) for risk.</p><p><strong>Results: </strong>Altogether, 2668 confirmed RSV index episodes occurred. In ≥ 60-year-olds, 862 episodes incurred mean excess costs of €3773 (95% confidence interval [CI]: €2956-€4591) per episode during the index quarter and €3286 (95% CI: €1841-€4732) in the following four quarters. Mean costs were €5553 per episode for inpatients and €116 for outpatients. In ≥ 60-year-olds, risk for congestive heart failure hospitalization (OR 2.3; 95% CI: 1.4-3.8), exacerbation of asthma (OR 6.0; 95% CI: 1.7-20.9), and chronic obstructive pulmonary disease (OR 3.9; 95% CI: 2.6-5.8) were higher for confirmed RSV than controls. In younger groups, costs, HCRU, and complications were also higher in cases than controls. The complication frequencies increased with age. RSV-possible episodes incurred mean excess costs of €615 (95% CI: €605-€626) during the index quarter and €610 (95% CI: €583-€637) during the following four quarters, while in the ARI cohort, the excess costs were €1003 (95% CI: €991-€1015) during the index quarter and €1003 (95% CI: €973-€1032) in the following four quarters. For all three cohorts, individuals who had comorbidities, were immunocompromised, or living in long-term care facilities incurred higher costs.</p><p><strong>Conclusions: </strong>Confirmed RSV is associated with high excess costs - especially in hospital settings - and HCRU. Complication risk increased with RSV presence.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":"445-459"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Effectiveness of Left Ventricular Assist Devices (LVADs) as Destination Therapy: A Systematic Review.","authors":"Tuba Saygın Avşar, Louise Jackson, Pelham Barton, Sophie Beese, Okeke Ogwulu Chidubem, Sern Lim, David Quinn, Malcolm J Price, David J Moore","doi":"10.1007/s41669-025-00564-4","DOIUrl":"10.1007/s41669-025-00564-4","url":null,"abstract":"<p><strong>Objectives: </strong>Left ventricular assist devices (LVADs) can extend life and improve quality of life among advanced heart failure patients ineligible for transplantation (destination therapy). High-quality evidence on the cost effectiveness of LVADs compared with optimal medical management is needed to inform policy. This study identifies economic evaluations of LVADs for destination therapy and assesses their methodological quality.</p><p><strong>Methods: </strong>The review followed Centre for Review and Dissemination guidelines for methods, and PRISMA standards for reporting, and was registered on PROSPERO (CRD42020158987). Six databases were searched for studies published up to October 2024. Full economic evaluations of LVADs for destination therapy were included. Two reviewers independently conducted study selection, data extraction and quality assessment using validated tools.</p><p><strong>Results: </strong>The study identified 14 economic evaluations, including 10 modelling studies. Most studies were from the US and UK. There was substantial variation in model structure, methods, and cost estimates. Only seven studies used a lifetime horizon. Resource use was typically estimated based on data from small single-centre samples. Overall quality was moderate due to key limitations such as insufficient time horizons, omitting complications and costs, and limited consideration of uncertainty. Only two studies examined severity, and none assessed cost effectiveness by patient age. Most studies found LVADs not to be cost effective compared with medical management except for two UK-based evaluations.</p><p><strong>Conclusion: </strong>This review reveals important limitations in the current evidence on the cost effectiveness of LVADs as destination therapy. More comprehensive, robust evaluations are needed to inform policy decisions.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":"351-363"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}