PharmacoEconomics Open最新文献

{"title":"Cost-Effectiveness of an Insertable Cardiac Arrhythmia Monitor after Non-ST-Elevation Myocardial Infarction in the UK.","authors":"Amy Dymond, E Barker, N Tsitiridis, A Schmetz, S Thompson Hilpert, C Jøns, S Behrens, P Søgaard, W Green","doi":"10.1007/s41669-025-00595-x","DOIUrl":"https://doi.org/10.1007/s41669-025-00595-x","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patients surviving a non-ST-elevation myocardial infarction (NSTEMI) have an elevated risk of future major adverse cardiovascular events (MACE), which can be mitigated through long-term cardiac arrhythmia monitoring. The present study evaluated the cost-effectiveness of continuous remote arrhythmia monitoring using an insertable cardiac monitor (ICM) combined with standard of care (SoC) compared with SoC alone.</p><p><strong>Methods: </strong>A cost-effectiveness analysis using a lifetime partitioned survival model was developed for high-risk NSTEMI patients from a UK National Health Service (NHS) perspective. Survival analysis was used to determine the transition of patients from the pre-MACE health state (where patients could experience arrhythmia, major bleeding, or systemic embolism) to the MACE health state (worsening heart failure, stroke, and acute coronary syndrome events). The survival analysis and arrhythmia diagnosis rates were informed by the BIO|GUARD-MI trial. The model captured direct costs associated with each MACE and implantation and removal of the ICM device and treatment costs following arrhythmia detection. The model captured the health implications for an ICM with SoC, compared with SoC alone, in terms of the total quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses were undertaken to explore the impact of parameter uncertainty on the model results.</p><p><strong>Results: </strong>The use of ICMs plus SoC for daily remote cardiac arrhythmia monitoring is cost effective, when compared with SoC alone, in high-risk NSTEMI patients over a lifetime horizon, with an incremental cost-effectiveness ratio of £7766 per QALY gained. The ICM was associated with an additional 0.184 QALYs per patient for an additional cost of £1430. The ICM remained cost effective during the deterministic and probabilistic sensitivity analyses.</p><p><strong>Conclusion: </strong>The addition of an ICM to SoC in high-risk NSTEMI patients is cost effective from the perspective of the UK NHS and would, therefore, be a further option for the management of such patients in clinical practice.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708416","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 Lecanemab for Early Symptomatic Alzheimer's Disease in South Korea.","authors":"Seungyeon Shin, Maryanne Kim, Song Hee Hong","doi":"10.1007/s41669-025-00593-z","DOIUrl":"https://doi.org/10.1007/s41669-025-00593-z","url":null,"abstract":"<p><strong>Background/objectives: </strong>Alzheimer's disease (AD) exerts a considerable economic burden on South Korea's aging population. Lecanemab, an amyloid-targeting therapy, has demonstrated efficacy in mitigating cognitive decline in early-stage AD but remains non-reimbursed in South Korea due to concerns over its economic feasibility. This study aimed to examine the cost-effectiveness of lecanemab using nationwide claims data for cost estimation within the South Korean healthcare system. Considering the substantial societal burden of AD, we also evaluated the cost-effectiveness of lecanemab from a limited societal perspective.</p><p><strong>Methods: </strong>A Markov state transition cohort model was developed to compare costs and outcomes of lecanemab combined with standard of care (SoC) versus SoC alone. The model simulated five stages of AD progression: mild cognitive impairment, mild AD, moderate AD, severe AD, and death. Transition probabilities between health states were derived from data provided by the National Alzheimer's Coordinating Center. Formal medical costs and long-term care costs were obtained from the national claims database, while drug cost and other medical expenses were derived from previous studies. Additional cost components such as opportunity cost of caregiver time, out-of-pocket expenses, and time and travel costs for hospital visits were included in the limited societal perspective. Korean-specific utilities for patients and caregivers differentiated by states of AD progression and care settings were obtained from the published literature. Effectiveness was measured in quality-adjusted life years (QALYs) over a lifetime horizon. Scenario analyses were conducted by varying compositions of the cohort, age of onset, and drug pricing.</p><p><strong>Results: </strong>The incremental cost-effectiveness ratio (ICER) of lecanemab combined with SoC was 198,171,820 Korean Won (KRW)/QALY from the healthcare payer perspective and 181,185,820 KRW/QALY from the limited societal perspective, which significantly exceeded South Korea's willingness-to-pay (WTP) threshold of 30 million KRW/QALY. Sensitivity analyses revealed that the ICER was highly influenced by variations in treatment effect and discount rates. The result of scenario analyses suggested that targeting lecanemab to patients with mild AD or implementing price reductions could substantially improve its cost-effectiveness.</p><p><strong>Conclusions: </strong>Lecanemab's high cost poses a challenge to its inclusion in the National Health Insurance formulary under South Korea's current WTP thresholds. Strategic price adjustments and patient targeting are essential to enhance its economic viability. These findings provide valuable insights for policymakers and stakeholders in balancing treatment outcomes and resource allocation for AD management.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675469","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":"Missing Pieces of the Puzzle to Address Market Failures for Antibiotics: Delinked Payment Systems and Insurance Value.","authors":"Neil Hawkins, Adrian Towse, Amanda Adler","doi":"10.1007/s41669-025-00591-1","DOIUrl":"https://doi.org/10.1007/s41669-025-00591-1","url":null,"abstract":"<p><p>Too few companies develop new antibiotics because of the threat of market failure. To address this, a 'delinked' payment, distinct from the usual payment model for drugs, makes payments to manufacturers that do not depend on the volume of antibiotic prescribed. A delinked system removes incentives to overpromote antibiotic use. If total payments are high enough, this system should provide incentives for manufacturers to develop new antibiotics. This assumes that using antibiotics remains consistent with antimicrobial stewardship, a coordinated approach to prescribing antimicrobials responsibly. A delinked system can address market failure that occurs when a disproportionate degree of clinical benefit from a new antibiotic occurs after patent protection ends, reducing the 'reward' to the innovator. Determining value in a delinked payment system requires that the health service estimates the lifetime value of an antimicrobial product, and then decides what proportion of that value to include. These values depend in part on 'STEDI' values including the 'insurance' value new antibiotics would offer in reducing society's risk of major health loss from possible future major episodes of antibiotic resistance. Estimating insurance value requires estimating the health consequences of catastrophic outcomes. Payments in a delinked system can incorporate an 'insurance premium'. We use the example of the UK's delinked payment scheme to illustrate issues and solutions.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554130","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":"Using Generative Artificial Intelligence in Health Economics and Outcomes Research: A Primer on Techniques and Breakthroughs.","authors":"Tim Reason, Sven Klijn, Will Rawlinson, Emma Benbow, Julia Langham, Siguroli Teitsson, Kasper Johannesen, Bill Malcolm","doi":"10.1007/s41669-025-00580-4","DOIUrl":"10.1007/s41669-025-00580-4","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The emergence of generative artificial intelligence (GenAI) offers the potential to enhance health economics and outcomes research (HEOR) by streamlining traditionally time-consuming and labour-intensive tasks, such as literature reviews, data extraction, and economic modelling. To effectively navigate this evolving landscape, health economists need a foundational understanding of how GenAI can complement their work. This primer aims to introduce health economists to the essentials of using GenAI tools, particularly large language models (LLMs), in HEOR projects. For health economists new to GenAI technologies, chatbot interfaces like ChatGPT offer an accessible way to explore the potential of LLMs. For more complex projects, knowledge of application programming interfaces (APIs), which provide scalability and integration capabilities, and prompt engineering strategies, such as few-shot and chain-of-thought prompting, is necessary to ensure accurate and efficient data analysis, enhance model performance, and tailor outputs to specific HEOR needs. Retrieval-augmented generation (RAG) can further improve LLM performance by incorporating current external information. LLMs have significant potential in many common HEOR tasks, such as summarising medical literature, extracting structured data, drafting report sections, generating statistical code, answering specific questions, and reviewing materials to enhance quality. However, health economists must also be aware of ongoing limitations and challenges, such as the propensity of LLMs to produce inaccurate information ('hallucinate'), security concerns, issues with reproducibility, and the risk of bias. Implementing LLMs in HEOR requires robust security protocols to handle sensitive data in compliance with the European Union's General Data Protection Regulation (GDPR) and the United States' Health Insurance Portability and Accountability Act (HIPAA). Deployment options such as local hosting, secure API use, or cloud-hosted open-source models offer varying levels of control and cost, each with unique trade-offs in security, accessibility, and technical demands. Reproducibility and transparency also pose unique challenges. To ensure the credibility of LLM-generated content, explicit declarations of the model version, prompting techniques, and benchmarks against established standards are recommended. Given the 'black box' nature of LLMs, a clear reporting structure is essential to maintain transparency and validate outputs, enabling stakeholders to assess the reliability and accuracy of LLM-generated HEOR analyses. The ethical implications of using artificial intelligence (AI) in HEOR, including LLMs, are complex and multifaceted, requiring careful assessment of each use case to determine the necessary level of ethical scrutiny and transparency. Health economists must balance the potential benefits of AI adoption against the risks of maintaining current practices, while also considering issues such ","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":"501-517"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022846","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-Benefit Analysis of the Enhancing Men's Awareness of Testicular diseases (E-MAT) Feasibility Trial: A Virtual Reality Experience to Increase Testicular Knowledge and Self-Examination among Male Athletes.","authors":"Aileen Murphy, Ann Kirby, Federica De Blasio, Megan McCarthy, Frances Shiely, Josephine Hegarty, Martin P Davoren, Janas M Harrington, Gillian W Shorter, David Murphy, Billy O'Mahony, Eoghan Cooke, Michael J Rovito, Steve Robertson, Serena FitzGerald, Alan O Connor, Mícheál O Riordan, Mohamad M Saab","doi":"10.1007/s41669-025-00571-5","DOIUrl":"10.1007/s41669-025-00571-5","url":null,"abstract":"<p><strong>Background: </strong>Virtual reality (VR) is potentially effective in raising awareness of testicular diseases, promoting self-examination and early help-seeking among men. This paper presents an early economic evaluation exploring the potential cost-effectiveness of Enhancing Men's Awareness of Testicular diseases (E-MAT)_VR, a VR interactive experience compared with E-MAT_E, electronic information, among male athletes Results from this economic evaluation will inform and support the design of a future randomized controlled trial (RCT).</p><p><strong>Methods: </strong>Results from an Irish feasibility trial (ClinicalTrials.gov identifier: NCT05146466) with 74 participants conducted in 2022 were employed. Benefits were measured in monetary units whereby the contingent valuation method was used to elicit participants' preferences through willingness-to-pay measures. A micro-cost analysis estimated the costs of the intervention and comparator and subsequent resource use. The costs and benefits of E-MAT_VR and E-MAT_E were compared to determine the net benefit. Sensitivity analyses were also conducted.</p><p><strong>Results: </strong>Base case analysis suggests participants were willing to pay €21.88 for E-MAT_VR and €11.16 for E-MAT_E. The total cost of E-MAT_VR was €104.09 and of E-MAT_E was €22.75 per participant. These estimates include capital and delivery costs, of which delivery costs were €25.02 and €22.40 for E-MAT_VR and E-MAT_E, respectively. A negative net benefit indicates E-MAT_VR was not cost-beneficial as delivered in the feasibility trial. Scenario analyses demonstrated reducing costs via delivery modifications increased the probability of E-MAT_VR being considered cost-effective. The cost-benefit analysis was feasible, response rates were acceptable, and willingness-to-pay estimates were stable.</p><p><strong>Conclusions: </strong>Economic evaluations alongside feasibility trials enable early economic evaluations, informing the design and conduct of a future RCT. E-MAT_VR had higher expected benefits (WTP) and costs than E-MAT_E, yielding a negative net benefit. Given the high cost of digital health interventions, investigating their cost-effectiveness early is important to inform and optimize resource allocation decisions. We present a series of scenarios to demonstrate how delivery modifications to reduce costs could improve the likelihood of E-MAT_VR being considered cost-effective.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":"671-682"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664018","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 Ultrasound Renal Denervation for Resistant Hypertension in Belgium, France and The Netherlands.","authors":"Rod S Taylor, Kaylie Metcalfe, Antoine Cremer, Sofie Brouwers, Joost Daemen, Sam Carter, Kieran Murphy, Marie-Claude Morice, Isabelle Durand-Zaleski, Linh Ngo, Michel Azizi, Ajay J Kirtane","doi":"10.1007/s41669-025-00574-2","DOIUrl":"10.1007/s41669-025-00574-2","url":null,"abstract":"<p><strong>Background: </strong>Endovascular ultrasound renal denervation (uRDN) with the Paradise System has emerged as an adjunctive treatment option for the management of uncontrolled resistant hypertension (rHTN). This study assesses the cost-effectiveness of uRDN for rHTN across three European countries-Belgium, France and the Netherlands.</p><p><strong>Methods: </strong>On the basis of a previously developed state-transition Markov model, we projected costs, life years (LYs) and quality adjusted life years (QALYs) with the addition of uRDN to standard of care (SoC) compared with SoC alone over patient lifetime. Analyses were based on the RADIANCE-HTN TRIO trial, which demonstrated a mean reduction in office systolic blood pressure from a baseline of 8.5 mmHg at 2 months post-uRDN among patients with rHTN. Mortality and costs data were separately sourced and applied for each country independently. Country-specific discount rates were applied to both cost and outcomes. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty surrounding the model inputs and sensitivity of the model results to changes in parameter inputs. Results were reported as incremental cost-effectiveness ratios (ICERs).</p><p><strong>Results: </strong>The base-case analyses of the models for all three countries show uRDN plus SoC results in improvement in both LYs and QALYs per patient and higher costs compared with SoC alone. The mean ICERs for each country model fall well below the respective country-specific willingness-to-pay thresholds (WTPs)-Belgium: WTP €40,000 and ICER €4426/QALY gained; France: WTP €50,000 and ICER €6261/QALY gained; and the Netherlands: WTP €20,000 and ICER €1654/QALY gained. Results were robust across scenarios and sensitivity analyses.</p><p><strong>Conclusions: </strong>The addition of endovascular uRDN offers clinicians and payers a cost-effective adjunctive treatment approach alongside hypertensive medication for the management of rHTN in the healthcare systems of Belgium, France and the Netherlands.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":"585-595"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985994","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":"A Systematic Literature Review of the Economic and Healthcare Resource Utilization Burden of Relapsed/Refractory Follicular Lymphoma.","authors":"Bijal Shah, Mei Xue, Wesley Furnback, Erlene K Seymour, Jin Kim, Po-Ya Chuang, Madeline Dec, Keri Yang","doi":"10.1007/s41669-025-00577-z","DOIUrl":"10.1007/s41669-025-00577-z","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the economic or healthcare resource utilization (HCRU) burden and examine the value of interventions for relapsed or refractory (R/R) follicular lymphoma (FL).</p><p><strong>Methods: </strong>The PubMed and Embase databases were searched for full-text studies and conference abstracts published between 1 January 2019 and 31 December 2023 that reported either the economic or HCRU burden of R/R FL or reported the results of health economic models assessing interventions for R/R FL. A supplemental manual search was also undertaken to identify conference abstracts that may not have been indexed in the primary databases. A data extraction sheet was used to develop evidence tables.</p><p><strong>Results: </strong>A total of 30 records were included spanning 11 retrospective or prospective studies, 11 cost-effectiveness evaluations, and 8 other economic models. Costs and HCRU generally tended to increase as the line of therapy increased, reaching over US$400,000 annually in later lines. Costs associated with recently approved chimeric antigen receptor T-cell therapy (CAR-T) ranged from US$450,000 to over US$700,000 per patient. Economic models evaluating novel therapies, such as CAR-T, tazemetostat, and mosunetuzumab, estimated they would generally be cost-effective and have minimal budget impact or cost-savings. However, these models noted considerable assumptions regarding treatment duration and discontinuation. Real-world costs and resource use for newly approved therapies including CAR-Ts and bispecifics were limited.</p><p><strong>Conclusions: </strong>The burden of R/R FL is substantial and increases as patients progress. Considerable gaps exist for the real-world impact of novel therapies, including CAR-Ts and bispecifics, on the economic burden and will need to be studied to properly assess their value.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":"541-570"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034466","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":"Measuring the Socioeconomic Impact of Cancer: A Systematic Review and Standardized Assessment of Patient-Reported Outcomes (PRO) Instruments.","authors":"Phu Duy Pham, Jasper Ubels, Rachel Eckford, Michael Schlander","doi":"10.1007/s41669-025-00568-0","DOIUrl":"10.1007/s41669-025-00568-0","url":null,"abstract":"<p><strong>Background: </strong>A number of instruments have been developed to measure the socioeconomic impact (SEI) of cancer. A standardized comparison of the quality and content validity of these instruments is lacking. This study aimed to (1) conduct a standardized assessment of the quality of SEI instruments and (2) assess the content validity of these instruments using the conceptual framework developed by the Organization of European Cancer Institutes (OECI) for SEI analysis.</p><p><strong>Method: </strong>We identified articles measuring the SEI of cancer with ad hoc and/or validated instruments from an existing database. These articles were the initial pearls in a systematic review of published articles that applied and validated these instruments using the pearl-growing search strategy in PubMed, Web of Science, and Google Scholar databases. The Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool was utilized to provide quantitative assessment and comparison of the quality of identified instruments. To examine content validity, we allocated each instrument's items against the themes and sub-themes of the established conceptual framework for SEI analysis.</p><p><strong>Results: </strong>We identified and investigated 21 validation studies using nine original instruments. The number of articles varied significantly among the identified instruments. The COmprehensive Score for financial Toxicity (COST) instrument was the most frequently used, validated in ten different settings, whereas some newer instruments have not been applied yet. This variation resulted in significant differences in EMPRO overall scores among these instruments. Regarding content validity, we found that not all themes of the OECI framework were covered by the content of the instruments.</p><p><strong>Conclusion: </strong>The quality and the application of instruments measuring the SEI of cancer varied significantly. The content of the instruments seems not to cover all related themes of the applied OECI framework in this study. Further studies are warranted to confirm the quality and content validity of the instruments measuring the SEI of cancer.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":"519-539"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780613","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":"Effects of Generic Entry on Market Shares and Prices of Originator Drugs: Evidence from Chinese Pharmaceutical Market.","authors":"Weimiao Li, Xiaoyu Li, Yaoguang He, Luwen Shi, Jing Chen","doi":"10.1007/s41669-025-00570-6","DOIUrl":"10.1007/s41669-025-00570-6","url":null,"abstract":"<p><strong>Objectives: </strong>This article analyzes how market shares and prices for brand-name drugs are affected by generic competition in China.</p><p><strong>Methods: </strong>Data were collected for originator drugs that experienced initial generic entry between 2006 and 2016 from China Medicine Economic Information (CMEI), a large database of drug procurement records covering 699 tertiary hospitals across 28 provinces in mainland China. Quarterly utilization and expenditure data were collected. We compared the change of market share and price of originator drugs eight quarters after the first generic entry. General linear regression was performed to analyze the factors that influence the market share and price of originator drugs.</p><p><strong>Results: </strong>A total of 15 of 27 originator drugs maintained over 70% market share eight quarters after the first generic entry. In addition, 24 brand-name companies lowered prices with an average price decrease of 3% eight quarters after the first generic competitor appeared; prices for 3 drugs rose by an average of 0.62%. The median price ratio between originator and generic drugs was 1.76 when the first generic substitution entered, and the ratio became 2.00 eight quarters later. Regression showed that the number of generic manufacturers and time interval since the first generic entry exhibited a negative relation with the market share of originator drugs (P < 0.01; P < 0.01), and no relation with the prices of originator drugs (P = 0.61; P = 0.42).</p><p><strong>Conclusions: </strong>Generic medicines in China had only modest market penetration and little effect on originator drugs' prices eight quarters after first generic entry.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":"639-648"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664043","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 Analysis of Molnupiravir Versus Best Supportive Care for the Treatment of Outpatient COVID-19 in High-Risk Older Adults in Japan.","authors":"Hardik Goswami, Atsushi Tajima, Taizo Matsuki, Amy Puenpatom","doi":"10.1007/s41669-025-00578-y","DOIUrl":"10.1007/s41669-025-00578-y","url":null,"abstract":"<p><strong>Objectives: </strong>This analysis aimed to evaluate the cost effectiveness of molnupiravir versus best supportive care for the treatment of older adult patients (aged ≥ 65 years) in Japan with mild to moderate COVID-19 who are at risk of disease progression leading to hospitalization, predominantly using input data derived from the Omicron era of the SARS-CoV2 pandemic.</p><p><strong>Methods: </strong>A decision-analytic model was developed, comprising a decision-tree model for the acute COVID-19 phase (30 days), followed by a lifetime Markov model. Inputs used to parametrize the model were derived from a database study conducted in Japan and a published systematic literature review of real-world studies, and from ad-hoc literature searches and other research (for disease progression, cost, and utility estimates). This analysis modelled death averted due to COVID-19 hospitalization as an indirect effect of molnupiravir (through preventing hospitalization). Costs were expressed in 2022 Japanese yen (¥; JPY), from the perspective of payers (the base case) or society (in a scenario analysis). Costs and QALYs were discounted at 2% per year. Cost effectiveness of molnupiravir versus best supportive care was primarily compared to a willingness-to-pay (WTP) threshold of ¥5,000,000 per quality-adjusted life year (QALY) gained.</p><p><strong>Results: </strong>Treatment with molnupiravir is associated with a QALY gain of 0.018 and an incremental cost of ¥81,472 over best supportive care and is cost effective (with an incremental cost-effectiveness ratio [ICER] of ¥4,638,477) versus best supportive care based on the predefined WTP threshold of ¥5,000,000 per QALY gained. Molnupiravir leads to a reduction in the proportion of patients who die due to COVID-19 hospitalization (0.09% with molnupiravir vs 0.29% with best supportive care). Molnupiravir is also associated with lower costs associated with COVID-19 hospitalizations compared with best supportive care (¥22,527 vs ¥27,472). In a deterministic sensitivity analysis, the top five most sensitive parameters were baseline hospitalization rate, mortality benefit of molnupiravir, mortality rate in general ward, discount rate, and mortality rate in intensive care unit. In a probabilistic sensitivity analysis, at the predefined WTP threshold of ¥5,000,000 per QALY gained, molnupiravir had an 80% probability of being cost effective versus best supportive care.</p><p><strong>Conclusions: </strong>Molnupiravir is a cost-effective treatment option for the treatment of older adult outpatients (age ≥ 65 years) with symptomatic COVID-19 in Japan, relative to best supportive care.</p>","PeriodicalId":19770,"journal":{"name":"PharmacoEconomics Open","volume":" ","pages":"571-584"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005178","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}