ClinicoEconomics and Outcomes Research最新文献

{"title":"The HIV Epidemic in the United States - Epidemiological Projections and Public Economic Impact of Achieving Zero Transmission Goals.","authors":"Cillian Copeland, Rui Martins, Ryan Thaliffdeen, Nikos Kotsopoulos, James Jarrett, Paresh Chaudhari, Uche Mordi, Maarten J Postma","doi":"10.2147/CEOR.S565189","DOIUrl":"10.2147/CEOR.S565189","url":null,"abstract":"<p><strong>Background: </strong>The United States (US) HIV/AIDS strategy has targeted a 90% reduction in HIV infections by 2030. Whilst progress has been made in US HIV policy, the persistence of nearly 32,000 new infections annually highlights substantial barriers that still hinder effective treatment and the achievement of national targets. While the humanistic burden of HIV is well documented, there are broader economic effects on employment, disability and retirement. The objective of this study is to evaluate these economic gains when improving various HIV policies.</p><p><strong>Methodology: </strong>This analysis adapts a published Markov model assessing the role of six key policy parameters related to diagnosis, pre-exposure prophylaxis (PrEP) uptake, treatment initiation, and treatment as prevention (TasP) on the HIV epidemic in the US. Improvements in these parameters were explored to estimate averted HIV infections over 50 years and, subsequently, the feasibility of achieving the 2030 target of a 90% reduction in HIV incidence.A fiscal economic framework was also applied, linking HIV cases and policy targets to productivity, tax revenue, transfer benefits, and healthcare costs incurred by the US government.</p><p><strong>Results: </strong>Results were calculated for the general US population and for men who have sex with men (MSM), a subgroup experiencing a high HIV burden. For the general US population, policy improvements led to an average of 5,324 averted HIV infections annually over the 50-year horizon, corresponding to a total net annual fiscal gain of $397 million or $74,511 per averted infection. For the MSM subgroup, 911 infections were averted annually resulting in a net fiscal gain of $96 million, or $105,031 per averted infection.</p><p><strong>Conclusion: </strong>This analysis demonstrates that the benefits of HIV policy are not limited to the healthcare setting and show how initial investments provide long-term benefits by preventing HIV transmission and the associated impact on individuals' labor market outcomes. While relying on assumptions and projections that may not capture all real-word complexities, fiscal analyses can provide a useful tool for policy evaluation that facilitate a holistic assessment of the wider costs and benefits that fall on governments as well as benefits of achieving policy targets.</p>","PeriodicalId":47313,"journal":{"name":"ClinicoEconomics and Outcomes Research","volume":"17 ","pages":"755-769"},"PeriodicalIF":2.6,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12558104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145393551","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":"Retrospective Study of Real-World Treatment Patterns of Subcutaneous Semaglutide Use Among Patients with Metabolic Dysfunction-Associated Steatohepatitis in the United States.","authors":"Yestle Kim, Ni Zeng, Jessamine P Winer-Jones, Machaon Bonafede, Francis Lobo, John O'Donnell, Taylor Ryan","doi":"10.2147/CEOR.S546841","DOIUrl":"10.2147/CEOR.S546841","url":null,"abstract":"<p><strong>Background: </strong>Interim results from the ESSENCE clinical trials indicate that 72-week treatment with high-dose subcutaneous (SC) semaglutide may result in metabolic dysfunction-associated steatohepatitis (MASH) resolution and improvements in fibrosis. As some patients with MASH have been prescribed SC semaglutide for the treatment of comorbid type 2 diabetes and/or obesity, this study assessed real-world 72-week treatment patterns among patients with MASH.</p><p><strong>Methods: </strong>In a linked electronic health records (Veradigm Network EHR) and claims (Komodo Health) dataset, adults (≥18 years old) with a MASH diagnosis, who initiated treatment with SC semaglutide between 7/1/2018 and 6/30/2023, were identified. Other causes of liver disease (eg, viral hepatitis) or severe complications (eg, cirrhosis) were excluded. The study period included ≥52 weeks before and ≥72 weeks after the first SC semaglutide claim. A subgroup analysis was conducted among those who received the brand approved for 2.4 mg/week dosage (SC semaglutide 2.4) and among people at risk for MASH. Patient characteristics and treatment patterns are reported.</p><p><strong>Results: </strong>This study identified 6,537 patients with MASH, who initiated treatment with SC semaglutide, 358 of whom received only the brand approved for 2.4 mg/week dosage. Patients were ~50 years old, and a majority were female. Non-persistence occurred in 68.4% of the overall SC semaglutide cohort and 78.5% of the SC semaglutide 2.4 subgroup. The mean time to non-persistence was 24.8 (19.3) and 20.1 (16.9) weeks in the SC semaglutide and SC semaglutide 2.4 groups, respectively. In the SC semaglutide 2.4 subgroup, 182 patients (50.8%) reached the recommended dosage of 2.4 mg/week, and 28 (7.8%) reached the recommended dosage within the first 16 weeks and sustained that dosage for ≥56 weeks. Trends were similar among patients at risk for MASH.</p><p><strong>Conclusion: </strong>In a real-world setting, very few patients achieved the treatment regimen associated with MASH resolution and improvements in fibrosis.</p>","PeriodicalId":47313,"journal":{"name":"ClinicoEconomics and Outcomes Research","volume":"17 ","pages":"743-754"},"PeriodicalIF":2.2,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12554272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379428","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 Real-World Treatment Effectiveness and Economic and Humanistic Burden in Patients With Muscle-Invasive Bladder Cancer Who Underwent Radical Cystectomy.","authors":"Vanessa Shih, Lei Yin, Eleni Theodorou, Ryan Dillon, Sam J Brancato, Lily Hamilton, Heidi S Wirtz","doi":"10.2147/CEOR.S532071","DOIUrl":"10.2147/CEOR.S532071","url":null,"abstract":"<p><strong>Purpose: </strong>Treatment options for muscle-invasive bladder cancer (MIBC) are generally limited to radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC), adjuvant chemotherapy (AC), or immunotherapy. To contextualize emerging data on novel therapies, a systematic literature review (SLR) was conducted to evaluate real-world treatment effectiveness and economic and humanistic burden in patients with MIBC who received RC with or without systemic therapy.</p><p><strong>Methods: </strong>Literature searches identified studies (published January 2018-June 2023) in adult patients with MIBC who received RC in the US, Germany, France, Italy, Spain, and the UK and reported effectiveness, economic burden, or humanistic burden.</p><p><strong>Results: </strong>Of 4192 references identified, 61 reported real-world effectiveness, 12 economic burden, and 5 humanistic burden. No studies on immunotherapy were identified. Reported median overall survival (OS) ranged from 0.7 to 8.3 years with RC alone (n=9), 1.8-7.5 years with NAC+RC (n=6), and 1.5-6.1 years with RC+AC (n=7). Hospital stays for RC had median length of 5-10 days (n=5) and cost >$34,000 in the US. Health-related quality of life (HRQOL) was reported during 1 to 2 years post RC (n=5), but approximately 40% of patients continued to experience high psychosocial distress or low HRQOL.</p><p><strong>Conclusion: </strong>Real-world studies have reported modestly longer survival with NAC or AC over RC alone; however, rates of disease recurrence were high and OS remained poor. Given this and the high economic burden for patients with MIBC, more effective therapies are needed.</p>","PeriodicalId":47313,"journal":{"name":"ClinicoEconomics and Outcomes Research","volume":"17 ","pages":"729-742"},"PeriodicalIF":2.2,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12553346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373185","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":"Budget Impact Analysis of Botulinum Toxin Type A for Patients with Severe Blepharospasm in Thailand.","authors":"Parima Hirunwiwatkul, Unchalee Permsuwan, Sureerat Ngamkiatphaisan, Niphon Chirapapaisan, Jiruth Sriratanaban","doi":"10.2147/CEOR.S540982","DOIUrl":"10.2147/CEOR.S540982","url":null,"abstract":"<p><strong>Objective: </strong>Severe blepharospasm is a disabling neurological condition that significantly affects patients' quality of life. Botulinum toxin type A (BoNT-A) is considered the standard treatment due to its targeted therapeutic effect and fewer systemic side effects compared to oral medications. However, its high cost poses a barrier to access within Thailand's healthcare system. This study aimed to assess the budget impact of introducing BoNT-A treatment (Onabotulinumtoxin A and Abobotulinumtoxin A) compared with current oral medications for severe blepharospasm in Thailand.</p><p><strong>Methods: </strong>A budget impact model was developed from the perspective of Thailand's healthcare system over a 5-year time horizon. The current scenario (oral medications use) was compared with a new scenario involving BoNT-A treatment. The costs considered included drug acquisition, outpatient visits, and accident-related injuries. The base-case assumed gradual uptake of BoNT-A (30% in year 1, 50% in year 2, and 100% from year 3). Sensitivity analyses explored full uptake from year 1, no dose sharing, and inclusion of injury-related costs.</p><p><strong>Results: </strong>Excluding injury-related costs, the 5-year net budget impact (NBI) was 7.91 million THB (223,040 USD) for onabotulinumtoxin A and 7.27 million THB (205,064 USD) for abobotulinumtoxin A. Including injury-related costs reduced the NBI to 4.20 million THB (118,564 USD) and 3.57 million THB (100,588 USD), respectively. Without dose sharing, the NBI rose significantly, reaching 40.5 million THB (1.14 million USD) for abobotulinumtoxin A.</p><p><strong>Conclusion: </strong>BoNT-A treatment increases healthcare costs, primarily due to drug costs. However, reduced injury costs and dose-sharing strategies may enhance affordability and support BoNT-A's inclusion in Thailand's National List of Essential Medicine.</p>","PeriodicalId":47313,"journal":{"name":"ClinicoEconomics and Outcomes Research","volume":"17 ","pages":"717-728"},"PeriodicalIF":2.2,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12523557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309542","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":"Retrospective Database Analysis of the Clinical and Economic Outcomes Associated with Disruptive Surgical Bleeding.","authors":"Mosadoluwa Afolabi, Prathiksha N V, Amitha Kumar, Walter A Danker Iii, Stephen S Johnston","doi":"10.2147/CEOR.S549490","DOIUrl":"10.2147/CEOR.S549490","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the clinical and economic outcomes associated with disruptive surgical bleeding (ie, hemorrhage/hematoma that complicates a procedure despite the use of hemostatic agents) among patients with bariatric, colorectal, spine, total hip arthroplasty (THA), and total knee arthroplasty (TKA) surgery.</p><p><strong>Methods: </strong>Premier Healthcare Database patients aged ≥18 with one of the five procedures and hemostatic agent use between January 1-December 31, 2019, were included. Clinical and economic outcomes (ie, operating room time, 90-day all-cause inpatient readmission, in-hospital mortality, intensive care unit [ICU] admission/duration, ventilator use, hospital costs, and length of stay [LOS]) were compared between patients with and without disruptive surgical bleeding. Multivariable analyses adjusted for differences in baseline characteristics.</p><p><strong>Results: </strong>Among 119,994 patients meeting inclusion criteria, 10.8% had disruptive surgical bleeding despite the use of hemostatic agents (bariatric surgery 5.4%, colorectal surgery 20.0%, spine surgery 11.0%, THA 11.5%, TKA 5.6%). Disruptive bleeding was associated with significantly longer operating room times for bariatric, colorectal, and spine surgery (incremental increases 42.3-62.4 minutes; p≤0.001), increased 90-day all-cause readmission risks for bariatric and spine surgery (incremental absolute risk increases 4.1% bariatric, 0.7% spine; both p=0.011), and increased inpatient mortality risk for all procedures except TKA (incremental absolute risk increases 0.2-55.0%; p≤0.001). ICU admission risks were increased for all procedures except TKA (incremental absolute risk increases 3.0-21.4%; p≤0.05), and ICU days were increased for bariatric, colorectal, and spine surgery (incremental increases 0.8-2.8 days; p≤0.001). Risks for ventilator use were higher for all procedures except THA (incremental absolute risk increases 3.5-25.2%; p≤0.05). Disruptive bleeding increased hospital costs (incremental increases $3,377-$23,346; p≤0.05) and LOS (incremental increases 1.0-4.9 days; p≤0.05) for all five procedures.</p><p><strong>Conclusion: </strong>The clinical and economic burden of disruptive bleeding despite hemostatic agent use among patients with bariatric, colorectal, spine, THA, and TKA surgery was substantial, highlighting the need for improved surgical bleeding interventions.</p>","PeriodicalId":47313,"journal":{"name":"ClinicoEconomics and Outcomes Research","volume":"17 ","pages":"705-716"},"PeriodicalIF":2.2,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12509958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281238","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":"Improving Efficiency and Safety with Prefilled Syringes: A Model-Based Economic Evaluation for US Healthcare Settings.","authors":"Matthias Borms, Ashley Taneja, Mia Weiss, Haymen Girgis, Cecile Frolet, Julia D Lucaci","doi":"10.2147/CEOR.S544296","DOIUrl":"10.2147/CEOR.S544296","url":null,"abstract":"<p><strong>Background: </strong>Prefilled syringes provide an opportunity to improve clinical safety and operational efficiency in hospital settings, especially amid mounting and ongoing challenges such as staff shortages, escalating drug costs, and increasing importance of safe medication administration. Despite these potential benefits, adoption remains limited. This study develops an economic model to assess the clinical and financial impacts of switching from conventional vial-and-syringe methods to prefilled syringes in United States (US) hospitals' intensive care units (ICU).</p><p><strong>Methods: </strong>To address the gap between the potential benefits of prefilled syringes and their limited adoption, an economic model was developed to help decision-makers make informed choices based on the clinical and financial impact of switching to prefilled syringes in US ICUs. The model used peer-reviewed literature and hospital practices around the most utilized dosages in a US hospital. To illustrate model utility, three hypothetical ICU cases were developed: administering 30 daily doses of atropine 1mg/10mL, epinephrine 1mg/10mL, and ephedrine 25mg/10mL. Sensitivity analyses were performed to test model robustness.</p><p><strong>Results: </strong>Switching to prefilled syringes resulted in annual cost savings of $729,912 for atropine, $786,502 for epinephrine, and $709,772 for ephedrine. The model estimated annual savings to be $696,551 due to fewer pADEs, along with savings of $53,411, $89,744 and $50,244 annually, due to unused drug wastage reduction for each drug, respectively. Hospital staff preparation time decreased by 255 hours for atropine, 285 for epinephrine and 227 hours for ephedrine per year. Sensitivity analyses confirmed the robustness of the model by varying drug wastage rates, with potential savings of up to $740,443, $795,894 and $724,757 for each drug, respectively, showing the model's adaptability across different ICU scenarios.</p><p><strong>Conclusion: </strong>This model suggests prefilled syringes may help hospitals address pharmacy operational challenges by reducing preparation time, drug wastage, and pADEs. They offer a practical approach to support safer and more efficient medication delivery in clinical settings.</p>","PeriodicalId":47313,"journal":{"name":"ClinicoEconomics and Outcomes Research","volume":"17 ","pages":"673-685"},"PeriodicalIF":2.2,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259671","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":"Prevalence & Economic Burden of Adult Spinal Deformity in a Large United States Commercial Payer Population.","authors":"Jayme C B Koltsov, Stacey J Ackerman, Kelly H McFarlane, Sanket Mehta, Marsalis Brown, Michael J Gardner, Serena S Hu, David W Polly","doi":"10.2147/CEOR.S546619","DOIUrl":"10.2147/CEOR.S546619","url":null,"abstract":"<p><strong>Purpose: </strong>Evaluate the prevalence and economic burden of adult spinal deformity (ASD) in a large, United States (US) commercial payer population.</p><p><strong>Patients and methods: </strong>Patients aged 21-64 having an encounter with an ASD diagnosis from the Merative^TM Marketscan^® Commercial Databases 2016-2022 were included to calculate prevalence. The economic burden cohort included those with an outpatient ASD encounter and no spine surgery within the prior year. Continuous health plan enrollment was required for tracking. Expenditures are tabulated from the payer and societal perspectives (2023 US$) and rates of utilization and expenditures are reported overall and by service category.</p><p><strong>Results: </strong>Annual ASD prevalence was 0.50%. 169,855 patients (46±13 years, 67.7% female) had an outpatient ASD encounter and were included in the economic burden cohort. Total spine-related payer expenditures averaged $7,619 (95% CI; $7,438, $7,800) per patient within 1 year - a payer burden of $3.8 million per 100,000 commercially-insured beneficiaries. Spine-related societal expenditures were $8,759 ($8,570, $8,947) per patient within 1 year - a societal burden of $6.2 billion among the US commercially-insured population. Nonoperative costs comprised 44% of the 1-year payer burden and 48% of the societal burden. While surgical treatment rates were low (3.5% fusions and 2.9% decompressions within 1 year), the associated economic burden was high (55% of payer burden, 51% of societal burden). The 2-year cumulative payer burden totaled $5.4 million per 100,000 commercially-insured beneficiaries, and the US commercially-insured societal burden totaled $8.9 billion.</p><p><strong>Conclusion: </strong>The burden of both operative and nonoperative care for ASD is large. Considerable opportunity exists for development of improved nonoperative treatment modalities to increase the value of ASD care by reducing the need for continued nonoperative interventions of limited benefit and reducing the use of costly surgical interventions.</p>","PeriodicalId":47313,"journal":{"name":"ClinicoEconomics and Outcomes Research","volume":"17 ","pages":"687-704"},"PeriodicalIF":2.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253067","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":"Economic Evaluation of Molecular Testing for Pulmonary Tuberculosis Diagnosis: A Systematic Review.","authors":"Natthakan Chitpim, Panida Yoopetch, Jiraphun Jittikoon, Wanvisa Udomsinprasert, Kornkanok Bunwong, Surakameth Mahasirimongkol, Usa Chaikledkaew","doi":"10.2147/CEOR.S541923","DOIUrl":"10.2147/CEOR.S541923","url":null,"abstract":"<p><strong>Purpose: </strong>Rapid molecular assays such as Xpert MTB/RIF and TB-LAMP accelerate pulmonary tuberculosis (TB) diagnosis but are more expensive than smear microscopy. This study provided an updated economic synthesis for presumptive adult pulmonary TB in high-burden settings, broadening the evidence from Xpert MTB/RIF to other WHO endorsed tests compared to conventional strategies.</p><p><strong>Methods: </strong>Medline, Embase and Scopus were searched through March 2025. The strategy combined search terms related to molecular diagnostic tests, pulmonary tuberculosis, and economic evaluation study designs. Full economic evaluations comparing molecular tests with smear microscopy, culture or passive case-finding were eligible. Two reviewers independently screened articles, extracted data, and adjusted costs to 2025 US dollars (USD) using average exchange rates. Reporting quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. Due to heterogeneity in evaluation criteria, model structures, time horizons, and outcome measures, meta-analysis were not feasible. Therefore, results were synthesized narratively, and incremental cost-effectiveness ratios (ICERs) were contextualized against country-specific cost-effectiveness thresholds to enable meaningful cross-study interpretation.</p><p><strong>Results: </strong>Eight studies conducted in low- and middle-income countries with high TB burdens were included. All evaluated Xpert MTB/RIF and the Thai studies also examined TB-LAMP. Five studies reported cost per disability-adjusted life years (DALYs) averted or quality-adjusted life years (QALYs) gained, while three used TB cases detected or years of life saved (YLS). CHEERS reporting quality was high (median is 23/28 items). Reported ICERs for molecular testing were either cost-saving or highly cost-effective compared with country-specific thresholds. Probabilistic sensitivity analyses (five studies) indicated ≥90% probability of cost-effectiveness in four studies and 6% in one.</p><p><strong>Conclusion: </strong>Recent evidence supports the cost-effectiveness and cost-saving of Xpert MTB/RIF and TB-LAMP for diagnosing adult pulmonary TB. Policymakers should prioritize reducing cartridge costs and implementing models that capture patient-level benefits to maximize economic benefits.</p>","PeriodicalId":47313,"journal":{"name":"ClinicoEconomics and Outcomes Research","volume":"17 ","pages":"661-671"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239893","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 Assessment of Pediatric Haploidentical Hematopoietic Stem Cell Transplantation.","authors":"Leila Achour, Ikram Fazaa, Chema Drira, Yosr Trabelsi, Monia Ouederni, Ines Fradi","doi":"10.2147/CEOR.S525645","DOIUrl":"10.2147/CEOR.S525645","url":null,"abstract":"<p><strong>Purpose: </strong>Evaluate the costs related to the pediatric haplo-SCT and adult and pediatric geno-SCT at the CNGMO in order to establish a tailored reimbursement package by the Tunisian Health Insurance Fund.</p><p><strong>Patients and methods: </strong>This pharmaco-economic study compared the cost of pediatric haplo-SCT to adult and pediatric geno identical hematopoietic stem cell transplantation (geno-SCT) using the activity-based costing method. The cost assessment was conducted from the hospital's perspective and considered direct medical and non-medical costs.</p><p><strong>Results: </strong>The cost assessment indicated that pediatric patients incurred higher expenses than adult patients. Furthermore, haplo-SCT was more expensive than geno-SCT for pediatric patients. The conditioning regimens used before haplo-SCT are more intensive than other preparative regimens and typically require longer inpatient therefore resulting in more costs. Complications, such as infections during the early phase of neutropenia and late-onset issues following hematopoietic stem cell transplantation (HSCT), particularly graft-versus-host disease (GVHD) and cytomegalovirus (CMV) reactivation, significantly contribute to increased procedural costs.</p><p><strong>Conclusion: </strong>This study sets the standards for new specific packages for haplo-SCT and geno-SCT in pediatric patients.</p>","PeriodicalId":47313,"journal":{"name":"ClinicoEconomics and Outcomes Research","volume":"17 ","pages":"653-659"},"PeriodicalIF":2.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233775","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":"Determinants of Economic Costs Following Road Traffic Injuries in Canada: A Quantile Regression Forests Machine Learning Approach.","authors":"Somayeh Momenyan, Herbert Chan, Lina Jae, John A Taylor, John A Staples, Devin R Harris, Jeffrey R Brubacher","doi":"10.2147/CEOR.S533069","DOIUrl":"10.2147/CEOR.S533069","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to identify major determinants of the cost of road traffic (RT) injuries, rank their importance, and assess their effects on different quantiles of cost distribution.</p><p><strong>Methods: </strong>This study analyzed data collected from 1372 Canadian RT survivors from July 2018 to March 2020. Costs, including healthcare and lost productivity costs over a year following RT injury, were estimated for each participant in 2023 Canadian dollars. Productivity loss was measured using the Institute for Medical Technology Assessment Productivity Cost Questionnaire. We considered 24 potential determinants of costs, which were grouped into five domains: sociodemographic, psychological, health, crash, and injury factors assessed during baseline interview. We employed a quantile regression forests machine learning approach alongside classical quantile regression to analyze costs. These methods were selected to capture heterogeneous effects across cost distribution, which are overlooked by traditional mean-based models, and to inform policy decisions targeting high-cost subgroup.</p><p><strong>Results: </strong>The results showed that the 10th, 50th, and 90th quantiles of costs were $1,141.9, $7,403.1, and $49,537.5, respectively. ISS, GCS, and age were the top three influential variables among low-cost, medium-cost, and high-cost patients. ISS, GCS, age, sex, employment status, and living situation were common major determinants at all quantiles. Ethnicity was selected as an important determinant at the 50th and 90th quantiles. Education level, years lived in Canada, somatic symptoms severity, psychological distress, HRQoL, road user type, and head, torso, spine/back, and lower extremity injuries were selected only for high-cost patients (90th quantile). Classical quantile regression showed that selected major predictors disproportionately affected low-cost, middle-cost and high-cost patients.</p><p><strong>Conclusion: </strong>High-cost patients were more likely to be older, retired, less educated, and have worse clinical and psychological indicators. These insights can guide targeted prevention and resource allocation strategies to reduce the economic burden of RT injuries.</p>","PeriodicalId":47313,"journal":{"name":"ClinicoEconomics and Outcomes Research","volume":"17 ","pages":"639-652"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070831","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}