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Assumptions Matter: The Long-Term Cost Analysis of IsaVRd vs DVRd. 假设很重要:IsaVRd与dvd的长期成本分析。
IF 2.3 Q2 ECONOMICS Pub Date : 2025-10-17 eCollection Date: 2025-01-01 DOI: 10.36469/001c.145075
Feng Lin, Audrey Petitjean, Medha Sasane
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引用次数: 0
Frequency and Mortality of Adult Meningitis, Pneumonia, or Bacteremia in Colombia from 2015 to 2022: A Retrospective Database Study in a Health Maintenance Organization. 2015年至2022年哥伦比亚成人脑膜炎、肺炎或菌血症的发病率和死亡率:一个健康维护组织的回顾性数据库研究
IF 2.3 Q2 ECONOMICS Pub Date : 2025-09-17 eCollection Date: 2025-01-01 DOI: 10.36469/001c.141461
Juan M Reyes Sánchez, Carlos Bello, Jhon Bolaños López, Jair Arciniegas, Farley J González, Manuela Duque, Jose M Oñate, Mónica García, Omar Escobar, Lidia Serra, Jennifer Onwumeh-Okwundu, Florence Lefebvre d'Hellencourt, Jorge La Rotta, Mark A Fletcher

Background: Meningitis, pneumonia, and bacteremia, prevalent community-acquired diseases that can lead to multi-organ failure, are influenced by age, comorbidities, and living conditions. Despite meningitis surveillance in Colombia, information on pneumonia and bacteremia remains limited. This study aims to determine frequency of these diseases among Colombian patients and estimate related healthcare resources.

Objective: To measure the frequency and mortality of meningitis, pneumonia, and bacteremia in all diagnosed adult patients in Colombia from 2015 to 2022.

Methods: This retrospective study analyzed adult (≥18 years) patients, from structured data collection (International Classification of Diseases, Tenth Revision) in a health maintenance organization (HMO). Diagnosis of a first meningitis, pneumonia, or bacteremia episode-unknown cause (bacterial etiology undetermined)-between 2015 and 2022 was reviewed. Index date was defined as when the diagnosis was registered. Frequency was calculated by dividing the number of cases by the number of members in the HMO system over the study period.

Results: Among 112 205 patients, 96.0% had pneumonia, 6.2% bacteremia, and 0.4% meningitis, not mutually exclusive. Inpatient pneumonia incidence, which peaked in 2019 and dropped post-COVID pandemic, was 167 cases per 100 000 person-years in 2022. Incidence of meningitis, pneumonia, and bacteremia was higher in patients over 60 years. Common comorbidities were chronic obstructive pulmonary disease and cardiovascular disease. Bacteremia incidence decreased from 143 cases per 100 000 in 2015 to 69.6 in 2022. Meningitis incidence dropped from 5.3 to 2.2 cases per 100 000 in the COVID period. All-cause mortality rates were 12.0%, 33.5% and 13.8% for pneumonia, bacteremia, and meningitis, respectively.

Discussion: This study is the first to use health electronic databases from an HMO to estimate the burden of these diseases in Colombian patients. Incidence was consistent with COVID-period patterns observed in other studies. Mortality rates were higher with bacteremia. Comorbidities like chronic pulmonary disease, cardiovascular disease, kidney diseases, and dementia were linked with increased incidence and mortality, emphasizing the need for targeted healthcare interventions and vaccination programs.

Conclusion: Incidence and mortality, whether pneumonia (inpatient or outpatient), bacteremia, or meningitis with bacteremia, vary with age and comorbidities, while all-cause mortality was greater for bacteremia than pneumonia or meningitis.

背景:脑膜炎、肺炎和菌血症是常见的社区获得性疾病,可导致多器官衰竭,受年龄、合并症和生活条件的影响。尽管在哥伦比亚进行了脑膜炎监测,但关于肺炎和菌血症的信息仍然有限。本研究旨在确定哥伦比亚患者中这些疾病的频率,并估计相关的医疗资源。目的:测量2015 - 2022年哥伦比亚所有确诊成人患者脑膜炎、肺炎和菌血症的发病率和死亡率。方法:本回顾性研究分析了来自健康维护组织(HMO)结构化数据收集(国际疾病分类,第十版)的成人(≥18岁)患者。回顾了2015年至2022年间首次脑膜炎、肺炎或菌血症发作的诊断,原因不明(细菌病因未确定)。索引日期定义为登记诊断的时间。频率是通过在研究期间将病例数除以HMO系统成员数来计算的。结果:112 205例患者中,96.0%发生肺炎,6.2%发生菌血症,0.4%发生脑膜炎,两者并不相互排斥。住院肺炎发病率在2019年达到高峰,在covid大流行后下降,到2022年为每10万人年167例。60岁以上患者的脑膜炎、肺炎和菌血症发生率较高。常见的合并症是慢性阻塞性肺病和心血管疾病。菌血症发病率从2015年的每10万人143例下降到2022年的69.6例。在COVID期间,脑膜炎发病率从每10万人5.3例降至2.2例。肺炎、菌血症和脑膜炎的全因死亡率分别为12.0%、33.5%和13.8%。讨论:本研究首次使用来自卫生组织的卫生电子数据库来估计哥伦比亚患者的这些疾病负担。发病率与其他研究中观察到的covid - 19期间模式一致。菌血症的死亡率更高。慢性肺病、心血管疾病、肾脏疾病和痴呆等合并症与发病率和死亡率的增加有关,这强调了有针对性的医疗干预和疫苗接种计划的必要性。结论:肺炎(住院或门诊)、菌血症或脑膜炎合并菌血症的发病率和死亡率随年龄和合并症的不同而不同,而菌血症的全因死亡率高于肺炎或脑膜炎。
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引用次数: 0
Cost-Effectiveness of Aerial Logistics for Maternal and Newborn Health: A Simulation-Based Analysis Grounded in Real-World Evidence from the Ashanti Region in Ghana. 航空物流对孕产妇和新生儿健康的成本效益:基于加纳阿散蒂地区真实世界证据的模拟分析。
IF 2.3 Q2 ECONOMICS Pub Date : 2025-09-17 eCollection Date: 2025-01-01 DOI: 10.36469/001c.143065
Maria J Ospina-Fadul, Pedro Kremer, Florence Haruna, Fred Adomako-Boateng, Kenneth Fosu Oteng, Diana N Tsali

Background: In sub-Saharan Africa, low antenatal care (ANC) coverage and limited access to facility-based deliveries remain key drivers of adverse maternal and newborn health (MNH) outcomes. Inadequate service provision at health facilities and insufficient care-seeking behavior are exacerbated by supply chain inefficiencies that restrict access to essential maternal health commodities. Aerial logistics (centralized storage and drone delivery) has shown promise as a novel approach to addressing these logistical challenges and supporting maternal health service delivery, but its cost-effectiveness has not been evaluated.

Objectives: This study evaluates the cost-effectiveness of aerial logistics as an intervention for MNH. It builds on previously observed programmatic effects (increases in ANC visits, facility-based deliveries, and reductions in maternal mortality in Ghana's Ashanti Region) to model downstream health outcomes and estimate incremental economic value.

Methods: Using microsimulation and published epidemiological parameters, the study models additional health outcomes resulting from increased service utilization among 11 249 pregnant women, including reductions in low birth weight, postpartum hemorrhage, neonatal mortality, and early-onset neonatal sepsis. Alongside the observed maternal mortality reduction, all outcomes are translated into life-years saved and discounted disability-adjusted life-years (DALYs) averted. Cost estimates are based on real-world aerial logistics operations and national data on health system expenditures and household out-of-pocket costs. Incremental cost-effectiveness ratios (ICERs) are calculated from both health system and societal perspectives. Uncertainty is addressed through one-way and probabilistic sensitivity analyses.

Results: The intervention averted 3754.99 discounted DALYs at a net cost of US 400 987 f r o m t h e g o v e r n m e n t p e r s p e c t i v e , y i e l d i n g a n I C E R o f U S 106.79 per DALY averted. From the societal perspective, the ICER was US 377.82 . T h e c o s t p e r p r e m a t u r e d e a t h a v e r t e d w
背景:在撒哈拉以南非洲,产前保健(ANC)覆盖率低和在医院分娩的机会有限仍然是孕产妇和新生儿健康(MNH)不良结果的主要驱动因素。由于供应链效率低下,限制了获得基本孕产妇保健商品的机会,从而加剧了卫生设施提供服务不足和求医行为不足的问题。空中物流(集中储存和无人机配送)有望成为应对这些后勤挑战和支持孕产妇保健服务提供的一种新方法,但其成本效益尚未得到评估。目的:本研究评估航空物流作为MNH干预措施的成本效益。它以先前观察到的规划效果(ANC就诊人数增加、在医院分娩以及加纳阿散蒂地区孕产妇死亡率降低)为基础,建立下游健康结果模型并估计增量经济价值。方法:使用微观模拟和已发表的流行病学参数,该研究模拟了11249名孕妇增加服务利用率所带来的额外健康结果,包括低出生体重、产后出血、新生儿死亡率和早发新生儿败血症的减少。除了观察到的孕产妇死亡率降低外,所有结果都转化为节省的生命年和避免的残疾调整生命年折扣。费用估算是根据实际的空中物流业务和有关卫生系统支出和家庭自付费用的国家数据作出的。增量成本效益比(ICERs)是从卫生系统和社会角度计算的。不确定性通过单向和概率敏感性分析来解决。结果:干预措施避免了3754.99个折扣DALY,净成本为400987美元/每例折扣DALY,净成本为400987美元/每例折扣DALY,净成本为400987美元/每例折扣DALY。从社会角度看,ICER为US 377.82。这是美国标准3072.87号。这是美国标准3072.87号。服务利用率ICERs包括88.46美元/次,每次访问2.24美元/次,每次基于设施的交付5.60美元/次。在敏感性分析中,所有估计数仍低于国家成本效益阈值。讨论:航空物流产生了巨大的健康和经济收益,这源于先前记录的服务利用率的增加,并且是有记录的最具成本效益的MNH干预措施之一。结论:在资源有限的情况下,航空物流是一种成本效益高、可扩展的战略,可改善孕产妇和新生儿健康。
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引用次数: 0
Societal Economic Burden of Cystic Fibrosis in Iran: A Cost-of-Illness Study. 伊朗囊性纤维化的社会经济负担:一项疾病成本研究
IF 2.3 Q2 ECONOMICS Pub Date : 2025-09-09 eCollection Date: 2025-01-01 DOI: 10.36469/001c.143266
Hassan Karami, Shideh Rafati, Maryam Shirvani Shiri, Ali Mouseli, Hedayat Salari, Amin Ghanbarnejad, Mitra Nowrouzpour, Fatemeh Noroozian, Ali Alizadeh, Fatemeh Asadi, Narges Salehi

Background: Cystic fibrosis (CF) is a rare genetic disorder that places a substantial financial burden on patients, families, and the healthcare system. This study aimed to estimate the economic impact of CF in southern Iran.

Methods: A cross-sectional, prevalence-based cost-of-illness study was conducted from a societal perspective, using a bottom-up approach and the human capital method. Data were collected through insurance records and a standardized cost questionnaire. Mean annual per-patient costs were calculated, and cost determinants were analyzed using the Mann-Whitney and Kruskal-Wallis tests.

Results: The average annual cost per CF patient was US $4070, with 67% attributed to direct medical costs, 20% to direct nonmedical costs, and 13% to indirect costs. Higher total costs were significantly associated with disease severity, hospitalization history, and absence of supplementary insurance.

Conclusion: CF imposes a considerable economic burden in Iran, predominantly driven by drug and hospitalization expenses. Direct nonmedical costs and indirect costs also contribute meaningfully. These findings highlight the need for improved access to specialized CF care, enhanced insurance coverage, and stronger support for informal caregivers to alleviate the financial pressure on affected families.

背景:囊性纤维化(CF)是一种罕见的遗传性疾病,给患者、家庭和医疗保健系统带来了巨大的经济负担。本研究旨在估计CF对伊朗南部的经济影响。方法:采用自下而上的方法和人力资本方法,从社会角度进行了一项基于患病率的横断面疾病成本研究。通过保险记录和标准化成本问卷收集数据。计算每位患者的平均年成本,并使用Mann-Whitney和Kruskal-Wallis测试分析成本决定因素。结果:每位CF患者的年平均成本为4070美元,其中67%为直接医疗成本,20%为直接非医疗成本,13%为间接成本。较高的总费用与疾病严重程度、住院史和缺乏补充保险显著相关。结论:CF在伊朗造成了相当大的经济负担,主要是由药品和住院费用造成的。直接非医疗费用和间接费用也有很大贡献。这些发现突出表明,有必要改善CF专业护理的可及性,扩大保险覆盖范围,并加强对非正规护理人员的支持,以减轻受影响家庭的经济压力。
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引用次数: 0
Reasonable Cost for Procedures: An Anonymous Survey of Healthcare Providers. 程序的合理成本:对医疗保健提供者的匿名调查。
IF 2.3 Q2 ECONOMICS Pub Date : 2025-09-08 eCollection Date: 2025-01-01 DOI: 10.36469/001c.143489
David Shin, Carson Cummings, David Cheng, Chandler Dinh, Daniel Im, Timothy Tang, Isabella Oh, Lauren Han, Patricia Carlson, Gideon Harianja, Jacob Razzouk, Olumide Danisa, Wayne Cheng
<p><strong>Background: </strong>The cost of medical procedures in the United States varies dramatically depending on the payment system, including Medicare, Medi-Cal (California's Medicaid program), private insurance, or lien-based payment models used in personal injury cases. Cost discrepancies can discourage physician participation in Medicare and Medi-Cal, potentially limit access to care for vulnerable patient populations, and complicate the determination of proper compensation in court.</p><p><strong>Objectives: </strong>To survey healthcare providers to determine reasonable costs for medical procedures, potentially aligning legal standards with healthcare costs.</p><p><strong>Methods: </strong>An anonymous, 8-question electronic survey was distributed through Survey Legend® between February and September 2023 to providers in orthopedic surgery, neurosurgery, anesthesiology, interventional radiology (IR), physical medicine and rehabilitation (PMR), pain management, and physician assistants (PAs) or nurse practitioners (NPs). Three procedures-epidural injection, facet injection/medial branch block, and radiofrequency ablation-were included, with participants selecting from 5 cost categories: < <math><mn>1000</mn> <mo>,</mo></math> 1000- <math><mn>4999</mn> <mo>,</mo></math> 5000- <math><mn>9999</mn> <mo>,</mo></math> 10000- <math><mn>19999</mn> <mo>,</mo> <mi>a</mi> <mi>n</mi> <mi>d</mi> <mo>></mo></math> 20,000. Additional questions explored participant insight into discounts for cash and lien-based payments.</p><p><strong>Results: </strong>For all procedures and participants, the most common value was <math><mn>1000</mn> <mo>-</mo></math> 4999. Neurosurgery selected significantly higher epidural values than pain management (<i>P</i>=.025), PMR (<i>P</i>=.029), and PA/NP (<i>P</i>=.04); higher facet injection/medial branch block values than PMR (<i>P</i>=.03) and PA/NPs (<i>P</i>=.01); and higher radiofrequency ablation values than PA/NPs (<i>P</i>=.02). Physicians not accepting lien payments showed significantly lower values across all specialties and procedures.</p><p><strong>Discussion: </strong>The range of reported reasonable costs by respondents reflects a discrepancy between physician expectations and existing reimbursement models, indicating a lack of a standardized value for procedural pricing. Medicare's estimated <math><mn>500</mn> <mi>r</mi> <mi>e</mi> <mi>i</mi> <mi>m</mi> <mi>b</mi> <mi>u</mi> <mi>r</mi> <mi>s</mi> <mi>e</mi> <mi>m</mi> <mi>e</mi> <mi>n</mi> <mi>t</mi> <mi>f</mi> <mi>o</mi> <mi>r</mi> <mi>e</mi> <mi>p</mi> <mi>i</mi> <mi>d</mi> <mi>u</mi> <mi>r</mi> <mi>a</mi> <mi>l</mi> <mi>i</mi> <mi>n</mi> <mi>j</mi> <mi>e</mi> <mi>c</mi> <mi>t</mi> <mi>i</mi> <mi>o</mi> <mi>n</mi> <mi>s</mi> <mi>a</mi> <mi>n</mi> <mi>d</mi> <mi>f</mi> <mi>a</mi> <mi>c</mi> <mi>e</mi> <mi>t</mi> <mi>i</mi> <mi>n</mi> <mi>j</mi> <mi>e</mi> <mi>c</mi> <mi>t</mi> <mi>i</mi> <mi>o</mi> <mi>n</mi> <mrow><mo>/</mo></mrow> <mi>m</mi> <mi>e</mi> <mi
背景:美国医疗程序的费用因支付系统的不同而有很大差异,包括医疗保险、Medi-Cal(加州医疗补助计划)、私人保险或人身伤害案件中使用的基于留置权的支付模式。费用差异会阻碍医生参与医疗保险和Medi-Cal,可能会限制弱势患者群体获得医疗服务,并使法庭上适当赔偿的确定复杂化。目的:调查医疗保健提供者,以确定医疗程序的合理成本,可能使法律标准与医疗保健成本保持一致。方法:在2023年2月至9月期间,通过survey Legend®对骨科、神经外科、麻醉学、介入放射学(IR)、物理医学与康复学(PMR)、疼痛管理、医师助理(PAs)或执业护士(NPs)的提供者进行了一项8题的匿名电子调查。包括三种手术-硬膜外注射,关节突注射/内侧分支阻滞和射频消融,参与者从5个成本类别中选择:< 1000,1000- 4999,5000- 9999,10000- 19999,和bbb20,000。其他问题探讨了参与者对现金和留置权支付折扣的见解。结果:对于所有程序和参与者,最常见的值是1000 - 4999。神经外科选择的硬膜外值明显高于疼痛管理(P= 0.025)、PMR (P= 0.029)和PA/NP (P= 0.04);关节突注射/内侧分支阻滞值高于PMR (P=.03)和PA/NPs (P=.01);射频消融值高于PA/NPs (P= 0.02)。不接受留置权支付的医生在所有专业和程序中都显示出明显较低的价值。讨论:受访者报告的合理费用范围反映了医生期望与现有报销模式之间的差异,表明缺乏程序定价的标准化值。医疗保险的大约500 r e i m b u r s e m e n t f o r e p i d u r l i n j e c t i o n s n d f c e t i n j e c t i o n / m e d l b r n c h b l o c k s n d 1000射频消融术低于physician-perceived合理成本和膨胀的指控在lien-based案件中经常发现。相比之下,硬膜外注射的个人伤害费用可能高达20,000美元,只有2.9%的受访者选择这一费用类别。结论:这项调查突出了医疗保健提供者对合理费用的看法,可能有助于改进报销模式,确保法律程序的一致性,并为患者和提供者保持适当的可及性和补偿。
{"title":"Reasonable Cost for Procedures: An Anonymous Survey of Healthcare Providers.","authors":"David Shin, Carson Cummings, David Cheng, Chandler Dinh, Daniel Im, Timothy Tang, Isabella Oh, Lauren Han, Patricia Carlson, Gideon Harianja, Jacob Razzouk, Olumide Danisa, Wayne Cheng","doi":"10.36469/001c.143489","DOIUrl":"10.36469/001c.143489","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The cost of medical procedures in the United States varies dramatically depending on the payment system, including Medicare, Medi-Cal (California's Medicaid program), private insurance, or lien-based payment models used in personal injury cases. Cost discrepancies can discourage physician participation in Medicare and Medi-Cal, potentially limit access to care for vulnerable patient populations, and complicate the determination of proper compensation in court.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To survey healthcare providers to determine reasonable costs for medical procedures, potentially aligning legal standards with healthcare costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An anonymous, 8-question electronic survey was distributed through Survey Legend® between February and September 2023 to providers in orthopedic surgery, neurosurgery, anesthesiology, interventional radiology (IR), physical medicine and rehabilitation (PMR), pain management, and physician assistants (PAs) or nurse practitioners (NPs). Three procedures-epidural injection, facet injection/medial branch block, and radiofrequency ablation-were included, with participants selecting from 5 cost categories: &lt; &lt;math&gt;&lt;mn&gt;1000&lt;/mn&gt; &lt;mo&gt;,&lt;/mo&gt;&lt;/math&gt; 1000- &lt;math&gt;&lt;mn&gt;4999&lt;/mn&gt; &lt;mo&gt;,&lt;/mo&gt;&lt;/math&gt; 5000- &lt;math&gt;&lt;mn&gt;9999&lt;/mn&gt; &lt;mo&gt;,&lt;/mo&gt;&lt;/math&gt; 10000- &lt;math&gt;&lt;mn&gt;19999&lt;/mn&gt; &lt;mo&gt;,&lt;/mo&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mo&gt;&gt;&lt;/mo&gt;&lt;/math&gt; 20,000. Additional questions explored participant insight into discounts for cash and lien-based payments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For all procedures and participants, the most common value was &lt;math&gt;&lt;mn&gt;1000&lt;/mn&gt; &lt;mo&gt;-&lt;/mo&gt;&lt;/math&gt; 4999. Neurosurgery selected significantly higher epidural values than pain management (&lt;i&gt;P&lt;/i&gt;=.025), PMR (&lt;i&gt;P&lt;/i&gt;=.029), and PA/NP (&lt;i&gt;P&lt;/i&gt;=.04); higher facet injection/medial branch block values than PMR (&lt;i&gt;P&lt;/i&gt;=.03) and PA/NPs (&lt;i&gt;P&lt;/i&gt;=.01); and higher radiofrequency ablation values than PA/NPs (&lt;i&gt;P&lt;/i&gt;=.02). Physicians not accepting lien payments showed significantly lower values across all specialties and procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The range of reported reasonable costs by respondents reflects a discrepancy between physician expectations and existing reimbursement models, indicating a lack of a standardized value for procedural pricing. Medicare's estimated &lt;math&gt;&lt;mn&gt;500&lt;/mn&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;b&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;f&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;p&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;l&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;j&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;c&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt; &lt;mi&gt;f&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;c&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;j&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;c&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mrow&gt;&lt;mo&gt;/&lt;/mo&gt;&lt;/mrow&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 2","pages":"108-115"},"PeriodicalIF":2.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12422406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040309","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}
引用次数: 0
Healthcare Resource Use, Healthcare Costs, and Unmet Needs Among Patients Treated for EGFR-Mutated Advanced or Metastatic Non-small Cell Lung Cancer. egfr突变晚期或转移性非小细胞肺癌患者的医疗资源使用、医疗费用和未满足需求
IF 2.3 Q2 ECONOMICS Pub Date : 2025-08-29 eCollection Date: 2025-01-01 DOI: 10.36469/001c.142771
David Waterhouse, Iris Li, Laura Morrison, Bruno Emond, Marie-Hélène Lafeuille, Annalise Hilts, Jill Korsiak, Patrick Lefebvre, Pratyusha Vadagam, Dexter Waters
<p><strong>Background: </strong>Approximately 17% of patients with non-small cell lung cancer (NSCLC) have epidermal growth factor receptor-mutated (EGFRm) NSCLC, 84% of which are exon 19 deletions (Ex19del)/exon 21 substitutions (L858R). Unmet needs for patients treated with tyrosine kinase inhibitors (TKIs) for EGFRm (Ex19del/L858R) advanced NSCLC, including osimertinib, are relevant to US population health decision makers.</p><p><strong>Objectives: </strong>To describe healthcare resource utilization (HRU) and costs by line of therapy (LOT) among patients with EGFRm (Ex19del/L858R) advanced NSCLC initiating first-line (1L) treatment.</p><p><strong>Methods: </strong>IBM MarketScan® Research Databases (1/1/2010-1/31/2023) were used to select adult patients with advanced NSCLC initiating an EGFR-TKI during any LOT on/after 4/18/2018 (osimertinib approval; EGFRm Ex19del/L858R proxy). Per-patient-per-month (PPPM) all-cause HRU and costs were described in 1L, second-line (2L), and third-line (3L) overall and among subgroups receiving 1L osimertinib monotherapy or platinum-based chemotherapy (PBC) without immunotherapy, separately.</p><p><strong>Results: </strong>The study included 409 patients with EGFRm advanced NSCLC (mean age, 60.5 years; 70.2% female). In 1L, 72.9% initiated osimertinib-based therapy (2L, 45.9%; 3L, 41.2%), 21.0% initiated chemotherapy (2L, 30.0%; 3L, 36.5%), 4.6% initiated another EGFR-TKI (2L, 12.9%; 3L, 12.9%), and 1.5% initiated immunotherapy (2L, 11.2%; 3L, 9.4%). Overall, 170 patients (41.6%) progressed to 2L among whom 85 (50.0%) progressed to 3L. Mean LOT duration decreased with each successive LOT (1L, 10.2 months; 2L, 8.7 months; 3L, 8.0 months). Across LOTs, patients had a mean of >4 outpatient visits PPPM (1L, 4.79; 2L, 4.26; 3L, 4.40), and the 1L osimertinib monotherapy subgroup (n = 279) had a mean of 0.69 inpatient days PPPM during 1L (2L, 0.82; 3L, 0.74). Mean all-cause costs PPPM were <math><mn>27</mn> <mrow><mo> </mo></mrow> <mn>751</mn> <mi>i</mi> <mi>n</mi> <mn>1</mn> <mi>L</mi> <mo>,</mo></math> 28 971 in 2L, and <math><mn>31</mn> <mrow><mo> </mo></mrow> <mn>251</mn> <mi>i</mi> <mi>n</mi> <mn>3</mn> <mi>L</mi> <mo>.</mo> <mi>A</mi> <mi>m</mi> <mi>o</mi> <mi>n</mi> <mi>g</mi> <mi>t</mi> <mi>h</mi> <mi>e</mi> <mn>1</mn> <mi>L</mi> <mi>o</mi> <mi>s</mi> <mi>i</mi> <mi>m</mi> <mi>e</mi> <mi>r</mi> <mi>t</mi> <mi>i</mi> <mi>n</mi> <mi>i</mi> <mi>b</mi> <mi>m</mi> <mi>o</mi> <mi>n</mi> <mi>o</mi> <mi>t</mi> <mi>h</mi> <mi>e</mi> <mi>r</mi> <mi>a</mi> <mi>p</mi> <mi>y</mi> <mi>s</mi> <mi>u</mi> <mi>b</mi> <mi>g</mi> <mi>r</mi> <mi>o</mi> <mi>u</mi> <mi>p</mi> <mo>,</mo> <mi>m</mi> <mi>e</mi> <mi>a</mi> <mi>n</mi> <mi>P</mi> <mi>P</mi> <mi>P</mi> <mi>M</mi> <mi>c</mi> <mi>o</mi> <mi>s</mi> <mi>t</mi> <mi>s</mi> <mi>w</mi> <mi>e</mi> <mi>r</mi> <mi>e</mi></math> 27 610 in 1L, <math><mn>35</mn> <mrow><mo> </mo></mrow> <mn>501</mn> <mi>i</mi> <mi>n</mi> <mn>2</mn> <mi>L</mi> <mo>,</mo> <mi>a</mi> <mi>n</mi> <mi>d</mi><
背景:约17%的非小细胞肺癌(NSCLC)患者为表皮生长因子受体突变(EGFRm)型NSCLC,其中84%为外显子19缺失(Ex19del)/外显子21替换(L858R)。EGFRm (Ex19del/L858R)晚期NSCLC患者未满足的酪氨酸激酶抑制剂(TKIs)治疗需求,包括奥西替尼,与美国人口健康决策者相关。目的:描述EGFRm (Ex19del/L858R)晚期NSCLC患者开始一线(1L)治疗的医疗资源利用率(HRU)和费用(LOT)。方法:使用IBM MarketScan®研究数据库(2010年1月1日- 2023年1月31日)选择2018年4月18日/之后任何LOT期间启动EGFR-TKI的晚期NSCLC成年患者(奥西替尼批准;EGFRm Ex19del/L858R代理)。每个患者每月(PPPM)的全因HRU和成本分别在1L、二线(2L)和三线(3L)总体上和接受1L奥西替尼单药治疗或铂基化疗(PBC)不进行免疫治疗的亚组中进行描述。结果:该研究纳入409例EGFRm晚期NSCLC患者(平均年龄60.5岁,70.2%为女性)。在1L中,72.9%的患者开始了基于奥西替尼的治疗(2L, 45.9%; 3L, 41.2%), 21.0%的患者开始了化疗(2L, 30.0%; 3L, 36.5%), 4.6%的患者开始了另一种EGFR-TKI (2L, 12.9%; 3L, 12.9%), 1.5%的患者开始了免疫治疗(2L, 11.2%; 3L, 9.4%)。总体而言,170例(41.6%)进展为2L,其中85例(50.0%)进展为3L。平均LOT持续时间随每次LOT的延长而减少(1L, 10.2个月;2L, 8.7个月;3L, 8.0个月)。在所有批次中,患者的平均门诊次数PPPM为4840次(1L, 4.79; 2L, 4.26; 3L, 4.40), 1L单药治疗亚组(n = 279)在1L期间的平均住院天数PPPM为0.69天(2L, 0.82; 3L, 0.74)。平均全因成本PPPM为27 751 i / 1 L, 28 971 / 2L, 31 251 / 3 L。m o n g t h e 1 L o s i m e r t i n i b m o n o t h e r p y s u b g r o p m e n p p p m c o s t s w e r e 27 610年1 L,我35 501 n 2 L, n d 36 618 3 L。在1L PBC亚组(n = 58)中,1L的平均PPPM成本为23 820美元,2L为24 788美元,3L为23 348美元。讨论:在EGFRm (Ex19del/L858R)晚期NSCLC患者中,每次连续LOT的时间更短,费用更高。结论:研究结果强调了使用最有效的1L治疗来延缓疾病进展、降低HRU和成本的重要性。
{"title":"Healthcare Resource Use, Healthcare Costs, and Unmet Needs Among Patients Treated for EGFR-Mutated Advanced or Metastatic Non-small Cell Lung Cancer.","authors":"David Waterhouse, Iris Li, Laura Morrison, Bruno Emond, Marie-Hélène Lafeuille, Annalise Hilts, Jill Korsiak, Patrick Lefebvre, Pratyusha Vadagam, Dexter Waters","doi":"10.36469/001c.142771","DOIUrl":"10.36469/001c.142771","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Approximately 17% of patients with non-small cell lung cancer (NSCLC) have epidermal growth factor receptor-mutated (EGFRm) NSCLC, 84% of which are exon 19 deletions (Ex19del)/exon 21 substitutions (L858R). Unmet needs for patients treated with tyrosine kinase inhibitors (TKIs) for EGFRm (Ex19del/L858R) advanced NSCLC, including osimertinib, are relevant to US population health decision makers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To describe healthcare resource utilization (HRU) and costs by line of therapy (LOT) among patients with EGFRm (Ex19del/L858R) advanced NSCLC initiating first-line (1L) treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;IBM MarketScan® Research Databases (1/1/2010-1/31/2023) were used to select adult patients with advanced NSCLC initiating an EGFR-TKI during any LOT on/after 4/18/2018 (osimertinib approval; EGFRm Ex19del/L858R proxy). Per-patient-per-month (PPPM) all-cause HRU and costs were described in 1L, second-line (2L), and third-line (3L) overall and among subgroups receiving 1L osimertinib monotherapy or platinum-based chemotherapy (PBC) without immunotherapy, separately.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 409 patients with EGFRm advanced NSCLC (mean age, 60.5 years; 70.2% female). In 1L, 72.9% initiated osimertinib-based therapy (2L, 45.9%; 3L, 41.2%), 21.0% initiated chemotherapy (2L, 30.0%; 3L, 36.5%), 4.6% initiated another EGFR-TKI (2L, 12.9%; 3L, 12.9%), and 1.5% initiated immunotherapy (2L, 11.2%; 3L, 9.4%). Overall, 170 patients (41.6%) progressed to 2L among whom 85 (50.0%) progressed to 3L. Mean LOT duration decreased with each successive LOT (1L, 10.2 months; 2L, 8.7 months; 3L, 8.0 months). Across LOTs, patients had a mean of &gt;4 outpatient visits PPPM (1L, 4.79; 2L, 4.26; 3L, 4.40), and the 1L osimertinib monotherapy subgroup (n = 279) had a mean of 0.69 inpatient days PPPM during 1L (2L, 0.82; 3L, 0.74). Mean all-cause costs PPPM were &lt;math&gt;&lt;mn&gt;27&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;751&lt;/mn&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mn&gt;1&lt;/mn&gt; &lt;mi&gt;L&lt;/mi&gt; &lt;mo&gt;,&lt;/mo&gt;&lt;/math&gt; 28 971 in 2L, and &lt;math&gt;&lt;mn&gt;31&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;251&lt;/mn&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mn&gt;3&lt;/mn&gt; &lt;mi&gt;L&lt;/mi&gt; &lt;mo&gt;.&lt;/mo&gt; &lt;mi&gt;A&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;g&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;h&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mn&gt;1&lt;/mn&gt; &lt;mi&gt;L&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;b&lt;/mi&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;h&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;p&lt;/mi&gt; &lt;mi&gt;y&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;b&lt;/mi&gt; &lt;mi&gt;g&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;u&lt;/mi&gt; &lt;mi&gt;p&lt;/mi&gt; &lt;mo&gt;,&lt;/mo&gt; &lt;mi&gt;m&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;P&lt;/mi&gt; &lt;mi&gt;P&lt;/mi&gt; &lt;mi&gt;P&lt;/mi&gt; &lt;mi&gt;M&lt;/mi&gt; &lt;mi&gt;c&lt;/mi&gt; &lt;mi&gt;o&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;t&lt;/mi&gt; &lt;mi&gt;s&lt;/mi&gt; &lt;mi&gt;w&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt; &lt;mi&gt;r&lt;/mi&gt; &lt;mi&gt;e&lt;/mi&gt;&lt;/math&gt; 27 610 in 1L, &lt;math&gt;&lt;mn&gt;35&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;501&lt;/mn&gt; &lt;mi&gt;i&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mn&gt;2&lt;/mn&gt; &lt;mi&gt;L&lt;/mi&gt; &lt;mo&gt;,&lt;/mo&gt; &lt;mi&gt;a&lt;/mi&gt; &lt;mi&gt;n&lt;/mi&gt; &lt;mi&gt;d&lt;/mi&gt;&lt;","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 2","pages":"98-107"},"PeriodicalIF":2.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957076","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}
引用次数: 0
Real-World Treatment Patterns and Cost of Care in US Ovarian Cancer Patients Undergoing BRCA Testing. 接受BRCA检测的美国卵巢癌患者的现实世界治疗模式和护理成本。
IF 2.3 Q2 ECONOMICS Pub Date : 2025-08-26 eCollection Date: 2025-01-01 DOI: 10.36469/001c.142444
Srujitha Marupuru, Kristin Moore, Desiree Hall, Sarah Aurit, Gretchen Hultman, Noah Webb, Yong Zhu, Gieira Jones

Background: Patients with ovarian cancer incur substantial economic burdens. However, little is known about the differences in metrics such as treatment patterns, healthcare resource utilization (HCRU), and costs between those with BRCA mutant (BRCAm) and BRCA wildtype (BRCAwt) tumors.

Objective: This study assessed demographic and clinical characteristics, treatment patterns, and HCRU and costs among patients diagnosed with ovarian cancer, stratified by BRCA testing status and result.

Methods: This retrospective study included patients with ovarian cancer between Jan. 1, 2017, and June 30, 2022, with electronic health record (EHR) and administrative claims data in Optum's Clinical EHR and claims databases. Data collected included baseline characteristics, lines of therapy (LOTs) (captured at 6, 12, and 24 months follow-up), HCRU (captured for 12-month baseline and follow-up periods), and costs (captured for 6-month baseline and 12-month follow-up periods). Patients were stratified by the presence or absence of a BRCA test and by BRCA testing results.

Results: A total of 13 981 patients were included in the sample; 23.3% had a BRCA test and 76.7% did not. Among those with a BRCA test, 62.0% were BRCAm and 35.8% were BRCAwt. Patients who did not receive BRCA testing were more likely to be non-Hispanic African American and to live in the South (all P < .001). Patients who received testing were more likely to progress to a subsequent LOT but also more likely to receive BRCA-targeted therapies. The median per-patient-per-month (PPPM) total costs were 62% higher in BRCA-tested patients than those without tests ( 6242 v s 3845). Similarly, median PPPM ambulatory visits cost and pharmacy cost were 81% and 137% higher in those with BRCA tests than those without tests ( 2236 v s 1232, and 793 v s 335, respectively).

Conclusions: Approximately one-fourth of patients received BRCA testing. Disparities existed between those who received testing and those who did not. Patients who were tested had higher costs than those who were not; this difference was driven mostly by ambulatory visits and pharmacy costs, potentially due to increased clinical encounters and higher costs of targeted treatments.

背景:卵巢癌患者承受着巨大的经济负担。然而,对于BRCA突变型(BRCAm)和BRCA野生型(BRCAwt)肿瘤患者在治疗模式、医疗资源利用(HCRU)和成本等指标上的差异知之甚少。目的:本研究评估卵巢癌患者的人口学和临床特征、治疗模式、HCRU和成本,并根据BRCA检测状态和结果进行分层。方法:本回顾性研究纳入了2017年1月1日至2022年6月30日期间的卵巢癌患者,这些患者在Optum的临床EHR和索赔数据库中使用电子健康记录(EHR)和行政索赔数据。收集的数据包括基线特征、治疗线(批次)(随访6个月、12个月和24个月)、HCRU(12个月基线和随访期)和成本(6个月基线和12个月随访期)。根据是否进行BRCA检测和BRCA检测结果对患者进行分层。结果:共纳入13 981例患者;23.3%的人有BRCA检测,76.7%的人没有。在BRCA检测中,62.0%为BRCAm, 35.8%为brcat。未接受BRCA检测的患者更有可能是非西班牙裔非裔美国人,并且生活在南方(所有P 6242 vs s 3845)。同样,进行BRCA检测的患者的PPPM门诊费用和药房费用中位数比未进行BRCA检测的患者高81%和137%(分别为2236 v和1232 v, 793 v和335 v)。结论:大约四分之一的患者接受了BRCA检测。接受测试的人和没有接受测试的人之间存在差异。接受检测的患者比未接受检测的患者花费更高;这种差异主要是由门诊就诊和药房费用造成的,可能是由于临床就诊次数增加和靶向治疗费用增加。
{"title":"Real-World Treatment Patterns and Cost of Care in US Ovarian Cancer Patients Undergoing BRCA Testing.","authors":"Srujitha Marupuru, Kristin Moore, Desiree Hall, Sarah Aurit, Gretchen Hultman, Noah Webb, Yong Zhu, Gieira Jones","doi":"10.36469/001c.142444","DOIUrl":"10.36469/001c.142444","url":null,"abstract":"<p><strong>Background: </strong>Patients with ovarian cancer incur substantial economic burdens. However, little is known about the differences in metrics such as treatment patterns, healthcare resource utilization (HCRU), and costs between those with BRCA mutant (BRCAm) and BRCA wildtype (BRCAwt) tumors.</p><p><strong>Objective: </strong>This study assessed demographic and clinical characteristics, treatment patterns, and HCRU and costs among patients diagnosed with ovarian cancer, stratified by BRCA testing status and result.</p><p><strong>Methods: </strong>This retrospective study included patients with ovarian cancer between Jan. 1, 2017, and June 30, 2022, with electronic health record (EHR) and administrative claims data in Optum's Clinical EHR and claims databases. Data collected included baseline characteristics, lines of therapy (LOTs) (captured at 6, 12, and 24 months follow-up), HCRU (captured for 12-month baseline and follow-up periods), and costs (captured for 6-month baseline and 12-month follow-up periods). Patients were stratified by the presence or absence of a BRCA test and by BRCA testing results.</p><p><strong>Results: </strong>A total of 13 981 patients were included in the sample; 23.3% had a BRCA test and 76.7% did not. Among those with a BRCA test, 62.0% were BRCAm and 35.8% were BRCAwt. Patients who did not receive BRCA testing were more likely to be non-Hispanic African American and to live in the South (all <i>P</i> < .001). Patients who received testing were more likely to progress to a subsequent LOT but also more likely to receive BRCA-targeted therapies. The median per-patient-per-month (PPPM) total costs were 62% higher in BRCA-tested patients than those without tests ( <math><mn>6242</mn> <mi>v</mi> <mi>s</mi></math> 3845). Similarly, median PPPM ambulatory visits cost and pharmacy cost were 81% and 137% higher in those with BRCA tests than those without tests ( <math><mn>2236</mn> <mi>v</mi> <mi>s</mi></math> 1232, and <math><mn>793</mn> <mi>v</mi> <mi>s</mi></math> 335, respectively).</p><p><strong>Conclusions: </strong>Approximately one-fourth of patients received BRCA testing. Disparities existed between those who received testing and those who did not. Patients who were tested had higher costs than those who were not; this difference was driven mostly by ambulatory visits and pharmacy costs, potentially due to increased clinical encounters and higher costs of targeted treatments.</p>","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 2","pages":"85-97"},"PeriodicalIF":2.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12393876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956997","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}
引用次数: 0
Costs of First-Line Treatment With FOLFIRINOX, Modified FOLFIRINOX, and Gemcitabine With Nab-Paclitaxel in Metastatic Pancreatic Ductal Adenocarcinoma. FOLFIRINOX、改良FOLFIRINOX和吉西他滨联合nab -紫杉醇治疗转移性胰腺导管腺癌的一线治疗成本
IF 2.3 Q2 ECONOMICS Pub Date : 2025-08-22 eCollection Date: 2025-01-01 DOI: 10.36469/001c.142403
Syvart Dennen, Marty Masek, Paul Cockrum, Elizabeth Nagelhout, Ravi Paluri
<p><strong>Background: </strong>Further research is needed to determine real-world costs of first-line (1L) treatment of metastatic pancreatic ductal adenocarcinoma (mPDAC) with FOLFIRINOX (FFX), modified FFX (mFFX), and gemcitabine with nab-paclitaxel (GnP).</p><p><strong>Objectives: </strong>To describe healthcare costs by treatment regimen, stratified by commercial and Medicare Advantage insurance.</p><p><strong>Methods: </strong>This retrospective cohort study of adult patients with mPDAC utilized Optum's de-identified Market Clarity Dataset. Demographics, clinical characteristics, and 1L unadjusted all-cause healthcare costs were examined. Total all-cause costs included costs from inpatient, outpatient, chemotherapy drug and administration, granulocyte colony-stimulating factor (G-CSF), radiation therapy, and other outpatient and pharmacy costs.</p><p><strong>Results: </strong>A total of 3115 patients met the criteria for inclusion and received 1L treatment with either FFX, mFFX, or GnP. Among those, 1703 had commercial insurance (FFX, 536; mFFX, 673; GnP, 494) and 1412 had Medicare Advantage (FFX, 201; mFFX, 317; GnP, 894). Total cost of care (mean [SD]) was similar between regimens for each insurance cohort (mean [SD] commercial: FFX, <math><mn>137</mn> <mrow><mo> </mo></mrow> <mn>813</mn> <mo>[</mo></math> 127 504]; mFFX, <math><mn>120</mn> <mrow><mo> </mo></mrow> <mn>109</mn> <mo>[</mo></math> 112 208]; GnP, <math><mn>133</mn> <mrow><mo> </mo></mrow> <mn>042</mn> <mo>[</mo></math> 154 248]; Medicare Advantage: FFX, <math><mn>110</mn> <mrow><mo> </mo></mrow> <mn>788</mn> <mo>[</mo></math> 98 492]; mFFX, <math><mn>98</mn> <mrow><mo> </mo></mrow> <mn>667</mn> <mo>[</mo></math> 83 437]; GnP, <math><mn>110</mn> <mrow><mo> </mo></mrow> <mn>211</mn> <mo>[</mo></math> 100 150]). For both insurance cohorts, chemotherapy drug costs were highest for GnP (mean [SD] commercial: FFX, <math><mn>10</mn> <mrow><mo> </mo></mrow> <mn>916</mn> <mo>[</mo></math> 21 647]; mFFX, <math><mn>7653</mn> <mo>[</mo></math> 10 054]; GnP, <math><mn>60</mn> <mrow><mo> </mo></mrow> <mn>466</mn> <mo>[</mo></math> 112 589]; Medicare Advantage: FFX, <math><mn>8028</mn> <mo>[</mo></math> 11 044]; mFFX, <math><mn>6016</mn> <mo>[</mo></math> 7688]; GnP, <math><mn>49</mn> <mrow><mo> </mo></mrow> <mn>263</mn> <mo>[</mo></math> 49 373]), while chemotherapy administration costs were higher for FFX and mFFX (commercial: FFX, <math><mn>25</mn> <mrow><mo> </mo></mrow> <mn>458</mn> <mo>[</mo></math> 33 350]; mFFX, <math><mn>22</mn> <mrow><mo> </mo></mrow> <mn>795</mn> <mo>[</mo></math> 24 309]; GnP <math><mn>12</mn> <mrow><mo> </mo></mrow> <mn>206</mn> <mo>[</mo></math> 15 766]; Medicare Advantage: FFX, <math><mn>25</mn> <mrow><mo> </mo></mrow> <mn>512</mn> <mo>[</mo></math> 36 352]; mFFX, <math><mn>21</mn> <mrow><mo> </mo></mrow> <mn>524</mn> <mo>[</mo></math> 22 317]; GnP <math><mn>11</mn> <mrow><mo> </mo></mrow> <mn>103</mn> <mo>[</mo></math> 13 089]). G-CSF costs were also higher
背景:需要进一步的研究来确定转移性胰腺导管腺癌(mPDAC)的一线(1L)治疗成本,包括FOLFIRINOX (FFX)、改良的FFX (mFFX)和吉西他滨联合nab-紫杉醇(GnP)。目的:描述医疗保健费用按治疗方案,按商业和医疗保险优势分层。方法:利用Optum的去识别市场清晰度数据集对成年mPDAC患者进行回顾性队列研究。调查了人口统计学、临床特征和1L未调整的全因医疗保健费用。总全因费用包括住院、门诊、化疗药物和给药、粒细胞集落刺激因子(G-CSF)、放射治疗以及其他门诊和药房费用。结果:共有3115例患者符合纳入标准,并接受了FFX、mFFX或GnP的1L治疗。其中,1703人有商业保险(FFX, 536; mFFX, 673; GnP, 494), 1412人有医疗保险优惠(FFX, 201; mFFX, 317; GnP, 894)。每个保险队列的总医疗成本(平均[SD])在不同方案之间相似(平均[SD]商业:FFX, 137 813 [127 504]; mFFX, 120 109 [112 208]; GnP, 133 042[154 248];联邦医疗保险优势:FFX, 110 788 [98 492]; mFFX, 98 667 [83 437]; GnP, 110 211[100 150])。对于保险组,化疗药物成本最高国民生产总值(意味着(SD)商业:FFX 10 916 [21 647]; mFFX, 7653[054],国民生产总值,60 466(112 589),医疗保险优势:FFX, 8028 [11 044]; mFFX, 6016[7688],国民生产总值,49 263[49 373]),而化疗管理成本更高的FFX和mFFX(商业:FFX, 25 458 [33 350]; mFFX, 22 795[24 309]; 206年国民生产总值12日[15 766];医疗保险优势:FFX, 25 512 [36 352]; mFFX, 21 524 (22 317);GnP 11 103[13 089])。FFX和mFFX的G-CSF成本也较高(商业:FFX, 38 074 [56 593], mFFX, 27 823 [41 166]; GnP, 4029 [14 181]; Medicare Advantage: FFX, 30 535 [56 630]; mFFX, 24 596 [39 286]; GnP, 2412[9115])。讨论:1L FFX、mFFX和GnP的总成本在商业保险和医疗保险优势队列中是相似的。FFX和mFFX成本主要由化疗给药和G-CSF成本驱动,而GnP成本主要由化疗药物成本驱动。结论:为了充分评估mPDAC在1L治疗中的经济影响,必须考虑总成本和个体成本组成部分,如化疗药物、给药和支持护理成本。
{"title":"Costs of First-Line Treatment With FOLFIRINOX, Modified FOLFIRINOX, and Gemcitabine With Nab-Paclitaxel in Metastatic Pancreatic Ductal Adenocarcinoma.","authors":"Syvart Dennen, Marty Masek, Paul Cockrum, Elizabeth Nagelhout, Ravi Paluri","doi":"10.36469/001c.142403","DOIUrl":"10.36469/001c.142403","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Further research is needed to determine real-world costs of first-line (1L) treatment of metastatic pancreatic ductal adenocarcinoma (mPDAC) with FOLFIRINOX (FFX), modified FFX (mFFX), and gemcitabine with nab-paclitaxel (GnP).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To describe healthcare costs by treatment regimen, stratified by commercial and Medicare Advantage insurance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study of adult patients with mPDAC utilized Optum's de-identified Market Clarity Dataset. Demographics, clinical characteristics, and 1L unadjusted all-cause healthcare costs were examined. Total all-cause costs included costs from inpatient, outpatient, chemotherapy drug and administration, granulocyte colony-stimulating factor (G-CSF), radiation therapy, and other outpatient and pharmacy costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 3115 patients met the criteria for inclusion and received 1L treatment with either FFX, mFFX, or GnP. Among those, 1703 had commercial insurance (FFX, 536; mFFX, 673; GnP, 494) and 1412 had Medicare Advantage (FFX, 201; mFFX, 317; GnP, 894). Total cost of care (mean [SD]) was similar between regimens for each insurance cohort (mean [SD] commercial: FFX, &lt;math&gt;&lt;mn&gt;137&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;813&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 127 504]; mFFX, &lt;math&gt;&lt;mn&gt;120&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;109&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 112 208]; GnP, &lt;math&gt;&lt;mn&gt;133&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;042&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 154 248]; Medicare Advantage: FFX, &lt;math&gt;&lt;mn&gt;110&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;788&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 98 492]; mFFX, &lt;math&gt;&lt;mn&gt;98&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;667&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 83 437]; GnP, &lt;math&gt;&lt;mn&gt;110&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;211&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 100 150]). For both insurance cohorts, chemotherapy drug costs were highest for GnP (mean [SD] commercial: FFX, &lt;math&gt;&lt;mn&gt;10&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;916&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 21 647]; mFFX, &lt;math&gt;&lt;mn&gt;7653&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 10 054]; GnP, &lt;math&gt;&lt;mn&gt;60&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;466&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 112 589]; Medicare Advantage: FFX, &lt;math&gt;&lt;mn&gt;8028&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 11 044]; mFFX, &lt;math&gt;&lt;mn&gt;6016&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 7688]; GnP, &lt;math&gt;&lt;mn&gt;49&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;263&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 49 373]), while chemotherapy administration costs were higher for FFX and mFFX (commercial: FFX, &lt;math&gt;&lt;mn&gt;25&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;458&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 33 350]; mFFX, &lt;math&gt;&lt;mn&gt;22&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;795&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 24 309]; GnP &lt;math&gt;&lt;mn&gt;12&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;206&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 15 766]; Medicare Advantage: FFX, &lt;math&gt;&lt;mn&gt;25&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;512&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 36 352]; mFFX, &lt;math&gt;&lt;mn&gt;21&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;524&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 22 317]; GnP &lt;math&gt;&lt;mn&gt;11&lt;/mn&gt; &lt;mrow&gt;&lt;mo&gt; &lt;/mo&gt;&lt;/mrow&gt; &lt;mn&gt;103&lt;/mn&gt; &lt;mo&gt;[&lt;/mo&gt;&lt;/math&gt; 13 089]). G-CSF costs were also higher ","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 2","pages":"75-84"},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12375408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957042","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}
引用次数: 0
Erratum: Effect of Fresh Frozen Plasma Infusion on Hospital Length of Stay for Patients With Hereditary Angioedema. 勘误:新鲜冷冻血浆输注对遗传性血管性水肿患者住院时间的影响。
IF 2.3 Q2 ECONOMICS Pub Date : 2025-08-21 eCollection Date: 2025-01-01
Subhan Khalid, Alan T Hitch

[This corrects the article DOI: 10.36460/jheor.2025.141471.].

[这更正了文章DOI: 10.36460/jheor.2025.141471.]。
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引用次数: 0
Erratum: Characteristics and Comorbidities Influencing Mortality Risk Among Hereditary Angioedema Patients. 影响遗传性血管性水肿患者死亡风险的特征和合并症。
IF 2.3 Q2 ECONOMICS Pub Date : 2025-08-21 eCollection Date: 2025-01-01 DOI: 10.36469/001c.143450
Subhan Khalid, Alan T Hitch

[This corrects the article DOI: 10.36469/jheor.2025.141747.].

[这更正了文章DOI: 10.36469/jheor.2025.141747.]。
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引用次数: 0
期刊
Journal of Health Economics and Outcomes Research
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