Journal of Medical Economics最新文献

Aims: Hospitals, in particular intensive care units (ICUs), account for a large proportion of healthcare costs and environmental burden. Preventing unexpected patient transfer to ICU via continuous vital sign monitoring (CVSM) may mitigate this burden. Country-specific evidence on the cost-effectiveness of CVSM is missing. This analysis explored the impact of CVSM versus intermittent monitoring in post-surgical patients across France, Germany, the Netherlands, Spain, and the UK.

Materials and methods: A health-economic, decision-tree model was developed to compare CVSM versus intermittent monitoring for costs, resources, and environmental consequences up to 30 days after hospital discharge for a hypothetical, 100-patient cohort. Hospital data from the UK were used to populate the initial country model, while data were extracted from the literature for Netherlands, Germany, Spain, and France. Key outcomes were costs (in 2024 currency), days in hospital, and environmental impact (kg of CO_2eq and kg of waste). Robustness of results to changes in model inputs were assessed via 2,000 Monte Carlo simulations, results being presented reporting the 95% credible interval (95% CrI).

Results: For 100 patients, the cost savings with use of CVSM ranged from -€111,381 (95% CrI = -35,164; -159,176) in the Netherlands to -€22,745 (95% CrI = -7,656; -44,134) in France. In no country did the range of the 95% CrI cross zero, indicating significant cost savings with CVSM. Cost savings mainly resulted from reductions of ICU days, which ranged from -25 (95% CrI = 8; -43) in Germany to -9 (95% CrI = -1; -28) in France. Changes in ICU days were not always significant. On average, 3,866 kg of CO_2eq and 247 kg of waste were saved per cohort and country.

Limitations: Published data was limited and data was proxied across countries when unavailable.

Conclusions: CVSM is expected to be a cost-saving, sustainable solution for most hospitals of the countries included.

Objective: While multiple reversible contraceptives are available, long-acting reversible contraception (LARC) offers multi-year protection with minimal user burden. The etonogestrel implant is the most effective LARC but carries higher upfront acquisition costs. This analysis evaluated whether the acquisition costs for the etonogestrel implant are offset via pregnancy prevention and pregnancy-related expenditures.

Methods: A discrete Markov chain model with 5-year time horizon simulated pregnancy outcomes among 1,000 women 18-49 years initiating 1 of 8 hormonal contraceptive methods: branded or generic oral contraception (OC; progestin only and combined), medroxyprogesterone acetate injection, etonogestrel/ethinyl estradiol vaginal ring, norelgestromin/ethinyl estradiol transdermal patch, 3- or ≥5-year levonorgestrel IUD, and the etonogestrel implant. The model specified 28-day cycles. Contraceptive acquisition costs, typical-use failure rates, discontinuation rates, pregnancy outcomes and costs, and healthcare resource use were examined from a United States managed care perspective. Sensitivity analyses were also conducted.

Results: The etonogestrel implant followed by IUDs were associated with the fewest pregnancies (60 [etonogestrel implant], 105 [3-year IUD], and 104 [≥5-year IUD], respectively) and the lowest per-woman costs ($3,428 [etonogestrel implant], $5,275 [3-year IUD], and $4,728 [≥5-year IUD], respectively). Cost offsets occurred in Year 1 and increased incrementally through Year 5. In comparison, branded and generic OC resulted in 299 and 323 pregnancies, respectively, and $8,477 and $8,678 per-woman costs; the vaginal ring, injection, and patch resulted in 328, 265, and 327 pregnancies, respectively, with per-woman costs ranging from $8,781 to $13,963. Discontinuation rates, not acquisition costs, were the primary driver impacting overall costs.

Conclusions: The etonogestrel implant was the most cost-effective contraceptive option when modeled over a 5-year period, offering the fewest pregnancies and lowest associated healthcare costs. Policies and practices that support initiation and continuation of the etonogestrel implant can enhance both clinical outcomes and overall cost-effectiveness.

Aims: To evaluate costs per responder for patients with triple-class exposed (TCE) relapsed or refractory multiple myeloma (RRMM) receiving talquetamab (Tal) on weekly (QW) and biweekly (Q2W) dosing schedules, compared with usual care from a United States commercial payer's perspective.

Methods: A cost per responder model was developed over a 6-month time horizon, incorporating pre-progression and post-progression costs. For Tal QW and Tal Q2W, pre-progression costs included costs of drug acquisition, inpatient step-up doses (hospitalization, pre-medication, and tocilizumab), outpatient visits, and monitoring. Pre-progression costs for usual care were estimated based on a weighted average of the 10 most used regimens in a real-world LocoMMotion/MoMMent study, including costs of acquisition, administration, co-medication, and monitoring. Post-progression costs included subsequent treatment for a subset of patients and terminal care costs prior to death. All costs were reported in 2025 United States Dollars. Clinical data of overall response rate (ORR), progression-free survival, and overall survival were obtained from an indirect treatment comparison using MonumenTAL-1 (September 2024 data cut) and LocoMMotion/MoMMent (October 2022 and August 2023 data cuts) as data sources. Deterministic sensitivity analyses and scenario analyses were conducted to assess the robustness of model results.

Results: Over the 6-month period, the total cost of care was $179,556 for usual care, $295,993 for Tal QW, and $315,135 for Tal Q2W. Despite higher costs, Tal demonstrated superior ORR, resulting in lower cost per responder: $575,962 for usual care, $405,470 for Tal QW, and $443,165 for Tal Q2W, representing a 23-30% reduction in cost per responder with Tal. Sensitivity and scenario analyses showed consistent findings.

Conclusion: Although Tal QW and Q2W are associated with higher total per-patient costs compared with usual care, they offer improved clinical effectiveness, resulting in lower cost per responder. These findings suggest greater economic value for Tal in the treatment of TCE RRMM.

Aims: To quantify the clinical and economic burden of Coronavirus disease 19 (COVID-19), and burden potentially avoided with annual vaccination, in German adults in an endemic setting.

Materials and methods: A decision tree model was constructed to estimate the clinical and economic impact of COVID-19 and projected burden avoided with BNT162b2, a seasonally adapted mRNA vaccine against severe COVID-19 disease. The majority of cost inputs and clinical event probabilities were informed by German real-world evidence from seasons 2022/23 and 2023/24. Vaccine efficacy was derived from US and German studies. Long/Post COVID impact was assessed in scenario analysis.

Results: The model estimated up to 20.8 million symptomatic infections per year in adults, including 7.5 million in people aged 60+, and 6.0 million in comorbid adults. This translates to an estimated 198,598 hospitalizations and 24,626 COVID-attributable deaths, with 93.6% of deaths occurring in people aged 60+. The total economic burden including productivity loss was estimated at €1.4 billion in people aged 60+, €2.0 billion in comorbid adults, and €3.9 billion in all working adults. Long/Post COVID increased the economic burden by 1.7 times.

Assuming vaccination of 100% of recommended groups, 11.0 million symptomatic infections could be prevented, with the greatest impact in people aged 60+ (estimated 110,362 hospitalizations and 13,685 deaths avoided). For people aged 60+, comorbid adults, and all working adults, the number needed to vaccinate to prevent one symptomatic infection was 7, 4, and 4 people; to prevent one hospitalization, 231, 2,363, and 4,549; and to avoid one death, 1,862, 19,055, and 36,683, respectively.

Conclusion: COVID-19 imposes a substantial clinical and economic burden on the German population, which could be mitigated with an expanded COVID-19 vaccination program. Further research into Long/Post COVID is needed. Our study presents considerations highlighting the value of broad vaccination especially for working adults.

Background: Acromegaly is a rare and progressive condition caused by excessive secretion of growth hormone and insulin-like growth factor type 1. Pasireotide long-acting release (LAR) is indicated as a second-line therapy for adults with acromegaly who are unsuitable for or unresponsive to surgery and inadequately controlled with first-generation somatostatin receptor ligands (FGSRLs). Although its efficacy and safety have already been established, its cost-effectiveness remains unclear. The primary objective of this study was to systematically assess the cost-effectiveness of pasireotide LAR compared to other second-line medical options, particularly pegvisomant.

Methods: A systematic literature review was conducted in May 2024 in Medline, Medline In Process, Web of Science, and the Centre for Reviews and Dissemination (CRD), York. Studies were eligible if they were full or partial economic analyses of pasireotide LAR as a second-line pharmacological treatment for adult patients with acromegaly. Studies not available in English and publications prior to 2009 were excluded. Included articles were assessed for transparency using the appropriate checklists. Data extraction focused on costs, incremental cost-effectiveness ratios and quality-adjusted life years. Formal data synthesis of outcomes was not undertaken due to the small number of studies and notable heterogeneity between them. Methodological assessment involving the evaluation of model inputs, data sources, and their alignment with the evidence on the course of disease and clinical practice was performed to examine the main factors contributing to discrepancies in cost-effectiveness outcomes and assess the credibility of the results.

Results: Of 160 records identified, six publications met the inclusion criteria. Their findings demonstrated variability. The critical assessment highlighted considerable variability in methodological rigor among the included studies.

Conclusions: Evidence on pasireotide LAR's cost-effectiveness versus pegvisomant regimens remains inconclusive. Although two studies indicated that pegvisomant is more cost-effective, the study with the highest methodological credibility found that pasireotide LAR is a cost-effective alternative.

Background: Underreporting of infections, hospitalizations, and deaths can pose challenges to accurately estimating the true burden of COVID-19. Consequently, health burden assessments and economic evaluations may underestimate the public health impact of interventions such as vaccination.

Methods: This targeted literature review summarized economic evaluations of COVID-19 that reported having adjusted for underreporting of epidemiological burden. Searches were performed in PubMed through 08/31/2025 with no geographic restrictions. Key study characteristics extracted: country, time period, population, parameters adjusted for underreporting, and the adjustment multipliers used. A high-level quality assessment of evidence was conducted, building on Drummond checklist and CHEERS. Given the qualitative nature of the question and the expected heterogeneity in study designs, the results were summarized qualitatively.

Results: A total of 20 studies met the inclusion criteria. Of these, 14 (70%) reported numerical adjustment factors, and the remaining 30% did not report a numerical factor. The studies covered diverse geographic regions and time frames, with adjustments applied to parameters such as infections, hospitalizations, and mortality. The study quality was moderate to high. The multipliers used ranged widely across studies: 1 to 5 for mortality, 1 to 5 for hospitalizations, and 1 to 10 for infections, where a value higher than 1.0 reflects an adjustment factor for underreporting. The methodologies used to estimate underreporting varied, including comparisons to excess mortality data, Monte Carlo simulations, and validation against external datasets.

Limitations: Most studies used pandemic time horizons.

Conclusions: This review identified 14 modelling studies reporting numerical adjustment factors. The studies used diverse approaches and adjustment factors, reflecting variability in data availability and estimation methods. Recognizing and standardizing these adjustments is crucial for improving the accuracy and comparability of health economic analyses that inform policy decisions. Further research could refine underreporting estimates and assess their impact on economic model outcomes.

Background: Septic shock is a life-threatening condition associated with high morbidity, mortality, and healthcare costs. Vasopressin (VA) is recommended as a second-line vasopressor in septic shock, but its cost-effectiveness-especially regarding the timing of administration-remains unclear in European settings.

Methods: A hybrid decision-analytic model combining a short-term decision tree and a long-term Markov model was developed to evaluate the cost-effectiveness of VA in adult patients with septic shock. The analysis was conducted from both a healthcare payer and societal perspective. Clinical efficacy inputs were derived from high-quality meta-analyses and systematic reviews. The model incorporated health-states such as end-stage renal-disease (ESRD) with need for renal replacement therapy (RRT), atrial fibrillation (AF), and mortality over a lifetime horizon. Two comparisons were analyzed: VA versus No VA, and early (within 3-12 h of shock onset) versus late VA administration. Outcomes included incremental cost-effectiveness ratio (ICER), life-years (LYs), quality-adjusted life-years (QALYs), and direct and indirect cost estimates.

Results: Adding VA was a dominant strategy, improving clinical outcomes while reducing lifetime costs by 10,570 €per patient and yielding 0.09 additional QALYs. VA therapy reduced RRT dependence by 2.5% and increased AF-free survival by 6.2%. Early VA administration was even more cost-effective, providing 0.55 additional QALYs, 0.77 extra LYs, and 4,746 €in additional savings compared to late administration.

Conclusion: Second-line VA is a cost-effective intervention for septic shock, notably when initiated early. These findings support guideline recommendations for early vasopressor use and emphasize the clinical and economic value of timely VA therapy.

Objectives: This study assessed the long-term clinical benefits and cost savings associated with achieving composite treatment targets (CTT) of stringent glycemic control, weight reduction and no hypoglycemia in predominantly Chinese patients with Type 2 Diabetes (T2D) inadequately controlled with metformin and/or sulfonylurea.

Methods: The study was conducted using an implementation of the UK Prospective Diabetes Study Outcomes Model Version 2 (UKPDS OM2) in Microsoft Excel, with additional modules for treatment switching, weight change, and hypoglycemia. Thirty-year healthcare costs were projected to capture macro- and microvascular complications, hypoglycemia and diabetic treatment. Baseline and efficacy inputs were extracted from the SURPASS-AP-Combo trial (NCT04093752), a predominantly Chinese cohort. Cost inputs were derived from literature review. Patients were categorized as "Achieved" or "Failed" based on whether they met the CTT (i.e. HbA1c ≤6.5%, ≥10% weight reduction, and no hypoglycemia event [blood glucose < 3.0 mmol/L or severe hypoglycemia]) at the end of SURPASS-AP-Combo trial, regardless of treatment received. For the Achieved group, sustained CTT was assumed for 3, 5, or 10 years before natural disease progression per UKPDS OM2 progression trajectories. The Failed group followed UKPDS OM2 progression trajectories throughout. Treatment intensification to basal-bolus insulin was triggered when HbA1c levels reached predefined CTT-based thresholds. Scenario analyses applied less stringent CTT.

Results: Sustained achievement of CTT for 3, 5 and 10 years yielded 0.31, 0.40 and 0.56 quality-adjusted life years (QALYs) and cost savings of ¥22,336, ¥32,692, ¥53,234 per patient, respectively. These savings were attributable to reduced complications, hypoglycemia and delayed treatment intensification. Slightly smaller savings were observed applying less stringent CTT.

Conclusions: In this modeling study, a sustained achievement of CTT led to improved clinical benefits and significant direct medical cost savings. The longer the achievement period and the more stringent CTT, the greater the clinical benefits and cost savings.

Background and objective: Chronic kidney disease (CKD) affects a significant proportion of the population leading to a substantial economic burden on healthcare systems and societies. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have been shown to slow CKD progression and reduce cardiovascular risks in patients regardless of their diabetes status, leading to cost-savings and health benefits for patients with CKD. Currently, published cost-effectiveness studies in the UK and Southeast Asia demonstrate a significantly high value of adding empagliflozin in CKD management. This study aims to simulate a CKD progression model to assess the cost-effectiveness of adding empagliflozin to the standard of care (SoC) compared to SoC alone for CKD management in the Philippines.

Methods: We conducted an individual microsimulation model of CKD progression and its related complications using annual cycles from a healthcare perspective. The simulation incorporated local costs, life tables, and utility values derived from local and best available evidence from published CKD literature.

Results: The addition of empagliflozin to the SoC leads to significant lifetime cost-savings per patient of PHP 8,360,571.52 (USD 146,986.14) for the full cohort of the CKD population, PHP 7,944,677.72 (USD 139,674.36) for the diabetic cohort, and PHP 9,339,394.50 (USD 164,194.70) for the non-diabetic cohort. Patients on empagliflozin also experienced higher quality-adjusted life years (QALYs) of 0.84, 0.90, and 0.78 for the full, diabetic, and non-diabetic cohorts, respectively. Adding empagliflozin to the SoC is economically dominant across willingness-to-pay (WTP) thresholds ranging from 0.5 to 1 times the Philippine gross domestic product (GDP) per capita of 2024. Sensitivity analyses confirmed these findings, demonstrating consistency across varied input parameters.

Conclusion: Empagliflozin is cost-saving and provides utility benefits when added to SoC among patients with CKD. This finding holds significant value for patients with CKD, regardless of diabetes status.