Journal of Medical Economics最新文献

Aim: Urinary incontinence (UI) is a common condition for adult women impacting over 60% of women with 9.8% experiencing daily symptoms and 32.4% experiencing monthly symptoms. It is associated with significant negative impacts on patients' quality of life, well-being, and social functioning, resulting in substantial healthcare costs to payers. The goal of this study was to analyze 24-month budget impact of treatment of urinary incontinence (UI) in adult women enrolled in a 1-million-member US commercial health plan by comparing clinical practice that includes the use of the Leva Pelvic Health System (CP with Leva) to current clinical practice without Leva (CCP).

Methods: A budget-impact model compared 24-month costs associated with first-line pelvic floor muscle training (PFMT) in women seeking UI treatment in two cohorts: 85% receiving first-line CCP treatment/15% receiving the CP with Leva, compared to all patients treated with CCP. Medical spending per treated patient and per-member-per-month were calculated by summing 24-month UI treatment costs comparing CCP to CP with Leva. The treatment pathway was developed based on published guidelines and literature to obtain estimates of success and complications. Commercial payer costs were estimated by applying a 1.50× multiplier to published Medicare costs based on Congressional Budget Office data for Hospital and Physician Services.

Results: In a 1-million-beneficiary US commercial health plan with 334,191 adult women, 31,438 (9.4%) adult women were treated for UI over a 24-month period. Total estimated 24-month cost per treated patient was $11,267 in the CCP and $10,447 in the CP with Leva groups, respectively. Estimated total health plan 24-month savings was $25,782,112, or $1.07 per-member-per-month.

Limitations: The model may not capture all events in the care pathway for female UI patients seeking medical treatment, as there are significant variations in practice patterns; the rate of Leva adoption as a first-line therapy is based on estimates. The costs and savings calculated in this model may not be generalizable to every commercial health plan, given that actual costs routinely rely on specifically negotiated reimbursement rates.

Conclusions: The model demonstrates that access to first-line Leva therapy can reduce two-year UI treatment costs compared to CCP.

Background: Pimavanserin (PIM) is the only FDA approved atypical antipsychotic treatment (AAP) for hallucinations and delusions associated with Parkinson's disease psychosis (PDP) among patients with or without coexisting dementia; however, Other-AAPs (i.e. quetiapine (QUE), risperidone, olanzapine, aripiprazole) are commonly prescribed off-label. Healthcare resource utilization (HCRU) patterns among patients with PDP and coexisting dementia (PDP+D) who newly initiate PIM versus (vs.) Other-AAPs (i.e. other AAP-mix) or QUE in real-world settings is limited.

Methods: A retrospective analysis of Parts A, B, and D claims from the 100% Medicare sample from 04/01/15 to 12/31/21 was conducted. AAP-naïve patients with PDP+D who initiated ≥12-month continuous monotherapy with PIM vs. Other-AAPs or vs. QUE during 04/01/16-12/31/20 were propensity score matched 1:1 on thirty-one variables (age, sex, race, region and 27 Elixhauser comorbidity characteristics). Adjusted log binomial regressions compared all-cause HCRU [(e.g. inpatient hospitalizations and by hospitalization-type [short-term stays (ST-stays), long-term stays (LT-stays), skilled nursing facility stays (SNF-stays)], and emergency room (ER) visits] risk between cohorts.

Results: Of the 5,932 patients with PDP+D, matched cohorts (n = 1,294 in each) on continuous- monotherapy of PIM vs. Other-AAPs or QUE had similar demographics and comorbidities. Adjusted regression results showed those who initiated PIM vs. Other-AAPs had significantly lower relative risk (RR) of ≥1 all-cause inpatient hospitalizations (RR = 0.88, 95% CI: 0.80-0.97), ST-stays (RR = 0.86, 95% CI: 0.77-0.95), SNF-stays (RR = 0.79, 95% CI: 0.68-0.92), and ER visits (RR = 0.89, 95% CI: 0.84-0.94). PIM vs. QUE also experienced significantly lower RR for ≥1 all-cause IP hospitalizations (RR = 0.88, 95% CI: 0.80-0.96), ST-stays (RR = 0.85, 95% CI: 0.77-0.95), SNF-stays (RR = 0.81, 95% CI: 0.70-0.94), and ER visits (RR = 0.88, 95% CI: 0.83-0.94).

Conclusions: Patients initiating PIM-monotherapy for PDP+D experienced 12% lower all-cause inpatient hospitalizations vs. Other-AAPs or QUE. These results are consistent with prior real-world research in PDP with or without dementia.

Background: Streptococcus pneumoniae represents a significant global public health threat, causing approximately 45 million lower respiratory tract infections and 350,000 deaths annually among children under 5 years of age. Conjugate pneumococcal vaccines (PCVs), such as PCV15 and PCV20, have been developed to mitigate this burden by providing protection against serotypes responsible for the disease. The present analysis aims to evaluate the cost-utility of PCV20 compared to PCV15 as a vaccination strategy for preventing pneumococcal diseases in children in Italy.

Methods and materials: A cost-utility analysis (CUA) was conducted using a static Markov model adapted to the Italian context to simulate the economic and clinical effects of vaccination over a 10-year time horizon. The study adopted the perspective of the Italian National Health Service (NHS), considering only direct healthcare costs. Deterministic and probabilistic sensitivity analyses were performed to explore parameter uncertainty.

Results: The model showed that PCV20 is a dominant strategy compared to PCV15, generating cost savings of €6.45 million and a gain of 101,708 QALYs (quality-adjusted life years). These benefits are attributed to PCV20's broader serotype coverage, which significantly reduces the incidence of invasive and non-invasive pneumococcal diseases. Vaccination with PCV20 offers substantial clinical and economic advantages over PCV15.

Conclusions: The introduction of PCV20 as a vaccination strategy for children in Italy represents a cost-effective and clinically advantageous option. Its implementation can reduce the burden of pneumococcal disease and associated healthcare costs, improving public health outcomes and the economic efficiency of the healthcare system.

Introduction: Obstructive sleep apnea (OSA) is characterized by repeated episodes of airway obstruction during sleep, resulting in intermittent hypoxia, disrupted sleep, and reduced quality of life. Obesity management medications may provide new options for patients with OSA and obesity. Health state utilities will be needed as inputs in economic modeling conducted to inform decision-making about these medications for treatment of OSA. The purpose of this study was to estimate utilities associated with OSA severity based on preferences of individuals with OSA and obesity.

Methods: Participants with OSA and obesity (BMI ≥ 30) in the UK and US valued health state vignettes in time trade-off interviews. Vignettes described four levels of OSA severity defined by apnea-hypopnea index: remission (<5), mild (5-14.9), moderate (15-29.9), and severe (≥30). Participants were instructed to imagine having the option to use non-pharmacologic treatment for OSA when valuing the health states. Utilities were first estimated for OSA with these treatment options. Then, for health states where participants imagined using positive airway pressure or another device, they were asked to value the vignettes a second time without this treatment to estimate utilities associated with symptoms of OSA at each severity level.

Results: A total of 208 participants (UK = 105; US = 103) completed interviews (50.0% male; mean age = 53.6y). Mean (SD) utilities ranged from 0.93 (0.08) for mild OSA to 0.85 (0.15) for severe OSA when considering health states with the option to use non-pharmacologic treatment. When participants imagined living with the symptoms of OSA without the non-pharmacologic treatment option, mean utilities ranged from 0.89 (0.13) for mild OSA to 0.68 (0.27) for severe OSA.

Discussion: Results provide insight into preferences associated with OSA among people with OSA and obesity. The health state utilities estimated in this study may be useful in cost-effectiveness models evaluating treatments for OSA in individuals with obesity.

Aim: Food allergy (FA) imposes a large burden on patients/caregivers, but there is limited recent information on the societal economic burden of FA. We aimed to quantify this burden in the United States (US) using a health economic population cost exercise.

Methods: A prevalence-based model was adopted to estimate the US population with FA and the annual societal/patient costs of FA (in 2024 US$). The Markov model consisted of 3 mutually exclusive health states: "avoidance (with sensitivity)," "full tolerance," and death. Inputs included published data on epidemiology, clinical outcomes, and estimated costs. The model focuses on a comprehensive societal scenario. Scenario analyses utilized a conservative costing approach, determined if the estimated burden exhibited heterogeneity across underserved populations of race/ethnicity and household income, and assessed the impact of allergen desensitization on estimated costs.

Results: The model estimated 16,678,832 people with ≥1 physician-diagnosed FA, an annual total societal cost of $370.8 billion, and an annual cost per patient of $22,234, which was higher for children and adolescents than adults. Societal cost was primarily attributed to indirect costs (92.7% of total cost). In the scenario analysis, conservative total societal cost was $39.6 billion; Hispanic, African American, and other races/multiracial patients had ∼3% increased cost relative to White patients; direct medical cost for the low-income group was 39.1% higher than for the high-income group; and total cost was reduced by ∼4% for each additional 10% of the population that entered the model as desensitized.

Conclusions: Using a population cost exercise that incorporated a range of epidemiologically plausible explanations, we estimated the annual total societal cost of FA in the US may approach $370.8 billion, mostly from indirect costs borne by patients/caregivers during daily living. This assessment may assist population-level healthcare decision-makers in investing in measures that reduce economic burden, valuing interventions, and considering approaches to reduce economic/health disparities for underserved populations.

Objective: Long-acting reversible contraception (LARC) is the most effective form of reversible contraception. Leading organizations agree that LARC should be offered immediately postpartum. The etonogestrel implant is the most effective LARC but carries higher upfront acquisition costs. This study evaluated whether the acquisition costs for the etonogestrel implant are offset via pregnancy prevention and pregnancy-related costs in the year after childbirth.

Methods: A Markov model with 1-year time horizon simulated pregnancy outcomes among 1,000 women 18-49 years initiating 1 of 8 hormonal contraceptives for postpartum contraception: progestin-only oral contraception (OC), combined OC, progestin-only injectable, etonogestrel/ethinyl estradiol vaginal ring, norelgestromin/ethinyl estradiol transdermal patch, 3- or ≥5-year levonorgestrel IUD, and the etonogestrel implant. Time to postpartum initiation for each method and IUD expulsion rates were incorporated. Contraceptive acquisition costs, failure rates, discontinuation rates, pregnancy outcomes and costs, and healthcare resource use were examined from Commercial and Medicaid payor perspectives. Sensitivity analyses were conducted.

Results: The etonogestrel implant followed by IUDs were associated with the fewest short-interval pregnancies (8 [etonogestrel implant], 49 [3-year IUD], and 47 [≥5-year IUD], respectively) and the lowest Commercial (Medicaid) per-woman costs ($1,650 ($1,535) [etonogestrel implant]; $2,364 ($1,979) [3-year IUD]; and $2,519 ($2,145) [≥5-year IUD], respectively). In comparison, short-acting reversible contraception (SARC) resulted in 59-167 pregnancies, and Commercial (Medicaid) per-woman costs ranged from $2,244 ($1,749) to $5,102 ($4,106). Acquisition costs and discontinuation rates were the key drivers impacting overall costs.

Conclusions: The immediate postpartum provision of the etonogestrel implant produced the greatest cost savings due to fewer short-interval pregnancies and related expenditures. These results highlight the etonogestrel implant as a cost-effective option for clinicians seeking to reduce short-interval pregnancy and health system costs.

Background: Patients with refractory multiple myeloma (MM) often progress through lines of therapy (LOTs) comprising multiple drug classes, which may impose severe economic burden. In this retrospective US claims database study, we examined healthcare resource utilization (HCRU) and costs of patients with MM who received 1 to 3 prior LOTs.

Patients and methods: Adults with MM from the IBM Truven MarketScan Claims Database (1 January 2011-22 April 2023) were required to be continuously enrolled in a medical benefit/pharmacy plan for ≥12 months before initial MM diagnosis date and to have received 1 to 3 LOTs (including receiving ≥1 proteasome inhibitor and immunomodulatory drug and receiving and discontinuing lenalidomide) after diagnosis date. Index dates (start of subsequent treatment after fulfilling inclusion criteria) occurred after 1 January 2018, to capture contemporary cost estimates. Primary outcomes included all-cause and MM-related healthcare costs and HCRU after index date.

Results: The primary analysis included 338 patients with MM without post-index stem cell transplant (SCT), with a mean age of 61.1 years (55.3% male). During an average follow-up of 11.5 months, total all-cause healthcare costs averaged US $41,614 per patient per month. MM-related healthcare costs ($39,699) contributed 95% to total all-cause costs. Most MM-related monthly costs were attributed to drug/infusion costs (71%; $28,144). Sensitivity analyses that included patients with post-index SCT (N = 520) yielded similar results.

Conclusions: Patients with MM with 1 to 3 prior LOTs experienced high economic burden largely attributable to MM-related treatment, highlighting the need for more cost-effective therapies.

Objective: The LungFlag risk prediction model uses individualized clinical variables to identify individuals at high-risk of non-small cell lung cancer (NSCLC) for screening with low-dose computed tomography (LDCT). This study evaluates the cost-effectiveness of LungFlag implementation in the Spanish setting for the identification of individuals at high-risk of NSCLC.

Methods: A model combining a decision-tree with a Markov model was adapted to the Spanish setting to calculate health outcomes and costs over a lifetime horizon, comparing two hypothetical scenarios: screening with LungFlag versus non-screening, and screening with LungFlag versus screening the entire population meeting 2013 US Preventive Services Task Force (USPSTF) criteria. Model inputs were obtained from the literature and the clinical practice of a multidisciplinary expert panel. Only direct costs (€of 2023), obtained from local sources, were considered. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of our results.

Results: A cohort of 3,835,128 individuals meeting 2013 USPSTF criteria would require 2,147,672 LDCTs scans. However, using LungFlag would only require 232,120 LDCTs scans. Cost-effectiveness results showed that LungFlag was dominant versus non-screening scenario, and outperformed the scenario where the entire population were screened since the observed loss of effectiveness (-224,031 life years [LYs] and -97,612 quality-adjusted life years [QALYs]) was largely offset by the significant cost savings provided (€7,053 million). The resulting incremental cost-effectiveness ratio (ICER) for this strategy of screening the whole population versus using LungFlag was €72,000/QALY, showing that LungFlag is cost-effective. Various were described, such as the source of the efficacy or adherence rates, and other limitations inherent to cost-effectiveness analyses.

Conclusions: Using LungFlag for the selection of high-risk individuals for NSCLC screening in Spain would be a cost-effective strategy over screening the entire population meeting USPSTF 2013 criteria and is dominant over non-screening.

Introduction: A cell harvesting device for preparing non-cultured autologous skin cell suspension (ASCS) at the point-of-care is FDA-approved for repigmentation of stable depigmented vitiligo lesions in patients 18 years and older. The pivotal RSVP trial showed ≥80% repigmentation at Week-24 in 36% of lesions treated with laser ablation, ASCS, and narrowband ultraviolet B phototherapy compared to 0% with phototherapy alone (p = 0.012). The objective of this analysis was to evaluate the potential economic impact of laser ablation plus ASCS with phototherapy versus phototherapy alone for repigmentation of stable vitiligo lesions from a US payer perspective.

Methods: A 5-year decision-tree model was developed reflecting clinical pathways of adults with stable vitiligo lesions who had an inadequate response to prior topicals and phototherapy. Patients entering the model were treated with ASCS plus phototherapy or phototherapy alone and assessed for treatment response at Weeks-24 and 52 based on the RSVP trial's effectiveness endpoints. Durable response for Year-2 onwards was proxied by melanocyte-keratinocyte transplantation data. Model outcomes included per-patient total and incremental healthcare costs, treatment costs and total costs, cost per-patient per-month (PPPM), and cost per-patient per-year (PPPY). One-way sensitivity analyses assessed model result robustness.

Results: The cumulative total per-patient cost for ASCS plus phototherapy increased from $28,177 to $92,779 between Year-1 and Year-5. Phototherapy alone increased from $21,146 to $101,518 over the same period. Compared to phototherapy alone, ASCS plus phototherapy incurred $7,030 more total per-patient cumulative costs in Year-1 and $8,738 less by Year-5 (-$146 PMPM; -$1,748 PPPY). Breakeven occurred between Years 2-3. Results were most sensitive to changes in ASCS response at Weeks-24 and 52 and healthcare costs.

Conclusion: Among adults with stable vitiligo with prior inadequate response to topicals or phototherapy, ASCS treatment may lead to lower all-cause direct medical costs over 5 years compared to phototherapy alone.