AIMDostarlimab plus carboplatin-paclitaxel (CP) significantly increased progression-free survival in patients with primary advanced or recurrent endometrial cancer (pA/rEC) vs CP alone in the RUBY trial (NCT03981796). This analysis estimated the per-member-per-month (PMPM) costs of introducing dostarlimab + CP as a treatment alternative from a third-party US payer perspective.MATERIALS AND METHODSA budget impact model was developed to estimate the costs of introducing dostarlimab + CP into commercial and Medicare health plans over a 3-year time horizon (2023-2025). Costs were sourced from relevant literature and US-specific databases and were calculated using epidemiology data, clinical inputs, treatment costs, and market share estimates. Clinical inputs were sourced from primary clinical trials for each respective treatment (ie, dostarlimab + CP, CP, pembrolizumab, pembrolizumab plus lenvatinib, bevacizumab + CP, and pembrolizumab + CP). Current and future market shares assumed dostarlimab + CP reduced the market share of CP only. Analyses were performed in mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) and overall populations using a US 2023 cost year.RESULTSFor a commercial plan, the model estimated (dMMR/MSI-H and overall populations) that 7 and 26 patients would be treated with dostarlimab + CP, respectively; average annual budget impacts per patient treated were $118,257 and $116,094; average budget impacts per patient treated per month (PPPM) were $9,855 and $9,675; average budget impacts PMPM were $0.02 and $0.06. For a Medicare plan, the model estimated that 28 and 93 patients, respectively, would be treated with dostarlimab + CP. Average annual budget impacts per patient treated and PPPM were the same as those for the commercial plan in both populations; average budget impacts PMPM were $0.07 and $0.22, respectively.CONCLUSIONSIntroducing dostarlimab + CP as a first-line treatment for patients with pA/rEC results in minimal budget impact PMPM from a US third-party payers' perspective. Together with the efficacy and safety results from RUBY, these results support the use of dostarlimab + CP as a treatment option.
{"title":"Budget impact of dostarlimab plus carboplatin-paclitaxel for primary advanced or recurrent endometrial cancer from a third-party US payer perspective.","authors":"Solomon J Lubinga,Lydia Walder,Mark Burton,Qin Shen","doi":"10.1080/13696998.2024.2403278","DOIUrl":"https://doi.org/10.1080/13696998.2024.2403278","url":null,"abstract":"AIMDostarlimab plus carboplatin-paclitaxel (CP) significantly increased progression-free survival in patients with primary advanced or recurrent endometrial cancer (pA/rEC) vs CP alone in the RUBY trial (NCT03981796). This analysis estimated the per-member-per-month (PMPM) costs of introducing dostarlimab + CP as a treatment alternative from a third-party US payer perspective.MATERIALS AND METHODSA budget impact model was developed to estimate the costs of introducing dostarlimab + CP into commercial and Medicare health plans over a 3-year time horizon (2023-2025). Costs were sourced from relevant literature and US-specific databases and were calculated using epidemiology data, clinical inputs, treatment costs, and market share estimates. Clinical inputs were sourced from primary clinical trials for each respective treatment (ie, dostarlimab + CP, CP, pembrolizumab, pembrolizumab plus lenvatinib, bevacizumab + CP, and pembrolizumab + CP). Current and future market shares assumed dostarlimab + CP reduced the market share of CP only. Analyses were performed in mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) and overall populations using a US 2023 cost year.RESULTSFor a commercial plan, the model estimated (dMMR/MSI-H and overall populations) that 7 and 26 patients would be treated with dostarlimab + CP, respectively; average annual budget impacts per patient treated were $118,257 and $116,094; average budget impacts per patient treated per month (PPPM) were $9,855 and $9,675; average budget impacts PMPM were $0.02 and $0.06. For a Medicare plan, the model estimated that 28 and 93 patients, respectively, would be treated with dostarlimab + CP. Average annual budget impacts per patient treated and PPPM were the same as those for the commercial plan in both populations; average budget impacts PMPM were $0.07 and $0.22, respectively.CONCLUSIONSIntroducing dostarlimab + CP as a first-line treatment for patients with pA/rEC results in minimal budget impact PMPM from a US third-party payers' perspective. Together with the efficacy and safety results from RUBY, these results support the use of dostarlimab + CP as a treatment option.","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1080/13696998.2024.2399435
Monika P Jun,Alex Mutebi,Anindit Chhibber,Chenxue Liang,Allison Keshishian,Anthony Wang,Fernando Rivas Navarro,Anupama Kalsekar,Jing He,Tongsheng Wang
AIMSTo understand treatment patterns, healthcare resource utilization (HCRU), and economic burden of diffuse large B-cell lymphoma (DLBCL) in elderly adults in the US.MATERIALS AND METHODSThis retrospective database analysis utilized US Centers for Medicare and Medicaid Services Medicare fee-for-service administrative claims data from 2015 to 2020 to describe DLBCL patient characteristics, treatment patterns, HCRU, and costs among patients aged ≥66 years. Patients were indexed at DLBCL diagnosis and required to have continuous enrollment from 12 months pre-index until 3 months post-index. HCRU and costs (USD 2022) are reported as per-patient per-month (PPPM) estimates.RESULTSA total of 11,893 patients received ≥1-line (L) therapy; 1633 and 391 received ≥2L and ≥3L therapy, respectively. Median (Q1, Q3) age at 1L, 2L, and 3L initiation, respectively, was 76 (71, 81), 77 (72, 82), and 77 (72, 82) years. The most common therapy was R-CHOP (70.9%) for 1L and bendamustine ± rituximab for 2L (18.7%) and 3L (17.4%). CAR T was used by 14.8% of patients in 3L. Overall, 39.6% (1L), 42.1% (2L), and 47.8% (3L) of patients had all-cause hospitalizations. All-cause mean (median [Q1-Q3]) costs PPPM during each line were $22,060 ($20,121 [$16,676-$24,597]) in 1L, $30,027 ($20,868 [$13,416-$31,016]) in 2L, and $47,064 ($25,689 [$15,555-$44,149]) in 3L, with increasing costs driven primarily by inpatient expenses. Total all-cause 3L mean (median [Q1-Q3]) costs PPPM for patients with and without CAR T were $153,847 ($100,768 [$26,534-$253,630]) and $28,466 ($23,696 [$15,466-$39,107]), respectively.CONCLUSIONSNo clear standard of care exists in 3L therapy for older adults with relapsed/refractory DLBCL. The economic burden of DLBCL intensifies with each progressing line of therapy, thus underscoring the need for additional therapeutic options.
{"title":"Treatment patterns, healthcare resource utilization, and costs in Medicare patients with diffuse large B-cell lymphoma: A retrospective claims analysis (2015-2020).","authors":"Monika P Jun,Alex Mutebi,Anindit Chhibber,Chenxue Liang,Allison Keshishian,Anthony Wang,Fernando Rivas Navarro,Anupama Kalsekar,Jing He,Tongsheng Wang","doi":"10.1080/13696998.2024.2399435","DOIUrl":"https://doi.org/10.1080/13696998.2024.2399435","url":null,"abstract":"AIMSTo understand treatment patterns, healthcare resource utilization (HCRU), and economic burden of diffuse large B-cell lymphoma (DLBCL) in elderly adults in the US.MATERIALS AND METHODSThis retrospective database analysis utilized US Centers for Medicare and Medicaid Services Medicare fee-for-service administrative claims data from 2015 to 2020 to describe DLBCL patient characteristics, treatment patterns, HCRU, and costs among patients aged ≥66 years. Patients were indexed at DLBCL diagnosis and required to have continuous enrollment from 12 months pre-index until 3 months post-index. HCRU and costs (USD 2022) are reported as per-patient per-month (PPPM) estimates.RESULTSA total of 11,893 patients received ≥1-line (L) therapy; 1633 and 391 received ≥2L and ≥3L therapy, respectively. Median (Q1, Q3) age at 1L, 2L, and 3L initiation, respectively, was 76 (71, 81), 77 (72, 82), and 77 (72, 82) years. The most common therapy was R-CHOP (70.9%) for 1L and bendamustine ± rituximab for 2L (18.7%) and 3L (17.4%). CAR T was used by 14.8% of patients in 3L. Overall, 39.6% (1L), 42.1% (2L), and 47.8% (3L) of patients had all-cause hospitalizations. All-cause mean (median [Q1-Q3]) costs PPPM during each line were $22,060 ($20,121 [$16,676-$24,597]) in 1L, $30,027 ($20,868 [$13,416-$31,016]) in 2L, and $47,064 ($25,689 [$15,555-$44,149]) in 3L, with increasing costs driven primarily by inpatient expenses. Total all-cause 3L mean (median [Q1-Q3]) costs PPPM for patients with and without CAR T were $153,847 ($100,768 [$26,534-$253,630]) and $28,466 ($23,696 [$15,466-$39,107]), respectively.CONCLUSIONSNo clear standard of care exists in 3L therapy for older adults with relapsed/refractory DLBCL. The economic burden of DLBCL intensifies with each progressing line of therapy, thus underscoring the need for additional therapeutic options.","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1080/13696998.2024.2400857
K Ray Chaudhuri, Lars Bergmann, Jonathan Belsey, Trishal Boodhna, Emanuele Leoncini
In advanced Parkinson’s disease (aPD), adequate 24-hour control of OFF-time may not be achievable using oral/transdermal therapies. Clinical trials of foslevodopa/foscarbidopa (LDp/CDP) demonstrate...
{"title":"Foslevodopa/foscarbidopa (LDp/CDp) in advanced Parkinson’s Disease (aPD): demonstration of savings from a societal perspective in the UK","authors":"K Ray Chaudhuri, Lars Bergmann, Jonathan Belsey, Trishal Boodhna, Emanuele Leoncini","doi":"10.1080/13696998.2024.2400857","DOIUrl":"https://doi.org/10.1080/13696998.2024.2400857","url":null,"abstract":"In advanced Parkinson’s disease (aPD), adequate 24-hour control of OFF-time may not be achievable using oral/transdermal therapies. Clinical trials of foslevodopa/foscarbidopa (LDp/CDP) demonstrate...","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1080/13696998.2024.2399438
Elena Arbelo,Roberto De Ponti,Lucas Cohen,Laura Pastor,Graca Costa,Marike Hempel,Daniel Grima
AIMSTo determine the clinical and economic implications of first-line or drug-naïve catheter ablation compared to antiarrhythmic drugs (AADs), or shorter AADs-to-Ablation time (AAT) in atrial fibrillation (AF) patients in France and Italy, using a patient level-simulation model.MATERIALS AND METHODSA patient-level simulation model was used to simulate clinical pathways for AF patients using published data and expert opinion. The probabilities of adverse events (AEs) were dependent on treatment and/or disease status. Analysis 1 compared scenarios of treating 0%, 25%, 50%, 75% or 100% of patients with first-line ablation and the remainder with AADs. In Analysis 2, scenarios compared the impact of delaying transition to second-line ablation by 1 or 2 years.RESULTSOver 10 years, increasing first-line ablation from 0% to 100% (versus AAD treatment) decreased stroke by 12%, HF hospitalization by 29%, and cardioversions by 45% in both countries. As the rate of first-line ablation increased from 0% to 100%, the overall 10-year per-patient costs increased from €13,034 to €14,450 in Italy and from €11,944 to €16,942 in France. For both countries, the scenario with no delay in second-line ablation had fewer AEs compared to the scenarios where ablation was delayed after AAD failure. Increasing rates of first-line or drug-naïve catheter ablation, and shorter AAT, resulted in higher cumulative controlled patient years on rhythm control therapy.LIMITATIONSThe model includes assumptions based on the best available clinical data, which may differ from real-world results, however, sensitivity analyses were included to combat parameter ambiguity. Additionally, the model represents a payer perspective and does not include societal costs, providing a conservative approach.CONCLUSIONIncreased first-line or drug-naïve catheter ablation, and shorter AAT, could increase the proportion of patients with controlled AF and reduce AEs, offsetting the small investment required in total AF costs over 10 years in Italy and France.
{"title":"Clinical and economic impact of first-line or drug-naïve catheter ablation and delayed second-line catheter ablation for atrial fibrillation using a patient-level simulation model.","authors":"Elena Arbelo,Roberto De Ponti,Lucas Cohen,Laura Pastor,Graca Costa,Marike Hempel,Daniel Grima","doi":"10.1080/13696998.2024.2399438","DOIUrl":"https://doi.org/10.1080/13696998.2024.2399438","url":null,"abstract":"AIMSTo determine the clinical and economic implications of first-line or drug-naïve catheter ablation compared to antiarrhythmic drugs (AADs), or shorter AADs-to-Ablation time (AAT) in atrial fibrillation (AF) patients in France and Italy, using a patient level-simulation model.MATERIALS AND METHODSA patient-level simulation model was used to simulate clinical pathways for AF patients using published data and expert opinion. The probabilities of adverse events (AEs) were dependent on treatment and/or disease status. Analysis 1 compared scenarios of treating 0%, 25%, 50%, 75% or 100% of patients with first-line ablation and the remainder with AADs. In Analysis 2, scenarios compared the impact of delaying transition to second-line ablation by 1 or 2 years.RESULTSOver 10 years, increasing first-line ablation from 0% to 100% (versus AAD treatment) decreased stroke by 12%, HF hospitalization by 29%, and cardioversions by 45% in both countries. As the rate of first-line ablation increased from 0% to 100%, the overall 10-year per-patient costs increased from €13,034 to €14,450 in Italy and from €11,944 to €16,942 in France. For both countries, the scenario with no delay in second-line ablation had fewer AEs compared to the scenarios where ablation was delayed after AAD failure. Increasing rates of first-line or drug-naïve catheter ablation, and shorter AAT, resulted in higher cumulative controlled patient years on rhythm control therapy.LIMITATIONSThe model includes assumptions based on the best available clinical data, which may differ from real-world results, however, sensitivity analyses were included to combat parameter ambiguity. Additionally, the model represents a payer perspective and does not include societal costs, providing a conservative approach.CONCLUSIONIncreased first-line or drug-naïve catheter ablation, and shorter AAT, could increase the proportion of patients with controlled AF and reduce AEs, offsetting the small investment required in total AF costs over 10 years in Italy and France.","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.1080/13696998.2024.2385191
Keruo Zhou, Min Zhang, Chenyu Zuo, Xiazhen Xie, Jianwei, Xuan
Objectives: To evaluate the cost-effectiveness of budesonide/formoterol reliever and maintenance therapy compared with salmeterol/fluticasone plus salbutamol as reliever therapy for asthma patients...
{"title":"Cost-effectiveness analysis of budesonide/formoterol SMART therapy versus salmeterol/fluticasone plus as-needed SABA among patients ≥12 years with moderate asthma from the Chinese societal perspective","authors":"Keruo Zhou, Min Zhang, Chenyu Zuo, Xiazhen Xie, Jianwei, Xuan","doi":"10.1080/13696998.2024.2385191","DOIUrl":"https://doi.org/10.1080/13696998.2024.2385191","url":null,"abstract":"Objectives: To evaluate the cost-effectiveness of budesonide/formoterol reliever and maintenance therapy compared with salmeterol/fluticasone plus salbutamol as reliever therapy for asthma patients...","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141770782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-29DOI: 10.1080/13696998.2024.2349471
Yang Z. Lu, Kenny Yat-Choi Kwong
Objective: To compare the cost, healthcare utilization, and outcomes between skin and serum-specific IgE (sIgE) allergy testing.Methods: This retrospective cohort study used IBM® MarketScan claims ...
{"title":"A comparison of healthcare utilization and outcomes following skin vs. serum-specific IgE allergy testing","authors":"Yang Z. Lu, Kenny Yat-Choi Kwong","doi":"10.1080/13696998.2024.2349471","DOIUrl":"https://doi.org/10.1080/13696998.2024.2349471","url":null,"abstract":"Objective: To compare the cost, healthcare utilization, and outcomes between skin and serum-specific IgE (sIgE) allergy testing.Methods: This retrospective cohort study used IBM® MarketScan claims ...","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140810399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1080/13696998.2024.2346397
Junjiro Kobayashi, Suzanne J. Baron, Kensuke Takagi, Christin A Thompson, Xiayu Jiao, Kaoru Yamabe
OBJECTIVE To analyze the cost-effectiveness of transcatheter aortic valve implantation (TAVI) using the SAPIEN 3 (Edwards Lifesciences, Irvine, CA) compared to surgical aortic valve replacement (SAVR) in low- and intermediate-risk patients from a Japanese public healthcare payer perspective. METHODS A Markov model cost-effectiveness analysis was developed. Clinical and utility data were extracted from a systematic literature review. Cost inputs were obtained from analysis of the Medical Data Vision claims database and supplemented with a targeted literature search. The robustness of the results was assessed using sensitivity analyses. Scenario analyses were performed to determine the impact of lower mean age (77.5 years) and the effect of two different long-term mortality hazard ratios (TAVI versus SAVR: 0.9-1.09) on both risk-level populations. This analysis was conducted according to the guidelines for cost-effectiveness evaluation in Japan from Core 2 Health. RESULTS In intermediate-risk patients, TAVI was a dominant procedure (TAVI had lower cost and higher effectiveness). In low-risk patients, the incremental cost effectiveness ratio (ICER) for TAVI was ¥750,417/quality-adjusted-life-year (QALY), which was below the cost-effectiveness threshold of ¥5 million/QALY. The ICER for TAVI was robust to all tested sensitivity and scenario analyses. CONCLUSIONS TAVI was dominant and cost-effective compared to SAVR in intermediate- and low-risk patients, respectively. These results suggest that TAVI can provide meaningful value to Japanese patients relative to SAVR, at a reasonable incremental cost for patients at low surgical risk and potentially resulting in cost-savings in patients at intermediate surgical risk.
目的从日本公共医疗支付方的角度分析在中低风险患者中使用 SAPIEN 3（爱德华兹生命科学公司，加利福尼亚州欧文市）经导管主动脉瓣植入术（TAVI）与外科主动脉瓣置换术（SAVR）的成本效益。临床和效用数据来自系统性文献综述。成本输入数据来自于对 Medical Data Vision 索赔数据库的分析，并辅以有针对性的文献检索。使用敏感性分析评估了结果的稳健性。进行了情景分析，以确定较低平均年龄（77.5 岁）的影响以及两种不同的长期死亡率危险比（TAVI 与 SAVR：0.9-1.09）对两种风险水平人群的影响。结果 在中危患者中，TAVI 是主要的手术方式（TAVI 成本更低，效果更好）。在低风险患者中，TAVI的增量成本效益比（ICER）为750,417日元/质量调整生命年（QALY），低于500万日元/QALY的成本效益阈值。结论在中危和低危患者中，TAVI 与 SAVR 相比分别具有优势和成本效益。这些结果表明，相对于 SAVR，TAVI 能为日本患者带来有意义的价值，对于手术风险低的患者，其增量成本合理，而对于手术风险中等的患者，则有可能节省成本。
{"title":"Cost-effectiveness analysis of transcatheter aortic valve implantation in aortic stenosis patients at low- and intermediate-surgical risk in Japan.","authors":"Junjiro Kobayashi, Suzanne J. Baron, Kensuke Takagi, Christin A Thompson, Xiayu Jiao, Kaoru Yamabe","doi":"10.1080/13696998.2024.2346397","DOIUrl":"https://doi.org/10.1080/13696998.2024.2346397","url":null,"abstract":"OBJECTIVE\u0000To analyze the cost-effectiveness of transcatheter aortic valve implantation (TAVI) using the SAPIEN 3 (Edwards Lifesciences, Irvine, CA) compared to surgical aortic valve replacement (SAVR) in low- and intermediate-risk patients from a Japanese public healthcare payer perspective.\u0000\u0000\u0000METHODS\u0000A Markov model cost-effectiveness analysis was developed. Clinical and utility data were extracted from a systematic literature review. Cost inputs were obtained from analysis of the Medical Data Vision claims database and supplemented with a targeted literature search. The robustness of the results was assessed using sensitivity analyses. Scenario analyses were performed to determine the impact of lower mean age (77.5 years) and the effect of two different long-term mortality hazard ratios (TAVI versus SAVR: 0.9-1.09) on both risk-level populations. This analysis was conducted according to the guidelines for cost-effectiveness evaluation in Japan from Core 2 Health.\u0000\u0000\u0000RESULTS\u0000In intermediate-risk patients, TAVI was a dominant procedure (TAVI had lower cost and higher effectiveness). In low-risk patients, the incremental cost effectiveness ratio (ICER) for TAVI was ¥750,417/quality-adjusted-life-year (QALY), which was below the cost-effectiveness threshold of ¥5 million/QALY. The ICER for TAVI was robust to all tested sensitivity and scenario analyses.\u0000\u0000\u0000CONCLUSIONS\u0000TAVI was dominant and cost-effective compared to SAVR in intermediate- and low-risk patients, respectively. These results suggest that TAVI can provide meaningful value to Japanese patients relative to SAVR, at a reasonable incremental cost for patients at low surgical risk and potentially resulting in cost-savings in patients at intermediate surgical risk.","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140668340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1080/13696998.2024.2342209
Michael F Mørup, V. Taieb, Damon Willems, Micah Rose, Nikos Lyris, Mark Lamotte, L. Gerlier, Howard Thom
AIMS To estimate the cost-effectiveness of a treatment-pathway initiated with bimekizumab, a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F in addition to IL-17A, in patients with axial spondyloarthritis (axSpA) compared with IL-17A inhibitors, ixekizumab, and secukinumab, from the National Health Service (NHS) of Scotland perspective. METHODS The axSpA treatment-pathway was modeled using a one-year decision tree followed by a lifetime Markov model. The pathway included first- and second-line biologic disease-modifying antirheumatic drugs (bDMARD), followed by best supportive care (bDMARD or nonbiologic). Bimekizumab followed by any bDMARD ('BKZ') was compared with IL-17Ai's: secukinumab 150 mg followed by a blend ('SEC') of dose up-titration to secukinumab 300 mg and any bDMARD, or ixekizumab followed by any bDMARD ('IXE'). Transition to the next therapy was triggered by Bath Ankylosing Spondylitis Disease Activity Index-50% (BASDAI50) non-response or any-cause discontinuation. A published network meta-analysis provided efficacy data. EuroQoL-5-dimensions utilities were derived by mapping from Ankylosing Spondylitis Disease Activity Score. Costs included disease management (linked to functional limitations), biologics acquisition (list prices, British National Formulary 2022), administration and monitoring (NHS 2021/22). Discounting was 3.5%/year. Probabilistic results from patients with non-radiographic axSpA (nr-axSpA) and ankylosing spondylitis (AS) were averaged to reflect the full axSpA disease spectrum. Scenario and sensitivity analyses were performed. RESULTS The incremental cost-effectiveness ratio (ICER) of BKZ was £24,801/quality-adjusted life-year (QALY) vs. SEC (95% credible interval £24,163-£25,895). BKZ had similar costs (Δ -£385 [-£15,239-£14,468]) and QALYs (Δ 0.039 [-0.748-0.825]) to IXE, with £1,523 (£862-£2,222) net monetary benefit. Conclusions remained unchanged in most scenarios. Results' drivers included BASDAI50 response rate and disease management cost. CONCLUSION The bimekizumab treatment-pathway represents a cost-effective option across the axSpA disease spectrum in Scotland. Bimekizumab is cost-effective compared to a secukinumab-pathway that includes dose up-titration, and has similar costs and QALYs to an ixekizumab-pathway.
{"title":"The cost-effectiveness of a bimekizumab versus IL-17A inhibitors treatment-pathway in patients with active axial spondyloarthritis in Scotland.","authors":"Michael F Mørup, V. Taieb, Damon Willems, Micah Rose, Nikos Lyris, Mark Lamotte, L. Gerlier, Howard Thom","doi":"10.1080/13696998.2024.2342209","DOIUrl":"https://doi.org/10.1080/13696998.2024.2342209","url":null,"abstract":"AIMS\u0000To estimate the cost-effectiveness of a treatment-pathway initiated with bimekizumab, a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F in addition to IL-17A, in patients with axial spondyloarthritis (axSpA) compared with IL-17A inhibitors, ixekizumab, and secukinumab, from the National Health Service (NHS) of Scotland perspective.\u0000\u0000\u0000METHODS\u0000The axSpA treatment-pathway was modeled using a one-year decision tree followed by a lifetime Markov model. The pathway included first- and second-line biologic disease-modifying antirheumatic drugs (bDMARD), followed by best supportive care (bDMARD or nonbiologic). Bimekizumab followed by any bDMARD ('BKZ') was compared with IL-17Ai's: secukinumab 150 mg followed by a blend ('SEC') of dose up-titration to secukinumab 300 mg and any bDMARD, or ixekizumab followed by any bDMARD ('IXE'). Transition to the next therapy was triggered by Bath Ankylosing Spondylitis Disease Activity Index-50% (BASDAI50) non-response or any-cause discontinuation. A published network meta-analysis provided efficacy data. EuroQoL-5-dimensions utilities were derived by mapping from Ankylosing Spondylitis Disease Activity Score. Costs included disease management (linked to functional limitations), biologics acquisition (list prices, British National Formulary 2022), administration and monitoring (NHS 2021/22). Discounting was 3.5%/year. Probabilistic results from patients with non-radiographic axSpA (nr-axSpA) and ankylosing spondylitis (AS) were averaged to reflect the full axSpA disease spectrum. Scenario and sensitivity analyses were performed.\u0000\u0000\u0000RESULTS\u0000The incremental cost-effectiveness ratio (ICER) of BKZ was £24,801/quality-adjusted life-year (QALY) vs. SEC (95% credible interval £24,163-£25,895). BKZ had similar costs (Δ -£385 [-£15,239-£14,468]) and QALYs (Δ 0.039 [-0.748-0.825]) to IXE, with £1,523 (£862-£2,222) net monetary benefit. Conclusions remained unchanged in most scenarios. Results' drivers included BASDAI50 response rate and disease management cost.\u0000\u0000\u0000CONCLUSION\u0000The bimekizumab treatment-pathway represents a cost-effective option across the axSpA disease spectrum in Scotland. Bimekizumab is cost-effective compared to a secukinumab-pathway that includes dose up-titration, and has similar costs and QALYs to an ixekizumab-pathway.","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140668794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1080/13696998.2024.2345507
Nicole Ferko, Stacey Priest, L. Almuallem, Alicyia Walczyk Mooradally, Di Wang, Abril Oliva Ramirez, Erika Szabo, Arturo Cabra
Aims: This systematic literature review (SLR) consolidated economic and healthcare resource utilization (HCRU) evidence for positron emission tomography (PET) and single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) to inform future economic evaluations.Materials and Methods: An electronic search was conducted in MEDLINE, Embase, and Cochrane databases from 2012-2022. Economic and HCRU studies in adults who underwent PET- or SPECT-MPI for coronary artery disease (CAD) diagnosis were eligible. A qualitative methodological assessment of existing economic evaluations, HCRU, and downstream cardiac outcomes was completed. Exploratory meta-analyses of clinical outcomes were performed.Results: The search yielded 13,439 results, with 71 records included. Economic evaluations and comparative clinical trials were limited in number and outcome types (HCRU, downstream cardiac outcomes, and diagnostic performance) assessed. No studies included all outcome types and only one economic evaluation linked diagnostic performance to HCRU. The meta-analyses of comparative studies demonstrated significantly higher rates of early- and late-invasive coronary angiography and revascularization for PET- compared to SPECT-MPI; however, the rate of repeat testing was lower with PET-MPI. The rate of acute myocardial infarction was lower, albeit non-significant with PET- vs. SPECT-MPI.Limitations and Conclusions: This SLR identified economic and HCRU evaluations following PET- and SPECT-MPI for CAD diagnosis and determined that existing studies do not capture all pertinent outcome parameters or link diagnostic performance to downstream HCRU and cardiac outcomes, thus, resulting in simplified assessments of CAD burden. A limitation of this work relates to heterogeneity in study designs, patient populations, and follow-up times of existing studies. Resultingly, it was challenging to pool data in meta-analyses. Overall, this work provides a foundation for the development of comprehensive economic models for PET- and SPECT-MPI in CAD diagnosis, which should link diagnostic outcomes to HCRU and downstream cardiac events to capture the full CAD scope.
{"title":"Economic and healthcare resource utilization assessments of pet imaging in coronary artery disease diagnosis: a systematic review and discussion of opportunities for future economic evaluations.","authors":"Nicole Ferko, Stacey Priest, L. Almuallem, Alicyia Walczyk Mooradally, Di Wang, Abril Oliva Ramirez, Erika Szabo, Arturo Cabra","doi":"10.1080/13696998.2024.2345507","DOIUrl":"https://doi.org/10.1080/13696998.2024.2345507","url":null,"abstract":"Aims: This systematic literature review (SLR) consolidated economic and healthcare resource utilization (HCRU) evidence for positron emission tomography (PET) and single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) to inform future economic evaluations.Materials and Methods: An electronic search was conducted in MEDLINE, Embase, and Cochrane databases from 2012-2022. Economic and HCRU studies in adults who underwent PET- or SPECT-MPI for coronary artery disease (CAD) diagnosis were eligible. A qualitative methodological assessment of existing economic evaluations, HCRU, and downstream cardiac outcomes was completed. Exploratory meta-analyses of clinical outcomes were performed.Results: The search yielded 13,439 results, with 71 records included. Economic evaluations and comparative clinical trials were limited in number and outcome types (HCRU, downstream cardiac outcomes, and diagnostic performance) assessed. No studies included all outcome types and only one economic evaluation linked diagnostic performance to HCRU. The meta-analyses of comparative studies demonstrated significantly higher rates of early- and late-invasive coronary angiography and revascularization for PET- compared to SPECT-MPI; however, the rate of repeat testing was lower with PET-MPI. The rate of acute myocardial infarction was lower, albeit non-significant with PET- vs. SPECT-MPI.Limitations and Conclusions: This SLR identified economic and HCRU evaluations following PET- and SPECT-MPI for CAD diagnosis and determined that existing studies do not capture all pertinent outcome parameters or link diagnostic performance to downstream HCRU and cardiac outcomes, thus, resulting in simplified assessments of CAD burden. A limitation of this work relates to heterogeneity in study designs, patient populations, and follow-up times of existing studies. Resultingly, it was challenging to pool data in meta-analyses. Overall, this work provides a foundation for the development of comprehensive economic models for PET- and SPECT-MPI in CAD diagnosis, which should link diagnostic outcomes to HCRU and downstream cardiac events to capture the full CAD scope.","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1080/13696998.2024.2346406
James X Zhang, Lisa R Shugarman
Cell and gene therapies (CGTs) treat patients in ways different from traditional medical and surgical approaches by providing “living drugs” that can heal and replace damaged tissues or diseased organs. These technological breakthroughs offer hope for curing many rare and hard-to-treat conditions, including blood disorders, cancer, eye disease, neurological disorders, and immune conditions. However, due to high cost for a single therapy, high upfront costs, uncertainty about long-term benefits, relatively small patient population size to pool insurance risk, and the fragmentation of the US insurance market, it is difficult to recoup healthcare cost savings for one insurer as patients move around various insurance plans. Even with outcome-based contracts (OBCs) with risk spreading, capping costs based on expected volume, and performance-based models, the financial risk the insurance plan takes and benefits it receives may not be in alignment, limiting the benefits of the new technology, which in turn impacts medical innovation, population health, and equitable access to care. A publicly funded special plan with OBCs for CGTs may help address the problem of the fractured insurance market. This special plan will pool funds from public sources, with a matching scheme between the federal and state governments, to support the payment for these therapies. A private insurance company that agrees to “buy in” to the treatment and pay a certain fee upfront would need to pay amortized benefits per annum (e.g. expected cost savings due to treatments) should its enrollee receive such a treatment.
{"title":"Value-based payment and financing for cell and gene therapies: challenges and potential solutions.","authors":"James X Zhang, Lisa R Shugarman","doi":"10.1080/13696998.2024.2346406","DOIUrl":"https://doi.org/10.1080/13696998.2024.2346406","url":null,"abstract":"\u0000 Cell and gene therapies (CGTs) treat patients in ways different from traditional medical and surgical approaches by providing “living drugs” that can heal and replace damaged tissues or diseased organs. These technological breakthroughs offer hope for curing many rare and hard-to-treat conditions, including blood disorders, cancer, eye disease, neurological disorders, and immune conditions. However, due to high cost for a single therapy, high upfront costs, uncertainty about long-term benefits, relatively small patient population size to pool insurance risk, and the fragmentation of the US insurance market, it is difficult to recoup healthcare cost savings for one insurer as patients move around various insurance plans. Even with outcome-based contracts (OBCs) with risk spreading, capping costs based on expected volume, and performance-based models, the financial risk the insurance plan takes and benefits it receives may not be in alignment, limiting the benefits of the new technology, which in turn impacts medical innovation, population health, and equitable access to care. A publicly funded special plan with OBCs for CGTs may help address the problem of the fractured insurance market. This special plan will pool funds from public sources, with a matching scheme between the federal and state governments, to support the payment for these therapies. A private insurance company that agrees to “buy in” to the treatment and pay a certain fee upfront would need to pay amortized benefits per annum (e.g. expected cost savings due to treatments) should its enrollee receive such a treatment.\u0000","PeriodicalId":16229,"journal":{"name":"Journal of Medical Economics","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140670313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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