Journal of Medical Economics最新文献

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.

Aim: Anti-PD-(L)1 agents, inhibitors of programmed cell death protein 1 (PD-1) or its ligand (PD-L1), are established therapies that improve cancer management as well as the disease and societal burden of specific metastatic and early-stage cancers. The aim of the study was to determine the impact of adopting anti-PD-(L)1 agents for the treatment of all eligible patients with early-stage cancers versus reserving anti-PD-(L)1 agents for patients with metastatic disease alone in Hungary.

Methods: This study evaluated two scenarios, one where anti-PD-(L)1 agents were used to treat all eligible early-stage disease cases (ESD scenario) of melanoma (stage IIB-C and III), renal cell carcinoma (RCC), and triple-negative breast cancer (TNBC) versus a reference scenario where anti-PD-(L)1 agents were only used to treat metastatic disease cases in Hungary (2024-2033). A Markov-modeling approach estimated the health outcomes and productivity losses from each scenario from a societal perspective. Outcomes included recurrence-/event-/disease-free life-years, total life-years, quality-adjusted life-years (QALYs), productive years (patients and caregivers), recurrences/events, active treatments for metastatic disease, and deaths. The cumulative health and productivity impact of ESD treatment with anti-PD-(L)1 agents in Hungary was the difference in health and productivity outcomes between the ESD and reference scenarios for the time horizon of the model.

Results: ESD treatment with anti-PD-(L)1 agents was estimated to increase recurrence-/event-/disease-free life-years (+13.8%), total life-years (+3.7%), and QALYs (+4.7%), as well as productive work years for patients (+39.6%) and caregivers (+27.6%). Concurrently, there would be fewer recurrences/events (-31.0%), active treatments for metastatic disease (-34.0%), post-recurrence deaths (-30.3%), and total deaths (-23.1%).

Conclusion: Investing in anti-PD-(L)1 agents for early-stage disease may not only increase the life expectancy and QALYs for patients in Hungary but also increase productive work years for both patients and caregivers in Hungary. In addition, it may also help to reduce metastatic disease treatments and cancer-related deaths.

Introduction: This study evaluated the health and economic impacts of the 21-valent pneumococcal conjugate vaccine (PCV21) compared to the 20-valent pneumococcal conjugate vaccine (PCV20) in Swiss adults aged 65 years and older using the delta-price approach.

Method: A published state-transition Markov model was used to track health and economic outcomes of invasive pneumococcal disease (IPD), inpatient non-bacteremic pneumococcal pneumonia (NBPP), and post-meningitis sequelae (PMS). Estimated quality-adjusted life years (QALYs)and cost outcomes were discounted at 3%. All costs were presented in 2024 Swiss Franc (CHF). Price premiums were estimated as the difference between the prices of PCV21 and PCV20, and the maximum premiums at which PCV21 remains cost-saving and cost-effective (at a willingness-to-pay threshold of CHF 40,000) were reported. A scenario analysis was conducted to include a pneumococcal polysaccharide vaccine 23-valent (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13) vaccine-experienced population. Sensitivity analysis identified the input categories that were most influential on the price premiums.

Results: Overall, PCV21 averted more cases of IPD, NBPP, PMS and associated deaths, and saved more direct costs than PCV20. Compared to PCV20, PCV21 was cost-saving until a price premium of CHF 25.10 and cost-effective up to a price premium of CHF 88.01. In the scenario analysis, PCV21 was cost-saving up to a price premium of CHF 25.38, and cost-effective up to a price premium of CHF 88.68. Vaccine effectiveness and disease costs were the most influential inputs on the price premiums.

Conclusion: PCV21 provides greater health and economic benefits than PCV20 and is cost-effective over a range of price premiums.

Aims: Evaluate treatment switching and healthcare costs of onabotulinumtoxinA (onabotA) compared to calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) for the preventive treatment of chronic migraine (CM).

Materials and methods: Adult patients with CM who initiated onabotA or a CGRP mAb between 1 October 2021 and 31 December 2023 were identified from the Optum de-identified Clinformatics Data Mart database. Index date was the first recorded treatment claim and patients must have had continuous Medicare coverage 12-months pre- and post-index period. Treatment switching, defined as ≥1 claim for a different branded migraine preventive treatment in the 12 months post-index period, was evaluated. Two additional treatment switch definitions were evaluated. All-cause healthcare resource utilization and costs were evaluated over the 12-month follow-up. Multivariable logistic regression adjusted for baseline characteristic differences when comparing odds of switching between onabotA and CGRP mAbs. Patient information on CM severity was not available in the database and not reported.

Results: Of 887 patients identified, 367 initiated onabotA and 520 a CGRP mAb as index treatment. After 12 months of follow-up, 8.7% of onabotA users and 18.3% of CGRP mAb users initiated a different branded migraine preventive treatment. After adjusting for differences in baseline characteristics, CGRP mAb users had 134% higher odds of switching treatment during the 12-month follow-up compared to onabotA users (OR, 2.34; 95% CI: 1.49, 3.67, p < 0.001), or 9.3% absolute risk difference. Results for additional treatment switch definitions were consistent. OnabotA and CGRP mAb users had comparable all-cause healthcare costs during the 12-month follow-up.

Limitations: Outcomes could only be adjusted for known and observed confounders, which could introduce bias between comparators.

Conclusions: Patients with CM on a CGRP mAb were significantly more likely to switch to a different branded migraine preventive treatment within 12 months of treatment initiation compared to those on onabotA. Total costs were comparable between treatments.

Objective: To investigate the extent to which employment and productivity losses could be prevented by mitigating cervical spinal cord injury (SCI) and concurrent traumatic brain injury (TBI) in Taiwan.

Design: Using Taiwan's National Health Insurance Database, we identified individuals with cervical SCI and concurrent TBI, with the 7-year data collection period (2012-2018) and a general population cohort as the reference. Survival and employment status were extrapolated to lifetime and age using rolling extrapolation with restricted cubic spline regression and generalized linear models.

Results: This study included 2,852 patients with cervical SCI and 367 with concurrent TBI. In cervical SCI, loss-of-life expectancy, loss-of-lifetime employment duration (LED), and loss-of-lifetime insured salary (LIS; a proxy for productivity) were 19.3 years, 7.5 years, and $122,998, respectively. The relative loss-of-LED of motor-vehicle-related cervical SCI with concurrent TBI was significantly higher than that without TBI (72.7% vs. 64.2%). The relative loss-of-LED in middle-aged cervical SCI was significantly higher than loss-of-LIS (58.2% vs. 63.5%), suggesting that total productivity was more severely affected than working time.

Conclusion: This 7-year nationwide cohort provides the first lifetime employment and productivity loss estimates for cervical SCI, demonstrating that concurrent TBI and younger age amplify economic burden. The findings shift the policy focus from generic SCI prevention to specific, high-yield interventions: mandatory TBI screening, age-tailored vocational programs, and productivity-targeted workplace accommodations. These evidence-based figures enable precise cost-benefit analyses for preventive measures (e.g. enhanced helmet legislation, road safety) and rehabilitation investments, offering actionable data for Taiwan's health and labor policymakers.

Aims: Seasonal influenza and COVID-19 pose significant ongoing threats to global health. Vaccination remains central to their prevention. Messenger RNA combination influenza and COVID-19 vaccines (mRNA combo vaccines) are in development. Payers will soon need to make value-for-money (VfM) assessments and coverage decisions regarding these vaccines. Value taxonomies play an important role in VfM assessments and coverage decisions. However, no taxonomy exists that captures the full value of mRNA combo vaccines. We aimed to construct a taxonomy of the full value, from a societal perspective, of mRNA combo vaccines in working-age (18-64 years) and older adults (65+ years).

Methods: We (1) performed a targeted literature review (TLR) of existing value taxonomies and value attributes of COVID-19, influenza, other mRNA, and other combination vaccines; and (2) synthesized the value elements found in the TLR into a comprehensive taxonomy specific to mRNA combo vaccines.

Results: Of 1851 identified studies, 57 contained relevant value elements. We constructed a taxonomy distinguishing narrow health-related from broader societal values, and traditional from novel values. Value elements in the taxonomy included improved health and reduced treatment costs; improved productivity; improved strain selection, raising vaccine efficacy; greater compliance with vaccine schedules, increasing uptake; improved patient and caregiver health and reduced treatment costs from such greater efficacy and uptake; reduced adverse events, anxiety and vaccination costs from reduced doses; process utilities from increased convenience; higher patient and provider acceptability; increased equity; and health-related R&D spillovers.

Limitations: The TLR was non-systematic. We do not address potential redundancies or the relative importance of different values.

Conclusions: Many value elements in the taxonomy are traditional narrow values and fit within a health payer perspective, but the taxonomy also captures broader societal values. This taxonomy can support more comprehensive valuations of mRNA combo vaccines in national vaccine recommendation and funding decisions.

Aims: The main objective of this study was to estimate the incremental healthcare resource utilization (HCRU) and costs attributable to metabolic dysfunction-associated steatohepatitis (MASH) from a Medicare fee-for-service perspective by comparing beneficiaries diagnosed with MASH with those not diagnosed with MASH.

Material and methods: This observational study used 100% Medicare fee-for-service claims data from January 1, 2016, through December 31, 2022. The study population was stratified in cohorts based on MASH status. In the main analysis, the MASH cohort included all beneficiaries diagnosed with MASH, while the non-MASH cohort comprised a random sample of beneficiaries without a MASH diagnosis, matched in size to the MASH cohort. To compare the 2 cohorts, stabilized inverse probability of treatment weighting (IPTW) was used to adjust for differences in baseline covariates, including selected cardiometabolic conditions. Reported outcomes included all-cause, cardiovascular-related, and liver-related HCRU and costs after IPTW.

Results: The study included 128 622 beneficiaries in the MASH cohort and 128 579 beneficiaries in the non-MASH cohort. After IPTW, MASH was associated with higher all-cause HCRU rates, particularly for inpatient hospitalizations (rate ratio, 1.36; 95% CI, 1.33-1.39). This increase appeared to be driven by liver-related hospitalizations (rate ratio, 10.41; 95% CI, 9.40-11.42). Consistent with HCRU findings, mean total cost per patient per year was higher for MASH compared with non-MASH ($27 816 vs $25 666; mean cost difference, $2150; 95% CI, $1673-$2627).

Limitations: The HCRU and cost attributed to MASH could be underestimated because of MASH underdiagnosis and underreporting, as well as potential overadjustment for MASH-driven comorbidities in the IPTW model.

Conclusions: Among Medicare fee-for-service beneficiaries aged 66 years and older, MASH was associated with significantly greater HCRU and costs, even after adjustment for cardiometabolic and other comorbidities. The higher HCRU and costs are likely driven by the management of liver disease, which may include cirrhosis and hepatic decompensation.

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.

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.