ClinicoEconomics and Outcomes Research最新文献

Background: This study evaluated the clinical and economic outcomes associated with disruptive surgical bleeding (ie, hemorrhage/hematoma that complicates a procedure despite the use of hemostatic agents) among patients with bariatric, colorectal, spine, total hip arthroplasty (THA), and total knee arthroplasty (TKA) surgery.

Methods: Premier Healthcare Database patients aged ≥18 with one of the five procedures and hemostatic agent use between January 1-December 31, 2019, were included. Clinical and economic outcomes (ie, operating room time, 90-day all-cause inpatient readmission, in-hospital mortality, intensive care unit [ICU] admission/duration, ventilator use, hospital costs, and length of stay [LOS]) were compared between patients with and without disruptive surgical bleeding. Multivariable analyses adjusted for differences in baseline characteristics.

Results: Among 119,994 patients meeting inclusion criteria, 10.8% had disruptive surgical bleeding despite the use of hemostatic agents (bariatric surgery 5.4%, colorectal surgery 20.0%, spine surgery 11.0%, THA 11.5%, TKA 5.6%). Disruptive bleeding was associated with significantly longer operating room times for bariatric, colorectal, and spine surgery (incremental increases 42.3-62.4 minutes; p≤0.001), increased 90-day all-cause readmission risks for bariatric and spine surgery (incremental absolute risk increases 4.1% bariatric, 0.7% spine; both p=0.011), and increased inpatient mortality risk for all procedures except TKA (incremental absolute risk increases 0.2-55.0%; p≤0.001). ICU admission risks were increased for all procedures except TKA (incremental absolute risk increases 3.0-21.4%; p≤0.05), and ICU days were increased for bariatric, colorectal, and spine surgery (incremental increases 0.8-2.8 days; p≤0.001). Risks for ventilator use were higher for all procedures except THA (incremental absolute risk increases 3.5-25.2%; p≤0.05). Disruptive bleeding increased hospital costs (incremental increases $3,377-$23,346; p≤0.05) and LOS (incremental increases 1.0-4.9 days; p≤0.05) for all five procedures.

Conclusion: The clinical and economic burden of disruptive bleeding despite hemostatic agent use among patients with bariatric, colorectal, spine, THA, and TKA surgery was substantial, highlighting the need for improved surgical bleeding interventions.

Background: Prefilled syringes provide an opportunity to improve clinical safety and operational efficiency in hospital settings, especially amid mounting and ongoing challenges such as staff shortages, escalating drug costs, and increasing importance of safe medication administration. Despite these potential benefits, adoption remains limited. This study develops an economic model to assess the clinical and financial impacts of switching from conventional vial-and-syringe methods to prefilled syringes in United States (US) hospitals' intensive care units (ICU).

Methods: To address the gap between the potential benefits of prefilled syringes and their limited adoption, an economic model was developed to help decision-makers make informed choices based on the clinical and financial impact of switching to prefilled syringes in US ICUs. The model used peer-reviewed literature and hospital practices around the most utilized dosages in a US hospital. To illustrate model utility, three hypothetical ICU cases were developed: administering 30 daily doses of atropine 1mg/10mL, epinephrine 1mg/10mL, and ephedrine 25mg/10mL. Sensitivity analyses were performed to test model robustness.

Results: Switching to prefilled syringes resulted in annual cost savings of $729,912 for atropine, $786,502 for epinephrine, and $709,772 for ephedrine. The model estimated annual savings to be $696,551 due to fewer pADEs, along with savings of $53,411, $89,744 and $50,244 annually, due to unused drug wastage reduction for each drug, respectively. Hospital staff preparation time decreased by 255 hours for atropine, 285 for epinephrine and 227 hours for ephedrine per year. Sensitivity analyses confirmed the robustness of the model by varying drug wastage rates, with potential savings of up to $740,443, $795,894 and $724,757 for each drug, respectively, showing the model's adaptability across different ICU scenarios.

Conclusion: This model suggests prefilled syringes may help hospitals address pharmacy operational challenges by reducing preparation time, drug wastage, and pADEs. They offer a practical approach to support safer and more efficient medication delivery in clinical settings.

Purpose: Evaluate the prevalence and economic burden of adult spinal deformity (ASD) in a large, United States (US) commercial payer population.

Patients and methods: Patients aged 21-64 having an encounter with an ASD diagnosis from the Merative^TM Marketscan^® Commercial Databases 2016-2022 were included to calculate prevalence. The economic burden cohort included those with an outpatient ASD encounter and no spine surgery within the prior year. Continuous health plan enrollment was required for tracking. Expenditures are tabulated from the payer and societal perspectives (2023 US$) and rates of utilization and expenditures are reported overall and by service category.

Results: Annual ASD prevalence was 0.50%. 169,855 patients (46±13 years, 67.7% female) had an outpatient ASD encounter and were included in the economic burden cohort. Total spine-related payer expenditures averaged $7,619 (95% CI; $7,438, $7,800) per patient within 1 year - a payer burden of $3.8 million per 100,000 commercially-insured beneficiaries. Spine-related societal expenditures were $8,759 ($8,570, $8,947) per patient within 1 year - a societal burden of $6.2 billion among the US commercially-insured population. Nonoperative costs comprised 44% of the 1-year payer burden and 48% of the societal burden. While surgical treatment rates were low (3.5% fusions and 2.9% decompressions within 1 year), the associated economic burden was high (55% of payer burden, 51% of societal burden). The 2-year cumulative payer burden totaled $5.4 million per 100,000 commercially-insured beneficiaries, and the US commercially-insured societal burden totaled $8.9 billion.

Conclusion: The burden of both operative and nonoperative care for ASD is large. Considerable opportunity exists for development of improved nonoperative treatment modalities to increase the value of ASD care by reducing the need for continued nonoperative interventions of limited benefit and reducing the use of costly surgical interventions.

Purpose: Rapid molecular assays such as Xpert MTB/RIF and TB-LAMP accelerate pulmonary tuberculosis (TB) diagnosis but are more expensive than smear microscopy. This study provided an updated economic synthesis for presumptive adult pulmonary TB in high-burden settings, broadening the evidence from Xpert MTB/RIF to other WHO endorsed tests compared to conventional strategies.

Methods: Medline, Embase and Scopus were searched through March 2025. The strategy combined search terms related to molecular diagnostic tests, pulmonary tuberculosis, and economic evaluation study designs. Full economic evaluations comparing molecular tests with smear microscopy, culture or passive case-finding were eligible. Two reviewers independently screened articles, extracted data, and adjusted costs to 2025 US dollars (USD) using average exchange rates. Reporting quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. Due to heterogeneity in evaluation criteria, model structures, time horizons, and outcome measures, meta-analysis were not feasible. Therefore, results were synthesized narratively, and incremental cost-effectiveness ratios (ICERs) were contextualized against country-specific cost-effectiveness thresholds to enable meaningful cross-study interpretation.

Results: Eight studies conducted in low- and middle-income countries with high TB burdens were included. All evaluated Xpert MTB/RIF and the Thai studies also examined TB-LAMP. Five studies reported cost per disability-adjusted life years (DALYs) averted or quality-adjusted life years (QALYs) gained, while three used TB cases detected or years of life saved (YLS). CHEERS reporting quality was high (median is 23/28 items). Reported ICERs for molecular testing were either cost-saving or highly cost-effective compared with country-specific thresholds. Probabilistic sensitivity analyses (five studies) indicated ≥90% probability of cost-effectiveness in four studies and 6% in one.

Conclusion: Recent evidence supports the cost-effectiveness and cost-saving of Xpert MTB/RIF and TB-LAMP for diagnosing adult pulmonary TB. Policymakers should prioritize reducing cartridge costs and implementing models that capture patient-level benefits to maximize economic benefits.

Purpose: Evaluate the costs related to the pediatric haplo-SCT and adult and pediatric geno-SCT at the CNGMO in order to establish a tailored reimbursement package by the Tunisian Health Insurance Fund.

Patients and methods: This pharmaco-economic study compared the cost of pediatric haplo-SCT to adult and pediatric geno identical hematopoietic stem cell transplantation (geno-SCT) using the activity-based costing method. The cost assessment was conducted from the hospital's perspective and considered direct medical and non-medical costs.

Results: The cost assessment indicated that pediatric patients incurred higher expenses than adult patients. Furthermore, haplo-SCT was more expensive than geno-SCT for pediatric patients. The conditioning regimens used before haplo-SCT are more intensive than other preparative regimens and typically require longer inpatient therefore resulting in more costs. Complications, such as infections during the early phase of neutropenia and late-onset issues following hematopoietic stem cell transplantation (HSCT), particularly graft-versus-host disease (GVHD) and cytomegalovirus (CMV) reactivation, significantly contribute to increased procedural costs.

Conclusion: This study sets the standards for new specific packages for haplo-SCT and geno-SCT in pediatric patients.

Introduction: This study aimed to identify major determinants of the cost of road traffic (RT) injuries, rank their importance, and assess their effects on different quantiles of cost distribution.

Methods: This study analyzed data collected from 1372 Canadian RT survivors from July 2018 to March 2020. Costs, including healthcare and lost productivity costs over a year following RT injury, were estimated for each participant in 2023 Canadian dollars. Productivity loss was measured using the Institute for Medical Technology Assessment Productivity Cost Questionnaire. We considered 24 potential determinants of costs, which were grouped into five domains: sociodemographic, psychological, health, crash, and injury factors assessed during baseline interview. We employed a quantile regression forests machine learning approach alongside classical quantile regression to analyze costs. These methods were selected to capture heterogeneous effects across cost distribution, which are overlooked by traditional mean-based models, and to inform policy decisions targeting high-cost subgroup.

Results: The results showed that the 10th, 50th, and 90th quantiles of costs were $1,141.9, $7,403.1, and $49,537.5, respectively. ISS, GCS, and age were the top three influential variables among low-cost, medium-cost, and high-cost patients. ISS, GCS, age, sex, employment status, and living situation were common major determinants at all quantiles. Ethnicity was selected as an important determinant at the 50th and 90th quantiles. Education level, years lived in Canada, somatic symptoms severity, psychological distress, HRQoL, road user type, and head, torso, spine/back, and lower extremity injuries were selected only for high-cost patients (90th quantile). Classical quantile regression showed that selected major predictors disproportionately affected low-cost, middle-cost and high-cost patients.

Conclusion: High-cost patients were more likely to be older, retired, less educated, and have worse clinical and psychological indicators. These insights can guide targeted prevention and resource allocation strategies to reduce the economic burden of RT injuries.

Introduction: Terlipressin is the only Food and Drug Administration-approved medication for adults with hepatorenal syndrome-acute kidney injury (HRS-AKI) with rapid reduction in kidney function. Treatment with terlipressin, particularly in patients with lower serum creatinine (SCr) at diagnosis, improves outcomes. Despite evidence suggesting that treating HRS-AKI at lower SCr thresholds may improve clinical outcomes, the impact on healthcare resource utilization (HCRU) and medical costs of an earlier intervention strategy remains unquantified. This model-based analysis was conducted from a United States hospital perspective to project the clinical and economic impact of early HRS-AKI diagnosis and treatment with terlipressin among adults.

Methods: A decision-analytic model compared two SCr level-based scenarios and projected the outcomes for both scenarios. For current clinical practice, patient distribution was based on the CONFIRM trial (SCr <3 mg/dL: 45% and ≥3 to <5 mg/dL: 55%). For early diagnosis and treatment, distribution was based on the HRS medical chart review study (<3 mg/dL: 85% and ≥3 to <5 mg/dL: 15%). Terlipressin HRS reversal rate for the on-label population (SCr <5 mg/dL and acute-on-chronic liver failure grade 0-2) was 52.2% for SCr <3 mg/dL and 33.3% for SCr ≥3 to <5 mg/dL. An annual HRS incidence of 50,000 was assumed.

Results: Based on the modeled projections, early diagnosis and treatment with terlipressin versus current practice yielded an additional 3040 HRS reversals and consequently led to a reduction in hospital days and intensive care unit days. Early intervention resulted in 960 fewer patients requiring renal replacement therapy during hospitalization and 1200 more patients with 90-day transplant-free survival. Early intervention is projected to save $11,504 per patient, with total national savings of $460.2 million annually.

Conclusion: Based on the modeled projections using data from clinical trial, earlier HRS diagnosis and treatment with terlipressin may improve clinical outcomes, reduce HCRU, and save costs versus current clinical practice.

Purpose: The COVID-19 pandemic disrupted healthcare services globally, necessitating innovative care delivery models for non-communicable diseases. Remote healthcare pathways, including telehealth with pharmacy at home (PAH) and deferred care (DC), emerged as potential solutions for managing stable hypertension (HT) and diabetes mellitus (DM) patients. This study aims to estimate the budget impact of implementing PAH and DC compared to usual care (UC) for HT and DM patients in Thai tertiary care hospitals from the government perspective.

Methods:  A retrospective budget impact analysis was conducted using data from July-December 2021 (COVID-19 period) and July-December 2022 (new normal period). The study included stable patients from 35 tertiary care hospitals in Thailand. Direct medical costs were obtained from administrative databases and national costing studies. Multivariate log-linear regression models estimated conditional costs, controlling for patient characteristics. The analysis compared baseline scenario (UC only) versus alternative scenario (UC+PAH+DC). Sensitivity analyses were performed using 95% confidence intervals and ±20% population variations.

Results:  The alternative scenario demonstrated lower total budgets in both periods. During COVID-19, total costs were 12.23 versus 12.94 million USD (baseline), yielding 0.71 million USD in savings. In the new normal, costs were 11.93 versus 12.54 million USD (baseline), generating 0.61 million USD in savings. Cost-saving ratios were 0.06 USD and 0.05 USD per dollar allocated during the COVID-19 and new normal periods, respectively. Sensitivity analyses confirmed robustness across parameter variations.

Conclusion: PAH and DC pathways represent economically advantageous alternatives, demonstrating cost savings from the government perspective. These findings support implementing remote healthcare delivery in resource-constrained settings, though comprehensive evaluations incorporating societal and patient perspectives are warranted. The findings are based on extrapolation-based results and should be interpreted with caution due to variability in parameters including adoption rates of PAH/DC, unit costs applied, patient numbers, retrospective design, bundled interventions, and the savings ratio.

Background: Current treatment guidelines recommend consideration of neurostimulators and other alternative treatments to antiseizure medications in patients with drug-resistant epilepsy (DRE). This study assessed patterns of utilization and cost of healthcare services and prescription pharmacotherapies during the 2-year period before neurostimulator implantation among Medicaid enrollees with DRE.

Methods: This retrospective, observational cohort study used healthcare claims and enrollment data obtained from the US Centers for Medicare and Medicaid Services. Medicaid enrollees who met study selection criteria (ie, evidence of DRE and neurostimulator implantation) between January 1, 2011, and December 31, 2020, were included. Those without antiseizure medication (ASM) dispenses within 12 months of their implantation date or continuous enrollment for the 24-month period before this date were excluded. Demographic/clinical characteristics, utilization and cost of healthcare services, and prescription pharmacotherapies were assessed over the 2-year period before implantation. Care was designated as all-cause or epilepsy-related; the latter was defined as all ASM dispenses and all claims for medical care (ie, inpatient or outpatient) with a diagnosis code (any position) of epilepsy.

Results: In total, 2469 patients met the selection criteria. Mean age at implantation was 20.8 years. Comorbidities were common. Over the 2-year period before implantation, patients were prescribed a mean of 4.4 unique ASMs. Fifty-seven percent had at least one all-cause hospital admission, and 82.9% had at least one all-cause emergency department visit; corresponding epilepsy-related values were 55.3% and 66.1%. Less than half of patients received specific cranial imaging, including video electroencephalographs. Total mean all-cause healthcare costs were $117,013; epilepsy-related healthcare costs accounted for $48,169 (41.2%).

Conclusion: Medicaid enrollees with DRE experience high use and cost of healthcare services and pharmacotherapy over the 2 years before neurostimulator implantation. Further research is needed to understand the impacts associated with broader access to specialized epilepsy care, such as cranial imaging and neurostimulators.

Introduction: The Ethiopian health system is largely financed through household out-of-pocket payments and external donor support, increasing the risk of catastrophic health expenditures. To address these challenges, the government introduced two health insurance schemes: Community-Based Health Insurance (CBHI) targeting the informal sector and a still to be implemented Social Health Insurance (SHI) scheme for the formal sector. Although designed to operate separately, the long-term goal is to integrate them into a unified national risk pool. Achieving this integration requires cross-group solidarity, especially as formal sector employees may subsidize CBHI. This study investigates the willingness of formal sector workers to support CBHI, which is critical for long-term financial sustainability in the Ethiopian health insurance landscape.

Methods: The paper is based on a survey of 1,919 formal sector workers and pensioners in major administrative regions of Ethiopia. A survey-based experiment was used to elicit support for CBHI. Respondents were randomly assigned to one of five cases that varied by the information provided on CBHI subsidies and benefits. Descriptive statistics and logit models were used to analyze willingness to support CBHI.

Results: There is strong support from urban formal sector employees for the CBHI. Regardless of the scenario presented, after adjusting for non-response, at least 66% of participants supported the scheme. Regional variations were observed, and knowledge of health insurance was positively associated with support. Existing access to formal insurance was linked with lower support.

Discussion: Strong evidence of solidarity among formal sector workers bodes well for further expansion of the CBHI. Despite supporting CBHI, formal sector employees are resisting SHI due to cost concerns and skepticism about its benefits, unlike CBHI's known outcomes. SHI resistance signals the need for targeted communication and trust-building as the country moves toward achieving universal health coverage.