ClinicoEconomics and Outcomes Research最新文献

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.

Purpose: Major depressive disorder (MDD) is a disabling condition that may require adjunctive treatment with atypical antipsychotics (AAs). However, little is known about how different adjunctive AAs impact disability outcomes. This analysis compared disability events, days, and costs among patients with MDD before and after initiating adjunctive treatment with cariprazine, brexpiprazole, or aripiprazole, which all belong to a class of AAs known as dopamine partial agonists.

Patients and methods: The Merative^TM MarketScan^® Commercial Database and the Health and Productivity Management Database (1/1/2015-12/31/2022) were used to identify adults with MDD and ≥2 dispensings of cariprazine, brexpiprazole, or aripiprazole (first dispensing=index) adjunctive to antidepressant therapy. Baseline characteristics between cohorts were balanced using inverse probability of treatment weighting. Changes (post-index minus pre-index) in all-cause and mental health (MH)-related disability claim rates, days, and costs were compared for cariprazine vs brexpiprazole and cariprazine vs aripiprazole via a difference-in-difference analysis; 95% CIs were generated using nonparametric bootstrap procedures. P-values <0.05 were considered statistically significant.

Results: In the cariprazine (n=224) vs brexpiprazole (n=643) analysis, the cariprazine cohort had significantly greater reductions in all-cause disability claims, days, and costs vs the brexpiprazole cohort (between-cohort difference: -0.23 claims [P<0.05], -25.27 days [P<0.001], -$4577.08 [P<0.01], respectively). The cariprazine cohort also had a significantly greater reduction in MH-related disability days (-12.07 [P<0.05]); reductions in MH-related disability claims and mean costs vs brexpiprazole were similar. In the cariprazine (n=174) vs aripiprazole (n=2931) analysis, a significantly greater reduction for cariprazine vs aripiprazole was observed for all-cause and MH-related disability costs (all-cause: -$3275.91 [P<0.01]; MH-related: -$2196.36 [P<0.05]); reductions in all-cause and MH-related disability claims and days were similar.

Conclusion: In this real-world analysis of patients with MDD using AAs adjunctively to antidepressants, significantly greater reductions were observed in disability claims and days for cariprazine vs brexpiprazole and in disability costs for cariprazine vs aripiprazole. These results suggest that adjunctive cariprazine may have beneficial effects on disability outcomes for patients with MDD.

Objective: To determine the challenges requiring psychosocial and economic support faced by children living with HIV, to describe the interventions in place and to explore the experience of professionals providing services in a health district in the city of Lubumbashi in the DRC.

Methods: A descriptive case study using the phenomenological qualitative approach was conducted in the Katuba health district. Over the course of eight months (June 1, 2024 - February 8, 2025), with data collection from July 1 and August 1, 2024. HIV focal points participated in in-depth, semi-structured interviews, and case managers participated in focus groups. ATLAS.ti (version 12) was used to conduct the thematic analysis.

Results: On average, the participants had 15.5 ± 11.43 years of experience, and 50% were senior nurses. The average age of the sample was 44.21 ± 9.40 years, and 57% of participants were female. Significant obstacles included the daily stresses of therapy, difficulties with adherence (especially when symptoms were not obvious), and experiences of discrimination, stigma, and exclusion within families, schools, and wider society. These issues adversely impacted education, work, and interpersonal connections. Children people also experienced financial difficulties, limited access to job opportunities and vocational training, and anxiety about an uncertain future. While psychosocial support was universally accepted, economic assistance was considered only partially beneficial due to funding delays and resource limitations. The recommendations focused on increasing government financing, improving access to medical and emotional support services, raising awareness of prevention measures, and strengthening human and material resources.

Conclusion: This research highlights the challenges faced by children living with HIV and underlines the importance of early identification and effective management of these problems to improve their quality of life. Current interventions are deemed effective, but could be improved by strengthening the support system, particularly in terms of human and organisational resources.

Purpose: Robotic platforms are commonly used for sleeve gastrectomy, despite the high capital costs and little understanding of the roles of platform-specific consumables and standard surgical alternatives in clinical outcomes and healthcare resource utilization. This study evaluates the trend, the effectiveness (outcomes) and efficiency (resource utilization) of different types of surgical staplers used in robotic sleeve gastrectomy (RSG).

Patients and methods: This was a retrospective observational cohort study analyzing data from the PINC AI™ Healthcare Data database. Patients were included if they underwent elective, inpatient, primary sleeve gastrectomy performed using the Intuitive Surgical robotic system (Sunnyvale, CA) with either a bedside stapler (BS, Signia™, Endo-GIA™, or Tri-staple™) or a robotic stapler (RS, Sureform™). The primary outcome measures included inpatient costs, complications, operating room time (ORT), length of stay (LOS), and intensive care unit visits. Outcomes were analyzed using bivariate analyses, multivariable generalized linear models (GLM), and propensity-score matching (PSM).

Results: Of 18,892 total RSG procedures that met eligibility criteria, robotic staplers were used in 15,152 procedures (80.2%) and bedside staplers were used in 3740 (19.8%). While RSG increased dramatically during the period, RS were shown to be associated with a greater risk of blood transfusion compared to bedside staplers both in a GLM [0.5% (BS) vs 0.7% (RS); Odds ratio (OR): 1.55; 95% confidence interval (CI): 1.02-2.36; p = 0.04] and after PSM [0.3% (BS) vs 0.9% (RS); OR: 3.02; 95% CI: 1.35-6.73; p = 0.007]. Bedside staplers were associated with total costs reduction [mean cost savings: $3084; 95% CI: $2860 - $3309; p < 0.001] and shorter ORT (21 minutes; 95% CI: 18.6-23.5; p < 0.001) compared to robotic staplers. Difference in LOS was not clinically significant.

Conclusion: When used during RSG, bedside staplers are cost-saving, with equivalent or better clinical outcomes and reduced resource utilization compared to robotic staplers.

Purpose: Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) are rare chronic autoimmune diseases, potentially fatal, with frequent relapses. They are associated with vital organ damage, especially renal, often resulting in end-stage renal disease. While current standard of care with immunosuppressants has improved renal function and survival, the main risks for patients under life-long immunosuppression are infections and other concomitant diseases. This study evaluated the burden of AAV using patient-level data from a disease-specific registry.

Patients and methods: The cohort of incident AVV patients (2013-2022) in the REDCap registry in a university hospital in Spain was studied. Patients with Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) and Eosinophilic Granulomatosis with Polyangiitis (EGPA) with at least one year of follow-up (or deceased during the period) were included. Clinical outcomes, including Birmingham Vasculitis Activity Score (BVAS) and healthcare resource consumption were analysed for the first year after diagnosis. Mean annual costs were calculated using unitary costs from the hospital accounting department.

Results: Seventy-five patients (12% EGPA, 32% GPA, and 56% MPA) were included. Fifty-two percent were women. Mean age at diagnosis was 65.20±14.70 years. At baseline, mean BVAS was 17.35±5.70, 93.33% of patients showed renal affectation, mean estimated glomerular filtration rate was 33.32±29.93mL/min/1.73m². As induction treatment, 62.67% received methylprednisolone, 37.33% rituximab, 25.33% cyclophosphamide, 14.67% rituximab plus cyclophosphamide, 34.67% plasmapheresis. During the first year after diagnosis, 17.33% relapsed and 78.67% had at least 1 hospitalisation; 97.33% received steroids; 13.33% were on dialysis at some point; one patient received a kidney transplant; 46.67% presented infections and 28% suffered corticosteroid-associated complications; 4 patients died, being 50% of deaths treatment-related. The highest observed mean cost per patient for the first year was €11,647.95 for hospital care.

Conclusion: This study revealed a considerable burden of AAV, as evidenced by high rates of hospitalisation, relapses, and the need for intensive medical interventions.

Background: Metabolic bariatric surgery (MBS) is an effective and relatively safe intervention for managing obesity. This study aimed to evaluate the cost-utility of MBS compared with the standard treatment-lifestyle modification plus liraglutide-in the Kingdom of Saudi Arabia (KSA).

Methods: A Markov model was developed to estimate the lifetime costs and outcomes of MBS. Costs and outcomes were discounted at an annual rate of 3%. The analysis was conducted from societal and healthcare system perspectives, using a willingness-to-pay (WTP) threshold of one to three times the gross domestic product (GDP) per capita per quality-adjusted life years (QALY) gained. Direct medical and nonmedical costs were obtained from hospital records and patient surveys, respectively. Transitional probabilities and utility values were obtained from published literature and primary data collection in the KSA. One-way and probabilistic sensitivity analyses were performed to assess parameter uncertainty.

Results: Over a lifetime horizon, MBS yielded 0.38 incremental QALY and US$ 11,975 (Saudi Riyal [SAR] 44,905; purchasing power parity [PPP] 23,911) incremental costs, leading to an incremental cost-effectiveness ratio (ICER) of US$ 31,909 (SAR 119,660; PPP 63,717) per QALY gained from a societal perspective and US$ 36,353 (SAR 136,324); PPP 72,590) from a healthcare system perspective. The model was most sensitive to the discount rates of costs and outcomes and the direct medical costs associated with MBS. At a WTP threshold of one GDP per capita (US$ 30,436; SAR 114,135; PPP 60,775), the standard treatment had a 63% probability of being cost-effective. However, at a threshold of approximately 1.8 GDP per capita (US$ 56,000; SAR 210,000; PPP 111,821), MBS was cost-effective in 100% of the iterations.

Conclusion: MBS is a cost-effective intervention compared with standard treatment in the context of the KSA. Efforts should be made to expand earlier and equitable access to MBS for individuals with a BMI > 40 kg/m² without comorbidities across the country.

Purpose: To estimate the economic impact of implementing smart infusion pump interoperability for a hypothetical health system in the United States (US).

Patients and methods: An economic model was developed to assess the financial impact of implementing smart infusion pump interoperability with electronic health records (EHRs) for a health system. The model perspective was that of a moderately-large hypothetical US heath-system consisting of 6 hospitals, with 1,500 staffed beds and 50,000 discharges annually. The main outcomes of interest in this model were patient safety and outpatient intravenous (IV) administration charge capture. The impact of interoperability on patient safety was assessed by measuring the estimated reduction in preventable adverse drug events (pADEs). The impact on outpatient charge capture was assessed by estimating the reduction in lost charges due to the implementation of interoperability. All model parameters and inputs were derived and supported by peer-reviewed literature.

Results: In the base-case analysis, the implementation of smart infusion pump interoperability resulted in an annual reduction of 56 pADEs, saving the health system $531,891 in associated pADE treatment costs. This equates to a total reduction of 281 pADEs over the 5-year time-horizon, with a cumulative cost savings of $2,659,457. Additionally, the implementation of interoperability recouped $2,419,673 in outpatient infusion administration charges annually, which is equivalent to $12,098,363 in recouped charges over five years.

Conclusion: The implementation of smart infusion pump interoperability has the potential to enhance patient safety by reducing pADEs and improving outpatient administration charge capture. However, it is important to note that while the model is based on peer-reviewed model inputs, the model itself is theoretical in nature without real-world data validation and does not account for investment costs. Health systems should carefully evaluate the safety and economic implications of smart infusion pump interoperability when deciding whether to invest in this technology.

Purpose: This analysis sought to characterize patients with relapsed or refractory multiple myeloma (RRMM) on triplet therapy with immunomodulatory agents/proteasome inhibitors/monoclonal antibodies combined with dexamethasone, describing their demographic and clinical features, therapeutic pathways and the related healthcare costs for the Italian National Health Service (NHS).

Patients and methods: A retrospective observational analysis was conducted on administrative databases of Italian healthcare entities, covering about 3.6 million health-assisted residents. From 2017 to 2020, patients receiving at least one triplet combination reimbursed by the Italian NHS for the treatment of RRMM were included. RRMM treatment pathways were evaluated in terms of duration of therapy and treatment lines. Healthcare costs per patient were assessed on monthly basis during the therapy period by computing expenditures for drugs, hospitalizations and outpatient specialist services.

Results: A total of 209 RRMM patients on triplet combinations were identified, with a mean age of 67.4 years, 56% males and mild-to-moderate comorbidity profile, with heart disease and renal disease as the most common coexisting conditions (respectively, 13.4% and 7.7% of patients). KRd (carfilzomib/lenalidomide/dexamethasone) was the triplet administrated to the largest proportion of patients (44%), then DaraRd (daratumumab/lenalidomide/dexamethasone) triplet (24%). Treatment duration was on average 7 months for overall patients, 7.7 months for 118 patients with triplet as second line at inclusion, and 6 months for 91 patients with triplet as third or further line at inclusion. The monthly overall costs were € 9,517, with drug expenses accounting for 93% of total expenditures. Progressing to later treatment lines, cost analysis showed comparable trends, being drugs as the most impactive item.

Conclusion: This analysis on RRMM patients under triplet medication in real-life Italian clinical practice confirmed the complex multifaceted profile of this frail population, highlighting a challenging clinical management for the oncologists and a major economic burden for the NHS.