Journal Of Medical Economics[JOURNAL]
Sun
200 papers
Economic evaluation of a bivalent respiratory syncytial virus prefusion F vaccine for maternal vaccination in Sweden: cost-effectiveness and budget impact.
Szilcz M, Naghipour P, Fridh AC … +3 more , Zakikhany-Gilg K, Palmborg A, Toghanian S
J Med Econ · 2026 Dec · PMID 42258348 · Publisher ↗
AIMS: To compare the clinical and economic outcomes of three infant RSV prevention strategies, monoclonal antibody prophylaxis with nirsevimab alone, maternal RSVpreF vaccination alone, and maternal RSVpreF vaccination w...
AIMS: To compare the clinical and economic outcomes of three infant RSV prevention strategies, monoclonal antibody prophylaxis with nirsevimab alone, maternal RSVpreF vaccination alone, and maternal RSVpreF vaccination with complementary nirsevimab versus no intervention in Sweden, to estimate cost-effectiveness and budget impact. METHODS: A population-based, multi-cohort Markov model followed 12 monthly birth cohorts from birth to 1 year with age- and season-specific RSV risks. Three seasonal (October-February) strategies (87% uptake) were evaluated versus no intervention: monoclonal antibody prophylaxis with nirsevimab alone; maternal RSVpreF vaccination alone; and maternal RSVpreF vaccination with complementary use of nirsevimab for infants not protected maternal vaccination. Outcomes included RSV outpatient visits, hospitalizations, deaths, costs (healthcare- and societal), Quality-Adjusted Life Years (QALYs), and Incremental Cost-Effectiveness Ratios (ICERs). Scenario analyses assessed the impact of uptake rates, seasonal severity and administration windows. RESULTS: Without intervention, a Swedish birth cohort (98,475 infants in 2024) was projected to experience 1,452 RSV hospitalisations, 7,841 outpatient visits, and 1 RSV death, costing SEK 252.3 million. Maternal RSVpreF vaccination alone reduced RSV hospitalisations by 33.3% and outpatient visits by 22.0%, yielding net savings of SEK 19.4 million (total SEK 232.9 million) and +18 QALYs (dominant, i.e. more effective and less costly). Nirsevimab alone reduced RSV hospitalisations by 35.7% and outpatient visits by 32.3%, but increased costs to SEK 302.3 million (ICER SEK 1,328,063/QALY). The complementary strategy reduced RSV hospitalisations by 40.8% and outpatient visits by 28.5% and was cost-saving (SEK 243.8 million; dominant). CONCLUSION: Compared with no intervention, all three strategies reduced RSV-related morbidity in Swedish infants. Maternal RSVpreF vaccination alone was the most economically favourable option, while the complementary strategy, including both maternal RSVpreF vaccination and nirsevimab, achieved the largest health gains and was also dominant. Nirsevimab alone reduced RSV burden but at substantially higher incremental cost per QALY.
A global model for symptomatic obstructive hypertrophic cardiomyopathy to assess the cost-effectiveness of mavacamten: results from a Dutch societal perspective.
Ektare V, Simons C, Johannesen K … +14 more , Krause T, Zema CL, Buisman LR, Treur M, Moura A, Dasari M, Verkaik M, van de Wetering G, Pronk L, Pompen M, Li X, Contente M, Knackstedt C, Hurst M
J Med Econ · 2026 Dec · PMID 42258343 · Publisher ↗
OBJECTIVES: To explore the cost-effectiveness of mavacamten + beta-blocker/calcium channel blocker therapy (BB/CCB) versus BB/CCB monotherapy for the treatment of symptomatic obstructive hypertrophic cardiomyopathy (HCM)...
OBJECTIVES: To explore the cost-effectiveness of mavacamten + beta-blocker/calcium channel blocker therapy (BB/CCB) versus BB/CCB monotherapy for the treatment of symptomatic obstructive hypertrophic cardiomyopathy (HCM). MATERIALS AND METHODS: A 5-state Markov model (New York Heart Association classes I-IV, death) that included treatment sequencing was developed. It used a Dutch societal perspective and lifetime horizon stratified into short-term (mavacamten + BB/CCB: 30 weeks; BB/CCB: 46 weeks) and long-term (i.e. post short-term) periods. The model population reflected the EXPLORER-HCM trial intention-to-treat population. Model parameters were aligned with 2016 Zorginstituut Nederland guidelines, including annual discount rates of 4.00% and 1.50% for costs and health outcomes. Costs (2022/2023 Euros), life-years (LYs) and quality-adjusted LYs (QALYs) per patient, incremental costs and LYs/QALYs, and incremental cost-utility ratios were estimated. Sensitivity and scenario analyses were conducted to evaluate the robustness of the results. RESULTS: Treatment with mavacamten + BB/CCB resulted in an incremental discounted gain of 3.09 QALYs and 3.17 LYs versus the BB/CCB monotherapy strategy. Incremental discounted costs were €49,388 over a lifetime; the additional costs of mavacamten were driven by increased treatment acquisition costs but partly offset by savings in healthcare resource utilization and indirect costs, particularly informal care costs. Mavacamten + BB/CCB was cost-effective at a €50,000 per QALY threshold versus BB/CCB monotherapy at €15,961 per QALY gain. The deterministic and probabilistic sensitivity and scenario analyses supported the robustness of the model results. CONCLUSIONS: In the Netherlands, mavacamten + BB/CCB is a cost-effective treatment strategy for symptomatic obstructive HCM compared to BB/CCB monotherapy.
The productivity losses due to cancer mortality and morbidity in 13 Asia-Pacific geographies across 2010, 2015, 2019, and 2022.
Gambhir M, Siddiqui AH, Meiwald A … +3 more , Perera C, Fox A, Gokhale S
J Med Econ · 2026 Dec · PMID 42226721 · Publisher ↗
BACKGROUND: Cancer is a major health and economic burden in the Asia-Pacific region, with significant disparities between countries. This study aimed to quantify productivity losses for the five cancers with high mortali...
BACKGROUND: Cancer is a major health and economic burden in the Asia-Pacific region, with significant disparities between countries. This study aimed to quantify productivity losses for the five cancers with high mortality and morbidity burden across 13 Asia-Pacific geographies. METHODS: Productivity losses were calculated for high-income geographies (HIGs) and middle-income geographies (MIGs) for 2010, 2015, 2019, and 2022. Tracheal, bronchus, lung, stomach, colorectal, breast, and cervical cancer were included. HIGs comprised of Australia, Hong Kong, Japan, New Zealand, Singapore, South Korea, and Taiwan. MIGs included India, Indonesia, Malaysia, Philippines, Thailand, and Vietnam. Data on deaths, Years of Life Lost (YLL), and Years Lived with Disability (YLD) were sourced from the Institute for Health Metrics and Evaluation. Years of Productive Life Lost (YPLL), Present Value of Future Lost Productivity (PVFLP), Productive YLD (PYLD), and Value of YLD (VYLD) were estimated using retirement age, average wage, labor force participation, and unemployment rate. Linear regression evaluated temporal trends, and a deterministic sensitivity analysis assessed the impact of variations in model inputs. RESULTS: In HIGs, cancer deaths increased from 2010 (411,651) to 2022 (468,480). YLLs remained steady with PVFLP dropping from $12.3 billion to $10.1 billion. YLD rose from 466,498 to 553,782, while VYLD was stable at $2.9 billion. In MIGs deaths increased from 753,961 to 1,113,815, YLL from 24,615,518 to 35,018,065, and YLD from 436,749 to 750,609. PVFLP rose from $2.6 billion to $3.2 billion, and VYLD from $238.1 million to $360.3 million. Regression analysis showed a decline in YLL per death across income categories. YLD per incidence case decreased in HIGs but increased in MIGs. CONCLUSION: Disparities between HIGs and MIGs are widening, with MIGs showing greater morbidity and productivity losses. Investment in prevention, early detection, and equitable treatment are needed.
Cost-effectiveness analysis of apixaban compared with other oral anticoagulants for the treatment of non-valvular atrial fibrillation in a Belgian healthcare setting.
Goovaerts H, Subash R, Salter C … +3 more , Dickerson C, Ricci-Pacifici L, Stawowczyk E
J Med Econ · 2026 Dec · PMID 42223336 · Publisher ↗
AIMS: Direct oral anticoagulants (DOACs) are recommended for stroke and systemic embolism prevention in patients with non-valvular atrial fibrillation (NVAF) in preference to vitamin K antagonists (VKAs, e.g. warfarin)....
AIMS: Direct oral anticoagulants (DOACs) are recommended for stroke and systemic embolism prevention in patients with non-valvular atrial fibrillation (NVAF) in preference to vitamin K antagonists (VKAs, e.g. warfarin). This study assessed the cost-effectiveness of apixaban versus warfarin, dabigatran, edoxaban, and rivaroxaban for patients with NVAF from the Belgian payer perspective. METHODS: Based on a previously-validated model, a lifetime cohort-level Markov model was built in Microsoft Excel for the Belgian setting, incorporating costs (2025) representative of a DOAC market following patent expiry. The cohort ( = 1,000) included patients with NVAF eligible for oral anticoagulation. Different study types provided clinical inputs for event risk in the base case analysis (based on a network meta-analysis of randomised controlled trials) and in a scenario analysis (based on real-world evidence). The primary model outcome was the incremental cost-effectiveness ratio (ICER), measured by the cost per quality-adjusted life year (QALY) gained. Cost-effectiveness was determined by a willingness-to-pay threshold of €30,000/QALY gained. RESULTS: Driven by a reduction in clinical event risk, apixaban treatment was associated with QALY gains of 0.306, 0.068, 0.115 and 0.034 compared with warfarin, dabigatran, edoxaban, and rivaroxaban, respectively. In the base case analysis, apixaban treatment was associated with lower total costs due to a reduction in acute event costs and long-term management costs, resulting in apixaban dominating (i.e. more effective and less costly) all comparators from a Belgian payer perspective. Similar conclusions were observed in a scenario analysis using clinical inputs derived from real-world evidence. CONCLUSIONS: Apixaban is associated with fewer clinical events and lower total costs versus warfarin, dabigatran, edoxaban, and rivaroxaban for patients with NVAF, dominating (i.e. more effective and less costly) all comparators from a Belgian payer perspective under post-patent-expiry assumptions. The consistency of model outcomes between base case and scenario analyses suggests a level of robustness to these findings.
Response to "methodological opacity in sword health digital pelvic health".
Costa F, Pereira AP, M Seet A … +11 more , Domingues B, Janela D, Pradhan A, C Areias A, Tong X, Bento V, Yanamadala V, P Cohen S, Atherton J, Dias Correia F, Belz L
J Med Econ · 2026 Dec · PMID 42223253 · Publisher ↗
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Real-world burden of hypertrophic cardiomyopathy on healthcare use and health-related quality of life in Italy, Spain, and the United States.
Gebrehiwet P, Jackson J, Hargreaves L … +8 more , Barlow S, LeBrocq L, Brekke J, Butzner M, Freeman E, Shreay S, Akita K, Shimada Y
J Med Econ · 2026 Dec · PMID 42223221 · Publisher ↗
BACKGROUND AND AIMS: Hypertrophic cardiomyopathy (HCM) is a chronic, progressive, genetic heart disease characterized by hypercontractility and hypertrophy. As treatment options evolve, characterizing the existing health...
BACKGROUND AND AIMS: Hypertrophic cardiomyopathy (HCM) is a chronic, progressive, genetic heart disease characterized by hypercontractility and hypertrophy. As treatment options evolve, characterizing the existing healthcare needs and health-related quality of life (HRQoL) for patients with HCM is important. METHODS: Data were derived from the Adelphi Real World HCM Disease Specific Programme, a cross-sectional survey in Italy, Spain, and the United States. Physicians reported demographic and clinical characteristics; patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ-23), EQ-5D-5L and EQ-VAS, and the Work Productivity and Activity Impairment (WPAI) questionnaire. Outcomes were statistically compared by New York Heart Association (NYHA) class or KCCQ clinical summary score (KCCQ-CSS) to assess impact of disease severity. RESULTS: Patient mean age was 56.5 ± 14.8 years; 60.7% were male, and 78.3% had NYHA class II disease. Patients most commonly received beta blockers (88.4%) and diuretics (31.8%). HCM-related hospitalizations were reported for 25.8% of patients, increasing with higher NYHA or lower KCCQ-CSS. Mean EQ-5D-5L was 0.85, while EQ-VAS was 75.0, both decreasing with higher NYHA class or lower KCCQ-CSS. Overall work impairment and activity impairment (WPAI) were 16.1% and 26.6%, respectively, increasing with higher NYHA class or lower KCCQ-CSS. CONCLUSION: Our data show a significant remaining symptom burden and healthcare resource utilization (HCRU), as well as impact on HRQoL, work productivity, and daily activities, despite treatment intervention across a commonly applied measure of disease severity in HCM. These findings underscore the need for new treatments that can reduce HCRU and improve HRQoL of patients with HCM.
Budget impact analysis of delgocitinib for moderate to severe Chronic Hand Eczema in the United States.
Singh-Landa J, Bin Sawad A, Bappoo Y … +4 more , Llewellyn B, Barnes M, Maslin D, Balu S
J Med Econ · 2026 Dec · PMID 42202037 · Publisher ↗
BACKGROUND: Chronic Hand Eczema (CHE) is an inflammatory skin disease defined as eczema affecting the hands and/or wrists lasting >3 months and/or re-occurring ≥2 times per year. Delgocitinib cream 20 mg/g, a topical jan...
BACKGROUND: Chronic Hand Eczema (CHE) is an inflammatory skin disease defined as eczema affecting the hands and/or wrists lasting >3 months and/or re-occurring ≥2 times per year. Delgocitinib cream 20 mg/g, a topical janus kinase inhibitor (JAKi), is approved in multiple countries for the treatment of moderate to severe CHE in adults who have had an inadequate response to topical corticosteroids (TCS) or for whom TCS are inadvisable. This budget impact analysis aimed to estimate the economic impact of the introduction of delgocitinib cream as a treatment for moderate to severe CHE in the United States (US). METHODOLOGY: The model was developed with a 3-year time horizon from the perspective of a hypothetical US commercial healthcare plan involving one million members. Comparator treatments included other topical and oral JAKis and biologics. Proportions of patients using each treatment were accounted for in calculating healthcare costs. The eligible population with moderate to severe CHE refractory to steroids was estimated considering prevalent and incident populations. Different healthcare costs, including drug, monitoring, and adverse event (AE) costs, were accounted for. AEs were included based on clinical trial data. Costs were adjusted to 2024. RESULTS: Of one million members overall, the study population included 10,494, 11,095, and 11,696 patients with CHE in Years 1, 2 and 3, respectively. The introduction of delgocitinib cream was associated with overall cost savings of $2,973,478 in Year 1, $21,424,214 in Year 2, and $63,355,366 in Year 3, constituting total accumulated savings of $87,753,057. Savings were derived almost entirely from drug costs (97.2%), with reduced AE (1.54%) and monitoring costs (1.27%) also contributing. CONCLUSION: Adoption of delgocitinib cream for moderate to severe CHE in adults for whom TCS were inadequate or inadvisable is predicted to generate significant cost savings to US commercial healthcare plans over 3 years.
A systematic review of acute and long-term outcomes in patients with non-transvenous implantable cardioverter-defibrillators.
Zweibel S, Lanctin D, Holbrook R … +1 more , Kapur S
J Med Econ · 2026 Dec · PMID 42171458 · Publisher ↗
BACKGROUND: Non-transvenous implantable cardioverter-defibrillator (ICD) systems have been developed to address limitations of transvenous ICDs. This systematic literature review aimed to summarize periprocedural and lon...
BACKGROUND: Non-transvenous implantable cardioverter-defibrillator (ICD) systems have been developed to address limitations of transvenous ICDs. This systematic literature review aimed to summarize periprocedural and long-term outcomes of non-transvenous ICD systems in adult patients with guideline-based indications for ICD therapy. METHODS: A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420261327618). Eligible studies enrolled adults (≥18 years) receiving a non-transvenous ICD for primary or secondary prevention. Outcomes included periprocedural and long-term endpoints and were summarized descriptively. The Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) checklist for case series were used to assess risk of bias. RESULTS: Twenty-five publications representing 18 unique studies and 4,633 patients were included. Most studies were single-arm ( = 13), while 2 were randomized controlled trials and 3 were nonrandomized comparative studies. Procedural success ranged from 81%-100%, with rates ≥94% of patients in all but one early-phase study; defibrillation threshold testing success ranged from 89%-100% (≥96% in studies with ≥ 100). Periprocedural complications were reported in 0%-5% of patients in most studies. Long-term complication rates ranged from 0%-8% at 0.5-1.5 years of follow-up and 1%-14% beyond 1.5 years. All-cause mortality ranged from 1%-5% within 6 months and increased to 16%-26% at 4-8 years. Clinical defibrillation success was consistently high (95%-100%). Incidence of inappropriate shock generally ranged from 7%-13% at 1 year and 2%-18% at later timepoints. Appropriate shock incidence ranged from 2% to 9% within 1 year and increased with longer follow-up. Risk of bias was predominantly moderate, with limited variation using NOS and greater discrimination observed with JBI. CONCLUSIONS: Non-transvenous ICD systems demonstrate favorable safety and effectiveness profiles, with high procedural and defibrillation success and acceptable complication and inappropriate shock rates across studies. Overall, the available evidence supports their use in appropriately selected adult patients with standard ICD indications.
Economic burden associated with switching from frontline pegaspargase or calaspargase pegol to second-line recombinant in pediatrics and adolescents/young adults with acute lymphoblastic leukemia.
McCormick M, Gu T, Bhagnani T … +4 more , Prashar A, Chatterjee I, Papademetriou E, Maese L
J Med Econ · 2026 Dec · PMID 42166382 · Publisher ↗
AIMS: This study aims to quantify costs and healthcare resource utilization (HCRU) associated with switching from frontline (1 L) pegaspargase (PEG)/calaspargase pegol (CAL-PEG) to second-line (2 L) recombinant in pedia...
AIMS: This study aims to quantify costs and healthcare resource utilization (HCRU) associated with switching from frontline (1 L) pegaspargase (PEG)/calaspargase pegol (CAL-PEG) to second-line (2 L) recombinant in pediatric and adolescent/young adult (AYA) patients aged <40 years with acute lymphoblastic leukemia (ALL), overall and by use of therapeutic drug monitoring (TDM). MATERIALS AND METHODS: This was a retrospective study using Optum's deidentified Clinformatics Data Mart database. Pediatric/AYA patients (US) diagnosed with ALL between January 2021 and September 2023 and treated with 1 L asparaginase-containing regimens were identified. Asparaginase switch rates were assessed. HCRU and per-patient per-year (PPPY) costs were compared between patients who completed treatment with PEG/CAL-PEG and those who switched to recombinant . Outcomes were compared between patients who received TDM and those who did not. RESULTS: A total of 154 pediatric/AYA patients with ALL were identified who initiated 1 L treatment with a PEG/CAL-PEG-containing regimen. Overall, 35/154 (22.7%) patients switched from 1 L asparaginase to recombinant . Patients who switched from 1 L asparaginase to recombinant had significantly higher mean total healthcare costs ($1,006,262 vs. $429,502; < 0.0001), primarily driven by higher outpatient visits (82.57 vs. 72.75 PPPY; = 0.0988) and their associated costs ($754,063 vs. $245,978; < 0.0001), compared with patients who remained on 1 L asparaginase. When compared by use of TDM (61/154 [39.6%]), 28.0% in the non-TDM group and 14.8% in the TDM group switched from 1 L asparaginase to recombinant . Mean outpatient costs were $381,017 and $319,468 ( < 0.0003), respectively. LIMITATIONS: Caution is required in the interpretation of the results of this retrospective study as claims data are not designed specifically for research purposes. CONCLUSIONS: Switching from 1 L PEG/CAL-PEG to 2 L recombinant is associated with higher healthcare costs. Consideration should be given to TDM, which may mitigate unnecessary switches of asparaginase.
Methodological opacity in Sword Health digital pelvic health: can superiority be claimed without defined interventions?
Ramos L
J Med Econ · 2026 Dec · PMID 42154457 · Publisher ↗
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Beyond direct medical costs: what we miss when indirect costs are ignored.
Religioni U, Barrios-Rodríguez R, Requena P … +1 more , Pakulska T
J Med Econ · 2026 Dec · PMID 42139461 · Publisher ↗
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Cost-effectiveness of vagus nerve-mediated neuroimmune modulation for the treatment of moderate-to-severe rheumatoid arthritis.
Air EL, Ryschon AM, Rosenow JM … +4 more , Garner AM, Levin RW, Konrad PE, Pietzsch JB
J Med Econ · 2026 Dec · PMID 42126406 · Publisher ↗
AIMS: Rheumatoid arthritis (RA) is associated with increased healthcare resource utilization and high-cost pharmacologic treatment. The objective of the current analysis was to evaluate the cost-effectiveness of vagus ne...
AIMS: Rheumatoid arthritis (RA) is associated with increased healthcare resource utilization and high-cost pharmacologic treatment. The objective of the current analysis was to evaluate the cost-effectiveness of vagus nerve-mediated neuroimmune modulation therapy (NIMT) using a novel implantable neurostimulation technology compared to status-quo pharmacologic treatment of moderate-to-severe rheumatoid arthritis patients in the US. MATERIALS AND METHODS: A decision-analytic Markov model was utilized to project strategy-specific costs and outcomes over 2-, 10-year, and lifetime horizons for NIMT and the status-quo. Clinical data from the RESET-RA study informed key model inputs including cohort characteristics, utilities, event rates, and medication utilization. Costs were derived from published literature and current reimbursement rates. The analysis was conducted from the US payer perspective, with both costs and outcomes discounted 3% in accordance with US cost-effectiveness guidelines. Cost-effectiveness was evaluated using established US willingness-to-pay thresholds of $50,000 (highly cost-effective) and $150,000 (cost-effective) per quality-adjusted life year (QALY) gained. Deterministic and probabilistic sensitivity analyses (PSA) were performed. RESULTS: Under the base case assumptions, NIMT was cost-saving in less than 2 years. Over lifetime, NIMT was associated with incremental cost-savings of $350,052 and QALY gain of 0.87, and led to cost-savings of $25,397 and $197,062, and concurrent incremental QALY gains of 0.10 and 0.46 at 2 and 10 years, rendering NIMT the dominant strategy across all three horizons. In the PSA, NIMT was cost-effective at thresholds of $50,000 and $150,000 per QALY gained in 96.25% and 99.20% of simulations at 2 years, and 100% of simulations at 10 years and lifetime. CONCLUSION: In this model-based analysis of a recent randomized trial, the use of NIMT therapy corresponded to a reduction in total costs of care, improved quality of life, and was found to be a highly cost-effective or dominant treatment option for moderate-to-severe rheumatoid arthritis in a US setting.
CPAP treatment persistence following nasal procedures in obstructive sleep apnea: a real-world claims-based analysis of 1.3 million patients.
Malhotra A, Takashima M, Vahabzadeh-Hagh A … +2 more , Yaremchuk K, Niklewski P
J Med Econ · 2026 Dec · PMID 42126088 · Full text
OBJECTIVE: To evaluate the association between nasal procedures and long-term continuous positive airway pressure (CPAP) treatment persistence in a large US administrative claims database. METHODS: Retrospective cohort s...
OBJECTIVE: To evaluate the association between nasal procedures and long-term continuous positive airway pressure (CPAP) treatment persistence in a large US administrative claims database. METHODS: Retrospective cohort study using the Komodo Health Sentinel Database (2020-2026). Adults with sleep apnea (ICD-10 G47.3x) who initiated CPAP were classified into six cohorts: temperature-controlled radiofrequency (TCRF) nasal valve remodeling ( = 920), septoplasty ( = 24,575), functional rhinoplasty ( = 758), combined functional rhinoplasty and septoplasty ( = 3,910), other nasal surgery ( = 12,995), and no nasal surgery ( = 1,297,292). The primary outcome was CPAP discontinuation, defined as a ≥180-day gap in positive airway pressure claims. Covariate-adjusted Cox regression and coarsened exact matching (CEM) on six variables assessed the association between nasal procedures and discontinuation. Sensitivity analyses included inverse probability of censoring weighting (IPCW), alternative gap thresholds (90-365 days), E-values, and insurance stratification. RESULTS: Among 1,340,450 CPAP initiators, the overall discontinuation rate was 29.0%. TCRF was associated with the lowest discontinuation (HR 0.62, 95% CI 0.53-0.72; < 0.001); IPCW addressing informative censoring strengthened this association (HR 0.48, 0.41-0.56). Other nasal procedures showed more modest associations: combined FR and septoplasty (HR 0.84, 0.79-0.90), other nasal surgery (HR 0.86, 0.83-0.89), septoplasty (HR 0.87, 0.84-0.89), and functional rhinoplasty (HR 0.90, 0.78-1.02). CEM confirmed these findings, with TCRF showing HR 0.57-0.61 across model specifications. One-year persistence was 84.2% for TCRF versus 76.1% for no surgery. The TCRF association was consistent across insurance types and all sensitivity analyses. The E-value was 2.61 (CI bound 2.12). CONCLUSIONS: Nasal procedures were associated with higher CPAP persistence compared with no surgery, with TCRF showing the strongest and most consistent association. These findings suggest that treating nasal obstruction may help sustain long-term CPAP use, though prospective studies are needed to confirm causality.
2025 in review: high-impact articles from the .
Abraham I, Gregg M
J Med Econ · 2026 Dec · PMID 42105312 · Publisher ↗
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Cost-effectiveness analysis of xanomeline and trospium chloride for the treatment of adults with schizophrenia in the US.
Mantaian T, Gillard K, Kowalski J … +3 more , Kramer K, Sidovar MF, Cutler AJ
J Med Econ · 2026 Dec · PMID 42105309 · Publisher ↗
AIM: The objective of this analysis was to evaluate the cost-effectiveness of xanomeline and trospium chloride (KarXT) as first line (1 L) treatment for adults with schizophrenia from a third-party US payer perspective c...
AIM: The objective of this analysis was to evaluate the cost-effectiveness of xanomeline and trospium chloride (KarXT) as first line (1 L) treatment for adults with schizophrenia from a third-party US payer perspective compared with commonly used antipsychotics, considering both costs and patient quality of life. METHODS: A decision tree-Markov hybrid approach was used to develop an economic model which included both acute and maintenance phases, accounting for probability of treatment response, discontinuation, relapse, adverse events, and death over a lifetime horizon. Clinical data were drawn from published trials, with costs and utilities coming from publicly available sources. Incremental cost-effectiveness ratios (ICERs) were calculated, and sensitivity and scenario analyses were performed to test the robustness of the results. RESULTS: In the base case analysis, KarXT was found to be more costly but more effective than common generic antipsychotics, yielding cost-effective ICERs, and less costly and more effective than branded antipsychotics. The model was associated with moderate sensitivity to treatment response inputs. Scenario analyses showed that implementation of a societal perspective, no tardive dyskinesia risk for KarXT, and a 50% reduction KarXT's relapse probability improved the cost-effectiveness of KarXT. Conversely, a 50% increase in KarXT's relapse probability and a second line analysis worsened cost-effectiveness. LIMITATIONS: At the time of the analysis, relapse data did not exist for KarXT therefore an average of other treatments was assumed and tested in a sensitivity analysis. Also, patients may receive multiple lines of therapy in a lifetime, however, the model only incorporated three lines of treatment. CONCLUSIONS: KarXT, the first schizophrenia medication in 70 years with a non-dopaminergic mechanism of action, is a valuable and potentially cost-effective 1 L treatment option, highlighting the need for continued innovation in this disease space.
Correction.
J Med Econ · 2026 Dec · PMID 42091578 · Publisher ↗
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The incidence of opioid use disorder among people with acute and chronic pain managed with prescription opioids in the United States: economic and societal burden.
Schoenfeld AJ, Jeyakumar S, Morlando Geiger J … +5 more , Princic N, Moynihan M, Varker H, Shi L, Menzie AM
J Med Econ · 2026 Dec · PMID 42084418 · Publisher ↗
AIMS: This retrospective, longitudinal, observational study evaluated the incidence of opioid use disorder (OUD) among patients newly initiating opioids to manage acute and chronic pain in the United States. Additionally...
AIMS: This retrospective, longitudinal, observational study evaluated the incidence of opioid use disorder (OUD) among patients newly initiating opioids to manage acute and chronic pain in the United States. Additionally, healthcare resource utilization (HCRU) and associated costs were analyzed. MATERIALS AND METHODS: Adult patients newly treated with prescription opioids were identified within the MarketScan administrative claims databases (2016-2018). Patients were classified as experiencing acute or chronic pain based on total prescription pain medication use within one year of the initial opioid prescription. Subgroups of patients with or without OUD were identified using diagnosis codes. RESULTS: The 1-, 2-, and 3-year incidence rates of OUD were 0.21%, 0.32%, and 0.43%, respectively, among acute pain patients and 1.11%, 1.52%, and 1.92% among chronic pain patients. Unadjusted all-cause HCRU were substantially higher among patients with OUD compared to those without OUD over the 12-month period following OUD diagnosis. The associated unadjusted total all-cause healthcare costs were 3.1-times and 2.0-times higher for those with OUD compared to those without OUD in the acute and chronic pain cohorts, respectively. The total all-cause healthcare costs for patients with OUD remained significantly higher, even after adjusting for baseline characteristics. When extrapolated nationally, estimated costs for patients managing acute or chronic pain and newly diagnosed with OUD were $3.3 billion (B) and $5.9B, respectively, totaling $9.2B. LIMITATIONS: Pain medication use was identified using claims for filled prescriptions; patients' actual medication usage and use of over-the-counter medications cannot be ascertained. OUD diagnosis was based on specific ICD-10-CM diagnosis codes, potentially underestimating the true incidence and economic impact. CONCLUSIONS: Newly diagnosed OUD following prescription opioid use for managing acute and chronic pain imposes a substantial economic burden within the first year following OUD diagnosis. Increased use of effective non-opioid analgesics may help reduce the incidence and economic burden of OUD.
Correction.
J Med Econ · 2026 Dec · PMID 42080478 · Publisher ↗
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Clinical burden and healthcare resource utilization after allogeneic hematopoietic stem cell transplant for sickle cell disease or β-thalassemia.
Brown D, Li N, Li J … +3 more , Imren S, Evans KA, Jerry M
J Med Econ · 2026 Dec · PMID 42054156 · Publisher ↗
INTRODUCTION: Allogeneic hematopoietic stem cell transplant (allo-HSCT) is a potentially curative treatment for patients with sickle cell disease (SCD) with recurrent vaso-occlusive crises (VOCs) or β-thalassemia. Real-w...
INTRODUCTION: Allogeneic hematopoietic stem cell transplant (allo-HSCT) is a potentially curative treatment for patients with sickle cell disease (SCD) with recurrent vaso-occlusive crises (VOCs) or β-thalassemia. Real-world data on post-allo HSCT outcomes are limited among these patients. METHODS: Patients with SCD with recurrent VOCs or β-thalassemia with allo-HSCT were identified in the Merative MarketScan Research Databases. Clinical outcomes, allo-HSCT complications, and healthcare resource utilization were summarized after allo-HSCT. RESULTS: Eighty-one patients with SCD with recurrent VOCs and 33 with β-thalassemia were included. About one-third of patients with SCD experienced a VOC and one-quarter of patients with β-thalassemia required a red blood cell transfusion, in the year after the first 100 days following allo-HSCT. Approximately 40.7% of patients with SCD and 42.4% of patients with β-thalassemia developed acute graft-versus-host disease (GvHD), while 32.1% and 27.3% developed chronic GvHD, respectively. Patients with SCD had a mean of 74.1 (59.6) outpatient visits per patient per year and patients with β-thalassemia had a mean (SD) of 76.1 (61.3). LIMITATIONS: Due to the lack of International Classification of Diseases, 10th Revision (ICD-10) codes to distinguish between different types of allo-HSCT, this study was unable to assess outcomes of patients with haploidentical hematopoietic stem cell transplantation (haplo-HSCT), which is a type of allo-HSCT. CONCLUSION: Many patients with SCD with recurrent VOCs or β-thalassemia endure potentially life-threatening transplant-related complications and require substantial healthcare utilization following allo-HSCT. These findings suggest limitations of allo-HSCT and underscore the need for alternative curative treatment options.
Medical costs attributable to obesity and obesity-related health disorders in a Japanese population using JMDC claims database.
Kojima T, Osaga S, Aranishi T … +2 more , Fukuda H, Shingaki T
J Med Econ · 2026 Dec · PMID 42048154 · Publisher ↗
AIM: This study aimed to estimate the medical costs attributable to obesity among Japanese adults with obesity-related health disorders using the JMDC claims database and assess the impact of body mass index (BMI) catego...
AIM: This study aimed to estimate the medical costs attributable to obesity among Japanese adults with obesity-related health disorders using the JMDC claims database and assess the impact of body mass index (BMI) categories on the medical costs during a five-year follow-up period. MATERIALS AND METHODS: A retrospective cohort study using anonymized claims and health checkup data from the JMDC database was conducted. Participants aged ≥18 years with first recorded BMI between December 2012 and December 2018 and diagnosed with obesity-related health disorders were included. Participants were stratified into two groups: those without obesity (BMI <25.0 kg/m) and those with obesity (BMI ≥25.0 kg/m). Annual medical costs (total, outpatient, inpatient, medication) were summarized. Generalized estimating equations (GEE) with a gamma regression model and log link function were used to estimate cost ratios and adjusted mean total medical costs, adjusting for age category, sex, baseline BMI category, and baseline outpatient visit frequency. Sensitivity analyses were performed to assess robustness across different age groups and regression models. RESULTS: A total of 244,150 eligible participants were analyzed (without obesity: 150,217; with obesity: 93,933). Over five-year follow-up, total medical costs per person-year increased from 218,929 to 265,919 JPY in those without obesity and from 234,093 to 323,086 JPY in those with obesity. Higher baseline BMI showed greater five-year increases in the adjusted medical costs, resulting in 27.7% increase by excess costs due to obesity with 83.3% of those attributable to BMI ≥27.0 kg/m. Sensitivity analyses confirmed the robustness of these findings. CONCLUSIONS: The estimated excess costs due to obesity indicate higher healthcare costs among Japanese adults with obesity-related health disorders. The per capita burden appeared higher in those with higher BMI, with most excess costs concentrated in individuals with BMI ≥27.0 kg/m. These results highlight the healthcare cost burden associated with obesity and suggest that effective weight management strategies may contribute to reducing healthcare expenditures.
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