Journal Of Medical Economics[JOURNAL]
Sun
200 papers
Subcutaneous foslevodopa/foscarbidopa (LDp/CDp) in advanced Parkinson's disease (aPD): societal cost impact analysis for the UK, France, Germany, Spain, and Canada.
Ray Chaudhuri K, Parra JC, Boodhna T … +1 more , Belsey J
J Med Econ · 2026 Dec · PMID 42047110 · Publisher ↗
BACKGROUND: The costs associated with advanced Parkinson's disease (aPD) extend beyond direct medical expenditure. As symptoms become more severe, professional and informal personal care costs are likely to exceed those...
BACKGROUND: The costs associated with advanced Parkinson's disease (aPD) extend beyond direct medical expenditure. As symptoms become more severe, professional and informal personal care costs are likely to exceed those incurred for medical and pharmacological treatment. The objective of this analysis is to explore the impact of treatment with subcutaneous foslevodopa/foscarbidopa (LDp/CDp) on the societal cost impact in the UK, France, Germany, Spain, and Canada. METHODS: A model was developed to aggregate expected costs incurred by a cohort with aPD over a 5-year time frame. Resource use for direct medical, non-medical, and informal care are estimated from a real world data source (Adelphi), mapped to the severity of disease as estimated by the extent of OFF-time experienced by patients. Indirect societal costs are estimated from published literature. Unit costs for each of the included countries are then applied to these resource use estimates. Symptom progression of individuals within the cohort are derived from a previously developed Markov model, which captures the differential effect on OFF-time of LDp/CDp versus best medical treatment (BMT). RESULTS: Overall costs for aDP patients were shown to rise over the 5-year time horizon, as symptom progression occurred. The use of LDp/CDp incurred greater drug costs than BMT, but, by delaying exacerbation of OFF-time, this additional cost was more than offset by other savings - principally attributable to professional and informal care. Aggregated results showed a net cumulative saving of €96,273 per patient over the 5 year time horizon. Results for the five individual countries evaluated ranged from €50,297 to €135,208 per patient saving. CONCLUSION: LDp/CDp has been shown to significantly improve OFF-time burden in patients with aPD, compared with BMT. Once the costs of professional and informal care are taken into account, the additional acquisition costs of LDp/CDp are more than offset, yielding a net societal saving.
Cost-effectiveness analysis of lorlatinib as first-line treatment for anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer in Italy.
Valentini I, Rumi F, Di Brino E … +5 more , Bearz A, Pasello G, Novelli G, Di Virgilio R, Basile M
J Med Econ · 2026 Dec · PMID 42043888 · Publisher ↗
BACKGROUND: Lorlatinib is a third-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) with high central nervous system penetration and activity against resistance mutations. Although its clinical...
BACKGROUND: Lorlatinib is a third-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) with high central nervous system penetration and activity against resistance mutations. Although its clinical efficacy as first-line treatment for ALK-positive advanced non-small cell lung cancer (NSCLC) has been demonstrated, its economic value within the Italian healthcare system remains to be fully established. This study evaluated the cost-effectiveness of lorlatinib compared with alectinib as first-line therapy in Italy. METHODS: A partitioned survival model with three health states (progression-free, progressed disease, and death) was developed from the Italian National Health Service and societal perspectives over a 30-year time horizon. Clinical efficacy inputs were derived from the CROWN trial and indirect treatment comparisons using network meta-analysis. Costs (2026 euros) included drug acquisition, subsequent treatments, healthcare resource use, adverse events, end-of-life care, and societal costs. Health outcomes were expressed as life-years (LYs) and quality-adjusted life-years (QALYs). Deterministic, probabilistic, and scenario analyses were conducted to assess uncertainty. RESULTS: In the base case, lorlatinib was dominant over alectinib, providing higher benefits (+2.01 LYs; +1.66 QALYs) at lower costs (-€19,210 per patient). This finding was robust across pricing scenarios. Probabilistic sensitivity analysis showed an almost 98,40% probability of cost-effectiveness at Italian willingness-to-pay thresholds. CONCLUSIONS: From both NHS and societal perspectives, lorlatinib represents a cost-saving and clinically superior first-line treatment option compared with alectinib for patients with ALK-positive advanced NSCLC in Italy.
Addressing the challenges of health economic modelling in the context of suboptimal evidence base - case study based on a comparison between photodynamic diagnosis and narrow band imaging in non-muscle invasive bladder cancer.
Belsey J, Chrosny W, Lapon J
J Med Econ · 2026 Dec · PMID 42033426 · Publisher ↗
INTRODUCTION: Standard economic models, which have been developed to reflect typical data availability for pharmaceutical products, often struggle with non-pharmaceutical interventions like diagnostics and medical device...
INTRODUCTION: Standard economic models, which have been developed to reflect typical data availability for pharmaceutical products, often struggle with non-pharmaceutical interventions like diagnostics and medical devices, where clinical trial data is more likely to be short-term or non-comparative. This paper explores methodological challenges in evaluating Photodynamic Diagnosis (PDD) blue light cystoscopy (BLC) versus Narrow Band Imaging (NBI) for non-muscle invasive bladder cancer (NMIBC). METHODS: A semi-Markov state-transition cost-utility model was developed for a health technology appraisal (HTA) by the Danish Treatment Council. The basis of the model was a differential effect of the two technologies on the risk of early local cancer recurrence. Due to a lack of direct comparative trials, an indirect hazard-function-based approach was used. Using TreeAge Pro software, baseline hazard curves were derived from ten-year survival data for conventional white light cystoscopy. Hazard ratios (HRs) from meta-analyses were then applied to these curves to derive simulated time-to-event curves for BLC and NBI. RESULTS: The base-case analysis yielded an incremental cost-effectiveness ratio (ICER) of DKK 70,707/QALY for BLC-TURBT versus NBI-TURBT. Sensitivity analyses confirmed results remained robust and well below the DKK 500,000/QALY willingness-to-pay threshold. The model was most sensitive to HRs for time to first recurrence. Scenario analyses, including traditional parametric extrapolation, yielded consistent ICERs between DKK 36,775 and DKK 215,965/QALY. DISCUSSION: The hazard-based workflow effectively integrated survival data from disparate sources, using a software-based method was quicker, simpler and more intuitive to use than conventional statistical methods. The approach used is equally applicable to a partitioned survival structure. The alignment between hazard-based and traditional parametric methods suggests this is a valid, efficient alternative for developing models in the face of evidence gaps. CONCLUSIONS: A hazard-function approach provides a transparent, practical solution for building robust economic models when clinical data is limited or incompatible with standard approaches.
Interpreting per-death productivity estimates in human capital analyses of lung cancer: the role of working-age-restricted denominators.
Tariq A
J Med Econ · 2026 Dec · PMID 42033423 · Publisher ↗
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Response to Kirshner et al.: updated cost consequence analyses using requested inputs.
Patel VP, Collins K, Heinemann K … +2 more , Ngantung W, Saeedian M
J Med Econ · 2026 Dec · PMID 42033420 · Publisher ↗
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Cost-effectiveness analysis of atezolizumab and bevacizumab as first-line systemic therapy in unresectable hepatocellular carcinoma in Malaysia.
Wong YF, Mohamed R, Sulaiman Shah AA … +2 more , Chaiyakunapruk N, Patikorn C
J Med Econ · 2026 Dec · PMID 42033418 · Publisher ↗
AIM: This study aims to evaluate the cost-effectiveness of atezolizumab plus bevacizumab as first-line systemic therapy for unresectable hepatocellular carcinoma (uHCC) in Malaysia, compared with the current standard tre...
AIM: This study aims to evaluate the cost-effectiveness of atezolizumab plus bevacizumab as first-line systemic therapy for unresectable hepatocellular carcinoma (uHCC) in Malaysia, compared with the current standard treatments in the Malaysian Ministry of Health (MOH) to inform public healthcare decision‑making. MATERIALS AND METHODS: A cost-effectiveness analysis was conducted from the MOH perspective, following the national pharmacoeconomic guidelines (2019). The study compared atezolizumab plus bevacizumab with sorafenib and lenvatinib, respectively, using a partitioned survival model to project health outcomes and costs over a lifetime horizon. Clinical efficacy data were sourced from published trials and network meta-analyses. Cost inputs reflected local healthcare resource use and prices, using 2024 Malaysian Ringgit values inflated the Consumer Price Index for Health. Costs and outcomes were discounted at 3% annually. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of key parameter uncertainties on the results. RESULTS: Atezolizumab plus bevacizumab provided the highest quality-adjusted life years (QALYs) and life years compared to sorafenib and lenvatinib. Sorafenib was dominated by lenvatinib due to lower QALYs and higher costs and excluded from further analysis. Compared to lenvatinib, atezolizumab plus bevacizumab yielded 0.873 additional QALYs and RM 44,863 additional cost, resulting in an incremental cost-effectiveness ratio (ICER) of RM 51,399 per QALY gained (∼0.906 GDP/capita at Malaysia's 2024 GDP/capita RM 56,734). CONCLUSIONS: Atezolizumab plus bevacizumab is cost-effective compared to lenvatinib and sorafenib across willingness-to-pay (WTP) values of one to three times Malaysia's GDP per capita. These findings provide evidence to inform public health policy that expanding funding and adoption of atezolizumab plus bevacizumab is likely to improve health outcomes cost-effectively.
Enhancing economic modelling in obesity: integrating novel type 2 diabetes progression & obstructive sleep apnea remission - a UK case study.
Annemans L, Johansson E, Spaepen E … +4 more , van Hest N, Grist J, Zimner-Rapuch S, Wilding JPH
J Med Econ · 2026 Dec · PMID 42021523 · Publisher ↗
PURPOSE: This study presents an updated health economic model for evaluating the long-term cost-effectiveness of interventions in overweight and obesity, integrating new clinical evidence from the SURMOUNT clinical trial...
PURPOSE: This study presents an updated health economic model for evaluating the long-term cost-effectiveness of interventions in overweight and obesity, integrating new clinical evidence from the SURMOUNT clinical trial programme and methodological advancements in type-2 diabetes and obstructive sleep apnea (OSA) modelling. PATIENTS AND METHODS: An updated individual patient simulation model evaluated the costs and long-term clinical outcomes of tirzepatide (5, 10, 15.0 mg) versus diet and exercise (D&E) alone in patients with a body mass index (BMI) ≥30 kg/m (obesity), or BMI ≥27 to <30 kg/m (overweight) + ≥1 obesity-related complication with a UK healthcare perspective. Key improvements over a previously published model were introduced, including modelling remission and progression of OSA, capturing realistic patterns of D&E discontinuation, incorporating HbA1c as a continuous cardiometabolic endpoint and transition to R-based implementation over VBA. Primary results include incremental cost-effectiveness ratios (ICERs; cost/QALY), costs, life years gained and quality-adjusted life years (QALYs). Secondary outcomes including clinical outcomes, random seed and cohort convergence, deterministic sensitivity results and run time were also calculated. RESULTS: The refined model predicted that all tirzepatide doses were cost-effective compared to D&E at a £20,000/QALY gained WTP (willingness-to-pay) threshold (ICERs: £8,327-£10,157). Refined estimation of long-term D&E discontinuation and OSA remission likely contributed to lower incremental costs, higher QALYs, and reduced ICERs compared with the previous model, aligning outcomes more closely with expected benefits from weight management treatment. Transitioning to R-based implementation reduced run time (e.g. by 4.52 h for deterministic sensitivity analyses) and enhanced model stability in all analyses conducted. CONCLUSION: This enhanced economic model represents a significant advancement in the evaluation of obesity pharmacotherapy, designed to enhance clinical relevance, technical robustness, and increase usability. It supports evidence-based decision-making for chronic weight management treatment in the UK, and beyond, while offering a scalable platform for future therapeutic evaluations.
Value frameworks for digital health technologies: a comparative analysis.
Choi BM, Lee JK, Erstad B … +3 more , Edwards C, McBride A, Abraham I
J Med Econ · 2026 Dec · PMID 42020185 · Publisher ↗
AIMS: This study aimed to review and compare existing value frameworks for digital health technologies (DHTs) and identify common domains to guide their evaluation. MATERIALS AND METHODS: A comprehensive literature searc...
AIMS: This study aimed to review and compare existing value frameworks for digital health technologies (DHTs) and identify common domains to guide their evaluation. MATERIALS AND METHODS: A comprehensive literature search was conducted across PubMed, Embase, and Google Scholar, along with citation and website searches, was conducted in August 2025. English-language publications that provided guidance on evaluating value of DHTs were included. A narrative review approach was employed to synthesize findings and identify key value domains and indicators. RESULTS: From an initial pool of 1,132 articles, four met the inclusion criteria and formed the basis of the review, supplemented by additional frameworks from relevant organizations. Six core value domains were identified: technical and security aspects, data rights and governance, clinical characteristics, economic characteristics, health inequalities, and user preferences. Five value frameworks from the United Kingdom (UK) National Health Service, Digital Therapeutic Alliance, World Bank, Institute for Clinical and Economic Review-Peterson Health Technology Institute, and UK National Institute for Health and Care Excellence were compared across these domains. A heat map analysis demonstrated variation in the inclusion of indicators, reflecting differing stakeholder priorities and perspectives. LIMITATIONS: Limitations include potential bias, subjectivity, and limited scope inherent in a narrative review, although elements of PRISMA were applied to reduce risks. Non-English frameworks and those specific to certain technologies were excluded. Additionally, frameworks for both DHTs and digital therapeutics were considered together. CONCLUSION: Six core value domains are consistently emphasized across value frameworks. However, variations across value frameworks highlights the influence of stakeholder needs and priorities. Further research is needed to refine these frameworks and support consistent and informed decision-making in DHTs adoption and implementation.
Cost-effectiveness analysis of rapid antimicrobial susceptibility testing as a point of care for patients with uncomplicated urinary tract infection in Japan.
Niiro H, Yoshida A, Kino F … +4 more , Matsuyama F, Tashiro N, Murata T, Ohmagari N
J Med Econ · 2026 Dec · PMID 42018481 · Publisher ↗
BACKGROUND: Empirical antibiotic therapy for patients with urinary tract infections (UTIs) has contributed to the rise of overuse or use of inappropriate antibiotics, which is a significant public health concern. The int...
BACKGROUND: Empirical antibiotic therapy for patients with urinary tract infections (UTIs) has contributed to the rise of overuse or use of inappropriate antibiotics, which is a significant public health concern. The introduction of point-of-care diagnostic tests (POCTs) for the rapid determination of antimicrobial susceptibility is predicted to help reduce unnecessary broad-spectrum antibiotic use and produce actionable information for an approach to antibiotic stewardship. AIMS: To evaluate the cost-effectiveness of UTI diagnostic and treatment strategies, including a POCT in Japan. METHODS: A decision tree model was constructed from a healthcare payer perspective to compare three diagnostic and treatment strategies for patients with uncomplicated UTIs visiting community clinics or hospital outpatient settings in Japan: (1) a POCT-guided strategy; (2) empirical broad-spectrum antibiotic treatment alone; and (3) empirical broad-spectrum antibiotic treatment with concurrent conventional culture. The study population was stratified into patients with cystitis and those with pyelonephritis. The time horizon was set at 30 days for cystitis and 60 days for pyelonephritis. RESULTS: For patients with cystitis, the incremental cost-effectiveness ratio (ICER) for the POCT strategy was JPY 10,787,224 per quality-adjusted life year (QALY) gained compared with broad-spectrum antibiotic agents only, and JPY 1,552,864/QALY compared with broad-spectrum antibiotic agents plus culture. For patients with pyelonephritis, the ICERs for the POCT strategy were JPY 2,362,912/QALY versus broad-spectrum antibiotic agents only, and JPY 222,752/QALY versus broad-spectrum antibiotic agents plus culture. CONCLUSIONS: Compared with the broad-spectrum antibiotic agents plus culture strategy, which is common practice in Japan, the POCT strategy demonstrated potential cost-effectiveness for patients with cystitis and pyelonephritis. These results suggest that introducing POCTs for patients with UTIs in Japan may be a cost-effective approach.
Integrating single-inhaler triple therapy into global asthma management: clinical breakthroughs and economic realities.
Menzella F
J Med Econ · 2026 Dec · PMID 42018474 · Publisher ↗
Abstract loading — click title to view on PubMed.
Correction.
J Med Econ · 2026 Dec · PMID 42018461 · Publisher ↗
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A system dynamics modelling protocol to evaluate the impact of a health financing mechanism for breast cancer pharmacotherapies in Malaysia.
Lim JS, Fun WH, Lee KKC … +1 more , Sellappans R
J Med Econ · 2026 Dec · PMID 42012911 · Publisher ↗
INTRODUCTION: The rising cost of targeted breast cancer therapies challenges financial sustainability and equitable access in dual-tier health systems. In Malaysia, public cancer care is highly subsidized but budget cons...
INTRODUCTION: The rising cost of targeted breast cancer therapies challenges financial sustainability and equitable access in dual-tier health systems. In Malaysia, public cancer care is highly subsidized but budget constrained, shifting patients toward private services that are typically financed through out-of-pocket payments, private health insurance or employer-sponsored insurance. Rakan KKM (MOH's Friend) is a fee-for service initiative in selected public hospitals designed to provide lower-cost private care, with revenues reinvested into the public system. However, its financial implications for breast cancer pharmacotherapy remain uncertain. This manuscript presents a methodological protocol for a system dynamics (SD) model developed to evaluate the financial implications of Rakan KKM for breast cancer pharmacotherapy in Malaysia. METHODOLOGY: A system dynamics model has been developed to model breast cancer disease progression across stages and patient movement between public, private and Rakan KKM care settings, integrating associated healthcare expenditures and revenue flows from the perspective of the Ministry of Health. An influence diagram was constructed through stakeholder engagement to identify key feedback mechanisms influencing access, affordability and system sustainability. Model parameterisation is complete, using national epidemiological data, published registries data, national drug acquisition cost estimates and expert elicitation from oncology clinicians and pharmacists. This protocol details the simulation framework where a status quo scenario is compared against intervention scenarios over a 10-year horizon. One-way sensitivity analysis and monte-carlo simulations address parameter and clinical uncertainties, while scenario analyses guided by the Diffusion of Innovation framework examine alternative uptake rates and capacity constraints. CONCLUSION: This protocol describes a transparent and adaptable SD modelling approach to assess the fiscal sustainability of financing high-cost breast cancer therapies in mixed public-private systems by projecting how patient switching influences pharmacotherapy expenditure and the net resources potentially available to support public service investment through Rakan KKM.
Cost-utility of implantable tibial neuromodulation (Revi) versus conservative therapy for urgency urinary incontinence in adults: a US payer perspective.
Amundsen CL, Sutherland SE, Lenherr SM … +3 more , Niklewski PJ, Rodine PR, Dmochowski RR
J Med Econ · 2026 Dec · PMID 42012858 · Publisher ↗
AIMS: Implantable tibial nerve neuromodulation (ITNM) represents a minimally invasive intervention for urgency urinary incontinence (UUI). This study evaluated the 3-year cost-utility of ITNM with an external wearable ba...
AIMS: Implantable tibial nerve neuromodulation (ITNM) represents a minimally invasive intervention for urgency urinary incontinence (UUI). This study evaluated the 3-year cost-utility of ITNM with an external wearable battery (Revi System) versus conservative treatments (behavioral ± pharmacotherapy) from a US payer perspective. MATERIALS AND METHODS: A cohort state-transition (Markov) model with annual cycles compared ITNM to conservative treatment modalities (behavioral ± pharmacotherapy). ITNM clinical parameters were derived from the OASIS pivotal trial ( = 150); parameter uncertainty was propagated 20,000 Monte Carlo simulations. Health states captured responder and non-responder status with permitted transitions, rescue interventions (onabotulinumtoxinA, sacral neuromodulation, percutaneous tibial nerve stimulation), and downstream event modules (falls, urinary tract infection, incontinence-associated dermatitis, depression, cognitive decline/dementia, and nursing-home entry). Costs and quality-adjusted life-years (QALYs) were discounted at 3% annually and expressed in 2025 US dollars. Parameter uncertainty was assessed using probabilistic sensitivity analysis (PSA; 20,000 simulations) and tornado analysis. RESULTS: ITNM was both more effective and less costly than behavioral ± pharmacotherapy. Mean 3-year costs were $39,308 versus $43,737 (ΔCost = -$4,428), with mean QALYs of 2.188 and 1.940, respectively (ΔQALY = +0.249). The incremental cost-effectiveness ratio was -$17,818/QALY (dominant). Incremental net monetary benefit at $40,000/QALY was $14,369, with 100% probability of cost-effectiveness across thresholds from $20,000-$150,000/QALY. Key value drivers were responder utility and fall-related parameters. LIMITATIONS: The analysis adopts a US payer perspective with direct medical costs only. Some event risks were applied from population-level sources and may not fully capture patient-level heterogeneity. The 3-year base-case horizon may miss longer-term durability effects, though extended-horizon scenarios support consistent findings. CONCLUSIONS: Over 3 years, ITNM with an external wearable battery improves quality-adjusted survival and lowers overall payer costs compared with conservative therapies for UUI, supporting its inclusion as a value-consistent minimally invasive therapy.
Cost-per-responder analysis of TAR-200 versus other Food and Drug Administration-approved novel and generic treatments among patients with Bacillus Calmette-Guérin-unresponsive, high-risk, non-muscle-invasive bladder cancer with carcinoma in situ in the United States.
Williams S, Cho S, Morrison L … +8 more , Joshi K, Pilon D, Gwyn K, Libchaber B, Wong G, Lee F, Desai U, Singhal M
J Med Econ · 2026 Dec · PMID 42012856 · Publisher ↗
AIMS: Bacillus Calmette-Guérin (BCG)-unresponsive high-risk non-muscle-invasive bladder cancer (HR-NMIBC) with carcinoma (CIS) is aggressive and treatment options are suboptimal. TAR-200, a novel intravesical drug-relea...
AIMS: Bacillus Calmette-Guérin (BCG)-unresponsive high-risk non-muscle-invasive bladder cancer (HR-NMIBC) with carcinoma (CIS) is aggressive and treatment options are suboptimal. TAR-200, a novel intravesical drug-releasing system, received United States (US) Food and Drug Administration (FDA) approval on 09/09/2025 for this population. An economic model compared the cost per responder for US patients with BCG-unresponsive HR-NMIBC with CIS treated with TAR-200 versus other FDA-approved treatments. METHODS: A 15-month cost-per-responder model was developed from a Medicare payer perspective (2025 USD). Patients treated with TAR-200 monotherapy were compared to those treated with pembrolizumab, nadofaragene firadenovec (NF), nogapendekin alfa inbakicept (NAI)+BCG (with/without reinduction), or valrubicin based on published clinical trial data. Model inputs included costs for initial/subsequent treatment, medical visits, and radical cystectomy (RC). Outcomes comprised the total cost per patient achieving and sustaining complete response (CR) for ≥12 months, based on overall CR rates and digitized Kaplan-Meier curves and swimmer plots for the 12-month duration of response. Patients experiencing non-response received subsequent treatment or underwent an RC. RESULTS: At 15 months, the proportion of patients achieving and sustaining CR for ≥12 months was 43.5% for TAR-200, 18.8% for pembrolizumab, 21.9% for NF, 26.8% for NAI+BCG (36.6% with reinduction), and 10.1% for valrubicin. The total cost per patient achieving and sustaining CR for ≥12 months was $1,892,569 for TAR-200, resulting in cost savings of $698,262 versus pembrolizumab, $406,840 versus NF, $832,346 versus NAI+BCG, and $1,541,999 versus valrubicin. Considering NAI+BCG reinduction, cost savings of $162,599 per patient achieving and sustaining CR for ≥12 months were observed for TAR-200 versus NAI+BCG. LIMITATIONS: Model inputs were based on trial publications, possibly limiting generalizability. CONCLUSIONS: TAR-200 demonstrated the highest proportion of patients achieving and sustaining CR for ≥12 months, yielding substantial cost savings per responder compared to other FDA-approved treatments for BCG-unresponsive HR-NMIBC with CIS.
Cost-effectiveness of tirzepatide versus semaglutide for patients with obesity or overweight in the US: evidence from the SURMOUNT-5 head-to-head phase-3 trial.
Johansson E, Wilding JPH, Upadhyay N … +6 more , van Hest N, Kirk M, Spaepen E, Zimner-Rapuch S, Annemans L, Bays H
J Med Econ · 2026 Dec · PMID 42012820 · Publisher ↗
PURPOSE: This study evaluated the cost-effectiveness (from the United States [US] societal perspective) of tirzepatide at its maximum-tolerated-dose (MTD) compared to semaglutide (MTD), both administered adjunct to a red...
PURPOSE: This study evaluated the cost-effectiveness (from the United States [US] societal perspective) of tirzepatide at its maximum-tolerated-dose (MTD) compared to semaglutide (MTD), both administered adjunct to a reduced-calorie diet and increased physical activity. The analysis focused on individuals with obesity (body mass index [BMI] ≥ 30 kg/m), or overweight (BMI ≥27 to <30 kg/m + ≥1 obesity-related complication), using data from the head-to-head Phase-3 SURMOUNT-5 trial (patients without type 2 diabetes [T2D]). PATIENTS AND METHODS: This patient-level simulation modeling study assessed the cost and long-term clinical outcomes of tirzepatide (MTD) versus semaglutide (MTD), using data from the SURMOUNT-5 trial population. The modeled population were at risk of developing obesity-related complications including cardiovascular disease (CVD) and obstructive sleep apnea (OSA), amongst others. These outcomes were modeled using cardiometabolic parameters including weight, systolic blood pressure, high-density lipoprotein, glycated hemoglobin (HbA1c) and total cholesterol, by assessing their impact on healthcare and wider societal costs, quality of life, and mortality. Incremental cost-effectiveness ratios (ICERs; cost/quality-adjusted life year [QALY]) and incremental net health benefit (iNHBs) were calculated, and uncertainty was assessed through sensitivity and scenario analyses. RESULTS: Tirzepatide (MTD) was estimated to be less costly and more efficacious compared to semaglutide (MTD) with per patient cost savings of $41,688, 0.506 QALYs gained and positive iNHB of 0.784, indicating a net health benefit for tirzepatide. The model predicted that per 1,000 patients, 70 fewer patients will develop T2D, 10 fewer will develop CVD with tirzepatide (MTD) and patients spend 3.07 more years living with moderate/severe OSA when treated with semaglutide (MTD). CONCLUSION: Based on this simulation model, using head-to-head SURMOUNT-5 trial data, tirzepatide (MTD) had lower total costs and higher QALYs compared to semaglutide (MTD). This supports that tirzepatide (MTD) is a cost-effective treatment option for individuals with obesity or overweight compared to semaglutide (MTD).
Cost-effectiveness analysis of capivasertib plus fulvestrant in the -altered subgroup with HR+/HER2- advanced breast cancer: a United States payer perspective.
Liang X, Malone DC, Tan CJ
J Med Econ · 2026 Dec · PMID 42009253 · Publisher ↗
AIMS: Capivasertib plus fulvestrant has emerged as a promising targeted therapy for HR+/HER2- advanced breast cancer (ABC). This study evaluated the cost-effectiveness of capivasertib plus fulvestrant vs. fulvestrant mon...
AIMS: Capivasertib plus fulvestrant has emerged as a promising targeted therapy for HR+/HER2- advanced breast cancer (ABC). This study evaluated the cost-effectiveness of capivasertib plus fulvestrant vs. fulvestrant monotherapy in pathway-altered patients with HR+/HER2- ABC from a U.S. payer's perspective. MATERIALS AND METHODS: A partitioned survival model with three health states (progression-free, progressive disease, and death) was developed over a 5-year time horizon. Progression-free survival (PFS) and overall survival (OS) data were derived from the CAPItello-291 trial (NCT04305496). Utility, disutility, and direct medical costs were obtained from published literature and the Centers for Medicare and Medicaid Services. Capivasertib cost was based on wholesale acquisition cost. Costs were presented in 2025 U.S. dollars. Both costs and outcomes were discounted by 3%. Incremental cost-effectiveness ratios (ICERs) based on quality-adjusted life-year (QALY) gained and equal value of life years gained (evLYG) were compared using a willingness-to-pay (WTP) threshold of $150,000. Sensitivity analyses, scenario analyses (10-year horizon and phase II trial data) and threshold analysis were conducted. RESULTS: Capivasertib plus fulvestrant yielded more QALYs (1.89 vs. 1.29) and life years (3.31 vs. 2.49) but higher costs ($539,625 vs. $158,679) than fulvestrant alone, resulting in ICERs of $636,455/QALY gained and $459,358/evLYG over a 5-year time horizon. The cost of capivasertib ($28,332/4 weeks) had the greatest impact and would need to be reduced to $5,598/4 weeks to achieve cost-effectiveness. LIMITATIONS: Extrapolation of survival data reflects limited long-term trial data and increases uncertainty surrounding model parameters. Efficacy based on clinical trials may differ from real-world effectiveness. CONCLUSIONS: Despite clinical benefits, capivasertib plus fulvestrant was not cost effective at current price from a U.S. payer's perspective. The cost of capivasertib per 4 weeks would be required to decrease by ∼80% from $28,332 to $5,598 (about $87 per 200 mg) to meet the WTP threshold of $150,000.
Publisher's note.
J Med Econ · 2025 Dec · PMID 42003677 · Publisher ↗
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Hand eczema in US employees: a retrospective observational study of workers' compensation and medical claims.
Brook RA, Bin Sawad A, Beren IA … +6 more , Rosenberg EM, Ghanjanasak T, Kleinman NL, Milovac B, Balu S, Gelfand JM
J Med Econ · 2026 Dec · PMID 41984619 · Publisher ↗
AIMS: This research quantified the impact of hand eczema (HE) on US employees. METHODS: Retrospective observational analysis of real-world data from >500 large, self-insured employers from 2010 through 2024. The database...
AIMS: This research quantified the impact of hand eczema (HE) on US employees. METHODS: Retrospective observational analysis of real-world data from >500 large, self-insured employers from 2010 through 2024. The database includes detailed workers' compensation (WC) claims: eligibility, duration (days claims were open), medical costs, salary replacement, and absence days. The protocol included employees with medical claims (ICD-10s [L20.x, L23.x, L24.x, L25.x, L30.x] or ICD-9 = 691.x) and WC claims suggestive of HE based on body-parts and nature of injury. The analysis quantified HE-related WC claims: incidence, work loss, costs, and duration. HE-related WC incidence and average cost/claim were reported by industry. Costs inflation-adjusted to December 2024. RESULTS: The analysis identified 1,937 WC claims with study body-part and nature of injury codes, >48,000 employees with medical claims for the study ICD codes. 226 employees met the study criteria and had 6.1 HE-related WC claims/100,000 eligible person-years. Their 226 closed WC claims remained open for a mean of 343 days (SD = 616; median = 121) and cost a mean of $10,197 per claim (SD=$45,172; median=$477), including $4,535 in WC medical costs, $3,992 in salary-replacement costs, and $1,670 in other WC costs. Lost work time occurred in 11.5% ( = 26) of cases, with a mean duration of 277 days (SD = 680; median = 51). HE-related WC incidence was highest in manufacturing (11.2/100,000 person-years) and retail trade (10.5/100,000 person-years). Manufacturing had the highest average cost per claim ($29,587; SD=$94,790) and "healthcare and social assistance" had the highest average lost work time. CONCLUSION: HE-related WC claims were associated with significant lost work time and costs. Costs approached $30,000 per claim among those in the manufacturing industry. These findings underscore the severe burden of occupational HE and the need for early diagnosis and treatment to limit disability.
Letter to the editor: five-year implant versus other contraception missing correct data.
Kirshner SG, Hutchison CE, Creinin MD
J Med Econ · 2026 Dec · PMID 41973760 · Publisher ↗
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Reforming the delivery of smoking cessation: a distributional cost-effectiveness analysis of providing smoking cessation as part of targeted lung cancer screening.
Fewster H, Nuttall P, Evison M … +2 more , Holmes H, Malcolm R
J Med Econ · 2026 Dec · PMID 41973660 · Publisher ↗
BACKGROUND: Lung cancer is a leading cause of cancer death, and smoking-related disease is a major cause of health inequality in England, driven by increased prevalence of smoking in deprived areas. Integrating smoking c...
BACKGROUND: Lung cancer is a leading cause of cancer death, and smoking-related disease is a major cause of health inequality in England, driven by increased prevalence of smoking in deprived areas. Integrating smoking cessation support into the English Lung Cancer Screening (LCS) programme may optimize services and has been found cost-effective. However, limited evidence is available on its health equity impact. AIM: The objective was to conduct an aggregate distributional cost-effectiveness analysis (DCEA) of providing smoking cessation as part of LCS compared with usual care (referral to stop smoking services to estimate its impact on health inequalities and health-related social welfare in England. METHODS: The DCEA used an aggregate approach, stratifying people who smoke, aged 55-74 who were attending LCS by Index of Multiple Deprivation (IMD) quintiles. Discounted incremental costs and quality-adjusted life years (QALYs) were derived from a Markov model, adapted from previous NICE guidelines. The base case analysis applied a Health Opportunity Cost (HOC) of £15,000 per QALY and an Atkinson inequality aversion parameter (IAP) of 6.5, assuming a equal distribution across groups for intervention uptake. RESULTS: Under all base case assumptions, smoking cessation provided as part of targeted LCS had a positive net health benefit and health equity impact. The intervention dominated usual care, resulting in a total net health benefit of 142,035 QALYs. The distribution of benefit strongly favored the most deprived quintile (IMD1: 34,863 QALYs vs. IMD5: 23,612 QALYs), driven by smoking prevalence. CONCLUSION: Reforming smoking cessation services as part of LCS would likely improve both population health and health equity. Uptake of smoking cessation is a key determinant of the impact on health inequalities, underscoring the importance of targeted implementation strategies for optimizing population health, while reducing health inequalities.
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