BACKGROUND AND AIM:High-risk patients with COVID-19 remained at elevated risk of severe outcomes in the Omicron era, even after receiving multiple vaccine doses. We report the Omicron-era healthcare resource utilization (HCRU) and cost burden of COVID-19 among commercially insured, oral antiviral therapy-eligible patients at high risk of severe disease. METHODS:This retrospective analysis used the TriNetX Linked US database. Eligible commercially insured patients were aged ≥18 years, had a COVID-19 diagnosis between 1 July 2023 and 30 June 2024, and had ≥1 risk factor for severe COVID-19. All-cause and COVID-19-related HCRU and costs were assessed during acute (0-30 days from diagnosis) and post-acute (31 days until December 31, 2024) follow-up. RESULTS:Of the 43,487 eligible patients, 56.2% were aged ≥50 years and 85.6% had 1-5 high-risk conditions. Patients were followed for a mean of 11.4 months following COVID-19 diagnosis (acute phase, 1.0 month; post-acute phase, 10.6 months). 13,499 patients (31.0%) received treatment for COVID-19. 9.8% of patients had ≥1 all-cause inpatient general ward admission, with a mean per-patient (PP) total cost of $14,715 (acute phase, $10,833 PP; post-acute phase, $14,403 PP). 1.3% of patients had an all-cause intensive care unit (ICU) admission, with a mean PP total cost of $75,371 (acute phase, $62,882 PP; post-acute phase, $71,666 PP). Among the small number of patients requiring mechanical ventilation in the ICU, mean all-cause PP costs were $135,677 PP overall (acute phase, $106,577 PP; post-acute phase, $130,309 PP). 28.4% of patients had ≥1 all-cause emergency department visit (mean total cost, $1,434 PP; acute phase, $842 PP; post-acute phase, $1,408 PP). CONCLUSIONS:During the Omicron era, HCRU and costs remained substantial and increased with disease severity among commercially insured patients at high risk of severe COVID-19. These findings are crucial to inform economic evaluations and payer decision‑making regarding COVID‑19 antiviral therapies.
INTRODUCTION:This study assessed the budget impact, from the perspective of the Kuwaiti healthcare payer, of introducing an as-needed fixed-dose combination of albuterol and budesonide (alb/bud-FDC) compared with albuterol alone and ICS-SABA for the management of asthma. METHODS:A budget impact analysis (BIA) was conducted to estimate the financial consequences of introducing alb/bud-FDC rescue inhaler compared with albuterol and ICS/SABA over a four-year time horizon. Only direct medical costs were measured, including medications, follow-up investigations, and hospital admissions. Resource utilization data were extracted from the existing literature and subsequently validated. Clinical parameters were derived from clinical trials. The uncertainty inherent in the model was explored through a one-way sensitivity analysis. RESULTS:The total asthma patient population (n = 15,763) was estimated. Of these, 11,823 patients were identified as having partially controlled or uncontrolled asthma and were deemed eligible for treatment with alb/bud-FDC. The total annual costs (drug and non-drug costs) were estimated to be KWD 14,870,455 ($82 million) before alb/bud-FDC entry (SABA scenario) compared to KWD 14,479,021 ($80 million) post-entry (new scenario), resulting in a total budget savings of KWD 391,434 ($2.1 million) after four years. The total annual costs were estimated to be KWD 9,009,634 ($50 million) before alb/bud-FDC entry (ICS/SABA scenario) compared to KWD 8,717,921 ($48 million) post-entry (new scenario), resulting in a total budget savings of KWD 291,713 ($1.6 million) after four years, primarily driven by reduction in healthcare resource utilization. Sensitivity analysis indicated that the most influential parameters affecting the budget impact were the rates of exacerbation associated with the use of SABA and alb/bud-FDC, and alb/bud-FDC average unit/inhaler per year and costs. CONCLUSION:Our findings indicate that replacing albuterol or ICS-SABA with the alb/bud-FDC rescue inhaler across different asthma severity levels improves clinical outcomes while reducing overall healthcare costs through lower expenditures associated with severe asthma exacerbations and maintenance oral corticosteroid (OCS) use. This evaluation is relevant to healthcare decision makers for guiding that alb/bud-FDC is budget-saving for eligible patients, while reducing the burden to patients and improving their control and symptoms. These savings should be interpreted within the context of the overall asthma management budget.
AIMS:To estimate the projected cost-effectiveness of NMR-guided metabolism-informed care (MIC) compared with standard care (SC) for smoking cessation in China. MATERIALS AND METHODS:A 24-week decision tree was linked to an annual semi-Markov cohort model that followed individuals from age 45 to age 100. Clinical inputs were informed by the China National Tobacco Cessation Cohort Study. Stabilized inverse probability of treatment weights were estimated using a multinomial propensity-score model, trimmed at the 1st and 99th percentiles, and analyzed using robust sandwich variance estimators. Under MIC, fast metabolizers (NMR ≥ 0.31) received varenicline, while slow metabolizers (NMR < 0.31) received either nicotine replacement therapy (NRT) or bupropion. Costs were expressed in 2023 Chinese yuan (CNY), and costs and health outcomes were discounted at 5% annually. RESULTS:Over the lifetime model horizon, SC generated 13.125 QALYs per person at a total cost of CNY 40,832.29. Both MIC medication-cost scenarios generated an additional 0.003 QALYs. MIC-Bupropion cost CNY 41,033.81 and yielded an ICER of CNY 67,930.00 per QALY gained versus SC. The corresponding deterministic INMB versus SC was CNY 63.57 at the primary threshold. In the fully incremental analysis, MIC-NRT was strictly dominated by MIC-Bupropion. At CNY 89,358.00 per QALY, MIC-Bupropion had the highest net monetary benefit in 50.4% of probabilistic simulations. LIMITATIONS:Findings depended on observational clinical inputs, literature-derived long-term parameters, and structural assumptions, and did not fully capture all smoking-related diseases, adherence, adverse effects, or implementation costs. CONCLUSIONS:MIC-Bupropion showed favorable expected economic performance relative to SC, whereas MIC-NRT was strictly dominated. Further comparative-effectiveness, budget-impact, and implementation studies are warranted before routine adoption.
AIMS:The objective of this study was to quantify all-cause direct healthcare costs and healthcare resource utilization (HCRU) in the six months before and after COVID-19-associated hospitalization among Medicare fee-for-service (FFS) beneficiaries during the recent Omicron period (March 2023-March 2025). METHODS:This retrospective observational study used 100% Medicare FFS claims data. Beneficiaries aged ≥65 years with a COVID-19 hospitalization between September 2023 and September 2024 and continuous enrollment for six months pre-admission and post-discharge were included. A within-group pre/post design compared mean cumulative per-patient healthcare costs and HCRU during the six-month pre-admission and post-discharge periods, excluding index hospitalization costs. Outcomes were stratified by hospitalization severity and post-discharge care setting. RESULTS:Among 72,053 beneficiaries (mean age 80.8 years; 55.1% female), 96.5% had ≥1 high-risk condition. Mean total healthcare costs increased by $13,808 per patient post-discharge versus pre-admission (p < 0.001), driven primarily by care facility/home health ($8,461) and inpatient ($4,278) costs. Larger increases were observed among patients requiring invasive mechanical ventilation ($21,122), with index stays ≥7 days ($23,223), and those discharged to healthcare facilities ($28,857) (all p < 0.001). Mean total healthcare claims increased by 6.1 per patient and inpatient length of stay by 3.6 days (both p < 0.001). CONCLUSIONS:COVID-19 hospitalization among Medicare FFS beneficiaries is associated with substantial increases in post-discharge healthcare costs and utilization, particularly among patients with greater severity and post-acute care needs. These findings highlight the sustained economic burden of COVID-19 in older adults and underscore the need for targeted post-discharge care strategies.
AIMS:Cell and gene therapies (CGTs) are increasingly transforming the treatment of serious and life-threatening conditions, offering durable and, in some cases, potentially curative benefit. However, high upfront costs paired with the expectation for long-term value realization create misalignment with conventional managed care and reimbursement models. Although innovative payment and risk-sharing strategies have been proposed, adoption remains limited. Understanding how payers are navigating these challenges is increasingly critical as CGTs continue to transition into established standards of care. METHODS:Sixty-minute, double-anonymized, semi-structured interviews were conducted to assess United States (US) payer perspectives toward CGT reimbursement. Participants were recruited via third-party vendors to minimize bias. Data collection included Likert-scale ratings and open-ended inquiries regarding access, formulary processes, and reimbursement frameworks. RESULTS:Twenty payer decision-makers were interviewed. While 17 viewed CGTs as among the most important medical innovations of our time, 18 agreed that the US healthcare system is not adequately prepared for broad CGT adoption. Top barriers to reimbursement include high upfront costs and long-term durability uncertainty. Preferred mitigation strategies include reinsurance/stop-loss and risk pools. Member portability and data tracking remain primary barriers to innovative payment models. LIMITATIONS:Sample size may not represent all US payers. Qualitative study findings identify trends and consensus only. CONCLUSIONS:Payers acknowledge the significant clinical promise of CGTs, but high upfront costs and long-term durability uncertainty continue to complicate coverage strategies and limit broader adoption. Ongoing evaluation of reimbursement frameworks, financing strategies, and emerging long-term evidence may help characterize how coverage and payment models evolve as the CGT landscape expands.
AIM:This study aimed to quantify the health benefits that can be achieved by treating axicabtagene-ciloleucel (axi-cel)-eligible large B-cell lymphoma patients with axi-cel instead of historical standard of care (hSoC) in Portugal. "Estimated Opportunity Lost" quantified the difference in outcomes in 2024 if all axi-cel-eligible patients were treated with axi-cel versus if only a fraction received axi-cel and the remaining patients received hSoC. "Potential Future Gains" quantified the difference in outcomes in 2026-2028 if all axi-cel-eligible patients receive axi-cel versus all patients receiving hSoC. METHODS:A Population Level Health Impact model was developed to obtain the weighted average results for 2L and 3L + models. Both underlying models used a partitioned survival model with extrapolations performed using mixture cure assumption. At model entry, patients were treated with axi-cel or hSoC. Each cohort of "year of entry/line of entry" was followed for 5 years. Outcomes were life years (LY), progression-free survival years (PFSY), quality-adjusted life-years (QALY), and absolute number and proportion of patients alive at 5 years and potentially cured (not progressed) at 5 years. Model inputs were based on publicly available literature, a modified Delphi panel, and real-world data. Utilities and mortality data were Portuguese-specific. RESULTS:Of 284 axi-cel-eligible patients in 2024, 23 (8%) received axi-cel. Over 5 years, the Estimated Opportunity Lost by not treating all eligible patients with axi-cel was 203 LY, 45 deaths, and 36 patients that could have been potentially cured. The Potential Future Gains from treating all eligible patients with axi-cel are an estimated 527 more PFSY, 582 more LY, 119 more patients alive, and 85 more potentially cured. CONCLUSION:The model suggests that limited axi-cel uptake in Portugal resulted in lost health benefits for axi-cel-eligible patients. When considering the next 3 years, substantial health benefits may be gained if all eligible patients receive axi-cel treatment.
INTRODUCTION:Interstitial cystitis/bladder pain syndrome (IC/BPS) is a persistent and heterogeneous condition diagnosed by exclusion, defined by a bladder-associated unpleasant sensation (e.g. pain, pressure, or discomfort), and affecting patients' quality of life. This real-world study aimed to describe all-cause healthcare resource utilization (HCRU) and costs associated with IC/BPS in the United States. METHODS:This matched-cohort study compared patients with an IC/BPS diagnosis to those without using real-world claims from the Merative MarketScan Commercial and Medicare Supplemental Databases (Set B; January 1, 2016-June 30, 2025). The index date was the first IC/BPS diagnosis during the identification period (January 1, 2017-September 30, 2022). During the baseline and follow-up periods, all-cause HCRU and costs (i.e. billed expenses) were reported as means per patient per year (PPPY) and rate ratios (RR). RESULTS:In the 1-year baseline period, the IC/BPS cohort demonstrated higher all-cause HCRU and costs across all categories compared with the control cohort. During the follow-up period, mean all-cause total visits were nearly 2-fold higher in the IC/BPS cohort than in the control cohort (21.78 vs. 10.94 PPPY; RR, 1.99; 95% CI, 1.95-2.04); mean all-cause total healthcare costs were also nearly 2-fold higher in the IC/BPS cohort than in the control cohort ($20,288 vs. $10,222 PPPY; RR, 1.98; 95% CI, 1.92-2.05). LIMITATIONS:This observational study of all-cause HCRU based on claims data provides insights rather than conclusions. Claims data rely on coded diagnoses and may lack information on disease severity, adherence, and indirect costs, introducing bias (e.g. diagnosis misclassification or residual confounding) and affecting the generalizability of results. CONCLUSIONS:This exploratory study demonstrated that the healthcare burden among patients diagnosed with IC/BPS remained substantial over time. These findings highlight the need for further research on cost drivers and management strategies to improve outcomes and reduce all-cause HCRU and costs among patients with IC/BPS.
AIMS:KEYNOTE-689 trial results demonstrated that neoadjuvant pembrolizumab followed by adjuvant pembrolizumab plus standard of care (NP/AP + SOC) significantly improved event-free survival (EFS) versus SOC alone in patients with locoregionally advanced head and neck squamous cell carcinoma (LA HNSCC). This study evaluated the cost-effectiveness of NP/AP + SOC vs. SOC from the Swiss healthcare perspective. MATERIALS AND METHODS:A 4 mutually exclusive health state US-specific Markov cohort model was adapted to the Swiss healthcare perspective. Efficacy inputs were derived from patient-level KEYNOTE-689 data using parametric survival analysis. Healthcare resource utilisation and costs (2025 Swiss Franc [CHF]) were obtained from Swiss clinical experts and national tariffs. Health state utilities were derived from EuroQoL-5 dimension data collected in KEYNOTE-689. Outcomes included costs, quality-adjusted life-years (QALYs) and life-years (LYs), measured over a lifetime horizon. At the base-case, a 3.0% discount rate was applied to costs and effectiveness. Cost-effectiveness was evaluated as an incremental cost-effectiveness ratio (ICER) at a hypothetical willingness-to-pay (WTP) threshold of CHF 100,000/QALY gained. Deterministic, probabilistic, and scenario analyses were conducted for sensitivity. RESULTS:NP/AP + SOC treatment extended life expectancy by 1.81 years compared to SOC, generating 1.42 incremental QALYs. Total costs were CHF 172,086 for NP/AP + SOC versus CHF 151,908 for SOC, resulting in incremental costs of CHF 20,178/patient. ICERs were CHF 14,227/QALY gained and CHF 11,130/LY gained. At a WTP of CHF 100,000/QALY gained, NP/AP + SOC had a 96% probability of being cost-effective. LIMITATIONS:Long-term follow-up data (median 3.2 years) required extrapolation; real-world Swiss cost data were unavailable necessitating expert opinion; Belgian utility values were used as Swiss-specific data were unavailable. CONCLUSION:NP/AP + SOC is cost-effective for LA HNSCC in Switzerland, supporting clinical implementation.
BACKGROUND:The TheraP trial compared cabazitaxel to Lutetium-177-labeled PSMA-617 (Lu-PSMA) in metastatic castration-resistant prostate cancer (mCRPC) following docetaxel and an androgen receptor pathway inhibitor (ARPI). Lu-PSMA demonstrated improved PSA response (66% vs 37%; p < 0.0001) and progression-free survival (HR = 0.63; p = 0.0028), while overall survival (OS; median 16.4 vs. 19.4 months) and rates of Grade 3 (0.88 vs. 0.96 events/patient) and Grade 4 adverse events (AE; 0.11 vs. 0.08 events/patient) were comparable. The comparative economic implications of these two therapies in the United States (US) remain uncertain. METHODS:A cost-consequence Excel model was developed from the US Medicare perspective to evaluate the direct cost outcomes for mCRPC patients receiving cabazitaxel or Lu-PSMA. Inputs were derived from TheraP, supplemented by literature and clinical expert validation. Costs included PSMA testing, drug acquisition and administration, supportive care, AE management, and end-of-life care. Outcomes (derived from TheraP inputs) included OS, progression-free survival (PFS), PSA-PFS, and radiographic-PFS (rPFS). An 18-month time horizon aligned with clinical follow-up. Costs were reported in 2025 USD. RESULTS:At 18 months in the modeled cohort of 100 patients, cabazitaxel was associated with nine additional modeled survivors; this should be interpreted cautiously, as TheraP reported no statistically significant difference in OS between cabazitaxel and Lu-PSMA. In contrast, Lu-PSMA demonstrated improved PFS outcomes in the modeled cohort, with eight more patients remaining progression-free and 15 more radiographic progression-free. From the Medicare perspective, cabazitaxel was associated with a per-patient cost of $107,729, versus $303,338 per patient for Lu-PSMA (-$195,608). Cost differences were driven primarily by lower drug acquisition costs for cabazitaxel. CONCLUSIONS:Cabazitaxel provides a clinically validated and economically favorable treatment option post-docetaxel and ARPI, providing substantial cost savings across payer scenarios with no observed difference in OS. Lu-PSMA offers improved PSA-based outcomes and progression-related endpoints at higher treatment costs. These findings support clinical-economic trade-off considerations when sequencing therapies for mCRPC.
OBJECTIVES:Arrhythmias, including atrial fibrillation and ventricular tachycardia, are associated with substantial morbidity and healthcare utilization in older adults. Ambulatory cardiac monitoring (ACM) is used to evaluate suspected or known arrhythmias; however, monitoring modalities vary in duration, diagnostic yield, and cost. We evaluated differences in total cost of care across major ACM modalities using real-world Medicare claims data. METHODS:We conducted a retrospective cohort analysis using the Merative MarketScan Medicare Claims Database to estimate per patient per month (PPPM) costs in the 12 months following initiation of one of four ACM modalities among Medicare beneficiaries newly monitored between 2016 and 2024. The analytic cohort included 132,082 beneficiaries: Holter (n = 70,799), long-term continuous monitoring (LTCM, n = 25,294), mobile cardiac telemetry (MCT, n = 20,085), and external ambulatory event monitoring (AEM, n = 15,904). Entropy balancing was applied to align baseline covariates. Weighted mean PPPM costs and Tukey-adjusted pairwise cost differences were estimated using weighted regression models. RESULTS:Holter monitors accounted for the largest share of index monitoring, while LTCM utilization increased substantially over the study period. Weighted PPPM costs were lowest for LTCM ($2,678), followed by AEM ($2,721), Holter ($2,873), and MCT ($3,034) (overall p < .001). In pairwise comparisons, Holter and MCT had significantly higher weighted PPPM costs than LTCM, with absolute differences of $196 (p = .002) and $357 (p < .001), respectively. AEM had numerically higher weighted PPPM costs than LTCM ($44; p = .938). CONCLUSION:Among Medicare beneficiaries, LTCM was associated with lower weighted 12-month total costs of care compared with Holter and MCT.
AIMS:Seasonal influenza continues to cause severe disease among older adults in the United States despite enhanced vaccine recommendations, driven by immunosenescence and vaccine mismatch with circulating influenza viruses. mRNA-based influenza vaccines (mRNA-1010), addressing some of these challenges, have been developed for this population. A previous trial found mRNA-1010 demonstrated superior immunogenicity compared to enhanced high-dose influenza vaccination. As no direct evidence exists comparing mRNA-1010 efficacy to currently available enhanced influenza vaccines (EVs), we aimed to indirectly compare the effectiveness of mRNA-1010 and licensed EVs against medically attended influenza infection among adults ≥65 years in the US. MATERIALS AND METHODS:We conducted an anchored indirect treatment comparison (ITC) using the Bucher method to estimate the relative vaccine effectiveness (rVE) of mRNA-1010 vs EV, with standard-dose egg-based influenza vaccine as the anchor, using individual patient-level data from adults ≥65 years from a real-world Optum claims-based analysis and the pivotal mRNA-1010-P304 clinical trial. Target trial emulation and inverse probability weighting (IPW) were implemented to address potential bias due to cross-population differences. Sensitivity analyses were conducted using alternative outcome definition, alternative weighting approaches and US trial sites only. RESULTS:Assessments of post-IPW supported a comparable common anchor for the ITC. Among adults ≥65 years, the indirect rVE of mRNA-1010 vs. enhanced vaccines against medically attended influenza was 12.82% (95% CI: -36.91%, 44.49%). Sensitivity analyses also supported these findings. LIMITATIONS AND CONCLUSIONS:mRNA-1010, a new mRNA-based influenza vaccine, was shown to be comparable to currently licensed EVs among older adults ≥65 years against medically attended influenza outcomes. Consistency of findings across sensitivity analyses support the robustness of these results. Newer influenza vaccine modalities, including mRNA-based vaccines provide an additional comparable option to existing EVs to help further reduce severe influenza disease burden among older adults ≥65 years for whom enhanced vaccines are recommended.
BACKGROUND AND AIMS:HIV diagnoses have increased in Brazil from 2020 to 2023, with 54% of new diagnoses in 2023 occurring among men who have sex with men. This increase suggests a substantial need for HIV prevention, including pre-exposure prophylaxis (PrEP). We developed a fiscal health model to assess the financial impact of enhancing HIV prevention in Brazil. METHODS:The fiscal health model used a multicohort Markov structure covering 15 annual cohorts of men who have sex with men aged 15-29 years, linking individual health states (off PrEP, on PrEP, diagnosed with HIV) to 4 fiscal states that individuals could occupy across their modeled lifetime (formally employed, informally employed, unemployed, retired). The model compared the status quo (current provision of HIV prevention, i.e. daily oral PrEP) with enhanced prevention (availability of long-acting PrEP and outreach programs to increase PrEP uptake and adherence). Outcomes are presented as an average fiscal benefit-cost ratio across all age cohorts' lifetimes (discounted at 5%). Scenario analyses were conducted over the cohorts' total lifetime (including retirement phase) and preretirement lifetime using either conservative or alternative estimates (differing viral suppression and employment reduction estimates). RESULTS:In all scenarios, enhancing HIV prevention compared with status quo averts >70,000 HIV diagnoses among the modeled population of 526,046 young men who have sex with men. Enhancing HIV prevention generates a return on investment of 5% and 17% over the cohorts' total lifetimes and preretirement lifetimes, representing returns of R$0.5 billion (∼US$100 million) and R$1.7 billion (∼US$340 million), respectively. With alternative estimates, enhancing HIV prevention generates a return of 20% and 33% over the total lifetimes and preretirement lifetimes, respectively. CONCLUSIONS:Enhancing HIV prevention shows a positive return on investment. Decision-makers should consider long-term perspectives, ensuring opportunities to improve population health and contribute to a stronger economy are realized.
AIMS:Generalized myasthenia gravis (gMG) is a rare, chronic autoimmune disorder with substantial healthcare resource utilization (HRU) and high economic burden. This study evaluated HRU, costs, and predictors of high-cost events in adults with gMG, using data from VIVACITY-MG3. METHODS:Post-hoc analyses used the primary efficacy dataset from VIVACITY-MG3, a randomized, double-blind, placebo-controlled study of nipocalimab and standard-of-care (SoC) versus placebo and SoC in seropositive adults with gMG. HRU endpoints included hospital admissions (HA), emergency department visits (EDV), and hospital days. Logistic regression analysis identified clinical and demographic HA/EDV predictors. Hospital costs per patient per year (PPPY) were estimated using United States (US) cost data from published sources and from a claims database, adjusted to 2024 US dollars. RESULTS:Among 153 patients, nipocalimab numerically reduced the proportion experiencing ≥1 all-cause (9.1% vs 15.8%) and gMG-related (3.9% vs 7.9%) HA/EDV events versus placebo. The incidence rate of HA/EDV events was 51% numerically lower with nipocalimab. Mean hospital stay duration was numerically shorter with nipocalimab for all-cause (8.4 vs 14.6 days) and gMG-related admissions (11.2 vs 17.6 days). All-cause and gMG-related hospital days per 100 patient-years were statistically significantly reduced by 60% and 68% with nipocalimab, respectively. Estimated cost offsets for reduced HRU were $10,860-$13,253 PPPY. Multivariate analysis identified worsening in Myasthenia Gravis-Activities of Daily Living (MG-ADL) total score and higher baseline Quantitative Myasthenia Gravis (QMG) respiratory total score as independent predictors. Patients switching from placebo to nipocalimab in the VIVACITY-MG3 open-label extension experienced a 64% reduction in hospital days PPPY. LIMITATIONS AND CONCLUSION:Study limitations include the post-hoc nature of the analysis and the relatively short study duration. Nipocalimab added to SoC significantly reduces overall HRU and associated costs in adults with gMG, particularly by lowering rates and severity of HA/EDV events. Clinical deterioration and high baseline disease severity independently predict high-cost events.
BACKGROUND AND OBJECTIVE:Accurate nodal staging in intermediate- to high-risk prostate cancer (PCa) is crucial for treatment decisions. While extended pelvic lymph node dissection (ePLND) is the standard, it is invasive and has a low diagnostic yield. A 2019 analysis suggested that non-invasive imaging such as PSMA-PET/CT and ferumoxtran-enhanced macrophage-MRI (m-MRI) is cost-effective, but at the possible expense of a small QALY loss compared to ePLND, based on limited evidence. Recent Phase 3 trials have provided new data, prompting a reevaluation. Therefore, the aim of this article is to update a model with recent trial data to assess the cost-effectiveness of m-MRI and PSMA-PET/CT versus ePLND in Germany. MATERIAL AND METHODS:We adapted a Markov model to simulate lifetime outcomes for men with intermediate- to high-risk PCa from a German insurer's perspective, with costs updated to 2025 level. Diagnostic accuracy data were derived from recent multicenter trials. Costs and QALYs were calculated using a 3% discount rate. Sensitivity analyses tested uncertainties. A practical interactive online-tool is provided for clinical decision-making and research purposes, which can incorporate various input data (https://macrophage-mri.app). RESULTS:Both imaging options were dominant over ePLND (€37,855; 18.11 QALYs). PSMA-PET/CT was €7,869 cheaper and gained 0.800 QALYs; m-MRI was €9,985 cheaper and gained 0.990 QALYs. m-MRI was superior, saving €2,116 and gaining 0.19 QALYs over PSMA-PET/CT. The probabilistic analysis showed that m-MRI was optimal over 95% of the time at an €80,000/QALY threshold; the probability of PSMA-PET/CT being optimal was less than 5%. CONCLUSIONS:An imaging-first approach outperforms routine ePLND, with m-MRI as a cost-effective option. PSMA-PET/CT's low sensitivity limits its usefulness, though it is still cheaper than ePLND. These results support including m-MRI in guidelines for initial staging.
AIM:Screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization by culture-based or molecular-based methods in hospitals identifies patients for decolonization, mitigating transmission. This study aimed at quantifying the impact of expanding MRSA screening at hospital admission in Spain to all patients at high risk of being colonized with MRSA (HRP), using on-demand molecular PCR instead of culture. METHODS:In the base case, HRP were those admitted to coronary, burn, or hemodialysis units, hematology or oncology medical departments, intensive care units (ICU) or specified surgical departments. A decision-tree model was developed to compare MRSA screening strategies: S1 was preventive contact precautions (PrevCP) + screening with on-demand molecular PCR (Xpert MRSA NxGi) applied to all HRP; S2 was PrevCP + culture-based screening applied to all HRP; S3 was current clinical practice in Spain of PrevCP + culture-based screening for ICU-admitted patients only. A 60-day time horizon was considered, and the hospital perspective was adopted. Model input values were obtained from publicly available data and expert opinion. RESULTS:In a hospital with 20,000 annual admissions, S1 versus S2 was estimated to generate 7.4 more MRSA-positive tests, 4.3 more successful decolonizations, and 0.8 fewer MRSA-related infections. The increase in total testing costs (+61,447.4€) was more than compensated by savings in excess cost due to PrevCP (-792,211.0€) and infection-related costs (-18,271.2€). Estimated total cost savings with S1 versus S2 were 748,971.2€ (-438.8€/HRP tested). Screening with S1 versus S3 increased the number of HRP tested (1,524.0), identified 113.3 more MRSA-positive tests, with 12.6 fewer MRSA-related infections, and 3.4 fewer deaths. Estimated total cost savings with S1 versus S3 were 272,118.5€ (-3,278.0€/HRP tested). CONCLUSION:Screening all HRP with Xpert MRSA NxG in Spain compared with culture and current clinical practice could generate savings from a hospital perspective and prevent infections, nosocomial colonization, and mortality.
AIMS:The prevalence of inflammatory bowel disease (IBD) in the Netherlands is approximately 100,000 individuals currently (578 per 100,000 inhabitant), and is rising. Iron deficiency anaemia (IDA) is common in patients with IBD, secondary to chronic blood loss and impaired iron absorption. Intravenous iron is recommended as first-line treatment in patients with clinically active IBD, with previous intolerance to oral iron and in patients who need erythropoietin stimulating agents. The objective was to evaluate the difference in treatment costs and consequential costs of ferric derisomaltose (FDI) versus ferric carboxymaltose (FCM) in patients with IBD and IDA in the Netherlands, based on a casemix model using hospital data from the DBC (Diagnose Behandel Combinatie) system. This study aims to elucidate the differences in budget impact, from a health insurers perspective. MATERIALS AND METHODS:In order to model the hospital business, a coding analysis was done, to identify the relevant codes, tariffs, and volumes. In a casemix scenario analysis, the clinical differences between the use of FCM and FDI have been modelled, with a time horizon of 5 years. RESULTS:The analysis showed that with FDI the overall costs were lower than with FCM. With full use of FDI in the eligible population, the potential annual savings excluding complications in the national health insurer perspective is €2.9 million (excl. VAT) on iron infusion cost only. Including related costs and complications, the potential annual savings are €28.2 million. The sensitivity analyses proved the outcome to be robust. LIMITATIONS:Whilst using the DBC data would seem to reflect the real-life clinical behavior, it is known that the DBC system may show some underreporting. The analysis timeframe is limited to 5 years. CONCLUSIONS:Results showed that FDI significantly reduces healthcare expenditures versus FCM in patients with IBD and IDA in the Netherlands.
