Journal of Medical Economics

ObjectiveThe main objective was to estimate the potential public health impact and cost-effectiveness of an annual dose of mRNA-1273 (2025/2026 formula) in the United States (US) for the 2025-2026 season compared with no vaccination in the mRNA-1273 licensed population (6 months-64 years with underlying medical conditions and all [&ge;]65 years). mRNA-1273 was also compared to BNT162b2 in high-risk adults ages 18-64 years and all [&ge;]65 years. MethodsAnalyses were conducted using a previously developed static decision-analytic model (1-year horizon) from the societal cost perspective. Vaccine effectiveness (VE) against infection and hospitalization for mRNA-1273 versus no vaccination was based on a 2024-2025 real world effectiveness study. VE estimates for mRNA-1273 versus BNT162b2 were based on systematic literature reviews and meta-analyses. Cost-effectiveness was assessed in terms of incremental cost per quality-adjusted life-year (QALY) gained and the benefit cost ratio (BCR) in the licensed target population as well as age-specific subgroups. Sensitivity and scenario analyses were performed. ResultsThe incremental cost per QALY gained for mRNA-1273 compared to no vaccine was $23,265. For every 1 USD of mRNA-1273 vaccine related costs, there is a return of 1.91-7.90 dollars in societal perspective cost savings and monetized health benefit gained. In the subgroup of high-risk individuals 6 months-4 years, mRNA-1273 was associated with lower costs and improved health outcomes, resulting in mRNA-1273 dominating no vaccine. Study results are sensitive to COVID-19 incidence, percentage hospitalized, post-discharge mortality, and VE assumptions. Compared to BNT162b2, given improved clinical outcomes, combined with a lower vaccine unit cost, mRNA-1273 was shown to dominate BNT162b2. ConclusionsmRNA-1273, the only licensed vaccine for those <5 years of age at high risk of severe COVID-19 related outcomes, could substantially reduce the clinical and economic burden of COVID-19 among US high-risk populations and older adults. These benefits were observed both in comparison to no vaccination and the BNT162b2 vaccine.

COVID-19 remains a substantial public health challenge in the Netherlands. Next-generation COVID-19 vaccine, mRNA-1283, is approved in the European Union, with potential for higher relative vaccine efficacy compared with originally-licensed COVID-19 vaccines. Its potential public health and economic impact, in adults [&ge;]60 years and high-risk 18-59 years, was modelled versus no vaccination and originally-licensed mRNA-1273 and BNT162b2, adapting a published static Markov model with 1-year time horizon. COVID-19 burden reflected two full post-pandemic seasons. Vaccine efficacy versus mRNA-1273 was based on pivotal phase 3 NextCOVE trial data; efficacy versus BNT162b2 was derived from an indirect treatment comparison. The economically justifiable price (EJP) of mRNA-1283 versus no vaccination, and price premiums over existing vaccines, were determined at a willingness-to-pay threshold of {euro}50,000/quality-adjusted life-year (QALY) gained. Without COVID-19 vaccination, an estimated 460,000 infections, 23,800 hospitalizations and 5,300 deaths would occur. With current coverage, mRNA-1283 was estimated to prevent 68,000 infections, 5,400 hospitalizations, and 1,200 deaths, saving 9,667 QALYs and over {euro}66.5 million in treatment costs. The EJP was {euro}238 versus no vaccination. Compared with mRNA-1273 and BNT162b2, mRNA-1283 was estimated to prevent additional burden (e.g., 1,309 and 1,679 hospitalizations, respectively), and was cost-effective at an incremental EJP of {euro}62 versus mRNA-1273, and {euro}80 versus BNT162b2. The results support continued COVID-19 vaccination to mitigate the ongoing health and societal burden of SARS-CoV-2 in the Netherlands. The comparative analyses indicate that mRNA-1283 may be associated with substantial health benefits over originally-licensed mRNA vaccines; consequently, its use may further improve health outcomes and economic efficiency within COVID-19 vaccination programs.

ObjectiveTo evaluate the impact of implementing pediatric medication pathways on operational management under the DRG/DIP payment model in a specialized childrens hospital, using DRG as a case study. MethodsAll medical records with DRG codes DT13 and GW15 from 2023 (pre-implementation control group) and 2024 (post-implementation observation group) were included. A systematic comparative analysis of clinical data was performed to assess the effects on hospital operational metrics. ResultsThe observation group exhibited a significantly lower average cost per case (DT13: 17.82%; GW15: 26.05%) and a higher medical insurance payment margin (DT13: {yen}186,500; GW15: {yen}89,000) compared to the control group. The examination cost proportion and total hospitalization expenses decreased significantly (P < 0.05), whereas the drug cost proportion showed a non-significant decreasing trend (P > 0.05). Regarding efficiency, the average length of stay and number of drug varieties were significantly reduced (P < 0.05). Quality indicators, including antibiotic usage rate, antibiotic use intensity, and adverse drug reaction incidence, were significantly improved (P < 0.05), alongside an increased rational prescription review rate. Furthermore, the number of high-cost cases decreased while low-cost cases increased for both disease groups post-implementation, with all case distributions remaining within clinically acceptable bounds. ConclusionPediatric medication pathways represent an effective strategy for balancing cost-containment with the unique clinical demands of pediatric care within the DRG/DIP framework. They provide a practical reference for precision management in pediatric hospitals and empirical evidence to inform pediatric-sensitive medical insurance payment policies.

BackgroundSeasonal influenza imposes a significant clinical and economic burden in the United States despite the availability of effective vaccines. ObjectivesTo estimate the cost of illness associated with seasonal influenza among U.S. adults and to examine the relationship between vaccination coverage and influenza related outcomes. MethodsWe combined Centers for Disease Control and Prevention influenza burden estimates with contemporary healthcare utilization, cost, and labor market data to estimate direct medical costs and productivity losses for the 2023 24 influenza season. Panel data regressions with fixed effects were used to evaluate the association between adult influenza vaccination rates and hospitalization and mortality outcomes using data from the 2010 11 through 2023 24 seasons. Scenario analyses assessed how alternative vaccination rates would have affected costs and mortality. ResultsInfluenza among adults was associated with an estimated $29 billion in total economic burden in the 2023 24 season, including approximately $16 billion in direct healthcare costs and $13 billion in productivity losses. Higher vaccination rates were significantly associated with lower mortality among adults aged 18 years and older and reduced hospitalization rates among adults aged 50 years and older. Achieving historical peak vaccination coverage would have reduced total costs by approximately $3 billion and averted more than 8000 deaths. ConclusionsAdult influenza vaccination is associated with substantial reductions in mortality and economic burden, underscoring its value as a cost relevant public health intervention.

BackgroundRespiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections and hospitalizations among infants in Canada. New long-acting monoclonal antibodies (mAbs) and vaccines administered during pregnancy have expanded prevention options, yet the most cost-effective immunization program remains uncertain. MethodsWe updated a Canadian cost-utility model to evaluate seven seasonal RSV prevention strategies over one year (with a lifetime horizon for mortality impacts), from health system and societal perspectives. Strategies included RSVpreF vaccination in late pregnancy; targeted or universal infant mAb programs using nirsevimab or clesrovimab; and combination programs in which infants could receive protection from either RSVpreF or mAbs. Sequential incremental cost-effectiveness ratios (ICERs) were estimated in 2024 Canadian dollars per quality-adjusted life year (QALY), using a $50,000/QALY threshold. The primary analysis used immunization product list prices. FindingsThe most cost-effective strategy was a seasonal combination program: RSVpreF vaccination for pregnancies due during RSV season with mAb for infants at high risk (<32 weeks gestation), including catch-up for infants at high-risk born before the season. This strategy had an ICER of $35,408/QALY compared to seasonal mAb for infants at moderate risk (320/7 to 366/7 weeks gestation) or high-risk with catch-up. Expanding mAb to unimmunized non-high-risk infants born in-season increased the ICER to $132,131/QALY. Universal infant protection (mAb alone or combined with RSVpreF in pregnancy) was not cost-effective across analyses. RSVpreF alone was dominated. Results were most sensitive to product prices, target populations, age at administration, and RSV burden. ConclusionsA seasonal combination program with RSVpreF for in-season deliveries and mAb for infants at high-risk offers the best value for money for protecting Canadian infants from RSV disease. Broader infant immunization programs may be cost-effective with substantial price reductions or in regions with higher disease burden and healthcare costs.

IntroductionThe adoption of biologic therapies imposes a substantial financial burden on the Jordanian healthcare system. Ranibizumab is prescribed for various retinal disorders, and its associated costs are considerable. The introduction of biosimilars is beneficial in retaining desired clinical parameters while providing cost relief and enhanced access to patients. ObjectiveTo examine the budget impact and expanded access of switching to ranibizumabs biosimilar for the management of retinal diseases in guideline-based practice and in real-world practice in Jordan. MethodA 4-year budget impact analysis from Jordanian public sector payers sector was performed (2023 to 2026) that included patient prevalence and incidence, average ranibizumab dose per year, and anticipated shifts in the market share of ranibizumab and aflibercept. The model took into account the anticipated price erosion of the biosimilar in 2025 and 2026. Sensitivity analyses were performed to assess the effect of changes in uptake rates, price, and market share. ResultsThe annual cost savings per patient when switching from aflibercept to ranibizumabs biosimilar were from 20.55 JOD (Jordanian Dinar) to 1519.93 JOD, translating to a percentage saving of 2.68% to 35.12% across the various scenarios and indications. The total budget impact ranged widely from 6.9 M JOD to 21.2 M JOD based on treatment regimens adjusted to current practice, PRN (Pro re nata), or T&E (Treat and extend). Patient access improved between 2.75% to 124.76% in the different scenarios. ConclusionThe introduction of ranibizumabs biosimilar significantly reduces the expenditures and enhances treatment access.

BackgroundQuadruple therapy, comprising an angiotensin receptor-neprilysin inhibitor (ARNI), {beta}-blocker, mineralocorticoid receptor antagonist (MRA), and sodium-glucose cotransporter 2 inhibitor (SGLT2i), is guideline-recommended for heart failure with reduced ejection fraction (HFrEF). However, uptake in Singapore remains low. This study evaluated the cost-effectiveness of scaling up quadruple therapy from the current 30% uptake to realistic (80%) and stretch (100%) targets. MethodsWe developed a decision-analytic model combining a decision tree and Markov structure to simulate clinical and economic outcomes over a 10-year horizon from the Singapore healthcare system perspective. Transition probabilities were estimated using local real-world data for current regimens, and published literature for quadruple therapy. Costs were derived from hospital billing data and drug utilisation patterns. A probabilistic sensitivity analysis (1,000 simulations) assessed uncertainty. The willingness-to-pay (WTP) threshold was S$45,000 per quality-adjusted life year (QALY) gained. ResultsBoth scale-up scenarios were cost-effective. Compared to current practice, the 80% uptake scenario resulted in an incremental cost of S$2.57M and 110 additional QALYs (ICER: S$23,392/QALY) for 1000 patients over 10 years, while the 100% uptake scenario yielded 137 QALYs at an incremental cost of S$2.88M (ICER: S$21,117/QALY). Under conservative assumptions, both scenarios remained cost-effective. The probability of being cost-effective was 92% (80% uptake) and 96% (100% uptake). InterpretationScaling up quadruple therapy for HFrEF in Singapore is highly cost-effective. Implementation strategies to close the treatment gap should be prioritised to improve outcomes and maximise value in heart failure care.

BackgroundThe United Nations General Assembly High-level Meeting on Antimicrobial Resistance (UNGA HLM-AMR) committed to a target that 70% of global human antibiotic use (ABU) should be from the Access group of the WHO AWaRe system. MethodsWe used 2019 IQVIA MIDAS(R) global ABU Quarterly value sales, volumes (kg/SU) and average ex-manufacturer prices to evaluate price per daily defined dose (DDD) by AWaRe group across countries. IQVIA MIDAS volumes/value data reflect public, private, or mixed sectors. We estimated potential national pharmaceutical expenditure savings if i) the UNGA 70% Access target was met, and ii) national ABU aligned with the WHO Model List of Essential Medicines (EML). We evaluated 7-day treatment prices for common oral and parenteral antibiotics across AWaRe groups. We measured affordability in middle-income countries (MICs) by income group, as the percentage of the population at risk of falling below national poverty lines if paying out-of-pocket, using income distributions and generalised beta distributions of the second kind. Prices were reported in 2019 international dollars (I$). ResultsVolume-weighted ex-manufacturer prices per DDD were lower for Access (I$1{middle dot}2, IQR I$0{middle dot}7) than Watch (I$2{middle dot}6, IQR I$2{middle dot}1) and highest (I$83{middle dot}8, IQR I$80{middle dot}9) for Reserve antibiotics. Lower prices were seen in high-income countries for Access antibiotics. Meeting the 70% Access target could save countries I$0{middle dot}1 million-I$4{middle dot}9 billion annually. Global savings could reach I$10{middle dot}4 billion if only WHO EML-listed antibiotics were used. Seven-day parenteral meropenem could put 7% (IQR 9%) of the population in MICs at risk of impoverishment. ConclusionAntibiotic policies focused on achieving the UNGA-AMR 70% Access target could generate significant potential national and global expenditure savings. FundingThis work was supported by the Wellcome Trust (304681/Z/23/Z) as part of the Antibiotic Data to Inform Local Action (ADILA) project and the Global Antibiotic Policy initiative (GAPi) project (RES 2024-495).

BackgroundThe Most Favored Nation (MFN) policy is a mechanism that incorporates foreign prices to determine the maximum allowable net price for any branded drug within US government-funded healthcare. Two proposed rules, the Global Benchmark for Efficient Drug Pricing ("GLOBE") (90 Fed. Reg. 60,244) for Medicare Part B and the Guarding US Medicare Against Rising Drug Costs ("GUARD") (90 Fed. Reg. 60,338) for Medicare Part D, invoke the Center for Medicare and Medicaid Innovation Centers payment and service model demonstration and waiver authority, under Section 1115A of the Social Security Act (42 U.S.C. [&#167;] 1315a), to calculate the US MFN price which is the lowest average price within a basket of specified foreign countries. Unlike voluntary manufacturer agreements, GLOBE and GUARD would mandate participation from all applicable manufacturers. MethodsWe derive MFNs potential impact on Medicare pricing from a proprietary dataset provided by IQVIA which contained net prices for the top 37 oncology products by total US sales from January 1, 2019 through June 30, 2025 ranked by total US sales in the following countries: Australia, Belgium, France, Germany, Ireland, Italy, South Africa, Spain, Switzerland, the UK, and the US. For each drug, we select the lowest GDP-adjusted international price from a basket of those countries within 60% of the US GDP per capita, adjusted for purchasing power parity, and calculate the reduction in US price required to match its MFN price, and hence the corresponding reduction in revenues under MFN. A retrospective Net Present Value (NPV) analysis is then used to address the counterfactual question of whether each drug would have been developed had MFN pricing been in place at the time of its FDA approval. ResultsUnder MFN, the average reduction in US prices across our drug cohort was 67%. Eighty-four percent of the 37 cancer drugs in our cohort evidenced a negative NPV if MFN had been in place at the time of their FDA approval and the commercial market is impacted. When the analysis is restricted to MFNs impact on Medicare, the indications for these lost drugs have a total US population of 2.4 million patients. When the analysis is combined across the Medicare and commercial markets, the loss of lead indications impacts over 15 million US patients. ConclusionsMandatory MFN policies reduce the financial incentives required to develop cancer medicines; our projections show a substantial decline in new cancer drug launches and will likely lead companies to pursue indications for populations outside Medicares authority. If so, MFN will reduce the number of new therapies for the very population the Executive Orders are allegedly designed to aid: the Medicare-aged population who require effective new therapies in areas of high unmet medical need, such as late-stage cancers. This creates the perverse outcome of a policy nominally designed to help Medicare beneficiaries by instead redirecting innovation away from their most urgent therapeutic needs.

BackgroundInnovative treatments for rare diseases often strain healthcare budgets. Precision medicine can improve care and reduce costs by guiding treatment allocation. One example is the forskolin-induced swelling (FIS) assay, which uses patient-derived organoids to predict-response to Cystic Fibrosis Transmembrane conductance Regulator (CFTR) modulators in people with Cystic Fibrosis (pwCF). However, it remains unclear when and for whom this assay adds most value. Therefore, the impact of assay accuracy and target population on health-benefits and costs needs assessment. Research questionTo quantify the impact of sensitivity, specificity and target population on health benefits and costs to inform further development of a predictive assay to guide treatment allocation in pwCF. Study design and methodsAn early economic evaluation was conducted using a decision tree and Markov model. Two strategies were compared over a 40-year horizon: (i) treat all pwCF with CFTR modulators and (ii) predict-response using the FIS assay to guide treatment. Scenario analyses varied assay sensitivity, specificity and treatment responsiveness, reflecting subpopulations of pwCF, including rare CFTR variants. Outcomes included quality-adjusted life years (QALY), false negative rates and costs. Model inputs were based on literature on pwCF with F508del mutations. ResultsThe primary analysis yielded a loss of 1.22 QALYs, with {euro}2,16 million cost-savings per patient in the predict-response strategy. Increasing assay sensitivity reduced QALY loss and false negatives while maintaining cost-savings, while specificity had limited effect on outcomes. Lower treatment responsiveness reduced QALY loss and false negatives while maintaining cost-savings. ConclusionThe assay appears most valuable in pwCF with rare CFTR variants, where treatment response is uncertain. Improving sensitivity is crucial to prevent QALY loss, especially in high-responder populations like pwCF with F508del. The model provides insights into variables impacting personalized testing and serves as a dynamic dashboard to explore scenarios once clinical data becomes available. Key pointsO_LIThis early economic evaluation provides insights in key variables affecting personalized testing to guide CFTR treatment allocation to inform further assay development. C_LIO_LIHigh assay sensitivity is crucial to prevent QALY loss in high responder CF populations, such as pwCF with F508del. C_LIO_LIThe FIS assay appears most value for pwCF with rare CFTR variants and uncertain treatment response. C_LI

ImportanceAs the population of older people with HIV (PWH) in the US is growing, costs to Medicare are expected to rise substantially. ObjectivesTo project the number of Medicare beneficiaries with HIV aged 65y+ on ART in the US from 2026-2035 and the budget impact on Medicare. Design, Setting, and ParticipantsWe developed the novel CHARMED simulation model and projected the number of Medicare beneficiaries with HIV aged 65y+ on ART and associated costs from 2026 to 2035; we populated the model with age and sex-stratified clinical data and costs derived from 2023 Traditional Medicare (TM) claims and accounted for enrollment in Medicare Advantage, as well as healthcare inflation. Main Outcomes and MeasuresNumbers of Medicare beneficiaries with HIV aged 65y+ on ART and undiscounted costs to Medicare from 2026-2035. ResultsWe projected that 111,600 PWH would be enrolled in Medicare and in care at the beginning of 2026 (65-69y: 57,370; 70-74y: 32,940; 75-79y: 14,670; 80y+: 6,610). By the end of 2035, this number would nearly double, to 193,560 (65-69y: 70,490; 70-74y: 62,820; 75-79y: 38,290; 80y+: 21,960). Annual costs to Medicare for PWH 65y+ on ART would increase 2.5-fold, from $11.4 billion at the end of 2026 to $28.6 billion at the end of 2035. Cumulative 10-year costs are projected to be $195.6 billion with 66.5% of cumulative costs due to ART. If ART costs are reduced by 60% as per the Inflation Reduction Act or generic ART, Medicare would save $78.0 billion over the next decade. Conclusions and RelevanceThe number of Medicare beneficiaries with HIV 65y+ on ART will more than double over the next decade, resulting in $195.6 billion in 10-year total costs to Medicare. Reducing ART costs through the IRA or generic oral ART could lead to 40% lower overall Medicare spending for older Medicare beneficiaries with HIV. KEY POINTSO_ST_ABSQuestionC_ST_ABSAs the population of people with HIV in the US grows older, what are the expected costs to Medicare and the impact of antiretroviral therapy (ART) costs? FindingsUsing microsimulation modeling, we find that the number of Medicare beneficiaries with HIV 65y+ on ART will more than double over the next decade. At current costs of ART and health care-associated inflation, total 10-year costs to Medicare are anticipated to be $196.5 billion; reducing ART costs through the Inflation Reduction Act or generic ART could lower Medicare spending by 40%. MeaningEfforts to reduce ART costs, while maintaining access to high-quality ART, are critical to reduce total Medicare costs as more people with HIV are anticipated to enroll in Medicare in the next 10 years.

The risk of esophageal adenocarcinoma (EAC) in Barretts esophagus (BE) varies substantially by segment length and dysplasia grade. This study evaluated the cost-effectiveness and health impacts of dysplasia-stratified EAC surveillance strategies for the Japanese BE population. A state-transition model was developed comparing endoscopy, sponge test, breath test, and miRNA test with no surveillance from a healthcare payer perspective over a lifetime. Non-invasive strategies were assessed as primary surveillance tools, with positive results triggering confirmatory endoscopy, and a scenario analysis evaluated AI-assisted endoscopy. Five BE populations of 50-year-old individuals were modeled: ultra-short segment BE (USSBE), short-segment BE (SSBE), long-segment nondysplastic BE (LSBE-NDBE), LSBE with low-grade dysplasia (LSBE-LGD), and LSBE with high-grade dysplasia (LSBE-HGD). Each modality was evaluated at surveillance intervals of 1, 2, 3, 4, 5, or 10 years. Primary outcomes included net monetary benefits, costs, quality-adjusted life-years, incremental cost-effectiveness ratios, and EAC deaths, with sensitivity analyses assessing parameter uncertainty. Surveillance was not cost-effective for USSBE, SSBE, or LSBE-NDBE. For LSBE-LGD, annual endoscopy was most cost-effective, averting 83 EAC deaths per 10,000 individuals, while for LSBE-HGD, annual breath testing was most cost-effective, averting 295 deaths. These findings support dysplasia-specific surveillance in LSBE with implications for global surveillance practice.

ObjectivesDigital biomarkers offer scalable screening for type 2 diabetes, yet adoption is stalled by uncertainty regarding economic viability. This study evaluates the cost-effectiveness and budget impact of digital screening compared to opportunistic screening from a Swiss payer perspective. MethodsA probabilistic Markov cohort model was developed to simulate at-risk Swiss adults (age [&ge;]45, BMI [&ge;]25 kg/m{superscript 2}) over a 40-year horizon. The model incorporates a digital attrition parameter, inputs derived from Swiss-specific sources (e.g., the CoLaus study and FSO life tables), and statutory tariffs. Costs and outcomes were discounted at 3.0%. ResultsIn the deterministic base-case, digital screening yielded an incremental cost-effectiveness ratio of CHF 2,912 per quality-adjusted life-year gained. Probabilistic sensitivity analysis indicated a 93.2% probability of cost-effectiveness at the CHF 50,000 threshold. The budget impact analysis estimated a Year 1 gross investment budget of CHF 27 million to identify prevalent cases, followed by long-term savings from averted complications. ConclusionsDigital screening can be highly cost-effective in Switzerland. While the required Year 1 gross investment poses a liquidity challenge, reimbursement via pathway-oriented models under the Swiss tariff could align incentives with long-term complication avoidance.

BackgroundHigh-dose inactivated influenza vaccination (HD-IIV) demonstrates superior effectiveness versus standard-dose vaccination (SD-IIV) in adults aged [&ge;]60 years. A recent meta-analysis integrated complementary evidence sources of representing over 85 million individuals across 14 influenza seasons. MethodsA previously developed model was updated using life-time horizon and societal perspective. Updated parameters included demographics, costs, hospitalization rates, and relative vaccine effectiveness (rVE): RCT evidence (24% for ILI, 7% for cardiorespiratory hospitalizations) and RCT + real-world evidence (RWE) (15% for ILI, 8% for cardiorespiratory hospitalizations). ResultsHD-IIV resulted in incremental cost-effectiveness ratios of {euro}7,300/QALY (RCT evidence) and {euro}5,800/QALY (RCT+RWE evidence). Implementation would prevent 7,200 general practitioner visits, 6,300 cardiorespiratory hospitalizations, and 269 deaths, by using RCT evidence. Probabilistic sensitivity analysis demonstrated >99% probability of cost-effectiveness at {euro}20,000/QALY threshold for both RCT and RCT+RWE evidence. ConclusionsHD-IIV remains highly cost-effective for Dutch adults aged [&ge;]60 years under updated evidence scenarios, supporting implementation in the national immunization programme. HighlightsO_LIThe economic analysis of high-dose inactivated influenza vaccine was updated. C_LIO_LIRelative vaccine effectiveness of HD-IIV incorporating recent evidence was used. C_LIO_LIHD-IIV remains cost-effective in Dutch adults aged [&ge;]60. C_LI

AimsWe aimed to elicit preferences for weight and harm outcomes of glucagon-like peptide-1 receptor agonist (GLP-1 RA) treatment. We examined heterogeneity across key patient subgroups to support tailored treatment decisions to identify patients most likely to benefit with minimal risks. Material and MethodsWe conducted a best-worst scaling survey of adults with overweight or obesity in 15 European countries, assessing 21 GLP-1 RA outcomesincluding 5% and 10% weight gain (to align with harms) and 19 adverse outcomes (eg. gastrointestinal events, hypoglycaemia, pancreatitis, gallbladder outcomes). Participants were provided lay descriptions of outcomes, rated seriousness on a visual analogue scale, and completed a best-worst scaling task. Preferences were estimated using a Bayesian hierarchical mixed multinomial logit model and rescaled from 0 (least worrisome) to 1 (most worrisome). Subgroup analyses were conducted based on sex, age, body mass index (BMI), and physical activity (36 subgroups). ResultsAmong 2112 participants (48.1% female; mean age 39.51 years; median BMI 30.0 kg/m2), the least concerning outcomes were eructation (0.04) and flatulence (0.05), and the most concerning were pancreatitis (0.42), followed by 10% weight gain (0.41), cholecystitis (0.35), and cholelithiasis (0.32). Other outcome weights ranged from 0.11 to 0.25. Preference patterns were similar for extremes but varied by sex, age, BMI, and physical activity. ConclusionsPreferences for GLP-1 RA outcomes varied across individuals and subgroups. Incorporating explicit patient preferences into routine care may better align GLP-1 RA prescribing with patient values and support individualised benefit-harm decisions.

BackgroundBacille Calmette-Guerin (BCG) is the most commonly-used vaccination globally, but multi-country cost-effectiveness analyses are outdated and have not considered sequelae in tuberculosis survivors. A rationale is lacking to guide the size of safety stocks. MethodsFor the 110 countries using universal neonatal BCG vaccination, we used a decision tree model to compare the costs and health benefits of status-quo BCG vaccination for children aged 0-4 years in 2023 to a counterfactual where no BCG was used, accounting for post-tuberculosis sequelae. We assessed cost-effectiveness against a threshold of 30% per capita gross domestic product from a health system perspective. We determined the safety stock that maximized expected net benefit. FindingsBCG vaccination prevented 742,000 (95% uncertainty interval[UI]: 541,000 to 991,000) tuberculosis episodes and 192,000 (95%UI:138,000 to 264,000) tuberculosis deaths globally. Of these, 49,000 (95%UI: 32,300 to 72,100) episodes and 30,000 (95%UI: 19,600 to 45,100) deaths prevented were from tuberculous meningitis. Universal neonatal BCG vaccination was cost-effective in the majority (75/110) of countries where it is used and in all countries with estimated tuberculosis incidence over 42 per 100,000 per year, with a median incremental cost-effectiveness ratio of $276 (interquartile range: $84 to $1514) per disability-adjusted life-year averted. Median optimal safety stock for a 10% uncertainty in demand was 11% (IQR: 7% to 17%) of expected demand. InterpretationBCG vaccination continues to prevent substantial morbidity and mortality in children globally, and cost-effectiveness considerations support continued universal vaccination in most countries with this policy currently. FundingUK EPSRC & DHSC

OBJECTIVEOpioid misuse exacts a tremendous toll on society. Mindfulness-Oriented Recovery Enhancement (MORE) is an efficacious treatment for opioid misuse. Yet, the cost-effectiveness of this intervention remains unknown. METHODSCost-effectiveness and cost-benefit analyses of a randomized clinical trial with enrollment of 250 adults with chronic pain prescribed long-term opioid therapy who were misusing opioids. Participants were randomized to MORE (training in mindfulness, reappraisal, and savoring positive experiences) or supportive group psychotherapy across 8 weekly 2-hour groups. Incremental cost-effectiveness ratios (ICER) and benefit-to-cost ratios (BCRs) were computed using the primary outcome of opioid misuse at 9-month follow-up, as assessed by a composite measure based on self-report, clinical interview, and urine screen. RESULTS250 randomized patients (64.0% female) had an average age of 51.8 years (SD=11.9), were mostly taking oxycodone or hydrocodone (69%), and had mean morphine equivalent opioid dose of 101.0 (IQR=74) mg. At 9-mo. follow-up, the difference in the probability of having a positive Drug Misuse Index (DMI) rating was 0.24 (0.54 for MORE participants vs. 0.78 for controls). The ICER of MORE relative to supportive psychotherapy was $116.3 per averted case of opioid misuse, $8.9 per life-year, and $8.0 per quality-adjusted life-year. MORE is cost-saving vs. supportive psychotherapy after adjusting for healthcare costs. Excluding all benefits associated with averting fatal overdoses results in a BCR of 84.2. CONCLUSIONSGiven MOREs cost-effectiveness, private and public payers should consider disseminating this evidence-based therapy broadly across the nation to reduce mortality and morbidity associated with the ongoing opioid crisis. HIGHLIGHTSO_LIMindfulness-Oriented Recovery Enhancement (MORE) substantially reduced opioid misuse among adults with chronic pain on long-term opioid therapy. C_LIO_LIMORE was highly cost-effective vs. supportive psychotherapy, costing $116 per averted opioid misuse case, and MORE was cost saving when accounting for healthcare costs associated with opioid misuse. C_LIO_LIFindings suggest wide dissemination of this evidence-based treatment could yield major healthcare and other economic benefits in addressing the opioid crisis. C_LI

ObjectiveThis study is to evaluate the cost-effectiveness of an annual screening program for diabetic retinopathy (DR) at primary healthcare level among patients with type 2 diabetes mellitus (type 2 DM) from a societal perspective in Danang city, Vietnam. MethodsA Markov model was developed to compare costs and effects of an annual screening program for DR using non-mydriatic fundus photography with the absence of the screening on a cohort of 23,951 patients with type 2 DM aged 40 years in Danang city from a societal perspective over a lifetime horizon of 40 years. The effect was estimated using quality-adjusted life years (QALY). Costs were measured in both Viet Nam Dong and US dollar. Both costs and effects were discounted annually at 3%. One-way and probabilistic sensitivity analyses were conducted to assess parameter uncertainty. ResultsThe ICER for the DR screening program compared with the absence of screening was VND 86,631,252 per QALY (USD 3,630/QALY). In the one-way sensitivity analyses, a decrease in the screening participation rate, screening every two years, lower sensitivity of fundus photography and the poor treatment compliance rate, as well as an increase in costs of screening and treatment, which all led to higher ICER values. Increasing the incidence of DM did not change ICER value. Conversely, reducing treatment costs caused lower ICER. At a willingness-to-pay (WTP) threshold of VND 86,631,252 (USD 3,630) per QALY, the probability of the screening program being cost-effective was 92.3%. When the WTP increases at VND 95,294,377 (USD 3,993) or higher, the probability of cost-effectiveness approached 100%. ConclusionDiabetic retinopathy screening for patients with type 2 diabetes for aged 40 to 80 years is cost-effective in Danang city, Vietnam according to World Health Organization criteria.

BackgroundDuring the COVID-19 pandemic period, healthcare systems substantially reorganized their management of several diseases, including acute cardiovascular diseases (ACVD) such as heart failure, stroke, myocardial infarction, and pulmonary embolism. While previous studies have reported changes in hospitalization rates and clinical outcomes, the economic impact of the pandemic on healthcare expenditures for patients with ACVD remains poorly documented. This study aimed to quantify disruptions in healthcare utilization and reimbursement trends among patients with ACVD in France during the pandemic period (2020-2023). MethodsUsing comprehensive French healthcare reimbursement data from 2015 to 2023, this nationwide cohort study analyzed 3.9 million ACVD-related patient-years, totaling {euro}86 billion in reimbursements. A two-step approach was employed: first, a linear regression model based on pre-pandemic trends (2015-2019) was used to project expected expenditures for the years 2020-2023, adjusting for age, sex, calendar year, and comorbidities. Second, expenditures observed during the years 2020-2023 were compared with these projections to estimate potential disruptions related to the pandemic period. Analyses were stratified across 21 expenditure categories. ResultsBetween 2020 and 2023, ACVD-related healthcare expenditures exceeded expected values by {euro}2.3 billion (+6.2%), with the largest gap in 2023 ({euro}1.1 billion above projections). Notably, pre-pandemic annual expenditure growth ({euro}86-212 per patient) sharply accelerated during the pandemic period ({euro}492-1320 per patient). Excess spending was higher in males ({euro}1.4 billion), patients with severe comorbidities ([&ge;]3 comorbidities: {euro}1.4 billion), and in the 65,195 patients with ACVD and a history of a COVID-19-related hospitalization(s) ({euro}0.9 billion, driven primarily by short stay hospitalizations and rehabilitation care). Among non-COVID-19 ACVD patients, significant increases were observed in drug expenses, short stay hospitalizations, and hospitalizations in psychiatry. ConclusionIn France, the COVID-19 pandemic years were marked by substantial and sustained disruptions in healthcare expenditures among patients with ACVD, extending beyond care directly related to COVID-19. Excess costs were linked both to pandemic-related complications and broader systemic shifts, including increased psychiatric and rehabilitation needs. These findings have critical public health implications: they highlight the need to address ongoing healthcare system disruptions for this vulnerable population while also reinforcing vigilance in future health crises.

IntroductionAge-group specific disparities for dentalcare use persist in the United States. The COVID-19 led to delays in non-urgent dentalcare. We provide national estimates on dentalcare use and influencing factors for the U.S. population before and during the COVID-19. MethodsWe used nationally representative Medical Expenditure Panel Survey for over pre-COVID-19 years (2018-2019) and COVID-19 years (2020-2021) We estimated yearly survey-weighted trends in mean non-zero dental visits by age followed Poisson regression, controlling for a comprehensive set of confounders across five domains of influence. Dentalcare visits were defined as visits to any dentalcare provider. ResultsOverall analytic sample included non-institutionalized community living persons (unweighted n=6518, weighted N[~]320 million) grouped as ages 0-17, 18-44, 45-64, 65-74 and 75+ present in all four years The prevalence ratio (PR) for dental visits was slightly higher for ages 75+ in comparison to ages 65-74 across years 2018-2021 and increased from 1.73 (95% CI: 1.4, 2.1) to 1.84 (95% CI: 1.5, 2.3) to 2.13 (95% CI: 1.7, 2.7) from 2018 to 2020 but rebounding to near pre-pandemic level in 2021 to 1.66 (95% CI, 1.3, 2.0). Consistent factors during COVID-19 pandemic years 2020-2021 that increased dental visits included dental insurance, high income, and having a usual source of care (p<0.01). ConclusionsDentalcare use rebounded for older adults in 2021 but remained below pre-pandemic levels. Practical ImplicationsIncreasing dentalcare visits across ages remains a key policy priority. Continued monitoring of dentalcare use trends beyond COVID-19 among older adults is critical to improve their oral health.