We briefly review the literature on cognitive behavioral therapy for menopause, characterizing these interventions within their proper social cognitive context, and situating them within the broader research literature on cognitive behavioral therapy approaches. Furthermore, we highlight critical knowledge gaps and underscore the need for targeted next steps in research. Unlike menopause hormone therapy, traditional cognitive behavioral therapy for menopause protocols are not necessarily designed to reduce the frequency or severity of vasomotor symptoms (e.g. hot flashes/night sweats). They do, however, reduce the functional impact of (i.e. hot flash-related interference) and psychological distress associated with (i.e. hot flash-related distress) vasomotor symptoms. Generalization effects, including concomitant improvements in mood, sleep, and overall quality of life, are common. The paucity of studies that examine the efficacy and effectiveness of these interventions for women with mental health conditions, however, has left a critical knowledge gap that warrants attention. Cognitive behavioral therapy for menopause is an evidence-based treatment for the reduction of psychological symptoms associated with vasomotor symptoms. This treatment should not be misconstrued as the nonpharmacologic equivalent of menopause hormone therapy, and further research is needed to determine how and when this treatment is helpful to women with mental health conditions.

Sarcopenia and sarcopenic obesity may increase surgical complications and impact recovery and function after total joint arthroplasty (TJA). We assessed the feasibility of identifying these conditions in an orthopedic practice setting using published consensus criteria. Patients in a lower extremity TJA clinic were assessed for sarcopenia and sarcopenic obesity using EWGSOP2 and ESPEN/EASO diagnostic frameworks, respectively. Low strength testing involved maximal handgrip strength (HGS) and number of chair sit-to-stands in 30 seconds (CSTS). Same day dual-energy x-ray absorptiometry (DXA) testing was used to assess for low muscle mass (i.e. appendicular lean soft tissue) in patients with low strength. One hundred-one of a possible 128 patients were assessed in clinic (93% male, mean age 69.6±8.9 years and BMI 31.7±7.9 kg/m2). HGS was completed in 99% of screened patients; only 44.5% completed CSTS due to joint pain and balance limitations. Thirty-nine patients had low strength and were recommended for DXA. In 16 patients who completed DXA, 3 had sarcopenia and 5 had sarcopenic obesity. Screening for sarcopenia and sarcopenic obesity was challenging to complete in all patients during routine clinic flow with dedicated personnel. Despite our pragmatic approach and limited screening completion in all patients, we identified sarcopenic and sarcopenic obesity in 6.25% of patients. This is likely a lower bound for the true prevalence but suggests an opportunity to assess and intervene for these conditions before surgery to improve total joint arthroplasty outcomes.

To examine which hospital-payer contracts include Diagnosis Related Group (DRG) codes and whether they set prices as a consistent multiple of hospital list prices or Medicare's DRG fee schedule. We study the cash rates and negotiated contracts (including commercial group, Medicare Advantage, Medicaid Managed Care, and individual market health plans) of US general and surgical acute care hospitals. We develop bunching and regression-based methods to classify the pricing bases of DRGs within contracts. We show the unadjusted and regression-adjusted variation in DRG inclusion and pricing across hospital and insurer characteristics. Hospital price transparency data from Turquoise Health (May 2024) is joined with hospital characteristics from the American Hospital Association, insurer market concentration from Clarivate, and Medicare DRG rates. We observe 4033 hospitals with 157,313 hospital-health plan contracts and 3902 sets of cash rates. About 17% of hospitals do not include DRGs in any of their negotiated contracts or cash rates, while 54% include them in some, but not all contracts. Nearly half (48%) of hospitals exclude DRGs from their cash rates. Among commercial group contracts with DRGs, 25%-27% benchmark their DRG prices to hospital list prices, while 32%-36% are based on Medicare's fee schedule. Medicare Advantage contracts are more likely to be benchmarked to Medicare (64%), while most hospitals base their cash rates on list prices (85%). Hospitals facing less competition had lower rates of DRG contracting but were observed to be more likely to negotiate prices based on list prices conditional on including DRGs. Our findings suggest that hospital market power may influence hospital-health plan negotiations beyond the average price levels. Policies aimed at standardizing these contracts must account for the wide variation in payment and pricing bases currently used in the private market.

To evaluate the cost-effectiveness of opportunistic CT for sarcopenia screening compared with standard-of-care clinical screening methods, using a decision-analytic model based on quality-adjusted life years (QALYs) and healthcare costs. We developed a decision-analytic model simulating a hypothetical cohort of 70-year-old male patients at risk for sarcopenia over a 3-year time horizon from a US healthcare system perspective. The model compared two screening strategies: standard-of-care clinical evaluation per EWGSOP2 guidelines (physical exam + DXA evaluation of lean mass) and opportunistic CT as measures of muscle mass and quality. Model inputs-including screening sensitivities/specificities, costs, utility values, and probabilities of cardiovascular complications-were derived from published literature. Incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) were calculated, and sensitivity analyses were performed to assess the robustness of findings across variable inputs. Opportunistic CT was the favored strategy, with lower costs ($845 vs. $1,295), comparable effectiveness (0.87 QALYs), and higher net monetary benefit ($86,037 vs. $85,588) relative to the standard-of-care strategy. The standard-of-care strategy's ICER was $47.7 million per QALY, exceeding our willingness-to-pay threshold of $100,000. Probabilistic sensitivity analysis across 100,000 simulations demonstrated that opportunistic CT was favored across all tested willingness-to-pay thresholds up to $200,000. Opportunistic CT is a cost-effective strategy for sarcopenia screening, offering similar effectiveness at a lower cost compared to the standard-of-care approach. By leveraging existing imaging studies, opportunistic CT screening has the potential to enhance early detection and decrease the underdiagnosis of sarcopenia while also reducing the burden of additional DXA scans and clinical visits.