Health Insurance Plan Research Articles

Interactive exploration of adverse events and multimorbidity in CKD.

Persons with chronic kidney disease (CKD) are at increased risk of adverse events, early mortality, and multimorbidity. A detailed overview of adverse event types and rates from a large CKD cohort under regular nephrological care is missing. We generated an interactive tool to enable exploration of adverse events and their combinations in the prospective, observational German CKD (GCKD) study. The GCKD study enrolled 5217 participants under regular nephrological care with an estimated glomerular filtration rate of 30-60 or >60mL/min/1.73m2 and an overt proteinuria. Cardio-, cerebro- and peripheral vascular, kidney, infection, and cancer events, as well as deaths were adjudicated following a standard operation procedure. We summarized these time-to-event data points for exploration in interactive graphs within an R shiny app. Multivariable adjusted Cox models for time to first event were fitted. Cumulative incidence functions, Kaplan-Meier curves and intersection plots were used to display main adverse events and their combinations by sex and CKD etiology. Over a median of 6.5 years, 10271 events occurred in total and 680 participants (13.0%) died while 2947 participants (56.5%) experienced any event. The new publicly available interactive platform enables readers to scrutinize adverse events and their combinations as well as mortality trends as a gateway to better understand multimorbidity in CKD: incident rates per 1000 patient-years varied by event type, CKD etiology, and baseline characteristics. Incidence rates for the most frequent events and their recurrence were 113.6 (cardiovascular), 75.0 (kidney), and 66.0 (infection). Participants with diabetic kidney disease and men were more prone to experiencing events. This comprehensive explorative tool to visualize adverse events (https://gckd.diz.uk-erlangen.de/), their combination, mortality, and multimorbidity among persons with CKD may manifest as a valuable resource for patient care, identification of high-risk groups, health services, and public health policy planning.

Factors influencing patient selection of orthopaedic surgeons for total hip (THA) and total knee arthroplasty (TKA).

The importance of identifying how patients choose their healthcare providers has grown with the prevalence of consumer-centric health insurance plans. There is currently a lack of studies exploring the factors associated with how patients select their hip and knee joint arthroplasty surgeons. The purpose of this study was to determine how patients find their arthroplasty providers and the relative importance of various arthroplasty surgeon characteristics. An electronic mail survey was sent to 3522 patients who had visited our institution for an arthroplasty surgeon office visit between August 2022 and January 2023. The survey consisted of multiple-choice questions, which aimed to inquire about the patients' referral sources for their current arthroplasty surgeon. In addition, patients were requested to rate the significance of 22 surgeon-related factors, on a scale of 1 (Not Important At All) to 5 (Very Important), in choosing their arthroplasty surgeon. Of the 3522 patients that received the survey, 538 patients responded (15.3%). The most common referral sources were physician referral (50.2%), family/friend referral (27.7%), and self-guided research (24.5%). Of those that were referred by a physician, 54.4% of respondents were referred by another orthopaedic provider. Patients rated board certification (4.72 ± 0.65), in-network insurance status (4.66 ± 0.71), fellowship training (4.50 ± 0.81), bedside manner/personality (4.32 ± 0.86), and facility appearance (4.26 ± 0.81) as the five most important factors in picking an arthroplasty surgeon. Television (1.42 ± 0.83), print (1.50 ± 0.88), and online (1.58 ± 0.93) advertisements, along with social media presence (1.83 ± 1.08), and practice group size (2.97 ± 1.13) were rated as the five least important factors. Patients are most likely to select an arthroplasty surgeon based on referral from other physicians, namely orthopedic surgeons, in addition to board certification status, in-network insurance, and fellowship training. Overall, these findings highlight the importance of physician credentials and reputation within the orthopaedic community in order to attract and retain patients.

Association of residential environment with depression and anxiety symptoms among older adults in China: A cross-sectional population-based study

This study, grounded in environmental psychology, investigated the correlation between residential environments and the prevalence of depression and anxiety among older adults in China. Utilizing data from the Chinese Longitudinal Healthy Longevity Survey, it evaluated the incidence of depression and anxiety among 11,614 participants aged 65 and above across 23 provinces in China and examined how residential factors affect mental health. The findings revealed that 26.9 % of the participants had symptoms of depression and 11.7 % had symptoms of anxiety. A logistic regression analysis highlighted a significant relationship between various aspects of the residential environment and depression and anxiety among older adults. The influence risk factors from the residential environment included, but were not limited to, not house ownership, having no one's own bedroom, living in high-rise apartment, water leakage or a musty smell in the home and having no kitchen ventilation. The study makes a novel theoretical contribution by identifying key environmental factors affecting the well-being of the elderly, thereby filling a gap in the literature regarding the influence of physical living conditions on older adults' mental health. This pioneering research, with its nationwide scope and focus on Chinese older adult population, not only advances academic understanding but also has practical implications for urban planning and public health policies that aim to improve the quality of life for the elderly through interventions targeting residential environments.

Future Burden of Ischemic Stroke in Australia: Impact on Health Outcomes between 2019 and 2038

Background: Projections of the future burden of ischemic stroke (IS) has not been extensively reported for the Australian population; the availability of such data would assist in health policy planning, clinical guideline updates, and public health. Methods: First, we estimated the lifetime risk of IS (from age 40 to 100 years) using a multistate life table model. Second, a dynamic multistate model was constructed to project the burden of IS for the whole Australian population aged between 40 and 100 years over a 20-year period (2019–2038). Data for the study were primarily sourced from a large, representative Victorian linked dataset based on the Victorian Admitted Episode Dataset and National Death Index. The model projected prevalent and incident cases of nonfatal IS, fatal IS, and years of life lived (YLL) with and without IS. The YLL outcome was discounted by 5% annually; we varied the discounting rate in scenario analyses. Results: The lifetime risk of IS from age 40 years was estimated as 15.5% for males and 14.0% for females in 2018. From 2019 to 2038, 644,208 Australians were projected to develop incident IS (564,922 nonfatal and 79,287 fatal). By 2038, the model projected there would be 358,534 people with prevalent IS, 35,554 people with incident nonfatal IS and 5,338 people with fatal IS, a 14.2% (44,535), 72.9% (14,988), and 106.3% (2,751) increase compared to 2019 estimations, respectively. Projected YLL (with a 5% discount rate) accrued by the Australian population were 174,782,672 (84,251,360 in males and 90,531,312 in females), with 4,053,794 YLL among people with IS (2,320,513 in males, 1,733,281 in females). Conclusion: The burden of IS was projected to increase between 2019 and 2038 in Australia. The outcomes of the model provide important information for decision-makers to design strategies to reduce stroke burden.

Evaluating the Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in Patients with Cancer

The Commercially Insured health Plan Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) is an evidence-based tool to determine serious opioid-induced respiratory depression (OIRD) or overdose risk. The CIP-RIOSORD total score determines a risk class and estimates the probability for an OIRD event within the next 6 months. We performed a single-center, retrospective analysis to determine CIP-RIOSORD baseline scores and the most common predictive factors in patients with cancer. Patients (n = 160) were split into new consultations (n = 83, Group 1) versus the first documented follow-up consultation (n = 77, Group 2). Most patients were Caucasian women with metastatic gastrointestinal cancer. CIP-RIOSORD scores for Group 1 patients were 14.8 ± 15.2 (mean ± SD, risk class 4). Group 2 patients had higher CIP-RIOSORD scores (16.6 ± 14.9, risk class 4). For Group 1, the most common CIP-RIOSORD predictive factors were use of a long-acting opioid formulation (n = 24, 29%) and daily oral morphine equivalent (OME) ≥100 (n = 20, 24%); for Group 2, predictive factors were use of an antidepressant (n = 34, 44%) and a long-acting opioid formulation (n = 27, 35%). Based on the CIP-RIOSORD, there is a 15% probability of experiencing a serious OIRD event or overdose within the next 6 months.

Early Lessons From State-Based Public Option Plans

This JAMA Forum discusses the early lessons from state-run public option–style health insurance plans in Colorado and Washington State that can be used by Minnesota and Nevada for their plans that are still under development.

Retinal injury from a laser skin resurfacing device during medical tourism: a public health concern

BackgroundLaser skin resurfacing is a popular cosmetic procedure for noninvasive skin rejuvenation. Since health insurance plans often do not cover these types of procedures, patients often pay out of pocket. Consequently, there is an incentive to go abroad, where prices are more affordable. However, practitioners in destination countries may lack rigorous training on laser safety, regulatory oversight, or licensing, especially on devices used for “cosmetic” procedures. In certain cases, this can lead to tragic outcomes, especially when underqualified practitioners operate medical-grade laser devices.Case presentationA 29-year-old woman suffered a retinal burn from a handheld Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser pulse device used to perform skin resurfacing treatment at a medical spa in Vietnam. The patient was not adequately informed about the potential risk to her vision and was not provided with any eye protection. A momentary, unintended laser exposure to the patient’s right eye led to irreversible vision loss due to a macular burn. This incident caused immediate pain, followed by the sudden appearance of floaters, along with a retinal and vitreous hemorrhage. Despite treatment with off-label bevacizumab for the development of a choroidal neovascular membrane, vision remained at the level of counting fingers because of the presence of the macular scar.ConclusionWhen utilizing laser-based devices, it is crucial to employ safety measures, such as the wearing of safety goggles or the use of eye shields to protect ocular tissues from potential damage. The growing availability of cosmetic laser devices presents a substantial public health risk, because numerous operators lack adequate training in essential safety standards, or they neglect to follow them. Furthermore, patients seeking services abroad are subject to the regulatory practices of the destination country, which may not always enforce the requisite safety standards. Further research is needed to determine regional and global incidence of laser-related injuries to help direct educational and regulatory efforts.

Seizing pandemic lessons: a call to reinvent public health and healthcare policy planning in post-COVID-19 Hong Kong.

Seizing pandemic lessons: a call to reinvent public health and healthcare policy planning in post-COVID-19 Hong Kong.

A Markov multiple state model for epidemic and insurance modelling

AbstractWith recent epidemics such as COVID-19, H1N1 and SARS causing devastating financial loss to the economy, it is important that insurance companies plan for financial costs of epidemics. This article proposes a new methodology for epidemic and insurance modelling by combining the existing deterministic compartmental models and the Markov multiple state models to facilitate actuarial computations to design new health insurance plans that cover epidemics. Our method is inspired by the seminal paper (Feng and Garrido (2011) North American Actuarial Journal, 15, 112–136.) of Feng and Garrido and complements the work of Hillairet and Lopez et al. in Hillairet and Lopez ((2021) Scandinavian Actuarial Journal, 2021(8), 671–694.) and Hillairet et al. ((2022) Insurance: Mathematics and Economics, 107, 88–101.) In this work, we use the deterministic SIR model and the Eyam epidemic data set to provide numerical illustrations for our method.

Diagnosed behavioral health conditions during the perinatal period among a commercially insured population by race/ethnicity, 2008-2020.

We sought to examine trends in diagnosed behavioral health (BH) conditions [mental health (MH) disorders or substance use disorders (SUD)] among pregnant and postpartum individuals between 2008-2020. We then explored the relationship between BH conditions and race/ethnicity, acknowledging race/ethnicity as a social construct that influences health disparities. This study included delivering individuals, aged 15-44 years, and continuously enrolled in a single commercial health insurance plan for 1 year before and 1 year following delivery between 2008-2020. We used BH conditions as our outcome based on relevant ICD 9/10 codes documented during pregnancy or the postpartum year. In adjusted analyses, white individuals experienced the highest rates of BH conditions, followed by Black, Hispanic, and Asian individuals, respectively. Asian individuals had the largest increase in BH rates, increasing 292%. White individuals had the smallest increase of 192%. The trend remained unchanged even after adjusting for age and Bateman comorbidity score, the trend remained unchanged. The prevalence of diagnosed BH conditions among individuals in the perinatal and postpartum periods increased over time. As national efforts continue to work toward improving perinatal BH, solutions must incorporate the needs of diverse populations to avert preventable morbidity and mortality.

A Comparison of U.S. Individual and Family Plan Medication Coverage for Overactive Bladder.

There is strong evidence for long-term cognitive effects with anticholinergic use. Differences in insurance coverage of anticholinergics and beta-3 agonists hinder individualization of overactive bladder (OAB) treatment. The aims of the study were to assess individual and family health insurance plan coverage for select OAB medications and to compare coverage of preferred medications to those with a greater risk of cognitive dysfunction. This cross-sectional study analyzed formularies for the top 7 U.S. medical insurers. Coverage tiers were assessed for the following 7 OAB medications: (1) oxybutynin instant-release 5 mg, (2) oxybutynin extended-release 5 mg, (3) solifenacin 5 mg, (4) trospium instant-release 20 mg, (5) trospium extended-release 60 mg, (6) mirabegron 25 mg, and (7) vibegron 75 mg. Coverage was compared between nonpreferred (oxybutynin, solifenacin) and preferred medications (trospium, mirabegron, vibegron). Coverage scores, representing a weighted average based on coverage tier frequency relative to the number of plans investigated for each state or insurer, were generated with a lower coverage score indicating better coverage (range, 0.2-1.0). A total of 2,780 insurance plans from 41 states representing a 47% market share for the individual and family marketplace were evaluated. Oxybutynin IR had the best coverage score across insurers (0.2) while vibegron had the worst (0.92). Preferred medications were more often designated to higher tiers with worse coverage compared with nonpreferred medications (P < 0.001). Less concordance in coverage between insurers was noted for anticholinergics with greater bladder specificity and for extended-release formulations. Despite risks with anticholinergics, beta-3 agonists were more expensive across all insurers highlighting the need for expanded coverage of preferred medications to avoid cognitive dysfunction when undergoing treatment for OAB.

Out-of-pocket costs for diabetes medications in employer-sponsored health insurance plans.

Out-of-pocket costs of diabetes medications other than insulin can be quite high for individuals with employer-sponsored health insurance.

Hospital Facility Prices Declined As A Result Of Oregon's Hospital Payment Cap.

Hospital prices for commercially insured people are high and vary widely, prompting states to seek ways to control hospital price growth. In October2019, the Oregon state employee health insurance plan instituted a cap on hospital payments. Using 2014-21 data from the Oregon All Payer All Claims Reporting Program database, we performed a difference-in-differences analysis to test the impact of the cap on hospital facility prices for Oregon's state employee plan enrollees. We found that the cap was not associated with a significant reduction in inpatient facility prices across the post period (-$901.9 per admission) but was associated with a significant reduction in the second year after implementation (-$2,774.20). The cap was associated with a significant reduction in outpatient facility prices over the course of the first twenty-seven months of the policy (-$130.50 per procedure). We estimated $107.5million (or 4percent of total plan spending) in savings to the state employee plan during the first two years. The hospital payment cap successfully reduced hospital prices for enrollees in that plan.

Decision for Carpal Tunnel Surgery: High-deductible Health Plans versus Traditional Health Plans.

Delay in surgical treatment for carpal tunnel syndrome (CTS) may result in long-term decreased functional outcomes. Few investigators have examined the relationship between type of health insurance plan and time to definitive treatment of CTS following diagnosis. We investigated the relationship between insurance type, treatment decision, and the time between diagnosis and surgery across groups. This was a retrospective cohort study using the MarketScan Commercial Claims and Encounters Database 2011-2020. We used χ2 tests, linear regression, and logistic regression models to analyze demographic data and the time lag interval between CTS diagnosis and treatment. Overall, 28% of high-deductible health plan (HDHP) patients underwent carpal tunnel release, compared with 20% of traditional insurance patients (P < 0.001). HDHPs are defined by the internal revenue service as a deductible of $1400 for an individual or $2800 for a family per year. The odds of undergoing surgery versus no treatment for HDHP patients were 47% higher than traditional patients (P < 0.001). Among the patients who underwent surgery, HDHP patients underwent surgery 65 days earlier on average following diagnosis compared with traditional patients (P < 0.001). Patients with HDHPs who receive a diagnosis of CTS are more likely to undergo surgery, with a shorter time lag between diagnosis and surgery. The results from this study call attention to differences in surgical decision-making between patients enrolled in different insurance plans.

Analisis Penerapan Sistem Manajemen Keselamatan dan Kesehatan Kerja Di PT. PLN (Persero) Sektor Tambora Kabupaten Sumbawa Barat

Occupational Safety and Health Management System (SMK3) is part of a management system that includes the company's organizational structure, planning, responsibility, implementation, achievement, assessment and development of occupational safety and health policies. PLN Tambora West Sumbawa is a business unit of PT PLN (Persero) which manages the electricity system in West Nusa Tenggara Province PT PLN (PERSERO) Tambora sector. In the Tambora sector, it was found that the implementation of SMK3 is still not effective, which can cause occupational accidents and occupational diseases such as the use of coal as a flammable material, slipping, falling from a height, disturbance, electric shock, and coal ash residue (FABA) which, if inhaled continuously, will cause respiratory problems. Continuous inhalation will cause respiratory distress. Therefore, an analysis was carried out on the implementation of the occupational safety and health system (SMK3) at PT PLN (PERSERO) by using data in the form of a questionnaire related to the implementation of the company's K3 management towards ISO 45001: 2018 and processing the data using the Gap Analysis method, then providing recommendations for improvement. The results showed that the implementation of ISO 45001: 2018 amounted to 88%. There is a gap of 12% because there are 4 clauses that have not been implemented optimally, namely clause 4.2 concerning understanding the needs and expectations of workers and other interested parties, clause 5.3 concerning roles, responsibilities and organizational management, clause 5.4 concerning worker consultation and participation and clause 7.2 concerning competence, so improvements are proposed for each clause.

Site of Ambulance Origination and Billing for Out-of-Network Services

The No Surprises Act implemented in 2022 aims to protect patients from surprise out-of-network (OON) bills, but it does not include ground ambulance services. Understanding ground ambulance OON and balance billing patterns from previous years could guide legislation aimed to protect patients following ground ambulance use. To characterize OON billing from ground ambulance services by evaluating whether OON billing risk differs by the site of ambulance origination (home, hospital, nonhospital medical facility, or scene of incident). Cross-sectional study of the Merative MarketScan dataset between January 1, 2015, and December 31, 2020, using claims-based data from employer-based private health insurance plans in the US. Participants included patients who utilized ground ambulances during the study period. Data were analyzed from June to December 2023. Medical encounter requiring ground ambulance transportation. Ground ambulance OON billing prevalence was calcuated. Linear probability models adjusted for state-level mixed effects were fit to evaluate OON billing probability across ambulance origins. Secondary outcomes included the allowed payment, patient cost-sharing amounts, and potential balance bills for OON ambulances. Among 2 031 937 ground ambulance services (1 375 977 unique patients) meeting the inclusion and exclusion criteria, 1 072 791 (52.8%) rides transported men, and the mean (SD) patient age was 41 (18) years. Of all services, 1 113 676 (54.8%) were billed OON. OON billing probabilities for ambulances originating from home or scene were higher by 12.0 percentage points (PP) (95% CI, 11.8-12.2 PP; P < .001 for home; 95% CI, 11.7-12.2 PP; P < .001 for scene) vs those originating from hospitals. Mean (SD) total financial burden, including cost-sharing and potential balance bills per ambulance service, was $434.70 ($415.99) per service billed OON vs $132.21 ($244.92) per service billed in-network. In this cross-sectional study of over 2 million ground ambulance services, ambulances originating from home, the scene of an incident, and nonhospital medical facilities were more likely to result in OON bills. Legislation is needed to protect patients from surprise billing following use of ground ambulances, more than half of which resulted in OON billing. Future legislation should at minimum offer protections for these subsets of patients often calling for an ambulance in urgent or emergent situations.

Public Health Insurance Status and Utilization of Healthcare Services Across India: A Narrative Review.

Health insurance literacy gauges how knowledgeable people are regarding the comparison of health insurance plans to find out the optimal health plan that suits their needs and preferences. Enrolling in a comprehensive plan and proactively addressing health and financial aspects can fortify the stability of families. The plan needs to be used effectively by adapting to evolving circumstances and prioritizing the well-being and prosperity of the household. Having public health insurance can significantly impact an individual's utilization of healthcare services. Having health insurance encourages individuals to promptly seek medical attention without hesitating or avoiding treatment due to financial worries. This results in higher utilization of healthcare services, encompassing routine check-ups, preventive care, and timely intervention for illnesses and injuries. Public health insurance can also improve access to specialized care and expensive treatments that may otherwise be unaffordable for individuals without insurance. By having health insurance, individuals and families can experience a decrease in the economic strain associated with healthcare expenses, thereby enhancing the accessibility and affordability of healthcare services.

Covered Lives: Industry Term for Number of People Enrolled in a Health Insurance Plan, Including Policyholder and Dependents.

Covered Lives: Industry Term for Number of People Enrolled in a Health Insurance Plan, Including Policyholder and Dependents.

Rates of genetic consultation in high-grade serous ovarian cancer patients in the era of PARP inhibitor therapy: A population-based study.

The American Society of Clinical Oncology recommends all patients with high-grade serous ovarian carcinoma (HGSC) undergo germline genetic testing. Genetic consultation rates in Ontario, Canada, only reached 13.3% in 2011. In 2016, PARP inhibitor maintenance therapy became available in Ontario for BRCA-positive HGSC patients. Given expanding treatment options, we re-examined genetic consultation rates among HGSC patients. This retrospective cohort study identified patients diagnosed with HGSC between 2012 and 2019 using population-based administrative data from Ontario. Genetics consultations were identified using Ontario Health Insurance Plan billing codes. Consultation rates over time were analyzed using Cochran-Armitage trend test and segmental regression analysis. Multivariable analysis identified factors associated with attending genetics consultation. This study included 4645 HGSC patients. The mean age was 64.2 years (±SD 12.3); 56.3% had stage 3-4 disease. Overall, approximately 35% attended genetics consultations. The genetic consultation rate per year increased significantly from 21.6% to 42.6% (P < 0.001). Shorter times between diagnosis and genetics consult were observed after PARP inhibitors became available (68.1 vs 34.1 weeks, P < 0.001). Patients treated at designated cancer centers (odds ratio [OR] 2.11, P < 0.001), diagnosed in later years (OR 1.33, P < 0.001), and from higher income groups (P < 0.05) were more likely to attend genetics consultation; older patients were less likely (OR 0.98, P < 0.001). After PARP inhibitors became available, consultation rates plateaued (P < 0.001). Between 2012 and 2019, genetic consultation rates improved significantly among HGSC patients; however, a large proportion of patients never attended consultation. Further exploration of barriers to care is warranted to improve consultation rates and ensure equitable access to care.

BUDGET IMPACT OF MIRIKIZUMAB-MRKZ IN THE TREATMENT OF ADULT PATIENTS WITH MODERATELY-TO-SEVERELY ACTIVE ULCERATIVE COLITIS IN THE UNITED STATES

Abstract BACKGROUND Mirikizumab (miri), an IL-23p19 antagonist, is undergoing US FDA review for treatment of moderately-to-severely active ulcerative colitis (UC) in adults. However, the budget impact of its addition to payer formularies is unknown. METHODS A de novo budget impact model was developed to estimate the cost of introducing miri to the formulary of a hypothetical one-million-member health insurance plan. Epidemiological inputs drew primarily from published sources, while market research informed the current and future market share of advanced therapies. The model accounted for drug acquisition, drug administration, treatment monitoring, and adverse event management, derived from US prescribing information, trial results, and published sources. Discontinuation and dose escalation rates were based on the literature, applying assumptions where data gaps existed. In the base case, the model assumed that half of miri’s market share would be accrued from ustekinumab (an IL-12/IL-23 antagonist). The base-case analysis adopted a US commercial payer perspective over a 3-year period. Deterministic sensitivity analyses (DSA) assessed the implications of uncertainty in model inputs, while scenario analyses estimated budget impact under alternative assumptions about the origin of miri’s market share, and about the patient population under consideration. RESULTS In the base-case, 445, 480, and 515 patients were predicted eligible for advanced therapies for UC in Year1, Year2, and Year3, respectively with total UC drug management expenditures of $137.4 million over three years. Introducing miri to formulary for moderately-to-severely active UC yielded cumulative incremental costs of $1.3 million (relative impact=0.93%), equivalent to $0.04 per member per month (PMPM) or $0.43 per member per year (PMPY). Among patients who had already failed an advanced therapy, miri yielded lower cumulative incremental costs of $0.8 million (relative impact=1.1%), equivalent to $0.02 PMPM/$0.28 PMPY, consistent with the more narrowly defined eligible patient population (219, 252, and 284 patients in Year1, Year2, and Year3, respectively). In the scenario in which miri’s market share derived only from ustekinumab, the model predicted total cost savings of $2.6 million over three years (relative impact=-1.9%), as well as PMPM savings of $0.07 and PMPY savings of $0.85, due to higher estimated average drug costs associated with ustekinumab. DSA results suggested that base-case results were robust to uncertainty in the value of key model parameters. CONCLUSION Introducing miri to formulary for moderately-to-severely active UC may offer patients and clinicians an additional therapeutic option to manage this challenging and debilitating condition at minimal added cost to payers. The addition of miri to formulary could be relatively budget neutral or cost saving in some contexts.