Abstract Background The use of genomic testing in patients with node-negative (N0) and 1-3 lymph nodes positive (N1) early-stage breast cancer has had a significant impact on the delivery of chemotherapy in this setting. Our previous studies have identified a reduction in the use of chemotherapy of over 50% in N0 and N1 patients. This has substantial direct economic benefits for the third-party payer, and for the patient in the avoidance of chemotherapy. An area which is often overlooked is the considerable societal costs that are associated with chemotherapy, and there is a paucity of studies that have included an evaluation of these costs for early-stage breast cancer. These costs include lost productivity due to work absence, caregiver productivity losses, and out-of-pocket expenses. The objective of this study was to examine the societal implications of Oncotype DX ® testing in N1 patients at a national level in 5 Irish cancer centres over an 11-year period. Methods A retrospective observational study was undertaken including patients with early-stage ER-positive breast cancer and 1-3 positive lymph nodes who underwent Oncotype DX ® testing between March 2011 to October 2022 across five of Ireland’s cancer centres. A survey of Irish Breast Oncologists provided the assumption that all patients in our study with N1 disease who underwent Oncotype DX ® testing would be recommended adjuvant chemotherapy without testing. Data was collected via electronic records and clinical chart review. The estimated societal costs of chemotherapy were based on UK cost estimates from a report published by the University of East Anglia which used an incidence-based-cost-of-illness model to estimate annual societal costs associated with chemotherapy for early-stage breast cancer. Sterling estimates were converted to euro costs based on the exchange rate of 1 GBP = 1.17025 EUR. Information regarding costing was provided by the National Healthcare Pricing Regulatory Authority and the economic analysis was adjusted for changing costs over the study time-period. Results We identified 828 patients for inclusion in this analysis of societal cost savings associated with the use of Oncotype DX ® testing. The mean age was 58 years (range 22-81). 171 patients (21%) were <50 years at diagnosis, and 657 (79%) were ≥50 years. With the use of Oncotype DX ® testing 58% of patients avoided chemotherapy. As previously published, this resulted in savings of over €6 million in treatment costs, leading to net savings of over €3.3 million euro when the assay cost was deducted. For this societal cost impact analysis, we estimated potential societal costs per patient with early-stage breast cancer undergoing chemotherapy to be €43,628. This figure includes €38,450 and €4,008 due to lost productivity from long-term and short-term work absence respectively, and €1,170 from lost productivity for caregivers. Per patient out-of-pocket expenses totalled €1,287. The total estimated impact of Oncotype DX ® testing among the study cohort on societal costs of chemotherapy treatment was €22,053,500. Conclusion Societal costs are often overlooked as they are not as easily calculated as direct costs, however, it is evident that chemotherapy use carries considerable indirect costs for society. These wider costs alongside a comprehensive consideration of benefits and harms should be incorporated when deciding on a patient’s treatment paradigm. The use of Oncotype DX® testing in N1 patients has led to an estimated societal cost saving of over 22 million euro in across 5 of Ireland’s oncology centres for the period of our study. Citation Format: I. M. Browne, R. A. McLaughlin, C. S. Weadick, S. O'Sullivan, D. K. Hadi, S. J. Millen, M. J. Higgins, J. P. Crown, C. M. Quinn, R. S. Prichard, D. P. McCartan, H. K. Carroll, K. E. Ronan, A. D. Hill, R. M. Connolly, S. A. Noonan, D. O'Mahony, C. O'Hanlon-Brown, B. T. Hennessy, C. M. Kelly, S. O'Reilly, P. G. Morris, J. M. Walshe. The Societal Cost Impact of Oncotype-DX® Testing in an Irish Healthcare Setting [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-09-03.

ABSTRACT Background: This study evaluates the economic impact of incorporating a fully liquid combined acellular hexavalent vaccine within Expanded Program on Immunizations (EPI) of the Dominican Republic (DR). Research design and methods A cost-consequence analysis model was conducted comparing two different vaccination schemes in 1 year. Inputs and costs were extracted from both official and literature sources. Two vaccination schedules were assessed: 3 + 0 and 3 + 1. Additionally, a 5-year budget impact analysis evaluated the implications of introducing the hexavalent vaccine into the EPI. The analysis was performed from both a third-party payer and considering productivity losses. (1 USD = 55.67, 2023). Results The hexavalent vaccine resulted in an increase in total costs of 43.1% and 57.9% for the 3 + 0 and 3 + 1 scenarios. Vaccine acquisition costs drove this increase. However, adverse events, logistics cost and productivity losses were reduced by 51.87%–74.87%, 38.20%–49.23%, and 28.5%–44.9% (3 + 0–3 + 1) respectively. The budget impact analysis showed an overall budget increase of 61.7% and 80.2% with a 37.5% and 50% reduction in total vaccine doses administered, for the 3 + 0 and 3 + 1 scenarios. Conclusion The incorporation of the hexavalent vaccine increases spending but reduces adverse events, logistics cost, and productivity losses, supporting modernization of the DR immunization program.

In April 2012, the American Society of Clinical Oncology joined the Choosing Wisely (CW) initiative to reduce the use of low-value oncology services. Neurokinin-1 receptor antagonists (NK1-RAs) are a class of expensive antiemetic drugs and are not recommended for patients who receive low to moderate risk emetogenic anticancer agents. To identify patient factors and costs associated with NK1-RAs prophylactic use in a real- world setting post-Choosing Wisely among patients with breast cancer. Using Optum's de-identified Clinformatics® Data Mart Database (2013 to 2018), a retrospective cohort study was conducted for women aged 18years and older with breast cancer who initiated a low/minimal/moderate emetogenic chemotherapy (index date) and received prophylactic antiemetics 2 weeks prior to the index date through the day after index (N = 18,515). Patients with no claims for antiemetics or who had negative costs were excluded from the costs analysis (n = 12,068). All US Food and Drug Administration-approved NK1-RAs were included. A multivariable logistic regression model was used to assess the association between patient demographic and socioeconomic characteristics, health system and environmental factors, and NK1-RA use, with results presented as adjusted odds ratios (AORs) and 95% CIs. A generalized linear model with gamma distribution and log link and two-part model were used to model mean third-party and out-of-pocket antiemetic-specific costs per patient, respectively, controlling for baseline patient characteristics. Out of 18,515 women included, 7.7% (n = 1,429) received NK1-RAs. As compared with women aged 75years and older, those aged 50-64 and 65-74years had 1.96 (95% Cl = 1.50-2.57) and 1.39 (95% Cl = 1.19-1.63) times higher odds to receive NK1-RAs, respectively. Black women (AOR: 1.35; 95% Cl = 1.12-1.63), intravenous low-emetogenic chemotherapy (AOR: 3.94; 95% Cl = 3.16-4.91), enrolled in Medicare low-income subsidy (AOR: 1.49; 95% Cl = 1.08-2.07), had higher odds of receiving prophylactic NK1-RAs as compared with White patients, intravenous moderate emetic risk chemotherapy, and commercial insurance, respectively. In the adjusted analysis for costs, the mean total third-party payer antiemetic-specific costs for women who received steroids only, first-generation serotonin-receptor antagonists (5HT3-RAs) with or without steroids, or second-generation 5HT3-RAs with or without steroids were found to be significantly lower by 97.8% (P < 0.001), 95.0% (P < 0.001), and 42.1% (P = 0.023), respectively, when compared with those who received NK1-RAs. Variability in the potential overuse of NK1-RAs was driven by certain patient- (age, race and ethnicity), clinical- (emetic risk), and health care- (insurance, health plan type) related factors. Furthermore, the mean total costs reimbursed by payers were significantly higher for those who received NK1-RAs as compared with other antiemetics, except for those who received both first- and second-generation 5HT3-RAs with or without steroids. Guideline-concordant use of NK1-RAs could result in significant cost-avoidance for patients and payers.

The September 2018 public charge announcement led many undocumented immigrants to avoid public programs over immigration concerns. Whether this extended to Emergency Medicaid and increased self-pay emergency department (ED) visits is unclear. To assess whether the likelihood of self-pay ED visits (visits not covered by any third-party payer because patients lacked or declined insurance coverage) increased among likely undocumented patients vs US-born patients after the public charge announcement. This retrospective cohort study analyzed ED encounters from major safety-net hospitals in Los Angeles County from May 1, 2017, to December 31, 2019. Adult patient encounters were classified as likely undocumented or US born; likely undocumented encounters were identified based on country of birth and lack of a valid Social Security Number and were further refined with insurance information data. Difference-in-differences and event study models estimated changes in self-pay ED visits after the September 22, 2018, public charge expansion announcement, comparing groups over time to capture differential changes. The study was conducted between September 2024 and August 2025. The main outcome was the proportion of ED visits that were self-paid. Both difference-in-differences and event study approaches were used. A total of 375 258 ED patient encounters, including 200 852 (53.5%) US born (mean [SD] age, 41.0 [16.2] years; 120 905 [60.2%] female) and 174 406 (46.5%) likely undocumented (mean [SD] age, 47.4 [13.9] years; 92 802 [53.2%] female), were studied. After the announcement, self-pay status for ED visits increased by 2.10 (95% CI, 1.65-2.47) percentage points among undocumented patient encounters compared with US-born encounters, equivalent to approximately 1755 visits. Event study models found that the increase among likely undocumented patients persisted from November 2018 through August 2019, peaking at 17.8%. In this cohort study of ED encounters, likely undocumented patients had an increase of 2.10 (95% CI, 1.65-2.47) percentage points of self-pay for ED visits compared with US-born patients after the 2018 public charge announcement. This finding suggests how anti-immigrant policies can alter payment patterns, carrying implications for patient financial burden and safety-net hospital fiscal sustainability.

Unlike labral tears associated with shoulder dislocation, isolated labral lesions are generally not treated surgically, mainly due to associated risks such as capsulitis. This preliminary study aims to assess the relevance of conducting a randomized trial to potentially alter current practice guidelines regarding shoulder labral tears. The goal is to assess the effectiveness of such surgery by examining recovery, postoperative complications, as well as the impact of insurance coverage on patient outcomes. The study also assesses the diagnostic accuracy of labral tear detection using various imaging techniques. This retrospective descriptive study was conducted on 188 patients with isolated labral tears who underwent labral repair surgery performed by a single surgeon between October 2019 and December 2023. Cases involving concurrent rotator cuff or subscapularis repairs, and those associated with recurrent shoulder instability, were excluded from the record review. Data collected through chart review included patient outcomes, the presence of third-party payers, and the diagnostic accuracy of MRI arthrogram compared to CT arthrogram. Descriptive statistics were used. Preliminary results show that out of the 188 patients who underwent surgery, 95.2% reported an improvement in symptoms postoperatively, 3.7% noted no significant change at the time of review, one patient reported a worsening of symptoms, and one patient was lost to follow-up. Postoperative complications were noted in 8.5% of the patients, including 6.9% with stiffness and 1.6% with other complications. Capsulitis was noted in 14.3% of the cases, and all resolved with treatment. Among patients with third-party coverage (worker's compensation or insurance), 93% reported improvement, while 7% experienced no change. For patients without third-party coverage, 97% reported improvements, with one patient remaining stable, one reporting worsened symptoms, and one lost to follow-up. Out of the 188 patients with an intraoperatively confirmed labral tear, 91 had an MR arthrogram, and 66 had a CT arthrogram. Out of 91 MRI arthrograms, 41.8% were interpreted as normal, while 57.1% revealed a labral tear. Out of 66 CT arthrograms, 27.3% were interpreted as normal, while 59.1% revealed a labral tear. For the remaining exams, the radiologist concluded that a sublabral foramen was present. In all cases, a labral tear was noted intraoperatively and was repaired. Postoperative symptom improvement in most patients undergoing isolated labral tear repair outweighs the risk of capsulitis associated with surgery. The current gold standard imaging modality, MRI arthrogram, underestimates the presence of labral tears. CT arthrogram is more sensitive and should be favored when searching for a shoulder labral tear. These findings suggest that surgical repair of isolated labral tears is a promising treatment, highlight the need for improved diagnostic methods, and challenge current practice guidelines that often discourage surgical intervention for isolated labral tears.

Barrett's esophagus is the known precursor to esophageal adenocarcinoma (EAC), a cancer with poor prognosis. While endoscopic surveillance detects early dysplasia and prevents progression, most Barrett's esophagus patients do not progress to EAC, leading to invasive and costly surveillance. This study aimed to identify cost-effective endoscopic surveillance strategies by risk stratifying patients based on Barrett's esophagus segment length and sex. A Markov cohort model was developed to simulate the natural history of Barrett's esophagus to EAC. The model assessed 85 surveillance strategies and varied endoscopy intervals from 2 to 10 years for nondysplastic Barrett's esophagus and 6-12 months for dysplasia. Risk stratification was based on segment length (≤ 2 and ≤ 3 cm) and sex. Costs, utilities and transition probabilities were derived from published literature and clinical databases. Deterministic and probabilistic sensitivity analyses were performed, and cost-effectiveness was evaluated from a third-party payer perspective using a threshold of AU$50 000/QALY (2023 US dollars 35 945/QALY). The most cost-effective strategy was biennial surveillance for long-segment BE (> 2 cm) and 12-month surveillance for LGD, excluding surveillance in low-risk patients (ICER US$23 737/QALY). Risk-based surveillance consistently outperformed nonstratified strategies. Sensitivity analyses confirmed the robustness of the model, with key drivers being transition rates and endoscopy costs. We identified cost-effective risk-stratified endoscopic surveillance strategies for Barrett's esophagus, particularly when excluding low-risk patients. Tailored risk-guided surveillance strategies could improve resource allocation and clinical outcomes in managing Barrett's esophagus. The conserved resources can then be utilized to identify high-risk individuals in the community.

Insurance interference in electrophysiology: Reclaiming control for timely cardiac care.

How is obesity defined? Moving beyond the limitations of current measures to redefine obesity.

Telehealth has the potential to mitigate maternal and child health access challenges, reduce health system dependency and healthcare expenditures, and facilitate the delivery of healthcare to women and children remotely. Exhaustive searches of the literature were performed across multiple databases, including PubMed, Scopus, PDQ-Evidence for Informed Health Policymaking, CINAHL, EconLit, International Health Technology Assessment (HTA), Google Scholar, and the UniSQ RISE Research Repository. These searches targeted peer-reviewed, English-language articles published from inception to February 2024. The quality of the reports was assessed via CHEERS 2022. In this review, 20 studies comparing telehealth to usual care for maternal and child healthcare in remote, rural, and regional (RRR) Australia were included. Of these, 18 found telehealth to be a cost-saving option, while two reported comparable costs and outcomes. These findings were assessed from a range of perspectives, including those of the health system, society, family, providers, and third-party payers. The review findings indicate that telehealth has potential for addressing health disparities among women and children in remote, rural, and regional Australia. Health disparities are reduced by overcoming access barriers, reducing expenses, fostering healthy behaviors, increasing service utilization, shortening hospital stays, and enhancing care coordination. This review highlights that telehealth is a predominantly cost-saving alternative to usual care for maternal and child health services in remote, rural, and regional Australia. It has the potential to reduce health inequality among women and children residing in remote, rural, and regional Australia. A broader evaluation incorporating societal costs and benefits, along with a long-term view of the clinical and economic impacts of telehealth, is essential for its wider implementation. PROSPERO CRD42024518089.

Readmissions are a major source of burden to patients, hospitals, and third-party payers. Remote patient monitoring (RPM) was initially implemented during the COVID-19 pandemic but was later expanded to other high-risk patients upon discharge from the hospital. The authors used a retrospective data of convenience sample of adult patients enrolled in their RPM program from March 2024 to May 2025. Inclusion criteria included adult patients > 21 years of age, members of Geisinger Health Plan or Keystone Accountable Care Organization, high-priority diagnosis-related groups with elevated Epic readmission risk score, home internet availability, and discharge disposition to home. Exclusion criteria included patients' age < 21 years old, not members of Geisinger Health Plan or Keystone Accountable Care Organization, lack of home internet eligibility, and discharge disposition other than home. The primary outcome measure was 30-day all-cause readmissions. The analysis of patients enrolled in RPM and those who were followed afterward showed a significant reduction in 30-day readmissions, with 30% absolute reduction (11% in enrolled group vs 41% in non-enrolled group). Finally, through modeling, the authors opine on the potential effect of RPM on the national readmission landscape. The RPM program provided a significant benefit to 30-day readmission among the authors' convenience sample.

PurposeThis study provides one of the few national comparisons of antineoplastic expenditures from 2010 to 2021, offering new insight into how spending patterns have evolved over the past decade. In addition, it examines how out-of-pocket expenses relate to patient quality of life, an essential domain to evaluate healthcare interventions.Patients and MethodsThis study provides an updated estimate of the costs of antineoplastic agents using 2021 data and compares them with estimates from 2010. Medical Expenditures Panel Survey (MEPS) files were analyzed for national estimates. Antineoplastic treatment was defined in the MEPS using Multum Lexicon variables from the Cerner Multum. All reported prescriptions and refills were included in the expense and usage estimates. The 2010 costs were adjusted to 2021 figures using the consumer price index for out-of-pocket expenses and gross domestic products for third-party payers. SAS Studio 3.81 (Enterprise Edition) was employed for analysis.ResultsBetween 2010 and 2021, cancer diagnoses in the United States rose by 20.46%, while patients getting antineoplastic therapy increased by 7.6%. During this time, the cost of these medicines increased by thrice, from $9.78 billion to $35.12 billion. Prescription numbers were steady, with an average of four per patient per year. Males, older patients, and the insured were more likely to use the service. Breast cancer was the most common, with prostate and skin cancers increasing. The average prescription expenditure for cancer patients increased significantly compared to non-cancer individuals. Finally, there was no significant relationship observed between patients’ quality of life and their out-of-pocket expenses.ConclusionThe substantial increase in cancer treatment expenses had no positive impact on patients’ physical or mental well-being. This cost-quality gap necessitates a study on spending efficiency and patient well-being.

Budget impact analysis of a muscle-targeted nutritional intervention for sarcopenia.

Cost-effectiveness of biomarker-based and universal strategies for the treatment of advanced-stage endometrial cancer.

Methamphetamine use disorder (MUD) during pregnancy is associated with adverse maternal and perinatal outcomes, including increased risk of preterm birth, cesarean delivery, neonatal intensive care unit admission, placental abruption, and maternal or perinatal death. For the few evidence-based treatments for MUD, including transcranial magnetic stimulation (TMS) and injectable naltrexone with bupropion combination, there are few data available for pregnant individuals. We completed an exploratory model applying existing knowledge in clinical practice and available research to examine the potential cost-effectiveness of TMS compared to the combination of injectable naltrexone with bupropion or care as usual in a population of pregnant individuals with MUD. We aim to utilize the outcome of this analysis to inform future trial designs that examine TMS efficacy and safety in MUD during pregnancy. A decision tree model was developed to evaluate the direct medical costs and clinical outcomes of TMS compared to injectable naltrexone with bupropion or usual care for pregnant individuals with MUD. The analysis included three strategies from the start of pregnancy through delivery, focusing on mode of delivery, gestational age, and infant birth weight. The primary outcome was the percentage of full-term vaginal deliveries of infants with normal birth weight. The analysis was conducted from a third-party payer perspective, considering only direct medical costs, and used a $50,000 willingness-to-pay threshold to determine cost-effectiveness. In this experimental model, TMS demonstrated the lowest overall cost and highest effectiveness, yielding 76% full-term vaginal deliveries with normal-weight infants, compared to 44% for injectable naltrexone with bupropion combination and 39% for no intervention. Sensitivity analyses confirmed the robustness of TMS as a cost-effective intervention. Our exploratory model found that TMS was cost-effective compared to injectable naltrexone and bupropion or usual care, potentially improving outcomes at low costs. This study provides preliminary data supporting TMS being a promising cost saving option for MUD during pregnancy. The study's limitations include absence of direct TMS efficacy data in pregnant populations, necessitating the use of extrapolated data, small sample size, and short-term nature of efficacy data in non-pregnant populations. Additionally, there was insufficient data on the adverse effects of the interventions on fetuses and infants, highlighting the need for studies to confirm safety and efficacy. Both TMS and the combination of injectable naltrexone and bupropion show potential for treating pregnant individuals with MUD. However, neither treatment is FDA-approved or extensively studied in this population. If TMS proves to be a cost-effective and safe treatment option, it could significantly improve maternal and perinatal outcomes. Excluding pregnant individuals from MUD clinical trials limits evidence on treatments for this population. Funding large clinical trials focused on pregnant individuals with MUD is crucial. Limited data exist on the safety of TMS and injectable naltrexone with bupropion for fetuses and infants. Future research is crucial to update this model, confirm safety and efficacy, and explore perinatal outcomes for MUD in pregnancy, ensuring optimal care for this population.

BackgroundObesity is a major public health issue associated with significant humanistic and economic burden. In Greece, liraglutide 3.0 mg is currently the only reimbursed pharmacotherapy for obesity, restricted to patients with morbid obesity and selected comorbidities. Semaglutide 2.4 mg has demonstrated superior clinical efficacy in the STEP-8 clinical trial; however, its cost-effectiveness relative to liraglutide requires further investigation to ensure informed reimbursement decision-making.MethodsA state-transition model was developed in Microsoft Excel to evaluate the long-term cost-effectiveness of semaglutide 2.4 mg compared with liraglutide 3.0 mg in adults with obesity (BMI ≥ 35 kg/m2 and ≥ one weight-related comorbidity). Clinical efficacy and safety inputs were derived from the STEP 8 trial, while cost inputs (expressed in 2025 euros) and utility values were obtained from the literature and published local sources. The analysis was conducted over a 40-year time horizon, with both costs and outcomes discounted at an annual rate of 3.5%. Health outcomes were reported as life-years (LYs) and quality-adjusted life-years (QALYs). The evaluation was conducted from the perspective of the Greek third-party payer, and deterministic, scenario, and probabilistic sensitivity analyses were performed.ResultsSemaglutide 2.4 mg was associated with an incremental mean increase in quality-adjusted life expectancy of 0.09 at modestly incremental higher costs of 1,083 compared with liraglutide 3.0 mg, yielding an incremental cost-effectiveness ratio (ICER) of €12,724 per QALY gained, below the willingness-to-pay threshold of €27,117. Probabilistic sensitivity analysis showed semaglutide dominated liraglutide in 80.8% of simulations (greater QALYs and lower costs) and reached 100% probability of cost-effectiveness at a willingness-to-pay threshold of €9,000 per QALY. Deterministic and scenario analysis identified treatment duration, time horizon, discount rates, and diabetes-related complication costs as key drivers of ICER variability.ConclusionsSemaglutide 2.4 mg is likely to be a cost-effective treatment option compared to liraglutide 3 mg for patients with a BMI ≥ 35 and at least one weight-related comorbidity in Greece.

This pharmacoeconomic assessment aimed to explore the cost-effectiveness of the fixed-dose combination of Dorzolamide+Timolol (DTFC) in ocular hypertension and primary open-angle glaucoma (OH/POAG) in Vietnam. A cost-effectiveness analysis from third-party health payer perspective was designed with mixed modelling technique to simulate the long-term care for OH/POAG patients in Vietnam. With fixed-dose combination of Brinzolamide+Timolol (BTFC) as comparator, the treatment process was simulated by the decision-tree model for initial therapy and continued with the Markov model for maintenance therapy. Model parameters were derived from multiple sources, including real-world data, literature reviews and clinician consultations. Sensitivity analysis, including deterministic and probabilistic analyses, was conducted to explore the uncertainty of model outcomes. Base case analysis showed that the cost of treatment for each patient by DTFC was 42,906,600 VND, and by BTFC was 43,864,938 VND, while the comparative effectiveness was not different. Costs for healthcare services and medications were the most influential factors to model outcomes. DTFC demonstrated a 51.53% probability of being cost-effective compared to BTFC at the standard willingness-to-pay threshold. From third-party health payer perspective, DTFC was the more cost-saving option while maintaining treatment benefits, compared to BTFC.

Purpose: To perform a cost-utility analysis comparing primary pars-plana vitrectomy (PPV) within 24 hours with primary nonsurgical vitreous tap (or tap and inject [T&I]) for the management of endophthalmitis. Methods: Retrospective cost-utility analysis using decision tree modeling. The Victorian Endophthalmitis Registry was used to model outcome probabilities and costs from a third-party payer perspective. Australian Medicare data were used to calculate costs in a hospital-based setting (Australian dollars [A$]). Cost utility was based on preserved visual acuity and cost per quality-adjusted life year (QALY). Results: The authors identified 206 eyes treated between January 1, 2011, and January 1, 2021; 36 eyes received PPV, and 170 eyes received T&I. Seventeen eyes in the T&I group required delayed PPV. Mean incident ages were 76.29 years (53% female) in the PPV group and 74.28 years (55% female) in the T&I group. Imputed costs were A$1,523 and A$310 for PPV and T&I, with additional per-night admission costs of A$1,177. The mean presenting vs discharge logMAR of endophthalmitis was 2.24 vs 1.25 for the PPV group and 1.88 vs 1.03 for the T&I group. The mean durations of admission were 4.33 nights (PPV) and 4.04 nights (T&I). Total calculated costs per admission were A$6,929.41 and A$5,065.08 for PPV and T&I, respectively. Estimated lifetime QALYs gained were 2.23 (PPV) and 2.45 (T&I). The final costs derived per QALY were A$3,107 (PPV) and A$2,067 (T&I). Conclusions: PPV and T&I are both cost-effective per gained QALY, though the latter provided superior cost utility. A prospective randomized trial is indicated as the 2 groups differed at baseline, with eyes receiving vitrectomy having worse presenting visual acuity and prognosis.

Cost Effectiveness of the 8-Strain Probiotic in Primary and Secondary Prophylaxis of Pouchitis

Background/Objectives: Obesity is a global health issue with profound humanistic and financial implications. Novel pharmacological treatments, such as tirzepatide and semaglutide, offer promising options for sustained weight management; however, their cost-effectiveness warrants assessment. This study investigates the short-term cost-effectiveness of tirzepatide compared to semaglutide in achieving weight loss targets over 72 weeks in Greece. Methods: A short-term cost-effectiveness analysis was conducted from the perspective of the Greek third-party payer (EOPYY), comparing treatment costs and clinical outcomes for semaglutide and tirzepatide over a 72-week horizon. Clinical efficacy was assessed by the proportion of patients achieving weight loss targets of ≥10%, ≥15%, ≥20%, ≥25%, and ≥30%, using data from the SURMOUNT-5-a 72-week, phase 3b, head-to-head study among overweight adults or those with obesity without diabetes. Only direct medical costs were included, and no discount was employed due to the short time horizon. Price scenario, deterministic, and probabilistic sensitivity analyses were performed. Results: Over 72 weeks, the deterministic analysis found the total treatment cost was EUR 5645.70 for tirzepatide and EUR 3201.68 for semaglutide. These base-case results indicated the cost per responder for tirzepatide at higher weight loss targets (e.g., EUR 28,658 and EUR 46,401 at ≥30%) and lower costs for semaglutide at lower targets (e.g., EUR 1627 lower at ≥10%). However, probabilistic sensitivity analysis revealed overlapping 95% confidence intervals at all thresholds, indicating no statistically significant difference in the cost of control between the treatments. Conclusions: Semaglutide showed a numerically lower cost of control at lower weight loss targets, while tirzepatide was favoured at higher targets; however, these differences were not statistically significant.

Occupational therapy practitioners play an essential role in supporting the occupational performance needs of people with osteoarthritis (OA) and rheumatoid arthritis (RA). These Practice Guidelines aim to assist occupational therapy practitioners, educators, and researchers in applying evidence-based clinical recommendations within the scope of occupational therapy for people with OA and RA. These guidelines can also serve as a reference for people with arthritis as well as other health care professionals, health care managers, regulators, policymakers, third-party payers, and managed-care organizations. The ADAPTE methodology was the basis for the development of these Practice Guidelines. It supported efficiency by allowing us to systematically adapt existing clinical practice guidelines (CPGs) to occupational therapy practice. We selected existing CPGs for inclusion, extracted relevant evidence-based clinical recommendations, and developed associated action statements to align the recommendations with occupational therapy practice. We evaluated the quality of all the included CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and AGREE-Recommendations Excellence instruments. Seven existing CPGs were included, from which 53 evidence-based clinical recommendations were extracted. Six action statements were developed related to (1) client education and self-management interventions, (2) psychosocial interventions, (3) lifestyle management interventions, (4) physical activity and exercise interventions, (5) interventions to support occupation, and (6) interventions for work participation. These statements can guide the application of the evidence-based clinical recommendations to develop personalized care solutions to support people with OA and RA so they can live well with these chronic conditions. Plain-Language Summary: These Practice Guidelines provide strategies for occupational therapy practitioners to help people with osteoarthritis and rheumatoid arthritis live well with their chronic condition. The guidelines include specific recommendations that have been published by other professional groups. The guidelines also provide examples of how to apply these recommendations in ways that are relevant for occupational therapy practitioners. The strategies focus on educating clients with arthritis and supporting them in managing pain, fatigue, well-being, health, and participation in daily activities.