Real-world patient characteristics and utilization patterns in patients with cholangiocarcinoma who received pemigatinib in the United States of America.

The environmental impact of tibial fracture-related infections.

Economic benefit of expanding mammography screening for breast cancer in Colombia: A cost modelling analysis.

Burden of respiratory syncytial virus and influenza in adults - a Danish nationwide cohort study.

Despite receiving triple therapy (i.e., long-acting β2-agonist + long-acting muscarinic antagonist + inhaled corticosteroid), patients with chronic obstructive pulmonary disease (COPD) continue to experience exacerbations. This study aimed to investigate the moderate and severe annualized exacerbation rate (AER) and healthcare resource utilization of patients with COPD on triple therapy in China, addressing a significant evidence gap regarding the clinical and economic disease burden in this population. This retrospective cohort study was conducted using the Chongqing Regional Electronic Health Record Database (2018-2022). Patients with COPD aged ≥ 40years who had received ≥ 3months of triple therapy during the 12-month baseline period were included. AER, COPD-related hospital visits, length of hospital stay and readmissions, and direct medical costs during the 12-month observation period were analyzed. A total of 6393 patients with COPD on triple therapy were included in the study. Among patients with available data, 17.3% had blood eosinophil count of ≥ 300 cell/μL at baseline. The percentage of patients having at least one moderate and severe exacerbation during the observation period was 53.7%, with the moderate and severe AER (95% confidence interval) being 1.37 (1.32-1.42). The mean (standard deviation (SD)) numbers of outpatient, emergency room, and inpatient visit due to COPD were 6.1 (5.56), 0.4 (1.58), and 1.0 (1.64), respectively. The direct medical costs per patient per year were ¥14,208.7. Our findings reveal a high disease burden among patients with COPD in China despite stable triple therapy, reflecting the high-risk clinical profile of these patients and supporting an ongoing need for improved management strategies.

Real-world evidence for the use of nirmatrelvir/ritonavir in routine clinical practice remains limited in the Kingdom of Saudi Arabia (KSA). This study aimed to describe the demographic and clinical characteristics, treatment patterns, and healthcare resource utilization (HCRU) of adult patients with coronavirus disease 2019 (COVID-19) prescribed nirmatrelvir/ritonavir in the KSA. This was a multicenter, retrospective observational cohort study, including adult patients with COVID-19 who were prescribed nirmatrelvir/ritonavir between April 2022 and June 2024. Data were collected through an electronic case report form from patients' electronic medical records and included patient demographics, clinical characteristics, vaccination history, prescribing characteristics, and HCRU. Data were collected from the index date, defined as the date of nirmatrelvir/ritonavir prescription, up to 30days post-index. Descriptive analyses were conducted to summarize patient and clinical characteristics, treatment patterns, and HCRU. Logistic regression models were used to assess associations between patient characteristics and COVID-19-related hospitalization at the index date. A total of 248 patients were included. The mean age was 49.9years, 59.7% of patients were women, and 90.3% had at least one comorbidity. At the index date, 48.4% of patients were hospitalized, with 60.0% of hospitalizations related to COVID-19. Within 30days post-index, 9.3% of patients had a documented hospitalization, of which 8.7% were COVID-19-related. In multivariable analysis, patients aged 50-64years had a lower likelihood of COVID-19-related hospitalization at the index date compared with those aged 18-30years (odds ratio 0.33; 95% confidence interval [CI] 0.11-0.99). This study revealed a relatively young adult patient population with a high rate of hospitalization at the time of nirmatrelvir/ritonavir initiation. Older age (50-64years) was associated with a lower likelihood of COVID-19-related hospitalization at the index date. Further research is needed to better characterize the real-world use of nirmatrelvir/ritonavir and to investigate its potential benefit among hospitalized patients. ClinicalTrials.gov identifier NCT06016556.

This study aimed to assess 10-year trends in healthcare resource utilization (HCRU) and associated direct and indirect costs related to chronic kidney disease (CKD) from both a societal and payer (CatSalut) perspectives in Catalonia, Spain. Retrospective, population-based cohort study including 447,202 newly diagnosed CKD cases from the SIDIAP database between 2012 and 2022. HCRU and costs were analyzed annually using a bottom-up, prevalence-based approach and reported per 1,000 patient-years. Data sources included primary care (PC), hospital admissions, and national cost databases. Over the 10-year study period, drug treatments and outpatient visits consistently accounted for the largest share of HCRU. Between 2014 and 2021, total CKD-related costs rose from €3.66million to €4.61million, representing a 26% increase. Hospitalizations consistently accounted for over 50% of total costs, with CKD-specific hospitalization costs increasing notably after 2017. Visit-related costs were the second-largest expenditure, declining from 25.2% of total costs in 2014 to 18.2% in 2021, with PC visits remaining the dominant outpatient category. Expenditures related to kidney replacement therapy increased substantially, rising from €144,188 in 2014 to €370,111 in 2021, a 157% rise, primarily driven by dialysis. Indirect costs associated with sick leave nearly doubled, rising from €324,770 in 2014 to €680,672 in 2021, representing a 110% increase. CKD-related hospitalizations were a significant cost driver in Catalonia. Enhancing early detection, reinforcing PC capacity, and optimizing outpatient management could help reduce costly hospital dependence and address the rising clinical and economic burden of CKD in regional health systems.

Position paper on the clinical impact of anemia and iron deficiency prior to cardiac surgery. Part 1: diagnosis

In chronic obstructive pulmonary disease, exacerbations drive morbidity, healthcare resource utilization, and mortality. Hospitalization and emergency department visits reflect acute clinical instability. Systemic corticosteroids are usually prescribed for exacerbations, but cumulative exposure is a concern. To evaluate the effect of dupilumab on emergency department visits/hospital admissions and systemic corticosteroid use in patients experiencing exacerbations. BOREAS and NOTUS, two phase 3, randomized, double-blind, placebo-controlled trials, enrolled patients (40-85 years) with chronic obstructive pulmonary disease, moderate-to-severe airflow limitation, and type 2 inflammation (screening blood eosinophil count ≥ 300 cells/µL). Patients received dupilumab 300 mg (N = 938) or placebo (N = 936) for 52 weeks. Systemic corticosteroid use and annualized rate and time to first emergency department visit/hospital admission were assessed. Dupilumab versus placebo reduced emergency department visits/hospital admissions of any duration by 38% (relative risk: 0.62 [95% confidence interval: 0.43-0.90]; P = .0121), delayed time to first event, and reduced risk of a first event by 45% (hazard ratio: 0.55 [95% confidence interval: 0.38-0.78]; P = .0010). Compared with placebo, systemic corticosteroid use was reduced in patients treated with dupilumab who experienced severe exacerbations by 42% (relative risk: 0.58 [95% confidence interval: 0.38-0.89]; P = .0126) and moderate exacerbations by 28% (relative risk: 0.72 [95% confidence interval: 0.60-0.87]; P = .0005). Dupilumab reduced emergency department visits/hospital admissions of any duration. Patients who experienced moderate and/or severe exacerbations required fewer systemic corticosteroids with dupilumab compared with placebo.

Approximately 17% of patients with non-small cell lung cancer (NSCLC) have epidermal growth factor receptor mutations (EGFRm). Amivantamab received United States Food and Drug Administration approvals in advanced NSCLC for patients with EGFR exon 20 insertions (exon20ins) who progressed after platinum-based chemotherapy (PBC) on 05/21/2021, for first-line (1L) EGFR exon20ins on 03/01/2024, and for 1L and second-line or later (2L+) EGFR exon 19 deletion and L858R on 08/20/2024 and 09/19/2024, respectively. This claims-based study describes real-world treatment patterns and healthcare resource utilization (HRU) among insured patients with advanced NSCLC initiating amivantamab in 2L or later (2L+). Komodo Research Data closed claims (01/01/2016-10/31/2023) were used to analyze insured adults with a diagnosis of lung cancer who initiated amivantamab on/after 05/21/2021 in 2L+. Treatment patterns, including prior PBC and immunotherapy (IO) use, were described by line of therapy (LOT). All-cause HRU per-patient-per-month (PPPM) was assessed during the amivantamab LOT and all LOTs preceding amivantamab. Time to next treatment or death (TTNT-D) was reported using Kaplan-Meier analysis for each LOT. Overall, 126 patients initiated amivantamab in 2L+ (mean age: 60.2 years, 63.5% female). Amivantamab was initiated in 2L by 51.6% of patients, while 32.5% and 15.9% initiated amivantamab in third-line (3L) and fourth-line or later (4L+), respectively. Most patients initiated amivantamab as monotherapy (2L: 92.3%; 3L: 73.2%; 4L+: 80.0%), had prior PBC use (2L: 83.1%; 3L: 100.0%; 4L+: 100.0%), and prior IO use (2L: 60.0%; 3L: 63.4%; 4L+: 85.0%). Mean outpatient service use was 5.87 days PPPM before amivantamab initiation and 6.79 days PPPM during amivantamab treatment. Mean inpatient admissions PPPM were 0.05 before amivantamab and 0.08 during amivantamab treatment. Among patients initiating amivantamab in 2L, 3L, or 4L+, median TTNT-D was 11.0 months, 5.3 months, and 6.1 months, respectively. Among insured patients with advanced NSCLC receiving amivantamab in 2L+, TTNT-D aligned with results reported in clinical trials. Before initiating amivantamab, most patients received IO, despite IO use being inconsistent with treatment guidelines and limited demonstrated benefit. HRU was similar before and during amivantamab treatment, suggesting that amivantamab does not contribute to an increase in medical services compared to treatment regimens used in earlier LOTs.

Anastomotic leak (AL) is a serious postoperative complication following colorectal surgery (CS). This study compared healthcare resource utilization (HCRU) and costs between patients with and without AL after left-sided CS to highlight the significant burden of AL, and to address the evidence gap regarding its economic impact in England. This was a retrospective matched cohort study of patients with and without AL after left-sided CS. Data for adult patients undergoing CS between 2018 and 2021 in England were drawn from the Hospital Episode Statistics database. Patients with and without AL after left-sided CS were exactly matched 1 : 1 on age, sex, surgery date and type, and indication. Comparative analyses were conducted on patients with versus without AL, as well as on patients with minor and major AL versus those without AL. The primary objective was to compare all-cause costs for hospitalization; secondary outcomes were to determine AL incidence rates, baseline characteristics of those with AL (major and minor) versus those without, and the implications of AL in terms of interventions and length of hospital stay (LOS). Multivariate models were adjusted for the Charlson co-morbidity index and geographical region. Of 36 948 adult patients who underwent left-sided CS with anastomosis without stoma formation, after excluding those with bleeding complications, 2059 patients with AL and 27 590 without AL were identified. After exact matching, there were 1982 patients in each group. Among patients with AL, 1116 had major AL and 866 had minor AL. AL was associated with a significantly higher mean all-cause inpatient cost (adjusted difference €11 728; 95% confidence interval (c.i.) €10 313 to €13 209; P < 0.001). Patients with AL also had a significantly higher mean cumulative LOS (adjusted difference 15.93 days; 95% c.i. 14.24 to 17.61 days; P < 0.001). The estimated incidence of AL requiring intervention was 5.6%. Patients with any AL had significantly more mean all-cause hospitalizations (adjusted difference 0.37; 95% c.i. 0.26 to 0.49; P < 0.001) and higher cumulative LOS (adjusted difference 15.93; 95% c.i. 14.24 to 17.61; P < 0.001) than patients without AL. AL is associated with poorer clinical outcomes, increased HCRU, and a substantial economic burden.

To assess trends in volume and utilization of neuroimaging (CT and MR) across Europe over the last decade, within the context of evolving clinical practice on behalf of the European Society of Neuroradiology's Choosing Wisely committee. A systematic search of PubMed was performed (following PRISMA 2020 guidelines) to identify studies reporting European neuroimaging volumes. As no eligible studies were identified, descriptive analysis of Eurostat and OECD data was performed for 29 European countries from 2015 to 2022, covering CT and MR examination volumes and scanner availability per 100,000 population across four geographic regions (Northern, Southern, Eastern, and Western Europe). Total CT/MR volumes served as neuroimaging surrogates. 316 publications were identified (with none meeting predefined inclusion criteria). Eurostat data from 29 countries revealed substantial growth in imaging from 2015 to 2022. Per capita CT exam rates increased 40.8% (10,872 to 15,312 per 100,000 population), and MR scan rates increased 43.5% (5746 to 8244 per 100,000 population). Scanner availability also increased (CT scanners from 2.3 to 2.68, MR scanners from 1.43 to 2.11 per 100,000 population). Regional variations were evident: Western Europe showed the highest utilization rates, Eastern Europe demonstrated the largest relative growth despite lower absolute numbers. All regions experienced consistent growth except during the 2020 COVID-19 disruptions. Neuroimaging utilization has substantially increased across Europe from 2015 to 2022, with disproportionate growth in scan volumes relative to scanner availability. These findings highlight regional disparities in utilization and underscore the need for coordinated evidence-based appropriateness initiatives to support sustainable neuroimaging practice. Question Have CT and MR neuroimaging utilization rates changed across Europe over the last decade compared to scanner availability? Findings CT and MR scan rates increased 40.8% and 43.5%, respectively, from 2015 to 2022, reflecting increased per-scanner utilization across the continent. Clinical relevance Neuroimaging examination volumes increased substantially across Europe from 2015 to 2022. This highlights the value of evidence-based imaging appropriateness initiatives to ensure sustainable healthcare resource utilization.

Loneliness has become a global public health problem associated with serious diseases and early mortality. A promising non-medical group-based strategy to address loneliness is nature-based social prescribing (NBSP). The aim of this paper is to describe the design of a health economic evaluation of NBSP interventions alongside trials conducted in the EU H2020 project RECETAS. The health economic evaluation will be conducted alongside the RECETAS randomized controlled trials in Barcelona, Prague, and Helsinki, and comprises cost-utility, cost-effectiveness, and cost-capability analyses. Depending on each study site's specific setting and target population, the economic evaluation will be performed from a societal and/or a healthcare perspective. NBSP interventions, which include referring lonely people to participate in activities organized in a natural environment and providing a selection of nearby nature-based community resources, will be evaluated against usual care. Effectiveness measures include health-related quality of life assessed with the EQ-5D-5L questionnaire, changes in loneliness obtained from the De Jong Gierveld Loneliness Scale, and capability derived from the ICECAP-A questionnaire. Direct healthcare costs, indirect and informal costs as well as the actual costs of the intervention will be included. The data on health outcome and health care resource utilization will be collected at baseline and at three-, six- and twelve-months follow-up of the trial. The incremental cost-utility ratio, incremental cost-effectiveness ratio, and incremental cost-capability ratio will be calculated. National willingness-to-pay thresholds will be applied where available. Our study protocol provides a systematic framework designed prospectively for conducting the health economic evaluation of the NBSP intervention for people suffering from loneliness. Through the publication of the study protocol, the research process becomes transparent and reproducible. This reduces bias when interpreting the results and conclusions and ensures good evidence-based practice, so that decision makers can provide evidence-based recommendations without arbitrariness to support NBSP implementation. Barcelona (Spain) trial ClinicalTrials.gov, ID NCT05488496. Registered 29 July 2022 Prague (Czech Republic) trial ClinicalTrials.gov, ID NCT05522140. Registered August 25, 2022 Helsinki (Finland) trial ClinicalTrials.gov, ID NCT05507684. Registered August 12, 2022.

The ARRIVE trial showed that elective induction of labor at 39weeks for low-risk nulliparous women compared to expectant management reduced cesarean delivery rates with a nonsignificant trend toward decreased perinatal morbidity. However, the generalizability of these findings to other health care systems and obstetric contexts outside of the United States remains uncertain. The FRENCH-ARRIVE multicenter, randomized controlled trial with two parallel groups, modeled on the ARRIVE trial, will include 4200 low-risk nulliparous women with singleton pregnancies from 37 weeks 0 days through 38 weeks 6 days of gestation. Women will be randomized in a 1:1 ratio to either elective induction between 39 weeks 0 days and 39 weeks 4 days of gestation or expectant management. The primary outcome will be the incidence of cesarean deliveries after randomization, regardless of indication. This study will have a power of 80% to show a 20% reduction in the cesarean incidence from 15.0% to 12.0%. Secondary outcomes will include indicators of maternal and perinatal morbidity and of health-care resource utilization, defined consistently with those of the ARRIVE trial to allow meaningful comparisons. This large, multicenter, randomized controlled trial, as the first replication of the ARRIVE trial in a different setting, aims to compare the effect of elective induction of labor at 39 weeks of gestation versus expectant management on the incidence of cesarean delivery in low-risk nulliparous women. ClinicalTrials.gov NCT04799912 (March 12, 2021).

Chronic spontaneous urticaria (CSU) is a skin disorder for which short-course systemic corticosteroids are recommended only as rescue medication during acute exacerbations. Here, we describe real-world corticosteroid use, adverse events (AEs) occurring post-corticosteroid initiation, and health care resource utilization (HCRU) of patients with CSU in the USA. This retrospective cohort study used data from the US HealthVerity claims database of adults with diagnosed CSU (January 2016-March 2023). Only prescription and non-antihistamine claims were included in the analysis of treatment patterns. In the AE and HCRU analyses, patients were stratified into five cohorts on the basis of total days of systemic corticosteroid supply as a proxy for duration of use: ≤ 31 days, > 31 to ≤ 60 days, > 60 days, ≥ 90 days (subcohort of > 60 days), and non-corticosteroid users. Of 200,298 patients, corticosteroids were the most prescribed treatment (78.3% all; 68.2% systemic) following CSU diagnosis, excluding over-the-counter medication and antihistamines. The ten most common AEs occurring after systemic corticosteroid initiation (hypertension, lipid disorders, anxiety, obesity, fatigue, depression, diabetes, insomnia, cataracts, and gastritis) occurred in higher proportions of all corticosteroid user types versus non-users. The proportion of patients experiencing AEs generally increased with longer duration of corticosteroid use. More frequent HCRU was generally observed after the first systemic corticosteroid prescription and with increasing duration of corticosteroid use. Patients with CSU who were prescribed corticosteroids reported a higher proportion of AEs and more frequent HCRU than those who were not. These trends in AEs and HCRU were more prominent with increasing duration of corticosteroid use.

To systematically evaluate associations between comorbidities and differences in treatment decisions, outcomes, health-related quality of life (HRQoL), healthcare resource utilisation and costs, in patients with colon or rectal cancer. Systematic review. PubMed (Medline) and Embase databases were searched for studies published from January 2000 until January 2024. We included articles that compared the presence and absence of comorbidities, evaluated multiple comorbid conditions or used the Charlson Comorbidity Index, or variations such as the Charlson-Deyo Index. Primary and secondary outcome measures included cancer treatments, outcomes (including complications from treatments, survival and mortality rates), HRQoL, healthcare resource use and costs. Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Joanna Briggs Institute checklists to ensure the quality of data. Findings were summarised narratively. After duplicates were removed, 15 394 hits were screened and 31 studies were selected for inclusion in this systematic review. Comorbidities were associated with a lower likelihood of receiving treatment and lower survival rates and HRQoL, alongside a higher likelihood of complications following treatment, higher mortality rates and higher healthcare resource use. There were very limited studies that reported on HRQoL and resource use, and none reporting data directly relating to the impact of comorbidities on costs. These results were consistent across North America, Europe, Australia and New Zealand. For patients with colon and rectal cancer, comorbidities are associated with a lower likelihood of receiving treatments and poorer health outcomes. With global populations ageing, there is likely to be an increase in patients with colon and rectal cancer with comorbidities. Therefore, further research is necessary, especially to inform decisions regarding patient management and treatment, and to understand the implications on healthcare resource allocation, costs and HRQoL.

The environmental impact of diagnosis and therapy in obstructive sleep Apnea: A systematic review.

Diabetic ketoacidosis (DKA) increasingly occurs in patients with end-stage renal disease (ESRD), in whom standard management strategies may not be appropriate. Prior studies evaluating outcomes of DKA in ESRD are limited and yield inconsistent results. We compared in-hospital outcomes and healthcare utilization among patients hospitalized with DKA with and without ESRD using a national database. We performed a retrospective cohort study using the National Inpatient Sample (2016-2022) of adult hospitalizations with a primary diagnosis of DKA, comparing patients with and without ESRD. Propensity score matching was used to balance demographics and comorbidities; multivariable regression was used to estimate adjusted odds ratios (aORs) for in-hospital mortality, major in-hospital complications, length of stay, and inflation-adjusted hospitalization costs. After propensity score matching, 78,470 hospitalizations were included (39,235 with ESRD and 39,235 without ESRD). In-hospital mortality was similar between patients with and without ESRD (0.9% vs. 1.0%; aOR 0.90, 95% CI 0.65-1.24; p = 0.524). However, ESRD was associated with significantly higher odds of vasopressor use (aOR 1.56), invasive mechanical ventilation (aOR 1.74), non-invasive ventilation (aOR 1.62), septic shock (aOR 1.71), seizures (aOR 1.67), and sudden cardiac arrest (aOR 1.65) (all p < 0.05). ESRD was also associated with longer hospital length of stay (+ 1.42 days) and higher inflation-adjusted hospitalization costs (+$24,686) compared with matched non-ESRD patients. Among patients hospitalized with DKA, ESRD was not associated with increased in-hospital mortality after adjustment but was linked to substantially greater morbidity and healthcare resource utilization. These findings highlight the need for ESRD-adapted DKA management strategies aimed at reducing complications rather than mortality alone.

Assessing the impact of buprenorphine for opioid use disorder on infectious disease management.

Long-acting cabotegravir + rilpivirine (CAB+RPV LA) is the first US Food and Drug Administration-approved complete long-acting regimen for people with HIV who are virologically suppressed. Long-acting CAB+RPV may alleviate adherence challenges with daily oral therapy. To evaluate and compare real-world adherence, persistence, and health care resource utilization in people with HIV who switched to CAB+RPV LA vs maintained daily oral antiretroviral therapy (ART). ABOVE is a retrospective US cohort study using Symphony Health Solutions Integrated Dataverse administrative claims data from January 1, 2020, to August 31, 2023. The study included people with HIV aged 12years and older on stable oral ART and with continuous clinical activity for at least 12 months before the index date, categorized into people initiating CAB+RPV LA (LA ART cohort) and people remaining on oral ART (oral ART cohort). The index date was defined as the first injection of CAB+RPV LA or imputed for the oral ART cohort. We used standardized mortality ratio weighting based on propensity scores to balance baseline characteristics. Adherence (proportion of days covered ≥0.9 over 12 months following index) and persistence to the index regimen (days from index to earliest of treatment discontinuation or end of follow-up) were compared. A doubly robust logistic regression model estimated the adjusted odds ratio and 95% CI. Health care resource utilization including preventive care was compared using the doubly robust generalized linear model, with results reported as incidence rate ratios and corresponding 95% CIs. After applying eligibility criteria, the study included 1,245 people in the LA ART cohort (mean age, 47years; 24.1% female). The oral ART cohort included 58,644 people (mean age, 50years; 23.3% female). In the standardized mortality ratio-weighted analysis, the LA ART cohort had higher adherence rates (73.7% vs 30.1%) and higher persistence (median [IQR], 424 [201, 537] vs 393 [174, 431] days; P < 0.001 for all) compared with the oral ART cohort. Over 12 months, we observed significantly higher odds of adherence for the LA ART vs oral ART cohorts (adjusted odds ratio = 8.06; 95% CI = 6.62-9.81; P < 0.001). The LA ART cohort also had higher rates of vaccinations, cancer and STI screenings, and bone density testing and lower hospitalization rates. People who switched to LA ART had significantly higher 12-month adherence and persistence over the follow-up compared with people remaining on oral ART. Higher key preventive measure rates and lower hospitalization rates among people who switched to LA ART highlight increased medical engagement benefits.