Jeong-Yeon Cho

Cost-effectiveness evidence of chimeric antigen receptor T-cell therapy (CAR-T) for the treatment of relapsed or refractory large B-cell lymphoma (r/r LBCL) remains controversial given the potential CAR-T has to cure patients coupled with the high cost of therapy. This study aims to synthesize the cost-effectiveness data of CAR-T for the treatment of r/r LBCL in adults using a systematic review and meta-analysis. Cost-effectiveness analyses of CAR-T for the treatment of r/r LBCL from inception through November 2024 were identified through database searches (MEDLINE, EMBASE, and CENTRAL). Costs were converted to 2023 US dollars using purchasing power parity. Incremental net benefit (INB) was calculated using country-specific willingness-to-pay thresholds and pooled using a random-effects model. Results were stratified by country income level and line of therapy. The risk of bias was assessed using the ECOBIAS checklist. Protocol registered at PROSPERO #CRD42024602683. Thirty-four studies were included in this systematic review. Twenty-six studies compared CAR-T to platinum-based chemotherapy with autologous stem cell therapy (ASCT) for r/r LBCL and eight studies compared between CAR-T therapies. As 2nd-line therapy for LBCL, CAR-T was found to have an INB of $28,846 (95% Confidence Interval [CI]: -$43,265 to $100,957; I² = 0%) (n = 9) compared to platinum-based chemotherapy with ASCT in high-income countries (HICs). As 3rd-line therapy against the same comparator, CAR-T had an INB of $48,838 (95% CI: -$156,625 to $254,302; I² = 79%) (n = 9) for HICs. Over a lifetime horizon, CAR-T was not significantly cost-effective for the treatment of r/r LBCL, though positive INBs suggest a trend toward cost-effectiveness as 2nd or 3rd-line therapy in HICs. Further cost-effective analyses should be conducted to compare between CAR-T products for the treatment of patients with r/r LBCL, as well as between CAR-T products and emerging novel therapies for r/r LBCL treatment, as this study did not address these comparisons.

Aims This study aimed to evaluate the cost-effectiveness of newly developed higher-valent pneumococcal conjugate vaccines (PCVs)-including PCV15, PCV20, and PCV21-for adult populations through a systematic review and meta-analysis of economic evaluations (MAEE), providing pooled incremental net benefits (INBs) as a quantitative summary across studies.Methods Economic evaluation studies of PCV15, PCV20, or PCV21 were identified through database searches (PubMed, EMBASE, EconLit, Tufts CEA registry, HTA database, and NITAG resource center) through November 2024. INBs were calculated and pooled using a random-effects model, with positive INB indicating cost-effectiveness. Outcomes were stratified by population age (≥18, ≥50, and ≥60 years), perspective (healthcare and societal), and country income level. Sensitivity analyses assessed the impact of funding sources, imputed variance, and incomplete sensitivity analysis.Results Twenty-seven studies were included, with 14 comparisons eligible for meta-analysis. PCV20 was the most frequently studied vaccine. From a healthcare perspective, PCV20 was significantly cost-effective compared to PCV15 followed by PPSV23 (PCV15 + PPSV23) in ≥18 population (INB: 19.3; 95% CI: 14.2 to 24.4) and ≥60 population (44.3; 21.1 to 67.4). A similar trend was observed when compared against PPSV23 alone (269.3; 96.4 to 442.1 and 161.2; 3.5 to 318.9). Among ≥18 population, PCV20 showed favorable INBs compared to PCV13 + PPSV23 (241.7; -5.6 to 488.9; healthcare perspective) and (171.4; -44.2 to 386.9; societal perspective), and no vaccine (65.6; -35.7 to 167.0; healthcare perspective). Among ≥60 population, PCV20 was significantly cost-effective compared to PCV15 alone (37.5; 28.0 to 47.0), but not compared to no vaccine (-13.3; -122.0 to 95.5). PCV15 and PCV21 had few meta-analyzable comparisons.Conclusions Higher-valent PCVs appear cost-effective in most adult populations and settings, especially in high-income countries and from the healthcare perspective. This meta-analysis provides a rigorous quantitative synthesis to support vaccine policy decisions.

Melanoma imposes substantial clinical and financial burdens, particularly in advanced stages where systemic therapies are increasingly utilized. To establish a baseline for evaluating the statewide War on Melanoma™ (WoM) early detection initiative, we analyzed stage-specific melanoma expenditures in Oregon from 2011-2021 using a novel pseudostaging algorithm applied to the Oregon All Payer All Claims (APAC) database. The algorithm classified cases into early (in situ/localized), regional, and distant stages based on diagnostic, procedural, and treatment codes and was validated against SEER-Medicare claims and chart review. Over the study period, the number of melanoma cases in claims rose steadily, and total annual expenditures tripled, driven primarily by late-stage disease. Expenditures for early-stage melanoma remained relatively stable, while costs for regional and distant stages increased sharply with the adoption of immune checkpoint inhibitors and targeted therapies. These findings provide the first comprehensive, claims-based baseline of stage-specific melanoma costs in Oregon and highlight the disproportionate economic burden of advanced disease. Establishing such baselines is critical for evaluating population-level initiatives like WoM and for assessing the potential economic benefits of earlier detection and treatment. Summary We quantified the stage-specific economic burden of melanoma in Oregon using a pseudostaging algorithm applied to statewide claims data, demonstrating sharp increases in cost, particularly in advanced disease. These estimates provide essential baseline evidence for evaluating the War on Melanoma™, a statewide initiative designed to promote earlier detection and reduce the need for costly late-stage treatment. The reproducible claims-based approach offers a scalable framework for other states and health systems to assess the value of cancer prevention and early detection initiatives. Significance We establish stage-specific costs of melanoma in Oregon using a validated claims-based pseudostaging algorithm. The results highlight the disproportionate financial burden of advanced disease and provide essential context for the War on Melanoma™, a statewide early detection initiative. These baseline estimates enable rigorous evaluation of whether shifting toward earlier-stage diagnosis can reduce healthcare costs and improve patient outcomes, offering a framework relevant to other states and cancer prevention programs.

Containment policies were essential in controlling the spread of the COVID-19 pandemic in the United States, but they also introduced significant economic challenges. This scoping review aimed to examine the macroeconomic indicators used to assess COVID-19 closure and containment policies in the United States. We reviewed 42 eligible studies from 4516 records identified across PubMed, Web of Science, and EconLit. These studies explored various economic impacts, focusing on employment, labor market indicators, consumer spendings, etc., primarily using publicly available sources. During the pandemic, high-frequency data (eg, mobility and card transactions) became newly accessible and played a key role in evaluating the real-time effects of mitigation policies. Our review summarizes macroeconomic indicators investigated and provides researchers and policymakers with a list of data sources for assessment of economic impacts in the future. This review emphasizes the need for comprehensive evaluations to balance public health measures with economic considerations in future pandemic responses.

Background: Poor adherence to chronic cardiovascular treatments can impede targeted clinical outcomes. This study estimates the potential benefits of improving adherence among patients with cardiovascular disease requiring secondary prevention in Mexico, Thailand, and China. Methods and Results: We performed Markov model simulation for patients with cardiovascular disease in 3 countries from health care and societal perspectives over a lifetime horizon. Two scenarios were compared: (1) optimal adherence based on a meta‐analysis of 51 randomized controlled trials and (2) status quo. The association between adherence and cardiovascular disease outcomes derives from a dose–response meta‐analysis of 4 051 338 patients. Outcomes include the accumulated number of cardiovascular events and associated costs in 2022 US dollars, life years, and quality‐adjusted life years. Optimal adherence could prevent 42 (95% credible interval [CrI], 29–56) cardiovascular events in Mexico, 34 (95% CrI, 24–50) in Thailand, and 63 (95% CrI, 43–89) in China per 1000 patients over a lifetime. Incremental effectiveness per patient was 0.60 (95% CrI, 0.47–0.74) life‐years in Mexico, 0.68 (95% CrI, 0.37–0.94) quality‐adjusted life years in Thailand, and 0.93 (95% CrI, 0.44–1.27) quality‐adjusted life years in China. Cost savings from societal perspective amounted to $412 (95% CrI, $211–$723), $316 (95% CrI, $187–$541), and $700 (95% CrI, $355–$1144) per patient for Mexico, Thailand, and China, respectively. Findings remained cost saving in deterministic and probabilistic sensitivity analyses. Conclusions: Achieving optimal adherence in patients with cardiovascular disease requiring lipid‐lowering therapy saves costs and improves health outcomes in Mexico, Thailand, and China. These findings support national health care systems implementing strategies to improve adherence in these countries.

Introduction: Neglected tropical diseases (NTDs) mainly affect underprivileged populations, potentially resulting in catastrophic health spending (CHS) and impoverishment from out-of-pocket (OOP) costs. This systematic review aimed to summarize the financial hardship caused by NTDs. Methods: We searched PubMed, EMBASE, EconLit, OpenGrey, and EBSCO Open Dissertations, for articles reporting financial hardship caused by NTDs from database inception to January 1, 2023. We summarized the study findings and methodological characteristics. Meta-analyses were performed to pool the prevalence of CHS. Heterogeneity was evaluated using the I² statistic. Results: Ten out of 1,768 studies were included, assessing CHS (n = 10) and impoverishment (n = 1) among 2,761 patients with six NTDs (Buruli ulcer, chikungunya, dengue, visceral leishmaniasis, leprosy, and lymphatic filariasis). CHS was defined differently across studies. Prevalence of CHS due to OOP costs was relatively low among patients with leprosy (0.0–11.0%), dengue (12.5%), and lymphatic filariasis (0.0–23.0%), and relatively high among patients with Buruli ulcers (45.6%). Prevalence of CHS varied widely among patients with chikungunya (11.9–99.3%) and visceral leishmaniasis (24.6–91.8%). Meta-analysis showed that the pooled prevalence of CHS due to OOP costs of visceral leishmaniasis was 73% (95% CI; 65–80%, n = 2, I² = 0.00%). Costs of visceral leishmaniasis impoverished 20–26% of the 61 households investigated, depending on the costs captured. The reported costs did not capture the financial burden hidden by the abandonment of seeking healthcare. Conclusion: NTDs lead to a substantial number of households facing financial hardship. However, financial hardship caused by NTDs was not comprehensively evaluated in the literature. To develop evidence-informed strategies to minimize the financial hardship caused by NTDs, studies should evaluate the factors contributing to financial hardship across household characteristics, disease stages, and treatment-seeking behaviors.

The Immunization Agenda 2030 prioritizes the populations without access to vaccines. Health equity has been increasingly incorporated into economic evaluations of vaccines to foster equitable access. Robust and standardized methods are needed to evaluate the health equity impact of vaccination programs to ensure monitoring and effective addressing of inequities. However, methods currently in place vary and potentially affect the application of findings to inform policy decision-making. We performed a systematic review by searching PubMed, Embase, Econlit, and the CEA Registry up to 15 December 2022 to identify equity-informative economic evaluations of vaccines. Twenty-one studies were included that performed health equity impact analysis to estimate the distributional impact of vaccines, such as deaths averted and financial risk protection, across equity-relevant subgroups. These studies showed that the introduction of vaccines or improved vaccination coverage resulted in fewer deaths and higher financial risk benefits in subpopulations with higher disease burdens and lower vaccination coverage—particularly poorer income groups and those living in rural areas. In conclusion, methods to incorporate equity have been evolving progressively. Vaccination programs can enhance equity if their design and implementation address existing inequities in order to provide equitable vaccination coverage and achieve health equity.