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•Pneumococcal infections are associated with high morbidity, hospitalisation and mortality.•Invasive pneumococcal infections remain a public health problem with significant cost.•The Health Insurance and patient’s cost perspectives were considered.•Estimation of the hospitalization cost per age- and risk- groups were considered.•Pneumococcal infections justify more attention for vaccination. pneumococcal infections are associated with high morbidity, hospitalisation and mortality. The objective of this study was to investigate the health and economic burden of all-cause pneumonia and invasive pneumococcal disease in Belgian hospital settings, by patient’s age and risk profile. This descriptive retrospective study was conducted in 17 Belgian hospitals. Univariate and multivariate logistic linear regression models were performed. The Health Insurance and patient’s cost perspectives were considered because a few studies report these costs. The analysis has included 4,712 hospital admissions over the year 2018. Median hospitalization costs were higher for invasive pneumococcal infection diagnosis than for all-cause pneumonia (p < 0,001), respectively 4,051€ and 3,362€. Other factors associated with higher hospitalization cost were patient’s high-risk profile, admission to emergency unit, transfer from nursing home, admission to intensive care unit and length of stay. Streptococcus pneumoniae infections remain a public health problem with significant cost for the Health Insurance and poor prognosis. Invasive pneumococcal infections are associated with longer hospital stays and required more intensive care than all other causes of pneumonia, in addition to be more costly, which justifies more attention for vaccination. This study also suggests an increase of economic and health burden with age and presence of underlying conditions.

Introduction This study aimed to estimate and compare the lifetime clinical and economic burden of invasive pneumococcal diseases (IPD) attributable to the serotypes contained in a new 21-valent pneumococcal conjugate vaccine (V116) vs. the 20-valent pneumococcal conjugate vaccine (PCV20) among adults aged 18 years and above in the USA. Methods A state-transition Markov model was used to track IPD cases and deaths as well as the associated direct medical costs (in 2023 US dollars) from a US healthcare payer perspective at 3% annual discount rate. The results were summarized for V116, PCV20, and eight unique serotypes contained in V116. A sensitivity analysis was conducted to determine the most influential inputs on the overall total direct lifetime cost. Results For the total population of US adults aged 18 years and above in 2021 (approx. 258 million residents), the estimated lifetime numbers of cases of IPD, post-meningitis sequelae (PMS), and IPD-related deaths attributable to the serotypes contained in V116 were approximately 1.4 million, 17,608, and 186,200, respectively, with a total discounted lifetime direct cost of $32.6 billion. A substantial proportion (approx. 31%) of those were attributable to the unique eight serotypes. The corresponding estimates for PCV20 were approximately 35% lower—934,000, 11,500, and 120,000, respectively—with a total discounted direct lifetime cost of $21.9 billion. Conclusion These results show that V116 serotypes (compared to PCV20) are associated with substantially higher clinical and economic burden of IPD. The addition of V116 to vaccination recommendations can help to reduce the residual burden of IPD in US adults.

IntroductionDespite the availability of vaccines, pneumococcal disease (PD) is associated with high clinical and economic burden, mainly caused by non-vaccine serotypes and certain vaccine-type serotypes. V114 is a 15-valent pneumococcal conjugate vaccine (PCV) that contains two epidemiologically important serotypes, 22F and 33F, in addition to the 13 serotypes in 13-valent PCV (PCV13). This study quantified the epidemiologic and economic burden of PD attributable to V114 serotypes among adults in the USA.MethodsA Markov model was used to estimate the burden of V114 serotypes in a hypothetical, non-vaccinated cohort of US adults ≥ 19 years of age who were tracked from 2019 until death. The model calculated all the invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP) cases, deaths, and costs. Economic burden was estimated from a healthcare payer perspective (2019 US dollars) and discounted at 3%.ResultsThe model estimated 415,229 and 10.3 million lifetime cases of V114-type IPD and NBPP, respectively. Serotypes 22F and 33F caused approximately 33% of IPD cases and 20% of NBPP cases, while serotype 3 accounted for approximately 36% of IPD cases and 13% of NBPP cases. V114 serotypes caused 472,063 total lifetime deaths. Total discounted lifetime costs attributable to V114 serotypes were $44.8 billion US dollars.ConclusionsIn this hypothetical model of a non-vaccinated cohort of US adults, V114 serotypes were associated with a substantial health and economic burden, the majority of which was attributable to serotypes 3, 22F, and 33F. The addition of V114 to the national vaccination recommendations may help to reduce the epidemiologic and economic burden associated with PD in adults ≥ 19 years of age in the USA by providing increased coverage of these serotypes.

Background and objectives Motor Neuron Diseases (MND) are rare diseases but have a high impact on affected individuals and society. This study aims to perform an economic evaluation of MND in Germany. Methods Primary patient-reported data were collected including individual impairment, the use of medical and non-medical resources, and self-rated Health-Related Quality of Life (HRQoL). Annual socio-economic costs per year as well as Quality-Adjusted Life Years (QALYs) were calculated. Results 404 patients with a diagnosis of Amyotrophic Lateral Sclerosis (ALS), Spinal Muscular Atrophy (SMA) or Hereditary Spastic Paraplegia (HSP) were enrolled. Total annual costs per patient were estimated at 83,060€ in ALS, 206,856€ in SMA and 27,074€ in HSP. The main cost drivers were informal care (all MND) and disease-modifying treatments (SMA). Self-reported HRQoL was best in patients with HSP (mean EuroQoL Five Dimension Five Level (EQ-5D-5L) index value 0.67) and lowest in SMA patients (mean EQ-5D-5L index value 0.39). QALYs for patients with ALS were estimated to be 1.89 QALYs, 23.08 for patients with HSP and 14.97 for patients with SMA, respectively. Cost-utilities were estimated as follows: 138,960€/QALY for ALS, 525,033€/QALY for SMA, and 49,573€/QALY for HSP. The main predictors of the high cost of illness and low HRQoL were disease progression and loss of individual autonomy. Conclusion As loss of individual autonomy was the main cost predictor, therapeutic and supportive measures to maintain this autonomy may contribute to reducing high personal burden and also long-term costs, e.g., care dependency and absenteeism from work.

AbstractObjectivesTo use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016.DesignSystematic analysis.Main outcome measuresCrude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education).ResultsThe total number of deaths from suicide increased by 6.7% (95% uncertainty interval 0.4% to 15.6%) globally over the 27 year study period to 817 000 (762 000 to 884 000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7% (27.2% to 36.6%) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6%. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0%, 95% uncertainty interval 42.6% to 54.6%) than men (23.8%, 15.6% to 32.7%).ConclusionsAge standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates.

SummaryHospital use by patients with osteogenesis imperfecta was largely unknown. This study found that the English NHS provides a significant number of hospital admissions to these patients, translating into large costs to the NHS. Admissions and costs both increased over time. Children under 14 years old accounted for more of the admissions and costs than any other age group.IntroductionThe aim of this study was to characterise hospital use by patients with osteogenesis imperfecta (OI) in the English National Health Service (NHS).MethodsRoutinely collected aggregate data about all inpatient hospital records from patients with OI were used for the period 1 April 2014 to 31 March 2018. Information was extracted on number of admissions, number of patients, length of stay, and costs. Hospital use was summarised using descriptive statistics, categorising patients into 5-year age groups.ResultsThere were 16,245 hospital admissions for OI patients during the analysis period, with a total cost to the NHS of £24,052,451. Of the 4370 patients involved, 2700 (62%) were female. Female patients averaged 3.3 admissions per year and male patients 4.4 admissions per year. Patients aged 0 to 14 years old accounted for 54% of all admissions. Those aged 90 to 94 years had the longest average length of stay per admission (10.5 days) of any age group. Elective admissions cost on average £1260 and non-elective admissions £2529. Over the 4-year study period, number of admissions increased on average by 2.1% per year and number of patients by 6.4% per year.ConclusionThe treatment of patients with OI is associated with a significant number of hospital admissions at an important cost for the NHS, with both number of admissions and costs increasing over time. Children below the age of 14 years had more admissions at a greater total cost than other ages, while the oldest adults had longer average stays and higher costs per admission.

Background While the Next Generation Air Transportation System (NextGen) in the United States optimizes flight patterns, it has led to the unintended consequence of increasing aircraft noise exposure in some communities near airports. Despite the evidence that chronic exposure to high noise levels produces detrimental health effects, potential adverse health consequences due to increased noise in the affected communities have not been adequately considered in aviation policy discussions. Objective We assessed the long-term health and associated economic burden of increased aircraft noise caused by NextGen near the Baltimore-Washington Thurgood Marshall International (BWI) airport in Maryland. Methods A probabilistic Markov model projected the incremental health and associated economic burden over 30, 20, and 10 years, comparing post-NextGen noise exposure levels to pre-NextGen levels. Health outcomes included cardiovascular disease (CVD), anxiety disorders, noise annoyance, and low birth weight (LBW). Noise exposure was categorized into four levels (<55 dB DNL, 55–60 dB DNL, 60–65 dB DNL, >65 dB DNL). A Monte Carlo simulation with 2000 iterations was run to obtain incremental burden estimates and uncertainty intervals. One-way sensitivity analyses for noise effect parameters were conducted. Results Increased aircraft noise exposure was estimated to produce (discounted) incremental mortality costs of $362 million, morbidity costs of $336 million, and losses of 15,326 Quality-Adjusted Life Years (QALYs) over the next 30 years. Sensitivity analyses revealed the greatest uncertainty for CVD outcomes. Impact NextGen is a system that can increase the operational efficiency of airports by optimizing flight patterns. While operational efficiency is beneficial in many ways, changes in flight patterns and volume can also produce noise pollution, a major public health concern that should be considered in policy decision-making. This study quantifies the long-term health and economic implications of increased aircraft noise exposure following the implementation of NextGen in communities near the Baltimore-Washington International Airport. Our findings underscore the importance of considering public health consequences of noise pollution.

Background Trastuzumab is an established adjuvant therapy for early-stage HER2-positive breast cancer. Previous economic evaluations in Thailand demonstrated its cost-effectiveness; however, earlier analyses did not incorporate trastuzumab-associated cardiac toxicity, costs of HER2 and hormone receptor testing, or the budgetary implications of expanding reimbursement eligibility. This study aimed to provide an updated economic evaluation using current biosimilar pricing and to assess the affordability of expanded access under Thailand’s Universal Health Coverage scheme. Methods A cost–utility analysis using a Markov cohort model was conducted from a societal perspective over a lifetime horizon, comparing adjuvant trastuzumab plus paclitaxel with paclitaxel monotherapy. The model incorporated disease progression, cardiac toxicity, and mortality. Costs and health outcomes were expressed in 2024 Thai Baht (THB), and quality-adjusted life years (QALYs) were discounted at 3% annually. A budget impact analysis was performed to estimate the fiscal implications of expanding reimbursement to high-risk node-negative patients. Results Trastuzumab plus paclitaxel resulted in higher lifetime costs (THB 989,794 vs. THB 606,142) and greater health benefits (12.69 vs. 8.10 QALYs) than paclitaxel alone, yielding an incremental cost-effectiveness ratio of THB 83,520 per QALY gained, which is well below Thailand’s cost-effectiveness threshold of THB 160,000 per QALY. Incorporating diagnostic testing and cardiac toxicity costs had minimal impact on cost-effectiveness results. The annual budget impact of expanding coverage was estimated at THB 53.9 million, reflecting a modest increase relative to the expected health gains. Conclusions Using current biosimilar pricing, adjuvant trastuzumab remains a cost-effective intervention for early-stage HER2-positive breast cancer in Thailand. The findings support expanding reimbursement to selected high-risk node-negative patients, demonstrating that such policy expansion can deliver substantial health benefits while remaining affordable within existing healthcare budgets.

Background Aiming to reduce hospitalization expenses through shorter stays and improved resource allocation, China’s national day surgery cancer treatment reforms were implemented by local health authorities. This study evaluates the impact of the day-surgery management model implemented in Ningxia in 2019 on cancer hospitalization costs, including treatment, comprehensive, diagnostic, consumption, and medicine costs. Methods From January 2015 to December 2022, this retrospective study analyzed data on cancer hospitalization costs from municipal hospitals in Yinchuan, Ningxia. Data on 122,252 patients were collected, excluding deceased patients, incomplete records, and waived costs. Patient data included sex, age, occupation, payment method, admission date, clinical condition, and hospitalization costs. Statistical analysis used STATA, with χ² tests and Fisher’s exact tests comparing patient characteristics pre- and post-implementation of the day-surgery model. A sharp regression discontinuity design (RDD) assessed the model’s impact, dividing observations into pre- (2015–2018) and post-implementation (2019–2022) phases. A sensitivity analysis controlling for length of stay (LOS) was conducted to verify our cancer hospitalization costs changes. Results RDD analysis showed that the day-surgery model had no significant impact on total hospitalization costs ( p  = 0.084). Nevertheless, it was associated with significant reductions in several cost components, significant reductions occurred in comprehensive fees (-RMB293.85), diagnostic fees (-RMB508.3), consumption fees (-RMB386.38), and medicine fees (-RMB1569.5), while treatment fees rose by 46.2%. Crucially, the sensitivity analysis revealed that when controlling for LOS, the total hospitalization cost shifted to a significant increase (+ RMB564.7), and the surge in treatment fees intensified (+ RMB1614.2). This confirms that apparent aggregate cost neutrality masks underlying shifts in cost structure, with savings largely mediated by shorter stays that offset higher daily treatment intensity under the day-surgery model. Diagnostic and comprehensive fee reductions showed time-specific responsiveness, while medicine costs fluctuated at non-policy nodes. Conclusion The day-surgery model in Ningxia did not significantly reduce aggregate hospitalization costs, with the lower diagnostic, medicine, consumption and comprehensive fee categories offset by increased treatment costs. These results underscore the complexity of day-surgery economics: efficiency gains from faster turnover were partially offset by technology-driven cost escalations. Simply “improving efficiency” is insufficient, with policymakers and hospitals encouraged to enhance the financial sustainability of day-surgery reforms by targeted treatment cost-containment strategies. Key points This study employed a sharp regression discontinuity design (RDD) to assess the impact of the day-surgery management model on total cancer treatment expenses. The findings indicate that while the model did not significantly affect overall hospitalization costs, it altered the cost structure by reducing comprehensive, diagnostic, consumption, and medicine fees, but significantly increasing treatment fees. This highlights the necessity for hospitals to balance operational efficiency with overall cost control, as the rise in treatment costs imposes an additional financial burden on patients.

Background Congenital cytomegalovirus (cCMV) infection can cause severe neurological damage, growth retardation, hearing loss, and microcephaly in infants. We aimed at assessing healthcare costs of infants with recorded cCMV diagnosis in an administrative claims database in the first 2 years of life. Methods We conducted a retrospective, controlled cohort study using German claims data from the Institute for Applied Health Research Berlin (InGef) database. Incremental healthcare costs during the first and second year of life were assessed by matching (1:60) infants with cCMV diagnoses ≤ 90 days after birth (cCMV 90 cohort) to infants without cCMV diagnosis (“representative” controls) and infants with cCMV diagnoses ≤ 21 days after birth plus specific symptoms (cCMV 21-S ) to infants without cCMV and any ICD-10-GM records (besides Z00-Z99) until 4 th preventive health check-up (“healthy” controls). Due to missing data, mean imputation was applied for aids and remedies costs. Results We identified 54 and 24 infants born 2014–2018 for the cCMV 90 and cCMV 21-S cohorts, respectively. During the first year, mean (median) healthcare costs were significantly higher in cCMV 90 cases vs. “representative” controls (€22,737 (€9759) vs. €3091 (€863), p < 0.001), with 87.2% inpatient costs. Healthcare costs for cCMV 21-S cases compared to “healthy” controls were €34,498 (€20,924) vs. €680 (€569), p < 0.001. Differences decreased for both comparisons in the second year but remained statistically significant. Conclusions cCMV comprises a considerable economic burden for the German healthcare system (€19,646 to €33,818 higher mean costs for infants with recorded cCMV diagnosis in the first year of life). Attempts should be made to reduce this burden.