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Background: Although cancer mortality has been decreasing since 1991, many cancers are still not detected until later stages with poorer outcomes. Screening for early-stage cancer can save lives because treatments are generally more effective at earlier than later stages of disease. Evidence of the aggregate benefits of guideline-recommended single-site cancer screenings has been limited. This article assesses the benefits in terms of life-years gained and associated value from major cancer screening technologies in the United States., Methods: A mathematical model was built to estimate the aggregate benefits of screenings for breast, colorectal, cervical, and lung cancer over time since the start of US Preventive Services Task Force (USPSTF) recommendations. For each type, the full potential benefits under perfect adherence and the benefits considering reported adherence rates were estimated. The effectiveness of each screening technology was abstracted from published literature on the life-years gained per screened individual. The number of individuals eligible for screening per year was estimated using US Census data matched to the USPSTF recommendations, which changed over time. Adherence rates to screening protocols were based on the National Health Interview Survey results with extrapolation., Results: Since initial USPSTF recommendations, up to 417 million people were eligible for cancer screening. Assuming perfect adherence to screening recommendations, the life-years gained from screenings are estimated to be 15.5-21.3 million (2.2-4.9, 1.4-3.6, 11.4-12.3, and 0.5 million for breast, colorectal, cervical, and lung cancer, respectively). At reported adherence rates, combined screening has saved 12.2-16.2 million life-years since the introduction of USPSTF recommendations, ~ 75% of potential with perfect adherence. These benefits translate into a value of $8.2-$11.3 trillion at full potential and $6.5-$8.6 trillion considering current adherence. Therefore, single-site screening could have saved an additional 3.2-5.1 million life-years, equating to $1.7-$2.7 trillion, with perfect adherence., Conclusions: Although gaps persist between the full potential benefit and benefits considering adherence, existing cancer screening technologies have offered significant value to the US population. Technologies and policy interventions that can improve adherence and/or expand the number of cancer types tested will provide significantly more value and save significantly more patient lives., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objectives: This article provides systematic evidence on the share of the value of health generated by drugs and other healthcare goods and services that accrue to patients on the demand side versus the manufacturers on the supply side., Methods: We exploit a large data set with > 9000 cost-effectiveness measures for various interventions, which we convert into measures of the shares of the value of improved health appropriated by the supply side using literature estimates of how patients value gains in health., Results: We find that if patients value a quality-adjusted life-year at $450 000 the median share appropriated for drugs on the supply side is approximately 6% and has declined at 0.1% per year between 1997 and 2019. This compares with other healthcare interventions, such as screenings or medical procedures, which have a median value of 9% but decline at 0.3% per year over the same period. If patients value a quality-adjusted life-year at $150 000, the median share appropriated for drugs and other healthcare interventions on the supply side is approximately 18% and 27%, respectively. Our estimates of appropriations are upper bounds, partly due to QALYs not capturing full producer value., Conclusions: Many policy debates center on the idea that the supply side is capturing too much of the value of the medical innovation that they generate. We find that, for these interventions, a large share of the value of medical innovation accrues to patients on the demand side given that the revenue to innovators is often far less than the patient's value of these medical innovations., (Copyright © 2023. Published by Elsevier Inc.)

Objectives: To determine the lifetime social value of using the guideline-recommended vaccines for children born in the United States in 2009., Study Design: This study utilized an economic model with parameter values sourced from clinical and observational data, as well as the literature., Methods: The model quantified the health effects of routine vaccination for 14 diseases in terms of quality-adjusted life-years (QALYs) saved. The health effects were then valued by applying an economic value of a QALY. Producers' profits were estimated using data on vaccine prices, profit margins, and the number of vaccines administrated in the 2009 US birth cohort. The costs of producing the vaccines were subtracted from the value of the health effects to yield the total social value of vaccination. The producers' and consumers' shares of this social value were calculated. Sensitivity analyses were conducted to determine how results depend on underlying parameter assumptions., Results: Estimates indicated that vaccination of this cohort will save 1.2 million QALYs, relative to no vaccination. Of those health gains, 88% stemmed from reduced mortality and 12% from reduced morbidity. We estimated a social value of $184.1 billion from these gains, of which $3.4 billion accrues to manufacturers as profits, while $180.7 billion accrues to the rest of society. In sensitivity analysis, the total social value ranged from $40 billion to $675 billion, and the manufacturers' share ranged from 0.3% to 11.5%., Conclusions: Policy makers should account for this social value when considering policies affecting incentives to vaccinate and develop new vaccines.

Objectives: Organs for transplantation are scarce, but new medical therapies can prevent organ failure and the need for transplants. We sought to describe the unique value created by treatments that spare organs from failure and thus conserve donated organs for transplant into others, using hepatitis C virus (HCV) as a case study., Study Design: Epidemiologic-economic model., Methods: Using data on trends in chronic liver disease, liver disease progression, and liver transplant allocation models, as well as the effectiveness of new HCV treatments, we estimate the potential effects of systematic HCV screening and treatment on the demand for liver transplants in the United States. We estimate the spillover benefits to patients with all-cause liver disease in terms of increased availability of transplants and life-years gained., Results: We estimated that systematic HCV screening and treatment could spare 10,490 liver transplants to HCV-infected patients from 2015 to 2035. An estimated 7321 transplants would accrue to patients with end-stage liver disease without HCV and 3169 transplants to those with uncured HCV, providing approximately 52,700 and 22,800 additional life-years, respectively., Conclusions: Treatment advances for HCV have the potential to generate considerable spillover benefits to patients awaiting transplants for non-HCV-mediated liver failure. For other diseases in which organ transplants are in short supply, our study provides a novel pathway by which positive spillovers may accrue from treatments that prevent end-stage organ disease.

Aim: This study aims to analyze the impacts of a range of clinical evidence generation scenarios associated with comparative effectiveness research (CER) on pharmaceutical innovation., Materials & Methods: We used the Global Pharmaceutical Policy Model to project the effect of changes in pharmaceutical producer costs, revenues and timings on drug innovation and health for the age 55+ populations in the USA and Europe through year 2060 using three clinical scenarios., Results: Changes in producer incentives from widespread CER evidence generation and use had varied but often large predicted impacts on simulated outcomes in 2060. Effect on the number of new drug introductions ranged from a 81.1% reduction to a 45.5% increase, and the effect on population-level life expectancy ranged from a 15.6% reduction to a 11.4% increase compared to baseline estimates., Conclusion: The uncertainty surrounding the consequences of increased clinical evidence generation and use on innovation calls for a carefully measured approach to CER implementation, balancing near-term benefits to spending and health with long-term implications for innovation.

Improving medication adherence has been identified as a crucial step towards improving health outcomes for patients with chronic disease and has provided the motivation for many changes in our health care system. Despite the volume of research done on this topic, however, we still lack important basic information about how to improve adherence in a cost-effective way. There is a need for a better understanding of what areas of research are most likely to produce advances that could be used by policymakers, providers, payers, or other stakeholders to generate real improvements in medication adherence. To address this, we developed a set of research priorities designed to improve understanding about whom to target for adherence interventions and which particular interventions to employ for specific subpopulations. To produce this research agenda, we synthesized information from the existing literature with a series of stakeholder interviews and expert panel meetings. We identified 6 key areas for research: (1) predicting nonadherence, (2) behavioral factors affecting nonadherence, (3) measuring the impact of nonadherence on health and cost outcomes, (4) effectiveness of existing interventions, (5) misaligned incentives between payers and providers, and (6) provider training and coordination of care. We provide detailed descriptions and example topics within each area.  As the health care system continues to embrace reforms designed to improve the value of care, more and better information is needed to guide efforts designed to improve medication adherence. Addressing the topic areas identified here will be an important step towards accomplishing this goal.

Objectives: To assess the effect of inpatient oral nutritional supplement (ONS) use on length of stay, episode cost, and 30-day readmission probability., Study Design: Eleven-year retrospective study (2000 to 2010)., Methods: Analyses were conducted using the Premier Perspectives Database, which contained information on 44.0 million adult inpatient episodes. Using a matched sample of ONS and non-ONS episodes for any inpatient diagnosis, instrumental variables regression analysis was performed to quantify the effect of ONS use on length of stay, episode cost, and probability of approximate 30-day readmission. For the readmission outcome, the matched sample was restricted to episodes where the patient was known to be at risk of readmission. The fraction of a hospital's episodes in a given quarter involving ONS was used as an instrumental variable., Results: Within the database, 1.6% of 44.0 million adult inpatient episodes involved ONS use. Based on a matched sample of 1.2 million episodes, ONS patients had a shorter length of stay by 2.3 days (95% confidence interval [CI] - 2.42 to -2.16), from 10.9 to 8.6 days (21.0% decline), and decreased episode cost of $4734 (95% CI - $4754 to - $4714), from $21,950 to $17,216 (21.6% decline). Restricting the matched sample to the 862,960 episodes where patients were readmitted at some point, ONS patients had a reduced probability of early readmission (within 30 days) of 2.3 percentage points (95% CI - 0.027 to - 0.019), from 34.3% to 32.0% (6.7% decline)., Conclusions: Use of ONS decreases length of stay, episode cost, and 30-day readmission risk in the inpatient population.

This paper reviews the evidence on external costs of risky behaviors in the U.S. and provides a framework for estimating them. External costs arise when a person does not bear all the costs of his or her behavior. They provide one of the strongest rationales for government interventions. Although the earlier estimates of external costs no longer have policy relevance, they demonstrated that the existence of external costs was an empirical question. We recommend that the estimates of external costs be updated as insurance structures, environments, and knowledge about these behaviors change. The general aspects of external costs may apply to countries other than the U.S. after taking into account differences in institutional, policy and epidemiological characteristics.

Objectives: To examine how cost sharing for prescription drugs affects compliance with antiplatelet therapy and subsequent health outcomes among patients with acute coronary syndrome (ACS)., Study Design: Retrospective outcomes study using administrative data from medical and pharmaceutical claims of patients enrolled at health plans offered by 26 large employers drawn from all regions of the country., Methods: A total of 14,325 patients were diagnosed as having ACS and underwent coronary stent implantation between 2002 and 2005. Each patient was followed up for a maximum of 2 years. Primary outcomes measures were adoption of outpatient antiplatelet therapy, adherence to outpatient therapy, hospital admissions, and healthcare expenditures., Results: Patients with ACS who face higher coinsurance are less likely to adopt outpatient antiplatelet therapy within the first month after stent implantation and are more likely to discontinue treatment in the first year after stent implantation (P <.01). Higher coinsurance is also associated with an increased number of ACS rehospitalizations (P <.01). For patients in health plans with higher coinsurance rates, expected costs from ACS hospitalizations are $2796 (38%) higher in the first year after stent implantation (P <.01)., Conclusions: Higher copayments for prescription drugs are associated with lower utilization of antiplatelet therapy and with higher likelihood of rehospitalization among patients with ACS. As a consequence, total healthcare spending for patients with ACS increases by approximately $615 in the first year after stent implantation.

GDP per capita is usually used to proxy for the quality of life of individuals living in different countries. Welfare is also affected by quantity of life, however, as represented by longevity. This paper incorporates longevity into an overall assessment of the evolution of cross-country inequality and shows that it is quantitatively important. The absence of reduction in cross-country inequality up to the 1990s documented in previous work is in stark contrast to the reduction in inequality after incorporating gains in longevity. Throughout the post–World War II period, health contributed to reduce significantly welfare inequality across countries. This paper derives valuation formulas for infra-marginal changes in longevity and computes a "full" growth rate that incorporates the gains in health experienced by 96 countries for the period between 1960 and 2000. Incorporating longevity gains changes traditional results; countries starting with lower income tended to grow faster than countries starting with higher income. We estimate an average yearly growth in "full income" of 4.1 percent for the poorest 50 percent of countries in 1960, of which 1.7 percentage points are due to health, as opposed to a growth of 2.6 percent for the richest 50 percent of countries, of which only 0.4 percentage points are due to health. Additionally, we decompose changes in life expectancy into changes attributable to 13 broad groups of causes of death and three age groups. We show that mortality from infectious, respiratory, and digestive diseases, congenital, perinatal, and “ill-defined” conditions, mostly concentrated before age 20 and between ages 20 and 50, is responsible for most of the reduction in life expectancy inequality. At the same time, the recent effect of AIDS, together with reductions in mortality after age 50--due to nervous system, senses organs, heart and circulatory diseases--contributed to increase health inequality across countries.