An assessment of two environmental and economic benefits of ‘Cash for Clunkers’

This research aims to provide a more comprehensive, life cycle accounting of two categories of environmental and economic benefits associated with the $3 billion US “Cash for Clunkers” vehicle scrappage program. First, using a life cycle emissions methodology developed in Lenski et al. (2010), we find that about 29,000 metric tons of criteria pollutant emissions were avoided, for a benefit of about $23 million; avoided carbon dioxide emissions, by comparison, provided a benefit worth $90 million. Second, we compare the market value of scrapped vehicles to the rebates provided, calculating the consumer surplus or “gift” to participants to be up to $2 billion (about $2000 to $3000 per vehicle). This is significantly more than offered in previous vehicle scrappage programs, and suggests opportunities to get more environmental and economic “bang for the buck.” Finally, these two categories of benefits are found to be heavily concentrated geographically around urban centers. About 2% of US counties (50 counties) received 50% and 30% of the aggregate benefits from avoided criteria pollutant emissions and consumer surplus from the rebates, respectively.     

Bioenergy Crop Production in the United States: Potential Quantities, Land Use Changes, and Economic Impacts on the Agricultural Sector

The U.S. Departments of Agriculture and Energyjointly analyzed the economic potential for,and impacts of, large-scale bioenergy cropproduction in the United States. Anagricultural sector model (POLYSYS) wasmodified to include three potential bioenergycrops (switchgrass, hybrid poplar, and willow). At farmgate prices of US $2.44/GJ, anestimated 17 million hectares of bioenergycrops, annually yielding 171 million dry Mg ofbiomass, could potentially be produced at aprofit greater than existing agricultural usesfor the land. The estimate assumes highproductivity management practices are permittedon Conservation Reserve Program lands. Traditional crops prices are estimated toincrease 9 to 14 percent above baseline pricesand farm income increases annually by US $6.0billion above baseline.At farmgate prices of US $1.83/GJ, anestimated 7.9 million hectares of bioenergycrops, annually yielding 55 million dry Mg ofbiomass, could potentially be produced at aprofit greater than existing agricultural usesfor the land. The estimate assumes managementpractices intended to achieve highenvironmental benefits on Conservation ReserveProgram lands. Traditional crops prices areestimated to increase 4 to 9 percent abovebaseline prices and farm income increasesannually by US $2.8 billion above baseline.     

Economies of superscale in commercial banking

Most previous studies of scale economies in banking have excluded banks larger than $1 billion in assets. Thus study, by contrast, estimates cost functions for the 100 largest US commercial banks. ‘Hedonic’ terms are incorporated to correct for the aggregated nature of the Call Report data available for these banks. In addition, we attempt to quantify the cost benefit of diversification in the model. We estimate efficient bank scale to range from $15 billion to $37 billion in total assets, a thousandfold increase over some previous findings. These results are supported by comparison of actual average costs, as well as by casual historical observation and the level of widespread concern over interstate banking. Our findings suggest some cost incentive or benefit to expansion or consolidation among large regional banks, including interstate expansion or consolidation.     

The economic burden of kidney disorders in Korea

Aims: To estimate the economic burden of kidney disorders in Korea.

Materials and methods: The economic burden of kidney disorders was estimated using a prevalence-based approach. Related kidney diseases in patients with kidney disorders (RPWKD) were defined using codes from the tenth International Classification of Disease (E70–E90, F30–F48, F60–F69, F90–F99, K65–K67, N00–N08, N17–N19, and N30–N39). All diseases in patients with kidney disorders (APWKD) were defined as kidney disorders that involved all disease codes. Economic costs were divided into direct costs (medical costs and non-medical costs) and indirect costs (productivity loss because of morbidity and premature mortality).

Results: The prevalence of kidney disorders increased from 0.08% (2008) to 0.11% (2011). The total economic burden of RPWKD also substantially increased from $898.9 million (2008) to $1.43 billion (2011). This ～59.4% increase in the economic burden was equal to 0.12% of the Korean gross domestic product. The economic burden of APWKD also increased during the study period: $1.06 billion (2008), $1.23 billion (2009), $1.44 billion (2010), and $1.46 billion (2011).

Conclusions: The present study provides the first data regarding the economic burden of kidney disorders in Korea. The findings support the need for early intervention services and prevention programs to prevent, identify, and manage kidney disorders.     

Economic cost of deforestation in semi-deciduous forests — A case of two forest districts in Ghana

The ecological, economic and socio-cultural roles of forests are under threat in Ghana due to the high rate of deforestation. Efforts are being made to combat this problem through rehabilitation measures. However, the costs of deforestation and restoration benefits are not adequately estimated. This paper fills in the gap in knowledge by providing an empirical estimation of the cost of deforestation in monetary terms. Primary data collected regarding timber, non-timber forest products and soils in semi-deciduous forests were analyzed using opportunity cost and replacement cost techniques. The results emphasize differences in the value of these forest goods and services lost annually. The largest losses were in stumpage fees, edible fruits, and avoided carbon emissions values. The results show that US$133,650,000 gross revenue, equivalent to 2.6% of the 2008 agricultural sector Gross Domestic Product, is lost annually. It can be concluded that restoring the degraded forest lands would bring benefits particularly to the local communities through increased stumpage revenues and harvest of non-timber forest products, as well as additional funds from carbon credits. It is recommended that stakeholders of forest resources are made aware of these costs in order to raise awareness of what they are losing through deforestation.     

Valuing intangible outcomes from the Cooperative Research Centres-Projects program

The growing use of triple helix arrangements to stimulate national systems of innovation (NSIs) for broader economic benefits has largely focussed on quantifiable and compliance-based metrics to evaluate the ‘success’ of industry-university strategic collaborative research ventures. This metrics-focus largely ignores secondary, and even tertiary, outcomes of the collaborative ventures that are difficult to capture by research and innovation administrators with traditional metrics. A research project conducted on the Cooperative Research Centres—Projects (CRC-P) Program in Australia found that, in a number of cases, secondary and tertiary outcomes were highly valued by participants, and provided important but hitherto officially unacknowledged socio-economic benefits to the Australian NSI. This discussion proposes a typology of collaborative research outcomes beyond traditional compliance-based metrics, and challenges policy makers and research and innovation administrators to consider the development of an ‘Innovation Ecosystem Body of Knowledge’ to inform future collaborative research projects and enhance the ability of actors to access this ecosystem in an efficient and productive manner in order to ensure that potential economic gains from collaborative research are maximised.     

VALUING HEALTH EFFECTS: THE CASE OF OZONE AND FINE PARTICLES IN SOUTHERN CALIFORNIA

This study presents a conservative estimate of the health benefits that would result from attainment of the federal ozone and fine particle (PM_2.5) standards in the South Coast Air Basin of southern California. A three‐stage approach is used that links pollution exposures to adverse health outcomes to economic values. The annual value of the aggregate health benefits approaches $500 million (with a range of $295–$646 million) for ozone and exceeds $21 billion (with a range of $12.85–$34.22 billion) for fine particles. Such results are useful to regulatory agencies and other policy makers when evaluating the merits of various air pollution reduction strategies. (JEL Q51, Q53)     

Improving Human Wellbeing and Ecosystem Health on BC’s Coast: The Challenge Posed by Historic Resource Extraction

Synopsis Haida Gwaii and the Great Bear Rainforest (GBR) comprise the world’s largest intact coastal temperate rainforest. British Columbia has encouraged industrial logging of this region. As a result, ecological values have been eroded and natural capital has been drawn down. The logging industry has provided few local economic benefits. Colonization and industrial resource extraction have contributed to high levels of social distress in First Nations communities. Since 2001, logging companies, environmental organizations, and the provincial and First Nations governments have collaborated in developing an Ecosystem Based Management (EBM) approach. EBM is intended to maintain ecosystem integrity and improve human wellbeing. In 2006, the province began implementing EBM by setting aside one third of the GBR’s land base from logging and by proposing transitional EBM requirements. This paper draws on stumpage and forest cover data to analyze natural capital depletion. The analysis indicates that much of the GBR’s natural capital, as represented by timber, has been depleted. Industrial logging was already on the decline before the decision was taken to implement an EBM approach. Expectations for improved socio-economic outcomes under EBM may not be realistic given the constraints implied by past logging. If EBM performance is measured using conventional economic indicators without accounting for past depletion, it risks being found to have failed the goal of improving human wellbeing. This would create pressure to relax EBM provisions to allow more logging, an outcome that would fail both ecosystems and human communities in the long term. If much reduced extraction levels are to support local human wellbeing, a greater share of economic benefits must be retained locally.      

Modelling economy-ecology linkages in mangroves: Economic evidence for promoting conservation in Bintuni Bay, Indonesia

Woodchip exports pose a potential threat to a 300 000-ha mangrove ecosystem in the Bintuni Bay area of Irian Jaya, Indonesia. The bay supports an important shrimp export industry, and coastal areas support 3000 households. Traditional non-commercial uses of mangroves have an estimated value of Rp20 billion/yr (US$10 million/yr); commercial fisheries are valued at Rp70 billion/yr (US$35 million/yr) and selective commercial mangrove cutting schemes have a maximum value of Rp40 billion/yr (US$20 million/yr).Forest management options, ranging from clear cutting to a cutting ban, are evaluated in a cost–benefit analysis incorporating linkages among mangrove conversion, offshore fishery productivity, traditional uses, and benefits of erosion control and biodiversity maintenance functions. “Linkage scenarios” are developed that reflect potential ecosystem component interactions in Bintuni Bay. Clear cutting is optimal only if linkages are ignored. A cutting ban is optimal if linear and immediate linkages between ecosystem components exist. Under a scenario with linear but delayed linkages of 5 years, selective cutting of 25% of the harvestable mangrove is the optimal strategy; it has a present value of Rp70 billion (US$35 million) greater than the clear cutting option, and more extensive cutting would yield no additional net benefits.Strong economic arguments exist for conservative mangrove clearing. Where strong ecological linkages occur, severe restrictions on clearing activities will be economically optimal. Where ecosystem dynamics are uncertain, programs reducing linkage effects – such as greenbelts, replanting, or selective cutting – will minimise potential economic losses.     

Cost-efficiency analyses for the US of biosimilar filgrastim-sndz,reference filgrastim,pegfilgrastim, and pegfilgrastim with on-body injector in the prophylaxis of chemotherapy-induced (febrile) neutropenia

Aims: Guidelines recommend prophylaxis with granulocyte colony-stimulating factor for chemotherapy-induced (febrile) neutropenia (CIN/FN) based on regimen myelotoxicity and patient-related risk factors. The aim was to conduct a cost-efficiency analysis for the US of the direct acquisition and administration costs of the recently approved biosimilar filgrastim-sndz (Zarxio EP2006) with reference to filgrastim (Neupogen), pegfilgrastim (Neulasta), and a pegfilgrastim injection device (Neulasta Onpro; hereafter pegfilgrastim-injector) for CIN/FN prophylaxis.

Methods: A cost-efficiency analysis of the prophylaxis of one patient during one chemotherapy cycle under 1–14 days’ time horizon was conducted using the unit dose average selling price (ASP) and Current Procedural Terminology (CPT) codes for subcutaneous prophylactic injection under four scenarios: cost of medication only (COSTMED), patient self-administration (SELFADMIN), healthcare provider (HCP) initiating administration followed by self-administration (HCPSTART), and HCP providing full administration (HCPALL). Two case studies were created to illustrate real-world clinical implications. The analyses were replicated using wholesale acquisition cost (WAC).

Results: Using ASP?+?CPT, cost savings achieved with filgrastim-sndz relative to reference filgrastim ranged from $65 (1?day) to $916 (14 days) across all scenarios. Relative to pegfilgrastim, savings with filgrastim-sndz ranged from $834 (14 days) up to $3,666 (1?day) under the COSTMED, SELFADMIN, and HPOSTART scenarios; and from $284 (14 days) up to $3,666 (1?day) under the HPOALL scenario. Similar to the cost-savings compared to pegfilgrastim, filgrastim-sndz achieved savings relative to pegfilgrastim-injector: from $834 (14 days) to $3,666 (1?day) under the COSTMED scenario, from $859 (14 days) to $3,692 (1?day) under SELFADMIN, from $817 (14 days) to $3,649 (1?day) under HPOSTART, and from $267 (14 days) to $3,649 (1?day) under HPOALL. Cost savings of filgrastim-sndz using WAC?+?CPT were even greater under all scenarios.

Conclusions: Prophylaxis with filgrastim-sndz, a biosimilar filgrastim, was associated consistently with significant cost-savings over prophylaxis with reference filgrastim, pegfilgrastim, and pegfilgrastim-injector, and this across various administration scenarios.     

Clinical and economic benefits of professional CGM among people with type 2 diabetes in the United States: analysis of claims and lab data

Background: It is estimated that one in 10 people in the US have a diagnosis of diabetes. Type 2 diabetes accounts for 95% of all cases in the US, with annual costs estimated to be $246 billion per year. This study investigated the impact of a glucose-measuring intervention to the burden of type 2 diabetes.

Objective: This analysis seeks to understand how professional continuous glucose monitoring (professional CGM) impacts clinical and economic outcomes when compared to patients who are not prescribed professional CGM.

Methods: This study utilized a large healthcare claims and lab dataset from the US, and identified a cohort of patients who were prescribed professional CGM as identified by CPT codes 95250 and 95251. It calculated economic and clinical outcomes 1 year before and 1 year after the use of professional CGM, using a generalized linear model.

Results: Patients who utilized professional CGM saw an improvement in hemoglobin A1C. The “difference-in-difference” calculation for A1C was shown to be –0.44%. There was no statistically significant difference in growth of total annual costs for people who used professional CGM compared to those who did not ($1,270, p?=?.08). Patients using professional CGM more than once per year had a –$3,376 difference in the growth of total costs (p?=?.05). Patients who used professional CGM while changing their diabetes treatment regimen also had a difference of –$3,327 in growth of total costs (p?=?.0023).

Conclusion: Significant clinical benefits were observed for patients who used professional CGM. Economic benefits were observed for patients who utilized professional CGM more than once within a 1-year period or who used it during a change of diabetes therapy. This suggests that professional CGM may help decrease rising trends in healthcare costs for people with type 2 diabetes, while also improving clinical outcomes.     

Cost effectiveness of adding clostridial collagenase ointment to selective debridement in individuals with stage IV pressure ulcers

Objective: The purpose of this study was to determine the cost effectiveness (from a payer’s perspective) of adding clostridial collagenase ointment (CCO) to selective debridement compared with selective debridement alone (non-CCO) in the treatment of stage IV pressure ulcers among patients identified from the US Wound Registry.

Methods: A 3-state Markov model was developed to determine costs and outcomes between the CCO and non-CCO groups over a 2-year time horizon. Outcome data were derived from a retrospective clinical study and included the proportion of pressure ulcers that were closed (epithelialized) over 2 years and the time to wound closure. Transition probabilities for the Markov states were estimated from the clinical study. In the Markov model, the clinical outcome is presented as ulcer-free weeks, which represents the time the wound is in the epithelialized state. Costs for each 4-week cycle were based on frequencies of clinic visits, debridement, and CCO application rates from the clinical study. The final model outputs were cumulative costs (in US dollars), clinical outcome (ulcer-free weeks), and incremental cost-effectiveness ratio (ICER) at 2 years.

Results: Compared with the non-CCO group, the CCO group incurred lower costs ($11,151 vs $17,596) and greater benefits (33.9 vs 16.8 ulcer-free weeks), resulting in an economically dominant ICER of ?$375 per ulcer. Thus, for each additional ulcer-free week that can be gained, there is a concurrent cost savings of $375 if CCO treatment is selected. Over a 2-year period, an additional 17.2 ulcer-free weeks can be gained with concurrent cost savings of $6,445 for each patient.

Conclusions: In this Markov model based on real-world data from the US Wound Registry, the addition of CCO to selective debridement in the treatment of pressure ulcers was economically dominant over selective debridement alone, resulting in greater benefit to the patient at lower cost.     

How ‘Islamic’ is Islamic Banking?

Islamic Banks hold well over US $700 billion in assets and are growing at over 15% p.a. Islamic Banking and Finance (IBF) involves wider ethical and moral issues than simply ‘interest-free’ transactions. Its advocates argue that these make it more economically efficient than conventional banking and promote greater economic equity and justice. To what extent, then, do actual Islamic Banking practices live up to the ideal, and how different are they from conventional banking? A preliminary investigation shows that, three decades after its introduction, there remain substantial divergences between IBF's ideals and its practices, and much of IBF still remains functionally indistinguishable from conventional banking. This runs counter to claims by IBF advocates that it would rapidly differentiate itself from conventional banking. However, despite not providing an alternative to conventional banking and finance, IBF does strengthen a distinctly Islamic identity by providing the appropriate Islamic terminology for de facto conventional financial transactions.     

Economic evaluation of a pharmacogenomic multi-gene panel test to optimize anti-hypertension therapy: simulation study

Abstract

Aims: Hypertension is the strongest modifiable risk factor for cardiovascular disease, affecting 80 million individuals in the US and responsible for ～360,000 deaths, at total annual costs of $93.5 billion. Antihypertension therapies guided by single genotypes are clinically more effective and may avert more adverse events than the standard of care of layering anti-hypertensive drug therapies, thus potentially decreasing costs. This study aimed to determine the economic benefits of the implementation of multi-gene panel guided therapies for hypertension from the payer perspective within a 3-year time horizon.

Materials and methods: A simulation analysis was conducted for a panel of 10 million insured patients categorized clinically as untreated, treated but uncontrolled, and treated and controlled over a 3-year treatment period. Inputs included research data; empirical data from a 11-gene panel with known functional, heart, blood vessel, and kidney genotypes; and therapy efficacy and safety estimates from literature. Cost estimates were categorized as related to genetic testing, evaluation and management, medication, or adverse events.

Results: Multi-gene panel guided therapy yielding savings of $6,256,607,500 for evaluation and management, $908,160,000 for medications, and $37,467,508,716 for adverse events, after accounting for incremental genetic testing costs of $2,355,540,000. This represents total 3-year savings of $42,276,736,216, or a 47% reduction, and 3-year savings of $4,228 and annual savings of $1,409 per covered patient.

Conclusions: A precision medicine approach to genetically guided therapy for hypertension patients using a multi-gene panel reduced total 3-year costs by 47%, yielding savings exceeding $42.3 billion in an insured panel of 10 million patients. Importantly, 89% of these savings are generated by averting specific adverse events and, thus, optimizing choice of therapy in function of both safety and efficacy.     

An economic analysis of the Cattlemen’s Beef Promotion and Research Board demand-enhancing programmes

The research reported here addressed two objectives. The first objective was to measure the overall impact of the Cattlemen’s Beef Board as well as eight-specific advertising, promotion and research activities on US beef demand. The second objective was to compute marginal benefit–cost ratios (BCRs) for the eight individual checkoff activities and for the overall programme. The results indicated that Cattlemen’s Beef Board’s Promotion activities increased total domestic beef demand by 15.7 billion pounds in total, or 2.1 billion pounds per year between 2006 and 2014. Collectively, the overall marginal BCR for all Cattlemen’s Beef Board activities was $11.20.     

Economic costs and impacts of climate-induced sea-level rise and storm surge in Canadian coastal provinces: a CGE approach

We estimated the economic costs and impacts of future sea-level rise (SLR) and storm surge due to climate change in Canada’s coastal provinces using regional, dynamic computable general equilibrium models that track provincial welfare, GDP, trade, prices and inputs over the 2009–2054 period. We also assessed the economic costs of coastal adaptation investments, to determine whether such investments can be justified on economic grounds. Results indicated that SLR and storm surge could cost Canada in the range of $4.6–$25.5 billion in present value welfare, and between $53.7 and $108.7 billion in present value GDP. We found significant variation in costs and impacts across coastal provinces, with some provinces such as Newfoundland and Labrador experiencing only marginal costs/impacts, and others such as British Columbia experiencing costs as high as $21 billion in welfare over the period. Coastal adaptation investments were supported on economics grounds. Overall, this study provides the first (and preliminary) provincial economic impact estimates of climate-induced SLR and storm surge, as well as adaptation investments, in Canada. Additional research is needed to refine the analysis in order to produce reliable estimates that can be used to guide coastal adaptation policies in Canada.     

Valuing ecosystem and economic services across land-use scenarios in the Prairie Pothole Region of the Dakotas, USA

This study uses biophysical values derived for the Prairie Pothole Region (PPR) of North and South Dakota, in conjunction with value transfer methods, to assess environmental and economic tradeoffs under different policy-relevant land-use scenarios over a 20-year period. The ecosystem service valuation is carried out by comparing the biophysical and economic values of three focal services (i.e. carbon sequestration, reduction in sedimentation, and waterfowl production) across three focal land uses in the region [i.e. native prairie grasslands, lands enrolled in the Conservation Reserve and Wetlands Reserve Programs (CRP/WRP), and cropland]. This study finds that CRP/WRP lands cannot mitigate (hectare for hectare) the loss of native prairie from a social welfare standpoint. Land use scenarios where native prairie loss was minimized, and CRP/WRP lands were increased, provided the most societal benefit. The scenario modeling projected native prairie conversion to cropland over the next 20 years would result in a social welfare loss valued at over $4 billion when considering the study's three ecosystem services, and a net loss of about $3.4 billion when reductions in commodity production are accounted for.     

Estimates of the direct and indirect cost savings associated with heart disease that could be avoided through dietary change in the United States

Aims: Diets high in saturated fat are associated with elevated risk of heart disease. This study estimates the savings in direct (medical care) costs and indirect (job absenteeism) costs in the US from reductions in heart disease associated with substituting monounsaturated fats (MUFA) for saturated fats.

Materials and methods: A four-part model of the medical care cost savings from avoided heart disease was estimated using data on 247,700 adults from the 2000–2010 Medical Expenditure Panel Survey (MEPS). The savings from reduced job absenteeism due to avoided heart disease was estimated using a zero-inflated negative binomial model of the number of annual work loss days applied to data on 164,577 adults from the MEPS.

Results: Estimated annual savings in medical care expenditures resulting from a switch from a diet high in saturated fat to a high-MUFA diet totaled ～ $25.7 billion (95% CI = $6.0–$45.4 billion) in 2010, with private insurance plans saving $7.9 billion (95% CI?=?$1.8–$14.0 billion), Medicare saving $9.4 billion (95% CI?=?$2.1–$16.7 billion), Medicaid saving $1.4 billion (95% CI?=?Aims: Diets high in saturated fat are associated with elevated risk of heart disease. This study estimates the savings in direct (medical care) costs and indirect (job absenteeism) costs in the US from reductions in heart disease associated with substituting monounsaturated fats (MUFA) for saturated fats.

Materials and methods: A four-part model of the medical care cost savings from avoided heart disease was estimated using data on 247,700 adults from the 2000–2010 Medical Expenditure Panel Survey (MEPS). The savings from reduced job absenteeism due to avoided heart disease was estimated using a zero-inflated negative binomial model of the number of annual work loss days applied to data on 164,577 adults from the MEPS.

Results: Estimated annual savings in medical care expenditures resulting from a switch from a diet high in saturated fat to a high-MUFA diet totaled ～ $25.7 billion (95% CI = $6.0–$45.4 billion) in 2010, with private insurance plans saving $7.9 billion (95% CI?=?$1.8–$14.0 billion), Medicare saving $9.4 billion (95% CI?=?$2.1–$16.7 billion), Medicaid saving $1.4 billion (95% CI?=?$0.2–$2.5 billion), and patients saving $2.2 billion (95% CI?=?$0.5–$3.8 billion). The annual savings in terms of reduced job absenteeism ranges from a lower bound of $600 million (95% CI?=?$100 million to $1.0 billion) to an upper bound of $1.2 billion (95% CI?=?$0.2–$2.1 billion) for 2010.

Limitations: The data cover only the non-institutionalized population. Decreased costs due to any decreases in the severity of heart disease are not included. Cost savings do not include any reduction in informal care at home.

Conclusions: Diets high in saturated fat impose substantial medical care costs and job absenteeism costs, and substantial savings could be achieved by substituting MUFA for saturated fat.     

Heart rate variability testing: could it change spending for rheumatoid arthritis patients in the United States? An exploratory economic analysis

Background: Autonomic nervous system (ANS) testing with heart rate variability (HRV) has been shown in early research to predict 52-week outcomes in rheumatoid arthritis (RA). HRV testing could be combined with putative ANS biologic pathways to improve treatment response for RA patients. This study explored potential costs and health outcomes of introducing HRV testing into RA treatment, without and with ANS optimization.

Methods: A decision tree exploratory economic model compared HRV testing to standard care in moderate-to-severe biologic-eligible patients over a 10-year time horizon. HRV data was derived from an observational study of RA patients (n?=?33). Patients were stratified into treatment groups based on HRV test scores indicating “low probability of response” and “moderate to high probability of response”. This study explored adding ANS optimization based on HRV score followed by clinically-appropriate treatment. Costs and quality-adjusted life-years (QALYs) for the US population were estimated.

Results: HRV testing in biologic-eligible patients decreased non-effective biologic use, reducing US healthcare costs by $34.6 billion over 10 years with QALYs unchanged. When combined with ANS optimization in biologic-eligible patients, HRV testing could increase costs by $3.6 billion over 10 years but save over 350,000 QALYs. Among all RA patients, HRV testing with ANS optimization could save over $8 billion and over 100,000 QALYs over 10 years, depending on the positive predictive value (PPV) of the HRV test.

Conclusions: The potential economic impact of introducing HRV testing and ANS optimization into RA treatment appears substantial and cost-effective based on the exploratory analysis. Additional rigorous studies are warranted in larger patient samples to better inform decision-making.