Objective To study the impact of financial barriers to healthcare on health status, healthcare utilisation and costs among patients with cognitive impairment. Design Cross-sectional. Setting National Health Interview Survey (NHIS), 2011–2017. Participants Patients with cognitive impairment aged 18 years or older. Interventions Financial barriers to healthcare were identified using a series of NHIS prompts asking about the affordability of healthcare services. Primary outcome measures Health status was based on a survey prompt about respondents’ general health. Healthcare utilisation included office visits, home healthcare visits, hospital stays and emergency department (ED) visits. Economic burden was based on the family spending on medical care. Logistic regression models were used to examine the impact of financial barriers to healthcare access on health status, home healthcare visits, office visits, hospital stays and ED visits, respectively. Results Compared with cognitively impaired respondents without financial barriers to healthcare access, those with financial barriers were more likely to be unhealthy (OR 0.64, 95% CI 0.57 to 0.72). Cognitively impaired respondents with financial barriers were less likely to have home healthcare (OR 0.69, 95% CI 0.48 to 0.99) and more likely to have hospital stays (OR 1.33, 95% CI 1.19 to 1.48) and ED visits (OR 1.50, 95% CI 1.35 to 1.67). In addition, compared with cognitively impaired respondents without financial barriers to healthcare access, those with the barriers were more likely to have an increased economic burden (OR=1.85, 95% CI 1.65 to 2.07). Conclusion Financial barriers to healthcare worsened health status and increased use of ED, hospitalisation and economic burden. Policy decision-makers, providers and individuals with cognitive impairment should be aware of the impact of financial barriers and take corresponding actions to reduce the impact.

Objectives To assess the cost-effectiveness of aducanumab at its updated price for treating patients with mild cognitive impairment (MCI) and mild Alzheimer’s disease (AD). Design Cost-effectiveness analysis. Settings A five-state Markov model was constructed using 10 000 virtual patients to assess the cost-effectiveness of aducanumab from the perspective of the US healthcare system. The model employed a one-year cycle time and a lifetime time horizon. Transition probabilities and mortality rates were derived from a literature review. To address uncertainty and generalise the base case results, both one-way and probabilistic sensitivity analyses were conducted. Participants 10 000 virtual patients with MCI and mild AD. Interventions The study group consisted of patients using aducanumab, while the control group consisted of those using a placebo. Primary and secondary outcome measures Primary outcomes included costs and quality-adjusted life years (QALYs). In line with the healthcare system perspective, only direct medical costs were included. Drug costs were obtained from official records, while other medical costs were derived from literature reviews. Utilities used to calculate QALYs were also obtained from the literature. Incremental analysis was conducted to assess cost-effectiveness in the base case analysis by comparing the incremental cost-effectiveness ratio (ICER) against the willingness-to-pay (WTP) threshold. A discount rate of 3% was applied to both costs and effectiveness. Results From the perspective of the US healthcare system, compared with the control group, the study group had an incremental cost of US$143 821.1 and an incremental QALY of 0.10. The ICER of patients using aducanumab compared with those using placebo was US$1 012 219.0 per QALY gained, which was much greater than the WTP threshold of US$50 000 to US$150 000, indicating that using aducanumab was not cost-effective. One-way sensitivity analysis showed the five most sensitive parameters were relative risk of progressing from MCI to mild AD, the utility of MCI, initial age, discount rate and the price of aducanumab. In the probabilistic sensitivity analysis, when the WTP was the WTP threshold of US$150 000, the probability of aducanumab being cost-effective was 0%. In addition, when the probability of aducanumab being cost-effective was 50%, the WTP was US$1 180 000, and when the probability of aducanumab being cost-effective was 95%, the WTP was US$1 906 000. Conclusions Even with the updated price being half of the original, aducanumab is still not cost-effective, underscoring the need for affordable, evidence-based AD treatments.

Background: The Food and Drug Administration (FDA) authorized three COVID-19 antivirals, including remdesivir, nirmatrelvir/ritonavir, and molnupiravir. Although medication errors involving these treatments have been reported, national-level evidence on their frequency and clinical impact remains limited. Objectives: This study aimed to evaluate medication errors and associated serious clinical outcomes linked to FDA-approved COVID-19 antivirals using national postmarketing safety data. Design: A retrospective pharmacovigilance study using postmarketing adverse event reports. Methods: We analyzed data from the FDA Adverse Event Reporting System (FAERS) from January 2020 to December 2024. COVID-19 antivirals were identified using both their generic and brand names. Medication errors were identified using MedDRA preferred terms categorized under “medication errors and other product use errors.” Serious outcomes included death, hospitalization, life-threatening conditions, disability, required medical intervention to prevent permanent harm, and other clinically significant events. Descriptive analyses summarized the report characteristics. Disproportionality analysis was performed using reporting odds ratios (RORs) with 95% confidence intervals (CIs) to evaluate associations between antivirals and medication errors, as well as between medication errors and serious outcomes. Results: Among 10,768 medication error reports involving COVID-19 antivirals, nirmatrelvir/ritonavir accounted for the highest number of reports, while molnupiravir had the highest proportion of medication errors relative to total reports. Remdesivir (ROR = 0.50, 95% CI: 0.48–0.53) and nirmatrelvir/ritonavir (ROR = 0.86, 95% CI: 0.84–0.88) were associated with lower odds of medication errors, whereas molnupiravir showed significantly increased odds (ROR = 3.98, 95% CI: 3.77–4.21). Medication errors were significantly associated with serious outcomes, including death (ROR = 1.31, 95% CI: 1.19–1.46), life-threatening events (ROR = 1.38, 95% CI: 1.21–1.57), and required interventions to prevent permanent harm (ROR = 3.84, 95% CI: 2.58–5.72). Conclusion: Medication errors involving COVID-19 antivirals remain a safety concern, particularly with molnupiravir. Errors were associated with serious outcomes, highlighting the need for targeted safety interventions in prescribing and dispensing practices to reduce preventable harm.