A4SLR: An Agentic AI-Assisted Systematic Literature Review Framework to Augment Evidence Synthesis for HEOR and HTA.

Objectives: Systematic literature reviews (SLRs) are essential for synthesizing high-quality evidence in clinical research, health economics and outcome research (HEOR), and health technology assessments (HTAs). However, the growing volume of published data has made SLRs time-consuming, labor-intensive, and costly. To address these challenges, we introduce A4SLR, an Agentic Artificial intelligence (AI)-Assisted SLR framework, that provides a flexible, extensible methodology for automating the entire SLR process-from initial query formulation to evidence synthesis-across various study fields.

Zero Dollar Co-pay Pharmacy Benefit Decreases Healthcare Expenditures among Type 2 Diabetes Members of Blue Cross Blue Shield of Louisiana.

Objective: Blue Cross Blue Shield of Louisiana (BCBSLA) implemented the Zero Dollar Co-payment (ZDC) program on July 1, 2020. This study aims to evaluate if the ZDC program can reduce total healthcare expenditures.

Methods: BCBSLA's medical and pharmacy claims from January 2019 - December 2021 was used in this study and the index date was July 1, 2020.

Heterogeneous effects of sodium-glucose cotransporter-2 inhibitors compared to dipeptidyl peptidase-4 inhibitors on nephrolithiasis in older adults with type 2 diabetes.

Background: Type 2 diabetes (T2D) is associated with an increased risk of nephrolithiasis. Emerging evidence suggests that sodium-glucose cotransporter 2 inhibitors (SGLT2i) may reduce this risk; however, data remain inconclusive.

Objective: To examine the risk of nephrolithiasis among users of SGLT2i compared to dipeptidyl peptidase-4 inhibitors (DPP4i) in a real-world population of older adults with T2D.

Long-Term Testosterone Shows Cardiovascular Safety in Men With Testosterone Deficiency in Electronic Health Records.

Objective: Our objective is to examine the association between cardiovascular (CV) safety and long-term testosterone therapy (TTh) in men with testosterone deficiency (TD) in real-world practice.

Method: We extracted the electronic health records of 2683 adult men with TD from 3 healthcare systems from January 1, 2012, to June 30, 2023. We matched TTh and non-TTh groups in a 1:1 ratio based on age, race, Charlson Comorbidity Index, and serum testosterone level via propensity score.

Long-term cost-effectiveness of tirzepatide for individuals with type 2 diabetes and comorbid obesity.

Objectives: This study evaluates the cost-effectiveness of tirzepatide (TZP) 10 and 15 mg once weekly (QW) compared to placebo among individuals with type 2 diabetes (T2D) and comorbid obesity in the United States (US).

Research Design And Methods: The Building, Relating, Assessing and Validating Outcomes (BRAVO) Diabetes Model was used to assess the cost-effectiveness of the two TZP doses in individuals with T2D and comorbid obesity from the US healthcare perspective, using a 30-year time horizon. Treatment effects were derived from the SURMOUNT-2 trial and assumed to persist for 5 years.

Association Between Diabetes Management Behaviors and State-Level Social Vulnerability: A Cross-sectional Study.

Introduction: Type 2 diabetes mellitus remains a major public health concern in the United States. Previous research demonstrates that social determinants of health, including inequities in living conditions, directly affect the biological and behavioral outcomes associated with diabetes control and prevention. New tools such as the social vulnerability index (SVI) can be used to assess these inequities.

Treatment patterns and healthcare resource use among veterans initiating medication for incident moderate-to-severe alcohol use disorder.

Background And Objectives: Several medications for alcohol use disorder (MAUDs) are recommended to treat alcohol use disorder (AUD) in the Veterans Affairs (VA) guidelines. This study descriptively characterized treatment patterns and healthcare resource utilization (HCRU) among VA patients with AUD treated with VA-recommended MAUDs.

Methods: Veterans Health Administration data (VHA; 08/01/2013-11/30/2019) were used to identify 31,384 adults aged ≥18 years with AUD who initiated disulfiram (n = 2115), acamprosate (n = 3756), oral naltrexone (n = 25,082), or extended-release naltrexone (XR-NTX; n = 431) following AUD diagnosis.

Cost Effectiveness of Pediatric Blunt Cerebrovascular Injury Screening: A Decision Tree Analysis.

Background: Early identification of blunt cerebrovascular injury in the pediatric (<18 years) population (pBVCI) is essential to minimize stroke. However, the most cost-effective screening strategy for pBCVI is unknown, and there is high variability in practice nationwide. We sought to identify the most cost-effective screening strategy for identifying pBCVI and hypothesized that Memphis criteria (MC) would be the most cost-effective due to its high sensitivity.

Evaluating Financial Incentives as a Tool to Increase Medication Adherence for Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Introduction: Type 2 diabetes mellitus (T2DM) is a common chronic disease with high rates of complications. Although there are successful treatments, rates of medication non-adherence remain high. This study aims to evaluate the impact of financial incentives on medication adherence in people living with T2DM.

Capturing the Additional Cardiovascular Benefits of SGLT2 Inhibitors and GLP-1 Receptor Agonists Beyond the Control of Traditional Risk Factors in People With Diabetes.

Objectives: This study aimed to quantify the additional cardioprotective effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) beyond the traditional risk factors control in individuals with type 2 diabetes. This helps calibrate the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes simulation model to capture the total cardiovascular benefits of new diabetes medications accurately.

Methods: We extracted patient characteristics and treatment efficacy data from 4 cardiovascular outcome trials (CVOTs) of SGLT2is and 4 CVOTs of GLP-1RAs completed before May 2023.

Long-term health benefit and economic return of time in range (TIR) improvement in individuals with type 2 diabetes.

Objective: Time in range (TIR) is an important metric to measure variability of blood glucose levels. The aim is to quantify the long-term health benefits and economic return associated with improved TIR for individuals with type 2 diabetes (T2D).

Method: A Markov model with three states (T2D, T2D with cardiovascular disease (CVD) and death) estimated 20-year medical costs, quality-adjusted life-years (QALY) gained and CVD risk under four TIR scenarios: >85%, 71%-85%, 51%-70% and ≤50%.

The Southern Center for Maternal Health Equity (SCMHE): a multisector multifaceted community-based approach to reduce disparities in maternal morbidity and mortality in the Gulf South.

Introduction: The maternal mortality crisis in the United States disproportionately affects women who are Black, especially those living in the Gulf South. These disparities result from a confluence of healthcare, policy, and social factors that systematically place Black women at greater risk of maternal morbidities and mortality. This study protocol describes the Southern Center for Maternal Health Equity (SCMHE), a research center funded by the National Institutes of Health in 2023 to reduce preventable causes of maternal morbidity and mortality while improving health equity.

Stakeholder perspectives on facilitators and barriers to implementing a zero-dollar copay program for chronic conditions study.

Background: Type 2 diabetes mellitus (T2D) remains a pressing public health concern. Despite advancements in antidiabetic medications, suboptimal medication adherence persists among many individuals with T2D, often due to the high cost of medications. To combat this issue, Blue Cross and Blue Shield of Louisiana (Blue Cross) introduced the $0 Drug Copay (ZDC) program, providing $0 copays for select drugs.

Ensuring safety and optimization in total joint arthroplasty of cancer patients: A comprehensive analysis of complication risks and modifiable risk factors.

Aims & Objectives: The primary objective of this study is to determine whether an active cancer diagnosis results in an increased risk of perioperative TJA complications and postoperative mortality. The secondary objective is to analyze the effects of demographic factors on perioperative complication rates in cancer patients undergoing TJA.

Materials & Methods: Patients with active cancer diagnoses undergoing total joint arthroplasty from 2014 to 2020 were included in this retrospective analysis.

Characteristics and healthcare utilization of patients with myasthenia gravis exacerbation.

Purpose: This retrospective cohort study describes the characteristics of patients with myasthenia gravis (MG) who developed exacerbations (MG-E) and compares their healthcare utilization (HRU) to patients who did not experience exacerbations (MG-O).

Method: De-identified data from patients who had ≥2 MG-related diagnostic code submissions were extracted from the National Veterans Affairs Health Care Network electronic health records between 1999 and 2022. Descriptive statistics, Kaplan-Meier analysis, and per-patient per-year (PPPY) HRU were used to compare the two patient groups.

Overall Survival in Real-World Patients with Unresectable Hepatocellular Carcinoma Receiving Atezolizumab Plus Bevacizumab Versus Sorafenib or Lenvatinib as First-Line Therapy: Findings from the National Veterans Health Administration Database.

This study evaluated comparative overall survival (OS) of United States veterans with unresectable hepatocellular carcinoma (uHCC) receiving first-line (1L) atezolizumab plus bevacizumab vs. sorafenib or lenvatinib, overall and across racial and ethnic groups. In this retrospective study, patients with uHCC who initiated atezolizumab plus bevacizumab (post-2020) or sorafenib or lenvatinib (post-2018) were identified from the Veterans Health Administration National Corporate Data Warehouse (1 January 2017-31 December 2022).

Treatment Journey and Healthcare Resource Use Among Patients With Alcohol Use Disorder Who Initiated Extended-Release Naltrexone: An Analysis of Veterans Affairs Data.

Background: The US Department of Veterans Affairs, Department of Defense (VA/DoD) clinical guidelines recommend extended-release naltrexone (XR-NTX) as a treatment option for moderate-to-severe alcohol use disorder (AUD); however, contemporary real-world outcomes related to this guideline are lacking. This retrospective, observational, descriptive study examined treatment patterns and healthcare resource use (HCRU) among veterans with an AUD diagnosis who initiated XR-NTX.

Methods: Veterans with incident AUD who initiated XR-NTX between 8/2014 and 11/2018 were identified.

Sodium-glucose cotransporter 2 inhibitors and the risk of Parkinson disease in real-world patients with type 2 diabetes.

Importance: Diabetes increases the risk of Parkinson disease (PD). Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a new glucose-lowering therapeutic class, have shown neuroprotective effects in mechanistic studies. However, the association between SGLT2 inhibitors and PD risk in real-world populations with type 2 diabetes (T2D) remains unclear.

Decision Support and Behavioral Health for Reducing High-Dose Opioids in Comorbid Chronic Pain, Depression and Anxiety: Stepped-Wedge Cluster Randomized Trial.

Background: High prevalence of depression or anxiety with opioid use for chronic pain complicates co-management and may influence prescribing behaviors.

Objective: Compare clinical effectiveness of electronic medical record clinical decision support (EMR-CDS) versus additional behavioral health (BH) care management for reducing rates of high-dose opioid prescriptions.

Design: Type 2 effectiveness-implementation hybrid stepped-wedge cluster randomized trial in 35 primary care clinics within a health system in LA, USA.

Cost-effectiveness analysis of a digital diabetes-prevention programme versus an in-person diabetes-prevention programme in people with prediabetes in the United States.

Aim: To assess the cost-effectiveness of a digital diabetes prevention programme (d-DPP) compared with a diabetes prevention programme (DPP) for preventing type 2 diabetes (T2D) in individuals with prediabetes in the United States.

Methods: A Markov cohort model was constructed, simulating a 10-year period starting at the age of 45 years, with a societal and healthcare sector perspective. The effectiveness of the d-DPP intervention was evaluated using a meta-analysis, with that of the DPP as the comparator.