The study, led by researchers at the Institute for Health Metrics and Evaluation (IHME) in collaboration with partners at the University of Queensland and published in The Lancet, identified that mental disorders disproportionately impact people aged 15–19 and women. It examined the prevalence and burden of mental disorders across both sexes, 25 age groups, 21 regions, and 204 countries and territories from 1990 to 2023, making it the most comprehensive analysis of mental disorder burden to date.

The study assessed 12 mental disorders, with anxiety disorders and major depressive disorder (MDD) ranking 11th and 15th, respectively, in burden among 304 diseases and injuries worldwide.

Mental disorders are now the leading driver of disability worldwide. 

In 2023, mental disorders accounted for 171 million disability-adjusted life years (DALYs) globally, placing these conditions as the fifth-leading cause of total disease burden. DALYs are a measure of overall health loss, combining years lived with disability and years of life lost due to premature death. Mental disorders accounted for more than 17% of all years lived with disability worldwide. This reflects the substantial and growing impact of mental disorders across populations.

Recent increases have been driven largely by anxiety disorders and major depressive disorder. Since 2019, the age-standardized prevalence of major depressive disorder has risen by about 24%, while anxiety disorders have increased by more than 47%, with both conditions peaking in the years following the COVID-19 pandemic.

“These rising trends may reflect both the lingering effects of pandemic-related stress and longer-term structural drivers such as poverty, insecurity, abuse, violence, and declining social connectedness. Addressing this growing challenge will require sustained investment in mental health systems, expanded access to care, and coordinated global action to better support populations most at risk,” said first author Dr. Damian Santomauro, Associate Professor at the Queensland Centre for Mental Health Research in partnership with the University of Queensland. Dr. Santomauro is also an Affiliate Assistant Professor at IHME.

The burden peaks in adolescence and disproportionately affects women. 

Mental disorders affect individuals across all stages of life, but the types of conditions and their impact vary by age. In early childhood, conditions such as autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), conduct disorder, and idiopathic developmental intellectual disability are most prevalent, with boys affected at higher rates than girls. As children grow into adolescence, anxiety and MDD are the leading contributors to mental disorder burden.

“Our findings show that mental disorder burden peaks among 15–19-year-olds, which is a critical developmental period that can shape trajectories for education, employment, and relationships,” said co-author Dr. Alize Ferrari, Honorary Associate Professor at the Queensland Centre for Mental Health Research in partnership with the University of Queensland. Dr. Ferrari is also an Affiliate Assistant Professor at IHME.

In 2023, 620 million women of all ages were living with a mental disorder compared to 552 million men of all ages globally. Women accounted for 92.6 million DALYs, compared to 78.6 million among men, indicating a higher overall burden. These differences are likely shaped by a complex mix of factors, including greater exposure to domestic violence and sexual abuse, increased caregiving responsibilities, and structural inequalities such as gender discrimination.

Mental disorders impact populations worldwide, highlighting gaps in care. 

Mental disorders burden increased in every region of the world between 1990 and 2023, though the scale and pattern of that burden differ substantially across regions and levels of development. High-income regions such as Australasia and Western Europe recorded some of the highest burden rates globally, particularly in countries like the Netherlands, Portugal, and Australia. Large increases in mental disorder burden rates were also observed in Western sub-Saharan Africa and parts of South Asia.

These patterns translate into substantial impacts for communities worldwide. Mental disorders impact families and caregivers, reduce workforce participation and productivity, and place growing demands on health systems and government resources. GBD analyses estimate that only about 9% of individuals with major depressive disorder globally receive minimally adequate treatment, with less than 5% receiving adequate care in 90 countries. Across 204 countries and territories, only a small number of high-income settings, including Australia, Canada, and the Netherlands, have treatment coverage exceeding 30%, highlighting major global gaps in care.

Expanding access to services, particularly in low- and middle-income countries, will be critical to improving coverage. Achieving this will require coordinated global action and sustained investment in mental health systems to improve outcomes worldwide.

For interviews with the authors, please contact IHME’s Media Team at ihmemedia@uw.edu.

The Inflation Reduction Act of 2022 mandated an out-of-pocket cap of $35 for a 30-day insulin supply for Medicare Part D beneficiaries starting January 1, 2023. This is the first time the federal government has imposed caps on insulin prices for all Medicare beneficiaries.

For their study, the researchers analyzed Medicare claims data covering nearly 3.8 million patients who had at least one claim for insulin during the five-year period from 2019 to 2023.

The percentage of these patients who paid $35 or less out of pocket for a 30-day equivalent supply increased from 48% in 2019 to 75% in 2023.

The findings were published online in a peer-reviewed research letter March 19 in JAMA.

The study also showed that the mean out-of-pocket cost for that quantity of insulin dropped from $50.87 in 2019 to $21.98 in 2023. Cost decreases during 2019–2023 were seen in every U.S. state. The study is thought to be the first to analyze the Inflation Reduction Act’s insulin-cap impacts.

“This is compelling evidence that Medicare policies in recent years have done what they were meant to do—improve insulin access and affordability,” says study lead author Michael Fang, PhD, MHS, assistant professor in the Bloomberg School’s Department of Epidemiology. “Insulin costs are now at historically low levels for people on Medicare.”

The researchers note that the finding that about one-quarter of Medicare beneficiaries paid more than $35 for a 30-day supply of insulin in 2023 was unexpected. Their analysis found that these beneficiaries had at least one prescription that was not prorated to the Inflation Reduction Act limit.

Approximately 3.8 million Medicare beneficiaries use insulin as a treatment for type 1 or type 2 diabetes. Insulin replaces the natural metabolic hormone of the same name, whose production is virtually nonexistent in type 1 diabetes, and is also compromised in many cases of type 2 diabetes.

To help rein in insulin costs for beneficiaries, the Centers for Medicare & Medicaid Services (CMS) capped out-of-pocket cost at $35 for a 30-day supply in 2021 as a limited, voluntary initiative. The Inflation Reduction Act of 2022’s mandated $35 cap for out-of-pocket cost for a 30-day supply for Medicare Part D beneficiaries took effect January 1, 2023.

The study covered all Medicare Part D patients who had at least one claim for insulin during the study window and were not receiving Medicare low-income subsidies. The researchers grouped the claims data into five calendar years from 2019 to 2023 for their analysis.

As for the insulin-using Medicare Part D beneficiaries still paying more than $35 for a 30-day supply in 2023, Fang notes that CMS’s formal guidance is for the $35 rule to be applied only for full multiples of 30 days. “If the prescription falls in between, the patient can be charged up to the next full multiple of a month,” Fang says. “For example, health plans can treat a 45-day supply the same as a 60-day supply and charge up to $70.”

He adds that variations in average 30-day insulin costs by state—from $10.36 in Washington, D.C., to $31.09 in Minnesota in 2023—may partly reflect state-level differences in how pro-rating is handled by Medicare insurance plans.

The researchers are now exploring the issue of prorating prescriptions that fall outside the current 60- and 90-day supply window to see in more detail how average costs vary across plans, and whether policy changes are needed to close the gap.

“Trends in Insulin Out-of-Pocket Costs Among U.S. Medicare Beneficiaries” was co-authored by Michael Fang, Chen Dun, Dan Wang, Caitlin Hicks, Elizabeth Selvin, Jung-Im Shin, and Mariana Socal.

Support for the research was provided by the National Institute of Diabetes and Digestive and Kidney Diseases (K01DK138273, R01DK139324).

The emergence of online healthcare via mobile apps has brought about changes in the availability of and demand for health care. The current study, published in The Economic Journal, analyzes the consumption patterns of 19- and 20-year-olds.

The study is based on data from young people in the regions of Stockholm and Västra Götaland. During the study period, 1 9-year-olds were not charged a co-pay for online consultations, while 20-year-olds had to pay a fee..

Price sensitivity among patients was evident. Those who had turned 20 had on average half the number of online consultations compared to 19-year-olds. Women generally had higher consultation rates than men, and experienced a sharper decline once they turned 20.

The value of easing worries

“People often seek online healthcare for simple ailments, a type of care for which price generally matters more,” says Gustav Kjellsson, a researcher in health economics at the University of Gothenburg. “This doesn’t necessarily mean that it is unwarranted care. It’s important to bear in mind that without access to medical expertise, it is difficult to determine which healthcare needs you actually have. Easing people’s worries also has a value.”

The researchers estimate that 45% of the online consultations by 19-year-olds substituted a physical visit, while the remaining 55% represented care that would not have taken place without easy access to online care.

“These often relate to respiratory infections, skin conditions, and healthcare related to sexual and reproductive health, such as contraceptive management, which would typically be handled by a midwife,” he continues. “What we are seeing is a shift toward more care provided by doctors.”

Cost-neutral increase in volume

The researchers found no measurable negative medical effects from the shift toward more online and fewer in-person consultations, either on follow-up care or complication rates. A secondary finding is that young men, who are generally less inclined to seek healthcare, increased their visits to youth clinics.

“This may be an effect of an initial online doctor consultation,” says Gustav Kjellsson. “Accessibility may make it easier to seek help for conditions that are sensitive in nature, such as sexually transmitted diseases.”

The Swedish debate on online doctors involves quality of healthcare, resource allocation, the extent to which the burden on primary care is relieved, and not least how the regions reimburse private online doctor consultations. Against this background, there is another finding in the study that the researchers say stands out: The increased consumption of healthcare among 19- and 20-year-olds did not result in higher total production costs.“Interestingly, our estimates indicate that the increased volume of healthcare is more or less cost neutral. The regions’ costs for digital healthcare are not primarily due to production costs, but to the reimbursement models of private online consultation.”

A research team including experts from IIASA and the Vienna University of Economics and Business (WU Vienna) has calculated the economic impact of diabetes across 204 countries from 2020 to 2050. The findings are striking: Excluding informal care provided by family members, global costs amount to approximately US$ 10 trillion – equivalent to 0.2% of the annual global GDP. When informal care is factored in, costs soar to as much as US$ 152 trillion, or 1.7% of GDP. This is particularly significant for diseases like diabetes.

“Caregivers often drop out of the labor market, at least partially, which creates additional economic costs,” explains WU economist Klaus Prettner, one of the study authors.

The high share of informal caregiving, ranging between 85% and 90% of the total economic burden, is explained by the fact that prevalence exceeds mortality by a factor of 30-50. Although diabetes is more common in lower-income countries, the United States bears the highest absolute costs, followed by China and India.

”To some extent, these rankings reflect the size of the economies included in our analysis in terms of GDP and population, but it is interesting to note that at 0.5% the Czech Republic has the highest burden as a percentage of GDP, followed by the United States and Germany at 0.4%. Ireland, Monaco, and Bermuda face the largest per capita economic burdens at $18,000, $12,000, and $8,000 dollars respectively,” notes coauthor Michael Kuhn, Acting Economic Frontiers Research Group Leader at IIASA.

One prime distinction between high- and low-income countries is the distribution of the burden across the treatment cost and lost labor channels, where the former makes up 41% of the economic burden (net of caregiving) for high-income countries as opposed to 14% for low-income countries.

“This is a stark illustration of how medical treatment regimes for chronic diseases such as diabetes are accessible to high income countries only,” Kuhn adds.

Role of COVID-19
Diabetes has proved to be one of the main risk factors for mortality from COVID-19. In a side analysis the authors explored how the economic burden of diabetes has been affected when factoring in morbidity and mortality from COVID-19 that can be attributed to diabetes. The effects are sizeable, where the economic burden increases from 0.16% to 0.22% per unit of GDP for China, from 0.4% to 0.65% per unit of GDP for the US, and from 0.4% to 0.45% per unit of GDP for Germany.

“Previous estimates of diabetes-related costs were often based on overly simplified assumptions and tended to ignore economic dynamics,” says Prettner. “This study’s innovative approach incorporates labor market effects, such as work absences due to caregiving responsibilities. It also recognizes that healthcare spending does not necessarily reduce economic output but often represents a shift from consumer spending toward health sector spending.”

Urgent need for policy action
When compared to other diseases over the same period, such as Alzheimer’s, dementia, or cancer, the economic impact of diabetes is enormous. The authors emphasize that the most effective way to prevent diabetes and reduce its economic impact lies in promoting healthier lifestyles. Regular physical activity combined with a balanced diet can significantly lower the risk of developing the disease.

In addition, early detection plays a crucial role: comprehensive diabetes screening programs for the entire population, along with rapid diagnosis and timely treatment for individuals showing symptoms or risk factors, are essential steps toward mitigating both health and economic consequences.

“Such steps are particularly relevant for low-income countries, where high levels of underdiagnosis and its role in raising mortality from infectious diseases render diabetes a severe risk factor for the stability of health care systems,” Kuhn concludes.

Reference
Chen, S., Cao, Z., Chen, W., Zhao, J., Jiao, L., Prettner, K., Kuhn, M., Pan, A., Bärnighausen, T.W., Bloom, D.E. (2025). The global macroeconomic burden of diabetes mellitus. Nature Medicine DOI: 10.1038/s41591-025-04027-5

“If we can get more patients to continue taking their blood pressure medication and refrain from discontinuing their treatment, this will clearly improve their cardiovascular health and they will live longer,” says Karl Laurell, a researcher at Uppsala University. “At the same time, healthcare costs decrease if patients are prescribed the medicine they are most likely to persist with from the start. For patients and doctors, these findings mean that ARB drugs should be the preferred choice when treatment for high blood pressure is initiated, unless there are obvious reasons to choose something else.”

A risk factor for cardiovascular disease

High blood pressure is the most important risk factor for cardiovascular disease and premature death. At least 1.8 million people in Sweden are estimated to have high blood pressure. There are several effective drugs that lower blood pressure and prolong life, but despite this, many patients fail to achieve their treatment goals. Many also stop taking their medicine. The researchers in this study therefore wanted to investigate whether the choice of the first medication affects the way the treatment works in the longer term.

The study compared the four classes of drugs that are recommended most strongly for treating high blood pressure: angiotensin receptor blocker (ARB), angiotensin-converting enzyme inhibitor (ACEi), calcium channel blocker (CCB), and thiazide/thiazide-like diuretic (TD).

340,000 participants

The study is based on data from several national healthcare registers and involves more than 340,000 people with high blood pressure but without previous cardiovascular disease. The participants began their treatment between 2011 and 2018 and were followed for several years, focusing on how well they persisted with their original treatment.

Fewer side effects with ARB treatment

The results show that patients who started with ARB continued with the same drug class over time to a greater extent than others. After five years, 80 per cent of these patients were still showing good adherence to their original medicine, compared with 65 per cent for calcium channel blockers, the second best drug class. The majority of those who stopped taking their medicine continued their treatment but with another blood pressure drug, usually ARB.

“The primary explanation is probably that ARB has fewer side-effects than other drugs. Patients who are already using another blood pressure medicine that works well for them without side-effects have no reason to change. Having said that, it’s important to check your blood pressure regularly as it often rises with age and further medication may then need to be added,” says Laurell.

Post-traumatic stress disorder (PTSD) is a significant anxiety disorder that can be triggered as a result of witnessing or experiencing a traumatic event or events. It is estimated that across the UK military and civilian population, 4% of people – or 2,612,000 individuals – have PTSD, with a total of 6,665,000 people expected to develop PTSD at some point in their life.

Despite increased awareness of mental health conditions and the increased prevalence of PTSD, the disorder continues to be misunderstood, misdiagnosed and stigmatised, and the cost to the UK economy has been unknown.

Now, new research from the University of Birmingham has found that the economic and societal burden of PTSD in the UK is far greater than previously understood.

The research was funded by Supporting Wounded Veterans and The Veterans Foundation, and published in BMJ Open.

Paul Montgomery, Professor of Social Intervention at the University of Birmingham, said: “Health and well-being can have significant impacts not only on individuals’ economic situations, but also on the wider UK economy. Appointments, treatment, missed work and other related issues can all add up quickly. The impact that poor mental health can have on the economy has been recognised by successive governments, with various pledges being made to reduce this cost. But, now for the first time, we have a more detailed and current picture of what part of that previously unknown cost is when it comes to PTSD.”

The researchers analysed databases for different types of quantitative data that evaluated the direct and indirect economic and societal costs related to PTSD from 1990-2023.

Direct costs included hospital (inpatient beds), medication, general practitioner/doctors, treatment for alcohol and/or substance abuse, psychiatrists, psychologists, and counsellor costs.

Indirect costs include homelessness, disability living allowance, unemployment allowance, productivity loss at work (absenteeism and presenteeism), home-care workers, social workers (mental health), and premature mortality.

The researchers found that the annual average direct excess costs for a patient with PTSD in the UK is approximately £1,118, whilst the average indirect cost is £13,663 per year, totalling £14,781, with a range from around £11,373 to £16,797. Based on the prevalence figures for PTSD, this comes out at an average annual cost to the UK economy of £40 billion.

Siddhartha Bandyopadhyay, Professor of Economics, explained: “Despite this detailed breakdown of costs and this high figure, there are other factors that may add further costs which we are not able to provide figures for. It is incredibly hard to measure the cost of stigma and discrimination, which could lead to reduced income and a higher dependence on social security assistance. There may also be an increased cost relating to criminal justice, relationship and family support services, and education. This suggests that the actual costs of PTSD on the economy may well exceed that £40 billion figure.”

The researchers also acknowledge that PTSD is often present with other mental health conditions, so disentangling one condition from the other is difficult, and the severity of PTSD can vary from person to person.

Professor Montgomery concluded: “PTSD affects millions of people in the UK, and as a result of the COVID-19 pandemic, it is anticipated that there will be a rise of 77,000 cases per year. This presents even more demand for social and economic services and further increases in the associated costs.

“If the government is serious about reducing the cost of poor mental health and well-being on the economy, then collecting high-quality and accurate cost data, developing more effective therapies and expanding evidence-based interventions for PTSD should be a key part of that plan.”

The IRA starting this year caps Medicare beneficiaries’ annual out-of-pocket costs at $2,000 for covered drugs and eliminates the longstanding “coverage gap” for those with moderate drug spending — while shifting more costs onto Part D plans.

Although these changes provide Medicare beneficiaries with crucial protection against high drug costs, the vast majority won’t reach the $2,000 limit. Instead, most who don’t hit the cap will likely face higher out-of-pocket costs as insurers scale back plan features that make prescriptions more affordable at the pharmacy counter.

The white paper identifies two major shifts in Part D plan offerings that leave patients more exposed to drugs’ sticker prices:

• A sharp increase in annual deductibles, or the amount that patients pay out of pocket before coverage begins.
• Fixed co-pays for common brand-name drugs are increasingly being replaced with coinsurance, in which patients pay a percentage of a drug’s list price, often a much higher amount.

“The new annual cap will provide valuable relief to the small share of beneficiaries with the highest drug spending. But our research shows this comes with a clear tradeoff — most  Medicare beneficiaries will likely see their drug costs go up,” said lead author Erin Trish, co-director of the Schaeffer Center and associate professor at the USC Mann School of Pharmacy and Pharmaceutical Sciences.

Shifting costs

Researchers analyzed Part D stand-alone prescription drug plans and drug coverage within more comprehensive Medicare Advantage plans from 2020 to 2025.

Average annual deductibles in Medicare Advantage drug plans nearly quadrupled from $62 to $224 between 2024 and 2025, reversing years of declines or modest growth. This was largely driven by a steep decrease in the share of enrollment in more generous, “enhanced” plans with zero deductible, which fell from 78% to 41%.

In stand-alone drug plans, average deductibles jumped from $425 to $491 — the largest annual increase since at least 2020.

The share of enrollment in Medicare Advantage drug plans requiring coinsurance, rather than co-pays, for common brand-name drugs also sharply increased, from 2.6% in 2024 to 27.5% this year.

In the stand-alone drug plan market, this shift toward coinsurance has been more substantial and sustained. This year, 84.1% of enrollment was in plans requiring coinsurance for these medications, compared to 9.9% in 2020.

By linking drug costs to list prices, beneficiaries typically could expect to pay much more for widely used brand-name drugs, such as the blood thinner Eliquis or diabetes treatment Ozempic, the researchers found in a recent JAMA study. Coinsurance amounts, usually about 25% of a drug’s list price, are being driven higher as list prices are artificially inflated by secret rebates and discounts negotiated by pharmacy benefit managers.

The researchers said beneficiary costs for certain drugs may decrease in 2026, when the first prices set under IRA-mandated Medicare negotiations take effect. However, because of the expanding use of coinsurance, patients may still find themselves paying more for those drugs than they would have with flat copays.

“Despite the IRA’s many changes, patients are still burdened by a fundamental flaw in the drug pricing system,” Trish said. “Pharmacy middlemen continue to pocket savings while patients are left to shoulder rising list prices. Providing rebates directly to patients would meaningfully lower their costs, ensuring more people can access needed therapies.”

Barbara Blaylock, founder of Blaylock Health Economics LLC, is a co-author. This white paper was supported by the Schaeffer Center. A complete list of supporters of the Schaeffer Center can be found in our annual report.

The survey found almost 20% of Americans aged 49 and under needed to borrow money to cover medical costs compared with just 9% of those 50 to 64. Women between the ages of 50 and 64 were twice as likely as men in the same age group to say they had to borrow (12% vs. 6%). Two percent of Medicare-eligible adults (those over the age of 65) reported having to borrow.

“Too many Americans are racking up medical debt whether they have health insurance or not,” said Tim Lash, President, West Health Policy Center, part of West Health, a family of nonprofit organizations focused on healthcare and aging. “A high-priced healthcare system that requires Americans to take out loans or make painful tradeoffs just to stay healthy is in desperate need of policy reform or things will get even worse.”

Black (23%) and Hispanic adults (16%) were significantly more likely to report having borrowed money than White (9%) adults. The biggest disparities were found among adults under the age of 50. Black adults aged 18-49 (29%) were the biggest borrowers followed by Hispanic adults (19%) and White adults (14%) in the same age range. Americans with children under the age of 18 were twice as likely to report borrowing compared to households with no children (19% vs. 8%).

Breakdown of Borrowing

Americans collectively borrowed about $74 billion to pay for healthcare last year, with more than half (58%) borrowing $500 or more and 41% borrowing $1,000 or more. Fourteen percent borrowed $5,000 or more.

Concerns Over Medical Debt Across Age, Race and Income

Most Americans (58%) report being at least somewhat concerned that a major health event could land them in debt, including 28% who say they are “very concerned.” Concerns span income levels, with more than six in 10 households with annual incomes under $120,000 worried. Fewer higher earners were concerned, but 40% of households making over $180,000 report they too have concerns.

Even with Medicare eligibility, more than half (52%) of people aged 65 or older say they are at least somewhat concerned they could go into medical debt if they suffered a major health event. Concerns also run high among Black adults (62%), Hispanic adults (63%) and women (62%). Only 14% of respondents say they are not concerned at all.

“It is clear that high healthcare costs continue to burden the American people, and financial insecurity around care is not limited to any one demographic,” said Dan Witters, director of wellbeing research at Gallup. “These findings underscore the need for solutions that make healthcare more affordable for all Americans.”

Methodology

The West Health-Gallup Survey was conducted via web Nov. 11-18, 2024, with a nationally representative sample of 3,583 U.S. adults aged 18 and older. The margin of sampling error is ±2.1 percentage points at the 95% confidence level.

About West Health

Solely funded by philanthropists Gary and Mary West, West Health is a family of nonprofit and nonpartisan organizations that include the Gary and Mary West Foundation and Gary and Mary West Health Institute in San Diego and the Gary and Mary West Health Policy Center in Washington, D.C. West Health is dedicated to lowering healthcare costs to enable seniors to successfully age in place with access to high-quality and affordable health and support services that preserve and protect their dignity, quality of life and independence. Learn more at westhealth.org.

About Gallup

Gallup delivers analytics and advice to help leaders and organizations solve their most pressing problems. Combining more than 80 years of experience with its global reach, Gallup knows more about the attitudes and behaviors of employees, customers, students and citizens than any other organization in the world.

The findings from the landmark REGARD-VAP trial, published in Lancet Respiratory Medicine, and the accompanying economic analyses published in Lancet Global Health, highlight how prudent antibiotic use can curb resistance, effectively safeguarding patients as well as combatting the global threat of antimicrobial resistance while reducing healthcare costs.

Led by the NUS Medicine research team, the clinical trial examined over 450 patients across intensive care units (ICUs) in Singapore, Thailand, and Nepal. Results revealed that short-course antibiotics—carefully tailored to individual patients’ recovery—are just as effective as traditional longer treatments in preventing death and recurrence of pneumonia. “By shortening the duration of antibiotics, we can reduce the risks of side effects and resistance without compromising patient outcomes,” added Dr Mo Yin, Junior Academic Fellow at the Department of Medicine, NUS Medicine, and principal investigator of the clinical trial, and co-author of the economic analysis.

The economic analyses, led by the Duke-NUS research team, accompanying the trial were just published in the prestigious journal Lancet Global Health. They demonstrated that adopting short-course antibiotics offers significant value for healthcare systems. In Singapore, the strategy is cost-saving, reducing hospital expenditure while maintaining excellent outcomes for patients. In Thailand and Nepal, short-course antibiotics were highly cost-effective, with health gains outweighing the modest additional costs incurred. “Short-course antibiotics are a pragmatic solution that benefits patients and healthcare systems alike, particularly in resource-limited settings,” said Assistant Professor Yiying Cai, lead researcher from the Health Services and Systems Research Programme at Duke-NUS.

The REGARD-VAP study’s findings have practical implications for hospitals worldwide. Short-course antibiotics can streamline treatment in ICUs, where managing infections efficiently is vital. The approach is effective across high-income (Singapore), middle-income (Thailand), and low-income (Nepal) settings, making it a scalable solution for diverse healthcare systems. These results provide robust evidence including cost-effectiveness data for policymakers to adopt short-course antibiotics into national and institutional guidelines.

The team hopes to disseminate their findings globally to encourage the adoption of short-course antibiotics, particularly in regions with limited resources. They also advocate for integrating cost-effectiveness studies into future clinical trials to strengthen both clinical and economic decision-making processes. By reducing unnecessary antibiotic exposure, short-course treatments help preserve the effectiveness of existing drugs for future generations. Every additional day of antibiotic use increases the risk of drug resistance by 7%. Reducing treatment duration is a critical step in combating this silent epidemic. “Prudent antibiotic use is essential to combat antimicrobial resistance and optimise healthcare outcomes. Our findings[1] make a strong case for adopting short-course antibiotics as the new standard of care,” concluded Dr Mo Yin.

The REGARD-VAP trial was supported by the UK Medical Research Council, the Wellcome Trust and National Research Foundation, Singapore, under its Central Gap Fund (Award ID: CTGIIT18may0005). The trial, which combines clinical and economic data, sets a new benchmark for trials that evaluate healthcare interventions.

[1] Any opinions, findings and conclusions or recommendations expressed in this material are those of the author(s) and do not reflect the views of National Research Foundation, Singapore.

The study, published Dec. 3 in the journal Health Affairs, analyzes local and market characteristics of pharmacy closures between 2010 and 2021. With thousands of more pharmacy closures expected in the coming years, researchers said their findings offer a roadmap for identifying which communities are most at risk of losing drugstores and for crafting policies that may help them survive.

“At the same time many states are making efforts to expand the scope of pharmacy services beyond dispensing drugs to include the provision of preventive and emergency care, we found that there are—for the first time for at least a decade—fewer pharmacies available to provide them,” said senior author Dima Mazen Qato, a senior scholar at the USC Schaeffer Center for Health Policy & Economics and the Hygeia Centennial Chair and associate professor at the USC Mann School of Pharmacy and Pharmaceutical Sciences.

Accelerating closures have led to net loss in pharmacies for the first time since at least 2010

For most of the 2010s, pharmacy openings in the U.S. outpaced closures. And in previous work, the researchers found that pharmacies closed at a much slower rate during the first half of the decade, with 1 in 8 drugstores shuttered between 2009 and 2015.

Their new study finds an unprecedented decline in the number of pharmacies began in 2018, primarily driven by closures of chain pharmacies during an active period for industry consolidation. This included the merging of large pharmacy chains with dominant pharmacy benefit managers (PBMs), which negotiate prescription drug benefits and steer patients to preferred pharmacies.

Researchers identified pharmacies using a registry maintained by a national nonprofit and linked the data to county- and neighborhood-level data from the U.S. Census Bureau and the National Center for Health Statistics. Among their findings:

• Between 2018 and 2021, the number of pharmacies declined in 41 states. During the entire study period (2010-2021), nearly one-third of counties experienced a net decline in pharmacies, affecting 91.6 million people.
• In seven states, more than half of counties experienced a net decline in pharmacies: Illinois, Maine, Mississippi, New York, Pennsylvania, Rhode Island and Vermont.
• At the community level, pharmacy closure rates were higher in predominately Black and Latino neighborhoods—37.5% and 35.6%, respectively—than predominately white ones (27.7%).

The last finding is partly explained by the struggles of independent pharmacies, which were more than twice as likely to close as chain stores. They were also much more likely to be in Black, Latino and low-income neighborhoods, as well as those with disproportionate rates of people with Medicare or Medicaid coverage.

“Our findings suggest that closures may widen health disparities in access to prescription and other essential pharmacy services, such as vaccinations and pharmacist-prescribed regimens, including contraceptives, medications for HIV prevention, and treatments for opioid use disorder,” said first author Jenny Guadamuz, an Assistant Professor at the UC Berkeley School of Public Health and the Health Equity Program Director for the UC-Berkeley Center for Health Management & Policy Research.

“Without safeguarding pharmacies in marginalized neighborhoods, expanding health care services at pharmacies may enhance convenience for more affluent populations while failing to address the health needs of communities disproportionately affected by pharmacy closures, particularly Black and Brown populations in low-income urban areas,” added Guadamuz.

Preventing Future Closures

“As highlighted in a recent FTC report, a key factor contributing to the higher risk of closure for independent pharmacies may be their frequent exclusion from preferred pharmacy networks,” said Guadamuz. PBMs use preferred pharmacy networks to encourage patients to visit certain locations by offering lower cost-sharing or out-of-pocket costs. The recent mergers of large pharmacy chains and PBMs also likely contributed to low reimbursements from PBMs at these combined companies to independent pharmacies and rival chain pharmacies, the researchers added.

The researchers said federal and state policymakers should consider policies that would increase participation of independent pharmacies in preferred networks. This could include mandating Medicare and Medicaid plans to give preferred status to pharmacies at heightened risk of closure or those serving “pharmacy deserts” with reduced access to pharmacy services.

In the commercial market, federal and state regulators should also consider requiring that PBMs’ preferred networks do not disproportionately favor pharmacy chains, including those part of the same company, the researchers said.

“Federal, state and local policies and programs should consider targeted strategies, including increases in Medicare Part D and Medicaid pharmacy reimbursement rates, to protect critical access pharmacies most at-risk for closure, particularly those serving neighborhoods that are or are at risk of becoming pharmacy deserts,” Qato said.

Prescription medications are not universally covered under Canada’s 13 provincial and territorial health insurance systems. In 2021, Canadian households paid more than $7.4 billion out of pocket for prescription medications.

The study, which included a nationally representative sample of more than 223 000 respondents over age 12, was conducted to better understand the burden of prescription costs in Canada. One in 20 (5%) respondents reported cost-related nonadherence, meaning they skip or reduce dosages, delay refilling prescriptions, or do not fill prescriptions at all because of out-of-pocket costs. The authors found that females were 44% more likely to report cost-related problems than males, as were bisexual, pansexual, and questioning individuals (43%).

“Our findings show that intersections of personal, health, and health care system factors affect whether people in Canada skip or cut back on medications because of cost. We saw this pattern in the overall population and in both males and females when looking at them separately,” says Dr. Mary De Vera, a pharmacoepidemiologist and associate professor in medication adherence in the Faculty of Pharmaceutical Sciences at University of British Columbia and Arthritis Research Canada, Vancouver, BC.

Race and ethnicity were also associated with prescription affordability, with Indigenous, Latin American, West Asian, Arab, Black, and multiracial people having 20%–67% higher odds of nonadherence. People aged 18–34 years were 9 times more likely to report cost-related nonadherence than adults aged 75 years and older.

People living in Quebec were least affected by prescription costs, as each province has its own drug insurance program.

“The lack of national standards for these programs has led to interprovincial disparities in public drug coverage related to eligibility, premiums, and cost-sharing policies (e.g., deductibles, co-payments, out-of-pocket limits) and has created the need for financing of prescription drugs via private insurance and out-of-pocket costs incurred by patients,” says Nevena Rebić, a postdoctoral fellow at the University of Toronto who led the analysis.

Previous studies have been restricted to specific populations or a narrow time frame, whereas this study is more comprehensive and includes data from 5 iterations of the Canadian Community Health Survey from 2015 to 2020.

The authors suggest that these findings can help inform public drug coverage plans, premium amounts, and other ways to reduce financial barriers to prescription medications in Canada.

In October 2024, Canada took concrete steps to ensure a national pharmacare program, as it became law under Bill C-64.

“As an initial step toward full national pharmacare, it is a laudable achievement,” writes Dr. Matthew Stanbrook, deputy editor, CMAJ, in a related editorial https://www.cmaj.ca/lookup/doi/10.1503/cmaj.241650. “Yet the legislation is low on substance, high on promises and aspirations, and vulnerable to political change. This leaves people living in Canada mired in uncertainty as to when or whether they will have the guaranteed access to medications and therapies, regardless of ability to pay, that citizens of almost all other countries with a public health care system receive.”

He urges the federal government and people of Canada to ensure that pharmacare is extended in the future.

A new study published today in Health Affairs Scholar suggests that 52% of Medicare beneficiaries with stand-alone Part D plans did not switch because they made no plan comparisons at all for 2024. Many of these beneficiaries (41%) also reported not knowing how to switch plans.

“Comparing these Medicare Part D plans is hard, so many beneficiaries just don’t do it. But beneficiaries who don’t compare plans may not notice if they are sticking with more expensive plans or plans that are not optimal for their health conditions,” said lead author Wändi Bruine de Bruin, director of the Behavioral Science & Policy Initiative at the USC Schaeffer Institute for Public Policy & Government Service.

This study confirms a long-standing suspicion that beneficiaries with stand-alone Part D plans do not switch because they do not compare plans.

“Not surprisingly, my mother delegated her Medicare Part D decisions to me, her PhD health economist son,” said Dana Goldman, director of the Schaeffer Institute. “I paid close attention the first year. Eventually, the decisions became so complicated that I stopped comparing plans.”

The average beneficiary can choose from about 12 to 18 Part D plans that have varying deductibles, co-pays, access to drugs, pharmacy networks and other features which may change from year to year. Making an active choice may be especially important in the ongoing enrollment period for 2025 coverage, which runs through Dec. 7, due to premium increases in some plans, according to the healthcare policy research organization KFF.

For their study, researchers surveyed 439 Medicare beneficiaries with stand-alone Part D plans from the Understanding America Study at USC, a nationally representative sample of U.S. adults. The survey was conducted in the weeks immediately following the close of the 2024 enrollment period. Among their findings:

• Nearly all of those who said they did not compare coverage options last year did not switch plans (98%). Among those who shopped around, 67% did not switch plans.
• The 52% who said that they didn’t compare or switch plans were more likely than those who switched to say they perceived switching as difficult.
• They were also more likely to report their existing plans were continued, had not been changed and were satisfactory. They were less likely to rely on plan advisors or the Medicare Plan Finder website, which allows people to compare coverage options based on personal need.
• Beneficiaries who did compare plans but kept their coverage said that they didn’t find it hard to compare or switch. However, they reported receiving more mailed marketing, which consumers may find overwhelming, and they were less likely to have a college degree.

Previous research from study co-authors indicated that beneficiaries who did not switch plans risk ending up in plans that aren’t financially optimal, potentially resulting in overspending by hundreds of dollars or more per year. This overspending could have health consequences if people then try to manage their costs by limiting their use of prescribed medicines.

Recognizing that most beneficiaries often stay in the same plan, Part D insurers may be exploiting this complacency to boost profits, other researchers have found.

“Our research on Part D indicates that a common strategy is for plans to start with a low premium to attract enrollees and then take advantage of their inattention by raising premiums year after year,” said Erin Trish, co-director of the Schaeffer Center for Health Policy & Economics. “Since most beneficiaries don’t switch plans, they end up paying higher premiums than they need to.”

The study authors suggested that beneficiaries may welcome policies that reduce the need for shopping, such as auto-enrollment into an optimal plan or extending the coverage period from one year to multiple years. While those options may be politically challenging, policymakers could do more to make plan shopping less daunting for Medicare beneficiaries, said Bruine de Bruin, who is also Provost Professor of Public Policy, Psychology, and Behavioral Science at the USC Price School of Public Policy and the USC Dornsife Department of Psychology.

Bruine de Bruin said: “Policymakers often think that it is good to give people lots of choices because it makes companies compete to offer the best plans. But having lots of choices can be so overwhelming that people just stick with their old plan year after year, potentially at a major cost to themselves and the government.”

Read the release online here.