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Article History

Received: 11 December 2025

Accepted: 21 May 2026

First Online: 30 July 2026

Declarations

Conflict of interest: There are no competing interests to declare beyond the funding support disclosed above.

Availability of data and materials: This study used a combination of data extracted from publicly available published sources and confidential proprietary data provided by MSD Portugal. All publicly available data are cited within the article. The proprietary datasets from MSD Portugal are not publicly available, due to confidentiality and licensing restrictions, but may be available from the corresponding author upon reasonable request and with permission from MSD Portugal.

Author contributions: PC, JS, JF, and BR were responsible for conception and design of the study, and contributed to the interpretation of the results. PC was responsible for carrying out the initial analyses, performed statistical analyses, contributed to the interpretation of the results, and drafted the first version of the manuscript. All authors critically reviewed the manuscript for important intellectual content. All authors approved the final version of the published manuscript and agree to be accountable for all aspects of the work.

Ethics approval: Not applicable.

Consent to participate: Not applicable.

Consent for publication: Not applicable.

Code availability: The Microsoft Excel-based model used in this study contains proprietary inputs and structures derived from multiple cost-effectiveness models submitted to INFARMED I.P. and is therefore not publicly available. Additional details may be provided by the corresponding author upon reasonable request, subject to permission from MSD Portugal.