Forum for Health Economics and Policy最新文献

Chronic obstructive pulmonary disease (COPD) is a group of progressive lung diseases, leading to increased healthcare use, expenditures, and risk of mortality. In June 2024, the Institute for Clinical and Economic Review (ICER) released a traditional cost-effectiveness analysis (CEA) of ensifentrine + background maintenance therapy (BMT) for the treatment of moderate-to-severe COPD. This study's objective is to analyze the sensitivity of ICER's traditional CEA methods to various adjustments to their model, including Generalized Cost-Effectiveness Analysis (GCEA) elements such as generalized risk-adjusted cost-effectiveness (GRACE), dynamic pricing, and stacked cohorts. A Markov model simulated the value of ensifentrine + BMT relative to BMT only for treating moderate-to-severe COPD, with patients transitioning across health states defined by levels of lung functionality. We estimated the annual value-based prices (VBPs) and incremental cost-effectiveness ratios of ensifentrine + BMT relative to BMT using traditional CEA and GCEA methods, including multiple scenario analyses. The VBP of ensifentrine + BMT is estimated at $61,008 when all GCEA elements are included. Relative to the traditional CEA static pricing scenario, GRACE increases VBPs by roughly 10 %, while dynamic pricing increases VBPs by 7-11 %. Stacked cohorts with dynamic pricing increases VBPs by 86-170 %. When including GCEA elements and adjustments to better reflect real-world COPD clinical pathways, ensifentrine + BMT is cost-effective below an annual price of $61,000 at a willingness-to-pay of $150,000 per quality-adjusted life-year.

Individuals of Middle Eastern and North African (MENA) ancestry in the US have been the targets of anti-immigrant policies, counterterrorism operations, and vitriolic political rhetoric. Yet, lack of data identifying MENA individuals has prevented systematic evaluation of the impact of these policies and rhetoric on MENA communities' wellbeing, including investment in health capital. We begin to address this gap in knowledge by focusing on the travel ban from majority Muslim countries implemented at the start of the first Trump administration. Using a large, longitudinal medical records database we evaluate the impact of this policy on preventive care use among MENA children in the US, finding decreased well-visits, and associated vaccinations among MENA children. Documenting MENA health outcomes following changes in official US policy is paramount for understanding the full consequences of policies that target underrepresented groups.

The rapid emergence of vaccines and therapeutics in response to the onset of the coronavirus (COVID-19) pandemic demonstrated the value of medical innovation. These advances not only led to enhanced patient welfare by reducing the disease's mortality and morbidity but also reduced the need for costly prevention measures, such as cuts in economic activity. This paper offers the first estimate of the portion of economic value generated by these medical innovations that was appropriated as earnings by the innovating companies, measured by the ratio of company earnings to the overall societal value generated by the innovations. To estimate the value and appropriation of COVID-19 innovations, one must necessarily make assumptions about what disease-specific and preventive activity would have been in the absence of these new innovations. To obtain robustness in our findings across such scenarios, we estimate industry appropriation across a wide range of counterfactual scenarios that would occur under no innovation. These scenarios include previous assessments of the contributing subparts of the value generated by the innovations. Our primary finding is that, within the large range of these counterfactual scenarios, upper-bound measures of the proportion of value appropriated by the industry ranged from 0.2 % to 4.6 % of the value generated by the vaccine and treatment innovations. Even though these are upper bound appropriation rates, they are significantly lower than those documented for other significant health sciences innovations. This suggests that COVID-19 vaccines and treatments were remarkable, not only in their swift development but also in the considerable societal value they provided, which extended far beyond the rewards to the innovating companies.

This study argues that value assessment conducted from a societal perspective should rely on the Generalized Cost-Effectiveness Analysis (GCEA) framework proposed herein. Recently developed value assessment inventories - such as the Second Panel on Cost-Effectiveness's "impact inventory" and International Society of Pharmacoeconomics Outcomes Research (ISPOR) "value flower" - aimed to more comprehensively capture the benefits and costs of new health technologies from a societal perspective. Nevertheless, application of broader value elements in practice has been limited in part because quantifying these elements can be complex, but also because there have been numerous methodological advances since these value inventories have been released (e.g. generalized and risk-adjusted cost effectiveness). To facilitate estimation of treatment value from a societal perspective, this paper provides an updated value inventory - called the GCEA value flower - and a user guide for implementing GCEA for health economics researchers and practitioners. GCEA considers 15 broader value elements across four categories: (i) uncertainty, (ii) dynamics, (iii) beneficiary, and (iv) additional value components. The uncertainty category incorporates patient risk preferences into value assessment. The dynamics category petals account for the evolution of real-world treatment value (e.g. option value) and includes drug pricing trends (e.g. future genericization). The beneficiary category accounts for the fact health technologies can benefit others (e.g. caregivers) and also that society may care to whom health benefits accrue (e.g. equity). Finally, GCEA incorporates additional broader sources of value (e.g. community spillovers, productivity losses). This GCEA user guide aims to facilitate both the estimation of each of these value elements and the incorporation of these values into health technology assessment when conducted from a societal perspective.

Despite the implementation of significant measures by European countries in recent years, smoking rates in Europe remain persistently high. The European Commission is currently undertaking a comprehensive review of its tobacco regulations. This article aims to address critical inquiries that arise during the amendment of the regulatory framework. We evaluate the effectiveness of existing tobacco control methods and observe a diminishing impact on promoting smoking cessation. Additionally, we explore how individuals of varying genders respond to the regulatory environment. We propose a comprehensive and evidence-based framework for implementing a taxation system in response to the proliferation of emerging products, including e-cigarettes and heated tobacco. This system is designed to align effectively with health policy objectives, providing a strategic approach to curbing tobacco use and promoting public health.

As the tax base for traditional tobacco excise taxes continues to erode, policymakers have growing interest to expand taxation to novel and reduced-risk tobacco products. Chief among the latter are electronic nicotine delivery systems (ENDS; commonly known as e-cigarettes), although other reduced-risk tobacco products such as heated tobacco and smokeless tobacco products are also being considered for taxation. There are many possible rationales for taxing such products: to raise revenue, to correct for health externalities, to improve public health, to correct for internalities caused by irrationality or misinformation, and to redistribute income. Although each rationale leads to a different objective function, the conclusions regarding relative tax rates are largely the same. The relatively higher price elasticity of demand for e-cigarettes (compared to cigarettes) and the lower marginal harms from use imply in each case that taxes on e-cigarettes and other harm-reduced products should be relatively lower, and likely much lower, than those on cigarettes. Additional considerations concerning the policy goal of discouraging use of any tobacco product by youth are discussed as well.

This research examines the mental health inequalities between employed and unemployed individuals among the fluctuations over the business cycle. To analyze whether a recession affects self-evaluated mental health and consequently increases the demand for mental health care, I exploit the sudden increase of the unemployment rate in Spain during the period 2007-2009. First, I analyze the impairment of self-evaluated mental health as a consequence of the Great Recession and if it prevails during the economic recovery. In addition, I estimate if the effect on self-reported mental health is reflected in demand for mental health care. The results from an event study design show that the economic downturn increases the differences between employed and unemployed individuals in self-evaluated mental health. However, and despite the continuous improvement in unemployment, the mental health gap remained unchanged between 2014 and 2017, which could imply the persistence of some lasting impacts of the Great Recession on mental health. Nonetheless, I find a reduction in the differences of using drugs related to mental health during the period 2011-2012, when I estimate the largest inequalities in self-evaluated mental health.

In recent years, Medicare margins of U.S. short-term acute care hospitals participating in the inpatient prospective payment system (IPPS) have declined nationally by over 10 percentage points, from 2.2% in 2002 to -8.7% in 2019. This trend conceals critical regional variations, with recent studies documenting particularly low and negative margins in metropolitan areas with higher labor costs despite geographic adjustments by the Centers for Medicare & Medicaid Services (CMS). In this article, we describe recent trends in California hospitals' traditional fee-for-service Medicare operating margins compared to hospital operating margins across payers and changes in the CMS hospital wage index (HWI) used to adjust Medicare payments. We conduct an observational study of audited financial reports of IPPS-participating California hospitals using California Department of Health Care Access and Information and CMS data for years 2005-2020 (n = 4429 reports included in the analysis). We describe trends in financial measures by payer and investigate associations between HWI and traditional Medicare margins, focusing on the pre-COVID period of 2005 through 2019. During that period, California hospitals' statewide traditional Medicare operating margin declined from -27 to -40%, and financial shortfalls in caring for fee-for-service Medicare patients more than doubled ($4.1 billion in 2005 to $8.5 billion in 2019, both values in 2019 dollars). Meanwhile, operating margins from commercial managed care patients increased from 21% in 2005 to 38% in 2019. There was a stable negative association between HWI and traditional Medicare operating margins throughout the period (p = 0.000 in 2005; p < 0.0001 in 2006-2020), indicating that areas of California with higher health care wages had persistently worse traditional Medicare operating margins than areas with lower wages.