Health Economics Policy and Law最新文献

This study estimates productivity losses resulting from intellectual decrement due to paediatric lead exposure in low- and middle-income countries (LMICs). The published literature on blood lead levels in LMICs was reviewed and summarised. Intelligence Quotient decrement and consequent productivity losses were calculated for a one-year cohort of 5-year-old children in each country. We calculated the present value of lifetime earnings as the discounted average earning potential for workers in a specific economy. Blood lead level (BLL) data for children were available for 39 countries and could be interpolated for additional 82 countries, resulting in 121 countries in the final analysis. Total lead-attributable productivity losses in LMICs ranged from USD 305 billion in our high discount scenario to USD 499 billion in our low discount scenario for each one-year cohort of 5-year-old children (2019 USD). As a share of GDP, these costs ranged from 0.7 to 4.2% by region, depending on discount scenario used. Total economic impacts were generally consistent with previous estimates and further validate those efforts with a substantially expanded dataset. Differences in the findings resulted primarily from the use of a more conservative dose-response model in the present study. Improved reporting of BLLs is essential and could be facilitated through a centralised registry of study results.

Therapeutic positioning reports (IPTs, Spanish acronym) are a crucial tool for informing funding and pricing decisions for drugs in the Spanish healthcare system. In 2020, for the first time the inclusion of economic evaluations (EEs) was explicitly set as a primary objective in a new Action Plan aimed at consolidating IPTs. This paper seeks to examine the uptake of EE into IPTs and to compare the methods and techniques employed in the EEs conducted during the two-year pilot phase following the reform, i.e., from June 2021 to July 2023. During this period, a total of 181 IPTs were published, with 19 (10.5%) incorporating an EE section. However, out of these 19 identified IPTs, six did not actually conduct a de novo EE, and four only performed a drug cost minimisation analysis. Six IPTs conducted EE analyses following international methodological standards. Based on this review, we observe that the percentage of IPTs incorporating EEs had remained low and exhibited significant heterogeneity. The experience of these two years must be translated into lessons that can serve to reinforce the evaluation of the efficiency of medicines in Spain in the coming years.

Although the criteria that support reimbursement decisions for medicines are often set by legislation, as is the case in Spain, in many cases neither the definition nor the measurement methods for these criteria are provided. Our goal was to elicit the views of a large sample of Spanish technical specialists on how to evaluate each one of the criteria that inform pricing and reimbursement decisions in Spain. Professionals from various stakeholder groups involved in health economics, health technology assessment, and industry participated in a survey. Participants recommended that reimbursement decisions should take specific account of unmet medical need and rare diseases. Health benefit should be measured using quality-adjusted life-years. There should be an explicit cost-effectiveness threshold, and this threshold should take account of population groups and special situations.

This editorial introduces the special issue dedicated to commemorating the life and scholarly achievements of Professor Joan Rovira Forns, a distinguished health economist whose pioneering work continues to influence global health policy and research. We discuss why Professor Rovira was a prominent figure in the field and summarise some of his key contributions. Next, we highlight the collection of papers featured in this issue, explaining how they connect to his work and contribute to his lasting legacy by celebrating his interdisciplinary approach and dedication to societal impact.

We examine the impact of decentralisation on COVID-19 mortality and various health outcomes. Specifically, we investigate whether decentralised health systems, which facilitated greater regional participation and information sharing, were more effective in saving lives. Our analysis makes three contributions. First, we draw on evidence from several European countries to assess whether the decentralisation of health systems influenced COVID-19 mortality rates. Second, we explore the regional disparities in one of the most decentralised health systems, Spain, to untangle some of the determinants shaping health outcomes. Third, we estimate the regional loss of Quality Adjusted Life Years (QALYs) due to COVID-19 mortality, broken down by the wave of the pandemic. Our findings suggest that coordinated decentralisation played a critical role in saving lives throughout the COVID-19 pandemic.

A substantial share of the global population continues to face barriers to accessing essential medicines. While the pharmaceutical industry's business model has successfully facilitated the development of innovative medications, efforts to promote universal access to medicines (UAM) remain ineffective. This paper critically assesses the existing barriers to global access to medicines, including the role of unsuitable governance, the protection of intellectual property rights, and other market barriers such as shortages, quality shortcomings, and high prices. Furthermore, we explore a number of promising potential strategies that can help towards achieving the UAM. Specifically, we evaluate the evidence from various initiatives, including alternative models of innovation, manufacturing, procurement, intellectual property management, and structural/organisational operations. We argue that the effective realisation of UAM requires a robust framework to implement these initiatives. This framework must strike a delicate balance between addressing public health needs, incentivising research and development, and ensuring affordability. Achieving such a balance encompasses a careful oversight and collaboration between national and international regulatory bodies.

We present a methodology for a new composite, quantitative "mash-up" index of health system sustainability and resilience, drawing on a qualitative framework developed to assess these dimensions of the health system. The paper summarises quantifiable measures of sustainability and resilience, with sustainability defined through 7 domains and 50 indicator variables, while health system resilience is based on 6 domains and 23 variables. Each domain is captured by a separate index. A composite index is constructed through aggregation across the two dimensions, and their associated domains and indicators. All indices are aggregated through estimation of a geometric means, and are bound between 0 and 100. We pilot across 5 countries over 23 years, with the ultimate aim of identifying health policy strategies for improving national health system capacities and performances; as well as facilitating policy responses to address problematic issues of sustainability and resilience. Face validity suggests that the index captures the non-resilience to the COVID-19 pandemic. The pilot study reveals considerable differences at both the dimension and domain levels within and between the examined countries, while suggesting scope for improvement in both dimensions across all countries. The index thus provides an indicative approach for temporal and spatial yardstick comparison.

While a substantial amount of evidence exists on factors associated with positive health technology assessment (HTA) outcomes, the evidence on the same regarding rejections is scarce. Using a proprietary dataset of HTA outcomes in seven Organisation for Economic Co-operation and Development (OECD) countries, we empirically examine the factors associated with HTA rejections and study the magnitude of inter-agency differences in technology appraisals. Data were extracted from HTA reports between 2009 and 2020. The primary outcome was the probability of rejection, which was examined with respect to several regulatory, disease-related, evidence (clinical and economic) and unaddressed uncertainty variables. Multivariate logistic regression analysis was used. Out of N = 1,405 HTA assessments, the rejection rate was 12.9% (n = 181). Significant predictors of HTA rejection were submissions for drugs with cancer or orphan indications (but not both), low quality of evidence and the presence of uncertainties surrounding clinical benefit, cost-effectiveness, and economic model utility inputs. Systematic differences between agencies in their propensity for rejecting the same drugs were revealed, particularly in relation to cancer and rare diseases. Despite the low rejection rate, our findings suggest that it is critical to improve quality of evidence, focus on risk mitigation strategies as a means of reducing the impact of uncertainties and share HTA practices across borders to increase consistency in decision-making.

Competition regulation plays a key role in determining firm size, market structure, and what firms can do with their market power. In this paper, we explore how competition regulation in many countries has largely tolerated rising industry concentration and market power in harmful consumer product industries, which, in turn, has likely facilitated an increase in preventable death and disease associated with such industries (ie. industrial epidemics). One important reason for this tolerance has been the rise of the 'consumer welfare' standard, which contends that competition regulators should only focus on a narrow set of concerns mostly relating to consumer price and output. Yet, recent developments shed light on potential avenues through which competition regulation could work more synergistically with public health policies and programmes. While discussions on how to leverage competition regulation along these lines are invariably contested and complex, we argue that it is critical that public health advocates engage with these discussions.

This article examines the relationship between primary care (PC) settings and the uptake of COVID-19 and influenza vaccines in 29 European countries. Using multiple linear regression, the study evaluates whether PC settings influence vaccine uptake (VU) for these two vaccines. Based on secondary data, the study shows that people behave differently in the context of COVID-19 and influenza vaccination. Our findings suggest that health systems relied less on PC during the pandemic, not fully using its potential for COVID-19 vaccination. Even if the bivariate correlations highlight the importance of PC, the regression analysis did not verify a direct relation between PC strength and the COVID-19 VU. In contrast, for influenza vaccination, PC strength was the only significant variable. The core research message is that systematic comparative evidence regarding the relation between PC and VU is needed. Based on the belief that appropriate PC setting and adequate general practitioners (GP) involvement in vaccination could contribute to higher VU, the main policy implication of the research is that more attention needs to be paid to PC setting and the role of GPs in vaccination policy.