Health Economics Review最新文献

Purpose: Squamous NSCLC (sqNSCLC), a subtype with few targetable mutations, is often diagnosed at advanced stages. Platinum-based chemo-therapy, the first-line treatment, yields median overall survival (OS) of less than or equal to one year, underscoring the need for better therapies. Penpulimab, a novel PD-1 inhibitor developed in China, is a humanized IgG1 antibody with a modified Fc region. Phase III trial data (AK105-302) showed penpulimab + carboplatin-paclitaxel (PEN-CP) significantly improved progression-free survival (PFS) and OS in metastatic sqNSCLC vs. placebo (CP), with a favorable safety profile. However, its high cost and lack of cost-effectiveness analyses warrant further study. This research evaluates PEN-CP's cost-effectiveness vs. CP from the Chinese healthcare perspective.

Methods: A three-state Markov model was developed to evaluate the cost-effectiveness of PEN-CP as a first-line treatment for metastatic sqNSCLC. Clinical efficacy data were sourced from the AK105-302 trial, while drug costs were derived from national tender prices. Additional costs and health utilities were obtained from published literature. The primary outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). To assess the robustness of the findings, both one-way and probabilistic sensitivity analyses were conducted.

Results: Compared to CP, the ICER for PEN-CP was $14,918.81 per QALY. The ICER values were below the willingness-to-pay (WTP) threshold of $38,060.00 per QALY. The key drivers of the model outcomes were the price of penpulimab, the PFS stage utility value, and the cost of optimal supportive care.

Conclusions: From the perspective of the Chinese healthcare system, penpulimab combined with first-line chemotherapy demonstrates is cost-effective at a willingness-to-pay threshold of $38,060.00 per QALY for patients with metastatic sqNSCLC and represents a promising first-line treatment option.

Background: The global push to achieve universal health coverage (UHC) by 2030 has gained widespread attention, with many countries, including low- and middle-income nations like Cameroon, striving to implement reforms. However, financial, infrastructural, and systemic barriers make achieving UHC in Cameroon challenging. In pursuit of this goal, health insurance systems, particularly private health insurance, have been increasingly promoted to reduce out-of-pocket health expenses. However, the key question remains whether patients receive value for their money. This study aimed to examine the perspectives of patients and healthcare providers on the effectiveness of health insurance in Cameroon, with a focus on awareness, satisfaction, and the challenges influencing its accessibility and functionality.

Method: Following ethical approvals, this study employed a qualitative exploratory design, using key informant interviews (KII) to examine the perspectives of patients and healthcare providers on the effectiveness of health insurance in Cameroon. The study focused on awareness, satisfaction, and challenges influencing accessibility and functionality. Reflective thematic analysis was used to identify important aspects of our study.

Result: To ensure that the identified themes accurately represented the data and remained distinct, they were systematically reviewed and refined. This process resulted in five main themes: (1) Accessibility and Quality of Healthcare Services, (2) The Financial Paradox of Health Insurance, (3) Structural and Operational Challenges in the Health Insurance Framework, (4) Information Gaps and Awareness about Health Insurance, and (5) Divergent Experiences and Perspectives on Health Insurance Effectiveness. All participants agreed that health insurance reduces out-of-pocket health costs. Uninsured patients cited high premiums, distrust in the healthcare system, and insufficient knowledge about insurance options as reasons for not enrolling. Insured patients expressed significant dissatisfaction with their insurance packages, particularly with lengthy reimbursement processes and inadequate medical coverage.

Conclusion: The findings indicate a general agreement on the benefits of health insurance in Cameroon. To improve enrolment and satisfaction, premiums need to be made affordable across all socioeconomic levels, and consider increasing information dissemination and publicity about insurance options. Streamlining reimbursement processes is also crucial.

Background: Reimbursing high-cost cancer drugs presents challenges in managing uncertainty, setting appropriate prices, and controlling pharmaceutical expenditures. We examined the perspectives of the South Korean public on high-cost cancer drugs and policy options to improve reimbursement for these treatments.

Methods: We conducted a self-rated, web-based survey from November to December 2023. We used a quota sampling method based on South Korean census data to recruit study participants. The questionnaire comprised four sections: socio-demographics, definitions of high-cost cancer drugs and reasons for their reimbursement, uncertainties associated with high-cost cancer drugs, and policy options to improve reimbursement for these treatments.

Results: Of the 11,974 invitations sent, 1,000 participants completed the survey, resulting in a response rate of 8.35%. Three-quarters of the respondents agreed or strongly agreed that high-cost cancer drugs should be reimbursed. More than 70% accepted the need for price negotiations, even if they lead to drug withdrawals or delays in reimbursement decisions. A similar proportion agreed that new policy options, such as dual pricing and additional funding, should be introduced with caution.

Conclusion: The South Korean public perceives the reimbursement of high-cost cancer drugs as both a human rights measure and a government responsibility. However, they support reimbursement only when they are confident that the drug is safe, effective, and cost-effective.

Background: Health is a crucial component of an economy, influencing the performance of various sectors. As a result, nearly every country has implemented health policies to achieve the United Nations Development Goals and Universal Health Coverage (UHC) targets, which focus on providing universal access to necessary, sufficient, and quality healthcare without financial barriers. Implementing such policies in the sub-Saharan region led Burundi, Gabon, Ghana, and Rwanda to emerge as the only four countries in the region to have healthcare coverage over 20%. This study sought to investigate whether the health insurance policies implemented impact the wealth stratification of households in these countries.

Methods: The study used data from the sub-Saharan region section of the Demographic and Health Surveys (DHS) Program by the U.S. Agency for International Development (USAID) with Robust Ordered Probit Estimation Technique.

Results: The results show that health insurance negatively impacts the Wealth levels of those in the poorest, poorer, and middle-income levels in Burundi and Rwanda more than those in the wealthiest group. Community-based insurance in Gabon and national health insurance in Ghana positively impact the income of lower households.

Conclusions: The government should improve social amenities, especially in rural areas. Also, the study identified limited information as one reason for the outcome. We propose increasing education on the importance of health and the benefit package when one subscribes to a health insurance scheme to encourage patronage and decrease out-of-pocket expenditure.

Background: The impact of population health on economic growth has been widely discussed, but the extent of its influence remains inconclusive. One possible reason is the heterogeneity of health's impact on economic growth across different stages of economic development. This paper, from the perspective of changes in economic structure, attempts to study the long-term and marginal effects of health on economic growth.

Methods: By deriving from the Cobb-Douglas production function, this study constructs an empirical model to analyze the impact of health on economic growth, considering economic structure. Instrumental variable methods are employed to address potential endogeneity issues. Panel data at the country level are constructed using data from the World Bank database, Penn World Tables, and the World Health Organization, covering the period from 1980 to 2015.

Results: It reveals a positive long-term relationship between health and economic growth, particularly in post-demographic transition nations. The marginal impact of health on economic growth varies depending on the economic structure, the economic benefit of health promotion is notably pronounced in countries with a larger share of the primary sector. As countries reach higher levels of economic development, the marginal effect of health tends to decrease. Furthermore, health changes affect labor force distribution across industries, with varying impacts.

Conclusions: The findings suggest that developing nations, having undergone demographic transition, experience greater returns on health investments compared to developed counterparts. This research offers novel insights into the diverse effects of health on economic growth, emphasizing the importance of economic structure in understanding these dynamics.

Background: The alignment of preferences between physicians and patients can cause variations in treatment decision-making, thereby affecting health outcomes. However, research on the differences in preferences between physicians and the general population is scarce. This study examines the risk and time preferences of physicians compared with those of the general population, exploring the influence of gender concordance on health outcomes and decision-making in healthcare.

Methods: We conducted an online field experiment in October and November 2022 in Japan and analyzed the responses of 469 individuals, including physicians and the general population. The survey was stratified by age and gender to align with the demographics of physicians nationally. Participants' preferences were measured across the health and monetary domains by using a modified multiple price list test format.

Results: The findings revealed that physicians tended to be more risk-averse than the general population in the health and monetary domains, although no statistically significant differences were observed. Physicians were found to be statistically significantly future-oriented, particularly regarding their significant health or monetary gains. Furthermore, while the female general population was more risk-averse in both domains, a gender difference in the physician group was observed only in the monetary domain.

Conclusion: The results affirm that preference differences between physicians and the general population exist in Japan and clarify the unique preference traits of female physicians.

Background: The economic impact of RARP versus laparoscopic (LRP) or open surgical radical prostatectomy (OSRP) is unclear. The objective is to estimate and compare the total cost of radical prostatectomy with and without robot assistance from the French establishment perspective. This estimate can assess the cost benefit of robotic-assisted radical prostatectomy (RARP) and determine who should pay.

Methods: A micro-costing bottom-up time-and-motion approach was used based on 2018 prices (€). In public hospitals, observed data for OSRP and RARP was used; in private hospitals, expert opinions were sought from clinicians for RARP and LRP. Average costs, costs per minute of surgery and costs per expenditure were compared between techniques. A sensitivity analysis accounted for variability in cost of personnel and amortized cost of Da Vinci robot.

Results: The average estimated cost of surgery was 4683.35€ [95% CI=2900; 6467.2] more for RARP versus LRP in private clinics, and 3744€ [95% CI=3525; 3963] for RARP versus OSRP in public hospital. Recovery costs were equivalent between techniques (112.9€ for RARP and LRP in private and 46.1€ [95% CI=31.8; 60.4] for OSRP and 47.8€ [95% CI=39.1; 56.5] for RARP in public hospital). The sensitivity analysis confirmed the extra cost for RARP versus LRP or OSRP.

Conclusions: Depending on the surgery compared (OSRP or LRP), institute type (public or private) and data source (observed or expert opinion), the extra cost of the robot varied from 3744€ to 4683.35€. The amortized cost of the robot and its specific materials were the main elements of the difference.

Trial registration: This comparative, multi-centre economic study combines one secondary objective from the RoboProstate study (NCT01577836) and part 1 of the OptiPRobot study (IRB #19.07.03).

Objective: The costs of robot-assisted surgery are high compared to traditional surgeries, the main objective of this study is to investigate the cost-effectiveness of robotic total knee arthroplasty (rTKA) and manual total knee arthroplasty (mTKA) in Iran.

Method: The economic evaluation carried out from the perspective of the healthcare system used patients aged 64 years and older in Markov models. A cohort of 10,000 patients receiving either rTKA or mTKA was simulated using a Markov model. The time horizon of the study was lifetime and the model cycles were considered to be annual. From the literature and Iranian experts, transition probabilities, costs, and utility values were extracted. The incremental cost-effectiveness ratio (ICER) was also calculated. The evaluator was willing to pay ppp$ 16,153 for each quality-adjusted life year (QALY) gained. Sensitivity analyses were performed to test the robustness of the uncertainties of the model's variables.

Results: A base case analysis showed the rTKA strategy to be more costly ($18,599) than the mTKA strategy ($16,804), with an associated greater effectiveness of 9.20 versus 9.05 QALYs. The value of the incremental cost-effectiveness ratio (ICER) of rTKA in contrast to mTKA stood at $12,037 per QALY with a follow-up duration of 16 years, which is within the bounds of the threshold value of $16,153 per QALY set in Iran. In the probabilistic sensitivity analysis, there was a 90% probability that rTKA would be found cost-effective in comparison to mTKA.

Conclusion: In conclusion, this study finds that rTKA may be cost-effective than traditional methods in the context of Iran, especially as its value comes to be appreciated.

Objective: Given the critical role of pharmacoeconomics in supporting decision-making and the urgent need to address the study quality of economic evaluations (EEs), this study aimed to analyse whether the China Guidelines for Pharmacoeconomic Evaluations (China PE Guidelines, 4 versions) improved the study quality of EEs and summarize existing methodological issues of EEs in China.

Methods: We searched 4 Chinese databases (China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc) and included original EEs since 2016 in China. The quality assessment included 6 dimensions and was conducted using the framework of China PE Guidelines 2020. Study quality was compared between studies referencing and not referencing the China PE Guidelines, studies published before and after the China PE Guidelines 2020, and traditional Chinese medicine (TCM) and non-TCM studies.

Results: A total of 3,046 studies were included. Most studies did not report the study perspective (76.8%). Individual-level data-based studies were the most common type (75.0%), with the characteristic of a short time horizon. There were 2,044 studies reporting time horizon, and 437 studies reported discounting rate among 722 studies with time horizon longer than 1 year. And 2,484 studies measured direct cost only. Clinical outcomes and patient-reported outcomes were the most commonly used primary outcomes (81.5%). Most of cost-effectiveness analysis was used (71.4%), and approximately half of the studies did not conduct incremental analysis or uncertainty analysis (52.6% and 55.6%, respectively). The quality of studies referencing any of the 4 China PE Guidelines (435 studies) was better in all six assessment dimensions, and the study quality improved after the release of China PE Guidelines 2020 (686 studies) in most included dimensions. Whether before or after the release of the China PE Guidelines 2020, the quality of TCM studies (459 studies) was better than that of non-TCM studies (2587 studies).

Conclusions: China PE Guidelines have improved the study quality of EEs in China. To better support decision-making, the quality of EE remains to be improved, especially in terms of the study perspective, time horizon, cost identification scope and discounting aspects.

Background: University-based hospitals in Thailand face increasing financial strain due to insufficient reimbursement for inpatient care. The public health financing system comprises three major schemes: the Universal Coverage Scheme (UCS), Social Security Scheme (SSS), and Civil Servant Medical Benefit Scheme (CSMBS), which differ in funding mechanisms and reimbursement rates. Although all schemes apply the Diagnosis-Related Groups (DRG) system for inpatient payment, variations in base rates and case-mix complexity often leave tertiary hospitals underfunded. Medication reconciliation (MR) with a subtraction strategy-deducting patients' home medications from discharge prescriptions-has been implemented to optimize hospital resources. This study aimed to evaluate cost savings and identify key determinants influencing the economic outcomes of MR across public insurance schemes.

Methods: We conducted a retrospective cohort study of 563 hospitalized internal medicine patients at a university-based hospital. Of these, 324 underwent MR with subtraction. Cost savings and reimbursement margins were calculated from the provider's perspective. Patients were stratified by healthcare scheme (CSMBS, UCS, SSS) and length of stay (LOS). Generalized Linear Mixed Models were used to identify factors associated with cost savings.

Results: The highest mean cost savings per patient were observed in the SSS group (508.5 ± 56.1 THB [~ 14.1 USD]), and the lowest in CSMBS (133.5 ± 23.6 THB [~ 3.7 USD]). Prolonged LOS was associated with significantly greater savings (LOS > 21 days: IRR = 2.45, p < 0.001). SSS patients achieved the greatest overall savings (IRR = 3.95, p < 0.001). Nonetheless, negative reimbursement margins persisted across all schemes.

Conclusions: Although MR with subtraction achieved measurable cost savings, it failed to offset reimbursement deficits. Broader financial reforms are needed to ensure sustainability, with MR positioned as a potentially scalable strategy within value-based care frameworks.