Health Economics Review最新文献

Background: China's fast economic growth has been accompanied by rapid urbanization and urban renewal. Millions of households have experienced housing demolition and relocation ("chaiqian") to vacate the land for urban renewal and infrastructure projects. Housing demolition can be a major life disruption and place a considerable burden on both mental and physical health. Meanwhile, replacement housing, provided as compensation for demolition, can improve housing quality and access to care, thus improving health.

Methods: Using data from the China Family Panel Studies and an event study model with a staggered difference-in-differences framework, we examined the effects of housing demolition on individuals' medical utilization in the year of demolition, as well as two and four years afterward. Medical utilization was measured as whether an individual uses medical services (incurring medical expenditure) and the amount of medical expenditure if using medical services. We also explored the effects of housing demolition on health measures, namely self-rated health and mental health status, as potential mechanisms through which housing demolition affects medical utilization.

Results: Overall, housing demolition did not affect whether an individual used medical services. However, conditional on using medical services, housing demolition increased the amount of medical expenditure by approximately 1,639 CNY (234 USD) two years after demolition. We did not find evidence that housing demolition is associated with self-rated health or mental health status. Moreover, we found urban-rural heterogeneity in the effects of housing demolition. Rural residents have a higher likelihood of using medical services and higher medical expenditure two years after demolition, while urban residents have a lower likelihood of using medical services four years after demolition.

Conclusions: Our findings highlight the importance of housing as a social determinant of health and contribute to the growing literature on development-induced displacement. The increased medical expenditure after housing demolition calls for a multidimensional evaluation of compensation for housing demolition. The compensation should consider both the loss of property itself and other associated adverse impacts, such as on health and medical care, to fully offset the burden of housing demolition, especially for rural residents who are particularly vulnerable after housing demolition.

Background: Artificial Intelligence (AI) is revolutionizing the healthcare sector, offering unprecedented opportunities to enhance clinical efficiency, decision-making, and patient outcomes. However, alongside these benefits, AI brings considerable environmental costs due to its high computational demands. The study by Pariso et al. on AI-driven energy management in Italian hospitals illustrates the dual nature of this transformation, highlighting both the potential for increased efficiency and the structural challenges involved. In this context, the paradigm of Green AI has emerged, advocating for environmentally sustainable approaches to AI development and implementation in healthcare.

Main text: While AI offers tools to optimize hospital operations, such as predictive maintenance, resource allocation, and patient flow, its widespread adoption demands vast computational resources. These requirements result in significant energy consumption, CO₂ emissions, freshwater use, and electronic waste. Data centers, essential to AI functionality, contribute notably to global electricity use and water stress, especially in areas already facing environmental constraints. To address these concerns, healthcare institutions should adopt strategies such as energy monitoring tools, lifecycle assessments, and low-carbon infrastructures. Implementing circular approaches, including waste heat reuse and equipment recycling, can further mitigate environmental impact. Beyond being a source of resource consumption, AI can also support sustainability in healthcare through intelligent systems that optimize water use, manage medical waste, and reduce material inefficiencies. Moreover, AI-enabled telemedicine, remote monitoring, and personalized patient support can significantly lower the need for physical infrastructure use, aligning healthcare delivery with environmental goals. These innovations not only support sustainability but also foster a culture of responsibility and efficiency among healthcare professionals.

Conclusions: The integration of AI in medicine must be accompanied by critical reflection on its environmental footprint. Through standardized monitoring, efficient design practices, and circular resource management, healthcare systems can harness the power of AI while minimizing ecological harm. Future research should explore the environmental trade-offs of AI-enabled clinical workflows, assess energy and material use, and promote Fair AI to ensure equity and global health inclusion. By aligning innovation, fairness, and environmental responsibility, AI can fulfill its promise of advancing medical science without compromising planetary health.

Background: The ASCENT and OptiTROP-Breast01 trials indicated that sacituzumab govitecan and sacituzumab tirumotecan significantly improved clinical benefits in metastatic triple-negative breast cancer (TNBC). This study evaluated the cost-effectiveness of trophoblast cell-surface antigen 2 (TROP2)-targeted antibody-drug conjugate (ADC) from the Chinese healthcare system perspective.

Methods: A partitioned survival model with 21-day cycles was developed to simulate total costs, life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER) over 10-year time horizons. Clinical data was extracted from the ASCENT and OptiTROP-Breast01 trial, costs and utilities were estimated from public bid-winning databases, local charges and published literature. The willingness-to-pay (WTP) threshold was three times gross domestic product per capita in 2024 ($40,334.05). In scenario analysis, models were constructed employing network meta-analyses based on chemotherapy as the reference arm. One-way and probabilistic sensitivity analyses were implemented to examine the robustness of the model.

Results: In the base-case, the ICERs were $92,593.65/LY and $122,486.54/QALY for sacituzumab tirumotecan, and $348,005.00/LY and $409,219.27/QALY for sacituzumab govitecan compared with chemotherapy. Sacituzumab tirumotecan was dominant versus sacituzumab govitecan by virtue of lower costs and higher QALYs. When the unit costs of sacituzumab tirumotecan and sacituzumab govitecan were lower than $475.12 per 200 mg and $141.54 per 180 mg, they would be cost-effective over chemotherapy. The utility value of progression-free survival state was the most critical role on the base-case result. Probabilistic sensitivity analyses revealed that substantial price reductions for sacituzumab tirumotecan and sacituzumab govitecan could dramatically increase the probabilities of becoming cost-effective.

Conclusion: Sacituzumab tirumotecan and sacituzumab govitecan were unlikely to be cost-effective in previously treated metastatic TNBC. Sacituzumab tirumotecan was the preferred TROP2-targeted ADC in China.

Objective: To evaluate the total societal costs of postoperative antibiotic use compared to non-use in patients undergoing surgery for high horseshoe anal fistula (HHAF), based on a randomized controlled trial.

Methods: We conducted a single-blinded randomized controlled trial in 90 patients with HHAF treated using a standardized loose combined cutting seton (LCCS) procedure at the Department of Colorectal Surgery, China-Japan Friendship Hospital, between January and October 2023. Participants were randomly assigned to either a postoperative Antibiotic group or a No Antibiotic groups. The primary outcome was total societal cost. Clinical outcomes, including wound healing time and early recurrence, were assessed as secondary measures A societal cost-minimization analysis (CMA) was performed, encompassing direct medical costs, outpatient visit costs, and indirect costs due to lost productivity. Patient follow-up was completed by December 2024.

Results: Ninety patients were randomized equally (45 per group) with comparable baseline data. The Antibiotic group showed significantly higher hospitalization costs (¥13,202 ± 3,054 vs. ¥9,322 ± 1,205; p < 0.001) and longer stays (12.5 ± 5.8 vs. 7.9 ± 2.4 days; p < 0.001), without differences in wound healing (p = 0.490). Regression confirmed that both incision number (β = 1735.18, p = 0.020) and antibiotic use (β = 3287.06, p < 0.001) independently increased cost, with a significant interaction (β = 3641.00, p = 0.010). Antibiotic use also led to more outpatient visits (5.25 vs. 2.75; p = 0.013) and higher total societal costs (¥9,802 vs. ¥7,931; p = 0.014). Sensitivity analyses under multiple scenarios consistently confirmed higher overall costs in the Antibiotic group.

Conclusion: Routine postoperative antibiotics showed no significant additional clinical benefit in terms of wound healing or recurrence in HHAF patients treated with LCCS, yet significantly increase societal costs and postoperative burdens. A selective, evidence-based approach to antibiotic use should be adopted in the surgical management of complex anal fistulas.

Trial registration: This study was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2400093477) on December 5, 2024, after the enrollment of participants began in January 2023. The retrospective registration is in accordance with the journal's editorial policy for studies involving healthcare interventions in human participants.