Health Economics Review最新文献

Objective: This study examines the incidence, intensity, and inequality of catastrophic health expenditure (CHE) among households with hypertension and type 2 diabetes mellitus (T2DM) in cold regions of China. It also explores key drivers of CHE and compares across diseases.

Methods: Using data from the 2023 Seventh Health Services Survey in Heilongjiang Province, this study applies the World Health Organization's (WHO) normative algorithm for basic food needs to analyze CHE incidence, average gap (G_cat), and mean positive gap (MPG) in 1,051 hypertension households and 294 T2DM households. The concentration curve and concentration index (CI) are used to quantify CHE inequality. Key drivers of CHE are analyzed through univariate analysis, Logistic regression, and Tobit regression models.

Results: The CHE incidence for hypertension and T2DM households were 31.11% and 34.69%, respectively. The G_cat was 6.38% for hypertension households and 7.02% for T2DM households, while the MPG was 20.51% and 20.24%, respectively. The CI for hypertension and T2DM households were - 0.2541 and - 0.2762. CHE decreased as economic status improved but increased with the number of chronic conditions. Under different CHE thresholds, the incidence and G_cat of CHE in T2DM households are generally higher than in hypertension households, but the MPG in hypertension households is slightly higher than in T2DM households. Determinant analysis revealed that low household economic status, multiple chronic conditions, and utilization of outpatient and inpatient services are significant drivers of CHE in chronic disease households, while being employed and having a larger household size are important protective factors.

Conclusion: Households with hypertension and T2DM in cold regions of China face a high risk of CHE, particularly among those with lower economic status. There is a pressing need for a more equitable healthcare financing system and improved management of chronic diseases in these populations.

Background: Obesity is a chronic condition with significant health and economic impact worldwide. While conventional treatments, including dietary changes, lifestyle modifications, and non-targeted pharmacotherapy, are widely used, their long-term effectiveness in sustaining weight loss remains limited. Metabolic and bariatric surgery has shown superior clinical benefits, including comorbidity remission and increased life expectancy, but its initial cost raises concerns about its economic viability compared to non-surgical treatments. Therefore, this study assesses the long-term cost-effectiveness of bariatric surgery versus conventional treatment, considering health outcomes and economic impact within the Portuguese healthcare.

Methods: The patient journey was mapped based on clinical guidelines and adapted to the Portuguese context via stakeholder interviews. Obesity prevalence and associated comorbidities were estimated using epidemiological data. A Markov model was created to simulate obesity progression over ten, twenty years, and lifetime horizons, using monthly cycles. The model accounts for weight regain, complications, and different health states, including obesity with diabetes, cardiovascular diseases, stroke, cancer, and death. It was implemented in R Studio using heemod package. Direct healthcare costs and health outcomes were calculated. A probabilistic sensitivity analysis (PSA), with 500 iterations, was conducted to assess uncertainty.

Results: The results demonstrate that bariatric surgery, compared to conventional treatment, enhances life expectancy, quality-adjusted life years (QALYs), and reduces obesity-related comorbidities. Over 10 years, surgery yields 6 QALYs to each patient costing 9243€, compared to 4.9 QALYs and a cost of 6328€ for the non-surgical arm. The cost-effectiveness analysis shows that, despite higher initial costs, bariatric surgery is cost-effective over time. The incremental cost per QALY gained is estimated at 2756€, positioning bariatric surgery as an economically advantageous intervention at commonly accepted willingness-to-pat thresholds (WTP). After 20 years, this strategy emerges as dominant, improving health outcomes while reducing overall costs. On the lifetime horizon, surgical patients gain 7 additional QALYs and cost 4534€ less than non-surgical patients. PSA shows that the cost-effectiveness of this strategy is maintained.

Conclusion: The analysis suggests that surgery is an effective strategy to improve outcomes and managing expenses. Future research should refine the model exploring upcoming treatment strategies as additional evidence on its outcomes becomes available.

The third Sustainable Development Goal (SDG) aims to enable everyone to live in good health and to promote the well-being of all. However, despite the various efforts made to achieve this goal, sub-Saharan Africa (SSA) is still characterised by low human longevity. To increase longevity, authors have stressed the importance of public spending on health. However, continuous borrowing and servicing of public debt deprive the SSA of funds that could be devoted to public spending on health. In this context, this research provides evidence on how public debt mitigates the effect of public health spending on human longevity in SSA. Using public indebtedness as a transition variable, this paper uses dynamic panel threshold regression to analyse the effects of public health expenditure on human longevity in 27 SSA countries covering the period 2010-2020. The results reveal a nonlinear relationship between public health spending and human longevity. This research shows that a level of public debt greater than 35.1348% of gross domestic product leads to a reduction in public spending on health and a decrease in human longevity. In view of these results, the governments of SSA countries must strengthen prudent budgetary measures to reduce public debt and increase the mobilisation of domestic resources to finance the health sector.

Background: Currently, diabetic hypoglycemic events are increasing, and this review aimed to synthesize global evidence on the economic burden of hypoglycemia.

Method: We conducted a systematic search in both databases (PubMed and Scopus) and a forward citation search. We included worldwide studies regardless of publication year. Two independent authors are involved in screening, selection, extraction, and quality appraisal. We used a consensus-based checklist for quality appraisal. We reported the costs in 2024 international dollars. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and registered the review with the International Prospective Register of Systematic Reviews (CRD420251069256).

Result: We reached out to 1235 articles and included 29 in the final report from high- and middle-income countries. Most studies estimated costs using prevalence-based and health system perspectives. The average direct and indirect costs per event per patient ranged from $1.90 to $24,932.73 and $3.46 to $3,339.34, respectively. The average annual direct cost per patient ranged from $1,938.41 to $25,092.76. This direct expense emerged from medications, consultation services, hospitalization, emergency care, and other services. Indirect costs primarily identified productivity losses due to sick leave, late arrivals, and early departures from work, with annual monetary estimates per patient ranging from $2,504.22 to $16,129.64. Patient direct costs were generally higher than the indirect costs. Annual hypoglycemia attributable costs ranged from $1,431.72 to $14,414.20 per patient per year. The annual national economic burden of hypoglycemia was substantial, ranging from $39.04 to $3.03 billion. Diabetes severity, type of diabetes, treatment regimen, and health facility level are sources of cost variation.

Conclusion: This systematic review concludes that diabetes-related hypoglycemia imposes a substantial economic burden, with both direct and indirect costs being significant. Preventive efforts focusing on hypoglycemia and its contributing factors are crucial to mitigate the financial impact on patients, healthcare providers, and the health system.

The coronavirus-19 (COVID-19) public health emergency created an economic crisis with unprecedented and far-reaching impacts across the health sector. Among the greatest challenge areas experienced were in areas of changing supply and demand, rising costs, decreased revenue, and widening health inequities (Blumenthal etal. N Engl J Med 383:1483-1488, 2020; Cypress, Nurs Forum 57:323-327, 2022; Centers for Medicare and Medicaid Services, National health spending in 2020 increases due to impact of COVID-19 pandemic, 2021). As we emerge from the pandemic, we must capitalize on the opportunity to transform and adapt to be better equipped to handle the next public health crisis. This article examines the impacts of the COVID-19 pandemic and preparedness strategies within the context of the United States.

Background: Clinical guidelines recommend surgery for early-stage breast cancer in operable patients; however, primary endocrine therapy (PET) is often used in older women aged ≥ 70. This study aimed to estimate the cost-effectiveness and value of implementation of surgery plus adjuvant endocrine therapy (ET) compared with PET for older women with early breast cancer who are fit for surgery.

Method: A partitioned survival analysis model was developed using effectiveness data from the published literature (time horizon: lifetime). Health outcomes were measured as quality-adjusted life years (QALYs; EQ-5D-3L UK tariff). Direct costs were estimated from the perspective of NHS England (discount rate: 3.5%). Probabilistic sensitivity analysis and value of implementation analysis were conducted using a cost-effectiveness threshold of £20,000-£30,000 per QALY gained.

Results: Surgery + ET resulted in higher QALYs (4.57) compared to PET (3.87) and higher costs (£10,628 vs. £6,102). The incremental cost-effectiveness ratio (ICER) was £6,412.62 per QALY gained, indicating that surgery + ET is cost-effective compared to PET. The value of implementation analysis showed that imperfect implementation of surgery + ET resulted in a loss of 0.12 QALYs per patient, equating to 9,267 QALYs at the population level.

Conclusion: Surgery with adjuvant ET is a clinically effective and cost-effective strategy compared with PET for older women with ER + operable early-stage breast cancer. Strengthening adherence to national guidelines will improve population health outcomes and healthcare resource use. Future economic evaluations should focus on the value of management strategies for older patients unfit for surgery due to frailty or comorbidities.

Background: Models evaluating both costs and economic benefits of assisted reproductive technology (ART) implementation are lacking. This constitutes a major limitation in the decision-making process of resource allocation. Herein, we aimed to estimate the economic and social impact of female infertility in Italy and examine the benefits generated by investment in ART from a national perspective.

Methods: A retrospective cohort study was conducted using the Italian Hospital Discharge Records database to identify women aged 18-50 undergoing ART between 2014 and 2016 in Italy. Patients were followed for up to 36 months after the first ART complete cycle. Hospitalization costs were analyzed nationally, while outpatient care and drug consumption costs were assessed in a sub-analysis using administrative databases from LHU Umbria 2. A fiscal impact model was developed from a governmental perspective, projecting lifetime tax revenues and public expenditures associated with the ART birth cohort, including costs for healthcare, education, pensions, and social transfers. All future values were discounted at 3% in line with Italian economic evaluation guidelines.

Results: A total of 33,713 women met the inclusion criteria. During the follow-up, 48.4% achieved pregnancy resulting in childbirth. The average hospital care cost per patient was €5,853, with a projected national expenditure of €337 million for ART management. Younger women (18-33 years) had the highest success rates (61.8%). Assuming 16,300 live births, the model estimated net fiscal benefits of €3.3 billion over the lifetime of these individuals, equivalent to €203,856 per live birth.

Conclusion: This study highlights the economic and fiscal benefits of ART, emphasizing the need for policies promoting early access to treatment. ART investment represents a strategic approach to mitigate demographic decline, with each live birth substantially contributing to national fiscal stability.

In Colombia, health expenditure is highly concentrated, with a small portion of the population incurring most costs, particularly in rural areas. Men show greater inequality than women. The study suggests that current risk-adjustment models have opportunities for improvement, emphasizing the need for better health premium definitions and stronger health policies.

Objective: To examine a 2018 rule change allowing pediatric providers to bill the child's Medicaid ID for post-partum depression (PPD) screening of mothers conducted during well-child visits, and document its relationship with PPD treatment and infant hospitalizations.

Study setting and design: Screening rates during well-child visits are calculated at the zip code level and used in linear probability and Instrumental Variable (IV) models to examine increases in screening after the policy change and relate them to PPD treatment and infant hospitalizations.

Data sources and analytic sample: Individual-level Medicaid claims were used to compute PPD screening rates and measures of PPD treatment and infant hospitalization.

Principal findings: The policy was associated with increases in screening rates, although take up was uneven and overall screening rates remained low at 8.8%. There was little overall increase in treatment, although in zip codes in the top third of screening rates, higher screening was associated with 10.1% higher probability of maternal treatment. Zip codes with high fractions in poverty and/or minority had low screening rates, but screening was more likely to be associated with increases in treatment in these areas. There are no effects in the full sample of children, but among children above the poverty line, the observed increases in screening reduced the probability of infant hospitalization in the first six months by 7.7%.

Conclusions: The policy change had only limited success increasing screening, but increased screening could lead to more maternal PPD treatment and lower infant hospitalization rates if accompanied by expanded access to PPD treatment.