Health Economics Review最新文献

Background: Renal denervation (RDN) has been introduced as a novel non-pharmacological intervention for patients with hypertension that is poorly controlled by pharmacological means. Our study aims to evaluate the cost-effectiveness of the Netrod RDN treatment plus antihypertensives compared with antihypertensives alone for hypertension in Mainland China, Japan and Thailand.

Methods: A Markov decision-analytic model was developed to simulate the long-term clinical events, quality-adjusted life years (QALYs) and related costs among patients who underwent RDN regimen and antihypertensive regimen in line with Netrod-HTN trial, with yearly cycles over a 30-year horizon. This study adopted the perspectives of the healthcare systems. Cost and utility inputs were collected from published literature, price databases, expert consultations, and hospital information systems. Both costs and outcomes were discounted at a rate of 5%. Model validation, univariate and probabilistic sensitivity analyses, and scenario analyses were conducted to verify the robustness of the results.

Results: Compared with the antihypertensive regimen alone, the RDN regimen yielded a 30.61% reduction in cardiovascular, cerebral and renal events. Cost-effectiveness analysis showed the RDN regimen yielded the most favorable incremental cost-effectiveness ratio in Japan at $3,451 per QALY, followed by Thailand at $13,932 per QALY, and Mainland China at $19,049 per QALY. Sensitivity and scenario analyses confirmed the robustness of the findings.

Conclusions: Netrod RDN is a cost-effective intervention from the healthcare system perspective in Mainland China, Japan, and Thailand. However, its cost-effectiveness varies across countries, reflecting differences in socioeconomic contexts. In middle- and low-income countries, appropriate pricing strategies may play a key role in enhancing its affordability and cost-effectiveness.

Background: The difficulties in mobilizing financial resources in developing countries combined with the low level of health of populations reveal the need to seek levers for optimal use of available resources. This paper aims at analyzing the dynamics of the relationship between governance and public health expenditure in Côte d'Ivoire as part of the "health for all" policy.

Methods: The estimates show, from a cointegration model based on the ARDL (self-regressive with staggered delays) approach and causality in the sense of that corruption influences and causes the increase in public health expenditure in the long term.

Results: The results includes poor health outcomes due to the diversion of resources on budgetary allocations. A 1% increase in the level of corruption generates 0.9% short-term and 0.5% long-term decrease in public health spending. Also, causality indicates a unidirectional link between the two variables ranging from corruption to the level of public health resources.

Conclusions: The authorities should therefore strengthen the institutional framework and the quality of central and internal governance of vertical health structures and programs in order to induce better use of resources likely to improve health outcomes.

Background: The outbreak of COVID-19 posed significant health and economic challenges worldwide, prompting governments to implement various containment measures, including quarantine policies. This study examines the cost-benefit analysis of Iran's quarantine policy during the pandemic, evaluating its economic impact, public health outcomes, and overall effectiveness. The research explores the direct and indirect costs of quarantine, including reduced economic activity, government expenditures, and social consequences, while assessing the benefits in terms of lives saved, healthcare system relief, and long-term economic stability. Findings suggest that while quarantine measures imposed substantial financial burdens, they played a crucial role in controlling the virus's spread and preventing a greater economic and human toll. The study highlights the necessity of balancing public health interventions with economic sustainability, offering insights for future pandemic response strategies.

Methods: This study has used the cost-benefit analysis method. In the financial evaluation, benefits such as the reduction of fuel costs, gratuitous payments, and the benefit of credits paid to employees have been compared to expenses such as the average cost of corona treatment in the hospital and at home for the population of employees who have contracted the disease. Also, in the economic evaluation, the benefits of reducing electricity costs and food for employees, the willingness of people to pay the government for protective measures, and reducing overtime payments to employees compared to costs such as food for hospitalized employees, paying subsidies to employees and reducing GDP Has been studied.

Results: Application of quarantine is optimal from the view of government employees (financial point of view) with a benefit-cost ratio of 1.98, and the government's point of view (economic point of view) is cost-effective with a benefit-cost ratio of 2.68.

Conclusions: These results indicate that applying quarantine for employees benefits both the people and the government. Thus, the results of this study can be a guide for policymakers in managing similar disasters or the spread of other strains of the Coronavirus in the future.

Background: Public transportation, including high-speed rail (HSR), exerts a significant influence on people's health and health-related behaviors in various ways around the world. Several studies have investigated the impact of HSR on patients' health-seeking behavior, however, many issues regarding the impact of HSR remain to be investigated in depth. We aim to explore whether the effect of HSR on patients' health-seeking behavior crowds out the market for medical services in county regions based on China's practice.

Methods: The opening of two important HSR lines connecting two megacities in western China, Xi'an to Chengdu (opened on December 6, 2017) and Yinchuan to Xi'an (opened on December 26, 2020), were considered as quasi-experimental intervention, and Event Study and Synthetic Difference-in-Differences (DID) research design were applied in this study. A monthly report database about county-level hospitals of the health statistical data collection from 2017 to 2018 and 2020 to 2021 was used.

Results: There is no significant change in the total number of visits (TOV) and the number of bed days occupied by discharged persons (BDODP) in county-level hospitals before and after the opening of two major HSR lines being observed. The estimates of TOV from synthetic DID were 319.38 (95% CI, -761.01, 1399.77) and -915.69 (95% CI, -5079.07, 3247.68) for the two HSR lines, respectively. The estimates of BDODP from synthetic DID were -581.34 (95% CI, -1555.27, 392.59) and -960.62 (95% CI, -3932.40, 2011,17) for the two HSR lines, respectively. The results from the event study DID estimates are in line with the synthetic DID.

Conclusions: Our findings suggest that the construction of HSR does not substantially modify the utilization of medical services at the county level. Moreover the effect of the construction of HSR on the flow of patients to large hospitals may be an incremental effect. These findings hold important implications for infrastructure policy, suggesting that improvements in transportation can coexist with and perhaps even bolster local healthcare services without compromising their usage.

Health shocks are a critical driver of poverty in low- and middle-income countries (LMICs). This study investigates the impact of health shocks on household poverty risk in Nigeria and evaluates the protective capacity of existing health insurance mechanisms, using data from the 2023/2024 General Household Survey (n = 4,779 households). We first estimated household vulnerability using Chaudhuri's (2003) Vulnerability as Expected Poverty framework, addressing heteroskedasticity in consumption estimation via feasible generalized least squares. We then modeled the probability of household vulnerability following health shocks using probit regression. Finally, we implemented propensity score matching to isolate the effect of health shocks on households' vulnerability. Our results indicate that 56.1% and 59.2% of Nigerian households are vulnerable to poverty, using the international ($2.15/day) and national ($2.48/day) poverty lines, respectively. Vulnerable households are more prevalent in northern regions, rural areas, larger households, and poorer households. We found evidence that, based on the international poverty line, health shocks significantly increased the probability of household vulnerability (ATT = 0.053, SE = 0.023) compared to matched households without health shocks, with a slightly higher impact (ATT = 0.054, SE = 0.023) if using the national poverty line. Household size, dependency ratio, household head's education and employment status, and residence were significant predictors of vulnerability. Despite their potential, health insurance, covering only 2.2% of households, did not offer adequate protection against health shocks. This study provides robust evidence that health shocks increase households' vulnerability to poverty and perpetuate existing poverty. Financial protection measures need to be considered in broader poverty reduction policies.

Background: Globally, health remains an important issue on governments agenda. Subsequently, the health insurance scheme was introduced in Ghana to reduce out-of-pocket payments for healthcare delivery. However, there are several challenges facing the scheme including continuous membership (retention) and financial constraints. These issues pose threat to the sustainability of the scheme. This study examined the effect of NHIS enrolment status on NHIS retention status in Ghana. The study further assesses the socio-demographic determinants of the NHIS retention and the major constraints in Ghana.

Methods: The expected utility theory of decision-making on health insurance underpins the study. The study's sample is drawn from the Ghana Living Standards Survey Round 7 (2016/2017) and the Heckman probit estimation technique is used to address the potential endogeneity in the sample selection process.

Results: There is positive effect of NHIS enrolment on the NHIS retention decision. Again, the study shows that the NHIS retention is driven by factors such as being female, being married, higher education, urban locality and household expenditure affect NHIS retention status positively. However, younger age and household size were found to deter NHIS retention status. The study further identified finance as the main constraint for the NHIS non- retention in Ghana (66.6%) followed by poor service delivery (12.5%). The financial constraint was higher for females (69.1%) than males (64.0%). It is also higher for rural areas (75.4%) than urban areas (48.8%).

Conclusions: Government should continue to strengthen efforts towards improving the quality of NHIS service delivery and monitor the implementation particularly in the rural areas. Again, government should continue to subsidize the health insurance premium particularly for the poor and the youth in Ghana. Also, public education should continue to be strengthened on the NHIS renewal process in Ghana.

Objectives: This study provides step-by-step guidance to calculate willingness-to-pay (WTP) in discrete choice experiments that involve discrete cost. It highlights the limitations of assuming a linear disutility for cost in WTP calculation.

Methods: Five mixed-logit models were considered. Log-normal distributions were applied to cost parameters for four models under the assumption that utility (disutility) for cost should be negative (positive) or at least non-positive (non-negative) for all individuals. Piecewise linear utility in cost, using an iterative process, was proposed to calculate the WTP for the discrete cost models. Individual level simulations - considering individual random preference - were conducted to obtain the median WTP across all individuals and compared with the population mean WTP. A case study exploring preferences for colorectal cancer screening was used to demonstrate these models and methods.

Results: Models utilising discrete cost exhibited higher disutilities in cost at lower costs relative to models using continuous cost, but lower disutilities in cost at higher costs. Modelling using continuous cost tended to overestimate the WTP at low costs and underestimate the WTP at high costs. Adding a quadratic cost term only partially solved the problem, as the quadratic functional form may not capture the sharp change in preference for cost at low-cost levels. Divergent policy recommendations emerged when comparing results from continuous and discrete cost models. Although WTP was calculated using the population mean and the median across individuals, no systematic pattern was identified.

Conclusion: This study highlights the importance of incorporating discrete cost and selecting appropriate distribution assumptions for cost parameters to accurately derive the WTP.

Aims: Heart failure is a leading cause of hospitalisation in patients over 50, significantly impacting both quality of life and survival. Despite the well-established benefits of Cardiac Resynchronisation Therapy (CRT), its utilisation in clinical practice remains suboptimal. Traditional incentives, have shown limited effectiveness in increasing CRT referrals. This manuscript explores how behavioural economics can offer a novel framework for improving CRT uptake by leveraging behavioural incentives, particularly choice architecture and social incentives, to influence physician referral patterns.

Methods and results: We underscore key concepts of behavioural economics, including choice architecture (nudges, reference points, sludges), cognitive biases (status quo bias, overconfidence bias, availability bias), and social incentives, which are applied in designing incentives to promote CRT referrals. A survey was conducted with 51 physicians from six European countries, including electrophysiologists, heart failure specialists, and general cardiologists, recruited through cardiology networks and personal contacts. Participants rated their perceptions of five incentive strategies using a Likert scale (1-5). Behavioural incentives, such as peer comparison through league tables (social incentive) and decision prompts in electronic health records (choice architecture nudge), were perceived as more effective than traditional financial incentives, with a median Likert score of 4.0 [IQR 3.0-5.0] versus 2.5 [IQR 1.5-3.0] for traditional incentives (p < 0.001).

Conclusions: These findings suggest that interventions drawing on behavioural economics, particularly those utilising social incentives and choice architecture redesign, may offer more effective to increasing CRT referrals than traditional incentives. Such interventions could enhance CRT uptake and outcomes for heart failure patients.

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.