European Journal of Health Economics最新文献

Bevacizumab, originally developed by Genentech under the brand name Avastin^® as an anti-cancer drug, has gained widespread off-label use in ophthalmology due to its similar mechanism of action to other anti-VEGF treatments and its significantly lower cost compared to available on label alternatives for ophthalmological indications. While off-label bevacizumab has been standard in clinical practice for over a decade, recently, a repurposed formulation (brand name: Lytenava^®, Outlook Therapeutics Ltd), developed specifically for vascular retinal conditions, received marketing approval from the European Medicines Agency. This raises questions about what the price for a repurposed formulation should reasonably be, reflecting the efforts to obtain regulatory approval. This paper examines potential cost-based-plus pricing for such a repurposed formulation of bevacizumab using a novel pricing framework across four scenarios. By evaluating the pricing structure through an analysis of critical cost components, including, among others, research and development expenditures, manufacturing costs, and cost-of-capital, the study proposes a price range of €73 to €177 per injection. The explicit breakdown of these cost components provides valuable insights into the economic structure of repurposed biosimilars like bevacizumab, emphasizing how a cost-based-plus pricing model can support more transparent and informed negotiations between pharmaceutical companies and healthcare payers. Ultimately, this approach contributes to the development of pricing strategies that balance affordability for healthcare systems with sustainable returns for manufacturers while fostering the broader development of repurposed treatments. The findings of this paper aim to advance the dialogue on equitable pricing for repurposed therapies.

Financial incentives are a promising intervention to promote healthier behaviours and potentially reduce health inequalities. Despite robust evidence supporting their effectiveness in encouraging actions such as smoking cessation, increased physical activity, and improved diet, large-scale implementation of financial incentives in Europe remains limited. This perspective identifies three key challenges impeding their broader use: (1) difficulties in reaching the populations most in need, (2) short-lived behavioural effects after removal of the incentives, and (3) uncertainty about sustainable and equitable funding. Drawing on interdisciplinary evidence, we explore potential solutions such as tailored incentive design, strategies to prolong behavioural change (e.g. intermittent reinforcement or dynamic phase-outs), and the development of public or private funding models. We argue that while financial incentives should not replace structural health policy interventions, they can be a powerful complementary tool. A coordinated research agenda is needed to inform scalable and effective implementation.

Breast cancer survivors require continuing long-term care, which leads to substantial resource use and subsequently increased healthcare costs (HC), having an impact on both the individual and society. This paper aims to investigate the impact of a breast cancer diagnosis on monthly HC and out-of-pocket (OOP) costs among survivors. We apply an event study methodology using a two-part fixed-effect model. Data from the Australian Longitudinal Study of Women's Health (2002-2017) is utilised, which is linked to extensive high-frequency administrative records from the Medicare Benefits Schedule, the Pharmaceutical Benefits Scheme, the Australian Cancer Database and the National Death Index. The findings reveal that a diagnosis leads to a persistent and substantial increase in total HC and OOP costs, with the largest increases occurring in the first six months. The effects' duration and magnitude vary by the type of healthcare service and pharmaceuticals.

Objectives: The treatment of multiple myeloma (MM) has changed substantially in the last two decades due to many therapeutic innovations. This study aims to analyse the authorization trends of drug regimens for the treatment of MM in Spain and evaluate their availability within the Spanish National Health System (NHS).

Methods: Drug regimens authorized in the European Union (EU) and/or in Spain for MM treatment between April 2004 and November 2024 were identified through regulatory agencies' websites. Authorization trends were analysed by number of components, line of treatment and approval frequency. Reimbursement information was extracted from the Spanish Ministry of Health website.

Results: A total of 48 drug regimens were authorized for MM treatment in the EU and/or in Spain. Of these, 25% were monotherapies, 25% doublets, 40% triplets, and 6% quadruplets. One-third were indicated for the first line of treatment and two-thirds for the relapsed/refractory disease. Approvals increased from six in 2004-2009 to 18 in 2020-2024. Notably, 86% of authorizations in 2004-2014 were standard, while 53% were conditional in 2015-2024. All drug regimens authorized in 2004-2014 were reimbursed, compared to 22 out of 36 (61%) in 2015-2024. The average time to first reimbursement decision was 449 days.

Conclusions: MM drug regimens approved in the EU and Spain have increased from 2004 to 2024, with a shift towards combinations, conditional authorizations and a more selective reimbursement in recent years. Most authorized treatments are available in the Spanish NHS, though the reimbursement rate has decreased in the last decade.

While a substantial body of empirical research documents the negative wellbeing and labour force participation effects of transitioning into and maintaining informal care roles, studies of transitions out of caregiving are small in number and present conflicting results. We contend that these conflicting results reflect differences in sample selection and methodological approaches. As such, we implement a novel research design known as staggered difference-in-differences to account for heterogeneities in carers' transition dates, caregiving intensity, and demographic and socio-economic characteristics to deliver robust evidence on their post-transition wellbeing and labour force participation outcomes. Our sample is drawn from Waves 5 to 18 of the Household, Income and Labour Dynamics in Australia Survey, Australia's largest longitudinal household survey, and comprises 6,090 respondent-Wave-level observations from respondents who transitioned out of carer roles. We find that respondents who previously devoted at least 10 hours per week to care enjoy significantly better mental health, emotional wellbeing and social functioning than those with ongoing carer duties. These benefits are immediate and generally persist for years after transitioning out of carer roles. Labour market participation outcomes follow a similar pattern: both employment rates and hours worked rise sharply upon exit and remain elevated. Our results also underscore the importance of using care intensity measures that accurately reflect the burden of caregiving, specifically, time- rather than role-based metrics.

We develop and calibrate a two-layer macroeconomic model of a pandemic to examine the macroeconomic costs and benefits of COVID-19 public health interventions. By integrating policies into a stratified epidemic compartmental model (Susceptible-Infected-Recovered, or SIR), we analyze the impact of non-pharmaceutical interventions (NPIs) on disease transmission. We then apply a dynamic stochastic general equilibrium (DSGE) model to simulate the effects of containment policy shocks on consumption, labor supply, and production, and their implications for macroeconomic variables. The model is calibrated and simulated for the province of Ontario, Canada. Our findings highlight the significant reduction in infections due to NPIs, quantify the negative economic consequences of policy shocks, and acknowledge that labor market flexibility and business adaptations played a key role in mitigating these adverse effects. This study provides a qualitative framework for evaluating the delicate balance between public health and economic considerations in policymaking during a public health emergency.

We study the effect of education on health (hospital stays, number of diagnosed conditions, poor or bad self-rated health, and body mass index) over the life cycle, using German compulsory schooling reforms as a source of exogenous variation. Our results show clear correlations between educational attainment and better health across all age groups (30 to 74). However, we do not find causal relationships between additional schooling and health or health care utilization, neither earlier nor later in life. A simulated ex-post power analysis shows that this is not due to a lack of statistical power. One reason for the absence of effects may be that the studied compulsory schooling reforms succeeded in raising the educational attainment of the target group - individuals at the lowest educational margin - but did not lead to healthier employment opportunities.

Introduction: Value sets for the EQ-5D-3L have been developed since the 1990's, using methods that are now considered outdated. The Dutch EQ-5D-3L value set was developed using data collected in 2003, and population's preferences may have shifted over time. Consequently, the existing value set may no longer accurately represent the preferences of the Dutch general population. This study aims to develop a new EQ-5D-3L value set using state-of-the-art methods and compare it with the existing value set.

Methods: A nationally representative sample of 417 Dutch adults, stratified by age and sex, completed 12 composite time trade-off (cTTO) tasks via online EuroQol Valuation Technology interviews. The data were modelled using a Tobit model that accounts for heteroskedasticity and the censored nature of cTTO data. Agreement between the new and existing value set was assessed using Bland-Altman and scatter plots.

Results: Pain/discomfort and mobility were the most important dimensions in the new value set, whereas pain/discomfort and anxiety/depression were most important in the existing value set. The lowest health state value was - 0.723, considerably lower than the - 0.329 of the existing value set. The Bland-Altman and scatter plots indicated limited agreement between the two value sets.

Conclusion: The new Dutch EQ-5D-3L value set differs substantially from the existing value set. We recommend its adoption and replacement of the previous value set. Our findings suggest that other countries with older value sets should consider similar updates to ensure accurate representation of contemporary societal preferences.

Postponements of non-acute care during the COVID-19 pandemic commonly raised concerns about harmful health consequences and increased healthcare costs, particularly among older individuals. Using nationwide register data from Finland, we employ a regression discontinuity design to examine the effect of an age-specific stay-at-home recommendation on healthcare utilization during the first wave of the pandemic. We find that the recommendation reduced non-acute visits, such as dental care, physiotherapy, and specialized care visits, but had no effect on acute care use, including emergency department visits or inpatient stays. The reductions in dental care use were partly compensated for after the lockdown was lifted, but not in other non-acute services. Additionally, we find indicative evidence of a slight increase in mortality during the three-months post-period after the lockdown. Our findings suggest that a Scandinavian-type social distancing recommendation targeting the elderly may reduce non-acute healthcare use in the short term, thereby temporarily alleviating pressure on healthcare resources during a pandemic. However, the absence of rebound in some non-acute services highlight potential unmet needs, which may imply longer-term risks of functional decline, preventable hospitalizations, and associated healthcare costs. These findings point to the importance of policies that ensure continued access to essential non-acute care for older populations.