European Journal of Health Economics最新文献

Objective: Mental disorders impose a substantial economic burden, making updated cost estimates essential for informed policymaking. This study provides recent cost-ofillness estimates for mental disorders in the general population and examines trends over a 12-year period.

Method: The Netherlands Mental Health Survey and Incidence Study (NEMESIS) is a cohort representative for the Dutch population in which common DSM-IV/DSM-5 mental disorders (mood disorders, anxiety disorders, substance use disorders and attention-deficit/hyperactivity disorder) were diagnosed using the Composite International Diagnostic Interview 3.0. In baseline data of NEMESIS-3 (2019-2022, N=6,194, age 47.9±16.4 years, 50.4% women) we estimated healthcare, productivity, travel costs associated with mental disorders through weighted regression models and compared these estimates with baseline data from NEMESIS-2 (2007-2009; N=6,506, age 44.3±12.5 years, 55.2% women), assuming identical unit prices.

Results: Total annual per capita costs of any mental disorder were €5,630. Productivity costs comprised the largest share of total costs (61%-85%). In all conditions, except substance use disorder, both total annual costs and productivity costs were lower in 2019-2022 compared to 2007-2009. Healthcare costs were substantially lower for mood and substance use disorders in 2019- 2022, even though primary healthcare utilization was increased in 2019-2022.

Discussion: Productivity costs are the primary cost driver of mental disorders. While primary care utilization has increased- possibly due to the introduction of general practice mental health professionals- healthcare resource use has decreased over time. This may indicate a shift in service provision toward primary care from specialized mental healthcare, potentially contributing to more cost-effective mental healthcare delivery.

Background: Post-procedural complications after transfemoral transcatheter aortic valve implantation (TF-TAVI) lead to extended healthcare resource consumption. A comparison with resource consumption after surgical aortic stenosis valve replacement (SAVR) complications has not been conducted.

Methods: The impact of acute kidney injury (AKI), stroke, severe bleeding and permanent pacemaker implantation (PPI) on length of stay, mechanical ventilation > 48 h and reimbursement was analyzed by risk-adjusted linear and logistic regression analyses of all German aortic stenosis TF-TAVI and SAVR cases 2021/2022.

Results: 48,565 TF-TAVI and 9,803 SAVR procedures for aortic stenosis treatment were performed in Germany 2021/2022. The length of stay for TF-TAVI was shorter (10.16 ± 7.19 vs. 13.91 ± 9.82 days, p < 0.001), the rate of mechanical ventilation > 48 h was lower after TF-TAVI (1.3% vs. 7.0%, p < 0.001) and reimbursement was higher for TF-TAVI (26,483 ± 4,487 vs. 20,538 ± 11,748 €, p < 0.001). Length of stay was increased by all investigated complications after TF-TAVI and SAVR (p < 0.001) with the highest increase after bleeding in TF-TAVI. Odds ratios for mechanical ventilation > 48 h were significantly increased for stroke, severe bleeding and AKI (p < 0.001) but not for PPI after both TF-TAVI and SAVR with the highest OR increase after bleeding in TF-TAVI. Reimbursement was significantly increased after TF-TAVI and SAVR by all investigated complications (p < 0.001) finding significantly higher increases after SAVR compared to TF-TAVI for all complications. The total hospital stay after stroke, AKI and PPM was longer for SAVR (p < 0.001), while severe bleeding led to longer total hospital stay after TF-TAVI (p < 0.001). Total reimbursement remained higher for TF-TAVI after all investigated complications (p < 0.001).

Conclusion: Healthcare resource consumption differs between TF-TAVI and SAVR for aortic stenosis treatment also after procedural complications. SAVR is associated with longer hospitalization and more mechanical ventilation, while TF-TAVI is associated with higher reimbursement in the German healthcare system. Complications lead to increased resource use for both procedures with higher extra reimbursement for SAVR and more extra hospital days for TF-TAVI after bleeding reversing the length of stay advantage.

To address the shortage of donor organs, some countries have adopted opt-out legislation, whereby consent for post-mortem donation is presumed unless individuals explicitly object prior to death. However, an increase in post-mortem organ donations may reduce the willingness of relatives to make living donations. We test this hypothesis using data from 26 countries over a 21-year period. Using fatal injuries as an instrument for cadaveric kidney supply, we find a significant effect on living donation rates; 50% of the higher living donation rate observed in opt-in countries can be attributed to a lower supply of cadaveric organ transplants.

Despite medical advancements, the burden of cancer is increasing. Germany introduced the accreditation of local provider networks as organ cancer centers to enhance care quality. Treatment in these centers is associated with higher survival rates, prompting policymakers to advocate for further centralization. While an impact beyond treatment outcomes has been suggested, accreditation's broader effects on population health and potential spillovers across regions remain unclear. This retrospective cohort study evaluates the impact of local access to accredited cancer care on survival for eight cancer types. Using data from the German cancer registry (1999-2018), covering 5.3 million cases, and accreditation records, we identified 861,508 patients with local access to accredited care. Using nearest neighbor matching, incorporating individual and regional factors (e.g., accreditation in neighboring districts), these patients were matched with those who lacked accredited care in their vicinity. Cox proportional hazard models and G-Computation estimated hazard ratios (HR) and intention-to-treat effects for one-, three-, and five-year survival. Access to accredited centers significantly reduces mortality risk for breast, colon, and prostate cancer (HR: 0.87-0.96) and increases five-year survival probabilities for five cancer types (1.8-7.3 percentage points), with effects varying by disease severity. Access in neighboring districts improves survival rates for several cancer types, showing positive spillover effects beyond patients' home districts. These findings emphasize the role of accreditation in improving cancer care and suggest expanding such programs could enhance outcomes without imposing travel burdens on patients.

Background: The initial health technology assessments (HTA) for first-line pembrolizumab in PD-L1≥50% metastatic non-small cell lung cancer (mNSCLC) concluded that pembrolizumab could not be considered cost-effective based on clinical trial findings. We evaluated the real-world cost-effectiveness of first-line pembrolizumab versus platinum-based chemotherapy for PD-L1≥50% mNSCLC patients.

Methods: We retrospectively identified a population-based cohort of mNSCLC patients who received first-line pembrolizumab or platinum-based chemotherapy between April 2013 and March 2021, in Ontario, Canada. Propensity-score matching (1:1) was performed to balance covariates between the groups. Employing a public payer's perspective, all costs (CAD) and outcomes were estimated over a 4-year time horizon, adjusted for censoring and discounted at 1.5% yearly. Primary outcomes were life-years gained (LYG), quality-adjusted life years (QALY) and incremental cost-effectiveness ratios (ICER). To examine the sensitivity of the ICER to drug acquisition costs and discounting, we conducted a price reduction analysis and a scenario analysis of different discount rates.

Results: Propensity-score matching resulted in a total of 1,142 pairs of mNSCLC patients. Pembrolizumab extended survival with an incremental effect of 0.37 LYG and 0.35 QALY, but at an incremental cost of $56,681; the resulting ICERs were $154,941/LYG and $163,039/QALY. Though the ICERs were not sensitive to discounting rate, pembrolizumab price reductions of 31% and 55% were required to achieve cost-effectiveness at cost-effectiveness thresholds of $100,000/QALY and $50,000/QALY, respectively.

Conclusion: In the real world, first-line pembrolizumab improves survival, but is not considered to be cost-effective for PD-L1≥50% mNSCLC. Improvements in cost-effectiveness, however, may be achievable through price renegotiations for pembrolizumab.

Key points: This real-world cost-effectiveness analysis shows that pembrolizumab is not considered to be cost-effective compared to platinum-based chemotherapy in the real world, and that survival benefit was lower than observed in the initial trial. Notably, a price reduction analysis revealed that cost-effectiveness could be attained under conventional willingness-to-pay thresholds through 31-55% reductions to current list prices.

Objectives: To develop a value set reflecting the United Kingdom (UK) general population's preferences for health states described by the Functional Assessment of Cancer Therapy (FACT) eight-Dimension preference-based multi-attribute utility instrument (FACT-8D), derived from the FACT-General (FACT-G) cancer-specific health-related quality-of-life (HRQL) questionnaire.

Methods: A UK online panel was quota-sampled to achieve a general population sample representative by sex and age (≥ 18y). A discrete choice experiment (DCE) was used to value health states. The valuation task involved choosing between pairs of health states (choice-sets) described by varying levels of the FACT-8D HRQL dimensions and survival (life-years). The DCE included 800 choice-sets; each respondent was randomly allocated 16 choice-sets. Data were analyzed using conditional logistic regression parameterized to fit the quality-adjusted life-year framework, weighted for sociodemographic variables that were non-representative of the UK general population. Preference weights were calculated as the ratio of HRQL-level coefficients to the survival coefficient.

Results: 2239 panel members opted in, 2125 (95%) completed at least one choice-set, and 2054 (92%) completed 16 choice-sets. Pain and nausea were associated with the largest utility weights, followed by problems with work and sadness. Within dimensions, more severe HRQL levels were generally associated with larger decrements. A preference-weighting algorithm to estimate UK utilities from responses to the FACT-General questionnaire was generated. The worst health state's value was -0.402, worse than dead.

Conclusions: This value set provides UK population utilities for health states defined by the FACT-8D for use in evaluating oncology treatments.

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. Cure rate is high after first-line treatment, however, prognosis for relapse/refractory patients remains poor. Multiple treatments to DLBCL have recently been approved, therefore it is important to understand the underlying total costs of the different treatment lines.

Objective: To investigate the total healthcare costs per line of DLBCL treatment (first-line (1LoT), second-line (2LoT), third-line (3LoT), including best supportive care (BSC)), and to estimate patients' labour market attachment and sickness benefit level.

Method: A nationwide real-world registry study covering the Danish DLBCL patients diagnosed 2012-2021 (August) from the National Lymphoma Registry (LYFO). Data were linked with other national registries to estimate the total costs per treatment line. Additionally, costs per line were adjusted to costs per-patient-per-month (PPPM).

Results: 4,159 DLBCL patients were included. Average progression-free time before progression to next LoT or being cured decreased from 2 years (1LoT) to half a year (3LoT + BSC). Average total healthcare costs per patient were estimated to €51,660 (1LoT), €59,094 (2LoT) and €35,808 (3LoT + BSC). Adjusting for progression-free time periods, costs per PPPM increased with later treatment lines. Patients' labour market attachment was in general low, and weeks of sickness benefit increased with later treatment lines.

Conclusion: The study suggests that the total costs and weeks of sickness benefit increase with later treatment lines suggesting that more effective first-line treatment options not only have an importance for the patient prognosis but also may have an economic advantage for the healthcare sector and society.

Objectives: Chronic kidney disease and its most severe complication, end-stage renal disease (ESRD), represents an estimated financial burden of €4.4 billion in 2021 in France. Therapeutic patient education (TPE) improves ESRD management and health outcomes. This study explored whether providing access to an interactive web-based TPE platform with community features was cost-effective.

Methods: A within-trial cost-utility analysis was carried out over an 18 months horizon, using data from the PIC-R (Plateforme Interactive Communautaire-dialyse et transplantation Rénale) trial. ESRD or post-transplant patients were randomized 1:1:1 to a control group with no specific TPE program (Control), an intervention group with online TPE (e-TPE) and an intervention group with online TPE coupled with community features such as a patient forum and a chatroom with both patients and health care professionals (e-TPE + chat). The outcome measure was the cost per quality-adjusted life-year (QALY) and per year of full capability (YFC). Both intention-to-treat (ITT) and per protocol (PP) analyses were conducted, and missing data were handled using multiple imputation and selection models. Sensitivity analyses were performed.

Results: Among the 815 patients assessed for eligibility across 12 French centres, a total of 549 patients were included in the economic analysis: 186 in the Control group, 189 in the e-TPE group and 174 in the e-TPE + chat group. The e-TPE group demonstrated cost savings and slightly higher QALYs compared to the control group, making e-TPE dominant. Conversely, the e-TPE + chat intervention resulted in higher costs without substantial effectiveness gains, making it not cost-effective.

Conclusions: e-TPE was deemed cost-effective for ESRD patients, while e-TPE + chat was not. Web-based platforms improve ESRD management when targeted to likely users.

In developing countries, chronic patients face dual challenges: high healthcare expenditures coupled with inadequate utilization of outpatient services. Leveraging an administrative claim dataset and applying a two-way fixed effects approach, this study makes one of the first attempts to examine the impacts of chronic disease coverage, which extends additional insurance benefits for outpatient care, on healthcare utilization and expenditures among enrollees diagnosed with hypertension or diabetes in China. The empirical results reveal a dual effect of chronic disease coverage: (1) enrollees with hypertension or diabetes experienced a substantial reduction in outpatient cost-sharing rates, leading to a significant increase in both outpatient service utilization and associated expenditures; (2) concurrently, we observed decreases in general outpatient visits without this special coverage, inpatient utilization, and corresponding expenditures. Notably, the magnitude of expenditure reduction in these non-targeted services was outweighed by the increased spending on covered outpatient services, resulting in a net increase in total healthcare expenditures. Heterogeneity analysis further demonstrates that the impacts were more pronounced among older adults, those with more comprehensive insurance benefits and residents in areas with better-endowed medical facilities. This study offers empirically validated insights for enhancing chronic disease management within medical security systems and establishing age-friendly medical insurance schemes in China as well as other developing countries.

Background: Responses on health-related quality of life measured by disease-specific instruments can be mapped onto the EQ-5D to estimate utility values for economic evaluation. San Martin´s Quality of Life Scale (St. MQoL-S) is a preferred measure to obtain health outcomes in adults with cerebral palsy. Nevertheless, it lacks a preference-based health utility score for estimating quality-adjusted life years (QALYs).

Objective: To develop algorithms for mapping from the St. MQoL-S to allow future prediction of the EQ-5D-5L, in adults with cerebral palsy, when utility data have not been collected.

Methods: Direct mapping models were developed using ordinary least squares, a generalized linear model, and Tobit regression analysis to estimate EQ-5D-5L utilities, with St. MQoL-S total and domain scores as explanatory variables, in a cross-sectional study of adults with cerebral palsy in Spain. Goodness-of-fit was assessed using mean absolute error (MAE) and root mean square error (RMSE). Repeated k-fold cross-validation was employed to select the optimal mapping model demonstrating superior predictive performance.

Results: The best-performing model for predicting EQ-5D-5L utilities, includes the St. MQoL-S total scores, age, gender, and types of cerebral palsy as explanatory variables in a stepwise ordinary least squares regression, making it the most robust model for use as a mapping algorithm with external data.

Conclusion: This is the first study to present mapping algorithms between the St. MQoL-S and EQ-5D-5L. The mapping functions preferred in this study seem adequate for estimating the utilities of the EQ-5D-5L for economic evaluation and to obtain QALYs in adults with cerebral palsy.