European Journal of Health Economics最新文献

Aim: The study aims to establish the first set of normative data for OxCAP-MH capability instrument and to examine its association with sociodemographic and anxiety/depression severity variables.

Methods: A large-sample cross-sectional online survey was conducted among the Hungarian adult general population in 2021. OxCAP-MH standardized mean scores were compared across age, sex, education level, residence, employment, and marital status. Linear regression analysis was employed to determine the impact of sociodemographic and anxiety/depression severity on the OxCAP-MH score.

Results: In total, N = 2000 individuals completed the survey. The sample mean age was 47.1, with female majority (53.4%). Most respondents had completed primary education (51%), were active on labour market (52.4%), lived in larger cities (70.0%), and were married/in relationship (61.1%). Nearly half of the participants reported experiencing depression (48.5%), anxiety (44.3%), and 38.6% reported having both. The mean OxCAP-MH score for the total sample was 67.2 (SD = 14.4), the highest in the non-depressed (74.4) and non-anxious (73.6) subgroups, the lowest among those with extremely severe depression (45.0) and severe anxiety (47.7). Regression results indicated that older individuals (by β = 0.1), males (β = 2.3), those with secondary or higher education (β = 2.7 and 4.5) and students (β = 6.8) had significantly (p<0.01) higher mental capabilities. Respondents with mild, moderate, severe, or extremely severe depression (β =  -6.6, -9.6, -13.8, -18.3) and those with mild, moderate, or severe anxiety (β =  -4.1, -7.7, -10.3) had lower capability scores.

Conclusion: The OxCAP-MH instrument effectively differentiated capabilities across sociodemographic groups and highlighting the impact of depression and anxiety severity on general population's mental capability.

This article used register data on day-to-day working hours of hospital employees combined with patient characteristics at work unit (wards) level to measure workload and its implications for short, self-certified sickness absences. We measured statistically the average nursing treatment burden of different patient mixes in hospital wards, and then analyzed the overall workload (intensity) of working days by comparing it to the actual available nursing workforce. We found that a significant part of the workload variation occurred between working days, and it was related to unexpected changes in the number of employees. In atypical situations a long work shift was associated with caring for patients with fewer resources. The high workload of a day increased the risk of short sickness absences along the following 3-week period. The results show that managing short-term workload variability should be a key aim from the perspective of well-being at work, and that combining different data sources can provide novel, important insights to the measurement of workload.

Background/objectives: Remote patient monitoring (RPM) has demonstrated numerous benefits in cancer care, including improved quality of life, overall survival, and reduced medical resource use. This study presents a budget impact analysis of a nurse navigator-led RPM program, based on the CAPRI trial, from the perspective of the French national health insurance (NHI). The study aimed to assess the impact of the program on medical resource utilization and costs.

Methods: Medical resource utilization data were collected from both medico-administrative sources and patient-reported questionnaires. Costs were calculated by applying unit costs to resource utilization and estimating the average monthly cost per patient. Sensitivity analyses were conducted to explore different perspectives and varying resource consumption.

Results: The analysis included 559 cancer patients participating in the CAPRI program. From the NHI perspective, the program resulted in average savings of €377 per patient over the 4.58-month follow-up period, mainly due to reduced hospitalizations. The all-payers perspective yielded even greater savings of €504 per patient. Sensitivity analyses supported the robustness of the findings.

Conclusion: The budget impact analysis demonstrated that the CAPRI RPM program was associated with cost savings from the perspective of the NHI. The program's positive impact on reducing hospitalizations outweighed the additional costs associated with remote monitoring. These findings highlight the potential economic benefits of implementing RPM programs in cancer care. Further research is warranted to assess the long-term cost-effectiveness and scalability of such programs in the real-world settings.

Obesity has become a global health crisis, affecting people of all ages, regions, and socio-economic backgrounds. While individual behaviour and genetic factors contribute to obesity, the role of economic complexity in the evolution of obesity rates has not yet been empirically studied. Using a large panel of 110 countries over the period 1976-2015, this article estimates the linear and non-linear links between obesity and economic complexity. According to baseline results, an improvement in economic complexity will lead to an increase in obesity up to a certain threshold. Beyond this turning point, any further increase in economic complexity will significantly contribute to obesity reduction. The issue of simultaneity is tackled using the two-stage instrumental variable method. Our findings support the Obesity Kuznets Curve (OKC) pattern, which suggests that economic progress and obesity have an inverted U-shaped relationship. Our results suggest that greater embeddedness of knowledge in the products produced and exported by a country increases the likelihood of obesity in society, at least up to a threshold. From these results, some important policy implications are discussed.

Low adherence to preventative medications against life-long health conditions is a major contributor to global morbidity and mortality. We implemented a pilot randomized controlled trial in Mexico to measure the extent to which conditional economic incentives help male sex workers increase their adherence to pre-exposure prophylaxis (PrEP) for HIV prevention. We followed n = 110 male sex workers over 6 months. At each quarterly visit (at months 0, 3, and 6), all workers received a $10 transport reimbursement, a free 3-month PrEP supply, and completed socio-behavioral surveys. The primary outcome was an objective biomarker of medication adherence based on tenofovir (TFV) drug concentration levels in hair collected at each visit. Individuals randomized to the intervention received incentives based on a grading system as a function of PrEP adherence: those with high (> 0.043 ng/mg TFV concentration), medium (0.011 to 0.042 ng/mg), or low (< 0.011 ng/mg) adherence received $20, $10, or $0, respectively. Six-month pooled effects of incentives on PrEP adherence were analyzed using population-averaged gamma generalized estimating equation models. We estimated heterogeneous treatment effects by sex worker characteristics. The incentive intervention led to a 28.7% increase in hair antiretroviral concentration levels over 6 months consistent with increased PrEP adherence (p = 0.05). The effect of incentives on PrEP adherence was greater for male sex workers who were street-based (vs. internet) workers (p < 0.10). These pilot findings suggest that modest conditional economic incentives could be effective, at scale, for improving PrEP adherence among male sex workers, and should be tested in larger implementation trials. ClinicalTrials.gov Identifier: NCT03674983.

Knowing the determinants of rising health and long-term care costs is crucial to support cost containment policies and to predict future expenditures. According to the "red herring" debate, not ageing per se, but proximity to death is the most important determinant of future expenditures. This study aims to update and expand the existing Dutch literature after two major reforms in health and long-term care. Insurance claims data from 2018-2019 of 13,738,193 insured individuals were included. Using negative binomial regression analyses, the association between deceased individuals and survivors on total health and long-term care costs was investigated, as well as per health care sector. Costs rose sharply in the two months prior to death. Regression models showed an association with total health and long-term care costs of 10.8 for deceased individuals compared with survivors (crude model) and 3.3 (adjusted model). Especially including age and chronic diseases decreased the association. The largest differences in costs between deceased individuals and survivors in the adjusted model were found for geriatric rehabilitation care and primary care stays (16.7), home nursing (10,6), and long-term care (9.3). Not just the costs of deceased individuals are important for health care costs, but also age, as measured by being in the highest age category, and chronic diseases. The costs of deceased individuals were heterogeneous across health care sectors.

In market-based health care systems, insurers negotiate prices of hospital care products with providers. While few countries disclose these negotiated prices, in 2016, the Dutch government required the disclosure of insurer-provider negotiated prices for hospital products up to €885 - the maximum deductible in the Netherlands - to enhance price transparency. This aimed to increase price awareness among and price transparency for consumers, insurers, and providers, fostering price competition. We study if price dispersion for relatively homogeneous hospital care products decreased post-publication, resulting in price convergence. We used negotiated price data from three major Dutch health insurers on over 200 hospital products. Using descriptive statistics and linear regression, with the coefficient of variation (a measure of dispersion) regressed on the year, we examined the development of price dispersion and the occurrence of price convergence. Price dispersion for the studied sample of hospital products decreased by an average of 29% between 2016 and 2022. This decrease was not accompanied by a price level increase that was larger than expected based on general inflation. Regression analysis showed a significant negative association between year and the coefficient of variation, indicating price convergence. These findings support our hypothesis that price dispersion decreased after mandatory price disclosure. The government mandate potentially increased awareness of largely unexplainable price differences for products priced below €885, encouraging insurers and providers to reduce these through the negotiation process. The observed price convergence likely benefits patients, as it results in less random out-of-pocket payments across providers for the same hospitals products.

Background: Spinal muscular atrophy (SMA) is a rare genetic disease resulting in loss of motor function and, in severe cases (e.g., SMA type 1), infantile death. While treatments like nusinersen and onasemnogene abeparvovec improve prognosis for patients with SMA, costs for these medications can contribute to economic burden.

Objective: Direct costs were compared for onasemnogene abeparvovec, a one-time gene replacement therapy, versus nusinersen, a lifelong therapy, for patients with SMA type 1 and/or three or more survival motor neuron 2 (SMN2) gene copies in the Netherlands.

Methods: A cost comparison analysis model of 1-year incident patient population from the Netherlands was used to compare costs of onasemnogene abeparvovec versus nusinersen for patients eligible for onasemnogene abeparvovec immediately after diagnosis. Multiple analyses were conducted for economic outcomes (e.g., base-case, break-even, deterministic sensitivity, probabilistic sensitivity, scenario analyses).

Results: Cost differences of -€2.9 million (undiscounted) and -€1.5 million (discounted) per patient with SMA type 1 treated with onasemnogene abeparvovec versus nusinersen over a 20-year time horizon were identified (base-case). Reduced costs with onasemnogene abeparvovec versus nusinersen were evident after 8.25 years.

Conclusion: Onasemnogene abeparvovec was less costly than nusinersen after 8.25 years of treatment of patients with SMA type 1 in the Netherlands.

Purpose: The iMTA productivity cost questionnaire (iPCQ) has been recommended as a measurement tool for productivity cost, however, its use in routine care is hindered by the length of this questionnaire (18 questions). This study developed and tested a short-form (SF-) iPCQ.

Method: A secondary analysis of the Groningen Spine Cohort's baseline data from patients with low back pain referred for tertiary care was performed. Six SFs were evaluated against the comprehensive iPCQ. Spearman correlation (r), intraclass correlation coefficient (ICC, agreement), standard error of measurement (SEM), and Bland-Altman's plot tested the congruence of the SFs with the comprehensive iPCQ.

Results: The sample consisted of 1220 patients with low back pain. The SF version with the highest correlation (SF-3; 7 items) with the comprehensive iPCQ had r = 0.99, ICC = 0.99, SEM = 295, while the SF with the least number of items (SF-6; 5 items) had r = 0.84, ICC = 0.91, SEM = 2063. The mean productivity cost estimates of SF-3 and SF-6 were €3414 (95% CI: 3036-3791) and €3333 (95% CI: 2970-3696) respectively while that for the comprehensive iPCQ amounted to €3456 (95% CI: 3189-3720).

Conclusion: A SF with seven questions was developed with a high agreement with the comprehensive iPCQ. Initial clinimetric testing was satisfactory. Further assessment is recommended.