European Journal of Health Economics最新文献

Objective: To analyse the criteria influencing medicines' reimbursement decisions in the Spanish National Health Service and assess the extent to which these decisions have been supported by health technology assessment (HTA), considering the ongoing HTA reform.

Materials and methods: The sample includes all new medicines and new indications undergoing reimbursement between May 2019 and December 2022 in Spain. Criteria influencing the decision were derived from the Interministerial Pricing Committee for Medicines' reports. These were matched with the HTA reports obtained from the Spanish Medicines Agency's website. Spanish decisions are compared to those in France and England. The analyses include descriptive analysis, association statistical tests, sentiment text analysis, keyword extraction, decision analysis, and clustering.

Results: Out of 477 therapeutic indications, 253 could be matched to a HTA report. Positive recommendations (n = 110) were statistically significantly associated with severity and therapeutic value (including clinical and cost effectiveness) criteria, whereas negative recommendations (n = 143) were mostly associated with criteria based on budget impact and availability of a cheaper alternative option (p < 0.05). The innovation criterion was not used to support any decision. Only 9.49% of reimbursement reports mentioned the HTA in the conclusions, and 21.74% of the HTAs included keywords aligned with the specific decision-making criteria.

Conclusion: The criteria used to justify the reimbursement decisions of medicines in Spain do not align with the information included in the HTA. This discrepancy highlights the need for the ongoing HTA reform to develop an appraisal framework that aligns with the HTA assessment in a transparent, rigorous, and inclusive manner.

Objective: This study evaluated the cost-effectiveness of dialectical behaviour therapy (DBT) compared to treatment as usual (TAU) for autistic adults with suicidal behaviours.

Method: In a randomised controlled trial, 123 autistic outpatients were assessed over 12 months. Healthcare costs and societal costs were calculated in accordance with the Dutch standard. Outcomes were quality-adjusted life years (QALYs) and treatment response, defined as a reduction of at least 50% in symptoms of suicidal ideation from t₀-t₁₂ as measured by the Suicidal Ideation Attributes Scale (SIDAS), plus achieving SIDAS < 20 at t₁₂ (i.e. below the clinical threshold).

Results: From the healthcare perspective, DBT cost €371 less than TAU while gaining an additional 0.184 QALYs, with a 64% likelihood of being the dominant treatment option. From the societal perspective, DBT has higher costs than TAU by €232 per QALY gained, which can be considered cost-effective given a willingness-to-pay of €50,000 per QALY. DBT also showed better treatment response rates, with less suicidal ideation, at lower costs than TAU. Sensitivity analyses supported these findings.

Conclusion: DBT is a novel treatment for autistic adults with suicidality. It fills a significant treatment gap in lieu of any evidence-based alternative for this population. DBT reduces suicidality, enhances quality of life and is cost-effective across healthcare and societal perspectives, encouraging broader adoption. Future research should assess DBT's long-term impacts and its transferability to other countries and map pathways towards upscaled implementation.

Introduction: Antimicrobial resistance (AMR) remains one of the world's most pressing health, economic, and social challenges. To combat this crisis, innovative tools have been developed to enhance research and development (R&D) efforts like the Global AMR R&D Hub's Dynamic Dashboard. By aggregating data from projects worldwide, the Dynamic Dashboard highlights trends and gaps in AMR R&D investments, totalling more than 8.22 billion Euros in the period 2017-2021 across the One Health continuum - human, animal, plant and environment. Launched in March 2020, the Dynamic Dashboard supports global priority setting and decision-making in AMR research, fostering strategic planning to promote efficient use of international resources and cross sectoral collaboration in AMR R&D.

Methods: Recognizing the urgent need for innovative diagnostics, treatments, and prevention strategies against AMR, here we presented a comprehensive analysis of public and philanthropic investments in AMR R&D obtained from January 2017 to December 2021 across Europe.

Results: We calculated the investments by One Health sector, year of funding, gross domestic product (GDP), research area, type of project, and infectious agent to raise awareness and promote global visibility of the R&D landscape in Europe. Our analysis revealed limited AMR R&D investments in the non-human sectors and non-bacterial topics, geographical polarization of funders, and some unaligned trends between the amount of investments and number of projects funded over the study period.

Discussion: Harnessing these data-driven insights, we aimed to inform stakeholders and optimize the allocation of economic resources for AMR R&D. Prioritizing unmet needs with the greatest potential for impact in this field will expedite the development of effective solutions to mitigate the global threat of AMR.

Objectives: The composite time trade-off (cTTO) method has been found to be influenced by time preferences for future life years, which typically results in a downward bias on cTTO utilities without adjustment. Contrary to prior research that adjusted for this distortion ex-post, this study takes an ex-ante approach, using Episodic Future Thinking (EFT), to potentially prevent time preference distortion. We aim to investigate the effect of EFT on time preference and cTTO utilities compared to using alternative methods.

Methods: A total of 150 participants from the UK general public were recruited for interviewer-led online interviews and randomly assigned to either the control or treatment group. In the control group, they were asked to recall recent memories using the Episodic Recent Thinking (ERT) protocol, serving as filler tasks; in the treatment group, they were asked to imagine life in the next 10 to 20 years, i.e. using an EFT protocol. Afterwards, respondents were asked to value seven EQ-5D-5L health states with cTTO tasks, followed by a nonparametric method to measure time preference.

Results: We observed a similar pattern of time preference across the two groups, with the majority discounting positively. EFT did not significantly affect time preference. In addition, the difference between cTTO utilities mitigated by EFT and those adjusted using the ex-post approach for time preference is minimal.

Conclusions: In conclusion, EFT does not seem to mitigate time preference for life years and has negligible effect on cTTO utilities, necessitating alternative strategies for reducing bias in health utilities.

Objectives: The early detection of pancreatic cancer is an important step in reducing mortality by offering patients curative treatment. The aim of this study was to synthesize available evidence on the costs and cost-effectiveness of strategies for early pancreatic cancer detection.

Methods: The electronic databases PubMed, Web of Science, and EconLit were searched for peer-reviewed and published papers in English until April 2024 with no date or contextual restrictions. Economic evaluations of early pancreatic cancer detection strategies compared to alternative or no detection strategies were criteria for inclusion.

Results: Thirty-one articles were included, 22 were full and nine were partial economic evaluations. Fifteen studies screened target populations with pancreatic cancer-associated risk factors and 16 conducted surveillance of patients with precancerous lesions. Six studies found early detection strategies to be cost-effective, one did not, and thirteen reported partially cost-effective results. In all studies, populations of interest had an elevated pancreatic cancer risk compared to the general population. Endoscopic ultrasound, magnetic resonance imaging, and computed tomography were the most frequently evaluated imaging modalities. Patient engagement, valuation of outcomes and choice of discount rates were among incomplete reporting categories, and narrow evaluation perspectives may have biased the results.

Conclusions: Early detection strategies for pancreatic cancer may be cost-effective for certain high-risk patient groups. However, evaluations so far have applied heterogeneous methods, used different modalities, had various target groups and screened at different frequencies. Further evaluations will be required to systematically synthesize economic evidence regarding specific early detection strategies.

Registration: PROSPERO registration CRD42023475348.

Objective: To assess the psychometric performance of the Child Health Utility (CHU9D) proxy version compared with the Pediatric Quality of Life Inventory (PedsQL) in Australian children aged 0-7 years with anorectal malformations (ARM) or Hirschsprung disease (HD).

Methods: Parents of children with ARM or HD were identified from a patient database managed by a tertiary paediatric hospital in Australia over the past 20 years. Since 2020, CHU9D and PedsQL proxy report versions were administered to parents via telephone interview. Using data collected between 2020 and 2022, we assessed the feasibility, ceiling and floor effects, known-group validity and convergent validity for both instruments in the total sample, by conditions and child age.

Results: The study included 145 children with ARM or HD, among which, 13.1% had missing values on the CHU9D schoolwork dimension, and 20.7% had missing values on the PedsQL school functioning domain (2-4 year old version). The CHU9D and PedsQL did not demonstrate ceiling effects. The CHU9D showed stronger effect size (ES) in differentiating children with ARM (ES = 0.32) or HD (ES = 0.90) with healthy children compared to the PedsQL. We did not find statistically significant differences in CHU9D or PedsQL scores between ARM and HD. There were moderate to strong correlations in most theoretically related dimensions of the CHU9D and PedsQL.

Conclusion: The CHU9D and PedsQL demonstrated comparable and acceptable psychometric properties in Australian children aged 2 years and above with ARM or HD. However, the validity of the CHU9D in children under 2 years old needs to be further explored and modification may be needed.

Over the past three decades, advancements in collection methods for hematopoietic stem cell transplantation substantially reduced invasiveness and safety concerns. To what extent, however, registered donors are informed about extraction methods and how their beliefs drive their willingness to follow through with a donation is not well understood. Inaccurate beliefs about extraction methods may cause donors to overestimate their perceived cost, potentially reducing donations. In a survey with about 24,000 potential donors in Germany's largest stem-cell registry, we investigate how beliefs about extraction methods affect potential donors' willingness to follow through with a stem cell donation. We find widespread misconceptions about extraction methods, with many donors attributing a significant fraction of stem cell extractions to be coming from never-used methods. Importantly, a lack of knowledge and misconceptions about extraction methods persist among registered donors, often anchored to methods that prevailed at the time of registration. Exploring the link between donors' beliefs and their (stated) willingness to donate, we find that accurate beliefs about lower extraction costs correlate with a 2.2-2.9 percentage points higher willingness to donate, representing a 40% reduction in donor unavailability. Our results highlight the need for informational campaigns to correct donors' misconceptions and potentially save more lives among blood cancer patients.

This study used electronic health records from The Ohio State University Healthcare System to estimate hospital costs (payrolls, supplies, utilities) for foodborne diseases (FBD) across a range of clinical diagnoses. We considered the relationship between FBD and comorbidities since comorbidities may increase the risk of FBD or FBD sequelae. Our regression analysis advances prior work by estimating incremental FBD costs while adjusting for chronic conditions, comorbidities, and other confounders (e.g., demographics, payor and patient types) using large-scale EHR data, filling a critical gap in FBD cost estimation. We analyzed 8,147,264 encounter episodes from 2017 to 2021, totaling 697,732 patient years, with 930 being FBD-associated. Poisson regression yielded baseline annual FBD hospital costs of $8,258 per patient (cost-to-charge adjusted). When adjusting and comparing different types of comorbidities, the Clogg Z-test showed that cost estimates without comorbidity controls were $3,735 higher than baseline costs per patient-year (p = 0.098). However, there was little difference between the baseline and the estimates that took comorbidities into account. Instead of using foodborne pathogen-specific codes, costs were marginally lower by $1,492 (p = 0.058) when using gastroenteritis codes (such as infectious diarrhea). In contrast, gastrointestinal symptom codes such as diarrhea and others were associated with $3,440 (p < 0.001) higher costs than codes specific to foodborne pathogens. We discussed the implications of FBD cost variations through sensitivity analyses of comorbidity adjustments and diagnostic coding in methodology, and how these variations mimic liability assessments in the consumer and food industry.