European Journal of Health Economics最新文献

Objectives: Modelling health-state utility values (HSUVs) from clinical data offers a means to conduct retrospective cost-effectiveness analyses using clinical studies that did not collect direct HSUV measures. Such studies can support the efficient allocation of resources in kidney transplantation (KT). We aim to model KT recipients' EQ-5D-3L HSUVs using routinely collected clinical data.

Methods: From a French observational multicentric prospective cohort, we included 2,787 adult recipients of a first or second single renal graft transplanted between January 2014 and December 2021 who completed 5,679 EQ-5D-3L questionnaires post-KT, from which the HSUVs were calculated. Considering two time periods before and after 1-year post-KT, we estimated a linear mixed effect model (LME), a mixed adjusted limited dependent variable mixture model, and beta and two-part beta mixed models. We compared their predictive performances in terms of precision and calibration.

Results: In each model, recipient age, female sex, higher body mass index, presence of comorbidities and time spent on dialysis prior to KT were associated with lower HSUVs. The predicted HSUVs increased during the first year post-KT before slowly decreasing afterwards. The two-part beta mixed model resulted in the most precise predictions but showed poor calibration. The LME was associated with better calibration than the other models.

Conclusions: Our study illustrates the importance of estimating longitudinal predictive algorithms to consider possible time variations in HSUVs. We provide an online calculator for predicting the HSUVs of KT recipients over time. Future studies in international cohorts are important to support the external validity of our results.

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.