Applied Health Economics and Health Policy最新文献

Scientific advancements offer significant opportunities for better patient outcomes, but also present new challenges for value assessment, affordability and access. Alternative payment models (APMs) can offer solutions to the ensuing payer challenges. However, a comprehensive framework that matches the spectrum of challenges with the right solution, and places them within a framework for implementation, is currently missing. To fill this gap, we propose evidence-based steps for the effective selection and implementation of APMs. First, contracting challenges should be identified and mapped to potential APM solutions. We developed a decision guide that can serve as a starting point to articulate core problems and map these to APM solutions. The main problem categories identified are: budget impact and uncertainty, value uncertainty, and the scope of value assessment and negotiation. Sub-categories include affordability, uncertainty of effectiveness, and patient heterogeneity, which map onto APM solutions such as outcome-based agreements, instalments, and subscription models. Just as important are the subsequent identification and assessment of the feasibility of potential solutions as well as collaboration to reach agreement on the terms of the APM and lay the groundwork for effective implementation. We adduce recent examples of APM implementation as evidence of how commonly cited implementation barriers can be overcome by applying pragmatic design choices and collaboration. This step-by-step framework can aid payers and manufacturers in the process of effectively identifying, agreeing on, and implementing APMs to advance patient access to cost-effective medicines, while at the same time providing appropriate incentives to support future innovation.

Background: To sustain positive progress toward sustainable development goals as envisioned in goal 3 and beyond, safe and affordable care during pregnancy and birth for women, their families, and health facilities and professionals is essential. In this systematic review, we report the best available evidence regarding the cost and cost-effectiveness of birth in various settings, including hospitals, birth centres, and homes for women at low risk of complications from high-, middle-, and low-income countries.

Methods: We conducted a systematic review of cost and economic evaluation papers, following the comprehensive search of online databases, including Medline, CINAHL, Embase, Scopus, and Google Scholar, and grey literature, using predetermined search strategies. Both partial and full economic evaluation studies were included, and we appraised them using Joanna Briggs Institute's (JBI's) critical appraisal checklists for economic evaluation studies. Although we attempted to pool total incremental net benefit, the results were synthesised narratively without a meta-analysis due to the high heterogeneity between primary studies.

Findings: From 2307 identified studies, 11 studies (13 country level records from 11 countries) were included. Both direct and indirect costs of childbirth at home, midwife-led birth units (MLBUs), and hospitals were reported. Ten studies showed that births in MLBUs were less costly than hospital births, while home births were also reported to be less costly than hospital births in seven studies. Regarding cost-effectiveness, in Bangladesh, MLBUs generally showed better outcomes at lower costs than hospital births, while one site had higher costs. In Pakistan and Uganda, MLBUs displayed mixed results, with some being cost-effective and others more costly with poorer outcomes. In the Netherlands, MLBUs were less costly but had poorer outcomes, whereas home births were less costly and more effective. In Belgium, MLBUs were less costly but less effective in reducing caesarean and instrumental births, though they did reduce epidural analgesia use cost-effectively.

Conclusions: Most studies found that births in MLBUs and at home were less costly than births in hospital. There is the potential for these settings to provide a cost-effective option for women through reduced intervention rates and favourable outcomes in high-income countries and could offer birthing options to women in low- and middle-income countries that includes care by skilled maternity practitioners in potentially more affordable settings.

Background and objective: Genomic medicine offers an unprecedented opportunity to improve cancer outcomes through prevention, early detection and precision therapy. Health policy makers worldwide are developing strategies to embed genomic medicine in routine cancer care. Successful translation of genomic medicine, however, remains slow. This systematic review aims to identify and synthesise published evidence on the cost effectiveness of genomic medicine in cancer control. The insights could support efforts to accelerate access to cost-effective applications of human genomics.

Methods: The study protocol was registered with PROSPERO (CRD42024480842), and the review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) Guidelines. The search was run in four databases: MEDLINE, Embase, CINAHL and EconLit. Full economic evaluations of genomic technologies at any stage of cancer care, and published after 2018 and in English, were included for data extraction.

Results: The review identified 137 articles that met the inclusion criteria. Most economic evaluations focused on the prevention and early detection stage (n = 44; 32%), the treatment stage (n = 36; 26%), and managing relapsed, refractory or progressive disease (n = 51, 37%). Convergent cost-effectiveness evidence was identified for the prevention and early detection of breast and ovarian cancer, and for colorectal and endometrial cancers. For cancer treatment, the use of genomic testing for guiding therapy was highly likely to be cost effective for breast and blood cancers. Studies reported that genomic medicine was cost effective for advanced and metastatic non-small cell lung cancer. There was insufficient or mixed evidence regarding the cost effectiveness of genomic medicine in the management of other cancers.

Conclusions: This review mapped out the cost-effectiveness evidence of genomic medicine across the cancer care continuum. Gaps in the literature mean that potentially cost-effective uses of genomic medicine in cancer control, for example rare cancers or cancers of unknown primary, may be being overlooked. Evidence on the value of information and budget impact are critical, and advancements in methods to include distributional effects, system capacity and consumer preferences will be valuable. Expanding the current cost-effectiveness evidence base is essential to enable the sustainable and equitable translation of genomic medicine.

Objective: Anxiety and depression are prevalent in young people. Web-based mental health interventions (W-MHIs) have the potential to reduce anxiety and depression, yet the level of engagement remains low. This study aims to elicit young people's preferences towards W-MHIs and the relative importance of intervention attributes in influencing choice.

Methods: A discrete choice experiment (DCE) was conducted online among young people aged 18-25 years who lived in Australia, self-reported experiences of anxiety and/or depression in the past 12 months and had an intention to use W-MHIs and/or previous experience with W-MHIs for managing anxiety and/or depression. Participants were recruited via social media and Deakin University notice boards. The DCE design comprised six attributes, including out-of-pocket cost, access to trained instructors (e.g., therapists, coaches) to help users stay engaged with the intervention, total time required to complete the intervention, initial screening, quizzes within the W-MHIs to check user's understanding about the intervention content, and communication with other users. The DCE design consisted of three blocks, each with eight unlabelled choice tasks, each with two alternatives. Data were analysed using a mixed logit model.

Results: One hundred ninety-nine participants completed the DCE (mean age: 21.43 ± 2.29 years, 64.32% female). Lower cost, access to instructors, and moderate time required to complete the intervention (5 h) were significant facilitators. The W-MHIs including audio- or video-call access to instructors were 23 percentage points more likely to be chosen than those without and W-MHI with a moderate completion time (5 h) was 18 percentage points more likely to be chosen than one with a shorter time (2 h).

Conclusion: Our results highlight that low-cost W-MHIs with access to trained instructors and moderate completion time could increase uptake. More research is required to confirm these findings and examine whether these preferences vary across different population characteristics.

Introduction: The growth of scientific literature in health economics and policy represents a challenge for researchers conducting literature reviews. This study explores the adoption of a machine learning (ML) tool to enhance title and abstract screening. By retrospectively assessing its performance against the manual screening of a recent scoping review, we aimed to evaluate its reliability and potential for streamlining future reviews.

Methods: ASReview was utilised in 'Simulation Mode' to evaluate the percentage of relevant records found (RRF) during title/abstract screening. A dataset of 10,246 unique records from three databases was considered, with 135 relevant records labelled. Performance was assessed across three scenarios with varying levels of prior knowledge (PK) (i.e., 5, 10, or 15 records), using both sampling and heuristic stopping criteria, with 100 simulations conducted for each scenario.

Results: The ML tool demonstrated strong performance in facilitating the screening process. Using the sampling criterion, median RRF values stabilised at 97% with 25% of the sample screened, saving reviewers approximately 32 working days. The heuristic criterion showed similar median values, but greater variability due to premature conclusions upon reaching the threshold. While higher PK levels improved early-stage performance, the ML tool's accuracy stabilised as screening progressed, even with minimal PK.

Conclusions: This study highlights the potential of ML tools to enhance the efficiency of title and abstract screening in health economics and policy literature reviews. To fully realise this potential, it is essential for regulatory bodies to establish comprehensive guidelines that ensure ML-assisted reviews uphold rigorous evidence quality standards, thereby enhancing their integrity and reliability.

Objectives: To measure socioeconomic-related inequality in perceived unmet needs for financial reasons for mental health care in Spain and to assess socioeconomic-related inequity in access to mental health professionals and psychotropic drugs.

Methods: We used data from the Spanish adult sample of the European Health Interview Survey for 2014 and 2020. Corrected concentration indices were used to measure socioeconomic-related inequalities in unmet needs for financial reasons and inequity in access to mental health care. Social class, based on the occupation of the breadwinner, was used as a proxy of socioeconomic status. A decomposition analysis was performed to determine the variables that explain inequalities and to identify inequity in access.

Results: Unmet need for mental health care for financial reasons significantly concentrate on the worse-off, except for women in 2020. A reduction of inequality is observed along the study period. Socioeconomic disadvantage is associated with lower access to mental health consultations, despite also with higher need. This pro-rich inequity is significant for women in 2014, and for both sexes-although much higher for females-in 2020. In contrast, we found pro-poor inequity in women's access to psychotropic drugs in 2020, suggesting partial substitution of specialized health care with psychotropic drugs prescribed in primary care for the financially worse-off.

Conclusions: Barriers to accessing specialized mental health care should be reduced for those in need, particularly for disadvantaged women. A better access to therapy could also help to reduce their consumption of psychotropic drugs. Addressing access inequities requires different strategies for men and women, as the relevance of their determinants varies by gender.

Background: Midwives are essential in achieving universal health coverage targets and the health targets of the Sustainable Development Goals, yet a significant global shortfall exists in the midwifery workforce. Economic evaluations of midwifery are scarce but can assist in supporting evidence-informed decision-making for sustainable and equitable health care for women and girls.

Objectives: This review aimed to systematically identify, map and report on available literature regarding economic evaluations conducted on midwifery service provision and the midwifery workforce in all settings.

Methods: A scoping review was conducted following the Joanna Briggs Institute methodology. A comprehensive search strategy was developed and run in six health databases. Peer-reviewed studies and unpublished research theses conducting economic evaluations on midwifery service provision or midwifery workforce strategies were included. Sources were limited to English-language literature published in the past 20 years. Identified sources were screened and reviewed, and data from included sources were extracted, reviewed, mapped and synthesised to report findings. Quality appraisal was conducted on all included sources using the Joanna Briggs Institute Critical Appraisal Checklist for Economic Evaluations.

Results: A total of 32 studies were included in the review. Most were from high-income countries (26/32), and very few were from low- and middle-income countries (6/32). The quality of included studies varied greatly. Under half of the studies conducted full economic evaluations (15/32), and the remainder were partial economic evaluations (17/32). Most studies evaluated midwifery service provision (29/32) through either midwife-led models of care (15/29) or by place of birth (13/29), mostly for low-risk women (23/29) from the perspective of healthcare funders. Evaluation of midwifery education programs was less common, and these were all conducted in low- and middle-income countries (3/32). Most studies concluded that midwifery service provision was cost-saving, cost-effective or cost-beneficial.

Conclusions: Our review identified a significant gap in economic evaluation of midwifery from low- and middle-income countries. However, there is ongoing need for robust, quality economic evaluations on midwifery service provision and workforce strategies in all global regions. Such studies would further support health policymakers and governments to make evidence-informed decisions to address midwifery workforce shortages and provision of evidence-based and respectful care that meets the healthcare needs of women and girls.

Background and objective: The utility of genome-wide sequencing is often quantified in terms of its diagnostic yield. Although obtaining a diagnosis is a fundamental aspect of value, service users also value broader clinical, informational, process and psychological factors in the provision of genomic testing. This study aims to value genome-wide sequencing from the user perspective in Scotland.

Methods: A survey was developed and administered to 1014 patients and families with experience of genome-wide sequencing to diagnose a rare condition in Scotland. Participants' willingness to pay for genomic testing was elicited using a contingent valuation payment card. The survey included two genomic-related patient-reported outcome measures: (i) the Personal Utility Scale (PrU) to generate scores for the personal utility of genome-wide sequencing; and (ii) a subscale of the Feelings About Genomic Testing Results (FACTOR) questionnaire to measure negative psychological outcomes. Data were also collected on participants' prior experiences of genomic testing services. A double-hurdle regression model investigated the predictors of patients' willingness to pay for genomic testing.

Results: Of the 1014 invitations sent, 171 contingent valuation questionnaires were returned. Diagnosed participants reported higher personal utility on PrU than undiagnosed participants. However, both groups reported similar negative psychological outcomes on FACTOR. Diagnosed participants were willing to pay £2043 for genome-wide sequencing, compared with £835 for undiagnosed participants. Diagnostic status, waiting time for results and FACTOR scores (negative psychological outcomes) influenced users' valuations of genome-wide sequencing.

Conclusions: Obtaining a diagnosis is a fundamental component of utility in the provision of genomic testing. However, there is still value to those who do not receive a diagnosis. These results have implications for service delivery, such as providing targeted pre-test and post-test genetic counselling, and investing in efficient genome sequencing pipelines to reduce waiting times. Valuing the user experience of genomic testing aligns with patient-centred approaches to the provision of healthcare.

Background: No systematic country-level comparison has been undertaken between crosswalk- and EQ-VT-derived EQ-5D-5L value sets. Crosswalk values can differ from EQ-VT-based EQ-5D-5L value sets owing to valuation protocols, changes in societal preferences over time, and a change in the label of the highest level on mobility in moving from EQ-5D-3L to EQ-5D-5L. This study aimed to compare the five-level (5L) crosswalk and EQ-VT value sets to explore differences between them at the country level.

Methods: From the countries with both time trade-off (TTO)- or discrete choice experiment (DCE) + TTO-based EQ-5D-3L value sets and EQ-VT-based EQ-5D-5L value sets, 19 pairs of EQ-5D-3L/EQ-5D-5L sets were found. For each of these EQ-5D-3L value sets, 5L crosswalk sets were developed and compared with the corresponding national EQ-5D-5L valuation set using correlation analysis, ranges, values of specific states, Bland-Altman plots, and scatter plots. Three of the countries have EQ-5D-3L and EQ-5D-5L valuation data for the same set of respondents. These three cases were analyzed separately, as they provide a "true" test of the differences between the two value sets.

Results: Spearman correlation between the crosswalk and valuation sets ranged from 0.831 to 0.989, being below 0.9 in 11 pairs of value sets. The difference in the percentage of negative values ranged from +22.5 to -18.8%, and the difference in the ranges within each pair of value sets ranged from +42.7 to -18.4%. The average mean absolute difference of values (crosswalk versus EQ-VT) was 0.149. This was below 0.1 in only 5 of the 19 EQ-VT/crosswalk set pairs. For the states comprising one level 5 and four level 1s, no country preserved its ranking of importance of the five dimensions in moving from crosswalk to EQ-VT values. Most of the Bland-Altman plots and scatterplots revealed a pattern that placed states with the highest level on mobility as a separate band from other states.

Discussion: All of the criteria showed poor agreement between the crosswalk- and EQ-VT-based value sets. The differences in labels for the most extreme response option for the mobility dimension leads to substantial differences in values between these value sets.

Conclusions: Crosswalk and EQ-VT value sets should not be used interchangeably, except under circumstances where it is not possible or feasible to conduct a direct EQ-5D-5L valuation study.