Applied Health Economics and Health Policy最新文献

Background

Deep brain stimulation (DBS) has proven efficacy in advanced Parkinson’s disease (PD) and is the current standard of care for these patients. However, its cost-effectiveness in low- and middle-income settings has not been assessed before.

Objectives

This study aims to assess the cost-effectiveness of DBS compared with best medical therapy (BMT) in advanced PD from a societal perspective in Egypt.

Methods

We developed a Markov model with a 15-year time horizon and annual cycles to compare DBS with BMT. The cohort was aged 55-years-old at model entry and transitioned between three states: DBS, BMT, or death. Effectiveness was measured by improvement in the Unified Parkinson’s Disease Rating Scale (UPDRS) and reduction in drug doses. The main outcome was quality-adjusted life years (QALYs) mapped from the UPDRS scores. The model included medical, informal care, and indirect costs. Both costs and utilities were discounted at an annual rate of 3.5%.

Results

DBS had yielded an increase of 1.4 QALYs per patient at an additional cost of 1,159,150 Egyptian pounds (EGP)/patient ($25,566). This results in an incremental cost-effectiveness ratio (ICER) of 830,726 EGP/QALY ($18,322/QALY). Patients with DBS have lower costs for medications, hospitalizations, informal care, and productivity loss. The main cost driver in the DBS arm is the device and implantation procedure costs, which accounted for 70% of total costs. The model was most sensitive to informal care costs.

Conclusions

DBS markedly improves the quality of life for advanced patients with PD and reduces informal care and indirect costs. However, at its current price, the ICER exceeds the Egyptian cost-effectiveness threshold.

Objectives

Despite an increasing number of mapping studies being conducted in China, there is an absence of a systematic reviews, which makes it difficult to inform the applications and further assess the methodological consistency, accuracy, and applicability of existing mapping studies. The objective of this review is to consolidate existing evidence, identify methodological gaps, and provide recommendations for improving mapping studies conducted among the Chinese population.

Methods

A systematic literature search was conducted in 14 databases from inception to May 31, 2025 to identify studies that developed mapping algorithms to estimate health utility values, specifically among Chinese populations. A data template was applied to extract dataset information, source and target measures, mapping types (direct vs indirect), models used, goodness-of-fit indicators, validation methods, and the optimal mapping algorithms selected. Potential challenges for future related studies were further discussed.

Results

A total of 33 studies was included. Most studies (87.9%) focused on mapping disease-specific non–preference-based measures (PBMs) to generic PBMs. The studies covered a broad range of disease areas, including oncology (36.4%), musculoskeletal disorders (15.2%), metabolic diseases (15.2%), cardiovascular diseases (9.1%), and neurological conditions (6.1%). All studies used direct mapping, with the ordinary least squares model (n = 37) being used most frequently, followed by Tobit model (n = 32) and Beta model (n = 22). Eleven studies explored indirect mapping, with the Ordered Logit and Ordered Probit models being the most employed techniques. Thirty-two studies conducted internal validation, with the N-fold cross-validation being the most used method—no study conducted external validation. The sample size ranged from 133 to 3320, with a median sample size of 553. Conducted conceptual analysis was performed in 81.8% of the studies to assess the degree of overlap between the source measure and target measure; 72.7% of the studies reported the utility/score distributions, and 15.2% of studies further reported the response distributions.

Conclusion

This systematic review provides insights into methodologies employed in mapping studies in China and identifies key areas for improvement. Addressing issues related to sample size, conceptual overlap, model selection, and validation methods will enhance the quality and applicability of mapping algorithms, ultimately supporting more robust cost-utility analyses in the Chinese healthcare system.

Background

Methods for the economic evaluation of implementation initiatives to increase the uptake of cost-effective healthcare interventions are not standardised. Value of implementation and policy cost-effectiveness are two proposed approaches. This research aims to compare these two methods and propose a standardised approach. To illustrate this, we evaluated two implementation programmes to increase magnesium sulphate (MgSO₄) uptake in preterm labour to reduce the risk of cerebral palsy: (i) the National PReCePT Programme (NPP), which provided regional support and funded clinical time in maternity units in England, and (ii) an enhanced support programme (ESP) with additional unit-level coaching and extra funded time, which was nested within the NPP and subject to a cluster randomised control trial.

Methods

After summarising value of implementation and policy cost-effectiveness methods, we explored the extent to which the two methods can be viewed as mathematically equivalent for the purpose of evaluating the NPP (versus pre-existing trends) and the ESP (versus the NPP) calculating their incremental cost-effectiveness ratios, net monetary benefits and their probability of being cost-effective.

Results

We demonstrate how the value of implementation and policy cost-effectiveness approaches can be expressed in equivalent terms and set out our standardised stepwise method for evaluating the NPP (versus pre-existing trends) and the ESP (versus the NPP). Our method found that the NPP generated a net monetary benefit of £30,247 per maternity unit over 12 months, with a 98% probability of being cost-effective. In contrast, the ESP generated a net monetary loss of £28,682 per unit compared with the NPP, with a 22% probability of being cost-effective.

Discussion

Our standardised method could promote a more systematic assessment of the value for money of implementation interventions.

The health-related quality of life (HRQoL) instruments developed by EuroQol, an international not-for-profit organisation, have earned a unique position in health economics and outcomes research. The original instrument, EQ-5D-3L, aimed to provide a concise, generic way of measuring and valuing HRQoL in adults that would enable broad comparability of HRQoL across populations and facilitate estimation of quality-adjusted life years (QALYs). These goals remain central to efforts to develop new instruments; to strengthen methods and evidence in measuring and valuing HRQoL; and to expand the use of HRQoL evidence to improve decision making. These initiatives are facilitated by the EuroQol Research Foundation’s funding of research and provision of support for instrument users; the commitment of an international community of researchers; and the support of a professional staff team. This paper provides an overview of EuroQol’s current suite of instruments: EQ-5D-3L and EQ-5D-5L (for adults) and EQ-5D-Y-3L and EQ-5D-Y-5L (for children) and key elements of its current research agenda. We summarise research underway to expand measurement to very young children (EQ-TIPS), and to expand what is measured (the EuroQol Health and Wellbeing instrument EQ-HWB; and the EQ-5D Bolt-on Toolbox). Research is also generating new valuation methods—such as the development of discrete choice experiment methods that incorporate duration and account for time preference—and strengthening the application of instruments, e.g., to monitor population health and health inequalities (EQ-DAPHNIE). We conclude by highlighting ongoing challenges and their implications for the future of measurement and valuation of HRQoL.

Background

Opioid overdose remains a leading cause of mortality in the USA. Although distributing naloxone to laypersons for use during witnessed opioid overdoses has been shown to effectively reduce overdose deaths, clinician awareness of naloxone prescribing remains low. Academic detailing (AD) has been reported to be an effective strategy to increase naloxone distribution to individuals at risk of opioid-related overdose/death.

Objective

This study evaluated the cost effectiveness of an academic detailing program aimed at promoting naloxone prescribing for adults at risk of opioid-related overdose compared to no intervention (non-AD program).

Methods

A Markov model with an integrated decision tree was developed to estimate the costs and outcomes associated with the AD program over a lifetime horizon from the US payer perspective. Model robustness was tested using sensitivity and scenario analyses.

Results

The results indicated that the AD program incurred a total direct cost of US$6280 and achieved 16.52 quality-adjusted life years (QALYs). In comparison, the non-AD program incurred a total direct cost of US$5971 and achieved 15.92 QALYs. The incremental cost-effectiveness ratio for the AD program was US$514 per QALY gained with an incremental net monetary benefit of US$29,739. Sensitivity and scenario analyses confirmed the robustness of these findings, which suggest that AD is a cost-effective strategy for improving survival and quality of life in individuals at risk of opioid overdose.

Conclusions

For decision makers seeking to address the opioid crisis, implementing an academic detailing program represents a cost-effective option at a willingness-to-pay threshold of US$50,000 per QALY gained.

Objectives

With rising global healthcare expenditures, there is an increasing demand for value-based healthcare (VBHC). Time-driven activity-based costing (TDABC) has been proposed as a key component of VBHC for addressing cost-related challenges. This study aimed to review the application of TDABC in health economic analyses across the continuum of care, explore its methodological advantages, and assess adherence to the 7-step or 8-step methodological reporting frameworks.

Methods

This systematic review was conducted by screening the MEDLINE, Embase, and Scopus databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including all studies published until April 2025. Studies that used TDABC for diagnosis and treatment of health conditions were included, while costing studies involving any surgeries were excluded. The NVivo qualitative data analysis software was used to analyse data through content analyses.

Results

A total of 32 studies met inclusion criteria, including 25 partial economic evaluations (costing) and seven full economic evaluations (EEs). Time-driven activity-based costing was predominantly applied in cancer treatment and management, followed by diabetes care. This methodology proved applicable across all stages of healthcare, helping to accurately identify the cost of care and resource waste, enhancing value in healthcare, and overcoming the current cost accounting challenges. Studies that used hybrid data collection approaches combining direct observation with staff input were more likely to report detailed and actionable cost assessments. Studies using 8-step framework demonstrated improved methodological adherence and reduced reporting variability.

Conclusions

Time-driven activity-based costing supports more accurate, transparent, and resource-sensitive health economic analysis enabling informed decision making and system-level efficiency. Its application across diverse care stages and conditions demonstrates its adaptability and relevance for modern health-economic evaluation. Policy makers and healthcare providers should consider adopting TDABC to strengthen costing practices and advance the transition toward value-based healthcare.

PROSPERO Registration Number

ID CRD42023447085

Background and Objective

South Africa proposes the creation of a new health technology assessment (HTA) agency. In anticipation, the South African Values and Ethics for Universal Health Coverage (SAVE-UHC) value assessment framework has been created to make explicit the attributes of social value to inform priority setting. However, operationalising these values in an HTA process requires technical economic evaluation-based methods and little consideration has been given to appropriate approaches to determine these. We therefore used a novel pragmatic approach to identify economic evaluation methods to incorporate the SAVE-UHC value attributes in HTA methods.

Methods

We mapped the SAVE-UHC elements to value attributes described in an existing value assessment framework to help identify previously described methods. A survey of experts and a workshop were conducted to supplement the methods identified in the mapping. The combined results were compiled as a list of ways the SAVE-UHC elements could be measured, valued and incorporated into economic evaluation methods.

Results

The results revealed a comprehensive list of approaches to measuring and valuing the SAVE-UHC elements. The results were further categorised into health and the distribution of health, financial risk, healthcare utilisation, well-being, healthcare costs, performance indicators and constraints.

Conclusions

South Africa is in the process of institutionalising HTA to guide prioritisation of new healthcare technologies. This research presents a wide range of methods that could be used in South Africa to implement SAVE-UHC. The approach could also be used in other countries seeking to implement their own value assessment frameworks and identify appropriate methods to incorporate them in HTA processes.

Introduction

Health promotion initiatives are often promoted as being worth the investment given future cash-savings. This paper uses the findings of HomeHealth, a health promotion service for older adults with mild frailty, to examine how economic evaluation relates to local decision making in England.

Methods

The HomeHealth trial randomised 388 participants aged 65+ years with mild frailty to receive HomeHealth (195 participants) or treatment as usual (193 participants). Health and social care resource use and carer time were self-completed at baseline, 6 months and 12 months. Primary and secondary healthcare resource use and medications were collected from patient files at 12 months post recruitment, covering the past 18 months. Stakeholders including commissioners were consulted on the results of the trial and budget impact.

Results

Participants allocated to HomeHealth had a significant reduction in emergency hospital admissions at 12 months (incident rate ratio (IRR) 0.65; 95% confidence interval (CI) 0.45–0.92) and unpaid carer hours at 6 months (− 16 h (95% CI − 18 to − 14 h) or − £360 (95% CI − 369 to − 351) per patient). Although the intervention is cost saving overall due to fewer emergency admissions, at a cost of £457 per patient commissioners do not have the budget to fund it.

Discussion

This case study illustrates the problem with using standard economic evaluation methods to argue for implementation of health promotion initiatives in publicly financed healthcare systems. Although HomeHealth resulted in reduced emergency admissions and may be cost saving to the system as a whole, it is not locally cash releasing. Health promotion initiatives are unlikely to be funded from local budgets without significant system-wide changes.

Objectives

A distributional cost-effectiveness analysis (DCEA) was conducted to evaluate how alteplase for acute ischemic stroke affected overall health and disparities in the USA.

Methods

Using an existing, published, cost-effectiveness analysis, a DCEA was developed from a US payer perspective. The population was divided into 25 equity-relevant subgroups based on race and ethnicity (5 census-based groups), and county-level social vulnerability index (quintiles). Inputs for stroke outcomes, incidence and alteplase utilization varied across subgroups. Opportunity costs were estimated by converting total spend on alteplase into quality-adjusted life-years (QALYs) using an equal distribution across subgroups. Various scenarios explored the impact of health system changes to improve stroke care access.

Results

Alteplase treatment resulted in larger relative QALY gains in more vulnerable versus less vulnerable subgroups owing to increased acute ischemic stroke incidence and lower receipt of thrombolysis. Using an opportunity cost threshold of US$150,000/QALY, alteplase was estimated to improve social welfare by increasing population health (45,606 QALYs gained) and reducing existing overall US inequities by 0.0001% annually. Results were robust across all levels of population inequality aversion and alternate opportunity cost thresholds. Health system scenarios that reduced care gaps promoted additional reductions in existing inequalities, because more patients with lower baseline health were eligible for treatment.

Conclusions

Under current treatment patterns, this DCEA demonstrated that alteplase for acute ischemic stroke increased population health and improved health equity. It is critical to address existing care gaps to enable equitable access to alteplase across race, ethnicity and geography.

The realities of ecosystem breakdown and climate change pose a significant threat to the health of individuals around the world, disproportionately affecting poor and vulnerable populations. Every sector in society, including healthcare, needs to be engaged in the tremendous collective effort and transformational change needed to limit global warming. We see priority setting as having a key role to play in reallocating existing budgets within healthcare systems whilst at the same time being used to facilitate sustainable and more efficient resource allocation across countries. Priority setting looks to fairly distribute resources with the goal of improving patient and population health outcomes. However, these goals can be broadened to include consideration of environmental impact based on our understanding of the necessity of emissions reduction to address the climate crisis and promote population health. In this paper, we introduce key concepts of priority setting and identify the interplay between priority setting and the realities of resource scarcity in the realm of planetary healthcare. We propose that applying priority-setting principles could serve at least three goals; (1) protect and improve health outcomes; (2) limit unnecessary and marginal care; and (3) facilitate a just transition to a sustainable healthcare system.