Value in Health最新文献

{"title":"Understanding Preference Heterogeneity in Digital Neurorehabilitation: Results of a Discrete Choice Experiment.","authors":"Ann-Kathrin Fischer, Andrew Sadler, Thomas Kohlmann, Axel Mühlbacher","doi":"10.1016/j.jval.2026.03.2238","DOIUrl":"10.1016/j.jval.2026.03.2238","url":null,"abstract":"<p><strong>Objectives: </strong>Increasing demand, rising costs, and limited access pose major challenges for stroke rehabilitation. Digital interventions offer solutions, although acceptance varies. Understanding heterogeneity in preferences and decision consistency is essential.</p><p><strong>Methods: </strong>A discrete choice experiment (N = 1055 after data cleaning) assessed preferences for 7 attributes. Latent class analysis identified preference-based subgroups; a heteroscedastic conditional logit model examined scale heterogeneity.</p><p><strong>Results: </strong>Three classes were identified. Class 1 (21.3%) prioritized low copayment (β_80€ = -3.355; β_0€ = 3.058; P < .001) and showed limited digital readiness, placing less emphasis on technical features. Class 2 (32.2%) focused on therapy success, with large utility differences across levels (β₆₀% = -4.035; β_100% = 3.909; P < .001) and higher digital affinity. Class 3 (46.5%) valued professional contact (β = 0.941; P < .001), location flexibility (β = 0.632; P < .001), and progress feedback (β = 0.558; P < .001), reflecting differentiated engagement preferences. The heteroscedastic conditional logit model showed that satisfaction with health (γ = 0.114; P < .001) and quality of life (γ = 0.043; P < .001) were linked to greater consistency, whereas (very) good health status (γ = -0.177; P < .001) and therapy experience (γ = -0.014; P < .001) corresponded to increased variability.</p><p><strong>Conclusion: </strong>Tailored interventions should reflect distinct preference types to foster acceptance. Cost-sensitive users may need simple formats; digitally engaged individuals benefit from flexible solutions; and those with inconsistent decisions may require clearer guidance or structured onboarding. Conducted in stroke rehabilitation, the study also captured broader rehabilitation experience.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Social Distribution of Quality Adjusted Life Expectancy (QALE) among Social Deprivation Subgroups in China.","authors":"Xiaoning He, Peisong Dong, Yuhang Xin, Lijun Wang, Jinlei Qi, Jing Wu, Richard Cookson","doi":"10.1016/j.jval.2026.03.2237","DOIUrl":"https://doi.org/10.1016/j.jval.2026.03.2237","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate disparities in quality-adjusted life expectancy (QALE) across social deprivation subgroups in China using the County-level Social Deprivation Index 2020 (CSDI 2020).</p><p><strong>Methods: </strong>Mortality data from the 2021 Chinese Death Surveillance System were linked with a national EQ-5D-5L health utility survey. Mortality underreporting was calibrated using model life tables and benchmarked against official statistics. Health utilities were modeled using ordinary least squares (OLS) regression incorporating age-deprivation interactions. QALE was estimated via the Sullivan method. Additional analyses examined the interaction between geographic regions and deprivation quintiles.</p><p><strong>Results: </strong>QALE declined progressively as social deprivation increased. The national QALE gap at birth between the least and most deprived quintiles was estimated to be at least 7.73 QALYs (95% CI: 7.12-8.32) , with 77.4 QALYs in the least deprived group versus 69.6 QALYs in the most deprived. Men experienced larger disparities (7.98 QALYs) than women (7.31 QALYs). Sensitivity analyses confirmed a robust gradient, with gaps ranging from 7.45 to 8.71 QALYs. When accounting for region-deprivation interactions, this disparity widened to 10.65 QALYs between the least deprived Eastern and most deprived Western subgroups.</p><p><strong>Conclusions: </strong>Substantial, graded inequalities in QALE exist in China, significantly compounded by regional development gaps. These findings provide a critical empirical foundation for equity-informed health policy and distributional cost-effectiveness analysis.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The inequality-adjusted incremental cost-effectiveness ratio.","authors":"Richard Cookson, Gunjeet Kaur, Ieva Skarda, Shrathinth Venkatesh, Tim Doran, Matthew Robson, Ole F Norheim, Owen O'Donnell, Mike Paulden","doi":"10.1016/j.jval.2026.03.2236","DOIUrl":"https://doi.org/10.1016/j.jval.2026.03.2236","url":null,"abstract":"<p><strong>Objectives: </strong>To adjust the incremental cost-effectiveness ratio (ICER) to capture trade-offs between maximisation of total health and impact on social inequality in health.</p><p><strong>Methods: </strong>We used equity weights derived from a social welfare function to calculate an inequality-adjusted ICER, both indirectly and directly. We demonstrated equivalence of decision rules based on the inequality-adjusted ICER and equity-weighted net health benefit. We defined a health inequality modifier (HIM) to the cost-effectiveness threshold - the ratio of the ICER to the inequality-adjusted ICER - and illustrated its application to hypothetical treatments for 1,336 diseases in England. We used hospital admissions to estimate disease prevalence and health benefits by five social deprivation groups, assumed no social gradient in health opportunity costs and examined \"high\", \"medium\" and \"low\" health inequality aversion scenarios based on UK general public sample estimates.</p><p><strong>Results: </strong>Assuming medium inequality aversion, the inter-percentile HIM range was 0.96-1.18, indicating that inequality adjustment would reduce the threshold by 4% at the bottom percentile and increase it by 18% at the top percentile of diseases. The threshold was reduced by at least 10% for only 2 (/1,336 = 0.15%) diseases and raised by at least 10% for 142 (/1,336 = 10.6%). High inequality aversion widened the inter-percentile HIM range to 0.93-1.31.</p><p><strong>Conclusion: </strong>Use of the inequality-adjusted ICER would effectively modify the cost-effectiveness threshold to consider health inequality impact. In England, the modification would rarely exceed 30%, even assuming high inequality aversion, but could exceed 10% for about one tenth of diseases assuming medium aversion.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors and Angiotensin Receptor-Neprilysin Inhibitors in Addition to Standard Treatment of Chronic Heart Failure: A Systematic Review and Meta-Analysis.","authors":"Nattakrit Tongpoonsakdi, Amarit Tansawet, Teerapat Yingchoncharoen, Porntep Amornritvanich, Rini Noviyani, Montarat Thavorncharoensap, Gareth J McKay, John Attia, Ammarin Thakkinstian","doi":"10.1016/j.jval.2026.03.2233","DOIUrl":"10.1016/j.jval.2026.03.2233","url":null,"abstract":"<p><strong>Background: </strong>Guideline-directed medical therapies (GDMTs) have improved heart failure (HF) outcomes, particularly with the emergence of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor-neprilysin inhibitors (ARNI). However, their cost-effectiveness remains uncertain across HF phenotypes, income levels, and analytic perspectives.</p><p><strong>Objectives: </strong>The study aimed to evaluate and compare the incremental net benefit (INB) of SGLT2i and/or ARNI added to traditional GDMTs, stratified by HF phenotype, country income level, and study perspective.</p><p><strong>Methods: </strong>PubMed, Scopus, and the Cost-Effectiveness Analysis Registry were searched through October 2024. Economic evaluations assessing SGLT2i or ARNI added to traditional GDMTs were included. INBs and variances were extracted or calculated; if unavailable, variances were imputed via regression or based on similar studies. Random-effects meta-analyses were performed by treatment-comparator pairs, HF phenotype, income level, and perspective. Risk of bias was assessed using the Bias in Economic Evaluation checklist.</p><p><strong>Results: </strong>Seventy studies were included. Adding SGLT2i to traditional GDMTs was cost-effective in high-income countries (HICs) for HF with reduced ejection fraction (HFrEF) from healthcare perspective (pooled INB = US $13 114.52; 95% CI: 4257.40-21 971.63), whereas evidence was inconclusive for upper-middle (UMICs) or lower-income countries. Quadruple regimen (SGLT2i + ARNI) appeared cost-effective in HICs and UMICs, although evidence was limited. Replacing other renin-angiotensin-aldosterone system blockers with ARNI was only cost-effective for HFrEF from societal perspective in HICs (INB = US $14 843.66; 95% CI: 566.36-29 120.96). Evidence for other HF phenotypes remained inconclusive evidence.</p><p><strong>Conclusions: </strong>Adding SGLT2i and ARNI improves GDMTs cost-effectiveness for the treatment of HFrEF, especially in HICs. More evidence is needed for other HF types and income settings.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric performance of preference-weighted instruments in older adults: a systematic review.","authors":"Lidia Engel, Valeriia Sokolova, Jan Faller, Yared Belete Belay, Pei Wang, Jan Abel Olsen, Brendan Mulhern","doi":"10.1016/j.jval.2026.03.2234","DOIUrl":"https://doi.org/10.1016/j.jval.2026.03.2234","url":null,"abstract":"<p><strong>Background: </strong>Population ageing is a major public health concern. Preference-weighted instruments are widely used to assess health-related quality of life (HRQoL) and inform cost-effectiveness analyses. Given the range of available measures, it is important to identify those most suitable for older adults. This study systematically reviewed evidence on the psychometric properties of preference-weighted measures in older adults.</p><p><strong>Methods: </strong>Four databases (Medline, Embase, PsycINFO, CINAHL) were searched, supplemented by citation tracking. Peer-reviewed studies assessing the psychometric properties of preference-weighted measures in adults aged ≥60 were included. Two reviewers independently screened and extracted data. Methodological quality was assessed using the COSMIN risk of bias checklist, and evidence was graded using a modified GRADE approach.</p><p><strong>Results: </strong>106 studies were included, covering EQ-5D-3L (4), EQ-5D-5L (34), ICECAP-O (29), ASCOT (15), QOL-ACC (9), HUI3 (8), HUI2 (7), QWB (5), EQ-HWB-9 (5), WOOP (3), SF-6D (3), AQoL-8D (2), AQoL-4D (1), and 15D (1). EQ-5D versions showed acceptable performance on some criteria, though ceiling effects, limited inter-rater reliability, inconsistent responsiveness were reported. ICECAP-O and ASCOT showed more consistent evidence, but both need further testing on responsiveness. Limited and mixed findings were available for other measures. Early evidence for QOL-ACC and WOOP was promising but incomplete. While inter-rater reliability and responsiveness evidence remained limited across all measures, specific measures performed generally better than generic measures but had fewer studies.</p><p><strong>Conclusions: </strong>Preference-weighted measures are widely used with older adults, but psychometric evidence remains incomplete due to limited assessment of responsiveness, few head-to-head comparisons, and lack of age-group-specific analyses.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Minimization Analysis of the Women's Cancer Risk Identification-Quantitative Polymerase Chain Reaction Test for Endometrial Cancer Epigenetic Biomarker Compared With Transvaginal Ultrasound for Triaging Abnormal Uterine Bleeding.","authors":"Tristan M Snowsill, Sara Sleigh, James Barrett, Martin Widschwendter","doi":"10.1016/j.jval.2026.03.2235","DOIUrl":"10.1016/j.jval.2026.03.2235","url":null,"abstract":"<p><strong>Objectives: </strong>Abnormal uterine bleeding most often has benign cause, but symptomatic cancers need to be found and treated quickly. An objective DNA methylation test, the Women's Cancer Risk Identification-quantitative polymerase chain reaction test for Endometrial Cancer (WID-qEC), has equivalent sensitivity to transvaginal ultrasound (TVUS) for endometrial cancer detection but better specificity and lower failure rates. We conducted a cost-minimization analysis of WID-qEC versus TVUS for initial evaluation of abnormal uterine bleeding in those aged 45 years or older in secondary care cancer exclusion services.</p><p><strong>Methods: </strong>The EPI-SURE study was a single-center prospective evaluation of the comparative diagnostic accuracy of WID-qEC and TVUS. A decision-analytic model was constructed using individual-level EPI-SURE data and National Health Service reference costs. Data from participants in EPI-SURE were combined with assumptions about downstream testing and estimates of relevant costs to determine the costs associated with initial evaluation by WID-qEC or TVUS.</p><p><strong>Results: </strong>Definitive evaluation was required for 57% of patients with initial evaluation by TVUS but only for 12% of patients with initial evaluation by WID-qEC. A breakeven price of £302 was estimated, with a very high probability (>99%) of WID-qEC resulting in cost savings at an indicative price of £200. A sensitivity analysis using a higher threshold for WID-qEC generated greater savings (breakeven price £331). At a WID-qEC price of £150, the mean cost saving was £152 per patient.</p><p><strong>Conclusions: </strong>Use of the WID-qEC as the first line triage test in patients aged 45 years or older undergoing urgent evaluation of abnormal uterine bleeding has the potential to reduce costs and unnecessary invasive, often painful, subsequent testing.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Artificial Intelligence in Health Economics and Outcomes Research: Considerations on Reproducibility, Prompt Strategy, and Error Impact in Automated Data Extraction.","authors":"Huiyi Jin","doi":"10.1016/j.jval.2026.01.031","DOIUrl":"10.1016/j.jval.2026.01.031","url":null,"abstract":"","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of Elicitation Methods for Distributional Preferences in Healthcare Regarding the Concentration and Dispersion of Health Benefits.","authors":"Laura A Trigg, Aisha Moolla, Colin Angus, Aki Tsuchiya","doi":"10.1016/j.jval.2026.03.012","DOIUrl":"10.1016/j.jval.2026.03.012","url":null,"abstract":"<p><strong>Objectives: </strong>In conventional quality-adjusted life-year maximization, each unit of health is valued equally. It overlooks distributional preferences, such as whether health improvements should be concentrated on a smaller number of individuals or dispersed across a larger population. It is plausible that these preferences follow an S-shaped pattern, in which marginal social value of health gains initially increases before diminishing after a threshold. This review aims to identify and evaluate the methods used in empirical studies to elicit S-shaped preferences.</p><p><strong>Methods: </strong>Searches were conducted in PubMed, PsycINFO, and EconLit in August 2024 and October 2025, with 1 round of citation chasing for 4 key articles. Studies were included if they elicited preferences on concentration and dispersion of health gains among otherwise identical individuals. Data synthesis was conducted narratively.</p><p><strong>Results: </strong>Thirteen studies published between 1994 and 2025 were included, collectively involving 6799 participants. All studies used a Person Trade-Off (PTO) approach, but 2 also used Time Trade-off. Five key methodological themes emerged: whether health gains should be measured in life-years or health-related quality of life, the threshold between concentration and dispersion, perspective, framing effects, and specification of the social welfare functions.</p><p><strong>Conclusions: </strong>This review highlights methodological challenges associated with eliciting preferences for concentration and dispersion. Although there is a consensus on the use of PTO, other heterogeneity such as pool size or perspective and sparse evidence on the threshold effect warrants further research.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deepening and Broadening: Revisiting Theories, Long-Term Economic Impact, and Diversity in Parental Bereavement After the Loss of a Child to Spinal Muscular Atrophy","authors":"Xuancheng Zhou MD ,&nbsp;Jingxuan Dai MD ,&nbsp;Hao Chi MD","doi":"10.1016/j.jval.2025.10.018","DOIUrl":"10.1016/j.jval.2025.10.018","url":null,"abstract":"","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"29 4","pages":"Pages 703-704"},"PeriodicalIF":6.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145782763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"System-Wide Use of Patient-Reported Outcome Measures in Organization for Economic Co-operation and Development Countries: Insights From a Health Policy Survey and Key Informant Workshops","authors":"Candan Kendir MD ,&nbsp;Ana Sofia V. Carvalho MD ,&nbsp;Sophie Tran MPH ,&nbsp;Michael van den Berg PhD ,&nbsp;Kate de Bienassis MPH ,&nbsp;Óscar Brito-Fernandes PhD ,&nbsp;Frederico Guanais PhD ,&nbsp;Dionne Kringos PhD ,&nbsp;Jose Maria Valderas PhD ,&nbsp;Niek Klazinga PhD","doi":"10.1016/j.jval.2025.11.008","DOIUrl":"10.1016/j.jval.2025.11.008","url":null,"abstract":"<div><h3>Objectives</h3><div>Patient-reported outcome measures (PROMs) can systematically integrate the patient perspective to enhance value-based, people-centered healthcare. This study aims to assess the current systematic use of PROMs data across OECD countries and identify barriers and enablers for system-wide implementation from decision-makers’ perspectives.</div></div><div><h3>Methods</h3><div>A cross-sectional country-level survey was conducted among country officials from 38 OECD member and accession countries and key partners. Two researchers independently coded survey responses. Analysis of barriers and enablers to implementation was guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and survey results were validated through 2 online workshops, with 72 and 81 key informants, respectively.</div></div><div><h3>Results</h3><div>Among 38 countries surveyed, 44 PROMs programs were identified in 21 countries. Main purposes of data collection were quality improvement (95% of the programs) and quality assurance (55%). The primary users of PROMs data were healthcare professionals (68%), policy makers (59%), and healthcare professional organizations (59%). Programs more frequently engaged healthcare professionals (93%) than patients (81%). In most programs (73%), patients could complete PROMs via online platforms, whereas in less than half (39%) PROMs data were embedded into electronic health records. The most reported barriers to implementation included limited staffing capacity, technological challenges, and insufficient training for both patients and healthcare professionals.</div></div><div><h3>Conclusion</h3><div>Improved resource allocation, meaningful stakeholder engagement, and embedding PROMs into data infrastructures can contribute to system-wide PROMs implementation.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"29 4","pages":"Pages 623-631"},"PeriodicalIF":6.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}