Value in Health最新文献

{"title":"Addressing Subgroup-Specific Treatment Effects to Avoid Inefficient Care: The Conflict Between Statistical and Health Economic Analyses","authors":"Sopany Saing PhD ,&nbsp;Gerjon Hannink PhD ,&nbsp;H. Amarens Geuzinge PhD ,&nbsp;Hendrik Koffijberg PhD","doi":"10.1016/j.jval.2025.05.004","DOIUrl":"10.1016/j.jval.2025.05.004","url":null,"abstract":"<div><h3>Objectives</h3><div>When patients are classified into subgroups based on previously identified heterogeneity, this heterogeneity may affect the cost-effectiveness of health interventions. Whether this heterogeneity is reflected or ignored in cost-effectiveness analysis may influence reimbursement decisions. This is illustrated using a simulation study of a hypothetical treatment to prevent disease progression.</div></div><div><h3>Methods</h3><div>With the decision analysis in R for technologies in health Sick-Sicker Markov model, we analyzed the cost-effectiveness of Treatment versus standard of care in a population comprising group 1 (G1) and group 2 (G2). We compared 3 strategies for informing reimbursement decisions: (1) ignore evidence on subgroup differences (ignore subgroup evidence), (2) test for subgroup differences in trial data at hand (statistically guided), and (3) use all evidence on subgroup differences (all evidence). This simulation study varied total sample size, G2 proportion, treatment effectiveness, and baseline mortality risk. For each scenario, the net health benefit and reimbursement decision (ie, reimburse in both subgroups, G1 only, G2 only, or no reimbursement) was determined per strategy.</div></div><div><h3>Results</h3><div>The statistically guided strategy led to subgroups being ignored except for the largest total sample sizes. At a willingness-to-pay threshold of €50 000/quality-adjusted life years gained, the statistically guided strategy resulted in an incremental net health benefit of −1.00 and 0.49 when compared with the strategies of ignoring subgroup evidence and for incorporating, respectively.</div></div><div><h3>Conclusions</h3><div>When subgroup heterogeneity is known, ignoring subgroups or taking a statistically guided approach will result in suboptimal reimbursement decisions and thus fail to optimize societal benefits. Therefore, subgroup-specific cost-effectiveness analyses should be informed by all available evidence of subgroup differences.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 8","pages":"Pages 1145-1152"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143668","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":"Implementing the Generalized Risk-Adjusted Cost-Effectiveness Model for Sickle Cell Disease: A Case Study","authors":"Marlon Graf PhD, MPP ,&nbsp;Joris Kleintjens MSc ,&nbsp;Md Tahsin Hasan PhD ,&nbsp;Natalie Land MPH ,&nbsp;Jacquelyn W. Chou MPP, MPL ,&nbsp;Karen Mulligan PhD","doi":"10.1016/j.jval.2025.05.005","DOIUrl":"10.1016/j.jval.2025.05.005","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to quantify the societal value of curing sickle cell disease by implementing the generalized risk-adjusted cost-effectiveness (GRACE) method, thereby adjusting for factors such as disease severity, reduction of uncertainty in treatment outcomes, and trade-offs between quality of life (QoL) and life expectancy in a cost-effectiveness analysis (CEA).</div></div><div><h3>Methods</h3><div>Using GRACE, we recalibrated a recent health technology assessment in sickle cell disease for 2 gene therapies, lovo-cel and exa-cel. The GRACE framework modified existing CEA by adjusting willingness-to-pay thresholds based on untreated illness severity, incorporating treatment outcome uncertainty, and varying the substitution rates between life expectancy and QoL across health states.</div></div><div><h3>Results</h3><div>Implementing the GRACE framework resulted in a 6% reduction in both direct and societal incremental cost-effectiveness ratios for lovo-cel and exa-cel, demonstrating a decrease from $192 651 and $161 816 to $182 036 and $152 900 per quality-adjusted life year, respectively. Additionally, willingness-to-pay thresholds increased by approximately 50%, reflecting a higher valuation of treatments under GRACE. GRACE-adjusted estimates suggest that lovo-cel and exa-cel are cost-effective from both direct payer and societal perspectives.</div></div><div><h3>Conclusions</h3><div>The GRACE method offers a more comprehensive and precise estimation of societal value, leading to more efficient and equitable resource allocation. This study not only highlights the limitations of traditional CEA in capturing the total societal value of treatments for severe diseases but also provides a roadmap for incorporating GRACE model elements into health technology assessments, thereby facilitating a broader acceptance of innovative therapies that significantly enhance patient QoL.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 8","pages":"Pages 1153-1160"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143724","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 Value of Hope in Cancer Care: Risk Preference and Heterogeneity in Cancer Patients and the General Public","authors":"Jihyung Hong PhD ,&nbsp;Eun-Young Bae PhD ,&nbsp;Shuye Yu PhD","doi":"10.1016/j.jval.2025.04.2166","DOIUrl":"10.1016/j.jval.2025.04.2166","url":null,"abstract":"<div><h3>Objectives</h3><div>To quantify the value of hope in cancer care and examine age as a potential modifier, comparing patients and the general public.</div></div><div><h3>Methods</h3><div>A discrete choice experiment was conducted in 2024 with 426 cancer patients diagnosed within the past 5 years and 2048 general public members without prior cancer experience in South Korea. Choice options comprised treatment effects, health status, and out-of-pocket costs. Treatment effects included a fixed 2-year survival option and 4 risk options offering 10% chances of extended survival (5 or 10 years) paired with 10% chances of minimum survival (3 months or 1 year), with varying survival durations for the remaining 80% to yield the same expected survival. Each participant completed 10 choice tasks, repeated for hypothetical ages of 5 and 70. Mixed logit and latent class analyses were performed.</div></div><div><h3>Results</h3><div>Both groups, particularly cancer patients, positively valued treatments with 10% chances of 10-year and 1-year survival over certainty. The monetary value of hope for this option was $12 445 for patients, about double that for the general public ($5985). These values increased to $51 103 and $35 609, respectively, for age 5, but were much lower for age 70. Conversely, the certainty option was preferred over treatments with 10% chances of 5-year and 3-month survival. Latent class analyses revealed substantial preference heterogeneity.</div></div><div><h3>Conclusions</h3><div>The value of hope represents a meaningful aspect of treatment preferences, especially in pediatric contexts. However, substantial preference heterogeneity poses challenges to effectively incorporating hope into health technology assessments, particularly in publicly funded healthcare systems.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 8","pages":"Pages 1259-1267"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036196","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 Increasing Use of Clinical Outcome Assessments in US Food and Drug Administration Labels and the German Gemeinsamer Bundesausschuss, National Institute for Health and Care Excellence, and the French Haute Autorité de Santé Assessments From 2012 to 2022","authors":"Marieke Krol PhD ,&nbsp;Joshua Maher PhD ,&nbsp;Tom Halmos MSc ,&nbsp;Matthew Reaney PhD ,&nbsp;Ali Shana’a MSc ,&nbsp;Benoit Arnould PhD ,&nbsp;Veleka Allen PhD ,&nbsp;Catherine Coulouvrat MD","doi":"10.1016/j.jval.2025.05.002","DOIUrl":"10.1016/j.jval.2025.05.002","url":null,"abstract":"<div><h3>Objectives</h3><div>Clinical outcome assessments (COAs) are increasingly used in clinical trials. However, knowledge gaps remain around their inclusion in market access decision making for pharmaceuticals and the perceived added value in capturing the patient experience. This study examined trends in the inclusion of COAs in US Food and Drug Administration (FDA) labels and European health technology assessments (HTAs) beyond those that are essential for assessing primary endpoints or determining cost-effectiveness.</div></div><div><h3>Methods</h3><div>The inclusion of nonmandatory COAs was analyzed in FDA labels and HTAs of German, French, and English bodies, from 2012 to 2022. Changes in COA use are reported overall, by COA type, concept, and therapeutic area.</div></div><div><h3>Results</h3><div>In FDA labels, the inclusion of nonmandatory COA increased from 18.6% to 28.4% from 2012-2016 to 2017-2022. The average number of unique COAs in FDA labels approximately doubled. Nonmandatory COA inclusions in HTAs increased from 45.2% to 64.9%. The average number of unique COAs per HTA also approximately doubled. Patient-reported outcomes were the most reported COAs in FDA labels and HTAs in both time periods. In FDA labels and HTAs, most therapeutic areas showed increases in nonmandatory COA inclusion. In FDA labels, COA instruments mostly measured signs and symptoms. In HTAs, they mostly measured health status and quality of life.</div></div><div><h3>Conclusions</h3><div>The findings show increasing trends in the use of nonmandatory COA in HTAs and, to a lesser extent, FDA labels, suggesting a greater awareness of COA benefits and a changing practice of inclusion toward more patient centricity.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 8","pages":"Pages 1195-1203"},"PeriodicalIF":6.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132081","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":"Zero Dollar Copay Pharmacy Benefit Decreases Healthcare Expenditures Among Members With Type 2 Diabetes of Blue Cross Blue Shield of Louisiana.","authors":"Tiange Tang, Charles Stoecker, Debra Winberg, Miao Liu, Elizabeth Nauman, Mingyan Cong, Eboni Price-Haywood, Brice Labruzzo Mohundro, Alessandra N Bazzano, Lizheng Shi","doi":"10.1016/j.jval.2025.07.017","DOIUrl":"10.1016/j.jval.2025.07.017","url":null,"abstract":"<p><strong>Objectives: </strong>Blue Cross Blue Shield of Louisiana implemented the Zero Dollar Co-payment (ZDC) program on July 1, 2020. This study aims to evaluate whether the ZDC program can reduce total healthcare expenditures.</p><p><strong>Methods: </strong>Blue Cross Blue Shield of Louisiana's medical and pharmacy claims from January 2019 to December 2021 was used in this study, and the index date was July 1, 2020. We identified 7603 continuously enrolled members with type 2 diabetes, including 3045 ZDC-eligible members as the ZDC group and 4558 Administrative Service Only group members as the control group. The primary outcome measure was monthly total healthcare expenditure, which included monthly medical and pharmacy spending. ZDC program's effectiveness was evaluated by a 2-way fixed-effect difference-in-difference regression weighted by odds of propensity scores. The study population was further classified into 3 subgroups based on their baseline use of ZDC-eligible antidiabetic medications: pre-ZDC users, pre-ZDC nonusers, and complex users.</p><p><strong>Results: </strong>The ZDC pharmacy benefit was associated with a significant reduction in total healthcare spending of $-121.76 per member per month (PMPM) (P = .002) and medical spending of $-131.50 PMPM (P < .001). For complex users, the ZDC program was associated with reductions of $283.44 PMPM (P = .006) in total healthcare spending and $385.45 PMPM (P < .001) in medical spending, whereas pharmacy spending significantly increased by $102.01 PMPM (P = .022). No significant results were observed for pre-ZDC users and pre-ZDC nonusers.</p><p><strong>Conclusions: </strong>The ZDC program was effective in reducing total healthcare expenditures among ZDC-eligible members with type 2 diabetes in Louisiana.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754411","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":"Testing the Valuation of the EQ-5D-Y-5L in Adults and Adolescents: Results From a 5-Country Study and Implications for the Descriptive System.","authors":"Tianxin Pan, Juan Manuel Ramos-Goni, Bram Roudijk, Shitong Xie, Feng Xie, Zhihao Yang, Brendan Mulhern, Richard Norman, Nancy Devlin","doi":"10.1016/j.jval.2025.07.016","DOIUrl":"10.1016/j.jval.2025.07.016","url":null,"abstract":"<p><strong>Objectives: </strong>The EQ-5D-Y-5L (\"Y-5L\") is a new health-related quality-of-life instrument for children and adolescents. Value sets for the Y-5L are planned. This article aimed to test the ability of adult and adolescent respondents to differentiate the ordinal levels of the Y-5L in valuation tasks and to explore the characteristics of stated preferences for the Y-5L between adults and adolescents.</p><p><strong>Methods: </strong>We collected latent-scale discrete choice experiment data via an online survey of adults (≥18 years) and adolescents (12-17 years) in Australia, Canada, China, The Netherlands, and Spain. A D-Efficient design consisting of 192 choice pairs was grouped into 16 blocks of 12 choice tasks per respondent. We used mixed-logit models to analyze the data and incremental dummies to represent movements from a less-severe level to its consecutive more-severe level.</p><p><strong>Results: </strong>We did not observe preference inversions in adults or adolescents (ie, no statistically significant positive coefficients on the incremental dummies). Adults showed similar preferences for the Y-5L in terms of dimension importance: Pain/Discomfort was considered the most important dimension in all countries except for China; Looking After Myself and Usual Activity were the least important dimensions. In contrast, Mobility was considered the most important dimensions by adolescents in Canada, Spain, and China.</p><p><strong>Conclusions: </strong>Adults could differentiate between the Y-5L level labels in valuation tasks, whereas more randomness was observed in adolescents' choices. Observed differences between adult and adolescent stated preferences for the Y-5L raise questions about how these preferences should be reflected in cost-effectiveness analysis.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754410","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":"Physician-Directed Reinvestment: A Novel Cost-Savings Framework for Hospital Systems That Leverages Frontline Physicians.","authors":"Pooja S Yesantharao, Renee Box, Lisa Shieh, Paul Maggio, Arash Momeni","doi":"10.1016/j.jval.2025.07.015","DOIUrl":"10.1016/j.jval.2025.07.015","url":null,"abstract":"<p><strong>Objectives: </strong>Costs of healthcare delivery continue to rise; however, existing cost-savings programs are often top-down measures driven by external entities. These can pose considerable administrative burden on physicians, thereby discouraging longitudinal commitment. This study investigates a novel bottom-up physician-directed Cost-Savings Reinvestment Program (CSRP), which empowers frontline physicians to create high-value care initiatives, with a portion of the achieved savings reinvested in initiatives of their choosing.</p><p><strong>Methods: </strong>This study analyzed our institutional CSRP initiative between 2017 and 2023. A retrospective analysis on a prospectively maintained database was performed. Outcomes of interest included cost savings from proposal implementation compared with standard of care in that clinical area, return on investment of the program calculated using overhead costs, and physician engagement.</p><p><strong>Results: </strong>Between 2017 and 2023, 128 CSRP proposals were received, of which 70 (55%) were accepted. Of these, 56 (80%) were successfully completed, resulting in disbursement of funds to physicians for reinvestment. In total, 72 faculty contributed to the 70 accepted proposals, with multidisciplinary collaboration and participation rising significantly each year. Since implementation, the CSRP program resulted in $34 457 130 in validated savings, which represented a 13-fold return on investment. Reinvested funds were used to support clinical research, educational efforts, and capital purchases.</p><p><strong>Conclusions: </strong>Across the first 6 years of program implementation, the CSRP has generated sustained cost savings for a large healthcare system that have exceeded target metrics, while also engaging a growing, increasingly diverse physician participant base. As such, the CSRP represents an effective new paradigm for encouraging value-based care by leveraging frontline physicians.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733494","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":"Inequality aversion in health: Eliciting aversion to univariate health inequalities across different health distributions.","authors":"Sindre A Horn, Ole F Norheim, Mathias Barra","doi":"10.1016/j.jval.2025.07.014","DOIUrl":"https://doi.org/10.1016/j.jval.2025.07.014","url":null,"abstract":"<p><strong>Objectives: </strong>Health inequality aversion parameters can be used to inform health-related social welfare functions (HRSWFs) when trade-offs between maximising and equalising health arise in health policy. Empirical estimates of inequality aversion among the public can be valuable to ensure that approaches to the trade-off reflect public preferences. We aimed to elicit inequality aversion parameters in a large population sample across different health distributions to inform HRSWFs of the Atkinson and Kolm-Pollak type and compare responses from different distributions.</p><p><strong>Methods: </strong>We recruited a representative population sample to complete two sets of benefit trade-off tasks with different degrees of baseline health inequality. This allows to test for intra-individual concurrence between elicited inequality aversion parameters across two different distributions. Elicited parameters from each task-set are reported and compared across the two task-sets. Our study used univariate health distributions.</p><p><strong>Results: </strong>946 responses were retained after application of exclusion criteria. In our sample from Norway, we find median Atkinson and Kolm-Pollak inequality aversion parameters of 3.52 and 0.05, respectively, when pooling all responses. However, we do not find a convincing concurrence between elicited inequality aversion parameters from the two task-sets.</p><p><strong>Conclusions: </strong>Our results indicate that most respondents are willing to trade-off at least some total health gains to favour the worse-off. We do not find a general concurrence between individuals' inequality aversion parameters when presented with distributions with unequal baseline inequalities, which suggests that our sample's distributional preferences may not satisfy the assumption of constant relative or absolute inequality aversion.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733493","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 per Opioid-Free Year: A Systematic Review and Summary Analysis.","authors":"Babasoji E Oyemakinde, Danielle Ryan, Techna Cadet, Tyler Judge, Manesh Gopaldas, Ali Jalali, Sean M Murphy","doi":"10.1016/j.jval.2025.07.008","DOIUrl":"10.1016/j.jval.2025.07.008","url":null,"abstract":"<p><strong>Objectives: </strong>Opioids remain a leading cause of death in the United States, and time free from opioid use is a common measure of effectiveness in economic evaluations of opioid use disorder (OUD) interventions. This study reviews the economic evaluation literature on OUD, identifies studies that calculated incremental cost-effectiveness ratios (ICER) based on time free from opioids, and establishes a benchmark for comparison in future research.</p><p><strong>Methods: </strong>The review examined economic evaluations of OUD interventions published in the peer-reviewed literature from inception to September 2024. ICERs of cost per period of opioid-free time were extracted or calculated from studies meeting the inclusion criteria. Monetary values were converted to 2024 USD and ICERs normalized to cost per opioid-free year (OfY). Articles were classified by intervention location (United States vs international) and economic perspective.</p><p><strong>Results: </strong>Fourteen articles met the inclusion criteria: 8 from the United States, 4 from Australia, 1 from Malaysia, and 1 from the United Kingdom. Among the US-based studies, the average ICER per OfY for the healthcare-sector, the state policymaker, and the societal perspective were $243 053/OfY, $17 674/OfY, and $32 125/OfY, respectively. For international studies, average ICERs for the healthcare-sector and societal perspectives were $79 765/OfY and $195 980/OfY, respectively.</p><p><strong>Conclusions: </strong>Cost per OfY is a widely used metric in economic evaluations because of its relative importance as a measure of clinical effectiveness. However, a universally accepted benchmark for decision making does not yet exist. This review aggregates data from existing studies that provided this measure, offering an initial step for establishing a cost-effectiveness threshold for cost per OfY.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the County-Level Social Deprivation Index 2020 and Its Association With Health Outcomes in China.","authors":"Xiaoning He, Peisong Dong, Yuhang Xin, Richard Cookson, Jing Wu","doi":"10.1016/j.jval.2025.07.012","DOIUrl":"10.1016/j.jval.2025.07.012","url":null,"abstract":"<p><strong>Objective: </strong>The lack of an up-to-date area deprivation index for China is a major barrier to health inequality monitoring and evaluation in the world's most populous country. This study aimed to develop the County-Level Social Deprivation Index 2020 for China from the most recent census data and analyze its relation to health outcomes.</p><p><strong>Methods: </strong>On the basis of the 2020 census data, 14 indicators for 2844 counties were selected across 5 domains, including income, employment, housing, education, and urban-rural location. The index was created using principal component analysis with oblique rotation. Associations between deprivation quintile groups and life expectancy and infant mortality were examined, with extensive sensitivity analyses around alternative indicators and weighting methods.</p><p><strong>Results: </strong>The new deprivation index was based on a weighted sum of 3 components that altogether explained 74% of the variation in the 14 indicators. Counties in the Eastern region tended to be less deprived, whereas counties in the Southwestern region tended to be more deprived. The life expectancy was 4.51 years shorter, and the infant mortality was 5.18% higher for counties in the most deprived quintile than those in the least deprived quintile. The grouping result and the association with the health outcomes were consistent across the primary and sensitivity analyses.</p><p><strong>Conclusions: </strong>The County-Level Social Deprivation Index 2020 for China reveals a clear social gradient in life expectancy and infant mortality across deprivation quintile groups. It can be used to help monitor health inequalities, identify high-need populations and quantify health inequality impacts in China.</p>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699650","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}