Health Economics Review最新文献

{"title":"Cost-utility analysis of three PD-1 inhibitors combined with chemotherapy in the first-line treatment of locally advanced or metastatic esophageal squamous carcinoma in China.","authors":"Li Liao, Jing Gong","doi":"10.1186/s13561-026-00784-2","DOIUrl":"https://doi.org/10.1186/s13561-026-00784-2","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the economics of sintilimab combination chemotherapy versus chemotherapy and sintilimab combination chemotherapy versus camrelizumab/ toripalimab combination chemotherapy in the first-line treatment of locally advanced or metastatic esophageal squamous carcinoma (ESCC) from the perspective of the Chinese health system.</p><p><strong>Methods: </strong>A partitioned survival model (PSM) with a tracked time horizon of 5 years was developed. In the basal analysis, a direct cost-utility comparison of sintilimab + chemotherapy vs. chemotherapy in first-line treatment of advanced ESCC was performed based on survival data from the ORIENT-15 trial. Cost and utility value data were obtained from relevant databases or published literature, and the robustness of the model was assessed using one-way sensitivity analysis and probabilistic sensitivity analysis (PSA). In the exploratory analysis, the cost-utility of sintilimab + chemotherapy vs. camrelizumab/ toripalimab + chemotherapy was indirectly compared by Network Meta-Analysis (NMA) combined with hazard ratio (HR).</p><p><strong>Results: </strong>Sintilimab in combination with chemotherapy resulted in 0.33 quality-adjusted life years (QALYs) more than chemotherapy with an incremental cost-effectiveness ratio (ICER) of 25,409.27 USD/QALY, which was lower than the willingness-to-pay (WTP). Sensitivity analysis showed that the utility value of stable disease and the price of sintilimab had the greatest impact on outcome stability. Exploratory analysis indicate that toripalimab plus chemotherapy yields an additional 0.04 QALYs compared with sintilimab plus chemotherapy, with an ICER of 9,953.24 USD/QALY. In contrast, camrelizumab plus chemotherapy yields 0.05 fewer QALYs compared with sintilimab plus chemotherapy.</p><p><strong>Conclusion: </strong>For the first-line treatment of locally advanced or metastatic ESCC, the addition of sintilimab to conventional chemotherapy regimens was economical. Among similar PD-1 inhibitors, the toripalimab plus chemotherapy regimen is more costly but more effective than the sintilimab plus chemotherapy regimen, and is cost-effective at the WTP threshold of 3 × GDP per capita. In contrast, the camrelizumab plus chemotherapy regimen is dominated (higher cost and worse effectiveness) by the sintilimab plus chemotherapy regimen.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis and interpretation of the heterogeneity of community-based health insurance attributes and preferences in Senegal: evidence from a discrete choice experiment.","authors":"Oumar Sagna","doi":"10.1186/s13561-026-00767-3","DOIUrl":"https://doi.org/10.1186/s13561-026-00767-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Community-based health insurance (CBHI) schemes have been widely promoted to improve financial protection and expand access to healthcare in low- and middle-income countries (LMICs), particularly among populations working in the informal sector who lack access to formal health insurance. In Sub-Saharan Africa, CBHI has been implemented as part of broader efforts to advance universal health coverage (UHC), yet enrolment often remains low. In Senegal, CBHI schemes aim to expand insurance coverage among informal sector populations, but participation remains limited and uneven across geographic and socioeconomic groups. Evidence on how specific insurance design attributes influence enrolment decisions remains scarce. This study examines population preferences for CBHI attributes and their implications for scheme uptake.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A discrete choice experiment (DCE) was conducted with 912 households in the Ziguinchor region using a stratified two-stage sampling approach. First, communities were selected across rural and urban areas. Second, households were randomly selected within each selected community. Lists of households were obtained from local administrative records, and respondents were randomly chosen from these lists. Interviews were conducted with household heads or adult household representatives. Prior to the main survey, the questionnaire and choice tasks were pilot-tested with a small sample of households to ensure clarity and comprehension. Mixed logit models were used to estimate preferences for six CBHI attributes, and policy simulations predicted enrolment under alternative scheme designs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Chronic disease coverage (OR = 61.2; 95% CI: 46.5-81.7), transport availability (OR = 24.3; 95% CI: 17.1-33.1), and flexible payment options (OR = 6.0; 95% CI: 3.9-9.2) were the strongest determinants of enrolment. Significant heterogeneity in preferences was observed across population groups. Compared with urban households, rural households placed greater importance on transport availability and flexible payment mechanisms. Similarly, compared with high-income households, low-income households showed stronger preferences for flexible payment options, while high-income respondents preferred more comprehensive benefit packages. Scenario simulations predicted enrolment gains from 76.53% under the baseline DECAM model to 97.81% under an optimized scheme including chronic disease coverage, transport support, and flexible payment options. Willingness-to-pay also varied across income groups and locations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Designing CBHI schemes around user preferences significantly improves predicted uptake and equity. Rather than uniform models, differentiated and preference-aligned insurance designs can drive substantial increases in enrolment and equity. Tailored insurance models that incorporate chronic disease services, address transport barrier","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does long-term care insurance promote assistive device utilization? Evidence from pilot regions in China.","authors":"Xiaoting Liu, Jinjing Fu, Wenxuan Zhu, Hao Lyu, Shimin Li, Yanru Wang","doi":"10.1186/s13561-026-00779-z","DOIUrl":"https://doi.org/10.1186/s13561-026-00779-z","url":null,"abstract":"<p><strong>Background: </strong>As China's population aging rapidly, long-term care insurance (LTCI) has emerged as a critical policy instrument to address the care needs of older adults. While previous studies have examined the effects of LTCI on service utilization, less is known about its effect on assistive device utilization-a key component in supporting functional independence and reducing caregiver burden. This study examines the association between LTCI benefit design and assistive device use among older adults in China.</p><p><strong>Methods: </strong>We use cross-sectional data from 1,460 older adults residing in elderly care institutions located in non-pilot areas, general LTCI pilot areas (covering care services only), and special LTCI pilot areas (covering both care services and assistive devices). Logistic regression models were used to estimate the associations between LTCI benefit types and assistive device use. Robustness checks were conducted using propensity score matching (PSM), and subgroup analyses were performed by age, education, and household registration.</p><p><strong>Results: </strong>General LTCI programs that cover care service only were significantly associated with a lower probability of assistive device use, consistent with a potential substitution effect in which subsidized formal care services may replace the need for assistive devices. In contrast, LTCI programs that explicitly include assistive device benefits were associated with a higher probability of assistive device use. These associations were more pronounced among the oldest-old, individuals with urban household registration, and those with lower education levels. Additional analyses indicate that the observed associations are primarily driven by mobility-related devices, whereas estimates for ADL-related devices and total device counts are not statistically significant.</p><p><strong>Conclusion: </strong>The findings suggest that the design of LTCI benefit packages may influence older adults' care choices and technology adoption. While causal interpretation remains limited, the results highlight the potential role of benefit design in shaping the balance between formal care services and assistive technology use. Expanding assistive device coverage and improving accessibility may help support functional independence among older adults in ageing societies, particularly in underserved rural regions.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who wants to pay more taxes for better long-term care services: evidence from OECD surveys.","authors":"Sylvain Botteron, Christophe Courbage, Joël Wagner","doi":"10.1186/s13561-026-00761-9","DOIUrl":"https://doi.org/10.1186/s13561-026-00761-9","url":null,"abstract":"<p><strong>Background: </strong>This study examines the factors influencing individuals' willingness to pay higher taxes to support long-term care (LTC) services, a pressing issue as aging populations drive rising LTC demand and public spending.</p><p><strong>Methods: </strong>We use data from the 2020 and 2022 waves of the OECD's \"Risk that Matter\" survey, a cross-national survey examining people's perceptions of the social and economic risks they face. We employ generalized linear mixed-effects models configured as logistic regression models, including country-level random intercepts and country-level covariates. We also conduct standard logit regressions for individual countries to analyze local nuances further.</p><p><strong>Results: </strong>The findings reveal that higher income, older age, female gender, left-leaning political orientation, and caregiving responsibilities significantly increase the likelihood of willingness to pay for improved LTC services. At the country level, greater LTC spending as a share of GDP, higher trust in government, and policies offering cash benefits to carers also play a significant role.</p><p><strong>Conclusions: </strong>Overall, the results indicate strong support for additional LTC funding among sizeable demographic groups, especially older respondents and those in higher-income groups. At the same time, political orientation and certain socio-demographic characteristics are associated with differences in support. These findings are relevant for policymakers considering reforms to improve the provision of LTC services.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Provider behavior from FFS to DRGs payment: experimental evidence from real physicians.","authors":"Yefeng Chen, Weizheng Zhao, Ying Liu, Jun Luo","doi":"10.1186/s13561-026-00769-1","DOIUrl":"https://doi.org/10.1186/s13561-026-00769-1","url":null,"abstract":"<p><strong>Background: </strong>Controlling the escalation of healthcare costs is a critical issue in China, which has led to a shift in the health insurance payment system from Fee-for-Service (FFS) to Diagnosis-Related Groups (DRGs). While DRGs contribute to cost containment, they also introduce moral hazards such as upcoding and undertreatment, which threaten the sustainability of insurance funds and public health.</p><p><strong>Methods: </strong>This study conducted a lab-in-the-field experiment with real physicians to simulate the operation of FFS and DRGs payments, incorporating the uncertainty of medical outcomes.</p><p><strong>Results: </strong>The results indicate that DRGs reduce overtreatment but increase the risks of upcoding and undertreatment, particularly under conditions of uncertainty, leading to greater losses for insurance funds. Most physicians demonstrated a strong altruistic inclination, prioritizing case severity over fairness and efficiency. However, the conflict between financial incentives and professional ethics creates a dilemma where adherence to medical norms may compromise patient welfare under the DRGs system.</p><p><strong>Conclusions: </strong>This research underscores the necessity of regulatory interventions to address these moral hazards, thereby safeguarding our healthcare system and public health.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of intensive and emerging rehabilitation therapies in children with cerebral palsy: an observational cohort study using real-world evidence and microsimulation modelling.","authors":"Diana Marcela Nova-Díaz, Sergio Aguilera-Albesa, Eduardo Sánchez-Iriso","doi":"10.1186/s13561-026-00768-2","DOIUrl":"https://doi.org/10.1186/s13561-026-00768-2","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the short- and long-term cost-effectiveness of integrating Intensive and Emerging Rehabilitation Therapies into standard care for children with cerebral palsy (CP), compared to standard care alone, through a hybrid approach combining prospective real-world data analysis and individual-level microsimulation over a lifetime horizon.</p><p><strong>Methods: </strong>A prospective observational cohort of 148 children with CP, stratified by Gross Motor Function Classification System levels, was followed over 12 months. Short-term incremental costs and quality-adjusted life years (QALYs) were estimated using seemingly unrelated regression equations (SURE) based on EQ-5D-Y scores. Costs were assessed from the Spanish public healthcare system perspective. To extrapolate long-term outcomes, an individual-level microsimulation model projected costs and QALYs over a 30-year horizon, applying a 3% annual discount rate.</p><p><strong>Results: </strong>Compared with standard treatment, Therasuit and intensive physiotherapy demonstrated the most favourable cost-effectiveness profiles. Therasuit generated 0.222 additional QALYs at an incremental cost-effectiveness ratio (ICER) of €18,830/QALY, while intensive physiotherapy generated 0.216 additional QALYs at €31,772/QALY. Other therapies, including occupational therapy and hippotherapy, were dominated by standard care. Long-term microsimulation provided additional insights beyond short-term findings by capturing delayed benefits, which in some cases led to different cost-effectiveness rankings among therapies. Therasuit produced 5.49 additional QALYs at an ICER of €12,922/QALY compared to standard care, and intensive physiotherapy produced 4.92 additional QALYs at €25,789/QALY. Homeopathy and the Petö Method were cost-effective under broader willingness-to-pay thresholds but were less efficient.</p><p><strong>Conclusions: </strong>Therasuit and intensive physiotherapy are high-value options when added to standard care for children with CP. Findings support prioritising Intensive and Emerging Rehabilitation Therapies using real-world evidence and modelling to guide sustainable healthcare decision-making.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presenting a pragmatic model for evaluating the economic performance of hospitals in Iran based on multi-criteria decision-making.","authors":"Jalal Saeidpour, Ehsan Teymourzadeh, Parisa Mehdizadeh, Mohammad Amiri-Ara","doi":"10.1186/s13561-026-00780-6","DOIUrl":"https://doi.org/10.1186/s13561-026-00780-6","url":null,"abstract":"<p><strong>Background: </strong>Evaluating the economic performance of hospitals is crucial for improving efficiency and aligning healthcare services with organizational missions. This study presents an operational model for assessing the economic performance of hospitals in Iran, based on a multi-criteria decision-making (MCDM) approach.</p><p><strong>Methods: </strong>An expert panel was employed to evaluate and prioritize key economic performance indicators using the Analytic Hierarchy Process (AHP). Nine primary indicators and four criteria, including validity, alignment with hospital missions, adherence to national accreditation standards, and data availability, were used for prioritization. Pairwise comparison matrices were developed, and consistency ratios (CR) were calculated to ensure accuracy. The final model incorporates normalized scores of indicators to derive the overall economic performance of each hospital.</p><p><strong>Results: </strong>The expert panel identified nine key indicators for assessing hospital economic performance. Among these, bed occupancy rate (weight = 0.219), bed turnover rate (0.167), and insurance claim rejection rate (0.141) received the highest priorities. Validity in measuring efficiency and economic performance was the most influential criterion (weight = 0.505), followed by alignment with hospital missions and objectives (0.331). The final weighted model highlights that improvements in bed utilization, patient flow, and insurance claim management have the greatest potential impact on hospitals' economic performance. Sensitivity analysis confirmed the robustness of the results, as changes in criterion weights did not substantially alter the ranking of the top indicators.</p><p><strong>Conclusion: </strong>The proposed model provides a reliable framework for assessing hospital economic performance in Iran. It highlights key performance indicators that align with organizational goals and economic efficiency. This model can aid hospital administrators in decision-making to improve financial sustainability.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Has volume-based procurement reduced household catastrophic health expenditure in rural patients with chronic disease?-Evidence from CHARLS 2018 and 2020 in China.","authors":"Shaoliang Tang, Shuo Sun, Yunjie Feng, Yuke Xu, Yiwei Shi","doi":"10.1186/s13561-026-00783-3","DOIUrl":"https://doi.org/10.1186/s13561-026-00783-3","url":null,"abstract":"<p><strong>Background: </strong>The volume-based procurement aims to reduce drug prices, alleviate the burden of medical costs on residents, and improve public health and well-being.</p><p><strong>Method: </strong>This study uses data from the China Health and Retirement Longitudinal Study (CHARLS) to evaluate the impact of Volume-Based Procurement (VBP) on household catastrophic health expenditures (CHE) among rural patients with chronic diseases. A household-level difference-in-differences (DID) model is constructed, and PSM-DID is applied to control for potential selection bias. The analysis further examines heterogeneous effects across regions and population subgroups, and explores the potential mediating role of health service utilization.</p><p><strong>Results: </strong>The baseline DID estimates indicate that VBP is associated with a reduction of approximately 3.33% points in the probability of household CHE, corresponding to a reduction of about 13-14% relative to the average CHE incidence of 24.65%. The PSM-DID robustness checks yield broadly consistent results. Heterogeneity analyses show that the policy effect is strongest among households in central and western regions, elderly households, and households without a spouse. Mechanism analysis suggests that health service utilization does not constitute a significant mediating channel, implying that the reduction in CHE is unlikely to operate through changes in healthcare utilization.</p><p><strong>Conclusions: </strong>The findings suggest that the VBP policy may help reduce the risk of catastrophic health expenditures among rural households with chronic disease patients and contribute to alleviating household medical financial burden.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic burden of blindness and moderate to severe vision impairment in Slovenia.","authors":"Nina Vidic Krhlikar, Dalibor Gavrić, Mojca Globočnik Petrovič, Karmen Janša, Nataša Vidović Valentinčič, Petra Došenović Bonča","doi":"10.1186/s13561-026-00782-4","DOIUrl":"https://doi.org/10.1186/s13561-026-00782-4","url":null,"abstract":"","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-utility of first-line dostarlimab plus carboplatin-paclitaxel compared with placebo for patients with pA/rEC: a partitioned survival analysis.","authors":"Ziyad S Almalki, Saba S Albanna, Yahia A Hadadi, Ahmed M Alshehri, Kamar Z Jamal, Saja H Almazrou, Jameilh A Alsamiri, Abdulrahman A Alsuhibani, Abdullah A Alalwan, Ahmad A Alamer, Nehad J Ahmed, Abeer A Shhada, Ghuafran A Alnajem","doi":"10.1186/s13561-026-00778-0","DOIUrl":"https://doi.org/10.1186/s13561-026-00778-0","url":null,"abstract":"","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}