Health Economics Review最新文献

{"title":"Health economic evaluations of diagnostic tests for tuberculosis: a narrative review.","authors":"Cemre Arpa, Ahmed Abd El Wahed, Serap Aydin, Prakash Ghosh, Dinesh Mondal, Lydia Nakiyingi, Julius Boniface Okuni, Sophie Schneitler, Manfred Weidmann, Martin Siegel","doi":"10.1186/s13561-025-00639-2","DOIUrl":"10.1186/s13561-025-00639-2","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis is the leading cause of death from infectious diseases globally. Non-specific symptoms and limitations of existing diagnostics involve challenges for informed policymaking and clinical practice. This paper reviews common practices in reporting the selection and definition of cost and effect parameters, and in reporting the translation of effect parameters into utility and disability weights, in health economic evaluations of TB diagnostic tests.</p><p><strong>Methods: </strong>A targeted literature search in PubMed, Cochrane Library, Web of Science, and Google Scholar identified health economic evaluations of diagnosis and population screening strategies for TB.</p><p><strong>Results: </strong>We found 28 studies comprising 11 cost-effectiveness and 17 cost-utility analyses. Observed patient data were used in 6 studies, 22 relied solely on model-based evaluations. Variations in prevalence, accuracy, and utility parameters were common, the Consolidated Health Economic Evaluation Reporting Standards terminology for costing was only used in 8 out of 28 studies.</p><p><strong>Discussion: </strong>Future studies should state the exact type of TB studied, as it can manifest in multiple organs, remain inactive for long periods of time, and since different diagnostics can perform differently depending on the site involved it may influence test accuracies. Additionally, potential impacts of sequential diagnostics on test accuracy and the cost of inaction should receive more attention.</p><p><strong>Conclusion: </strong>Precise terminology and transparent definitions of parameters and methodology in health economics evaluations are necessary to generate evidence that guides policymakers and supports clinical decision-making in the context of TB.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"43"},"PeriodicalIF":2.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cost-effectiveness analysis comparing single-inhaler extrafine beclomethasone/formoterol/glycopyrronium bromide against other SITTs in adult patients with uncontrolled asthma in England.","authors":"Ioanna Vlachaki, Simon Donhauser, Alessandra Madoni, Marielle van der Deijl, Yuvraj Sharma, Dimitrios Tzelis, Ines Guerra","doi":"10.1186/s13561-025-00640-9","DOIUrl":"10.1186/s13561-025-00640-9","url":null,"abstract":"<p><strong>Background: </strong>In patients with asthma uncontrolled by a medium or high-strength (MS/HS) inhaled corticosteroid (ICS) plus long-acting β2-agonist (LABA), according to Global Initiative for Asthma (GINA) guidelines, a maintenance therapy option is the addition of a long-acting muscarinic antagonist (LAMA) via single-inhaler triple therapy (SITT). Evidence has previously been published on the cost-effectiveness of a SITT extra fine formulation of beclomethasone, formoterol and glycopyrronium bromide (BDP/FOR/GLY) vs. dual ICS/LABA combination, using data from two 52-week clinical trials (TRIMARAN and TRIGGER). However, there is limited evidence on the comparative cost-effectiveness of SITTs. The current analysis evaluated the cost-effectiveness of BDP/FOR/GLY versus other SITTs, in the UK setting.</p><p><strong>Methods: </strong>Markov cohort state-transition model was developed to investigate the cost-effectiveness of BDP/FOR/GLY Medium Strength (MS) vs. fluticasone, umeclidinium, and vilanterol (FF/UMEC/VI) MS and, BDP/FOR/GLY High Strength vs. FF/UMEC/VI HS and vs. indacaterol acetate, glycopyrronium bromide, and mometasone (IND/GLY/MF) HS. A network meta-analysis was performed to estimate comparative efficacy of BDP/FOR/GLY against other SITTs. The model analyzed cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), and was developed from the perspective of England National Health Service (NHS) and Prescribed Specialized Services expenditure (2022 costs). Uncertainty of the inputs was estimated using one-way and probabilistic sensitivity analyses.</p><p><strong>Results: </strong>BDP/FOR/GLY MS was projected to be a dominant treatment alternative against FF/UMEC/VI MS (£5,121 less costly, gained 0.065 additional QALYs). Similarly, BDP/FOR/GLY HS was a dominant treatment alternative against FF/UMEC/VI HS (£143, 0.003 additional QALYs) and IND/GLY/MF HS (£692 less costly, gained 0.023 additional QALYs). BDP/FOR/GLY MS and HS had 77.1%, 51.3%, and 61.2% likelihoods to be cost-effective vs. FF/UMEC/VI MS, FF/UMEC/VI HS, and IND/GLY/MF HS at the defined willingness-to-pay (WTP) threshold of £20,000 per QALY gained, respectively.</p><p><strong>Conclusions: </strong>BDP/FOR/GLY MS and HS were a dominant treatment alternative compared with FF/UMEC/VI, both MS and HS, and IND/GLY/MF HS in patients with asthma uncontrolled by ICS/LABA.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"42"},"PeriodicalIF":2.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost effectiveness of imaging strategies in the emergency department for the diagnostic workup of community-acquired pneumonia: a real-life retrospective study.","authors":"Sabrina Kepka, Kevin Zarca, Mickaël Ohana, Louise Hoffbeck, Charlène Heimann, Pierrick Le Borgne, François Severac, Joris Muller, Erik-André Sauleau, Pascal Bilbault, Isabelle Durand Zaleski","doi":"10.1186/s13561-025-00625-8","DOIUrl":"10.1186/s13561-025-00625-8","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to compare the length of stay (LOS) and costs of diagnostic workup by Ultra Low Dose (ULD) chest computed tomography and radiography for patients treated for a community-acquired pneumonia (CAP) in the emergency department (ED).</p><p><strong>Methods: </strong>We conducted a real-life retrospective study of patients treated for a CAP in two ED between March 1, 2019 and February 29, 2020. We estimated length of stay (LOS) as the difference between ED discharge and entry times, total hospital costs at 60 days including ED, initial admissions and readmissions. Patients with initial radiography were compared with patients with initial ULD CT using inverse probability weighing of the propensity score calculated from demographic variables, vital parameters and clinical presentation. We calculated the incremental cost effectiveness ratio as the difference between costs and the difference between LOS. Variability of the results was assessed using non-parametric bootstrapping.</p><p><strong>Results: </strong>We included 1609 consecutive patients, 1476 patients with radiography and 133 patients with ULD CT. The average costs were respectively €4317 [3483; 5067] and €4223 [4034; 4612] with 11.9 [10.1; 13.2] and 11.7 [11.5; 12.2] hours of LOS in the ED for chest radiography and ULD chest CT respectively, resulting in lower costs of € -94 [-870; 819] and a decreased LOS of 12 [-108; 76.9] minutes in favor of ULD chest CT.</p><p><strong>Conclusions: </strong>In this real-life study, the management of CAP in ED by ULD chest CT compared with chest radiography resulted in lower costs without increasing LOS.</p><p><strong>Trial registration: </strong>This study was registered with the Clinical Trials Registry (NCT05140408).</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"41"},"PeriodicalIF":2.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI integration in energy management: enhancing efficiency in Italian hospitals.","authors":"Paolo Pariso, Michele Picariello, Alfonso Marino","doi":"10.1186/s13561-025-00638-3","DOIUrl":"10.1186/s13561-025-00638-3","url":null,"abstract":"<p><strong>Background: </strong>In the rapidly evolving healthcare landscape, artificial intelligence (AI) is revolutionizing hospital operations by enhancing operational efficiency and patient care. This study focuses on the integration of AI in energy management within Italian hospitals and the role of energy managers.</p><p><strong>Methods: </strong>A comprehensive questionnaire was developed to understand current practices, challenges, and opportunities in AI adoption within hospital energy management. The study targeted regions in Italy with the highest concentration of hospital energy managers. A quantitative approach was employed, and the collected data were statistically analysed for reliability and validity using SPSS.</p><p><strong>Results: </strong>The analysis revealed significant benefits of integrating AI in energy management, including optimized energy consumption, predictive maintenance, and greater sustainability. Energy managers' roles are evolving to leverage AI technologies effectively, ensuring compliance with energy regulations and promoting eco-friendly practices.</p><p><strong>Conclusions: </strong>This research underscores AI's transformative potential in creating smarter, greener, and more efficient hospital environments. The findings highlight the importance of adopting AI-driven energy management solutions to enhance hospital efficiency. Future trends indicate further advancements in AI applications, necessitating ongoing adaptation and training for energy managers to exploit these technologies fully.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"40"},"PeriodicalIF":2.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Budgetary impact of increasing use of peritoneal dialysis over haemodialysis in Spain.","authors":"Gemma Barbado, Carla Garí, Asís Ariznavarreta, Neus Vidal-Vilar, Carlos Alvarez","doi":"10.1186/s13561-025-00633-8","DOIUrl":"https://doi.org/10.1186/s13561-025-00633-8","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) represents a significant public health concern, due to its high prevalence and incidence, as well as its substantial socio-economic costs. In Spain, estimates suggest that the direct healthcare costs of CKD will increase by 13.8% from 2022, which is why the cost of kidney replacement treatment (KRT) programs efficiency and sustainability is under constant analysis. Our analysis aimed to estimate the cost associated with peritoneal dialysis (PD) compared to hemodialysis (HD) from the Spanish National Health System (NHS) perspective and to evaluate the budgetary impact of an increase in the use of PD in our healthcare system environment.</p><p><strong>Methods: </strong>The number of patients eligible for KRT was calculated based on the total Spanish population and the incidence and prevalence of patients with end-stage renal disease (ESRD). Patients receiving each modality, type of dialysis, and location of dialysis were estimated. The annual costs of each dialysis modality were calculated and included the cost of dialysis sessions and additional costs (including the cost of peritoneal and vascular access, hospitalisation costs due to potential complications of dialysis, cost of health care personnel, and cost of health care transport used by patients). Population data and costs (€, 2024) were obtained from the Spanish databases and a nephrologist validated the assumptions. Budget impact analysis assessed the incremental budget impact between the current scenario and the alternative scenario, where 30% of incident patients on scheduled HD would receive PD.</p><p><strong>Results: </strong>We estimated that in Spain, there are 27,281 prevalent dialysis patients (3,141 receiving PD and 24,140 receiving HD/HDF) and 6,052 incident dialysis patients (1,173 receiving PD and 4,879 HD/HDF). The cost of dialysis amount to €1,555,573,771 (€141,361,374 PD and €1,414,212,397 to HD) in the current scenarios and to €1,540,584,011 (€167,593,157 PD and €1,372,990,854 HD) in the alternative scenario, resulting in a saving of €14,989,760 when 30% of the patients scheduled to receive HD would instead receive PD during the first year.</p><p><strong>Conclusions: </strong>The increased use of PD in Spain improves the system's efficiency, generating significant savings in the treatment of ESRD patients from the NHS perspective.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"39"},"PeriodicalIF":2.7,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and hospitalization costs of chronic kidney disease in Romania.","authors":"Ildiko Aliz Bradacs, László-István Bába, László Lorenzovici, Andreea Mihaela Precup, Szabolcs Farkas- Ráduly, Gyongyi Tar, Vasile Nastase, Lucia Georgeta Daina, Raul Bozu, Gyula Jozsef Nagy, Dimitrie Cristian Siriopol, Dorel Sandesc, Ovidiu Horea Bedreag, Florin Buicu, Gabriel Mircescu, Gener Ismail","doi":"10.1186/s13561-025-00614-x","DOIUrl":"https://doi.org/10.1186/s13561-025-00614-x","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease or chronic renal failure is a progressive condition defined as abnormalities of kidney structure or function, present for longer than 3 months. It is estimated to affect more than 10% of the general population worldwide. Management of CKD represents an especially large burden for the health systems of low- and middle-income countries, and it has been recognized as a leading public health problem. Previous research articles reported an age-adjusted prevalence of 7.6% for Romania, but the hospital costs generated by CKD are unknown. The present research article aimed to measure the hospital costs and one-year national healthcare budget impact of CKD, excepting the chronic care costs of RRTs.</p><p><strong>Methods: </strong>In this retrospective study we reviewed the electronic health records of 4 University, 3 County and 5 City hospitals from 1^st of January 2019 to 31^st of December 2019 in order to calculate costs related to hospitalization due to chronic kidney disease. Inclusion criteria were defined as: CKD-related diagnostic codes or dialysis-related procedures in medical cases (without surgical interventions). KDIGO severity grades 1-5 were considered, including dialysis costs. The costs generated by the chronic care of RRTs were not considered here. Hospitalization cost calculation was based on hospital controlling methodology including direct, indirect and overhead costs. For the national-level burden study, we analyzed the health claim records of all public and private hospitals for 2019.</p><p><strong>Results: </strong>In 2019 a total number of 229 276 cases reported chronic kidney disease in Romania. The average hospital costs per patient episode was €917.1, with significantly higher costs in cases with complications or higher severity grades. The total hospitalization cost-related budget impact in 2019 was €210 million.</p><p><strong>Conclusions: </strong>The high hospitalization costs of CKD (representing 2.6% of the NHIH budget, not considering the funds for sick leave) cause major impact on the national health payer`s budget. Preventive strategies, early diagnosis and management as well as health education measures could act as means of mitigation. Our results should warn the public health policy decision makers about the importance of this disease.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"38"},"PeriodicalIF":2.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the role of medical insurance in the \"Health shocks-consumption upgrading\" model: evidence from China.","authors":"Qi Hu, Ennan Wang, Minglai Zhu","doi":"10.1186/s13561-025-00635-6","DOIUrl":"https://doi.org/10.1186/s13561-025-00635-6","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has brought significant health shocks worldwide, along with a certain burden on healthcare systems. China's healthcare security system has been continuously improved and has essentially achieved universal coverage. Moreover, the health impact of COVID-19 on the Chinese population is diminishing, and the trend of consumption upgrading is becoming more pronounced.</p><p><strong>Methods: </strong>Based on the Ramsey-Cass-Koopmans model, this study constructs a theoretical model of \"health shocks-consumption upgrading\" to deduce the impact of health shocks on consumption upgrading. We examine the results of the theoretical model using provincial panel data from China spanning from 2002 to 2019 and employing the system GMM estimation method. Furthermore, based on a moderation effect model, we explore the mechanism of basic medical insurance systems in this model.</p><p><strong>Results: </strong>The theoretical model deduces that health shocks lead to a decline in consumption upgrading, which is empirically confirmed. Additionally, the results of moderation effect analysis demonstrate that basic medical insurance systems play a positive moderating role in the \"health shocks-consumption upgrading\" model. Among the basic medical insurance systems, the New Rural Cooperative Medical Scheme (NRCMS) primarily acts as a positive moderator.</p><p><strong>Conclusion: </strong>Health shocks lead to consumption downgrading, while basic medical insurance systems help to diversify medical risks, alleviate health shocks, reduce precautionary savings, and thereby promote consumption upgrading.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"37"},"PeriodicalIF":2.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12023390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Framing financial incentives to promote hypertension care among rural primary doctors in Shandong Province, China: study protocol of a randomized field trial.","authors":"Yue Zhong, Pengyang Fan, Jialong Tan, Elizabeth Maitland, Stephen Nicholas, Yiwei Qiao, Dejian Kou, Zehua Meng, Jian Wang","doi":"10.1186/s13561-025-00634-7","DOIUrl":"https://doi.org/10.1186/s13561-025-00634-7","url":null,"abstract":"<p><strong>Background: </strong>Managing hypertension in rural China poses significant challenges, as rural physicians often struggle to provide consistent, high-quality care. Insufficient financial incentives may explain the sub-optimal long-term treatment behavior by rural doctors. This study designs a protocol for studying better-framed financial incentives for rural physicians to manage hypertension treatment, specifically the impact of loss-framed versus gain-framed incentives in enhancing hypertension management.</p><p><strong>Methods: </strong>This protocol outlines a three-arm randomized controlled trial to be conducted in rural China. A total of 300 primary doctors, involving 1,500 hypertension patients, will be randomly assigned in a 1:1:1 ratio to two intervention groups or a control group. Financial incentives will be implemented in the two intervention groups, namely gain-framed incentives and loss-framed incentives. The trial will include a six-month intervention period followed by six months of follow-up. Changes in patients' blood pressure (BP) values include both systolic and diastolic BP, hypertension control rates, physicians' hypertension care performance and patient medication adherence will be measured. Data collection includes baseline information and regular blood pressure measurements.</p><p><strong>Discussion: </strong>This study will determine the effectiveness of a 6-month framing financial incentive intervention in improving doctors' hypertension management and patients' blood pressure control outcomes while comparing the different effects of loss framing and gain framing.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR) ChiCTR2300077733, Date registered: 07/11/2023.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"36"},"PeriodicalIF":2.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three decades in healthcare service efficiency evaluation: a bootstrapping Data Envelopment Analysis (DEA) of Ministry of Health Malaysia.","authors":"M Zulfakhar Zubir, Aizuddin A N, Mohd Rizal Abdul Manaf, A Aziz Harith, M Ihsanuddin Abas, Maizatul Izyami Kayat, M Firdaus M Radi, Mas Norehan Merican, Nurcholisah Fitra, Affendi M Ali, Sharifah Ain Shameera Syed Rusli","doi":"10.1186/s13561-025-00624-9","DOIUrl":"https://doi.org/10.1186/s13561-025-00624-9","url":null,"abstract":"<p><strong>Background: </strong>One of the most important ways to boost the health system's performance and lower the rising cost of healthcare is to increase its efficiency. The objective of this study is to evaluate the efficiency of the MOH in providing public health services and to gauge the progress of health plans in Malaysia.</p><p><strong>Methods: </strong>Three output variables (number of admissions, number of outpatient attendances, and number of maternal and child health attendances) and six input variables (budget allocation, number of doctors, dentists, pharmacists, nurses, and community nurses) were used in a Data Envelopment Analysis (DEA) Window Analysis. Eight input-output models' bias-corrected efficiency scores were obtained using bootstrapping.</p><p><strong>Setting: </strong>Ministry level in public health service.</p><p><strong>Participant: </strong>28 Decision making units (DMUs) from 1995 to 2022.</p><p><strong>Results: </strong>Robust performance over the study period was shown by the mean bias-corrected efficiency score of 0.974 (95% CI: 0.907-0.989) under the Variable Returns to Scale (VRS) model. Lower Constant Returns to Scale (CRS) model scores, on the other hand, draw attention to scale-level inefficiencies. During the COVID-19 pandemic, efficiency decreased due to higher input demands and limited outputs.</p><p><strong>Conclusions: </strong>Although MOH has attained a high level of technological efficiency, expanding operations and resolving inequalities in rural areas remain difficult. Targeted tactics including telemedicine adoption, resource redistribution, and a move towards preventive treatment are advised in order to improve fairness and resilience.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"34"},"PeriodicalIF":2.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of expanding the target population of biennial screening for breast cancer from ages 50-69 to 45 and/or 74: A cohort modelling study in the Finnish setting.","authors":"Filip Siegfrids, Sirpa Heinävaara, Tytti Sarkeala, Laura Niinikoski, Juha Laine","doi":"10.1186/s13561-025-00628-5","DOIUrl":"https://doi.org/10.1186/s13561-025-00628-5","url":null,"abstract":"<p><strong>Background: </strong>Within Finland's breast cancer screening program, all women aged 50-69 are invited to biennial screening. Current European guidelines recommend screening in ages 45-49 and 70-74 conditional upon, inter alia, demonstrated context-specific cost-effectiveness. This study aims to determine the cost-effectiveness of expanding the target population of biennial screening to ages 45 and/or 74, compared to the current national breast cancer screening strategy, in the Finnish setting.</p><p><strong>Methods: </strong>Screening strategies' costs and quality-adjusted life years (QALY), aggregated over a lifetime horizon for the population simulated through a decision-analytic model, allow for comparison through incremental cost-effectiveness ratios. The model, using a Markov cohort simulation approach, was adapted to the cancer stage classification system used by the Finnish Cancer Registry (FCR) and calibrated to observed metrics in the Finnish female population. The analysis was conducted from a limited societal perspective, using a discount rate of 3% for costs and outcomes. Sensitivity analyses were performed to assess decision uncertainty, using an implicit willingness-to-pay (WTP) threshold range of €25 000-50 000 per incremental QALY.</p><p><strong>Results: </strong>Compared to the current national screening strategy, both strategies with a starting age of 45 were cost-effective at the WTP-threshold of €50 000 per incremental QALY. Biennial screening in ages 45-69 was also cost-effective at €25 000 per QALY and demonstrated the highest probability of cost-effectiveness of all screening strategies over the whole WTP-threshold range of €25 000-50 000 per QALY. Biennial screening in ages 50-74 was dominated by all strategies over the threshold range.</p><p><strong>Conclusions: </strong>Expanding the national screening strategy target population age is likely to produce net health benefits to acceptable costs, insofar as women aged 45-49 are covered by the expansion. Only expanding the target population to age 74 is unlikely to be cost-effective, given a WTP-threshold range of €25 000-50 000 per incremental QALY.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"35"},"PeriodicalIF":2.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}