Health Economics Review最新文献

{"title":"Budget impact analysis of implementing point-of-care molecular testing for influenza A&B and RSV in Saudi older adult patients across hospital and home-care settings.","authors":"Walid Alkeridy, Khulud Alharbi, Amal Abuhamar, Abdullah Alarifi, Najim Z Alshaharni, Sulafa Alrkabi, Gihan Hamdy Elsisi, Saad M Alsaad","doi":"10.1186/s13561-026-00872-3","DOIUrl":"https://doi.org/10.1186/s13561-026-00872-3","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of our study is to compare the economic impact of adopting the molecular point-of-care test (mPOCT) for influenza A&B and RSV with current clinical judgment in Saudi Arabia, in both hospital-based and home care older adults.</p><p><strong>Methodology: </strong>A static Budget Impact Analysis (BIA) was developed in Microsoft Excel to evaluate the clinical and economic consequences of adopting mPOCT for influenza A&B and RSV testing among prevalent older adult patients in Saudi Arabia. The model adopted the perspective of the Saudi healthcare system over a one-season horizon, comparing two diagnostic strategies: current practice based on clinical judgement and a future scenario using mPOCT in both older-adult-friendly hospitals and homecare settings. Parallel decision-tree structures were constructed for influenza and RSV, incorporating test accuracy, diagnostic outcomes, treatment pathways, hospitalization requirements, and mortality. Costs included diagnostics, staff time, outpatient visits, hospital stays, medications, and resources used for complications and inappropriate antibiotic prescribing. Epidemiologic, clinical, and cost inputs were derived from published evidence and supplemented with Saudi-specific data where available. A deterministic sensitivity analysis varied cost parameters ± 20% and clinical parameters across published confidence intervals.</p><p><strong>Results: </strong>Adoption of the mPOCT was associated with substantial cost savings across all modeled (hospital and homecare settings) older adults. For Influenza A&B, total costs decreased from SAR 57,858,038 to SAR 26,933,837 in hospital settings and from SAR 13,254,535 to SAR 7,974,232 in homecare, yielding savings of SAR 30,924,201 and SAR 5,280,303, respectively. For RSV, hospital costs fell from SAR 40,640,192 to SAR 20,706,660, and homecare costs from SAR 9,157,462 to SAR 5,988,728, saving SAR 19,933,531 and SAR 3,168,733, respectively. Overall, mPOCT produced SAR 59,306,768 in combined savings, demonstrating strong economic value for respiratory infection management in Saudi Arabia.</p><p><strong>Conclusion: </strong>This BIA demonstrates that implementing the mPOCT platform for influenza A&B and RSV in Saudi Arabia may provide substantial clinical and economic value, particularly for high-risk older adults. By enabling rapid and accurate diagnosis at both hospital and homecare entry points, mPOCT may significantly reduce false negatives, mitigates progression to severe lower respiratory tract infections, and decreases unnecessary antiviral and antibiotic use. These improvements could translate into major reductions in healthcare utilization, including ward and ICU admissions, and may generate considerable cost savings across a single respiratory season.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"16 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185083","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":"Health economic evaluation of health promotion and disease prevention in Germany: a scoping review.","authors":"Eva Juliane Beer, Michaela Kirschneck, Michaela Coenen, Rosa Maria Sija Visscher","doi":"10.1186/s13561-026-00859-0","DOIUrl":"10.1186/s13561-026-00859-0","url":null,"abstract":"<p><strong>Background: </strong>Health promotion and disease prevention are receiving increasing attention in Germany because of their potential to improve population health and reduce healthcare costs. Health-economic evaluations (HEEs) are essential for informing evidence-based decision-making in this field. However, HEEs of preventive interventions often face methodological challenges. This scoping review examines the current state and characteristics of HEEs conducted in the context of health promotion and disease prevention in Germany.</p><p><strong>Methods: </strong>A scoping review was conducted to map the landscape of HEE of health promotion and disease prevention interventions in Germany, following a priori-registered protocol. Three bibliographic databases (MEDLINE, EMBASE and Web of Science) were searched from their inception to March 2025. The screening of titles, abstracts, and full texts was performed in a blinded, double-reviewer, and stepwise manner using predefined inclusion criteria: (i) focus on the German population, (ii) application of an HEE as the primary research method, and (iii) evaluation of a health-promoting or disease-preventing intervention. Studies focusing on tertiary prevention were excluded.</p><p><strong>Results: </strong>Of the 4,632 records identified, 162 eligible original studies met the inclusion criteria. The volume of published HEEs has increased over time. Most studies (53.7%) assessed primary preventive interventions. Cost-effectiveness analysis was the most frequently applied HEE analysis type. Incremental cost-effectiveness ratios (ICERs) are commonly reported as incremental costs per quality-adjusted life year (QALY) gained (42.4% of all ICERs). In 85.2% of the studies, the intervention was judged to be cost-effective. A model-based approach was used in 75.9% of the studies, and 81.3% of these studies relied partly on non-German data sources. More than half of all studies (56.1%) reported limitations due to a lack of German-specific data.</p><p><strong>Conclusions: </strong>HEEs related to health promotion and disease prevention interventions in Germany exhibit substantial methodological heterogeneity. Frequent reliance on non-German data and the large proportion of interventions deemed cost-effective may reflect contextual data gaps and potential publication bias. These issues complicate the interpretation of economic evidence and pose challenges for decision-makers seeking to prioritize preventive strategies.</p><p><strong>Trial registration: </strong>https://osf.io/h6749/overview.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"16 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064993","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":"Correction: Societal cost-of-illness analysis of self-injection of biologics for patients with rheumatoid arthritis in Japan using claims, surveys, and national statistics.","authors":"Kazuhiko Takahata, Eiichi Tanaka, Ryoko Sakai, Manabu Akazawa","doi":"10.1186/s13561-026-00816-x","DOIUrl":"10.1186/s13561-026-00816-x","url":null,"abstract":"","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"16 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041125","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":"Comment on: effects of emergency department length of stay on inpatient utilization and mortality.","authors":"Ching-Yi Chen, Shih-Fen Tseng, Yung-Shuo Kao, Raymond Nien-Chen Kuo","doi":"10.1186/s13561-026-00842-9","DOIUrl":"10.1186/s13561-026-00842-9","url":null,"abstract":"<p><p>Emergency department (ED) crowding is a persistent global challenge with well-documented consequences for patient outcomes and healthcare resource utilization. A recent study by Ma et al. reported that prolonged ED length of stay was associated with lower inpatient hospitalization costs, a finding that merits careful methodological scrutiny.We outline three considerations that may inform the interpretation of these findings. First, the aggregate cost of an admitted population is sensitive to its case-mix; hospitalization costs vary substantially across and within clinical services, and the relative proportion of admissions across departments, which the study does not report across length-of-stay strata, could materially affect the cost comparison; disentangling a true departmental effect from differences in case severity and procedure intensity would require risk-adjusted, standardized cost data. The cost outcome is further limited to inpatient charges, with ED costs unmeasured, yet the Discussion attributes lower costs among longer-stay patients to resource use shifting into the ED; because ED costs were not captured, this resource-shifting mechanism is asserted rather than demonstrated, and the pattern is equally consistent with a truncated or front-loaded inpatient work-up, differential case-mix, or survivorship effects given the concurrently higher mortality in the same strata. Second, comorbidity is operationalized as a binary variable, and the counterintuitive finding of higher adjusted mortality among patients recorded as comorbidity-free may, at least in part, reflect an apparent inversion of the comorbidity labels in the original tables, the limits of administrative coding, acute severity not captured by the Elixhauser index, or residual confounding. Third, the association between prolonged stays and lower costs may partly reflect institutional bed-allocation policy rather than patient-level factors alone, because occupancy measures and allocation rules are distinct.Addressing these considerations would strengthen the causal interpretability of the findings and advance the evidence base for ED operational policy.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"16 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002664","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":"Heterogeneous impact of health insurance on children's nutritional status: insights from Instrumental Variable Quantile Regression (IV-QR) approach.","authors":"Muhammad Shahid, Jiayi Song, Muhammad Ali Yahya, Zaiba Ali, Hafiz Muhammad Naveed, Muhammad Ali, Muneeb-Ur-Rehman Tahir, Ermo Chen","doi":"10.1186/s13561-026-00828-7","DOIUrl":"https://doi.org/10.1186/s13561-026-00828-7","url":null,"abstract":"<p><strong>Objective: </strong>Empirically, this study focuses on the impact assessment of health insurance uptake on the nutrition of kids under five with special attention to variation in wealth level in Pakistan. Theoretical frameworks argue that health insurance provides a safety net against poor health outcomes.</p><p><strong>Methods: </strong>We analyzed 4,499 children from the Pakistan Demographic and Health Survey (2017-18) using Instrumental Variable Quantile Regression (IV-QR) along with logistic and probit models as bassline, with internet access and distance to health facility as instruments. This approach addresses endogeneity while examining heterogeneity across the nutritional distribution.</p><p><strong>Results: </strong>The outcomes of the study are based on probit and logistic estimations. Health insurance in general and the Sehat Sahulat scheme in particular among the poor and most wealthy people in Pakistan greatly increases the positive health outcomes and nutrition of children. The Sehat Sahulat scheme of health insurance coverage of the malnourished children in the low economic class in rural and urban Pakistan provides substantial protection from malnutrition. The IV-QR results reveal that health insurance significantly reduces child malnutrition only for the poorest three wealth quintiles (Q1: OR = 0.64, p < 0.01; Q2: OR = 0.75, p < 0.01; Q3: OR = 0.41, p < 0.01), with no significant effect for wealthier households. The Sehat Sahulat program shows protective effects exclusively for low-income groups, confirming effective targeting. This study assesses the impact of health insurance uptake on child nutrition among children under five in Pakistan, with particular attention to variation across wealth groups.</p><p><strong>Conclusion: </strong>The Sehat Sahulat program effectively targets vulnerable populations, but persistent geographic disparities indicate that insurance alone is insufficient. Policymakers should expand coverage while investing in complementary sanitation, education, and region-specific interventions.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"16 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225088","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":"Explaining changes in socioeconomic inequality in catastrophic health expenditure in China: a mobility-determinant decomposition.","authors":"Jingxian Wu, Yaping Deng","doi":"10.1186/s13561-026-00825-w","DOIUrl":"10.1186/s13561-026-00825-w","url":null,"abstract":"<p><strong>Background: </strong>Catastrophic health expenditure (CHE) remains a central challenge to achieving financial protection and equity in health systems. While extensive evidence shows that CHE remains disproportionately concentrated among socioeconomically disadvantaged households, most studies adopt a static perspective and provide limited insights into how CHE inequality evolves over time and through which mechanisms. This study aims to examine changes in socioeconomic inequality in CHE in China and disentangle the underlying channels from a household mobility perspective.</p><p><strong>Methods: </strong>Using nationally representative longitudinal data from the 2010 and 2020 waves of the China Family Panel Studies, socioeconomic-related CHE inequality was measured using Erreygers' corrected concentration index, with household per capita wealth as the ranking variable. An integrated mobility-determinant decomposition framework was employed to quantify the contributions of both mobility processes and socioeconomic, demographic, and health system-related factors to changes in CHE inequality. Robustness analyses were performed using alternative CHE definitions, different specifications of household socioeconomic status, and an alternative decomposition approach.</p><p><strong>Results: </strong>CHE remained disproportionately concentrated among lower-wealth households in both waves, although the magnitude of inequality declined significantly between 2010 and 2020. This reduction was primarily driven by progressive contribution of wealth-related CHE mobility, indicating larger improvements in financial protection among initially poorer households, while the regressive contribution of CHE-related wealth mobility partially offset these gains. Lower wealth quintiles, urban residence, and social health insurance coverage were associated with the reduction in CHE inequality, whereas higher wealth quintiles and household ageing were associated with attenuating the inequality reduction, reflecting heterogenous contributions through distinct mobility channels. Robustness checks confirmed the stability of the main findings.</p><p><strong>Conclusions: </strong>Socioeconomic inequality in CHE in China has narrowed over the past decade, primarily due to progressive improvements in financial protection. However, persistent wealth stratification and population ageing continue to constrain further reductions in CHE inequality. Monitoring progress toward universal health coverage requires attention not only to aggregate CHE incidence but also to the underlying mobility processes and structural determinants that influence distributional change.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521135","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":"The influence of implant survival on cost-effectiveness in total knee arthroplasty: a patient-level discrete-event simulation study.","authors":"Pablo Oscar Roza Miguel, Jorge Albareda Albareda, Nuria García-Rodríguez, Eduardo González Fidalgo, Daniel Hernández Vaquero, José Antonio Queiruga Dios, María Rabanal Rubio, Carlos Revenga Giertych, Fernando J Tavares Sánchez-Monge, Carlos Martín Hernández","doi":"10.1186/s13561-026-00822-z","DOIUrl":"https://doi.org/10.1186/s13561-026-00822-z","url":null,"abstract":"<p><strong>Background: </strong>Although several studies have evaluated the cost-effectiveness of total knee arthroplasty (TKA) compared with conservative treatment, few have explored how implant revision rates may influence its long-term cost-effectiveness. The objective of this study was to evaluate the impact of implant revision rates on quality of life and cost-effectiveness in patients undergoing TKA.</p><p><strong>Methods: </strong>A cost-utility analysis from a healthcare system perspective was conducted using an individualized discrete-event simulation model parameterized with data from a Spanish cohort of patients undergoing TKA. Quality-adjusted life years were calculated with the SF-6D index, and implant alternatives were compared by assigning age- and sex-specific revision rates to each simulated patient while projecting long-term quality of life and life expectancy according to general population standards. The prosthetic models compared were those associated with the highest (WorstKnee) and lowest (BestKnee) revision rates in the UK National Joint Registry. The primary outcome was the incremental cost-effectiveness ratio. Secondary analyses included budget impact and deterministic sensitivity analyses.</p><p><strong>Results: </strong>The projected quality-adjusted life expectancy over 15 years was 9.767 QALYs for WorstKnee, compared with 10.004 QALYs for BestKnee. The incremental cost-effectiveness ratio was €6,219/QALY, which remained below the cost-effectiveness thresholds commonly used in Spain. Use of BestKnee was associated with an additional cost of €332.3 M over 15 years; however, it also led to a substantial reduction in revision surgeries, with 27,878 fewer procedures performed, resulting in gradual cost savings over time.</p><p><strong>Conclusion: </strong>Within the price ranges currently observed in the Spanish National Health System, total knee prostheses associated with lower revision rates provide a favorable long-term cost-effectiveness profile and may reduce future revision burden despite their higher acquisition cost.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473480","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 recurrence in patients with hepatocellular carcinoma after curative-intent treatment in Spain.","authors":"M Varela, J Feliu, M Garrido-Siles, M A Gómez-Bravo, S González, J Irurzun, L Ruiz de Alda, P Vieitez, D Carcedo, M Crespo, R Vera, M Reig","doi":"10.1186/s13561-026-00796-y","DOIUrl":"10.1186/s13561-026-00796-y","url":null,"abstract":"<p><strong>Background: </strong>Despite potentially curative-intent treatments such as resection, ablation, or liver transplantation, a significant proportion of patients with hepatocellular carcinoma (HCC) experience recurrence. This study aims to quantify the economic burden of HCC recurrence in patients initially diagnosed with a BCLC-0 or BCLC-A tumor, who received curative-intent treatment and achieved an initial radiological complete response.</p><p><strong>Methods: </strong>A decision-tree model was developed to simulate the management of HCC recurrence over a 1-year time horizon. As a secondary analysis, the time horizon was extended to 5 years to capture the cost of a potential second recurrence. Clinical parameters included HCC stage (0, A, B, C, and D, per Barcelona Clinic Liver Cancer [BCLC] staging), treatment modalities, adverse events and routine follow-up, were provided by a multidisciplinary panel of experts. The analysis was conducted from the Spanish National Health System perspective, considering only direct medical costs (expressed in 2025 euros). Deterministic sensitivity analyses were performed to assess the robustness of the base case results.</p><p><strong>Results: </strong>The target population was estimated to be 1,250 patients with HCC recurrence after curative-intent treatment of the first HCC in Spain. The total cost of managing these 1,250 recurrences over one year was estimated at €33 million, with an average cost per recurrence of €26,426. When the time horizon was extended to 5 years, the total cost increased to €43.3 million (+€10.3 million), primarily due to 228 additional recurrences. The average cost per recurrence over 5 years rose to €34,637, and a hypothetical patient experiencing two recurrences over this period would cost €59,542. Sensitivity analyses confirmed the robustness of these results.</p><p><strong>Conclusions: </strong>The literature on the economic burden of HCC is scarce. This study is the first to estimate the cost of HCC recurrence after curative-intent treatment in Spain. Further research is needed to better understand the full economic impact of this complex disease.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473528","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":"Establishing multiple cost-effectiveness thresholds in Oman: a stakeholder-driven approach.","authors":"Said Wani, Hilal Alsabti, Said Allamki, Ahmed Almandhari, Suleiman Alhajji, Ibrahim Alrashdi, Raid Alsabri, Adnan Alqassabi, Ahmed Alzaabi, Aisha Almaashani, Alia Alshuaili, Anisa Rasool, Asiya Alkindi, Bushra Salman, Faiza Alzadjali, Khalid Alrahbi, Khulood Almutawa, Manal Alansari, Mardheya Alkharusi, Nadiya Albulushi, Rahma Alghadani, Rana Aljaber, Safiya Almuaini, Said Alkindi, Salim Alzawamri, Sara Albalushi, Suha Allawati, Zuhair Alsalti, Hassan Albalushi, Ahmad Nader Fasseeh, Zoltan Kalo","doi":"10.1186/s13561-026-00817-w","DOIUrl":"10.1186/s13561-026-00817-w","url":null,"abstract":"<p><strong>Background: </strong>The rising cost of new health technologies and limited healthcare budgets challenge health systems worldwide, including Oman. Local value judgments are crucial for informed decision-making. This study aims to establish a cost-effectiveness thresholds (CETs) framework for Oman, aligned with the country's economic status and healthcare priorities.</p><p><strong>Methods: </strong>The key findings from a recent literature review on global CETs and their applications were shared and discussed during a multi-stakeholder workshop in March 2024. Presenting these findings has provided participants a broad understanding of global CET practices and highlighted the use of multiple thresholds across different settings. Afterwards, a survey was distributed, asking participants to anonymously vote on six key concepts: the basis for the threshold, the baseline threshold multiplier, the use of multiple thresholds, the criteria for multiple thresholds, the number of multipliers, and which criterion should receive the 3X multiplier. The results from this voting guided the design and final agreement on the threshold values.</p><p><strong>Results: </strong>Twenty respondents supported adopting multiple CET values based on cost per quality-adjusted life-year (QALY), linked to Oman's economic status. A baseline CET equal to 1x Gross Domestic Product (GDP) per capita was suggested. Participants recommended three different threshold multipliers to reflect policy priorities. A continuous multiplier (1-3x GDP), based on incremental QALY gains, was used to favor technologies with greater health gains. Additionally, a fixed multiplier of 2 was chosen for both orphan drugs and treatments for priority diseases. The resulting CET values reflect technical and expert consensus and do not include patient or public perspectives.</p><p><strong>Conclusions: </strong>In Oman, the incremental cost per QALY gained should not exceed 1x GDP per capita for new health technologies that offer minimal health gains in common diseases. However, thresholds might increase to 12x GDP per capita for curative treatments in rare priority disease areas. It is recommended that CET values be reviewed and updated within three years, based on initial implementation experiences.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449589","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":"Nonlinear modeling of health checkup factors and future claims-based healthcare costs in Japan: a retrospective cohort study.","authors":"Haruto Nakamura, Kaisei Harada, Kohei Hirako, Toshitaka Sawamura, Kousuke Imamura, Masahiko Sagae, Hidetaka Nambo, Shigehiro Karashima","doi":"10.1186/s13561-026-00818-9","DOIUrl":"10.1186/s13561-026-00818-9","url":null,"abstract":"<p><strong>Background: </strong>Population health checkups support disease prevention and health management. Clarifying how routinely collected checkup factors relate to subsequent healthcare costs may inform population-level risk assessment and preventive planning. We aimed to characterize nonlinear and sex-specific associations between routine checkup factors and near-term claims-based healthcare costs in Japan and to explore whether composite metabolic indices provide additional information beyond routine measures.</p><p><strong>Methods: </strong>We linked Japan's Specific Health Checkups (FY2012-FY2022) to subsequent administrative insurance claims in Hakui City and analyzed adults aged 60-74 years. The outcome was annual claims-based healthcare costs in the third and fourth fiscal years after baseline, expressed as fee schedule points. We fitted generalized additive models with a Gamma distribution and log link in the overall sample and separately for men and women. Predictors included routine checkup measures (including glycated hemoglobin [HbA1c]) and lipid- and adiposity-related indices (atherogenic index of plasma, arteriosclerosis index, non-high-density lipoprotein cholesterol, fatty liver index, and visceral adiposity index). Model fit and the stability of the observed association patterns were assessed using 50 repeated 80/20 individual-level split validations.</p><p><strong>Results: </strong>The dataset comprised 11,148 person-years from 6,757 residents. The models showed limited explanatory performance (mean R²=0.06), indicating that routine health checkup variables alone explained only a small proportion of variation in subsequent claims-based healthcare costs. Age and HbA1c showed consistent associations across groups. HbA1c showed a J-shaped association with costs, with a steeper increase above approximately 6.0%. Body mass index, waist circumference, and fatty liver index showed moderate association patterns, whereas the atherogenic index of plasma, arteriosclerosis index, and visceral adiposity index provided limited additional information beyond routine measures; the fatty liver index showed a notable association pattern in men.</p><p><strong>Conclusions: </strong>Routine health checkup factors exhibited nonlinear, sex-specific associations with near-term claims-based healthcare costs in a Japanese community. These findings may inform population-level hypothesis generation and future indicator selection. However, routine checkup variables alone appear insufficient for precise individual-level prediction. External validation and integration of additional information on comorbidities, medications, healthcare utilization, and socioeconomic factors are warranted.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438316","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}