Health Economics Review最新文献

{"title":"The economics of decision-making in dementia care and related life-limiting illness: a narrative review.","authors":"Ana Maksimovic, Simona Grassi, Clare Ellis-Smith, Peter May","doi":"10.1186/s13561-026-00803-2","DOIUrl":"10.1186/s13561-026-00803-2","url":null,"abstract":"<p><strong>Background: </strong>Dementia represents a profound healthcare and economic challenge for the 21st century. A significant proportion of associated costs originate in decision-making between people with dementia, family carers, and health and social care practitioners. Economics is a decision science that may inform such choices, but the research evidence has not been collated and synthesised. We review the decision-making literature to analyse how economic insights can be applied to decision-making in life-limiting illness and identify findings applicable to dementia.</p><p><strong>Methods: </strong>Our literature search was comprehensive and included EconLit, Medline, Embase, and PsycInfo, as well as a targeted search of relevant economic literature.</p><p><strong>Results: </strong>We identified 9,854 studies, of which 62 were included. We found six key economic concepts: (a) principal-agent problem, (b) uncertainty, (c) asymmetric information, (d) hyperbolic discounting, (e) the empathy gap, and (f) non-linear value of time. These findings are helpful in understanding established patterns in the evidence base, including high end-of-life costs and variable efficacy of advance care planning.</p><p><strong>Discussion: </strong>These findings are used to consider the modifiability of formal, social, and household costs, and identify opportunities for future research. Dynamic communication between all decision-makers (patient, family, clinicians) is essential to overcome the identified barriers and drive improvements in dementia care. Further, we note that by integrating economic insights with lived experience, health sciences researchers get a better understanding of how decisions are made.</p><p><strong>Conclusion: </strong>Examining the dynamics that shape individual-level decision-making promotes a better understanding of the drivers of costs in life-limiting illness. Economics should make wider use of this methodological approach to examine decision-making in dementia care.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13465789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164993","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":"Preferences towards digital health technologies: a scoping review.","authors":"Aimée Kingsada, Silvana Briones-Piedrafita, Thomas Rapp, Jonathan Sicsic","doi":"10.1186/s13561-026-00792-2","DOIUrl":"10.1186/s13561-026-00792-2","url":null,"abstract":"<p><strong>Background: </strong>Digital Health Technologies (DHTs) are expanding rapidly, offering new opportunities to support care delivery. Their adoption, however, depends on how well they match patients' needs and expectations. Accurately assessing patient preferences is challenging due to diverse user profiles and varying methods used to measure preferences. A synthesis of current evidence is needed to clarify what patients value in DHTs.</p><p><strong>Objectives: </strong>This study synthesizes evidence on patient preferences for DHTs-including eHealth, telehealth, telemedicine, and mHealth-and examines the methods used to elicit these preferences, highlighting opportunities to improve adoption and design.</p><p><strong>Methods: </strong>We conducted a scoping review of literature published from 2000 to 2026 following PRISMA-ScR guidelines. Searches were performed in PubMed, EMBASE, CINAHL, Scopus, and Web of Science. Two reviewers independently screened titles, abstracts, and full texts for eligibility. Data were charted and narratively synthesized, with study characteristics categorized by methodology (qualitative, quantitative, mixed methods) and preference elicitation techniques.</p><p><strong>Results: </strong>Of 2,419 records identified, 115 underwent full-text screening and 85 met all inclusion criteria: 27 qualitative studies (31.76%), 45 quantitative studies (52.95%), and 13 mixed-methods studies (15.29%). Quantitative studies primarily applied attribute-based methods (e.g., Discrete Choice Experiments, Conjoint Analysis, Best-Worst Scaling), and six studies used the Contingent Valuation method to estimate total willingness-to-pay for DHTs. Qualitative studies employed thematic analysis, deductive, inductive, and immersion-crystallization approaches. Across studies, patients consistently emphasized cost, privacy, convenience, and personalization of DHTs as key concerns. Only a few studies estimated the relative importance of the attributes or the marginal willingness to pay for the device's features. Considerable heterogeneity in preferences was observed by DHT type, patients' health condition and age.</p><p><strong>Conclusions: </strong>Quantitative, qualitative, and mixed-method approaches provide complementary insights into how patients perceive and value DHTs. Patients consistently seek personalized, easy-to-use, secure, and affordable solutions, which is particularly important for older adults managing chronic conditions. Given the diversity of patient preferences, it is essential to consider these differences when developing digital health technologies to ensure they effectively support patients and address their needs.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151016","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":"Assessing the scope and reporting quality of published health economic evaluation studies in Jordan: a systematic literature review.","authors":"Lama Sheikha, Rasha M Arabyat","doi":"10.1186/s13561-026-00802-3","DOIUrl":"10.1186/s13561-026-00802-3","url":null,"abstract":"<p><strong>Background: </strong>Jordan faces growing healthcare challenges driven by limited resources, rising healthcare expenditures, and an increasing burden of non-communicable diseases (NCDs). Economic evaluations are essential for informing resource allocation and supporting health technology assessment (HTA). To date, however, no systematic review has summarized the scope and reporting quality of published full health economic evaluation studies (HEEs) in Jordan.</p><p><strong>Objectives: </strong>This study aimed to systematically identify, describe, and assess the reporting quality of published full HEES conducted in Jordan using PRISMA.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus and Google Scholar databases was conducted up to November 2025. Eligible studies were full economic evaluation studies (cost-minimization, cost-effectiveness, cost-utility, or cost-benefit analyses) performed in Jordan and published in peer-reviewed journals. Data were extracted on study characteristics, economic analytical details, and outcomes. Adherence to reporting guidelines was appraised using CHEERS 2022 checklist.</p><p><strong>Results: </strong>Out of 546 records screened, 15 studies met the inclusion criteria. The earliest full HEEs appeared in 2014, with research activity increasing after 2020, coinciding with the governmental efforts to activate the role of economic evaluations at national institutions. Most studies were cost-effectiveness analyses (n = 8, 53.3%), followed by cost-utility (n = 4, 26.7%) and cost-benefit analyses (n = 3, 20%). Most studies utilized a model-based design, predominantly adopting a healthcare system or payer perspective and focusing on direct medical costs. Non-communicable diseases, particularly neoplasms, were the most frequently studied disease areas. The median CHEERS score was 22.5 (IQR: 21 to 23) out of 28, indicating fair reporting quality, with frequent gaps in specifying comparators in study titles, analysis plans, and model validation.</p><p><strong>Conclusions: </strong>The volume of health economics evaluations in Jordan is small but rapidly evolving showing overall fair reporting quality sustained by a high standard of classical reporting. Identified gaps in some reporting items reflect slow integration of new requirements rather than core methodological flaws. The current published research is structurally fragmented, biased toward pharmaceuticals, lacks standardized cost-effectiveness thresholds and localized empirical data. To effectively support Jordan's transition toward Universal Health Coverage, the evolving national HTA framework must shift from a reactive to proactive institutionalized mechanism.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151871","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":"Economic and health-related quality of life impacts of posttraumatic stress disorder: a systematic review.","authors":"Tran Hoang Tien, Tran Thu Ngan, Mai Xuan Thu, Meenakshi Sharma, Grainne Crealey, Ciaran O'Neill","doi":"10.1186/s13561-026-00800-5","DOIUrl":"10.1186/s13561-026-00800-5","url":null,"abstract":"<p><strong>Background: </strong>Post-traumatic stress disorder (PTSD) is a severe psychiatric condition associated with long-term mental health impairment, high healthcare utilization, and substantial societal costs. Despite growing recognition of its burden, few reviews integrate economic and health-related quality of life (HRQoL) impacts. This systematic review synthesizes global evidence on the economic and HRQoL consequences of PTSD to inform policy decision-making.</p><p><strong>Methods: </strong>A systematic search of six databases (Web of Science, EMBASE, MEDLINE, PsycINFO, PubMed, and EconLit) was conducted in April 2024 and updated in April 2025. Studies reporting real-world costs or HRQoL outcomes in PTSD populations were included. Quality was assessed using the Joanna Briggs Institute critical appraisal tools. Data were synthesized narratively due to heterogeneity in study design, populations, and outcome measures.</p><p><strong>Results: </strong>Twenty studies met inclusion criteria, spanning 2000-2024 and representing diverse settings including the US, Europe, South Korea, and Australia. However, most were from high-income countries, with limited representation from low- and middle-income countries (LMICs). PTSD was associated with high direct healthcare costs (e.g., $66.0 billion in US civilians) and substantial indirect costs from lost productivity, disability, caregiving, and premature mortality. Veterans and conflict-affected populations bore particularly high economic burdens. HRQoL was markedly reduced across all populations studied, with EQ-5D, AQoL, and MANSA scores indicating significant functional and psychosocial impairment. Co-occurring conditions (e.g., depression, anxiety), trauma severity, and sleep disturbances were key drivers of reduced HRQoL.</p><p><strong>Conclusions: </strong>PTSD imposes a substantial economic and quality of life burden globally. Findings provide evidence supporting the need for comprehensive treatment approaches, long-term support systems, and policies that address both economic and psychosocial outcomes in PTSD care.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151941","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 Spanish transplantation model as a benchmark: clinical, societal, and economic impact of liver transplants in Spain (1984-2024).","authors":"Edson Plasencia Sánchez, Concepción Gómez Gavara, Glòria Merino Pinto, Roger Sabater Mezquita, Itxarone Bilbao, Gerardo Blanco-Fernández, Gloria de la Rosa, Gemma Piella","doi":"10.1186/s13561-026-00801-4","DOIUrl":"10.1186/s13561-026-00801-4","url":null,"abstract":"<p><p>Spain leads the world in organ donation, and the 40th anniversary of its first liver transplant was recently commemorated. Our aim was to evaluate the evolution of the Liver Transplantation (LT) program in Spain over its four decades (1984-2024), examining clinical outcomes and societal economic benefits within a mature transplantation framework. Standardized national data from the Organización Nacional de Trasplantes and the Sociedad Española de Trasplante Hepático were used to reconstruct recipient cohorts by age group. Patient survival was estimated using Kaplan-Meier analysis. An economic evaluation from a societal perspective integrated surgical costs, long-term immunosuppressive therapy, and productivity gains associated with recipients' participation in the labour market. LT activity increased steadily during the initial expansion of the program and has stabilised at approximately 1,200 procedures per year over the past two decades. Both donor and recipient populations have aged; there are currently more patients over 60 years of age than two decades ago. Survival improved throughout the study period, extending life expectancy despite variations related to underlying disease. From an economic perspective, annual surgical costs remained below €60 million, increasing to €70-90 million when long-term immunosuppressive therapy was included. The economic contribution of surviving recipients to the labour market increased steadily, exceeding €75 million in 2024 and resulting in a positive balance since the early 2010s. Adult recipients generated net economic benefits, whereas paediatric recipients showed delayed but progressively increasing contributions as they entered the workforce. LT in Spain has produced sustained improvements in expected survival while generating substantial societal value, demonstrating that LT is both an effective clinical intervention and a valuable public health investment. The Spanish liver transplantation system may serve as a benchmark for evaluating the sustainability and societal impact of liver transplant programs in other healthcare systems.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13465184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145023","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":"Preferences for hospital in the home for COVID-19: a discrete choice experiment study.","authors":"Mohammad Ehsanikia, Vajihe Ramezani-Doroh, Deborah Street, Leili Tapak, Yadolah Hamidi","doi":"10.1186/s13561-026-00798-w","DOIUrl":"10.1186/s13561-026-00798-w","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess Tehran residents' preferences for COVID-19 hospital in the home, using a discrete choice experiment (DCE), to support evidence-based policy-making for future health crises.</p><p><strong>Methods: </strong>Nine hundred twenty-nine Tehran residents aged ≥ 18 years using a multistage sampling approach were surveyed. Data was collected via a structured questionnaire. Attributes (price, physician specialty, emergency contact availability, and caregiver's qualification) and levels were identified through literature review, and consultation with the experts. Data were analyzed by latent class conditional logit model, with class membership examined via a logit model. Marginal willingness-to-pay (MWTP) were calculated, and analyses were performed in Stata version 14 with 95% confidence interval.</p><p><strong>Results: </strong>A total of 929 participants (mean age = 36.8, SD = 10.8; 52.7% male) were included. Two latent classes were identified. In Class 1, participants were more price-sensitive (CE = - 0.02, p < 0.001), with a strong preference for emergency contact availability (CE = 5.69, p < 0.001) and combined physician teams (CE = 3.89, p < 0.001). In Class 2, price sensitivity was weaker (CE = - 0.002, p < 0.001), with lower but significant WTP values (111.95 USD for combined physician teams; 56.59 USD for emergency contact). Logistic regression showed that older age (p < 0.01), higher education (OR = 0.32, p < 0.001), very good health status (OR = 0.46, p = 0.001), COVID-19 hospitalization history (OR = 0.47, p < 0.001), and having social security/ health/ other basic insurance (p < 0.05) reduced the likelihood of class 2 membership, whereas larger family size (OR = 1.23, p = 0.003) and low income (p < 0.01) increased it; being married had a borderline significant positive association (OR = 1.52, p = 0.05).</p><p><strong>Conclusion: </strong>While both groups were price-averse, decisions were mainly driven by emergency support, clinical quality (physician specialty and caregiver's qualification). These findings underscore the need for patient-centered hospital in the home care models that integrate affordability with responsive and high-quality services.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13483721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138944","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":"Factors influencing the reimbursement decisions of cancer drugs in Spanish National Health System.","authors":"Pelayo Nieto-Gómez, Celia Castaño-Amores, Antonio José García-Ruiz, Juan Oliva-Moreno","doi":"10.1186/s13561-026-00804-1","DOIUrl":"10.1186/s13561-026-00804-1","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the influence of several factors, including added clinical benefit, cost-utility, availability of therapeutic alternatives, innovation level, and evidence uncertainty, on public reimbursement decisions for cancer drugs targeting solid tumours in Spanish National Health System between 2010 and 2023.</p><p><strong>Methods: </strong>220 drug indications for solid tumours authorised between January 2010 and December 2023 were included. Clinical benefit was assessed using the European Society for Medical Oncology- Magnitude of Clinical Benefit Scale (ESMO-MCBS). Cost-utility was estimated based on pharmacological costs and Quality Adjusted Life Years (QALY), using data from Health Technology Assessment Agencies (HTAAs) reports and list prices. Other variables included innovation, presence of therapeutic alternatives, quality of clinical trial evidence, and availability of overall survival (OS) and quality of life data (QoL). This influence was also controlled for by the year of the reimbursement decision. Statistical analysis included descriptive statistics and several probit regression models to estimate the impact of each factor on reimbursement likelihood.</p><p><strong>Results: </strong>Of the 220 indications analysed, 68.2% received public reimbursement. Substantial clinical benefit was observed in 50% of cases and was significantly associated with reimbursement (OR = 2.7, 95% CI: 1.4-5.3; p < 0.01). Median incremental cost-utility ratios (ICUR) were €86,770/QALY (list prices) and €47,190/QALY (reimbursed prices), with no significant differences between reimbursed and non-reimbursed indications. The probit results indicate that substantial clinical benefit significantly increases the probability of public reimbursement by between 17.5 and 20.1% points (pp). Another relevant factor is the absence QoL data, which decreases the probability of reimbursement by between 13.9 and 14.8 pp. Drugs with reimbursement decisions made between 2020 and 2023 had a 19.4 pp lower probability of being reimbursed.</p><p><strong>Conclusion: </strong>Substantial clinical benefit and absence of QoL uncertainty significantly increases the likelihood of public reimbursement for oncology drugs in Spain, while cost-utility estimates apparently show no influence under current decision-making processes. Decisions made between 2020 and 2023 had a lower probability of receiving public reimbursement compared to the 2010-2019 period possibly due to the accumulation of drugs approved by European Commission in recent years. These findings highlight the need for clearer integration of economic evaluations and transparent criteria as Spain updates its P&R framework.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057429","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":"Pooled survival and cost-effectiveness analysis of immune checkpoint inhibitors-based for metastatic non-small-cell lung cancer with PD-L1 lower than 1.","authors":"Kun Liu, Youwen Zhu, Hong Zhu, Manting Zeng","doi":"10.1186/s13561-026-00797-x","DOIUrl":"10.1186/s13561-026-00797-x","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess whether immune checkpoint inhibitors (ICIs)-based treatments offer significant survival benefits and economic viability for patients presenting with PD-L1 lower than 1%.</p><p><strong>Methods: </strong>This exploratory analysis was based on individual patient data from randomized controlled trials (CheckMate-227, CheckMate-9LA, KEYNOTE-189, and KEYNOTE-407). Survival outcomes evaluated for this study were overall survival (OS) and progression-free survival (PFS). Economic evaluations estimated total lifetime costs, incremental cost-effectiveness ratios (ICERs), and incremental net-health benefit (INHB) using the Markov model. The willingness-to-pay (WTP) thresholds were $150,000/quality-adjusted life-year (QALY) for the USA and $36,942/QALY for China.</p><p><strong>Results: </strong>Among patients receiving immunotherapy-based treatments (N = 754) relative to those treated with chemotherapy-alone (N = 502), survival outcomes were significantly improved (median OS: 17.0 vs. 12.0 months; hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.61-0.78; median PFS: 6.5 vs. 5.5 months; HR: 0.68; 95% CI: 0.60-0.77). The cost-effectiveness analysis found that the ICERs with INHBs for immunotherapy-based versus chemotherapy-alone were $273,440.73/QALY with -1.00 QALYs in the USA and $32,783.93/QALY with 0.89 QALYs in China. Crucially, among ICI-based regimens, nivolumab plus ipilimumab-based (INHB: 0.09 QALYs) and pembrolizumab plus chemotherapy (INHB: 0.17 QALYs) were the most cost-effective options in the USA and China, respectively.</p><p><strong>Conclusions: </strong>First-line immunotherapies-based therapy was cost-effective in metastatic NSCLC with PD-1 lower than 1% in China but not in the USA. Nivolumab plus ipilimumab-based was identified as the most favorable first-line immunotherapy in the USA, while pembrolizumab plus chemotherapy was preferred in China.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044131","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":"Procurement in German office based ambulatory physician practices: system specific challenges and evidence based management strategies.","authors":"Matthias B Stope","doi":"10.1186/s13561-026-00794-0","DOIUrl":"10.1186/s13561-026-00794-0","url":null,"abstract":"<p><p>Procurement is an important managerial function in healthcare, influencing supply continuity, process stability, and quality assurance. While hospital procurement has been studied extensively, evidence on procurement structures in German ambulatory care remains limited and conceptually fragmented. In particular, office based physician practices, group practices, medical care centers, outpatient hospital departments, and physician networks are often discussed under the same umbrella term, although these organizational forms differ substantially in governance, scale, and purchasing capacity.This narrative, concept driven review focuses specifically on office based ambulatory physician practices in Germany, with particular attention to small group practices in urban primary care settings. The available literature indicates that direct peer reviewed evidence quantifying procurement specific cost shares in this sector remains scarce. International physician practice economics further suggests that procurement related savings alone are unlikely to generate large absolute efficiency gains across all ambulatory settings. Procurement should therefore be understood not only as a cost factor, but also as a managerial field affecting supply reliability, workflow continuity, coordination, and resilience.Compared with hospitals, office based ambulatory practices are characterized by smaller purchasing volumes, limited economies of scale, fragmented supplier relationships, and restricted administrative capacity. Instruments such as ABC VED analyses, Kanban based replenishment, periodic stock review, and structured supplier arrangements may support procurement management in these settings. The proposed model should be interpreted as a practice oriented framework rather than as an intervention with proven large scale cost effects.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"16 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044128","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 using Intravenous Ferric Carboxymaltose compared to Intravenous Iron Sucrose for treatment of iron deficiency anemia in pregnancy.","authors":"Beena Joshi, Tejal Varekar, Revathy R, Kiran Sangwan, Deepti Tandon, Ragini Kulkarni, Shahina Begum","doi":"10.1186/s13561-026-00790-4","DOIUrl":"10.1186/s13561-026-00790-4","url":null,"abstract":"<p><strong>Background: </strong>Iron deficiency anemia (IDA) in pregnancy is a major public health concern in India, contributing significantly to adverse maternal and perinatal outcomes. Intravenous iron sucrose (IV ISC) is widely used; however, its low permissible dose necessitates multiple visits, reducing adherence and increasing out-of-pocket expenditure. Intravenous ferric carboxymaltose (IV FCM) offers an advantage of complete dose administration in a single visit, but the higher price of the drug is the major deterrent for its procurement. The study evaluates the cost-effectiveness of IV FCM versus IV ISC for managing moderate to severe IDA in pregnancy in the Indian public health system.</p><p><strong>Methods: </strong>A decision tree model was developed from an abridged societal perspective. The time horizon was defined as the period from the second trimester to delivery, including early neonatal outcomes. Effectiveness inputs were derived from both primary and secondary sources. Costs were estimated using national costing databases and procurement records. The outcome was measured in incremental cost-effectiveness ratio (ICER) per quality-adjusted-life-years (QALY) gained and incremental health gains. Uncertainty was explored using deterministic and probabilistic sensitivity analysis. Budget impact analysis estimated the fiscal implication of adopting IV FCM.</p><p><strong>Results: </strong>The use of IV FCM compared with IV ISC for managing moderate to severe IDA in pregnant women incurred an incremental cost of INR 1,316 (USD 15.62) for an additional 0.069 QALYs. The ICER of INR 19,091.66 (USD 226.69) per QALY gained-equivalent to 0.08 times the cost-effectiveness threshold of 1x Gross Domestic Product (GDP) per capita per QALY-demonstrates that IV FCM is cost-effective. IV FCM also provided measurable clinical benefits, including improved anemia correction and reductions in adverse drug events, adverse neonatal outcomes, and maternal mortality. Sensitivity analyses showed > 98% probability of cost-effectiveness. While the budget impact indicates a higher financial outlay for IV FCM, this increased expenditure is associated with substantial incremental health gains.</p><p><strong>Conclusions: </strong>IV FCM is likely to be a cost-effective alternative to IV ISC for managing moderate to severe IDA in pregnancy, improving anemia recovery, maternal and neonatal outcomes while reducing out-of-pocket expenditure, thereby strengthening Anemia Mukta Bharat and Universal Health Coverage in India.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036231","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}