Health Economics Review最新文献

{"title":"Securing Somalia's health: leveraging sin tax revenues to drive universal health coverage and financial protection for lifesaving care in Somalia's health system-scoping review.","authors":"Saadaq Adan Hussein, Marian Muse Osman, Yakub Burhan Abdullahi, Mohamed Mohamoud Hassan, Abdihakim Ibrahim Ahmed, Naima Ibrahim Ahmed, Yahye Sheikh Abdulle Hassan, Abdirahman Aden Hussein, Rage Adem, Abdirahman Moallim Ibrahim, Yusuf Hared Abdi, Ayan Nur Ali, Abdinur Hussein Mohamed, Abdullahi Ahmed Tahlil, Sharmake Gaiye Bashir, Mohamed Sharif Abdi, Khadar Hussein Mohamud, Abdihakim Mohamed Hassan, Mohamed Ahmed Ali, Mohamed Farah Yusuf, Abdinur Adan Hussein, Mohamed Sheikh Hassan, Walid Abdulkadir Osman","doi":"10.1186/s13561-026-00789-x","DOIUrl":"10.1186/s13561-026-00789-x","url":null,"abstract":"<p><strong>Introduction: </strong>Global non-communicable diseases account for 74% of deaths worldwide, causing 15 million premature deaths each year, and the WHO warns this could rise to 55 million by 2030. Universal Health Coverage (UHC) is therefore central to SDG 3.8, aiming to ensure access to essential services without financial hardship. In Somalia, where tax revenue is low, increasing sin-tax rates could boost fiscal capacity for health initiatives. This study aims to explore how sin-tax revenues can serve as a sustainable financial mechanism to address Somalia's health-financing challenges, promote UHC and enhance financial protection while examining global best practices and the political economy of implementation in fragile states.</p><p><strong>Methods: </strong>This review followed the PRISMA-ScR framework for scoping reviews and synthesised evidence from academic and grey-literature sources on sin-tax (health taxes) revenues, health financing and UHC in fragile states-particularly Somalia. An initial 194 records were identified; after screening, 92 studies met the inclusion criteria for full-text analysis.</p><p><strong>Results: </strong>In Fiscal Year 2024 Somalia collected US $ 369.35 million in revenue, a 12% rise from 2023; the additional US $ 40 million equals 0.35% of 2024 GDP. Estimates show that sin-tax instruments on tobacco and alcohol yield 0.01%-0.5% of GDP in fragile states. Sin-taxes in Somalia such as the khat tax in Somaliland, which generates about US $ 2 million annually demonstrate tangible scope to expand public-health financing while curbing harmful consumption.</p><p><strong>Conclusion: </strong>Somalia's path to UHC remains constrained by reliance on external aid, out-of-pocket spending and a narrow domestic tax base. Well-designed sin-tax instruments on tobacco, alcohol, sugary drinks and khat especially where revenues are partially earmarked (hypothecated) for priority health services offer a dual opportunity: they curb risk-laden consumption and create predictable revenue that can be earmarked for essential services such as primary care, maternal-and-child health and NCD prevention. Evidence from peer countries shows that high rates, automatic inflation adjustment and robust enforcement are critical for maximizing both health gains and fiscal space.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13325592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018127","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":"Stated preferences in the Iranian health system: a systematic review of discrete choice experiments and conjoint analysis.","authors":"Lucie Sabin, Mohammad Hajizadeh, Hassan Haghparast-Bidgoli, Ali Kiadaliri","doi":"10.1186/s13561-026-00795-z","DOIUrl":"10.1186/s13561-026-00795-z","url":null,"abstract":"<p><strong>Background: </strong>Discrete choice experiments (DCEs) are increasingly used in health to determine preferences and inform policy decisions. However, questions remain about adherence to best practices and validity of the studies. To date, no systematic review has synthesised the application of DCEs in health in Iran. We conducted a systematic review to examine characteristics, methods, quality, and topics of DCEs in Iran.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, CINAHL, PsycINFO, Web of Science, and Scopus. Studies were included if they collected participants' preferences for a health-related topic among relevant stakeholders using DCEs, conjoint analyses, or best-worst scaling. Data was extracted on study design, participants, attribute and choice set development, data collection, and estimation approaches. The quality of each study was assessed against good practice criteria.</p><p><strong>Results: </strong>Thirty studies met the eligibility criteria. The number of DCEs published increased from 2021 onwards. Most studies were conducted in urban areas, particularly in Tehran, the capital city, and focused on health services and workforce. Attributes were generally related to monetary, time, risk, or health outcomes. Pilot testing and qualitative work with target population to inform attribute selection and questionnaire design were conducted inconsistently. Nearly half of the studies used effective designs. However, reporting on key methodological elements such as software used, blocking, and opt-out options was often incomplete. Estimation approaches varied, with conditional logit models being most commonly used.</p><p><strong>Conclusions: </strong>This is the first systematic review of DCEs on health-related topics in Iran. Although the use of this method is expanding rapidly, gaps remain in questionnaire design, method reporting, and econometric modelling. Future DCEs would benefit from including more diverse populations, improving methodological rigour, and aligning objectives with target populations. Strengthening these aspects will improve the validity and policy relevance of DCEs in Iran.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007062","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":"Sustainable financing in Iran's health system: a policy analysis of agenda-setting through Kingdon's multiple streams framework.","authors":"Anahita Behzadi, Mohsen Barooni, Amirhossein Fatahpour","doi":"10.1186/s13561-026-00788-y","DOIUrl":"10.1186/s13561-026-00788-y","url":null,"abstract":"<p><strong>Background and objective: </strong>Sustainable financing is essential for Iran's health system to achieve universal health coverage and improve healthcare quality. It involves gathering and managing financial resources for health services, aiming to enhance access to quality care while keeping costs manageable. These financing needs to address current health system demands without burdening the government and public, while also boosting healthcare quality. The study explores how to prioritize sustainable financing using the Kingdon multiple streams model.</p><p><strong>Materials and methods: </strong>This qualitative study looks at how a sustainable financing program is set up in Iran's health system using Kingdon's multiple streams model. It identifies three main areas: issues (problem stream), solutions (policy stream), and political will (political stream). Data were gathered through interviews and analyzed for themes.</p><p><strong>Results: </strong>Sustainable financing in Iran's health system faces major challenges in three areas: problems, policies, and politics. Key issues include a lack of financial resources, high healthcare costs, unequal access to care, low government funding, and poor resource management. Other challenges are high out-of-pocket expenses, limited insurance coverage, and reliance on oil revenue. Proposed solutions are to improve resource tracking, increase public health budgets, encourage community involvement, and use modern technology. The government must recognize these issues to build political commitment for sustainable financing, prioritizing resilience and effectiveness.</p><p><strong>Discussion and conclusion: </strong>The collaboration between the World Health Organization, the Islamic Consultative Assembly, and health entities in Iran shows the alignment of problems, policies, and politics. By addressing financial issues and involving stakeholders, they create opportunities for sustainable health financing, improve community health, and strengthen the healthcare system.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147983686","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 maternal and neonatal health interventions in Ethiopia: a systematic review and meta-analysis.","authors":"Akalu Duguma Sima, Endale Tamiru Burayu, Zelalem Banjaw Zegeye","doi":"10.1186/s13561-026-00754-8","DOIUrl":"10.1186/s13561-026-00754-8","url":null,"abstract":"<p><strong>Background: </strong>Despite recent improvements in health service coverage, maternal and neonatal mortality remain major public health concerns in Ethiopia. Evidence regarding cost-effectiveness is crucial for prioritizing interventions within the Essential Health Services Package, particularly in resource-constrained settings.</p><p><strong>Objective: </strong>This study aims to systematically review and conduct a meta-analysis on the cost-effectiveness of maternal and neonatal health (MNH) interventions in Ethiopia.</p><p><strong>Methods: </strong>We conducted a comprehensive search across multiple databases (PubMed/MEDLINE, Embase, the Cochrane Library, CINAHL, Scopus, Web of Science, African Journals Online; including the Ethiopian Journal of Health Development, Tufts Cost-Effectiveness Analysis Registry, and Google Scholar) from January 2000 to December 2024. A total of twelve studies were included in the qualitative synthesis and meta-analysis. A random-effects meta-analysis was performed for interventions with three or more comparable estimates utilizing the DerSimonian-Laird method.</p><p><strong>Results: </strong>The pooled incremental cost-effectiveness ratios (ICERs) showed high cost-effectiveness for key neonatal interventions: US$6.23 per DALY averted (95% CI: 4.22-8.23; I² = 64.10%; n = 4) for neonatal resuscitation and US$8.78 per DALY averted (95% CI: 3.78-13.77; I² = 90.98%; n = 3) for neonatal sepsis management. Antenatal care had a pooled ICER of US$91.93 per DALY averted (95% CI: 62.84-121.02; I² = 79.65%; n = 5). The overall pooled ICER across all 12 studies was US$15.47 per DALY averted (95% CI: 11.07-19.87; I² = 94.14%), but high heterogeneity (primarily due to intervention diversity) severely limits direct comparability; subgroup analyses provide the most reliable insights.</p><p><strong>Conclusion: </strong>Neonatal resuscitation, sepsis management, and antenatal care are cost-effective interventions (all pooled ICERs substantially below commonly referenced Ethiopian contextual benchmarks, such as around 1 × projected 2025 GDP per capita of ≈US$950-1,100 per DALY averted, though we note debates on GDP-based approaches and the importance of opportunity costs and affordability). Community-based scale-up in rural regions can optimize outcomes.</p><p><strong>Trial registration: </strong>PROSPERO registration number: CRD420251182108.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976372","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-related quality of life in COVID-19 in the United Kingdom: a vignette study.","authors":"Dionysios Ntais, Viola Ntim, Samantha Barton, Alex Porteous, Alvin Ng, Jennifer Page, Hardik Goswami, Victoria Coles, Amy Puenpatom","doi":"10.1186/s13561-026-00781-5","DOIUrl":"10.1186/s13561-026-00781-5","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 (COVID-19) is an acute respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Severe disease may require hospitalisation and respiratory support, which can cause longer-term morbidity. Patient utility data are limited, especially for severe disease where data collection can be challenging or unethical. A vignette study was designed to estimate utility values for COVID-19 disease states.</p><p><strong>Methods: </strong>A sample of United Kingdom (UK)-based adults (N = 500) completed the EQ-5D-5 L questionnaire for eight vignettes as patient proxies in September 2021. Vignettes qualitatively described hospitalisation and disease severity permutations, informed by a large UK-based COVID-19 infection survey. Recruitment was stratified to reflect UK demographics. EQ-5D utilities were derived using the appropriate UK value set.</p><p><strong>Results: </strong>Recovery without long-term sequelae had the highest utility (mean [standard deviation]: 0.87 [0.14]), followed by pre-infection (0.73 [0.22]). The intensive care unit state had the lowest utility (-0.38 [0.14]). Mild and moderate outpatient states reported similar utility (0.29 [0.26] vs. 0.31 [0.27]). The severe general hospital ward state had lower utility than the high dependency unit state (-0.18 [0.24] vs. - 0.11 [0.25]). Recovery with long-term sequelae had low utility (0.21 [0.29]).</p><p><strong>Conclusions: </strong>Mean utility values declined as COVID-19 disease state severity increased, suggesting that COVID-19 is likely to impact patient quality of life, in line with published literature. However, the evolving nature of COVID-19 may limit the generalisability of findings to the current disease landscape. Nevertheless, generation of utility values using a vignette-based approach represents a reasonable alternative where collection patient health-related quality of life data is infeasible, albeit with some limitations.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976376","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 evidence of alternative formulations and routes of administration for identical active pharmaceutical ingredient: a systematic review.","authors":"Hanqiao Shao, Yunong Jiang, Mingye Zhao, Wenxi Tang","doi":"10.1186/s13561-026-00793-1","DOIUrl":"10.1186/s13561-026-00793-1","url":null,"abstract":"<p><strong>Background: </strong>Different formulations and routes of administration (e.g. oral, intravenous [IV], subcutaneous [SC]) of the same active pharmaceutical ingredient (API) may change value by altering administration burden, adherence, setting of care and resource use. This systematic review compared the economic impact of alternative formulations or routes of the same API and assessed reporting quality.</p><p><strong>Methods: </strong>PubMed and Embase were searched from inception to 31 January 2025 for full economic evaluations directly comparing dosage forms or administration routes of the same API in humans. Two reviewers independently screened records, extracted data, and appraised reporting quality using Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022). For cost minimization analyses (CMAs), costs were converted to 2024 US dollars (USD) and summarized as median annual total cost differences and relative changes. Mean CHEERS scores were compared between CMAs and non-CMAs.</p><p><strong>Results: </strong>Thirty-eight studies from 17 countries met criteria, spanning 11 ICD-11 categories and 10 route comparisons. CMA was most common (n = 20; 52.6%); all 18 non-CMA studies were model-based. Perspectives varied: healthcare system (42.1%), societal (36.8%), payer (15.8%), provider (15.8%). Industry funding was reported in 60.5%. CHEERS reporting was generally good; non-CMA studies scored higher than CMAs (mean 22.8 ± 0.9 vs. 20.9 ± 2.0; p < 0.001). Across indications, subcutaneous or oral administration versus intravenous were often associated with lower total costs, mainly through reductions in staff time, chair occupancy, consumables, travel, and productivity losses. In 18 CMAs with sufficient data, the median annual total cost difference was -$2,073 per patient (IQR -$3,594 to -$695), a -21.35% relative reduction (IQR - 30.96% to -5.24%). Subcutaneous versus intravenous comparisons showed a median annual difference of -$2,479 (IQR -$6,715 to -$1,943). Adherence was rarely modeled explicitly (10% of CMAs; 67% of non-CMAs), often based on assumptions; indirect and organizational costs were inconsistently captured.</p><p><strong>Conclusion: </strong>Alternative formulations and routes of the same API, particularly SC or oral instead of IV, often lower total treatment costs. However, frequent use of CMA, strong equivalence assumptions and incomplete costing limit robustness and support the need for more rigorous cost effectiveness analyses.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976356","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 comprehensive geriatric assessment: a systematic review.","authors":"Alberto Pilotto, Francesco Saverio Ragusa, Nicola Veronese, Carlo Custodero, Pascal Roberto Titone, Giusy Vassallo, Emanuele Seminerio, Wanda Morganti, Alessandro Botrugno, Benedetta Margilio, Mario Barbagallo, Romina Custureri, Mickaël Hiligsmann","doi":"10.1186/s13561-026-00758-4","DOIUrl":"10.1186/s13561-026-00758-4","url":null,"abstract":"<p><strong>Background: </strong>The role of Comprehensive Geriatric Assessment (CGA) is crucial from a clinical point of view for frail older patients, permitting tailored interventions that may address specific needs. In addition to its clinical significance, understanding the economic value of CGA is also essential. Cost-effectiveness analyses are increasingly conducted to evaluate health interventions, but the literature about CGA is still limited, and no comprehensive overview is currently available. The aim of our study is therefore to systematically review economic evaluations of CGA, including both cost analyses and cost-effectiveness analyses, to provide the most complete overview of the available evidence.</p><p><strong>Methods: </strong>We searched several databases from database inception to 01st January 2025. We included studies that reported costs and/or cost-effectiveness of CGA compared to usual care. The characteristics and results of included studies were summarized using a narrative summary that compared and evaluated the methods used and the principal results among studies.</p><p><strong>Findings: </strong>Among 3,839 articles initially screened, 36 studies with a total of 68,186 older people (mean age: 79 years old) followed on average for two years were included. Overall, 17 studies evaluated cost analysis, with 13 studies with lower cost in CGA group and 4 studies with higher cost. Similarly, 19 studies evaluated cost-effectiveness, among these 12 had Quality-Adjusted Life Years (QALYs) as outcome of which seven were dominant (lower costs for better health outcomes), and two were cost-effective. Finally, 7 studies assessed other outcomes than QALYs, with dominance achieved in five of them.</p><p><strong>Conclusion: </strong>CGA appears to have the potential to be cost-effective in several settings, with many studies reporting favorable economic outcomes. Overall, CGA shows promise as an effective and cost-effective intervention, but further research with longer follow-up and a broader range of economic models is needed to fully assess its economic value.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942813","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":"Policy options for controlling rising hospital prices and their outcomes: a framework-based analysis.","authors":"Mohammad Ali Rezaei, Hamid Pourasghari, Ali Akbari Sari, Aziz Rezapour","doi":"10.1186/s13561-026-00787-z","DOIUrl":"10.1186/s13561-026-00787-z","url":null,"abstract":"<p><strong>Background: </strong>Rising hospital prices drive healthcare spending and threaten access, fueled by consolidation, weak regulation, and inefficient procurement. This scoping review applied the \"Control Knobs\" framework to identify and compare policy options for controlling hospital prices.</p><p><strong>Methods: </strong>Following PRISMA-ScR guidelines, PubMed, Web of Science, Scopus, Embase, and Google Scholar were searched for English-language studies (Jan 2013-Jun 2024). Studies without hospital-specific price outcomes were excluded. Two reviewers independently screened and extracted data on study characteristics, policy options, and outcomes, which were synthesized narratively across the five \"Control Knobs\" domains: financing, payment, organization, regulation, and behavior.</p><p><strong>Results: </strong>Of 5,196 records, 50 studies met inclusion criteria, mostly from the U.S. (n = 30), with others from China, Italy, France, and eight additional countries. Policy options covered all five \"Control Knobs\" domains. Financing tools including competitive tenders, centralized procurement, and national negotiations, consistently reduced prices, particularly in China, Denmark, and India. Payment reforms, including fixed-rate contracts, price caps, reference pricing, and outcome-based procurement, generally lowered prices, though discounted-charge contracts and regional health technology assessment (HTA) sometimes increased them. Organizational changes had mixed effects. Mergers, Accountable Care Organization (ACO) acquisitions, and trauma center monopolies raised prices, while competition from ambulatory surgery centers (ASCs) and group purchasing organizations (GPOs) reduced them. Regulatory measures including caps, most-favored-nation (MFN) bans, and transparency tools, showed modest to substantial price reductions, whereas Certificates of Public Advantage (COPAs) had variable outcomes. Behavioral approaches, including HTA, biosimilar and generic entry, and public reporting, were generally associated with price declines.</p><p><strong>Conclusion: </strong>Hospital price control relies on the interplay of financing, payment, organizational, regulatory, and behavioral mechanisms, with financing and payment reforms exerting direct short-term effects and organizational and regulatory tools shaping long-term market dynamics. The most effective policy options enhanced competition and purchasing power, including competitive tendering, centralized procurement, and promotion of generics and biosimilars. National price negotiations and merger restrictions also contained prices, while transparency, HTA, and outcome-based contracting had modest or context-dependent effects. Some interventions, such as high-deductible health plans (HDHPs), consolidations, and poorly designed regulations, increased prices. Sustainable price control requires a coordinated, context-specific approach that ensures both affordability and equity.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934497","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":"Longitudinal trends and future projections of injury-related economic burden among middle-aged and older adults in China: analysis of CHARLS data 2011-2018.","authors":"Shaobo Zeng, Chen Liang, Shuanglong Yuan, Shuang Han, Caihong Li, Abulikemu Aili, Yaying Zhang, Guliziba Kuerbanjiang, Mingqin Cao","doi":"10.1186/s13561-026-00785-1","DOIUrl":"10.1186/s13561-026-00785-1","url":null,"abstract":"<p><strong>Background: </strong>Existing studies on the economic burden of injury in China lack dynamic, national-level assessments. Using data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018), this study examined trends in injury prevalence and economic burden among middle-aged and elderly adults and predicted the burden for 2021-2025. The findings aim to inform national injury prevention strategies and health policy-making.</p><p><strong>Methods: </strong>Data were extracted from four waves of the CHARLS database (2011, 2013, 2015, and 2018). After excluding missing values, the study included 9,742, 9,586, 10,198, and 12,202 residents aged 45 and above, respectively. To address the common issues of excess zeros and skewed distributions in medical expenditure data, a two-part model was employed to estimate the per capita direct and indirect economic burdens of the injured population, and to analyze the variations in these burdens across different demographic characteristics. Furthermore, a GM(1,1) model was utilized on limited time-series data to forecast the economic burden of injuries from 2021 to 2025.</p><p><strong>Results: </strong>The prevalence of injury among middle-aged and elderly individuals was 22.57% in 2011, 18.10% in 2013, 20.58% in 2015, and 19.45% in 2018, demonstrating an overall downward trend. Compared to 2011, the direct economic burden of injuries in 2018 decreased by 93.62% (from 9,689.6 CNY to 618.4 CNY), while the indirect economic burden decreased by 64.12% (from 321.1 CNY to 115.2 CNY). Stratified analysis indicated that the overall economic burden was higher for urban residents than for their rural counterparts; females bore a higher direct economic burden than males; and individuals with lower cognitive levels faced a higher economic burden than those with better cognitive function. Projections for 2021-2025 suggest that the economic burden of injuries in China will continue to decline, with the average direct and indirect economic burdens expected to drop to 191.3 CNY and 77.2 CNY, respectively, by 2025.</p><p><strong>Conclusion: </strong>The prevalence and economic burden of injury among middle-aged and older Chinese adults generally declined. However, urban residents, females, and populations with low cognitive levels continued to sustain comparatively higher economic burdens. Governments and society should refine policies targeting these key populations and strengthen injury prevention education in communities and public spaces to further reduce injury incidence and the associated economic losses.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875940","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-utility analysis of three PD-1 inhibitors combined with chemotherapy in the first-line treatment of locally advanced or metastatic esophageal squamous carcinoma in China.","authors":"Li Liao, Jing Gong","doi":"10.1186/s13561-026-00784-2","DOIUrl":"10.1186/s13561-026-00784-2","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the economics of sintilimab combination chemotherapy versus chemotherapy and sintilimab combination chemotherapy versus camrelizumab/ toripalimab combination chemotherapy in the first-line treatment of locally advanced or metastatic esophageal squamous carcinoma (ESCC) from the perspective of the Chinese health system.</p><p><strong>Methods: </strong>A partitioned survival model (PSM) with a tracked time horizon of 5 years was developed. In the basal analysis, a direct cost-utility comparison of sintilimab + chemotherapy vs. chemotherapy in first-line treatment of advanced ESCC was performed based on survival data from the ORIENT-15 trial. Cost and utility value data were obtained from relevant databases or published literature, and the robustness of the model was assessed using one-way sensitivity analysis and probabilistic sensitivity analysis (PSA). In the exploratory analysis, the cost-utility of sintilimab + chemotherapy vs. camrelizumab/ toripalimab + chemotherapy was indirectly compared by Network Meta-Analysis (NMA) combined with hazard ratio (HR).</p><p><strong>Results: </strong>Sintilimab in combination with chemotherapy resulted in 0.33 quality-adjusted life years (QALYs) more than chemotherapy with an incremental cost-effectiveness ratio (ICER) of 25,409.27 USD/QALY, which was lower than the willingness-to-pay (WTP). Sensitivity analysis showed that the utility value of stable disease and the price of sintilimab had the greatest impact on outcome stability. Exploratory analysis indicate that toripalimab plus chemotherapy yields an additional 0.04 QALYs compared with sintilimab plus chemotherapy, with an ICER of 9,953.24 USD/QALY. In contrast, camrelizumab plus chemotherapy yields 0.05 fewer QALYs compared with sintilimab plus chemotherapy.</p><p><strong>Conclusion: </strong>For the first-line treatment of locally advanced or metastatic ESCC, the addition of sintilimab to conventional chemotherapy regimens was economical. Among similar PD-1 inhibitors, the toripalimab plus chemotherapy regimen is more costly but more effective than the sintilimab plus chemotherapy regimen, and is cost-effective at the WTP threshold of 3 × GDP per capita. In contrast, the camrelizumab plus chemotherapy regimen is dominated (higher cost and worse effectiveness) by the sintilimab plus chemotherapy regimen.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}