Health Economics Review最新文献

{"title":"The economic burden of COVID-19 undervaccination: costs of hospitalisation, ICU admission, and death in Scotland.","authors":"Steven Kerr, Joan E Madia, Catia Nicodemo, Aziz Sheikh","doi":"10.1186/s13561-026-00775-3","DOIUrl":"10.1186/s13561-026-00775-3","url":null,"abstract":"<p><p>The COVID-19 pandemic has imposed substantial financial and operational pressures on healthcare systems globally. While vaccines were known to reduce severe outcomes, their broader economic impacts, especially in publicly funded health systems, requires clearer quantification. This study evaluates the direct healthcare costs associated with COVID-19 outcomes in relation to vaccination status, using linked individual-level data from Scotland’s EAVE II cohort (June to September 2022). We defined undervaccination as the shortfall between recommended and received COVID-19 vaccine doses, stratified by age group. Retrospective cohort analysis employing Cox proportional hazards and linear regression models was used to assess the associations between undervaccination and the risk, frequency, and duration of hospitalisation, intensive care unit (ICU) admission, and death. We also conducted a counterfactual analysis to estimate averted costs and quality-adjusted life years gained (QALYs) under a full vaccination scenario.Findings demonstrate a strong dose–response relationship between undervaccination and severe COVID-19 outcomes. Among individuals aged 75+, those with higher undervaccination levels showed significantly increased hazard ratios for hospitalisation (up to 3.92 for sub-optimal level 2), ICU admission (up to 12.53 for sub-optimal level 2), and mortality (up to 6.63 for sub-optimal level 3). These elevated risks translated into substantial direct healthcare costs. Hospitalisation costs reached £4.7 million for the 75+ group and £2.6 million for the 16–74 group, while ICU costs totalled £70,489 and £246,486, respectively. Under a counterfactual full vaccination scenario, potentially avertable hospital costs were estimated at £1.4 million for the 75+ group and £0.5 million for the 16–74 group. Vaccination rates were lower among younger individuals, ethnic minorities, and residents in more deprived areas, highlighting persistent health inequalities. Of the total cohort of 4,992,498 individuals, 65.8% were fully vaccinated on 1 June 2022, while 34.2% were undervaccinated. These inequalities were not only clinically consequential but also economically costly: undervaccinated individuals generated more than five-fold the COVID-19 healthcare spend of their fully vaccinated peers. Universal full vaccination could have averted approximately £1.4 million (75+) and £0.5 million (16–74) in hospital costs, and a further £38,000 in ICU costs, during summer 2022.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785497","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":"Consideration of the limitations of cost-effectiveness analysis for severe-rare disease drugs and potential solutions: a structured literature review.","authors":"Jia Pan, Anastasios Skroumpelos, Anouska Jha, Urs Arnet, Rachel Kewley, Johannes Michel, Ashleys C Humphries, Rogier Klok","doi":"10.1186/s13561-026-00771-7","DOIUrl":"https://doi.org/10.1186/s13561-026-00771-7","url":null,"abstract":"<p><strong>Background: </strong>Rare diseases affect more than 400 million people globally with only a small number having currently approved treatments. Drugs for rare diseases (medications developed to treat conditions affecting small patient populations), which may include innovative drugs (medications with novel mechanisms/new active ingredients) can face access challenges as they are often found not to be cost-effective under conventional health technology assessment methods. In this review we provide a comprehensive and up-to-date understanding of challenges associated with the economic evaluation of innovative drugs for severe-rare diseases, and any proposed solutions and associated barriers to solution adoption.</p><p><strong>Methods: </strong>This review included searches of electronic databases and select health technology assessment agency websites to identify relevant publications, guidelines or recommendations from 1st January 2014 to 29th July 2024. A pre-authorised protocol, including detailed eligibility criteria, was used to ensure robust methodology in the capture of materials. Relevant data extracted from included publications were synthesised thematically to support identification of the most prominent concepts within current literature.</p><p><strong>Results: </strong>Of the 1,803 records identified, 31 publications and eight health technology assessment guidance were included. Main challenges were related to the utilitarian principle underlying cost-effectiveness analysis, the limited scope of the quality-adjusted life year and the value elements assessed. Associated solutions included the incorporation of a societal willingness-to-pay or inclusion of equity in healthcare decision making, reduced weighting of the economic evaluation in resource allocation, consideration of additional value elements, and introducing a quality-adjusted life year weighting or alternative measures of health outcomes. While some payers have implemented modifications to economic evaluation guidelines in an attempt to address the challenges, for example including the consideration of additional value elements, the solutions employed are not consistent across payers and often do not address the root issue. Economic evaluation as part of health technology assessment therefore remains challenging for manufacturers of drugs for rare diseases.</p><p><strong>Conclusion: </strong>Conventional methods of economic evaluation contribute to the access challenge for innovative drugs for rare diseases. Collaboration between payers, manufacturers, and healthcare decision makers to foster greater understanding of how to evolve and adopt these novel solutions will be key to ensuring timely patient access.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718267","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 evaluation of automated scalp cooling systems for breast cancer patients in Spain.","authors":"Hernández-Yumar Aránzazu, García-Pérez Lidia, González-Pacheco Himar, de Armas-Castellano Aythami, Antón Torres Antonio, Martín Jiménez Miguel, Rueda-Domínguez Antonio, Serrano-Aguilar Pedro, Trujillo-Martín María Del Mar","doi":"10.1186/s13561-026-00776-2","DOIUrl":"10.1186/s13561-026-00776-2","url":null,"abstract":"<p><p>BACKGROUND: Different alternatives exist to prevent chemotherapy-induced alopecia (CIA), such as scalp cooling (SC). We conducted an economic evaluation to assess SC systems for breast cancer patients in Spain. METHODS: A decision tree was built to compare automated SC systems (DigniCap® and Paxman) with the usual clinical practice in Spain (not using the SC), over an 18-month time horizon and applying the National Health Service (NHS) and social perspectives. The target population were women diagnosed with breast cancer (stages I and II), undergoing chemotherapy treatment. We estimated the number of women preventing CIA, quality-adjusted life years (QALYs), incremental costs, and the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The DigniCap® system increased costs by €505.97 and €251.8 (NHS and social perspectives), while the Paxman system did by €176.95 (NHS perspective), compared to not using SC. Both systems could generate 0.03 QALYs more than the usual clinical practice. The ICERs were below the willingness to pay threshold (€25 000 per QALY). Paxman, from the social perspective, represented a cost reduction of €77.22, being less costly and more effective in terms of QALYs. Sensitivity analyses confirmed these results. SC systems prevented CIA in 47% of the target population. CONCLUSIONS: Automated SC systems could generate a higher cost (except Paxman from the social perspective) and more QALYs compared to the usual clinical practice in Spain. They could be considered cost-effectiveness technologies or a dominant alternative, in the case of Paxman applying a social perspective. </p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718261","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":"Socioeconomic barriers to healthcare cost-sharing in the Czech Republic: limited awareness and resistance.","authors":"Jan Hodač, Drahomíra Holmannová, Eva Čermáková, Michaela Tauchmanová Spoustová, Roman Prymula, Lenka Hodačová","doi":"10.1186/s13561-026-00773-5","DOIUrl":"10.1186/s13561-026-00773-5","url":null,"abstract":"<p><p>BACKGROUND: The Czech Republic provides near-universal healthcare through compulsory public health insurance yet rising costs have intensified debate on patient cost-sharing. This study examined (i) citizens’ experiences with out-of-pocket (OOP) payments, (ii) awareness of health insurance expenditures, and (iii) willingness to contribute financially beyond mandatory coverage. METHODS: A nationwide face-to-face survey was conducted in November–December 2024 in a quota-based sample of 1,809 individuals aged ≥ 15 years, with quotas set for age, gender, and region. A nationwide face-to-face survey was conducted in November–December 2024 on a representative sample of 1,809 individuals aged ≥ 15 years. A structured questionnaire assessed OOP payments, cost awareness, and attitudes toward additional financial contributions for consumed healthcare. Descriptive statistics, Chi-square tests, and logistic regression were used to evaluate associations with socioeconomic characteristics. RESULTS: Over 60% of respondents reported paying for non-reimbursed medications or supplements, and 43.7% for dental services; payments for above-standard services were uncommon. Cost awareness was low: 64.3% did not monitor their insurance expenditures. Only 24.3% were willing to contribute financially beyond mandatory payments, while almost half believed healthcare should be fully covered by public insurance. Willingness to contribute was significantly higher among younger respondents and those with higher education and income. CONCLUSIONS: Czech citizens demonstrate limited awareness of healthcare costs and low readiness for broader cost-sharing, shaped by socioeconomic factors. These findings suggest that any reform should balance solidarity and sustainability and be accompanied by transparent communication on healthcare financing and targeted efforts to improve health and financial literacy, supporting informed public debate and gradual acceptance of necessary changes. </p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A methodological analysis of systematic reviews of cost-effectiveness in screening, diagnosis, and treatment of colorectal cancer.","authors":"Mónica A Velásquez, Vivienne C Bachelet","doi":"10.1186/s13561-026-00774-4","DOIUrl":"10.1186/s13561-026-00774-4","url":null,"abstract":"<p><p>INTRODUCTION: Economic evaluations are essential for informing decisions on colorectal cancer screening, diagnosis, and treatment. However, substantial methodological variability across studies challenges the comparability and interpretation of cost-effectiveness evidence. OBJECTIVE: To identify, characterize, and critically analyze systematic reviews of economic evaluations in colorectal cancer, emphasizing their methodological characteristics and reporting practices. METHODS: We conducted a thorough search across multiple databases to identify systematic reviews published until 2025 that synthesized comprehensive economic evaluations (cost-effectiveness and cost-utility analyses) of colorectal interventions. We extracted data on intervention type (screening, diagnosis, treatment), model structure, time horizon, analytical perspective, discounting, handling of uncertainty, and model validation. We applied an integrated framework based on established methodological and reporting criteria. Findings were synthesized narratively. RESULTS: We included 20 systematic reviews, covering screening, diagnostic, and treatment strategies. Most economic evaluations used Markov or microsimulation models with lifetime horizons and discount rates ranging from 3% to 5%. The healthcare system perspective predominated, while societal perspectives were less frequently applied. Across domains, substantial heterogeneity was observed in comparators, modeling assumptions, cost inputs, and outcome measures. Screening studies showed the greatest variability, particularly in comparator selection and adherence assumptions. Although sensitivity analyses were commonly reported, formal model validation was infrequent. These findings are consistent with previous reviews, which have shown that colorectal cancer interventions are generally cost-effective but that variability in model assumptions limits the identification of optimal strategies. CONCLUSIONS: Systematic reviews of economic evaluations in colorectal cancer report widespread use of advanced modeling techniques and sensitivity analyses; however, significant limitations remain regarding validation, transparency, and methodological standardization. Improving reporting practices and enhancing model validation are essential to improve the reliability and policy relevance of economic evidence in colorectal cancer. </p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692646","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":"Residents' preferences for inclusive commercial supplementary medical insurance: a discrete choice experiment.","authors":"Yeyi Feng, Gaojie Li, Shumin Wu, Qingran Sun, Xiaoyu Xi, Ennan Wang","doi":"10.1186/s13561-026-00770-8","DOIUrl":"10.1186/s13561-026-00770-8","url":null,"abstract":"<p><p>BACKGROUND: In China, inclusive commercial supplementary medical insurance (ICSMI) has developed rapidly, and the size of the insured population is critical for its long-term sustainability. To enhance the attractiveness of ICSMI and increase enrolment, it is necessary to improve scheme design based on residents’ choice preferences. METHODS: A discrete choice experiment was conducted to elicit residents’ preferences for ICSMI. Seven attributes and their levels were identified through a literature review, analysis of policy clauses of existing ICSMI schemes, and face-to-face interviews. A D-efficient design was used to generate 20 choice sets. A mixed logit model was applied to estimate overall preferences for ICSMI, calculate willingness to pay for different attribute levels, rank the relative importance of attributes, perform heterogeneity analysis and scenario simulation analysis. RESULTS: Among the 634 respondents, ICSMI schemes with lower premiums, government participation, broader coverage scope, lower deductibles, higher reimbursement ratios, reimbursement of pre-existing conditions, and one-stop settlement were preferred. Residents attached the greatest importance to the reimbursement ratio. The highest willingness to pay was observed for the coverage scope: respondents were willing to pay CNY 211.301 for the coverage scope from low scope to high scope. Subgroup and interaction analysis based on demographic characteristics showed heterogeneity in preferences for some attributes. Respondents with chronic diseases exhibited stronger preferences for a higher reimbursement ratio and one-stop settlement. When these two items are included in the product plan, their uptake rate will also increase significantly. CONCLUSIONS: Residents showed significant preferences for all attributes. This study provides preference evidence directly from the target insured population and offers a reference for optimising the design of ICSMI products. </p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13196180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677605","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 AI-enhanced breast cancer screening in Iran: a microsimulation study.","authors":"Sajjad Dorri Kafrani, Rajabali Daroudi, Morteza Mohammadzadeh","doi":"10.1186/s13561-026-00765-5","DOIUrl":"10.1186/s13561-026-00765-5","url":null,"abstract":"<p><strong>Background: </strong>Recognized worldwide as a major health threat and Sustainable Development Goal priority, breast cancer places an especially heavy clinical and economic burden on Iran, making early detection imperative. To guide policy, we assessed the cost-effectiveness of ten mammography-based screening schedules.</p><p><strong>Methods: </strong>We developed an individual-level microsimulation model simulating 10,000 Iranian women over a 40-year horizon. Screening scenarios varied by interval (annual, biennial, triennial), incorporating mammography alone and two AI-enhanced strategies. Analyses adopted a payer perspective, discounting costs and quality-adjusted life years (QALYs) at 5% annually. Incremental cost-effectiveness ratios (ICERs) were evaluated against a willingness-to-pay (WTP) threshold of USD 4,500 per QALY (Iran's 2023 GDP per capita). Probabilistic sensitivity analyses (PSA) assessment ensured result robustness.</p><p><strong>Results: </strong>Compared with no screening, all screening schedules increased QALYs and total costs, while reducing breast-cancer incidence and mortality. Among the alternative tests, annual mammography interpreted by AI and a radiologist was the most cost-effective strategy, with an ICER of USD 4,064 per QALY, demonstrating a high level of cost-effectiveness relative to the next most effective strategy. Probabilistic sensitivity analysis confirmed robustness, with the selected strategy being cost-effective in 52% of simulations.</p><p><strong>Conclusions: </strong>AI-enhanced mammography is more cost-effective than conventional screening. Concurrent AI-radiologist double reading delivers the greatest value at Iran's USD 4,500 /QALY threshold, while AI-triage with radiologist confirmation, though less efficient, offers a practical alternative in settings where imaging and biopsy capacity cannot be rapidly expanded.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13191863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of modeling approaches to evaluate diagnostics programs for stable coronary heart disease: suggestions for future health economic models.","authors":"Wei Li, Haonan Li, Shuhua Tan, Mengtian Cai, Sheng Han, Yingyao Chen","doi":"10.1186/s13561-026-00762-8","DOIUrl":"10.1186/s13561-026-00762-8","url":null,"abstract":"<p><p>OBJECTIVE: To critically review health economic models used to evaluate diagnostic strategies for stable coronary artery disease (CAD), with a focus on methodological characteristics in model development. METHODS: A systematic literature review (SLR) was conducted across major electronic databases and health technology assessment (HTA) agency websites from inception to January 2025. Studies were independently screened using predefined criteria. Data extraction focused on general characteristics, model structure, approaches to uncertainty, model validation, and transparency. These aspects were then systematically described to identify common methodological characteristics and potential areas for improvement. RESULTS: Seventy articles were included, comprising 67 peer-reviewed publications and three HTA reports. Most studies were model-based (n = 46), and models were structured as decision tree models (n = 27), Markov models (n = 6), or hybrid approaches (n = 13). While only 18 studies explicitly justified their choice of model structure. Substantial heterogeneity was observed in key modeling assumptions, including time horizon, cycle length and data sources. Among studies using long-term Markov models (n = 19), none explicitly reported the use of half-cycle correction. Although most studies conducted sensitivity analyses (n = 56), approaches to uncertainty varied widely, and only seven models incorporated deterministic, probabilistic, and scenario analyses. Model validation was infrequently reported, with only two studies describing any formal validation activities. Overall, transparency was limited, as none of the studies provided sufficient technical documentation and reporting of model implementation tools was also incomplete (n = 28). CONCLUSION: Methodological heterogeneity and incomplete reporting exit in economic evaluation of diagnostic strategies for stable CAD, which may affect their transparency and comparability. Future research may benefit from clearer model justification, more consistent reporting of key technical assumptions, and systematic approaches to uncertainty and validation. </p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640090","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":"Behavioral responses of healthcare providers to prospective payment systems: a systematic review using the WHO framework (2000-2024).","authors":"Anahita Behzadi, Zohreh Bagherinezhad, Maliheh Ghobadi","doi":"10.1186/s13561-026-00750-y","DOIUrl":"10.1186/s13561-026-00750-y","url":null,"abstract":"<p><p>BACKGROUND: Prospective payment systems (PPS) have become increasingly prevalent in healthcare globally, yet their impact on provider behavior remains complex and context-dependent. This systematic review examines the behavioral responses of healthcare providers to PPS using the World Health Organization’s four-function framework. METHODS: A comprehensive systematic review was conducted in accordance with PRISMA 2020 guidelines. Electronic searches were performed in PubMed/MEDLINE, Web of Science, Scopus, and Embase for studies published between January 2000 and December 2024. Studies assessing the impact of PPS on healthcare provider behavior were included. Methodological quality was evaluated using the Joanna Briggs Institute checklists. Data were synthesized through narrative synthesis and thematic analysis aligned with the WHO framework (governance, service delivery, financing, and resource generation). RESULTS: From 8,615 identified records, 168 studies met the inclusion criteria. Among these, Diagnosis-Related Group (DRG)-based systems (32.1%) and pay-for-performance models (26.2%) were the most frequently examined payment mechanisms. The included studies covered 25 countries, with the United States (33.9%), China (28.0%), and European countries (24.4%) accounting for the largest shares. Most studies (64.9%) were published between 2016 and 2024. Hospitals (51.8%) and physicians (28.0%) were the primary provider groups investigated. Analysis within the WHO framework revealed distinct behavioral patterns across all four system functions. In the governance domain, PPS was associated with improvements in quality indicators and cost efficiency, alongside concerns regarding risk selection and potential reductions in care quality. Service delivery responses included greater emphasis on preventive care and shifts from inpatient to outpatient services, but also evidence of induced demand and selective patient provision. Financing-related outcomes demonstrated cost containment effects, accompanied by cost-shifting behaviors. In the resource generation function, PPS encouraged clinical process optimization and more efficient resource utilization. CONCLUSIONS: PPS implementation generates complex and multidimensional behavioral responses among healthcare providers. Although these systems generally support cost containment, they may also prompt strategic behaviors that risk undermining care quality and equity. The overall effectiveness of PPS depends on payment design, regulatory context, and provider characteristics. Incorporating behavioral insights into future payment system design is essential to enhance intended effects and mitigate unintended consequences. </p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640163","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 cost-effectiveness of telestroke in the treatment of acute ischemic stroke in China.","authors":"Lifeng Huang, Xuezhu Li, Hanting Liu, Wensu Zhou, Hui Zhang","doi":"10.1186/s13561-026-00759-3","DOIUrl":"10.1186/s13561-026-00759-3","url":null,"abstract":"<p><p>BACKGROUND: Telestroke improves access to stroke care in underserved areas but requires a high initial investment. Evidence on its cost-effectiveness is limited in developing countries. This study aims to evaluate the cost-effectiveness of treating acute ischemic stroke (AIS) patients with telestroke compared to non-telestroke in China. METHODS: A Markov model is developed to assess the costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) of telestroke compared with non-telestroke over a lifetime horizon. The model incorporates four treatment pathways (intravenous thrombolysis (IVT), endovascular therapy (EVT), bridging therapy, and conservative treatment) and symptomatic intracerebral hemorrhage (sICH). Health states are divided into independent (modified Rankin Scale(mRS) 0–2), dependent (mRS 3–5), or deceased (mRS 6). The model cycle length is 1 year. Both costs and QALYs are discounted at 3% annually. The willingness-to-pay (WTP) threshold is set at 3 × gross domestic product per capita (268,074 Chinese Yuan (CNY) or 38,042 United States Dollar (USD) per QALY in 2023). RESULTS: Compared to non-telestroke, telestroke increases costs by 18,020 CNY and adds 0.1142 QALYs, resulting in an ICER of 157,763 CNY (22,388 USD) per QALY in lifetime horizon. One-way sensitivity analyses reveal that ICER is most sensitive to the probability of patients being independent (mRS 0–2) after EVT. Probabilistic sensitivity analysis shows that telestroke is cost-effective in 86.59% of the 10,000 simulations. CONCLUSIONS: Telestroke is cost-effective for AIS management in China, supporting its broader adoption. </p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595185","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}