Cost Effectiveness and Resource Allocation最新文献

{"title":"Retirement and healthcare expenditures of urban Chinese males: causal evidence from the CHARLS 2020 wave.","authors":"Maoguo Wu, Yan Chen","doi":"10.1186/s12962-026-00774-5","DOIUrl":"10.1186/s12962-026-00774-5","url":null,"abstract":"<p><strong>Background: </strong>China's low male statutory retirement age (60) and its rapidly aging population make the causal effect of retirement on healthcare expenditures a pressing policy question. Centralized drug procurement, nationwide DRG/DIP payment reform, and expanded insurance coverage have reshaped the cost environment in which retirement‑related spending decisions occur, calling for up‑to‑date causal estimates.</p><p><strong>Methods: </strong>We use the most recent publicly available wave of the China Health and Retirement Longitudinal Study (CHARLS 2020, Wave 5) and apply a fuzzy regression discontinuity design that exploits the male statutory retirement age as an exogenous source of variation. The sample consists of urban males aged 55-65 (N = 2,538), the group for whom the retirement cut‑off is unambiguous and whose healthcare‑expenditure decisions are most directly affected by formal urban insurance systems. Expenditures are disaggregated into self‑treatment (medications and preventive products) and institution‑related (outpatient and inpatient) categories, and comprehensive mechanism tests are conducted across spending ability, health conditions, time availability, and lifestyle channels.</p><p><strong>Results: </strong>Retirement significantly increases self‑treatment expenditures, with out‑of‑pocket self‑treatment rising by approximately ¥14-16 per week at the age‑60 cutoff. The magnitude is modest, consistent with the post‑2018 drug‑price reductions that exceeded 50%. Institution‑related expenditures decline; out‑of‑pocket inpatient spending falls by roughly 40% relative to the pre‑retirement baseline. The gap between total and out‑of‑pocket expenditures is narrow, reflecting the decline in the national out‑of‑pocket share to 27%. The spending‑ability channel is weak, while health conditions, physical activity, and social engagement remain the dominant mechanisms. Education‑level and household‑size gradients are present but modest in magnitude.</p><p><strong>Conclusions: </strong>The retirement‑expenditure nexus in urban China is characterized by a shift toward self‑treatment and away from institutional utilization. Post‑2018 reforms have shaped the economic magnitudes of these effects, producing a contemporary benchmark for retirement‑policy calibration and health‑insurance design. Extensions to female and rural populations are warranted.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148102038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plate fixation vs. intramedullary nailing: Which is more cost-effective for tibial shaft fractures?","authors":"Seyed Houssien Saeed-Banadaky, Mehdi Raadabadi, Amir Mohammad Sotoudehnia, Rajabali Daroudi, Seyed Masoud Mousavi, Mohammad Ranjbar","doi":"10.1186/s12962-026-00776-3","DOIUrl":"10.1186/s12962-026-00776-3","url":null,"abstract":"<p><strong>Introduction: </strong>Tibial shaft fractures are among the most common injuries resulting from trauma and are typically managed surgically via either plate fixation or intramedullary nailing. Given the constraints on healthcare resources and the imperative to control costs, evaluating the cost-effectiveness of these treatment strategies is essential. This study aimed to assess and compare the cost-effectiveness of intramedullary nailing versus plate fixation for tibial shaft fractures.</p><p><strong>Methods: </strong>This cross-sectional economic evaluation was conducted from a modified societal perspective, incorporating direct medical costs (from hospital records and patient reports) and direct non-medical costs (from patient reports), alongside treatment effectiveness measured by health-related quality of life (HRQoL) and QALYs. The study included 276 patients with mid-shaft tibial fractures treated surgically with either intramedullary nailing or plate fixation at Shahid Dr. Rahnemoon Hospital, Yazd, Iran. Patients were followed for three months post-discharge. A willingness-to-pay (WTP) threshold of USD 4,771.4 per QALY (based on Iran's 2024 GDP per capita) was applied, and cost-effectiveness analysis was performed using Stata version 16 and TreeAge Pro 2020.</p><p><strong>Results: </strong>The mean total direct cost per patient was lower for intramedullary nailing (USD 602.87) than plate fixation (USD 669.68), with hospital expenses comprising the largest share (USD 448.47 vs. USD 472.84, respectively). Using a linear area-under-the-curve approach, accumulated QALYs over 90 days were higher for nailing (0.0627) than plate fixation (0.0448). Cost-effectiveness analysis identified intramedullary nailing as the undominated strategy, while plate fixation was absolutely dominated due to higher costs and lower effectiveness. Probabilistic sensitivity analysis, cost-effectiveness acceptability curves, and one-way sensitivity analyses consistently supported the cost-effectiveness advantage of intramedullary nailing under uncertainty at a willingness-to-pay threshold of USD 4,771.4 per QALY.</p><p><strong>Conclusion: </strong>This short-term economic evaluation indicates that intramedullary nailing is an undominated and more cost-effective option than plate fixation for the surgical management of tibial shaft fractures over a 90-day follow-up period, providing higher accumulated QALYs at lower direct costs. These findings support the preferential use of intramedullary nailing in similar clinical settings; however, longer-term studies incorporating fracture healing, complications, and indirect costs are needed to confirm cost-effectiveness beyond the early postoperative period.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When is elimination of an infectious disease cost-effective? An analytical framework to guide elimination priorities.","authors":"Sayara Ahmed, Tara D Mangal, Timothy B Hallett, Hugo C Turner","doi":"10.1186/s12962-026-00777-2","DOIUrl":"10.1186/s12962-026-00777-2","url":null,"abstract":"<p><strong>Background: </strong>Elimination targets for infectious diseases are increasingly common in global health, yet the economic rationale for pursuing elimination is often assumed rather than rigorously assessed. Existing evaluations frequently emphasise future cost savings or broader economic benefits while overlooking health opportunity costs-the health that could have been gained had resources been allocated elsewhere. This study aimed to develop an analytical framework to investigate when disease elimination generates positive net health benefit (NHB) and to illustrate how key factors interact to shape this assessment.</p><p><strong>Methods: </strong>We constructed a generalisable analytical framework incorporating ten factors related to intervention and disease costs, intrinsic disease/intervention characteristics, and stakeholder viewpoints and evaluation parameters. The framework was applied to create an exemplar model that showed how these factors jointly influence the NHB of achieving elimination. This was evaluated across wide parameter ranges informed by the literature, using different cost-effectiveness thresholds, discount rates, and time horizons.</p><p><strong>Results: </strong>The framework revealed distinct regions of parameter space in which elimination yield positive NHB. The cost-effectiveness threshold, discount rates, disease burden, and intervention impact were strong determinants of NHB. In particular, lower thresholds, higher discount rates, and shorter time horizons reduced the likelihood that elimination would generate positive NHB. The framework also showed that elimination may be cost-effective in some settings but not in others, even for the same disease, due to differences in costs, burden, and opportunity costs.</p><p><strong>Conclusions: </strong>Disease elimination is not always a good investment; its value depends on the interplay between disease characteristics, programme costs, and the health opportunity costs of resource use. The proposed framework provides a transparent, health opportunity cost-based structure for evaluating elimination strategies and supports more robust, context-specific priority-setting on elimination targets in global health.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capacity utilization of China's elderly care service industry during 2010-2022.","authors":"Xiuquan Huang, Tao Zhang, Xi Wang, Hanxiang Gong, Wenshuo Zhang","doi":"10.1186/s12962-026-00769-2","DOIUrl":"10.1186/s12962-026-00769-2","url":null,"abstract":"<p><strong>Background: </strong>China's elderly care service industry (ECSI) plays a critical role in addressing the needs of an aging population. However, the industry faces both resource shortages and waste, particularly of fixed assets, while capacity utilization (CU), which reflects fixed asset efficiency, has received limited attention.</p><p><strong>Methods: </strong>This study develops a CU measurement model based on the data envelopment analysis framework to evaluate the CU of ECSI across 30 provinces in China from 2010 to 2022. In addition, the Dagum Gini ratio and Moran's I are employed to analyze the spatial disparities and correlations.</p><p><strong>Findings: </strong>The CU of China's ECSI showed a downward trend with fluctuations, declining from 0.7426 in 2010 to 0.5889 in 2022. Central China generally exhibit higher CU than eastern and western China. Western China had the lowest CU and the most pronounced fluctuations. The Dagum Gini ratio indicated that the difference between subregions was the primary driver of the total difference (43%), followed by the difference within subregions (28%). Moran's I analysis showed that CU in China's ECSI exhibited increasing spatial agglomeration, with weak but significant spatial correlation. Economically developed provinces, such as Jiangsu, Zhejiang, and Hubei, formed High-High clusters. In contrast, underdeveloped western provinces, including Gansu and Xinjiang, formed Low-Low clusters.</p><p><strong>Conclusions: </strong>China's ECSI faces declining CU and pronounced regional imbalances. The increasing spatial agglomeration and distinct clustering patterns highlight the need for targeted policies to reduce regional disparities and improve resource allocation.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13410899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs and health outcomes of liver transplantation for hepatocellular carcinoma: a scoping review.","authors":"Uriel Palacios-Barahona, Luis Guillermo Toro Rendón, Yuli Agudelo Berruecos, Angelica Fonseca, Diego Rojas-Gualdrón","doi":"10.1186/s12962-026-00759-4","DOIUrl":"10.1186/s12962-026-00759-4","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is the most common primary liver cancer, accounting for 70-90% of all cases. Liver transplantation has demonstrated superior survival rates compared to surgery; however, there is a significant knowledge gap regarding the costs and outcomes across different healthcare settings and patient populations. This scoping review aimed to map the literature on the costs associated with hepatocellular carcinoma (HCC) and liver transplantation in patients with hepatocellular carcinoma (HCC).</p><p><strong>Methods: </strong>We conducted a scoping review of studies published between 2019 and 2024 using PubMed, Embase, Scopus, LILACS, and Google Scholar. Data extraction focused on study characteristics, economic perspective, time horizon, discounting practices, cost components, data sources, and reported clinical outcomes. A qualitative descriptive synthesis was performed to characterize methodological approaches used to assess costs and outcomes.</p><p><strong>Results: </strong>Fifteen studies were included, including 8 cost analyses and 7 cost-effectiveness studies. Study perspective was explicitly reported in 8 studies (53.3%), including 5 from the health system perspective and 3 from the payer perspective. Time horizons ranged from 3 years to lifetime. Among economic evaluations that reported discounting, annual discount rates ranged from 3% to 5%. Direct costs were assessed in 9 studies (60.0%), and institutional or hospital-based data sources were the most commonly used.</p><p><strong>Conclusion: </strong>The included studies showed substantial methodological variation in perspective, time horizon, costing approach, and outcome definitions, which limited cross-study comparability. More standardized economic reporting is needed to strengthen future evidence on liver transplantation for HCC and support resource allocation decisions.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the cost-effectiveness of 3-D-guided versus traditional 2-D corrective osteotomy in patients with a distal radius malunion.","authors":"Anne J H Vochteloo, Camiel J Smees, Quinty Teggeler, Judith Olde Heuvel, Michelle M A Kip, Xavier G L V Pouwels","doi":"10.1186/s12962-026-00756-7","DOIUrl":"10.1186/s12962-026-00756-7","url":null,"abstract":"<p><strong>Introduction: </strong>Distal radius malunion is a frequent complication after a distal radius fracture, impairing function and quality of life. Corrective osteotomy using conventional two-dimensional (2-D) planning often fails to achieve optimal alignment, leading to residual symptoms and revision surgery. Growing evidence shows that three-dimensional (3-D) planning with patient-specific surgical guides has better radiographic and clinical outcomes and fewer complications, but at increased upfront costs.</p><p><strong>Methods: </strong>We developed a health state transition model to assess the cost-effectiveness of 3-D versus 2-D based surgery in the Netherlands over a five-year time horizon from a societal perspective. Clinical outcomes of 3-D, including transition probabilities, were obtained from a clinical cohort, whereas literature informed 2-D transition probabilities. Literature was used to obtain costs, and utility values. Outcomes of interests were the number of revisions, quality-adjusted life years (QALYs) and societal costs in each strategy. All 3-D analyses and guide development were performed in our in-house 3-D lab.</p><p><strong>Results: </strong>Notably, revisions performed for nonunion or implant failure were reduced by 179 per 1,000 patients in the 3-D strategy. Overall, 3-D yielded slightly higher QALYs (+ 0.007) and lower costs (-€219), primarily due to fewer revisions performed for nonunion or implant failure and reduced productivity losses.</p><p><strong>Conclusion: </strong>Using this model, 3-D-guided corrective osteotomy (supported by an in-house 3-D lab) is anticipated to be cost-effective versus 2-D-planned corrective osteotomy from a Dutch societal perspective; it potentially yields a modest improvement in health outcomes alongside a slight reduction in costs. However further clinical validation, including prospective collection of clinical outcome data, is needed to confirm these findings in real-world practice.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13377804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of intravascular ultrasound (IVUS) vs. angiography-guided revascularization in femoropopliteal occlusive disease.","authors":"Pablo E Bretos-Azcona, Patricia Ruiz Gay-Pobes, Lucas Alvarez","doi":"10.1186/s12962-026-00751-y","DOIUrl":"10.1186/s12962-026-00751-y","url":null,"abstract":"<p><strong>Objectives: </strong>Intravascular ultrasound (IVUS)-guided revascularization offers clinical benefits compared to angiography-guided revascularization in patients with femoropopliteal occlusive disease. This study evaluates the cost-effectiveness of IVUS-guided versus angiography-guided revascularization from a Spanish payer perspective.</p><p><strong>Methods: </strong>A cost-effectiveness model combining a short-term decision tree and a long-term semi-Markov structure was developed to simulate clinical outcomes and costs over a lifetime horizon from the Spanish perspective. Transition probabilities, costs, and utility weights for health states including reintervention, amputation and death were derived from published literature and Spanish national databases. Health outcomes were measured in quality-adjusted life-years (QALYs), and costs were reported in 2025 Euros. One-way and probabilistic sensitivity analyses were conducted to assess model robustness.</p><p><strong>Results: </strong>IVUS-guided revascularization was associated with improved clinical outcomes and reduced lifetime costs, dominating angiography-guided revascularization. In the base case, IVUS yielded 0.29 additional lifetime QALYs and €3,289 in lifetime cost savings per patient compared with angiography, resulting in a dominance of IVUS. Scenario analysis assuming equal amputation risk still favored IVUS. One-way sensitivity analysis identified the reintervention risk and costs as key drivers, and probabilistic sensitivity analysis confirmed that IVUS dominated in over 90% of simulations.</p><p><strong>Conclusion: </strong>IVUS-guided revascularization is a cost-effective strategy for femoropopliteal occlusive disease in Spain, offering superior clinical outcomes and economic efficiency. These findings support broader adoption of IVUS in peripheral interventions.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cost comparison between patients undergoing robotic colorectal surgery with and without a clinical pathway.","authors":"Alfonso Valenzuela Hurtado, Onur Bayram, Jörg Kleeff, Johannes Klose, Manuela De Allegri, Ulrich Ronellenfitsch","doi":"10.1186/s12962-026-00770-9","DOIUrl":"10.1186/s12962-026-00770-9","url":null,"abstract":"<p><strong>Background: </strong>Clinical pathways (CPs) are guidelines to standardize processes, improve quality of care and maximize resources through the implementation of evidence-based care for a medical procedure, thus reducing variation and risk. Our aim was to evaluate the cost of care for robotic colorectal surgery using a CP compared to surgery without a CP.</p><p><strong>Methods: </strong>This was a non-interventional micro-costing study with a hospital-level perspective. It was carried out using the three standard steps. First, all resources involved in the implementation of the CP were identified. Second, resource consumption was measured. Third, the resources identified were valued and measured to estimate the average cost per group. This included the costs related to perioperative care and treatment of complications. Finally, a sensitivity analysis was conducted based on the hypothetical capacity utilization of the robotic equipment, costs of CP development and a discount rate of 3% over a period of five years.</p><p><strong>Results: </strong>The study population comprised 63 patients: 21 in the CP group (robotic colorectal surgery with CP) and 42 in the no-CP group (robotic colorectal surgery without CP). The mean cost per patient in the CP group was €12,663 (range: €8,093 to €26,475), whereas in the no-CP group it was €11,128 (range: €8,357 to €17,268). The main cost drivers in the CP group were materials and disposables (33% of total costs) and staff (20% of total costs). In the no-CP group, they accounted for 38% and 20% of total costs, respectively. The CP group was used for the sensitivity analysis. In year 1, at 100% utilization the mean cost per patient was €12,364, increasing to €17,883 at 20% utilization. In year 5, at 100% utilization the mean cost per patient was €13,986, rising to €20,519 at 20% utilization.</p><p><strong>Conclusion: </strong>The evidence from our study indicates that using a CP for perioperative care of patients undergoing robotic colorectal surgery was not associated with a statistically significant reduction in cost of care.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13198061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic burden of knee replacement, a case of Bushehr, Iran in 2023-2024.","authors":"Ramin Ravangard, Hamid Ebrahimi, Mohammad Reza Dehghanfard, Abdosaleh Jafari","doi":"10.1186/s12962-026-00763-8","DOIUrl":"10.1186/s12962-026-00763-8","url":null,"abstract":"<p><strong>Introduction: </strong>Joint disorders are diseases or injuries that affect the joints and disrupt their function. When non-surgical treatments do not effectively relieve joint pain and disability, arthroplasty (joint replacement surgery) is performed, with knee replacement surgery being the most common. This study aimed to calculate the economic burden of knee joint replacement surgery in patients referred to hospitals in Bushehr province in 2023-2024.</p><p><strong>Method: </strong>This cross-sectional study is an economic evaluation that examines the cost of disease from a social perspective. This study was conducted in Bushehr, Iran and included all eligible patients in 2023-2024 as the study population (n = 257). A researcher-made data collection form was used to gather data. A prevalence-based approach and a bottom-up method were employed to calculate costs. Data on direct medical, direct non-medical, and indirect costs were obtained from patients' files, insurance bills, and self-reports from patients or their companions. The human capital approach was used to calculate indirect costs.</p><p><strong>Result: </strong>The results showed that in 2023-2024, the average total cost per person for knee joint replacement was $10,083.75, with the largest share attributed to direct medical costs, amounting to $8,892.89. The largest components of direct medical cost, direct non-medical cost, and indirect cost were related to joint prosthesis ($4,260), Transportation ($152), and absence from work due to illness ($622.64). Additionally, the average total cost for women was higher than for men ($10,207.56 vs. $10,020.13), and among age groups, the highest average total cost was in those aged 61-70 years, amounting to $10,297.87.</p><p><strong>Conclusion: </strong>The findings of this study indicate that the largest contribution to direct medical costs comes from joint prostheses. Given the increasing age of the population and the high prevalence of skeletal diseases such as osteoarthritis, which necessitate knee joint replacement surgery, the costs associated with treatment and joint replacement surgery can impose a significant economic burden on society, the healthcare system, patients, and the country's insurance structure. It is suggested that mechanisms for insurance coverage and government subsidies for joint prostheses be established.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ghana's Diagnosis Related Grouping (G-DRG) tariffs versus hospital charges: implications for inpatient care financing at a secondary hospital in Ghana.","authors":"Peter Gyasi Darkwa, Genevieve Cecilia Aryeetey, Eric Nsiah-Boateng","doi":"10.1186/s12962-026-00747-8","DOIUrl":"10.1186/s12962-026-00747-8","url":null,"abstract":"<p><strong>Background: </strong>Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 as a means of achieving Universal Health Coverage. The Ghana-Diagnosis Related Groupings (G-DRG) is one of the payment mechanisms used to reimburse providers for services and procedures. However, evidence suggests that the amount reimbursed for services through the G-DRG tariffs may be lower than the market prices for same, creating a financial gap that concerns providers.</p><p><strong>Objective: </strong>The study assessed the financial implications of the G-DRG payment system on service delivery for inpatient services between 2018 and 2022 at the Greater Accra Regional Hospital in Ghana.</p><p><strong>Methods: </strong>The study adopted a descriptive cross-sectional study design approach to gather and analyze the data. The 2021 annual performance report of the hospital was used to identify the top hundred reported inpatient admissions. Institutional data on G-DRG tariffs issued by the National Health Insurance Authority (NHIA) and the approved hospital charges for managing sampled medical conditions were extracted. The top ten conditions from the sample were used to determine the price differentials between G-DRG tariff and hospital charges for same conditions on admission.</p><p><strong>Results: </strong>The study found that 3,323 (63.5%) of the top 10 conditions on admission in 2022 were related to children, with neonatal jaundice constituting the highest (1,177; 23%). Gastroenteritis, Septicaemia, hypertension and appendicitis were the common adult conditions on admission. While the G-DRG tariffs reported price increment every other year (16%), hospital price increment was unstable ranging from 20% to 58%. Nonetheless, the study found a cumulative financial gain to the facility of 23% on the top ten inpatient medical conditions over the five-year period.</p><p><strong>Conclusion: </strong>While the G-DRG had positive price differentials over the five-year period, ensuring macroeconomic stability is important in maintaining the gains and supporting the financial viability of the G-DRG payment system. Future research should look investigate the relationship between price differentials and average length of stay in admissions.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148006994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}