Cost Effectiveness and Resource Allocation最新文献

{"title":"Influence of clinical benefit and cost-effectiveness on reimbursement decisions for lung cancer drugs in Spain.","authors":"Pelayo Nieto-Gómez, Celia Castaño-Amores, Antonio José García-Ruiz, Juan Oliva-Moreno","doi":"10.1186/s12962-026-00771-8","DOIUrl":"10.1186/s12962-026-00771-8","url":null,"abstract":"<p><strong>Background: </strong>In principle, reimbursement decisions for oncological drugs in Spain hinge on clinical benefit and cost-effectiveness, yet factors guiding these decisions are not fully explained in reimbursement reports. This study examines these criteria for a cohort of lung cancer drugs in Spain and estimates and describes the cost-effectiveness, clinical benefit, and reimbursement decisions for lung cancer and mesothelioma drugs authorized in Spain between 2010 and 2023.</p><p><strong>Materials and methods: </strong>Clinical benefit was assessed using four scales from medical societies and Health Technology Assessment Agencies (HTAA). Cost-effectiveness was estimated using notified and reimbursed prices, and effects were obtained from HTAA reports. Reimbursement decisions were reviewed from official sources (BIFIMED). Statistical analyses and models were carried out to determine influencing factors.</p><p><strong>Results: </strong>28 drugs and 55 indications were analysed. A total of 50 drugs and 165 indications were excluded from the analysis as they were not related to lung cancer. A positive association was found between clinical benefit and reimbursement decision (OR: 3.20; CI95%: 1.46-7.44; p < 0.01). The median of the estimated incremental cost-utility ratio (ICUR) was €91,568 (IQR 43,944 - 133,384) per Quality-Adjusted Life Year (QALY) gained with notified prices and €41,030/QALY (IQR 22,213 - 76,390) with reimbursed prices (p < 0.0001). Statistical models showed that substantial clinical benefit increased the probability of positive reimbursement decision by 35-40% points. Cost-effectiveness, presence of therapeutic alternatives, disease incidence or presence of uncertainty had no significant influence.</p><p><strong>Conclusions: </strong>Our study reveals a positive association between clinical benefit and reimbursement decisions for lung cancer drugs in Spain. No evidence was found that cost-effectiveness is associated with reimbursement decisions.</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/PMC13371369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007081","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":"Prevalence and direct costs of vestibular disease in France - matched case-control study results from the 2022 and 2023 french health data system.","authors":"Eva Grill, Vincent Darrouzet, Xavier Dubernard, Dimitri Parise, Stéphane Sanchez, Andreas Zwergal, Christian Chabbert","doi":"10.1186/s12962-026-00773-6","DOIUrl":"10.1186/s12962-026-00773-6","url":null,"abstract":"<p><strong>Importance: </strong>Vestibular dysfunction causes vertigo, dizziness, and imbalance, impairing daily life and leading to substantial healthcare use. Precise prevalence and economic impact remain unclear.</p><p><strong>Objective: </strong>To estimate the one-year prevalence and direct healthcare costs of vestibular disorders in France.</p><p><strong>Design: </strong>A matched case-control study using the French national health data system covering over 67 million records in 2022.</p><p><strong>Setting: </strong>Nationwide health insurance data including all public and private healthcare interactions.</p><p><strong>Population: </strong>Adults aged ≥18 years diagnosed or treated for vestibular disease, matched 1:1 with controls by age, sex, comorbidities, region, and deprivation.</p><p><strong>Exposure: </strong>Vestibular disorder diagnosis or treatment in 2022.</p><p><strong>Outcome: </strong>Direct healthcare expenditures in 2022 and 2023.</p><p><strong>Results: </strong>Vestibular disorders affected 2.5% of adults (1,279,966 cases). Cases incurred mean costs of €4,233 versus €3,719 in controls in 2023, with an excess of €657 million nationally.</p><p><strong>Conclusions and relevance: </strong>Vestibular disorders are common and associated with significant excess healthcare costs. Standardizing diagnostic and therapeutic pathways may reduce expenditures and improve care quality.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13191933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147983749","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":"Transforming student health insurance with blockchain: a systematic review of efficiency, access, and implementation barriers.","authors":"Alaka O Chandak, Parth Chandak, Navin Soni, Anushree Soni","doi":"10.1186/s12962-026-00772-7","DOIUrl":"10.1186/s12962-026-00772-7","url":null,"abstract":"<p><strong>Objective: </strong>To systematically review studies examining blockchain-powered architecture, smart contract, operational efficiency, data governance, and challenges to implementation within the context of student and university health insurance networks.</p><p><strong>Methods: </strong>According to the PRISMA 2020 guidelines, Scopus, Web of Science, and PubMed databases were searched for articles published from January 2019 to December 2025. The searches yielded 957 records from the databases and an additional 12 records via citation searches. Of the remaining 478 articles, 18 studies were selected based on their relevance to the topic. The heterogeneous design, blockchain architecture, control groups, and outcomes precluded the use of meta-analysis.</p><p><strong>Results: </strong>The domains covered in the included studies were student health records, claims processing automation, EHR interoperability, fraud detection and transparency, and implementation challenges. The use of blockchain technology was associated with an improvement in terms of automation of the claims process, document provenance, privacy-preserving data access control, fraud detection, and administrative efficiency. However, the quantitative findings were inconsistent and should be considered operational descriptions and not pooled results or cost-effectiveness findings.</p><p><strong>Conclusion: </strong>There is preliminary evidence that blockchain may help students and universities with their health insurance programs, but further pilot testing, longitudinal research, cost-benefit analysis, and equitable governance are needed prior to widespread application.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976397","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":"The impact of hospital bed supply on medical insurance expenditure in China (2011-2024): evidence on Roemer's Law and threshold effects.","authors":"Jiacheng Zou, Jiazhen Yao, Lingqing Zhao, Tianming Zhao, Shaohua Li","doi":"10.1186/s12962-026-00768-3","DOIUrl":"10.1186/s12962-026-00768-3","url":null,"abstract":"<p><strong>Background: </strong>The rapid expansion of healthcare infrastructure may exert increasing pressure on the sustainability of social health insurance. China's concurrent pursuit of universal coverage, coupled with extensive hospital construction, offers a valuable context for examining whether the patterns observed in China align with Roemer's Law (1961), which is often summarized as 'a hospital bed built is a bed filled' within an insured population. This study investigates the relationship between hospital bed density and insurance expenditure to deepen our understanding of the factors associated with the growth of healthcare costs.</p><p><strong>Methods: </strong>We compiled a panel dataset encompassing 31 Chinese provinces covering the period from 2011 to 2024. To strengthen identification and address potential endogeneity concerns, we employed two-way fixed effects models alongside instrumental variable (IV-2SLS) estimation. Mediation analysis was employed to investigate potential pathways, while panel threshold regression was utilized to examine nonlinear patterns in the relationship between supply and expenditure.</p><p><strong>Results: </strong>The baseline estimates indicated a positive association, suggesting that higher provincial bed density correlates with increased province-level insurance spending. Mediation analysis revealed that the Average Length of Stay may serve as a potential aggregate pathway, accounting for 17.8% of the estimated relationship. Furthermore, threshold regression analysis indicated a possible nonlinear pattern, with an estimated threshold of 7.271 beds per 1,000 population. Below this threshold, hospital bed density is positively related to insurance spending (β = 0.217); however, above this threshold, the association loses statistical significance. Regional analysis demonstrated that the positive association was most pronounced in the western region, while no statistically significant association was observed in the northeastern region.</p><p><strong>Conclusion: </strong>Our findings support a conditional, province-level interpretation of Roemer's Law within the Chinese context, indicating that the association between bed density and insurance expenditure varies across institutional and capacity settings. Specifically, higher provincial bed density is more strongly associated with a longer average length of stay at the provincial level than with increased admission volumes. Beyond the exploratory threshold estimate, the marginal association between additional bed supply and insurance expenditure appears to weaken. These results suggest that payment reform, length-of-stay management, and regulatory oversight should be prioritized alongside careful capacity planning.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976483","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 (sub)acute rehabilitation services for spinal cord injury: a retrospective cohort analysis.","authors":"Stefan Metzger, Boris Polanco, Inge Eriks-Hoogland, Armin Gemperli, Ana Oña, Diana Pacheco Barzallo","doi":"10.1186/s12962-026-00767-4","DOIUrl":"10.1186/s12962-026-00767-4","url":null,"abstract":"<p><strong>Background: </strong>The global rise in disability and healthcare spending has intensified the need for cost-effective rehabilitation. Spinal cord injury/disease (SCI/D), though relatively rare, is associated with high costs and complex care needs, making it an ideal condition to study efficient resource allocation in rehabilitation.</p><p><strong>Methods: </strong>This retrospective observational study included 375 patients with SCI/D from a Swiss SCI centre. Outcome of rehabilitation was measured using the Spinal Cord Independence Measure III (SCIM III). Latent class analysis identified three patient profiles. Cost-effectiveness was assessed by relating total costs to functional improvement, with logistic regression identifying predictors of efficient rehabilitation.</p><p><strong>Results: </strong>Three distinct patient profiles showed significant differences in costs, service utilisation, and functional gains. Average efficiency-defined as achieving above-average functional improvement at below-average cost- was estimated at ΔSCIM III of 57, with a total cost of 118,000 Swiss francs. Efficient rehabilitation was most likely among patients. in profiles 1 and 2, younger with fewer comorbidities and with severe injuries.</p><p><strong>Conclusions: </strong>Patient segmentation enables targeted, equitable resource allocation in rehabilitation. Efficiency varies by patient profile, and even modest gains may be meaningful for severely impaired patients. A stratified cost-effectiveness evaluation is vital for policy and practice.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13361112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976421","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":"Factors associated with community-based health insurance beneficiaries' satisfaction with laboratory services in public hospitals of Arsi Zone, Ethiopia.","authors":"Abdene Weya Kaso, Deraro Bedado, Kedir Haji, Esmael Mohammed, Aman Nebi Ayato, Mohammed Hashim Harka, Jibril Bashir Adem, Taha Kaso, Gebi Agero, Alemayehu Hailu","doi":"10.1186/s12962-026-00765-6","DOIUrl":"10.1186/s12962-026-00765-6","url":null,"abstract":"<p><strong>Background: </strong>Client satisfaction is a key indicator to assess the quality of healthcare service and health outcomes. To expand the coverage of the Community-based Health Insurance (CBHI) program, it is essential to measure whether the members were satisfied with the healthcare services they received. However, empirical evidence on CBHI beneficiaries' satisfaction with laboratory services provided by contracted health facilities in the study area remains limited. Therefore, we assessed factors associated with the CBHI beneficiaries' satisfaction with laboratory service in public hospitals in the Arsi zone, Ethiopia.</p><p><strong>Methods: </strong>We performed a cross-sectional study at Public hospitals in Arsi Zone from January 1, 2024, to February 28, 2024. The study included 626 CBHI beneficiaries' selected using a systematic random sampling technique. The collected data were analyzed using SPSS version 25.0 software. Multivariable logistic regression analysis was employed to analyze factors associated with the CBHI beneficiaries' satisfaction with laboratory services. Adjusted odds ratio (AOR) with a 95% Confidence Interval was employed to identify variables associated with the CBHI beneficiaries' satisfaction with laboratory service.</p><p><strong>Results: </strong>The magnitude of the CBHI beneficiaries' satisfaction with laboratory services was 66.0%(95%CI: 62.2%- 69.6%). Age 31-45 years (AOR = 3.94, 95% CI: 2.46-6.33), age >45 years (AOR = 4.34, 95% CI: 2.23-8.44), Primary education (AOR = 1.79, 95% CI: 1.13-2.83), secondary and above education (AOR = 2.19, 95% CI: 1.25-3.83), perceived healthcare providers' attitude towards the CBHI beneficiaries (AOR = 8.84, 95% CI = 5.04-14.14), waiting time < 30 min to get services (AOR = 2.17, 95% CI = 1.43-3.29), presence of all requested laboratory services (AOR = 2.62, 95% CI = 1.64-4.19) and a single needle stick attempts during phlebotomy procedure (AOR = 2.78, 95% CI = 1.75-4.43) were significantly associated with CBHI beneficiaries' satisfaction with laboratory services.</p><p><strong>Conclusion: </strong>The study revealed that two-thirds of the CBHI beneficiaries were satisfied with laboratory services. Laboratory personnel's attitudes towards the CBHI beneficiaries, waiting time, availability of laboratory tests, and number of needle stick attempts were significantly associated with satisfaction with laboratory services. Therefore, health facility leaders and laboratory heads should work on strengthening the hospital supply chain management and provide continuous capacity-building training for laboratory staff on proper phlebotomy procedures to enhance patient satisfaction.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934667","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":"Comparative effectiveness and cost-effectiveness of ALK-positive NSCLC sequential strategies under physician and patient preferences.","authors":"Hao Li, Mingye Zhao, Yue Yin, Jiaqi Li, Wenxi Tang","doi":"10.1186/s12962-026-00762-9","DOIUrl":"10.1186/s12962-026-00762-9","url":null,"abstract":"<p><strong>Background: </strong>Although advances in multi-line cancer treatment have improved patient survival outcomes, they have also introduced significant economic and resource-allocation challenges. The ultimate survival outcome depends on the cumulative effect of all treatment lines and is significantly influenced by physician and patient preference​. Given the predominant focus of pharmacoeconomic evaluations in China on single-line treatments, further research that integrates high-quality clinical evidence with stakeholder preferences is necessary to evaluate sequential strategies.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, and ClinicalTrials.gov identified relevant clinical trials for advanced ALK-positive non-small-cell lung cancer (NSCLC). A semi-Markov model was applied to evaluate the effectiveness and cost-effectiveness of sequential strategies from the Chinese healthcare system perspective. The primary effectiveness outcomes measured were median overall survival (OS) and quality-adjusted life years (QALYs), and cost-effectiveness was assessed based on net monetary benefit (NMB). Health state utilities and costs were sourced from published literature, publicly available national databases. Additionally, we employed a discrete choice experiment (DCE) to quantify advanced NSCLC patients' preferences for treatment attributes. These preference weights were then integrated with the performance of ​​sequential strategies​​ to calculate the selection probabilities.</p><p><strong>Results: </strong>A total of 27 RCTs were included, informing 35 sequential strategies. The highest effectiveness were observed in ​​third-generation ALK-TKI lorlatinib-initiated regimens​​, particularly with the ​​lorlatinib-to-alectinib​​ sequence achieving ​​8.4 QALYs​​. At a willingness to pay(WTP) threshold of $ 25,799, the Che + Che+BSC regimen yielded the highest NMB ($16,180). Derived from the DCE, patient preference weights identified progression-free survival (PFS) as the most important attribute (40.9%). The alectinib-to-ensartinib sequential strategy demonstrated the highest selection probability in physician-patient preferences.</p><p><strong>Conclusions: </strong>According to current analyses, although treatment initiating with the third-generation ALK-TKI led in effectiveness, chemotherapy-dominated sequential treatment remained the most cost-effective option when costs were considered. Our study identified a strong physician-patient alignment on preference priorities for treatment pathway selection, placing greater weight on the efficacy dimension, which was reflected in the high preference for sequential second- and third-generation ALK-TKI strategies. These findings underscore the importance of strategic ALK-TKI sequencing and ​​advocate for​​ shared decision-making.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934608","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":"Pragmatic health technology appraisals of biosimilars: a pilot case study of bevacizumab in colorectal cancer for NICE.","authors":"Matthew D Stevenson, Mon Mon-Yee, Jessica E Forsyth, Amir Montazeri, Mark P Saunders","doi":"10.1186/s12962-026-00761-w","DOIUrl":"10.1186/s12962-026-00761-w","url":null,"abstract":"<p><strong>Background: </strong>The introduction of biosimilars can lead to substantial price reductions which can alter cost-effectiveness conclusions in health technology assessments. This study, undertaken for the National Institute for Health and Care Excellence (NICE), aimed to pilot a test-and-learn approach for biosimilars appraisals whilst pragmatically assessing the cost-effectiveness of bevacizumab (originator and biosimilars) plus fluoropyrimidine-based chemotherapy versus chemotherapy alone for patients with metastatic colorectal cancer.</p><p><strong>Methods: </strong>A partitioned survival model with three health states (progression-free, post-progression and dead) was used. No additional active lines of treatment were modelled assuming that all further treatments were cost-effective and assuming no interaction between bevacizumab and the efficacy of subsequent treatments. Analyses were undertaken independently for the use of bevacizumab plus fluoropyrimidine-based chemotherapy as first-line, and second-line, treatment. Analyses were conducted in line with NICE guidance. The clinical effectiveness of treatments was estimated from reviews of previous NICE technology appraisals, published literature, and expert input. Confidential prices of bevacizumab weighted by the market share were used.</p><p><strong>Results: </strong>The use of bevacizumab plus fluoropyrimidine-based chemotherapy was shown to extend life and increase quality-adjusted life-years (QALYs). Whilst cost per QALY values cannot be reported due to confidentiality reasons, the NICE Appraisal Committee stated that these were below what NICE considers a cost-effective use of resources for both first- and second-line treatment.</p><p><strong>Conclusions: </strong>The pragmatic modelling approach piloted was accepted by NICE and allowed for a quicker, internally funded, appraisal of bevacizumab biosimilars; this approach likely can be extended to other biosimilar appraisals.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934649","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":"An economic evaluation of the MultICath randomised controlled trial, comparing combined use of reusable and single-use intermittent catheters to single-use catheters only.","authors":"Sara McCloskey, Tracey H Sach, Margaret Macaulay, Miriam R Avery, Thomas J Chadwick, Bridget Clancy, Sylvia Dickson, Nicola Goudie, Karen Guerrero, Suzanne Hagen, Cathy Murphy, Gillian C Watson, Nina Wilson, Ruth Wood, Mandy Fader","doi":"10.1186/s12962-026-00750-z","DOIUrl":"10.1186/s12962-026-00750-z","url":null,"abstract":"<p><strong>Objectives: </strong>Widespread adoption of single-use intermittent catheters for bladder drainage has led to increased costs and environmental waste. Reusable catheters could reduce both. The MultICath study showed that combined reusable and single-use catheters (Mixed-use) was non-inferior to single-use catheters for urinary tract infection and quality of life, but the economic impact is unknown. We aim to determine whether Mixed-use is cost-effective compared to Single-use only.</p><p><strong>Methods: </strong>Cost-utility and cost-consequence analyses were conducted alongside MultICath. The analysis took the United Kingdom payer perspective, using individual patient-level data of the 578 randomised (1:1) trial participants over 12 months. Costs included catheter and cleaning costs, antibiotic costs, and health-related visit costs. Outcomes were measured in quality adjusted life years (QALYs), estimated from EQ-5D-5L data. Incremental, sensitivity, and scenario analyses were conducted.</p><p><strong>Results: </strong>Mixed-use participants used on average 902 (95% CI 755.13; 1049.31) fewer single-use catheters per annum than Single-use participants. Mixed-use was cost-effective in all analyses. Base-case annual incremental cost savings were -£1348.82 (95% CI -1939.98; -757.65) whilst incremental QALYs were negligible (-0.001; [-0.026; 0.024]). These estimates produced a positive net monetary benefit of £1328.82 at a willingness-to-pay threshold of £20,000. The probability of Mixed-use being cost-effective was never below 96.6%. The primary limitation was differential withdrawal rates between groups, accounted for in sensitivity analyses.</p><p><strong>Conclusions: </strong>Mixed-use is cost-effective for the UK National Health Service, and provision of reusable catheters should be considered. These findings are also relevant for other health services worldwide with high single-use catheter costs.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13198048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864576","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":"Diagnosis-Related group payment and its impact on hospitalization costs and patient financial protection for neurointerventional stroke care in a Chinese tertiary hospital: a retrospective analysis.","authors":"Zhishui Chen, Tao Zhang, Kai Meng, Haijing Guan, Beibei Xu","doi":"10.1186/s12962-026-00760-x","DOIUrl":"10.1186/s12962-026-00760-x","url":null,"abstract":"<p><strong>Background: </strong>Stroke continues to impose a substantial economic burden globally. To mitigate escalating healthcare costs and enhance financial protection for patients, diagnosis-related group (DRG) payment systems have been widely implemented in China. Neurointerventional stroke care, characterized by its complexity and high costs, represents a critical area for evaluating the impact of such payment reforms. This study investigates the effects of the DRG payment system on hospitalization costs and patient out-of-pocket expenditures (OOPE) for neurointerventional stroke patients in a leading neurological hospital in China.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using 2024 administrative data from Beijing Tiantan Hospital, China. The study included 5,205 inpatient stroke patients who underwent neurointerventional procedures (BE2 codes). Patients were categorized into a DRG payment group (Beijing residents, 18.87%) and a Fee-For-Service (FFS) payment group (non-Beijing residents, 81.13%) based on their medical insurance payment method. Pearson χ² tests and Mann-Whitney U tests were employed to compare total direct hospitalization costs (TDHC) and OOPE between the two groups. Quantile regression analysis further explored the impact of DRG payment across different expenditure levels to assess the heterogeneity of its financial protective effects.</p><p><strong>Results: </strong>Compared to the FFS group, patients in the DRG payment group demonstrated significantly lower median TDHC (RMB 86,268 vs. RMB 102,885; p < 0.001), representing a 16.15% reduction. Similarly, the median OOPE for DRG patients was significantly lower (RMB 19,851 vs. RMB 30,266; p < 0.001), a 34.41% reduction. Quantile regression analysis confirmed consistent cost reductions across all expenditure quantiles (TDHC: 3.84%-5.16%; OOPE: 14.49%-36.32%), with more pronounced financial protection for patients with higher OOPE levels. Notably, centrally procured medical supplies were associated with increased costs, while higher insurance reimbursement, non-centrally procured medications, ICU transfers, and prolonged length of stay independently predicted higher expenditures.</p><p><strong>Conclusions: </strong>This single-center study demonstrates a significant association between the DRG payment system and effective cost containment and enhanced patient financial protection for neurointerventional stroke care in a large Chinese neurological center. These findings underscore the necessity for future DRG payment policy development to include specialty-adjusted DRG weights and to ensure coordinated integration between payment reforms and medical supply procurement policies. Due to its single-center nature and reliance on single-year data, caution is warranted when generalizing these results to other institutions and policy contexts.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864628","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}