European Journal of Health Economics最新文献

{"title":"Age, morbidity, and time to death: End-of-life expenditures on health care for the young-old population.","authors":"Irene Torrini, Claudio Lucifora, Antonio Giampiero Russo","doi":"10.1007/s10198-025-01757-8","DOIUrl":"https://doi.org/10.1007/s10198-025-01757-8","url":null,"abstract":"<p><p>In this paper, we analyze resource allocation and explore the life-cycle evolution of health care expenditures (HCE) by investigating the effect of age, morbidity and time to death (TTD) on HCE for the young-old population. Using a rich 10-year population-level panel, we estimate a fixed-effects model to analyze HCE patterns for different health care services and by primary disease. Our main findings indicate that the effect of age on total HCE is lower when morbidity is controlled for while it increases when we also condition on TTD. This indicates that, compared to those incurred at older ages, earlier deaths are associated with higher HCE. At younger ages, increased expenditures are also observed as the severity of the health condition deteriorates. We also show that expenses for out-of-hospital services mainly drive the evolution of total HCE by age, while inpatient expenses are primarily determined by morbidity and TTD. In the end-of-life period, hospital costs continue to rise, whereas expenses incurred for all other services fall sharply in the year of death. We prove that expenses for long-lasting conditions start to increase long before death, while those for acute conditions grow exponentially only in the last two years of life. Our work contributes to informing cost-containment policies through a better understanding of HCE evolution during the life cycle and in the last years of life.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in disposable income of Polish households and growing trends in alcohol mortality.","authors":"Jacek Moskalewicz, Jakub Stokwiszewski, Łukasz Wieczorek, Bogdan Wojtyniak","doi":"10.1007/s10198-025-01758-7","DOIUrl":"https://doi.org/10.1007/s10198-025-01758-7","url":null,"abstract":"<p><strong>Background: </strong>Most of the studies investigate impact of affordability at national or regional levels with less attention being paid on changes in affordability and their impact on different socio-economic groups.</p><p><strong>Objectives: </strong>The aim of this article is better understanding of variations in alcohol male mortality in different socio-economic groups by a careful examination of changes in disposable income and alcohol affordability in households of different education levels.</p><p><strong>Methods: </strong>Data (2004-2018) on disposable income per household member were taken from a survey - Statistics Poland. Mortality data were taken from the national death register of Statistics Poland based on death certificates. Linear regression models were used to establish relationship between income, affordability and mortality.</p><p><strong>Results: </strong>In the study period, disposable incomes increased substantially in the households with primary, vocational, and secondary education. In the households with university education, where incomes were much higher their pace of growth was much lower. Parallel, proportional alcohol male mortality increased substantially in three lower educational groups while remained almost stable among men with university education, in particular in the last ten years under the study. Clear, linear relationship was found within primary, vocational, and secondary education between proportional alcohol mortality and disposable income. Even, after inclusion into the model alcohol affordability, crucial role of changes in disposable income was confirmed as it explained much higher variation in mortality than affordability. No association was identified within households with university education.</p><p><strong>Conclusions: </strong>The results of this study do not entirely confirm the relationship between alcohol affordability and mortality due to alcohol consumption in men as noted in the literature. Substantial and rapid increases in disposable income were shown as having much stronger impact. Policies which aim to reduce income disparities may produce negative unintended side-effects such as higher alcohol mortality among beneficiaries of these policies.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explaining variations in government health expenditure: evidence from Canada.","authors":"Livio Di Matteo, Fraser Summerfield","doi":"10.1007/s10198-024-01735-6","DOIUrl":"https://doi.org/10.1007/s10198-024-01735-6","url":null,"abstract":"<p><p>We examine factors affecting Canadian government health expenditure during 1968-2022. Our data provide evidence on expenditure decisions from 10 autonomous but similar healthcare systems operating under common standards and regulations. We show that expenditure-income elasticity as measured in the literature is sensitive to controls for the social determinants of health, rising from 0.23 to 0.35. We also extend the literature with novel results for total and for specific expenditure categories that have grown unevenly in recent decades finding higher elasticity for physician than for drug or hospital spending. Physician supply increases both hospital and physician expenditures. Mid-life population shares, often overlooked in the literature, explain changes in the rapidly growing drug expenditure category. Our relatively long time series allows us to illustrate the sensitivity of results to dynamic specifications, account for a structural break in 1996 and show that income elasticity has risen over time.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of different perspectives on the cost-effectiveness of remote patient monitoring for patients with heart failure in different European countries.","authors":"Hamraz Mokri, Pieter van Baal, Maureen Rutten-van Mölken","doi":"10.1007/s10198-024-01690-2","DOIUrl":"10.1007/s10198-024-01690-2","url":null,"abstract":"<p><strong>Background and objective: </strong>Heart failure (HF) is a complex clinical syndrome with high mortality and hospitalization rates. Non-invasive remote patient monitoring (RPM) interventions have the potential to prevent disease worsening. However, the long-term cost-effectiveness of RPM remains unclear. This study aimed to assess the cost-effectiveness of RPM in the Netherlands (NL), the United Kingdom (UK), and Germany (DE) highlighting the differences between cost-effectiveness from a societal and healthcare perspective.</p><p><strong>Methods: </strong>We developed a Markov model with a lifetime horizon to assess the cost-effectiveness of RPM compared with usual care. We included HF-related hospitalization and non-hospitalization costs, intervention costs, other medical costs, informal care costs, and costs of non-medical consumption. A probabilistic sensitivity analysis and scenario analyses were performed.</p><p><strong>Results: </strong>RPM led to reductions in HF-related hospitalization costs, but total lifetime costs were higher in all three countries compared to usual care. The estimated incremental cost-effectiveness ratios (ICERs), from a societal perspective, were €27,921, €32,263, and €35,258 in NL, UK, and DE respectively. The lower ICER in the Netherlands was mainly explained by lower costs of non-medical consumption and HF-related costs outside of the hospital. ICERs, from a healthcare perspective, were €12,977, €11,432, and €11,546 in NL, the UK, and DE, respectively. The ICER was most sensitive to the effectiveness of RPM and utility values.</p><p><strong>Conclusions: </strong>This study demonstrates that RPM for HF can be cost-effective from both healthcare and societal perspective. Including costs of living longer, such as informal care and non-medical consumption during life years gained, increased the ICER.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"71-85"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a link between health care utilisation and subjective well-being? An exploratory study among older Danes.","authors":"Maiken Skovrider Aaskoven, Trine Kjær, Dorte Gyrd-Hansen","doi":"10.1007/s10198-024-01691-1","DOIUrl":"10.1007/s10198-024-01691-1","url":null,"abstract":"<p><p>While extensive research has explored the influence of traditional factors such as socioeconomic position on health care utilisation, the independent role of an individual's well-being in their health care seeking behaviour remains largely uncharted territory. In this study, we delve into the role of subjective well-being (SWB) in health care utilisation. We use a unique link between survey data from a representative group of Danish citizens aged 50-80 and administrative register data containing information on health care utilisation and sociodemographics. We explore whether SWB is a predictor of health care utilisation (general practice services) over and above health (as measured by health-related quality of life (HRQoL)). We find that the association between SWB and number of services provided in general practice differs across levels of HRQoL. Among those with lower HRQoL, we find a positive association between health care utilisation and SWB. Results hold true even when controlling for previous health care utilisation, suggesting that the mechanism is not driven by reverse causality. Our findings suggest that, in particular for vulnerable individuals in poor health and with poor SWB, the propensity to seek care is inappropriately low, and there is a need for more proactive supply-driven health care.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"87-93"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 analysis of procalcitonin and lung ultrasonography guided antibiotic prescriptions in primary care.","authors":"Giulio Cisco, Armando N Meier, Nicolas Senn, Yolanda Mueller, Andreas Kronenberg, Isabella Locatelli, José Knüsli, Loïc Lhopitallier, Noemie Boillat-Blanco, Joachim Marti","doi":"10.1007/s10198-024-01694-y","DOIUrl":"10.1007/s10198-024-01694-y","url":null,"abstract":"<p><p>Antimicrobial resistance comes with high morbidity and mortality burden, and ultimately high impact on healthcare and social costs. Efficient strategies are needed to limit antibiotic overuse. This paper investigates the cost-effectiveness of testing patients with lower respiratory tract infection with procalcitonin, either at the point-of-care only or combined with lung ultrasonography. These diagnostic tools help detect the presence of bacterial pneumonia, guiding prescription decisions. The clinical responses of these strategies were studied in the primary care setting. Evidence is needed on their cost-effectiveness. We used data from a cluster-randomized bi-centric clinical trial conducted in Switzerland and estimated patient-level costs using data on resource use to which we applied Swiss tariffs. Combining the incremental costs of the two strategies and the reduction in the 28-days antibiotic prescription rate (APR) compared to usual care, we calculated Incremental Cost-Effectiveness Ratios (ICER). We also used the Cost-Effectiveness Acceptability Curve as an analytical decision-making tool. The robustness of the findings is ensured by Probabilistic Sensitivity Analysis and scenario analysis. In the base case scenario, the ICER compared to usual care is $2.3 per percentage point (pp) reduction in APR for the procalcitonin group, and $4.4 for procalcitonin-ultrasound combined. Furthermore, we found that for a willingness to pay per patient of more than $2 per pp reduction in the APR, procalcitonin is the strategy with the highest probability to be cost-effective. Our findings suggest that testing patients with respiratory symptoms with procalcitonin to guide antibiotic prescription in the primary care setting represents good value for money.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"129-139"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity epidemic in European countries: from an unaddressed risk factor to a medicalized disease?","authors":"Livio Garattini, Giovanni Fattore","doi":"10.1007/s10198-024-01752-5","DOIUrl":"10.1007/s10198-024-01752-5","url":null,"abstract":"","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1-5"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Lazzaro responds to Kennedy et al.","authors":"Carlo Lazzaro","doi":"10.1007/s10198-024-01703-0","DOIUrl":"10.1007/s10198-024-01703-0","url":null,"abstract":"","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"141-142"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs associated with insufficient physical activity in Germany: cross-sectional results from the baseline examination of the German national cohort (NAKO).","authors":"Sophie Gottschalk, Hans-Helmut König, Andrea Weber, Michael F Leitzmann, Michael J Stein, Annette Peters, Claudia Flexeder, Lilian Krist, Stefan N Willich, Katharina Nimptsch, Tobias Pischon, Sylvia Gastell, Karen Steindorf, Florian Herbolsheimer, Nina Ebert, Karin B Michels, Anja Dorrn, Volker Harth, Nadia Obi, André Karch, Henning Teismann, Henry Völzke, Claudia Meinke-Franze, Leon Klimeck, Teresa L Seum, Judith Dams","doi":"10.1007/s10198-024-01697-9","DOIUrl":"10.1007/s10198-024-01697-9","url":null,"abstract":"<p><strong>Background: </strong>Insufficient physical activity (PA) is a leading risk factor for non-communicable diseases posing a significant economic burden to healthcare systems and societies. The study aimed to examine the differences in healthcare and indirect costs between sufficient and insufficient PA and the cost differences between PA intensity groups.</p><p><strong>Methods: </strong>The cross-sectional analysis was based on data from 157,648 participants in the baseline examination of the German National Cohort (NAKO) study. Healthcare and indirect costs were calculated based on self-reported information on health-related resource use and productivity losses. PA in the domains leisure, transport, and work was assessed by the Global Physical Activity Questionnaire and categorized into sufficient/insufficient and intensity levels (very low/low/medium/high) based on PA recommendations of the World Health Organization. Two-part models adjusted for relevant covariates were used to estimate mean costs for PA groups.</p><p><strong>Results and conclusion: </strong>Insufficiently active people had higher average annual healthcare costs (Δ €188, 95% CI [64, 311]) and healthcare plus indirect costs (Δ €482, 95% CI [262, 702]) compared to sufficiently active people. The difference was especially evident in the population aged 60 + years and when considering only leisure PA. An inverse association was observed between leisure PA and costs, whereas a direct association was found between PA at work and costs. Adjusting for the number of comorbidities reduced the differences between activity groups, but the trend persisted. The association between PA and costs differed in direction between PA domains. Future research may provide further insight into the temporal relationship between PA and costs.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"117-128"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: AOTMiT reimbursement recommendations compared to other HTA agencies.","authors":"Aneta Mela, Dorota Lis, Elżbieta Rdzanek, Janusz Jaroszyński, Marzena Furtak-Niczyporuk, Bartłomiej Drop, Tomasz Blicharski, Maciej Niewada","doi":"10.1007/s10198-024-01720-z","DOIUrl":"10.1007/s10198-024-01720-z","url":null,"abstract":"","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"143-146"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}