European Journal of Health Economics最新文献

{"title":"The toll of voting in a pandemic? Regional elections and the spread of COVID-19 in Bavaria.","authors":"Jochen Güntner, Gerrit Stahn, Amelie Wuppermann, Felix Zwies","doi":"10.1007/s10198-026-01989-2","DOIUrl":"https://doi.org/10.1007/s10198-026-01989-2","url":null,"abstract":"<p><p>This study investigates whether the regional elections held in the German state of Bavaria on March 15 of 2020 - shortly after the WHO declared COVID-19 a global pandemic - contributed to the spread of COVID-19 cases and COVID-related deaths. Constructing synthetic controls for each of Bavaria's 96 districts based on non-Bavarian German districts, we find that over a third of the increase in positive test results cannot be explained by district-level demographic, economic, health or child care characteristics, nor by the distance to Ischgl - a proxy for skiing tourism associated with the first COVID-19 wave in Germany. Within Bavaria, districts with higher voter participation witnessed a steeper increase in COVID-19 cases and deaths after the election, while controlling for alternative drivers, such as the distance to Ischgl and the number of strong-beer festivals. Our results are highly robust and suggest that an unfortunate timing of elections contributed to the spreading of an infectious disease.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207340","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":"Economic burden of myasthenia gravis in France: A nationwide claims database study (STAMINA).","authors":"Gérard De Pouvourville, Pascal Laforet, Emmanuelle Salort-Campana, Anne Crochard, Grégory Chollet, Camille Nevoret, Stéphane Bouée, Céline Tard","doi":"10.1007/s10198-026-01975-8","DOIUrl":"https://doi.org/10.1007/s10198-026-01975-8","url":null,"abstract":"<p><p>Myasthenia gravis (MG) is a chronic autoimmune disease with symptoms of muscle weakness and fatigability. The aim of this study was to estimate MG-related healthcare resource use (HCRU), associated direct costs and their determinants in France. Data were extracted from the French national claims database (SNDS) for the period 1/1/2008-31/12/2019. Adult patients with MG were identified using an algorithm based primarily on the G70 ICD-10 code. The incident and prevalent MG populations were compared with matched non-MG controls and direct costs were estimated. An exploratory indirect cost analysis restricted to sick leave and disability was also performed and a multivariable model used to identify patients' characteristics associated with higher direct MG costs. In 2019, the mean annual direct cost per patient with MG was €8,506 compared with €3,670 in controls, leading to an MG-excess cost of €4,836 per patient. Patients with MG had significantly (p < 0.0001) higher HCRU than controls in all items of inpatient and outpatient care. MG-excess costs were high, especially in the first year after disease identification and were mainly driven by hospitalizationsfor crises and exacerbations. They remained relatively stable thereafter. Patients with MG were on sick leave more often and for longer periods and were 2-3 times more likely to receive disability or living allowance than controls. The highest costs were concentrated during the first year after MG identification due to exacerbations and crises requiring hospitalization with costly medications and procedures. Novel innovative treatments are expected to change these main drivers of medical costs.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186065","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":"Home-based geriatric rehabilitation after shortened inpatient rehabilitation: cost-effectiveness analysis of the \"Better@Home\" multicentre prospective cohort study with a matched historical control group.","authors":"C J Gamble, W G Groen, M Vaz, M W M de Waal, M C Pol, E F Vanvan DamIsselt, M Hiligsmann, A Gabrio, S M G Zwakhalen, J C M van Haastregt","doi":"10.1007/s10198-026-02002-6","DOIUrl":"https://doi.org/10.1007/s10198-026-02002-6","url":null,"abstract":"<p><strong>Purpose: </strong>Geriatric rehabilitation (GR) is facing increased demand due to population ageing. Home-based GR could reduce reliance on resource-intensive inpatient care. However, evidence is limited regarding the cost-effectiveness of home-based GR. The aim of this study is to assess the cost-effectiveness of home-based GR following shortened inpatient GR, compared to conventional inpatient GR.</p><p><strong>Methods: </strong>Eight GR facilities in the Netherlands implemented the Better@Home program, in which home-based GR following shortened inpatient GR is compared to a historical control group receiving conventional inpatient GR. The effect measure was independence in activities of daily living (ADL), assessed by the Barthel Index (BI). Costs were measured as healthcare and societal resource use. Data was gathered at GR-admission- and GR-discharge through semi-structured interviews, registration forms, and electronic patient files. Costs and effects were analyzed using linear mixed effects (LMM) and generalised linear (GLM) regression models, combined with multiple imputation and non-parametric bootstrapping. The primary analysis was conducted from a healthcare perspective valued using national unit sources.</p><p><strong>Results: </strong>A total of 350 participants were included (intervention n = 110; control n = 240). The adjusted incremental effect was 0.44 BI-points (95% CI - 0.44 to 1.31), and incremental costs of - €722,63 (95% CI - €2.693,68 to €1.248,43). Uncertainty assessments using non-parametric bootstrapping demonstrated an average mean incremental effect of 0.44 BI-points (95% CI 0.27 to 0.61) and incremental costs of - €654,72 (95% CI - €1.035,66 to - €267,48), indicating a probabilistic pattern favouring the Better@Home program.</p><p><strong>Conclusions: </strong>The Better@Home program achieved levels of independence in ADL comparable to conventional inpatient GR while showing lower mean costs, suggesting that the program may be cost-effective.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186176","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":"Age-specific COVID-19 case dynamics during school closure periods: Evidence from 12 european countries.","authors":"Damien Dupré, Edgar Morgenroth","doi":"10.1007/s10198-026-01997-2","DOIUrl":"https://doi.org/10.1007/s10198-026-01997-2","url":null,"abstract":"<p><p>School closures were among the most widely adopted non-pharmaceutical interventions against COVID-19, yet evidence on their association with infection dynamics remains uncertain given their substantial economic and educational costs. This observational study describes age-specific COVID-19 case dynamics during school closure periods across 12 European countries using Generalised Additive Models with zero-crossing derivative analysis and Transfer Entropy. Case dynamics were heterogeneous and non-monotonic across age groups: case counts declined early but rose again within the window among the youngest cohorts (0-4 and 5-9 years). By contrast, the 10-14 group rose steadily with no turning point, and older adolescents and young adults (15-19 and 20-24 years) rose early and then declined. Transfer Entropy analysis, with Benjamini-Hochberg correction, revealed asymmetric directional relationship between age cohorts that varied across national contexts. These patterns indicate that case trajectories during closure periods were not uniform across youth age groups, with no age group showing a sustained, uninterrupted decline. Interpreted cautiously, they raise questions about the cost-benefit balance of blanket closure policies when weighed against their documented economic, educational, and distributional costs, and motivate more targeted, age-sensitive quasi-experimental evaluation for future pandemic preparedness.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186103","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":"Correction: Exploring the consequences of including off-patent prices in reimbursement decisions for patented drugs.","authors":"Anton P H Klockhoff, Martin Henriksson","doi":"10.1007/s10198-026-01973-w","DOIUrl":"https://doi.org/10.1007/s10198-026-01973-w","url":null,"abstract":"","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166178","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":"Influenza disease burden investigation and cost-effectiveness analysis based on system dynamics model.","authors":"Lei Cao, Yu Shao, Zhen Zhang, Hui Zhen, Sijie Li, Lei Chen","doi":"10.1007/s10198-026-01987-4","DOIUrl":"https://doi.org/10.1007/s10198-026-01987-4","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the economic burden of influenza in Chongqing and evaluate the health economic effects of different influenza vaccination strategies.</p><p><strong>Methods: </strong>A sample survey was conducted among confirmed influenza cases in Chongqing from September 2024 to March 2025 to determine incidence profiles, epidemiological characteristics, and economic burden for establishing a system dynamics model of influenza.</p><p><strong>Results: </strong>A total of 1,023 questionnaires were collected, with 1,022 valid responses yielding a response rate of 99.90%. Among valid respondents, the male-to-female ratio was 1:1.05, median (P25-P75) age was 28 (6, 56), and only 30 individuals (2.94%) had received influenza vaccination within four years prior. Total direct medical costs reached 3,184,877 Chinese yuan (CNY), with an average of 3,116.32 CNY and median of 500 CNY per person, while total economic costs amounted to 3,519,954.00 CNY, with a mean of 3,444.182 CNY and median of 600 CNY per person. All economic burden indicators showed statistically significant differences across age groups and chronic disease status (P < 0.005). Significant variations (P < 0.005) were observed in average monthly individual household income across groups categorized by direct medical burden, direct non-medical burden, direct economic burden, and total economic burden. However, the indirect economic burden did not demonstrate statistically significant differences among these income groups (P = 0.229).System dynamics simulations revealed nonlinear cost-effectiveness patterns with threshold effects as vaccination coverage increased from 10% to 100%.</p><p><strong>Conclusions: </strong>Influenza imposes substantial economic burdens on patients, particularly through hospitalization costs. Vulnerable populations include minors, elderly individuals, those with chronic diseases or underlying medical conditions, and low-income groups. Vaccination demonstrates effectiveness as an intervention strategy for influenza prevention and control. Under the assumptions of our model, the cost-effectiveness ratio was most favorable at approximately 50% vaccination coverage.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149878","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":"Ordinal relationship of composite time trade-off and discrete choice experiment preference data.","authors":"Ling-Hsiang Chuang, Carl Lundberg, Sun Sun, Klas-Göran Sahlen, Paul Kind","doi":"10.1007/s10198-026-01955-y","DOIUrl":"https://doi.org/10.1007/s10198-026-01955-y","url":null,"abstract":"<p><strong>Objectives: </strong>Commensurability between the preference data derived from composite time trade-off (cTTO) and discrete choice experiment (DCE) is unknown. There is considerable information asymmetry associated with cTTO and DCE data; the single comparable property common to both cTTO and DCE, testable at the individual respondent level, is limited to the directional preference of health state A over health state B. Thus, this study aimed to investigate the ordinal relationship between cTTO and DCE data generated by individual respondents.</p><p><strong>Methods: </strong>A survey, using the EQ-VT platform, was conducted, where each participant answered a set of 10 cTTO and 12 DCE questions. Data was collected from members of the Swedish general public. Analyses focused on the agreement between implied ordinal rankings of pairs of states based on individual's cTTO values, and their explicit ranking when presented as a DCE pair. The observed disagreement was further compared with theoretical benchmarks estimated as the probability of choosing an unexpected state due to random errors under the Random Utility Theory.</p><p><strong>Results: </strong>The analysis sample consisted of 226 interviews. Amongst all compared pairs, the total agreement was 65%; of the remaining 35%, the pairs with tied cTTO values made up 22%. Stratifying by differences in cTTO scores of pairs (Δ cTTO scores), agreements did not continue to increase with increasing Δ cTTO scores-staying around 90% for subgroups with larger Δ cTTO scores. Compared to benchmarks, divergences of two methods were present around pairs with tied values and those involving health states worse than dead.</p><p><strong>Conclusion: </strong>cTTO and DCE preference data each possesses their own attributes, shaped by each unique procedural element. Combining such preference data needs a clear rationale based on explicit grounds. The findings of the current study suggest that there exist some methodological divergences between cTTO and DCE. To be able to safely combine both data and to maximize the potential of the hybrid model, first these divergences should be carefully reviewed and justified.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129303","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":"Wealth and weight revisited: A Bayesian model averaging approach to the Obesity Kuznets Curve.","authors":"K Restrepo Gómez, H Du, C Mendez","doi":"10.1007/s10198-026-01998-1","DOIUrl":"https://doi.org/10.1007/s10198-026-01998-1","url":null,"abstract":"<p><p>The substantial literature on the existence of an inverted U-shaped relationship between obesity prevalence and economic growth, known as the Obesity Kuznets Curve (OKC), has yielded mixed evidence due to uncertainty in model and variable selection. We address this using a comprehensive panel of 84 countries from 2000 to 2020. Our Two-Way Fixed Effects (TWFE) models suggest the OKC follows an inverted-N shape, suggesting multiple transition points in the obesity-wealth nexus. To account for model uncertainty, we employ Bayesian Model Averaging (BMA) against a large set of potential determinants. The inverted-N shape remains robust, with BMA identifying key predictors across economic, sociocultural, and environmental domains. Our results suggest that a single 'turning point' oversimplifies the obesity transition, and that targeted interventions must account for the multi-stage nature of economic development.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139144","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":"Inequalities in oral anticoagulant treatment patterns: a two-part model to estimate healthcare costs associated with atrial fibrillation.","authors":"Giorgio Ciminata, Ryan J Mulholland, Terry J Quinn, Kevin G Pollock, Claudia Geue","doi":"10.1007/s10198-026-01988-3","DOIUrl":"https://doi.org/10.1007/s10198-026-01988-3","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is a common cardiac rhythm disorder associated with an increased risk of stroke, contributing to high healthcare costs. Oral anticoagulants (OACs) are well established in the management of AF, failure to initiate treatment and discontinuation or cessation remain a significant issue, especially among socioeconomically disadvantaged populations. The aim of this study is to quantify, in economic terms, the impact of different OAC treatment patterns in individuals living with AF and assess how socioeconomic factors affect healthcare costs.</p><p><strong>Methods: </strong>This retrospective study analysed data from 47,427 individuals diagnosed with incident AF between 2010 and 2016 with CHA₂DS₂-VASC score of 2 or greater. The AF population was followed for five years, with Scottish data linked from inpatient, outpatient, prescribing, and care-home records. Four groups were defined based on OAC exposure: 1) never started OAC therapy, 2) continuous OAC therapy, 3) discontinuous OAC therapy, and 4) cessation of OAC therapy. We used Inverse Probability of Treatment Weights (IPTW) to estimate weights for our adjusted two-part econometric model, estimating inpatient, outpatient, prescribing, care-home and overall costs across the four OAC exposure groups.</p><p><strong>Results: </strong>Continuous OAC therapy was associated with the lowest healthcare costs per patient per year (£7,288), mainly due to reduced hospitalizations and care-home admissions. Those who never started (£22,751), or ceased OAC therapy (£22,157), incurred the highest costs, driven by inpatient and long-term care needs. Healthcare costs increased with age, with the highest costs observed in the 76-85 years old and > 85 age groups, particularly for those who never started OAC therapy. Socio-economic deprivation was associated with greater healthcare costs (£20,562) while the least deprived groups incur the lowest (£12,734).</p><p><strong>Conclusions: </strong>Continuous OAC therapy is associated with lower healthcare costs through fewer hospitalizations and reduced long-term care. Failure to initiate, discontinuation and cessation of OAC treatment are linked to higher costs, highlighting the relevance of sustained anticoagulation. Socioeconomic deprivation was associated with higher costs in disadvantaged groups. Improving treatment initiation and persistence, particularly in these populations, could reduce the economic burden of AF and improve patient outcomes.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118328","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":"Consultations, (antibiotic) prescriptions, and productivity losses of patients with community-acquired respiratory tract infection: country-specific findings from the PRUDENCE trial.","authors":"Clazinus Veijer, Pim W M Van Dorst, Simon Van Der Pol, Alike W Van Der Velden, Maarten J Postma, Antoinette D I Van Asselt","doi":"10.1007/s10198-026-01992-7","DOIUrl":"https://doi.org/10.1007/s10198-026-01992-7","url":null,"abstract":"<p><strong>Objective: </strong>Recent estimates of the cost-of-illness of community-acquired acute respiratory tract infections (CA-ARTI) are scarce. The current study aimed to estimate country-specific prescriptions, consultations, and productivity loss of patients with CA-ARTI in primary care.</p><p><strong>Methods: </strong>Data were collected via baseline data and a patient diary alongside the PRUDENCE trial. This multinational clinical trial recruited patients visiting their general practitioner (GP) with CA-ARTI symptoms in ten countries. Data collected included the antibiotic class prescribed, consultations with healthcare providers, non-antibiotic medication prescribed for CA-ARTI, disease duration, and missed working hours. Hours of work missed due to the disease were multiplied by country-specific hourly labour cost to calculate productivity loss in terms of absenteeism.</p><p><strong>Results: </strong>Proportions of CA-ARTI patients receiving an antibiotic prescription ranged from 37.2% in Germany to 68.2% in Ireland. Broad-spectrum penicillin was the most frequently prescribed class in Belgium, Germany, and Ireland (> 40%), whereas macrolides were most frequently prescribed in Georgia, Greece, and Hungary (> 36%). On average, approximately 50% of patients reported having a follow-up consultation with their GP within two weeks of the initial appointment. On average, work missed due to CA-ARTI was 15.4 h among employed patients, resulting in an average productivity loss of €358 per patient, and ranged from €1260 in Germany to €24 in Georgia.</p><p><strong>Conclusions: </strong>Antibiotic prescriptions, healthcare use, and missed work hours for CA-ARTI were substantially different across participating countries. This study adds valuable information on the generalizability of health economic evidence regarding CA-ARTI between countries and indicates the relevance to collect country-specific data and perform country-specific health economic analyses.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118274","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}