European Journal of Health Economics最新文献

{"title":"Cost comparison analysis of onasemnogene abeparvovec and nusinersen for treatment of patients with spinal muscular atrophy type 1 in the Netherlands.","authors":"Simon van der Schans, Rimma Velikanova, Diana Weidlich, Ruth Howells, Anish Patel, Matthias Bischof, Maarten J Postma, Cornelis Boersma","doi":"10.1007/s10198-024-01754-3","DOIUrl":"10.1007/s10198-024-01754-3","url":null,"abstract":"<p><strong>Background: </strong>Spinal muscular atrophy (SMA) is a rare genetic disease resulting in loss of motor function and, in severe cases (e.g., SMA type 1), infantile death. While treatments like nusinersen and onasemnogene abeparvovec improve prognosis for patients with SMA, costs for these medications can contribute to economic burden.</p><p><strong>Objective: </strong>Direct costs were compared for onasemnogene abeparvovec, a one-time gene replacement therapy, versus nusinersen, a lifelong therapy, for patients with SMA type 1 and/or three or more survival motor neuron 2 (SMN2) gene copies in the Netherlands.</p><p><strong>Methods: </strong>A cost comparison analysis model of 1-year incident patient population from the Netherlands was used to compare costs of onasemnogene abeparvovec versus nusinersen for patients eligible for onasemnogene abeparvovec immediately after diagnosis. Multiple analyses were conducted for economic outcomes (e.g., base-case, break-even, deterministic sensitivity, probabilistic sensitivity, scenario analyses).</p><p><strong>Results: </strong>Cost differences of -€2.9 million (undiscounted) and -€1.5 million (discounted) per patient with SMA type 1 treated with onasemnogene abeparvovec versus nusinersen over a 20-year time horizon were identified (base-case). Reduced costs with onasemnogene abeparvovec versus nusinersen were evident after 8.25 years.</p><p><strong>Conclusion: </strong>Onasemnogene abeparvovec was less costly than nusinersen after 8.25 years of treatment of patients with SMA type 1 in the Netherlands.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1101-1110"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469923","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":"Patient-level cost analysis of subfertility pathways in the Dutch healthcare system.","authors":"Maura Leusder, Hilco J van Elten, Kees Ahaus, Carina G J M Hilders, Evert J P van Santbrink","doi":"10.1007/s10198-024-01744-5","DOIUrl":"10.1007/s10198-024-01744-5","url":null,"abstract":"<p><strong>Background: </strong>Health economic evaluations require cost data as a key input, and reimbursement policies and systems should incentivize valuable care. Subfertility is a growing global phenomenon, and Dutch per-treatment DRGs alone do not support value-based decision-making because they don't reflect patient-level variation or the impact of technologies on costs across entire patient pathways.</p><p><strong>Methods: </strong>We present a real-world micro-costing analysis of subfertility patient pathways (n = 4.190) using time-driven activity-based costing (TDABC) and process mining in the Dutch healthcare system, and built a scalable and granular costing model.</p><p><strong>Results: </strong>We find that pathways (13.203 treatments, 4.190 patients, 10 years) from referral to pregnancy and birth vary greatly in costs (mean €6.329, maximum €36.976) and duration (mean 25,5 months, maximum 8,59 years), with structural variation within treatments (and DRGs) of up to 65%. Patient-level variation is highest in laboratory phases, and causally related to patients' cycle volume, type, and treatment methods. Large IVF or IVF-ICSI cycles are most common, and most valuable to patients and the healthcare system, but exceed their DRGs significantly (33%). We provide recommendations that reduce costs across patient pathways by €1.3 m in the Netherlands, to support value-based personalized care strategies. These findings are relevant to clinics following European protocols.</p><p><strong>Conclusions: </strong>Fertility treatments like IVF feature significant cost variation due to the personalization of treatments, and rapidly evolving laboratory technologies. Incorporating cost granularity at the patient and treatment level (cycle volume, type, method) is critical for decision-making, economic analyses, and policy as both subfertility rates and treatment demand are rising.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"927-943"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900350","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":"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":"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":"1069-1077"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","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":"Exploring the influence of medical staffing and birth volume on observed-to-expected cesarean deliveries: a panel data analysis of integrated obstetric and gynecological departments in Germany.","authors":"Arno Stöcker, Holger Pfaff, Nadine Scholten, Ludwig Kuntz","doi":"10.1007/s10198-024-01749-0","DOIUrl":"10.1007/s10198-024-01749-0","url":null,"abstract":"<p><strong>Introduction: </strong>Cesarean deliveries account for approximately one-third of all births in Germany, prompting ongoing discussions on cesarean section rates and their connection to medical staffing and birth volume. In Germany, the majority of departments integrate obstetric and gynecological care within a single department.</p><p><strong>Methods: </strong>The analysis utilized quality reports from German hospitals spanning 2015 to 2019. The outcome variable was the annual risk-adjusted cesarean section ratio-a metric comparing expected to observed cesarean sections. Explanatory variables included annual counts of physicians, midwives, and births. To account for case number-related staffing variations, full-time equivalent midwife and physician staff positions were normalized by the number of deliveries. Uni- and multivariate panel models were applied, complemented by multiple instrument variable analyses, including two-stage least square and generalized method of moments models.</p><p><strong>Results: </strong>Incorporating data from 509 integrated obstetric departments and 2089 observations, representing 2,335,839 deliveries with 720,795 cesarean sections (over 60% of all inpatient births in Germany), multivariate model with fixed effects revealed a statistically significant positive association between the number of physicians per birth and the risk-adjusted cesarean section ratio (0.004, p = 0.004). Two-stage least square instrument variable analysis (0.020, p < 0.001) and a system GMM estimator models (0.004, p < 0.001) validated these results, providing compelling evidence for a causal relationship.</p><p><strong>Conclusion: </strong>The study established a robust connection between the number of physicians per birth and the risk-adjusted cesarean section ratio in integrated obstetric and gynecological departments in Germany. While the cause of the effect remains unclear, one possible explanation is a lack of specialization within these departments due to the combined provision of both obstetric and gynecological care.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"987-1022"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015913","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":"Medical teleconsultation from the patient's perspective. A demographic segmentation.","authors":"Jorge Arenas-Gaitán, Patricio E Ramírez-Correa, Pablo Ledesma-Chaves, Luis J Callarisa Fiol","doi":"10.1007/s10198-024-01753-4","DOIUrl":"10.1007/s10198-024-01753-4","url":null,"abstract":"<p><p>Medical teleconsultation is a tool that is here to stay among the services offered by health systems. Therefore, it is important to understand the process of adopting this technology. However, most studies have endorsed the point of view of health professionals. Our research adopts the patient's point of view with a sample of 1500 patients who have used teleconsultation in Spain between May and November 2022, therefore, in a post-COVID-19 scenario. We started from a technology acceptance model, UTAUT, and applied a novel segmentation technique: Pathmox. As a result, we have obtained six segments of patients using teleconsultation with differentiated technology acceptance processes, and we also propose strategies adapted to each of them.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1023-1039"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069259","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":"How are patient inputs considered in HTA? A thematic document analysis of NICE ultra-rare disease appraisals.","authors":"Arianna Gentilini, Alina Rana","doi":"10.1007/s10198-024-01748-1","DOIUrl":"10.1007/s10198-024-01748-1","url":null,"abstract":"<p><p>Patient organisations are increasingly involved in HTA. Given this, it is important to understand what these organisations contribute and how their voices are accounted for in the decision-making process. This study characterises inputs from patient organisations and/or their nominated patient experts in technology appraisals for ultra-rare diseases in England and Wales and seeks to understand how these are considered in NICE final recommendations. We thematically analysed all HST appraisals completed between January 2022 and August 2024 (N = 15). We appraised inputs from patient organisations' and experts' written submissions, the novelty of patient inputs, as well as financial ties between contributing organisations and the manufacturer of the technology being appraised. We compared themes identified with those found in the Final Evaluation Determination documents to understand how and to what extent patients' inputs were considered in NICE final recommendations. We found that patient submissions mainly focused on disease aspects (54%). Patients raised concerns on access challenges, caregiver burden, and mental health impacts. Most patient themes overlapped with manufacturers' submissions (82%) and doctors' testimonies (45%), with most novel insights focusing on access issues and mental health. Patient organisations reported receiving funding from the technology manufacturer in most appraisals, with amounts ranging from £5,000 to £74,113. Approximately half of patient inputs were explicitly mentioned in NICE final decision documents, with some considerations being neglected despite being raised by patients. While NICE incorporates many issues of importance to patients, there is room for improvement to ensure all aspects patients deem important are captured. Further research could pinpoint optimal areas for patient contributions and assess their impact.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"945-968"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900345","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":"The ACA Medicaid expansions and abortion rates among young adults.","authors":"Masanori Kuroki","doi":"10.1007/s10198-024-01741-8","DOIUrl":"10.1007/s10198-024-01741-8","url":null,"abstract":"<p><p>This paper examines whether the expansion of Medicaid under the Affordable Care Act (ACA), which increases access to contraceptives to low-income childless women and allows them more autonomy to determine the timing of their pregnancies and births, is associated with lower abortion rates during the period 2008-2017. Using state-level data from the Guttmacher Institute and employing a difference-in-differences method, we find that Medicaid expansion is associated with a meaningful reduction in the abortion rate among women ages 18-24, presumably through increased use of contraceptives among low-income young adults. Our estimates imply that Medicaid expansion is associated with a relative decrease in the abortion rate among this age group, approximately 1-2 per 1000 women. By expanding access to contraceptives, Medicaid expansion may be an effective tool for preventing unplanned pregnancies and, consequently, reducing the number of abortions.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"969-985"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924039","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":"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":"1041-1067"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","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":"Population norms for the EQ-5D-5L for Hungary: comparison of online surveys and computer assisted personal interviews.","authors":"Márta Péntek, Viktor Jáger, Áron Kincses, Áron Hölgyesi, Zsombor Zrubka, Petra Baji, Levente Kovács, László Gulácsi","doi":"10.1007/s10198-024-01755-2","DOIUrl":"10.1007/s10198-024-01755-2","url":null,"abstract":"<p><strong>Background and objectives: </strong>The aims of this study were to provide population norms for EQ-5D-5L in Hungary and investigate the differences in EQ-5D-5L normative data by survey mode, i.e. online surveys and computer assisted personal interviews (CAPI).</p><p><strong>Methods: </strong>A pooled database was built comprising six online (N = 7,034) and two CAPI (N = 3,020) population-based studies with the EQ-5D-5L. Descriptive statistics were performed. Multinominal logistic and linear regression analyses were applied to compare the online and CAPI samples. Traditional and machine learning regression tools were used to investigate the determinants of EQ-5D-5L index values.</p><p><strong>Results: </strong>'No problems' in any of the five EQ-5D-5L domains were reported by 33.9% (online) and 58.9% (CAPI) of the participants. Most problems were reported on the pain/discomfort domain in both study types (51.9% and 33.6%, respectively). Men and more educated respondents had significantly higher average EQ-5D-5L index values. EQ-5D-5L index values and EQ VAS scores were significantly higher in the CAPI sample, except in age groups 65-74 (no difference) and 75+ (online scores were significantly higher). Only 7-10% of variance in the EQ-5D-5L index values was explained by the variables survey mode, education, sex and age, with age having the largest and sex the smallest effect.</p><p><strong>Conclusions: </strong>EQ-5D-5L population norms derived from online and CAPI studies may differ significantly from each other. It is recommended to consider the survey mode, sampling and sociodemographic characteristics of the participants when choosing population norms as reference set. Further comparative studies investigating EQ-5D-5L population norms by different study designs and administration modes are encouraged.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1111-1126"},"PeriodicalIF":3.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469926","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":"Critical issues with methods and results interpretation at validating the EQ-5D-5L and QLU-C10D utilities in gastric cancer patients : Referring to: Pan, C. W., he, J. Y., Zhu, Y. B., Zhao, C. H., Luo, N., & Wang, P.: Comparison of EQ-5D-5L and EORTC QLU-C10D utilities in gastric cancer patients. The European journal of health economics, 24(6), 885-893 (2003).","authors":"Simone Seyringer, Eva Maria Gamper","doi":"10.1007/s10198-025-01783-6","DOIUrl":"https://doi.org/10.1007/s10198-025-01783-6","url":null,"abstract":"","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745936","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}