European Journal of Health Economics最新文献

{"title":"The effect of workload on primary care doctors on referral rates and prescription patterns: evidence from English NHS.","authors":"Hanifa Pilvar, Toby Watt","doi":"10.1007/s10198-024-01742-7","DOIUrl":"https://doi.org/10.1007/s10198-024-01742-7","url":null,"abstract":"<p><p>This paper investigates the impact of workload pressure on primary care outcomes using a unique dataset from English general practices. Leveraging the absence of General Practitioner (GP) colleagues as an instrumental variable, we find that increased workload leads to an increase in prescription rates of antibiotics as well as in the share of assessment referrals. On the other hand, the quantity and frequency of psychotropics decreases. When there is an absence, workload is intensified mostly on GP partners, and the mode of consultation shifts toward remote interactions as a response to higher workload pressure. The effects are more pronounced for patients above 65 years-old and those in Short-staffed practices. Our study sheds light on the intricate relationship between workload pressure and patient care decisions in primary care settings.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792837","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":"Expensive today but cheaper tomorrow: lifetime costs of an active middle ear implant compared to alternative treatment options.","authors":"Markus Krohn, Klaas Kiesewetter, Annika Buchholz, Bettina Schlick, Susan Busch, Thomas Lenarz, Anke Lesinski-Schiedat, Hannes Maier, Cornelia Batsoulis, Michael Urban, Steffen Flessa","doi":"10.1007/s10198-024-01743-6","DOIUrl":"https://doi.org/10.1007/s10198-024-01743-6","url":null,"abstract":"<p><strong>Background: </strong>When choosing between different treatment options, implants often appear too costly. However, this perspective does not take future costs into account. This article evaluates lifetime costs for different surgical interventions to treat hearing loss.</p><p><strong>Methods: </strong>The analysis focused on three groups from the perspective of health insurers. Group 1 comprises patients who have only been implanted with a middle ear implant. Patients in Group 2 had already undergone middle ear surgery to improve hearing prior to the implantation of a middle ear implant. Group 3 consists of patients who were treated exclusively with hearing-improvement surgeries (no implant). The lifetime costs were calculated using the Monte Carlo simulation. The inputs were based on medical data from a maximum-care hospital and data from the German healthcare system.</p><p><strong>Results: </strong>Based on an average observation period of 26.73 years, the lifetime costs amounted to 28,325€ for group 1, 32,187€ for group 2 and 28,381€ for group 3. While the mean values between groups 1 and 3 appear comparable, group 1 has a significantly lower standard deviation (G1 vs. G3: 6120€ vs. 10,327€).</p><p><strong>Discussion/conclusion: </strong>Choosing a treatment option can be a complex medical decision and impose a substantial economic burden for the statutory health insurance. Hence, treatment decisions should be patient-centred at first but also including a shared-decision making on economic feasibility, whether proposed treatment alternatives are likely to be successful and economically reasonable.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786056","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 social value and design preferences for a home-based dementia community program in Australia.","authors":"Sabrina Lenzen, Brenda Gannon, Richard Norman, Sally Bennett, Lindy Clemson, Laura Gitlin","doi":"10.1007/s10198-024-01738-3","DOIUrl":"https://doi.org/10.1007/s10198-024-01738-3","url":null,"abstract":"<p><p>We study the monetary value and the relative importance of several program characteristics for an evidence-based intervention provided at home for people living with dementia and their carers in Australia. Using a discrete choice experiment, advised through an expert and consumer co-design approach, we consider the total number of sessions, the delivery mode, the primary outcome and focus of the program as well as its costs as attributes. Results from a representative sample of the Australian adult population show a high willingness to pay for the program overall, even greater than the actual costs. Choice data from 940 respondents show preferences for in-person sessions over telehealth options and respondents place a high value on improving mood and dementia-related behaviour as well as independence in daily activities. Preference heterogeneity shows that people who have experience with home care services place an even higher monetary value on the program, compared to the rest of the sample. In light of the increased emphasis of governments on expanding home care options over residential care, these results contribute towards the design and implementation of a home-based program for people with dementia and their carers and highlight its social value.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781781","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 attributable to hypercholesterolemia in a single period and over the life cycle.","authors":"Stephanie Reitzinger, Miriam Reiss, Thomas Czypionka","doi":"10.1007/s10198-024-01684-0","DOIUrl":"10.1007/s10198-024-01684-0","url":null,"abstract":"<p><p>Hypercholesterolemia is a major risk factor for atherosclerotic cardiovascular disease leading to reduced (healthy) life years. The aim of this study is to quantify the societal costs associated with hypercholesterolemia. We use epidemiologic data on the distribution of cholesterol levels as well as data on relative risks regarding ischemic heart disease, stroke, and other cardiovascular diseases. The analytical approach is based on the use of population-attributable fractions applied to direct medical, direct non-medical and indirect costs using data of Austria. Within a life-cycle analysis we sum up the costs of hypercholesterolemia for the population of 2019 and, thus, consider future morbidity and mortality effects on this population. Epidemiologic data suggest that approximately half of Austria's population have low-density lipoprotein cholesterol (LDL-C) levels above the target levels (i.e., are exposed to increased risk). We estimate that 8.2% of deaths are attributable to hypercholesterolemia. Total costs amount to about 0.33% of GDP in the single-period view. In the life-cycle perspective, total costs amount to €806.06 million, €312.1 million of which are medical costs, and about €494 million arise due to production loss associated with hypercholesterolemia. The study points out that significant shares of deaths, entries into disability pension and care allowance, full-time equivalents lost to the labor market as well as monetary costs for the health system and the society could be avoided if LDL-C-levels of the population were reduced.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1595-1603"},"PeriodicalIF":3.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140190320","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":"What remains after the money ends? Evidence on whether admission reductions continued following the largest health and social care integration programme in England.","authors":"Vasudha Wattal, Katherine Checkland, Matt Sutton, Marcello Morciano","doi":"10.1007/s10198-024-01676-0","DOIUrl":"10.1007/s10198-024-01676-0","url":null,"abstract":"<p><p>We study the long-term effects on hospital activity of a three-year national integration programme. We use administrative data spanning from 24 months before to 22 months after the programme, to estimate the effect of programme discontinuation using difference-in-differences method. Our results show that after programme discontinuation, emergency admissions were slower to increase in Vanguard compared to non-Vanguard sites. These effects were heterogeneous across sites, with greater reductions in care home Vanguard sites and concentrated among the older population. Care home Vanguards showed significant reductions beginning early in the programme but falling away more rapidly after programme discontinuation. Moreover, there were greater reductions for sites performing poorly before the programme. Overall, this suggests the effects of the integration programme might have been lagged but transitory, and more reliant on continued programme support.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1485-1504"},"PeriodicalIF":3.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068955","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 causal effect of early retirement on medication use across sex and occupation: evidence from Danish administrative data.","authors":"Jolien Cremers, Torben Heien Nielsen, Claus Thorn Ekstrøm","doi":"10.1007/s10198-023-01660-0","DOIUrl":"10.1007/s10198-023-01660-0","url":null,"abstract":"<p><p>We examine the causal effect of early retirement on medication use using Danish registry data. A reform in early retirement schemes in 2006 gradually increased eligibility ages from 60 to 64 differentially across birth cohorts. This enables an instrumental variable design that was applied using novel g-estimation methods that alleviate bias in binary outcome IV models. Our data allow studying patterns in the short run (ages 59½-60½) and in the long run (ages 57-63). For those who were eligible already at age 60, retirement did not change overall medication use. However, when investigating medication and population subgroups, we see that painkiller use decreases and hypertension medication as well as mental health medication use increase after retirement in almost all population subgroups. Moreover, males as well as the blue-collar occupation subgroups do show decreases in overall medication use after early retirement. In conclusion, our analyses reveal that retirement can have important heterogeneous health effects across population groups and are potentially informative about the welfare benefits of social insurance more broadly.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1517-1527"},"PeriodicalIF":3.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140112080","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 value of diastasis repair with the use of mesh compared to no intervention in Italy.","authors":"Carla Rognoni, Alessandro Carrara, Micaela Piccoli, Vincenzo Trapani, Nereo Vettoretto, Giorgio Soliani, Rosanna Tarricone","doi":"10.1007/s10198-024-01685-z","DOIUrl":"10.1007/s10198-024-01685-z","url":null,"abstract":"<p><strong>Aim: </strong>Rectus abdominal diastasis (RAD) can cause mainly incontinence and lower-back pain. Despite its high incidence, there is no consensus regarding surgical indication. We aimed at comparing RAD repair (minimally invasive technique with mesh implant) with no treatment (standard of care - SOC) through cost-effectiveness and budget impact analyses from both National Healthcare Service (NHS) and societal perspectives in Italy.</p><p><strong>Methods: </strong>A model was developed including social costs and productivity losses derived by the online administration of a socio-economic questionnaire, including the EuroQol for the assessment of quality of life. Costs for the NHS were based on reimbursement tariffs.</p><p><strong>Results: </strong>Over a lifetime horizon, estimated costs were 64,115€ for SOC and 46,541€ for RAD repair in the societal perspective; QALYs were 19.55 and 25.75 for the two groups, respectively. Considering the NHS perspective, RAD repair showed an additional cost per patient of 5,104€ compared to SOC, leading to an ICUR of 824€. RAD repair may be either cost-saving or cost-effective compared to SOC depending on the perspective considered. Considering a current scenario of 100% SOC, an increased diffusion of RAD repair from 2 to 10% in the next 5 years would lead to an incremental cost of 184,147,624€ for the whole society (87% borne by the NHS) and to incremental 16,155 QALYs.</p><p><strong>Conclusion: </strong>In light of the lack of economic evaluations for minimally invasive RAD repair, the present study provides relevant clinical and economic evidence to help improving the decision-making process and allocating scarce resources between competing ends.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1569-1580"},"PeriodicalIF":3.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121365","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":"Antivirals to prepare for surges in influenza cases: an economic evaluation of baloxavir marboxil for the Netherlands.","authors":"Simon van der Pol, Maarten J Postma, Cornelis Boersma","doi":"10.1007/s10198-024-01683-1","DOIUrl":"10.1007/s10198-024-01683-1","url":null,"abstract":"<p><strong>Objectives: </strong>We perform a cost-effectiveness analysis (CEA) and budget impact analysis (BIA) of baloxavir marboxil compared to current care in the Netherlands for patients at risk of influenza-related complications, including patients with comorbidities and the elderly.</p><p><strong>Methods: </strong>In the CEA, a decision tree model was developed to assess the cost-effectiveness of baloxavir marboxil for a cohort of 52-year-olds from a societal perspective. A lifetime horizon was taken by incorporating the quality-adjusted life expectancy. The BIA included different epidemiological scenarios, estimating different plausible epidemiological scenarios for seasonal influenza considering the whole Dutch population with an increased risk of influenza complications.</p><p><strong>Results: </strong>The base-case ICER was estimated to be €8,300 per QALY. At the willingness-to-pay threshold of €20,000 per QALY, the probability of being cost effective was 58%. The base-case expected budget impact was €5.7 million on average per year, ranging from €1.5 million to €10.5 million based on the severity of the influenza epidemic and vaccine effectiveness.</p><p><strong>Conclusion: </strong>In the Netherlands, baloxavir is a cost-effective treatment option for seasonal influenza, with a base-case ICER of €8,300 per QALY for the population aged 60 years and over and patients at high risk of influenza-related complications. For a large part, this ICER is driven by the reduction of the illness duration of influenza and productivity gains in the working population.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1557-1567"},"PeriodicalIF":3.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133245","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 EORTC QLU-C10D is a valid cancer-specific preference-based measure for cost-utility and health technology assessment in the Netherlands.","authors":"Micha J Pilz, Simon Seyringer, Lára R Hallsson, Andrew Bottomley, Femke Jansen, Madeleine T King, Richard Norman, Marianne J Rutten, Irma M Verdonck-de Leeuw, Peter D Siersema, Eva Maria Gamper","doi":"10.1007/s10198-024-01670-6","DOIUrl":"10.1007/s10198-024-01670-6","url":null,"abstract":"<p><strong>Background: </strong>Cost-utility analysis typically relies on preference-based measures (PBMs). While generic PBMs are widely used, disease-specific PBMs can capture aspects relevant for certain patient populations. Here the EORTC QLU-C10D, a cancer-specific PBM based on the QLQ-C30, is validated using Dutch trial data with the EQ-5D-3L as a generic comparator measure.</p><p><strong>Methods: </strong>We retrospectively analysed data from four Dutch randomised controlled trials (RCTs) comprising the EORTC QLQ-C30 and the EQ-5D-3L. Respective Dutch value sets were applied. Correlations between the instruments were calculated for domains and index scores. Bland-Altman plots and intra-class correlations (ICC) displayed agreement between the measures. Independent and paired t-tests, effect sizes and relative validity indices were used to determine the instruments' performance in detecting clinically known-group differences and health changes over time.</p><p><strong>Results: </strong>We analysed data from 602 cancer patients from four different trials. In overall, the EORTC QLU-C10D showed good relative validity with the EQ-5D-3L as a comparator (correlations of index scores r = 0.53-0.75, ICCs 0.686-0.808, conceptually similar domains showed higher correlations than dissimilar domains). Most importantly, it detected 63% of expected clinical group differences and 50% of changes over time in patients undergoing treatment. Both instruments showed poor performance in survivors. Detection rate and measurement efficiency were clearly higher for the QLU-C10D than for the EQ-5D-3L.</p><p><strong>Conclusions: </strong>The Dutch EORTC QLU-C10D showed good comparative validity in patients undergoing treatment. Our results underline the benefit that can be achieved by using a cancer-specific PBM for generating health utilities for cancer patients from a measurement perspective.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1539-1555"},"PeriodicalIF":3.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133246","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 awareness among intensivists in their daily clinical practice: a prospective multicentre study.","authors":"Timothée Lehut, Céline Lambert, Romain Mortier, Emmanuel Futier, Russell Chabanne, Ulrich Bauer, Philippe Verdier, Ramin Ravan, Philippe Ocquidant, Charline Mourgues, Alexandre Lautrette","doi":"10.1007/s10198-024-01686-y","DOIUrl":"10.1007/s10198-024-01686-y","url":null,"abstract":"<p><strong>Background: </strong>Better cost-awareness is a prerogative in achieving the best benefit/risk/cost ratio in the care. We aimed to assess the cost-awareness of intensivists in their daily clinical practice and to identify factors associated with accurate estimate of cost (50-150% of the real cost).</p><p><strong>Methods: </strong>We performed a prospective observational study in seven French ICUs. We compared the estimate of intensivists of the daily costs of caring with the real costs on a given day. The estimates covered five categories (drugs, laboratory tests, imaging modalities, medical devices, and waste) whose sum represented the overall cost.</p><p><strong>Results: </strong>Of the 234 estimates made by 65 intensivists, 70 (29.9%) were accurate. The median overall cost estimate (€330 [170; 620]) was significantly higher than the real cost (€178 [124; 239], p < 0.001). This overestimation was found in four categories, in particular for waste (€40 [15; 100] vs. €1.1 [0.6; 2.3], p < 0.001). Only the laboratory tests were underestimated (€65 [30; 120] vs. €106 [79; 138], p < 0.001). Being aware of the financial impact of prescriptions was factor associated with accurate estimate (OR: 5.05, 95%CI:1.47-17.4, p = 0.01). However, feeling able to accurately perform estimation was factor negatively associated with accurate estimate (OR: 0.11, 95%CI: 0.02-0.71, p = 0.02).</p><p><strong>Conclusion: </strong>French intensivists have a poor awareness of costs in their daily clinical practice. Raising awareness of the financial impact of prescriptions, and of the cost of laboratory tests and waste are the main areas for improvement that could help achieve the objective of the best care at the best cost.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1529-1537"},"PeriodicalIF":3.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140112129","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}