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":"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":"817-837"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204936/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional variation in the utilization of nursing home care in Germany.","authors":"Annika Herr, Maximilian Lückemann, Amela Saric-Babin","doi":"10.1007/s10198-024-01732-9","DOIUrl":"10.1007/s10198-024-01732-9","url":null,"abstract":"<p><p>Approximately 32 percent of individuals aged over 64 years old, with care needs, are residing in nursing homes in Germany. However, this percentage exhibits significant regional disparities, ranging from under 15 percent in certain counties to over 50 percent in others. The purpose of this study is to elucidate the underlying factors explaining this regional variation in nursing home utilization. We employed comprehensive administrative data encompassing the entire elderly care-dependent population and all nursing homes. Our analytical approach involves the use of linear regression models at the county level, accounting for an extensive array of control variables and fixed effects. Additionally, we analyzed regional dependencies by applying spatial lag models. In summary, our model successfully predicts up to 73 percent of the observed regional variation in nursing home utilization. Key factors include care needs, the presence of informal care support and the supply of professional care. Spatial dependencies can be detected but exhibit a minor influence on these variations controlling for care needs. Noteworthy, enabling factors, such as a region's wealth or rurality, have a very limited impact in a country with a generous social insurance system that covers care for those with limited financial resources.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"757-776"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711887","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":"Cancer-specific utility: clinical validation of the EORTC QLU-C10D in patients with glioblastoma.","authors":"Simone Seyringer, Micha J Pilz, Andrew Bottomley, Madeleine T King, Richard Norman, Eva M Gamper","doi":"10.1007/s10198-024-01729-4","DOIUrl":"10.1007/s10198-024-01729-4","url":null,"abstract":"<p><strong>Introduction: </strong>Many health economic evaluations rely on the validity of the utility measurement for health-related quality of life (HRQoL). While generic utility measures perform well in HRQoL assessments of many diseases and patient populations, appropriateness for cancer-specific disease burdens needs attention and condition-specific measures could be a viable option. This study assessed the clinical validity of the cancer-specific EORTC QLU-C10D, a utility scoring algorithm for the EORTC QLQ-C30, in patients with glioblastoma. We expect the EORTC QLU-C10D to be sensitive and responsive in glioblastoma patients. Furthermore, we compared its statistical efficiency with the generic utility measure EQ-5D-3L.</p><p><strong>Methods: </strong>We used data from a multi-center randomized controlled trial (NCT00689221) with patients from 146 study sites in 25 countries. Both, the QLQ-C30 and the EQ-5D-3L, had been administered at seven assessment points together. Utilities of both measures were calculated for four country value set (Australia, Canada, UK, USA). Ceiling effects, agreement (Bland-Altman plots (BA), intra-class correlation (ICC)), were calculated to analyze construct validity. Sensitivity to known-groups (performance status; global health) and responsiveness to changes (progressive vs. non-progressive; stable vs. improved or deteriorated HRQoL) were investigated for clinical validity. Relative Efficiency (RE) was calculated to compare statistical efficiency of both utility measures.</p><p><strong>Results: </strong>435 patients were included at baseline and six subsequent time points (median timeframe 497 days). QLU-C10D country value set showed negligible ceiling effects (< 6.7%) and high agreement with EQ-5D-3L (ICC > 0.750). BA indicated that differences between both utility measures increased with deteriorating health states. While the QLU-C10D was more sensitive to global health groups (RE > 1.2), the EQ-5D-3L was more sensitive to performance status groups (RE < 0.7) than the other utility measure. Statistical efficiency to detect differences between change groups and within HRQoL deterioration group (RE > 1.4) favored QLU-C10D in 18 of 24 (75%) and 20 of 24 (83%) comparisons with the EQ-5D-3L respectively. Responsiveness to overall HRQoL change (RE > 3.4) also favored the QLU-C10D.</p><p><strong>Conclusion: </strong>Our results indicate that the QLU-C10D is a valid utility measure to assess HRQoL in patients with glioblastoma. This facilitates the investigation of HRQoL profiles and utilities in this patient population by administering a single questionnaire, the EORTC QLQ-C30. Efficiency analyses point to higher statistical power of the QLU-C10D compared to the EQ-5D-3L.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"721-733"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677695","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-utility of cochlear implantation in single-sided deafness and asymmetric hearing loss: results of a randomized controlled trial.","authors":"Mathieu Marx, Michaël Mounié, Isabelle Mosnier, Frédéric Venail, Michel Mondain, Alain Uziel, David Bakhos, Emmanuel Lescanne, Yann N'Guyen, Daniele Bernardeschi, Olivier Sterkers, Benoit Godey, Gwenaëlle Creff, Sébastien Schmerber, Nicolas-Xavier Bonne, Christophe Vincent, Bernard Fraysse, Olivier Deguine, Nadège Costa","doi":"10.1007/s10198-024-01740-9","DOIUrl":"10.1007/s10198-024-01740-9","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the Incremental Cost-Utility Ratio (ICUR) of cochlear implantation in the treatment of adult patients with single-sided deafness (SSD) and asymmetric hearing loss (AHL).</p><p><strong>Methods: </strong>This prospective multicenter pragmatic study including a randomized controlled trial (RCT) enrolled 155 subjects with SSD or AHL. Subjects chose a treatment option between: abstention, Contralateral Routing Of the Signal hearing aids, Bone Conduction Device or Cochlear Implant (CI). Participants who opted for CI were then randomized between two arms: \"immediate CI\" where the cochlear implantation was performed within one month and \"initial observation\" where subjects were first observed. The ICUR of CI was determined at 6 months follow-up by comparing the two arms. Utility was measured using EuroQoL- 5 dimensions (EQ-5D), to calculate the gain in Quality-Adjusted Life Years (QALY). Individual costs were extracted from the French National Health Insurance database. A Markovian MultiState (MMS) model assessed the ICUR evolution over the lifetime horizon.</p><p><strong>Results: </strong>Among the 155 included participants, 51 opted for a CI and were randomized. For a 6 months follow-up period, the ICUR was €422,279/QALY gained after CI. Using the MMS model, the ICUR of CI decreased to €57,561/QALY at 10 years follow-up, €38,006/QALY at 20 years, and dropped to €26,715 at 50 years. In the participants with severe tinnitus, mean ICUR was €31,105/QALY at 10 years.</p><p><strong>Conclusions: </strong>CI can be considered as an efficient treatment in SSD and AHL from 20 years follow-up in the global population, and before 10 years follow-up in patients with severe associated tinnitus.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"735-744"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677696","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":"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":"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":"797-816"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204881/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can wage changes solve the labour crisis in the National Health Service?","authors":"Xingzuo Zhou, Jolene Skordis, Junjian Yi, Yiang Li, Jonathan Clarke, Hongkun Zhang","doi":"10.1007/s10198-024-01737-4","DOIUrl":"10.1007/s10198-024-01737-4","url":null,"abstract":"<p><p>This study aimed to examine the healthcare labour demand and supply elasticity regarding wage in the National Health Service (NHS) in England amid a labour crisis. A simultaneous error-correction regression analysis was conducted using secondary data from the NHS and Office for National Statistics from 2009 Q3 to 2022 Q1. Findings indicate both labour demand and supply of HCHS doctors in the NHS are highly inelastic with respect to real wages, with only a 0.1% decrease in NHS staff hiring and a 0.8% rise in NHS staff's willingness to work as full-time equivalents per 10% wage increase. Approximately 22% of the wage disequilibrium adjusts quarterly, indicating moderate speed of wage adjustment. Our results suggest that wage setting is not a sufficient solution to the labour crisis. Innovative and sustainable solutions are needed to reduce the demand for skilled health labour and increase the supply of health labour.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"839-853"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803059","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":"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":"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":"777-795"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","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":"Cost-effectiveness and cost-utility analysis of a nurse-led, transitional care model to improve care coordination for patients with cardiovascular diseases: results from the \"Cardiolotse\" study.","authors":"Marie Coors, Wiebke Schüttig, Katrin C Reber, Harald Darius, Alfred Holzgreve, Sebastian Karmann, Anica Stürtz, Rebecca Zöller, Saskia Kropp, Petra Riesner, Leonie Sundmacher","doi":"10.1007/s10198-024-01734-7","DOIUrl":"10.1007/s10198-024-01734-7","url":null,"abstract":"<p><strong>Objective: </strong>To assess the 12-month cost-effectiveness of the nurse-led transitional care program \"Cardiolotse\" (CL) for patients with cardiovascular diseases compared to usual care (UC).</p><p><strong>Methods: </strong>A cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) were conducted from the perspective of statutory health insurance (SHI), covering a time horizon of 12 months. Analyzed outcomes included the number of rehospitalizations and health-related quality of life (HRQoL). Total costs comprised program costs and the utilization of healthcare resources. Point estimates are presented as incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs). Sensitivity and subgroup analyses were conducted to illustrate uncertainty and provide insights into the impact mechanisms of the CL program.</p><p><strong>Results: </strong>The study population consisted of 2550 patients, with 1256 allocated to the intervention group and 1294 to the control group. Patients who received support from CLs experienced fewer rehospitalizations and lower inpatient costs from an SHI perspective, compared to the UC group. HRQoL assessments indicated higher utility values for CL patients at the 12-month follow-up. Total program costs amounted to €1454.65 per patient. The CEA and CUA demonstrate that the CL program is dominant compared to UC from the SHI perspective.</p><p><strong>Conclusion: </strong>Our study shows that the CL program not only reduces the number of rehospitalizations and costs but increases HRQoL, resulting in a dominant ICER and ICUR. Further research is necessary to evaluate longer periods of time, different levels of care intensity, and perspectives of different healthcare stakeholders.</p><p><strong>Trial registration: </strong>German Clinical Trial Register DRKS00020424, 2020-06-18, retrospectively registered.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"697-710"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584851","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 of treatments for presymptomatic newborn patients with spinal muscular atrophy and two or three copies of the survival motor neuron 2 gene in Italy.","authors":"Ilaria Valentini, Gianni Ghetti, Marika Pane, Filippo Rumi, Eugenio Di Brino, Michele Basile, Gabriele Maria Pistillo, Matthias Bischof","doi":"10.1007/s10198-025-01806-2","DOIUrl":"https://doi.org/10.1007/s10198-025-01806-2","url":null,"abstract":"<p><strong>Objective: </strong>We assessed the cost effectiveness of onasemnogene abeparvovec (OA) for presymptomatic infants with two or three copies of the survival motor neuron 2 (SMN2) gene (diagnosed/treated ≤ 6 weeks old) who lack functional SMN1 gene (biallelic SMN1 mutations). This cost-utility model compared three disease-modifying treatments and best supportive care (BSC) (scenario analysis) in an Italian setting.</p><p><strong>Methods: </strong>For a cohort of 1000 children, a Markov model simulated costs and benefits of OA (a one-time treatment), nusinersen and risdiplam (continuous lifelong treatments), and BSC. A lifetime time horizon (up to age 100 years) was applied, and the perspective of the Italian National Health Service was considered. Results are reported as incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the model and validity of results.</p><p><strong>Results: </strong>In the full cohort, OA was dominant (less costly, more effective) compared with nusinersen or risdiplam (ICERs,-€4,562,815 and-€718,640), and cost effective (more costly, more effective) compared with BSC (ICER, €65,894). Similar results were found for patients with two SMN2 copies. For patients with three SMN2 copies, OA was less costly, with a similar efficacy profile compared with nusinersen, dominant versus risdiplam, and cost effective compared with BSC. Probabilistic sensitivity analysis demonstrated the robustness of the model and validated deterministic sensitivity analysis results for the full cohort.</p><p><strong>Conclusions: </strong>OA for the treatment of presymptomatic newborns was dominant or cost effective compared with other treatments or BSC in the full patient cohort within the Italian context.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499179","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":"Cost-effectiveness of Mavacamten for the treatment of patients with symptomatic obstructive hypertrophic cardiomyopathy using a French healthcare perspective.","authors":"Francois-Emery Cotté, Michael Hurst, Sarah Akarkoub, Melissa Ho, Julien Vernon, Lou Chambry, Sandy Leproust","doi":"10.1007/s10198-025-01808-0","DOIUrl":"https://doi.org/10.1007/s10198-025-01808-0","url":null,"abstract":"","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477835","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}