European Journal of Health Economics最新文献

{"title":"Ex ante evaluation of risk adjustment models for prospective provider payment: a conceptual framework and empirical application.","authors":"Andreea Panturu, Richard van Kleef, Frank Eijkenaar","doi":"10.1007/s10198-025-01871-7","DOIUrl":"10.1007/s10198-025-01871-7","url":null,"abstract":"<p><p>Alternative payment models (APMs) aim to improve efficiency and fairness in healthcare by shifting financial responsibility from payers to providers. Given their prospective nature, APMs require effective risk adjustment (RA) to prevent risk-selection incentives. RA design comes with complex trade-offs between risk selection, cost control and gaming. In the light of these trade-offs, thorough ex-ante evaluation of RA models is crucial. Traditionally, RA-model evaluation in the context of APMs has heavily relied on statistical metrics like R-squared. While useful for assessing model fit, these metrics often fail to capture the full spectrum of relevant incentives. This study therefore addresses the question: \"What do meaningful incentive metrics for ex-ante evaluation of RA models look like in the context of prospective APMs for healthcare providers?\" We conducted a literature review and consulted experts to synthesize existing work on RA evaluation. This informed the development of a conceptual framework for defining incentive metrics, distinguishing among risk-selection, cost-control, and gaming incentives. We applied our framework in a simulation of prospective payments to primary care practices (PCPs) in the Netherlands, using 2019 claims data from 346 PCPs (N = 1.4 M patients). The analysis focused on selection incentives, comparing traditional statistical metrics with metrics derived from our framework. Results show that statistical metrics like R-squared fall short in assessing selection incentives compared to our incentive metrics. This highlights the need for tailored incentive metrics for the ex-ante evaluation of RA models that are grounded in a thorough understanding of relevant provider behaviors in the light of APM goals.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1003-1026"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cost-effectiveness of enzyme replacement therapies versus best supportive care for treating late onset Pompe disease in the UK NHS.","authors":"Matthew Walton, Nyanar Jasmine Deng, Mark Corbett, Chinyereugo Umemneku-Chikere, Sarah Nevitt, Helen Fulbright, Chong Yew Tan, Robin Lachmann, Rachel Churchill, Robert Hodgson","doi":"10.1007/s10198-025-01868-2","DOIUrl":"10.1007/s10198-025-01868-2","url":null,"abstract":"","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"945-956"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543494","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":"Demographic and health impacts of women's bodily autonomy: switching prescription requirements for emergency contraceptives.","authors":"Fabian Grünwald, Tom Stargardt","doi":"10.1007/s10198-025-01863-7","DOIUrl":"10.1007/s10198-025-01863-7","url":null,"abstract":"<p><p>Over the past decades, most European countries switched emergency contraceptive availability from prescription to over-the-counter (OTC) status. However, the effect of OTC switches on emergency and regular contraceptive use, on demographic indicators (birth rate, abortion rate) and health outcomes (sexually transmitted diseases) varies depending on the study setting. Only Poland switched emergency contraceptives back to prescription (Rx) status after previously loosening restrictions and causal analyses of an Rx switch are lacking entirely. We employ multiple (staggered/synthetic) difference-in-differences models to evaluate the effect of (a) an OTC switch, exploiting variation in the timing of the OTC switch among several European countries and (b) a Rx switch at the example of Poland. We find that the use of emergency contraceptives increased (decreased) after OTC (Rx) switches. The use of regular hormonal contraceptives, the rate of births and abortions and the incidence of various sexually transmitted diseases remained essentially unaffected or - if found - effects did not withstand robustness checks. Our results suggest that increased use of emergency contraceptives due to liberalized over-the-counter access may be reversed by a return to prescription bound access.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"987-1002"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566042","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":"A cross-country comparison of the psychometric performance of SF-6Dv2 and EQ-5D-5L.","authors":"Hosein Ameri, Brendan Mulhern, Richard Norman, Takeru Shiroiwa, Rajabali Daroudi, Thomas G Poder","doi":"10.1007/s10198-025-01867-3","DOIUrl":"10.1007/s10198-025-01867-3","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the comparative performance of SF-6Dv2 and EQ-5D-5L in the general population of Quebec (Canada), Tehran (Iran), and Japan.</p><p><strong>Methods: </strong>Data on SF-6Dv2 and EQ-5D-5L were collected in the three countries. Descriptive differences in utility values between SF-6Dv2 and EQ-5D-5L were assessed using t-tests, as well as ceiling effects were evaluated based on the percentage of \"no problem\" levels reported. The known-group validity of both measures was assessed by comparing utility scores across health and demographic subgroups using t-tests or ANOVA and by calculating effect sizes across known groups. The area under the receiver operating characteristic curve (AUROC) analysis and F-statistic ratios were used to further validate the findings from the known-group validity analyses. Convergent validity for both instruments was assessed using Spearman's rank correlation coefficient. The agreement between instruments was evaluated using intraclass correlation coefficients (ICC) and Bland-Altman plots.</p><p><strong>Results: </strong>A total of 2,378 respondents for Quebec, 3,061 for Tehran, and 3,933 for Japan were included. Differences in utility values between SF-6Dv2 and EQ-5D-5L were statistically significant, with SF-6Dv2 generally yielding lower utility scores. Both instruments demonstrated strong known-group validity, effectively distinguishing between diseased and healthy groups as well as various demographic characteristics. However, EQ-5D-5L outperformed SF-6Dv2 for most demographic characteristics based on AUROC analysis and F-statistic ratios. In contrast, their performance in distinguishing between healthy and diseased groups did not favor a particular instrument. Convergent validity analyses indicated strong associations between SF-6Dv2 and EQ-5D-5L utility values in Quebec (0.760) and Tehran (0.737). The agreement between SF-6Dv2 and EQ-5D-5L utility values was moderate in Quebec (0.69) and strong in Tehran (0.837). Bland-Altman plots indicated that differences between the two instruments tended to increase as the average score decreased.</p><p><strong>Conclusion: </strong>Both EQ-5D-5L and SF-6Dv2 demonstrated favorable psychometric performance in terms of known-group validity and convergent validity. These findings suggest that both instruments are valid tools for health utility measurement for use in general population.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1073-1085"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679380","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 eosinophilic esophagitis in the first year after diagnosis in Spain: A direct medical cost analysis.","authors":"Leticia Rodriguez-Alcolado, Isaac Aranda-Reneo, Sergio Casabona, Isabel Pérez-Martínez, Danila Guagnozzi, Carolina Gutiérrez-Junquera, Edurne Amorena, Antonio Guardiola-Arévalo, Luisa de la Peña-Negro, Leonardo Blas Jhon, Sandra López García-Dionisio, Jennifer Fernández-Pacheco, Jesús Barrio, Sonia Fernández-Fernández, Elena Betoré, Susana de la Riva, Carlos Teruel Sánchez-Vegazo, Juan Armando Rodríguez-Oballe, Juan Enrique Naves, Juan K Bisso-Zein, Silvia Carrión, Adolfo Suárez, Ronald Llerena-Castro, Alejandro García-Díaz, Óscar Nantes-Castillejo, Alicia Granja-Navacerrada, Antonia Perelló, Marta Álvarez-García, Cecilio Santander, Emilio J Laserna-Mendieta, Juan Oliva-Moreno, Alfredo J Lucendo","doi":"10.1007/s10198-025-01872-6","DOIUrl":"10.1007/s10198-025-01872-6","url":null,"abstract":"<p><strong>Background: </strong>Despite its increasing prevalence, the economic impact of eosinophilic esophagitis (EoE) in Europe is understudied and direct economic costs remain unknown.</p><p><strong>Objective: </strong>To assess contemporaneous direct medical costs during the first year after EoE diagnosis in Spain to identify key cost determinants and assess variables that could affect these costs.</p><p><strong>Methods: </strong>Observational study of Spanish participants in the EUREOS EoE CONNECT registry with incident EoE in 2017-2018. We assessed average costs/year in Euros for endoscopic procedures, out-patient visits, medication, emergency room visits and hospitalizations, 2018 being our base year. Official regional tariffs were used to estimate direct costs from a healthcare provider perspective; official price lists were used for drug therapies. Cost differences and determinants were assessed with multivariate models.</p><p><strong>Results: </strong>The mean annual direct cost of EoE per person among 302 patients (76.5% male, 77.5% adults) was €1,842.07 (SD €795.69). Endoscopic procedures accounted for 68% of this, followed by outpatient visits (15.9%) and drug prescriptions (10.8%). Cost was higher for pediatric compared to adult patients (€2,101.51 vs. €1,784.29, p < 0.01), for those with higher EREFS score (€1,979.36 vs. €1,794.49; p < 0.01), and in high-volume hospitals (€1,941.48 vs. €1,723.92; p = 0.02). Early response to first-line treatment reduced annual costs by -€368.95 (p < 0.01), by avoiding further medical procedures.</p><p><strong>Conclusion: </strong>First year after EoE diagnosis produces significant direct costs in Spain, mainly due to endoscopic procedures, which are reduced in early responders to first-line therapy. Research for non-invasive methods for EoE assessment and identifying predictors of response are, therefore, key.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"957-967"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543458","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 testing biofluid biomarkers to diagnose Alzheimer's disease: a systematic review.","authors":"Hanzi Jiang, Sergio Escamilla, Molly Beestrum, Federico Salas-Lucia","doi":"10.1007/s10198-025-01877-1","DOIUrl":"10.1007/s10198-025-01877-1","url":null,"abstract":"<p><strong>Background: </strong>Alzheimer's disease (AD) affects tens of millions of individuals and their families in the world. As AD progresses, the effectiveness of treatment declines, making a timely diagnosis crucial. One promising approach for timely diagnosis is testing biofluid biomarkers in patients' blood and cerebrospinal fluid (CSF). However, a comprehensive evaluation of whether these tests are cost-effective is missing. Here, we conducted a systematic review to assess the cost-effectiveness of testing biofluid biomarkers to diagnose AD.</p><p><strong>Method: </strong>We searched PubMed, Embase, Cochrane Library, and Web of Science for studies published until October 2024. Studies were included if published in English, conducted an economic evaluation of CSF or blood biomarker testing to diagnose AD, and provided economic outcomes. We assessed the quality of studies using the CHEERS 2022 criteria.</p><p><strong>Results: </strong>Nine studies were included: six evaluated CSF biomarker tests and three on blood biomarker tests. All studies used model-based simulations (decision trees or Markov models) rather than trial-based evaluations. CSF biomarker tests were mostly cost-effective compared to neurocognitive assessments or neuroimaging, while blood biomarker tests showed mixed results. Key cost-effectiveness contributors included AD prevalence, diagnostic accuracy, and treatment effectiveness. Studies met ~ 80% of the CHEERS criteria, with missing information on patient engagement.</p><p><strong>Conclusion: </strong>Our review supports that biofluid biomarker testing could be cost-effective to diagnose AD. Given the lack of trial-based economic evaluations, model-based studies are a valuable starting point. Future evaluations should incorporate patient-centered outcomes and consider the emotional value and other socio-economic factors that affect patients and families suffering from AD.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1103-1115"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745727","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":"Willingness to pay for a quality adjusted life year across different time horizons: direct elicitation in Quebec.","authors":"Hosein Ameri, Dan Alexandru Danita, Thomas G Poder","doi":"10.1007/s10198-025-01869-1","DOIUrl":"10.1007/s10198-025-01869-1","url":null,"abstract":"","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1047-1059"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The disability and care squeeze: the effects of children's disability and special healthcare needs on parents' employment in Australia.","authors":"Benojir Ahammed, Khorshed Alam, Zahirul Hoque, Syed Afroz Keramat","doi":"10.1007/s10198-025-01878-0","DOIUrl":"10.1007/s10198-025-01878-0","url":null,"abstract":"<p><strong>Background: </strong>Children with disabilities and special healthcare needs can considerably affect parental employment and family financial stability. This study aims to investigate the effects of children's disabilities, special healthcare needs, and their coexistence on parental employment in Australia.</p><p><strong>Methods: </strong>This study utilised data from the nationally representative Baby (B) and Kindergarten (K) cohorts, spanning Waves 1 to 8 of the Longitudinal Study of Australian Children (LSAC). Fixed-effects logistic regression was employed to examine the relationship between children's disability, special healthcare needs, and parental (for both mothers and fathers) employment status.</p><p><strong>Results: </strong>The findings show that within the same family, children's disability (adjusted odds ratio [aOR] = 0.81, 95% confidence interval [CI]: 0.70-0.94, p = 0.006) and having a child with special healthcare needs (aOR = 0.87, 95% CI: 0.76-0.99, p = 0.038) reduces the likelihood of a mother being employed. Furthermore, the results indicate that the interaction between disability and special healthcare needs (aOR = 0.69, 95% CI: 0.56-0.87, p = 0.001) significantly reduces the likelihood of mothers' participation in employment. Similarly, the findings show that within the same family, having a child with a disability (aOR = 0.60, 95% CI: 0.45-0.78, p < 0.001) results in a 40% decrease in the odds of paternal employment.</p><p><strong>Conclusion: </strong>Children with disabilities and special healthcare needs significantly reduce maternal employment participation within the same family, while only disabilities are associated with reduced employment for fathers. These findings offer vital evidence for policymakers to improve support systems for families with children who have disabilities and special healthcare needs. Such support may include access to essential services and resources, leading to improved parental employment outcomes and enhanced overall family well-being.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"1087-1102"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679392","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":"Coordinating care across hospitals: how integration shapes patient mobility.","authors":"Guérin Loïc, Sirven Nicolas","doi":"10.1007/s10198-026-01939-y","DOIUrl":"10.1007/s10198-026-01939-y","url":null,"abstract":"<p><strong>Background: </strong>In 2016, France reformed its health system by requiring public hospitals to form territorial groups. Policymakers, following experiences with integrated care provision in the United States and NHS-type networks in Italy and England, expected these groups to improve coordination and system efficiency. However, it remains unclear whether such administrative integration creates new care pathways within groups or substitutes for existing referral relationships with external providers.</p><p><strong>Methods: </strong>We analyzed national hospital administrative data from 2013 to 2021. Changes in inter-facility transfer rates were estimated using a synthetic difference-in-differences approach. The main outcome was the annual percentage of patients transferred to another hospital, overall and within the same group.</p><p><strong>Results: </strong>Following group formation, smaller local hospitals experienced an average increase of 1.25 percentage points in transfers to hospitals within their group. Transfers to hospitals outside the group remained broadly stable, suggesting limited substitution away from pre-existing referral channels.</p><p><strong>Conclusions: </strong>Territorial grouping are associated with an increase in internal patient mobility, particularly among local hospitals, without reducing exchanges with external providers. These findings suggest that administrative integration may have layered new coordination arrangements onto existing care pathways and reinforced patterns of functional specialization. The results contribute to understanding how network-based integration reshapes organizational behaviour and patient mobility in regulated health systems.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354697","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":"A comparative analysis of managed entry agreements in Europe: trends, reporting practices, and financial outcomes.","authors":"N Franzen, J Vancoppenolle, V P Retèl, S Vogler, W H van Harten","doi":"10.1007/s10198-026-01942-3","DOIUrl":"10.1007/s10198-026-01942-3","url":null,"abstract":"<p><strong>Background: </strong>Payers use Managed Entry Agreements (MEAs) across Europe to manage the financial risks associated with high-cost medicines. While these agreements aim to improve affordability and address uncertainty, their confidential nature raises concerns about transparency, international price referencing, and the validity of economic evaluations. This study examines MEA practices across 13 European countries, analyzing adoption trends, reporting practices, and financial outcomes, and their implications for payer decision-making.</p><p><strong>Methods: </strong>Data from 2016 to 2022 were collected through (1) mapping national MEA frameworks, stakeholders, and implementation processes; (2) desk research on publicly available activity and financial reports; and (3) validation interviews with public-sector negotiators in each country.</p><p><strong>Results: </strong>Across 13 countries, 24 MEA frameworks were identified. MEA usage increased substantially, with the highest numbers in 2022 in Germany (356) and France (349), and the largest growth in Belgium (+ 250%) and Norway (+ 227%). Reported expenditure reductions ranged from €0.04 billion (Slovakia) to €5.56 billion (France), with estimated discounts between 14% (Germany) and 54% (Belgium). Reporting remained heterogeneous, with activity data available for fourteen frameworks and financial data for ten. More granular reporting, such as by discount mechanism (Netherlands), therapeutic class (France), or gender (Sweden), was uncommon.</p><p><strong>Conclusion: </strong>The growing use of MEAs across Europe has widened the gap between list and actual prices. Incomplete and non-standardized reporting reduces the ability to assess financial performance and limits cross-country comparability. Harmonized reporting of aggregated data, without compromising confidentiality, could improve transparency, accountability, and support value-based pricing strategies.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347344","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}