Applied Health Economics and Health Policy最新文献

{"title":"Insights from Financial Economics to Value Healthcare Investments that Reduce System-Level Risks: Example of Disease Elimination and Eradication","authors":"Megha Rao,&nbsp;Mark Freeman,&nbsp;Jacco Thijssen,&nbsp;Simon Bland,&nbsp;Mark Sculpher,&nbsp;Karl Claxton,&nbsp;Paul Revill","doi":"10.1007/s40258-026-01037-3","DOIUrl":"10.1007/s40258-026-01037-3","url":null,"abstract":"<div><p>System-level risks generate volatility that can threaten the stability of public health systems and jeopardise population health. In financial terms, these risks may be systematic, arising from macroeconomic shocks, or systemic, arising from cascading failures due to interconnectedness. Interventions such as disease elimination and eradication (DEE) play a crucial role in mitigating the aggregate impact of such risks. However, conventional health economic evaluations often overlook these broader benefits realised during periods of instability, focusing instead on programme-specific risks under steady-state assumptions. Insights from financial economics can help capture this value and inform a more robust economic appraisal. This paper explores how concepts from financial economics can strengthen conventional health economic methods for evaluating programmes that reduce the aggregate impact of such system-level risks, using DEE as a primary example. It draws on asset pricing theory, macroeconomic models of rare disasters, real options analysis, and discounting practices. Key recommendations include recognising the added value of programmes that perform better during downturns due to the protection they offer against macroeconomic shocks or catastrophic events; using ‘real options’ thinking to manage uncertainty and preserve flexibility in long-term, high sunk cost projects; and accounting for equity considerations when setting discount rates for programmes with significant intergenerational impacts. The financial economics tools highlighted here could serve as key components of a broader analytical framework, supporting investment decisions that recognise and more accurately capture the value of investments that reduce the aggregate impact of system-level risks.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"449 - 458"},"PeriodicalIF":3.3,"publicationDate":"2026-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-026-01037-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Increasing Value of Environmental Sustainability Assessments in Healthcare Policy and Technology Evaluation","authors":"Lindsay Nicholson,&nbsp;Nick Pooley,&nbsp;Gregor Skeldon,&nbsp;Sue Langham,&nbsp;Antony Wright,&nbsp;Nina Embleton","doi":"10.1007/s40258-026-01034-6","DOIUrl":"10.1007/s40258-026-01034-6","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"443 - 447"},"PeriodicalIF":3.3,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-026-01034-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147455355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 and Public Health Impact of Newborn Screening for Spinal Muscular Atrophy in France","authors":"Sebastien Eymere,&nbsp;Oyin Opeifa,&nbsp;Aurélie Meunier,&nbsp;Marine Sivignon,&nbsp;Fanny Cayre,&nbsp;Aymeric de Chasteigner,&nbsp;Guillaume Leiba,&nbsp;Clément François,&nbsp;Didier Lacombe,&nbsp;Isabelle Borget,&nbsp;Vincent Laugel","doi":"10.1007/s40258-026-01035-5","DOIUrl":"10.1007/s40258-026-01035-5","url":null,"abstract":"<div><h3>Aims</h3><p>Spinal muscular atrophy (SMA) was recently included in the French national newborn screening (NBS) program. The aim of this study was to assess the public health impact and cost–utility of SMA NBS in the French setting.</p><h3>Materials and Methods</h3><p>A cost–utility model combining a decision tree with a lifetime state transition model (six health states) was adapted from a previous model. The model simulated a cohort of 700,000 newborns annually, aligned with French birth statistics. Clinical inputs were derived from SMA trials. Cost and utility estimates reflected French healthcare system data and societal burden studies. Analyses were conducted from a societal perspective, with key outcomes including the incremental cost–utility ratio (ICUR), quality-adjusted life years (QALYs), and incremental net monetary benefit (INMB). Deterministic, probabilistic, and scenario analyses were performed.</p><h3>Results</h3><p>With NBS, 66.5 patients are expected to be treated presymptomatically each year. At age 15 years, mortality is reduced to 2% in the NBS arm compared with 26% without screening; 94% of patients will retain the ability to sit or walk versus 38% without NBS. NBS is a dominant strategy versus no NBS, with lower costs (− 233.9 million [M] euros) and higher QALYs (+ 1586). The INMB was 265.6M € at a 20,000 €/QALY threshold. Results were robust across all sensitivity and scenario analyses.</p><h3>Limitations</h3><p>Key limitations include uncertainty in long-term treatment effects, exclusion of SMA type 0 and 4 from the model, and limited data on long-term outcomes of presymptomatically treated patients.</p><h3>Conclusions</h3><p>NBS for SMA in France offers significant clinical and economic value, supporting its national implementation.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"597 - 611"},"PeriodicalIF":3.3,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Italian Assessment System for Innovative Medicines: An 8-Year Retrospective Analysis of Outcomes, Criteria, Timelines and Funding Dynamics","authors":"Lorenzo Martellone,&nbsp;Camilla Servidio,&nbsp;Marcello Vaccaro,&nbsp;Katiuscja Malandrini,&nbsp;Adriana Coluccia,&nbsp;Alessandra Oliva,&nbsp;Claudio Maria Mastroianni,&nbsp;Giacomo Polito","doi":"10.1007/s40258-026-01032-8","DOIUrl":"10.1007/s40258-026-01032-8","url":null,"abstract":"<div><h3>Background</h3><p>The Italian assessment system for innovative medicines represents a distinctive European regulatory approach. Integrated with the Italian Medicines Agency (AIFA), since 2017 it has provided a formal evaluation based on three predefined criteria, Therapeutic Need (TN), Added Therapeutic Value (ATV) and Quality of Evidence (QoE), granting access to dedicated funds and simplified procedures.</p><h3>Objective</h3><p>This study investigated the evolution of the Italian system from 2017 to the 2025 reform, focusing on outcomes, decision criteria, timelines, and financial implications.</p><h3>Methods</h3><p>Publicly available AIFA data on 266 assessments were analysed and stratified by outcome, therapeutic area, orphan status and Advanced Therapy Medicinal Product (ATMP) designation. Logistic regression models were used to assess the internal consistency of appraisal criteria and to explore whether regulatory attributes modified their association with innovativeness outcomes. Time to recognition (TIR) and Decision-to-Implementation Interval (DII) were calculated for “Full Innovative” medicines. Annual spending was compared to fund availability to assess the financial impact of innovative medicines.</p><h3>Results</h3><p>Among the 266 evaluations, approximately 29% were classified as “Full Innovative”, 29% “Conditionally Innovative” and 42% “Not Innovative”. Added Therapeutic Value and QoE showed the strongest associations with positive designations, while orphan and ATMP status showed no independent association. Access timelines were comparable across therapeutic areas, with slightly longer delays for ATMPs. Spending exceeded fund limits several times but fell below budget after fund unification in 2022.</p><h3>Conclusions</h3><p>The Italian system has been applied consistently over time, with appraisal outcomes largely reflecting the formal decision criteria rather than regulatory status. The 2025 reform may represent a turning point, potentially changing designation patterns and their determinants. Ongoing monitoring is needed to ensure access does not compromise evidence standards or sustainability, offering lessons that may be relevant to other health systems considering similar mechanisms.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"541 - 551"},"PeriodicalIF":3.3,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-026-01032-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy Levers for First-Contact Healthcare Provider Choice: A Discrete Choice Experiment in Shanghai’s Hierarchical Medical System","authors":"Yi Gong","doi":"10.1007/s40258-026-01033-7","DOIUrl":"10.1007/s40258-026-01033-7","url":null,"abstract":"<div><h3>Background</h3><p>China’s hierarchical medical system seeks to route first-contact care for mild, nonurgent conditions to primary healthcare (PHC), yet hospital-centrism persists. Evidence is needed on how financing and visible access/quality signals jointly shape initial provider choice, and which groups respond most. This study quantifies those trade-offs and simulates policy impacts in Shanghai.</p><h3>Methodology</h3><p>A discrete choice experiment (12 tasks; two labeled provider alternatives plus opt-out) was administered to adult residents and long-term migrants in Shanghai (<i>N</i> = 441). Attributes included reimbursement rate, deductible, travel time, provider title (ref. General physician), hospital tier (ref. PHC), and online booking. A respondent-panel mixed logit with random coefficients for reimbursement, deductible, and travel time captured unobserved heterogeneity; effects were summarized as marginal rates of substitution (MRS) in reimbursement percentage points.</p><h3>Results</h3><p>Higher reimbursement pulled patients toward PHC. Beyond price, visible access and quality signals exerted strong influence on first-contact choice. Price responsiveness varied meaningfully across people, with those who better understand insurance reacting more strongly to reimbursement. Policy simulations raised PHC’s first-contact share from 23.4% (UEBMI baseline) to 29.7% with a PHC-tilted reimbursement schedule, and to 33.3% when pairing the same schedule with assured booking and senior staffing at PHC.</p><h3>Conclusions</h3><p>Price gradients are necessary but insufficient; coupling PHC-tilted financing with visible access/quality signals delivers the largest shift of mild first-contact care away from tertiary hospitals.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"567 - 582"},"PeriodicalIF":3.3,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-026-01033-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Evaluation of Bruton’s Tyrosine Kinase Inhibitors for Chronic Lymphocytic Leukaemia in South Africa","authors":"Rochelle Woudberg,&nbsp;Edina Sinanovic","doi":"10.1007/s40258-026-01031-9","DOIUrl":"10.1007/s40258-026-01031-9","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Targeted therapy with Bruton's tyrosine kinase inhibitors has demonstrated promising efficacy and safety outcomes in both untreated and relapsed or refractory chronic lymphocytic leukaemia (CLL); however, evidence regarding their cost effectiveness remains limited. This study evaluated the cost effectiveness of ibrutinib, acalabrutinib, and zanubrutinib for the treatment of CLL from the perspective of South Africa’s public healthcare system.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A partitioned survival model was developed with three health states: progression-free survival (PFS), progression, and death. The model used a 10-year time horizon with a cycle length of 28 days. Clinical inputs were derived from reference trials representing untreated and relapsed or refractory CLL populations. As no head-to-head trials directly compare all three Bruton's tyrosine kinase (BTK) inhibitors, a naïve (unadjusted) indirect comparison was used, with survival curves sourced independently from pivotal trials for each agent. The distribution of patients in each health state over time was estimated using extrapolated PFS and overall survival (OS) curves for each treatment strategy. Utility values were obtained from published literature, and cost data from national public-sector tariffs. The model estimated total costs, life-years (LYs) gained, and quality-adjusted life-years (QALYs) gained. Outcomes were based on calculated incremental cost effectiveness, with costs and effects discounted at 5.0% per year. Deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the results.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;In the base-case analysis, acalabrutinib versus ibrutinib resulted in an incremental cost-effectiveness ratio of US$1206 per LY gained and US$2124 per QALY gained in untreated CLL patients and US$1140 per LY gained and US$2104 per QALY gained in relapsed or refractory CLL patients. Zanubrutinib was dominant in both populations compared to ibrutinib, providing greater health benefits at lower total costs. In untreated CLL, zanubrutinib resulted in 0.32 more QALYs and cost savings of US$9086 per patient; in the relapsed or refractory CLL, it yielded 0.35 additional QALYs with US$6052 in savings. Additionally, acalabrutinib was more effective but more costly than zanubrutinib, with incremental cost-effectiveness ratio (ICERs) of US$24,010 per QALY gained in untreated CLL patients and US$33,009 per QALY gained in relapsed or refractory CLL patients. The model was most sensitive to drug acquisition costs and costs incurred in the progression-free health state. Probabilistic sensitivity analysis confirmed that zanubrutinib had the highest probability of being cost effective, at 61% in untreated and 65% in relapsed or refractory CLL patients at a willingness-to-pay threshold of US$3407 per QALY. Acalabrutinib showed a 23% and 22% probability of being cost effective in the respective groups, while ibrutinib had the lowest cost-effec","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"553 - 566"},"PeriodicalIF":3.3,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-026-01031-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147281824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferences of Women for Maternal Health Services in Sidama Region, Ethiopia: Discrete Choice Experiment","authors":"Daniel Gashaneh Belay,&nbsp;Gizachew A. Tessema,&nbsp;Jennifer Dunne,&nbsp;Melaku Birhanu Alemu,&nbsp;Richard Norman","doi":"10.1007/s40258-026-01027-5","DOIUrl":"10.1007/s40258-026-01027-5","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Skilled maternal health services, including antenatal care (ANC) services, childbirth services and postnatal care (PNC) services, can save the lives of women and newborns. However, women in resource-limited countries, such as Ethiopia, tend to have a relatively lower uptake, partly because current services may not align with their preferences. This study assessed the stated preferences ofwomen for maternal health services in the Sidama region, Ethiopia.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A multi-stage sampling technique was used to select reproductive-aged women (15–49 years) from the Central Sidama Zone, Sidama region, Ethiopia. A D-efficient discrete choice experiment (DCE) with two blocks of 24 choice tasks was designed. Six attributes, including healthcare provider attitude, availability of medication and supplies, distance to the health facility, privacy, waiting times, and service cost, were identified through literature reviews, focus group discussions and in-depth interviews with women and other stakeholders. Respondents were randomly assigned to one of the three interrelated but distinct maternal health services (ANC, childbirth and PNC). A latent class analysis (LCA) model was used to estimate preferences and estimate the relative importance of attributes, uptake probability, and willingness-to-pay (WTP). The association between individual sociodemographic characteristics and latent classes was examined using a class membership model.&lt;/p&gt;&lt;h3&gt;Result&lt;/h3&gt;&lt;p&gt;A total of 1558 women, including 526 for ANC services, 537 for childbirth services and 495 for PNC services, were included in the analysis. For each service, three classes were identified, and notable differences in preferences were observed across the classes within each maternal health service. For ANC services, Class 1 was a medication-sensitive group (34.3%) that prioritised the availability of essential medications. In contrast, Class 2 was a price-sensitive group (21.9%), exhibiting high disutility for costly services (7500 ETB ≈ US$137). For childbirth services, Class 1 was a time-sensitive group (21.1%) exhibiting strong aversion to long waiting times (24 hours), while Class 2 was a price-sensitive group (19.3%). For PNC services, Class 1 was a medication-sensitive group (48%), whereas Class 3 was a price-sensitive group (25%). The predicted uptake probability in ideal conditions was above 96% across all maternal health services; however, it ranged from 60% for class 2 PNC services to 99% for class 2 childbirth services in average conditions. Overall, women showed a higher willingness to pay (WTP) approximately 8604 ETB (US$159) and 5118 ETB (US$95 ), to avoid childbirth services that lacked medications and supplies or had long waiting times, respectively. Sociodemographic factors, including age, residence, and education level, significantly shaped women's preferences for maternal health services.&lt;/p&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p&gt;The cost of service, availability of medic","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"517 - 539"},"PeriodicalIF":3.3,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-026-01027-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147281867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards a Multi-sectoral Approach to Population Health: A Scoping Review of Cross-sectoral Evaluations of Health Interventions","authors":"Rositsa Koleva-Kolarova,&nbsp;Emily Hulse,&nbsp;Bertalan Németh,&nbsp;Maureen Rutten-van Mölken,&nbsp;Rhiannon Tudor Edwards,&nbsp;Balázs Babarczy,&nbsp;Balázs Nagy,&nbsp;Sarah Wordsworth,&nbsp;Apostolos Tsiachristas","doi":"10.1007/s40258-025-01023-1","DOIUrl":"10.1007/s40258-025-01023-1","url":null,"abstract":"<div><h3>Background</h3><p>Health interventions, particularly those targeted at health promotion and disease prevention, often have a range of impacts that span beyond the healthcare sector. Making the case for investment in these interventions may require an inventory of costs and outcomes across multiple sectors beyond the health sector.</p><h3>Objectives</h3><p>To perform a scoping review of economic evaluations that used existing approaches for cross-sectoral evaluation of healthcare interventions and provide an understanding of how these approaches have been applied in empirical studies.</p><h3>Methods</h3><p>Scoping reviews, a type of evidence synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. We used the PRISMA extension for scoping reviews and a pearl-growing search approach. A forward citation searching in Google Scholar and Web of Science of an initial set of selected papers that recommend cross-sectoral evaluations of health interventions was performed, complemented by free-word search in Google and Google Scholar. Cross-sectoral evaluations of health interventions that consider costs and outcomes beyond healthcare were included.</p><h3>Results</h3><p>From the 204 identified cross-sectoral evaluation studies of health interventions, the vast majority (85%) were cost-effectiveness and cost-utility analyses taking the societal costing perspective. Other approaches included social return on investment (6%), cost-benefit analysis (4%), cost study (3%), and combined approaches (2%). Two-thirds of the studies evaluated a treatment-based intervention while the remainder evaluated preventive interventions. In addition to healthcare, studies evaluated mostly costs related to productivity and non-direct medical costs, e.g., transport costs. Outcomes were focused on clinical results and patient-reported health and well-being.</p><h3>Conclusions</h3><p>There is a limited number of published cross-sectoral evaluations of health interventions despite the need of public and private investors for global value assessment. Issuing guidance on performing cross-sectoral evaluations and highlighting their need by health technology assessment agencies may improve existing evidence and therefore novel forms of investment in population health interventions.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"479 - 497"},"PeriodicalIF":3.3,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-01023-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It’s Time to Rethink ‘Real-World Evidence’: A Call for Terminological Clarity in Health Technology Assessment","authors":"Hesam Ghiasvand,&nbsp;Haipeng Liu","doi":"10.1007/s40258-026-01028-4","DOIUrl":"10.1007/s40258-026-01028-4","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"437 - 441"},"PeriodicalIF":3.3,"publicationDate":"2026-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ensuring Epidemiological Consistency in Risk-Stratified Cancer Screening Models: A Novel Approach Based on Flemish Breast Cancer Screening","authors":"Max Lelie,&nbsp;Bo VandenBulcke,&nbsp;Nick Verhaeghe,&nbsp;Lieven Annemans,&nbsp;Steven Simoens,&nbsp;Koen Putman","doi":"10.1007/s40258-026-01029-3","DOIUrl":"10.1007/s40258-026-01029-3","url":null,"abstract":"<div><h3>Objective</h3><p>We present a novel dynamic risk-stratified breast cancer screening Markov model designed to maintain robust and epidemiologically consistent cancer prevalences, regardless of the number or composition of risk-stratification groups. This approach addresses a common limitation in existing models, where altering risk-group definitions or proportions can unintentionally distort overall incidence rates. By overcoming this constraint, the method lowers barriers to developing interactive, flexible and policy-relevant models that can be shared directly with decision makers. The paper serves as both a methodological contribution and a practical guide for implementation.</p><h3>Methods</h3><p>Our approach combines conditional transition probabilities with pre-stratified ‘at-risk’ states within a conventional Markov cohort framework. Lifetime risk is determined at the structural level, while the timing of onset is governed by age-specific conditional probabilities. These components are derived directly from Flemish cancer registry data, enabling close alignment with the target population and facilitating epidemiological validation.</p><h3>Results</h3><p>We validate the model against empirical breast cancer incidence data from Flanders, comparing predicted outcomes across age bands and cancer stages. The method consistently reproduces observed incidence patterns without additional calibration, maintaining stability when risk group definitions or sizes are varied.</p><h3>Conclusions</h3><p>Combining pre-stratified ‘at-risk’ states with conditional transition probabilities offers a simple yet powerful means of achieving epidemiological consistency in both risk-stratified and non-stratified cancer screening models. The method is data driven, transparent, and adaptable to different cancers or screening contexts, making it especially valuable for interactive models intended for use by policymakers.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"627 - 635"},"PeriodicalIF":3.3,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146211822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}