Applied Health Economics and Health Policy最新文献

{"title":"The Impact of Alteplase Coverage on Health Equity for the Treatment of Ischemic Stroke in the USA: A Distributional Cost-Effectiveness Analysis.","authors":"Thomas Majda, Elizabeth S Mearns, Stacey Kowal","doi":"10.1007/s40258-025-00985-6","DOIUrl":"https://doi.org/10.1007/s40258-025-00985-6","url":null,"abstract":"<p><strong>Objectives: </strong>A distributional cost-effectiveness analysis (DCEA) was conducted to evaluate how alteplase for acute ischemic stroke affected overall health and disparities in the USA.</p><p><strong>Methods: </strong>Using an existing, published, cost-effectiveness analysis, a DCEA was developed from a US payer perspective. The population was divided into 25 equity-relevant subgroups based on race and ethnicity (5 census-based groups), and county-level social vulnerability index (quintiles). Inputs for stroke outcomes, incidence and alteplase utilization varied across subgroups. Opportunity costs were estimated by converting total spend on alteplase into quality-adjusted life-years (QALYs) using an equal distribution across subgroups. Various scenarios explored the impact of health system changes to improve stroke care access.</p><p><strong>Results: </strong>Alteplase treatment resulted in larger relative QALY gains in more vulnerable versus less vulnerable subgroups owing to increased acute ischemic stroke incidence and lower receipt of thrombolysis. Using an opportunity cost threshold of US$150,000/QALY, alteplase was estimated to improve social welfare by increasing population health (45,606 QALYs gained) and reducing existing overall US inequities by 0.0001% annually. Results were robust across all levels of population inequality aversion and alternate opportunity cost thresholds. Health system scenarios that reduced care gaps promoted additional reductions in existing inequalities, because more patients with lower baseline health were eligible for treatment.</p><p><strong>Conclusions: </strong>Under current treatment patterns, this DCEA demonstrated that alteplase for acute ischemic stroke increased population health and improved health equity. It is critical to address existing care gaps to enable equitable access to alteplase across race, ethnicity and geography.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537860","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":"Cost-Effectiveness and Value of Information Analyses of Caplacizumab for the Treatment of Thrombotic Thrombocytopenic Purpura in Brazil.","authors":"Julia Simões Correa Galendi, Hannes Rasch, Carlos Antonio Caramori, Rafael Dezen Gaiolla, Dirk Müller, Vania Santos Nunes Nogueira","doi":"10.1007/s40258-025-00968-7","DOIUrl":"10.1007/s40258-025-00968-7","url":null,"abstract":"<p><strong>Objectives: </strong>The objective was to evaluate the cost effectiveness of caplacizumab for the treatment of patients with acquired immune thrombocytopenic thrombotic purpura (iTTP) compared to standard of care from the perspective of the Brazilian Unified Health System (SUS).</p><p><strong>Methods: </strong>A decision tree followed by a Markov model with a lifetime horizon was developed. Patients entered the model with an acute iTTP event. All patients were assumed to be admitted to hospital where they either respond to treatment or die. The model offered three health states: remission, relapse or death. Input data were obtained from literature searches with the data on efficacy of caplacizumab based on the HERCULES trial. The incremental cost-effectiveness ratio (ICER) was compared to the willingness-to-pay threshold for rare diseases of Brazilian reais (R$)120,000/quality-adjusted life years (QALYs). In addition to various sensitivity analyses, a value of information (VOI) analysis was conducted.</p><p><strong>Results: </strong>In the base case, caplacizumab resulted in 0.70 QALYs gained, and cost R$1,333,601 more, with an ICER of R$1,901,729/QALY. The cost of the caplacizumab vial was the most influential parameter. Probabilistic analysis showed that caplacizumab was not cost effective in any iterations for the threshold of the rare disease. The expected value of perfect information per year is R$0.</p><p><strong>Conclusion: </strong>Although caplacizumab results in incremental QALYs, based on the proposed cost, caplacizumab is not cost effective from the SUS perspective, and VOI results indicate that further research would not be worthwhile.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":"649-660"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970304","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":"Machine Learning-Assisted Health Economics and Policy Reviews: A Comparative Assessment.","authors":"Ludovico Cavallaro, Vittoria Ardito, Michael Drummond, Oriana Ciani","doi":"10.1007/s40258-025-00963-y","DOIUrl":"10.1007/s40258-025-00963-y","url":null,"abstract":"<p><strong>Introduction: </strong>The growth of scientific literature in health economics and policy represents a challenge for researchers conducting literature reviews. This study explores the adoption of a machine learning (ML) tool to enhance title and abstract screening. By retrospectively assessing its performance against the manual screening of a recent scoping review, we aimed to evaluate its reliability and potential for streamlining future reviews.</p><p><strong>Methods: </strong>ASReview was utilised in 'Simulation Mode' to evaluate the percentage of relevant records found (RRF) during title/abstract screening. A dataset of 10,246 unique records from three databases was considered, with 135 relevant records labelled. Performance was assessed across three scenarios with varying levels of prior knowledge (PK) (i.e., 5, 10, or 15 records), using both sampling and heuristic stopping criteria, with 100 simulations conducted for each scenario.</p><p><strong>Results: </strong>The ML tool demonstrated strong performance in facilitating the screening process. Using the sampling criterion, median RRF values stabilised at 97% with 25% of the sample screened, saving reviewers approximately 32 working days. The heuristic criterion showed similar median values, but greater variability due to premature conclusions upon reaching the threshold. While higher PK levels improved early-stage performance, the ML tool's accuracy stabilised as screening progressed, even with minimal PK.</p><p><strong>Conclusions: </strong>This study highlights the potential of ML tools to enhance the efficiency of title and abstract screening in health economics and policy literature reviews. To fully realise this potential, it is essential for regulatory bodies to establish comprehensive guidelines that ensure ML-assisted reviews uphold rigorous evidence quality standards, thereby enhancing their integrity and reliability.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":"639-647"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735586","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":"Design Patents: A Potential Threat to Drug Competition.","authors":"Janet Freilich, Aaron S Kesselheim","doi":"10.1007/s40258-025-00967-8","DOIUrl":"10.1007/s40258-025-00967-8","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":"531-534"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810155","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":"Evaluating Access Improving Interventions: An Economic Evaluation of Surgical Task-Shifting for C-Sections in Sierra Leone.","authors":"Bryony Dawkins, Bethany Shinkins, Tim Ensor, David Jayne, Thomas Ashley, Alex J van Duinen, Håkon A Bolkan, David Meads","doi":"10.1007/s40258-025-00965-w","DOIUrl":"10.1007/s40258-025-00965-w","url":null,"abstract":"<p><strong>Background: </strong>Access to safe, timely and affordable surgical care is lacking globally. Less than 6% of all surgical operations are carried out in low- and middle-income countries, where over a third of the world's population lives. CapaCare, an NGO operating in Sierra Leone, have developed a surgical training programme (STP) for Associate Clinicians based on principles of task-shifting to improve access. Interventions to increase healthcare access have the same value evidence requirements as new technologies but their evaluation presents methodological challenges as access is not routinely incorporated explicitly in economic evaluations.</p><p><strong>Objective: </strong>To evaluate the cost-effectiveness of surgical task-shifting in Sierra Leone, implemented through the CapaCare STP, to increase provision of caesarean section (C-section).</p><p><strong>Methods: </strong>We evaluated the impact of the STP on the provision of C-section and subsequent maternal and child outcomes, measured in disability-adjusted life-years (DALYs), relative to the costs using a healthcare system perspective and decision-tree model parameterised using data from surgical logbooks, national data, and the literature.</p><p><strong>Results: </strong>Results indicate that the surgical task-shifting programme in Sierra Leone would be considered cost-effective in increasing provision for C-section. It is cost saving (USD - 16.77) and results in 2.14 DALYs averted, per women with an indication for C-section, due to avoidance of maternal and child deaths as well as reduced complications.</p><p><strong>Conclusion: </strong>Investment in surgical task-shifting initiatives should be considered by policymakers as a potentially cost-effective way to increase access to quality surgical services. Future evaluations of access-increasing interventions should seek to capture the distributional impact of this strategy and system benefits.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":"705-723"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957179","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 Cost and Cost-Effectiveness of Childbirth Settings: A Systematic Review.","authors":"Vanessa Scarf, Habtamu Kasaye, Kate Levett, Emily Callander","doi":"10.1007/s40258-025-00957-w","DOIUrl":"10.1007/s40258-025-00957-w","url":null,"abstract":"<p><strong>Background: </strong>To sustain positive progress toward sustainable development goals as envisioned in goal 3 and beyond, safe and affordable care during pregnancy and birth for women, their families, and health facilities and professionals is essential. In this systematic review, we report the best available evidence regarding the cost and cost-effectiveness of birth in various settings, including hospitals, birth centres, and homes for women at low risk of complications from high-, middle-, and low-income countries.</p><p><strong>Methods: </strong>We conducted a systematic review of cost and economic evaluation papers, following the comprehensive search of online databases, including Medline, CINAHL, Embase, Scopus, and Google Scholar, and grey literature, using predetermined search strategies. Both partial and full economic evaluation studies were included, and we appraised them using Joanna Briggs Institute's (JBI's) critical appraisal checklists for economic evaluation studies. Although we attempted to pool total incremental net benefit, the results were synthesised narratively without a meta-analysis due to the high heterogeneity between primary studies.</p><p><strong>Findings: </strong>From 2307 identified studies, 11 studies (13 country level records from 11 countries) were included. Both direct and indirect costs of childbirth at home, midwife-led birth units (MLBUs), and hospitals were reported. Ten studies showed that births in MLBUs were less costly than hospital births, while home births were also reported to be less costly than hospital births in seven studies. Regarding cost-effectiveness, in Bangladesh, MLBUs generally showed better outcomes at lower costs than hospital births, while one site had higher costs. In Pakistan and Uganda, MLBUs displayed mixed results, with some being cost-effective and others more costly with poorer outcomes. In the Netherlands, MLBUs were less costly but had poorer outcomes, whereas home births were less costly and more effective. In Belgium, MLBUs were less costly but less effective in reducing caesarean and instrumental births, though they did reduce epidural analgesia use cost-effectively.</p><p><strong>Conclusions: </strong>Most studies found that births in MLBUs and at home were less costly than births in hospital. There is the potential for these settings to provide a cost-effective option for women through reduced intervention rates and favourable outcomes in high-income countries and could offer birthing options to women in low- and middle-income countries that includes care by skilled maternity practitioners in potentially more affordable settings.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":"551-568"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771111","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":"GaitSmart Rehabilitation Exercise Programme for Gait and Mobility Issues: A NICE Medical Technologies Guidance.","authors":"Huey Yi Chong, Michal Pruski, Megan Dale, Rhys Morris","doi":"10.1007/s40258-025-00955-y","DOIUrl":"10.1007/s40258-025-00955-y","url":null,"abstract":"<p><p>GaitSmart (Dynamic Metrics Ltd) is a class I CE-marked sensor-based digital technology designed to measure lower limb movement via sensors placed on the body. GaitSmart aims to identify any problems with gait, and provide a personalised rehabilitation programme via the integrated vGym app. The company identified people referred for knee or hip replacement and people at risk of falling as potentially being able to benefit from GaitSmart. The clinical evidence identified was limited in its applicability to the scope of the assessment, and there was large variability in the comparators used in these studies and in the current care pathways, especially for people at risk of falls. There is some limited evidence that patients like the report generated by the technology and found it helpful in understanding their condition. Clinical experts thought GaitSmart had the potential to improve outcomes for patients and could be used in the community setting by a range of healthcare professionals. Economic modelling over a 1-year time horizon from a UK National Health Service (NHS) perspective for the falls model and a 17-week horizon for the rehabilitation model indicate that GaitSmart is cost saving; however, this is dependent on the model of standard care. Where GaitSmart is delivered by trained healthcare assistants, it would lead to a reduction in staff time costs compared to most alternative standard care options. Uncertainty is greater in the falls model given the high variability in standard care. In April 2024, the National Institute for Health and Care Excellence recommended that GaitSmart can be used to treat gait and mobility issues in adults at risk of falls, while more evidence is gathered. For adults having hip or knee replacements, access to GaitSmart should be via the company, research or non-core NHS funding, with appropriate management of any risks.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":"625-637"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596037","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":"Is the Use of Unanchored Matching-Adjusted Indirect Comparison Always Superior to Naïve Indirect Comparison on Survival Outcomes? A Simulation Study.","authors":"Ying Liu, Xiaoning He, Jia Liu, Jing Wu","doi":"10.1007/s40258-025-00952-1","DOIUrl":"10.1007/s40258-025-00952-1","url":null,"abstract":"<p><strong>Objective: </strong>To compare the performance of matching-adjusted indirect comparison (MAIC) and naïve indirect comparison (NIC) under a wide range of data scenarios on survival outcome.</p><p><strong>Methods: </strong>A simulation study included 729 (3⁶) single-arm trial data scenarios, which were created by performing a three-level full factorial arrangement of six situational variables, including individual patient data (IPD) sample size, aggregate data (AgD) sample size, covariate strength, covariate correlation, covariate overlap, and relative treatment effect. In each scenario, 1000 repetitions of simulated datasets were generated using the Monte Carlo approach. MAIC and NIC methods were used to estimate the relative treatment effect of each simulated dataset. The performance was evaluated in terms of bias, empirical standard error (ESE), mean squared error (MSE), and confidence interval coverage, respectively.</p><p><strong>Results: </strong>MAIC yielded relatively unbiased estimates of relative treatment effect compared with NIC in most scenarios, with better coverage and MSE but higher ESE. None of the situational variables had a significant impact on the bias and coverage of MAIC. However, increasing IPD sample size and covariate overlap significantly reduced the ESE and MSE of MAIC. In scenarios with low covariate overlap and high covariate strength, the bias of MAIC was larger and even greater than that of NIC.</p><p><strong>Conclusions: </strong>The performance of MAIC consistently demonstrates advantage over NIC across various scenarios. MAIC often provides more unbiased estimates and achieves confidence interval coverage close to nominal values compared with NIC. While MAIC may exhibit higher ESE in specific scenarios, this additional uncertainty can offer a more accurate reflection of variability, enhancing the robustness of the results. Researchers should thoroughly comprehend the influencing factors and interactions affecting the performance of these methods and judiciously apply research findings.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":"693-704"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482011","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":"Priority Setting in the Context of Planetary Healthcare.","authors":"Glory O Apantaku, Lydia Kapiriri, Ole F Norheim, Ingrid Cardoso Couto de Azevedo, Dan Kim, Martin Hensher, Jaithri Ananthapavan, Anand Bhopal, Andrea J MacNeill, Jodi D Sherman, Craig Mitton","doi":"10.1007/s40258-025-00980-x","DOIUrl":"https://doi.org/10.1007/s40258-025-00980-x","url":null,"abstract":"<p><p>The realities of ecosystem breakdown and climate change pose a significant threat to the health of individuals around the world, disproportionately affecting poor and vulnerable populations. Every sector in society, including healthcare, needs to be engaged in the tremendous collective effort and transformational change needed to limit global warming. We see priority setting as having a key role to play in reallocating existing budgets within healthcare systems whilst at the same time being used to facilitate sustainable and more efficient resource allocation across countries. Priority setting looks to fairly distribute resources with the goal of improving patient and population health outcomes. However, these goals can be broadened to include consideration of environmental impact based on our understanding of the necessity of emissions reduction to address the climate crisis and promote population health. In this paper, we introduce key concepts of priority setting and identify the interplay between priority setting and the realities of resource scarcity in the realm of planetary healthcare. We propose that applying priority-setting principles could serve at least three goals; (1) protect and improve health outcomes; (2) limit unnecessary and marginal care; and (3) facilitate a just transition to a sustainable healthcare system.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473839","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":"Health Technology Assessment and Environmental Impact: A Scoping Review of State of Art and Future Perspective.","authors":"Ippazio Cosimo Antonazzo, Giorgia Gribaudo, Lisa Ye, Pietro Ferrara, Lorenzo Losa, Paolo Abrate, Fabio Iraldo, Lorenzo Giovanni Mantovani, Paolo Angelo Cortesi","doi":"10.1007/s40258-025-00984-7","DOIUrl":"https://doi.org/10.1007/s40258-025-00984-7","url":null,"abstract":"<p><strong>Introduction: </strong>Manufacture, distribution, use, excretion, and disposal of health technologies all have environmental impacts (EIs). In the health technology assessment (HTA) definition, EI is recognized as a domain that should be assessed. However, EIs in HTA methods are lacking. The aim of this scoping review was to identify current advances and limitations in incorporating EI in HTA evaluation.</p><p><strong>Methods: </strong>We searched two databases, PubMed and Embase (01/01/2019-20/10/2023, updated on 15/05/2025), using the following keywords: \"HTA\" and \"environmental impact.\" Articles published in English were included. Additionally, no filters by study design or type of evaluated technology were used.</p><p><strong>Results: </strong>In total, 264 studies were screened after duplicates had been removed. Among them, 15 articles were included. Identified publications highlighted the necessity of robust and clear methods of EI assessment and its inclusion in the HTA process. Several authors have outlined the importance of assessing the EI of health technology throughout its life cycle, including raw materials, manufacturing, use, and disposal. However, the EI assessment in HTA presents significant challenges, such as determining a clear domain of EI, the perspective, and the time horizon for the assessment. EI assessment challenges also include the lack of disaggregated data on pollutant emissions and natural resource consumption, as well as recommendations on the use of the EI data by decision makers and HTA agencies. In the literature, different methods and approaches have been proposed to incorporate EI in HTA; some rely on already establish assessment methods (\"enriched\" cost-utility analysis, adjusted willingness to pay, and multicriteria decision analysis) and others proposed more specific approaches, such as \"information conduit,\" \"parallel evaluation,\" \"integrated evaluation,\" and \"environment-focused evaluation.\"</p><p><strong>Conclusion: </strong>HTA framework needs adjustments to incorporate environmental information, including environmental healthcare technology impact. Clear and robust methods on EI assessment and inclusion in the HTA process should be provided by HTA agencies and international societies. Further, manufacturers should improve the data generation on the EI of their products, with new studies able to generate individual-level data on environmental technology impact.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473838","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}