Applied Health Economics and Health Policy最新文献

{"title":"Using Patient and Public Involvement to Develop a Survey for Economic Evaluation in Dementia Research.","authors":"Gillian Eaglestone, Charlotte Stoner, Rosana Pacella, Paul McCrone","doi":"10.1007/s40258-026-01061-3","DOIUrl":"https://doi.org/10.1007/s40258-026-01061-3","url":null,"abstract":"<p><strong>Background: </strong>This methodological paper reflects on how people with lived experience of dementia contributed to the development and refinement of a survey intended to identify priorities for future economic evaluation in dementia research. Although Patient and Public Involvement (PPI) is increasingly recognised as essential for producing relevant and ethical health research, people living with dementia are rarely included in PPI activities related to health economics, where outcomes are often predetermined by decision-making bodies.</p><p><strong>Method: </strong>To support the development and refinement of the survey, a small bespoke PPI group comprising four individuals with lived experience in England reviewed draft survey materials through online meetings and helped ensure the survey was accessible and meaningful through feedback on survey clarity, accessibility, and response options.</p><p><strong>Results: </strong>PPI contributions led to important refinements, including simplifying terminology, removing ambiguous or burdensome items, and enhancing overall usability.</p><p><strong>Discussion: </strong>The findings demonstrated the significant value of involving PPI contributors early and collaboratively, showing that co-design approaches enrich the relevance and sensitivity of research tools. The experience also highlighted the need for tailored support and an accessible introduction to health economic concepts for PPI contributors, alongside broader participation across study stages and engagement in dissemination activities.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519829","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":"Active Transport Health Model: Valuing the Health Benefits of Active Transport","authors":"Mary Njeri Wanjau,&nbsp;Holger Möller,&nbsp;Christopher Standen,&nbsp;Fiona Haigh,&nbsp;J. Lennert Veerman","doi":"10.1007/s40258-026-01050-6","DOIUrl":"10.1007/s40258-026-01050-6","url":null,"abstract":"<div><h3>Background</h3><p>Active transport can increase physical activity at the population level, thereby improving population health. Knowing the health and related economic benefits of infrastructure measures that change physical activity may help underpin the case for investment, but valuing such benefits is challenging.</p><h3>Objective</h3><p>The aim of this study was to develop a model to estimate the health benefits of changes in active transport behaviour and translate these to an economic value. We applied the model to the state of New South Wales, Australia.</p><h3>Methods</h3><p>The The Active Transport Health Model\u0000 is a proportional multi-state lifetable model that quantifies the health impacts of changes in active transport behaviour over a population’s lifetime. Health outcomes related to physical activity, air pollution and road trauma are modelled. Model outputs include age- and sex-specific changes in disease incidence, prevalence and mortality, summarised as health-adjusted life-years, which are translated to monetary terms. Changes in healthcare costs are also modelled. Values per additional person-kilometres of walking and cycling are reported (in Australian dollars). A 5% discount rate is applied.</p><h3>Results</h3><p>Compared to car use, the health benefits for an additional person-kilometre walked are AU$4.41 (95% uncertainty interval AU$3.81–AU$5.05), and AU$2.42 (95% uncertainty interval AU$2.05–AU$2.76) for an additional person-kilometre cycled. This varies with various factors such as age and current physical activity level.</p><h3>Conclusions</h3><p>The Active Transport Health Model can be used to assess and value the health benefits of active transport. The monetary per-kilometre values in our study were higher than those of previous studies. This has important implications for infrastructure planning and guidelines on transport projects where monetised health benefits of physical activity are factored into cost-benefit analyses.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 5","pages":"841 - 856"},"PeriodicalIF":3.1,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-026-01050-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534822","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":"A Review of the Application of Generic Preference-Based Instruments with Older People Across Care Settings","authors":"Kiri Lay,&nbsp;Jenny Cleland,&nbsp;Jyoti Khadka,&nbsp;Rachel Milte,&nbsp;Julie Ratcliffe","doi":"10.1007/s40258-026-01060-4","DOIUrl":"10.1007/s40258-026-01060-4","url":null,"abstract":"<div><p>Global population ageing continues to place pressure on health and care systems. In Australia, the increasing integration of health and aged care systems is a rising policy approach to alleviating the burden on the health system and improving the quality of care for older people. Preference-based instruments (PBMs) have become increasingly important as a tool to enable quality assessment and economic evaluation of both health and aged care services. Given the changing policy context towards more integrated services and older peoples’ frequent movement across both health and aged care settings, it is important that PBMs are applicable across different care settings. This literature review aimed to assess the application of generic PBMs with older people across health and aged care settings. A systematic search of three databases for studies utilising PBMs with older people in health or aged care settings resulted in 204 articles included for review. The EQ-5D instruments were the most frequently utilised instrument across studies, followed by the Quality of Life-Aged Care Consumers (QOL-ACC). Most instruments were applied in either health or aged care settings, with few being used across both. The measurement of quality of life in older people across these settings using PBMs requires consideration of several issues particularly pertinent to this population, including the appropriateness, relevance and comprehensiveness of dimensions, the use of a suitable recall period and enabling self-report for people with cognitive impairment.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 5","pages":"809 - 823"},"PeriodicalIF":3.1,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-026-01060-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148496925","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 Cost Effectiveness of Treatment Strategies for Depression in Ethiopia: A Multiple Cohort Markov Model Analysis","authors":"Yared Belete Belay,&nbsp;Cathrine Mihalopoulos,&nbsp;Lidia Engel,&nbsp;Yong Yi Lee","doi":"10.1007/s40258-026-01055-1","DOIUrl":"10.1007/s40258-026-01055-1","url":null,"abstract":"<div><h3>Objectives</h3><p>This study aimed to evaluate the cost effectiveness of delivering treatment interventions for major depression among Ethiopian adults aged 18–64 years.</p><h3>Methods</h3><p>A multiple cohort Markov model was developed to simulate how population cohorts move between three health states over time: healthy, depression and dead. Three drug interventions (tricyclic antidepressants [TCAs], selective serotonin reuptake inhibitors [SSRIs] and serotonin norepinephrine reuptake inhibitors [SNRIs]), one non-pharmacological therapy (psychotherapy) and one combination therapy (drug plus psychotherapy) were compared to a common comparator, a partial null scenario. We modelled interventions for Ethiopians aged 18–64 years with major depression in 2021 (<i>n</i> = 2,431,898). The study employed a cost-utility analysis framework to estimate the incremental cost-effectiveness ratios (ICERs), expressed as a cost per quality-adjusted life year (QALY). The model was run over a 10-year period, adopted a health sector perspective to estimate population-level costs and benefits with a 3% annual discount rate. Uncertainty analysis was conducted using a Monte Carlo simulation with 3000 iterations.</p><h3>Results</h3><p>Psychotherapy was associated with incremental cost of US$17million (M) (95% CI US$9M–US$26M) and QALY gains of 11,857 (95% CI 125–35,227). In comparison, antidepressants, such as SNRIs, had a higher cost of US$236M (95% confidence interval [CI] US$132M–US$353M) with QALY gains of 15,369 (95% CI − 304 to 50,059). Combination therapy was associated with the highest health benefit (40,755 QALYs [95% CI − 210 to 124,928]) and incurred an incremental cost of US$162M (95% CI US$89M–US$244M). The ICER for psychotherapy was US$1,419 per QALY gained (95% CI US$344–US$22,433/QALY), suggesting cost effectiveness when adopting a one-times GDP per capita per QALY threshold. In contrast, combination therapy had an ICER of US$3,973/QALY (95% CI dominated to $63,677/QALY) and may be an appropriate option for individuals requiring both pharmacotherapy and psychotherapy. Conversely, drug therapies did not appear to be cost effective.</p><h3>Conclusions</h3><p>Psychotherapy appears to be a cost-effective intervention in Ethiopia, while combination therapy may be an alternative cost-effective option. However, access to psychotherapy and combination therapy in Ethiopia is currently restricted to hospitals and the private sector, largely due to a shortage of trained professionals such as clinical psychologists. To address this gap, policymakers should explore cost-effective strategies to expand the availability of psychotherapy services.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 5","pages":"909 - 924"},"PeriodicalIF":3.1,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-026-01055-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403274","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":"Action Plan to Better Approximate Reality in Cost-Effectiveness Analyses","authors":"Melanie D. Whittington,&nbsp;Jonathan D. Campbell","doi":"10.1007/s40258-026-01058-y","DOIUrl":"10.1007/s40258-026-01058-y","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 5","pages":"797 - 800"},"PeriodicalIF":3.1,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410041","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 Price of National Pharmaceutical Pricing in the EU: A Proposal for “Common Procurement”","authors":"Markus Frischhut,&nbsp;Simona Gamba,&nbsp;Laura Magazzini,&nbsp;Paolo Pertile","doi":"10.1007/s40258-026-01054-2","DOIUrl":"10.1007/s40258-026-01054-2","url":null,"abstract":"<div><p>Within the European Union (EU), pricing and reimbursement decisions for new medicines are the responsibility of individual Member States. The presence of many regulated prices for medicines within the EU single market drives strategic decisions by payers and manufacturers, resulting, among other things, in launch delays and unequal patient access across European countries. To increase equity in patient access, we propose strengthening collaboration on medicines procurement among Member States beyond emergency situations. Joint initiatives undertaken by groups of countries have demonstrated their potential to deliver benefits, and the need for common procurement initiatives has become apparent during the coronavirus disease 2019 (COVID-19) pandemic. We present our proposal within the context of the current European regulatory framework and the recently proposed “Critical Medicines Act”, emphasising the key legislative provisions that can be invoked to support a common procurement initiative. We also provide relevant, actionable options for designing such initiatives. Strong political commitment and agreement on equity and solidarity principles would be needed for the successful implementation of the proposal.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 5","pages":"801 - 808"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-026-01054-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366679","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 Price of Speed: Estimating the Impact of List Prices on Time to Availability of New Medicines in 18 European Countries","authors":"Afschin Gandjour","doi":"10.1007/s40258-026-01053-3","DOIUrl":"10.1007/s40258-026-01053-3","url":null,"abstract":"<div><h3>Objectives</h3><p>To examine whether higher national list prices for new medicines are associated with faster patient access across 18 European countries.</p><h3>Methods</h3><p>Data were drawn from the 2023 European Federation of Pharmaceutical Industries &amp; Associations (EFPIA) Patients Waiting to Access Innovative Therapies (WAIT) Indicator Survey and the Swedish TLV’s 2023 international price index. Time to availability was defined as the number of days between marketing authorisation and national reimbursement access. A multivariable linear regression model was applied, controlling for gross domestic product (GDP) per capita, population size, health technology assessment (HTA) duration, and the use of Managed Entry Agreements (MEAs). To address endogeneity, a two-stage least squares (2SLS) regression was conducted using a composite headquarters (HQ) Index as an instrumental variable for national list prices.</p><h3>Results</h3><p>In the multivariable model, each one-point increase in the list price index (European average = 100) was associated with a 7.9-day reduction in time to availability (<i>p</i> = 0.091). A slow HTA/reimbursement process was significantly associated with longer delays (<i>p</i> = 0.022). Managed entry agreement intensity was positively associated with longer delays but did not reach statistical significance (<i>p</i> = 0.103). In the 2SLS model, a one-point increase in the instrumented list price was associated with a 14.1-day reduction in access delays in the preferred parsimonious specification (<i>p</i> = 0.011). Sensitivity analyses showed that the negative association was generally preserved across alternative instrumental variable specifications and after exclusion of Poland, although effect sizes and first-stage strength varied.</p><h3>Conclusions</h3><p>Higher national list prices may be associated with faster patient access to new medicines in European markets. Although the findings are consistent with a possible causal effect, they should be interpreted with caution given the sensitivity of the estimates to specification and sample composition, as well as concerns about instrument validity and strength. The results highlight a potential policy trade-off between affordability and timely availability in pharmaceutical pricing and access frameworks.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 5","pages":"899 - 907"},"PeriodicalIF":3.1,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-026-01053-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148343774","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":"Deprescribing Interventions in Older Adults with Polypharmacy: A Systematic Review of Economic Evaluations","authors":"Josephine Aikpitanyi,&nbsp;Florence Pierrard,&nbsp;Catherine Pétein,&nbsp;Perrine Evrard,&nbsp;Anne Spinewine,&nbsp;Sandy Tubeuf","doi":"10.1007/s40258-026-01052-4","DOIUrl":"10.1007/s40258-026-01052-4","url":null,"abstract":"<div><h3>Background</h3><p>Deprescribing is increasingly promoted to address polypharmacy and medication-related harm in older adults. However, its economic value as a distinct intervention remains unclear, as prior reviews have often conflated deprescribing with broader medication optimisation strategies. This systematic review synthesises the economic evidence on deprescribing using a strict conceptual definition.</p><h3>Methods</h3><p>A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted from January 2000 to June 2025. Studies were included if they reported full economic evaluations (cost-effectiveness, cost-utility, cost-benefit, or cost-consequence analyses) of interventions explicitly involving medication discontinuation in adults aged ≥ 65 years. The methodological quality of included studies was assessed using the Consensus on Health Economic Criteria (CHEC) checklist, and reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 statement. Cost data were standardised to 2024 US dollars using purchasing power parity where feasible.</p><h3>Results</h3><p>Eight studies were included (two trial-based, six model-based). Deprescribing interventions targeting medications with well-established harm profiles, such as sedatives, non-steroidal anti-inflammatory drugs, and proton pump inhibitors (prolonged use), were most consistently cost-saving or dominant, primarily through reductions in adverse drug events. In contrast, evidence for antihypertensive deprescribing was limited and context dependent, with one model-based study suggesting potential long-term harms under specific assumptions. Across studies, economic outcomes were strongly influenced by intervention design and implementation, with structured, multi-component approaches demonstrating greater effectiveness. Quality assessment indicated generally robust methodological foundations but identified gaps in the handling of uncertainty, transparency in reporting, and the inclusion of broader cost components.</p><h3>Conclusion</h3><p>Deprescribing can represent good value for money when targeted to high-risk medications and supported by structured implementation strategies. Its economic value is not universal but depends on patient context, medication class, and intervention design. Future research should prioritise methodologically rigorous, transparent, and context-sensitive economic evaluations to inform policy and practice.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 5","pages":"825 - 840"},"PeriodicalIF":3.1,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248868","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":"Causal Impact of Primary Care and Publicly Funded Health Insurance on Catastrophic Health Spending From Climate-Sensitive Diseases in India","authors":"Divya Chaudhary,&nbsp;Indranil Mukhopadhyay","doi":"10.1007/s40258-026-01051-5","DOIUrl":"10.1007/s40258-026-01051-5","url":null,"abstract":"<div><h3>Background</h3><p>Universal health coverage has become central to health policy debates, particularly as a strategy to protect households from financial hardship and impoverishment related to out-of-pocket (OOP) spending. Many low- and middle-income countries (LMICs), including India, have relied predominantly on publicly funded health insurance (PFHI) to improve financial protection against OOP spending. PFHI generally covers low-frequency, high-cost hospitalization expenses, even though non-hospitalization expenses are the main contributors to OOP. Global evidence suggests that stronger primary health care (PHC) provision is crucial for reducing catastrophic health expenditure (CHE). This issue becomes particularly important in the context of climate-sensitive diseases (CSDs), whose incidence is increasing due to more frequent and extreme weather events, which may increase the risk of CHE.</p><h3>Objective</h3><p>This study estimates the causal impact of publicly provided PHC and PFHI on CHE arising from CSDs.</p><h3>Methods</h3><p>Using district-level data for all 640 Census districts in India, we applied propensity score matching and inverse probability weighting to compare the effects of PHC and PFHI on CHE associated with CSDs.</p><h3>Results</h3><p>The findings show that strengthened PHC substantially reduces OOP spending and CHE associated with CSDs, whereas PFHI shows no statistically significant effect.</p><h3>Conclusion</h3><p>These results highlight the need to prioritize climate-resilient PHC systems to address the escalating health impacts of climate change and advance equitable progress toward universal health coverage in LMICs.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 5","pages":"883 - 897"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136512","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 Economic Evaluations of Breast Cancer Screening Strategies: A Systematic Review Focusing on Methodology and Quality Assessment","authors":"Thi Hao Pham,&nbsp;Susan de Braak,&nbsp;Sjoukje van der Werf,&nbsp;Sudewi Mukaromah Khoirunnisa,&nbsp;Xuanqi Pan,&nbsp;Andre Pfob,&nbsp;Abrham Wondimu,&nbsp;Jurjen van der Schans,&nbsp;Maarten J. Postma,&nbsp;Antoinette D. I. van Asselt,&nbsp;Lisa A. de Jong","doi":"10.1007/s40258-026-01049-z","DOIUrl":"10.1007/s40258-026-01049-z","url":null,"abstract":"<div><h3>Background</h3><p>Breast cancer screening is vital for early detection and improved health outcomes but requires robust health economic evaluations to guide implementation. This systematic review examines the methodology, quality, and results of health economic evaluations of screening strategies to support decision making and future research.</p><h3>Methods</h3><p>A literature search was performed in PubMed, Embase, Web of Science, EconLit, and the HTA database. Health economic evaluations of breast cancer screening strategies using imaging modalities were included and screened independently by two reviewers. Data on study design, screening strategies, and outcomes were extracted and synthesized. Quality was assessed using the ISPOR checklist for model-based studies and the Consensus on Health Economics criteria (CHEC-extended) checklist for empirical data–based studies. All results were made publicly accessible via an interactive platform and the Open Science Framework, providing an open resource that facilitates transparency, reuse, and future updates.</p><h3>Results</h3><p>The review included 128 studies, comprising 96 model-based studies, 14 empirical data-based studies, 15 studies combining empirical data with extrapolation using a modeling approach, and 3 studies with unclear methods. Microsimulation and cohort simulation were used in 47 and 53 studies, respectively. Incremental cost-effectiveness ratios varied widely across studies depending on the screening modality, risk factors, age range of screening, and screening interval. Most studies found mammography to be cost effective compared with no screening, while some studies showed it as being not cost effective, especially for women at average risk of breast cancer, in young screening ages (40–49 years), or with an annual interval. Ultrasound-based screening programs were generally cost effective compared with no screening in the women with average risk of breast cancer. Supplementing magnetic resonance imaging (MRI) with mammography was generally cost effective in women with dense breasts and a family history of breast or ovarian cancer but not cost effective in women with previous treatment using radiation therapy. The median quality score was 55% for model-based studies, with microsimulations having higher quality than cohort simulations. Empirical data–based studies with and without extrapolation had a similar median quality score of 65%.</p><h3>Conclusions</h3><p>Mammography was generally reported as cost effective compared with no screening. Supplementing mammography with ultrasound and/or MRI could be cost effective depending on comparator, risk factors, age range, and screening interval. Suboptimal quality was commonly observed across published health economic evaluations. Future studies should prioritize enhancing overall quality, particularly in data, validation, and reporting.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 4","pages":"671 - 689"},"PeriodicalIF":3.3,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-026-01049-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052019","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}