Applied Health Economics and Health Policy最新文献

{"title":"Time-Driven Activity-Based Costing and Its Use in Health Economic Analysis: A Systematic Literature Review","authors":"Sangita Shakya,&nbsp;Shalika Bohingamu Mudiyanselage,&nbsp;Suzanne Robinson,&nbsp;Sean Randall,&nbsp;Lan Gao","doi":"10.1007/s40258-025-00988-3","DOIUrl":"10.1007/s40258-025-00988-3","url":null,"abstract":"<div><h3>Objectives</h3><p>With rising global healthcare expenditures, there is an increasing demand for value-based healthcare (VBHC). Time-driven activity-based costing (TDABC) has been proposed as a key component of VBHC for addressing cost-related challenges. This study aimed to review the application of TDABC in health economic analyses across the continuum of care, explore its methodological advantages, and assess adherence to the 7-step or 8-step methodological reporting frameworks.</p><h3>Methods</h3><p>This systematic review was conducted by screening the MEDLINE, Embase, and Scopus databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including all studies published until April 2025. Studies that used TDABC for diagnosis and treatment of health conditions were included, while costing studies involving any surgeries were excluded. The NVivo qualitative data analysis software was used to analyse data through content analyses.</p><h3>Results</h3><p>A total of 32 studies met inclusion criteria, including 25 partial economic evaluations (costing) and seven full economic evaluations (EEs). Time-driven activity-based costing was predominantly applied in cancer treatment and management, followed by diabetes care. This methodology proved applicable across all stages of healthcare, helping to accurately identify the cost of care and resource waste, enhancing value in healthcare, and overcoming the current cost accounting challenges. Studies that used hybrid data collection approaches combining direct observation with staff input were more likely to report detailed and actionable cost assessments. Studies using 8-step framework demonstrated improved methodological adherence and reduced reporting variability.</p><h3>Conclusions</h3><p>Time-driven activity-based costing supports more accurate, transparent, and resource-sensitive health economic analysis enabling informed decision making and system-level efficiency. Its application across diverse care stages and conditions demonstrates its adaptability and relevance for modern health-economic evaluation. Policy makers and healthcare providers should consider adopting TDABC to strengthen costing practices and advance the transition toward value-based healthcare.</p><h3>PROSPERO Registration Number</h3><p>ID CRD42023447085</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 6","pages":"989 - 1004"},"PeriodicalIF":3.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00988-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658186","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":"Reflecting Social Values in HTA Methods: A Case Study of South Africa","authors":"Peter Murphy,&nbsp;Celeste Holden,&nbsp;Yirui Qian,&nbsp;Simon Walker,&nbsp;Evelyn Thsehla,&nbsp;Susan Griffin","doi":"10.1007/s40258-025-00990-9","DOIUrl":"10.1007/s40258-025-00990-9","url":null,"abstract":"<div><h3>Background and Objective</h3><p>South Africa proposes the creation of a new health technology assessment (HTA) agency. In anticipation, the South African Values and Ethics for Universal Health Coverage (SAVE-UHC) value assessment framework has been created to make explicit the attributes of social value to inform priority setting. However, operationalising these values in an HTA process requires technical economic evaluation-based methods and little consideration has been given to appropriate approaches to determine these. We therefore used a novel pragmatic approach to identify economic evaluation methods to incorporate the SAVE-UHC value attributes in HTA methods.</p><h3>Methods</h3><p>We mapped the SAVE-UHC elements to value attributes described in an existing value assessment framework to help identify previously described methods. A survey of experts and a workshop were conducted to supplement the methods identified in the mapping. The combined results were compiled as a list of ways the SAVE-UHC elements could be measured, valued and incorporated into economic evaluation methods.</p><h3>Results</h3><p>The results revealed a comprehensive list of approaches to measuring and valuing the SAVE-UHC elements. The results were further categorised into health and the distribution of health, financial risk, healthcare utilisation, well-being, healthcare costs, performance indicators and constraints.</p><h3>Conclusions</h3><p>South Africa is in the process of institutionalising HTA to guide prioritisation of new healthcare technologies. This research presents a wide range of methods that could be used in South Africa to implement SAVE-UHC. The approach could also be used in other countries seeking to implement their own value assessment frameworks and identify appropriate methods to incorporate them in HTA processes.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 6","pages":"977 - 987"},"PeriodicalIF":3.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00990-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636010","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":"Funding Health Promotion Activities to Reduce Avoidable Hospital Admissions in Frail Older Adults (HomeHealth): Further Challenges to the “Cost-Effective but Unaffordable” Paradox","authors":"Rachael Maree Hunter,&nbsp;Rachael Frost,&nbsp;Sarah Kalwarowsky,&nbsp;Louise Marston,&nbsp;Shengning Pan,&nbsp;Cristina Avgerinou,&nbsp;Andrew Clegg,&nbsp;Claudia Cooper,&nbsp;Vari M. Drennan,&nbsp;Benjamin Gardner,&nbsp;Claire Goodman,&nbsp;Pip Logan,&nbsp;Dawn A. Skelton,&nbsp;Kate Walters","doi":"10.1007/s40258-025-00987-4","DOIUrl":"10.1007/s40258-025-00987-4","url":null,"abstract":"<div><h3>Introduction</h3><p>Health promotion initiatives are often promoted as being worth the investment given future cash-savings. This paper uses the findings of HomeHealth, a health promotion service for older adults with mild frailty, to examine how economic evaluation relates to local decision making in England.</p><h3>Methods</h3><p>The HomeHealth trial randomised 388 participants aged 65+ years with mild frailty to receive HomeHealth (195 participants) or treatment as usual (193 participants). Health and social care resource use and carer time were self-completed at baseline, 6 months and 12 months. Primary and secondary healthcare resource use and medications were collected from patient files at 12 months post recruitment, covering the past 18 months. Stakeholders including commissioners were consulted on the results of the trial and budget impact.</p><h3>Results</h3><p>Participants allocated to HomeHealth had a significant reduction in emergency hospital admissions at 12 months (incident rate ratio (IRR) 0.65; 95% confidence interval (CI) 0.45–0.92) and unpaid carer hours at 6 months (− 16 h (95% CI − 18 to − 14 h) or − £360 (95% CI − 369 to − 351) per patient). Although the intervention is cost saving overall due to fewer emergency admissions, at a cost of £457 per patient commissioners do not have the budget to fund it.</p><h3>Discussion</h3><p>This case study illustrates the problem with using standard economic evaluation methods to argue for implementation of health promotion initiatives in publicly financed healthcare systems. Although HomeHealth resulted in reduced emergency admissions and may be cost saving to the system as a whole, it is not locally cash releasing. Health promotion initiatives are unlikely to be funded from local budgets without significant system-wide changes.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 6","pages":"1099 - 1113"},"PeriodicalIF":3.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00987-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590319","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 Impact of Alteplase Coverage on Health Equity for the Treatment of Ischemic Stroke in the USA: A Distributional Cost-Effectiveness Analysis","authors":"Thomas Majda,&nbsp;Elizabeth S. Mearns,&nbsp;Stacey Kowal","doi":"10.1007/s40258-025-00985-6","DOIUrl":"10.1007/s40258-025-00985-6","url":null,"abstract":"<div><h3>Objectives</h3><p>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><h3>Methods</h3><p>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><h3>Results</h3><p>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><h3>Conclusions</h3><p>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></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 6","pages":"1057 - 1072"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00985-6.pdf","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":"OA","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,&nbsp;Lydia Kapiriri,&nbsp;Ole F. Norheim,&nbsp;Ingrid Cardoso Couto de Azevedo,&nbsp;Dan Kim,&nbsp;Martin Hensher,&nbsp;Jaithri Ananthapavan,&nbsp;Anand Bhopal,&nbsp;Andrea J. MacNeill,&nbsp;Jodi D. Sherman,&nbsp;Craig Mitton","doi":"10.1007/s40258-025-00980-x","DOIUrl":"10.1007/s40258-025-00980-x","url":null,"abstract":"<div><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></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 6","pages":"935 - 945"},"PeriodicalIF":3.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00980-x.pdf","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":"OA","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,&nbsp;Giorgia Gribaudo,&nbsp;Lisa Ye,&nbsp;Pietro Ferrara,&nbsp;Lorenzo Losa,&nbsp;Paolo Abrate,&nbsp;Fabio Iraldo,&nbsp;Lorenzo Giovanni Mantovani,&nbsp;Paolo Angelo Cortesi","doi":"10.1007/s40258-025-00984-7","DOIUrl":"10.1007/s40258-025-00984-7","url":null,"abstract":"<div><h3>Introduction</h3><p>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><h3>Methods</h3><p>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><h3>Results</h3><p>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><h3>Conclusion</h3><p>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></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 6","pages":"1027 - 1038"},"PeriodicalIF":3.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00984-7.pdf","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trump’s Drug Pricing Order and the Domestic Economic Trade-Off","authors":"Afschin Gandjour","doi":"10.1007/s40258-025-00986-5","DOIUrl":"10.1007/s40258-025-00986-5","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 5","pages":"755 - 758"},"PeriodicalIF":3.3,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00986-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324350","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":"Real-World Health and Economic Effects of a Large-Scale Outpatient Screening and Continuing Care Programme for Early Detection and Care of Microvascular Complications in Patients with Type 2 Diabetes Implemented in Routine Care Across Germany: A Quasi-Experimental Study Using Health Insurance Claims Data","authors":"Min Fan,&nbsp;Anna-Janina Stephan,&nbsp;Michael Hanselmann,&nbsp;Andreas Lueg,&nbsp;Michael Laxy","doi":"10.1007/s40258-025-00978-5","DOIUrl":"10.1007/s40258-025-00978-5","url":null,"abstract":"<div><h3>Aim</h3><p>The aim of this study was to analyse the real-world health and economic effect of an outpatient screening and continuing-care programme for early detection and care of microvascular complications in patients with type 2 diabetes (T2D) delivered through a selective contract between a large statutory health insurance company and ambulatory care physicians in the German health care system.</p><h3>Methods</h3><p>Building on methods of target trial emulation and programme impact evaluation, we used a quasi-experimental approach and health insurance claims data from 790,375 patients with T2D over a time horizon of 5.75 years. We applied a two-stage matching approach in which we exploited the staggered implementation of the selective contract across federal states in Germany to control for selection bias at the physician level and used propensity scores to control for selection bias at the patient level, where we considered socio-demographic, health consciousness-related, care-related, and comorbidity-related potential confounders in the matching process.</p><h3>Results</h3><p>Within a matched sample of 16,490 patients, over 1 year, enrolment into the programme increased the number of visits to primary care physicians (relative risk [RR]: 1.09, 95% confidence interval [CI] 1.07, 1.10), increased the frequency of prescriptions for sodium-glucose cotransporter-2 (SGLT2) inhibitors (RR: 1.30, 95% CI 1.12, 1.50) and for statins (RR: 1.08, 95% CI 1.03, 1.13) and decreased the risk of hospitalisations (RR: 0.88, 95% CI 0.84, 0.92). Outpatient costs in the enrolled patients were on average 14% (cost ratio: 1.14, 95% CI 1.09, 1.20) or €194.4 higher, but overall, the programme was budget neutral over a time horizon of 1 year.</p><h3>Conclusion</h3><p>Investing in secondary prevention to detect and manage the early stages of microvascular complications is likely a cost-effective or cost-saving approach to improve health in patients with T2D.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 6","pages":"1039 - 1055"},"PeriodicalIF":3.3,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00978-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324349","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":"Discrete Event Simulation in R using the ‘Simmer’ Package for Health Economic Modelling: A Tutorial and Illustration in Colon Cancer","authors":"Koen Degeling,&nbsp;Jonathan Karnon,&nbsp;Michiel van de Ven,&nbsp;Alan Brennan,&nbsp;Hendrik Koffijberg","doi":"10.1007/s40258-025-00983-8","DOIUrl":"10.1007/s40258-025-00983-8","url":null,"abstract":"<div><p>Discrete event simulation (DES) provides enhanced flexibility over modelling techniques that have been traditionally used for assessing health-economic outcomes, making it a particularly interesting technique for modelling complex clinical pathways. Discrete event simulation also facilitates consideration of resources and capacity constraints, making it suitable for addressing a wide range of research questions in health care and beyond. However, those unfamiliar with DES often perceive it to be more complex compared to traditional health-economic modelling techniques, such as state-transition modelling. To address this perceived complexity, this tutorial provides a detailed illustration of implementing DES in the open-source R software using the simmer package, through a case study in colon cancer. The tutorial is aimed at those who have a conceptual model that they want to implement as a DES in R, and are looking for practical guidance. It discusses methodological aspects related to DES and individual-level modelling in general that have not been extensively covered in literature, the conceptual model structure and corresponding pseudocode, data analysis, model implementation, and the deterministic and probabilistic analysis of the model. The documented code provides all building blocks required to develop a wide range of DES models in R using the simmer package.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 6","pages":"961 - 975"},"PeriodicalIF":3.3,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00983-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315797","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 of a Universal School-Based Mental Health Prevention Program: An Economic Modeling Study in a Limited Income Context","authors":"Ha T. Nguyen,&nbsp;Anh Q. Nguyen,&nbsp;Nga T. Nguyen,&nbsp;Nga L. La,&nbsp;Thach Tran,&nbsp;Astrid Wurfl,&nbsp;Jayne Orr,&nbsp;Hau Nguyen,&nbsp;Ian Shochet,&nbsp;Jane Fisher,&nbsp;Huong T. Nguyen","doi":"10.1007/s40258-025-00982-9","DOIUrl":"10.1007/s40258-025-00982-9","url":null,"abstract":"<div><h3>Objective</h3><p>This study aims to evaluate the cost-effectiveness of a school-based mental health prevention program in a limited income context to inform investment decisions.</p><h3>Methods</h3><p>The Resourceful Adolescent Program, an evidence-based resilience intervention designed for adolescents, was culturally adapted as Happy House (HH) in a two-arm, controlled trial in selected high schools in Vietnam. A Markov model assessed HH’s cost-effectiveness in preventing depression compared with doing nothing from a societal perspective over 5-year, 10-year, and lifetime horizons. The model underwent face, internal, and cross-validation with experts in health economics, mental health, and education. Effect size was drawn from the HH trial, utility values from an EuroQol 5-Dimension 5-Level (EQ-5D-5L) survey of 1004 adolescents and systematic reviews, and costs from the HH trial and Vietnam data. Incremental cost-effectiveness ratios (ICERs) were expressed in 2020 Vietnamese dong (VND) per quality-adjusted life year (QALY) gained, with costs and benefits discounted at 3%. Sensitivity analyses and a scenario on nationwide HH scaling were also conducted.</p><h3>Results</h3><p>Compared with do-nothing, HH had ICERs of 43.8 million VND (US $5512), 30.4 million VND (US $3831), and 22.9 million VND (US $2886) per QALY gained over 5-year, 10-year, and lifetime horizons, respectively. Nationwide scaling reduced ICERs to 27.6 million VND (US $3470), 18.8 million VND (US $2370), and 13.5 million VND (US $1698) per QALY over the same periods. ICERs were sensitive to changes in effect size, disease incidence, and intervention costs. Sensitivity analyses demonstrated that the results were robust despite parameter uncertainty and variations in key assumptions</p><h3>Conclusions</h3><p>Investing in a universal school-based mental health prevention program is cost-effective compared with doing nothing in a limited income context such as Vietnam. Scaling up HH implementation amidst rising depression incidence further enhances the cost-effectiveness of this investment.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 6","pages":"1085 - 1098"},"PeriodicalIF":3.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265120","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}