Applied Health Economics and Health Policy最新文献

{"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}

{"title":"Trump's Drug Pricing Order and the Domestic Economic Trade-Off.","authors":"Afschin Gandjour","doi":"10.1007/s40258-025-00986-5","DOIUrl":"https://doi.org/10.1007/s40258-025-00986-5","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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, Anna-Janina Stephan, Michael Hanselmann, Andreas Lueg, Michael Laxy","doi":"10.1007/s40258-025-00978-5","DOIUrl":"https://doi.org/10.1007/s40258-025-00978-5","url":null,"abstract":"<p><strong>Aim: </strong>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><p><strong>Methods: </strong>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><p><strong>Results: </strong>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><p><strong>Conclusion: </strong>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>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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, Jonathan Karnon, Michiel van de Ven, Alan Brennan, Hendrik Koffijberg","doi":"10.1007/s40258-025-00983-8","DOIUrl":"https://doi.org/10.1007/s40258-025-00983-8","url":null,"abstract":"<p><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>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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, Anh Q Nguyen, Nga T Nguyen, Nga L La, Thach Tran, Astrid Wurfl, Jayne Orr, Hau Nguyen, Ian Shochet, Jane Fisher, Huong T Nguyen","doi":"10.1007/s40258-025-00982-9","DOIUrl":"https://doi.org/10.1007/s40258-025-00982-9","url":null,"abstract":"<p><strong>Objective: </strong>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><p><strong>Methods: </strong>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><p><strong>Results: </strong>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 CONCLUSIONS: 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>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"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}

{"title":"Selection and Prioritization of Medical Devices for HTA Evaluation: A Systematic Review of Existing Approaches.","authors":"João Félix Pimenta, Ana C L Vieira","doi":"10.1007/s40258-025-00981-w","DOIUrl":"10.1007/s40258-025-00981-w","url":null,"abstract":"<p><strong>Background: </strong>Efficient resource allocation in the health technology assessment process of medical devices requires a robust selection and prioritization of medical devices for evaluation. Despite its importance, there is currently no generally accepted approach for such a prioritization task, and a comprehensive review of adaptable approaches is needed.</p><p><strong>Objective: </strong>Our study aimed to provide a comprehensive review of existing approaches that could be used or adapted to select and prioritize medical devices for health technology assessment (HTA) evaluation.</p><p><strong>Methods: </strong>Searches were conducted in PubMed, Web of Science, Scopus, and the databases of the International Network of Agencies for Health Technology Assessment and the Centre for Reviews and Dissemination. Following the screening, analyses and comparisons were based on data such as publication year, target jurisdiction, decision context, health technology focus, methods used for value assessment and included attributes, and the social methods used for stakeholder engagement.</p><p><strong>Results: </strong>From 1055 identified records, 51 studies were eligible for review. Only 31 records mentioned the value assessment method used and, although there was a wide variety of techniques found in this sample, the majority of them (77%) applied multicriteria decision analysis. A total of 22 studies were specifically focused on HTA prioritization and, within this set, the most frequently used value attributes were Clinical efficacy and/or effectiveness (n = 21, 95%), Impact of the disease (n = 13, 59%), and Ethical, social and legal aspects (n = 11, 50%). Social methods commonly implemented were questionnaires/surveys and the Delphi technique, with 15 and 7 reported applications, respectively.</p><p><strong>Conclusions: </strong>A wide variety of methods have been reported to assess value in HTA contexts, and our premise that a generally accepted approach for prioritizing medical devices for HTA is still lacking was confirmed. Despite such heterogeneity, it was noticed that a multicriteria decision analysis is predominantly applied, with both intervention- and disease-related attributes being considered. Underreporting of the approaches used was recurrent, which should be avoided in the future to ensure their transparency and replicability.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246096","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-Effectiveness of Initiating Patients on Home Dialysis Compared with In-Centre Haemodialysis.","authors":"Harry Hill, James Fotheringham, Jessica Potts, Ivonne Solis-Trapala, Mark Lambie, Sarah Damery, Kerry Allen, Allan Wailoo, Iestyn Williams, Simon Davies","doi":"10.1007/s40258-025-00976-7","DOIUrl":"https://doi.org/10.1007/s40258-025-00976-7","url":null,"abstract":"<p><strong>Objectives: </strong>Kidney failure can be treated at home with peritoneal dialysis or home haemodialysis. The combination of reduced staffing, transport and overhead costs and improved quality of life through treatment at home could make initiating dialysis at home highly cost-effective. The primary objective is to estimate the cost-effectiveness of initiating patients on home dialysis therapy (HDT) compared with in-centre haemodialysis (ICHD). The secondary objective is to determine the upper limit of net benefit from removing potential service barriers within dialysis centres that hinder the adoption of HDT.</p><p><strong>Method: </strong>A multistate model using UK Renal Registry data combined with national survey data was developed to estimate patient and dialysis centre influences on dialysis treatment modality changes and the duration in each modality. These are used as inputs to a microsimulation estimating the lifetime quality-adjusted life years (QALYs) and UK National Health Service (NHS) costs incurred for patients, the cost-effectiveness of HDT compared with ICHD and the differences in costs and health outcomes associated with removing specific barriers to HDT uptake.</p><p><strong>Results: </strong>Commencing HDT compared with ICHD resulted in 0.30 additional QALYs and saved Great British (GB) £15,272. HDT has an 82% probability of being cost-effective. Implementing quality-improvement initiatives and alleviating stresses on staff capacity are identified as influential in the multistate model. Addressing these led to QALY gains of 0.22 and 0.08 and cost increases of GB £10,059 and GB £5127 from an increase of life years lived of 0.54 and 0.22, respectively.</p><p><strong>Conclusions: </strong>Initiating patients on HDT is cost-effective compared with ICHD. Alleviating stresses on staff capacity and implementing quality improvement initiatives in dialysis centres leads to health improvements, although these changes are not cost-effective owing to the associated increase in healthcare costs.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140983","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":"Using a Markov Model and Real-World Evidence to Identify the Most Cost-Effective Cholesterol Treatment Escalation Threshold for the Secondary Prevention of Cardiovascular Disease.","authors":"Alfredo Mariani, Syed Mohiuddin, Patrick Muller, Eleanor Samarasekera, Sharon A Swain, Joseph Mills, Riyaz Patel, David Preiss, Eduard Shantsila, Beatrice C Downing, Michael Lonergan, Shaun Rowark, Nicky J Welton, Rachael Williams, David Wonderling","doi":"10.1007/s40258-025-00977-6","DOIUrl":"https://doi.org/10.1007/s40258-025-00977-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Despite the decreased risk of cardiovascular disease (CVD) with statins, there remains an unfulfilled clinical need to prevent CVD events and premature mortality through further cholesterol-modifying interventions. In people with established CVD taking a statin, lipid therapy escalation to reduce low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C) levels may lower the risk of CVD hospital admissions and improve survival. However, the cost-effectiveness of different cholesterol treatment escalation thresholds is uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to identify the most cost-effective cholesterol threshold for escalating lipid therapy in people with established CVD who are taking a statin, to support the 2023 update of the NICE guideline on CVD in England.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cohort Markov model with a yearly cycle length was developed to compare the lifetime costs and quality-adjusted life years (QALYs) of various LDL-C treatment escalation thresholds (0-4.0 mmol/L), using a combination of treatment effects from an original network meta-analysis of randomised controlled trials (RCTs), real-world data for estimating baseline cholesterol levels and CVD event rates from a published meta-analysis of statin RCTs. The model used the following CVD events: ischaemic stroke; transient ischaemic attack; peripheral artery disease; myocardial infarction; unstable angina; coronary revascularisation; and mortality. The model also used evidence-based estimates of resource use and costs, and published quality of life data. Baseline LDL-C levels and CVD hospital admission rates were estimated through a bespoke analysis of the English primary care data from Clinical Practice Research Datalink (CPRD), linked to Hospital Episode Statistics Admitted Patient Care (HES) and Office for National Statistics (ONS) death registrations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Data from 590,917 adult individuals (61.7% men) with CVD on a statin in primary care between 1 January 2013 and 28 February 2020 were included in the CPRD-HES-ONS analysis. The most cost-effective threshold for lipid therapy escalation was an LDL-C of 2.2 mmol/L (or equivalent non-HDL-C of 2.9 mmol/L) at NICE's lower cost per QALY of £20,000. An LDL-C of 2.0 mmol/L (or equivalent non-HDL-C of 2.6 mmol/L) was the most cost-effective treatment escalation threshold in a significant proportion (38%) of probabilistic simulations and produced more health. At this threshold, the model predicted that 42% of people with CVD would require combination therapy with ezetimibe while 19% would require an injectable drug such as inclisiran. At NICE's upper cost per QALY of £30,000, the most cost-effective LDL-C treatment escalation threshold was 1.7 mmol/L (or equivalent non-HDL-C of 2.2 mmol/L).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The results demonstrate the importance of establishing evidence of cost-effectiv","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144135927","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":"Comment on: \"Comparison of Caregiver and General Population Preferences for Dependency‑Related Health States\".","authors":"Sadia Farhana","doi":"10.1007/s40258-025-00973-w","DOIUrl":"https://doi.org/10.1007/s40258-025-00973-w","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075494","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":"Authors' Reply to Sadia Farhana's Comment on: \"Comparison of Caregiver and General Population Preferences for Dependency-Related Health States\".","authors":"Eva Rodríguez-Míguez, Antonio Sampayo","doi":"10.1007/s40258-025-00974-9","DOIUrl":"https://doi.org/10.1007/s40258-025-00974-9","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075438","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}