Applied Health Economics and Health Policy最新文献

{"title":"Antimicrobial Resistance (AMR) Development Map: A Conceptual Map and a Tool to Support Economic Evaluation of AMR Interventions.","authors":"Kristina Aluzaite, Marta O Soares, Catherine Hewitt, William Hope, Julie Robotham, Beth Woods","doi":"10.1007/s40258-025-00969-6","DOIUrl":"https://doi.org/10.1007/s40258-025-00969-6","url":null,"abstract":"<p><strong>Introduction: </strong>Antimicrobial resistance (AMR) is a complex, inter-sectoral and international problem. Economic evaluation (EE) methods offer systematic, evidence-driven approaches to inform policy decisions about which AMR interventions to fund. EE of AMR interventions is complicated owing to diffuse effects, complex mechanics of the problem and high levels of uncertainty. Current AMR EE literature restricts the analytical scope, potentially resulting in omissions of effects that may limit the utility of EE to inform policy decisions. We aimed to systemise the key evolutionary and ecological processes of AMR to elucidate the paths through which AMR interventions impact population health and healthcare costs to support EE design and to support decision makers in understanding the limitations of EE evidence for decision-making.</p><p><strong>Methods: </strong>A conceptual map and a corresponding tool were developed on the basis of a literature review in consultation with experts across the relevant disciplines of molecular biology, infectious disease modelling, health economics and ecology.</p><p><strong>Results: </strong>The AMR development map: (1) distils the key AMR processes and process drivers behind AMR development and maps the available types of AMR interventions to AMR process drivers; (2) proposes a way to conceptualise the spatial scope of analysis through considering the connectivity of the wider ecosystem and (3) outlines the key dimensions that AMR burden and intervention effects could be measured across. An AMR development map tool was developed to support conceptual modelling, with the focus on the choice of scope in the EE of AMR interventions, and an illustrative case study was provided.</p><p><strong>Discussion: </strong>This work summarises the key underlying biological principles of AMR development to provide mechanistical grounding for considering the scope of effects of AMR interventions and the appropriate system of analysis to support conceptual modelling in EE of AMR interventions. In addition, this map can facilitate the identification of effects that cannot be considered or quantified, thus enabling transparency about these omissions within decision-making.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970301","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 Elective Surgical Procedures with Longer NHS Waiting Lists: A Targeted Review.","authors":"Laura A Trigg, Caroline Farmer, Madhusubramanian Muthukumar, Edward C F Wilson, Alan Lovell, Dawn Lee","doi":"10.1007/s40258-025-00975-8","DOIUrl":"https://doi.org/10.1007/s40258-025-00975-8","url":null,"abstract":"<p><strong>Objectives: </strong>Our aim was to review the evidence for the cost effectiveness of elective surgeries with long waiting lists within the NHS in England. This is to inform understanding of national spending priorities in the context of significant demand for elective surgeries and to inform the debate on appropriate cost-effectiveness thresholds across healthcare decision making.</p><p><strong>Methods: </strong>We conducted a targeted literature review to identify published cost-effectiveness analyses for nine elective procedures with long waiting lists in the NHS, selected based on previous reviews. These were percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), hysterectomy, cholecystectomy, knee replacement, groin hernia repair, hip replacement, prostatectomy, and cataract surgery. We made comparisons adjusted for currency and price year (2024).</p><p><strong>Results: </strong>We identified 21 evaluations; in these, the cost effectiveness of surgeries was compared with no surgery (n = 9), medical management (n = 5), and between early and delayed surgery (n = 10). The evaluations reported that almost all procedures would be considered cost effective yielding incremental cost-effectiveness ratios (ICERs) below £20,000 per quality-adjusted life-year gained. Cholecystectomy, prostatectomy, hip and knee replacement surgeries were associated with ICERs of between £5,000 and £10,000.</p><p><strong>Conclusions: </strong>These findings offer insights for policymakers on optimising finite healthcare resources, particularly post-COVID-19, with surgical waiting lists a priority for the NHS. Prioritising these elective procedures is likely to be a highly cost-effective use of NHS resources. Allocation of investment to areas that are more cost effective than others is likely to increase the efficiency of the NHS, resulting in a net health gain compared with the reimbursement of less cost-effective interventions.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961715","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":"Aggregate Distributional Cost-Effectiveness Analysis of Biologics for the Treatment of Ankylosing Spondylitis in Chile.","authors":"Magdalena Walbaum, Nicolas Jana-Valencia","doi":"10.1007/s40258-025-00972-x","DOIUrl":"https://doi.org/10.1007/s40258-025-00972-x","url":null,"abstract":"<p><strong>Background and objective: </strong>Ankylosing spondylitis is a complex rheumatic disease, characterised by chronic and progressive inflammation of the spine, causing an important health and economic burden for the person with the condition. Evidence shows the unequal impact of the disease in different groups of people, with a higher burden for lower socioeconomic groups. The objective of this study is to evaluate the impact of the use of biologics for the treatment of ankylosing spondylitis on health inequities in Chile.</p><p><strong>Methods: </strong>We conducted an aggregate distributional cost-effectiveness analysis. Data on health outcomes and costs were derived from a cost-effectiveness model of secukinumab, etanercept, certolizumab pegol, infliximab, adalimumab and golimumab versus treatment as usual for the treatment of ankylosing spondylitis from the Chilean healthcare system perspective. Health gains and health opportunity costs were distributed across socioeconomic subgroups. Health and equity impacts, measured using the Atkinson index, were assessed on an equity-efficiency impact plane.</p><p><strong>Results: </strong>All treatments had a positive impact on equity relative to treatment as usual. At an opportunity cost threshold of 1 Gross Domestic Product per capita/quality-adjusted life-year, secukinumab improved societal welfare irrespective of the Atkinson index value. When varying thresholds (2 and 3 Gross Domestic Product), all assessed technologies contributed to an increase in societal welfare, regardless of the Atkinson index.</p><p><strong>Conclusions: </strong>Biologic treatment for ankylosing spondylitis, such as secukinumab, may reduce health inequity in the Chilean population. An aggregate distributional cost-effectiveness analysis framework is feasible to implement alongside a cost-effectiveness analysis in the context of the Chilean healthcare system to provide additional information of equity impacts for health technology assessment recommendations and policy making.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962073","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 Analysis of Evolocumab or Inclisiran in Combination with Statins Versus Statin Monotherapy Among Patients with ASCVD in China.","authors":"Pengpeng Wang, Le Liang, Yamei Li","doi":"10.1007/s40258-025-00971-y","DOIUrl":"https://doi.org/10.1007/s40258-025-00971-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objective: &lt;/strong&gt;Several innovative proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been approved for combination lipid-lowering therapy in China. Compared with their high initial launch prices, some PCSK9 inhibitors have been subjected to the National Drug Price Negotiation (NDPN) policy with substantial price reductions, such as a 78.14% reduction for evolocumab (EVO). Others, such as inclisiran (INC), have not been included in this policy and maintain high prices. This study aimed to: (1) assess the cost-effectiveness of representative PCSK9 inhibitors (EVO and INC) in combination with statins versus statin monotherapy for Chinese patients with atherosclerotic cardiovascular disease (ASCVD), and (2) evaluate the influence of the NDPN policy on cost-effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A Markov model was developed from the Chinese healthcare system perspective. Atorvastatin monotherapy was used as the standard of care (SOC), and the combinations of EVO or INC with SOC were employed as the intervention regimens. The transition probabilities and treatment effects were based on the Asian subgroup of the FOURIER trial and pooled analysis of the ORION-8, -9, and -10 trials, or calculated with results from a meta-analysis. Costs and utilities were derived from published literature or calculated with methods from literature and assumptions. Sensitivity and scenario analyses were conducted to evaluate the robustness of the model and the influence of the NDPN policy. Finally, the cost threshold analyses were conducted to estimate the annual costs required for EVO and INC to achieve a 75% probability of cost-effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The base-case incremental cost-effectiveness ratios (ICERs) of EVO + SOC and INC + SOC were 168,066 Chinese yuan (CNY) [23,652 US dollars (USD)] and 586,119 CNY (82,485 USD) per quality-adjusted life year (QALY), respectively. At WTP thresholds of three and one times GDP per capita (268,200 CNY [37,744 USD] and 89,400 CNY [12,581 USD]) per QALY gained, the probabilities that the intervention regimens were cost-effective would be 89.86% and 0.30% for EVO + SOC and 0.54% and 0% for INC + SOC, respectively. To achieve a 75% probability of cost-effectiveness, the required annual costs would be 9851 CNY (1386 USD) and 3434 CNY (483 USD) for EVO and 6554 CNY (922 USD) and 2096 CNY (295 USD) for INC, respectively. When the price reduction caused by the NDPN policy was removed from EVO and added to INC (assuming that the price of INC also reduces by 78.14%), the ICERs were 782,954 CNY (110,185 USD) and 130,877 CNY (18,418 USD) per QALY, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;With the intervention of the NDPN policy, EVO + SOC has been a cost-effective option for Chinese patients with ASCVD at the WTP threshold of three times GDP per capita. However, INC + SOC is not a cost-effective regimen at the current price, and the NDPN policy may be an","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968647","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 Health Economics of Genomic Technologies: A Growing Evidence Base on Value","authors":"James Buchanan,&nbsp;Ilias Goranitis,&nbsp;Deirdre Weymann","doi":"10.1007/s40258-025-00970-z","DOIUrl":"10.1007/s40258-025-00970-z","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 3","pages":"331 - 335"},"PeriodicalIF":3.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00970-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143908740","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":"Measurement Properties of the EQ-5D Instruments in Children and Adolescents: A Systematic Review.","authors":"Caique de Melo do Espirito Santo, Verônica Souza Santos, Alessandro Chiarotto, Gisela Cristiane Miyamoto, Tiê P Yamato","doi":"10.1007/s40258-025-00953-0","DOIUrl":"https://doi.org/10.1007/s40258-025-00953-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The EQ-5D instruments have been widely used to measure health-related quality of life (HRQoL) in child and adolescent populations, especially the EQ-5D-Y-3L and EQ-5D-Y-5L (beta version). Although not specifically designed for younger users, the adult versions (EQ-5D-3L and EQ-5D-5L) are also used in these populations. While the measurement properties of these instruments have been evaluated in children and adolescents, no systematic review to date has employed a rigorous method to assess risk of bias. Additionally, quality criteria for good measurement properties and certainty of evidence have not been thoroughly evaluated. The aim of this study was to summarize and critically appraise the evidence on the measurement properties of all EQ-5D instruments in children and adolescents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted electronic searches on MEDLINE, EMBASE, CINAHL, EconLit, National Health Service Economic Evaluation Database (NHS-EED), and Health Technology Assessment (HTA) databases up to May 2024. We included studies measuring HRQoL using either the self-reported or proxy-reported version of the EQ-5D instruments-EQ-5D-3L, EQ-5D-5L, EQ-5D-Y-3L, and EQ-5D-Y-5L-using the descriptive system, visual analogue scale, and/or utility score in children and adolescents up to 19 years of age, and that tested at least one measurement property (e.g., reliability). The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology was followed to assess risk of bias, to score results for measurement properties, and to perform an evidence synthesis using a modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From 3586 records identified through the search, 65 studies were included in this systematic review. We found moderate certainty of evidence of sufficient comprehensibility and comprehensiveness of the EQ-5D-Y-3L and EQ-5D-Y-5L. Furthermore, we found very low certainty of evidence of inconsistent relevance for the EQ-5D-Y-3L, whereas the EQ-5D-Y-5L had sufficient relevance. Almost all the measurement properties (reliability, hypothesis testing for construct validity, and responsiveness) considering all the EQ-5D versions ranged from moderate certainty of evidence of insufficient results to very low certainty of evidence of insufficient results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;There is moderate certainty of evidence that the EQ-5D-Y-3L and EQ-5D-Y-5L have sufficient content validity. Both instruments can be recommended to measure HRQoL in children and adolescents aged 8-15 years. However, most of the measurement properties across all EQ-5D versions showed insufficient results, with certainty of evidence ranging from moderate to very low due to inconsistency and doubtful to inadequate risk of bias. Therefore, further research is needed to improve the methodological quality of studies on EQ-5D instruments ","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957202","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":"Financial Viability of Private Hospitals Operating Under India's National Health Insurance Scheme Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB PM-JAY).","authors":"Gaurav Jyani, Praveen Gedam, Sameer Sharma, Jyoti Dixit, Shankar Prinja","doi":"10.1007/s40258-025-00966-9","DOIUrl":"https://doi.org/10.1007/s40258-025-00966-9","url":null,"abstract":"<p><strong>Background: </strong>Private hospitals account for 46% of all hospitals empanelled in India's national health insurance scheme and contribute to 54% of all the hospitalizations under it. However, insufficient package prices are often cited as a constraint to viable hospital operations. This study assesses the financial viability of establishing such hospitals at district level, with a focus on determining the break-even threshold by forecasting the financial trajectory of hospitals.</p><p><strong>Methods: </strong>By utilizing primary data from 27 district hospitals across nine states in India on cost of providing healthcare services, a blend of bottom-up and top-down micro-costing methods was used to estimate financial cost across input resource categories, including land procurement, building construction, human resources, equipment, drugs, consumables, maintenance, and overheads. Revenue from inpatient services was estimated using healthcare provider payment rates under India's largest tax-funded health insurance scheme, coupled with patient volume data stratified by distinct diseases across different specialties. Revenue projections from outpatient services were extrapolated as a fixed proportion of their inpatient counterparts. A 10-year evaluation framework was employed to forecast the hospital operations using revenue-expenditure perspective. Sensitivity analyses were undertaken to assess the extent of variations in the output owing to varying bed-occupancy levels and doctor-to-bed ratios.</p><p><strong>Results: </strong>For a model 100-bed private hospital operating at district level, the average annual expenditure and revenue are projected to be at Indian Rupee (₹)85.27 million (US $1.03 million) and ₹104.36 million (US $1.26 million), respectively, for the initial 10 years. Human resources constitute the primary share (40%) of total expenditure, followed by spending on drugs and consumables (20%). A sequential evaluation of annual revenue and expenditure reveals that hospitals reach breakeven by their fourth operational year, subsequently transitioning into a profitable phase.</p><p><strong>Conclusions: </strong>The study suggests a viable financial trajectory for private hospitals at district level, following the pricing structure of government-sponsored health insurance scheme.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954980","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":"Guiding Health Resource Allocation: Using Population Net Health Benefit to Align Disease Burden with Cost Effectiveness for Informed Decision Making.","authors":"Megha Rao, Simon Walker, Karl Claxton, Simon Bland, Jessica Ochalek, Andrew Phillips, Mark Sculpher, Paul Revill","doi":"10.1007/s40258-025-00964-x","DOIUrl":"https://doi.org/10.1007/s40258-025-00964-x","url":null,"abstract":"<p><p>Limited healthcare resources necessitate a strategic approach to their allocation. This paper highlights the importance of population net health benefit (NHB) metric as a means of aligning two existing concepts used for resource prioritization in health: burden of disease and cost effectiveness. By explicitly incorporating health opportunity costs and eligible patient population size, NHB provides a clearer understanding of the likely scale of impact of interventions on population health. Moreover, when expressed in disability-adjusted life years (DALYs) averted, NHB enables policymakers to effectively communicate the population-level health gains from interventions relative to the existing disease burden. Using a stylized example, we demonstrate the estimation of population NHB for four alternative health interventions and its use in resource allocation decisions. The analysis reveals how variations in patient population size and health opportunity costs can significantly impact NHB estimates, ultimately influencing resource allocation decisions. The results further illustrate how NHB can be expressed as a proportion of the total disease burden, allowing for the consideration of the percentage of the overall burden addressed by each intervention. The paper demonstrates how population NHB combines cost effectiveness with components of disease burden, offering a more comprehensive approach to health intervention selection and implementation. As countries move towards universal health coverage, this metric can aid policymakers in making informed, evidence-based decisions.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958646","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 Genomic Medicine in Cancer Control: A Systematic Literature Review","authors":"Mackenzie Bourke,&nbsp;Aideen McInerney-Leo,&nbsp;Julia Steinberg,&nbsp;Tiffany Boughtwood,&nbsp;Vivienne Milch,&nbsp;Anna Laura Ross,&nbsp;Elena Ambrosino,&nbsp;Kim Dalziel,&nbsp;Fanny Franchini,&nbsp;Li Huang,&nbsp;Riccarda Peters,&nbsp;Francisco Santos Gonzalez,&nbsp;Ilias Goranitis","doi":"10.1007/s40258-025-00949-w","DOIUrl":"10.1007/s40258-025-00949-w","url":null,"abstract":"<div><h3>Background and Objective</h3><p>Genomic medicine offers an unprecedented opportunity to improve cancer outcomes through prevention, early detection and precision therapy. Health policy makers worldwide are developing strategies to embed genomic medicine in routine cancer care. Successful translation of genomic medicine, however, remains slow. This systematic review aims to identify and synthesise published evidence on the cost effectiveness of genomic medicine in cancer control. The insights could support efforts to accelerate access to cost-effective applications of human genomics.</p><h3>Methods</h3><p>The study protocol was registered with PROSPERO (CRD42024480842), and the review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) Guidelines. The search was run in four databases: MEDLINE, Embase, CINAHL and EconLit. Full economic evaluations of genomic technologies at any stage of cancer care, and published after 2018 and in English, were included for data extraction.</p><h3>Results</h3><p>The review identified 137 articles that met the inclusion criteria. Most economic evaluations focused on the prevention and early detection stage (<i>n</i> = 44; 32%), the treatment stage (<i>n</i> = 36; 26%), and managing relapsed, refractory or progressive disease (<i>n</i> = 51, 37%). Convergent cost-effectiveness evidence was identified for the prevention and early detection of breast and ovarian cancer, and for colorectal and endometrial cancers. For cancer treatment, the use of genomic testing for guiding therapy was highly likely to be cost effective for breast and blood cancers. Studies reported that genomic medicine was cost effective for advanced and metastatic non-small cell lung cancer. There was insufficient or mixed evidence regarding the cost effectiveness of genomic medicine in the management of other cancers.</p><h3>Conclusions</h3><p>This review mapped out the cost-effectiveness evidence of genomic medicine across the cancer care continuum. Gaps in the literature mean that potentially cost-effective uses of genomic medicine in cancer control, for example rare cancers or cancers of unknown primary, may be being overlooked. Evidence on the value of information and budget impact are critical, and advancements in methods to include distributional effects, system capacity and consumer preferences will be valuable. Expanding the current cost-effectiveness evidence base is essential to enable the sustainable and equitable translation of genomic medicine.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 3","pages":"359 - 393"},"PeriodicalIF":3.1,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00949-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762647","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":"Therapy, Pills and Unmet Needs for Financial Reasons: Socioeconomic Inequalities and Inequities in Access to Mental Health Care in Spain 2014-2020.","authors":"Rosa M Urbanos-Garrido, Laura Agúndez","doi":"10.1007/s40258-025-00961-0","DOIUrl":"https://doi.org/10.1007/s40258-025-00961-0","url":null,"abstract":"<p><strong>Objectives: </strong>To measure socioeconomic-related inequality in perceived unmet needs for financial reasons for mental health care in Spain and to assess socioeconomic-related inequity in access to mental health professionals and psychotropic drugs.</p><p><strong>Methods: </strong>We used data from the Spanish adult sample of the European Health Interview Survey for 2014 and 2020. Corrected concentration indices were used to measure socioeconomic-related inequalities in unmet needs for financial reasons and inequity in access to mental health care. Social class, based on the occupation of the breadwinner, was used as a proxy of socioeconomic status. A decomposition analysis was performed to determine the variables that explain inequalities and to identify inequity in access.</p><p><strong>Results: </strong>Unmet need for mental health care for financial reasons significantly concentrate on the worse-off, except for women in 2020. A reduction of inequality is observed along the study period. Socioeconomic disadvantage is associated with lower access to mental health consultations, despite also with higher need. This pro-rich inequity is significant for women in 2014, and for both sexes-although much higher for females-in 2020. In contrast, we found pro-poor inequity in women's access to psychotropic drugs in 2020, suggesting partial substitution of specialized health care with psychotropic drugs prescribed in primary care for the financially worse-off.</p><p><strong>Conclusions: </strong>Barriers to accessing specialized mental health care should be reduced for those in need, particularly for disadvantaged women. A better access to therapy could also help to reduce their consumption of psychotropic drugs. Addressing access inequities requires different strategies for men and women, as the relevance of their determinants varies by gender.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717764","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}