Applied Health Economics and Health Policy最新文献

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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}

{"title":"A Scoping Review Mapping Economic Evaluations of Midwifery Service Provision and the Midwifery Workforce.","authors":"Boe Calvert, Caroline S E Homer, Sarah Bar-Zeev, Alicia Ferguson, Vanessa Scarf","doi":"10.1007/s40258-025-00962-z","DOIUrl":"https://doi.org/10.1007/s40258-025-00962-z","url":null,"abstract":"<p><strong>Background: </strong>Midwives are essential in achieving universal health coverage targets and the health targets of the Sustainable Development Goals, yet a significant global shortfall exists in the midwifery workforce. Economic evaluations of midwifery are scarce but can assist in supporting evidence-informed decision-making for sustainable and equitable health care for women and girls.</p><p><strong>Objectives: </strong>This review aimed to systematically identify, map and report on available literature regarding economic evaluations conducted on midwifery service provision and the midwifery workforce in all settings.</p><p><strong>Methods: </strong>A scoping review was conducted following the Joanna Briggs Institute methodology. A comprehensive search strategy was developed and run in six health databases. Peer-reviewed studies and unpublished research theses conducting economic evaluations on midwifery service provision or midwifery workforce strategies were included. Sources were limited to English-language literature published in the past 20 years. Identified sources were screened and reviewed, and data from included sources were extracted, reviewed, mapped and synthesised to report findings. Quality appraisal was conducted on all included sources using the Joanna Briggs Institute Critical Appraisal Checklist for Economic Evaluations.</p><p><strong>Results: </strong>A total of 32 studies were included in the review. Most were from high-income countries (26/32), and very few were from low- and middle-income countries (6/32). The quality of included studies varied greatly. Under half of the studies conducted full economic evaluations (15/32), and the remainder were partial economic evaluations (17/32). Most studies evaluated midwifery service provision (29/32) through either midwife-led models of care (15/29) or by place of birth (13/29), mostly for low-risk women (23/29) from the perspective of healthcare funders. Evaluation of midwifery education programs was less common, and these were all conducted in low- and middle-income countries (3/32). Most studies concluded that midwifery service provision was cost-saving, cost-effective or cost-beneficial.</p><p><strong>Conclusions: </strong>Our review identified a significant gap in economic evaluation of midwifery from low- and middle-income countries. However, there is ongoing need for robust, quality economic evaluations on midwifery service provision and workforce strategies in all global regions. Such studies would further support health policymakers and governments to make evidence-informed decisions to address midwifery workforce shortages and provision of evidence-based and respectful care that meets the healthcare needs of women and girls.</p>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662174","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":"Beyond the Diagnosis: Valuing Genome-Wide Sequencing for Rare Disease Diagnosis Using Contingent Valuation","authors":"Michael Abbott,&nbsp;Mandy Ryan,&nbsp;Rodolfo Hernández,&nbsp;Sebastian Heidenreich,&nbsp;Zosia Miedzybrodzka","doi":"10.1007/s40258-025-00948-x","DOIUrl":"10.1007/s40258-025-00948-x","url":null,"abstract":"<div><h3>Background and Objective</h3><p>The utility of genome-wide sequencing is often quantified in terms of its diagnostic yield. Although obtaining a diagnosis is a fundamental aspect of value, service users also value broader clinical, informational, process and psychological factors in the provision of genomic testing. This study aims to value genome-wide sequencing from the user perspective in Scotland.</p><h3>Methods</h3><p>A survey was developed and administered to 1014 patients and families with experience of genome-wide sequencing to diagnose a rare condition in Scotland. Participants’ willingness to pay for genomic testing was elicited using a contingent valuation payment card. The survey included two genomic-related patient-reported outcome measures: (i) the Personal Utility Scale (PrU) to generate scores for the personal utility of genome-wide sequencing; and (ii) a subscale of the Feelings About Genomic Testing Results (FACTOR) questionnaire to measure negative psychological outcomes. Data were also collected on participants’ prior experiences of genomic testing services. A double-hurdle regression model investigated the predictors of patients' willingness to pay for genomic testing.</p><h3>Results</h3><p>Of the 1014 invitations sent, 171 contingent valuation questionnaires were returned. Diagnosed participants reported higher personal utility on PrU than undiagnosed participants. However, both groups reported similar negative psychological outcomes on FACTOR. Diagnosed participants were willing to pay £2043 for genome-wide sequencing, compared with £835 for undiagnosed participants. Diagnostic status, waiting time for results and FACTOR scores (negative psychological outcomes) influenced users’ valuations of genome-wide sequencing.</p><h3>Conclusions</h3><p>Obtaining a diagnosis is a fundamental component of utility in the provision of genomic testing. However, there is still value to those who do not receive a diagnosis. These results have implications for service delivery, such as providing targeted pre-test and post-test genetic counselling, and investing in efficient genome sequencing pipelines to reduce waiting times. Valuing the user experience of genomic testing aligns with patient-centred approaches to the provision of healthcare.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 3","pages":"425 - 439"},"PeriodicalIF":3.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00948-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622972","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-Utility Analysis of Genomic Profiling in Directing Targeted Therapy in Advanced NSCLC in Thailand","authors":"Saowalak Turongkaravee,&nbsp;Surakit Nathisuwan,&nbsp;Thanyanan Baisamut,&nbsp;Jennis Meanwatthana","doi":"10.1007/s40258-025-00950-3","DOIUrl":"10.1007/s40258-025-00950-3","url":null,"abstract":"<div><h3>Background</h3><p>Sequential next-generation sequencing (NGS) testing has demonstrated cost-effectiveness in guiding targeted therapy with tyrosine kinase inhibitors (TKIs) for advanced non-small cell lung cancer (aNSCLC) in developed countries. However, its cost-effectiveness in developing countries remains uncertain.</p><h3>Objective</h3><p>The aim was to conduct a cost-utility analysis comparing sequential NGS testing with the current approach of single epidermal growth factor receptor (EGFR) testing combined with first-line targeted therapy, as implemented under Thailand's Universal Health Coverage scheme for aNSCLC.</p><h3>Method</h3><p>Hybrid decision tree and Markov models were developed to estimate the lifetime costs and quality-adjusted life years (QALYs) associated with each strategy. The models simulate cohorts of aNSCLC patients who receive platinum-based chemotherapy or TKIs based on identified gene alterations. Patients enter the model at 60 years of age. The incremental cost-effectiveness ratio (ICER) was computed from a societal perspective. The analysis employed a lifetime horizon and discounted costs and outcomes at a rate of 3%. Furthermore, uncertainty and scenario analyses were conducted.</p><h3>Findings</h3><p>A sequential NGS testing strategy could identify an additional 19% of patients with biomarker-positive findings who subsequently received biomarker-driven targeted therapy compared to a single EGFR testing strategy. The number needed to screen to identify a single gene mutation and administer first-line TKI was six for the sequential NGS testing strategy. Compared to the single EGFR testing, the ICER of the sequential NGS testing strategy was 1,851,150 THB/QALY (US$51,335). At a willingness-to-pay threshold of 160,000 THB/QALY (US$4437), the single EGFR testing strategy demonstrated 100% cost-effectiveness. In contrast, the sequential NGS testing was not deemed cost-effective. The sensitivity of the ICER was influenced by the overall survival rates associated with anaplastic lymphoma kinase<b> (</b>ALK) inhibitors and platinum-based chemotherapy.</p><h3>Interpretation</h3><p>Sequential NGS testing identified a greater number of patients with aNSCLC eligible for targeted therapies, resulting in improved survival rates and enhanced QALYs compared to single EGFR testing. However, in the context of Thailand, sequential NGS testing was not cost-effective. The single EGFR testing strategy emerged as the most cost-effective option for guiding first-line targeted therapy.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 3","pages":"479 - 491"},"PeriodicalIF":3.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00950-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363317","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 Economic Evaluations of Obesity Interventions: Expert Views on How We Can Identify, Interpret, Analyse and Translate Effects","authors":"Samira B. Jabakhanji,&nbsp;Gintare Valentelyte,&nbsp;Fabian Manke-Reimers,&nbsp;Vidar Halsteinli,&nbsp;Rønnaug Ødegård,&nbsp;Adam Martin,&nbsp;Grace O’Malley,&nbsp;Jan Sorensen,&nbsp;Emilia Hagman","doi":"10.1007/s40258-025-00946-z","DOIUrl":"10.1007/s40258-025-00946-z","url":null,"abstract":"<div><p>Economic evaluations of obesity interventions are critical to informing policymakers and clinical practitioners about best-value prevention and treatment interventions. However, existing studies often fail to measure appropriate outcomes over sufficient time periods and to adequately address the complexity of data, environments and outcomes. An international, multidisciplinary workshop in Ireland (May 2023) addressed these issues through scientific presentations on obesity modelling, group discussions and interactive small-group exercises. Nineteen presenters and participants co-created a list of research needs, priorities and strategies for the long-term study of obesity and its complications. To support availability of relevant outcome and cost data for health economic analyses, participants highlighted a need to define standards for data collection, data sharing, modelling, and integrating a systems perspective. For example, regarding data collection, careful consideration must be given to selecting valid and relevant health-related outcomes for determining future health risk. Although these issues have been previously highlighted, they remain critical barriers to comprehensive economic obesity studies. To identify best-value obesity interventions, researchers should prioritise strategies to overcome these barriers. This includes early engagement with multidisciplinary stakeholders to integrate diverse perspectives. Developing infrastructure to support international collaborations between researchers, policymakers and patient representatives was also recommended. Additionally, establishing best-practice guidelines could help researchers navigate the complexities of obesity data, environments and outcomes, particularly in data-scarce research environments. The creation of a core outcomes set for obesity would standardise measures for economic evaluations, thereby facilitating more robust cross-country comparisons of intervention effects and improving the evidence base and overall quality of future obesity research.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 2","pages":"161 - 169"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00946-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073496","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":"Contextual Factors that Influence Antibiotic Prescribing: A Discrete Choice Experiment of GP Registrars","authors":"Gregory Merlo,&nbsp;Lisa Hall,&nbsp;Parker Magin,&nbsp;Amanda Tapley,&nbsp;Katie J. Mulquiney,&nbsp;Alison Fielding,&nbsp;Andrew Davey,&nbsp;Joshua Davies,&nbsp;Mieke van Driel","doi":"10.1007/s40258-025-00944-1","DOIUrl":"10.1007/s40258-025-00944-1","url":null,"abstract":"<div><h3>Introduction</h3><p>Antimicrobial resistance is a global emergency related to overprescribing of antibiotics. Few studies have explored how prescribing behaviours may change as the consequence of changing resistance. Understanding how contextual factors influence antibiotic prescribing will facilitate improved communication strategies to promote appropriate antibiotic prescribing. We aimed to develop and conduct a discrete choice experiment (DCE) to measure how contextual factors influence intended antibiotic prescribing of general practitioner (GP) registrars.</p><h3>Methods</h3><p>Factors included as attributes in the DCE were level of antibiotic resistance, requirement for an authority to prescribe, existence of a Practice Incentives Program (PIP) for low prescribing and supervisor support for low prescribing. The survey was administered in an online format for GP registrars undergoing training between 2020 and 2021. Regression analysis using a conditional logit model with interaction effects was used on the basis of the assumptions of independence of irrelevant alternatives, independence of error terms and no preference heterogeneity.</p><h3>Results</h3><p>In total, 617 unique respondents answered at least one choice set question. Respondents showed significant preference for avoiding prescribing antibiotics when antibiotic resistance was 25–35% or 40–60% compared with 5–8%. There was also a significant preference for avoiding prescribing when an authority to prescribe was required, or when there was supervisory support of low antibiotic prescribing. In the main effects analysis, respondents were significantly less likely to choose a prescribing option if there was a PIP; however, when interaction effects were included in the regression analysis there was a significant interaction between PIP and resistance rates, but the preference weights for PIP was no longer significant.</p><h3>Conclusions</h3><p>Knowledge about community resistance impacts the stated intention of GP registrars to prescribe antibiotics. The use of the DCE may have made it possible to determine factors influencing prescribing that would not be detected using other survey methods. These findings provide guidance for producing, explaining and communicating issues regarding antibiotic prescribing to GP registrars.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 2","pages":"311 - 317"},"PeriodicalIF":3.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00944-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031649","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}