Applied Health Economics and Health Policy最新文献

{"title":"Evaluating Access Improving Interventions: An Economic Evaluation of Surgical Task-Shifting for C-Sections in Sierra Leone","authors":"Bryony Dawkins,&nbsp;Bethany Shinkins,&nbsp;Tim Ensor,&nbsp;David Jayne,&nbsp;Thomas Ashley,&nbsp;Alex J. van Duinen,&nbsp;Håkon A. Bolkan,&nbsp;David Meads","doi":"10.1007/s40258-025-00965-w","DOIUrl":"10.1007/s40258-025-00965-w","url":null,"abstract":"<div><h3>Background</h3><p>Access to safe, timely and affordable surgical care is lacking globally. Less than 6% of all surgical operations are carried out in low- and middle-income countries, where over a third of the world’s population lives. CapaCare, an NGO operating in Sierra Leone, have developed a surgical training programme (STP) for Associate Clinicians based on principles of task-shifting to improve access. Interventions to increase healthcare access have the same value evidence requirements as new technologies but their evaluation presents methodological challenges as access is not routinely incorporated explicitly in economic evaluations.</p><h3>Objective</h3><p>To evaluate the cost-effectiveness of surgical task-shifting in Sierra Leone, implemented through the CapaCare STP, to increase provision of caesarean section (C-section).</p><h3>Methods</h3><p>We evaluated the impact of the STP on the provision of C-section and subsequent maternal and child outcomes, measured in disability-adjusted life-years (DALYs), relative to the costs using a healthcare system perspective and decision-tree model parameterised using data from surgical logbooks, national data, and the literature.</p><h3>Results</h3><p>Results indicate that the surgical task-shifting programme in Sierra Leone would be considered cost-effective in increasing provision for C-section. It is cost saving (USD − 16.77) and results in 2.14 DALYs averted, per women with an indication for C-section, due to avoidance of maternal and child deaths as well as reduced complications.</p><h3>Conclusion</h3><p>Investment in surgical task-shifting initiatives should be considered by policymakers as a potentially cost-effective way to increase access to quality surgical services. Future evaluations of access-increasing interventions should seek to capture the distributional impact of this strategy and system benefits.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 4","pages":"705 - 723"},"PeriodicalIF":3.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957179","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":"Cost-Effectiveness and Value of Information Analyses of Caplacizumab for the Treatment of Thrombotic Thrombocytopenic Purpura in Brazil","authors":"Julia Simões Correa Galendi,&nbsp;Hannes Rasch,&nbsp;Carlos Antonio Caramori,&nbsp;Rafael Dezen Gaiolla,&nbsp;Dirk Müller,&nbsp;Vania Santos Nunes Nogueira","doi":"10.1007/s40258-025-00968-7","DOIUrl":"10.1007/s40258-025-00968-7","url":null,"abstract":"<div><h3>Objectives</h3><p>The objective was to evaluate the cost effectiveness of caplacizumab for the treatment of patients with acquired immune thrombocytopenic thrombotic purpura (iTTP) compared to standard of care from the perspective of the Brazilian Unified Health System (SUS).</p><h3>Methods</h3><p>A decision tree followed by a Markov model with a lifetime horizon was developed. Patients entered the model with an acute iTTP event. All patients were assumed to be admitted to hospital where they either respond to treatment or die. The model offered three health states: remission, relapse or death. Input data were obtained from literature searches with the data on efficacy of caplacizumab based on the HERCULES trial. The incremental cost-effectiveness ratio (ICER) was compared to the willingness-to-pay threshold for rare diseases of Brazilian reais (R$)120,000/quality-adjusted life years (QALYs). In addition to various sensitivity analyses, a value of information (VOI) analysis was conducted.</p><h3>Results</h3><p>In the base case, caplacizumab resulted in 0.70 QALYs gained, and cost R$1,333,601 more, with an ICER of R$1,901,729/QALY. The cost of the caplacizumab vial was the most influential parameter. Probabilistic analysis showed that caplacizumab was not cost effective in any iterations for the threshold of the rare disease. The expected value of perfect information per year is R$0.</p><h3>Conclusion</h3><p>Although caplacizumab results in incremental QALYs, based on the proposed cost, caplacizumab is not cost effective from the SUS perspective, and VOI results indicate that further research would not be worthwhile.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 4","pages":"649 - 660"},"PeriodicalIF":3.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970304","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":"Compulsory Licensing as an Instrument to Tackle High Medicine Prices: A Realist Review of Industrial and Health Consequences","authors":"Steven Simoens,&nbsp;Walter Van Dyck,&nbsp;Rosanne Janssens,&nbsp;Liese Barbier,&nbsp;Jeroen Luyten","doi":"10.1007/s40258-025-00956-x","DOIUrl":"10.1007/s40258-025-00956-x","url":null,"abstract":"<div><p>Although compulsory licensing of medicines is traditionally discussed in the context of low- and middle-income countries tackling high prices, it has recently sparked debate in several high-income countries. This study aims to examine the industrial and health consequences of compulsory licensing when applied by a high-income country. Our literature review found that the impact of compulsory licensing is challenging to predict as it can have multiple (opposing) consequences in terms of economic activity, patient outcomes and public health. Compulsory licensing can, under particular circumstances, serve as a lever of industrial policy in a country that wishes to develop its domestic generic pharmaceutical industry. However, originator pharmaceutical companies and other industries may reduce investment, which can be negative for countries with a high presence of innovators, adversely impacting long-term economic activity. Compulsory licensing may also induce state retaliation against the license-issuing country. From a health policy perspective, compulsory licensing likely increases patient access to expensive medicines and frees up resources that can be invested in other (health) programs. However, pharmaceutical companies may delay medicine launches or cancel clinical trials in the license-issuing country. Although there are benefits resulting from a credible threat to use compulsory licensing, the overall desirability of actually using it depends on the specific context and needs to be assessed on a case-by-case basis.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 4","pages":"613 - 624"},"PeriodicalIF":3.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957184","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":"Measurement Properties of the EQ-5D Instruments in Children and Adolescents: A Systematic Review","authors":"Caique de Melo do Espirito Santo,&nbsp;Verônica Souza Santos,&nbsp;Alessandro Chiarotto,&nbsp;Gisela Cristiane Miyamoto,&nbsp;Tiê P. Yamato","doi":"10.1007/s40258-025-00953-0","DOIUrl":"10.1007/s40258-025-00953-0","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&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;h3&gt;Methods&lt;/h3&gt;&lt;p&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;h3&gt;Results&lt;/h3&gt;&lt;p&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;h3&gt;Conclusion&lt;/h3&gt;&lt;p&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 for children and adolescents.&lt;/p&gt;&lt;h","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 5","pages":"797 - 822"},"PeriodicalIF":3.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00953-0.pdf","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision-Analytical Modelling of Medicines in the Middle East: A Systematic Review of Economic Evaluation Studies","authors":"Zainab Abdali,&nbsp;Tuba Saygın Avşar,&nbsp;Sue Jowett,&nbsp;Muslim Syed,&nbsp;Khalifa Elmusharaf,&nbsp;Louise Jackson","doi":"10.1007/s40258-024-00940-x","DOIUrl":"10.1007/s40258-024-00940-x","url":null,"abstract":"<div><h3>Background</h3><p>Economic evaluations through decision-analytical models have played a limited role in shaping healthcare resource optimisation and reimbursement decisions in the Middle East.</p><h3>Objective</h3><p>This review aims to systematically examine economic evaluation studies focusing on decision-analytical models of medicines in the Middle East, defining methodological characteristics and appraising the quality of the identified models.</p><h3>Methods</h3><p>A systematic review approach was employed to identify published decision-analytical models of medicines in the Middle East. Six databases were searched (MEDLINE, EMBASE, Econlit, Web of Science, Global Health Cost-Effectiveness Analysis Registry and the Global Index Medicus) from 1998 to July 2024. Studies meeting the inclusion criteria—full economic evaluations of medicines using decision-analytical models in the Middle East—were considered. Data were extracted and tabulated to include study characteristics and methodological specifications, and data were narratively analysed. The Philips checklist was used to assess the quality of studies.</p><h3>Results</h3><p>Sixty-three decision-analytical modelling studies of medicines were identified and reviewed, from eight Middle Eastern countries, with the majority (90%) conducted in Iran, Saudi Arabia, Qatar and Egypt. The cost-effectiveness of medications for non-communicable diseases was explored in 77% of the models. Gross domestic product-based cost-effectiveness thresholds were commonly used, and international sources provided data on intervention effectiveness and health outcomes, while national sources were mainly used for the costs of resource use. Most models incorporated an assessment of parameter uncertainty, whereas other types of uncertainty were not explored. Studies from high-income countries were generally of higher quality than those from middle-income countries.</p><h3>Conclusions</h3><p>The number of published decision-analytical models in the Middle East was low, considering the available medicinal products and disease burden. Key elements related to the quality of decision-analytical models, including analysis of the model structure, appropriateness of model inputs and uncertainty assessment, were not consistently fulfilled. Recommendations are provided to enhance the quality of future economic evaluation studies. This includes strengthening the existing health economics capacities, establishing country-specific health technology assessment systems (where possible), and initiating collaborations to generate national cost and outcome data.</p><p>PROSPERO registration: CRD42021283904.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 4","pages":"569 - 612"},"PeriodicalIF":3.3,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967422","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,&nbsp;Praveen Gedam,&nbsp;Sameer Sharma,&nbsp;Jyoti Dixit,&nbsp;Shankar Prinja","doi":"10.1007/s40258-025-00966-9","DOIUrl":"10.1007/s40258-025-00966-9","url":null,"abstract":"<div><h3>Background</h3><p>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><h3>Methods</h3><p>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><h3>Results</h3><p>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><h3>Conclusions</h3><p>The study suggests a viable financial trajectory for private hospitals at district level, following the pricing structure of government-sponsored health insurance scheme.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 5","pages":"841 - 853"},"PeriodicalIF":3.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00966-9.pdf","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":"OA","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,&nbsp;Simon Walker,&nbsp;Karl Claxton,&nbsp;Simon Bland,&nbsp;Jessica Ochalek,&nbsp;Andrew Phillips,&nbsp;Mark Sculpher,&nbsp;Paul Revill","doi":"10.1007/s40258-025-00964-x","DOIUrl":"10.1007/s40258-025-00964-x","url":null,"abstract":"<div><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></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 5","pages":"759 - 766"},"PeriodicalIF":3.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-00964-x.pdf","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design Patents: A Potential Threat to Drug Competition","authors":"Janet Freilich,&nbsp;Aaron S. Kesselheim","doi":"10.1007/s40258-025-00967-8","DOIUrl":"10.1007/s40258-025-00967-8","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 4","pages":"531 - 534"},"PeriodicalIF":3.3,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810155","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":"Alternative Payment Models for Innovative Medicines: A Framework for Effective Implementation","authors":"Frederick McElwee,&nbsp;Amanda Cole,&nbsp;Gomathi Kaliappan,&nbsp;Andrea Masters,&nbsp;Lotte Steuten","doi":"10.1007/s40258-025-00960-1","DOIUrl":"10.1007/s40258-025-00960-1","url":null,"abstract":"<div><p>Scientific advancements offer significant opportunities for better patient outcomes, but also present new challenges for value assessment, affordability and access. Alternative payment models (APMs) can offer solutions to the ensuing payer challenges. However, a comprehensive framework that matches the spectrum of challenges with the right solution, and places them within a framework for implementation, is currently missing. To fill this gap, we propose evidence-based steps for the effective selection and implementation of APMs. First, contracting challenges should be identified and mapped to potential APM solutions. We developed a decision guide that can serve as a starting point to articulate core problems and map these to APM solutions. The main problem categories identified are: budget impact and uncertainty, value uncertainty, and the scope of value assessment and negotiation. Sub-categories include affordability, uncertainty of effectiveness, and patient heterogeneity, which map onto APM solutions such as outcome-based agreements, instalments, and subscription models. Just as important are the subsequent identification and assessment of the feasibility of potential solutions as well as collaboration to reach agreement on the terms of the APM and lay the groundwork for effective implementation. We adduce recent examples of APM implementation as evidence of how commonly cited implementation barriers can be overcome by applying pragmatic design choices and collaboration. This step-by-step framework can aid payers and manufacturers in the process of effectively identifying, agreeing on, and implementing APMs to advance patient access to cost-effective medicines, while at the same time providing appropriate incentives to support future innovation.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"23 4","pages":"535 - 549"},"PeriodicalIF":3.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762645","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}