Applied Health Economics and Health Policy最新文献

{"title":"Towards a Multi-sectoral Approach to Population Health: A Scoping Review of Cross-sectoral Evaluations of Health Interventions","authors":"Rositsa Koleva-Kolarova,&nbsp;Emily Hulse,&nbsp;Bertalan Németh,&nbsp;Maureen Rutten-van Mölken,&nbsp;Rhiannon Tudor Edwards,&nbsp;Balázs Babarczy,&nbsp;Balázs Nagy,&nbsp;Sarah Wordsworth,&nbsp;Apostolos Tsiachristas","doi":"10.1007/s40258-025-01023-1","DOIUrl":"10.1007/s40258-025-01023-1","url":null,"abstract":"<div><h3>Background</h3><p>Health interventions, particularly those targeted at health promotion and disease prevention, often have a range of impacts that span beyond the healthcare sector. Making the case for investment in these interventions may require an inventory of costs and outcomes across multiple sectors beyond the health sector.</p><h3>Objectives</h3><p>To perform a scoping review of economic evaluations that used existing approaches for cross-sectoral evaluation of healthcare interventions and provide an understanding of how these approaches have been applied in empirical studies.</p><h3>Methods</h3><p>Scoping reviews, a type of evidence synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. We used the PRISMA extension for scoping reviews and a pearl-growing search approach. A forward citation searching in Google Scholar and Web of Science of an initial set of selected papers that recommend cross-sectoral evaluations of health interventions was performed, complemented by free-word search in Google and Google Scholar. Cross-sectoral evaluations of health interventions that consider costs and outcomes beyond healthcare were included.</p><h3>Results</h3><p>From the 204 identified cross-sectoral evaluation studies of health interventions, the vast majority (85%) were cost-effectiveness and cost-utility analyses taking the societal costing perspective. Other approaches included social return on investment (6%), cost-benefit analysis (4%), cost study (3%), and combined approaches (2%). Two-thirds of the studies evaluated a treatment-based intervention while the remainder evaluated preventive interventions. In addition to healthcare, studies evaluated mostly costs related to productivity and non-direct medical costs, e.g., transport costs. Outcomes were focused on clinical results and patient-reported health and well-being.</p><h3>Conclusions</h3><p>There is a limited number of published cross-sectoral evaluations of health interventions despite the need of public and private investors for global value assessment. Issuing guidance on performing cross-sectoral evaluations and highlighting their need by health technology assessment agencies may improve existing evidence and therefore novel forms of investment in population health interventions.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"479 - 497"},"PeriodicalIF":3.3,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-01023-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269658","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":"It’s Time to Rethink ‘Real-World Evidence’: A Call for Terminological Clarity in Health Technology Assessment","authors":"Hesam Ghiasvand,&nbsp;Haipeng Liu","doi":"10.1007/s40258-026-01028-4","DOIUrl":"10.1007/s40258-026-01028-4","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"437 - 441"},"PeriodicalIF":3.3,"publicationDate":"2026-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257177","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":"Ensuring Epidemiological Consistency in Risk-Stratified Cancer Screening Models: A Novel Approach Based on Flemish Breast Cancer Screening","authors":"Max Lelie,&nbsp;Bo VandenBulcke,&nbsp;Nick Verhaeghe,&nbsp;Lieven Annemans,&nbsp;Steven Simoens,&nbsp;Koen Putman","doi":"10.1007/s40258-026-01029-3","DOIUrl":"10.1007/s40258-026-01029-3","url":null,"abstract":"<div><h3>Objective</h3><p>We present a novel dynamic risk-stratified breast cancer screening Markov model designed to maintain robust and epidemiologically consistent cancer prevalences, regardless of the number or composition of risk-stratification groups. This approach addresses a common limitation in existing models, where altering risk-group definitions or proportions can unintentionally distort overall incidence rates. By overcoming this constraint, the method lowers barriers to developing interactive, flexible and policy-relevant models that can be shared directly with decision makers. The paper serves as both a methodological contribution and a practical guide for implementation.</p><h3>Methods</h3><p>Our approach combines conditional transition probabilities with pre-stratified ‘at-risk’ states within a conventional Markov cohort framework. Lifetime risk is determined at the structural level, while the timing of onset is governed by age-specific conditional probabilities. These components are derived directly from Flemish cancer registry data, enabling close alignment with the target population and facilitating epidemiological validation.</p><h3>Results</h3><p>We validate the model against empirical breast cancer incidence data from Flanders, comparing predicted outcomes across age bands and cancer stages. The method consistently reproduces observed incidence patterns without additional calibration, maintaining stability when risk group definitions or sizes are varied.</p><h3>Conclusions</h3><p>Combining pre-stratified ‘at-risk’ states with conditional transition probabilities offers a simple yet powerful means of achieving epidemiological consistency in both risk-stratified and non-stratified cancer screening models. The method is data driven, transparent, and adaptable to different cancers or screening contexts, making it especially valuable for interactive models intended for use by policymakers.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"627 - 635"},"PeriodicalIF":3.3,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146211822","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":"Indirect Effects in Health Economic Models of Vaccines: Should We Include Them, and How Do We Model Them?","authors":"Rachel J. Oidtman,&nbsp;Min Huang,&nbsp;Walter A. Orenstein,&nbsp;Matthew S. Kelly,&nbsp;Zinan Yi,&nbsp;Elamin Elbasha,&nbsp;Michael Drummond","doi":"10.1007/s40258-025-01017-z","DOIUrl":"10.1007/s40258-025-01017-z","url":null,"abstract":"<div><p>Indirect effects refer to the population-level effects of vaccination on vaccinated and unvaccinated individuals, including herd protection, serotype replacement, and age shifts, which can substantially impact the real-world effectiveness of vaccination programs. Despite their importance, most economic evaluations omit indirect effects, likely owing to the complexity of underlying mechanisms, data limitations, and difficulties in disentangling confounding factors. Static models and dynamic transmission models (DTMs) are two common approaches for incorporating indirect effects in economic evaluations. Static models rely on simplified assumptions and readily available data but often overlook the temporal and population-level dynamics of disease transmission. In contrast, DTMs account for complex factors (e.g., population mixing, serotype competition, and long-term epidemiological changes) but require more complex model structure and extensive data. In this article, we illustrate the applications, strengths, and limitations of these two modeling approaches through case studies. We demonstrate how choices of model structure and assumptions, data sources, and parameter estimation methodologies can influence projected epidemiological and economic outcomes, sometimes leading to divergent conclusions. While international guidelines increasingly recognize the importance of including indirect effects in economic evaluations, limited methodological guidance from National Immunization Technical Advisory Groups (NITAGs) and health technology assessment (HTA) bodies continues to hinder consistent implementation. This paper advocates for a collaborative effort among stakeholders to generate high-quality surveillance data and establish guidelines for methodological considerations to model indirect effects. Such efforts will improve the accuracy of epidemiological and economic assessments of vaccination programs and strengthen evidence-based decision-making in public health.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 4","pages":"637 - 646"},"PeriodicalIF":3.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-01017-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083881","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":"Estimation of ‘spectrum value’: A discrete choice experiment to investigate the willingness-to-pay for narrow-spectrum based on other antimicrobial characteristics","authors":"Nadine T. Hillock,&nbsp;Gang Chen,&nbsp;Tracy L. Merlin,&nbsp;Jennie Louise,&nbsp;John Turnidge,&nbsp;Jonathan Karnon","doi":"10.1007/s40258-025-01025-z","DOIUrl":"10.1007/s40258-025-01025-z","url":null,"abstract":"<div><h3>Background</h3><p>Narrow-spectrum antimicrobials are likely to drive fewer antimicrobial resistances. However, they may be more expensive than broad-spectrum alternatives.</p><h3>Objective</h3><p>To determine the preferences of antimicrobial stewardship (AMS) experts regarding antimicrobial choice relative to relevant pharmacological and economic attributes, and how those attributes impact their willingness-to-pay for narrow-spectrum of activity.</p><h3>Methods</h3><p>Two discrete choice experiments (DCEs), consisting of six pharmacological and economic attributes, were administered via an online survey to Australian infectious disease physicians, clinical microbiologists and hospital AMS pharmacists. Respondents were asked to complete each DCE from a public hospital perspective, assuming 100 or 1000 patients would be treated each year, respectively. A conditional logit model was used to analyse the DCE data.</p><h3>Results</h3><p>155 respondents participated in one or both DCEs. Antimicrobial price, spectrum of activity, administration route, and public funding significantly affected drug choice in both scenarios (<i>p</i> &lt; 0.001). Whether the antimicrobial was a novel class did not significantly impact choice. As the price of a narrow-spectrum antimicrobial increased, it became less preferred compared to a broad-spectrum cheaper alternative. With all other attributes being equal, participants were willing to pay an additional AU$862 for the narrow-spectrum option (95% CI $726–$998).</p><h3>Conclusions</h3><p>While narrow-spectrum antimicrobials are preferred for targeted therapy by health practitioners with AMS expertise, price significantly influenced drug choice. Willingness-to-pay values reflect the knowledge and experience of AMS experts who are best-placed to gauge the opportunity costs of paying more for narrow-spectrum antimicrobials. These findings can inform the quantification of spectrum-value for health-system funding decisions.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"613 - 625"},"PeriodicalIF":3.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-01025-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145964945","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":"Partnerships in Public Health Economics: Reflective Lessons from UK Obesity Research","authors":"Humera Sultan,&nbsp;Nafsika Afentou,&nbsp;Luiz F. Andrade,&nbsp;Lin Fu,&nbsp;Bassit Malik,&nbsp;Hamideh Mohtashami Borzadaran,&nbsp;Bisola Osifowora,&nbsp;Irina Pokhilenko,&nbsp;Hanna Wride,&nbsp;Emma Frew","doi":"10.1007/s40258-025-01024-0","DOIUrl":"10.1007/s40258-025-01024-0","url":null,"abstract":"<div><h3>Background and Objective</h3><p>Partnerships between health economists and multi-sectoral stakeholders are essential for public health economics research. While most evidence comes from low- and middle-income countries, high-income countries also face challenges in governance, communication and translating complex analyses into policy-relevant insights. This study provides a reflective account of partnership working from a UK academic health economics team engaged in population obesity research, identifying key enablers, barriers and lessons for high-income countries contexts, with comparisons to low- and middle-income countries literature.</p><h3>Methods</h3><p>The MacPhee partnership model guided reflections across inputs, activities, outputs and outcomes. Semi-structured interviews with eight research staff and two PhD students captured experiences working with local government, community organisations, practitioners, funders and commercial stakeholders. Transcripts were analysed thematically, mapping initial codes to the MacPhee framework and refining themes to highlight transferable lessons.</p><h3>Results</h3><p>Effective partnerships relied on pre-existing relationships, clarity on mutual goals, adaptive communication and flexibility. Trust emerged as both an input and an outcome, requiring sustained investment. Partnerships with weak governance, particularly involving commercial stakeholders, were more likely to falter. Compared with low- and middle-income countries contexts, it was noted that the focus should shift from policymaker capacity building towards equipping health economists with relational, translational and governance skills.</p><h3>Conclusions</h3><p>High-income countries partnerships between academic health economists and multi-sectoral stakeholders benefit from explicit attention to governance, trust and communication. These findings support integrating partnership working skills into health economics training and ensuring project design accommodates the time and resources required to build sustainable policy-relevant collaborations.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"583 - 596"},"PeriodicalIF":3.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40258-025-01024-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970301","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":"Politicised Changes to the NICE Threshold Risk Making Cost-Effectiveness Analysis Performative, Not Informative","authors":"Laura Vallejo-Torres,&nbsp;Laura C. Edney,&nbsp;Oscar Espinosa,&nbsp;Jonathan Karnon,&nbsp;Francesco Longo,&nbsp;Mike Paulden,&nbsp;Daniel Howdon,&nbsp;David J. Vanness","doi":"10.1007/s40258-025-01026-y","DOIUrl":"10.1007/s40258-025-01026-y","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 2","pages":"243 - 246"},"PeriodicalIF":3.3,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12924830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145942209","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":"Should the Spanish National Health System Invest in Psychotherapy for Depression? A Microsimulation Cost-Utility Study to Estimate the Economically Justifiable Price of Cognitive Behavioral Therapy Versus Anti-depressant Medication","authors":"Alberto de la Cuadra-Grande,&nbsp;Mónica Oltra-Díaz,&nbsp;Mara Lerma de Antonio,&nbsp;Miguel Ángel Casado,&nbsp;Itziar Oyagüez","doi":"10.1007/s40258-025-01022-2","DOIUrl":"10.1007/s40258-025-01022-2","url":null,"abstract":"<div><h3>Background</h3><p>Cognitive behavioral therapy (CBT) represents an effective psychotherapeutic intervention for patients with depression compared with anti-depressant medications (ADM).</p><h3>Objective</h3><p>The aim of this study was to determine the economically justifiable price (EJP), consisting of an average cost of CBT per patient-year for which the intervention is cost effective versus ADM for the treatment of adults with depression in Spain.</p><h3>Methods</h3><p>A patient-level microsimulation model was developed to conduct a cost-utility analysis over the patients’ lifetime horizon. Patient demographics, epidemiology of depression, health resources consumption and health utilities feeding the model were sourced from the Spanish national health survey. Additional longitudinal inputs were derived from previously published economic analyses in depression. In the base case, the EJP was estimated for several willingness-to-pay (WTP) thresholds, including €0/QALY (dominancy) and €22,000/QALY. Two scenarios were considered presenting CBT as a substitute of ADM and both CBT and ADM combined (CBT/ADM). The robustness of the model and its results were tested using both deterministic and probabilistic sensitivity analyses.</p><h3>Results</h3><p>For the scenario of CBT versus ADM, the EJP was estimated at €5236 for a WTP threshold of €22,000/QALY. At an EJP of €549, CBT was a dominant intervention compared with ADM. In the scenario considering CBT/ADM versus ADM, the EJP was €5449, CBT/ADM being dominant at an EJP of €255. Sensitivity analyses demonstrated that the base-case results were robust.</p><h3>Conclusion</h3><p>CBT and CBT/ADM achieved incremental health benefits compared with ADM. Under the estimated EJPs, CBT and CBT/ADM could represent a cost effective or dominant intervention for adult patients with depression in Spain.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 3","pages":"499 - 516"},"PeriodicalIF":3.3,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145817414","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":"Do the Poor Gain More? The Impact of Secondary-Care Expenditure on Health Inequality","authors":"Misael Anaya-Montes,&nbsp;Katja Grašič,&nbsp;James Lomas,&nbsp;Laura Anselmi,&nbsp;Miqdad Asaria,&nbsp;Christodoulos Kypridemos,&nbsp;Benjamin Barr,&nbsp;Matthew Sutton,&nbsp;Chris Bentley,&nbsp;Richard Cookson","doi":"10.1007/s40258-025-01016-0","DOIUrl":"10.1007/s40258-025-01016-0","url":null,"abstract":"<div><h3>Background</h3><p>Quasi-experimental studies of mortality variation and trends among large administrative areas of England in the 2000s and early 2010s have suggested that more deprived populations gain larger mortality benefits from marginal increases in public expenditure on secondary care.</p><h3>Objective</h3><p>To identify causal effects of marginal changes in expenditure on mortality variation in 2018 among 32,784 more and less deprived small areas of England, with a mean population of 1700, allowing more fine-grained measurements of deprivation and mortality.</p><h3>Methods</h3><p>We used cross-sectional data on secondary-care funding allocated to 195 National Health Service administrative areas in England in 2018/19 and employed a well-established instrumental variable approach based on the “distance from target” component of the funding formula, which generates quasi-exogenous variation in funding based on historical factors unrelated to current need for secondary care.</p><h3>Results</h3><p>We found an inverted U-shape pattern of mortality gains by deprivation group, whereby the middle group gained significantly more than others. However, we could not reject the null hypothesis that the two more deprived groups received the same mortality gain as the two less deprived groups. These findings were robust to extensive sensitivity analysis using different levels of analysis, control variables, mortality outcomes, functional forms, first-stage regression specifications, and exclusions, and our preferred specifications all satisfied standard instrumental variable diagnostic tests.</p><h3>Conclusions</h3><p>We found that the poor do not always gain more from marginal increases in public expenditure on secondary care and, conversely, might not always bear the largest share of the health opportunity costs of cost-increasing programmes.</p></div>","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 2","pages":"309 - 324"},"PeriodicalIF":3.3,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12924834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762020","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":"Acknowledgement to Reviewers","authors":"","doi":"10.1007/s40258-025-01021-3","DOIUrl":"10.1007/s40258-025-01021-3","url":null,"abstract":"","PeriodicalId":8065,"journal":{"name":"Applied Health Economics and Health Policy","volume":"24 1","pages":"1 - 3"},"PeriodicalIF":3.3,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740480","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}