Health Economics Research Articles

Health Care Spending and Economic Growth: Armey-Rahn Curve in a Panel of European Economies

Health Care Spending and Economic Growth: Armey-Rahn Curve in a Panel of European Economies

AssertHE: an R package to improve quality assurance of HTA models

Background Health economic models are increasingly used to inform decisions about the allocation of healthcare resources. Ensuring the robustness and reliability of these models is critical. Currently, quality assurance is conducted by both technical and non-technical experts assessing different components of the model manually. This is resource intensive. Understanding how the different components of the model fit together is time consuming, and testing every part of the model is sometimes not feasible in the time available. To aid in this, we have developed the assertHE R package. Methods The open-source assertHE package provides testing functionality for those building and reviewing health economic models built in R programming language. It provides a series of checks which can be integrated into the model development workflow to reduce the probability of common errors. It also provides a suite of functions which allow users to better understand the network of R functions contained in a model, where they are defined, if (and where) they are tested, and provides a simple metric to quantify the extent to which they are tested. Results We applied the assertHE package to three open-source health economic models built in R, showing how to include check functions within the model code and how to visualise the network of functions, see the test coverage, and obtain a Generative Pretrained Transformer Large Language Model (GPT-LLM) generated summary of any function in the code-base. We have worked with collaborators from industry, regulators and academia to develop the package to be applicable to the widest possible range of models, making adaptations to the source code based upon feedback. Conclusions assertHE offers an open-source toolkit for health economists building and reviewing models, promoting collaborative development and facilitating a more robust and efficient quality assurance process.

The value of a neurosurgeon: is neurosurgical compensation proportional to value added? A systematic review of the literature and an update on a changing healthcare economy.

Determining the value of a neurosurgeon is complex. Services provided by neurosurgeons have a range of interested parties-from a patient's singular health interest to a community catchment area rendering on-call emergency services. Such complexity makes it difficult to determine and define value. As healthcare reimbursement changes continue to transition further toward value-based/bundled payments, such determinations remain difficult and confusing. Given these factors, now more than ever before, neurosurgeons need to be active participants in the evolving discussions surrounding healthcare advocacy, value, and compensation in an ever-evolving and convoluted system. The objective of this study was to review and present current trends within the evolving landscape of healthcare economics and their impacts on the perceived value of neurosurgical services. A systematic review regarding payments and compensation within neurosurgery was performed using a key term search. Additionally, a neurosurgical value model for hospitals was created using Medicare reimbursement methods to attempt to determine the financial contribution of a single neurosurgeon to a hospital system. Furthermore, Internal Revenue Service (IRS) form 990 tax filings from 5380 organizations were examined for comparative trends in profits and revenue on a hospital-wide basis. Mean and median annualized excess hospitalization revenue from a neurosurgeon over the same number of equal medical admissions was $5,120,533 and $5,141,160, respectively. For private practice groups, the annualized mean and median yearly hospital revenue over a comparable medical admission was calculated to be $1,539,704 and $1,902,555, respectively. For hospital-employed neurosurgeons, the respective addition of Medicare part B payments increased the mean and median values to $2,249,552 and $2,612,403, respectively. Analysis of nonprofit hospital IRS form 990 filings revealed a substantial increase in executive compensation and hospital revenue since 2011. Neurosurgeon median earnings over a similar period, reported through surveys, exhibited varied increases, but significant reporting variation exists. Medical compensation continues to evolve toward more value-driven methods. Value created as a neurosurgeon is complex, but it should not be underestimated as a key driver of hospital revenue, with up to $2.6 million created annually from neurosurgical hospital admissions. Further discussion is needed to elucidate alternative innovative payment strategies to ensure physicians remain active in the evolving structure of our healthcare system.

The IMPACT Survey: the humanistic impact of osteogenesis imperfecta in adults

BackgroundThe IMPACT Survey explored the humanistic, clinical, and economic burden of osteogenesis imperfecta (OI) on individuals with OI, their families, caregivers, and wider society. Two previous publications report research methodology, initial insights of the survey, and cost of illness of OI. Here, we present data on the impact of OI on the quality of life (QoL) of adults with OI and explore potential drivers of this impact.MethodsThe IMPACT Survey was an international mixed methods online survey in eight languages (fielded July–September 2021), aimed at adults (aged ≥ 18 years) or adolescents (aged 12–17 years) with OI, caregivers (with or without OI) of individuals with OI, and other close relatives. Survey domains included demographics, socioeconomic factors, clinical characteristics, treatment patterns, QoL, and health economics. We conducted a descriptive analysis of the QoL data, as well as exploratory regression analyses to identify drivers of impact of OI on QoL (independent associations between patient characteristics and the impact on QoL).Results1,440 adults with OI participated in the survey. The proportion who reported an impact of OI on their QoL across individual areas in the physical, socioeconomic, and mental well-being domains ranged between 49 and 84%. For instance, 84% of adults reported an impact of OI on the types of leisure activities they could do and 74% on the type of job they could do. More severe self-reported OI and higher fracture frequency were consistently identified as drivers of OI’s impact on QoL. The proportion of adults who reported worrying about different aspects of their lives due to their OI, such as mobility loss, future fractures, and ageing, ranged between 31 and 97%.ConclusionIMPACT provides insights into the humanistic burden of OI on adults, revealing that OI has a substantial impact on the QoL of adults. OI severity and fracture frequency were consistently identified as drivers of impact on QoL across all domains. Understanding these drivers may aid in identifying areas for targeted interventions, such as fracture prevention.

Health economics of virtual versus face-to-face glaucoma clinics: a time-driven activity-based costing study

Background/AimsStaffing represents the most significant cost to the National Health Service, and ophthalmology is its largest outpatient specialty. Value-based healthcare (VBH) focuses on care processes. Innovative models include a shift...

High-Sensitivity Cardiac Troponin Assays in Acute Heart Failure, Moving Beyond Myocardial Infarction.

Cardiac troponins are essential structural proteins found in the contractile apparatus of cardiac myocytes. During myocardial damage, such as in myocardial infarction (MI), these troponins are released into the bloodstream. As a result, they play a central role in the diagnosis of MI, serving as sensitive and specific markers for cardiac injury. Earlier assays that were used for measuring troponin levels were considered as a dichotomous test, categorizing patients as being positive or negative for MI. The recent introduction of high-sensitivity cardiac troponin assays has revolutionized cardiac troponin detection. These assays can detect troponin levels that are 100 times lower than what traditional methods can detect. Hence it is now considered a quantitative measure of cardiac myocyte injury not only in the setting of MI but also in subjects without MI such as heart failure, in whom it can be regarded as a marker for myocardial stress. This review aims to establish the relationship between high-sensitivity cardiac troponin levels and the prognosis of patients suffering from acute heart failure. Additionally, this seeks to identify other applications where the release of troponin from the cardiomyocyte can provide prognostic information. This information can be vital in determining the appropriate treatment options for patients, ultimately improving their quality of life and positively impacting health economics.

Digital tooling with soft power to drive the smart silver economy under the aged society of Thailand

“Thailand 4.0” is the current national strategic plan driven by digital technology and innovation; “Silver Economy” is one among the urgent flagship to serve the urgent needs of aged society with its approximately 20-30 percent of Thai population. Besides, around 60 percent of the elderly proven being under the poverty line. Most of the urgent demands is economics opportunities, digital skills, and health care, respectively. Objectives are 1) the current situation of elderly towards “Silver Economy” embedded with “Soft Power”; 2) the digital literacy & competency skills of elderly towards “Silver Economy” embedded with “Soft Power”; and 3) the recommendation to support the elderly towards “Silver Economy” embedded with “Soft Power”. Mix research methods were used 1) Quantitative research by e-survey among the 100 elderlies across the country who involved with Silver Economy and Soft Power. Qualitative research by in-depth-interview and Focus Group Discussion among 15 key informants from the elderly and all stakeholders. Results found 1) most of the elderly have a very good attitude, high demands to run their Silver Economy activities especially with their own Soft Power; 2) most of the elderly gain fundamental digital literacy & competency. More digital top skills are needed to run their Silver Economy activities i.e., creative digital marketing skills, AI in digital PR, digital storytelling, and local tourism, etc. and 3) Recommendations for more tangible collaborations among all the relevant stakeholders from policy to the practical agencies. Friendly and effective portal for all kinds of collabolations among the stakeholders and the elderly themselves.

Combining azole antifungals with venetoclax plus azacitidine in patients with newly diagnosed acute myeloid leukemia

ABSTRACT The combination of venetoclax (VEN) with hypomethylating agents (HMAs) improves survival in patients with acute myeloid leukemia (AML) and may cause neutropenia requiring combined antifungal therapy or prophylaxis. The inhibition of cytochrome P450 activity by azole antifungal agents leads to elevated blood concentrations of VEN. This study aimed to evaluate the efficacy and safety of venetoclax plus azacitidine (AZA) with azoles in newly diagnosed AML patients. The primary endpoints included complete remission (CR), complete remission with incomplete blood cell recovery (CRi), composite CR (CRc, CR + CRi), blood cell recovery time and incidence of infections. The CRc was 50.0% in the azole group and 56% in the nonazole group (p > 0.05). In the azole group, the median recovery times for patients with ANC >500 cells/mm3 and ANC >1,000 cells/mm3 were 19 and 25 days, respectively. For the nonazole group, the corresponding times were 16 and 19 days (p < 0.05). In the azole group, the median durations for patients with a PLT >50,000/mm3 and >100,000/mm3 were 18 and 20 days, respectively. For the nonazole group, the corresponding times were 16 and 19 days (p > 0.05). The incidences of fungal and bacterial infections were not significantly different (30.8% vs 26.1% and 50.0% vs 56.0%) (p > 0.05). The cost-effectiveness ratio of the azole group is lower. There was no significant difference between VEN + AZA with or without azole in terms of efficacy, infection, or partial hematological toxicity. However, the combination of azoles may prolong the neutrophil recovery time. Azole combination could reduce the amount of venetoclax and improve health economics.

Utilisation patterns of radiotherapy among older patients: Insights from Portuguese National Cancer Registry data

IntroductionRadiation therapy (RT) will be required by millions of those aged 70 or older by 2040 based on European growth in cancer incidence among this age group. PurposeThis study evaluates the use of external radiotherapy (EBRT) using data from the Portuguese National Cancer Registry (RON), analysing various cancer locations and age groups. A comparative analysis was conducted between actual EBRT utilization and comorbidity-adjusted optimal rates. MethodsBased on RON’s data, cancer diagnoses from January to June 2018 were analysed. Optimal Utilization Proportions (OUP) of EBRT were obtained from European SocieTy for Radiotherapy and Oncology (ESTRO), Health Economics in Radiation Oncology (HERO) project. Actual utilization percentages (AUP) were calculated using national cancer registry data, and a comparative analysis adjusting for comorbidities was conducted. ResultsFor most cancer locations and age groups, the actual EBRT utilisation fell below the ESTRO-HERO recommendations, with potential untreated patients estimated at 22 % of all new cancer cases across all age groups. Disparities were observed for older patients, such as breast cancer EBRT actual utilisation declining from 68 % to 25 % for patients aged under 70 and 85 or older, respectively. Also, cervix cancer patients aged 75 or older exhibited nearly 100 % optimal EBRT utilisation. Conversely, older patients with bladder and colon cancer had significantly lower RT actual utilisation rates. Comorbidity-adjusted EBRT utilisation rates for lung, rectal, cervix, and breast cancers in patients aged 70–79 did not reached ESTRO-HERO task force recommended rates. The actual EBRT usage in Portugal failed to meet the comorbidity-adjusted optimal utilisation rate for all cancer locations and age groups. Nevertheless, Portuguese actual EBRT for rectal and prostate cancer, exceeded the actual rates in Australian cohort. ConclusionWhile EBRT is essential for older adults with cancer, disparities and suboptimal utilization highlight opportunities for improving cancer care provision.

Outcomes, safety and health economics of introduction of video laryngoscopy-assisted less invasive surfactant administration.

Less invasive surfactant administration (LISA) is associated with better outcomes than InSurE (Intubation-Surfactant administration-Extubation). Video-laryngoscopy (VL) facilitates intubation in neonates, however safety and cost-effectiveness of VL-assisted LISA have not been evaluated. We compared the outcomes of infants receiving VL-assisted LISA (n = 67) with a historical cohort of infants who received InSurE (n = 52). Secondary aims were to evaluate safety and cost-effectiveness. VL-assisted LISA was associated with reduced duration of non-invasive ventilation (NIV), reduced duration of oxygen therapy, reduced composite days on NIV and mechanical ventilation (MV), and shorter NICU stay with lower hospital costs for infants ≥29 weeks GA, compared to InSurE. In the VL-assisted LISA group, 66% of the tracheal catheters were placed on the first attempt and 16% of infants displayed desaturation during placement. In infants ≥29 weeks GA, VL-assisted LISA reduced exposure to NIV, oxygen, NIV and MV combined, length of stay, and cost of care compared to InSurE.

Scoping Review of Indices to Measure a Community's Health Status.

Composite health indicators are valuable tools to assess population health over time and identify areas for intervention. This scoping review (ScR) aimed to map the literature describing comprehensive health-related metrics used to assess community health. The Arksey and O'Malley framework was used to conduct the ScR, using the following steps: identifying the research question, identifying relevant studies, charting the data, collating and reporting results. United States-based studies that developed/utilized a composite health index using geographic information system (GIS) mapping capabilities to assess community health at the county level or more granular were identified through literature searches conducted in PubMed and EMBASE databases. Literature searches identified 5112 articles; of these, 8 studies describing composite health indices were included. The number of indicators used in each index ranged from 4 to 75 (median: 22). Health outcomes, health behaviors, education, and economics were incorporated into most indices. High school graduation rate (n = 6 indices), health insurance status (n = 5), commute time, median household income, unemployment, and obesity rates (n = 4 each) were the most common indicators across indices. All indicators were derived from publicly available data sources, such as the American Community Survey and US Census Bureau. Although a limited number of community health indices were identified in the ScR, the indices included a broad range of indicators covering both health outcomes and factors contributing to health vulnerabilities. The public data sources and GIS integration of the indices provide potential for broad, insightful applications to various contexts across the United States.

Expert Consultation: Factors Influencing End-of-Life Decision-Making for Dairy Cattle Across the United States Supply Chain.

The end-of-life (i.e., on-farm euthanasia and culling, including fitness for transport to slaughter) of a dairy cow or calf is preceded by a series of decisions often influenced by many complex factors. The aim of this study was to utilize the opinions of experts with roles in the dairy supply chain to identify factors that influence end-of-life decision-making for dairy cattle. Twenty experts serving in supporting roles in the dairy supply chain participated in a survey containing 17 open-ended questions. Of the participants, 55% (n = 11) identified as veterinarians and the remaining 45% (n = 9) participated in other segments of the dairy supply chain. Twelve themes were identified in the qualitative analysis of survey responses. The themes included: Training and Resources, Cattle Health Management, Decision-Making Criteria, Company Culture, Personal Beliefs, Human Well-Being, Animal Welfare, Economics, Guidelines and Inspections, Consumer Perceptions, Supply Chain Considerations, and Communication. Experts indicated that training programs should address euthanasia or fitness-for-transport criteria, the knowledge of common health conditions, and information about what happens to cattle after leaving the dairy. Additional influencing factors included personal beliefs, economics, company culture, and supply chain considerations.

Addressing incentive-driven prescribing

Market failures in health care1 thrive on conflict ofinterest. Take the example of market failure due to“information discrepancy” between doctors and patients.This uneven knowledge is the basis for exploitation by thealliance between the health technology industry andmedical profession an alliance fraught with conflict ofinterest. Patients pay the cost through their health andmoney.Whereas market failures are well established and wellstudiedphenomenon in health economics and healthcare literature, there is a weak research base, including inPakistan, for conflict of interest in health care despite itscharacterization as “an invisible force shaping healthsystems and policies”.2 It “remain(s) a global issue that isneglected, underestimated, and overlooked by healthpolicy makers and researchers”. Continued...

Challenges and Growth of Physical Medicine and Rehabilitation Around the World

Physical Medicine and Rehabilitation (PM&amp;R) is a criticalmedical specialty that improves function, reducesdisability, and decreases healthcare costs. However, manylow- and middle-income countries (LMICs) have minimalor absent PM&amp;R services. Recent World HealthOrganization resolutions call for the scaling up of PM&amp;R,presenting a unique opportunity to address disability ona global scale. Successful PM&amp;R integration requires amulti-pronged approach involving governments,healthcare systems, employers, and patients. Investing inPM&amp;R is not just a humanitarian imperative; it's soundeconomic policy. Policymakers must act now toincorporate PM&amp;R into healthcare systems in LMICs,leading to healthier populations, reduced disability, andstronger economies.Keywords: Physical Medicine and Rehabilitation,Disability, Health Policy, Health Economics, World HealthOrganization.

A novel way to integrate economic information into clinical practice guidelines

BackgroundClinical guidelines are widely used to support clinical decision making, so they could also provide economic information about medical interventions to promote cost-conscious health care. We developed a new way to integrate economic information into the Finnish Current Care Guidelines.MethodsOur development team consisted of clinical guideline specialists and health economists. We first looked at integration of economic information in clinical guidelines of other countries. Our key principle was that economic information should be integrated only to mutually exclusive medical interventions where the extensive choice of one the options will yield a significant cost differences on the national level. For the comparative effectiveness information of the interventions, we primarily looked for network meta-analyses. We then combined the effectiveness information presented as number needed to treat with prices or costs for the interventions and present the result as a cost per responder, which reflects both effectiveness and price or costs.ResultsWe introduce a process to integrate and present the economic information of the selected interventions in tables in the Current Care Guidelines.ConclusionsOur novel way to integrate economic information into the Current Care Guidelines is an effort to support cost-conscious clinical decision making to promote cost-effective health care in Finland. This process is general and could be used in clinical guidelines in other countries as well.

Electronic patient-reported outcomes as digital therapeutics for patients with cancer: a narrative review of current practices and future directions.

Improved cancer treatment outcomes have increased the demand for medical care that considers the quality of life of patients with cancer. Patient-reported outcomes (PROs) help assess the quality of life because they involve direct evaluation of the patients. Recently, electronic PROs (ePROs) have been used in clinical cancer care settings in Europe and the United States. Electronic PROs positively affected communication between patients with cancer and healthcare providers, enhanced education, optimized self-management, contributed to healthcare economics, assisted in monitoring adverse events, and improved prognosis. However, challenges such as adherence, burden on healthcare providers, lack of personalized formats, low digital literacy, and implementation costs remain. Therefore, carefully selecting the items to be recorded by ePROs in alignment with specific objectives is essential. Additionally, developing systems using lifelogs-digital records of daily activities-and creating mechanisms that automatically encourage patient behavioral changes based on the reported data are crucial. This review delineates the advantages and challenges of ePROs according to their history and proposes the prospects of ePRO.

The economic burden of nosocomial infections for hospitals: evidence from Germany

BackgroundNosocomial infections (NI) significantly worsen patient outcomes, resulting in higher mortality rates and reduced health-related quality of life. Furthermore, they pose substantial economic strain on healthcare systems and hospitals. For instance, patients with nosocomial infections (NIs) experience prolonged hospital stays compared to those without NIs. These extended stays result in occupied bed-days, leading to opportunity costs for hospitals. This study aimed to estimate the opportunity costs for a German hospital based on hospital stays, daily revenue, and occupancy rates (OCR).MethodsWe analysed cost data obtained from routine records maintained by the accounting department of a German hospital's surgical and orthopedic units from 2018 to 2019 for the “HygArzt” research project. To ensure balance, we employed genetic matching. We estimated the differences in length of stay (LOS) and daily revenue between patients with and without nosocomial infections (NI) using linear regression. Finally, we calculated the opportunity cost borne by the hospital by treating NI patients instead of non-NI patients. All costs are reported in 2018 Euros.ResultsThe final sample included 81 patients with NI matched with 207 patients without NI. The majority of the NI patients (77.0%) had surgical site infection (SSI). Compared to non-NI patients, we observed that NI patients had a longer LOS (10 days, p < 0.001) and lower daily revenue (€400, p < 0.001). We also found that comorbidities and the frequency of operations had significant impact on the LOS. Using a baseline 30 to 50% preventable NIs, successful prevention of a single NI could potentially reduce the length of hospital stay by 3 to 5 days and increase hospital revenue by approximately €120 to €200 per day per prevented NI. Consequently, the hospital saves 3 to 5 more bed-days to backfill and generate more revenue, and/or make more efficient resource allocation by changing bed-capacity and staffing. The resulting opportunity costs can potentially exceed €1,000 per preventable case.ConclusionNIs pose a substantial economic burden for hospitals. From a health economics’ perspective, there are strong economic incentives for hospitals to implement infection control interventions, such as the involvement of a prevention link physician/nurse.

Economic evaluation of the Liverpool heart failure virtual ward model.

A virtual ward (VW) supports patients who would otherwise need hospitalisation by providing acute care, remote monitoring, investigations, and treatment at home. By March 2024 the VW programme had treated 10 950 patients across six speciality VWs, including heart failure (HF). This evaluation presents the economic assessment of the Liverpool HF VW. A comprehensive economic cost comparison model was developed by York Health Economics Consortium (University of York) to compare the costs of the VW to standard hospital inpatient care (SC). The model included direct VW costs and additional costs across the care pathway. Costs and resource use for 648 patients admitted to the HF VW were calculated for 30 days post discharge and total cohort costs were extrapolated to a full year. Primary outcomes included costs related to length of stay, readmissions, and NHS 111 contact. The total cost for the HF VW pathway, including set-up costs, was £467 524. This results in an incremental net cost benefit of £735 512 compared to the total SC cost of £1 203 036, indicating a substantial net cost benefit of £1 135 per patient per episode (PPPE). This advantage remains despite initial setup expenses and ongoing costs such as home visits, virtual consultations, point-of-care (POC) testing and home monitoring equipment. Our HF VW model offers a substantial net cost benefit, driven by reduced hospital stays, fewer emergency department visits, and lower readmission rates. The study highlights the importance of considering system-wide impacts and continuous monitoring of VWs as they develop.

Value in acute care surgery, part 4: The economic value of an acute care surgery service to a hospital system

ABSTRACT The Healthcare Economics Committee of the American Association for the Surgery of Trauma has published a series of three articles on the topic of value in acute care surgery (ACS). In this series, the key elements of value, cost and outcomes, and the impact of stakeholder perspective on what constitutes high-value care are discussed. The fourth article in this series continues the discussion by focusing on the unique economic value that an ACS service brings to a hospital system and its patients. Characterized by the immediate 24-hour availability of surgeons trained in trauma management, emergency general surgery, and surgical critical care, acute care surgeons extend the benefits of surgical rescue and critical care to all hospitalized patients. As such, an ACS service acts as a vital part of a hospital's infrastructure to successfully care for complex and seriously ill patients, in addition to enabling the establishment of other, high revenue-generating services such as vascular, transplant, and complex oncologic surgery programs. The trauma service acts as intake for patients that lead to downstream revenue creation by other disciplines such as orthopedic and neurological surgery, while trauma center designation itself results in dedicated state funding to ensure trauma readiness in many states in the United States. The traditional “value equation” in health care of outcomes achieved per dollar spent is ill-suited to capture many of these unique aspects and benefits of ACS. This article provides the background to understand the economic value of an ACS service and future directions toward improving overall value of care. LEVEL OF EVIDENCE Economic &amp; Value-based Evaluations: Level IV.

Lessons Learnt from HIV and Noncommunicable Disease Healthcare Integration in Sub-Saharan Africa.

In sub-Saharan Africa (SSA), a rising burden of noncommunicable diseases (NCDs) coexists with a persistent high burden of human immunodeficiency virus (HIV). Integrating care for chronic conditions is potentially beneficial, but the optimal approach remains unclear. By use of a narrative review of 14 recent case studies from different SSA countries, examples of NCD and HIV healthcare integration were described. Case studies were categorized into three models: integrating NCD care into existing HIV care (n = 8), integrating HIV care into existing NCD care (n = 2), and simultaneous implementation of HIV and NCD services (n = 4). Facilitators include staff and patient education, while barriers encompass the lack of guidelines and inadequate infrastructure. Providers, patients, and policymakers support integrated care but note several challenges. Available health economics data suggest cost-effectiveness in the long run. Concluding, NCD and HIV healthcare integration in SSA was deemed feasible with models of service integration related to the implementation context.