Abstract Background Type 2 Diabetes Mellitus (T2DM) imposes a severe economic burden on Indonesia’s Social Health Insurance Administration Body (BPJS Kesehatan), driven predominantly by expensive late-stage complications. While the Prolanis program offers community-based prevention, a lack of long-term economic forecasting hinders optimal resource allocation among its core interventions. To address this gap, this study aims to evaluate community-based intervention strategies to determine which approach is the most cost-effective for long-term T2DM management in Indonesia. Methods We developed a deterministic linear compartmental state-transition model to forecast the 25-year epidemiological and economic impacts of six intervention strategies derived from three Prolanis pillars: health education, physical activity, and lifestyle modification. The model integrated an economic resource allocation framework, Indonesian epidemiology data, and a 3.8-fold complication cost penalty multiplier for complication states. Cost-effectiveness was evaluated from a healthcare payer perspective using the Incremental Cost-Effectiveness Ratio (ICER) and Time-Horizon Sensitivity Analysis. Results Over 25 years, the Lifestyle Modification intervention emerged as the dominant strategy compared to baseline care. It generated the highest increase in the managed T2DM population while incurring the lowest total systemic cost. ICER analyses demonstrated that Lifestyle Modification strictly dominated individual and combined promotive activities, which were subject to severe budgetary restrictions due to their high delivery cost-weights. Furthermore, temporal analysis confirmed that Lifestyle Modification achieves systemic net savings rapidly by Year 5. By Year 25, it resulted in projected cumulative net savings of 19.22 trillion IDR under the 3% base-case discount rate, with sensitivity analyses confirming robust dominance across 0% (27.61 trillion IDR savings) and 5% (15.48 trillion IDR savings) discount rates. Conclusion Lifestyle Modification is the most economically dominant community-based intervention for managing T2DM in Indonesia. To avert the financial penalties of downstream complications, policymakers should strategically rebalance the Prolanis capitation budget to prioritize proactive, monitoring-driven lifestyle interventions.
Bacterial vaginosis (BV) is associated with reduced fecundability in women. To address the limited accessibility and diagnostic sensitivity of current preconception BV screening in China, this study evaluated the cost-effectiveness of BV Blue, an accessible, self-administered rapid test. A decision tree model was constructed from a societal perspective to compare five screening strategies: No screening, Amsel criteria, BV Blue testing alone, sequential BV Blue–Nugent testing, and Nugent scoring alone. Effectiveness was defined as the number of pregnancies per 100,000 women over one year. Cost-effectiveness was evaluated using incremental cost-effectiveness ratios (ICERs), referenced against a willingness-to-pay (WTP) threshold based on China’s per capita GDP. Sensitivity analyses were conducted to assess model robustness. In a simulated cohort of 100,000 women, BV Blue testing yielded 842 additional pregnancies compared with no screening (ICER: CNY 2,827 per pregnancy), well below the WTP threshold of CNY 99,665. The sequential and Amsel strategies were absolutely dominated by BV Blue testing. Compared with BV Blue testing, Nugent strategy yielded 171 additional pregnancies (ICER: CNY 198,051 per pregnancy), remaining below the three-fold per capita GDP threshold (CNY 298,995). However, sensitivity analyses indicated that the cost-effectiveness of Nugent strategy was not robust, being highly sensitive to BV Blue testing’s diagnostic sensitivity and pregnancy rates. On the cost-effectiveness acceptability curve, BV Blue testing consistently demonstrated the highest probability of being the optimal strategy. In the preconception period, all screening strategies yielded more pregnancies than no screening. Both BV Blue testing and Nugent scoring were cost-effective, whereas the Amsel and sequential strategies were not. BV Blue testing is a promising screening tool for preconception BV management. These findings may inform the selection of diagnostic pathways in China’s national preconception screening program.
The pharmaceutical industry plays a pivotal role in the healthcare economy, with drug quality and pricing being critical to consumer welfare. China’s government has implemented National centralized volume-based drug procurement(NVBP) policy, aiming to reduce medication costs through bulk purchasing. While existing research confirms its price-reduction effects, unintended consequences regarding pharmaceutical quality incentives remain overlooked. This study investigates how the NVBP policy reshapes firms’ quality-pricing strategies, addressing a critical gap in policy evaluation. Game-theoretical model is constructed to simulate interactions between two pharmaceutical firms with distinct technological capabilities before and after China’s National volume-based procurement (NVBP) policy. Prior to the policy, the Hotelling model’s spatial competition is reinterpreted as a quality-preference spectrum After the policy, drugs are standardized through consistency evaluation, and competition reduces to pure price competition as in the Bertrand model. Then a double-envelope bidding game is introduced where the government sets a minimum quality standard and firms bid on price. After winning the bid, firms need to decide the production strategy. Before NVBP policy implementation, equal-quality price differences depend solely on technical parameters. Under endogenous quality, a firm’s quality rises with its own technology; the technologically superior firm charges a higher price, but a weaker firm facing a superior rival lowers its price. After NVBP policy implementation, during the bidding time, if both firms pass consistency evaluation, the winning bid price falls, but quality may drop below pre-NVBP levels. If the low-tech firm fails, the high-tech firm gains monopoly pricing power and raises prices. During the production time, some unintended consequences may occur, such as quality risk and supply disruption risk. The implementation of NVBP policy could lower drug prices and improve access, but it may also generate unintended consequences. Low standards induce price competition and reduce quality investment, while high standards may create sole-supplier monopoly. Excessively low bids pose quality or supply risks. Policy should calibrate standards, use tiered incentives, and strengthen surveillance, but empirical validation remains needed.
This study aimed to assess the cost-utility of luseogliflozin compared with Standard of Care (SoC) for patients with T2DM in Vietnam, under two reimbursement scenarios by Vietnam Social Health Insurance (VSHI). A Markov model with five health states was developed to simulate lifetime disease progression. The analysis adopted the VSHI perspective, including only direct medical costs. Health outcomes were expressed as quality-adjusted life-years (QALYs), and cost-effectiveness was evaluated against a willingness-to-pay (WTP) threshold of 1 GDP per capita in Vietnam (USD 4,700 per QALY). Both costs and outcomes were discounted at 3
The present study evaluates the cost-effectiveness of India’s 2019 childhood pneumonia management guidelines compared with no treatment, assuming 100
Innovation in the pharmaceutical industry relies on sustained R D investment, but the high-input, long-cycle, and high-risk characteristics of R D activities often create financing constraints for enterprises. How to effectively incentivize enterprises to increase R D investment through fiscal and tax policies is a focus of attention for both the government and academia. Based on the panel data of 57 pharmaceutical companies from 2016 to 2024, this study employs a benchmark regression model to investigate the impact of government tax refunds on pharmaceutical companies’ R D investment, and conducts empirical analysis using semi-parametric estimation. When LTr < 15, the partial derivative graph of tax refunds on R D investment generally exhibits a horizontal trend. When 15 ≤ LTr, it shows a linear growth trend. For companies with innovative drugs, there is a “W”-shaped fluctuation trend between tax refunds and R D investment, while for companies without innovative drugs, the impact of tax refunds on pharmaceutical companies’ R D investment exhibits a “U”-shaped fluctuation trend. There is a certain optimal range for the promotional effect of tax refunds on pharmaceutical companies’ R D investment. Compared with companies without innovative drugs, companies with innovative drugs are more sensitive to tax refunds on R D investment.
Dementia is one of the most serious health issues in an aging society, placing a significant burden on patients and their families, while also posing considerable socioeconomic challenges at the national level. In response, the Korean government introduced the National Responsibility for Dementia Care policy in 2017 to improve healthcare accessibility for patients with dementia and reduce their financial burden. This study utilized the cohort data of patients with dementia collected from Ajou University Hospital between 2012 and 2022. To quantitatively assess the changes in healthcare utilization, we applied panel multivariate negative binomial regression and panel multivariate gamma regression analyses. The analysis identified key factors influencing healthcare utilization, including place of residence, presence of comorbidities, age, and duration of dementia. After the policy was implemented, there was a general decline in outpatient visits and medical expenditure, suggesting a positive effect of the policy on alleviating the economic burden on patients with dementia. Significant changes in healthcare utilization were observed among patients in the early stages of dementia, highlighting the importance of early diagnosis and home-based care services. The findings indicate a need for personalized treatment and the expansion of community-based healthcare services for patients with dementia.
Extended Cost-Effectiveness Analysis (ECEA) extends conventional cost-effectiveness analysis by incorporating financial risk protection (FRP) and examining the distribution of health and economic outcomes across socioeconomic groups. This scoping review aimed to map the application of ECEA in health-sector studies, identify methodological patterns, and explore geographic and thematic research gaps. A scoping review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed on 29 October 2025 in PubMed, Scopus, Web of Science, ProQuest, and Google Scholar. Studies published between 2000 and 2025 that applied ECEA to evaluate health interventions were eligible for inclusion. Data were extracted on intervention characteristics, analytical approaches, equity measures, and FRP outcomes and were synthesized narratively. A total of 1,955 records were identified, of which 19 studies met the inclusion criteria. Most studies were conducted in low- and middle-income countries, particularly in Asia and Africa. The included studies primarily evaluated vaccination programs, taxation policies on harmful products, publicly financed health services, and maternal and child health interventions. Financial Risk Protection (FRP) outcomes were most commonly reported as reductions in out-of-pocket expenditures, catastrophic health expenditures averted, and poverty cases averted. Across studies, ECEA was predominantly used to assess the distribution of health and financial outcomes across socioeconomic groups, with outcomes commonly reported by income quintiles. ECEA applications remain limited and are predominantly concentrated in low- and middle-income countries, particularly within preventive and fiscal health interventions. The reviewed evidence suggests that ECEA provides a useful framework for assessing both health outcomes and financial risk protection across socioeconomic groups. Future research should expand ECEA applications to underrepresented settings and promote greater methodological standardization of equity and FRP measures.
Provider payment mechanisms are critical policy tools for shaping healthcare delivery, yet their effectiveness is mediated by contextual and organizational factors. This study examines the implementation of capitation prepayment under China’s Integrated County Healthcare Consortium (ICHC) system, aiming to elucidate the complex interplay of factors influencing provider behavioral responses and the resulting system dynamics. We conducted a mixed-methods study in Datong prefecture, China. Qualitative data from 63 semi-structured interviews with county hospital physicians and administrators were analyzed using Latent Dirichlet Allocation (LDA) to identify key influencing factors. Social Network Analysis (SNA) and Interpretative Structural Modeling (ISM) were employed to examine the interrelationships and hierarchical structure of these factors. A System Dynamics Model (SDM) was developed using longitudinal data (2015–2019) from 15 county hospitals to simulate the incentive mechanisms of capitation prepayment. The analysis revealed four primary domains influencing provider behavior under capitation prepayment: (1) external environmental factors (population characteristics, economic conditions, market competition), (2) institutional resources (bed capacity, workforce, medical equipment), (3) management strategies (particularly cost-control measures), and (4) service delivery outcomes. Management strategies emerged as the most direct determinant of provider behavior, while environmental factors and institutional resources moderated the effects of payment incentives. The SDM simulations indicated potential unintended consequences, including cost-shifting from inpatient to outpatient services. The study demonstrates that provider responses to capitation prepayment are predominantly driven by institutional cost-control measures, mediated by contextual and resource factors. Policy implementation should address potential unintended consequences through strengthened referral mechanisms between county and tertiary hospitals and enhanced monitoring of service shifting. These findings contribute to the global understanding of payment reform implementation in resource-constrained settings and highlight the importance of contextual adaptation in payment system design.
A comprehensive policy framework constitutes a crucial institutional foundation for the sustainable development of healthcare systems and quantitative evaluation of public policies offers a scientific basis for policy refinement and optimization. Amid ongoing healthcare reform and profound shifts in the structure of demand for medical resources, systematically assessing the textual quality of national-level medical resource allocation policies, together with examining of their structural characteristics and evolutionary trajectories, carries considerable practical significance. Through a systematic screening process, 16 national-level policy documents on medical resource allocation were identified. Text-mining techniques were applied to extract high-frequency keywords and build a keyword co-occurrence network, after which the PMC-index model was then used to quantitatively assess the overall quality of these policies. Heterogeneity analyses were then conducted across policy quality grades and time periods to reveal structural differences and evolutionary patterns. The average PMC-index across the 16 policies was 6.67, suggesting that China’s medical resource allocation policies are generally of relatively high quality. However, the analysis revealed several structural weaknesses, including limited predictive and forward-looking content, insufficient medium- to long-term planning, and an under-supply of higher-level policy instruments. Temporal analysis showed that the PMC-index increased from the Exploration Stage to the Deepening Stage before declining modestly in the Focus Stage. China’s medical resource allocation policies are of relatively high overall quality, yet further improvements remain necessary. Future policy efforts should focus on three priorities: optimizing the hierarchical structure of the policy system, strengthening policy predictability and medium- to long-term planning orientation, and refining policy content and implementation mechanisms. Together, these efforts would enhance the systematization, stability, and governance effectiveness of the policy framework.
Egypt’s health financing is characterised by persistently high out-of-pocket (OOP) payments exceeding 50
Pharmacoeconomic evaluations are critical for healthcare decision-making, especially as South Korea has emphasized cost-effectiveness since the 2006 positive list system. However, no official cost-effectiveness threshold (CET) has been established. This study aimed to systematically review cost-utility analyses (CUAs) conducted in South Korea since 2007 and to describe how CET values have been reported and applied in published pharmacoeconomic studies. We conducted this systematic review following the PRISMA guidelines. We searched five databases, including PubMed and KoreaMed, for CUAs published after 2007. We included CUAs of medications conducted in South Korea that reported CET. Data on baseline year, outcome measures, CET values, drug type (anticancer drugs, vaccines, and other treatments), and funding sources were extracted. We assessed the association between CETs and categorical variables using the chi-square tests or Fisher’s exact tests, as appropriate. A total of 8,510 studies were initially identified, of which 53 met the inclusion criteria after screening. Median CETs showed an increasing trend over time. GDP per capita–based references were more frequently used than WTP-based approaches (60.4
The prevalence of dementia is currently set to rise to 1.7 million by 2040, with associated costs estimated at £90 billion. Given its substantial impact on quality of life (QoL) and the growing societal and financial burden, identifying efficient approaches to dementia support is a key policy priority. Current policy direction emphasises a shift toward community-based models of care; however, economic evidence is required to determine whether such approaches can improve outcomes while representing cost-effective use of limited healthcare resources. This study presents a cost-effectiveness analysis of the Sage House Model, a community-based dementia support intervention integrating NHS diagnostic services, third-sector provision, and local partnerships within a single hub. A preliminary cost-effectiveness analysis was conducted using a natural experimental design comparing individuals with dementia accessing the Sage House Model (n = 65) to those receiving usual care (n = 153). Health-Related Quality of Life (HRQoL) and health and social care utilisation were collected over a three-month period and valued from a health and social care perspective. Incremental costs and outcomes were estimated to assess cost-effectiveness. The Sage House Model was associated with lower incremental costs and higher incremental QALYs compared to usual care over the three-month time horizon and was likely to be cost-effective, with a 72.2
The HD21 trial demonstrated efficacy and safety of brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone (BrECADD) vs. bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) as frontline therapy for advanced-stage, classical Hodgkin lymphoma. This analysis evaluated the cost-effectiveness of BrECADD from a US healthcare payer perspective. Building upon a multicenter, randomized, open-label phase 3 HD21 trial (NCT02661503) that evaluated BrECADD versus eBEACOPP in advanced-stage, classical Hodgkin lymphoma patients, we constructed a Markov model with 3-week cycles over a 50-year horizon. The model’s primary outcomes encompassed total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios, with all economic parameters discounted at 3.0
Periodontal disease (PD) is common in the UK and is associated with higher risks of stroke and myocardial infarction (MI). Non-surgical periodontal treatment (NSPT) may therefore generate downstream cardiovascular benefits, but its value for money as a CVD-prevention strategy for the NHS is unclear. A Markov cohort model simulated 65-year-olds with severe PD and no prior CVD over 10 years (with a 25-year scenario). Eight health states captured acute and chronic phases of stroke, MI, combined events, and death. Baseline CVD risks were derived from published sources; NSPT effects (stroke HR 0.55, MI HR 0.70) were taken from large international cohort studies. Costs (2024 € , NHS payer perspective) and QALYs (EQ-5D) were discounted at 3.5
Conventional diagnosis tests for vaginal flora abnormalities in pregnant women are heterogeneous and not easily reproducible, and treatments have been shown insufficient if not combined with screening for recurrence. This paper investigates, alongside a randomised controlled trial, the cost-effectiveness of testing pregnant women for bacterial vaginosis with a point-of-care polymerase chain reaction screening combined with treatment and screening for recurrence (S T) vs. standard of care. Clinical and costs data of 6,671 pregnant women were collected from the AuTop trial. Administrative databases were used to fulfill resource utilization data. The perspective of the French health insurance was adopted, using national tariffs schedules when existed, such as for qPCR. The time horizon was less than one year, corresponding to the follow-up of the trial. The reduction in preterm birth rate was used as primary outcome and subgroup analyses were performed based on risk level. Compared to standard of care, S T reduced the rate of preterm births (3.8
Abstract Background Vertigo, dizziness and balance disorders affect over half of adults aged 65 and older. The MobilE-PHY2 study, conducted in Germany, evaluated the effectiveness of an evidence-based, multidisciplinary care pathway for this population. From a health economic perspective, the intervention was expected to increase outpatient and physiotherapy costs while reducing resource utilisation in other healthcare areas and improving patient-relevant outcomes. Objective This health economic evaluation examined the cost-effectiveness of the care pathway compared to optimised routine care. Incremental costs were related to incremental changes in both quality-adjusted life years (QALYs) and the Dizziness Handicap Inventory (DHI) as a disease-specific outcome; expressed as incremental cost-effectiveness ratios (ICER). Methods The study was a multicentre, cluster-randomised controlled trial with six -month follow-up. The health economic evaluation was conducted from a societal perspective. Cost-effectiveness was determined via incremental cost-utility ratios (ICURs) and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed using cost-effectiveness acceptability and net-monetary-benefit curves. Missing data were handled using Multiple Imputation by Chained Equations. Sensitivity analyses excluded informal care costs and focused on a subgroup with reduced imputation uncertainty. Results The ICER was 81,246.85€ per additional patient achieving a clinically relevant DHI improvement. Indicating that if the willingness-to-pay threshold were €50,000 per additional patient achieving a clinically relevant DHI improvement, the intervention would be cost-effective with 71% probability. The ICUR was negative (-121,847.54€/QALY), meaning optimised routine care dominated the intervention. From a payer perspective, the intervention was less costly, though with lower QALYs. Findings were robust in sensitivity analyses. Conclusion The care pathway shows potential for cost-effectiveness among patients achieving DHI improvements, supporting cautious, targeted implementation in routine care. Future research should address the economic burden on informal caregivers. Trial registration DRKS00028524 retrospectively registered on March 24, 2022.
China’s low male statutory retirement age (60) and its rapidly aging population make the causal effect of retirement on healthcare expenditures a pressing policy question. Centralized drug procurement, nationwide DRG/DIP payment reform, and expanded insurance coverage have reshaped the cost environment in which retirement‑related spending decisions occur, calling for up‑to‑date causal estimates. We use the most recent publicly available wave of the China Health and Retirement Longitudinal Study (CHARLS 2020, Wave 5) and apply a fuzzy regression discontinuity design that exploits the male statutory retirement age as an exogenous source of variation. The sample consists of urban males aged 55–65 (N = 2,538), the group for whom the retirement cut‑off is unambiguous and whose healthcare‑expenditure decisions are most directly affected by formal urban insurance systems. Expenditures are disaggregated into self‑treatment (medications and preventive products) and institution‑related (outpatient and inpatient) categories, and comprehensive mechanism tests are conducted across spending ability, health conditions, time availability, and lifestyle channels. Retirement significantly increases self‑treatment expenditures, with out‑of‑pocket self‑treatment rising by approximately ¥14–16 per week at the age‑60 cutoff. The magnitude is modest, consistent with the post‑2018 drug‑price reductions that exceeded 50
Abstract Background Elimination targets for infectious diseases are increasingly common in global health, yet the economic rationale for pursuing elimination is often assumed rather than rigorously assessed. Existing evaluations frequently emphasise future cost savings or broader economic benefits while overlooking health opportunity costs—the health that could have been gained had resources been allocated elsewhere. This study aimed to develop an analytical framework to investigate when disease elimination generates positive net health benefit (NHB) and to illustrate how key factors interact to shape this assessment. Methods We constructed a generalisable analytical framework incorporating ten factors related to intervention and disease costs, intrinsic disease/intervention characteristics, and stakeholder viewpoints and evaluation parameters. The framework was applied to create an exemplar model that showed how these factors jointly influence the NHB of achieving elimination. This was evaluated across wide parameter ranges informed by the literature, using different cost-effectiveness thresholds, discount rates, and time horizons. Results The framework revealed distinct regions of parameter space in which elimination yield positive NHB. The cost-effectiveness threshold, discount rates, disease burden, and intervention impact were strong determinants of NHB. In particular, lower thresholds, higher discount rates, and shorter time horizons reduced the likelihood that elimination would generate positive NHB. The framework also showed that elimination may be cost-effective in some settings but not in others, even for the same disease, due to differences in costs, burden, and opportunity costs. Conclusions Disease elimination is not always a good investment; its value depends on the interplay between disease characteristics, programme costs, and the health opportunity costs of resource use. The proposed framework provides a transparent, health opportunity cost-based structure for evaluating elimination strategies and supports more robust, context-specific priority-setting on elimination targets in global health.
