Migraine is a highly prevalent neurological disorder associated with substantial disability and economic burden. Considering the recent introduction of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs), expenditure analysis are needed to evaluate a rapidly evolving therapeutic field. Therefore, we analyzed national pharmaco-utilization trends of antimigraine drugs in Italy over the decade 2014–2023 using publicly available data from the “Osservatorio Nazionale sull’Impiego dei Medicinali” (OsMed) report of the Italian Medicines Agency (AIFA). All antimigraine drugs reimbursed by the National Health Service and classified under the antimigraine drug group were included. Indicators comprised defined daily doses (DDD) per 1,000 inhabitants per day, per-capita expenditure, cost per DDD, and user-level measures. In 2023, 0.6
This paper examines the willingness to pay (WTP) for duplicative private health insurance in Italy, a country with universal healthcare system characterized by broad public coverage alongside substantial waiting times and relatively high out-of-pocket expenditure. Using nationally representative data from the Italian Survey of Consumer Expectations (ISCE), we elicit individual WTP through a structured bidding mechanism for insurance offering faster access to surgeries, outpatient procedures, and diagnostic examinations already covered by the public system. Willingness to pay increases with income, perceived health risk, prior medical expenditure, and familiarity with insurance products. WTP appears primarily driven by exposure to financial and opportunity costs associated with delayed access rather than by generalized dissatisfaction with public healthcare. We embed a randomized controlled trial providing factual information on public waiting times and private-sector costs. While the intervention does not significantly affect average WTP, it reshapes its determinants: information increases the responsiveness of WTP to direct financial exposure and raises valuations among self-employed individuals and respondents holding inaccurate prior beliefs. Overall, informational frictions influence how individuals weigh economic risks rather than its aggregate level.
This study aimed to examine the psychometric performance of the proxy-reported EQ-5D-Y-3L (Y-3L) for children living with spinal muscular atrophy (SMA) aged between 5 and 12 years, with a particular focus on examining whether its properties differ across three age groups. Patients were recruited through a nation-wide patient advocacy association in China. Parents of eligible patients were invited to complete a web-based survey. Proxy-reported cross-sectional data from children aged 5–12 years were included in the analysis and categorized into three age groups: 5–6, 7–8, and 9–12 years. Convergent validity, known-groups validity, and the explanatory power of the Y-3L were assessed across the three age groups as well as in the overall sample. The Y-3L showed strong ceiling effects for “pain/discomfort” and “feeling worried, sad, or unhappy,” and floor effects in the three physical dimensions. Ceiling effects generally decreased with age for “pain/discomfort” and “feeling worried, sad, or unhappy.” Level sum scores and index values correlated moderately to strongly with other measures. Four dimensions correlated well with comparator scales, but “doing usual activities” showed weaker links. Known-groups validity was highest for Y-3L, with clear age differences. Y-3L dimensions explained less EQ VAS variance with age, while emotional problems were more influential in 5–6-year-olds. The Y-3L is a valid instrument for assessing health-related quality of life in SMA children aged between 5 and 12 years, with better psychometric properties observed in older children aged over 7 years.
Respiratory syncytial virus-associated acute respiratory illness (RSV-ARI) is an underrecognized cause of illness in older adults aged ≥ 75 years (OAs) and individuals at increased risk (AIR), contributing to a substantial disease burden. AS01E-adjuvanted RSV PreFusion protein 3 vaccine (aRSVPreF3) is approved for the prevention of RSV-associated lower respiratory tract disease (LRTD) in OAs. This study assesses the cost-effectiveness of a single dose of aRSVPreF3 vaccine among OAs and AIR individuals aged 60–74 years over 5 years in Italy. A static multi-cohort Markov model with 5-year horizon and 1-month cycle length was developed to model the effect of aRSVPreF3 vaccination. Inputs were obtained from national databases and scientific literature. Sensitivity analyses were performed to assess the robustness of the results to variations in input parameters. At 75
Increased body mass index (BMI) is associated with increased medical costs, but no information is available for Switzerland. We investigated the association of individual BMI categories with healthcare use and healthcare expenditures. Data from an ongoing prospective, community-based study conducted in Lausanne, Switzerland. Information on healthcare use, type of insurance and deductible level were provided by the participants for period 2018–2021. Health expenditures were obtained from health insurers. 1960 participants (64.5 ± 9.6 years, 50.4
Public debt is widely assumed to constrain social spending by shrinking fiscal space, yet empirical evidence from advanced economies shows little consistent association between debt levels and public health expenditure. This study revisits the debt–health nexus by distinguishing between two analytically separate fiscal constraints: long-term solvency, captured by public debt stock, and short-term liquidity, captured by debt service obligations. Using an unbalanced panel of 26 OECD European countries from 2000 to 2022, the analysis combines data from the World Bank, the International Monetary Fund, and the OECD and employs a dynamic panel framework estimated with bias-corrected least squares dummy variable methods. The empirical strategy explicitly separates stock and flow effects, controls for total government expenditure to identify compositional crowding-out, and tests whether fiscal constraints vary across macroeconomic conditions. The results indicate that public debt stock does not exert a robust negative effect on health expenditure, suggesting a form of “stock neutrality” in mature welfare states. By contrast, interest payments are associated with significantly lower public health expenditure, even conditional on total government expenditure, indicating compositional crowding-out. Moreover, this liquidity-based crowding-out is shaped by macro-fiscal context, with its strength varying across periods of fiscal stress and more stable economic conditions. These findings highlight the importance of debt-service costs, rather than debt accumulation per se, as a key fiscal mechanism shaping health system financing in advanced economies.
Maintaining or improving the health-related quality of life (QoL) of lung cancer patients is essential throughout treatment. To support shared decision-making and improve patient–physician communication, patients’ preferences should be understood and considered in clinical decision-making; however, existing research indicates notable discrepancies between patient and physician priorities. This study therefore aims to elicit and compare their preferences regarding QoL dimensions in lung cancer care in Germany. Based on systematic literature reviews as well as qualitative analysis, two discrete choice experiments (DCEs) were applied to elicit the preferences of patients and treating physicians. In the DCE scenarios, both groups chose between alternative QoL profiles reflecting different health states during lung cancer treatment. Data were analyzed using multinomial logit models. The final DCEs comprised five common attributes — activities of daily living, shortness of breath, anxiety, social life, and emotional impairment — and one group-specific attribute: financial difficulties in the patient DCE and severity of pain in the physician DCE. Overall, 162 patients (mean age: 60.39 years, SD 10.05) and 154 referring physicians (mean age: 51.26 years, SD 11.28) participated. All model coefficients were statistically significant (p < 0.001). Patients prioritized “Shortness of breath” (28.0
To assess measurement properties of self-complete (SC), interviewer-administered (IA), and proxy-report versions of EQ-5D‐Y-5L and to assess the degree of agreement in response between these versions. SC, IA, and proxy-report were administered to children and adolescents with and without health conditions on two occasions, separated by either a 10-day interval (to assess test-retest reliability) or a one-month interval (to assess responsiveness). The SC and IA versions were administered in randomized order. Agreement and test–retest reliability assessed using Gwet’s agreement coefficient (Gwet’s AC2) and intraclass correlation coefficient (ICC) and, interpreted based on predefined thresholds. Feasibility, known-group validity, and responsiveness were assessed using missing values, Kruskal-Wallis test, and standardized effect size (SES), respectively. A total of 644 child/parent dyads participated. Missing values were higher for SC, particularly among younger children aged 8–12 years (4.65
Pricing policies may contribute to improving patient access to medicines. Innovative Medicines and Advanced Therapies represent promising treatment options; however, their high costs and limited clinical evidence pose both clinical and financial risks. In many cases, prices do not reflect the actual benefit or degree of innovation, highlighting the need to better understand and refine pricing approaches. The objective of this scoping review is to assess the application of pricing policies for these products worldwide. The methodology followed the JBI Manual for Evidence Synthesis and the PRISMA Extension for Scoping Reviews guidelines. Publications describing pricing policies applied to the definition of prices for Innovative Medicines and Advanced Therapies were included. A comprehensive literature search was conducted. Study selection was performed in two stages by independent reviewers, who also carried out data extraction. Fifty-five publications describing pricing policies for these products across different countries were included. A wide range of policies and methodologies for price determination were identified. The review assessed value-based pricing, external reference pricing, tendering and/or negotiation, internal reference pricing, cost-plus approaches, and initiatives promoting price transparency. Pricing policies play an essential role in regulating the costs of Innovative Medicines and Advanced Therapies. Although such policies may facilitate access to these technologies, challenges such as lack of transparency and heterogeneous methodologies remain. It is crucial that policymakers establish fair and transparent pricing frameworks that balance access, incentives for innovation, and the sustainability of health systems.
This study provides a comprehensive overview of the Italian framework for the appraisal of drug innovativeness, covering all 294 appraisals conducted by AIFA between 2017 and June 2025. It aims to describe the evolution and application of the 2017 criteria, explore the determinants of innovativeness recognition, and discuss the implications of the 2025 revision for value assessment and market access. All AIFA innovativeness reports available up to June 2025 were systematically reviewed and coded across the three appraisal domains - therapeutic need, added therapeutic value, and quality of evidence - together with contextual and regulatory variables (orphan designation, study design, EMA approval type, accelerated assessment, and PRIME designation). Descriptive and multinomial regression analysis were performed to identify predictors of appraisal outcomes and to explore associations with European and national timelines. Among 294 appraisals, 27
To describe healthcare resource utilization (HCRU), direct costs, and survival of DLBCL patients in Sweden. This retrospective cohort study followed adult patients with DLBCL from 2015 to 2023 using Swedish national registers. Time in specialty care was calculated as days per-person-year (PPY). Nordic diagnosis-related-group weights were used to estimate costs. 7,503 patients were diagnosed with DLBCL. Median age was 73.0 years; 56.9
Herpes zoster (HZ) is common in Finland, leading to long-term postherpetic neuralgia (PHN) especially with ageing. HZ reduces productivity, placing an economic burden on society. An integrated actuarial and macroeconomic model assessed the return on investment of recombinant zoster vaccine (RZV) in Finland for adults ≥ 50 years versus no vaccination. A validated economic model determined HZ cases and complications avoided, health gains (quality-adjusted life-years, QALYs), and healthcare cost-savings. Actuarial techniques projected population trends incorporating employment factors. Lost productivity averted through vaccination provided fiscal revenue for the government, and increased gross domestic product (GDP) for society. QALY gains were monetised using 1–3xGDP per QALY. RZV was administered for 20 years, with lifetime impact assessment. RZV vaccination of around 790,000 50year-olds was estimated to save 3,779 QALYs and €52 million (M) in healthcare costs. Averted productivity losses generated €152 M in fiscal revenue and €367 M in GDP, while vaccination costs were €236 M. From the fiscal perspective, 90
The RECOVER-E project supported the shift away from mental health care provided in institutional settings (treatment as usual, TAU) towards community-based mental healthcare by introducing multidisciplinary community mental health teams (CMHT) for people with schizophrenia, bipolar disorder, and severe depression across five sites in Bulgaria, Croatia, Montenegro, North Macedonia, and Romania. This paper presents the cost-effectiveness of CMHT compared to TAU. Data from all five RECOVER-E trials (N = 931) was used to compute healthcare costs and societal costs which included additional patient and family costs, and costs stemming from productivity losses. Outcomes were incremental cost-effectiveness ratio’s (ICER) for gaining a QALY and gaining a treatment responder (based on WHODAS 2.0). Compared to TAU, CMHT had small incremental effects favouring CMHT (QALY: M = 0·023, SD = 0·013; Response: M = 0·093, SD = 0·034). The incremental costs were higher in CMHT than in TAU as seen from both the societal and healthcare perspective (societal costs: M=€1,892, SD=€950; healthcare costs: M = 1,125, SD=€720). The ICER for gaining a QALY was €82,261 and €48,913 as seen from the societal and healthcare perspective, respectively. These ICERs were well above the willingness to pay threshold of €20,000 for gaining a QALY. A similar picture arose with treatment response as outcome. Overall CMHT appeared to be more effective but also more costly, with the additional cost outweighing the benefits across countries, except in Bulgaria, which may highlight that cost-effectiveness is likely to be context dependent. Therefore, a recommendation for scaling up or sustaining CMHT must also depend on arguments other than health-economic alone, such as medical ethical, equity and human rights considerations. Bulgaria: NCT03922425, Croatia: NCT03862209, Macedonia: NCT03892473, Montenegro: NCT03837340, Romania NCT03884933.
BACKGROUND:In 2016, France reformed its health system by requiring public hospitals to form territorial groups. Policymakers, following experiences with integrated care provision in the United States and NHS-type networks in Italy and England, expected these groups to improve coordination and system efficiency. However, it remains unclear whether such administrative integration creates new care pathways within groups or substitutes for existing referral relationships with external providers. METHODS:We analyzed national hospital administrative data from 2013 to 2021. Changes in inter-facility transfer rates were estimated using a synthetic difference-in-differences approach. The main outcome was the annual percentage of patients transferred to another hospital, overall and within the same group. RESULTS:Following group formation, smaller local hospitals experienced an average increase of 1.25 percentage points in transfers to hospitals within their group. Transfers to hospitals outside the group remained broadly stable, suggesting limited substitution away from pre-existing referral channels. CONCLUSIONS:Territorial grouping are associated with an increase in internal patient mobility, particularly among local hospitals, without reducing exchanges with external providers. These findings suggest that administrative integration may have layered new coordination arrangements onto existing care pathways and reinforced patterns of functional specialization. The results contribute to understanding how network-based integration reshapes organizational behaviour and patient mobility in regulated health systems.
Payers use Managed Entry Agreements (MEAs) across Europe to manage the financial risks associated with high-cost medicines. While these agreements aim to improve affordability and address uncertainty, their confidential nature raises concerns about transparency, international price referencing, and the validity of economic evaluations. This study examines MEA practices across 13 European countries, analyzing adoption trends, reporting practices, and financial outcomes, and their implications for payer decision-making. Data from 2016 to 2022 were collected through (1) mapping national MEA frameworks, stakeholders, and implementation processes; (2) desk research on publicly available activity and financial reports; and (3) validation interviews with public-sector negotiators in each country. Across 13 countries, 24 MEA frameworks were identified. MEA usage increased substantially, with the highest numbers in 2022 in Germany (356) and France (349), and the largest growth in Belgium (+ 250
This study empirically examines the role of Universal Health Coverage (UHC) as a strategic facilitator in enhancing the effectiveness of government health expenditure (GHE) on financial protection and health outcomes across 14 SAARC and ASEAN nations from 2000 to 2023. Using a Two-Way Fixed Effects (TWFE) regression model, the study identifies that higher GHE alone does not guarantee reductions in out-of-pocket (OOP) expenses or mortality rates, but its impact is significantly mediated by UHC adoption and structure. To capture distributive heterogeneity, quantile regression analysis is employed, revealing that mandatory insurance-based and hybrid UHC models provide greater financial protection, particularly for lower-income populations, while public-sector-dominant service provision maximizes mortality reductions. The findings emphasize that UHC enhances the transmission of government health investments into tangible sectoral benefits, reinforcing its role as a policy accelerator for achieving Sustainable Development Goal (SDG) 3.8. Policy recommendations include strengthening UHC financing, optimizing risk-pooling mechanisms, and aligning fiscal priorities with equitable healthcare access. This study contributes to global UHC discourse by offering an empirically grounded, region-specific roadmap for ensuring financial sustainability and universal healthcare accessibility in emerging economies.
Existing socioeconomic status (SES) scales in India are limited by outdated income categories, urban-centric assumptions, and unidimensional frameworks that inadequately capture contemporary socioeconomic realities. This study aimed to develop and validate a theoretically grounded, multidimensional SES assessment tool suitable for Indian settings with potential relevance for South Asia. A cross-sectional study was conducted to design and validate Solomon’s Socioeconomic Status Index (SESI). Scale development was informed by literature review, expert consultation, and focus group discussions. SESI comprises nine weighted dimensions: education (15
This paper examines the distributional welfare effects of strengthening the UK Soft Drinks Industry Levy (SDIL). Using individual-level dietary data from the UK National Diet and Nutrition Survey, we simulate three scenarios for strengthening the SDIL within a comparative risk assessment framework and translate policy-induced reductions in sugar intake from sugar-sweetened beverages into changes in quality-adjusted life years over a 10-year horizon. Health gains are monetised at willingness-to-pay thresholds of £20,000 and £30,000 per quality-adjusted life year, while consumer burden is expressed relative to household resources using Office for National Statistics income and expenditure benchmarks.Results show that stronger levy designs yield greater reductions in sugar intake and body mass index, and deliver positive net monetised benefits under the two stronger scenarios. Health gains are disproportionately concentrated among more deprived groups because baseline sugar-sweetened beverage exposure is socially graded, and these groups exhibit greater price responsiveness. Health-gain ratios between the most and least deprived quintiles consistently exceed the corresponding burden ratios across all age groups. When expressed relative to income or expenditure, consumer burden shares decline monotonically from the most to the least deprived quintile, confirming financial regressivity. Weighted gradient tests show that this regressivity is a consistent structural feature across age groups rather than being concentrated in any particular life stage. Overall, a strengthened levy appears regressive in payment incidence but progressive in health terms, highlighting the importance of jointly assessing financial burdens and health benefits when evaluating corrective health taxes.
Fair distribution of limited health funding is a universal challenge for health systems. Decisions about funding new technologies provide a helpful lens on this complex issue. This study examined how two of the world’s most mature centralised review processes for health technology funding, namely the Australian Pharmaceutical Benefits and Medical Services Advisory Committees (PBAC and MSAC) have approached fairness over time. Using the Accountability for Reasonableness (A4R) framework, which defines fair priority-setting through four conditions (Relevance, Publicity, Revision, and Enforcement), we conducted (i) a detailed document review of policy changes (2014–2022) and (ii) semi-structured interviews with decision-makers at PBAC and MSAC in 2014 (n = 12) and 2021/22 (n = 11). In both the document review and the interviews, we found increased alignment with A4R principles over time, including enhanced Relevance through increased consumer representation, increased Publicity of decision rationales, and greater Enforcement through broader committee deliberation. However, Revision was not a pressing concern of committee members at either time point despite notable policy changes that improved Revision. Persistent barriers to Publicity were identified, particularly the redaction of decision rationales in public summary documents due to sponsor confidentiality requirements and challenges of explaining nuanced deliberations rather than formulaic criteria. Our findings illustrate how A4R principles are applied in practice and highlight the challenge of balancing procedural fairness with substantive ethical considerations, such as equity and cost effectiveness, that underlie the criterion of Relevance.
