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Cornford P, Halpin C, Sassmann J, Frankcom I, Braybrook S. Increased use of 6-monthly gonadotropin-releasing hormone agonist therapy for prostate cancer: a capacity and cost-minimization analysis for England. J Med Econ 2023; 26:208-218. [PMID: 36749636 DOI: 10.1080/13696998.2023.2172281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIMS The National Health Service (NHS) in England is facing extreme capacity pressures. The backbone of prostate cancer care is gonadotropin-releasing hormone agonist (GnRHa) therapy, commonly administered every month or 3 months. We estimated the cost and capacity savings associated with increased use of 6-monthly GnRHa therapy in England. METHODS A capacity and cost-minimization model including a societal perspective was developed (in Microsoft Excel) to generate cost and capacity estimates for GnRHa drug acquisition and administration for "Current practice" and for a "Base case" scenario. In the "Base case" scenario, 50% of patients who were receiving monthly or 3-monthly GnRHa therapy in "Current practice" switched/transitioned to a 6-monthly formulation. Cost/capacity estimates were calculated per patient per administration and scaled to annualized population levels. Sensitivity analyses were conducted to assess the impact of individual model assumptions: 1 tested the impact of drug acquisition costs; 2 and 3 tested the level of nurse grade and the time associated with treatment administration, respectively; 4 tested the rate of switch/transition to 6-monthly GnRHa therapy; and 5 tested differing diagnostic patterns following the coronavirus disease 2019 pandemic. RESULTS Compared with "Current practice", the "Base case" scenario was associated with annual cost savings of £5,164,296 (148,478 fewer appointments/year and 37,119 fewer appointment-hours/year). The largest savings were in drug administration (£2.2 million) and acquisition (£1.6 million) costs. Annual societal cost savings totaled £1.4 million, mainly in reduced appointment-related travel, productivity and leisure time opportunity losses. Increased use of 6-monthly versus monthly or 3-monthly GnRHa therapy consistently achieved system-wide annual cost and capacity savings across all sensitivity analysis scenarios. CONCLUSIONS Our holistic model suggests that switching/transitioning men from monthly or 3- monthly GnRHa therapy to a 6-monthly formulation can reduce NHS cost and capacity pressures and the societal and environmental costs associated with prostate cancer care.
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Affiliation(s)
- Philip Cornford
- Department of Urology, Royal Liverpool University Hospitals, Liverpool, UK
| | - Caolan Halpin
- Department of Market Access and Health Economics Outcomes Research, Ipsen, Slough, UK
| | | | - Ian Frankcom
- Department of Market Access and Health Economics Outcomes Research, Ipsen, Slough, UK
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Garcia-Diaz R. Effective access to health care in Mexico. BMC Health Serv Res 2022; 22:1027. [PMID: 35962375 PMCID: PMC9373534 DOI: 10.1186/s12913-022-08417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives This paper assesses the impact of effective access on out-of-pocket health payments and catastrophic health expenditure. Effective access cannot be attained unless both health services and financial risk protection are accessible, affordable, and acceptable. Therefore, it represents a key determinant in the transition from fragmented health systems to universal coverage that many low- and middle-income countries face. Methods We use a definition of effective access as the utilization of health insurance when available. We conducted a cross-sectional analysis using the 2018 Mexican National Health Survey (ENSANUT) at the household level. The analysis is performed in two stages. The first stage is a multinomial analysis that captures the factor associated with choosing effective access against the alternative of paying privately. The second stage consists of an impact analysis regarding the decision of not choosing effective access in terms of out-of-pocket (OOP) health payments and catastrophic health expenditures (CHE). The analysis corrects for both the decision to buy insurance and the decision to pay for health care. Results We found that, on average, not choosing effective access increases OOP health payments by around 2300 pesos annually. Medicine payments are the most common factor in this increase. Nevertheless, outpatient and medicines health care are the main drivers of the increase in OOP health payments in all insurance beneficiaries. Not having effective access increases the probability of CHE health expenditures by 2.7 p.p. for the case of Social Security Insurance and 4.0 p.p. for Social Government insurance. Household enrolled in Prospera program for the poor are more likely to choose effective access while having household heads with more education and assets value does the opposite. Diabetes illnesses are associated with a higher probability of effective access. Conclusion Improving effective access is a middle step that cannot be disregarded when seeking universal coverage because OOP health payments and catastrophic outcomes are direct consequences. Public insurance in general, has around 50% effective access which remains a challenge in terms of health services utilization and health public policy design, calling for the need of better coordination across insurance types and pooling mechanisms to increase sustainability of needed health services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08417-0.
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Affiliation(s)
- Rocio Garcia-Diaz
- Tecnologico de Monterrey, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., Mexico.
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Jakovljevic M, Liu Y, Cerda A, Simonyan M, Correia T, Mariita RM, Kumara AS, Garcia L, Krstic K, Osabohien R, Toan TK, Adhikari C, Chuc NTK, Khatri RB, Chattu VK, Wang L, Wijeratne T, Kouassi E, Khan HN, Varjacic M. The Global South political economy of health financing and spending landscape - history and presence. J Med Econ 2021; 24:25-33. [PMID: 34866543 DOI: 10.1080/13696998.2021.2007691] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Global South nations and their statehoods have presented a driving force of economic and social development through most of the written history of humankind. China and India have been traditionally accounted as the economic powerhouses of the past. In recent decades, we have witnessed reestablishment of the traditional world economic structure as per Agnus Maddison Project data. These profound changes have led to accelerated real GDP growth across many LMICs and emerging countries of the Global South. This evolution had a profound impact on an evolving health financing landscape. This review revealed hidden patterns and explained the driving forces behind the political economy of health spending in these vast world regions. The medical device and pharmaceutical industry play a crucial role in addressing the unmet medical needs of rising middle class citizens across Asia, Latin America, and Africa. Domestic manufacturing has only been partially meeting this ever rising demand for medical services and medicines. The rest was complemented by the participation of multinational pharmaceutical industry, whose focus on investment into East Asia and ASEAN nations remains part of long-term market access strategies. Understanding of the past remains essential for the development of successful health strategies for the present. Political economy has been driving the evolution of health financing landscape since the establishment of early modern health systems in these countries. Fiscal gaps these governments face in diverse ways might be partially overcome with the spreading of cost-effectiveness based decision-making and health technology assessment capacities. The considerable remaining challenges ranging from insufficient reimbursement rates, large out-of-pocket spending, and lengthy lag in the introduction of cutting-edge technologies such as monoclonal antibodies, biosimilars, or targeted oncology agents, might be partially resolved only in the long run.
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Affiliation(s)
- Mihajlo Jakovljevic
- Institute of Comparative Economic Studies, Hosei University Faculty of Economics, Tokyo, Japan
- Department Global Health Economics & Policy, University of Kragujevac, Kragujevac, Serbia
| | - Yansui Liu
- Institute of Geographic Sciences and Natural Resources Research (IGSNRR), Chinese Academy of Sciences, Beijing, China
| | - Arcadio Cerda
- Faculty of Economics and Business, University of Talca, Talca, Chile
| | - Marta Simonyan
- Department of Pharmaceutical Management, Yerevan State Medical University, Yerevan, Armenia
| | - Tiago Correia
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Ajantha Sisira Kumara
- Department of Public Administration, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Leidy Garcia
- Faculty of Economics and Business, University of Talca, Talca, Chile
| | | | - Romanus Osabohien
- Department of Economics and Development Studies, Centre for Economic Policy and Development Research (CEPDeR), Covenant University, Ota, Nigeria
| | - Tran Khanh Toan
- Family Medicine Department, Hanoi Medical University, Hanoi, Vietnam
| | - Chiranjivi Adhikari
- Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, India
- School of Health and Allied Sciences (SHAS), Pokhara University, Lekhnath, Nepal
| | | | - Resham B Khatri
- School of Public Health, University of Queensland, Brisbane, Australia
| | | | - Liang Wang
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Tissa Wijeratne
- Department of Neurology and Stroke at Western Health, The University of Melbourne, St Albans, Australia
| | - Eugene Kouassi
- Department of Economics, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | | | - Mirjana Varjacic
- Department of Pathology of Pregnancy, University of Kragujevac, Kragujevac, Serbia
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Hwang WS, Kim HS. Does the adoption of emerging technologies improve technical efficiency? Evidence from Korean manufacturing SMEs. Small Bus Econ (Dordr) 2021; 59:627-643. [PMID: 38624928 PMCID: PMC8496439 DOI: 10.1007/s11187-021-00554-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 04/17/2024]
Abstract
Despite the proliferation of innovative technologies during the Fourth Industrial Revolution (4IR), there is a severe lack of quantitative and empirical studies that deal with the effectiveness of recently emerging technologies. This study examines the impact of employing core technologies of the 4IR on small and medium enterprises (SMEs). We used the firm-level cross-sectional data on Korean manufacturing SMEs, including the information on technology utilization. The stochastic production frontier estimation with selectivity correction is employed, besides matching technique to obtain unbiased estimates on technology efficiency. The empirical analysis finds that adopting emerging technologies enhances the productivity of SMEs. After observed and unobserved factors are controlled, the technical efficiency of adopters is higher by more than 26% on average, compared to non-adopters. Moreover, if the gap among production frontiers is considered, the difference in productivity would rise further. Additionally, a strategic alliance is a crucial route for SMEs to accept new technologies.
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Affiliation(s)
- Won-Sik Hwang
- Department of Economics, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54896 Republic of Korea
| | - Ho-Sung Kim
- Business Administration Department, Korea Army Academy At Yeong - Cheon (KAAY), 495, Hoguk-ro, Gogyeong-myeon, Yeongcheon-si, Gyeongsangbuk-do 38900 Republic of Korea
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Lindgren P, Althin R. Something borrowed, something new: measuring hospital performance in the context of value based health care. Eur J Health Econ 2021; 22:851-854. [PMID: 32548650 DOI: 10.1007/s10198-020-01209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
- The Swedish Institute for Health Economics, Lund, Sweden.
| | - Rikard Althin
- The Swedish Institute for Health Economics, Lund, Sweden
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Mounié M, Costa N, Conte C, Petiot D, Fabre D, Despas F, Lapeyre-Mestre M, Laurent G, Savy N, Molinier L. Real-world costs of illness of Hodgkin and the main B-Cell Non-Hodgkin lymphomas in France. J Med Econ 2020; 23:235-242. [PMID: 31876205 DOI: 10.1080/13696998.2019.1702990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Lymphomas are costly diseases that suffer from a lack of detailed economic information, notably in a real-world setting. Decision-makers are increasing the search for Real-World Evidence (RWE) to assess the impact, in real-life, of healthcare management and to support their public decisions. Thus, we aimed to assess the real-world net costs of the active treatment phases of adult Hodgkin Lymphoma (HL), Follicular Lymphoma (FL) and Diffuse Large B Cell Lymphoma (DLBCL).Methods: We performed a retrospective cohort study using population-based data from a national representative sample of the French population covered by the health insurance system. Cost analysis was performed from the French health insurance perspective and took into account direct and sick leave compensation costs (€2,018). Healthcare costs were studied over the active treatment phase. We used multivariate modeling to adjust cost differences between lymphoma subtypes.Results: Analyses were performed on 224 lymphoma patients and 896 controls. The mean additional monthly costs due to HL, FL and DLBCL patients were respectively €5,188, €3,242 and €7,659 for the active treatment phase. The main additional cost driver was principally inpatient stay (hospitalization costs and costly cancer-related drugs), followed by outpatient medication and productivity loss. When adjusted, DLBCL remains significantly the most costly lymphoma subtype.Conclusion: This study provides an accurate assessment of the main lymphoma subtypes related cost with high magnitude of details in a real-world setting. We underline where potential cost saving could be realized via the use of biosimilar medication, and where lymphoma management could be improved with the early management of adverse events.KEY POINTSThis is one of the first studies which assess the additional cost of lymphoma in Europe, according the main sub-types of lymphoma and with real-world database.The additional monthly cost due to HL, FL and DLBCL patients were respectively €5,188, €3,242 and €7,659 for the active treatment phase and the main additional cost driver was principally inpatient stay (i.e. hospitalization costs and additional inpatient medicines, notably rituximab), followed by outpatient medication and productivity loss.This study provides an accurate and detailed lymphoma subtype cost description and comparison which supply data for efficiency evaluations and will allow French health policy to improve lymphoma management.
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Affiliation(s)
- Michael Mounié
- Unité d'Evaluation Médico-Economique, Centre Hospitalier Universitaire, Toulouse, France
- Institut National de la Santé et de la Recherche Médicale - INSERM, Unité Mixte de Recherche-UMR 1027, Toulouse, France
| | - Nadège Costa
- Unité d'Evaluation Médico-Economique, Centre Hospitalier Universitaire, Toulouse, France
- Institut National de la Santé et de la Recherche Médicale - INSERM, Unité Mixte de Recherche-UMR 1027, Toulouse, France
| | - Cécile Conte
- Laboratoire de Pharmacologie Médicale, facultés de Médecine, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Dominique Petiot
- Département d'Information Médicale, Centre Hospitalier Universitaire, Toulouse, France
| | - Didier Fabre
- Département d'Information Médicale, Centre Hospitalier Universitaire, Toulouse, France
| | - Fabien Despas
- Laboratoire de Pharmacologie Médicale, facultés de Médecine, Université Toulouse III Paul Sabatier, Toulouse, France
- Service de Pharmacologie Clinique, CIC 1436, CHU Toulouse, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Laboratoire de Pharmacologie Médicale, facultés de Médecine, Université Toulouse III Paul Sabatier, Toulouse, France
- Service de Pharmacologie Clinique, CIC 1436, CHU Toulouse, Toulouse, France
| | - Guy Laurent
- Service d'hématologie CHU Toulouse, Institut Universitaire du Cancer-Oncopôle de Toulouse, Toulouse, France
| | - Nicolas Savy
- Institut Mathématiques de Toulouse, UMR 5219, CNRS, Toulouse, France
| | - Laurent Molinier
- Unité d'Evaluation Médico-Economique, Centre Hospitalier Universitaire, Toulouse, France
- Institut National de la Santé et de la Recherche Médicale - INSERM, Unité Mixte de Recherche-UMR 1027, Toulouse, France
- Département d'Information Médicale, Centre Hospitalier Universitaire, Toulouse, France
- Faculty of Medicine of Purpan, Université Toulouse III Paul Sabatier, Toulouse, France
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Ariga J, Mabaya E, Waithaka M, Wanzala-Mlobela M. Can improved agricultural technologies spur a green revolution in Africa? A multicountry analysis of seed and fertilizer delivery systems. Agric Econ 2019; 50:1-12. [PMID: 32406412 PMCID: PMC7198120 DOI: 10.1111/agec.12533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 10/07/2019] [Accepted: 10/16/2019] [Indexed: 05/13/2023]
Abstract
Sub-Saharan Africa faces low agricultural productivity amid a confluence of trends that include rapid population growth, climate change, and the rise of the middle class. To raise productivity, governments-in partnership with donors and development organizations-have launched numerous initiatives to encourage the development of sustainable and competitive agricultural input markets. Despite these efforts, markets remain underdeveloped in most countries and access to affordable seeds and fertilizers remains a major challenge for smallholder farmers. This paper explores evidence from recent multicountry analyses of input delivery systems to assess the possibility of a Green Revolution in Africa. It describes use and adoption levels, challenges, policy and regulatory issues, and investments needed to expand smallholder access to these productivity-enhancing agricultural technologies.
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Affiliation(s)
- Joshua Ariga
- Bill & Melinda Gates Foundation, Seattle, Washington, USA
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