Search

Objectives: The implementation of disease‐modifying treatments for Alzheimer's Disease (AD) will require cost‐effective diagnostic processes. As part of The Precision Medicine In AD consortium (PMI‐AD) project, the aim is to analyze the baseline costs of diagnosing early AD at memory clinics in Norway, Slovenia, and the Netherlands. Methods: The costs of cognitive testing and a clinical examination, apolipoprotein E, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF), positron emission tomography and blood‐based biomarkers (BBM), which are used in different combinations in the three countries, were analyzed. Standardized unit costs, adjusted for GDP per capita and based on Swedish conditions were applied. The costs were expressed in euros (€) as of 2019. A diagnostic set comprising clinical examination, cognitive testing, MRI and CSF was defined as the gold standard, with MRI mainly used as an exclusion filter. Results: Cost data were available for 994 persons in Norway, 169 in Slovenia and 1015 in the Netherlands. The mean diagnostic costs were 1478 (95% confidence interval 1433–1523) € in Norway, 851 (731–970) € in Slovenia and 1184 (1135–1232) € in the Netherlands. Norway had the highest unit costs but also the greatest use of tests. With a uniform diagnostic test set applied, the diagnostic costs were 1264 (1238–1291) €, in Norway, 843 (771–914) € in Slovenia and 1184 (1156–1213) € in the Netherlands. There were no major cost differences between the final set of diagnoses. Conclusions: The total costs for setting a diagnosis of AD varied somewhat in the three countries, depending on unit costs and use of tests. These costs are relatively low in comparison to the societal costs of AD. Key points: The introduction of blood‐based biomarkers for detecting Alzheimer's Disease (AD) can change the diagnostic process.Given the expected demands for treatment of cognitive disorders such as AD, the costs and capacity of the diagnostic work‐up are of great importance for care funders and planners.Our study incorporating diagnostic costs from three distinct European regions provides valuable inputs for cost‐effectiveness studies. [ABSTRACT FROM AUTHOR]

Determining the residual value of tractors is imperative for comprehensive cost analyses within the agricultural machinery sector. Despite numerous studies offering various models and independent variables, the double square root regression approach, originally developed by Cross and Perry and adapted by ASABE for North American contexts, has been widely utilized. However, factors such as the complexity of OEM portfolios, steep price increases due to compliance with diesel emission regulations, and limited data availability in Europe and its market specificities necessitate improvements in predictive accuracy. This study evaluates different tractor cohort alternatives beyond engine horsepower to enhance predictive robustness. Incorporating brand and powertrain type alongside engine power significantly improved model performance and exhibited the strongest robustness, as evidenced by reduced the root mean square error (RMSE) and increased R-squared values. These findings contribute to the refinement of tractor residual value estimation models, offering valuable insights for stakeholders in the agricultural machinery industry. [ABSTRACT FROM AUTHOR]

Many researchers, consumer groups, activists and civil society organizations agree that the pharmaceutical sector has been left too much to the private sector, which is solely driven by a profit motive. Therefore, it is imperative to take a bold initiative to turn the idea of medicine, pharmaceutical products, and health technology as a common good into a reality. We propose to establish a European institute that can oversee an ambitious research portfolio. This institute can provide research grants or do in-house research but, in any case, any intellectual property rights emanating from the research will have to be shared in the interest of the public good. A collective knowledge pool, where all results and technological knowledge are gathered and shared, will likewise be part of the institute. Any final product developed within the Institute will be subject to an open license. We ensure that all necessary data and information remain public and that know-how about the production of a medicine can be passed on to those who need it. Finally, this institute should have a focus on production and distribution. Price, quality, availability and even working conditions of the staff will be criteria in any bidding process. [ABSTRACT FROM AUTHOR]

One of the objectives of the newly adopted European Child Guarantee is to ensure effective and free access to at least one healthy meal each school day for all children at risk of poverty and social exclusion in Europe. However, little is known about the starting point of Member States in terms of school meal provision. This paper aims to fill this information gap. It maps the current free school meal provision in the 27 Member States, reviews existing relevant evidence to illustrate the expected impact and presents estimates of the public budget needed to meet the Child Guarantee's objective. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, several hospitals have incorporated MRI equipment managed directly by their cardiology departments. The aim of our work is to determine the total cost per test of both CT and MRI in the setting of a Cardiology Department of a tertiary hospital. Materials and Methods: The process followed for estimating the costs of CT and MRI tests consists of three phases: (1) Identification of the phases of the testing process; (2) Identification of the resources consumed in carrying out the tests; (3) Quantification and assessment of inputs. Results: MRI involves higher personnel (EUR 66.03 vs. EUR 49.17) and equipment (EUR 89.98 vs. EUR 33.73) costs, while CT consumes higher expenditures in consumables (EUR 93.28 vs. EUR 22.95) and overheads (EUR 1.64 vs. EUR 1.55). The total cost of performing each test is higher in MRI (EUR 180.60 vs. EUR 177.73). Conclusions: We can conclude that the unit cost of each CT and MRI performed in that unit are EUR 177.73 and EUR 180.60, respectively, attributable to consumables in the case of CT and to amortization of equipment and staff time in the case of MRI. [ABSTRACT FROM AUTHOR]

The aim of this paper was to assess the cost-effectiveness of pembrolizumab in first-line for microsatellite-instability-high or mismatch-repair-deficient metastatic colorectal cancer. We have considered the pivotal phase III randomized controlled trial of pembrolizumab in first-line for microsatellite-instability-high mismatch-repair-deficient metastatic colorectal cancer. The last available update of each trial was considered as the original source. Incremental cost-effectiveness ratio was calculated as the ratio between the difference of the costs in the intervention and in the control groups (pharmacy costs) and the difference between the effect in the intervention and in the control groups (progression-free survival). The costs of drugs are at the Pharmacy of the Mater Salutis Hospital of Legnago (VR, Italy) and are expressed in euros (€). Three hundred and seven patients were considered in the pivotal phase III randomized controlled trial. Pembrolizumab obtained a cost per month progression-free survival gained ranged from 6471 € towards mFOLFOX (5-FU, oxaliplatin and leucovorin) plus cetuximab to 7886 € towards mFOLFOX. To sum up, combining pharmacological costs of drugs with the measure of efficacy represented by progression-free survival, at the actual prize pembrolizumab cannot be considered cost-effectiveness for first-line treatment for microsatellite-instability-high mismatch-repair-deficient metastatic colorectal cancer. A reduction in pharmacological costs is mandatory. [ABSTRACT FROM AUTHOR]

Salvage logging is increasing in Central Europe because of the growth of severe meteorological events, and timber harvesting in these conditions is challenging in terms of both productivity performances and safety of the operations. In recent years, with the increase of natural calamities, several researchers studied machinery productivity performances regarding salvage logging carried out by ground-based systems. In fact, a common post-disturbance management approach is salvage logging which consists of the widespread removal of damaged trees. In this research, system productivity and the cost of salvage logging are analysed in European beech stands affected by wet snow. The accretion of heavy wet snow poses the greatest risk to forests in the Northern Hemisphere. This type of snow attaches more effectively to tree crowns and branches when temperatures are close to freezing at the time of precipitation. As a result, trees may break or bend and may be uprooted when the soil is unfrozen. This study has been implemented to evaluate the productivity and cost-effectiveness of extraction in salvage logging deployed with a skidder in beech stands affected by two different types of wet snow damage. The results show that the productivity of the four-wheel-drive cable skidder, despite operating in salvage cutting with a removal intensity of 10%, is 14.73 m3·SMH-1, similar to skidder performances in 'ordinary' cuttings. Skidder's productive time was 86% of the scheduled time, whereas the delays were due to organisational reasons, mechanical delays, and adverse weather conditions. The mean travel speed of the cable skidder obtained in this study is close to the results obtained from other studies on similar machines. The costs per unit are lower than effective cost consumptions for the other cable skidders and agricultural tractors, adapted for skidding operated in hardwood salvage logging. Therefore, under the given conditions, the operation of the fourwheel-drive cable skidder is viable from a silvicultural, technical, and economic point of view in the salvage operation logging. [ABSTRACT FROM AUTHOR]

Background: Direct oral anticoagulants (DOACs) have been increasingly utilised over warfarin. However, little is known about the relative consumption trends and costs of each DOAC at the global level. Methods: An ecological study using pharmaceutical sales data from IQVIA-MIDAS database was used to estimate consumption and cost of individual DOACs in 65 countries from 2008 to 2019. Consumption was estimated from the volume of DOACs sold, expressed as defined-daily-dose/1000-inhabitants/day (DDDTID). Compound and absolute annual growth rates were reported to quantify consumption changes over time. Costs were estimated as manufacturer price per day-of-therapy. Results: Global consumption of dabigatran, rivaroxaban, apixaban and edoxaban were 0.31, 1.05, 1.08 and 0.78 DDDTID, respectively, in Q2–2019, compared to 0.23, 0.54, 0.21 and 0.03 in Q2–2015, with highest consumption in Western Europe, Northern Europe and Oceania (18.2, 14.07, 13.14 DDDTID). In most countries (46/65, 70%), rivaroxaban contributed to most DOAC consumption (35%–100%), whereas dabigatran accounted for less than one-third. Edoxaban accounted for < 20% of the total in Northern America and Europe but contributed significant proportions in Japan (28.58%) and South Korea (31.37%). Longer median time-to-adoption from FDA approval for apixaban and edoxaban was observed. Costs of all DOACs were ~2–4 times higher in the USA, Puerto Rico and Thailand than in other countries. Conclusions: Regional differences exist in consumption pattern and trends of individual DOACs over the past decade. Consumption of rivaroxaban and apixaban overtook dabigatran in most countries, whereas use of edoxaban remains limited except in East Asian countries. The USA pays higher prices for DOACs than other countries. [ABSTRACT FROM AUTHOR]

This systematic study aims at analyzing the differences between the approach of the European healthcare systems to the pharmaceutical market and the American one. This paper highlights the opportunities and the limitations given by the application of managed entry agreements (MEAs) in European countries as opposed to the American market, which does not regulate pharmaceutical prices. Data were collected from the Organisation for Economic Co-operation and Development (OECD), the European Medicines Agency, and the national healthcare agencies of US and European countries. A literature review was undertaken in PubMed, Scopus, MEDLINE, and Google for a period ten years (2010–2019). The period 2020–2021 was considered to compare health expenditure before and after the SARS-CoV-2 pandemic. Scarce information from national agencies has been given in terms of MEAs related to the COVID-19 pandemic. The comparison between the United States approach and the European one shows the importance of a market access regulation to reduce the cost of therapies, increasing the efficiency of national healthcare systems and the advantages in terms of quality and accessibility to the final users: patients. Nevertheless, it seems that the golden age of MEAs for Europe was during the examined period. Except for Italy, countries will move to other forms of reimbursements to obtain higher benefits, reducing the costs of an inefficient implementation and outcomes in the medium term. [ABSTRACT FROM AUTHOR]

Agricultural commodities used for feed and food production are frequently contaminated with mycotoxins, such as Aflatoxin B1 (AFB1). In Europe, both the government and companies have monitoring programs in place for the presence of AFB1. With limited resources and following risk-based monitoring as prescribed in EU Regulation 2017/625, these monitoring programs focus on batches with the highest probability of being contaminated. This study explored the use of machine learning algorithms (ML) to design risk-based monitoring programs for AFB1 in feed products, considering both monitoring cost and model performance. Historical monitoring data for the presence of AFB1 in feed products (2005–2018; 5605 records in total) were used. Four different ML algorithms, including Decision tree, Logistic regression, Support vector machine and Extreme gradient boosting (XGB), were applied and compared to predict the high-risk feed batches to be considered for further AFB1 sampling and analysis. The monitoring cost included the cost of: sampling and analysis, disease burden, storage, and of recalling and destroying contaminated feed batches. The ML algorithms were able to predict the high-risk batches, with an AUC, recall, and accuracy higher than 0.8, 0.6, and 0.9, respectively. The XGB algorithm outperformed the other three investigated ML. Its incorporation would result into up to 96% reduction in monitoring cost in 2016–2018, as compared to the official monitoring program. The proposed approach for designing risk based monitoring programs can support authorities and industries to reduce the monitoring cost for other food safety hazards as well. [ABSTRACT FROM AUTHOR]

Public policies supporting families with children differ among countries but with the same goal of improving the well-being of children. Using a microsimulation model, this article assesses the cash support which families receive for their children in Croatia, Greece, Germany, the Slovak Republic, Sweden and the United Kingdom. The impact of policies across the income distribution on different family sizes, child-rearing cost compensation and child poverty is estimated. A method for the calculation of child-contingent payments for each child by order of birth in the family is proposed as a complementary indicator of policy design. The results confirm that a combination of universal and targeted support (either from family or social assistance benefits) is the most effective in poverty reduction and cost compensation. While high support for larger families greatly reduces poverty, generous universal or even lower support for large families has proved to be at least equally effective. [ABSTRACT FROM AUTHOR]

The aim of this paper is to discuss the controversies surrounding the most recent European regulations, as well as the cost, for a 3D printing workflow using free-source software in the context of a tertiary level university hospital in the Spanish public health system. Computer-aided design and manufacturing (CAD/CAM) for head and neck oncological surgery with the printing of biomodels, cutting guides, and patient-specific implants has made it possible to simplify and make this type of highly complex surgery more predictable. This technology is not without drawbacks, such as increased costs and the lead times when planning with the biomedical industry. A review of the current European legislation and the literature on this subject was performed, and comparisons made with the authors' in-house 3D printing setup using free software and different 3D printers. The cost analysis revealed that for the cheapest setup with free software, it would be possible to amortize the investment from case 2, and in all cases the initial investment would be amortized before case 9. The timeframe ranged from 2 weeks with the biomedical industry to 72 h with point-of-care 3D printing. It is now possible to develop point-of-care 3D printing in any hospital with almost any budget., (Copyright © 2024 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Affordable access to healthcare including medicines is a key social policy goal in Europe. However, it has rarely been addressed in comparative social policy research. Although the concept of decommodification has already been used in the context of healthcare and sickness benefits, we argue that the scope of such studies should be expanded to medicines to understand how welfare states protect their citizens from market forces in case of illness. We examine and compare the relationship between income, other characteristics, and subjective financial burden of medicines (FBM) across five countries with universal health systems pursuing egalitarian aims (Denmark, Finland, the Netherlands, Norway and Sweden). Analyses using 2017 EU-SILC microdata and linear probability models showed large differences in the level of FBM across countries, with the highest income quintile in Finland reporting FBM more frequently than the lowest income quintile in Denmark. Finland differed from the rest by increasing probability of FBM with age. In other countries, middle-aged adults tended to be the most affected, and older adults were well-protected. The association between income and FBM was strongest in the Netherlands; however, the higher probability of FBM was skewed towards the lower quintiles in all countries. FBM and financial burden of medical care were strongly associated although FBM tended to be more common. Unmet needs for medical examination were rare and lacked sensitivity in capturing manifestations of market risk. Decommodification literature has focused healthcare services as proxy of access; nevertheless, our study shows that further functions, and broader outcomes should be examined to capture market risk. Our evidence further highlights that important differences can be found even in countries with relatively similar health policy aims. The cost of medicines should be considered in comparative studies of health and welfare states. • Access to medicines should be considered in studies of decommodification. • Market risk manifested predominantly as subjective financial burden. • Significant country differences in financial burden were found. [ABSTRACT FROM AUTHOR]

Background: The lack of transparency in the methodology of unit cost estimation and the usage of confidential or undisclosed information prevents cost comparisons and makes the transferability of the results across countries difficult. The objective of this article is to compare the methodologies used in the estimation of the cost of a day case cataract extirpation that are described in the official and publicly available sources and to study how these translate into different unit cost estimates. Methods: A literature review was conducted to identify the main sources of unit costs of cataract extirpation. A semi-structured questionnaire to obtain information on national costing methodologies was developed and sent to consortium partners in nine European countries. Additionally, publicly available sources of unit cost of cataract surgery in those countries included in the European Healthcare and Social Cost Database (EU HCSCD) were analysed. Results: The findings showed a considerable diversity across countries on unit costs varying from 432.5€ in Poland (minor degree of severity) to 3411.96€ in Portugal (major degree of severity). In addition, differences were found in the year of cost publication and on the level of detail of different types of cataract surgery. The unit of activity were Diagnosis-Related Groups in all countries except Slovenia. All unit costs include direct costs and variable overheads (except Germany where nursing costs are financed separately). Differences were identified in the type of fixed overheads included in unit costs. Methodological documents explaining the identification, measurement and evaluation of resources included in the unit costs, as well as use of appropriate cost drivers are publicly available only in England, Portugal and Sweden. Conclusions: We can conclude that while unit costs of cataract extirpation are publicly available, the information on methodological aspects is scarce. This appears to pose a significant problem for cross-country comparisons of costs and transferability of results from one country to another. [ABSTRACT FROM AUTHOR]

The enormous growth in house prices in Europe since the 1990s has led to increasing concerns about the affordability of housing for ordinary citizens. This article explores the relationship between housing affordability – house prices relative to incomes – and the demand for redistributive and housing policy, using data drawn from European and British social surveys and an analysis of British elections. It shows that, as unaffordability rises, citizens appear in aggregate to become less supportive of redistribution, interventionist housing policy and left-wing parties. However, this aggregate rise, driven by the predominance of homeowners in most European countries, masks a growing polarization in preferences between renters and owners in less affordable regions. [ABSTRACT FROM AUTHOR]

Background: For care planning and support, under-detection and late diagnosis of Alzheimer's disease (AD) is a great challenge. Models of Patient-Engagement for Alzheimer's Disease (MOPEAD) is an EU-funded project aiming at testing different strategies to improve this situation.Objective: To make a cost-consequence analysis of MOPEAD.Methods: Four screening strategies were tested in five countries (Germany, the Netherlands, Slovenia, Spain, and Sweden): 1) a web-approach; 2) Open-House initiative; 3) in primary care; and 4) by diabetes specialists. Persons-at-risk of AD in all strategies were offered referral to a hospital-based specialist. The primary health-economic outcome was the cost per true-positive case (TP) of AD from the screened population.Results: Of 2,847 screened persons, 1,121 screened positive (39%), 402 were evaluated at memory clinics (14%), and 236 got an AD diagnosis (8%). The cost per TP of those screened was €3,115 with the web-approach, €2,722 with the Open-House, €1,530 in primary care, and €1,190 by diabetes specialists. Sensitivity analyses that more likely reflect the real-world situation confirmed the results. The number-needed-to-screen was 30 with the web-approach, 8 with the Open-House and primary care, and 6 with the diabetes specialists.There were country differences in terms of screening rates, referrals to memory clinics, staff-types involved, and costs per TP.Conclusion: In primary care and by the diabetes specialist, the costs per TP/screened population were lowest, but the capacity of such settings to identify cases with AD-risk must be discussed. Hence new diagnostic strategies such as web-solutions and Open-House initiatives may be valuable after modifications. [ABSTRACT FROM AUTHOR]

Prehospital care for traumatic brain injury (TBI) is important to prevent secondary brain injury. We aim to compare prehospital care systems within Europe and investigate the association of system characteristics with the stability of patients at hospital arrival. We studied TBI patients who were transported to CENTER-TBI centers, a pan-European, prospective TBI cohort study, by emergency medical services between 2014 and 2017. The association of demographic factors, injury severity, situational factors, and interventions associated with on-scene time was assessed using linear regression. We used mixed effects models to investigate the case mix adjusted variation between countries in prehospital times and interventions. The case mix adjusted impact of on-scene time and interventions on hypoxia (oxygen saturation <90%) and hypotension (systolic blood pressure <100mmHg) at hospital arrival was analyzed with logistic regression. Among 3878 patients, the greatest driver of longer on-scene time was intubation (+8.3 min, 95% CI: 5.6–11.1). Secondary referral was associated with shorter on-scene time (-5.0 min 95% CI: −6.2– −3.8). Between countries, there was a large variation in response (range: 12–25 min), on-scene (range: 16-36 min) and travel time (range: 15–32 min) and in prehospital interventions. These variations were not explained by patient factors such as conscious level or severity of injury (expected OR between countries: 1.8 for intubation, 1.8 for IV fluids, 2.0 for helicopter). On-scene time was not associated with the regional EMS policy (p= 0.58). Hypotension and/or hypoxia were seen in 180 (6%) and 97 (3%) patients in the overall cohort and in 13% and 7% of patients with severe TBI (GCS <8). The largest association with secondary insults at hospital arrival was with major extracranial injury: the OR was 3.6 (95% CI: 2.6–5.0) for hypotension and 4.4 (95% CI: 2.9–6.7) for hypoxia. Hypoxia and hypotension continue to occur in patients who suffer a TBI, and remain relatively common in severe TBI. Substantial variation in prehospital care exists for patients after TBI in Europe, which is only partially explained by patient factors. [ABSTRACT FROM AUTHOR]

The 2030 climate and energy framework includes EU-wide targets and policy objectives for the period 2021–2030 of (1) at least 55% cuts in greenhouse gas emissions (from 1990 levels); (2) at least 32% share for renewable energy; and (3) at least 32.5% improvement in energy efficiency. In this context, the methodology of the cost-optimal level from the life-cycle cost approach has been applied to calculate the cost of renovating the existing building stock in Europe. The aim of this research is to analyze a pilot building using the cost-optimal methodology to determine the renovation measures that lead to the lowest life-cycle cost during the estimated economic life of the building. The case under study is an apartment building located in a mild Mediterranean climate (Castellon, SP). A package of 12 optimal solutions has been obtained to show the importance of the choice of the elements and systems for renovating building envelopes and how energy and economic aspects influence this choice. Simulations have shown that these packages of optimal solutions (different configurations for the building envelope, thermal bridges, airtightness and ventilation, and domestic hot water production systems) can provide savings in the primary energy consumption of up to 60%. [ABSTRACT FROM AUTHOR]

Hyperphosphatemia is common among patients with advanced chronic kidney disease (CKD) undergoing dialysis. The iron-based phosphate binder (PB), sucroferric oxyhydroxide (SO), has a low daily pill burden and is indicated for the control of serum phosphorus in these patients. In a retrospective database study, hemodialysis patients switched to long-term SO therapy had fewer hospitalizations compared with patients switched to other PB therapies. This economic analysis aimed to quantify potential cost-savings of reduced hospitalizations associated with SO for healthcare systems in five European countries. All-cause hospital admissions incidence data were sourced from a real-world retrospective database study comparing adult, in-center hemodialysis patients maintained on 2 years of SO therapy (mSO) versus patients who discontinued SO (dSO) within 90 days of their first prescription and switched to other PBs. A literature search was conducted to determine the cost per hospital admission for dialysis patients in the healthcare setting of each European country. A cost-model combined the incidence rate of all-cause hospital admissions and the cost per admission to estimate the country-specific inpatient costs for the mSO and dSO groups. Annual inpatient cost-savings per patient in the mSO group versus the dSO group were €1,201, €2,097, €2,059, €1,512, and €3,068 in France, Germany, Italy, Spain, and the UK, respectively. When annual PB drug costs per patient were considered, the net annual economic cost-savings per patient were €327, €1,585, €1,022, €1,100, and €2,204, respectively. Hospital admissions data used in the analysis were observational in nature and derived from a US hemodialysis patient population; the effect of SO therapy on hospitalization rates for US and European hemodialysis patients may differ. The analysis did not consider indirect healthcare costs associated with hospitalizations. SO therapy may offer substantial inpatient cost-savings by reducing all-cause hospital admissions attributable to uncontrolled hyperphosphatemia. [ABSTRACT FROM AUTHOR]

Objectives: To inform allocation decisions in any healthcare system, robust cost data are indispensable. Nevertheless, recommendations on the most appropriate valuation approaches vary or are nonexistent, and no internationally accepted gold standard exists. This costing analysis exercise aims to assess the impact and implications of different calculation methods and sources based on the unit cost of general practitioner (GP) consultations in Austria.Methods: Six costing methods for unit cost calculation were explored, following 3 Austrian methodological approaches (AT-1, AT-2, AT-3) and 3 approaches applied in 3 other European countries (Germany, The Netherlands, United Kingdom). Drawing on Austrian data, mean unit costs per GP consultation were calculated in euros for 2015.Results: Mean unit costs ranged from €15.6 to €42.6 based on the German top-down costing approach (DE) and the Austrian Physicians' Chamber's price recommendations (AT-3), respectively. The mean unit cost was estimated at €18.9 based on Austrian economic evaluations (AT-1) and €17.9 based on health insurance payment tariffs (AT-2). The Dutch top-down (NL) and the UK bottom-up approaches (UK) yielded higher estimates (NL: €25.3, UK: €29.8). Overall variation reached 173%.Conclusions: Our study is the first to systematically investigate the impact of differing calculation methods on unit cost estimates. It shows large variations with potential impact on the conclusions in an economic evaluation. Although different methodological choices may be justified by the adopted study perspective, different costing approaches introduce variation in cross-study/cross-country cost estimates, leading to decreased confidence in data quality in economic evaluations. [ABSTRACT FROM AUTHOR]

Objective: This study examines European decision makers' consideration and use of quantitative preference data.Methods: The study reviewed quantitative preference data usage in 31 European countries to support marketing authorization, reimbursement, or pricing decisions. Use was defined as: agency guidance on preference data use, sponsor submission of preference data, or decision-maker collection of preference data. The data could be collected from any stakeholder using any method that generated quantitative estimates of preferences. Data were collected through: (1) documentary evidence identified through a literature and regulatory websites review, and via key opinion leader outreach; and (2) a survey of staff working for agencies that support or make healthcare technology decisions.Results: Preference data utilization was identified in 22 countries and at a European level. The most prevalent use (19 countries) was citizen preferences, collected using time-trade off or standard gamble methods to inform health state utility estimation. Preference data was also used to: (1) value other impact on patients, (2) incorporate non-health factors into reimbursement decisions, and (3) estimate opportunity cost. Pilot projects were identified (6 countries and at a European level), with a focus on multi-criteria decision analysis methods and choice-based methods to elicit patient preferences.Conclusion: While quantitative preference data support reimbursement and pricing decisions in most European countries, there was no utilization evidence in European-level marketing authorization decisions. While there are commonalities, a diversity of usage was identified between jurisdictions. Pilots suggest the potential for greater use of preference data, and for alignment between decision makers. [ABSTRACT FROM AUTHOR]

Research & Development on new medicines plays an important role in life and well-being, making pharmaceutical companies important players in global health. Accessibility and financing new medicines, however, poses challenges for governments and patients around the world. Due to pricing and aggressive patent policy issues, pharma companies started to adopt access to medicines as a strategy to not only improve their public image but also to increase their economic performance. More than a useful institutional advertisement to attract new business, initiatives to improve access to medicines must be socially responsible and sustainable. Using content analysis methodology from CSR reports, the present study evaluated how 44 global companies are positioning themselves regarding access, whether these initiatives are aligned to existing access programmes and whether the actions disclosed on behalf of access are sustainable. We have identified 13 major access to medicines approaches that were classified into intrinsic, potentially sustainable and robust actions. We concluded that companies overvalue the term access to medicine. This can generate initiatives focused on advertisements rather than long-term actions and highlights the need for clear global criteria for companies and programmes that want to effectively publicise access to medicines as a social responsibility strategy. [ABSTRACT FROM AUTHOR]

We study physiotherapy providers' prices in repeated competitive biddings where multiple providers are accepted in geographical districts. Historically, only very few districts have rejected any providers. We show that this practice increased prices and analyze the effects the risk of rejection has on prices. Our data are derived from three subsequent competitive biddings. The results show that rejecting at least one provider decreased prices by more than 5% in the next procurement round. The results also indicate that providers have learned to calculate their optimal bids, which has also increased prices. Further, we perform counterfactual policy analysis of a capacity-rule of acceptance. The analysis shows that implementing a systematic acceptance rule results in a trade-off between direct cost savings and service continuity at patients' usual providers. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore whether brokered network governance, run by the manufacturer, affects relational embeddedness and thus contributes to yielding the Coleman rent in the triadic supply chains. Design/methodology/approach: Building upon the theoretical tenets of transaction cost analysis, complemented by the underpinnings of social capital theory, this study involves an empirical investigation that uses survey data collected from the triadic supply chains in Europe. The research covers a two-step analysis. In the first step, the Coleman rent was estimated through the regression analysis with the interaction effects. Then, partial least squares–structural equation modeling was used to estimate the reflective-formative nature of higher component model and test the research hypotheses. Findings: The results of the study demonstrate that the distribution of three mechanisms in network governance is relatively even; however, market and hierarchy still emerge as the most impactful dimensions. Interestingly, though, this study shows that social capital can actually coexist with market and hierarchy in the triadic supply chains with the structural hole. Likewise, the research indicates that the impact of brokered network governance on the strength of network relational embeddedness is significant, but relatively weak, whereas network relational embeddedness has a strong and positive effect on the Coleman rent. Research limitations/implications: This study makes three major contributions. First, this study is one of very few that explicitly considers brokered network governance, run by the manufacturer positioned on the structural hole in its triadic supply chain. Second, as the triadic perspective is still uncommon in the supply chain studies, this research investigates a triad with the structural hole within the manufacturing setting. Third, the paper seeks to investigate the ability to yield the Coleman rent in the triadic supply chains with the structural hole, although this type of rent is typically linked to another arrangement called closure. Originality/value: Given the increasing attention paid to the role of social capital within supply chains, this study investigates how relational embeddedness can be used by the manufacturer, sitting on the structural hole and running the network governance mechanism, to yield the Coleman rent in the triadic supply chain. [ABSTRACT FROM AUTHOR]

Background Tobacco-control policies have been suggested to reduce smoking among adolescents. However, there is limited evidence on the real-world costs of implementation in different settings. In this study, we aimed at estimating the costs of school smoking bans, school prevention programmes and non-school bans (smoking bans in non-educational public settings, bans on sales to minors and bans on point-of-sale advertising), implemented in Finland, Ireland, the Netherlands, Belgium, Germany, Italy and Portugal, for 2016. Methods We retrospectively collected costs related to the inspection, monitoring and sanctioning activities related to bans and educational activities related to smoking prevention programmes. We used an 'ingredients-based' approach, identifying each resource used, quantity and unit value for one full year, under the state perspective. Costs were measured at national, regional, local and school-level and were informed by data on how these activities were performed in reality. Results Purchasing power parities adjusted-costs varied between €0.02 and €0.74 (average €0.24) per person (pp) for bans implemented outside schools. Mean costs of school smoking bans ranged from €3.31 to €34.76 (average €20.60), and mean costs of school educational programmes from €0.75 to €4.65 (average €2.92). Conclusions It is feasible to estimate costs of health policies as implemented in different settings. Costs of the tobacco control policies evaluated here depend mainly on the number of person-hours allocated to their implementation, and on the scale of intervention. Non-school bans presented the lowest costs, and the implementation of all policies cost up to €36 pp for 1 year. [ABSTRACT FROM AUTHOR]

Background: Colonoscopies are carried out for a range of reasons including for the detection of colon cancer and investigation of abdominal and bowel related symptoms. Inadequate preparation can increase the burden of repeat procedures.Methods: A systematic review aimed to identify the rate of repeat colonoscopies due to inadequate bowel preparation in France, Germany, Italy, Spain and the United Kingdom. The information obtained populated a decision analytic model to estimate the cost implications of inadequate bowel cleansing in the same five countries. The model explored scenarios by comparing one and two-litre polyethylene glycol-based bowel preparation.Results: The systematic review identified 14 eligible studies reporting on the proportion of patients with inadequate bowel cleansing indicated for a repeat procedure. Data were available for Italy (27.5%-35.9%), Spain (63%) and the UK (24.5%) only. The decision analytic model demonstrates that improving the proportion of adequate bowel cleansing at first colonoscopy is likely to generate cost savings.Conclusions: Based on the available evidence, increasing the proportion of people who have adequate bowel cleansing at index colonoscopy will likely have financial benefits in Italy, Spain and the UK. A paucity of data, for France and Germany, limits the robustness of conclusions in these countries. [ABSTRACT FROM AUTHOR]

The European energy label was established to reduce energy consumption in Europe. All classes and values on the energy label are stated by the supplier. The task of market surveillance is to ensure correct labels and to validate their values through compliance tests. However, this can only be done for a small fraction of all models on the market, since physical tests are expensive. Screening methods can be used to narrow down the number of critical products before compliance tests are done to decrease the costs of finding non-compliant models. This study shows a mathematical approach to analyze the cost benefits of screening methods to find non-compliant models. Furthermore, the analysis presented has been applied to 18 screening methods for tumble dryers. The performance test for tumble dryers consists of seven test runs. All screening methods evaluated are composed of a reduced number of test runs. The most efficient screening method reduces the surveillance costs by 40%. [ABSTRACT FROM AUTHOR]

Background: The objective of the present study was to evaluate effectiveness, complications and cost-effectiveness of any surgical or non-surgical treatment for radius or ulna fractures in elderly patients. Secondary objectives were to analyze present treatment traditions of distal radius fractures (DRF) in Sweden and to calculate resource usage for its treatment. Methods and findings: The assessment contains a systematic review of clinical and health economic studies comparing treatment options for radius or ulna fractures. The results regarding the effectiveness of the treatments are summarized in meta-analyses. In addition, the assessment contains a cost analysis for different treatment options commonly used for DRF care, and an analysis of registry data on the incidence and treatment of DRF. In total 31 randomized controlled trials were included in meta-analyses. When comparing functional outcome for plate fixation versus non-surgical treatment for DRF, there were no clinically important differences at one-year follow-up (mean difference [MD], -3.29, 95% CI, -7.03; 0.44). Similar results were found when comparing plating and percutaneous methods with respect to functional outcome (standardized mean difference [SMD], -0.07, 95% CI, -0.21; 0.07) and grip strength (MD, -3.47, 95% CI, -11.21; 4.28). There were no differences for minor complications, (risk difference [RD], -0.01, 95% CI, -0.07; 0.05) whereas major complications were less common for the percutaneous group, (RD, 0.02, 95% CI, 0.02; 0.03). Given the low number of studies, the evidence above was rated as moderate certainty. The cost for plate fixation versus plaster cast was estimated to 1698 compared to 137 US dollars. For DRF, plate fixation increased in Sweden between 2005 and 2013, and was the most common surgical method in 2013. Conclusions: Surgical treatment of moderately displaced distal radius fractures in elderly patients offers no clear benefit compared to non-surgical treatment. Plating procedures have become more common during the second millennium and involve higher costs and higher risk of major complications than percutaneous options. [ABSTRACT FROM AUTHOR]

Cost accounting has not been studied extensively in the context of European central governments. This article looks at the use of cost accounting with two New Public Management practices: performance management and decentralization. The research finds that there is an increasing use of cost accounting for central government ministries that make greater use of performance management, which follows the theoretical prediction that cost accounting information and performance information can be used together to address agency problems. Greater decentralization is associated with a greater use of cost accounting, but the relationship between decentralization and cost accounting does not vary by agency or ministry. [ABSTRACT FROM AUTHOR]

The article focuses on challenges surrounding pricing of pharmaceutical industry. It mentions about impact of intersection between supply and demand on drug prices; regulation of pharmaceutical prices in Western European countries; and approach for pricing new and innovative drugs. It also mentions about the impact of economic competition on the same.

Medical devices are estimated to account for 6 percent of health expenditures in the US and 7 percent in European Union (EU) countries. Cardiac implants are a large segment of the market, but little is known about their prices. Using 2006-14 data from a large hospital panel survey, this article provides a systematic comparison of prices of cardiac implants between the US and four EU countries. The data reveal that prices were two to six times higher in the US than in Germany, where cardiac implants were generally the cheapest. Prices also varied between EU countries. Prices of coronary stents and pacemakers were higher in France and Italy than in the UK, where prices were similar to those in Germany. The data also confirmed findings of prior studies that found significant price variation between hospitals within a given country. This study found that within- and between-country variations were similar in magnitude. While these findings can help assess whether technology-related policies effectively control the prices of cardiac devices, future research is necessary to establish a causal relationship between prices and several possible explanatory factors and help policy makers understand which mechanisms are available to control device prices. [ABSTRACT FROM AUTHOR]

Aim: Diabetic foot ulcers (DFUs) are challenging wounds associated with delayed healing, high risk of infection and lower-limb amputation; and so, very high treatment costs.TLC-NOSF dressing has proven its significant efficacy from a randomized, doubleblind clinical trial, when compared with neutral dressings. Authors will report the results of the economic impact of using TLCNOSF dressing in Europe, Asia and North America. Method: In Europe, the studies involved a Markov-model cost-effectiveness design. From the study endpoint of 20 weeks, extrapolation to a base-case time horizon of 1 year was adopted in the UK and French models and 100 weeks for Germany. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the model parameters. In China and Canada, independent studies involving a Markov-model were conducted respectively on 10 000 and 1000 patients. Results / Discussion: The NICE Guidance has recently supported the use of TLC-NOSF in the DFU treatment and reported an average annual cost-saving of £342 per patient in the UK; this treatment is also highly cost-effective in Germany (€3,767 cost savings) and in France (€3,345). The main cost driver was the time to heal. Furthermore, earlier the use of TLC-NOSF dressing, higher are efficacy and cost savings. In Canada, compared to conventional dressings, adding TLC-NOSF dressings resulted in an expected $5,878 decrease in health care costs over 5 years. Conclusion: TLC-NOSF dressing compared with neutral dressings is the dominant treatment strategy in the management of DFUs, resulting in significant annual cost savings in European, Asian and North American Healthcare systems. [ABSTRACT FROM AUTHOR]

Food cultures have developed in communities as according to the produce of local farms in the vicinity. The industrial revolution resulted in large cities and towns becoming reliant on farm produce from the neighbouring countryside; this stimulated development of farming, which itself became industrialized. However, although local diets in Europe differed markedly, the 'healthiness' of all diets was unquestioned until recently. Early in the 20th century, academic departments studying nutrition were established, but it is only since the 1980s that much interest in the 'healthiness' of our food began to be of concern outwith academia. At about this time it was becoming clear that existing patterns of farming and food production were having negative effects on the environment. Since the 1990s, environmental, farming and nutritional sciences have each progressed, but in parallel, and there has been all too little effort to unite them. However, it is clear that, in general, production of foods associated with 'unhealthy' nutrition is also the most damaging from an environmental viewpoint. This article summarizes the evidence on current European diets, analyses costs and benefits in transitioning to healthy and sustainable diets, identifies sustainable dietary guidelines as the way forward and discusses the role of public health in achieving dietary reform in the interests of improved nutrition and environmental protection. [ABSTRACT FROM AUTHOR]

• Homemade and untaxed alcoholic beverages are called unrecorded alcohol. • Survey data from 33 European countries were analysed. • 12% of adults drinking alcohol in the past week reported unrecorded alcohol use. • Higher prevalence (24%) was reported among high-risk alcohol users. • Unrecorded alcohol accounted for 7% of per capita consumption in 2020. Using data from 33 European countries (including all EU member states), this study aimed to 1) estimate the prevalence of unrecorded alcohol use among past-week alcohol users, 2) describe how unrecorded alcohol use is associated with drinking patterns, and 3) estimate the contribution of unrecorded alcohol to the total amount of alcohol consumed annually in these countries. Data from 25,728 adults who drank alcohol in the past week and self-reported their use of unrecorded alcohol in 2021 were analysed. Prevalence of unrecorded alcohol use in the last week was estimated for those with low, medium, and high risk drinking categorised using the WHO-recommended risk thresholds and definition of risky single occasion drinking. Prevalence estimates were weighted for the country-specific gender, age, and geographical population distribution. An adjusted weighted proportion of unrecorded drinking occasions in total drinking occasions was calculated and compared to 2020 recorded annual per capita consumption estimates. Among past-week alcohol users, the average prevalence of past-week unrecorded alcohol use was 12.1% (95% CI: 11.7-12.5%), with considerable difference between countries (min: 2.0% in Malta; max: 27.0% in Greece). Unrecorded alcohol use was much more prevalent among people with high-risk alcohol use in the past week (24.2%, 95% confidence interval [CI]: 22.9-25.5%) compared to people with low- (6.5, 95% CI: 6.0-6.9%) or medium-risk alcohol intake in the past week (13.6%, 95% CI: 12.9-14.3%). Unrecorded alcohol accounted for 7% of per capita consumption in 2020. This is the first comparable assessment of unrecorded alcohol use across EU and affiliated countries. The findings add support to the observation that availability of unrecorded alcohol may contribute to risky drinking in Europe. The observed country variations may be related to differences in country-specific pricing policies and measures to reduce the production and consumption of unrecorded alcoholic beverages. [ABSTRACT FROM AUTHOR]

Accounting for nearly 40% of final energy consumption, buildings are central to European energy policy. The Directive on Energy Performance of Buildings establishes a benchmarking system known as cost-optimality to set minimum energy performance requirements in new and existing buildings. This paper applies the cost-optimal methodology to an existing structure located in the Mediterranean area (Southern Italy). The building is composed of two units that have been considered for different uses: hotel and multi-residential. Several energy efficiency and renewable measures have been implemented both individually and as part of packages of measures. The cost-optimal solution has been identified as able to optimize energy consumption and costs from financial and macroeconomic perspectives. The first reference building (hotel use) shows a maximum reduction of primary energy and CO2 emission of about 42%, falling within the CasaClima energy class D, while the second reference building (residential use) achieves a value of 88% for primary energy and 85% for CO2 emissions, falling into class B. Thermal dispersions through the envelope can be limited using a suitable combination of insulating materials while a variety of technical variants are selected, such as VRF (variant refrigerant flow) systems, heat pumps with fan coils associated with controlled mechanical ventilation, solar thermal and photovoltaic. This paper illustrates the development of energy retrofit projects, in order to reach a balance between efficiency measures and costs for a building having two different uses, providing guidance to similar case studies related to a warm climate. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Stillbirth and in-hospital mortality rates associated with verypreterm births (VPT) vary widely across Europe. International comparisons are complicated by a lack of standardized data collection and differences in definitions, registration, and reporting. This study aims to determine what proportion of the variation in stillbirth and in-hospital VPT mortality rates persists after adjusting for population demographics, case-mix, and timing of death. METHODS: Standardized data collection for a geographically defined prospective cohort of VPTs (22+0-31+6 weeks gestation) across 16 regions in Europe. Crude and adjusted stillbirth and in-hospital mortality rates for VPT infants were calculated by time of death by using multinomial logistic regression models. RESULTS: The stillbirth and in-hospital mortality rate for VPTs was 27.7% (range, 19.9%- 35.9% by region). Adjusting for maternal and pregnancy characteristics had little impact on the variation. The addition of infant characteristics reduced the variation of mortality rates by approximately one-fifth (4.8% to 3.9%). The SD for deaths <12 hours after birth was reduced by one-quarter, but did not change after risk adjustment for deaths ≥12 hours after birth. CONCLUSIONS: In terms of the regional variation in overall VPT mortality, over four-fifths of the variation could not be accounted for by maternal, pregnancy, and infant characteristics. Investigation of the timing of death showed that these characteristics only accounted for a small proportion of the variation in VPT deaths. These findings suggest that there may be an inequity in the quality of care provision and treatment of VPT infants across Europe. [ABSTRACT FROM AUTHOR]

Background: In recent years, high-cost medicines have increasingly been challenging the public health budget in all countries including high-income economies. In this context, this study aims to survey, analyze and compare prices of medicines that likely contribute to high expenditure for the public payers in high-income countries.Methods: We chose the following 16 European countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, the Netherlands, Portugal, Sweden, Slovakia, Spain and United Kingdom. The ex-factory price data of 30 medicines in these countries were collected in national databases accessible through the Pharmaceutical Price Information (PPI) service of Gesundheit Österreich GmbH (Austrian Public Health Institute).Results: The ex-factory prices (median) per unit (e.g. per tablet, vial) ranged from 10.67 cent (levodopa + decarboxylase inhibitor) to 17,000 euro (ipilimumab). A total of 53% of the medicines surveyed had a unit ex-factory price (median) above 200 Euro. For two thirds of the medicines, price differences between the highest-priced country and lowest-priced country ranged between 25 and 100%; the remaining medicines, mainly low-priced medicines, had higher price differential, up to 251%. Medicines with unit prices of a few euros or less were medicines for the treatment of diseases in the nervous system (anti-depressants, medicines to treat Parkinson and for the management of neuropathic pain), of obstructive airway diseases and cardio-vascular medicines (lipid modifying agents). High-priced medicines were particularly cancer medicines.Conclusion: Medicine prices of Greece, Hungary, Slovakia and UK were frequently at the lower end, German and Swedish, as well as Danish and Irish prices at the upper end. For high-priced medicines, actual paid prices are likely to be lower due to confidential discounts and similar funding arrangements between industry and public payers. Pricing authorities refer to the higher undiscounted prices when they use price data from other countries for their pricing decisions. [ABSTRACT FROM AUTHOR]

Background: Policymakers and researchers frequently compare the prices of medicines between countries. Such comparisons often serve as barometers of how pricing and reimbursement policies are performing. The aim of this study was to examine methodological challenges to comparing generic drug prices.Methods: We calculated all commonly used price indices based on 2013 IMS Health data on sales of 3156 generic drugs in seven European countries.Results: There were large differences in generic drug prices between countries. However, the results varied depending on the choice of index, base country, unit of volume, method of currency conversion, and therapeutic category. The results also differed depending on whether one looked at the prices charged by manufacturers or those charged by pharmacists.Conclusions: Price indices are a useful statistical approach for comparing drug prices across countries, but researchers and policymakers should interpret price indices with caution given their limitations. Price-index results are highly sensitive to the choice of method and sample. More research is needed to determine the drivers of price differences between countries. The data suggest that some governments should aim to reduce distribution costs for generic drugs. [ABSTRACT FROM AUTHOR]

This paper proposes an economic analysis of three different types of processing in CDW (construction and demolition waste) recycling platforms, according to the sophistication of the processing technologies (current advanced, advanced and advanced sorting). The methodology that is adopted is in the economic evaluation concept of projects and is classified with a scoping study phase. In these contexts, three levels of CDW processing capabilities for recycling platforms are analyzed (100, 300 and 600 thousand tons per year). This article considers databases obtained from similar projects that have been published in the specialized literature; the data sources are primarily from the European continent. The paper shows that current advanced process has better economic performance, in terms of IRR, related to the other two processes. The IRR associated with advanced and advanced sorting processes could be raised by, (i) higher price of secondary primary material, and/or (ii) higher capacity of platforms, and/or (iii) higher sharing of secondary primary material in the total production. The first two points depend on the market conditions (prices and total quantity of CDW available) and (potential) fiscal or incentive policies. The last one depends on technological progress. [ABSTRACT FROM AUTHOR]

Despite established efficacy for cardiac implantable electrical devices (CIEDs), large differences in CIED implant rates have been documented across and within countries. The aim of this paper is to investigate the influence of socio-economic, epidemiological and supply side factors on CIED implant rates across 57 Regions in 5 EU countries and to assess the feasibility of using administrative data for this purpose. A total of 1 330 098 hospitalizations for CIED procedures extracted from hospital discharge databases in Austria, England, Germany, Italy and Slovenia from 2008 to 2012 was used in the analysis. Higher levels of tertiary education among the labour force and percent of aged population are positively associated with implant rates of CIED. Regional per capita GDP and number of implanting centres appear to have no significant effect. Institutional factors are shown to be important for the diffusion of CIED. Wide variation in CIED implant rates across and within five EU countries is undeniable. However, regional factors play a limited part in explaining these differences with few exceptions. Administrative databases are a valuable source of data for investigating the diffusion of medical technologies, while the choice of appropriate modelling strategy is crucial in identifying the drivers for variation across countries. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Surveys of patients' experiences with health care services can reveal how well a country's health system is meeting the needs of its population. Using data from a 2016 survey conducted in eleven countries--Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States--we found that US adults reported poor health and well-being and were the most likely to experience material hardship. The United States trailed other countries in making health care affordable and ranked poorly on providing timely access to medical care (except specialist care). In all countries, shortfalls in patient engagement and chronic care management were reported, and at least one in five adults experienced a care coordination problem. Problems were often particularly acute for low-income adults. Overall, the Netherlands performed at the top of the eleven-country range on most measures of access, engagement, and coordination. [ABSTRACT FROM AUTHOR]

Health Technology Assessment is increasingly used to evaluate the value of healthcare products and to prioritize resources; however, defining exactly what value is and how it should be measured remains a challenge. In this article, we report the results of a literature review, focusing on nine European countries, with the aim of investigating how value is defined from the perspective of different stakeholders, how definitions of value are used, and how value is incorporated into decision making. Only three articles were identified that presented definitions of value, and there was no single shared definition of value in healthcare, which appears to be a highly subjective concept. The majority of the countries investigated combine clinical assessment with economic evaluation to make reimbursement recommendations; the quality-adjusted life-year is the most commonly used measure of value but does not capture broader aspects of value that may be important to patients and healthcare systems. We describe the use of value-based pricing and multi-criteria decision analysis, two approaches to the incorporation of broader aspects of value into decision making. Overall, we have identified considerable variation in how a product's value is defined by different stakeholders. Although a universal understanding of value in healthcare is important, it is clear that current definitions are insufficient, potentially leading to inconsistent reimbursement decisions. Ultimately, the establishment of clearer policies for defining and measuring value in healthcare is needed, and is likely to lead to improvements in the consistency of decision making. [ABSTRACT FROM AUTHOR]

Background: The adverse relation between dietary trans fatty acid (TFA) intake and coronary artery disease risk is well established. Many countries in the European Union (EU) and worldwide have implemented different policies to reduce the TFA intake of their populations. Objective: The aim of this study was to assess the added value of EU-level action by estimating the cost-effectiveness of 3 possible EU-level policy measures to reduce population dietary TFA intake. This was calculated against a reference situation of not implementing any EU-level policy (i.e., by assuming only national or selfregulatory measures). Design: We developed a mathematical model to compare different policy options at the EU level: 1) to do nothing beyond the current state (reference situation), 2) to impose mandatory TFA labeling of prepackaged foods, 3) to seek voluntary agreements toward further reducing industrially produced TFA (iTFA) content in foods, and 4) to impose a legislative limit for iTFA content in foods. Results: The model indicated that to impose an EU-level legal limit or to make voluntary agreements may, over the course of a lifetime (85 y), avoid the loss of 3.73 and 2.19 million disability-adjusted life-years (DALYs), respectively, and save >51 and 23 billion euros when compared with the reference situation. Implementing mandatory TFA labeling can also avoid the loss of 0.98 million DALYs, but this option incurs more costs than it saves compared with the reference option. Conclusions: The model indicates that there is added value of an EU-level action, either via a legal limit or through voluntary agreements, with the legal limit option producing the highest additional health benefits. Introducing mandatory TFA labeling for the EU common market may provide some additional health benefits; however, this would likely not be a cost-effective strategy. [ABSTRACT FROM AUTHOR]

Objectives: Restrictive policies that limit access to abortion often lead women to seek services abroad. We present results from an exploratory study aimed at documenting the socio-demographic characteristics, travel and abortion-seeking experiences of non-resident women seeking abortions in the UK.Methods: Between August 2014 and March 2015, we surveyed a convenience sample of 58 non-UK residents seeking abortions at three British Pregnancy Advisory Service (BPAS) abortion clinics in England in order to better understand the experiences of non-resident women who travel to the UK seeking abortion services.Results: Participants travelled to England from 14 countries in Europe and the Middle East. Twenty-six percent of participants reported gestational ages between 14 and 20 weeks, and 14% (n = 8) were beyond 20 weeks since their last menstrual period (LMP). More women from Western Europe sought abortions beyond 13 weeks gestation than from any other region. Women reported seeking abortion outside of their country of residence for a variety of reasons, most commonly, that abortion was not legal (51%), followed by having passed the gestational limit for a legal abortion (31%). Women paid an average of £631 for travel expenses, and an average of £210 for accommodation. More than half of women in our study found it difficult to cover travel costs.Conclusions: Understanding how and why women seek abortion care far from their countries of residence is an important topic for future research and could help to inform abortion-related policy decisions in the UK and in Europe. [ABSTRACT FROM AUTHOR]

Objective: A combination of vinorelbine and cisplatin is a standard treatment in non-small-cell lung cancer; oral vinorelbine is registered in 45 countries. Pemetrexed and cisplatin are recommended in front-line chemotherapy of non-squamous non-small-cell lung cancer (NS-NSCLC). The objective of this study was to conduct a cost minimization analysis from the perspective of the national health service (NHS) in each of 12 European countries, based on a randomized phase II study in NS-NSCLC (NAVoTRIAL01), with 100 oral vinorelbine plus cisplatin patients (arm A) and 51 pemetrexed plus cisplatin patients (arm B).Research Design and Methods: Country-specific costs and DRG codes considered included those relating to anticancer drugs, administration settings (out-patient/in-patient/at home), serious adverse events (defined as involving hospitalization and considered due to anticancer drugs) and concomitant medications. Relevant costs were calculated based on country-specific reimbursement procedures and official tariffs.Main Outcome Measures: Cost and savings per patient.Results: Using the NHS perspective, savings per patient treated with oral vinorelbine ranged from €1317 (Denmark) to €35,001 (Germany). Expressed as percentages, savings per patient treated with oral vinorelbine compared with pemetrexed ranged between 5% (France) and 83% (Czech Republic). Pooled average costs for each treatment arm across the 12 countries resulted in cost savings for payers of €12,871, favoring oral vinorelbine plus cisplatin.Conclusions: Given the reported efficacy with both regimens, this pan-European economic analysis provides compelling evidence supporting oral vinorelbine use over pemetrexed for the treatment of NS-NSCLC. Oral vinorelbine provides similar efficacy and an easily manageable safety profile at lower overall cost per patient treated, combined with an easier/more convenient mode of administration. Sensitivity analysis across varied scenarios demonstrated the robustness of the results. The principle weakness of our study was its reliance upon a single small scale study to provide efficacy data, since this is the only study conducted in this specific population of patients. Further large scale trials are needed to confirm these results. [ABSTRACT FROM AUTHOR]

The author reflects on the pharmaceutical pricing schemes in Europe based on a third-party payer's perspective as of May 2016. The conceptual approaches to pricing are explored which are cost, reference, and value-based as well as reference pricing in Western European countries. Also discussed are the pricing trends and policy implications.

Objective: To estimate the social/economic costs of fragile X syndrome (FXS) in Europe and to assess the health-related quality of life (HRQOL) of patients and caregivers.Methods: A cross-sectional study was conducted in a sample of European countries. Patients were recruited through patients' associations. Data on their resource use and absence from the labour market were retrospectively obtained from an online questionnaire. Costs were estimated by a bottom-up approach and the EuroQol-5 Domain (EQ-5D) questionnaire was used to measure patients' and caregivers' HRQOL.Results: Five countries were included in the analysis. The mean annual cost of FXS per patient varied from €4951 in Hungary to €58,862 in Sweden. Direct non-healthcare costs represented the majority of costs in all countries but there were differences in the share incurred by formal and informal care among those costs. Costs were also shown to differ between children and adults. Mean EQ-5D utility score for adult patients varied from 0.52 in France (n = 42) to 0.73 in Hungary (n = 2), while for caregivers this score was consistently inferior to 0.87.Conclusion: Our findings underline that, although its prevalence is low, FXS is costly from a societal perspective. They support the development of tailored policies to reduce the consequences of FXS on both patients and their relatives. [ABSTRACT FROM AUTHOR]