The role of Comprehensive Geriatric Assessment (CGA) is crucial from a clinical point of view for frail older patients, permitting tailored interventions that may address specific needs. In addition to its clinical significance, understanding the economic value of CGA is also essential. Cost-effectiveness analyses are increasingly conducted to evaluate health interventions, but the literature about CGA is still limited, and no comprehensive overview is currently available. The aim of our study is therefore to systematically review economic evaluations of CGA, including both cost analyses and cost-effectiveness analyses, to provide the most complete overview of the available evidence. We searched several databases from database inception to 01st January 2025. We included studies that reported costs and/or cost-effectiveness of CGA compared to usual care. The characteristics and results of included studies were summarized using a narrative summary that compared and evaluated the methods used and the principal results among studies. Among 3,839 articles initially screened, 36 studies with a total of 68,186 older people (mean age: 79 years old) followed on average for two years were included. Overall, 17 studies evaluated cost analysis, with 13 studies with lower cost in CGA group and 4 studies with higher cost. Similarly, 19 studies evaluated cost-effectiveness, among these 12 had Quality-Adjusted Life Years (QALYs) as outcome of which seven were dominant (lower costs for better health outcomes), and two were cost-effective. Finally, 7 studies assessed other outcomes than QALYs, with dominance achieved in five of them. CGA appears to have the potential to be cost-effective in several settings, with many studies reporting favorable economic outcomes. Overall, CGA shows promise as an effective and cost-effective intervention, but further research with longer follow-up and a broader range of economic models is needed to fully assess its economic value.

This study examines the factors influencing individuals' willingness to pay higher taxes to support long-term care (LTC) services, a pressing issue as aging populations drive rising LTC demand and public spending. We use data from the 2020 and 2022 waves of the OECD's "Risk that Matter" survey, a cross-national survey examining people's perceptions of the social and economic risks they face. We employ generalized linear mixed-effects models configured as logistic regression models, including country-level random intercepts and country-level covariates. We also conduct standard logit regressions for individual countries to analyze local nuances further. The findings reveal that higher income, older age, female gender, left-leaning political orientation, and caregiving responsibilities significantly increase the likelihood of willingness to pay for improved LTC services. At the country level, greater LTC spending as a share of GDP, higher trust in government, and policies offering cash benefits to carers also play a significant role. Overall, the results indicate strong support for additional LTC funding among sizeable demographic groups, especially older respondents and those in higher-income groups. At the same time, political orientation and certain socio-demographic characteristics are associated with differences in support. These findings are relevant for policymakers considering reforms to improve the provision of LTC services.

Rare diseases affect more than 400 million people globally with only a small number having currently approved treatments. Drugs for rare diseases (medications developed to treat conditions affecting small patient populations), which may include innovative drugs (medications with novel mechanisms/new active ingredients) can face access challenges as they are often found not to be cost-effective under conventional health technology assessment methods. In this review we provide a comprehensive and up-to-date understanding of challenges associated with the economic evaluation of innovative drugs for severe-rare diseases, and any proposed solutions and associated barriers to solution adoption. This review included searches of electronic databases and select health technology assessment agency websites to identify relevant publications, guidelines or recommendations from 1st January 2014 to 29th July 2024. A pre-authorised protocol, including detailed eligibility criteria, was used to ensure robust methodology in the capture of materials. Relevant data extracted from included publications were synthesised thematically to support identification of the most prominent concepts within current literature. Of the 1,803 records identified, 31 publications and eight health technology assessment guidance were included. Main challenges were related to the utilitarian principle underlying cost-effectiveness analysis, the limited scope of the quality-adjusted life year and the value elements assessed. Associated solutions included the incorporation of a societal willingness-to-pay or inclusion of equity in healthcare decision making, reduced weighting of the economic evaluation in resource allocation, consideration of additional value elements, and introducing a quality-adjusted life year weighting or alternative measures of health outcomes. While some payers have implemented modifications to economic evaluation guidelines in an attempt to address the challenges, for example including the consideration of additional value elements, the solutions employed are not consistent across payers and often do not address the root issue. Economic evaluation as part of health technology assessment therefore remains challenging for manufacturers of drugs for rare diseases. Conventional methods of economic evaluation contribute to the access challenge for innovative drugs for rare diseases. Collaboration between payers, manufacturers, and healthcare decision makers to foster greater understanding of how to evolve and adopt these novel solutions will be key to ensuring timely patient access.

Existing studies on the economic impact of schizophrenia are fragmented and vary in methodology, hindering an ample understanding of the total economic burden. To quantify the global economic burden of schizophrenia by synthesizing findings from systematic reviews and meta-analyses, and to assess variations by cost category, world region and income level. We conducted a protocol-driven umbrella review registered on PROSPERO (CRD42024504092). A systematic search of MEDLINE, EMBASE, Cochrane Library, and APA PsycINFO identified reviews reporting annual per-patient monetary cost estimates for schizophrenia. Monetary values were adjusted for inflation and converted to 2024 US dollars. Twenty-six systematic reviews involving 152 primary studies were included. The median annual per-patient total cost of schizophrenia across included primary studies was $33,236 (mean $47,872), with direct costs accounting for $23,126 (medical: $19,543; ancillary: $1,152) and indirect costs for $21,333. Costs were varied by income level: in high-income countries, the median total cost was $34,175, compared to $3,345 in upper-middle-income and $3,452 in lower-middle-income countries. Regional disparities were substantial, with Europe & Central Asia reporting the highest median costs among high-income settings. Data from low- and middle-income regions were limited or absent. Methodological heterogeneity, lack of standardization in cost reporting, and underrepresentation of low-resource settings limit generalizability. The included cost-of-illness estimates indicate that schizophrenia is associated with substantial annual per-patient costs, with hospitalization, long-term care, and productivity losses frequently among the largest reported components. However, the evidence base is heavily weighted toward high-income countries, and limited data from lower-resource settings constrain cross-country comparability. Future research should adopt standardized costing frameworks and expand data collection in underrepresented regions to improve the consistency, transparency, and geographic coverage of economic burden estimates.

Under pressures of health insurance cost containment and high-quality development, diagnosis-related groups (DRGs) and other case-based payment schemes have become a major direction of China’s inpatient payment reform, yet their impacts may extend beyond changes in mean costs. Using large-scale inpatient settlement data, we evaluate the cost-containment effects of DRG payment reform from a distributional perspective, testing whether the reform is reflected not only in a decline in mean standardized inpatient spending but also in reshaping spending variability and heavy tails (tail risk). The study covers six cities in China’s Province S from January 2019 to December 2021; three cities launched DRG reform in November 2020, January 2021, and June 2021, respectively. The individual-level sample includes 6,882,875 admissions from 172 healthcare institutions and is aggregated into a hospital–month panel; we construct individual standardized inpatient spending as “spending per admission divided by DRG weight,” and then compute the hospital–month mean, standard deviation, skewness, and kurtosis of standardized spending. Our identification strategy applies a two-stage difference-in-differences (DID) estimator suited to staggered adoption to estimate the average treatment effect, and uses the Sun & Abraham event-study approach to test parallel trends and trace dynamic effects; we control for patient composition and city-level covariates and include institution and month fixed effects; we further assess heterogeneity by hospital level and DRG design (point-based vs. rate-based). The two-stage DID results show that DRG implementation is associated with a significant reduction in the hospital–month mean of standardized spending (β = −705.7, p < 0.001) and a significant reduction in the standard deviation (β = −1,098.0, p < 0.001); meanwhile, distributional shape metrics increase, with higher skewness (β = 0.380, p < 0.05) and higher excess kurtosis (β = 18.3, p < 0.01). In the event-study analysis, most pre-reform lead coefficients fluctuate around zero and their confidence intervals largely cover zero, providing overall support for the parallel-trends assumption. Regarding heterogeneity, relative to secondary hospitals, the interaction term for tertiary hospitals is not statistically significant across all four outcomes. Relative to the rate-based design, the point-based design shows a significant mitigating effect on distributional shape metrics, reducing skewness (β = −0.941, p < 0.001) and excess kurtosis (β = −38.4, p < 0.001), while differences in the mean and standard deviation are not statistically significant. While DRG payment reform reduces the mean level of standardized inpatient spending and within-hospital spending variability, it may be accompanied by a strengthened right tail and heavier tails, indicating that “mean-based cost containment” is insufficient to characterize the reform’s structural consequences; distributional metrics and tail risk should be incorporated into routine performance assessment and regulatory frameworks. Compared with the rate-based approach, the point-based approach appears more advantageous in curbing heavy-tail indicators, underscoring the importance of settlement mechanisms and payment-parameter design for risk discipline.

This paper examines the economic and institutional determinants of disability registration in the Russian Federation between 2018 and 2024, with a particular focus on differences between adults and children. Using regional panel data across 86 regions grouped into eight federal districts, the study employs regression analysis to explore how GRP per capita, physician density, educational conditions, and crisis events affect disability detection and reporting. Results show that adult disability prevalence decreases with higher regional income and healthcare access, reflecting poverty-related morbidity and long-term health risks. In contrast, childhood disability registration is positively associated with regional affluence and physician supply, highlighting the role of diagnostic infrastructure rather than underlying morbidity. During systemic disruptions such as the COVID-19 pandemic and the Russia-Ukraine war, adult disability rates remained relatively stable, while childhood disability detection fell sharply, particularly in less resourced regions. A possible explanation of these findings is that adult disability rates primarily capture structural deprivation and chronic illness, whereas childhood disability reflects the strength and resilience of local diagnostic systems.

Healthcare systems face challenges in optimizing resources while maintaining high-quality care. Breast cancer surgery represents a substantial share of elective surgery and provides an opportunity to evaluate different organizational models. This study presents a health economic analysis comparing two models for breast cancer surgery at the same hospital. A bottom-up micro-costing approach was employed to evaluate potential cost-savings of breast cancer surgeries performed at a general surgical department (GS) versus a cardiothoracic surgery department (CT). We analyzed 543 consecutive patients undergoing elective breast cancer surgery between January 2014 and September 2016. Resource use was identified through direct observation, hospital administrative systems, and operating room logs. Personnel, disposables, medications, and facility costs were quantified based on observed resource use within the study dataset; no external benchmarking was performed. CT was less expensive, with an average saving of 3,547 Swedish krona (SEK) per operation (95% CI: -674 to 7,510 SEK). Bootstrap analysis with 1,000 iterations showed CT was less costly in 96.2% of samples. Procedures were shorter at CT (170.8 vs. 221.3 min), enabling more operations per day (3.2 vs. 2.4). In our deterministic simulation, removing CT capacity increased waiting times by 15%, from 39 to 45.1 days, conditional on steady inflow and constant OR availability. Annual savings at the observed annual volume (~ 192 patients) were 681,104 SEK and could reach ~ 1.77 million SEK if volumes increased to 500 patients/year. The CT organizational model was more likely to be less costly while maintaining shorter waiting times. These findings suggest that CT capacity may be prioritized, particularly at higher patient volumes, to support both economic efficiency and patient access.

The increasing demand for high-quality healthcare and the persistent limited funding against the growing need for universal health coverage across African health systems has ignited interest in innovative financing models. Social Impact Bonds (SIBs) are becoming an alternative financing mechanism due to their ability to attract private investments through outcome-based funding. However, there’s low adoption of SIB health financing in the African context, calling for empirical evidence on its feasibility. Kenya’s public health sector is undergoing reforms to complement traditional funding with innovative instruments such as SIBs to improve tertiary healthcare quality. This qualitative study explored the perspectives of 55 key stakeholders—including Ministry of Health and National Treasury policy makers, hospital managers, and social health investors’ financial experts—on the feasibility of adopting SIBs to finance quality improvements in Kenya’s tertiary hospitals. Data were collected through semi-structured interviews and were analyzed thematically. Stakeholders perceived SIBs as conceptually attractive for promoting outcome-based financing and improving health care quality. The model has the potential to mobilize additional funding for Kenya’s tertiary health sector. However, legal, institutional, political, and financial barriers, as well as concerns about sustainability, applicability to continuous tertiary services, and the risk of prioritizing easily measurable outcomes, pose significant challenges. From a public finance perspective, the successful implementation of SIBs requires enabling legislation, political leadership, credible government financial commitments, and capacity-building to attract private investors. This is necessary to manage contingent liabilities, ensure budget credibility, and reduce investor risk premiums associated with outcome-based contracts. Pilot programs, strategic alignment with tertiary national health priorities, and robust institutional frameworks are essential. Further research is recommended to evaluate the feasibility, design, and impact in primary healthcare, including specific policy and legislative reforms.

South Africa (SA) is an upper-middle-income country with high-income disparity and coexisting private and public healthcare systems that create considerably differing breast cancer (BC) treatment outcomes. State-funded BC care is available in the public tertiary and quaternary hospitals, including surgery, chemotherapy, endocrine therapy, and radiation therapy, although the timely access to these modalities is often expensive and unpredictable. In a resource-constrained country like South Africa, understanding the total cost of BC care is crucial for health funders when budgeting and making decisions. There has been no systematic assessment of the financial impact of BC in the South African (SA) public sector. To estimate the cost of BC treatment with chemotherapy, including the associated costs, laboratory tests, radiological and consumables at a public tertiary hospital in SA. The study design was descriptive and retrospective file review of patients with breast cancer to obtain patients’ data. The data collection lasted three months, from July 2022 to September 2022. The study population included files of all adult patients who had received chemotherapy between 2018 and 2022. A total of 364 patient files were examined. A total of 364 breast cancer patients were included, with a mean age of 55.5 ± 13.3 years. Most patients presented with advanced disease: 39% at stage 3B and 26.1% at stage 4. The overall direct cost of treatment was R4.8 million, with a mean cost per patient of R 13,365.90. The most significant cost drivers were laboratory tests (34%), administrative overheads (27%), and chemotherapy (22%). The most frequently prescribed chemotherapy regimen was CAF (cyclophosphamide, adriamycin, 5-fluorouracil), given to 70.9% of patients. Stage 1 is a major outlier, costing 55% less than the mean average, while Stage 2 A is the most expensive per-patient stage, costing 11.6% more than the mean average. This study showed that direct costs were substantial and primarily influenced by chemotherapy, administrative, and laboratory costs. This research indicates that the direct provider costs for breast cancer treatment at a South African public tertiary hospital are considerable. A significant proportion of patients are diagnosed at advanced stages, but what drove the costs was repeated, cycle-based resource utilisation rather than by chemotherapy drug costs alone.

There are three common and significant causes of lymphadenopathy (LAP) in tuberculosis-and-HIV-endemic settings - tuberculosis, lymphoma, and metastatic solid organ cancers. Overlapping clinical symptoms of these diseases necessitates diagnostic procedural investigation. Fine needle aspiration (FNA) with Xpert TB/RIF Ultra has good sensitivity for tuberculosis diagnosis, while FNA cytology can detect solid cancer lymph node metastasis, although with lower sensitivity. Critically, lymphoma cannot be reliably detected or classified using FNA. Lymphoma diagnosis often is made after repeat testing and eventual surgical excision biopsy (SEB), contributing to treatment delays, inappropriate empiric anti-tuberculosis therapy, and increased strain on already limited healthcare resources. This study presents a comparative provider-perspective cost analysis of three diagnostic procedures: FNA, SEB and core-needle biopsy (CNB). Costs were evaluated for individual procedures and within investigative pathways for unexplained LAP. Data were collected at Groote Schuur Hospital, a tertiary academic hospital in South Africa, during 2018 and 2025. Costing was conducted using a mixed-methods approach combining bottom-up ingredients-based costing with top-down allocation of overheads. Capital costs were annualised, and all costs were adjusted to 2025 values in United States dollars. Histological diagnosis and tuberculosis testing using CNB were less costly (US$ 145) than either SEB (US$ 244), or FNA cytology and tuberculosis testing (US$ 179). Total investigative costs increased substantially when repeat FNAs were required while awaiting access to SEB (US$ 518). CNB demonstrated high diagnostic accuracy and obviated the need for further procedures in most cases, improving diagnostic efficiency and offering significant potential for cost savings. Sensitivity analyses suggested further reductions in CNB costs are possible through task-shifting to junior clinicians and through the use of reusable biopsy equipment. The CNB-centred diagnostic approach to lymphadenopathy provides lower-cost, timeous, and accurate diagnosis of the three most significant causes of LAP in tuberculosis- and HIV-endemic settings. This approach enables early initiation of appropriate treatment, reduces unnecessary procedures, and optimises the use of limited healthcare resources. These findings support the integration of CNB into national diagnostic algorithms and highlight the value of investments in training and equipment to enable its decentralised implementation.