Integrating Qualitative Techniques in Model Development: A Case Study Using the Framework Approach
ConclusionThe two settings in Ghana have different care pathways and any cost-effectiveness analysis should consider the alternative pathways separately. This study demonstrated that framework analysis is a qualitative methodology that is likely to be accessible and feasible across a wide range of health economic settings. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - July 18, 2018 Category: Health Management Source Type: research

Opportunities for Use of Blockchain Technology in Medicine
AbstractBlockchain technology is a decentralized database that stores a registry of assets and transactions across a peer-to-peer computer network, which is secured through cryptography, and over time, its history gets locked in blocks of data that are cryptographically linked together and secured. So far, there have been use cases of this technology for cryptocurrencies, digital contracts, financial and public records, and property ownership. It is expected that future uses will expand into medicine, science, education, intellectual property, and supply chain management. Likely applications in the field of medicine could ...
Source: Applied Health Economics and Health Policy - July 18, 2018 Category: Health Management Source Type: research

The Impact of Patent Expiry on Drug Prices: A Systematic Literature Review
ConclusionDrug prices decrease significantly after patent expiry. The extent of this price reduction varied greatly between products and countries. For this reason, country-specific analyses on price developments after patent expiry should be used when these are considered in decision making. Future research should be dedicated to gathering more country-specific data to reduce the uncertainty with regard to price developments. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - July 17, 2018 Category: Health Management Source Type: research

The Real-World Cost-Effectiveness of Coronary Artery Bypass Surgery Versus Stenting in High-Risk Patients: Propensity Score-Matched Analysis of a Single-Centre Experience
ConclusionsAt early follow-up, high-risk subgroups had lower ICERs than the overall cohort when CABG was compared with PCI. A personalised, multidisciplinary approach to treatment of patients may enhance cost containment, as well as improving clinical outcomes following revascularisation strategies. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - July 12, 2018 Category: Health Management Source Type: research

Shaping Pharmaceutical Tenders for Effectiveness and Sustainability in Countries with Expanding Healthcare Coverage
AbstractPolicy makers in countries, aiming to build and expand their healthcare systems and coverage, need effective procedures to support the most efficient use of limited financial resources. Tendering is commonly deployed to minimize and fix the purchasing price for the contract duration, especially for off-patent pharmaceuticals. While tenders can reduce acquisition costs, they may also expose the healthcare systems to risks including drug shortages, quality trade-offs, and ultimately, compromised patient health outcomes. Careful planning is therefore required. The effectiveness and impact of tendering were examined in...
Source: Applied Health Economics and Health Policy - July 10, 2018 Category: Health Management Source Type: research

Economic Evaluations of Guideline-Based Care for Chronic Wounds: a Systematic Review
Conclusions and Implications of Key FindingsWe found that guideline-based care may be cost-saving or cost-effective in most circumstances. The quality and usefulness of reviewed studies for decision making were variable. Better information and higher-quality economic evaluations will increase decision makers ’ confidence to promote guideline-based care.Systematic Review Registration NumberPROSPERO CRD42017051859. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - July 2, 2018 Category: Health Management Source Type: research

Development of Conversion Functions Mapping the FACT-B Total Score to the EQ-5D-5L Utility Value by Three Linking Methods and Comparison with the Ordinary Least Square Method
ConclusionThe problem of shrinkage in the variance occurred in the OLS method, but it provided an unbiased estimate for the mean and better agreement. Among the other three linking methods, the mean rank method better described the distribution, whereas the equipercentile and linear equating methods better assessed the association with risk factors. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - June 26, 2018 Category: Health Management Source Type: research

Impact of Reducing Glycated Hemoglobin on Healthcare Costs Among a Population with Uncontrolled Diabetes
DiscussionIn our analysis, A1C reduction among patients with T1DM and T2DM was associated with slower growth in healthcare costs within 1 –2 years. These findings suggest that programs aimed at reducing A1C over a short timeframe may lead to substantial savings and may be worth pursuing by health plans and other payers. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - June 23, 2018 Category: Health Management Source Type: research

Sugar-Sweetened Beverage Demand and Tax Simulation for Federal Food Assistance Participants: A Case of Two New England States
ConclusionA beverage price increase in the form of an excise tax would reduce sugar-sweetened beverage consumption and increase healthier beverage purchases among low-income families. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - June 19, 2018 Category: Health Management Source Type: research

Cost-Effectiveness of Obinutuzumab in Combination with Bendamustine Followed by Obinutuzumab Maintenance versus Bendamustine Alone in Treatment of Patients with Rituximab-Refractory Follicular Lymphoma in Norway
ConclusionsThe cost-effectiveness threshold in Norway is not public, but based on previous decisions it is estimated to be up to approximately €89,000 per QALY (NOK 800,000). The results of the analysis indicate that obinutuzumab in combination with bendamustine followed by obinutuzumab maintenance may be cost-effective compared to bendamustine alone in Norway. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - June 19, 2018 Category: Health Management Source Type: research

Public ’s Willingness to Pay Towards a Medical Device for Detecting Foot Ulceration in People with Diabetes
ConclusionThis study demonstrated that people are willing to pay for this device and they tend to contribute when they have experience of diabetes or similar devices and perceive self-benefit. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - June 9, 2018 Category: Health Management Source Type: research

Consequences of Biomarker Analysis on the Cost-Effectiveness of Cetuximab in Combination with FOLFIRI as a First-Line Treatment of Metastatic Colorectal Cancer: Personalised Medicine at Work
ConclusionScreening for mutations in both KRAS and NRAS may provide the most cost-effective approach to patient selection. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - June 9, 2018 Category: Health Management Source Type: research

Cost Analysis of Tuberculosis Diagnosis in Cambodia with and without Xpert ® MTB/RIF for People Living with HIV/AIDS and People with Presumptive Multidrug-resistant Tuberculosis
ConclusionsXpert test unit costs could be reduced through lower cartridge prices, longer usable life of GeneXpert® (Cepheid, USA) instruments, and increased test volumes; however, epidemiological and test eligibility conditions in Cambodia limit the number of specimens received at laboratories, leading to sub-optimal utilization of current instruments. Improvements to patient referral and specimen transport could increase test volumes and reduce Xpert test unit costs in this setting. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - June 4, 2018 Category: Health Management Source Type: research

EMA and NICE Appraisal Processes for Cancer Drugs: Current Status and Uncertainties
(Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - May 28, 2018 Category: Health Management Source Type: research

Cost-Effectiveness Analysis of Intracapsular Tonsillectomy and Total Tonsillectomy for Pediatric Obstructive Sleep Apnea
ConclusionStudy results suggest that overall monopolar-technique total tonsillectomy is more cost effective. However, with varying adjustments for disutility caused by procedural complications, intracapsular tonsillectomy could become a more cost-effective technique for treating pediatric OSA. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - May 24, 2018 Category: Health Management Source Type: research

Efficiency Measurement in Health Facilities: A Systematic Review in Low- and Middle-Income Countries
ConclusionThis review highlights the potential for methodological improvement and policy impacts in efficiency measurements. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - April 20, 2018 Category: Health Management Source Type: research

Inference Procedures to Quantify the Efficiency –Equality Trade-Off in Health from Stated Preferences: A Case Study in Portugal
ConclusionsRespondents revealed some aversion to health inequality. However, the extent of this aversion seems to be sensitive to (1) the identification of the groups by occupation status, (2) the size of the health gain, and (3) the inference procedure used. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - April 20, 2018 Category: Health Management Source Type: research

Uptake of and Expenditure on Direct-Acting Antiviral Agents for Hepatitis C Treatment in Australia
ConclusionsUptake of DAAs has been enthusiastic in the first 18  months of this funding agreement. However, the lack of transparency due to the confidential special pricing agreements means actual government expenditure is unknown. Post-marketing review by the Pharmaceutical Benefits Advisory Committee may enable renegotiation of DAA prices with the sponsors. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - April 19, 2018 Category: Health Management Source Type: research

Out of Pocket Costs and Health Insurance Take-Up Rates
ConclusionIn general, we found that the estimated elasticities are too small to explain the overall drop in take-up rates even in light of the large increases in required worker contributions and expected expenditures. Still, we highlight the growing importance of expected expenditures in explaining take-up rates. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - April 12, 2018 Category: Health Management Source Type: research

Cost-Consequence Analysis Alongside a Randomised Controlled Trial of Hospital Versus Telephone Follow-Up after Treatment for Endometrial Cancer
ConclusionTelephone follow-up was estimated to be cost-neutral for the NHS and may free up clinic time for other patients. There was some evidence that telephone follow-up may be more efficient for patients and wider society, and is not associated with additional psychological morbidity, lower patient satisfaction or reduced quality of life.Trial RegistrationISRCTN: 75220876, prospectively registered 28 October 2011. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - April 12, 2018 Category: Health Management Source Type: research

Cost-effectiveness of Genome and Exome Sequencing in Children Diagnosed with Autism Spectrum Disorder
ConclusionStrategic integration of ES into ASD care could be a cost-effective strategy. Long wait times for genetic services and uncertain utility, both clinical and personal, of sequencing results could limit broader clinical implementation. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - April 12, 2018 Category: Health Management Source Type: research

Spillover Effects of Long-Term Disabilities on Close Family Members
ConclusionsRecognizing the presence of health spillovers can help to design policies to better support families. Being the perceived health status a good indicator of the use of health services and mortality, the health system should focus on the entire family, and not only on the patient or the main caregiver. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - April 12, 2018 Category: Health Management Source Type: research

A Cost-Effectiveness Analysis of the 10-Valent Pneumococcal Non-Typeable Haemophilus influenzae Protein D Conjugate Vaccine (PHiD-CV) Compared to the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) for Universal Mass Vaccination Implementation in New Zealand
AbstractObjectivesInvasive pneumococcal disease (IPD), pneumonia and acute otitis media (AOM) still represent a significant medical burden in children  
Source: Applied Health Economics and Health Policy - April 9, 2018 Category: Health Management Source Type: research

The Case for a Private Healthcare Insurance Monopoly
This article advocates for a regulated private monopoly as an audacious solution to replace Obamacare, help manage Medicare and Medicaid and reform the US healthcare insurance industry. Contemporary economics vilifies monopolies and praises the ‘magic wand’ of perfect competition without much debate on the merits of these assumptions. The problems with the perfect competition model as applied to healthcare insurance are well established, but exploration of other possible economic models (i.e. monopoly and oligopoly) as a replacement fo r Obamacare is non-existent. New thinking about the role of monopolies may h...
Source: Applied Health Economics and Health Policy - April 6, 2018 Category: Health Management Source Type: research

The Memokath-051 Stent for the Treatment of Ureteric Obstruction: A NICE Medical Technology Guidance
AbstractMemokath-051 is a thermo-expandable, nickel-titanium alloy spiral stent used to treat ureteric obstruction resulting from malignant or benign strictures. The National Institute for Health and Care Excellence (NICE) selected Memokath-051 for evaluation. The company, PNN Medical, claimed Memokath-051 has clinical superiority and cost savings compared with double-J stents. It identified five studies reporting clinical evidence on Memokath-051 and constructed a de novo cost model comparing Memokath-051 to double-J stents. Results indicated that Memokath-051 generated cost savings of £4156 per patient over 2.5&nbs...
Source: Applied Health Economics and Health Policy - April 3, 2018 Category: Health Management Source Type: research

Economic Studies on Non-Communicable Diseases and Injuries in India: A Systematic Review
ConclusionsThe results indicate the lack of engagement of economists generally and health economists in particular in research on NCDI in India. Demand from health policy makers for evidence-based decision making appears to be lacking, which in turn solidifies the divergence between economics and health policy, and highlights  the need to prioritize scarce resources based on evidence regarding what works. Capacity building in health economics needs focus, and the government’s support in this is recommended. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - April 2, 2018 Category: Health Management Source Type: research

Understanding Treatment Effect Estimates When Treatment Effects Are Heterogeneous for More Than One Outcome
ConclusionsIf estimator assumptions are valid, estimates across outcomes can be used to assess the optimality of treatment rates in a study population. However, because true treatment effect parameters are sensitive to correlations of treatment effects across outcomes, decision makers should be cautious about generalizing estimates to other populations. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - March 27, 2018 Category: Health Management Source Type: research

Individual and Institutional Corruption in European and US Healthcare: Overview and Link of Various Corruption Typologies
AbstractIn recent years, the fight against healthcare corruption has intensified. Estimates from the European Healthcare Fraud and Corruption Network calculate an approximate €56 billion annual loss to Europe as a result of corruption. To promote understanding of the complexity and interconnection of corrupt activities, we aim to present healthcare-related corruption typologies of the European Union and European Healthcare Fraud and Corruption Network. We subsequently link them to the typology of individual and institutional corruption introduced by Dennis Thompson in the context of investigating misconduct of US Cong...
Source: Applied Health Economics and Health Policy - March 23, 2018 Category: Health Management Source Type: research

Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia
ConclusionsOffering BRCA mutation testing to early-stage breast cancer patients identified using a locally-validated risk-assessment tool may be cost effective compared to RCS in Malaysia. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - March 23, 2018 Category: Health Management Source Type: research

Does €1 Per Prescription Make a Difference? Impact of a Capped Low-Intensity Pharmaceutical Co-Payment
ConclusionA uniform capped low co-payment may give rise to a major reduction in drug consumption to a much greater extent among those who previously had free prescriptions. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - March 16, 2018 Category: Health Management Source Type: research

Long-Term Costs and Health Consequences of Issuing Shorter Duration Prescriptions for Patients with Chronic Health Conditions in the English NHS
ConclusionLonger repeat prescriptions may be cost-effective compared with shorter ones. However, the quality of the evidence base on which this modelling is based is poor. Any policy rollout should be within the context of a trial such as a stepped-wedge cluster design. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - March 12, 2018 Category: Health Management Source Type: research

Treating Type 1 Diabetes Mellitus with a Rapid-Acting Analog Insulin Regimen vs. Regular Human Insulin in Germany: A Long-Term Cost-Effectiveness Evaluation
ConclusionsRapid-acting analog insulin is associated with beneficial outcomes in patients with type 1 diabetes and is likely to be considered cost effective in the German setting vs. regular human insulin. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - March 10, 2018 Category: Health Management Source Type: research

The Determinants of Household Out-of-Pocket (OOP) Medical Expenditure in Rural Bangladesh
ConclusionsBangladesh needs a holistic approach to undertake any strategy; private healthcare facilities are relatively the most important source of high medicine costs; hence, the supply of medicine and its price should be given attention on a priority basis for pro-poor policy framing in conjunction with healthcare insurance and motivation to consult doctors rather than pharmacists in case of sickness. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - March 1, 2018 Category: Health Management Source Type: research

Medicinal Cannabis and the Tyranny of Distance: Policy Reform Required for Optimizing Patient and Health System Net Benefit in Australia
(Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - February 23, 2018 Category: Health Management Source Type: research

Pricing of HPV Vaccines in Europe: Back to the Future?
(Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - February 23, 2018 Category: Health Management Source Type: research

Multi-indication and Combination Pricing and Reimbursement of Pharmaceuticals: Opportunities for Improved Health Care through Faster Uptake of New Innovations
The objective of this article is to present examples of actual pricing and reimbursement decisions using current value-based pricing in Sweden and to discuss their implications and possible solutions. The value of several cancer drugs was estimated for various indications based on a willingness-to-pay threshold of 1 million SEK (EUR 104,000) per QALY gained. For some drugs, the estimated value was higher than the drug acquisition cost in several indications, whilst in others, the estimated value was lower than the drug acquisition cost. Drugs used in combination present a special case. If a drug prolongs survival and conse...
Source: Applied Health Economics and Health Policy - February 22, 2018 Category: Health Management Source Type: research

Does MCDA Trump CEA?
(Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - February 21, 2018 Category: Health Management Source Type: research

Policy Options for Infliximab Biosimilars in Inflammatory Bowel Disease Given Emerging Evidence for Switching
AbstractBiosimilars are becoming increasingly available internationally as patents expire on the originator biologic drugs they are intended to copy. Although substitution policies seen with generic drugs are being considered as a means to reduce expenditures on biologics, some biosimilars pose particular challenges in that the act of substitution may eventually lead to increased rates of therapeutic failure. As evidence requirements from regulators do not directly address this challenge, switch trials of biosimilars have emerged that may provide further answers. Using infliximab in inflammatory bowel disease as an example...
Source: Applied Health Economics and Health Policy - February 6, 2018 Category: Health Management Source Type: research

Cost of Illness for Five Major Foodborne Illnesses and Sequelae in Sweden
ConclusionsOur simulations indicated that campylobacter infection was more common and more costly than salmonella, EHEC, yersinia and shigella combined. Estimated costs for all illnesses were highly influenced by (1) considering potential information losses about cases in the population (which increased costs 7- to 11-fold), and (2) taking account of post-infection sequelae (which doubled the costs). (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - January 8, 2018 Category: Health Management Source Type: research

Investigating the Willingness to Pay for a Contributory National Health Insurance Scheme in Saudi Arabia: A Cross-sectional Stated Preference Approach
ConclusionsThis study demonstrates a theoretically valid WTP for a contributory national health insurance scheme by Saudi people. The research shows that willingness to participate in and pay for a contributory national health insurance scheme depends on participant characteristics. Identifying and understanding the main influencing factors associated with WTP are important to help facilitate establishing and implementing the national health insurance scheme. The results could assist policy-makers to develop and set insurance premiums, thus providing an additional source of healthcare financing. (Source: Applied Health Eco...
Source: Applied Health Economics and Health Policy - January 6, 2018 Category: Health Management Source Type: research

A National Budget Impact Analysis of a Specialised Surveillance Programme for Individuals at Very High Risk of Melanoma in Australia
ConclusionsSpecialised melanoma surveillance is likely to provide substantial cost savings for the Australian healthcare system. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - January 5, 2018 Category: Health Management Source Type: research

Correction to: Dutch Economic Value of Radium-223 in Metastatic Castration-Resistant Prostate Cancer
The article Dutch Economic Value of Radium-223 in Metastatic Castration-Resistant Prostate Cancer, written by Michel L. Peters, Claudine de Meijer, Dirk Wyndaele, Walter Noordzij, Annemarie M. Leliveld-Kors, Joan van den Bosch, Pieter H. van den Berg, Agni Baka, Jennifer G. Gaultney was originally published electronically on the publisher ’s internet portal (currently SpringerLink) on 2nd September, 2017 without open access. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - January 4, 2018 Category: Health Management Source Type: research

The Direct Medical Costs of Diseases Associated with Human Papillomavirus Infection in Manitoba, Canada
ConclusionsOverall, the average direct medical cost of HPV infection was $720 per newborn. The economic burden of HPV remains significant, although changes in cervical screening guidelines, prompted by the introduction of a public HPV vaccine program, appear to have promoted a promising trend towards lower costs. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - January 4, 2018 Category: Health Management Source Type: research

Rich and Well Educated: Are These Requirements Necessary to Claim Healthcare Tax Credits in Italy?
ConclusionPublic money is reimbursed to regions where people are, on average, richer and better educated. More equitable objectives could be reached by allocating the same resources in the provision of services covered by the NHS. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - December 7, 2017 Category: Health Management Source Type: research

Improving the Hospital Quality of Care during Winter Periods by Optimizing Budget Allocation Between Rotavirus Vaccination and Bed Expansion
ConclusionThe model allows determination of the most efficient allocation of the healthcare budget between rotavirus vaccination and bed expansion for improving QoC-scores during the annual epidemic winter seasons. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - November 20, 2017 Category: Health Management Source Type: research

Horses for Courses: Moving India towards Universal Health Coverage through Targeted Policy Design
AbstractThe debate on how India ’s health system should move towards universal health coverage was (meant to be) put to rest by the recent National Health Policy 2017. However, the new policy is silent about tackling bottlenecks mentioned in the said policy proposal. It aims to provide universal access to free primary care by st rengthening the public system, and to secondary and tertiary care through strategic purchasing from the private sector, to overcome deficiencies in public provisioning in the short run. Yet, in doing so, it ignores critical factors needed to replicate successful models of public healthcare de...
Source: Applied Health Economics and Health Policy - November 16, 2017 Category: Health Management Source Type: research

Acknowledgement to Referees
(Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - November 10, 2017 Category: Health Management Source Type: research

Scale Effects and Expected Savings from Consolidation Policies of Italian Local Healthcare Authorities
ConclusionsThe research findings of our paper provide practical insight into the concerns and challenges of LHA consolidations and may have important implications for NHS organisation and for the containment of public healthcare expenditure. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - November 9, 2017 Category: Health Management Source Type: research

Cost-Effectiveness Analysis of the Gonadotropin Treatments HP-hMG and rFSH for Assisted Reproductive Technology in France: A Markov Model Analysis
ConclusionThis analysis indicates that compared with rFSH, HP-hMG is less costly for IVF/ICSI management from the French healthcare payer ’s viewpoint. The results of the present Markov model analysis are consistent with previous findings in other European countries. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - November 9, 2017 Category: Health Management Source Type: research

Comparative Cost-Effectiveness Analysis of Three Different Automated Medication Systems Implemented in a Danish Hospital Setting
ConclusionThe model-based indirect comparison against the conventional practice showed that psAMS and npsAMS were more cost-effective than the cAMS alternative, and that psAMS was more cost-effective than npsAMS. (Source: Applied Health Economics and Health Policy)
Source: Applied Health Economics and Health Policy - November 8, 2017 Category: Health Management Source Type: research