Journal Description
Journal of Market Access & Health Policy
Journal of Market Access & Health Policy
(JMAHP) is an international, peer-reviewed, open access journal that covers all different subdisciplines of ‘market access’ from economic, technical, scientific, sociological, psychological and policy perspectives, published quarterly online. It is the official journal of the Market Access Society (MAS). Society members receive discounts on the APCs.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, PubMed, PMC, and other databases.
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 29.5 days after submission; acceptance to publication is undertaken in 11.3 days (median values for papers published in this journal in the first half of 2026).
- Journal Rank: CiteScore - Q2 (Health Policy)
- Recognition of Reviewers: Reviewers whose reports are timely and of high quality receive an APC discount voucher for a future publication in an MDPI journal. Become a reviewer.
- Journal Cluster of Public Health: International Journal of Environmental Research and Public Health, Infectious Disease Reports, Epidemiologia, Occupational Health, International Journal of Environmental Medicine (IJEM), Journal of Market Access & Health Policy (JMAHP), Hygiene, Trends in Public Health, Digital Health and Innovation (DHI), Green Health and Health Economics and Policy.
Latest Articles
Parent-Reported Satisfaction, Perceived Child Acceptance, and Ease of Administration of a Strawberry-Flavoured Ibuprofen Suspension for Children: A Cross-Sectional Survey of Experienced Users in Germany
J. Mark. Access Health Policy 2026, 14(3), 56; https://doi.org/10.3390/jmahp14030056 (registering DOI) - 18 Sep 2026
Abstract
Background: Palatability and ease of administration are recognised as key determinants of medication adherence in paediatric populations. Oral ibuprofen suspensions are among the most commonly used analgesic and antipyretic medications for children in Germany, yet parental and parent-perceived child perspectives on these formulation
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Background: Palatability and ease of administration are recognised as key determinants of medication adherence in paediatric populations. Oral ibuprofen suspensions are among the most commonly used analgesic and antipyretic medications for children in Germany, yet parental and parent-perceived child perspectives on these formulation attributes remain underreported for the German market. Methods: A cross-sectional, online market-research survey, commissioned to substantiate potential product communication claims, was conducted among 1005 parents residing in Germany, each of whom had administered a strawberry-flavoured ibuprofen suspension (Nurofen Junior Fever and Pain Suspension Strawberry, Reckitt Benckiser) to at least one child aged 3 months to 12 years within the preceding 12 months. Closed-ended items assessed overall satisfaction, willingness to recommend, parent-perceived child acceptance, perceived ease of administration, and taste satisfaction; all product-specific statements (Q17 and Q18) used a binary agree/do-not-agree format without a neutral option. Results: Overall satisfaction with the product was reported by 99% of respondents (995/1005), and 98% (985/1005) stated they would recommend it to other parents. Agreement rates exceeded 90% for all primary claim statements (Q18): easy and safe to administer (96%), satisfied with how well the child takes the medicine (92%), well accepted by child (92%), satisfied with flavour (92%), good feeling child takes medicine without problems (91%), child finds taste pleasant (90%), child likes the taste (90%), and child takes it without problems (88%). For comparative acceptance statements (Q17), agreement ranged from 83% to 93%. Fever was the primary indication for use (91%), and the product was used a mean of 3.3 times per year. Conclusions: These findings provide consumer-reported, real-world survey data indicating that, among surveyed parents with recent personal experience of using the product, reported satisfaction and perceived child acceptance were high. Because participation required experience with the product within the previous 12 months, while allowing concomitant experience with other paediatric products, and because fever and pain episodes commonly occur more than once over a year in children, the study relied on parent-reported outcomes. The study was designed as a descriptive survey of user experiences and was not intended as a comparative evaluation; accordingly, no comparator was included. The findings should therefore be interpreted as descriptive of this study population and cannot be used to infer comparative performance, improved adherence, or better clinical outcomes; they may, however, help identify taste and ease of administration as candidate domains of paediatric acceptability to be examined in future, more rigorously designed studies.
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Open AccessArticle
The Post-Authorisation Maze: Mapping of European Pharmaceutical Market Access Pathways in the Early JCA Era
by
Lisa-Maria Hagemann, Karolin Eberle, Jana Maurer, Alexandra Carls, Andreas D. Meid and Eva-Maria Reuter
J. Mark. Access Health Policy 2026, 14(3), 55; https://doi.org/10.3390/jmahp14030055 - 17 Sep 2026
Abstract
The Regulation (EU) 2021/2282 on health technology assessment (HTAR) harmonises clinical evidence assessment across Europe. However, national appraisal, pricing, and reimbursement processes remain divergent and could affect the efficiency of decision-making and patient access. Here we mapped the sequencing of national assessment, pricing,
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The Regulation (EU) 2021/2282 on health technology assessment (HTAR) harmonises clinical evidence assessment across Europe. However, national appraisal, pricing, and reimbursement processes remain divergent and could affect the efficiency of decision-making and patient access. Here we mapped the sequencing of national assessment, pricing, and reimbursement steps across 30 European countries. National pathways from marketing authorisation to reimbursed access were systematically identified and coded as categorical process sequences. Inpatient and outpatient pathways were analysed separately. Pathway dissimilarities were calculated using Optimal Matching and grouped by hierarchical clustering. We further explored whether clusters differed with regard to country-level indicators, including medicine availability, average time to access, gross domestic product, and healthcare expenditure. We found substantial procedural heterogeneity across countries in both inpatient and outpatient settings. Nevertheless, recurring pathway structures were identified. Across settings, the dominant distinction was between assessment-led pathways, in which evidence assessment precedes pricing and reimbursement steps, and pricing-led pathways, in which price formation occurs prior to assessment and reimbursement-related steps. Cluster membership was not associated with any country-level indicators. Our findings provide policymakers, agencies, and industry with a baseline for understanding national procedural heterogeneity and for evaluating how market access pathways evolve as the JCA is implemented.
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(This article belongs to the Collection European Health Technology Assessment (EU HTA))
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Open AccessArticle
Real-World Shelf Life of Epinephrine Auto-Injectors in Canada: Implications for Renewal Frequency and Patient Burden
by
John Papastergiou, Mille Vang Lybech, Christoffer Mertz, Anne Danø, Jess Finney and David Grabowski
J. Mark. Access Health Policy 2026, 14(3), 54; https://doi.org/10.3390/jmahp14030054 - 14 Sep 2026
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Although patients in Canada at risk of anaphylaxis are recommended to maintain access to two in-date epinephrine auto-injectors (EAIs) at all times, underuse during emergencies remains common. Multiple factors contribute to this gap, but the impact of real-world shelf life has been understudied.
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Although patients in Canada at risk of anaphylaxis are recommended to maintain access to two in-date epinephrine auto-injectors (EAIs) at all times, underuse during emergencies remains common. Multiple factors contribute to this gap, but the impact of real-world shelf life has been understudied. This study examines the remaining in-pharmacy shelf life of EAIs in Canada and considers its potential implications for patient burden, renewal frequency, and anaphylaxis preparedness. In this cross-sectional study, 50 licensed Canadian pharmacists from chain, independent, grocery/mass merchandise, and hospital pharmacies completed an online questionnaire and assessed EAI stock. Participating pharmacists verified all EAI stock on site, including batch numbers and expiry dates, and reported patient disposal practices. Of the 50 participating pharmacists, 49 reported 411 EAI devices across 98 batches. The mean in-pharmacy shelf life at dispensing was 12.8 months, with 47.4% of devices having 12 months or less remaining shelf life. Disposal practices varied and expiry was the most cited reason for disposal. Shortened in-pharmacy shelf life may increase renewal frequency, cost, waste, and the risk that patients carry expired devices or no device during anaphylaxis. Longer-shelf-life epinephrine treatment options or improved distribution chain practices may help reduce patient burden and enhance anaphylaxis preparedness in Canada.
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Open AccessArticle
Analysis of Factors Influencing Drug Prices Differently in Official Drug Pricing and Cost-Effectiveness Evaluation
by
Mariko Hara and Hiroshi Nakamura
J. Mark. Access Health Policy 2026, 14(3), 53; https://doi.org/10.3390/jmahp14030053 - 31 Aug 2026
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Background: In Japan, official prices of pharmaceuticals have been determined by efficacy and safety. In 2019, Cost-Effectiveness Evaluation (CEE) was introduced to adjust these prices according to Incremental Cost-Effectiveness Ratios (ICERs). Objectives: To analyze the differences in the factors influencing drug price between
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Background: In Japan, official prices of pharmaceuticals have been determined by efficacy and safety. In 2019, Cost-Effectiveness Evaluation (CEE) was introduced to adjust these prices according to Incremental Cost-Effectiveness Ratios (ICERs). Objectives: To analyze the differences in the factors influencing drug price between the initial official drug pricing and subsequent price adjustments based on CEE. Methods: Twenty-three drugs evaluated in Japan between 2019 and May 2025 were descriptively analyzed using public reports on official drug pricing and CEE. Results: Four differences were identified: (1) Official initial drug pricing grants premiums for certain characteristics that are not directly associated with improvements in Health-Related Quality of Life (HRQoL), whereas such premiums are not considered in CEE. (2) Official drug pricing limits comparators to existing drugs, whereas CEE did not impose such restrictions. (3) Official drug pricing excludes older drugs as comparators to reward innovation, whereas they were not excluded in CEE. (4) CEE requires sufficient data for CE analysis, such as clinical trial or real-world data, for comparators, unlike official drug pricing. Factors (1) and (3) were most frequent. Conclusion: Reducing these differences and maintaining consistent innovation evaluations may enhance price predictability and support sustainable pharmaceutical investments in the Japanese market.
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Open AccessEditorial
Procedural Theatre: EU-HTA Between Ritual and Purpose—Why the Buyer’s Audit Has Outgrown the Transaction
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Mondher Toumi, Maarten Jacobus Postma, Bruno Falissard, Frank-Ulrich Fricke, Stefano Capri, Jürgen Wasem, Steven Simoens, Renato Bernardini, Malgorzata Wojtal, Anna Kapuśniak, Oriol Sola Morales, Laurent Boyer, Jaime Espin and Pascal Auquier
J. Mark. Access Health Policy 2026, 14(3), 52; https://doi.org/10.3390/jmahp14030052 - 29 Aug 2026
Abstract
Health technology assessment is a discipline that has developed, over five decades, an elaborate scientific and institutional identity centered on the evaluation of clinical evidence, comparative effectiveness, and economic value [...]
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Open AccessArticle
A Model-Based Public-Payer Investment Appraisal of a National Home Hemodialysis Program in Greece: A Net Present Value Analysis
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Vasileios Zavvos, John Fanourgiakis, Michael A. Talias, Christos Iatrou and Christos Ntais
J. Mark. Access Health Policy 2026, 14(3), 51; https://doi.org/10.3390/jmahp14030051 - 27 Aug 2026
Abstract
Background: In-center hemodialysis is the dominant kidney replacement therapy modality in Greece and generates substantial recurring expenditure for the public payer. Home hemodialysis is not currently implemented at national scale, but it may reduce long-term public expenditure if early investment in training capacity,
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Background: In-center hemodialysis is the dominant kidney replacement therapy modality in Greece and generates substantial recurring expenditure for the public payer. Home hemodialysis is not currently implemented at national scale, but it may reduce long-term public expenditure if early investment in training capacity, equipment and home support is recovered over time. Objective: To evaluate, from the Greek public-payer perspective, the discounted budget impact and net present value (NPV) of implementing a national home hemodialysis program for 300 patients. Methods: We developed a deterministic investment-appraisal model comparing gradual implementation of home hemodialysis with continued in-center hemodialysis for the same projected cohort over 10 years. The in-center comparator was informed by a 2022 Greek patient-level micro-costing study. Home hemodialysis expenditure was constructed from explicit patient-flow equations, resource quantities, unit costs, capital purchases and hospital-tariff offsets. Annual incremental savings were discounted at 3% in the base case. Alternative discount rates, deterministic one-way sensitivity analyses and program-scale scenarios were examined. Fiscal benefit–cost ratio (BCR) and return on investment (ROI) were also calculated. Results: Undiscounted 10-year public expenditure was EUR 69,681,804 for home hemodialysis and EUR 86,700,267 for continued in-center hemodialysis, yielding savings of EUR 17,018,463. During the first 5 years, the program required EUR 1,724,012 in additional expenditure. At a 3% discount rate, NPV was EUR 12,696,564, the fiscal BCR was 2.89, fiscal ROI was 189.3% and discounted payback occurred during year 6. NPV remained positive at 5% (EUR 10,391,382) and across all tested one-way scenarios (range EUR 706,179 to EUR 24,686,948). Conclusions: The modeled national home hemodialysis program generated a positive 10-year public-payer NPV under the base-case and tested sensitivity assumptions. A positive NPV is not, however, a formal Greek health-system decision rule and does not capture health outcomes, patient and family costs, or equity. The findings support staged pilot implementation and prospective collection of Greek real-world data before wider rollout.
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Open AccessArticle
From Joint Clinical Assessment to National Decisions: EU HTA Implementation and Implications for Patient Access
by
Kalpana D’Oca, Ada Adriano, Eline Darquennes and Natalie Steck
J. Mark. Access Health Policy 2026, 14(3), 50; https://doi.org/10.3390/jmahp14030050 - 19 Aug 2026
Abstract
The introduction of Joint Clinical Assessments (JCAs) under the European Union Health Technology Assessment Regulation (EU HTAR) represents a major structural reform aimed at reducing fragmentation and duplication in clinical evidence assessment across Member States. While JCAs are intended to support national health
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The introduction of Joint Clinical Assessments (JCAs) under the European Union Health Technology Assessment Regulation (EU HTAR) represents a major structural reform aimed at reducing fragmentation and duplication in clinical evidence assessment across Member States. While JCAs are intended to support national health technology assessment (HTA) processes through a common EU-level clinical evaluation, their integration into established national HTA and reimbursement systems remains untested at this early stage of implementation. This paper reports findings from two surveys conducted in 2025 among local affiliate representatives with expertise in relevant HTA and market access activities across 25 European countries (comprising 24 EU Member States and Norway), capturing early national perspectives on key aspects of JCA implementation. The surveys explored anticipated impact on national reimbursement timelines, current opportunities for early HTA advice and PICO input, approaches to handling post-JCA data availability, and nationally prioritised policy and implementation issues. Results indicate mixed expectations regarding the potential impact of JCA on reimbursement timelines, with perceived risks of delay largely viewed as possibly transitional and mitigable through national process adaptation. Respondents emphasised the importance of transparency in PICO consolidation and clarity on the use of JCA reports in national appraisals. Overall, the findings suggest that JCA may represent a reconfiguration rather than a centralisation of evidence assessment, with national influence exercised earlier in the assessment lifecycle. These insights provide policy-relevant input to inform ongoing EU HTA implementation and future refinement of the JCA framework.
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(This article belongs to the Collection European Health Technology Assessment (EU HTA))
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Open AccessArticle
Treatment Preferences in Acute Allergic Reactions—How Can the Context Impact the Preference for a Corticosteroid Mouth Film Versus Conventional Tablets?
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Andrea Karadak, Karin Wahlberg, Göran Tornling, James Kereki, Leif Bjermer and Jonas Hjelmgren
J. Mark. Access Health Policy 2026, 14(3), 49; https://doi.org/10.3390/jmahp14030049 - 11 Aug 2026
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Background: The objective was to assess how preferences for a self-dissolving dexamethasone mouth film versus conventional tablets for acute allergic reactions may vary according to population characteristics and the level of outcome knowledge for the intervention (i.e., ex ante, interim, and ex post).
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Background: The objective was to assess how preferences for a self-dissolving dexamethasone mouth film versus conventional tablets for acute allergic reactions may vary according to population characteristics and the level of outcome knowledge for the intervention (i.e., ex ante, interim, and ex post). Methods: We used preference data from two studies: a questionnaire study with a choice between mouth film and tablets based on a description of the mouth film (ex ante), and a clinical trial with ratings of accessibility and perceived security when the mouth film was available (interim) or used for acute allergic reactions (ex post). Associations between preferences and participant characteristics (demographics and clinical history) were analyzed using logistic regression models. Results: Preference for the mouth film over tablets remained strong as outcome information increased from ex ante to ex post and was consistent across study populations. Higher relative preference was associated with female sex, longer disease duration, older age, and prior severe reactions, whereas satisfaction with current treatment and regular allergy check-ups were linked to weaker relative preference. Conclusions: Preference for the mouth film over tablets was stable, but the degree of preference may depend on characteristics that influence sensitivity to treatment challenges in acute situations.
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Open AccessArticle
Health-Related Quality of Life of Patients with Epidermolysis bullosa and Carers Using a Time Trade-Off Approach in the UK General Population to Elicit Utilities for Health Technology Assessment
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Luke Stainer, George Morgan, Thomas Snell, Claire Mather, Sagair Hussain and Keith Tolley
J. Mark. Access Health Policy 2026, 14(3), 48; https://doi.org/10.3390/jmahp14030048 - 11 Aug 2026
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Background: Epidermolysis bullosa (EB) is a complex group of rare, inherited skin disorders that blister easily, imposing substantial burden on patients and carers. There is a lack of published evidence in the UK quantifying health-related quality of life in EB patients and carers
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Background: Epidermolysis bullosa (EB) is a complex group of rare, inherited skin disorders that blister easily, imposing substantial burden on patients and carers. There is a lack of published evidence in the UK quantifying health-related quality of life in EB patients and carers as utility values suitable for use in Health Technology Assessment (HTA). Methods: A time trade-off (TTO) study was conducted with 120 UK general public members to estimate utility values for EB patient and primary carer vignettes depicting varying EB severity. An exploratory sub-study involving six carer and clinical experts was conducted to estimate utility values of second carers. Results: 115 general public participants were included in the final TTO analysis. Mean utility values declined as disease severity increased, from 0.82 in the least severe state, to 0.54 in the most severe. Carer utilities were higher than the equivalent patient health states, but with a similar pattern of decreasing utility with increasing EB severity, ranging from 0.85 to 0.64. The secondary carer sub-study, in six respondents estimated a second care burden factor relative to the primary carer of 77%. Conclusions: The utilities estimated for both EB patients and their carers have relevance for future economic evaluations and HTA of new EB therapies.
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Open AccessArticle
Valuation of Medical Innovation in Orphan Diseases with a Focus on Small Investors and Limited Diversifiable Risks
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Mark Nuijten and Pieter van Gelder
J. Mark. Access Health Policy 2026, 14(3), 47; https://doi.org/10.3390/jmahp14030047 - 5 Aug 2026
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This paper assesses the impact of uncertainty for investors on the economic valuation of medical innovation projects for orphan drugs or rare diseases. Conventionally, investor evaluation uses the deterministic discounted cash flow (DCF) method with an appropriate sensitivity analysis that captures some level
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This paper assesses the impact of uncertainty for investors on the economic valuation of medical innovation projects for orphan drugs or rare diseases. Conventionally, investor evaluation uses the deterministic discounted cash flow (DCF) method with an appropriate sensitivity analysis that captures some level of uncertainty. In healthcare, and particularly for rare diseases, the levels of uncertainty in financial outcomes (return on investment and net present value (NPV)) are broader than the ones normally captured by the DCF formula. Uncertainties include R&D costs, the approval process (level and timing) for obtaining reimbursement, sales, the production cost, and the failure probabilities of the clinical trial phases, to name a few. Additionally, there is not only one type of investor to consider, but different investors exposed to different levels of risk management of their investment. Our analysis tried to capture those two dilemmas (higher levels of uncertainty and different investor types) in two ways. One way was to identify a better method to enhance the different levels of uncertainty. The real option method of evaluation was proposed instead of DCF. For instance, the real option method better captures the uncertainty of the different phases of product development. The other way is to differentiate the investor types through their level of risk assessment perspectives. Small investors and start-up companies may see more benefit in applying the real option methodology to estimate their NPVs at different time points during product development. In summary, our evaluation identified various types of uncertainty when assessing an investment, along with methods to manage their effect on the economic/financial outcomes of medical innovations. Given the high uncertainty associated with early-stage drug development, such as orphan drugs for rare diseases, the real options approach is preferable to traditional DCF models. The analysis also showed that there is not just a single investor perspective to consider but specific perspectives that enhance the prime use of the real option methodology.
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Open AccessEditorial
Guidance on Multiplicity Analysis in Single-Trial Assessments: A No-Solution Equation
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Mondher Toumi, Bruno Falissard, Asma Jouini, Pascal Auquier, Claude Dussart and Laurent Boyer
J. Mark. Access Health Policy 2026, 14(3), 46; https://doi.org/10.3390/jmahp14030046 - 4 Aug 2026
Abstract
The European Health Technology Assessment (EU HTA) guidance on Multiplicity of Hypothesis Testing (MHT) [...]
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Open AccessPerspective
The European Union’s Health Technology Assessment Regulation (EU-HTA R) Will Prosper Despite Major Setbacks
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Mondher Toumi, Imen Soussi, Bruno Falissard, Steven Simoens, Asma Jouini, Maarten Postma, Juergen Wasem, Oriol Solà-Morales, Laurent Boyer, Claude Dussart, Borislav Borissov, Renato Bernardini, Stefano Capri, Jaime Espin and Pascal Auquier
J. Mark. Access Health Policy 2026, 14(3), 45; https://doi.org/10.3390/jmahp14030045 - 3 Aug 2026
Abstract
Background: The EU Health Technology Assessment Regulation (EU-HTA R), effective January 2025, mandates Joint Clinical Assessments (JCAs) to harmonize HTA across Member States. However, its implementation raises fundamental questions about methodological coherence, institutional capacity, and epistemological alignment. Objectives: This manuscript (1) systematically assesses
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Background: The EU Health Technology Assessment Regulation (EU-HTA R), effective January 2025, mandates Joint Clinical Assessments (JCAs) to harmonize HTA across Member States. However, its implementation raises fundamental questions about methodological coherence, institutional capacity, and epistemological alignment. Objectives: This manuscript (1) systematically assesses whether the stated strategic and operational objectives of the EU-HTA R are achievable under current implementation conditions; (2) examines the implications for EU institutional legitimacy if these objectives are not met; and (3) proposes an epistemological framework as a prerequisite for developing a coherent joint HTA methodology. Methods: We conducted a critical policy analysis of the EU-HTA R, its implementing guidance documents, and published templates, supplemented by a comparative review of Member State HTA methodologies and their underlying philosophical foundations. Results: The analysis reveals that the EU-HTA R is unlikely to achieve its strategic goals under current conditions. Key findings include: guidance documents of substandard methodological quality; a restricted assessment scope that excludes scientific judgement and contextualization; insufficient resources and additional workload for national HTA bodies without reducing existing obligations; unresolved epistemological divergences among Member States spanning Bayesian vs. frequentist approaches, Fisher vs. Neyman–Pearson frameworks, and utilitarian vs. deontological ethical foundations; and procedural shortcomings in stakeholder consultation and expert involvement. These shortcomings risk undermining the epistemic authority and legitimacy of EU institutions. Conclusions: Prior epistemological and normative alignment across Member States is a prerequisite for any robust shared HTA methodology. Revisions to the EU-HTA R and comprehensive updates of guidance documents are necessary, with concrete safeguards—including independent peer review, identified authorship, and adequate resourcing—to ensure substantive rather than merely nominal implementation. A phased roadmap is proposed: establishing clear objectives, aligning epistemological foundations, developing institutional structures, and creating operationally consistent guidance.
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Open AccessArticle
Direct Public-Payer Costs of Dialysis Therapies in Greece: A Patient-Level Micro-Costing Study Across Modality and Provider Sector
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Vasileios Zavvos, John Fanourgiakis, Michael A. Talias, Aimilia Zachariou, Marios Papasotiriou, Christos Iatrou, Nikolaos Kontodimopoulos and Christos Ntais
J. Mark. Access Health Policy 2026, 14(3), 44; https://doi.org/10.3390/jmahp14030044 - 28 Jul 2026
Cited by 1
Abstract
Background: Dialysis is a life-sustaining but resource-intensive treatment for patients with kidney failure. Contemporary Greek evidence on the public-payer cost of dialysis is limited, particularly for comparisons across modality, provider sector and treatment subtype. Methods: We performed a retrospective observational micro-costing study using
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Background: Dialysis is a life-sustaining but resource-intensive treatment for patients with kidney failure. Contemporary Greek evidence on the public-payer cost of dialysis is limited, particularly for comparisons across modality, provider sector and treatment subtype. Methods: We performed a retrospective observational micro-costing study using 2022 patient-level data from five hemodialysis units and one peritoneal dialysis unit in Greece. The perspective was that of the public payer and public health budget. Annual costs included dialysis treatment and consumables, patient allowances and transport reimbursement, dialysis-related drugs, laboratory and imaging tests, hospitalizations and public dialysis-unit operating costs where applicable. Results: The analytic sample included 359 patients: 337 receiving hemodialysis and 22 receiving peritoneal dialysis. Median annual total cost was EUR 35,902.53 for hemodialysis and EUR 57,136.44 for peritoneal dialysis per patient. Peritoneal dialysis generated higher annual cost than hemodialysis, mainly because of treatment and consumable costs, and remained more costly after excluding dialysis-unit operating costs in sensitivity analysis. Public-sector hemodialysis had higher recorded median annual public-payer/public-budget cost than private-sector hemodialysis (EUR 38,794.55 versus EUR 34,836.98), but this difference was no longer statistically significant after excluding dialysis-unit operating costs. Hemodiafiltration was more costly than conventional hemodialysis, and automated peritoneal dialysis was more costly than continuous ambulatory peritoneal dialysis. National extrapolation estimated annual public expenditure of EUR 466.6 million using mean costs and EUR 446.8 million using median-based sensitivity estimates. Conclusions: Dialysis imposes substantial annual public expenditure in Greece. In this dataset and reimbursement context, peritoneal dialysis was more costly than hemodialysis, while private-sector hemodialysis generated lower recorded public-payer cost than public-sector provision. The apparent public–private hemodialysis cost difference was sensitive to the treatment of operating costs. These results may help inform reimbursement review, procurement policy and future budget-impact analyses of dialysis service redesign.
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Open AccessArticle
A Real-World Clinical Trial Evaluating Satisfaction and Experiences with a Dexamethasone Mouth Film Compared to Corticosteroid Tablets as Rescue Medication for Moderate to Severe Acute Allergic Reactions
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Leif Bjermer, Göran Tornling, James Kereki, Karin Wahlberg, Bahram Javizian and Jonas Hjelmgren
J. Mark. Access Health Policy 2026, 14(3), 43; https://doi.org/10.3390/jmahp14030043 - 27 Jul 2026
Cited by 1
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Despite the need for immediate treatment during acute allergic reactions (AARs), many patients do not consistently carry medication. A new mouth-dissolving dexamethasone film offers a portable, easily administered alternative to corticosteroid tablets. This non-randomized, open-label, low-interventional real-world trial assessed satisfaction (accessibility and safety/security)
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Despite the need for immediate treatment during acute allergic reactions (AARs), many patients do not consistently carry medication. A new mouth-dissolving dexamethasone film offers a portable, easily administered alternative to corticosteroid tablets. This non-randomized, open-label, low-interventional real-world trial assessed satisfaction (accessibility and safety/security) with the mouth film versus betamethasone tablets in adults prescribed tablets for moderate to severe AARs at a Swedish primary care center. Over six months, participants had access to both treatments and reported monthly via an electronic diary; qualitative responses were converted to Likert scales where applicable. Of 50 enrolled, 44 provided diary data (mean age 50 years, 74% female, 58% had an epinephrine autoinjector). In total, 189 responses were collected: 98% stated that the participant was satisfied or very satisfied with mouth film accessibility versus 58% for tablets (mean Likert scores 3.5–3.7 vs. 2.5–2.8; p < 0.001). A higher feeling of safety with the mouth film versus tablets was reported in 78% of responses and improved medication carriage compliance in 77%. At six months, 69% preferred the film. Of 18 AARs in total reported by 13 participants, the mouth film was chosen for treatment of 16 (11 participants); in 94%, the mouth film was found immediately accessible, and in 94%, the efficacy was rated as good or very good. In conclusion, the mouth film improved perceived accessibility, safety/security, and medication-carriage compliance compared with tablets for the treatment of AARs.
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Open AccessEditorial
Analysis of How the Term “Shall” Is Understood and Applied to the EU-HTA Regulation
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Mondher Toumi, Samuel Aballéa, Bruno Fallissard, Claude Dussart, Pascal Auquier and Laurent Boyer
J. Mark. Access Health Policy 2026, 14(3), 42; https://doi.org/10.3390/jmahp14030042 - 27 Jul 2026
Abstract
The European Health Technology Assessment (EU-HTA) Regulation extensively uses the word “shall”, and its use has caused confusion among audiences unfamiliar with legal terminology [...]
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Open AccessReview
Multi-Criteria Decision-Making Framework for Sustainable Innovation Management in the Mexican Medical Device Manufacturing Industry: An Exploratory and Interdisciplinary Analysis
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José Cozain-Hernández, Josué Aarón López-Leyva, Miguel Angel Ponce-Camacho and Víctor Manuel Ramos-García
J. Mark. Access Health Policy 2026, 14(3), 41; https://doi.org/10.3390/jmahp14030041 - 27 Jul 2026
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The medical device manufacturing industry in Mexico faces a critical risk of losing competitiveness and sustainability due to its concentration on low-value-added manufacturing activities and limited integration into advanced stages of the value chain, such as R&D. This research addresses the lack of
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The medical device manufacturing industry in Mexico faces a critical risk of losing competitiveness and sustainability due to its concentration on low-value-added manufacturing activities and limited integration into advanced stages of the value chain, such as R&D. This research addresses the lack of validated quantitative methodologies to identify the critical factors that promote sectoral sustainability in the national context. Through a literature review and the analysis of MCDM, a taxonomy of the problem was developed that integrates dimensions of governance, technological innovation, and human capital. The findings emphasize the need to transition toward circular economy and additive manufacturing models, supported by hybrid algorithms such as AHP, TOPSIS, and DEMATEL to mitigate uncertainty in strategic decision making. As a main result, an innovation management flow aligned with international standards and several maturity levels (TRLs, MRLs, CRLs, and PRLs) is proposed, providing a structured roadmap to scale the Mexican industry toward more-sophisticated global segments.
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Open AccessEditorial
Epistemological Tensions in the EU HTA Joint Clinical Assessment: The Illusion of Judgment-Free Evaluation
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Mondher Toumi, Bruno Falissard, Asma Jouini, Imen Soussi, Steven Simoens, Maarten Postma, Laurent Boyer, Borislav Borissov, Renato Bernardini, Stefano Capri, David Danko, Claude Dussart, Frank-Ulrich Fricke and Pascal Auquier
J. Mark. Access Health Policy 2026, 14(3), 40; https://doi.org/10.3390/jmahp14030040 - 24 Jul 2026
Abstract
The practice of Health Technology Assessment (HTA) inherently involves moral, epistemological, and ontological commitments, which shape how assessments are conducted, interpreted, and used for decision-making [...]
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Open AccessPerspective
Market Care and Custody: A Health Policy Analysis of Incarceration and Long-Term Care Systems in the U.S.
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Travis W. Milburn and Iffath Unissa Syed
J. Mark. Access Health Policy 2026, 14(3), 39; https://doi.org/10.3390/jmahp14030039 - 17 Jul 2026
Abstract
The United States has one of the world’s largest criminal justice systems, with nearly 5.5 million people under correctional supervision and almost 2 million incarcerated. This scale of confinement, coupled with the rise of privatization across correctional and related services, reflects a broader
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The United States has one of the world’s largest criminal justice systems, with nearly 5.5 million people under correctional supervision and almost 2 million incarcerated. This scale of confinement, coupled with the rise of privatization across correctional and related services, reflects a broader neoliberal trend in public governance. This paper explores the consequences of privatization and marketization of the U.S. criminal justice system—particularly the proliferation of private prisons and immigrant detention centers—and draws parallels to the consequences of privatization of health and social care, especially long-term care (LTC). Both systems reveal shared logics of marketization that prioritize profit maximization, efficiency, and cost-cutting at the expense of care, justice, and equity. Relying on interdisciplinary perspectives from public health and criminology, this paper situates private corrections within the health policy framework of the Commercial Determinants of Health (CDoH), arguing that privatized carceral institutions not only harm incarcerated individuals but also endanger workers, families, and surrounding communities through systemic under-resourcing, precarious labor conditions, and structural violence. By comparing the private, for-profit prison industry with private for-profit LTC systems, we illustrate how these structures have commodified both care and correctional systems. These findings suggest that privatization within carceral and care sectors perpetuates health inequities and reinforces cycles of racial, gendered, and economic disadvantage. Accordingly, this paper calls for strengthening publicly held models and a reassertion of public accountability and interdisciplinary collaboration to restore social justice, health, and human dignity as central organizing principles of both systems for residents, workers, their families, and communities.
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Open AccessSystematic Review
The Analytical Framework of Clinical Trials Evaluating Clinical Outcomes of Artificial Intelligence-Based Digital Health Interventions: A Systematic Literature Review
by
Vladimir Zah, Dimitrije Grbic, Carl Asche and Filip Stanicic
J. Mark. Access Health Policy 2026, 14(3), 38; https://doi.org/10.3390/jmahp14030038 - 1 Jul 2026
Abstract
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Introduction: This systematic literature review (SLR) provides an analytical framework for clinical trials evaluating clinical outcomes of artificial intelligence-based digital health interventions (AI-DHI). Methods: The SLR was conducted in accordance with the PRISMA guidelines. Search was conducted (September 2025) in PubMed and Embase.
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Introduction: This systematic literature review (SLR) provides an analytical framework for clinical trials evaluating clinical outcomes of artificial intelligence-based digital health interventions (AI-DHI). Methods: The SLR was conducted in accordance with the PRISMA guidelines. Search was conducted (September 2025) in PubMed and Embase. Population included patients using AI-DHI. Only clinical trials exploring clinical outcomes, written in English, were considered. NICE checklist was used to assess studies’ quality. Results were analyzed descriptively. Results: Final sample had 84 studies, with metabolic (28.6%), musculoskeletal (20.2%), and mental health disorders (19.0%) as the most common indications. Most studies (75.0%) were controlled, parallel-group trials with 2+ arms, mostly comparing AI-DHI with standard-of-care or waitlist. Although type of intervention often precludes blinding (64.3% were open-label), a double-blinding is strongly recommended (only 6.0%). Only 9.5% of studies were conducted at multiple sites across different countries. Dropout rates in the total sample and each study arm should be <20% at all endpoints (64.3%). Statistical tests were used based on the outcome measures. The small sample sizes and limited generalizability of findings were reported as the main limitations. Conclusions: This SLR emphasized current methodological gaps and an urgent need for unified global guidelines. Standard SLR limitations apply to this research.
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Open AccessOpinion
The EU-Joint Clinical Assessment Guidance Documents Fail to Address the Significance of Systematic Literature Reviews and Deviate from the State of the Art
by
Beata Smela, Mondher Toumi, Samuel Aballéa, Steven Simoens, Laurent Boyer, Bruno Falissard, Renato Bernardini, Stefano Capri and Pascal Auquier
J. Mark. Access Health Policy 2026, 14(3), 37; https://doi.org/10.3390/jmahp14030037 - 24 Jun 2026
Cited by 2
Abstract
This paper summarizes an analysis of the Joint Clinical Assessment (JCA) subgroup’s recommendations for systematic literature reviews (SLRs). While the JCA offers clear guidance on study classification, exclusion criteria reporting, and PRISMA diagram use, several of its recommendations diverge from established best practices
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This paper summarizes an analysis of the Joint Clinical Assessment (JCA) subgroup’s recommendations for systematic literature reviews (SLRs). While the JCA offers clear guidance on study classification, exclusion criteria reporting, and PRISMA diagram use, several of its recommendations diverge from established best practices in evidence-based medicine (EBM). A comparison with recognized guidelines, such as those from Cochrane and EUnetHTA, reveals that the JCA guidance may lack reliability, comprehensiveness, and reproducibility. Aligning JCA recommendations with gold standards in SLR methodology would address these shortcomings and enhance methodological rigor.
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