NSBE: Health Economics & Management Knowledge Center
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Nova SBE Health Economics & Management Knowledge Center is Nova SBE’s research unit and knowledge center for Health Economics, Health Management, Health Policy, and Public Health. We produce research to create and share rigorous knowledge, empowering well-informed and well-reasoned decisions in health issues, for society’s benefit.
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- The role of real-world evidence in health technology assessment decision-making: harmonization of standards and evaluation of effective frameworks for reimbursement decisions a systematic literature reviewPublication . Gualerzi, Andrea; Barros, Pedro Pita; Leite, JoãoThis study examines how international HTA bodies harmonize evidence requirements for Real World Evidence (RWE) and identifies effective methodologies for reimbursement decisions. By comparing leading European agencies (NICE, HAS, IQWiG), it highlights discrepancies in RWE acceptance, patient involvement, and economic evaluations. Through case studies in oncology approvals and cost-effectiveness analyses, findings emphasize the need for standardized criteria, transparency, and structured frameworks like Managed Entry Agreements (MEA). This research contributes to the broader thesis by advocating for global harmonization to enhance healthcare decision-making and accessibility.
- Assessing potential misuse in the off-label use of ozempic for obesity tratment in non- diabetic individualsPublication . Westermann, Greta Sophie; Barros, Pedro PitaThis thesis investigates the potential misuse in the off-label use of Ozempic for weight lossa mong non-diabetics, focusing on factors driving demand, perceptions of misuse, and ethical and economic implications. Using survey data of 173 primarily young individuals from Germany, it highlights gaps in understanding motivations and behaviors related to off-label use. Key findings illustrate that familiarity with Ozempic increases consideration and risk perceptions, while perceived legitimacy and non-prescription availability enhance acceptability. These results highlight the social and ethical challenges of off-label drug use, emphasizing the need for stricter regulatory healthcare policies and further research into patient safety.
- Acesso a cuidados de saúde, 2025Publication . Barros, Pedro Pita; Santos, Carolina; NOVA School of Business and Economics (NOVA SBE)O acesso aos cuidados de saúde para a população é um objetivo central dos sistemas de saúde e um pilar fundamental da equidade. Este relatório, baseado numa amostra representativa de residentes com 15 ou mais anos em Portugal continental, analisa a evolução do acesso aos cuidados de saúde no país entre 2013 e 2025. Focando-se nas decisões tomadas pelos cidadãos desde o momento em que sentem doença, o relatório identifica desigualdades significativas associadas a fatores socioeconómicos, demográficos e geográficos, que comprometem a equidade no sistema de saúde. Tal como em anos anteriores, as desigualdades socioeconómicas na saúde e no acesso aos cuidados de saúde são evidentes na ocorrência de episódios de doença. De facto, os indivíduos pertencentes ao grupo económico mais desfavorecido têm uma probabilidade de 67% de reportar pelo menos um episódio de doença, em comparação com apenas 39% entre os indivíduos dos grupos mais favorecidos. Em 2025, as barreiras financeiras no acesso aos cuidados de saúde permanecem elevadas, acima dos níveis observados no período pré-pandémico (2013–2019) e durante a fase mais intensa da pandemia (2020–2021). Embora entre 2022 e 2025 se tenha verificado uma redução substancial na percentagem de inquiridos que recorrem exclusivamente aos cuidados de saúde no setor público — Serviço Nacional de Saúde (SNS) —, 83,52% dos inquiridos contactaram apenas o SNS durante o seu último episódio de doença. No setor público, os serviços mais procurados são os cuidados de saúde primários. Ainda assim, a cobertura da população por médicos de família no SNS continua a ser reduzida. Um ponto que merece destaque é a redução da procura dos serviços de urgência hospitalar públicos, que parece refletir a introdução do programa “Ligue antes, salve vidas”, uma iniciativa que procura promover a pré-triagem através da linha SNS 24 antes do recurso às urgências hospitalares. A maioria (61,9%) das pessoas que contactaram a linha SNS 24 manifestou-se satisfeita ou muito satisfeita com as recomendações fornecidas. A evidência sugere também que a possibilidade de os cidadãos emitirem uma autodeclaração de doença está igualmente a contribuir para uma utilização mais eficiente dos recursos do SNS. Por fim, uma vez que o tratamento e os cuidados não se limitam à resposta clínica à doença, mas envolvem o reconhecimento da singularidade de cada pessoa, da sua experiência subjetiva e do contexto em que vive, importa salientar que os níveis de satisfação da população com a humanização dos cuidados prestados no sistema de saúde — SNS, setor privado com fins lucrativos e setor privado sem fins lucrativos — permanecem abaixo dos registados durante a pandemia e no período pré-pandémico.
- Automedicação em PortugalPublication . Barros, Pedro Pita; Santos, Carolina; NOVA School of Business and Economics (NOVA SBE)The report “Self-medication in Portugal: Practices, Determinants, and Behavioral Profiles” analyzes how residents in Portugal manage episodes of illness in their daily lives through self-medication. Based on data from an unprecedented survey, the report examines when, how, and why individuals resort to this practice, what information underpins these decisions, and under what circumstances self-medication is perceived as effective. By distinguishing between self-medication as an expression of informed autonomy and self-medication as a possible response to difficulties in accessing healthcare, the report contributes to an informed debate on the role of this form of self-care, its limits, and its place within the concept of healthcare integration.
- Exploring young adults’ perceptions, awareness, and adoption barriers of digital mental health interventions in GermanyPublication . Zeller, Karen Jenny; Fonseca, Filipa Breia daThis study explores the adoption of digital mental health interventions (DMHIs) among young adults within the German healthcare system, focusing on apps that complement, rather than replace, in-person therapy. The research employs a mixed-method approach, combining quantitative survey data of potential users with qualitative interviews. Key findings highlight barriers like privacy concerns, accessibility challenges, and engagement difficulties. Adoption predictors include perceived effectiveness and engagement patterns, while long term engagement requires both relational support and user autonomy. The study underscores DMHI’s potential to bridge treatment gaps, emphasizing the need for patient-centered solutions with seamless system integration.
- Quais os desafios e oportunidades na criação de centros de referência laboratoriais no sistema de saúde nacional (SNS)?Publication . Jorge, Cátia Daniela da Silva; Redondo, Eduardo; Fonseca, Filipa Breia da
- The role of real-world evidence in health technology assessment decision-making: what differences between RWE and randomised controlled trials (RCTs) are highlighted in HTA guidelines, and how do these differences impact the assessment of effectiveness and safety? A systematic literature reviewPublication . Lialina, Elena; Barros, Pedro Pita; Leite, JoãoThis Systematic Literature Review (SLR) investigates the integration of Real-World Evidence (RWE) into Health Technology Assessment (HTA) processes to address the limitations of Randomized Controlled Trials (RCTs) in healthcare decision-making. The SLR examines methodological, data quality, and regulatory factors influencing RWE adoption across diverse healthcare systems. The findings reveal significant variability in HTA practices across countries, highlighting barriers such as inconsistent frameworks and limited interoperability. By synthesising evidence, this research underscores RWE’s potential to complement traditional evidence, improve patient access, and inform reimbursement decisions, supporting global efforts to optimise HTA methodologies and promote equitable healthcare policies.
- A DEA and SFA analysis on Public Emergency Department efficiency in PortugalPublication . Passas, Joana Ramos; Barros, Pedro PitaThis Work Project carries out a comparative analysis of the efficiency of 15 emergency departments (EDs) within the Portuguese National Health Service, using Data Envelopment Analysis (DEA) and Stochastic Frontier Analysis (SFA). The work takes on a Problem-based learning (PBL) approach, in which complex real-world problems—like the efficiency of healthcare services—are used as vehicles for learning and collaborative student work. The dataset used, covering 2021 to 2023, was collected by EDs and submitted to the Tribunal de Contas (Portuguese Court of Auditors) for an upcoming audit. The analysis highlights Decision-Making Units (DMUs) 8 and 10 as best performers, showcasing adequate resource management, staffing levels and time allocation. In contrast, DMUs 7 and 14 consistently underperform, exhibiting inefficiencies in staffing ratios and prolonged patient wait times. A seasonality analysis revealed that efficiency drops in summer, due to staffing shortages and operational challenges, while a cost-analysis identified DMU 13 as the more cost-effective unit. Further analyses are conducted to examine factors influencing ED efficiency, such as non urgent users, whose findings trace a clear path for targeted policy interventions, where underperforming units can benefit from adopting best practices observed in efficient EDs.
- Artificial Intelligence in mental healthcare: a blessing or a curse for businesses and healthcare professionals?Publication . Abaza, Vivien; Fonseca, Filipa Breia daThis study explores the integration of AI into mental healthcare, addressing its importance, system integration, challenges, and opportunities from business and healthcare professional perspectives. Qualitative interviews and a quantitative survey revealed that personalization and accessibility are essential, with AI complementing human therapists. Partnerships emerged as key for system integration, with healthcare professionals favoring healthcare institutions and businesses focusing on other collaborations. Challenges persist, with privacy and ethical concerns the most prominent, while healthcare professionals largely rejected concerns that AI diminishes the human element in care. Finally, virtual therapists faced skepticism, yet professionals broadly recognized AI's potential to reduce administrative burdens.
- Catastrophic healthcare spending and impoverishment in Portugal (2005-2022)Publication . Tao, Tzi Kieu; Barros, Pedro PitaThe study analyses the extent, evolution and impoverishing effects of catastrophic health expenditures (CHE) in Portugal from 2005 to 2022. The analysis also identifies factors predicting this outcome. A two-part model is employed to estimate unmet oral care expenditures by simulating the removal of financial constraints in the poorest income quintile. The results show a progressive reduction in financial burden. CHE incidence decreased from 9.42% (2005) to 5.04% (2022). Challenges remain regarding the protection of vulnerable groups. The estimations reveal the potential scale of households affected by financial barriers to accessing oral healthcare services, indicating that if the associated unmet needs were addressed, the CHE incidence would increase from 5.0% to 6.6%.