Suchergebnisse

This paper deals with the question how to model health effects after the cessation of a randomised controlled trial (RCT). Using clinical trial data on severe congestive heart failure patients we illustrate how survival beyond the cessation of a RCT can be predicted based on parametric survival models. In the analysis we compare the predicted survival and the resulting incremental cost-effectiveness ratio (ICER) of different survival models with the actual survival/ICER. Our main finding is that the results are highly sensitive to the choice of survival model and that extensive sensitivity analysis in the CE analysis is required. We also show that adding the true survival after the end of the clinical study will underestimate the true variability.

This paper provides a descriptive analysis of the level of and change in cigarette smoking, excessive alcohol consumption and body weight in Nordic countries and compares them with non-Nordic OECD countries. Our results show that the average prevalence of daily smokers is significantly lower for Nordic countries compared to non-Nordic countries. Four out of five Nordic countries are below the non-Nordic average. However, for alcohol consumption and obesity, it is more difficult to see a clear difference between Nordic countries and non-Nordic countries. Sweden ranks relatively low on all three health behaviors, while alcohol consumption is relatively high in Finland and Denmark. Smoking rates are relatively high in Norway, while the obesity rate is relatively high in Iceland. We conclude that although Nordic populations are often perceived as relatively homogeneous in terms of cultural and political aspects, there are interesting differences in health behaviors within these Nordic countries. These differences need more focus in health-economics research and may have a significant potential in light of the availability of health surveys and administrative register data that can sometimes be linked at the individual level. Such Nordic analyses may, in general, help to move the research front forward and can also be used to predict changes in population health and to study the effectiveness of health economic policies.Published: April 2016.

The purpose of this study was to document historical trends and socioeconomic inequalities in ill health outcomes related to alcohol consumption, narcotics use and tobacco smoking over the seventeen years prior to the implementation of the Swedish government's first strategy for alcohol, narcotics, doping and tobacco (ANDT) in 2011. We also sought to explain the changes over time in terms of changes in the population distribution of selected demographic and socioeconomic characteristics. Our two key research questions, for each of alcohol, narcotics and smoking were: 1) How have trends in a) consumption, inpatient care and deaths, and b) income-related inequalities therein developed over time? 2) To what extent can demographic (gender, age, civil status, foreign background), socioeconomic (parental education, own education) and social characteristics (social isolation, proportion of welfare recipients in the municipality) explain the trends in a) levels of consumption, inpatient care and deaths, and b) income-related inequalities therein? For consumption, we investigated the prevalence of heavy drinking and smoking; data on narcotics use were not available. We used International Classification of Diseases (ICD) codes to identify inpatient care and deaths related to alcohol, narcotics and smoking. In our main analyses we used income as a measure of socioeconomic rank. We performed sensitivity analyses to investigate: i) the use of education as an alternative socioeconomic rank, ii) differences between measures of relative and absolute inequality, and iii) sex-differences in the trends over time. We document increasing pro-poor socioeconomic-related inequalities in all of our outcomes except heavy drinking (which was concentrated among higher income individuals, and did not change significantly) during the study period. This reflects an increasing concentration of smoking, and inpatient care and deaths related to alcohol, narcotics and smoking among low income individuals. We are able to explain some of the change ...

This study compares the evolution of income-related health inequality (IRHI) in Australia (2001–2006) and in Great Britain (1999–2004) by exploring patterns of morbidity- and mortality-related health changes across income groups. Using Australian longitudinal data, the change in health inequality is decomposed into those changes related to health changes (income-related health mobility) and income changes (health-related income mobility), and compared with recent results from Great Britain. Absolute IRHI increased for both sexes, indicating greater absolute health inequality in Australia over this period, similar to that seen in Great Britain. The income-related health mobility indicates that this was due to health losses over this period being concentrated in those initially poor who were significantly more likely to die. The health-related income mobility further indicates that those who moved up the income distribution during the period were more likely to be those who were healthy. Australian estimates of mobility measures are similar, if not greater, in magnitude than for Great Britain. While reducing health inequality remains high on the political agenda in Great Britain, it has received less attention in Australia even though the evidence provided here suggests it should receive more attention.

AbstractThe value of a statistical life (VSL) is a widely used measure for the value of mortality risk reduction. As VSL should reflect preferences and attitudes to risk, there are reasons to believe that it varies depending on the type of risk involved. It has been argued that cancer should be considered a "dread disease," which supports the use of a "cancer premium." The objective of this study is to investigate the existence of a cancer premium (for pancreatic cancer and multiple myeloma) in relation to road traffic accidents, sudden cardiac arrest, and amyotrophic lateral sclerosis (ALS). Data were collected from 500 individuals in the Swedish general population of 50–74‐year olds using a web‐based questionnaire. Preferences were elicited using the contingent valuation method, and a split‐sample design was applied to test scale sensitivity. VSL differs significantly between contexts, being highest for ALS and lowest for road traffic accidents. A premium (92–113%) for cancer was found in relation to road traffic accidents. The premium was higher for cancer with a shorter time from diagnosis to death. A premium was also found for sudden cardiac arrest (73%) and ALS (118%) in relation to road traffic accidents. Eliminating risk was associated with a premium of around 20%. This study provides additional evidence that there exist a dread premium and risk elimination premium. These factors should be considered when searching for an appropriate value for economic evaluation and health technology assessment.

To decide how much resources to spend on reducing mortality risk, governmental agencies in several countries turn to the value of a statistical life (VSL). VSL has been shown to vary depending on the size of the risk reduction, which indicates that WTP does not increase near-proportional in relation to risk reduction as suggested by standard economic theory. Chained approach (CA) is a stated preference method that was designed to deal with this problem. The objective of this study was to compare CA to the more traditional approach contingent valuation (CV). Data was collected from 500 individuals in the Swedish adult general population using two web-based questionnaires, whereof one based on CA and the other on the CV method. Despite the two different ways of deriving the estimates, the methods showed similar results. The CV result showed scale insensitivity with respect to the size of the risk reduction and disease duration and resulted in more zero and protest response. The CA result did also vary depending on the procedure used, but not when chaining on individual estimates. The CA result was also found to be more sensitive to disease duration and severity. This study provides support for the validity of studies of the WTP for a risk reduction. It also shows that CA is associated with encouraging features for the valuation of non-fatal road traffic accidents, but the result does not support the use of one method over the other.

SUMMARY
We investigate two parallel school reforms in Sweden to assess the long-run health effects of education. One reform only increased years of schooling, while the other increased years of schooling but also removed tracking leading to a more mixed socioeconomic peer group. By differencing the effects of the parallel reforms we separate the effect of de-tracking and peers from that of more schooling. We find that the pure years of schooling reform reduced mortality and improved current health. Differencing the effects of the reforms shows significant differences in the estimated impacts, suggesting that de-tracking and subsequent peer effects resulted in worse health.

Objective: Our study aims to evaluate hypertensive case management in South Africa's public health sector using simulated patients. Method: Our study describes interactions between hypertensive simulated patients and primary healthcare workers at 39 public sector healthcare facilities in two metropolitan centres in the Eastern and Western Cape Provinces of South Africa. Our analysis focus on 97 interactions where our eight simulated patients tested within range for stage 1 hypertension, that is with SBP 140–159 mmHg and/or DBP 90–99 mmHg. For this subset, we describe how healthcare workers communicated the outcome of the blood pressure test, and whether they follow government guidelines on risk assessment and lifestyle advice. Results: Healthcare workers highlighted the risks associated with hypertension in one out of three cases and stressed the importance of regular monitoring of blood pressure in less than half of cases. Hypertensive patients received advice on all six lifestyle risk factors in 8% of cases. 39% of patients received no lifestyle advice at all. In one out of four cases, hypertensive patients left the facility without a hypertension diagnosis and with no prospect of a follow-up visit. Conclusion: Simulated patients can assess the quality of hypertension case management, yielding granular and comprehensive information that can help mobilize resources to improve care. The management of hypertension patients in South African public healthcare facilities is critically insufficient. Given that hypertension is responsible for a rising share of deaths in South Africa and many of these deaths are preventable, urgent intervention is needed