from The Academic Health Economists’ Blo… at https://bit.ly/3jp44qg on October 26, 2020 at 12:03PM
Every Monday our authors provide a round-up of the latest peer-reviewed journal publications. We cover all issues of major health economics journals as well as some other notable releases. If you’d like to write one of our weekly journal round-ups, get in touch.
Volume 21, Issue 8
This issue of EJHE opens with an editorial on how health technology assessment might become more ‘patient-centric’. In some senses, HTA agencies have been ahead of the curve in the inclusion of patient perspectives, relative to other players within our discipline. Yet, as the authors explain, there is little consensus on the most appropriate approach. For starters, the definition of ‘patient’ should probably include all past, present, and potential beneficiaries of technologies being assessed (i.e. everyone). The authors broadly accept the notion that more patient input is a good thing and describe a few ways in which HTA might become more patient-centric, such as encouraging patient participation and expanding the scope of value assessment.
Another study reports on a review to identify which multi-attribute utility instruments (‘preference accompanied measures‘?) are recommended by HTA agencies. The study was funded by the EuroQol group and you won’t be surprised to learn that the EQ-5D comes out on top across 34 official guidelines. One country that prefers the EQ-5D is Bulgaria, and this issue includes a study reporting EQ-5D-5L population norms for the country. Other measures don’t really get a look-in when it comes to being preferred in guidelines, though plenty of others at least get a mention. I’m a fan of the EQ-5D, but its outright dominance resembles a kind of VHS vs Betamax battle (or Blu-ray vs HD DVD, for the kids), and that doesn’t seem right. Multi-attribute utility instruments aren’t interchangeable, but neither are they totally incompatible.
There are also multi-attribute pseudo-utility instruments (pseudo because they aren’t supposed to measure utility but they are totally used to do so). Perhaps most popular among these is the ICECAP-A. This issue includes an application of the well-being valuation approach to health (using the EQ-5D-5L) and capabilities (using the ICECAP-A). The researchers conducted an online survey with participants in the UK. The main finding was that a year in full health (a QALY), based on the EQ-5D, was worth a lot less than a year in full capability (a CALY?), based on the ICECAP-A: £30,786 vs £66,597.
There’s a real mix of subject matter in this issue; plenty for those of you not interested in outcome measurement. There are a few useful studies on economic evaluation, both applied and methodological. One study reports on a trial-based economic evaluation in the context of myocardial infarction. Another reports on a review and meta-analysis of evidence for integrated care. A study to identify unit costs in the context of diabetes will be useful for anybody evaluating relevant interventions in France, Germany, or Italy.
Italy is particularly well represented in this issue, with studies on geographical variation in hospital quality and a study on informal care from outside of the household also using Italian data. Of most interest to me was a study on the impact of the Great Recession on mental health care in Italy. Given our current situation, research on the impact of economic downturns is particularly useful right now. The authors use panel data and regional variation to identify the causal effect of the unemployment rate on hospital admissions. A 1% point increase in unemployment was associated with one extra admission per 100,000 residents. And the effect was concentrated in disadvantaged areas.
Volume 10, September 2020
I’ve written before about my scepticism for the use of a ‘societal perspective’ in economic evaluation. So I was pleased to see a review of the use of the societal perspective in depression in HER last month. The headline finding is that around a quarter of the studies included in the review found differential results depending on whether a health care or a societal perspective was adopted. It seems that the quality of the methodology and reporting for the included studies was quite poor, and it would have been good to see some more constructive criticism from the authors of the review. The authors make the case that productivity losses tend to be important in the context of depression and should be considered in the design of an analysis.
There’s an intriguing study on the impact of mystery shoppers on prescribing behaviour in China. I haven’t read any research on mystery shoppers in health care before (I’m sure there is lots), but it is a pleasingly simple idea for quality improvement. In this study, the authors found that the overall probability of prescribing was reduced, but not specifically for antibiotics. Moving to the supply-side determinants of drug expenditures, we have a study on the role of generic competition in South Korea, where there are a large number of generic manufacturers. Most of the 986 drugs included in the review faced a low level of generic competition, and for these there was a low level of price variance. For the 13% or so drugs facing greater competition, price variance was much higher.
Volume 22, Issue 3
Another week and another journal that I didn’t know existed. This is the first issue I’ve ever seen but, if it’s anything to go by, this journal publishes research relevant to health economists.
This issue only includes two proper studies. One is from the behavioural economics camp on the role of motivated beliefs in diabetes self-management. Based on research with 100 people with diabetes, the authors find evidence that people identify a BMI (greater than their own) at which they should start preventive efforts, and that this is associated with people’s engagement in self-management. Back to Italy, the other study is on inequalities in smoking. Using survey data, the authors demonstrate that inequality is pro-rich among men, while the opposite is true for women.