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Inefficiencies in a healthcare system with a regulatory split of power: a spatial panel data analysis of avoidable hospitalisations in Austria. 效率低下的医疗保健系统与监管权力分裂:空间面板数据分析可避免住院在奥地利。
Pub Date : 2020-02-01 Epub Date: 2019-09-09 DOI: 10.1007/s10198-019-01113-7
Anna-Theresa Renner

Despite generous universal social health insurance with little formal restrictions of outpatient utilisation, Austria exhibits high rates of avoidable hospitalisations, which indicate the inefficient provision of primary healthcare and might be a consequence of the strict regulatory split between the Austrian inpatient and outpatient sector. This paper exploits the considerable regional variations in acute and chronic avoidable hospitalisations in Austria to investigate whether those inefficiencies in primary care are rather related to regional healthcare supply or to population characteristics. To explicitly account for inter-regional dependencies, spatial panel data methods are applied to a comprehensive administrative dataset of all hospitalisations from 2008 to 2013 in the 117 Austrian districts. The initial selection of relevant covariates is based on Bayesian model averaging. The results of the analysis show that supply-side variables, such as the number of general practitioners, are significantly associated with decreased chronic and acute avoidable hospitalisations, whereas characteristics of the regional population, such as the share of population with university education or long-term unemployed, are less relevant. Furthermore, the spatial error term indicates that there are significant spatial dependencies between unobserved characteristics, such as practice style or patients' utilization behaviour. Not accounting for those would result in omitted variable bias.

尽管有慷慨的全民社会健康保险,对门诊病人的使用几乎没有正式限制,但奥地利可避免的住院率很高,这表明初级保健的提供效率低下,可能是奥地利住院和门诊部门之间严格的监管分歧的结果。本文利用奥地利急性和慢性可避免住院的相当大的区域差异来调查初级保健的效率低下是否与区域医疗保健供应或人口特征有关。为了明确考虑区域间的依赖关系,空间面板数据方法应用于奥地利117个地区2008年至2013年所有住院的综合行政数据集。相关协变量的初始选择基于贝叶斯模型平均。分析结果表明,供应方面的变量,如全科医生的数量,与减少慢性和急性可避免的住院治疗显著相关,而区域人口的特征,如受过大学教育或长期失业的人口比例,相关性较低。此外,空间误差项表明,在未观察到的特征(如执业风格或患者的利用行为)之间存在显著的空间依赖性。不考虑这些因素会导致忽略变量偏差。
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引用次数: 0
Non-compensatory aggregation method to measure social and material deprivation in an urban area: relationship with premature mortality 衡量城市地区社会和物质剥夺的非补偿性汇总方法:与过早死亡的关系
Pub Date : 2019-12-06 DOI: 10.1007/s10198-019-01139-x
Carolina Bruzzi, Enrico Ivaldi, S. Landi
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引用次数: 15
Correction to: Cost–consequence analysis of fluticasone furoate/vilanterol for asthma management in Spain: an analysis based on the Salford Lung Study in asthma 更正:在西班牙,糠酸氟替卡松/维兰特罗用于哮喘治疗的成本-后果分析:基于哮喘索尔福德肺部研究的分析
Pub Date : 2019-12-04 DOI: 10.1007/s10198-019-01137-z
L. Vallejo-Aparicio, J. Molina, I. Ojanguren, A. Viejo Casas, A. Huerta, H. Svedsater
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引用次数: 0
Stratified medicine in schizophrenia: how accurate would a test of drug response need to be to achieve cost-effective improvements in quality of life? 精神分裂症的分层药物治疗:药物反应测试需要多精确才能达到具有成本效益的生活质量改善?
Pub Date : 2019-12-01 Epub Date: 2019-08-28 DOI: 10.1007/s10198-019-01108-4
Huajie Jin, Paul McCrone, James H MacCabe

Objective: Stratified medicine refers to the use of tests that predict treatment response to drive treatment decisions for individual patient. The pharmacoeconomic implications of this approach in schizophrenia are unknown. We aimed to assess the cost-effectiveness of a hypothetical stratified medicine algorithm (SMA) compared with treatment as usual (TAU), for patients with schizophrenia who failed a first-line antipsychotic.

Methods: A decision analytic model with embedded Markov process was constructed, which simulated the health and cost outcomes for patients followed SMA or TAU over a lifetime horizon, from healthcare and social care perspective. In the base-case analysis, sensitivity and specificity of the stratifier were both set as 60%. Extensive sensitivity analyses were conducted to test the impact of uncertainty around the value of important parameters. The primary outcome was the incremental cost per quality-adjusted life year (QALY) gained.

Results: When both sensitivity and specificity of the stratified test were set at 60%, SMA appeared to be the optimal strategy as it produces more QALYs and incurs lower costs than TAU. This is robust to all scenarios tested. At a willingness-to-pay threshold of £20,000 per QALY, the probability for SMA to be the optimal strategy is 82.4%.

Conclusions: Our results suggest that use of any stratifier with a sensitivity and specificity over 60% is very likely to be cost-effective comparing to TAU, for psychotic patients who failed a first-line antipsychotic. This finding, however, should be interpreted with caution due to lack of evidence for clozapine as a second-line antipsychotic.

目的:分层医学是指使用预测治疗反应的测试来驱动个体患者的治疗决策。这种方法在精神分裂症中的药物经济学意义尚不清楚。我们的目的是评估一种假设的分层药物算法(SMA)与常规治疗(TAU)相比,对一线抗精神病药物治疗失败的精神分裂症患者的成本效益。方法:构建嵌入马尔可夫过程的决策分析模型,从医疗保健和社会护理的角度,模拟SMA或TAU患者一生的健康和成本结果。在基础病例分析中,分层器的敏感性和特异性均设定为60%。进行了广泛的敏感性分析,以测试围绕重要参数值的不确定性的影响。主要结局是获得的每质量调整生命年(QALY)的增量成本。结果:当分层试验的敏感性和特异性均设置为60%时,SMA似乎是最佳策略,因为它比TAU产生更多的qaly并且成本更低。这对于所有经过测试的场景都是健壮的。在每个QALY的支付意愿阈值为20,000英镑时,SMA成为最优策略的概率为82.4%。结论:我们的研究结果表明,对于一线抗精神病药物治疗失败的精神病患者,与TAU相比,使用任何敏感性和特异性超过60%的分层剂都很可能具有成本效益。然而,由于缺乏氯氮平作为二线抗精神病药的证据,应该谨慎解释这一发现。
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引用次数: 0
The societal monetary value of a QALY associated with EQ-5D-3L health gains 与EQ-5D-3L健康收益相关的QALY的社会货币价值
Pub Date : 2019-11-28 DOI: 10.1007/s10198-019-01140-4
L. Vallejo-Torres, B. García-Lorenzo, O. Rivero-Arias, J. Pinto-Prades
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引用次数: 8
Economic evaluation of meningococcal vaccines: considerations for the future 脑膜炎球菌疫苗的经济评价:对未来的考虑
Pub Date : 2019-11-21 DOI: 10.1007/s10198-019-01129-z
H. Christensen, H. Al-Janabi, P. Levy, M. Postma, D. Bloom, Paolo Landa, O. Damm, D. Salisbury, J. Díez-Domingo, A. Towse, P. Lorgelly, K. Shah, K. Hernandez-villafuerte, Vinny Smith, L. Glennie, C. Wright, L. York, R. Farkouh
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引用次数: 23
Unfolding the relationship between mortality, economic fluctuations, and health in Italy 揭示意大利死亡率、经济波动和健康之间的关系
Pub Date : 2019-11-20 DOI: 10.1007/s10198-019-01135-1
Maddalena Cavicchioli, B. Pistoresi
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引用次数: 6
Cost-effectiveness analysis of the Neuropad device as a screening tool for early diabetic peripheral neuropathy Neuropad装置作为早期糖尿病周围神经病变筛查工具的成本-效果分析
Pub Date : 2019-11-12 DOI: 10.1007/s10198-019-01134-2
B. Rodríguez-Sánchez, L. M. Peña-Longobardo, A. Sinclair
{"title":"Cost-effectiveness analysis of the Neuropad device as a screening tool for early diabetic peripheral neuropathy","authors":"B. Rodríguez-Sánchez, L. M. Peña-Longobardo, A. Sinclair","doi":"10.1007/s10198-019-01134-2","DOIUrl":"https://doi.org/10.1007/s10198-019-01134-2","url":null,"abstract":"","PeriodicalId":22450,"journal":{"name":"The European Journal of Health Economics","volume":"44 1","pages":"335-349"},"PeriodicalIF":0.0,"publicationDate":"2019-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85756518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Trends in rates of orthopedic surgery in Germany: the good, the bad, and the ugly 德国骨科手术率的趋势:好的,坏的和丑陋的
Pub Date : 2019-11-11 DOI: 10.1007/s10198-019-01133-3
A. Gandjour
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引用次数: 0
Survival and costs of colorectal cancer treatment and effects of changing treatment strategies: a model approach 结直肠癌治疗的生存和成本以及改变治疗策略的效果:一个模型方法
Pub Date : 2019-11-09 DOI: 10.1007/s10198-019-01130-6
P. Joranger, A. Nesbakken, H. Sorbye, G. Hoff, A. Oshaug, E. Aas
{"title":"Survival and costs of colorectal cancer treatment and effects of changing treatment strategies: a model approach","authors":"P. Joranger, A. Nesbakken, H. Sorbye, G. Hoff, A. Oshaug, E. Aas","doi":"10.1007/s10198-019-01130-6","DOIUrl":"https://doi.org/10.1007/s10198-019-01130-6","url":null,"abstract":"","PeriodicalId":22450,"journal":{"name":"The European Journal of Health Economics","volume":"1 1","pages":"321-334"},"PeriodicalIF":0.0,"publicationDate":"2019-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75012555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
期刊
The European Journal of Health Economics
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