This OHE Occasional Paper by Adrian Towse discusses Professor Bengt Jonsson's observations in a 2011 publication about the role of relative effectiveness research (RE) in the European medicines market and how this could lead to improved efficiency in the development of medicines, the pricing and use of medicines, and of health systems. To ensure value for money, understanding actual use of medicines in the health care system is an essential supplement to information from clinical trials. To move in this direction, the author sets out the efficiency criteria that would need to be met. He defines a deceptively simple challenge - creating an environment where choice of therapy is based on an optimal amount of evidence from relative effectiveness research that is generated and used efficiently across health care systems both within Europe and as between the US and Europe. He identifies three sets of changes that must occur to meet the challenge - 1. A new drug development paradigm supported by regulatory authorities, HTA agencies and pharmaceutical companies that encourages the efficient collection of RE data before and after a medicine reaches the market. 2. Concerted efforts to eliminate the currently costly duplication across countries in infrastructure and RE-based assessments. 3. Understanding how and how well individual health systems use and benefit from new medicines, both to identify when expected differences mean country-specific RE may be needed and help identify instances where health systems use treatments inefficiently. The author notes that 'appraisal of RE evidence should edge both parties towards efficient pricing and use of a new drug on the assumption that pricing and use will reflect value and, as evidence of value changes, so will price and use.' He believes EU reforms can encourage improved efficiency in various ways. He is somewhat less optimistic about trans-Atlantic convergence, although he argues that, ironically, convergence on the mutual use of CER/RE evidence could occur before convergence of FDA and EMA approaches to efficacy and relative efficacy.
{"title":"Comparative and Relative Effectiveness: A Challenge for Health Systems, Regulators, or Pharmaceutical Companies?","authors":"A. Towse","doi":"10.2139/ssrn.2637910","DOIUrl":"https://doi.org/10.2139/ssrn.2637910","url":null,"abstract":"This OHE Occasional Paper by Adrian Towse discusses Professor Bengt Jonsson's observations in a 2011 publication about the role of relative effectiveness research (RE) in the European medicines market and how this could lead to improved efficiency in the development of medicines, the pricing and use of medicines, and of health systems. To ensure value for money, understanding actual use of medicines in the health care system is an essential supplement to information from clinical trials. To move in this direction, the author sets out the efficiency criteria that would need to be met. He defines a deceptively simple challenge - creating an environment where choice of therapy is based on an optimal amount of evidence from relative effectiveness research that is generated and used efficiently across health care systems both within Europe and as between the US and Europe. He identifies three sets of changes that must occur to meet the challenge - 1. A new drug development paradigm supported by regulatory authorities, HTA agencies and pharmaceutical companies that encourages the efficient collection of RE data before and after a medicine reaches the market. 2. Concerted efforts to eliminate the currently costly duplication across countries in infrastructure and RE-based assessments. 3. Understanding how and how well individual health systems use and benefit from new medicines, both to identify when expected differences mean country-specific RE may be needed and help identify instances where health systems use treatments inefficiently. The author notes that 'appraisal of RE evidence should edge both parties towards efficient pricing and use of a new drug on the assumption that pricing and use will reflect value and, as evidence of value changes, so will price and use.' He believes EU reforms can encourage improved efficiency in various ways. He is somewhat less optimistic about trans-Atlantic convergence, although he argues that, ironically, convergence on the mutual use of CER/RE evidence could occur before convergence of FDA and EMA approaches to efficacy and relative efficacy.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"10 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132390278","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}
Pub Date : 2014-11-16DOI: 10.16935/EJSS.2014.30.2.004
Sheery Cummings, S. Trecartin, Lyle Cooper
Older adults represent the fastest growing segment of the worldwide population. Mental health disorders present a major challenge to older individuals. Depression and anxiety are two of the most common mental health problems experienced by the older population and give rise to high impact adverse consequences, such as decreased quality of life and increased mortality. Poverty level older adults suffer from higher rates of mental health disorders than do their more highly resourced counterparts. Given worldwide growth of the older population an increasing number of low-income elderly live in public housing. This study examined the prevalence of depression and anxiety in older public housing residents and explored factors related to these disorders within context of the Social Antecedents Model of Psychopathology (SAMP). The SAMP posits a multi-stage model of cumulative demographic, behavioral and social factors that represent mental health risk correlates, with more proximal factors representing greater risk (George, 1989). Study participants included 187 older adults residing in two public housing facilities located in a mid-size city in the southeast United States. Data was gathered concerning residents’ demographic characteristics, psychiatric symptomatology, substance usage, health conditions, and social support via face-to-face interviews. The majority of the residents were male and the average age was 66.2 years (SD= 7.6). Residents reported high levels of clinically significant depression (20.1%) and anxiety (10%). Generalized linear models (GZLM) were used to identify variables that significantly predicted depression and anxiety among the residents. Social support, self-rated health, pain, years smoking, and opioid misuse were significant predictors of depression scores (LR x2 (11) = 90.4, p
老年人是世界人口中增长最快的部分。精神健康障碍是老年人面临的一个重大挑战。抑郁和焦虑是老年人最常见的两种心理健康问题，并会造成严重的不良后果，如生活质量下降和死亡率上升。处于贫困水平的老年人患精神疾病的比率高于资源更丰富的老年人。鉴于全球老年人口的增长，越来越多的低收入老年人住在公共住房中。本研究探讨了老年公屋居民抑郁和焦虑的患病率，并在精神病理学社会前因模型(SAMP)的背景下探讨了与这些疾病相关的因素。SAMP假设了一个多阶段的累积人口、行为和社会因素模型，这些因素代表着心理健康风险的相关性，更近的因素代表着更大的风险(George, 1989)。研究参与者包括187名老年人，他们居住在位于美国东南部一个中等城市的两个公共住房设施中。通过面对面访谈收集有关居民人口统计学特征、精神症状、物质使用、健康状况和社会支持的数据。男性居多，平均年龄66.2岁(SD= 7.6)。居民报告了高水平的临床显著抑郁(20.1%)和焦虑(10%)。采用广义线性模型(GZLM)识别显著预测居民抑郁和焦虑的变量。社会支持、自评健康、疼痛、吸烟年数和阿片类药物滥用是抑郁评分的显著预测因子(LR x2 (11) = 90.4, p
{"title":"Correlates of Depression and Anxiety Among Older Public Housing Residents","authors":"Sheery Cummings, S. Trecartin, Lyle Cooper","doi":"10.16935/EJSS.2014.30.2.004","DOIUrl":"https://doi.org/10.16935/EJSS.2014.30.2.004","url":null,"abstract":"Older adults represent the fastest growing segment of the worldwide population. Mental health disorders present a major challenge to older individuals. Depression and anxiety are two of the most common mental health problems experienced by the older population and give rise to high impact adverse consequences, such as decreased quality of life and increased mortality. Poverty level older adults suffer from higher rates of mental health disorders than do their more highly resourced counterparts. Given worldwide growth of the older population an increasing number of low-income elderly live in public housing. This study examined the prevalence of depression and anxiety in older public housing residents and explored factors related to these disorders within context of the Social Antecedents Model of Psychopathology (SAMP). The SAMP posits a multi-stage model of cumulative demographic, behavioral and social factors that represent mental health risk correlates, with more proximal factors representing greater risk (George, 1989). Study participants included 187 older adults residing in two public housing facilities located in a mid-size city in the southeast United States. Data was gathered concerning residents’ demographic characteristics, psychiatric symptomatology, substance usage, health conditions, and social support via face-to-face interviews. The majority of the residents were male and the average age was 66.2 years (SD= 7.6). Residents reported high levels of clinically significant depression (20.1%) and anxiety (10%). Generalized linear models (GZLM) were used to identify variables that significantly predicted depression and anxiety among the residents. Social support, self-rated health, pain, years smoking, and opioid misuse were significant predictors of depression scores (LR x2 (11) = 90.4, p","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126306082","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}
Researchers are often interested in combined measures such as overall ratings, indices of physical or mental health, or health-related quality-of-life (HRQoL) outcomes. Such measures are typically composed of two or more underlying discrete variables. I show that estimating the effect of a treatment on the combined measure is biased with non-random treatment selection. I provide a solution to this problem by adopting an alternative estimator that first estimates treatment effects on the underlying variables and then combines these effects into an overall effect on the combined outcome of interest.
{"title":"Eliminating Aggregation Bias When Estimating Treatment Effects on Combined Outcomes with Applications to Quality of Life Assessment","authors":"Ian Paul McCarthy","doi":"10.2139/ssrn.2536521","DOIUrl":"https://doi.org/10.2139/ssrn.2536521","url":null,"abstract":"Researchers are often interested in combined measures such as overall ratings, indices of physical or mental health, or health-related quality-of-life (HRQoL) outcomes. Such measures are typically composed of two or more underlying discrete variables. I show that estimating the effect of a treatment on the combined measure is biased with non-random treatment selection. I provide a solution to this problem by adopting an alternative estimator that first estimates treatment effects on the underlying variables and then combines these effects into an overall effect on the combined outcome of interest.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115536608","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}
We propose a Weibull mixture model considering both covariates and unobserved heterogeneity to examine how demographic variables affect individual survival times and to derive the annual number of deaths. We analyze the records of patients diagnosed with lung and bronchus cancer, the most common cancer in the United States. The result shows that the diagnosis year as well as age, gender, race, and registry significantly affect individual survival times. including unobserved heterogeneity, we remove a bias in hazard rates and provide better performance in forecasting the annual number of cancer deaths than other benchmarks. Furthermore, from segmenting patients into several groups, we specify the difference between groups and assess their group-specific survival probabilities within a given period. Our study is distinctive in that a bottom-up strategy is adopted to predict aggregate-level units. This makes health forecasting available in two sides: public and private sector. For the public sector, our study enables a more precise allocation of the government’s health and welfare budget. Also for the private sector, our segmentation results provide guidance to the insurance industry for targeting customers more specifically.
{"title":"Survival Analysis of Lung and Bronchus Cancer Patients Segmented by Demographic Characteristics","authors":"D. Jun, Kyung-Hoon Kim","doi":"10.2139/ssrn.2527780","DOIUrl":"https://doi.org/10.2139/ssrn.2527780","url":null,"abstract":"We propose a Weibull mixture model considering both covariates and unobserved heterogeneity to examine how demographic variables affect individual survival times and to derive the annual number of deaths. We analyze the records of patients diagnosed with lung and bronchus cancer, the most common cancer in the United States. The result shows that the diagnosis year as well as age, gender, race, and registry significantly affect individual survival times. including unobserved heterogeneity, we remove a bias in hazard rates and provide better performance in forecasting the annual number of cancer deaths than other benchmarks. Furthermore, from segmenting patients into several groups, we specify the difference between groups and assess their group-specific survival probabilities within a given period. Our study is distinctive in that a bottom-up strategy is adopted to predict aggregate-level units. This makes health forecasting available in two sides: public and private sector. For the public sector, our study enables a more precise allocation of the government’s health and welfare budget. Also for the private sector, our segmentation results provide guidance to the insurance industry for targeting customers more specifically.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114871786","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}
We survey the main economic aspects of the creation of an AIDS vaccine. We first describe the market conditions for this vaccine, and we show the critical importance of patents to start the costly R&D process. We then describe the main economic impediments to this venture, and the main financial mechanisms in place to alleviate them. We pinpoint their pitfalls, and we finally present novel mechanisms capable of restoring economic efficiency, and of providing greater incentives for investors toundertake R&D in this vaccine.
{"title":"The Economics of an HIV/AIDS Vaccine","authors":"P. Leoni","doi":"10.2139/ssrn.2515834","DOIUrl":"https://doi.org/10.2139/ssrn.2515834","url":null,"abstract":"We survey the main economic aspects of the creation of an AIDS vaccine. We first describe the market conditions for this vaccine, and we show the critical importance of patents to start the costly R&D process. We then describe the main economic impediments to this venture, and the main financial mechanisms in place to alleviate them. We pinpoint their pitfalls, and we finally present novel mechanisms capable of restoring economic efficiency, and of providing greater incentives for investors toundertake R&D in this vaccine.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"205 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131420702","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}
It is not possible to directly observe the distribution of individual treatment effects. However, this paper presents new results showing that the distribution may be inferred with data usually available from randomized control trials. Developing upon recent results presented in the computer science, signal engineering and economics literature, the paper presents necessary and sufficient conditions for non-parametric identification of mixture distributions. The identification results provide a natural analogy to a general method of moments estimator. The paper uses the procedure to estimate the distribution in survival benefits from chemotherapy treatments of colon cancer patients. For approximately 80% of patients the addition of adjuvant chemotherapy has little effect on survival, while for 20% of patients the proportion who survive past 4 years increase thirty five percentage points. However, these treatment effects are not estimated with precision
{"title":"Estimating Heterogeneous Treatment Effects in Randomized Control Trials","authors":"C. Adams","doi":"10.2139/ssrn.2433064","DOIUrl":"https://doi.org/10.2139/ssrn.2433064","url":null,"abstract":"It is not possible to directly observe the distribution of individual treatment effects. However, this paper presents new results showing that the distribution may be inferred with data usually available from randomized control trials. Developing upon recent results presented in the computer science, signal engineering and economics literature, the paper presents necessary and sufficient conditions for non-parametric identification of mixture distributions. The identification results provide a natural analogy to a general method of moments estimator. The paper uses the procedure to estimate the distribution in survival benefits from chemotherapy treatments of colon cancer patients. For approximately 80% of patients the addition of adjuvant chemotherapy has little effect on survival, while for 20% of patients the proportion who survive past 4 years increase thirty five percentage points. However, these treatment effects are not estimated with precision","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132134061","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}
We must act decisively to fix the broken business model for antibiotics and other methods to prevent and treat bacterial diseases. These other methods include vaccines, diagnostics, infection control, and devices. Last year, the CDC issued the first national threat assessment on antimicrobial resistance. The media reported that 23,000 Americans die each year from antibacterial resistance, but the CDC estimated an additional 14,000 deaths per year from a horrible intestinal disease related to antibiotic use, Clostridium difficile. These calculations are conservative and likely undercount the true impact in the US, the equivalent of a 100-passenger jet crashing every day.Antibiotic resistance deaths in Europe are in the same range, but the situation in poorer countries is also dire. Resistant pathogens in low-income countries cause several hundred thousand neonatal sepsis deaths each year. Similar numbers of people die in low-income countries from susceptible bacteria, so we face an antibiotic access crisis in addition to the global problem of resistance. Much of our world lives in a pre-antibiotic era.Future projections are much worse. If we lose antibiotics as a drug class, the social cost may be more than a trillion dollars, shaving several years off life expectancy and making many modern medical procedures either impossible or much more dangerous.The ability to prevent and treat bacterial diseases is a global common pool resource of immense value, akin to fisheries. Exhausting this resource is cheap and lazy; preserving it will take concerted effort and substantial resources. These future expenditures are an investment in the continued effectiveness of one of the greatest classes of drugs ever discovered. Consider this as an “insurance premium,” protecting us against the post-antibiotic era.
{"title":"Testimony of Kevin Outterson (Boston University School of Law) to the House Energy and Commerce Committee, September 19, 2014","authors":"K. Outterson","doi":"10.2139/SSRN.2500799","DOIUrl":"https://doi.org/10.2139/SSRN.2500799","url":null,"abstract":"We must act decisively to fix the broken business model for antibiotics and other methods to prevent and treat bacterial diseases. These other methods include vaccines, diagnostics, infection control, and devices. Last year, the CDC issued the first national threat assessment on antimicrobial resistance. The media reported that 23,000 Americans die each year from antibacterial resistance, but the CDC estimated an additional 14,000 deaths per year from a horrible intestinal disease related to antibiotic use, Clostridium difficile. These calculations are conservative and likely undercount the true impact in the US, the equivalent of a 100-passenger jet crashing every day.Antibiotic resistance deaths in Europe are in the same range, but the situation in poorer countries is also dire. Resistant pathogens in low-income countries cause several hundred thousand neonatal sepsis deaths each year. Similar numbers of people die in low-income countries from susceptible bacteria, so we face an antibiotic access crisis in addition to the global problem of resistance. Much of our world lives in a pre-antibiotic era.Future projections are much worse. If we lose antibiotics as a drug class, the social cost may be more than a trillion dollars, shaving several years off life expectancy and making many modern medical procedures either impossible or much more dangerous.The ability to prevent and treat bacterial diseases is a global common pool resource of immense value, akin to fisheries. Exhausting this resource is cheap and lazy; preserving it will take concerted effort and substantial resources. These future expenditures are an investment in the continued effectiveness of one of the greatest classes of drugs ever discovered. Consider this as an “insurance premium,” protecting us against the post-antibiotic era.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117254473","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}
We examine the economic and social determinants of suicide mortality in a panel of 25 OECD countries over the period 1970 – 2011 and explicitly analyze the effects of unemployment and labor market institutions on suicide rates. In line with a large body of literature our results suggest that unemployment increases suicide mortality, while real economic growth tends to decrease suicides. The results also indicate that unemployment benefits decrease suicides of males, while relatively strict employment protection regulations have a positive influence on suicide mortality. These findings indicate that labor market institutions may influence job satisfaction and the quality of life in industrial countries. We suggest taking into account the role of labor market institutions when analyzing the effects of institutional and economic determinants on health.
{"title":"Do Labor Market Institutions Influcence Suicide Mortality? An International Panel Data Analysis","authors":"Christian Breuer, H. Rottmann","doi":"10.2139/ssrn.2469743","DOIUrl":"https://doi.org/10.2139/ssrn.2469743","url":null,"abstract":"We examine the economic and social determinants of suicide mortality in a panel of 25 OECD countries over the period 1970 – 2011 and explicitly analyze the effects of unemployment and labor market institutions on suicide rates. In line with a large body of literature our results suggest that unemployment increases suicide mortality, while real economic growth tends to decrease suicides. The results also indicate that unemployment benefits decrease suicides of males, while relatively strict employment protection regulations have a positive influence on suicide mortality. These findings indicate that labor market institutions may influence job satisfaction and the quality of life in industrial countries. We suggest taking into account the role of labor market institutions when analyzing the effects of institutional and economic determinants on health.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115356541","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}
India is the global epicentre of the HIV/AIDS epidemic in Asia. Previous research indicates that the majority of HIV-positive women in India were infected by their husbands, their only sexual partner, which makes them difficult to identify as a high-risk population. This paper assesses social factors associated with the transmission of HIV based on demographic determinants, such as age; sexual risk behavior; and gendered discrimination, such as domestic violence. Bivariate and multivariate analysis of the National Family Health Survey yields the result that women's socioeconomic status could have an association with their serostatus, as HIV-positive women were significantly more likely to have a low level of education than their HIV-negative counterparts. In contrast, female HIV-positive respondents displayed low tendencies toward high-risk sexual behavior, as less than 10% had two or more sexual partners in their lifetime. Finally, they were significantly more likely to have previously experienced domestic violence (45%) and sexual violence (22%) than the general population. Overall, results illustrate that Indian women's vulnerability toward HIV infection may not be the product of their own sexual risk behavior. The most prominent social factors are their socioeconomic status, such as their level of education, and other sociodemographic determinants, including their region of residence.
{"title":"Social Factors Affecting Women's Susceptibility to HIV in India","authors":"P. Lall","doi":"10.2139/ssrn.2454257","DOIUrl":"https://doi.org/10.2139/ssrn.2454257","url":null,"abstract":"India is the global epicentre of the HIV/AIDS epidemic in Asia. Previous research indicates that the majority of HIV-positive women in India were infected by their husbands, their only sexual partner, which makes them difficult to identify as a high-risk population. This paper assesses social factors associated with the transmission of HIV based on demographic determinants, such as age; sexual risk behavior; and gendered discrimination, such as domestic violence. Bivariate and multivariate analysis of the National Family Health Survey yields the result that women's socioeconomic status could have an association with their serostatus, as HIV-positive women were significantly more likely to have a low level of education than their HIV-negative counterparts. In contrast, female HIV-positive respondents displayed low tendencies toward high-risk sexual behavior, as less than 10% had two or more sexual partners in their lifetime. Finally, they were significantly more likely to have previously experienced domestic violence (45%) and sexual violence (22%) than the general population. Overall, results illustrate that Indian women's vulnerability toward HIV infection may not be the product of their own sexual risk behavior. The most prominent social factors are their socioeconomic status, such as their level of education, and other sociodemographic determinants, including their region of residence.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127882135","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}
Worawan Chandoevwit, K. Thampanishvong, Rattanakarun Rojjananukulpong
This study uses the social return on investment (SROI) method to evaluate selected health promotion programs supported by Thai Health Promotion Foundation. The selected programs include one issue-based program, i.e., food and nutrition, and three target-based programs, namely disabled persons, the elderly, and children and youth. SROI is a useful method for measuring the social impacts of projects or programs. It enables monetizing the social values of projects through the use of financial proxies. The method is transparent and based on cost-benefit analysis. It was found that social investment provides positive returns to the general public. Programs focusing on food and nutrition can cover a wide range of the population with low investment. The return is about 10 baht for each baht of investment. Programs on children and youth provide about half that of programs on food and nutrition. Health promotion programs for disabled persons and the elderly provide much lower return on investment than the other two programs. One reason is because programs for disabled persons and the elderly were started off later than the other two programs.
{"title":"Social Return on Investment: Health Promotion Programs","authors":"Worawan Chandoevwit, K. Thampanishvong, Rattanakarun Rojjananukulpong","doi":"10.2139/ssrn.2497017","DOIUrl":"https://doi.org/10.2139/ssrn.2497017","url":null,"abstract":"This study uses the social return on investment (SROI) method to evaluate selected health promotion programs supported by Thai Health Promotion Foundation. The selected programs include one issue-based program, i.e., food and nutrition, and three target-based programs, namely disabled persons, the elderly, and children and youth. SROI is a useful method for measuring the social impacts of projects or programs. It enables monetizing the social values of projects through the use of financial proxies. The method is transparent and based on cost-benefit analysis. It was found that social investment provides positive returns to the general public. Programs focusing on food and nutrition can cover a wide range of the population with low investment. The return is about 10 baht for each baht of investment. Programs on children and youth provide about half that of programs on food and nutrition. Health promotion programs for disabled persons and the elderly provide much lower return on investment than the other two programs. One reason is because programs for disabled persons and the elderly were started off later than the other two programs.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"264 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116165916","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}
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