A stated objective of the Australian Plain Packaging Act 2011 is to reduce smoking prevalence. We use the Roy Morgan Single Source (Australia) data set over the time period January 2001 to December 2013 to analyze whether this goal has been achieved in the first year since the implementation. In particular, we carry out a statistical trend analysis to study the (possible) effect of plain packaging on smoking prevalence. Two informative analyses help to draw conclusions on the (actual) effect of plain packaging on smoking prevalence in Australia. First, we look at the year of data before plain packaging was introduced, which happened in December 2012. Second, we compute confidence intervals around the estimated treatment effects. Our main results can be summarized as follows. First, if a statistical significance level of 5% is required, then there is no evidence at all for a plain packaging effect on smoking prevalence. Second, if one is willing to accept a relatively low level of statistical significance (that is, 10%), then there is evidence for a very short-lived plain packaging effect on smoking prevalence, namely in December 2012 only (after which smoking prevalence is statistically indistinguishable from its pre-existing trend). A formal power analysis demonstrates that the power of our inference methods is remarkably high.
{"title":"The (Possible) Effect of Plain Packaging on Smoking Prevalence in Australia: A Trend Analysis","authors":"A. Kaul, Michael Wolf","doi":"10.2139/ssrn.2460704","DOIUrl":"https://doi.org/10.2139/ssrn.2460704","url":null,"abstract":"A stated objective of the Australian Plain Packaging Act 2011 is to reduce smoking prevalence. We use the Roy Morgan Single Source (Australia) data set over the time period January 2001 to December 2013 to analyze whether this goal has been achieved in the first year since the implementation. In particular, we carry out a statistical trend analysis to study the (possible) effect of plain packaging on smoking prevalence. Two informative analyses help to draw conclusions on the (actual) effect of plain packaging on smoking prevalence in Australia. First, we look at the year of data before plain packaging was introduced, which happened in December 2012. Second, we compute confidence intervals around the estimated treatment effects. Our main results can be summarized as follows. First, if a statistical significance level of 5% is required, then there is no evidence at all for a plain packaging effect on smoking prevalence. Second, if one is willing to accept a relatively low level of statistical significance (that is, 10%), then there is evidence for a very short-lived plain packaging effect on smoking prevalence, namely in December 2012 only (after which smoking prevalence is statistically indistinguishable from its pre-existing trend). A formal power analysis demonstrates that the power of our inference methods is remarkably high.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"60 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":"127837820","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}
D. Pahud, Lesa Mitchell, J. Wilbanks, Melissa Stevens, S. Weir, John McBride, Lili M. Portilla, E. Pezalla, Michael A. Nameth, B. O'Donoghue, A. Rai, D. Lappin, M. Ogle, Scott Howell
A diverse set of stakeholders within health care came together in the fall of 2013 to brainstorm potential new commercial paths for repurposed drugs for the treatment of rare diseases. This report highlights some of the identified solutions that potentially could create the right set of incentives for the efficient and accelerated development and delivery of needed therapies for patients suffering from rare diseases.
{"title":"A New Market Access Path for Repurposed Drugs","authors":"D. Pahud, Lesa Mitchell, J. Wilbanks, Melissa Stevens, S. Weir, John McBride, Lili M. Portilla, E. Pezalla, Michael A. Nameth, B. O'Donoghue, A. Rai, D. Lappin, M. Ogle, Scott Howell","doi":"10.2139/SSRN.2437502","DOIUrl":"https://doi.org/10.2139/SSRN.2437502","url":null,"abstract":"A diverse set of stakeholders within health care came together in the fall of 2013 to brainstorm potential new commercial paths for repurposed drugs for the treatment of rare diseases. This report highlights some of the identified solutions that potentially could create the right set of incentives for the efficient and accelerated development and delivery of needed therapies for patients suffering from rare diseases.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126317862","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}
A growing literature in economics and other disciplines has tied exposure to early health shocks, particularly in utero influenza, to reductions in a variety of socioeconomic and health outcomes over the life course. However, no current evidence exists that examines this health shock on mortality because of lack of available data. This paper uses newly released files from the large, representative National Longitudinal Mortality Study to explore the mortality effects of the 1918 influenza pandemic for those in utero. While the results on socioeconomic outcomes mimic those in the literature, showing reductions in completed schooling and income fifty years following influenza exposure, the findings also suggest no effect on overall mortality or by categories of cause-of-death. These results are counter-intuitive in their contrast with the many reported effects on cardiovascular health as well as the literature linking education with later mortality
{"title":"Examining the Long Term Mortality Effects of Early Health Shocks","authors":"Jason M. Fletcher","doi":"10.2139/ssrn.2423544","DOIUrl":"https://doi.org/10.2139/ssrn.2423544","url":null,"abstract":"A growing literature in economics and other disciplines has tied exposure to early health shocks, particularly in utero influenza, to reductions in a variety of socioeconomic and health outcomes over the life course. However, no current evidence exists that examines this health shock on mortality because of lack of available data. This paper uses newly released files from the large, representative National Longitudinal Mortality Study to explore the mortality effects of the 1918 influenza pandemic for those in utero. While the results on socioeconomic outcomes mimic those in the literature, showing reductions in completed schooling and income fifty years following influenza exposure, the findings also suggest no effect on overall mortality or by categories of cause-of-death. These results are counter-intuitive in their contrast with the many reported effects on cardiovascular health as well as the literature linking education with later mortality","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124974118","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}
Jason Abaluck, Leila Agha, C. Kabrhel, Ali Raja, A. Venkatesh
We develop a model of the efficiency of medical testing based on rates of negative CT scans for pulmonary embolism. The model is estimated using a 20% sample of Medicare claims from 2000- 2009. We document enormous across-doctor heterogeneity in testing decisions conditional on patient risk and show it explains the negative relationship between physicians' testing frequencies and test yields. Physicians in high spending regions test more low-risk patients. Under calibration assumptions, 84% of doctors test even when costs exceed expected benefits. Furthermore, doctors do not apply observables to target testing to the highest risk patients, substantially reducing simulated test yields.
{"title":"Negative Tests and the Efficiency of Medical Care: What Determines Heterogeneity in Imaging Behavior?","authors":"Jason Abaluck, Leila Agha, C. Kabrhel, Ali Raja, A. Venkatesh","doi":"10.3386/W19956","DOIUrl":"https://doi.org/10.3386/W19956","url":null,"abstract":"We develop a model of the efficiency of medical testing based on rates of negative CT scans for pulmonary embolism. The model is estimated using a 20% sample of Medicare claims from 2000- 2009. We document enormous across-doctor heterogeneity in testing decisions conditional on patient risk and show it explains the negative relationship between physicians' testing frequencies and test yields. Physicians in high spending regions test more low-risk patients. Under calibration assumptions, 84% of doctors test even when costs exceed expected benefits. Furthermore, doctors do not apply observables to target testing to the highest risk patients, substantially reducing simulated test yields.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133865172","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}
Many studies have found: (i) substance abusers discount delayed rewards more than non-abusers do, which is widely interpreted as implying that substance abusers are more impulsive than non-abusers; and (ii) discounting increases most sharply with time when delays are brief, and then increases more slowly as delays grow longer, in a pattern called “hyperbolic” that is at odds with exponential discounting. In a sample of 157 college students we implement a new delay discounting task introduced by Andreoni and Sprenger (2012a,b) that faces participants with rather complex choices about sooner and later rewards. We also follow Andreoni and Sprenger in giving participants explicit assurances that chosen future rewards will, in fact, be delivered, which past studies have not. Echoing Andreoni and Sprenger, but contrary to (ii), we find that most participants’ discounting is exponential in this new task. We nonetheless confirm (i). We discuss several possible explanations for our participants discounting exponentially. That both participants with problems and those without tend to discount exponentially in our task indicates neither group is behaving impulsively in our experimental setting. Finding, as we do, marked differences in exponential discounting between those with alcohol problems and those without suggests that better understanding the psychological roots and malleability of exponential discounting (that is, of impatience in the absence of impulsivity) might lead to new therapies for reducing substance abuse.
{"title":"Delay Discounting and Alcohol Abusers: More Impatient Even When Not Impulsive?","authors":"Courtney Lemenze, Michael P. Murray","doi":"10.2139/ssrn.2372634","DOIUrl":"https://doi.org/10.2139/ssrn.2372634","url":null,"abstract":"Many studies have found: (i) substance abusers discount delayed rewards more than non-abusers do, which is widely interpreted as implying that substance abusers are more impulsive than non-abusers; and (ii) discounting increases most sharply with time when delays are brief, and then increases more slowly as delays grow longer, in a pattern called “hyperbolic” that is at odds with exponential discounting. In a sample of 157 college students we implement a new delay discounting task introduced by Andreoni and Sprenger (2012a,b) that faces participants with rather complex choices about sooner and later rewards. We also follow Andreoni and Sprenger in giving participants explicit assurances that chosen future rewards will, in fact, be delivered, which past studies have not. Echoing Andreoni and Sprenger, but contrary to (ii), we find that most participants’ discounting is exponential in this new task. We nonetheless confirm (i). We discuss several possible explanations for our participants discounting exponentially. That both participants with problems and those without tend to discount exponentially in our task indicates neither group is behaving impulsively in our experimental setting. Finding, as we do, marked differences in exponential discounting between those with alcohol problems and those without suggests that better understanding the psychological roots and malleability of exponential discounting (that is, of impatience in the absence of impulsivity) might lead to new therapies for reducing substance abuse.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129691694","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}
This paper analyzes a maximum price system and a reference price system in a vertical differentiation model with a brand-name drug and a generic. In particular, both instruments are compared with respect to their performance in reducing public expenditure, limiting financial exposure of patients, improving access to pharmaceuticals, and stimulating competition. For identical regulatory prices, free pricing under the reference system tends to result in a higher price for the brand-name drug. For identical price reductions of the brand-name drug, the lower reimbursement amount under the reference price system results in lower health expenditure, but higher financial exposure of patients. Total welfare is higher under the maximum price system.
{"title":"Pharmaceutical Regulation and Health Policy Objectives","authors":"Laura Birg","doi":"10.2139/ssrn.2371095","DOIUrl":"https://doi.org/10.2139/ssrn.2371095","url":null,"abstract":"This paper analyzes a maximum price system and a reference price system in a vertical differentiation model with a brand-name drug and a generic. In particular, both instruments are compared with respect to their performance in reducing public expenditure, limiting financial exposure of patients, improving access to pharmaceuticals, and stimulating competition. For identical regulatory prices, free pricing under the reference system tends to result in a higher price for the brand-name drug. For identical price reductions of the brand-name drug, the lower reimbursement amount under the reference price system results in lower health expenditure, but higher financial exposure of patients. Total welfare is higher under the maximum price system.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129787909","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}
This report outlines a rapid economic evaluation of a nursing service for homeless people, taking as an example a service in Wirral, a borough of c.320,000 people in the North West of England. This service cost £60,393 ($96,876) in the year from April 2012-March 2013. The main outcome we looked at was the estimated change in quality adjusted life years (QALYs) experienced by clients. From looking at the evidence for cost effectiveness of some individual elements of this service, it would be regarded as cost effective using a willingness to pay threshold of £20,000 - £30,000 per QALY (quality adjusted life year) gained which is the UK standard recommended by NICE (the National Institute for Health and Care Excellence), or a threshold of less than $50,000 per QALY gained. Looking at six elements of the service; hep B and flu vaccinations, screening for gonorrhoea, chlamydia and hep C, and referral to alcohol treatment, the overall cost per QALY compared to no intervention is estimated at £8,876 ($14,238). There are likely to be a lot more elements of the service that are cost effective in improving people's health and wellbeing, reducing unnecessary Accident & Emergency presentations, and reducing the spread of infectious diseases.
{"title":"A Rapid Evidence-Based Economic Evaluation of a Nursing Service for Homeless People","authors":"B. Collins","doi":"10.2139/ssrn.2368043","DOIUrl":"https://doi.org/10.2139/ssrn.2368043","url":null,"abstract":"This report outlines a rapid economic evaluation of a nursing service for homeless people, taking as an example a service in Wirral, a borough of c.320,000 people in the North West of England. This service cost £60,393 ($96,876) in the year from April 2012-March 2013. The main outcome we looked at was the estimated change in quality adjusted life years (QALYs) experienced by clients. From looking at the evidence for cost effectiveness of some individual elements of this service, it would be regarded as cost effective using a willingness to pay threshold of £20,000 - £30,000 per QALY (quality adjusted life year) gained which is the UK standard recommended by NICE (the National Institute for Health and Care Excellence), or a threshold of less than $50,000 per QALY gained. Looking at six elements of the service; hep B and flu vaccinations, screening for gonorrhoea, chlamydia and hep C, and referral to alcohol treatment, the overall cost per QALY compared to no intervention is estimated at £8,876 ($14,238). There are likely to be a lot more elements of the service that are cost effective in improving people's health and wellbeing, reducing unnecessary Accident & Emergency presentations, and reducing the spread of infectious diseases.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128363687","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}
Advancements in our understanding of the causes and correlates of disease mean that we are now able to estimate an individual's level of risk. This, and the ever-increasing need for healthcare interventions to be cost-effective, has led to calls for the introduction of risk-based screening. Risk-based screening would involve the use of information about an individual's risk factors to decide whether or not they should be eligible for screening, or the frequency with which they should be invited to attend screening. Evidence is emerging that targeted screening, towards those at higher risk, can increase the cost-effectiveness of a screening programme. The relationship between individual risk and the cost-effectiveness of screening an individual is implicitly recognised in current population screening programmes in the UK. However, the nature of this relationship, and its implications for cost-effectiveness analysis, has not been presented in the academic literature. In this study we propose that an individual's risk of developing a disease has a consistent and quantifiable relationship with the cost-effectiveness of screening them. We suggest a simple modification to standard methods of cost-effectiveness analysis that enables the incorporation of individual risk. Using numerical examples we demonstrate the nature of the relationship between risk and cost-effectiveness and suggest means of optimising a screening intervention. This can be done either by defining a minimum level of risk for eligibility or by defining the optimal recall period for screening. We suggest that methods of decision modelling could enable such an analysis to be carried out, and that information on individual risk could be used to optimise the cost-effectiveness of population screening programmes.
{"title":"The Relationship between Individual Risk and Cost-Effectiveness in Screening Interventions","authors":"C. Sampson, M. James, D. Whynes","doi":"10.2139/ssrn.2362371","DOIUrl":"https://doi.org/10.2139/ssrn.2362371","url":null,"abstract":"Advancements in our understanding of the causes and correlates of disease mean that we are now able to estimate an individual's level of risk. This, and the ever-increasing need for healthcare interventions to be cost-effective, has led to calls for the introduction of risk-based screening. Risk-based screening would involve the use of information about an individual's risk factors to decide whether or not they should be eligible for screening, or the frequency with which they should be invited to attend screening. Evidence is emerging that targeted screening, towards those at higher risk, can increase the cost-effectiveness of a screening programme. The relationship between individual risk and the cost-effectiveness of screening an individual is implicitly recognised in current population screening programmes in the UK. However, the nature of this relationship, and its implications for cost-effectiveness analysis, has not been presented in the academic literature. In this study we propose that an individual's risk of developing a disease has a consistent and quantifiable relationship with the cost-effectiveness of screening them. We suggest a simple modification to standard methods of cost-effectiveness analysis that enables the incorporation of individual risk. Using numerical examples we demonstrate the nature of the relationship between risk and cost-effectiveness and suggest means of optimising a screening intervention. This can be done either by defining a minimum level of risk for eligibility or by defining the optimal recall period for screening. We suggest that methods of decision modelling could enable such an analysis to be carried out, and that information on individual risk could be used to optimise the cost-effectiveness of population screening programmes.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131092646","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}
E. Massad, A. D. da Rocha, M. Burattini, C. Struchiner
Objective. The objective of this work is to examine decision making in public health, considering the conflict between collective and individual interests.Study design. This is a theoretical work in which a mathematical model is proposed.Methods. Here we propose a mathematical model of decision-making that takes this conflict into account. The model assumes that the probability of deciding in favor of preventive or curative actions depends on the ratio of acceptance/compliance, as calculated for opportunity costs and benefits. Results. The model shows that the perceived fairness of the action increases as its acceptance increases relative to its compliance. Conflict is generated by the tension between acceptance and compliance and turns decision making into a difficult task.Conclusions. The acceptance of a public health action increases as its personal cost decreases relative to its perceived social benefits. On the other hand, compliance with the action increases as the perceived social cost increases relative to personal benefits.
{"title":"Modeling Decision Making Considering Collective Versus Individual Interests in Public Health","authors":"E. Massad, A. D. da Rocha, M. Burattini, C. Struchiner","doi":"10.2139/ssrn.2335633","DOIUrl":"https://doi.org/10.2139/ssrn.2335633","url":null,"abstract":"Objective. The objective of this work is to examine decision making in public health, considering the conflict between collective and individual interests.Study design. This is a theoretical work in which a mathematical model is proposed.Methods. Here we propose a mathematical model of decision-making that takes this conflict into account. The model assumes that the probability of deciding in favor of preventive or curative actions depends on the ratio of acceptance/compliance, as calculated for opportunity costs and benefits. Results. The model shows that the perceived fairness of the action increases as its acceptance increases relative to its compliance. Conflict is generated by the tension between acceptance and compliance and turns decision making into a difficult task.Conclusions. The acceptance of a public health action increases as its personal cost decreases relative to its perceived social benefits. On the other hand, compliance with the action increases as the perceived social cost increases relative to personal benefits.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115459005","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}
When analyzing many health-related quality-of-life (HRQoL) outcomes, statistical inference is often based on the summary score formed by combining the individual domains of the HRQoL profile into a single measure. Through a series of Monte Carlo simulations, this paper illustrates that reliance solely on the summary score may lead to biased estimates of incremental effects, and I propose a novel two-stage approach that allows for unbiased estimation of incremental effects. The proposed methodology essentially reverses the order of the analysis, from one of 'aggregate, then estimate' to one of 'estimate, then aggregate'. Compared to relying solely on the summary score, the approach also offers a more patient-centered interpretation of results by estimating regression coefficients and incremental effects in each of the HRQoL domains, while still providing estimated effects in terms of the overall summary score. I provide an application to the estimation of incremental effects of demographic and clinical variables on HRQoL following surgical treatment for adult scoliosis and spinal deformity.
{"title":"Putting the Patient in Patient Reported Outcomes: A Robust Methodology for Health Outcomes Assessment","authors":"Ian M. McCarthy","doi":"10.2139/ssrn.2328804","DOIUrl":"https://doi.org/10.2139/ssrn.2328804","url":null,"abstract":"When analyzing many health-related quality-of-life (HRQoL) outcomes, statistical inference is often based on the summary score formed by combining the individual domains of the HRQoL profile into a single measure. Through a series of Monte Carlo simulations, this paper illustrates that reliance solely on the summary score may lead to biased estimates of incremental effects, and I propose a novel two-stage approach that allows for unbiased estimation of incremental effects. The proposed methodology essentially reverses the order of the analysis, from one of 'aggregate, then estimate' to one of 'estimate, then aggregate'. Compared to relying solely on the summary score, the approach also offers a more patient-centered interpretation of results by estimating regression coefficients and incremental effects in each of the HRQoL domains, while still providing estimated effects in terms of the overall summary score. I provide an application to the estimation of incremental effects of demographic and clinical variables on HRQoL following surgical treatment for adult scoliosis and spinal deformity.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129153259","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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