This paper estimates the potential long-run impact on unhealthy habits of programs of early detection of chronic conditions as hypertension in England. This is done by estimating the parameters of a structural model on smoking, hypertension diagnosis and mortality. In order to deal with selection on screening I employ a feature of the English Longitudinal Study of Ageing (ELSA), a nation wide representative survey of the population aged over 50: the recommendation by a professional nurse, trained by the survey organizers, to visit a GP for a screening procedure depending on current readings of blood pressure. Selection into smoking due to live expectancy or health is addressed by employing unobserved heterogeneity and subjective survival probabilities. These mortality beliefs, which depend on a latent health process, are allowed to be a function of both actual and future smoking choices. Exploratory results show that five interventions every 2 years would reduce, at its peak in the seventh year, smoking prevalence by 0.22 pp. While these numbers provide an idea of the magnitude of the effects that can be obtained, they do not provide conclusive evidence.
{"title":"Could the NHS Frighten People into Healthy Habits? Smoking, Subjective Mortality Expectations and Health Information","authors":"P. Rodriguez-Lesmes","doi":"10.2139/ssrn.2345649","DOIUrl":"https://doi.org/10.2139/ssrn.2345649","url":null,"abstract":"This paper estimates the potential long-run impact on unhealthy habits of programs of early detection of chronic conditions as hypertension in England. This is done by estimating the parameters of a structural model on smoking, hypertension diagnosis and mortality. In order to deal with selection on screening I employ a feature of the English Longitudinal Study of Ageing (ELSA), a nation wide representative survey of the population aged over 50: the recommendation by a professional nurse, trained by the survey organizers, to visit a GP for a screening procedure depending on current readings of blood pressure. Selection into smoking due to live expectancy or health is addressed by employing unobserved heterogeneity and subjective survival probabilities. These mortality beliefs, which depend on a latent health process, are allowed to be a function of both actual and future smoking choices. Exploratory results show that five interventions every 2 years would reduce, at its peak in the seventh year, smoking prevalence by 0.22 pp. While these numbers provide an idea of the magnitude of the effects that can be obtained, they do not provide conclusive evidence.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124867557","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}
Malaria kills about 1,500 children every day. Based on the Demographic and Health Surveys, we examine malaria treatment practices of various health care providers in sub-Saharan Africa, where more than 90 percent of the world’s deaths due to malaria occur. To assess the quality of each health care provider (including, among others, public health centers and traditional healers), we estimate the likelihood of providers to administer ineffective antimalarial drugs such as chloroquine in areas of known resistance, and to relieve children of malaria symptoms after having had fever within the last two weeks. Our results indicate that relative to self-medication, seeking treatment at most providers significantly increases the likelihood to take any antimalarial drug and decreases the likelihood to use chloroquine. Traditional healers do not exert any effect.
{"title":"Biting Back at Malaria – Self-Medication, Traditional Healers, and the Public Sector","authors":"A. Paloyo, A. Reichert","doi":"10.2139/SSRN.2278840","DOIUrl":"https://doi.org/10.2139/SSRN.2278840","url":null,"abstract":"Malaria kills about 1,500 children every day. Based on the Demographic and Health Surveys, we examine malaria treatment practices of various health care providers in sub-Saharan Africa, where more than 90 percent of the world’s deaths due to malaria occur. To assess the quality of each health care provider (including, among others, public health centers and traditional healers), we estimate the likelihood of providers to administer ineffective antimalarial drugs such as chloroquine in areas of known resistance, and to relieve children of malaria symptoms after having had fever within the last two weeks. Our results indicate that relative to self-medication, seeking treatment at most providers significantly increases the likelihood to take any antimalarial drug and decreases the likelihood to use chloroquine. Traditional healers do not exert any effect.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126969418","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 suggests the hypothesis that variation in Sitting Height Ratio (SHR) may be a major and easily measurable factor to correct observed bias in mean basal metabolic rates (BMR) predicted from body weight, due to influence of SHR on the share of various body parts in total BMR, for given height, Body Mass Index or weight, affecting in turn estimation of energy needs and undernourishment. A modelling approach is used here to suggest that unexplained discrepancies between predicted and measured mean BMR in different ethnic groups and geographical areas may be due in large part to differences in SHR. This may significantly affect estimates of undernourishment worldwide and in specific countries and populations.
{"title":"Sitting Height Ratio, Metabolic Rates, Energy Needs and Undernourishment: A Modelling Approach","authors":"H. Maletta","doi":"10.2139/ssrn.1031206","DOIUrl":"https://doi.org/10.2139/ssrn.1031206","url":null,"abstract":"This paper suggests the hypothesis that variation in Sitting Height Ratio (SHR) may be a major and easily measurable factor to correct observed bias in mean basal metabolic rates (BMR) predicted from body weight, due to influence of SHR on the share of various body parts in total BMR, for given height, Body Mass Index or weight, affecting in turn estimation of energy needs and undernourishment. A modelling approach is used here to suggest that unexplained discrepancies between predicted and measured mean BMR in different ethnic groups and geographical areas may be due in large part to differences in SHR. This may significantly affect estimates of undernourishment worldwide and in specific countries and populations.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130438290","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 the timing decisions of pharmaceutical firms to launch a new drug in countries involved in international reference pricing. We show three important features of launch timing when all countries refer to the prices in all other countries and in all previous periods of time. First, there is no withdrawal of drugs in any country and in any period. Second, whenever the drug is sold in a country, it is also sold in all countries with larger willingness to pay. Third, there is no strict incentive to delay the launch of a drug in any country. We then show that the first and third results continue to hold when the countries only refer to the prices of a subset of all countries in a transitive way and in any period. We also show that the second result continues to hold when the reference is on the last period prices only. Last, we show that the seller's profits increase as the sets of reference countries decrease with respect to inclusion.
{"title":"Drug Launch Timing and International Reference Pricing","authors":"N. Houy, I. Jelovac","doi":"10.2139/ssrn.2207816","DOIUrl":"https://doi.org/10.2139/ssrn.2207816","url":null,"abstract":"This paper analyzes the timing decisions of pharmaceutical firms to launch a new drug in countries involved in international reference pricing. We show three important features of launch timing when all countries refer to the prices in all other countries and in all previous periods of time. First, there is no withdrawal of drugs in any country and in any period. Second, whenever the drug is sold in a country, it is also sold in all countries with larger willingness to pay. Third, there is no strict incentive to delay the launch of a drug in any country. We then show that the first and third results continue to hold when the countries only refer to the prices of a subset of all countries in a transitive way and in any period. We also show that the second result continues to hold when the reference is on the last period prices only. Last, we show that the seller's profits increase as the sets of reference countries decrease with respect to inclusion.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127053025","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 study uses two rounds of HIV prevalence data from eight sub-Saharan African DHS to examine the hypothesis that positive association between educational attainment and HIV prevalence is reversing. I compare a group of high prevalence countries to a group of low prevalence countries and find that the education-HIV relationship has weakened in higher prevalence countries among the youngest cohort. This is true both across and within regions. However, the association remains statistically significantly and positive across age cohorts in both country groups. Secondarily, I test for two commonly hypothesized explanations for such a change - the erosion of educational infrastructure in high prevalence areas and the behavior change among the educated. I find evidence of educational erosion among the low prevalence group of countries only. I also find evidence of an educational gradient in protective behavior in both country groups, but it does not appear to affect the Ed-HIV association.
{"title":"From Predictive to Protective? Is the Relationship between HIV and Education Changing?","authors":"Elizabeth Gummerson","doi":"10.2139/ssrn.2241437","DOIUrl":"https://doi.org/10.2139/ssrn.2241437","url":null,"abstract":"This study uses two rounds of HIV prevalence data from eight sub-Saharan African DHS to examine the hypothesis that positive association between educational attainment and HIV prevalence is reversing. I compare a group of high prevalence countries to a group of low prevalence countries and find that the education-HIV relationship has weakened in higher prevalence countries among the youngest cohort. This is true both across and within regions. However, the association remains statistically significantly and positive across age cohorts in both country groups. Secondarily, I test for two commonly hypothesized explanations for such a change - the erosion of educational infrastructure in high prevalence areas and the behavior change among the educated. I find evidence of educational erosion among the low prevalence group of countries only. I also find evidence of an educational gradient in protective behavior in both country groups, but it does not appear to affect the Ed-HIV association.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124661824","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}
The question of whether there is a lasting effect of childhood experience on mental health has eluded causal measurement. We draw upon identical twin data and econometric instrumentation to provide an unbiased answer. We find that 55% of a one standard deviation change in mental health due to idiosyncratic experience at age 9 will still be present three years later. Extending the analysis, we find such persistence to vary with age at impact, gender, and mental health sub-categories. This investigation allows us to get a grasp on the degree to which childhood events influence health and socio-economic outcomes by way of their lagged effect on subsequent mental health. A better understanding of the evolution of mental health also helps identifying when mental health issues can be most effectively treated.
{"title":"The Enduring Impact of Childhood Experience on Mental Health: Evidence Using Instrumented Co-Twin Data","authors":"Rachel Berner Shalem, F. Cornaglia, J. De Neve","doi":"10.2139/ssrn.2168369","DOIUrl":"https://doi.org/10.2139/ssrn.2168369","url":null,"abstract":"The question of whether there is a lasting effect of childhood experience on mental health has eluded causal measurement. We draw upon identical twin data and econometric instrumentation to provide an unbiased answer. We find that 55% of a one standard deviation change in mental health due to idiosyncratic experience at age 9 will still be present three years later. Extending the analysis, we find such persistence to vary with age at impact, gender, and mental health sub-categories. This investigation allows us to get a grasp on the degree to which childhood events influence health and socio-economic outcomes by way of their lagged effect on subsequent mental health. A better understanding of the evolution of mental health also helps identifying when mental health issues can be most effectively treated.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125344655","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 provide evidence on the significant effect of religiosity (measured by attendance to religious services) on reducing depression. In particular, it is found a significant negative effect of religiosity on the probability of being depressed. Findings of previous studies are extended by showing that while the religious denomination seems to have a non-significant effect on the probably of depression, other aspects of religiosity, in particular the religious diversity of the country of residence does affect the prospects of depression. The probability of being depressed is higher, the lower the religious diversity. Other personal socio-economic variables have the expected and documented effects.
{"title":"Religion, Religiosity and Depression: Re-Assessing Their Relationship","authors":"Natalia Melgar, S. Neuman, Máximo Rossi","doi":"10.2139/ssrn.2154626","DOIUrl":"https://doi.org/10.2139/ssrn.2154626","url":null,"abstract":"We provide evidence on the significant effect of religiosity (measured by attendance to religious services) on reducing depression. In particular, it is found a significant negative effect of religiosity on the probability of being depressed. Findings of previous studies are extended by showing that while the religious denomination seems to have a non-significant effect on the probably of depression, other aspects of religiosity, in particular the religious diversity of the country of residence does affect the prospects of depression. The probability of being depressed is higher, the lower the religious diversity. Other personal socio-economic variables have the expected and documented effects.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"586 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123041714","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}
Studies on health effects of unemployment usually neglect spillover effects on spouses. This study specifically investigates the effect of an individual's unemployment on the mental health of their spouse. In order to allow for causal interpretation of the estimates, it focuses on plant closure as entry into unemployment, and combines difference-in-difference and matching based on entropy balancing to provide robustness against observable and time-invariant unobservable heterogeneity. Using German Socio-Economic Panel Study data the paper reveals that unemployment decreases the mental health of spouses almost as much as for the directly affected individuals. The findings highlight that previous studies underestimate the public health costs of unemployment as they do not account for the potential consequences for spouses.
{"title":"The Effect of Unemployment on the Mental Health of Spouses – Evidence from Plant Closures in Germany","authors":"Jan Marcus","doi":"10.2139/ssrn.2166741","DOIUrl":"https://doi.org/10.2139/ssrn.2166741","url":null,"abstract":"Studies on health effects of unemployment usually neglect spillover effects on spouses. This study specifically investigates the effect of an individual's unemployment on the mental health of their spouse. In order to allow for causal interpretation of the estimates, it focuses on plant closure as entry into unemployment, and combines difference-in-difference and matching based on entropy balancing to provide robustness against observable and time-invariant unobservable heterogeneity. Using German Socio-Economic Panel Study data the paper reveals that unemployment decreases the mental health of spouses almost as much as for the directly affected individuals. The findings highlight that previous studies underestimate the public health costs of unemployment as they do not account for the potential consequences for spouses.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128876046","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}
M. Versteegh, A. Attema, M. Oppe, N. Devlin, E. Stolk
This paper examines the effect different specifications of the Time Tradeoff (TTO) task have on health state values. The new lead time TTO is compared to an equally viable method called lag time TTO, both in two time frames. We test whether the two methods yield comparable health state values and whether the relative importance of dimensions of health is similarly stable between TTO specifications. The tasks were applied online and compared to results from a study with identical TTO specifications but with a different mode of administration. Lag time TTO produced lower values than lead time TTO and the difference was larger in the longer time frame. The relative importance of different dimensions of health was affected by the duration of the health state. Generally, the lead time TTO performed in group sessions gave more favorable results than the online exercise based on feasibility and data quality.
{"title":"Time to Tweak the TTO: But How?","authors":"M. Versteegh, A. Attema, M. Oppe, N. Devlin, E. Stolk","doi":"10.2139/ssrn.2037770","DOIUrl":"https://doi.org/10.2139/ssrn.2037770","url":null,"abstract":"This paper examines the effect different specifications of the Time Tradeoff (TTO) task have on health state values. The new lead time TTO is compared to an equally viable method called lag time TTO, both in two time frames. We test whether the two methods yield comparable health state values and whether the relative importance of dimensions of health is similarly stable between TTO specifications. The tasks were applied online and compared to results from a study with identical TTO specifications but with a different mode of administration. Lag time TTO produced lower values than lead time TTO and the difference was larger in the longer time frame. The relative importance of different dimensions of health was affected by the duration of the health state. Generally, the lead time TTO performed in group sessions gave more favorable results than the online exercise based on feasibility and data quality.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116166838","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}
M. García Molina, Liliana Chicaíza, H. Quitián, Adriana Linares Ballesteros, Óscar Ramírez Wurttemberger
Objetive: To assess the cost effectiveness of unrelated stem cell transplantation versus consolidation chemotherapy in pediatric population with high-risk acute myeloid leukemia (AML).Methods: A decision tree model was built with life years gained as outcome, from the perspective of the health system, including all direct costs. Pharmaceutical prices were obtained from the official System of Information of Medicaments SISMED (2008), and the value of procedures was calculated from the 2001 ISS tariff manual adding 30%. All monetary amounts are expressed in Colombian pesos of 2010. No discount rate was applied as costs are incurred during the first year. The cost-effectiveness threshold used was three times the 2010 per capita GDP per life year gained. Deterministic and probabilistic sensitivity analyses were performed over the variables with the higher effect on the incremental cost-effectiveness ratio (ICER).Results: The ICER of transplantation was $9.226.421, which is lower than the per capita GDP of 2010, $12.047.418. Results are robust to changes in the model data. Probabilistic sensitivity analysis with ten thousand simulations showed that unrelated transplant has a 70% probability of being cost effective.Conclusions: In the Colombian health system, unrelated stem cell transplantation is a cost-effective strategy for the treatment of high risk AML in pediatric patients.
{"title":"Cost-Effectiveness of Unrelated Hematopoietic Stem Cell Transplantation Versus Chemotherapy for Consolidation Treatment to Acute Myeloid Leukemia in High-Risk Pediatric Patients","authors":"M. García Molina, Liliana Chicaíza, H. Quitián, Adriana Linares Ballesteros, Óscar Ramírez Wurttemberger","doi":"10.2139/SSRN.2194560","DOIUrl":"https://doi.org/10.2139/SSRN.2194560","url":null,"abstract":"Objetive: To assess the cost effectiveness of unrelated stem cell transplantation versus consolidation chemotherapy in pediatric population with high-risk acute myeloid leukemia (AML).Methods: A decision tree model was built with life years gained as outcome, from the perspective of the health system, including all direct costs. Pharmaceutical prices were obtained from the official System of Information of Medicaments SISMED (2008), and the value of procedures was calculated from the 2001 ISS tariff manual adding 30%. All monetary amounts are expressed in Colombian pesos of 2010. No discount rate was applied as costs are incurred during the first year. The cost-effectiveness threshold used was three times the 2010 per capita GDP per life year gained. Deterministic and probabilistic sensitivity analyses were performed over the variables with the higher effect on the incremental cost-effectiveness ratio (ICER).Results: The ICER of transplantation was $9.226.421, which is lower than the per capita GDP of 2010, $12.047.418. Results are robust to changes in the model data. Probabilistic sensitivity analysis with ten thousand simulations showed that unrelated transplant has a 70% probability of being cost effective.Conclusions: In the Colombian health system, unrelated stem cell transplantation is a cost-effective strategy for the treatment of high risk AML in pediatric patients.","PeriodicalId":396916,"journal":{"name":"Health Economics Evaluation Methods eJournal","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124742176","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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