Pub Date : 2024-09-12DOI: 10.1101/2024.09.10.24313438
Silke Fernandes, Andrew Briggs, Kara Hanson
Introduction Understanding the holistic impact of malaria during pregnancy is essential for improving maternal and child outcomes in malaria endemic settings. To be able to design appropriate research and conduct robust policy analyses, a comprehensive model of the underlying disease, representing the current understanding of mechanisms and consequences is essential. This study aimed to illustrate a methodology to co-develop a disease model with expert stakeholders using malaria during pregnancy as a case study. Methods An initial steering group was convened to develop a first model of malaria during pregnancy and its consequences for mother and child based on their understanding of the literature. Subsequently, this model was refined using a Delphi process to gain consensus amongst twelve experts, representing the disciplines of health economics, mathematical modelling, epidemiology and clinical medicine, working in the field of malaria during pregnancy. Experts reviewed drafts of the conceptual model and provided feedback in two rounds of semi-structured questionnaires with the aim of identifying the most important health outcomes and relationships in both mother and child as well as the most relevant stratifiers for the model. Consensus on any final disagreement was reached after two consensus meetings. Results The final model is a comprehensive disease model of malaria during pregnancy, including ten maternal and ten child outcomes with four stratifiers. The model developed in this study should be of value to malaria researchers, funders, evaluators and decision makers, though some adaptation will be required for each specific context and purpose. In addition, the methodology and process followed in this study is replicable and can guide researchers aiming to develop a conceptual model for other conditions. Discussion & Conclusion The model resulting from this study highlights the complexity required to depict appropriately the consequences of malaria during pregnancy for both the mother and the child. It also demonstrates how to conduct a rigorous process to develop a disease model. In addition the study has helped to identify a number of areas with scarce data and need for further research.
{"title":"Co-developing a comprehensive disease policy model with stakeholders: the case of malaria during pregnancy","authors":"Silke Fernandes, Andrew Briggs, Kara Hanson","doi":"10.1101/2024.09.10.24313438","DOIUrl":"https://doi.org/10.1101/2024.09.10.24313438","url":null,"abstract":"Introduction Understanding the holistic impact of malaria during pregnancy is essential for improving maternal and child outcomes in malaria endemic settings. To be able to design appropriate research and conduct robust policy analyses, a comprehensive model of the underlying disease, representing the current understanding of mechanisms and consequences is essential. This study aimed to illustrate a methodology to co-develop a disease model with expert stakeholders using malaria during pregnancy as a case study. Methods An initial steering group was convened to develop a first model of malaria during pregnancy and its consequences for mother and child based on their understanding of the literature. Subsequently, this model was refined using a Delphi process to gain consensus amongst twelve experts, representing the disciplines of health economics, mathematical modelling, epidemiology and clinical medicine, working in the field of malaria during pregnancy. Experts reviewed drafts of the conceptual model and provided feedback in two rounds of semi-structured questionnaires with the aim of identifying the most important health outcomes and relationships in both mother and child as well as the most relevant stratifiers for the model. Consensus on any final disagreement was reached after two consensus meetings. Results The final model is a comprehensive disease model of malaria during pregnancy, including ten maternal and ten child outcomes with four stratifiers. The model developed in this study should be of value to malaria researchers, funders, evaluators and decision makers, though some adaptation will be required for each specific context and purpose. In addition, the methodology and process followed in this study is replicable and can guide researchers aiming to develop a conceptual model for other conditions. Discussion & Conclusion The model resulting from this study highlights the complexity required to depict appropriately the consequences of malaria during pregnancy for both the mother and the child. It also demonstrates how to conduct a rigorous process to develop a disease model. In addition the study has helped to identify a number of areas with scarce data and need for further research.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190565","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 : 2024-09-09DOI: 10.1101/2024.09.08.24313274
Shi Jiankui, Hu Lun, Xia yingge, Hu Xiangdong
With the rapid advancement of industrialization and urbanization, China is facing an increasingly serious challenge of air pollution. The dramatic deterioration of air quality not only compromises the quality of daily life, but also poses a serious threat to public health. In order to deal with the urgent environmental problems, the Chinese government actively seeks treatment methods, among which the coal-to-gas policy, with its advantages of clean and low-carbon, has become a key part of the environmental governance strategy. However, in the initial implementation of the coal-to-gas policy, problems such as shortage of gas sources and pipeline access hindered the promotion of the policy. To provide an in-depth analysis of the actual impact of the coal-to-gas policy on residents' well-being, a comprehensive analysis was conducted based on data from the China General Social Survey. The study found that the implementation of the coal-to-gas policy not only significantly improved residents' subjective well-being and made the environment more livable, but also significantly improved residents' physical health and reduced health problems caused by air pollution. This positive effect is particularly pronounced among young people, women and residents of northern regions, who have benefited more from the clean-air benefits of the coal-to-gas policy. In addition, the study found that the availability of natural gas pipelines has a non-linear effect on residents' well-being. Moderate pipeline coverage can significantly improve the quality of life of residents and provide more convenient and reliable clean energy. Therefore, under the premise of ensuring stable supply, it is necessary to seek the optimal pipeline layout scheme. Finally, the coal-to-gas policy has boosted regional economic vitality and residents' well-being by promoting industrial restructuring and reducing pollution emissions.
{"title":"How does participation in coal-to-gas policy and availability of natural gas pipelines affect residents' well-being?","authors":"Shi Jiankui, Hu Lun, Xia yingge, Hu Xiangdong","doi":"10.1101/2024.09.08.24313274","DOIUrl":"https://doi.org/10.1101/2024.09.08.24313274","url":null,"abstract":"With the rapid advancement of industrialization and urbanization, China is facing an increasingly serious challenge of air pollution. The dramatic deterioration of air quality not only compromises the quality of daily life, but also poses a serious threat to public health. In order to deal with the urgent environmental problems, the Chinese government actively seeks treatment methods, among which the coal-to-gas policy, with its advantages of clean and low-carbon, has become a key part of the environmental governance strategy. However, in the initial implementation of the coal-to-gas policy, problems such as shortage of gas sources and pipeline access hindered the promotion of the policy. To provide an in-depth analysis of the actual impact of the coal-to-gas policy on residents' well-being, a comprehensive analysis was conducted based on data from the China General Social Survey. The study found that the implementation of the coal-to-gas policy not only significantly improved residents' subjective well-being and made the environment more livable, but also significantly improved residents' physical health and reduced health problems caused by air pollution. This positive effect is particularly pronounced among young people, women and residents of northern regions, who have benefited more from the clean-air benefits of the coal-to-gas policy. In addition, the study found that the availability of natural gas pipelines has a non-linear effect on residents' well-being. Moderate pipeline coverage can significantly improve the quality of life of residents and provide more convenient and reliable clean energy. Therefore, under the premise of ensuring stable supply, it is necessary to seek the optimal pipeline layout scheme. Finally, the coal-to-gas policy has boosted regional economic vitality and residents' well-being by promoting industrial restructuring and reducing pollution emissions.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190566","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 : 2024-08-31DOI: 10.1101/2024.08.30.24312834
Stephanie Zellers, Elissar Azzi, Antti Latvala, Jaakko Kaprio, Terhi Maczulskij
Background Job loss is related to morbidity and mortality, but generation of causal evidence is challenging due to confounding factors. Finland suffered a severe economic recession in the early 1990s with unemployment reaching almost 25%, with many job losses due to mass layoff or company closure. Such job displacements are assumed to be exogenous to the individual and create a natural experiment for causal inference.
{"title":"Causally-informative analyses of the effect of job displacement on all-cause and specific-cause mortality from the 1990s Finnish recession until 2020: A population registry study","authors":"Stephanie Zellers, Elissar Azzi, Antti Latvala, Jaakko Kaprio, Terhi Maczulskij","doi":"10.1101/2024.08.30.24312834","DOIUrl":"https://doi.org/10.1101/2024.08.30.24312834","url":null,"abstract":"<strong>Background</strong> Job loss is related to morbidity and mortality, but generation of causal evidence is challenging due to confounding factors. Finland suffered a severe economic recession in the early 1990s with unemployment reaching almost 25%, with many job losses due to mass layoff or company closure. Such job displacements are assumed to be exogenous to the individual and create a natural experiment for causal inference.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142224778","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 : 2024-08-27DOI: 10.1101/2024.08.13.24311908
Mengchun Gong, Yue Yu, Zihao OuYang, Wenzhao Shi, Chao Liu, Qilin Wang, Jiale Nan, Endi Cai, Fen Ding, Sheng Nie
Objectives: To formulate an efficacious approach for safeguarding the privacy information of electronic medical records. Design: Chinese patient electronic medical record text information. Setting: The Chinese Renal Disease Data System database. Participants: 3,233,174 patients between 1 Jan. 2010 and 31 Dec. 2023. Main outcome measures: Annotated patient privacy fields and the effectiveness of privacy protection Results: We have developed an automated tool named EPSTII, designed to protect the privacy of patients' sexually transmitted infection information within medical records. Through the refinement of keywords and the integration of expert knowledge, EPSTII currently achieves a 100% accuracy and recall rate. Our privacy protection measures have reached a 99.5% success rate, ensuring the utmost protection of STI patients' privacy. As the first large-scale investigation into privacy leakage and STI identification in Chinese electronic medical records, our research paves the way for the future development of patient privacy protection laws in China and the advancement of more sophisticated tools. Conclusions:The EPSTII method demonstrates a feasible and effective approach to protect privacy in electronic medical records from 19 hospitals, offering comprehensive insights for infectious disease research using Chinese electronic medical records, with protocols tailored for accurate STI data extraction and enhanced protection compared to traditional methods.
{"title":"Privacy Protection of Sexually Transmitted Infections Information from Chinese Electronic Medical Records","authors":"Mengchun Gong, Yue Yu, Zihao OuYang, Wenzhao Shi, Chao Liu, Qilin Wang, Jiale Nan, Endi Cai, Fen Ding, Sheng Nie","doi":"10.1101/2024.08.13.24311908","DOIUrl":"https://doi.org/10.1101/2024.08.13.24311908","url":null,"abstract":"Objectives: To formulate an efficacious approach for safeguarding the privacy information of electronic medical records.\u0000Design: Chinese patient electronic medical record text information.\u0000Setting: The Chinese Renal Disease Data System database.\u0000Participants: 3,233,174 patients between 1 Jan. 2010 and 31 Dec. 2023.\u0000Main outcome measures: Annotated patient privacy fields and the effectiveness of privacy protection\u0000Results: We have developed an automated tool named EPSTII, designed to protect the privacy of patients' sexually transmitted infection information within medical records. Through the refinement of keywords and the integration of expert knowledge, EPSTII currently achieves a 100% accuracy and recall rate. Our privacy protection measures have reached a 99.5% success rate, ensuring the utmost protection of STI patients' privacy. As the first large-scale investigation into privacy leakage and STI identification in Chinese electronic medical records, our research paves the way for the future development of patient privacy protection laws in China and the advancement of more sophisticated tools.\u0000Conclusions:The EPSTII method demonstrates a feasible and effective approach to protect privacy in electronic medical records from 19 hospitals, offering comprehensive insights for infectious disease research using Chinese electronic medical records, with protocols tailored for accurate STI data extraction and enhanced protection compared to traditional methods.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"2011 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190567","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 : 2024-08-26DOI: 10.1101/2024.08.24.24312530
Abdinasir Isaaq, Claudia Cooper, Victoria Vickerstaff, Julie Barber, Kate Walters, Iain Lang, Penny Rapaport, Vasiliki Orgeta, Kenneth Rockwood, Laurie Butler, Kathryn Lord, Gill Livingston, Sube Banerjee, Jill Manthorpe, Helen Kales, Jessica Budgett, Rachael M Hunter
Background: NIDUS-Family is a 6-8 session, psychosocial and behavioural intervention, delivered by non-clinical facilitators, tailored to goals set by dementia-unpaid/family carer dyads. It is effective in terms of attainment of personalised client goals. We aimed to determine if it is cost-effective. Methods: This cost utility and cost-effectiveness analysis is within a two-armed, single masked, multi-site, superiority Randomised Controlled Trial (RCT). We recruited 302 dyads from community settings. Randomisation was blocked and site-stratified, using a 2:1 ratio (intervention: control (goal-setting and routine care)), with allocation by remote web-based system. We calculated the probability that NIDUS-Family is cost-effective for a client with dementia based on Quality Adjusted Life Year (QALY) from health and personal social services and societal perspectives, at GBP 20,000-30,000 decision thresholds for QALY gained, compared to usual care over 12 months. Analyses were intention-to-treat. Trial registration: ISRCTN11425138. Findings: From 30.4.2020-9.5.2022, 204 participants (109 (53.4%) female) were randomised to intervention and 98 (60 (61.2%) female) to control. 218 (72.2%) participants at 6 months and 178 (58.9%) at 12 months provided cost data. There was 89% and 87% probability that NIDUS-Family was cost-effective compared to usual care from personal social services and societal perspectives respectively. Intervention participants accrued on average GBP 8934 (37%) less costs than control participants (95% CI -59,460 to 41,592). Interpretation: NIDUS-Family is the first personalised care and support intervention to demonstrate cost-effectiveness from the perspective of the quality of life of people with dementia, as well as clinical effectiveness and should be part of routine dementia care.
{"title":"Cost-utility of a new psychosocial goal-setting and manualised support intervention for Independence in Dementia (NIDUS-Family) versus goal-setting and routine care: economic evaluation embedded within a randomised controlled trial.","authors":"Abdinasir Isaaq, Claudia Cooper, Victoria Vickerstaff, Julie Barber, Kate Walters, Iain Lang, Penny Rapaport, Vasiliki Orgeta, Kenneth Rockwood, Laurie Butler, Kathryn Lord, Gill Livingston, Sube Banerjee, Jill Manthorpe, Helen Kales, Jessica Budgett, Rachael M Hunter","doi":"10.1101/2024.08.24.24312530","DOIUrl":"https://doi.org/10.1101/2024.08.24.24312530","url":null,"abstract":"Background: NIDUS-Family is a 6-8 session, psychosocial and behavioural intervention, delivered by non-clinical facilitators, tailored to goals set by dementia-unpaid/family carer dyads. It is effective in terms of attainment of personalised client goals. We aimed to determine if it is cost-effective. Methods: This cost utility and cost-effectiveness analysis is within a two-armed, single masked, multi-site, superiority Randomised Controlled Trial (RCT). We recruited 302 dyads from community settings. Randomisation was blocked and site-stratified, using a 2:1 ratio (intervention: control (goal-setting and routine care)), with allocation by remote web-based system. We calculated the probability that NIDUS-Family is cost-effective for a client with dementia based on Quality Adjusted Life Year (QALY) from health and personal social services and societal perspectives, at GBP 20,000-30,000 decision thresholds for QALY gained, compared to usual care over 12 months. Analyses were intention-to-treat. Trial registration: ISRCTN11425138. Findings: From 30.4.2020-9.5.2022, 204 participants (109 (53.4%) female) were randomised to intervention and 98 (60 (61.2%) female) to control. 218 (72.2%) participants at 6 months and 178 (58.9%) at 12 months provided cost data. There was 89% and 87% probability that NIDUS-Family was cost-effective compared to usual care from personal social services and societal perspectives respectively. Intervention participants accrued on average GBP 8934 (37%) less costs than control participants (95% CI -59,460 to 41,592). Interpretation: NIDUS-Family is the first personalised care and support intervention to demonstrate cost-effectiveness from the perspective of the quality of life of people with dementia, as well as clinical effectiveness and should be part of routine dementia care.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190569","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 : 2024-08-26DOI: 10.1101/2024.08.26.24312574
Bert Lenaerts
Crop breeding, through methods like biofortification, plays a crucial role in increasing agricultural yields, contributing to a stable and healthy food supply by boosting the micronutrient content of staples, which is pivotal for combating chronic and hidden hunger, especially in rural areas. This shift towards improved nutrition can be sustainably integrated into regular diets, marking a significant stride in public health. The burden of hunger and its consequences on health are increasingly quantified using the Disability-Adjusted Life Years (DALYs) approach, which merges years of life lost and years lived with disability, offering a comprehensive view of health impacts and aiding in resource allocation despite its complexity and subjective nature. A practical formula for quantifying the health impact of biofortification was introduced by Stein et al. (2005) and Zimmermann and Qaim (2004). This entails calculating the efficacy or relative reduction in hunger burden based on the current and post-intervention nutrient intake against the recommended dietary allowances. As data on consumption and recommended intake levels are variable and not readily available, this paper proposes relying on relative estimates to bridge the data gaps and uncertainties, thus streamlining the quantification of crop breeding's impact on diets and overall health.
{"title":"Quantifying the health impact of crop breeding: Revisiting the Disability-Adjusted Life Years Approach","authors":"Bert Lenaerts","doi":"10.1101/2024.08.26.24312574","DOIUrl":"https://doi.org/10.1101/2024.08.26.24312574","url":null,"abstract":"Crop breeding, through methods like biofortification, plays a crucial role in increasing agricultural yields, contributing to a stable and healthy food supply by boosting the micronutrient content of staples, which is pivotal for combating chronic and hidden hunger, especially in rural areas. This shift towards improved nutrition can be sustainably integrated into regular diets, marking a significant stride in public health. The burden of hunger and its consequences on health are increasingly quantified using the Disability-Adjusted Life Years (DALYs) approach, which merges years of life lost and years lived with disability, offering a comprehensive view of health impacts and aiding in resource allocation despite its complexity and subjective nature. A practical formula for quantifying the health impact of biofortification was introduced by Stein et al. (2005) and Zimmermann and Qaim (2004). This entails calculating the efficacy or relative reduction in hunger burden based on the current and post-intervention nutrient intake against the recommended dietary allowances. As data on consumption and recommended intake levels are variable and not readily available, this paper proposes relying on relative estimates to bridge the data gaps and uncertainties, thus streamlining the quantification of crop breeding's impact on diets and overall health.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190568","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 : 2024-08-23DOI: 10.1101/2024.08.23.24312494
Brittany Hagedorn, Rui Han
Previous work has shown that primary healthcare facilities can benefit from both in-kind support (e.g., medication shipments) as well as increased cash-on-hand to spend to address service readiness gaps. However, there is limited evidence on how facility managers choose to spend available cash or how their decisions to manage their facility budgets are affected by in-kind support. Economic theory suggests that the optimal allocation of cash resources would depend on the context and constraints to how it can be spent, and expenditures would in turn affect the availability of supplies and medications. We test this theory using regression analysis on data from the Nigeria Service Delivery Indicators for Health (SDI), a health facility survey from twelve states in 2013 that included both hospitals and primary healthcare centers (PHCs). We find that facilities with financial resources available to them have higher availability of essential medicines, especially if the facility had earmarked some cash for medication expenditures. However, earmarking for other expenditure categories did not have the same effect on medication availability, which indicates that budgeting processes are an important factor in ensuring medication availability. We find that cash support had large effect (p < 0.001) on availability and that in-kind donations had a negative effect on the probability of expenditure of medications. Additionally, we find the difference between hospitals and PHCs is due to their financial situation (variables become insignificant once support variables were in regressions). Regression analyses also showed that facilities that received in-kind medications had higher availability, but this only had a significant effect in facilities that did not have cash available to spend on medications, implying that facilities are able to address their own supply needs when they have resources available to them. Thus, in-kind supplies should be targeted to facilities that cannot otherwise procure them. Overall, facilities appear to be making effective trade-offs in the context of limited resources and they should receive both cash and support for appropriate budgeting and procurement practices.
{"title":"The impact of financial support and budgeting on medication availability and purchasing behavior in the Nigerian primary healthcare system","authors":"Brittany Hagedorn, Rui Han","doi":"10.1101/2024.08.23.24312494","DOIUrl":"https://doi.org/10.1101/2024.08.23.24312494","url":null,"abstract":"Previous work has shown that primary healthcare facilities can benefit from both in-kind support (e.g., medication shipments) as well as increased cash-on-hand to spend to address service readiness gaps. However, there is limited evidence on how facility managers choose to spend available cash or how their decisions to manage their facility budgets are affected by in-kind support. Economic theory suggests that the optimal allocation of cash resources would depend on the context and constraints to how it can be spent, and expenditures would in turn affect the availability of supplies and medications. We test this theory using regression analysis on data from the Nigeria Service Delivery Indicators for Health (SDI), a health facility survey from twelve states in 2013 that included both hospitals and primary healthcare centers (PHCs). We find that facilities with financial resources available to them have higher availability of essential medicines, especially if the facility had earmarked some cash for medication expenditures. However, earmarking for other expenditure categories did not have the same effect on medication availability, which indicates that budgeting processes are an important factor in ensuring medication availability. We find that cash support had large effect (p < 0.001) on availability and that in-kind donations had a negative effect on the probability of expenditure of medications. Additionally, we find the difference between hospitals and PHCs is due to their financial situation (variables become insignificant once support variables were in regressions). Regression analyses also showed that facilities that received in-kind medications had higher availability, but this only had a significant effect in facilities that did not have cash available to spend on medications, implying that facilities are able to address their own supply needs when they have resources available to them. Thus, in-kind supplies should be targeted to facilities that cannot otherwise procure them. Overall, facilities appear to be making effective trade-offs in the context of limited resources and they should receive both cash and support for appropriate budgeting and procurement practices.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142224780","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 : 2024-08-20DOI: 10.1101/2024.08.14.24311999
Afschin Gandjour
Background: Statins are widely prescribed to reduce cholesterol levels and decrease the risk of cardiovascular diseases. This study aims to determine cost-saving risk thresholds for statin use in Germany to inform better prescription practices and healthcare policies. Methods: A decision-analytic approach was employed, using secondary data to compare statin use with no statin use from the perspective of German sickness fund insurees. The analysis focused on cost savings from avoided cardiovascular (CV) events, translating these avoided events into net savings after accounting for treatment costs and potential side effects. The study considered the German adult population insured by sickness funds and used a lifetime horizon for the analysis. Results: The maximum number needed to treat (NNT) to achieve cost savings over 10 years was found to be 40, leading to a minimum risk threshold for savings of 9.8%. It was estimated that approximately 22% of the adult population in Germany has a 10-year CV risk of 9.8%, potentially avoiding between 307,049 and 705,537 CV events over 10 years, with net population savings of approximately 18 billion euros. Conclusions: The current official threshold for statin prescription in Germany, set at a 20% 10-year risk, is too stringent. Lowering the threshold to 9.8% could significantly increase the number of patients benefiting from statin therapy, reducing CV events and generating substantial cost savings. These findings suggest that adjustments to prescription guidelines could improve cardiovascular outcomes and economic efficiency within the German healthcare system.
{"title":"Determining Cost-Saving Risk Thresholds for Statin Use","authors":"Afschin Gandjour","doi":"10.1101/2024.08.14.24311999","DOIUrl":"https://doi.org/10.1101/2024.08.14.24311999","url":null,"abstract":"Background: Statins are widely prescribed to reduce cholesterol levels and decrease the risk of cardiovascular diseases. This study aims to determine cost-saving risk thresholds for statin use in Germany to inform better prescription practices and healthcare policies.\u0000Methods: A decision-analytic approach was employed, using secondary data to compare statin use with no statin use from the perspective of German sickness fund insurees. The analysis focused on cost savings from avoided cardiovascular (CV) events, translating these avoided events into net savings after accounting for treatment costs and potential side effects. The study considered the German adult population insured by sickness funds and used a lifetime horizon for the analysis.\u0000Results: The maximum number needed to treat (NNT) to achieve cost savings over 10 years was found to be 40, leading to a minimum risk threshold for savings of 9.8%. It was estimated that approximately 22% of the adult population in Germany has a 10-year CV risk of 9.8%, potentially avoiding between 307,049 and 705,537 CV events over 10 years, with net population savings of approximately 18 billion euros.\u0000Conclusions: The current official threshold for statin prescription in Germany, set at a 20% 10-year risk, is too stringent. Lowering the threshold to 9.8% could significantly increase the number of patients benefiting from statin therapy, reducing CV events and generating substantial cost savings. These findings suggest that adjustments to prescription guidelines could improve cardiovascular outcomes and economic efficiency within the German healthcare system.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190589","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 : 2024-08-16DOI: 10.1101/2024.08.15.24312076
Brittany Hagedorn, Benjamin Loevinsohn, Oluwole Odutolu
Previous studies have shown that facility autonomy, especially control over budget allocation, can have a modest positive effect on performance, but the findings depend on the context. Similarly, management practices are often cited as important contributors to facility performance, but the evidence is limited and usually qualitative. Data from the large-scale randomized evaluation of the Nigeria States Health Investment Project (NSHIP) offers an opportunity to quantitatively examine these relationships in the context of a lower middle-income country. We utilize non-parametric statistics to test for difference in means and apply regression analysis to test the hypothesis that autonomy and management affected facility performance. Our results show that facilities with greater autonomy, more budget control, and better management practices generally outperform their peers on a range of facility readiness and service delivery measures. For example, regression results found that facilities with high autonomy held on average 2.1 more outreach sessions per month than those without, and facilities with an annual business plan offered 1.8 additional outreach services. Supervision practices, such as more frequent visits and use of a quantitative checklist, are associated with 26% higher productivity and up to a 28.6% increase in equipment availability (percentage points), respectively. We conduct sensitivity analyses on our variable selection and use a random forest approach to validate that results are robust to changes in the model structure. We conclude that facility-level autonomy and especially budget control can improve primary healthcare facility readiness and service availability, even in resource-constrained contexts, Further, this can be achieved through good management practices that are reinforced through supportive supervision and routine performance monitoring to maximize the gains that result from incremental financing. This shows that these policies and practices can be critical contributors to efficiently achieving the goals of universal healthcare policies in the context of limited resources.
{"title":"Quantifying the intangible: Evidence from Nigeria on the impact of supervision, autonomy, and management practices on PHC performance in the context of Direct Facility Financing","authors":"Brittany Hagedorn, Benjamin Loevinsohn, Oluwole Odutolu","doi":"10.1101/2024.08.15.24312076","DOIUrl":"https://doi.org/10.1101/2024.08.15.24312076","url":null,"abstract":"Previous studies have shown that facility autonomy, especially control over budget allocation, can have a modest positive effect on performance, but the findings depend on the context. Similarly, management practices are often cited as important contributors to facility performance, but the evidence is limited and usually qualitative. Data from the large-scale randomized evaluation of the Nigeria States Health Investment Project (NSHIP) offers an opportunity to quantitatively examine these relationships in the context of a lower middle-income country. We utilize non-parametric statistics to test for difference in means and apply regression analysis to test the hypothesis that autonomy and management affected facility performance. Our results show that facilities with greater autonomy, more budget control, and better management practices generally outperform their peers on a range of facility readiness and service delivery measures. For example, regression results found that facilities with high autonomy held on average 2.1 more outreach sessions per month than those without, and facilities with an annual business plan offered 1.8 additional outreach services. Supervision practices, such as more frequent visits and use of a quantitative checklist, are associated with 26% higher productivity and up to a 28.6% increase in equipment availability (percentage points), respectively. We conduct sensitivity analyses on our variable selection and use a random forest approach to validate that results are robust to changes in the model structure. We conclude that facility-level autonomy and especially budget control can improve primary healthcare facility readiness and service availability, even in resource-constrained contexts, Further, this can be achieved through good management practices that are reinforced through supportive supervision and routine performance monitoring to maximize the gains that result from incremental financing. This shows that these policies and practices can be critical contributors to efficiently achieving the goals of universal healthcare policies in the context of limited resources.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142224779","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 : 2024-08-07DOI: 10.1101/2024.08.06.24311440
Xiao Li, Lander Willem, Caroline Klint Johannesen, Arantxa Urchueguia Fornes, Toni Lehtonen, Richard Osei-Yeboah, Heini Salo, Alejandro Orrico Sanchez, Javier Diez-Domingo, Mark Jit, Joke Bilcke, Philippe Beutels
Background: We aimed to identify influential drivers of the cost-effectiveness of older adult respiratory syncytial virus (RSV) vaccination in Denmark, Finland, the Netherlands and Valencia-Spain. Methods: A static multi-cohort model was parameterised using country- and age-specific hospitalisations using three approaches: (1) the International Classification of Diseases (ICD)-coded hospitalisations, (2) laboratory RSV-confirmed hospitalisations and (3) time-series modelling (TSM). Plausible hypothetical RSV vaccine characteristics were derived from two protein subunit vaccines for adults aged greater than 60 years (60y+). Costs and quality-adjusted life-years (QALYs) were compared between four strategies: (a) no intervention, and RSV vaccination in adults (b) 60y+; (c) 65y+; (d) 75y+, from both the healthcare payers and societal perspectives. Value of information, probabilistic sensitivity and scenario analyses identified influential drivers. Results: Besides vaccine price, the hospitalisation estimates were most influential: Using adjusted RSV-ICD-coded hospitalisations at a vaccine price of EUR150 per dose, no intervention was cost-effective up to willingness-to-pay (WTP) values of EUR 80 000 per QALY gained in Denmark, and up to EUR 34 000 and EUR 62 000 per QALY gained in Finland and the Netherlands, respectively. Using the adjusted RSV-confirmed dataset, the findings were consistent in Denmark and comparable in Finland. In Spain-Valencia, the 75y+ strategy became cost-effective at WTP > EUR 17 000. Using TSM-based estimates, the 75y+ strategy was cost-effective at WTP > EUR 16 000, > EUR 28 000, >EUR 13 000 and >EUR 37 000 in Denmark, Finland, the Netherlands and Spain-Valencia, respectively. The (in-hospital) case fatality ratio and the specification of its age dependency were both influential. Specifying different ways in which protective efficacy waned and RSV seasons were shaped and timed had both relatively limited impact on results. Conclusion: Data gaps and uncertainties on the RSV-related burden in older adults persists and influences the cost-effectiveness of RSV vaccination. More refined age- and country-specific data on the RSV attributable burden are crucial to aid decision making.
{"title":"Influential drivers of the cost-effectiveness of respiratory syncytial virus vaccination in European older adults: A multi-country analysis","authors":"Xiao Li, Lander Willem, Caroline Klint Johannesen, Arantxa Urchueguia Fornes, Toni Lehtonen, Richard Osei-Yeboah, Heini Salo, Alejandro Orrico Sanchez, Javier Diez-Domingo, Mark Jit, Joke Bilcke, Philippe Beutels","doi":"10.1101/2024.08.06.24311440","DOIUrl":"https://doi.org/10.1101/2024.08.06.24311440","url":null,"abstract":"Background: We aimed to identify influential drivers of the cost-effectiveness of older adult respiratory syncytial virus (RSV) vaccination in Denmark, Finland, the Netherlands and Valencia-Spain.\u0000Methods: A static multi-cohort model was parameterised using country- and age-specific hospitalisations using three approaches: (1) the International Classification of Diseases (ICD)-coded hospitalisations, (2) laboratory RSV-confirmed hospitalisations and (3) time-series modelling (TSM). Plausible hypothetical RSV vaccine characteristics were derived from two protein subunit vaccines for adults aged greater than 60 years (60y+). Costs and quality-adjusted life-years (QALYs) were compared between four strategies: (a) no intervention, and RSV vaccination in adults (b) 60y+; (c) 65y+; (d) 75y+, from both the healthcare payers and societal perspectives. Value of information, probabilistic sensitivity and scenario analyses identified influential drivers. Results: Besides vaccine price, the hospitalisation estimates were most influential: Using adjusted RSV-ICD-coded hospitalisations at a vaccine price of EUR150 per dose, no intervention was cost-effective up to willingness-to-pay (WTP) values of EUR 80 000 per QALY gained in Denmark, and up to EUR 34 000 and EUR 62 000 per QALY gained in Finland and the Netherlands, respectively. Using the adjusted RSV-confirmed dataset, the findings were consistent in Denmark and comparable in Finland. In Spain-Valencia, the 75y+ strategy became cost-effective at WTP > EUR 17 000. Using TSM-based estimates, the 75y+ strategy was cost-effective at WTP > EUR 16 000, > EUR 28 000, >EUR 13 000 and >EUR 37 000 in Denmark, Finland, the Netherlands and Spain-Valencia, respectively. The (in-hospital) case fatality ratio and the specification of its age dependency were both influential. Specifying different ways in which protective efficacy waned and RSV seasons were shaped and timed had both relatively limited impact on results. Conclusion: Data gaps and uncertainties on the RSV-related burden in older adults persists and influences the cost-effectiveness of RSV vaccination. More refined age- and country-specific data on the RSV attributable burden are crucial to aid decision making.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141946018","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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