European Journal of Health Economics最新文献

Background: The EQ-5D-Y-3L, EQ-5D-Y-5L and Child Health Utility 9-dimension (CHU9D) are instruments that measures health-related quality of life. These instruments are widely used in children and adolescents with health conditions, however the measurement properties of the three instruments have not been tested in Brazilian children.

Objective: To compare and test the measurement properties of the EQ-5D-Y-3L, EQ-5D-Y-5L and CHU9D in Brazilian children and adolescents with and without any self-reported musculoskeletal pain.

Methods: Children and adolescents aged 8-18 years were recruited from schools in Sao Paulo, Brazil and, self-completed the EQ-5D-Y-3L, EQ-5D-Y-5L and CHU9D at baseline and after 7 days. Reliability was determined by Kappa for the dimensions and intraclass correlation coefficient (ICC) for visual analogue scale (EQ VAS). Hypothesis were developed for construct validity and tested with Spearman and Pearson correlations (adequate if > 75% of the hypotheses confirmed). Children and adolescents with and without musculoskeletal pain were compared for known-group validity.

Results: We included 356 children and adolescents, with 51% (n = 181) reporting musculoskeletal pain. Majority were male (53%) and mean age of 11.5 years (SD: 2.9). The EQ-5D-Y-3L, EQ-5D-Y-5L and CHU9D ranged from poor to moderate reliability. Reliability of the EQ VAS was substantial (ICC: 0.81, 95% confidence interval [CI]: 0.72 to 0.87) to moderate (ICC: 0.40, 95% CI: 0.24 to 0.53) for those with musculoskeletal pain and without pain, respectively. In those with musculoskeletal pain the association was weak to moderate, with > 75% of hypotheses confirmed, when comparing EQ-5D-Y-3L and EQ-D-Y-5L with the PedsQL™ and comparing EQ-5D-Y-5L with CHU9D. All instruments were able to discriminate those with and without musculoskeletal pain.

Conclusion: All instruments had better measurement properties in children and adolescents with musculoskeletal pain, compared to those without for reliability and construct validity. These instruments could be used to assess health-related quality of life in Brazilian children and adolescents with musculoskeletal pain.

This study examines the impact of macroeconomic well-being indicators-GDP, health spending as a percentage of GDP, and the unemployment rate-on the prevalence of chronic diseases, including circulatory and respiratory diseases and diabetes mellitus, across 27 European Union countries over 21 years. Utilizing advanced econometric methods like General Method of Moments, Structural Equation Modeling, and wavelet coherence analysis, the research reveals that higher GDP correlates with increased disease prevalence, while greater health spending reduces it. The unemployment rate significantly affects diabetes prevalence. The study introduces the "Economic Prosperity and Chronic Disease Paradox," theory, which suggests that economic growth, while improving healthcare access and living standards, paradoxically increases chronic disease rates due to lifestyle changes such as unhealthy diets, sedentary behavior, and pollution. This theory highlights the need for strategic public health policies to counteract these adverse effects and promote sustainable health outcomes amidst economic development.

Objectives: The optimal point in time to measure willingness-to-pay (WTP) remains unclear. We investigated the role of health information shocks (HIS) in individuals' WTP, analyzing the extent to which news of SARS-CoV-2 infections among people they know/themselves altered WTP for booster vaccinations.

Methods: We elicited WTP in eight European countries using the European Covid Survey. First, we presented participants with a hypothetical setting recommending a booster vaccination that had to be paid out-of-pocket. To measure WTP, we elicited a lower and upper WTP limit, and a WTP value contingent on both of these. To measure HIS, we asked about the duration since participants received news of COVID-19 cases among people they know (including themselves), as well as the degree of personal connection to these cases and their severity. We used a two-part model to estimate the association between HIS and individuals' WTP.

Results: Among the 5809 observations, 76.8% stated a WTP for a booster vaccination greater than €0. At least one HIS was reported by 61.9% of participants. The occurrence of a HIS was associated with an increase in WTP of €14.54 (logistic: P <.0001, gamma: P =.1493) compared to no HIS. The WTP was higher when the HIS occurred in the four weeks before the survey. Controlling for socio-demographic and COVID-19 covariates decreased significance and effect sizes.

Conclusion: Our findings suggest that a recent HIS is associated with a higher probability of having a positive WTP. Timing, in relation to some relevant event, therefore may matter when measuring WTP for health interventions. If so, finding the optimal point in time to measure WTP is difficult and may depend on the policy question under consideration.

Economic evaluations of health technologies increasingly encompass a cost-effectiveness analysis (CEA) and a supplementary budget impact analysis (BIA) to inform reimbursement decisions on health technologies. Evidence from the Netherlands suggests that CEA requirements are consistent between the different stages of the decision-making process in the Netherlands, while BIA requirements are not. It remains unclear why aspects of BIAs vary in form and importance across decision stages, and why BIA results do not have a clear and consistent relationship with CEA results. Therefore, this study aimed to obtain further insight into the role of budget impact in the different stages of the decision-making process in the Netherlands, and into the experiences of decision-makers that may explain the variation in use of BIA across these stages. To meet this aim, we conducted semi-structured interviews with 12 decision-makers and 3 pharmaceutical industry representatives. Our findings indicate that BIAs serve multiple purposes depending on the responsibilities and needs of decision-makers in a specific decision stage. Each purpose may be relatively well-defined, and decision-makers seemingly have a clear understanding of the evidence on (aspects of) budget impact required for achieving their specific purpose. For example, the selection of pharmaceuticals for assessment is based on the maximum financial risk associated with reimbursement, discarding evidence on savings and substitution effects in other budgets and sectors, while these broader healthcare and societal elements are included during the appraisal stage. Hence, a clear framework for the consistent use of evidence on budget impact across decision stages has not yet been established.

In this study we use a unit record, panel dataset, to examine the behaviour of clinicians under a chronic disease management program (CDMP) that is designed to improve care and slow the progression of chronic kidney disease (CKD). Using 8 years of quarterly data on the population of CKD patients (n = 44,686) in the Emilia-Romagna region of northern Italy, we analyse a setting where medical practitioners are agents who respond to the demands of two principals: their patient and the third-party payer. Exploiting detailed information on specialist visits and the concentration of general practitioners (GP) in local areas, as well as disease severity, we study how GPs on one side, and specialist nephrologists and cardiologists on the other comply with the CDMP guidelines, as may be predicted on the basis of a dual-agency approach. Our application of both multiple-treatment differences-in-differences (DID_M) and panel fixed-effects linear probability models produces evidence coherent with income-maximizing and, to a lower extent, effort-reducing strategies on the part of the GPs, as well as with strategic behaviour by some specialists. We also produce evidence that specialists who practice in hub facilities with a leading role in CDMP implementation, also for reputational reasons, exhibit referral practices that are more closely related to the CDMP guidelines.

Introduction: Minimum important changes (MICs) represent thresholds for clinically meaningful change. Multi-attribute utility instruments (MAUIs) generate health state utilities (holistic measures of health-related quality of life). No systematic review of MICs specifically for MAUIs has been conducted. In addition, no guidelines for estimating MICs for MAUIs have been proposed. We aimed to correct these evidence gaps by producing guidelines contextualised by a systematic review.

Methods: We searched ten databases for relevant records using various search terms. Extracted data were analysed narratively and descriptively. The presence of key reporting items (relating to precision, sensitivity, and concurrent validity) was also evaluated. Guidelines for MIC estimation were informed by the broader MIC literature and contextualised using study results.

Results: The review identified 5035 non-duplicate records, with 68 entering the study. 282 unique, anchor-based MICs were extracted. Of these MICs, 119 (42.20%) pertained to the EQ-5D-3L, 82 (29.08%) to the EQ-5D-5L, and 50 (17.73%) to the SF-6D.v1. The most common anchor-based method used to estimate MICs (107, 37.94%) involved taking the mean change score for a group considered to have experienced a MIC. Distribution-based methods were also common, appearing in 31 (45.59%) of the included studies. The inclusion of key reporting items was generally deficient.

Conclusions: Deficiencies in reporting and diverse estimation methods raise concerns regarding the extant MAUI MIC literature. Researchers should exercise caution when using existing MAUI MICs. Recommendations presented in our study may assist researchers in effectively estimating MICs for use in health economics.

Several empirical papers suggest that individuals improve health-related behaviors in response to adverse shocks to physical health. However, little evidence exists regarding the questions of (i) how long-lasting these behavioral responses are and (ii) whether individuals respond similarly to mental health shocks. Using individual-level survey data from Germany and combining regression augmented inverse-probability weighting with machine learning prediction algorithms, we compare individuals hit by such shocks to undisturbed individuals up to fifteen years after that shock. The analysis confirms earlier findings that individuals experiencing a sharp deterioration of physical health immediately improve their health-related behaviors in terms of eating more healthily and being less likely to smoke. Contrarily, doing sports is negatively affected. We further find that the immediate response to shocks on mental health is weaker, with the exception of smoking. Tobacco consumption on average becomes more likely after a shock to mental health. We further find that the immediate response to shocks on mental health is weaker, with the exception of smoking behavior, which on average worsens after such kind of a shock. Yet the analysis does not reveal long lasting persistent effects. Significant differences in health behaviors are rarely found more than two years after the shock.

By 2030, it is anticipated that poor mental health will cost the global economy approximately $6 trillion per year, primarily due to productivity loss. It is crucial to understand how psychological distress contributes to productivity loss in the workplace. We aim to investigate the relationship between psychological distress and productivity loss in the Australian working population. We utilized eight waves of longitudinal data drawn from the Household, Income, and Labour Dynamics in Australia (HILDA) Survey (waves 7, 9, 11, 13, 15, 17, 19, and 21). We compiled an unbalanced panel data set comprising 70,973 person-year observations from 18,729 unique working adults. We used Fixed-effects Poisson regression and Fixed-effects logistic regression models to investigate the within-person differences in the relationship between psychological distress and productivity loss (measured through sickness absence, presenteeism, and underemployment). We found that moderate and high psychological distress is associated with a higher rate of sickness absence, presenteeism, and underemployment when a working adult shifted from low psychological distress after controlling socio-demographic, health, and employment-related characteristics. Our study demonstrated that moderate to high psychological distress adversely affected employees' job productivity through increased sickness absence, a higher likelihood of presenteeism, and greater levels of underemployment. Our findings also revealed that employees with moderate and high psychological distress incurred additional annual sickness absence costs of AUD 60.66 and AUD 99.26, respectively, compared to peers with low psychological distress. Additionally, our study found that employees with moderate and high levels of psychological distress experienced significantly higher levels of presenteeism, which resulted in additional annual costs of AUD 1,166.30 and AUD 3,656.05, respectively, compared to their counterparts with low psychological distress. Psychological distress imposed significant costs on Australian workplaces. Implementing workplace health promotion programs should be prioritized as a policy to address psychological distress among employees, enhance their well-being, and improve overall productivity.

Background: The EQ-5D-Y-3L is a generic, preference-accompanied health measure intended for pediatric populations. EQ-5D-Y-3L health states are valued using the perspective of a hypothetical 10-year-old child ('child perspective') rather than adults valuing for themselves ('adult perspective'). The perspective used has been shown to influence valuation outcomes, affecting comparability of health utilities. This study explored within-respondent differences in values between adult and child perspectives using data from Hungary.

Methods: A secondary analysis was conducted using composite time trade-off (cTTO) data from the Hungarian EQ-5D-Y-3L valuation study. Two hundred adults valued 10 health states from the child perspective and four from the adult perspective. The cTTO values for the matched health states (valued from both perspectives) were compared, with differences analyzed using t-tests and random-intercept regression. Associations with respondent characteristics were also explored.

Results: Differences in cTTO values were observed between perspectives, particularly for more severe health states. Compared to the adult perspective, the child perspective yielded significantly lower values for worse-than-dead observations, but higher values for better-than-dead observations. After adjusting for within-subject variation and respondent characteristics, perspective was not a significant predictor of cTTO values. Instead, differences were partly explained by education, region of residence, parental status, and the view that a child's life is more valuable than an adult's.

Conclusions: This is the first study to explore perspective differences in EQ-5D-Y-3L health state valuation within respondents using nationally representative data from outside Western Europe. The findings highlight the importance of considering individual-level attributes in pediatric health valuation.