European Journal of Health Economics最新文献

Background: Responses on health-related quality of life measured by disease-specific instruments can be mapped onto the EQ-5D to estimate utility values for economic evaluation. San Martin´s Quality of Life Scale (St. MQoL-S) is a preferred measure to obtain health outcomes in adults with cerebral palsy. Nevertheless, it lacks a preference-based health utility score for estimating quality-adjusted life years (QALYs).

Objective: To develop algorithms for mapping from the St. MQoL-S to allow future prediction of the EQ-5D-5L, in adults with cerebral palsy, when utility data have not been collected.

Methods: Direct mapping models were developed using ordinary least squares, a generalized linear model, and Tobit regression analysis to estimate EQ-5D-5L utilities, with St. MQoL-S total and domain scores as explanatory variables, in a cross-sectional study of adults with cerebral palsy in Spain. Goodness-of-fit was assessed using mean absolute error (MAE) and root mean square error (RMSE). Repeated k-fold cross-validation was employed to select the optimal mapping model demonstrating superior predictive performance.

Results: The best-performing model for predicting EQ-5D-5L utilities, includes the St. MQoL-S total scores, age, gender, and types of cerebral palsy as explanatory variables in a stepwise ordinary least squares regression, making it the most robust model for use as a mapping algorithm with external data.

Conclusion: This is the first study to present mapping algorithms between the St. MQoL-S and EQ-5D-5L. The mapping functions preferred in this study seem adequate for estimating the utilities of the EQ-5D-5L for economic evaluation and to obtain QALYs in adults with cerebral palsy.

The UN's Convention on the Rights of Persons with Disabilities includes a right to equal work opportunities. People with visual impairments (VI) are targeted by this convention and experience low employment rates. The initial transition from education to labor is a predictor for later labor market participation. Exploiting administrative register data, we identified a graduated subpopulation with VI and matched them to a control group. This paper evaluates (1) group differences in various socio-economic outcomes following graduation, and (2) following initial employment. Following graduation there are fewer transitions into (self-)employment for people with VI and more transitions to disability insurance or social benefits, but similar patterns for unemployment insurance and further education. Scrutinizing subsequent dynamics for those that secured initial employment revealed a greater share of those with VI maintained employment as dominant source of income given there was a change in employment status. However, there are more dynamics recorded for individuals with VI, which may reflect difficulties retaining a job. This group remained overrepresented in disability insurance as well as social benefits. Differences with regards to self-employment, unemployment insurance, further education and the other no income status did not reach significance. In conclusion, this study did not find equal labor market prospects for declarants with VI. The finding that VI declarants face less favorable labor market prospects than their matched counterparts, despite having similar cognitive ability, underscores the need for policies that not only improve their labor market outcomes but also promote greater equality in opportunities to reach the UN convention's ideals.

Background: Policymakers face challenges in developing pricing policies for potentially innovative healthcare technologies (pIHTs) that balance limited budgets, access, and incentives for innovation. This study aimed to map existing evidence and identify knowledge gaps regarding price determinants and pricing policies for pIHTs and their effect on access and sustainability.

Methods: We conducted a scoping Review of scientific and grey literature in English published between 2014 and September 2023 with pre-specified inclusion and exclusion criteria to identify stakeholder-informed price determinants, pricing policies applied by European Economic Area (EEA) or Organisation for Economic Cooperation and Development (OECD) member states, and their access-related impacts. Literature databases and various stakeholder organisation websites were searched. Further records were included through snowballing and manual addition.

Results: 135 Records were included. Stakeholder views on price determinants were available from 15 records and predominantly involved value-based determinants. Pricing policies in EEA/OECD member states are heterogeneous and often feature a mix of policy interventions and implementation methods. External price referencing (EPR), while yielding short-term affordability improvements, is associated with price inequities and launch strategies impairing patient access. Policies combining pricing methods and considering a pIHT's value have more positive access-related impact but may face feasibility and implementation challenges. Two records mentioned medical device pricing; none featured environmental aspects.

Conclusion: While EPR is commonly applied across Europe, value-informed pricing in connection with health technology assessment is more favoured regarding pIHT access in the literature. Knowledge gaps concern medical device pricing, stakeholder views on price determinants, and the implementation of environmental aspects in pIHT pricing.

This paper investigates the effects of regulations aiming to optimise the multi-agency relationships, with a focus on the prescription choice between generic versus branded medications. In 2012, Italian legislators introduced two laws targeting general practitioners prescription behaviour, a soft (recommendations) law followed by a hard (mandatory) law to promote generic medication. We implement a regression discontinuity in time framework and an event study to quarterly administrative data for individuals with chronic kidney disease linked to data from their general practitioners in Emilia-Romagna, Italy. The results indicate that the policies were effective, but had modest effects on increasing the prescription of generic medications. Hard laws seem to have played a key role in driving this change. Heterogeneity checks provide evidence that less competition among GPs and interaction with specialists increased generic medication prescriptions.

Knowing the determinants of rising health and long-term care costs is crucial to support cost containment policies and to predict future expenditures. According to the "red herring" debate, not ageing per se, but proximity to death is the most important determinant of future expenditures. This study aims to update and expand the existing Dutch literature after two major reforms in health and long-term care. Insurance claims data from 2018-2019 of 13,738,193 insured individuals were included. Using negative binomial regression analyses, the association between deceased individuals and survivors on total health and long-term care costs was investigated, as well as per health care sector. Costs rose sharply in the two months prior to death. Regression models showed an association with total health and long-term care costs of 10.8 for deceased individuals compared with survivors (crude model) and 3.3 (adjusted model). Especially including age and chronic diseases decreased the association. The largest differences in costs between deceased individuals and survivors in the adjusted model were found for geriatric rehabilitation care and primary care stays (16.7), home nursing (10,6), and long-term care (9.3). Not just the costs of deceased individuals are important for health care costs, but also age, as measured by being in the highest age category, and chronic diseases. The costs of deceased individuals were heterogeneous across health care sectors.

Objectives: There is growing interest in measuring health outcomes associated with minimally invasive cosmetic procedures (MICPs), such as botulinum toxin and hyaluronic acid injections. However, the EQ-5D may have limited content validity for this purpose. This study aims to psychometrically test five additional dimensions ('bolt-ons') for the EQ-5D-5L in individuals planning or undergoing MICPs.

Methods: In 2023, a cross-sectional, online survey was conducted with 149 women planning MICPs and 215 who had recently undergone them. Respondents completed the EQ-5D-5L, five bolt-ons (skin irritation, self-confidence, sleep, social relationships, tiredness), the Rosenberg Self-Esteem Scale (RSES) and the Brief Fear of Negative Evaluation Scale-Straightforward Items (BFNE-S). The following psychometric properties were tested for the EQ-5D-5L + bolt-on(s): ceiling, convergent and divergent validity, explanatory power and known-groups validity.

Results: Adding tiredness (22%), self-confidence (23%) or sleep bolt-ons (27%) substantially reduced the ceiling of the EQ-5D-5L (47%). The self-confidence and social relationships bolt-ons showed a moderate or strong correlation with the RSES and BFNE-S total scores (-0.462 to -0.679). The tiredness and self-confidence bolt-ons improved the EQ-5D-5L's explained variance in EQ VAS scores from 37% to 45%. The self-confidence and social relationships bolt-ons improved the EQ-5D-5L's discrimination between known groups based on self-esteem and bodily appearance (relative efficiency: 2.72 to 2.82).

Conclusions: Relevant bolt-ons substantially enhance the psychometric performance of the EQ-5D-5L in MICP populations. The self-confidence and tiredness bolt-ons may be recommended as primary choices for use alongside the EQ-5D-5L, both in clinical studies and as part of sensitivity analyses in economic evaluations of MICPs.

Purpose: The iMTA productivity cost questionnaire (iPCQ) has been recommended as a measurement tool for productivity cost, however, its use in routine care is hindered by the length of this questionnaire (18 questions). This study developed and tested a short-form (SF-) iPCQ.

Method: A secondary analysis of the Groningen Spine Cohort's baseline data from patients with low back pain referred for tertiary care was performed. Six SFs were evaluated against the comprehensive iPCQ. Spearman correlation (r), intraclass correlation coefficient (ICC, agreement), standard error of measurement (SEM), and Bland-Altman's plot tested the congruence of the SFs with the comprehensive iPCQ.

Results: The sample consisted of 1220 patients with low back pain. The SF version with the highest correlation (SF-3; 7 items) with the comprehensive iPCQ had r = 0.99, ICC = 0.99, SEM = 295, while the SF with the least number of items (SF-6; 5 items) had r = 0.84, ICC = 0.91, SEM = 2063. The mean productivity cost estimates of SF-3 and SF-6 were €3414 (95% CI: 3036-3791) and €3333 (95% CI: 2970-3696) respectively while that for the comprehensive iPCQ amounted to €3456 (95% CI: 3189-3720).

Conclusion: A SF with seven questions was developed with a high agreement with the comprehensive iPCQ. Initial clinimetric testing was satisfactory. Further assessment is recommended.

Introduction: Cost-utility analysis (CUA) is a commonly used method in Health technology assessment (HTA) that utilises generic metrics such as quality-adjusted life years (QALYs). QALY is a measure derived from individuals' preferences for different health states, with these preferences represented as utility values. However, utility values may differ by age, raising equity concerns in healthcare allocation. Given the globally ageing demographic, understanding the age-utility relationship becomes essential.

Objectives: This systematic review aimed to explore the impact of age on utility values derived from the EQ-5D, a widely used instrument in CUA that contributes to calculating QALYs by assessing five dimensions of health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.

Methods: Our search used the comprehensive pearl growing approach and database searching. We included studies that analysed the effect of age on EQ-5D utility values in the general population. We excluded qualitative, non-English, and non-EQ-5D instrument studies. Quality was appraised using the Joanna Briggs Institute tool, and a narrative synthesis was used.

Results: Of the 28 studies reviewed, primarily from Europe and the Americas, the average age of participants ranged from 34.1 and 47.7 years. Around 46% (n = 13) associated older age with lower utility values; 28% (n = 8) with higher utility; and 25% (n = 7) found no consistent relationship between age and utility.

Discussion: Age was identified as a critical factor affecting EQ-5D-derived utility values, with implications for the equitable distribution of healthcare resources. These findings corroborate previous research on utility measurement across different instruments, highlighting the ethical and policy issues due to age-related utility differences.

Background: In July 2017, a Dutch health insurer and primary care organization jointly implemented the All-In Contract (AIC), a population-based payment model for general practitioners (GPs). Affiliated GP-practices received a capitated payment per enrolled patient covering all GP care and multidisciplinary primary care for chronic conditions. Additionally, the care organization shared in savings and losses on total healthcare spending, contingent upon meeting quality targets. This study investigates the AIC's impact on spending, quality indicators, and provider experiences 2.5 years after implementation.

Methods: We employed a difference-in-differences approach comparing individual-level claims spending from enrollees of participating GP-practices (N = 16,425) with a control group (N = 212,251). Changes in indicators of chronic care management and patient satisfaction were investigated in a before-after analysis due to limited data availability. To contextualize the findings and explore provider experiences, focus groups were conducted with stakeholders involved in the development and/or implementation of the AIC.

Results: The AIC was associated with an insignificant 1.2% reduction of average quarterly total spending per enrollee (p = 0.476). We did find a - 10.2% decrease in primary care spending growth (p < 0.01), which was likely related to the indexation rate used for the capitation payment. Spending in other subcategories showed insignificant changes. Changes in patient satisfaction and chronic care management indicators were mixed and modest, but due to the lack of data from non-participating GPs, the extent to which these changes can be attributed to the AIC remains uncertain. The focus group participants reported improvements in provider flexibility in care provision, autonomy, and reduced administrative burdens. However, the focus group results may not fully capture the broader or more diverse experiences of all providers involved.

Conclusions: In its first 2.5 years, the AIC had no significant effect on total healthcare spending growth. Trends in quality indicators suggest mixed results for patient satisfaction and chronic care management, while focus group results indicated improved provider experiences. To comprehensively evaluate population-based payment reforms, stakeholders should improve data collection strategies to enable causal assessment of population health, patient experiences, and provider well-being.

Since 2010, most Dutch patients with diabetes mellitus type 2 (DM2), an increased risk of cardiovascular diseases (CVR), and chronic obstructive pulmonary disease (COPD), have been treated in single-disease management programs (SDMPs) provided by primary care cooperatives (PCCs). These SDMPs are funded through bundled payments. However, given the prevalence of multimorbidity among patients, there is a growing need for care that is more person-centred. We have previously published an alternative payment model that stimulates the integration of care required for a person-centred approach and in this paper, we demonstrate an operationalization of this model. We performed cluster analysis on claims data to distinguish between different subgroups of patients, predicted cluster probabilities with data available to general practitioners, designed different care packages and investigated the expected financial risk for PCCs of different sizes. We showed that mainly the size of the PCC and the content of the care package influenced the predicted losses or profits for the PCC. Two risk-mitigating measures-risk-adjustment and cost-capping-resulted generally in predicted losses or profits closer to 0, and therefore a reduced risk for the PCC.