1,721,117 research outputs found
Embedding Health Economics into Pharmacy Research: a three-part guide
No full textPART ONE: A basic guide to economic evaluation for primary care pharmacists. PART TWO: Sensitivity analysis - a tool for quantifying decision uncertainty. PART THREE: How to critically appraise an economic evaluation
Sex, benevolence and willingness to pay for screening
Full text linkPurpose: We report the findings of a contingent valuation survey of health care services, designed to illuminate self-interest and benevolence on the part of one sex for the other. Design/methodology/approach: In a constructed scenario, men and women recorded how much they would be willing to contribute to each of three different types of cancer screening, one of which would be available only to members of the opposite sex. Findings: Over two-thirds of individuals, amongst whom men were more heavily represented, chose an identical contingent valuation for all three services. Amongst those who nominated dissimilar values, a willingness to contribute to own-sex screening coupled with an unwillingness to contribute to opposite-sex screening was more common amongst women than amongst men. Both sexes valued own-sex screening more highly than opposite-sex screening yet, compared with men, women were prepared to offer proportionately less for the latter relative to the former. In an associated person trade-off task, women were considerably less likely than men to choose opposite-sex screening at the expense of a type from which they could benefit personally. Originality/value: To date, very little research has been undertaken on differential responses to health valuation of care provision by sex. The results suggest a degree of asymmetry between the sexes, with respect to self-interest and benevolence
WTP and WTA: do people think differently?
No full textContingent valuation (CV) studies in health care have used the willingness to pay (WTP) approach, to the virtual exclusion of willingness to accept (WTA). Outside the health care field, disparities between WTP and WTA values have been observed. Were such disparities to be demonstrated for health care technologies, the conventional assumption of a linear cost-effectiveness plane would be invalidated. This paper employs data derived from interviews with users of the UK's paediatric cochlear implantation (PCI) programme based in Nottingham (i) to assess the feasibility of estimating WTA for the potential discontinuation of an existing technology, and (ii) to investigate any WTA-WTP disparity which might be revealed. Only one-third of subjects providing WTP values were willing and able to offer a corresponding WTA value. Our qualitative data revealed that modes of response differed between the two valuation approaches. In particular, the presumption of fungibility of the health care intervention was a far more serious obstacle to completing the WTA task than it was for WTP. Among those prepared to offer values under both approaches, mean WTA was approximately four times mean WTP. Until more health studies are conducted, it remains unclear whether or not the findings are specific both to the intervention and to the elicitation format
Contingent valuation: what needs to be done?
Full text linkContingent valuation (CV) has been argued to have theoretical advantages over other approaches for benefit valuation used by health economists. Yet, in reality, the technique appears not to have realised these advantages when applied to health-care issues, such that its influence in decision-making at national levels has been non-existent within the health sector. This is not a result of a lack of methodological work in the area, which has continued to flourish. Rather, it is a result of such activities being undertaken in a rather uncoordinated and unsystematic fashion, leading CV to be akin to a 'ship without a sail'. This paper utilises a systematic review of the CV literature in health to illustrate some important points concerning the conduct of CV studies, before providing a comment on what the remaining policy and research priorities are for the technique, and proposing a guideline for such studies. It is hoped that this will initiate some wider and rigorous debate on the future of the CV technique in order to make it seaworthy, give it direction and provide the right momentum
Interpreting parental proxy reports of (health-related) quality of life for children with unilateral cochlear implants
No full textObjective: To examine what factors are associated with EuroQol EQ-5D scores in children after unilateral cochlear implantation and to explore parental conceptualisations of health-related quality of life (HRQL) and quality of life (QoL). Methods: Face to face interviews were conducted with the parents of 222 implanted children, in an attempt to elicit information on their child's HRQL and QoL. Post-implant, the child's HRQL was measured using the EQ-5D, completed by parental proxy. Regression analysis was undertaken in order to estimate the association between the child EQ-5D score and child characteristics, child performance, and parental characteristics, in order to assess the construct validity of the EQ-5D. HRQL was also measured using the EuroQol visual analogue scale (VAS), where the endpoints were the best and worst imaginable health state, and a VAS was also used to measure QoL (endpoints: best/worst imaginable QoL). Parents were asked to estimate scores on both these VAS measures both post-implantation and (retrospectively) pre-implantation. Throughout the HRQL and QoL elicitation process, subjects’ comments, and observations were noted. Results: Children who had an additional disability (p < 0.001), were male (p < 0.05) or had a lower level of auditory perception (p < 0.001) were estimated to have lower EQ-5D scores, as were children whose parents who left school before age 18 years (p < 0.05). According to the EuroQol VAS the mean difference between pre- and post-implantation score was 0.14, compared to 0.35 for the QoL VAS, demonstrating that parents tended not to see HRQL and QoL as equivalent. As 67% of parents deemed there to be no difference between the pre- and post-implant EuroQol VAS scores we also infer that the majority of parents rejected the notion of deafness being a HRQL issue. Conclusion: The evidence relating to the construct validity of the EQ-5D is variable—though it was able to discriminate between children with certain levels of auditory performance, it could not discriminate between children who differed in other ways. By limiting outcome from cochlear implantation to HRQL, as opposed to QoL, the benefits of cochlear implants are likely to be underestimated
Can you repeat that? Exploring the definition of a successful model replication in health economics
No full textBackground: The ISPOR modelling taskforce suggest decision models should be thoroughly reported and transparent. However, the level of transparency and indeed how transparency should be assessed, has yet to be defined. One way, may be to attempt to replicate the model and its outputs. The ability to replicate a decision model could demonstrate adequate reporting transparency. Objective: To explore published definitions of replication success, across all scientific disciplines, and to consider how such a definition should be tailored for use in health economic models. Methods: A literature review was conducted to identify published definitions of a ‘successful replication’. Using these as a foundation, several definitions of replication success were constructed to be applicable to replications of economic decision models, with the associated strengths and weaknesses of such definitions discussed. Results: A substantial body of literature discussing replicability was found, however relatively few studies, ten, explicitly defined a successful replication. These definitions varied from subjective assessments to expecting exactly the same results to be reproduced. Whilst the definitions that have been found may help to construct a definition specific to health economics, no definition was found that completely encompassed the unique requirements for decision models. Conclusion: Replication is widely discussed in other scientific disciplines, however as of yet there is no consensus on how replicable models should be within health economics or, what constitutes a successful replication. Replication studies can demonstrate how transparently a model is reported, identify potential calculation errors and inform future reporting practices. It may therefore be a useful adjunct to other transparency or quality measures
Measuring indirect costs: is there a problem?
No full textIt is generally accepted that, in order to appraise from a societal perspective, indirect costs should be included in economic evaluations. What is less generally accepted, however, is the method by which such indirect costs should be calculated. Different methods and assumptions can, in theory, produce different results. Previous studies have commented on this variability, and most suggest a need for consensus. This having been said, no previous study appears to have demonstrated that variability in method is actually a practical problem, in the sense that the use of different costing methods would lead to different policy conclusions. In this paper, we examine this issue with respect to a specific intervention, namely, paediatric cochlear implantation (PCI). Based on questionnaire data, we estimate the indirect costs of PCI using a variety of methods. Thereafter, we integrate these indirect costs into a cost-utility analysis of PCI, and demonstrate that the variability in methods can significantly affect the outcome of a cost-effectiveness study. Therefore, in this case at least, the measurement of indirect cost is indeed a problem.</p
Paediatric cochlear implantation: the views of parents
No full textThe purpose of this study was to understand the parental perspective on paediatric cochlear implantation over time. Face-to-face semi-structured interviews were conducted with 216 families of children who were implanted at the Nottingham Paediatric Cochlear Implant Programme between 1989 and 2002, and who were attending an appointment during the study period (July 2001 August 2002). The qualitative data revealed that time played an important role in family experiences of paediatric cochlear implantation. Expectations were continually revised throughout the process, as a result of new knowledge and new technological developments. The results show that outcomes are highly individualistic although parents had a shared hope of the implant enabling the child to function in a "hearing world"; that the biggest area of contention is in respect of their child's education; and that parents talked openly about constraints imposed on them by implantation. The vast majority of parents did not regret their decision to proceed with implantation.</p
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