How important is patient brand loyalty in the uptake of generic drugs?

Many western countries have developed policies to promote the substitution of branded ‘originator’ drugs with generic drugs, with the aim of containing pharmaceutical costs. However, success has been patchy and in some countries the phenomenon of the ‘generics paradox’ has been observed, where manufacturers are able to increase the prices of branded drugs after the market has been opened to generics. Using data from Spain, our study explored the extent to which the brand loyalty of patients – as opposed to their doctors or health insurers – plays a part in keeping the market penetration of generic drugs at a low level. Its findings suggest that the uptake of generics could be increased through targeted education and information on the identical properties of generics and the branded drugs they are intended to replace

Physician payment methods: a focus on quality and cost control

With rising health care costs, governments must develop innovative methods to deliver efficient and equitable health care services. With physician remuneration being the third largest health care expense, the design of remuneration methods is a priority in health care policy. Otolaryngology-Head and Neck surgeons should have an understanding of the behavioural incentives associated with different physician payment methods. This article will outline the different physician payment methods with a focus on discussing the impact on quality of care and health care costs

Decision-making under risk---the case of adolescent smoking.

This thesis examines decision-making about risks under conditions of uncertainty. Research specifically studies adolescents and smoking to uncover which information sources play influential roles in forming smoking risk perceptions. Findings aim to offer policy-related, theoretical and methodological meaning This study looks at two key issues. First, it links risk perceptions to smoking decisions to highlight the motivation for understanding the predictors of risk perceptions. Second, research investigates how individuals use information sources (ex. parents, doctors, peers, health warning messages) employing a Bayesian decision-making model. This thesis performs empirical analysis using The Canadian Youth Smoking Survey (2002) (19,018 respondents, 10-15 years) and The U.S. National Survey on Drug Use and Health (2004) (18,294 respondents, 12-17 years). Across both datasets, adolescents' risk perceptions and likelihood of having never smoking a cigarette were found to be positively related. However, smoking behaviors were never found to significantly predict risk perceptions once controlling for endogeneity between risk perceptions and behaviors. This suggests that adolescents rely on exogenous information sources about smoking risks rather than personal experiences to form perceptions of smoking risks. From a policy perspective, medical professionals talking with adolescent patients about smoking, parents' smoking, societal smoking prevalence (more than peers' smoking), awareness of tobacco package warning labels and knowledge of school smoking rules (but not the rules themselves) were found to predict adolescents' risk perceptions. From a theoretical perspective, this thesis alters the Bayesian model to include environmental and social effects. It also finds support for the role of affect heuristics in decision making involving risks. Findings also point to evidence of principal-agency relationships between medical professionals and adolescents. Analysis also highlights how spatial proximity impacts the credibility adolescents attach to behavioral examples and opinions regarding smoking. From a methodological standpoint, evidence suggests that adolescents' expressions of their assessment of risk depend upon elicitation methodology used and that work focusing on predictors of risk perceptions should include direct (ex. parents discussing risks) and indirect (ex. societal smoking prevalence) sources of information

Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death?

Ageing is assumed to be accompanied by greater health care expenditures but the association is also viewed as a ‘red herring’. This study aimed to evaluate whether age is associated with health care costs in the senior elderly, using electronic health records for 98,220 participants aged 80 years and over registered with the UK Clinical Practice Research Datalink and linked Hospital Episode Statistics (2010–2014). Annual costs of health care utilization were estimated from a two-part model; multiple fractional polynomial models were employed to evaluate the non-linear association of age with predicted health care costs while also controlling for comorbidities, impairments, and death proximity. Annual health care costs increased from 80 years (£2972 in men, £2603 in women) to 97 (men; £4721) or 98 years (women; £3963), before declining. Costs were significantly elevated in the last year of life but this effect declined with age, from £10,027 in younger octogenarians to £7021 in centenarians. This decline was steeper in participants with comorbidities or impairments; £14,500 for 80–84-year-olds and £6752 for centenarians with 7+ impairments. At other times, comorbidity and impairments, not age, were main drivers of costs. We conclude that comorbidities, impairments, and proximity to death are key mediators of age-related increases in health care costs. While the costs of comorbidity among survivors are not generally associated with age, additional costs in the last year of life decline with age

'Relative consent' or 'presumed consent'? Organ donation attitudes and behaviour

Legislation, in the form of presumed consent, has been argued to boost organ donation but most evidence disregards the practice of seeking relative’s consent, which can either ‘veto’ donation decisions, or ‘legitimize them’, by removing any possible conflict with the donor’s family. We study the effect of presumed consent alongside family consent on individu- als’ willingness to donate (WTD) one’s own and relatives’ organs, and on actual organ donation behaviours. Using data from 28 European countries for the period 2002–2010, we found that presumed consent (PC) policies are associated with increased willingness to donate organs, but this effect was attenuated once internal family discussions on organ donation were controlled for. Our findings indicate that relative’s consent acts as a veto of donation intentions and attenuates the effect of regulation on actual donations. More specifically, PC increases WTD one’s own and relatives’ organs in countries where no family consent is required. Consistently, we find that family consent attenuates the influence of regulatory environment on actual donations. The effect is driven by the influence of family discussions which increased WTD, and in combination with presumed consent translated into higher organ donation rates

Social v market value: how much is a COVID vaccine worth?

Vaccine uptake protects individuals and societies, but how much is the COVID-19 vaccine worth? Joan Costa-Font (LSE), Caroline Rudisill, Sayward Harrison (University of South Carolina), and Luca Salmasi (Università Cattolica del Sacro Cuore) estimate that the willingness to pay for a COVID-19 vaccine in the US, UK, Spain, and Italy in July 2020 ranged between 100 and 200 US dollars. However, the social value of the vaccine exceeds its market value

Social vs market value: how much is a COVID-19 vaccine worth?

Vaccine uptake protects individuals and societies, but how much is the COVID-19 vaccine worth? Joan Costa-Font, Caroline Rudisill, Sayward Harrison, and Luca Salmasi estimate that the willingness to pay for a COVID-19 vaccine in the US, UK, Spain, and Italy in July 2020 ranged between 100 and 200 US dollars. However, the social value of the vaccine exceeds its market value

Incidence of type 2 diabetes after bariatric surgery: population-based matched cohort study

Background:- The effect of currently used bariatric surgical procedures on the development of diabetes in obese people is not well defined. We aimed to assess the effect of bariatric surgery on development of type 2 diabetes in a large population of obese individuals. Methods:- We did a matched cohort study of adults (age 20–100 years) identified from a UK-wide database of family practices, who were obese (BMI ≥30 kg/m2) and did not have diabetes. We enrolled 2167 patients who had undergone bariatric surgery between Jan 1, 2002, and April 30, 2014, and matched them—according to BMI, age, sex, index year, and HbA1c—with 2167 controls who had not had surgery. Procedures included laparoscopic gastric banding (n=1053), gastric bypass (795), and sleeve gastrectomy (317), with two procedures undefined. The primary outcome was development of clinical diabetes, which we extracted from electronic health records. Analyses were adjusted for matching variables, comorbidity, cardiovascular risk factors, and use of antihypertensive and lipid-lowering drugs. Findings:- During a maximum of 7 years of follow-up (median 2·8 years [IQR 1·3–4·5]), 38 new diagnoses of diabetes were made in bariatric surgery patients and 177 were made in controls. By the end of 7 years of follow-up, 4·3% (95% CI 2·9–6·5) of bariatric surgery patients and 16·2% (13·3–19·6) of matched controls had developed diabetes. The incidence of diabetes diagnosis was 28·2 (95% CI 24·4–32·7) per 1000 person-years in controls and 5·7 (4·2–7·8) per 1000 person-years in bariatric surgery patients; the adjusted hazard ratio was 0·20 (95% CI 0·13–0·30, p<0·0001). This estimate was robust after varying the comparison group in sensitivity analyses, excluding gestational diabetes, or allowing for competing mortality risk. Interpretation:- Bariatric surgery is associated with reduced incidence of clinical diabetes in obese participants without diabetes at baseline for up to 7 years after the procedure

Pathos & ethos: emotions and willingness to pay for tobacco products

In this article we use data from a multi-country Randomized Control Trial study on the effect of anti-tobacco pictorial warnings on an individual’s emotions and behavior. By exploiting the exogenous variations of images as an instrument, we are able to identify the effect of emotional responses. We use a range of outcome variables, from cognitive (risk perception and depth of processing) to behavioural (willingness to buy and willingness to pay). Our findings suggest that the odds of buying a tobacco product can be reduced by 80% if the negative affect elicited by the images increases by one standard deviation. More importantly from a public policy perspective, not all emotions behave alike, as eliciting shame, anger, or distress proves more effective in reducing smoking than fear and disgust