22 research outputs found
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Estimating health effects in quality-of-life terms: health losses following road crashes
Currently, measures of disability and health-related quality of life are becoming important, even essential, parameters in the evaluation of treatment and prevention strategies for reducing the burden of injury. The estimation of the 'health effect' induced by these policies should incorporate several important aspects: the proper definition of health effect, at individual and aggregate levels; the correct selection of a health metric; the accurate estimation of the short-term effect (direct health gain/loss) and long-term effect (total of health gain/loss throughout the life of the individual) that injuries may produce; and the suitable selection and management of databases. This review article focuses on the particular topic of road crashes, but the analysis can be extended to any sort of injury
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A Study of the Relationship Between Health and Subjective Well-being in Parkinson’s Disease Patients
Objectives: In light of the apparent disconnect between traditional measures of societal well-being such as GDP and reported levels of happiness, governments globally are turning their attention to alternative subjective measures of well-being (SWB) to aid policy decisions. In the context of health, there is therefore growing interest in understanding how measures of health-related quality of life (HRQoL), widely used in health technology appraisal, relates to SWB, and whether SWB could provide a sound basis for resource allocation decisions in health and other sectors in the future. This study investigates the relationship between HRQoL, as measured by EQ-5D, and SWB in Parkinson’s disease (PD) and the extent to which patients’ self-reported health can explain (part of) their SWB.
Methods: A paper questionnaire including EQ-5D, four key SWB questions taken from the Office for National Statistics Integrated Household Survey in England and other demographic details was distributed to people with PD in the UK. Responses were used to estimate multiple regression models explaining SWB using each of the EQ-5D Index (UK weights), EQ-5D dimensions and EQ-VAS and patient socio-demographic characteristics.
Results: 276 questionnaires were distributed and 183 responses received. The EQ-5D Index was a moderate predictor of SWB (adjusted R2 range 0.19-0.38 in OLS models), but EQ-VAS performed better (adjusted R2 range 0.32-0.49).
Combining EQ-VAS and EQ-5D dimensions, especially anxiety/depression and mobility, and household status in some cases, yielded the best-fitting models (adjusted R2 range 0.40-0.52).
Conclusions: The findings imply that EQ-VAS and some dimensions of the EQ-5D, together with key demographic data, could potentially be used to predict SWB, e.g. via mapping. However, further empirical research into the relationship between SWB and EQ-5D longitudinally, and in different disease areas, is required to corroborate these findings, and further standardisation of SWB measures is recommended
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Adaptation to Health States: A Micro-Econometric Approach
Health care funding decisions in the UK are based on valuations of the general public. However, it has been shown that there is a disparity between a hypothetical valuation of the impact of a specific condition on health and the effect of that health state by someone who experiences it. This paper examines the issue of adaptation to health states, which partially may explain the discrepancy between hypothetical and experienced health state valuations. We use the British Cohort Study (BCS70) which is a longitudinal dataset that tracks a sample of British individuals since their birth in 1970. We use four BCS70 waves containing information on self-assessed health (SAH), morbidity as well as a number of socio-economic characteristics. To estimate the issue of adaptation, we implement a dynamic ordered probit model that controls for (health) state dependence. The empirical specification controls for morbidity and also includes a variable for the duration of the illness. We find that, for most chronic conditions, duration has a positive impact on self-assessed health, while for some conditions-such as diabetes- this does not occur. We interpret our results as evidence in support of the hypothesis that adaptation to chronic diseases exists and may explain at least in part the differences between general public and patients’ health state valuations
Allocating Public Spending Efficiently: Is There a Need for a Better Mechanism to Inform Decisions in the UK and Elsewhere?
In the UK few if any regular processes explicitly address comparisons of value for money between spending in different government departments, despite the existence of mechanisms that could in principle achieve that. This leaves a very important gap in evidence and means that decisions about public spending allocations are likely to miss opportunities to improve social welfare from existing budgets. Greater attention to the development of methods and evidence to better inform the allocation of public sector spending between departments is therefore urgently needed. We identify a number of possible approaches to this—some of which are being used in different countries—and highlight their strengths and weaknesses. We propose a new, pragmatic approach that incorporates a generic descriptive system to measure the disparate outcomes produced by public sector activities in a commensurate manner. Discrete-choice experiments could be used to generate evidence of the relative importance placed on different aspects of public sector outcomes by members of the general public. The proposed approach would produce evidence on value for money across departments, and the generation of evidence on public preferences to support that
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Adaptation to Health States: Sick yet better off?
Healthcare funding decisions in the UK rely on health state valuations of the general public. However, it has been shown that there is disparity between the valuation of the impact of hypothetical conditions on health and the reported health by those experiencing them. Patients' adaptation to health states is among the most common explanations for this discrepancy. Being diagnosed with a disease appears to affect individual perception of health over time so that better subjective health may be reported over a disease trajectory. This paper examines adaptation to health states using a longitudinal dataset. We use four waves of the British Cohort Study (BCS70), which tracks a sample of British individuals since birth in 1970 and contains information on self-assessed health (SAH), morbidity, and socioeconomic characteristics. We implement a dynamic ordered probit model controlling for health state dependence. Results are supportive of the existence of adaptation: Time since diagnosis has a positive impact on SAH. Moreover, adaptation happens over relatively long durations. We do not find significant results proving different adaptation paths for patients reporting prior better SAH. The analysis by specific conditions generally supports the existence of adaptation, but results are statistically significant only for a subset of conditions
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Accreditation as a quality-improving policy tool: family planning, maternal health, and child health in Egypt
Accreditation of healthcare providers has been established in many high-income countries and some low- and middle-income countries as a tool to improve the quality of health care. However, the available evidence on the effectiveness of this approach is limited and of questionable quality, especially in low- and middle-income countries. We exploit the interventions introduced under Egypt’s health sector reform program between 2000 and 2014 to estimate the effect of health facility accreditation on family planning, maternal health, and child health outcomes. We use difference-in-differences fixed-effects and propensity score matching difference-in-differences models. To do so, we spatially link women to their nearest mapped health facili-ties using their global positioning system coordinates. We find that accreditation had multiple positive effects, especially on delivery care and child morbidity prevalence. The effects appear to weaken over time though. Our findings suggest that facility accreditation can be effective in improving family planning, antenatal care, delivery care, and child health, but stress the need to study how the effects can be sustained
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Unmet Parenthood Goals, Health-Related Quality of Life and Apparent Irrationality: Understanding the Value of Treatments for Infertility
An increasing number of prospective parents are experiencing infertility along with associated negative impacts on mental health and life satisfaction that can extend across a network of individuals and family members. Assistive reproductive technologies (ART) can help prospective parents achieve their parenthood goals but, like any health technology, they must demonstrate acceptable 'value for money' to qualify for public funding. We argue that current approaches to understanding the value of ART, including quality-adjusted life-year (QALY) gains based on changes in health-related quality of life (HRQOL) and, more often, cost per live birth, are too narrow to capture the full impact of unmet parenthood goals and ART. We see a fundamental disconnect between measures of HRQOL and broader measures of wellbeing associated with met and unmet parenthood goals. We also suggest that simple concepts such as 'patient' and 'carer' are of limited applicability in the context of ART, where 'spillovers' extend across a wide network of individuals, and the person receiving treatment is often not the infertile individual. Consideration of individual and societal wellbeing beyond HRQOL is necessary to understand the full range of negative impacts associated with unmet parenthood goals and the corresponding positive impacts of successful ART. We suggest moving towards a wellbeing perspective on value to achieve a fuller understanding of value and promote cross-sector allocative efficiency
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Acceptability and Feasibility of a Mindfulness Intervention Delivered via Videoconferencing for People With Parkinson's
Mindfulness-based group therapy is a rapidly growing psychological approach that can potentially help people adjust to chronic illness and manage unpleasant symptoms. Emerging evidence suggests that mindfulness-based interventions may benefit people with Parkinson’s. The objective of the paper is to examine the appropriateness, feasibility, and potential cost-effectiveness of an online mindfulness intervention, designed to reduce anxiety and depression for people with Parkinson’s. We conducted a feasibility randomized control trial and qualitative interviews. Anxiety, depression, pain, insomnia, fatigue, impact on daily activities and health-related quality of life were measured at baseline, 4, 8, and 20 weeks. Semi-structured interviews were conducted at the end of the intervention. Participants were randomized to the Skype delivered mindfulness group (n = 30) or wait-list (n = 30). Participants in the mindfulness group were also given a mindfulness manual and a CD with mindfulness meditations. The intervention did not show any significant effects in the primary or secondary outcome measures. However, there was a significant increase in the quality of life measure. The incremental cost-effectiveness ratio was estimated to be £27,107 per Quality-Adjusted Life Year gained. Also, the qualitative study showed that mindfulness is a suitable and acceptable intervention. It appears feasible to run a trial delivering mindfulness through Skype, and people with Parkinson’s found the sessions acceptable and helpful