Incapacity Benefit: A Health or Labour Market Phenomenon?

The number of people claiming Incapacity Benefit has remained fairly constant in recent years at around 2.7 million (7% of the working age population), although the numbers have trebled since the 1970s when an earlier version of this benefit was available. In January 2006 the UK Government set the ambitious target of reducing the number of claimants by one million, or around 40% of the total, within the next decade. New initiatives will focus on increasing the number of people who remain in work and increasing the number leaving benefits and finding employment. This paper explores these two critical transitions using data from waves 5 to 13 of the British Household Panel Survey. We consider whether the moves onto and off benefit are driven by health status or whether labour market factors are also important. Our results show that while health, and in particular psychological health, is an important determinant of these transitions, other factors such as age, occupation and geographical location are also key explanatory factors. This suggests that a very broad range of policy measures will be required if the government is to meet its target

A comparison of the EQ-5D and the SF-6D across seven patient groups

As the number of preference-based instruments grows, it becomes increasingly important to compare different preference-based measures of health in order to inform an important debate on the choice of instrument. This paper presents a comparison of two of them, the EQ-5D and the SF-6D (recently developed from the SF-36) across seven patient/population groups (chronic obstructive airways disease, osteoarthritis, irritable bowel syndrome, lower back pain, leg ulcers, post menopausal women and elderly). The mean SF-6D index value was found to exceed the EQ-5D by 0.045 and the intraclass correlation coefficient between them was 0.51. Whilst this convergence lends some support for the validity of these measures, the modest difference at the aggregate level masks more significant differences in agreement across the patient groups and over severity of illness, with the SF-6D having a smaller range and lower variance in values. There is evidence for floor effects in the SF-6D and ceiling effects in the EQ-5D. These discrepancies arise from differences in their health state classifications and the methods used to value them. Further research is required to fully understand the respective roles of the descriptive systems and the valuation methods and to examine the implications for estimates of the impact of health care interventions

Drugs for exceptionally rare diseases: a commentary on Hughes et al

Recently in this journal, Hughes and colleagues discussed special funding status to ultra-orphan drugs. They concluded that there should be a uniform policy for the provision of orphan drugs across Europe; that complete restriction was impractical, and that UK policy should aspire to the values of the EU directive on orphan drugs. We critically assess these arguments, demonstrating that they failed to justify special status for treatments for rare diseases

Estimation of a preference based single index from the sexual quality of life questionnaire (SQOL) using ordinal data

There is increasing interest in using ordinal methods to estimate cardinal values for health states to calculate quality adjusted life years. This paper reports the estimation of models of rank data and discrete choice experiment (DCE) data to derive a preference-based index from a condition specific measure relating to sexual health and to compare the results to values generated from time trade-off valuation (TTO). The DCE data were analysed using a random effects probit model and the DCE predicted values were rescaled according to the highest and lowest predicted TTO values corresponding to the best and worst SQOL health states respectively. The rank data were analysed using a rank ordered logit model and re-scaled using two alternative methods. Firstly, re-scaling the rank predicted values using identical methods to those employed for DCE and secondly, re-scaling the rank model coefficients by dividing each level coefficient by the coefficient relating to death. The study raises some important issues about the use of ordinal data to produce cardinal health state valuations

Pump- and Probe-polarization Analyses of Ultrafast Carrier Dynamics in Organic Superconductors

We investigated photo-excited carrier relaxation dynamics in the strongly correlated organic superconductors kappa-(BEDT-TTF)(2)Cu(NCS)(2) and kappa-(BEDT-TTF)(2)Cu[N(CN)(2)]Br, using different polarizations of pump and probe pulses. Below the glasslike transition temperature (T (g)) anisotropic responses for probe polarization were observed in both compounds. Decomposing the data into anisotropic and isotropic components, we found the anisotropic component shows no pump polarization dependence, meaning that dissipative excitation process was dominant for the anisotropic carrier relaxation. This behavior indicates that the appearance of anisotropic responses can be associated with spatial symmetry breaking due to structural change of BEDT-TTF molecules

Common scale valuations across different preference-based measures: estimation using rank data

Background: Different preference-based measures (PBMs) used to estimate Quality Adjusted Life Years (QALYs) provide di¤erent utility values for the same patient. Differences are expected since values have been obtained using different samples, valuation techniques and descriptive systems. Previous studies have estimated the relationship between pairs of PBMs using patient self-reported data. However, there is a need for an approach capable of generating values directly on a common scale for a range of PBMs using the same sample of general population respondents and valuation technique but keeping the advantages of the different descriptive systems. Methods: General public survey data (n=501) where respondents ranked health states described using subsets of six PBMs were analysed. We develop a new model based on the mixed logit to overcome two key limitations of the standard rank ordered logit model, namely, the unrealistic choice pattern (Independence of Irrelevant Alternatives) and the independence of repeated observations. Results: There are substantial differences in the estimated parameters between the two models (mean di¤erence 0.07) leading to di¤erent orderings across the measures. Estimated values for the best states described by di¤erent PBMs are substantially and significantly di¤erent using the standard model, unlike our approach which yields more consistent results. Limitations: Data come from a exploratory study that is relatively small both in sample size and coverage of health states. Conclusions: This study develops a new, �exible econometric model specifically designed to reflect appropriately the features of rank data. Results support the view that the standard model is not appropriate in this setting and will yield very different and apparently inconsistent results. PBMs can be compared using a common scale by implementation of this new approach

Combining Rasch and cluster analysis: a novel method for developing rheumatoid arthritis states for use in valuation studies

Purpose: Health states that describe an investigated condition are a crucial component of valuation studies. The health states need to be distinct, comprehensible, and data-driven. The objective of this study was to describe a novel application of Rasch and cluster analyses in the development of three rheumatoid arthritis health states. Methods: The Stanford Health Assessment Questionnaire (HAQ) was subjected to Rasch analysis to select the items that best represent disability. K-means cluster analysis produced health states with the levels of the selected items. The pain and discomfort domain from the EuroQol-5D was incorporated at the final stage. Results: The results demonstrate a methodology for reducing a dataset containing individual disease-specific scores to generate health states. The four selected HAQ items were bending down, climbing steps, lifting a cup to your mouth, and standing up from a chair. Conclusions: Overall, the combined use of Rasch and cluster analysis has proved to be an effective technique for identifying the most important items and levels for the construction of health states

Combining Rasch and cluster analysis: a novel method for developing rheumatoid arthritis states for use in valuation studies

Purpose: Health states that describe an investigated condition are a crucial component of valuation studies. The health states need to be distinct, comprehensible, and data-driven. The objective of this study was to describe a novel application of Rasch and cluster analyses in the development of three rheumatoid arthritis health states. Methods: The Stanford Health Assessment Questionnaire (HAQ) was subjected to Rasch analysis to select the items that best represent disability. K-means cluster analysis produced health states with the levels of the selected items. The pain and discomfort domain from the EuroQol-5D was incorporated at the final stage. Results: The results demonstrate a methodology for reducing a dataset containing individual disease-specific scores to generate health states. The four selected HAQ items were bending down, climbing steps, lifting a cup to your mouth, and standing up from a chair. Conclusions: Overall, the combined use of Rasch and cluster analysis has proved to be an effective technique for identifying the most important items and levels for the construction of health states.health state; Rasch analysis; cluster analysis; quality of life; rheumatoid arthritis