Cigarette consumption in The Netherlands 1970-1995 - Does tax policy encourage the use of hand-rolling tobacco?

Background: Tax rises to reduce cigarette consumption are a major feature of European tobacco control policies. In many countries, hand-rolling tobacco is much cheaper than manufactured cigarettes. We Investigated whether changes in price differentials between manufactured and hand-rolled cigarettes influenced cigarette consumption in The Netherlands. Method: We developed regression models to explain changes in the consumption of the two cigarette types. Price elasticities, the percentage changes in consumption for a 1% change in price, are calculated from Netherlands data for 1970-1980 and 1985-1995. Results: The ratio of manufactured to hand-rolled cigarette prices changed little during 1970-1980 but varied subsequently. On multivariate analysis, manufactured cigarette consumption in 1970-1980 decreased as its price rose (elasticity = -0.74). In 1985-1995, manufactured cigarette consumption fell with increases in both its own price (elasticity = -0.54) and in the price differential between manufactured and hand-rolled cigarettes (elasticity = -0.60). During 1985-1995, roll-your-own consumption fell as the price ratio of manufactured to hand rolled cigarettes fell (elasticity = +1.0). Conclusion: When the price rise for hand-rolling tobacco is greater than the price rise for manufactured cigarettes, the fall in manufactured cigarette consumption is accompanied by a fall in roll-your-own use. Cigarette smokers are deterred from switching to hand rolled cigarettes instead of stopping smoking. This increases the health benefits of raising taxes on manufactured cigarettes, discourages the use of even more harmful forms of tobacco and may reduce inequalities in health

Finance and performance of Portuguese hospitals

This study analyses the impact of changing systems of finance on the performance of hospitals in Portugal, specifically in terms of costs per admission and per patient day, average length of stay and the number of admissions. The study is based on panel data (36 hospitals over a ten-year period), used to estimate cost functions. It is concluded that costs per admission decreased over the period in question, principally due to declining length of stay.DRG, financing systems, hospital, Portugal, prospective payment

Access to Primary Care Physicians Care Services Among African American Children With Asthma in Urban Areas

Access to appropriate asthma care may be challenging for low-income African-American parents. Parents’ and caregivers’ perceptions regarding access to primary care services for asthma treatment for their children were explored using a qualitative design. The Anderson behavioral model was the conceptual framework that guided the study. This model helps understand patients’ use of health services. The research questions asked about primary care for asthma treatment, barriers to treatment, and possible facilitators to seeking appropriate care for children with asthma. A general qualitative design was applied, with the thematic analysis used to determine the findings. Ten parents and guardians participated in a one-on-one interview via Zoom. Seven themes and subthemes were discovered. The themes included, for example, (a) Symptoms of Serious Illness in Child Encouraged Parents to Use Primary Care Services and (b) Difficulty in Finding Easily Accessible and Reliable Medical Facilities or Pediatricians was a Barrier. NVivo software helped with data analysis to sort codes and categories to develop overarching themes. The results indicated that more specialists, particularly African-American doctors, are needed to diagnose children rather than using general pediatricians. Health disparities and cultural competence were also noted in the results. Positive social change may be found in recognizing the need for African American children to have access to appropriate diagnosis and treatment for asthma within primary care clinics that include physicians who are also African American

Does the correspondence between EQ-5D health state description and VAS score vary by medical condition?

Background The EQ-5D health-related quality of life instrument comprises a health state classification (health problems by severity in five domains), followed by an evaluation using a visual analogue scale (VAS). Despite the EQ-5D’s use in health technology assessment and as a patient-reported outcome measure (PROM), the correspondence between the two parts of the instrument remains ill-understood. In this paper, we consider whether the association between health state classification and VAS score might vary by medical condition. Methods EQ-5D data collected for studies of patients in four different clinical conditions or circumstances (stroke, low back pain, colposcopic investigation or cytological surveillance) were pooled to generate a sample of 3,851 patient records. VAS scores were regressed on reported problem severities, with the inclusion of intercept and slope dummy variables specific to condition. Results The regression model achieved a goodness-of-fit of 0.54. Given its structure and the significance of the coefficients, the proportion of VAS scores which differed by condition for the same health state varied between 33.3 and 88.5 per cent of possible states. Conclusions Many of the patients with different medical conditions or in receipt of different interventions recorded different VAS valuations, in spite of ostensibly being in the same EQ-5D-defined health states. By implication, it is probable that the same state-to-state change would by valued differently by patients experiencing different conditions

Correspondence between EQ-5D health state classifications and EQ VAS scores

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: The EQ-5D health-related quality of life instrument comprises a health state classification followed by a health evaluation using a visual analogue scale (VAS). The EQ-5D has been employed frequently in economic evaluations, yet the relationship between the two parts of the instrument remains ill-understood. In this paper, we examine the correspondence between VAS scores and health state classifications for a large sample, and identify variables which contribute to determining the VAS scores independently of the health states as classified. Methods: A UK trial of management of low-grade abnormalities detected on screening for cervical pre-cancer (TOMBOLA) provided EQ-5D data for over 3,000 women. Information on distress and multi-dimensional health locus of control had been collected using other instruments. A linear regression model was fitted, with VAS score as the dependent variable. Independent variables comprised EQ-5D health state classifications, distress, locus of control, and socio-demographic characteristics. Equivalent EQ-5D and distress data, collected at twelve months, were available for over 2,000 of the women, enabling us to predict changes in VAS score over time from changes i

Could CT screening for lung cancer ever be cost effective in the United Kingdom?

<p>Abstract</p> <p>Background</p> <p>The absence of trial evidence makes it impossible to determine whether or not mass screening for lung cancer would be cost effective and, indeed, whether a clinical trial to investigate the problem would be justified. Attempts have been made to resolve this issue by modelling, although the complex models developed to date have required more real-world data than are currently available. Being founded on unsubstantiated assumptions, they have produced estimates with wide confidence intervals and of uncertain relevance to the United Kingdom.</p> <p>Method</p> <p>I develop a simple, deterministic, model of a screening regimen potentially applicable to the UK. The model includes only a limited number of parameters, for the majority of which, values have already been established in non-trial settings. The component costs of screening are derived from government guidance and from published audits, whilst the values for test parameters are derived from clinical studies. The expected health gains as a result of screening are calculated by combining published survival data for screened and unscreened cohorts with data from Life Tables. When a degree of uncertainty over a parameter value exists, I use a conservative estimate, i.e. one likely to make screening appear less, rather than more, cost effective.</p> <p>Results</p> <p>The incremental cost effectiveness ratio of a single screen amongst a high-risk male population is calculated to be around £14,000 per quality-adjusted life year gained. The average cost of this screening regimen per person screened is around £200. It is possible that, when obtained experimentally in any future trial, parameter values will be found to differ from those previously obtained in non-trial settings. On the basis both of differing assumptions about evaluation conventions and of reasoned speculations as to how test parameters and costs might behave under screening, the model generates cost effectiveness ratios as high as around £20,000 and as low as around £7,000.</p> <p>Conclusion</p> <p>It is evident that eventually being able to identify a cost effective regimen of CT screening for lung cancer in the UK is by no means an unreasonable expectation.</p

Finance and performance of portuguese hospitals

This study analyses the impact of changing systems of finance on the performance of hospitals in Portugal, specifically in terms of costs per admission and per patient day, average length of stay and the number of admissions. The study is based on panel data (36 hospitals over a ten-year period), used to estimate cost functions. It is concluded that costs per admission decreased over the period in question, principally due to declining length of stay.Fundação para a Ciência e a Tecnologia (FCT

Sex, benevolence and willingness to pay for screening

Purpose: 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

Hospital Costs of Colorectal Cancer Care

Objective In a hospital based setting, identify factors which influence the cost of colorectal cancer care? Design Retrospective case note review Setting Nottingham, United Kingdom Participants 227 patients treated for colorectal cancer Methods Retrospective review of the hospital records provided the primary data for the costing study and included all CRC related resource consumption over the study period. Results Of 700 people identified, 227 (32%) sets of hospital notes were reviewed. The median age of the study group was 70.3 (IQR 11.3) years and there were 128 (56%) males. At two years, there was a significant difference in costs between Dukes D cancers (£3641) and the other stages (£3776 Dukes A; £4921 Dukes B). Using univariate and multivariate regression, the year of diagnosis, Dukes stage of disease, intensive nursing care, stoma requirements and recurrent disease all significantly affected the total cost of care. Conclusions CRC remains costly with no significant difference in costs if diagnosed before compared to after 1992. Very early and very late stage cancers remain the least costly stage of cancers to treat. Other significant effectors of hospital costs were the site of cancer (rectal), intensive nursing care, recurrent disease and the need for a stoma