The scope of costs in alcohol studies: Cost-of-illness studies differ from economic evaluations

<p>Abstract</p> <p>Background</p> <p>Alcohol abuse results in problems on various levels in society. In terms of health, alcohol abuse is not only an important risk factor for chronic disease, but it is also related to injuries. Social harms which can be related to drinking include interpersonal problems, work problems, violent and other crimes. The scope of societal costs related to alcohol abuse in principle should be the same for both economic evaluations and cost-of-illness studies. In general, economic evaluations report a small part of all societal costs. To determine the cost- effectiveness of an intervention it is necessary that all costs and benefits are included. The purpose of this study is to describe and quantify the difference in societal costs incorporated in economic evaluations and cost-of-illness studies on alcohol abuse.</p> <p>Method</p> <p>To investigate the economic costs attributable to alcohol in cost-of-illness studies we used the results of a recent systematic review (June 2009). We performed a PubMed search to identify economic evaluations on alcohol interventions. Only economic evaluations in which two or more interventions were compared from a societal perspective were included. The proportion of health care costs and the proportion of societal costs were estimated in both type of studies.</p> <p>Results</p> <p>The proportion of healthcare costs in cost-of-illness studies was 17% and the proportion of societal costs 83%. In economic evaluations, the proportion of healthcare costs was 57%, and the proportion of societal costs was 43%.</p> <p>Conclusions</p> <p>The costs included in economic evaluations performed from a societal perspective do not correspond with those included in cost-of-illness studies. Economic evaluations on alcohol abuse underreport true societal cost of alcohol abuse. When considering implementation of alcohol abuse interventions, policy makers should take into account that economic evaluations from the societal perspective might underestimate the total effects and costs of interventions.</p

The Prosocial Versus Proself Power Holder: How Power Influences Sacrifice in Romantic Relationships

Romantic partners often have to sacrifice their interests to benefit their partner or to maintain the relationship. In the present work, we investigated whether relative power within the relationship plays an important role in determining the extent to which partners are likely to sacrifice. Drawing from both classic theories and recent research on power, we tested two competing predictions on the relationship between power and sacrifice in romantic relationships. We tested whether (a) power is negatively related to sacrifice and (b) power is positively related to sacrifice. Furthermore, we also explored whether the association between power and sacrifice is moderated by commitment and inclusion of the other in the self. To test our hypotheses, we used different methodologies, including questionnaires, diary studies, and videotaped interactions. Results across the five studies (N = 1,088) consistently supported the hypothesis that power is negatively related to tendencies to sacrifice in close relationships

Trading patients’ choice in providers for quality of maternity care? A discrete choice experiment amongst pregnant women

Background The introduction of bundled payment for maternity care, aimed at improving the quality of maternity care, may affect pregnant women’s choice in providers of maternity care. This paper describes a Dutch study which examined pregnant women’s preferences when choosing a maternity care provider. The study focused on factors that enhance the quality of maternity care versus (restricted) provider choice. Methods A discrete choice experiment was conducted amongst 611 pregnant women living in the Netherlands using an online questionnaire. The data were analysed with Latent Class Analyses. The outcome measure consisted of stated preferences in the discrete choice experiment. Included factors were: information exchange by care providers through electronic medical records, information provided by midwife, information provided by friends, freedom to choose maternity care provider and travel distance. Results Four different preference structures were found. In two of those structures, respondents found aspects of the maternity care related to quality of care more important than being able to choose a provider (provider choice). In the two other preference structures, respondents found provider choice more important than aspects related to quality of maternity care. Conclusions In a country with presumed high-quality maternity care like the Netherlands, about half of pregnant women prefer being able to choose their maternity care provider over organisational factors that might imply better quality of care. A comparable amount of women find quality-related aspects most important when choosing a maternity care provider and are willing to accept limitations in their choice of provider. These insights are relevant for policy makers in order to be able to design a bundled payment model which justify the preferences of all pregnant women

Plan van aanpakken; een plan van aanpak voor actie in de Veenkoloniën

Student Repor

Do body condition and plumage during fuelling predict northwards departure dates of Great Knots Calidris tenuirostris from north-west Australia?

It is often assumed that strong selection pressures give rise to trade-offs between body condition and time in long-distance migrating birds. Birds that are 'behind schedule' in fuel deposition or moult should delay departure, and this should result in a negative correlation between initial condition and departure date. We tested this hypothesis in the Great Knot Calidris tenuirostris migrating from north-west Australia to eastern Asia en route to Siberia. Great Knot gain mass and moult into breeding plumage before leaving northern Australia in late March and early April, and fly 5400-6000 km to eastern China and Korea. We radiotracked 27 individuals (17 males and ten females) to determine departure dates; 23 migrated and four remained in Australia. We characterized body condition at capture using body mass, predicted pectoral muscle mass (based on ultrasound estimates of the size of the pectoral muscles) and breeding plumage scores. Residual condition indices were uncorrelated, indicating that at the individual level, variation in one fuelling component was not strongly associated with variation in the other components. Birds that did not depart had lower residual body mass and breeding plumage indices than those that did migrate; these four birds may have been subadults. Neither sex, size nor the condition indices explained variation in departure date of migrants. Reasons for this are explored. Departure dates for northward migrating waders indicate that the migration window (span over which birds depart) decreases with proximity to the northern breeding grounds. We suggest that migration schedules become tighter as birds get nearer to the breeding grounds. Thus the lack of a relationship between condition and departure date in Great Knots may reflect the fact that the departure episode under study is the first one in sequence and is still 4-8 weeks before breeding

Ultimate Turbulent Taylor-Couette Flow

The flow structure of strongly turbulent Taylor-Couette flow with Reynolds numbers up to Re_i = 2*10^6 of the inner cylinder is experimentally examined with high-speed particle image velocimetry (PIV). The wind Reynolds numbers Re_w of the turbulent Taylor-vortex flow is found to scale as Re_w ~ Ta^(1/2), exactly as predicted for the ultimate turbulence regime, in which the boundary layers are turbulent. The dimensionless angular velocity flux has an effective scaling of Nu_{\omega} ~ Ta^0.38, also in correspondence with turbulence in the ultimate regime. The scaling of Nu_{\omega} is confirmed by local angular velocity flux measurements extracted from high-speed PIV measurements: though the flux shows huge fluctuations, its spatial and temporal average nicely agrees with the result from the global torque measurements

The polypill in the primary prevention of cardiovascular disease: cost-effectiveness in the Dutch population

OBJECTIVES: The aim of the present study was to estimate the cost-effectiveness of the polypill in the primary prevention of cardiovascular disease. DESIGN: A health economic modeling study. SETTING: Primary health care in the Netherlands. PARTICIPANTS: Simulated individuals from the general Dutch population, aged 45-75 years of age. INTERVENTIONS: Opportunistic screening followed by prescription of the polypill to eligible individuals. Eligibility was defined as having a minimum 10-year risk of cardiovascular death as assessed with the SCORE function of alternatively 5%, 7.5%, or 10%. Different versions of the polypill were considered, depending on composition: 1) the Indian polycap, with three different types of blood pressure lowering drugs, a statin, and aspirin; 2) as 1) but without aspirin; 3) as 2) but with a double statin dose. In addition, a scenario of (targeted) separate antihypertensive and/or statin medication was simulated. PRIMARY OUTCOME MEASURES: Cases of acute myocardial infarction or stroke prevented, QALYs gained, and the costs per QALY gained. All interventions were compared with usual care. RESULTS: All scenarios were cost-effective with an incremental cost-effectiveness ratio between €7,900-12,300 per QALY compared with usual care. Most health gains were achieved with the polypill without aspirin and containing a double dose of statins. With a 10-year risk of 7.5% as threshold, this pill would prevent approximately 3.5% of all cardiovascular events. CONCLUSIONS: Opportunistic screening based on global cardiovascular risk assessment followed by polypill prescription to those with increased risk offers a cost-effective strategy. Most health gain is achieved by the polypill without aspirin and a double statin dose

Willingness to participate in a lifestyle intervention program of patients with type 2 diabetes mellitus: a conjoint analysis

Background: Several studies suggest that lifestyle interventions can be effective for people with, or at risk for, diabetes. The participation in lifestyle interventions is generally low. Financial incentives may encourage participation in lifestyle intervention programs. Objetive: The main aim of this exploratory analysis is to study empirically potential effects of financial incentives on diabetes patients' willingness to participate in lifestyle interventions. One financial incentive is negative ("copayment") and the other incentive is positive ("bonus"). The key part of this research is to contrast both incentives. The second aim is to investigate the factors that influence participation in a lifestyle intervention program. Methods: Conjoint analysis techniques were used to empirically identify factors that influence willingness to participate in a lifestyle intervention. For this purpose diabetic patients received a questionnaire with descriptions of various forms of hypothetical lifestyle interventions. They were asked if they would be willing to participate in these hypothetical programs. Results: In total, 174 observations were rated by 46 respondents. Analysis showed that money was an important factor independently associated with respondents' willingness to participate. Receiving a bonus seemed to be associated with a higher willingness to participate, but having to pay was negatively associated with participation in the lifestyle intervention. Conclusion: Conjoint analysis results suggest that financial considerations may influence willingness to participate in lifestyle intervention programs. Financial disincentives in the form of copayments might discourage participation. Although the positive impact of bonuses is smaller than the negative impact of copayments, bonuses could still be used to encourage willingness to participate