A new outcome measure for cost-utility analyses of screening programs

We show that, under some plausible assumptions, the gain in QALYs a screening program offers is a positive linear transformation of the program's sensitivity level. This result simplifies considerably the cost-utility analysis of mutually exclusive screening programs.

Opportunity analysis of newborn screening programs

There exist congenital diseases that reduce newborns' potential opportunities. This reduction is sometimes alleviated if the congenital disease is early detected thanks to a newborn screening program. We propose an outcome measurement of newborn screening programs based on the opportunity gains they offer. We show that, under plausible assumptions, the ranking of the available screening programs for a particular disease, according to this new outcome measurement, do not depend on the metric of opportunity. We also apply our model to the current debate about choosing between a selective or a universal newborn hearing screening program to detect congenital hearing impairment.opportunities, potential success, screening programs

A NEW OUTCOME MEASURE FOR COST-UTILITY ANALYSES OF SCREENING PROGRAMS

In this paper we provide a new outcome measure for the cost-utility analyses of alternative screening programs of a particular disease. We show that for non-invasive screening programs satisfying plausible assumptions, QALYs can be replaced by a simpler outcome: the sensitivity of the program. In other words, the cost-utility analysis can be made without computing the utility each program offers. Consequently, results would be immune to two of the most controversial issues in the cost-utility analysis approach: the elicitation method to obtain quality weights of health profiles, and the discount rate for future health benefits. The assumptions are particularly suitable in the case of selecting between the universal and the selective implementation of a non-invasive screening program. Therefore, we apply our result to provide an additional viewpoint in the current debate about the implementation of a universal or selective newborn screening program to detect congenital hearing impairment.Cost-utility analysis, cost-sensitivity ratios, screening programs,

OPPORTUNITY ANALYSIS OF NEWBORN SCREENING PROGRAMS

There exist congenital diseases that reduce newborns' potential opportunities. This reduction is sometimes alleviated if the congenital disease is early detected thanks to a newborn screening program. We propose an outcome measurement of newborn screening programs based on the opportunity gains they offer after its implementation. We show that, under plausible assumptions, preferences among the available screening programs for a particular disease according to this new outcome measurement, do not depend on the metric of opportunity. We also apply our model to the current debate about choosing between a selective or a universal newborn hearing screening program to detect congenital hearing impairment.Opportunity analysis, potential success, screening programs

ECONOMIC EVALUATION OF NEWBORN HEARING SCREENING PROCEDURES

In the past few years, there has been a growing interest in the medical literature about the study of the different existing screening procedures to detect hearing impairment in infants and young children. However, concerning their economic evaluation, there are some important aspects, such as indirect costs, which are not considered by that literature. Here, we present an economic evaluation of these screening procedures, using utility theory, to measure benefits of a health care program, i.e. a cost-utility analysis. The analysis is presented from different points of view, depending on the cost we would like to compute. If we only consider direct costs, then targeted procedures, based on high risk criteria are preferred. On the other hand, if indirect costs, such as special education, and disability allowances were computed, then cost-utility analysis would advocate for the implementation of universal screening procedures.Economic Evaluation; Cost Utility Analysis; Cost-Sensitivity Ratios;

Tecnología de la información y organización del centro educativo.

Sin resume

GENERALIZED COST-ANALYSIS OF SCREENING PROGRAMS

Nowadays, there is a growing interest about including indirect costs of health care programs in economic evaluations. In this paper, we provide a generalized cost-analysis of screening programs and propose a technique to measure production gains associated with these programs. We apply this technique to show evidence in favor of implementing a newborn screening program to detect congenital hearing impairment.Production gains, screening programs, cost analysis, potential social earnings.

On the Adjudication of Conflicting Claims: An Experimental Study

This paper reports an experimental study on three well-known solutions for problems of adjudicating conflicting claims: the constrained equal awards, the proportional, and the constrained equal losses rules. We first let subjects play three games designed such that the unique equilibrium allocation coincides with the recommendation of one of these three rules. In addition, we let subjects play an additional game, that has the property that all (and only) strategy profiles in which players coordinate on the same rule constitute a strict Nash equilibrium. While in the first three games subjects’ play easily converges to the unique equilibrium rule, in the last game the proportional rule overwhelmingly prevails as a coordination device, especially when we frame the game as an hypothetical bankruptcy situation. We also administered a questionnaire to a different group of students, asking them to act as impartial arbitrators to solve (among others) the same problems played in the lab. Also in this case, respondents were sensitive to the framing of the questions, but the proportional rule was selected by the vast majority of respondents.Claims problems, Proportional rule, Experimental Economics

On the Adjudication of Conflicting Claims: An Experimental Study

This paper reports an experimental study on three well-known solutions for problems of adjudicating conflicting claims: the constrained equal awards, the proportional, and the constrained equal losses rules. We first let subjects play three games designed such that the unique equilibrium allocation coincides with the recommendation of one of these three rules. In addition, we let subjects play an additional game, that has the property that all (and only) strategy profiles in which players coordinate on the same rule constitute a strict Nash equilibrium. While in the first three games subjectsÕ play easily converges to the unique equilibrium rule, in the last game the proportional rule overwhelmingly prevails as a coordination device, especially when we frame the game as an hypothetical bankruptcy situation. We also administered a questionnaire to a different group of students, asking them to act as impartial arbitrators to solve (among others) the same problems played in the lab. Also in this case, respondents were sensitive to the framing of the questions, but the proportional rule was selected by the vast majority of respondents.Claims problems, Proportional rule, Experimental Economics