The cost of systemic corticosteroid-induced morbidity in severe asthma : a health economic analysis

The study data-set was supported by the Respiratory Effectiveness Group through their academic partnership with Optimum Patient Care. Ciaran O'Neill was funded under a HRB Research Leader Award (RL/13/16).Peer reviewedPublisher PD

Identifying an essential package for school-age child health: economic analysis

This chapter presents the investment case for providing an integrated package of essential health services for children attending primary schools in low- and middle- income countries (LMICs). In doing so, it builds on chapter 20 in this volume (Bundy, Schultz, and others 2017), which presents a range of relevant health services for the school- age population and the economic rationale for adminis- tering them through educational systems. This chapter identifies a package of essential health services that low- and middle-income countries (LMICs) can aspire to implement through the primary and secondary school platforms. In addition, the chapter considers the design of such programs, including targeting strategies. Upper- middle-income countries and high-income countries (HICs) typically aim to implement such interventions on a larger scale and to include and promote additional health services relevant to their populations. Studies have docu- mented the contribution of school health interventions to a range of child health and educational outcomes, partic- ularly in the United States (Durlak and others 2011; Murray and others 2007; Shackleton and others 2016). Health services selected for the essential package are those that have demonstrated benefits and relevance for children in LMICs. The estimated costs of implementation are drawn from the academic literature. The concept of a package of essential school health interventions and its justification through a cost-benefit perspective was pioneered by Jamison and Leslie (1990). As chapter 20 notes, health services for school-age children can promote educational outcomes, including access, attendance, and academic achievement, by mitigat- ing earlier nutrition and health deprivations and by addressing current infections and nutritional deficiencies (Bundy, Schultz, and others 2017). This age group is partic- ularly at risk for parasitic helminth infections (Jukes, Drake, and Bundy 2008), and malaria has become prevalent in school-age populations as control for younger children delays the acquisition of immunity from early childhood to school age (Brooker and others 2017). Furthermore, school health services are commonly viewed as a means for build- ing and reinforcing healthy habits to lower the risk of non- communicable disease later in life (Bundy 2011). This chapter focuses on packages and programs to reach school-age children, while the previous chapter, chapter 24 (Horton and Black 2017), focuses on early childhood inter- ventions, and the next chapter, chapter 26 (Horton and others 2017), focuses on adolescent interventions. These packages are all part of the same continuum of care from age 5 years to early adulthood, as discussed in chapter 1 (Bundy, de Silva, and others 2017). A particular emphasis of the economic rationale for targeting school-age children is to promote their health and education while they are in the process of learning; many of the interventions that are part of the package have been shown to yield substantial benefits in educational outcomes (Bundy 2011; Jukes, Drake, and Bundy 2008). They might be viewed as health interventions that leverage the investment in education. Schools are an effective platform through which to deliver the essential package of health and nutrition ser- vices (Bundy, Schultz, and others 2017). Primary enroll- ment and attendance rates increased substantially during the Millennium Development Goals era, making schools a delivery platform with the potential to reach large num- bers of children equitably. Furthermore, unlike health centers, almost every community has a primary school, and teachers can be trained to deliver simple health inter- ventions, resulting in the potential for high returns for relatively low costs by using the existing infrastructure. This chapter identifies a core set of interventions for children ages 5–14 years that can be delivered effectively through schools. It then simulates the returns to health and education and benchmarks them against the costs of the intervention, drawing on published estimates. The invest- ment returns illustrate the scale of returns provided by school-based health interventions, highlighting the value of integrated health services and the parameters driving costs, benefits, and value for money (the ratio of benefits to costs). Countries seeking to introduce such a package need to undertake context-specific analyses of critical needs to ensure that the package responds to the specific local needs

A review of clinical trials with an adaptive design and health economic analysis

An adaptive design uses data collected as a clinical trial progresses to inform modifications to the trial. Hence, adaptive designs and health economics aim to facilitate efficient and accurate decision-making. However, it is unclear whether the methods are considered together in the design, analysis and reporting of trials. This review aims to establish how health economic outcomes are utilised in the design, analysis and reporting of adaptive designs. Registered and published trials up to August 2016 with an adaptive design and health economic analysis were identified. The use of health economics in the design, analysis and reporting was assessed. Summary statistics are presented and recommendations formed based on the research team’s experiences and a practical interpretation of the results. Thirty-seven trials with an adaptive design and health economic analysis were identified. It was not clear whether the health economic analysis accounted for the adaptive design in 17/37 trials where this was thought necessary, nor whether health economic outcomes were utilised at the interim analysis for 18/19 of trials with results. The reporting of health economic results was sub-optimal for the (17/19) trials with published results. Appropriate consideration is rarely given to the health economic analysis of adaptive designs. Opportunities to utilise health economic outcomes in the design and analysis of adaptive trials are being missed. Further work is needed to establish whether adaptive designs and health economic analyses can be used together to increase the efficiency of health technology assessments without compromising accuracy

Essays on Societal Cost of Alcohol and Related Issues - A Health Economic Analysis

The consumption of alcoholic beverages has wide effects, for example, causes premature mortality, prevents certain heart diseases, increases crime rates, and affects quality of life. The main problems with alcohol consumption from an economic point of view are lack of information for consumers when making consumption decisions, externalities, and the addictive nature. It is expected that this results in non-optimal consumption levels, causing higher costs than benefits. Studying the effects of alcohol consumption is thus important in order to increase information and to allow interventions and regulations to be implemented targeting market failures, with the overall purpose of improving societal and individual welfare. The aim of this thesis is to study the effect of alcohol consumption on society, calculating the societal cost of consumption, and investigating possible improvements with regard to the estimation methods, data materials, and methodological assumptions. The focus of the latter is on issues related to labour market outcomes. Four research papers are included, together covering the aim. Paper I conservatively estimates the societal cost of alcohol consumption in Sweden, including health and quality of life effects. The costs add up to a net cost of SEK 20.3 billion (0.9% of GDP) in 2002. To this should a partial estimate of reduced quality of life be added, totalling 122,000 QALYs. Sensitivity analyses indicate a sensitivity range of 50% of the net cost. However, even the lowest plausible estimate shows net societal cost of alcohol consumption. Paper II investigates the effect of low alcohol consumption on health, measured as medical care costs and prevalence of alcohol-attributable diseases. It is found that low alcohol consumption increases medical care costs and episodes, with the exception for individuals above 80 years of age. Thus, the protective effect of low alcohol consumption for some diseases can not fully counter the detrimental effect from those diseases where low alcohol consumption increases the risk. Based on the epidemiological literature, low alcohol consumption should therefore not be considered to improve health. Paper III studies a methodological issue in connection to the wage equation; whether failure to account for individuals’ drinking histories causes heterogeneity within commonly pooled consumption groups, potentially causing bias in econometric estimations. By applying a multinomial logit model, it is found that pooled drinking groups (current abstainers and light drinkers) are heterogeneous, and that this might implicate estimation bias due to confounding and misclassification. This study thus argues that it is imperative to account for drinking history when studying the effect of alcohol consumption. Paper IV analyses the effect of women’s alcohol consumption on the likelihood of being long-term absent from work. Drinking history and selection effects are controlled for by applying a Heckman model. Women who are not a long-term light drinker is associated with an increase in the probability of long-term sickness-related absence, except for the insignificant effect of being a current light but former heavy drinker. The strongest effect is found for former drinkers (18%) followed by former abstainers (15%). Surprisingly are both being a long-term abstainer and a long-term heavy drinker associated with an increase of around 10%. Several simulation models were estimated, for example investigating the potential societal gain in productivity if all women were long-term light drinkers. It is found that the effect of alcohol consumption on long-term sickness-related absence is rather small on an individual level, although the added societal effect is substantial. It is shown in this thesis that alcohol consumption has a large societal impact. The societal cost was estimated in Paper I and Paper II – IV have supplied new information, with focus on the possible wage effect of alcohol consumption, in order to improve future estimations. Paper II rejects, based on the epidemiological literature, the possibility that the positive wage effect of low alcohol consumption is mediated through a protective health effect. According to Paper III, drinking history should be controlled for although this can not explain the commonly found inversed U-shaped relationship between alcohol and wages. Paper IV in turn suggests sickness-related absence as a mediator, potentially explaining (parts of) the alcohol – wage effect. Finally, the thesis has shown that the results of cost estimations are sensitive to what type of data is being used. Compared to a society without alcohol, the current Swedish consumption increases long-term sickness-related absence when using epidemiological data (Paper I), and decreases absence when using microdata and econometric methods (Paper IV)

Health Economic Analysis on a Psychosocial Intervention for Family Caregivers of Persons with Dementia.

Background/Aims: Psychosocial intervention has shown positive effects on the caregivers' burden and satisfaction. The aims of this study were to describe the cost and cost-effectiveness of such an intervention. Methods: We analyzed resource use and costs of formal care for 308 persons with dementia and their caregivers' health-related quality of life (HRQoL). Results: The costs of home help services were lower in the subgroup of spouse caregivers in the intervention group and the cost of nursing home placement was lower in the intervention group. While the person with dementia lived at home, caregivers in the intervention group reported a higher HRQoL (p < 0.01). After the person with dementia had moved to a nursing home, spouses in the control group had a lower HRQoL (p < 0.001). Conclusion: The result can be interpreted as a positive effect of the intervention focusing on the identified specific needs of the family caregivers. © 2013 S. Karger AG, Basel