http://www.healtheconomicsreview.com The latest research articles published by Health Economics Review 2012-05-06T00:00:00Z Background: An understanding of the complex relationship between health status and welfare is crucial for critical policy interventions. However, the focus of most policies in developing regions has been on current welfare to the neglect of forward-looking welfare analysis. The absence of adequate research in the area of future poverty or vulnerability to poverty has also contributed to the focus on current welfare. The objectives of this study were to estimate vulnerability to poverty among households in Ghana and examine the relationship between health status and vulnerability to poverty.MethodThe study used cross section data from the Fifth Round of the Ghana Living Standards Survey (GLSS 5) with a nationally representative sample of 8,687 households from all administrative regions in Ghana. A three-step Feasible Generalized Least Squares (FGLS) estimation procedure was employed to estimate vulnerability to poverty and to model the effect of health status on expected future consumption and variations in future consumption. Vulnerability to poverty estimates were also examined against various household characteristics. Results: Using an upper poverty line, the estimates of vulnerability show that about 56% of households in Ghana are vulnerable to poverty in the future and this is higher than the currently observed poverty level of about 29%. Households with ill members were vulnerable to poverty. Moreover, households with poor hygiene conditions were also vulnerable to future poverty. The vulnerability to poverty estimates were, however, sensitive to the poverty line used and varied with household characteristics. Conclusion: The results imply that policies directed towards poverty reduction need to take into account the vulnerability of households to future poverty. Also, hygienic conditions and health status of households need not be overlooked in poverty reduction strategies. http://www.healtheconomicsreview.com/content/2/1/11 Jacob Novignon Justice Nonvignon Richard Mussa Levison Chiwaula Health Economics Review 2012, null:11 2012-05-06T00:00:00Z doi:10.1186/2191-1991-2-11 /content/figures/2191-1991-2-11-toc.gif Health Economics Review 2191-1991 ${item.volume} 11 2012-05-06T00:00:00Z PDF We propose simple modifications for the Kakwani tax progressivity measure that make it suitable for evaluating access inequality for medical services. Our modification is to measure inequality using the ratio of the concentration index to the Gini coefficient instead of the difference between them. We also propose a measure using the Gini coefficient or concentration index of consumption expenditure as the denominator in the modified measure as an alternative type of modified measure. This measure can also be interpreted as the income/consumption expenditure elasticity evaluated at the mean. Additionally, we propose a decomposition method using expenditure components and provide an empirical example with Japanese data. http://www.healtheconomicsreview.com/content/2/1/10 Mototsugu Fukushige Noriko Ishikawa Satoko Maekawa Health Economics Review 2012, null:10 2012-05-06T00:00:00Z doi:10.1186/2191-1991-2-10 /content/figures/2191-1991-2-10-toc.gif Health Economics Review 2191-1991 ${item.volume} 10 2012-05-06T00:00:00Z PDF Background: The aim of the study was to determine the costs of treating schizophrenia from the perspective of the statutory health insurance, as well as the identification of predictors of hospitalisation of formerly stable schizophrenia patients. Methods: Claims data for the years 2004-2006 were analysed. Patients who did not have to be treated in a hospital as a result of an ICD diagnosis F20 both in the year 2005 as well as also in 2006 were defined as stable patients. In contrast, those patients who had to be treated in a hospital in 2006 because of a diagnosis of schizophrenia were defined as unstable. In addition to the overall healthcare costs, the costs specific to schizophrenia were also analysed. Also, based on binary logistic regression analysis, predictors for hospital treatment were determined. Results: 8497 stable and 1449 unstable patients were identified. The schizophrenia specific costs for stable patients were EUR 1605 and the overall costs were EUR 4029 in 2006, respectively. Unstable patients had indication-specific costs amounting to EUR 12864 and overall health care costs of EUR 16824. For unstable patients, the costs of hospital treatment were identified as being a substantial cost area. Predictors for a higher probability of hospital treatment were: female patients, at least one rehabilitation measure, at least one stay in hospital in 2004, and being co-morbid with substance abuse. In contrast, older patients, who were treated with concomitant medications, and if they received a continuous drug therapy in all quarters of a year had a lower probability of hospitalisation. In addition, an increased number of visits to a doctor reduced the probability of hospitalisation. The variable 'depot medication' were close to significance and the variable 'inability to work lasting more than six weeks' had, in contrast, no significant influence. Conclusions: The schizophrenia specific and overall health care costs of unstable patients were clearly higher than was the case with stable patients and mainly determined by inpatient hospital treatment. A range of potential predicting factors which can be extracted from routine claims data have a positive or negative influence on the probability of treatment in hospital. http://www.healtheconomicsreview.com/content/2/1/9 Jan Zeidler Lara Slawik Jochen Fleischmann Wolfgang Greiner Health Economics Review 2012, null:9 2012-05-04T00:00:00Z doi:10.1186/2191-1991-2-9 /content/figures/2191-1991-2-9-toc.gif Health Economics Review 2191-1991 ${item.volume} 9 2012-05-04T00:00:00Z PDF Background: Schizophrenia is a severe form of mental illness which is associated with significant and long-lasting health, social and financial burdens.The aim of this project is to assess the efficiency of the antipsychotics used in Spain in reducing schizophrenia relapses under the Spanish Health System perspective.Material and methodsA decision-analytic model was developed to explore the relative cost-effectiveness of five antipsychotic medications, amisulpride, aripiprazole, olanzapine, paliperidone Extended-Release (ER) and risperidone, compared to haloperidol, over a 1-year treatment period among people living in Spain with schizophrenia. The transition probabilities for assessed therapies were obtained from the systemic review and meta-analysis performed by National Institute for Health and Clinical Excellence (NICE). Results: Paliperidone ER was the option that yielded more quality-adjusted life years (QALYs) gained per patient (0.7573). In addition, paliperidone ER was the least costly strategy (Euros3,062), followed by risperidone (Euros3,194), haloperidol (Euros3,322), olanzapine (Euros3,893), amisulpride (Euros4,247) and aripiprazole (Euros4,712).In the incremental cost-effectiveness (ICE) analysis of the assessed antipsychotics compared to haloperidol, paliperidone ER and risperidone were dominant options. ICE ratios for other medications were Euros23,621/QALY gained, Euros91,584/QALY gained and Euros94,558/QALY gained for olanzapine, amisulpride and aripiprazole, respectively. Deterministic sensitivity analysis showed that risperidone is always dominant when compared to haloperidol. Paliperidone ER is also dominant apart from the exception of the scenario with a 20% decrease in the probability of relapses. Conclusions: Our findings may be of interest to clinicians and others interested in outcomes and cost of mental health services among patients with schizophrenia.Paliperidone ER and risperidone were shown to be dominant therapies compared to haloperidol in Spain. It is worthwhile to highlight that schizophrenia is a highly incapacitating disease and choosing the most appropriate drug and formulation for a particular patient is crucial.The availability of more accurate local epidemiological data on schizophrenia would allow a better adaptation of the model avoiding some of the assumptions taken in our work. Future research could be focused on this. http://www.healtheconomicsreview.com/content/2/1/8 Antonio Garcia-Ruiz Lucia Perez-Costillas Ana Montesinos Javier Alcalde Itziar Oyaguez Miguel Casado Health Economics Review 2012, null:8 2012-04-10T00:00:00Z doi:10.1186/2191-1991-2-8 /content/figures/2191-1991-2-8-toc.gif Health Economics Review 2191-1991 ${item.volume} 8 2012-04-10T00:00:00Z PDF Physician ownership of in-office ancillary services (IOASs) has come under increasing scrutiny. Advocates of argue that IOASs allow physicians to supervise the quality and coordination of care. Critics have argued that IOASs create financial incentives for physicians to increase ancillary service volume. In this paper we develop a conceptual framework to evaluate the tradeoffs associated with physician ownership of IOASs. There is some evidence supporting the existence of scope and transaction economies in IOASs. Improvement in flow and continuity of care are likely to generate scope economies and improvements in quality monitoring and reductions in consumer transaction costs are likely to generate transaction economies. Other factors include the capture of upstream and downstream profits, but these incentives are likely to be small compared to scope and transaction economies. Policy debates on the merits of IOASs should include an explicit assessment of these tradeoffs. http://www.healtheconomicsreview.com/content/2/1/7 John Schneider Robert Ohsfeldt Cara Scheibling Sarah Jeffers Health Economics Review 2012, null:7 2012-04-05T00:00:00Z doi:10.1186/2191-1991-2-7 /content/figures/2191-1991-2-7-toc.gif Health Economics Review 2191-1991 ${item.volume} 7 2012-04-05T00:00:00Z PDF On the basis of the Survey of Health, Ageing, and Retirement (SHARE), we analyse the determinants of who engages in mammography screening focusing on European women aged 50-69 years. A special emphasis is put on the measurement error of subjective life expectancy and on the measurement and impact of physician quality. Our main findings are that physician quality, better education, having a partner, younger age and better health are associated with higher rates of receipt. The impact of subjective life expectancy on screening decision substantially increases after taking measurement error into account. http://www.healtheconomicsreview.com/content/2/1/6 Ansgar Wuebker Health Economics Review 2012, null:6 2012-04-05T00:00:00Z doi:10.1186/2191-1991-2-6 /content/figures/2191-1991-2-6-toc.gif Health Economics Review 2191-1991 ${item.volume} 6 2012-04-05T00:00:00Z PDF Community-Based Health Insurance (CBHI) is an emerging concept for providing financial protection against the cost of illness and improving access to quality health services for low-income rural households who are excluded from formal insurance. CBHI is currently being provided in some rural areas in developing countries and there is ongoing research about its impact on the well-being of the poor in these areas. However, the success of CBHI revolves around the existence of social capital in the community. This has led researchers to explore the impact of CBHI on the well-being of the poor in rural areas, especially as it relates to social capital. The overall objective of this paper is to review recent developments that address the link between CBHI and social capital. Policy implications are also discussed. http://www.healtheconomicsreview.com/content/2/1/5 Hermann Donfouet Pierre Mahieu Health Economics Review 2012, null:5 2012-04-04T00:00:00Z doi:10.1186/2191-1991-2-5 /content/figures/2191-1991-2-5-toc.gif Health Economics Review 2191-1991 ${item.volume} 5 2012-04-04T00:00:00Z PDF Background: Invasive (IPD, defined as detection of pneumococci in sterile body fluids like meningitis or bacteremic pneumonia) and non-invasive Streptococcus pneumoniae infections (i.e. non-bacteremic pneumonia, otitis media) in adults are associated with substantial morbidity, mortality and costs. In Germany, Pneumococcal polysaccharide vaccination (PPV23) is recommended for all persons >60 years and for defined risk groups (age 5-59). The aim of this model was to estimate the potential cost-effectiveness and benefit-cost ratios of the adult vaccination program (18 years and older), considering the launch of the pneumococcal conjugate vaccine for adults (PCV13). Methods: A cross-sectional steady state Markov model was developed to estimate the outcomes of PCV13, PPV23 vaccination schemes and 'no vaccination'. Conservative assumptions were made if no data were available for PCV13 and PPV23 respectively. The effectiveness of individual pneumococcal vaccination in adults was adjusted for expected indirect effects due to the vaccination in infants. Data on incidences, effectiveness and costs were derived from scientific literature and publicly available databases. All resources used are indicated. Benefit-cost ratios and cost-effectiveness were evaluated from the perspective of the German Statutory Health Insurance as well as from social perspective. Results: Under the assumption that PCV13 has a comparable effectiveness to PCV7, a vaccination program with PCV13 revealed the potential to avoid a greater number of yearly cases and deaths in IPD and pneumonia in Germany compared to PPV23. For PCV13, the costs were shown to be overcompensated by monetary savings resulting from reduction in the use of health care services. These results would render the switch from PPV23 to PCV13 as a dominant strategy compared to PPV23 and 'no vaccination'. Given the correctness of the underlying assumptions every Euro spent on the PCV13 vaccination scheme yields savings of 2.09 E (social perspective: 2.16 E) compared to PPV23 and 1.27 E (social perspective: 1.32 E) compared to 'no vaccination', respectively. Conclusions: Results of the model indicate that the health economic benefit of immunizing adults with PCV13 can be expected to outperform the sole use of PPV23, if the effectiveness of PCV13 is comparable to the effectiveness of PCV7. http://www.healtheconomicsreview.com/content/2/1/4 Alexander Kuhlmann Ulrike Theidel Mathias Pletz J.-Matthias Graf von der Schulenburg Health Economics Review 2012, null:4 2012-03-30T00:00:00Z doi:10.1186/2191-1991-2-4 /content/figures/2191-1991-2-4-toc.gif Health Economics Review 2191-1991 ${item.volume} 4 2012-03-30T00:00:00Z PDF Background: Opioid addiction is a worldwide problem. Agonist opioid treatment (AOT) is the most widespread and frequent pharmacotherapeutic approach. Methadone has been the most widely used AOT, but buprenorphine, a partial μ-opiod agonist and a κ-opiod antagonist, is fast gaining acceptance. The objective was to assess the budgetary impact in Spain of the introduction of buprenorphine-naloxone (B/N) combination. Methods: A budgetary impact model was developed to estimate healthcare costs of the addition of B/N combination to the therapeutic arsenal for treating opioid dependent patients, during a 3-year period under the National Health System perspective. Inputs for the model were obtained from the specialized scientific literature. Detailed information concerning resource consumption (drug cost, logistics, dispensing, medical, psychiatry and pharmacy supervision, counselling and laboratory test) was obtained from a local expert panel. Costs are expressed in euros (€, 2010). Results: The number of patients estimated to be prescribed B/N combination was 2,334; 2,993 and 3,589 in the first, second and third year respectively. Total budget is €85,766,129; €79,855,471 and €79,137,502 in the first, second and third year for the scenario without B/N combination. With B/N combination the total budget would be €86,589,210; €80,398,259 and €79,708,964 in the first, second and third year of the analyses. Incremental cost/patient comparing the addition of the B/N combination to the scenario only with methadone is €10.58; €6.98 and €7.34 in the first, second and third year respectively. Conclusion: Addition of B/N combination would imply a maximum incremental yearly cost of €10.58 per patient compared to scenario only with methadone and would provide additional benefits. http://www.healtheconomicsreview.com/content/2/1/3 Jose Martinez-Raga Francisco Gonzalez-Saiz Julian Onate Itziar Oyaguez Eliazar Sabater Miguel Casado Health Economics Review 2012, null:3 2012-03-29T00:00:00Z doi:10.1186/2191-1991-2-3 /content/figures/2191-1991-2-3-toc.gif Health Economics Review 2191-1991 ${item.volume} 3 2012-03-29T00:00:00Z XML In April 2008, the specialization in departments of obstetrics and gynecology was conducted in Sennan area of Osaka prefecture in Japan, which aims at solving the problems of regional provision of obstetrical service. Under this specialization, the departments of obstetrics and gynecology in two city hospitals were combined as one medical center, whilst one hospital is in charge of the department of gynecology and the other one operates the department of obstetrics. In this paper, we implement a cost-benefit analysis to evaluate the validity of this specialization. The benefit-cost ratio is estimated at 1.367 under a basic scenario, indicating that the specialization can generate a net benefit. In addition, with a consideration of different kinds of uncertainty in the future, a number of sensitivity analyses are conducted. The results of these sensitivity analyses suggest that the specialization is valid in the sense that all the estimated benefit-cost ratios are above 1.0 in any case. http://www.healtheconomicsreview.com/content/2/1/2 Junyi Shen On Fukui Hiroyuki Hashimoto Takako Nakashima Tadashi Kimura Kenichiro Morishige Tatsuyoshi Saijo Health Economics Review 2012, null:2 2012-03-27T00:00:00Z doi:10.1186/2191-1991-2-2 /content/figures/2191-1991-2-2-toc.gif Health Economics Review 2191-1991 ${item.volume} 2 2012-03-27T00:00:00Z XML