http://www.healtheconomicsreview.com The most accessed research articles published by Health Economics Review 2012-05-06T00:00:00Z Background: Providing health care services in Africa is hampered by severe scarcity of personnel, medical supplies and financial funds. Consequently, managers of health care institutions are called to measure and improve the efficiency of their facilities in order to provide the best possible services with their resources. However, very little is known about the efficiency of health care facilities in Africa and instruments of performance measurement are hardly applied in this context.ObjectiveThis study determines the relative efficiency of primary care facilities in Nouna, a rural health district in Burkina Faso. Furthermore, it analyses the factors influencing the efficiency of these institutions.MethodologyWe apply a two-stage Data Envelopment Analysis (DEA) based on data from a comprehensive provider and household information system. In the first stage, the relative efficiency of each institution is calculated by a traditional DEA model. In the second stage, we identify the reasons for being inefficient by regression technique. Results: The DEA projections suggest that inefficiency is mainly a result of poor utilization of health care facilities as they were either too big or the demand was too low. Regression results showed that distance is an important factor influencing the efficiency of a health care institution Conclusions: Compared to the findings of existing one-stage DEA analyses of health facilities in Africa, the share of relatively efficient units is slightly higher. The difference might be explained by a rather homogenous structure of the primary care facilities in the Burkina Faso sample. The study also indicates that improving the accessibility of primary care facilities will have a major impact on the efficiency of these institutions. Thus, health decision-makers are called to overcome the demand-side barriers in accessing health care. http://www.healtheconomicsreview.com/content/1/1/5 Paul Marschall Steffen Flessa Health Economics Review 2011, null:5 2011-07-20T00:00:00Z doi:10.1186/2191-1991-1-5 /content/figures/2191-1991-1-5-toc.gif Health Economics Review 2191-1991 ${item.volume} 5 2011-07-20T00:00:00Z XML This paper examines the effect of job stress on two key health risk-behaviors: smoking and alcohol consumption, using data from the Canadian National Population Health Survey. Findings in the extant literature are inconclusive and are mainly based on standard models which can model differential responses to job stress only by observed characteristics. However, the effect of job stress on smoking and drinking may largely depend on unobserved characteristics such as: self control, stress-coping ability, personality traits and health preferences. Accordingly, we use a latent class model to capture heterogeneous responses to job stress. Our results suggest that the effects of job stress on smoking and alcohol consumption differ substantially for at least two "types" of individuals, light and heavy users. In particular, we find that job stress has a positive and statistically significant impact on smoking intensity, but only for light smokers, while it has a positive and significant impact on alcohol consumption mainly for heavy drinkers. These results provide suggestive evidence that the mixed findings in previous studies may partly be due to unobserved individual heterogeneity which is not captured by standard models. http://www.healtheconomicsreview.com/content/1/1/15 Sunday Azagba Mesbah Sharaf Health Economics Review 2011, null:15 2011-09-30T00:00:00Z doi:10.1186/2191-1991-1-15 /content/figures/2191-1991-1-15-toc.gif Health Economics Review 2191-1991 ${item.volume} 15 2011-09-30T00:00:00Z XML This study aims to identify the impact of a preterm birth on financial and emotional burden from the families' perspective. Additionally, a comprehensive schedule of recommendations for a sufficient evaluation of all aspects of burden is developed. Based on the results of a literature search relevant categories and sub-domains for a questionnaire covering multiple aspects of associated financial and emotional burden are identified and converted into a recommendation scheme. Results of the literature search illustrate the large extend of burden of prematurity on parents. This results in substantial out-of-pocket expenditures (OOPE) and emotional distress to the parents besides the medical problems and further financial costs to the health insurance system. According to the results on infants' state of health, OOPE and emotional distress are significantly increased with decreasing gestational age. OOPE for transportation often amounts to the main parental cost dimension. Moreover there is some evidence for a high magnitude of reduced income and missed work days. The family perspective has to be taken into account when calculating the overall costs of preterm births from a societal point of view. However, in recent years economic evaluations were performed rather inhomogeneously in this field. For future studies a) direct medical costs, b) direct non-medical costs, c) indirect costs as well as d) intangible costs (in terms of emotional distress and reduced quality of life for caregivers and children) are the main categories that should be evaluated measuring personal burden of preterm birth on families adequately. A detailed list of specific sub-domains is given. Additionally, the recommendations are not restricted to application in infants born preterm and/or at low birth weight. http://www.healtheconomicsreview.com/content/1/1/6 Jan-Marc Hodek J.-Matthias von der Schulenburg Thomas Mittendorf Health Economics Review 2011, null:6 2011-07-20T00:00:00Z doi:10.1186/2191-1991-1-6 /content/figures/2191-1991-1-6-toc.gif Health Economics Review 2191-1991 ${item.volume} 6 2011-07-20T00:00:00Z XML To our knowledge, the present study provides a first time assessment of the contributions of socioeconomic determinants of immunization coverage in India using the recent National Family Health Survey data. Measurement of socioeconomic inequalities in health and health care, and understanding the determinants of such inequalities in terms of their contributions, are critical for health intervention strategies and for achieving equity in health care. A decomposition approach is applied to quantify the contributions from socio-demographic factors to inequality in immunization coverage. The results reveal that poor household economic status, mother's illiteracy, per capita state domestic product and proportion of illiterate at the state level is systematically related to 97% of predictable socioeconomic inequalities in full immunization coverage at the national level. These patterns of evidence suggest the need for immunization strategies targeted at different states and towards certain socioeconomic determinants as pointed out above in order to reduce socioeconomic inequalities in immunization coverage.JEL Classification: I10, I12 http://www.healtheconomicsreview.com/content/1/1/11 Jorgen Lauridsen Jalandhar Pradhan Health Economics Review 2011, null:11 2011-08-05T00:00:00Z doi:10.1186/2191-1991-1-11 /content/figures/2191-1991-1-11-toc.gif Health Economics Review 2191-1991 ${item.volume} 11 2011-08-05T00:00:00Z XML 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 Health economists have studied the determinants of the expected value of health status as a function of medical and non-medical inputs, often finding small marginal effects of the former. However, medical inputs may have an additional benefit in the form of a reduced variability of health status. Using the standard deviation of life expectancy in 24 OECD countries between 1960 and 2005, a 10 percent increase of health care expenditure is associated with a decrease of an estimated 0.42 percent. Willingness to pay for such a reduction of uncertainty may well exceed the extra health care expenditure in the United States and Switzerland. This implies that even in these two countries with very high health care expenditure per capita, flat-of-the-curve medicine need not be wasteful.JEL-Classification: I12, J10 http://www.healtheconomicsreview.com/content/1/1/2 Johannes Schoder Peter Zweifel Health Economics Review 2011, null:2 2011-07-20T00:00:00Z doi:10.1186/2191-1991-1-2 /content/figures/2191-1991-1-2-toc.gif Health Economics Review 2191-1991 ${item.volume} 2 2011-07-20T00:00:00Z XML 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 Background: To compare improvement in quality of life (QoL) and symptoms' relief in vertebral compression fractures (VCF) due to osteoporosis for patients undergoing balloon kyphoplasty (BKP) to those undergoing non-surgical management (NSM) in a real-life setting. Methods: In this prospective, comparative study, quality-of-life was evaluated in eight centres in Germany between 2005 and 2008, for 82 patients, with the EQ-5D questionnaire, and the Roland Morris Disability Questionnaire (RMDQ). Results: BKP patients demonstrated a statistical and clinical significant higher improvement in EQ-5D than NSM patients, 0.44 and 0.25 from baseline to 12 months, respectively. Moreover, BKP patients showed a clinically relevant improvement in the RMDQ by 6.25 from baseline to 12 months, whereas NSM patients had no significant improvement in the RMDQ. Conclusions: This study demonstrates for VCF patients that in real-life quality of life for BKP patients improves more than for NSM patients; confirming the results of a large randomized clinical trial. http://www.healtheconomicsreview.com/content/1/1/7 Daniela Eidt-Koch Wolfgang Greiner Health Economics Review 2011, null:7 2011-07-20T00:00:00Z doi:10.1186/2191-1991-1-7 /content/figures/2191-1991-1-7-toc.gif Health Economics Review 2191-1991 ${item.volume} 7 2011-07-20T00:00:00Z XML 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 This literature review aims to analyse the costing methodology in economic analyses of primary preventive physical activity programmes. It demonstrates the usability of a recently published theoretical framework in practice, and may serve as a guide for future economic evaluation studies and for decision making.A comprehensive literature search was conducted to identify all relevant studies published before December 2009. All studies were analysed regarding their key economic findings and their costing methodology.In summary, 18 international economic analyses of primary preventive physical activity programmes were identified. Many of these studies conclude that the investigated intervention provides good value for money compared with alternatives (no intervention, usual care or different programme) or is even cost-saving. Although most studies did provide a description of the cost of the intervention programme, methodological details were often not displayed, and savings resulting from the health effects of the intervention were not always included sufficiently.This review shows the different costing methodologies used in the current health economic literature and compares them with a theoretical framework. The high variability regarding the costs assessment and the lack of transparency concerning the methods limits the comparability of the results, which points out the need for a handy minimal dataset of cost assessment. http://www.healtheconomicsreview.com/content/1/1/17 Silke Wolfenstetter Christina Wenig Health Economics Review 2011, null:17 2011-10-26T00:00:00Z doi:10.1186/2191-1991-1-17 /content/figures/2191-1991-1-17-toc.gif Health Economics Review 2191-1991 ${item.volume} 17 2011-10-26T00:00:00Z XML