Every Monday our authors provide a round-up of some of the most recently published peer reviewed articles from the field. We don’t cover everything, or even what’s most important – just a few papers that have interested the author. Visit our Resources page for links to more journals or follow the HealthEconBot. If you’d like to write one of our weekly journal round-ups, get in touch.
Development of a measure (ICECAP-Close Person Measure) through qualitative methods to capture the benefits of end-of-life care to those close to the dying for use in economic evaluation. Palliative Medicine [PubMed] Published 3rd June 2016
I’ve written somewhat critically about the use of ICECAP measures in economic evaluation. One thing that they do well is the development of the measures themselves. Here we have the latest: the ICECAP-CPM. End of life care is one area in which evaluations should take into account benefits (or burdens) experienced by family members or close persons, and government publications support this view. This paper reports on the development of a new measure to capture such spillover effects in terms of capabilities. People (n=27) who were either recently bereaved or had loved ones or relatives currently receiving end of life care were interviewed, and qualitative analysis was used to determine which attributes should be included in the measure. In the end, 6 attributes were selected: i) communication with those providing care services, ii) practical support, iii) privacy and space, iv) emotional support, v) preparing and coping, and vi) emotional distress. The measure allows for 5 levels within each of these domains. Notwithstanding my concerns about the use of ICECAP measures, the ICECAP-CPM represents an innovative and potentially useful way of capturing some of the wider benefits of end of life care. I expect it will start to be included in evaluative studies, though it may yet prove more useful as a routinely collected close-person-reported outcome measure. But the ICECAP-CPM also creates new questions. Who counts as a close person? Do we treat close person capabilities as additive? Do we really want to trade benefits to close persons against benefits to patients? This will keep researchers busy and means that the ICECAP-CPM (like all new outcome measures) should for now be used with caution.
QALY gain and health care resource impacts of air pollution control: A Markov modelling approach. Environmental Science & Policy Published 25th May 2016
Here’s something you don’t see every day: an evaluation of the health impacts and costs of a policy that falls outside of the remit of the Department of Health. The study reports on a Markov model based on 3 diseases: chronic obstructive pulmonary disease, coronary heart disease and lung cancer. The model is used to estimate the impact of changes in air quality for 40-90 year olds, and the main novelty of the study is the use of QALYs in this context. A 9% reduction in small particulate matter concentrations in England and Wales – in line with current targets – is evaluated. Data were taken from a variety of national sources to incorporate the impact of air quality on the risk of disease onset and death, and disease-related health service use. Health-related quality of life estimates were based on published EQ-5D index scores. The main finding is that the improvement in air quality would generate 540,000 QALYs. Due to improved longevity, additional health care costs would amount to around £263 million. Results are also presented by age and sex, though I can’t see why this would be important. The QALY benefit is on average greater for men than women and the savings from reduced morbidity are (of course) greater for younger people. On balance, the model probably produces underestimates as it does not include all possible health impacts of air pollution.
The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation. Journal of Epidemiology & Community Health [PubMed] Published 17th May 2016
People in more deprived areas have worse health outcomes and do not make equivalent use of health services. Some services are more heavily used in more deprived areas, while others are less likely to be used. The net impact on costs is therefore not clear, so this study looks at lifetime inpatient hospital costs for the English population. Hospital Episode Statistics for 2011/12 are used and analysed based on the 32,482 lower-layer super output areas (LSOA). Deprivation is measured using the index of multiple deprivation (IMD) and LSOAs are grouped by IMD quintile, age and sex. Average costs are estimated and then compared with the least deprived quintile. Mortality rates and survival curves are estimated. For 0-60 year olds, a greater number of episodes were observed with greater deprivation. For people over 75, the trend reversed; this seems to be caused by fewer people in deprived areas surviving into old age. Much of the inequality was driven by differences in emergency admissions, with a 71% higher rate for the most deprived compared with the least deprived quintile. The pattern for costs is very similar, so average cumulative lifetime costs were greater for people in the more deprived areas. It’s a bit of a leap to assert that the difference in costs is because of deprivation (and could be remedied by removing the inequality), but if we make that leap the total ‘cost’ of inequality in these terms was £4.8 billion in 2011/12.