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.
Systematic review of health economic impact evaluations of risk prediction models: stop developing, start evaluating. Value in Health [PubMed] Published April 2017
Risk prediction models are pervasive in clinical medicine. For example, one 2012 review of type 2 diabetes (T2DM) models identified 16 studies with 25 models. There was not much difference between the models in ability to predict T2DM and models including biomarkers were slightly better. But, obviously no model is perfect, the T2DM risk prediction tools generally overestimated the risk of development of diabetes. One could see parallels here with screening. When subjected to cost-benefit analyses, many screening programs become somewhat controversial. False positives can cause harm to patients both psychologically and through further procedures they may be subjected to. Such concerns thus may also apply to risk prediction models. This review surveys the literature on health economic evaluations of risk prediction models. Forty studies examining 60 risk models were included. Compare this number with the total of T2DM models above and you will see how the authors might arrive at the conclusion that economic evaluations of risk prediction models are rare. Another key finding, and one I empathize with as I am currently reviewing economic evaluations in another area of heath economics, is that there is a large amount of methodological heterogeneity and quality differences between studies. This makes comparisons difficult if not impossible. This limits the utility of these findings to decision makers. A routine, standardised approach to economic evaluation is needed.
The fading American dream: trends in absolute income mobility since 1940. Science [PubMed] [RePEc] Published 28th April 2017
This one is not strictly health. But it’s findings may have important implications for how we understand the relationship between income and health, and the inter-generational transmission of health. And, it’s not everyday an economics paper gets into Science. Economic mobility is a key goal for many societies – children should earn more than their parents. One way of examining this quantitatively is the proportion of children who earn more than their parents. This paper shows that this can be estimated using (i) the marginal income distribution of children, (ii) the marginal income distribution of parents, and (iii) the joint distribution of child and parent income ranks. The key finding is that mobility has declined over the 20th Century. While around 90% of children were earning more than their parents in 1940, by 1980 this is only around 40%. The authors look at what would happen to these estimates if GDP growth were more equally distributed and find much of the decline in mobility would be reversed.
Economic consequences of legal and illegal drugs: the case of social costs in Belgium. International Journal of Drug Policy [PubMed] Published 23rd April 2017
Put ten economists in a room and you’ll get 11 different opinions. Or so the saying goes. But while there is division on a number of topics in economics, some issues find a strong consensus. Drug prohibition is one of those issues many economists agree on. As a policy is has high costs and reasonably little benefit, especially when harm reduction is the goal. David Nutt, whose work we’ve discussed before, is a prominent critic of the UK government’s policy on drugs. Just this week he has discussed how the recent increase in the use of and health problems due to ‘spice’ (synthetic cannabinoids) may well be attributable to the prohibition of natural cannabis. However, recreational drug use, whether illegal or legal, does bear a societal cost. This paper attempts to quantify both the indirect and direct costs of drug use in Belgium. They take a ‘cost of illness’ approach, a term I think is a little unsuitable for the topic – most drug use causes no harm so could hardly be called illness. They also refer to the drugs as ‘addictive substances’, which is also a stretch for what they consider. Costs are further divided into health care and crime costs. The headline finding is that the total cost is 4.6 billion Euros annually. Interestingly, for illegal drugs, law enforcement expenditure was higher than the health care costs. In my mind this further undermines a prohibition policy. However, I think this study reveals the difficulty of taking an objective stance on these matters. Recreational substance use is an ‘illness’ and ‘addictive’ and bears a cost to society – the word ‘benefit’ is mentioned only once.
New metrics for economic evaluation in the presence of heterogeneity: focusing on evaluating policy alternatives rather than treatment alternatives. Medical Decision Making [PubMed] Published 25th April 2017
Cost-effectiveness analyses (CEA) are a key aspect of the evaluation of medical technologies and pharmaceutical products. Typically, the main output of these analyses is an incremental cost-effectiveness ratio (ICER) or other summary measure of incremental costs and benefits. However, these ICERs typically use an average treatment effect and complete adoption. This is unlikely to be realistic, though, from a policy perspective. Both effectiveness and adoption rates may differ between sub-groups. This paper proposes a ‘policy’ framework that takes this heterogeneity into account. In essence, the paper advocates a weighted average ICER taking into account adoption rates and heterogeneous effectiveness. It takes this idea a step further and considers uncertainty about all the parameters. Conceptually, the framework is a straightforward extension of CEA, but the paper is clear and lucid and it certainly makes sense to evaluate technologies on the basis of how they will actually be used. Similar ideas have been used to take forward clinical trial design: with more information patients will make different treatment choices, for example. The trouble is, innovative and sensible ideas can be very slow to catch on.