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Chris Sampson’s journal round-up for 1st June 2020

Every Monday our authors provide a round-up of the latest peer-reviewed journal publications. We cover all issues of major health economics journals as well as some other notable releases. 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.

Welcome to the first edition of our journal round-ups in a revised format. Rather than covering just a few recently published articles, we’ll now be summarising whole issues of recently published journals. Our original format was simultaneously demanding of contributors’ time while being restrictive in terms of word count. Instead, our contributors will be able to write fuller reviews of articles in standalone blog posts, while our journal round-ups provide a fuller summary of the latest publications, every week. We hope you like the new format. Feedback is always welcome. Contact us by email message or join our Discord server to connect with our contributors and other readers.

Applied Health Economics and Health Policy

Volume 18, Issue 3

This issue of AHEHP includes a themed section on COVID-19, made up of editorials and commentaries, rather than research proper. These short articles include arguments that i) African countries need to wage war against COVID-19, ii) decision modelling can reveal the rationale for COVID-19 policies, iii) random screening may be more valuable than testing symptomatic patients, iv) a COVID-specific income tax levy could ease the burden, and v) approaches to value assessment may be reassessed in light of the pandemic.

There’s also an article about the types of emotional and behavioural heuristics that are relevant to the response to the COVID crisis. Having acknowledged behavioural tendencies, the authors present some recommendations for policy, such as improving the cost-benefit of social distancing (free Disney+ subscriptions, anyone?) and drawing attention to examples of preferred behaviour in the community.

There are also some interesting opinion pieces with a few tête-à-têtes. One piece highlights the difficulty of value-based pricing in the context of personalised medicine. The authors argue that a dynamic perspective needs to be adopted in pricing strategies because of the role of competition and the importance of asymmetric information about heterogeneous treatment benefits. A letter in response expresses scepticism about value-based pricing and argues that payers may have a more difficult time of redressing the information asymmetry than the authors suggest. The original authors acknowledge the complexity and restate the need for sophisticated pricing strategies. There is also a letter to the editor and an authors’ response to an article by some of my colleagues that was published in an earlier issue of the journal. The article assessed preferences for diagnostics to manage antimicrobial resistance. The author of the letter (who is, perhaps, a bit annoyed to have not been cited) highlights a variety of limitations to the study’s generalisability.

A particularly useful opinion piece takes the example of weight loss interventions to highlight the divide between evidence generated with a societal or national decision-maker in mind and the reality of local commissioners being responsible for the allocation of resources. Local decision-makers have distinct budgetary issues to consider and do not necessarily value costs and outcomes in the same way. Cost-effectiveness thresholds used at a national level have little relevance.

Economic evaluations of several technologies are reported in this issue, including an implant system for sacroiliac joint pain and the use of safety-engineered syringes compared with disposable syringes in India. One study in this issue evaluates the use of re-usable inhalers for COPD and asthma. It incorporates estimates of the environmental impact within the economic evaluation, which is a fledgling field of interest. Inevitably, use of the inhalers reduces carbon emissions. The inhalers are cost-saving from a health care perspective, but the estimated 5.7 million fewer inhalers in Germany by 2023 also has a major environmental benefit, which should surely be considered.

A systematic review of economic evaluations of services provided by community pharmacists highlights the limitations of the current evidence base and the difficulty of economic evaluation in this context. The authors provide some recommendations to researchers.

And, finally, there are two empirical studies with potentially important implications for policy. An analysis of patient records looks at the impact of physicians’ working hours on inappropriate prescribing in a Chinese hospital. An association is found between longer working hours and inappropriate prescribing, which puts patients at risk, highlighting the importance of managing the workforce effectively. A discrete choice experiment reports on preferences for HIV testing in Uganda and includes a variety of methodological complexities to consider heterogeneity in the sample and provide actionable recommendations for policy. The results imply that the correct strategy could result in the uptake of testing by more than 90% of men, which could help to meet UN targets.

PharmacoEconomics – Open

Volume 4, Issue 2

This journal also starts with a couple of COVID-related opinion pieces, one on the lessons for our discipline (discussed in a previous blog post) and one arguing that group testing could be a solution to supply constraints. Elsewhere in the issue there is the usual mix of empirical studies.

There are four economic evaluations in this issue, relating to cancer, diabetes, and surgery, along with a few costing studies and some other policy-relevant analyses.

A partitioned survival model is used to evaluate a test and treat strategy for metastatic non-small-cell lung cancer using pembrolizumab in Hong Kong. The authors argue that the strategy is cost-effective based on a (very questionable) cost-effectiveness threshold of 3x Hong Kong’s GDP per capita. Over in Mexico, a cohort study was conducted to assess the treatment patterns for stage IV non-small-cell lung cancer, finding considerable variation in practice and in costs.

Using a previously-developed model, an economic evaluation of GLP-1 receptor agonists for type 2 diabetes finds exenatide to dominate alternatives in the Spanish setting. Similarly, use of a blood purification technology called CytoSorb dominates in cardiac surgery in the UK. A model-based evaluation of azacitidine for acute myeloid leukemia in elderly patients finds the drug to be effective but costly at about $160,000 (Canadian) per QALY.

There are several studies that will support future decision modellers. In particular, a Danish study provides a catalogue of prevalence data on chronic conditions, which can be used as fodder for future model-based analyses. Helpfully, the data are also presented by age and gender. A systematic review of model-based economic evaluations in the context of venous leg ulcers found poor reporting, while a review of evaluations of novel anti-tuberculosis regimens only identified four studies.

A budget impact analysis of metformin sustained release for people with type 2 diabetes predicts that the treatment delays the need for other treatments and reduces costs as a result, but adherence and persistence are key predictors in sensitivity analyses. In a notable costing study, the total costs and unit costs of community health centres and district hospitals in India were estimated. To many of us, the unit costs will seem startlingly low, with most unit costs being the equivalent of a few dollars. Also from the Indian context, a randomised controlled study found that pharmacist intervention could reduce medicine costs for people with COPD.

A willingness-to-pay survey, conducted in Nepal, confirms the importance of allowing women to have personal contact with menstrual health management tools, which the authors link to Pavlovian processes. Women allowed physical contact with the kit prior to completing the survey were willing to pay more.

This issue also includes a survival analysis for people with melanoma treated with adjuvant nivolumab. The analysis reveals the importance of the modelling approach, with each model producing different projections. Sticking with cancer, a letter to the editor describes a brief qualitative study, which highlights that cancer patients in the US are concerned about out-of-pocket costs.

The last two papers to mention relate to the public resource implications of bringing medicines to market. One study explores the HTA timeline in Ireland. The authors reviewed the timings of 207 submissions to the National Centre for Pharmacoeconomics (NCPE) and found that the NCPE’s appraisals were taking longer than their 90-day target. Across the pond, another study assesses the costs to the Canadian public of industry-sponsored drug trials. For 2016, the estimated cost is $2.1 billion (Canadian). That’s a big number, but it doesn’t seem particularly meaningful without any estimate of the benefits.


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