Chris Sampson’s journal round-up for 29th 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.

PharmacoEconomics

Volume 38, Issue 7

A chunk of this issue is dedicated to research and debate about the guidance provided by the US National Comprehensive Cancer Network (NCCN) in their ‘Evidence Blocks’, which essentially constitute a value framework. The article that triggered it all is concerned with the accuracy and usefulness of the NCCN’s affordability ratings for treatments. The authors reviewed the NCCN’s ‘Evidence Blocks’ against Medicare costs for a total of 1,386 treatments. In short, they found that the affordability rating was usually accurate, but that discrepancies were observed in some cases, such that higher cost treatments were identified as being more affordable. That doesn’t seem very controversial.

What spurred the debate was a commentary piece inspired by this research. The authors highlight that, by providing oncologists with a value assessment that takes into account affordability, the NCCN is implicitly (or perhaps explicitly) stating that societal costs should be considered by physicians. In the context of the NHS, this seems like a blatantly obvious requirement in achieving good health outcomes for all. But in the individualistic US, it’s arguably perverse. A further commentary piece in this issue pokes holes in the means by which the NCCN identifies affordability, with problems stemming – in part – from the conflict between a patient and a societal perspective. This matter is picked up in a letter, currently in press, essentially denying that the NCCN is trying to take any stance and is simply providing information to guide shared-decision making. But in choosing which evidence to use and include their Evidence Blocks, the NCCN is unavoidably dismounting the fence.

In addition to the original NCCN research article, there are three other studies in this issue based on reviews. One of them has been discussed before on the blog. It’s an educational review, with a particularly huge reference list, looking at methods for evaluating service delivery interventions. There’s also a methodological review of cost-effectiveness models in metastatic colorectal cancer and a systematic review of evidence on the costs associated with myasthenia gravis (a neuromuscular disease that I had to Google).

This issue also includes another two papers that we’ve written about before on the blog. There’s the new valuation protocol for the EQ-5D-Y, which I discussed in May. There’s also a case study of using R and Shiny for cost-effectiveness modelling, which was covered on the blog not once, but twice (and now, I suppose, thrice).

Health Policy

Volume 124, Issue 6

A themed section in this issue of Health Policy discusses the Sustainable Development Goals (SDGs). One article argues that UN indicators should account for city planning measures, such as those that promote good air quality or physical activity, in order to guide decision-makers. The authors identify inconsistencies between the SDG indicator framework and the UN Habitat’s New Urban Agenda, with the former focusing on outcomes and the latter focusing on interventions. On a similar note, another article considers infrastructure policy alongside public health in achieving the SDGs. Through a series of interviews, the authors explore the role of health in infrastructure policies and find that the focus tends to be on economic productivity. They hint at the need for cost-benefit analyses that account for both economic and health benefits while also capturing equity impacts. The third and final paper on SDGs is concerned with sexual health and population dynamics. The authors take a kind of One Health perspective and outline the relevance of sexual and reproductive rights to the SDGs.

This issue includes a study that spun out of the EQ-5D-5L valuation study for Ireland. The researchers looked into whether people who had private health insurance valued health states more highly than people without. From a societally representative sample, 61% had had private health insurance in the past 3 years. Regression models were run on the time trade-off data, including insurance status alongside each level of the EQ-5D-5L. In general, the coefficients relating to insurance status were not significant, implying that people with insurance don’t value health any higher (or lower) than people without.

Perhaps because I managed to burn my knees in the scorching sun last week, I was drawn to a policy evaluation on the banning of sunbeds in Australia. The authors assess the effect in a somewhat indirect fashion. The analysis is driven by data from three sources: prosecutions and confiscations following the ban, online indicators of consumer interest, and data from the literature on costs and health outcomes associated with melanoma. The study looks at trends over time and plugs the costs and outcomes into a (presumably quite simple) cost-effectiveness model. Consumer interest seemed to fall after the ban and there weren’t many clandestine operations facing prosecution. An estimated 3,000 melanoma deaths are said to have been averted by the ban. As policy evaluations go, this one seems pretty speculative. Nevertheless, it provides a useful take on a novel combination of data.

There’s also an intriguing study on society’s preferences for the allocation of health care resources. The study finds that people favour the allocation of resources to children. The methods are probably too simplistic to isolate this dynamic, but that isn’t the most interesting thing about the study. Prior to asking individuals to make trade-offs between health gains for children or adults, half of the group were randomised to receive a moral reasoning exercise highlighting relevant distributional issues. Contrary to the authors’ hypothesis, the moral reasoning exercise reduced people’s preference for the allocation of resources to children. Perhaps getting people to think more carefully about fairness inevitably leads them towards egalitarianism.

Finally, I’ll mention the opening article from the issue, which provides a set of policy-making lessons learned from the COVID-19 pandemic. It’s worth a read if only to provide you with something to say in conversations with friends and family that isn’t completely inane. Who knows? We’ll have to wait and see.

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  • Founder of the Academic Health Economists' Blog. Principal Economist at the Office of Health Economics. ORCID: 0000-0001-9470-2369

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