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Chris Sampson’s journal round-up for 3rd August 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.


Volume 38, Issue 8

Leading the way in the latest issue of PharmacoEconomics is some ICER bashing. Mike Paulden thinks it’s time to abandon the ICER, while James O’Mahony provides us with some reasons to be less drastic. In this issue, Paulden also provides a practical exposition of the use of incremental cost-effectiveness ratios and net benefit, focussing on how the two differ. The crux of the matter is that ICERs aren’t easy to interpret without knowing the value being attached to QALYs, and if we are explicit about the value of a QALY, a net benefit approach is far more attractive for a variety of reasons. I’m more wary of abandoning the ICER than both authors. We don’t have a good estimate of the opportunity cost of health care expenditure, so making our headline estimates of cost-effectiveness dependent on one can obscure the evidence. Net-benefit-hacking is easier than ICER-hacking.

This issue also continues with some debate on oncology value frameworks that I covered in my round-up of the previous issue of the journal, with a comment and a response.

There are a couple of nice papers on health state valuation in this issue. One presents a Swedish EQ-5D-5L value set using experience-based values, whereby survey respondents valued their own current health state using time trade-off and visual analogue scale techniques. Most health states are rare, so the authors recruited more than 25,000 people and were able to value 896 health states. Swedish decision-makers have favoured experience-based values in some cases, so it seems likely that the reported value set will actually be used.

Another study reports on a valuation of the AD-5D instrument for people with dementia. The value set was created using a discrete choice experiment in Australia. Interestingly, memory was the least important dimension, though I expect this is due to the broad nature of the other dimensions.

I was also interested to read a study of intertemporal discounting practice in cost-effectiveness analysis. The authors used the Tufts CEA Registry to review more than 2,000 analyses alongside the prevailing recommendations in seven countries. A key finding is that adherence was higher in manufacturer-sponsored studies. This makes sense to me as there is likely to be more at stake in breaking the rules. The use of differential discounting for costs and outcomes was also associated with greater adherence, which might be due to its tending to provide more favourable cost-effectiveness results. The authors conclude that the peer review process should be used to ensure that authors conform to national guidelines. I wholly disagree with this idea. National guidelines may not be well-advised. Rather, peer review should ensure that authors are transparent about their reasons for choosing a particular discount rate and encourage sensitivity and scenario analyses to test alternatives.

The European Journal of Health Economics

Volume 21, Issue 6

The latest issue of EJHE includes the token COVID-related editorial that we’ve come to expect, this one reviewing the historic evidence on the economic impact of epidemics. The rest of the issue is largely made up of budget impact and cost of illness studies, with a few other notable papers.

There are several studies for those interested in budget impact analysis. One study reviews 12 budget impact models submitted to the National Centre for Pharmacoeconomics in Ireland. Half of them under-predicted and half over-predicted utilisation. This might seem reassuring, but the authors identified a lot of inconsistency and so provide recommendations for more standardised analyses.

Another study describes a new methodology that can be used to predict the impact of expensive new medicines. Essentially, the authors build a prediction model based on historic evidence, using parameters such as orphan status and approval designation. They then validate the prediction model, finding that it works quite well. This seems like a reasonable approach, though its usefulness in the case of truly innovative technologies may be limited.

Staying with budget impact, there’s a simulation study that estimates the lifetime cost of unilateral cochlear implants (in Germany) to be €53,000 per person. The issue also includes a budget impact analysis in the context of non-small-cell lung cancer.

There’s been a lot of talk about the incidence of post-traumatic stress disorder as a result of the COVID pandemic, making a cost-of-illness study in this issue particularly timely. The authors used German claims data to match people with and without PTSD and found that health care costs for people with PTSD were three times greater than for the controls, at €43,000 per person over five years. The majority of the costs were attributable to mental health care. The usual caveats for cost-of-illness studies apply; it’s difficult to attribute the costs to PTSD as distinct from any other risk factors.

An econometric study of health care expenditures focuses on time to death. The novelty of this study is in allowing for the endogeneity of time to death by using data from twins and using the mother’s age of death as an instrument. The findings suggest that previous studies may have over-estimated the impact of proximity to death as a predictor for high health care costs.

Finally, I’ll highlight a study that estimates the extent to which alcohol taxes are passed through to consumers. The authors analysed data for OECD countries and compared pass-through for different alcoholic drinks. Wine drinkers get the short straw, with an over-shifted passthrough rate of 2.4. Most other drinks are closer to having an exact passthrough, though it seems clear that different pricing strategies are used for different drinks. This has implications for the use of excise taxes as levers for public health improvement.


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