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Chris Sampson’s journal round-up for 10th 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.

Health Care Analysis

Volume 28, Issue 3

Health Care Analysis is a journal that I would like to spend more time reading. This issue contains the usual crop of thoughtful articles on matters of fairness in health care.

Leading the way is an article about NICE and the way that its approach to health technology assessment has changed over the years. The author considers NICE’s commitment to the frameworks of ‘accountability for reasonableness’ and of the ‘ethics of opportunity costs’, which NICE (supposedly) use to guide the very difficult decisions that they need to make. Using thematic analysis of NICE documents and interviews with people who have participated in NICE processes, two trends are identified. First, that NICE’s approach to assessment and appraisal has become more formalised. Second, that NICE has become more lenient in its evidence requirements. The author has some concerns about the ethical implications of these trends.

We also have an article looking at access to mental health care under the Affordable Care Act (ACA) in the US. With a hefty overview of the literature, the authors identify the observed and expected benefits of the ACA for people with mental health care needs. Building on this, they consider the current gaps in insurance coverage and affordability. Much of the discussion focuses on the politics of achieving progress with respect to improving access to high-quality care, while curbing expenditure growth and protecting the positive outcomes of the ACA. It should be a useful paper for anyone interested in mental health care but relatively unfamiliar with the provisions of the ACA.

Elsewhere in the issue, there are articles on growth hormone for children with short stature, the importance of respect in hospital-based care decisions, and paternalism and vulnerable patients.

Forum for Health Economics & Policy

Volume 23, Issue 1

The latest issue of FHEP includes three articles.

First up is an analysis of switching costs in Medicare Advantage. The authors analysed five years’ worth of data on people’s plan choices, exploring the extent to which the characteristics of the plan and of the individual determine these choices. The novelty in their model is that they also incorporated prior choices as a predictor, which presumably captures a tendency towards inertia. Switching costs are much higher between insurers than across plans within insurers. The authors identify threshold willingness-to-switch values. On average, a plan needs to be seen to be $233/month better to trigger a switch within an insurer and $944/month better to trigger a switch to a different insurer.

Next up, as if we didn’t have enough already, is a discussion paper on the use of health economics methods in precision medicine. The authors review a wide selection of literature on matters of policy, research, investment, and pricing. They summarise the various ‘tools’ of our trade, such as decision modelling, value of information analysis, and policy evaluation, highlighting the potential value that we (as health economists) could bring to the world of precision medicine. The discussion is more thorough than many similar papers on this topic, making it a worthy starting point for people embarking on research in this area.

Finally, we have an applied cost-effectiveness analysis of early vitamin D therapy for people with chronic kidney disease. Using a model-based analysis, the authors demonstrate that early vitamin D therapy could save lives, slow progression to negative outcomes, and save costs, but there is limited observational evidence to support or validate these findings and the researchers had to make some heroic assumptions.

Health Economics Review

Volume 10, July 2020

Just two articles in Health Economics Review last month (four if you include the two corrections that were published).

Continuing a subject raised in last week’s round-up, one paper looks at the costs associated with post-traumatic stress disorder. In this study, the authors focused on what they call ‘somatic patients’ – by which I assume they mean people with a physical health problem – who have PTSD as a comorbidity. Using inpatient data from a German hospital, total costs were estimated and people with a PTSD comorbidity were matched to those without. Crucially, the authors compared these costs with reimbursement rates. They estimate that comorbid PTSD is associated with an additional cost of €2,311, but that only an additional €1,387 is reimbursed.

The other study is on high-intensity neonatal care. Using data from Canadian hospitals, the researchers were able to observe outcomes relevant to cerebral palsy and relate this to the level of neonatal care, which can be categorised into three levels of intensity. The analysis relies on the fact that access to hospitals with high-intensity care facilities varies by geography, so, along with various other risk factors, the researchers could (to some extent, at least) correct for a selection effect. In short, the findings suggest that high-intensity care is not associated with outcomes related to cerebral palsy. This means that significant savings could be achieved by reorganising services or improving triage processes.

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  • Chris Sampson

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

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