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.
The latest JHE includes several studies on American health policy, about which I find it difficult to get excited. But I will mention one study, if only for its ambition. The authors sought to identify whether Medicaid expansion under the Affordable Care Act saved lives. Not only that, but they also attempt to estimate the cost-benefit of the policy change. The model is built around propensity score matching counties in states that did and didn’t expand Medicaid. But the key strength of the analysis is that individual-level data on mortality are used that include demographic information and cause of death. The headline result is that 11 deaths in every 100,000 20-64-year-olds were prevented (delayed) within the first four years of the reform. Based on estimates of the value of a statistical life (VSL), the authors show that between 30% and 145% of the total cost of expansion is recouped by society, in terms of social welfare, within four years.
Had the authors of the previous paper attached their VSL estimates to QALYs, rather than just mortality, they’d have been in the firing line of a study on the validity of such an approach. Researchers outlined a utility maximisation model as the basis for identifying upper and lower bounds for individuals’ willingness to pay for improvements in health and longevity. In general, they show that not all QALYs are equal. But their key argument is that policy evaluations that divide VSL by future QALYs are identifying an upper bound and will overstate gains unless baseline expected QALYs are very low. On the flip side, a lower bound for willingness to pay can be identified by a standard gamble at near-perfect health.
Keeping with the QALY theme is a paper attempting to build risk aversion into QALY estimation. By incorporating uncertainty in what they call a generalised model, the authors demonstrate that willingness to pay for QALYs could be much greater for those in poorer health states. Unfortunately, the authors trot out the old nonsense line about QALYs being discriminatory.
In both of the QALY papers, there seems to be a jumble of ideas, with individuals’ valuations of health states and societal resource allocation questions being conflated, but I’ll need to spend more time with the papers to figure that out.
The issue also has a variety of studies with some interesting results to report. A meta-analysis shows that the impact of social capital on health outcomes is likely to be very small. Removing GP fees for over-70s in Ireland reduced their perceived stress. A study from Austria finds that unplanned C-sections result in an increase in maternal employment. And one for your ‘that sounds a bit dodgy’ collection, US counties with a lot of fracking have higher rates of gonorrhoea. There are also a couple of articles on nutrition, with one showing that nutrition labelling in the UK reduced total monthly calories purchased, and another on migrants’ dietary choices.
This issue also adds to the ever-present debate about the value of competition in health care. Using Dutch data, researchers found no evidence that price deregulation had a negative impact on quality in hip replacement. And, finally, there’s also an article that I discussed in a previous blog post, on smoking as a response to mental distress.
Volume 23, Issue 7
The latest issue of ViH includes a themed section on health preferences research. There are articles on reproducibility, current uses in regulation and resource allocation in Europe, and applied studies in diabetes, antiretroviral therapies, haemophilia, and HIV testing. There’s also an EQ-5D valuation study for Peru. But these aren’t the articles that interested me most from this issue.
I wouldn’t usually be drawn to something described as a mapping study, but there is one in this issue that is relevant to my ongoing work to develop a vision bolt-on for the EQ-5D. It isn’t a mapping study in the traditional sense. The authors used trial data to predict utility values from visual acuity for people with macular oedema. Using adjusted limited dependent variable mixture models, which are suited to EQ-5D data, the researchers provide functions to predict EQ-5D-3L values based on age, sex, and best-corrected visual acuity.
There’s a useful review study looking at how 40 NICE technology assessments have identified utility values for children. It reveals what you might expect. The majority used the adult version of the EQ-5D, which isn’t very encouraging given that it will have been inappropriate in most cases. Only 10 assessments used child-specific preference-accompanied measures (sounds good, right).
This issue also includes an exchange between a commentator and the editors about authorship. It’s mostly quite boring. In my view, the main problem is that authorship is too important to people, and blathering about it probably doesn’t help matters. Don’t be defined by your h-index. Nobody cares. Write a blog post, why don’t you.