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Chris Sampson’s journal round-up for 5th October 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. If you’d like to write one of our weekly journal round-ups, get in touch.

Journal of Health Economics

Volume 73

The latest issue of JHE includes a couple of papers on newborn health. One is on parental leave policies and is written by Caroline Chuard, who previously featured on the blog as a Thesis Thursday guest. In this paper, Caroline uses three policy changes in Austria to demonstrate that more generous parental leave has a significant impact on mothers’ labour market activity, but doesn’t seem to affect newborn health outcomes. Another study is nominally on the impact of military activity, though it seems to be more about water pollution. The authors show that the ceasing of naval bombing exercises in Puerto Rico resulted in a substantial decrease in congenital anomalies.

There’s a difference-in-difference study on the interaction between antidepressants and employment, with a focus on ‘black box warnings‘ (I had to Google what they were). Adding a serious warning to antidepressant medication in the US was associated with a reduction in employment for middle-aged women with a history of depression, presumably because their use of treatment decreased.

Research on the impact of retirement on health has a long history, and this issue adds some new evidence. One study looks at the association between retirement and health outcomes in England, using a variety of longitudinal data sources. The author considers a range of outcomes using a regression discontinuity at the pension age to show improvements in wellbeing after retirement. Another study, from Germany, investigates informal care in retirement, showing that an increase in the retirement age for women decreases the amount of informal care that they provide. Keeping with the older population, there’s also a Dutch study on the cost implications of nursing home eligibility, suggesting that earlier eligibility may be associated with reductions in service use.

Inevitably, there is a contribution to the never-ending struggle for an answer to the question of competition, with a paper on the impact of private hospitals in England. In the context of hip replacements, private hospital entry had no impact on quality and simply expanded capacity to include people with lower severity. That’s one less point for competition if you’re keeping track.

Also on hospitals is a study of the effects of DRG restructuring in the US, where allowing for differentiation according to severity resulted in just a little upcoding to inflate reimbursement. On a similar note, a study from Thailand looks at the impact of a change in the reimbursement system. The reform meant that providers could be directly reimbursed where previously patients had to pay and then reclaim their expenditures. The reform resulted in an increase in service use by those in need.

Elsewhere in this issue, there are papers on insurance and demand, private health expenditure in the context of malaria, the elimination of user fees in Jamaica, remote health care in Madagascar, pharmaceutical marketing, and predicting health care costs from biomarkers.

Value in Health

Volume 23, Issue 9

Of most interest to me, from the latest ViH, was a few studies relating to screening. In particular, there is a study on ‘risk-based’ follow-up for breast cancer. Though not explicitly about screening, the study uses some similar ideas to my PhD research. The researchers evaluated the use of a risk prediction model to schedule follow-up visits; higher risk means a sooner recall, but most people can have less frequent recall than current practice. Based on data for around 30,000 Dutch patients, the authors estimated savings of between €7 million and €25 million, depending on the risk threshold employed. Also on breast cancer, there are two linked studies of variation in care quality in the Netherlands – one focused on the causes of variation in indicators and one focused on summarising quality indicators.

Keeping with breast (and cervical) cancer, the issue also includes DCE of demand for screening. The study shows that women care most about what happens after a positive result, including prognosis and financial implications. They don’t care so much about monetary or other persuasion techniques. This issue also includes a model-based evaluation of microRNA blood tests to screen for gastric cancer every three years. It’s a relatively costly strategy, with a lot of uncertainty, but probably cost-effective.

Are you a competent HEOR professional? Find out now, with the ISPOR competencies framework! The report outlines 41 competencies across 13 topics, identified through expert discussion, analysis of job postings, and surveys. I thought it seemed a bit silly at first, but this could be a valuable tool for people looking to develop their career, or employers looking to strengthen skills within their organisation.

A couple of papers address some hot topics in HTA. There’s a timely methodological review of economic evaluation for gene therapies, though without any groundbreaking conclusions. There’s also a study on the impact of patient engagement at pCODR, Canada’s oncology drug review process. The researchers conducted qualitative interviews with patient group members to understand their priorities and perspectives on the use of their submission. A key finding was that it is not always clear how patient group submissions are used in the process and the impact that they might have on decisions. Patient engagement may also be limited by resource constraints within patient groups.

There are also a few studies on ‘preferences-based’ outcomes. A valuation study of the EQ-5D-5L and -3L in Hungary provides further reinforcement to the idea that 5L>3L. The parallel valuation also provides some useful insight into the effects of wording. For example, “unable to walk” resulted in higher valuations than “confined to bed”. We also have a useful study looking to tame the wild west of mapping algorithms to generate QALYs. The authors propose a definition for a valid algorithm, along with three sufficient conditions, which they test using simulations. Finally on outcomes, the issue includes a meta-analysis of utility values in schizophrenia, with an impressive 54 studies.

There is a variety of other topics covered in this issue. There are two studies on hepatitis C; one reporting a cost-effectiveness analysis of direct-acting antivirals in Vietnam and another on spending on hepatitis C drugs in the US and Canada. There’s a Mt Hood report on modelling cardiovascular outcomes in diabetes, a study on medication adherence, one on nephrology in Taiwan, and one on different approaches to identifying unit costs for GP consultations. There is also a report from an initiative and a related editorial on transparency in real-world evidence studies.

Expert Review of Pharmacoeconomics & Outcomes Research

Volume 20, Issue 4

There are 11 studies in the latest ERPOR. Perhaps most interesting is a study on the transferability of HTA in Europe, considering the possibilities of either Europe-wide joint assessments (with the support of EUnetHTA) or the adoption of assessments from Western European countries. On a similar topic is a comparison of value frameworks for cancer drugs in France, which outlines inconsistencies between three different appraisers.

There are a couple of papers on ‘preference-based’ outcomes. At first glance, an overview of the time trade-off method seems a bit unnecessary, but the study actually provides some valuable critique of this widely-used methodology that is often accepted as a gold standard. There is also a study looking at predictors of EQ-5D values in Brazil, where ‘belief in God’ was the strongest predictor of values. This might give you some more reason to be unsure about societal valuations based on time trade-off.

The issue also includes applied studies evaluating a digital screening technology for diabetes, hepatitis C screening in Bulgaria, and treatment for psoriatic arthritis in Germany. There are also analyses of the costs of chemotherapeutic agents for breast cancer in India, the burden of communicable diseases in Asia-Pacific, and a study on antibiotic use in Spain. The issue’s closer is a meta-analysis of roxadustat for people with chronic kidney disease.


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