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.
Value in Health
Volume 23, Issue 12
The paper of most interest to me in the latest ViH is a review of alternative approaches to QALY estimation. In my view, we should abandon the idea that there are ‘alternative approaches to QALY estimation’. A QALY is a person’s quality of life over one year – a multiplication of two numbers – there are no two ways about it. Rather, what this paper reviews is different ways of weighting QALYs, different ways of estimating quality of life, and some alternative metrics to the QALY. The authors identify nine alternatives and assess their impact on net benefit estimation and thus the ranking of different decisions about treatments. The alternatives are i) using ‘patient preferences’, ii) chaining techniques, iii) DALYs, iv) equity weighting, v) Pythagorean theorem approach (I don’t know, either), vi) healthy year equivalents, vii) capabilities, viii) the load model, and ix) equal value of life-years gained. The paper provides a useful overview of each and the authors argue that most of the approaches are not feasible within current approaches to cost-effectiveness analysis.
There’s a wide range of methodological contributions in this issue. One study explores the use of multiple imputation of information on patients’ preferences for treatments, within the context of multi-criteria decision analysis to inform decisions about non-inferior interventions. Another study models the determinants of response changes in Delphi panels. Based on two online modified-Delphi studies, the authors found that the primary predictor of the direction and frequency of response changes was a person’s level of engagement. There’s also an article on partitioned survival modelling methods, based on work conducted in the development of a NICE Technical Support Document, and a study presenting a new framework for costing in resource allocation modelling.
A lot of studies in this issue focus on matters of policy. A review of policy documents, across 200 countries or regions, looked at orphan drug policies and found numerous gaps, especially in lower income countries. An interrupted time series analysis using US claims data found that a biosimilar market entry reduced expenditures, but didn’t much affect out-of-pocket expenditures. According to another study in this issue, one way to reduce out-of-pocket expenditures is through the use of shared decision-making in cancer treatment decisions. Alternatively, we can let the machines decide; one article considers the potential role of machine learning in the context of acute coronary syndrome, finding that the system can identify people who would incur avoidable health care costs.
Turning the lens on the research world itself, there’s a review showing that not many economic evaluations have been published for treatments for which there was a trial funded by the US National Cancer Institute. And a discrete choice experiment shows that parents of children with suspected genetic conditions tend to support research using their children’s health records.
There are several cost-effectiveness studies in this issue, on amyotrophic lateral sclerosis (ALS); screening and treatment for hepatitis B and C; kidney transplant; and a value of information analysis for HIV/AIDS response in the US. I was particularly interested in a systematic review and modelling study of the cost-effectiveness of alternative formats of CBT for depression. Cognitive behavioural therapy can be delivered face-to-face – either one-to-one or in a group – as well as remotely (using various media), or some hybrid thereof. The authors developed a very simple three-state transition model and populated it with parameters identified in their review. Overall, they found that all modes of delivery are more cost-effective than treatment as usual, but that face-to-face sessions are more likely to be cost-effective.
Health Policy and Technology
Volume 9, Issue 4
Here we have a special issue on COVID-19. There is a lot of country-specific articles, variously summarising policy and technological responses and looking at their impact on health outcomes and implications for the future. The countries included in this issue are Australia; China; Finland; Ireland; Italy; the Netherlands; Nigeria; Norway; South Korea; Spain; Sweden; the United Kingdom; the United States; and five Latin American countries. A couple of studies focussed on groups of countries that have done relatively well, such as the ‘DACH’ region (Austria, Germany, Switzerland) and Greece, Iceland, New Zealand, and Singapore. There is also a less obvious grouping in the shape of Belgium, Canada, and France, chosen for comparison because of the countries’ distinct governance structures.
A few studies are more global in their scope. Two articles are linked to the Pandemic-Mental Health International Network (Pan-MHIN; a group with apparently no online presence). One of the articles makes international comparisons in the mental health response to the pandemic. Once the dust settles, the pandemic’s biggest indirect health impact is likely to have been on the mental health of the population. This article suggests that most health systems were not ready for a shock to population mental health of this magnitude, with many systems being under-resourced prior to the emergence of COVID-19. The view of a panel of experts consulted for this study is that systems have faired better where there is good availability of community-based and integrated mental health services. Sometimes it is worthwhile to state the obvious. The other article is more general than mental health, presenting an alternative framework for considering the phases of the pandemic.
In another article, we’re provided with a perspective on testing from the world of information economics. The article focusses on the conditions under which different diagnostic tests, with different sensitivities and specificities, and different pre-test information, should be chosen. Finally, there’s an article on the justice system in an online world.