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.
Applied Health Economics and Health Policy
Volume 18, Issue 6
This month we have a themed issue of AHEHP on health financing in sub-Saharan Africa, with all of the articles open access. The challenges are summarised in the opening editorial, and many of the papers focus on informing methods for future research.
A couple of papers are concerned with methods for evaluating inequalities. One article outlines a framework for including measures of the quality of care within benefit incidence analysis, which is used to assess equity in health financing. Another article considers how the impact of health financing on income inequality is characterised. The authors argue that any effect on income inequality ought to be decomposed to better understand the impact on different populations. The authors apply their framework to highlight the importance of out-of-pocket payments in Nigeria. Another study considers the equity and efficiency of pricing and payments in private health care.
Out-of-pocket payments are a key theme throughout the issue. One study considers alternative thresholds for catastrophic expenditure. The researchers analysed data across five countries, demonstrating the extent of financial catastrophe according to different thresholds. Another study presents a methodological framework for evaluating policies that reduce user fees. The framework can compare alternative methods for funding a free healthcare policy and assess each approach’s sustainability.
Health insurance schemes are available in some countries in sub-Saharan Africa. A study in this issue reviews the literature evaluating health insurance reforms, identifying 66 relevant articles. To inform future research, the authors summarise the methods used, highlighting the (over-)reliance on observational designs. Performance-based financing is an increasingly popular tool for policymakers in sub-Saharan Africa and the subject of a study in this issue. Based on findings from interviews, focus groups, and a review of documents, the authors assert that strong national leadership is a key factor in determining the success of performance-based financing in alignment with user fee policies and benefit packages. Without strong leadership, the result is likely to be fragmentation of policies and objectives.
Finally, there is a study on the potential for greater expenditure. The researchers used data from multiple countries to model the impact of greater health financing on reproductive, maternal, neonatal, and child health, disaggregating domestic and (external) aid financing. Both sources of expenditure were associated with improved outcomes, but domestic expenditure was more effective. For example, the elasticities suggest that a 10% increase in domestic expenditure was associated with a 1.5% reduction in under-5 mortality. The authors outline some options for creating the ‘fiscal space’ to support such expenditure.
Cost Effectiveness and Resource Allocation
Volume 18, November 2020
Six articles were published in CERA last month, including applied analyses and methodological work.
The main methodological contribution introduces the ‘relative density’ plot to probabilistic sensitivity analysis. It’s designed to overcome the relative uselessness of scatter plots. The authors demonstrate their approach to visualisation using a series of case studies and provide the requisite R script on GitHub. Relative density is shown using a colour gradient, with contours plotted according to the cumulative probability. Imagine an infrared aerial view of a volcano, with elevation contours overlaid. It’s no doubt prettier, and probably provides a more intuitive summary of the data generated by PSA. But I expect it would take a long time to be adopted, if at all, because it looks very alien to me and does not allow for the speedy cross-study comparisons that I am used to making in my head.
Two applied cost-effectiveness analyses were published in the journal last month. One analysis evaluated a smartphone app to mobilise first responders for cardiac arrest in Belgium. Another analysis used a partitioned survival model to show that ceritinib is likely to be more cost-effective than crizotinib for ALK-positive non-small cell lung cancer in Hong Kong. There’s also a budget impact analysis in the context of screening for Down syndrome.
An interesting application of modelling methods uses a discrete event simulation to predict the impact on pharmaceutical prices of different approaches to external price referencing. The researchers identified current policies across Europe and used them to define the base case, then they simulated alternative policies. The best predictors of lower prices were the consideration of discounts and use of the lowest price formula in reference countries.
Finally, a study using Iranian data sought to identify the efficiency of rural primary care. The authors used data envelopment analysis and Tobit regressions to predict efficiency in terms of child mortality. A key contribution of the study is in identifying the importance of care providers known as Behvarzes.
Volume 29, Issue S1
This recent issue of Health Economics is a special on sustaining innovation, cost containment and equity in the health care market, which seems like a broad topic for a special issue. The collection of eight articles discusses ageing, hospital ownership, and pharmaceutical innovation and pricing, and it isn’t obvious what unites them. The leading editorial essentially argues that sustainable innovation is complex and demands that greater attention be given to prevention and to the organisation of incentives in health care. Various subjects of singular focus are framed as ‘red herrings’.
Focussing on one of these red herrings is a study on the heterogeneous impact of ageing on health care use. The authors found support for the red herring hypothesis in that comorbidities and time to death explain higher resource use levels, rather than age. But the findings also show that different types of health care hold different relationships with age. Another article focussing on older patients uses data from a region of Italy, which is home to Europe’s highest proportion of people over 65. Based on data relating to cardiovascular disease, the authors show that geographic barriers to pharmacies affect medication adherence and that this, in turn, increases hospital visits. Some more evidence from Italy shows that adherence is related to treatment benefit in lowering cholesterol. The author outlines a theoretical model to predict the consequences of alternative policies.
Other articles in this issue model the adoption of new drugs in Germany and the impact of hospital ownership on C-sections. A couple of papers look at the pricing of new medicines. One article uses a theoretical model to show that managed entry agreements tend to increase prices. Another article predicts the efficiency of research and medicines pricing, depending on whether they are developed with public or private funding.