Chris Sampson’s journal round-up for 1st February 2021

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 19, Issue 1

AHEHP is the journal for me. Almost every issue includes a good mix of topics and methods from the broad church of health economics, and I like variety. This issue is no different. It opens with a commentary on medically assisted dying, which I previously discussed.

For the past couple of years, I’ve been working on an evaluation of a digital programme for sleep, which is currently being considered by NICE. Sleep problems aren’t necessarily related to mental health, but they often are, and the evaluation challenges are similar. So the first study in this issue to catch my eye was a systematic review of economic evaluations for digital mental health interventions. The review is focussed on methodological issues with a view to providing recommendations to researchers. The 67 included papers mostly described studies in anxiety or depression, and most were within-trial analyses. The authors discuss various shortcomings in the evidence base, such as the lack of evidence synthesis and the limitations associated with within-trial analyses. These aren’t really special to the context of digital interventions. But there is a helpful discussion of some common challenges in this context, particularly the existence of similar technologies and questions about whether or not evidence about them could be pooled. The issue also includes another systematic review, of health state utility values used for hepatitis C. It provides the now-familiar conclusion that decision modellers are selecting published utility values in a way that is neither consistent nor systematic.

From the opposite end of our discipline is a study of election results and mortality. The researchers modelled mortality data for the US with county-level election results from 1999 to 2017. What they wanted to know was whether voting for a losing candidate increases mortality. The headline result is that, for every 10% of the population voting for the loser, mortality rates increase by 0.7%. Partisanship may be bad for your health. Also from the US is an analysis of the pricing and availability of lumbar discectomy. The researchers contacted hospitals and pretended to be a patient looking for a self-pay price. It wasn’t easy to find a complete price, and there was a lot of variation across those hospitals that did provide prices.

Another article with a political angle is one on the use of programme budgeting and marginal analysis (PBMA) in Brazil, trying to make the best of a situation in which health care budgets have been frozen for 20 years. The opinion piece highlights the potential role of PBMA in shifting expenditure to high-value care, while also bringing into focus the health impacts of indiscriminate austerity. PBMA will have its day.

Eye-tracking has featured a few times on the blog. And there’s an example in this issue that I find particularly interesting; eye-tracking EQ-5D-5L valuation responses in the context of mild cognitive impairment. Twenty people aged over 65, half of whom had mild cognitive impairment, completed discrete choice tasks. Attribute non-attendance differed slightly according to cognition level, highlighting the potential value of providing simpler tasks and controlling for attribute non-attendance when modelling valuation data.

A study from Ireland evaluates an online reimbursement system to address off-label prescribing of lidocaine medicated plasters. Essentially, a new system was introduced that nudges doctors towards appropriate prescribing. The researchers conducted a segmented regression analysis on the prescribing rate and found a huge impact, with annual expenditure dropping from €27 million to €2 million. Wow.

This issue also includes applied cost-effectiveness analyses in the context of heart failure, type 2 diabetes, breast and ovarian cancer screening, and vulvovaginal atrophy. There’s also the journal’s annual acknowledgement to reviewers (which includes yours truly). Given the secrecy surrounding peer review, I feel that these acknowledgements are ripe for analysis within our discipline.

Journal of Population Economics

Volume 34, Issue 2

Owing to everybody joining the COVID research train, these round-ups have featured a more diverse selection of journals than might normally be expected. Journal of Population Economics is one of those visitors. This issue includes a few articles on COVID that are worth mentioning.

Many researchers are now turning to the pandemic’s unequal impact, as does one article in this issue on labour market shocks. The analysis uses data from an online wellbeing survey in Australia from mid-2020, which captured the occurrence of either unemployment or a reduction in earnings or working hours. Using quantile regressions, the researchers show that almost everyone experienced a hit to their financial wellbeing.

Continuing our earlier theme on voting and health outcomes is an analysis of the relationship between COVID-19 cases and votes for Trump. The researchers modelled Trump’s vote share with the incidence of COVID-19 as an explanatory variable. They found that more COVID cases meant fewer votes for Trump and suggest that Trump would’ve been re-elected if cases had been 5% lower.

Also on COVID in the US is an analysis of the determinants of self-protecting behaviour during the pandemic. Factors positively associated with social distancing, mask-wearing, and/or handwashing were having a higher income, being a woman, being older, and being in New York or California. Some of these relationships were related to people’s ability to change their circumstance (e.g. working from home).

This issue also includes a couple of studies on wellbeing. A study of the consistency of the U-shaped happiness and age relationship, across 145 countries, shows that it persists in low- and middle-income countries as it does in high-income countries. Another study looks at the role of children and family finances in determining happiness, showing that children’s negative impact is largely explained by their impact on finances and that stepchildren are particularly bad for wellbeing. Ouch.

Other topics in this issue include measuring gender attitudes, education and gender attitudes, education gender gaps, sex ratios and sodomy laws, and the impact of divorce,

Bioethics

Volume 35, Issue 2

There are a few interesting papers in the latest issue of Bioethics, but one in particular that I wanted to highlight, on ‘grandfather clauses‘ in resource allocation. The context of interest is NICE’s HTA decisions and the use of grandfather clauses when a technology is not recommended. In this case, people who are already in receipt of the technology before guidance is issued may continue to receive the same care. The authors conclude that grandfather clauses of this nature should not be automatically adopted by NICE and should instead be considered on a case-by-case basis. Essentially, ‘first-come, first-served’ is not a fair basis for allocating resources, and it circumvents NICE’s decision-making process. There are also efficiency issues to consider, as there is obviously an opportunity cost associated with this type of policy. The authors outline some of the reasoning that might decide whether a grandfather clause is appropriate for a given situation.

This issue includes some other articles that are likely to interest some health economists. For those interested in prioritisation of health care during the pandemic, there are articles on withdrawal of intensive care and triage guidelines relating to the scarcity of beds. There is also an article on the harms of false hope, including cost-related harm to the individual and the health system.

An article of interest to me (more as a vegan than as a health economist) compares the morality of eating meat and not vaccinating. The argumentation is at once both obvious and unconvincing, but if it encourages any readers (who are presumably pro-vaccination) to stop eating meat, then that’s fine by me! On a similar note is a paper on the ethics of nudging health care workers to receive vaccinations.

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

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