Alastair Canaway’s journal round-up for 30th July 2018

Every Monday our authors provide a round-up of some of the most recently published peer reviewed articles from the field. We don’t cover everything, or even what’s most important – just a few papers that have interested the author. 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.

Is there an association between early weight status and utility-based health-related quality of life in young children? Quality of Life Research [PubMed] Published 10th July 2018

Childhood obesity is an issue which has risen to prominence in recent years. Concurrently, there has been an increased interest in measuring utility values in children for use in economic evaluation. In the obesity context, there are relatively few studies that have examined whether childhood weight status is associated with preference-based utility and, following, whether such measures are useful for the economic evaluation of childhood obesity interventions. This study sought to tackle this issue using the proxy version of the Health Utilities Index Mark 3 (HUI-3) and weight status data in 368 children aged five years. Associations between weight status and HUI-3 score were assessed using various regression techniques. No statistically significant differences were found between weight status and preference-based health-related quality of life (HRQL). This adds to several recent studies with similar findings which imply that young children may not experience any decrements in HRQL associated with weight status, or that the measures we have cannot capture these decrements. When considering trial-based economic evaluation of childhood obesity interventions, this highlights that we should not be solely relying on preference-based instruments.

Time is money: investigating the value of leisure time and unpaid work. Value in Health Published 14th July 2018

For those of us who work on trials, we almost always attempt to do some sort of ‘societal’ perspective incorporating benefits beyond health. When it comes to valuing leisure time and unpaid work there is a dearth of literature and numerous methodological challenges which has led to a bit of a scatter-gun approach to measuring and valuing (usually by ignoring) this time. The authors in the paper sought to value unpaid work (e.g. household chores and voluntary work) and leisure time (“non-productive” time to be spent on one’s likings, nb. this includes lunch breaks). They did this using online questionnaires which included contingent valuation exercises (WTP and WTA) in a sample of representative adults in the Netherlands. Regression techniques following best practice were used (two-part models with transformed data). Using WTA they found an additional hour of unpaid work and leisure time was valued at €16 Euros, whilst the WTP value was €9.50. These values fall into similar ranges to those used in other studies. There are many issues with stated preference studies, which the authors thoroughly acknowledge and address. These costs, so often omitted in economic evaluation, have the potential to be substantial and there remains a need to accurately value this time. Capturing and valuing these time costs remains an important issue, specifically, for those researchers working in countries where national guidelines for economic evaluation prefer a societal perspective.

The impact of depression on health-related quality of life and wellbeing: identifying important dimensions and assessing their inclusion in multi-attribute utility instruments. Quality of Life Research [PubMed] Published 13th July 2018

At the start of every trial, we ask “so what measures should we include?” In the UK, the EQ-5D is the default option, though this decision is not often straightforward. Mental health disorders have a huge burden of impact in terms of both costs (economic and healthcare) and health-related quality of life. How we currently measure the impact of such disorders in economic evaluation often receives scrutiny and there has been recent interest in broadening the evaluative space beyond health to include wellbeing, both subjective wellbeing (SWB) and capability wellbeing (CWB). This study sought to identify which dimensions of HRQL, SWB and CWB were most affected by depression (the most common mental health disorder) and to examine the sensitivity of existing multi-attribute utility instruments (MAUIs) to these dimensions. The study used data from the “Multi-Instrument Comparison” study – this includes lots of measures, including depression measures (Depression Anxiety Stress Scale, Kessler Psychological Distress Scale); SWB measures (Personal Wellbeing Index, Satisfaction with Life Scale, Integrated Household Survey); CWB (ICECAP-A); and multi-attribute utility instruments (15D, AQoL-4D, AQoL-8D, EQ-5D-5L, HUI-3, QWB-SA, and SF-6D). To identify dimensions that were important, the authors used the ‘Glass’s Delta effect size’ (the difference between the mean scores of healthy and self-reported groups divided by the standard deviation of the healthy group). To investigate the extent to which current MAUIs capture these dimensions, each MAUI was regressed on each dimension of HRQL, CWB and SWB. There were lots of interesting findings. Unsurprisingly, the most important dimensions were in the psychosocial dimensions of HRQL (e.g. the ‘coping’, ‘happiness’, and ‘self-worth’ dimensions of the AQoL-8D). Interestingly, the ICECAP-A proved to be the best measure for distinguishing between healthy individuals and those with depression. The SWB measures, on the other hand, were less impacted by depression. Of the MAUIs, the AQoL-8D was the most sensitive, whilst our beloved EQ-5D-5L and SF-6D were the least sensitive at distinguishing dimensions. There is a huge amount to unpack within this study, but it does raise interesting questions regarding measurement issues and the impact of broadening the evaluative space for decision makers. Finally, it’s worth noting that a new MAUI (ReQoL) for mental health has been recently developed – although further testing is needed, this is something to consider in future.

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Meeting round-up: Essen Economics of Mental Health Workshop

The Essen Economics of Mental Health Workshop took place in Essen, Germany on 25th and 26th June 2018 organized by Ansgar Wübker and Christoph Kronenberg.

A heterogeneous group of fourteen attendees participated in the workshop, from PhD students to Emeritus Professor, from the UK to Switzerland all interested in the economics of mental health.

After a welcoming of the two hosts, Jan Böhnke started with the first Keynote. He focused on the classification of diagnoses and measurement of mental health in general and contrasted it with other concepts such as well-being and happiness. Since Jan’s background is in psychology and epidemiology, the change of perspective was very helpful for economists and created more awareness of adopting existing labels, measures or scores.

Rowena Jacobs held the second keynote in the afternoon. She talked about the organization and funding of mental health services. She pointed out a problem that is linked to mental illness is the stigma the patients are often confronted with. Fear of stigma and subsequently being socially excluded may lead to a treatment gap of affected people who do not seek help.

In between the keynote sessions and during the next day we concentrated on the work of the participants. Different to most conferences and workshops paper presentations were held by the discussants not the authors of the papers. Each discussant had 30 minutes to present and discuss the paper. Afterwards, the author had some minutes to clarify or respond before everyone could ask questions and participate in the discussion. The papers were shared among all participants before the workshop to allow everyone to contribute to the discussion.

Peter Zweifel presented the work of Sanne Kruse-Becher and her colleagues. They are analysing how migrants’ mental health is affected by conflicts in their home countries. A current and interesting topic. Sarah Hofmann was the discussant of the paper by Ingo Kolodziej and his co-authors. They are interested in the effect of the double burden of long-term care and work on the mental health of a caregiver. In a society with an ageing population, this is a topic with huge relevance. These two presentations show how different the research areas for the economics of mental health can be.

In the evening of the first day, we took a walk through the city and visited a nice restaurant. They served delicious Turkish food. It was nice to have some time to get to know each other.

I really enjoyed those two days. It was a successful workshop with a nice new format, which – in my opinion – leads to detailed comments and discussions.

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Meeting round-up: CINCH Academy 2018

On 18-23 June, researchers, coming from Australia, Germany, the Netherlands, and the United Kingdom, were gathered together at the annual CINCH summer school, an academic program for early stage researchers in health economics. The fifth CINCH Academy was held in Essen, Germany, by one of Germany’s leading health economics centres – CINCH. The institute brings together the region’s most notable health economics institutions: RWI – Leibniz Institute for Economic Research, the Faculty of Economics and Business Administration at the University of Duisburg-Essen, and the Institute for Competition Economics (DICE) at the Heinrich-Heine-University in Düsseldorf.

This year the focus of the Academy was hospital economics and mental health. On the first days of the event, Luigi Siciliani (University of York) gave a very informative block of lectures on hospital competition as well as currently often-debated quality of health care, waiting times and patient’s choice. To strengthen the learning process, after each topic, participants were requested to answer a set of questions and engaged in discussions that helped to better understand the lecture materials. After a productive first block of lectures, Richard G. Frank (Harvard University) provided a comprehensive insight into the economics of mental health and emphasized the distinguishing marks of topics in mental health such as salient features of mental illness, the role of government, mental health illness protection and mental health policy. Encouraged by the lecturer and with a high interest, each participant took part in the discussion and shared their knowledge about specific situations and handlings in their home countries.

In addition to the educational material, each participant had an opportunity to present his or her current research topic and be discussed by another participant. The large range of topics, such as the influence of crime on residents’ mental wellbeing, the influence of unpaid care on formal care utilization and the impact of increased hospital expenditures on population mortality, created a very interactive atmosphere for discussions. Senior researcher Daniel Howdon (University of Leeds) chaired the paper session and gave additional helpful comments for each presenter.

Apart from an interesting academic program, the summer school further fostered an interaction between participants in several social activities organized by the CINCH team. Besides several dinners after intensive days, participants had a chance to participate in a specially organized city tour in Essen and visit the Zollverein Coal Mine Industrial Complex (Zeche Zollverein) that is inscribed into the UNESCO list of World Heritage Sites. The large industrial monument is often named as the cultural heart of the Ruhr Area. After a guided tour through the complex, all participants once again gathered to have a dinner at a traditional restaurant of this region. Social activities not only allowed to further discuss topics of the lectures but also to share different personal experiences about pursuing a doctoral degree in different countries and about other daily interests for each early-stage researcher such as intensive learning, travelling to conferences, obtaining datasets, etc.

On the last day of the summer school, organizers announced the Best Paper Award, that was awarded to Elizabeth Lemmon (University of Stirling) for her research paper “Utilisation of personal care services in Scotland: the influence of unpaid carers”. Besides the financial reward, her work will be published in the CINCH Working Paper Series.

CINCH Academy was an excellent opportunity to deepen the knowledge and insights in hospital and mental health economics. Our special thanks goes to lecturers, Luigi Siciliani and Richard G. Frank, to paper sessions chair Daniel Howdon, as well as to the great organizational team Christoph Kronenberg and Annika Jäschke.

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