Health Economics (United Kingdom)

Recently, Ware and Sherbourne¹ published a new short‐form health survey, the MOS 36‐Item Short‐Form Health Survey (SF‐36), consisting of 36 items included in long‐form measures developed for the Medical Outcomes Study. The SF‐36 taps eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, general mental health, social functioning, energy/fatigue, and general health perceptions. It also includes a single item that provides an indication of perceived change in health. The SF‐36 items and scoring rules are distributed by MOS Trust, Inc. Strict adherence to item wording and scoring recommendations is required in order to use the SF‐36 trademark. The RAND 36‐Item Health Survey 1.0 (distributed by RAND) includes the same items as those in the SF‐36, but the recommended scoring algorithm is somewhat different from that of the SF‐36. Scoring differences are discussed here and new T‐scores are presented for the 8 multi‐item scales and two factor analytically‐derived physical and mental health composite scores.

Discrete choice experiments (DCEs) have become a commonly used instrument in health economics. This paper updates a review of published papers between 1990 and 2000 for the years 2001–2008. Based on this previous review, and a number of other key review papers, focus is given to three issues: experimental design; estimation procedures; and validity of responses. Consideration is also given to how DCEs are applied and reported. We identified 114 DCEs, covering a wide range of policy questions. Applications took place in a broader range of health‐care systems, and there has been a move to incorporating fewer attributes, more choices and interview‐based surveys. There has also been a shift towards statistically more efficient designs and flexible econometric models. The reporting of monetary values continues to be popular, the use of utility scores has not gained popularity, and there has been an increasing use of odds ratios and probabilities. The latter are likely to be useful at the policy level to investigate take‐up and acceptability of new interventions. Incorporation of interactions terms in the design and analysis of DCEs, explanations of risk, tests of external validity and incorporation of DCE results into a decision‐making framework remain important areas for future research. Copyright © 2010 John Wiley & Sons, Ltd.

Quality adjustment weights for quality‐adjusted life years (QALYs) are available with the EQ‐5D Instrument, which are based on a survey that quantified the preferences of the British public. However, the extent to which this British value set is applicable to other, especially non‐European, countries is yet unclear. The objectives of this study are (a) to compare the valuations obtained in Japan and Britain, and (b) to explore a local Japanese value set. A diminished study design is employed, where 17 hypothetical EQ‐5D health states are evaluated as opposed to 42 in the British study. The official Japanese version of the instrument and the Time Trade‐Off method are used to interview 543 members of the public. The results are: firstly, the evaluations obtained in Japan and those from Britain differ by 0.24 on average on a [−1, +1] scale, and mean absolute error (MAE) in predicting the Japanese preferences with the British value set is 0.23. Secondly, comparable regressions suggest that the two peoples have systematically different preference structures (p<0.001 for 8 of 12 coefficients; F‐test). Thirdly, using alternative models, the predictions are improved so that the local Japanese value set achieves MAE in the order of 0.01. Copyright © 2002 John Wiley & Sons, Ltd.

This paper explores the impact of the New Cooperative Medical Scheme (NCMS), a newly adopted public health insurance program in rural China. Using a longitudinal sample drawn from the China Health and Nutrition Survey (CHNS), we employed multiple estimation strategies (individual fixed‐effect models, instrumental variable estimation, and difference‐in‐differences estimation with propensity score matching) to correct the potential selection bias. We find that participating in the NCMS significantly decreases the use of traditional Chinese folk doctors and increases the utilization of preventive care, particularly general physical examinations. However, we do not find that the NCMS decreases out‐of‐pocket expenditure nor do we find that it increases utilization of formal medical service or improves health status, as measured by self‐reported health status and by sickness or injury in the past four weeks. Our study indicates that despite the wide expansion of coverage, the impact of the NCMS is still limited. Copyright © 2009 John Wiley & Sons, Ltd.

In cost‐utility analysis, the numbers of quality‐adjusted life years (QALYs) gained are aggregated according to the sum‐ranking (or QALY maximisation) rule. This requires that the social value from health improvements is a simple product of gains in quality of life, length of life and the number of persons treated. The results from a systematic review of the literature suggest that QALY maximisation is descriptively flawed. Rather than being linear in quality and length of life, it would seem that social value diminishes in marginal increments of both. And rather than being neutral to the characteristics of people other than their propensity to generate QALYs, the social value of a health improvement seems to be higher if the person has worse lifetime health prospects and higher if that person has dependents. In addition, there is a desire to reduce inequalities in health. However, there are some uncertainties surrounding the results, particularly in relation to what might be affecting the responses, and there is the need for more studies of the general public that attempt to highlight the relative importance of various key factors. Copyright © 2004 John Wiley & Sons, Ltd.