The European Journal of Health Economics

The aim of this work was to analyse the use of health care services by immigrants in Spain. Using a nationally representative health survey from 2006–2007 and negative binomial and hurdle models, it was found that there is no statistically significant difference in the patterns of visits to general practitioners and hospital stays between migrants and natives in Spain. However, immigrants have a lower access to specialists and visit emergency rooms with a higher frequency than nationals.

This paper explores in a two-period model the economic implications of people’s tendency to underestimate their ability to adapt to age-related health problems. We model this misperception by assuming that the individual underestimates his future subjective health. Under standard assumptions, we show that, when people allocate their resources during their youth between present consumption, savings, and health investment, they invest more in health as long as the magnitude of the cross-marginal utility of health and consumption is not too negative.

We compared the willingness-to-pay and willingness to give up time methods to assess preferences for digital subtraction angiography (DSA), computed tomography angiography (CTA) and magnetic resonance angiography (MRA). Respondents were hypertensive patients suspected of having renal artery stenosis. Data were gathered using telephone interviews. Both the willingness-to-pay and willingness to give up time methods revealed that patients preferred CTA to MRA in order to avoid DSA. The agreement between willingness-to-pay and willingness to give up time responses was high (kappa 0.65–0.85). The willingness-to-pay method yielded relatively more protest answers (12%) as compared to willingness to give up time (2%). So, our results provided evidence for the comparability of willingness to pay and willingness to give up time. The high percentage of protest answers on the willingness-to-pay questions raises questions with respect to the application of the willingness-to-pay method in a broad decision-making context. On the other hand, the strength of willingness-to-pay is that the method directly arrives at a monetary measure well founded in economic theory, whereas the willingness to give up time method requires conversion to monetary units.

This cost-of-illness analysis for Belgium is part of a Europe-wide study on the costs of multiple sclerosis (MS). The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity. Patients from four specialized MS centres participated in the survey by answering a mail questionnaire. In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all medical and non-medical resource consumption, sick leave, early retirement, informal care as well as QOL (in the form of utility weights). A total of 799 respondents were included in the analysis (response rate 38%). The mean age of the cohort was 48 years, and 12% of patients were 65 years or older. Forty-six percent of patients had mild disease (Expanded Disability Status Scale [EDSS] score 0–3), 20% severe disease (EDSS score ≥7), and the mean EDSS score in the sample was 4.2 (median 4.0), with a utility of 0.51. Costs and utility are highly correlated with disease severity. Workforce participation decreases from approximately 75 to 80% in early disease to approximately 6% in the very late stages. Hospitalization and ambulatory visits increase by a factor of 10 between early and late disease; investments and services increase from basically no cost to € 6.000 to € 7.000 per year; productivity losses increase ninefold; and informal care increases from € 300 per year at an EDSS score of 0–1 to € 15.000 to € 16.000 per year at an EDSS score ≥7. Hence, total mean costs per patient are driven essentially by the distribution of the severity levels in the sample, increasing from approximately € 12.000 per year at an EDSS score of 0–1 to € 51.500 per year at an EDSS score of 8-9. The same is true for utility, which decreases from 0.85 to 0.06 as the disease becomes severe. However, the utility loss compared to the general population is high at all levels of the disease (0.25 at an EDSS score of 2 to 0.44 at an EDSS score 5–6 leading to an estimated loss of 0.3 quality-adjusted life-year (QALY) per patient. Relapses for patients with an EDSS score <5 are associated with a cost of approximately € 3.360 and a utility loss of 0.1 during the quarter in which they occur. Public payers (health-care costs, community care, sick payments and invalidity pensions) cover an estimated 55% of all costs.

An important element of the process by which new drugs achieve widespread use is their adoption by GPs. In this paper, we explore the factors that shape the timing of the first prescription of six new drugs by General Practitioners in Ireland. Our analysis is based on a dataset that matches prescription data with data on GP characteristics. We then use duration analysis to explore both equilibrium and non-equilibrium determinants of prescribing innovation. Our study highlights a range of commonalities across all of the drugs considered and suggests the importance of GP and practice characteristics in shaping prescribing decisions. We also find strongly significant, and consistently signed, stock and order effects across these drugs: GPs who have a track record of early adoption tend also to be early adopters of other new drugs; and, the larger the proportion of GPs which have already adopted a new drug the slower is subsequent adoption. Epidemic and learning effects are also evident with slower adoption by rural practices and among those GPs with narrower prescribing portfolios.

This study examines the changes in marginal revenue during psychiatric inpatient stays in a large Swiss psychiatric hospital after the introduction of a mixed reimbursement system with tariff rates that vary over length of stay. A discrete time duration model with a difference-in-difference specification and time-varying coefficients is estimated to assess variations in policy effects over length of stay. Among patients whose costs are fully reimbursed by the mixed scheme, the model demonstrates a significant effect of marginal revenue on length of stay. No significant policy effects are found among patients for whom only health insurance rates are delivered as mixed tariffs and government contributions are made retrospectively. The results indicate that marginal revenue can affect length of stay in inpatient psychiatry facilities, but that the reduction in marginal revenue must be sufficiently large.

Second-generation atypical antipsychotics such as clozapine, olanzapine, risperidone, quetiapine, ziprasidone, amisulpride and ariprazole offer the potential to reduce the significant health care resource demands in the treatment of schizophrenia through improved levels of initial clinical response and reduced levels of long-term acute relapse. However, the optimal sequencing of these drugs remains unclear. To consider this issue from a health economic viewpoint a decision model approach was used comparing healthcare costs and clinical outcomes when treating patients with alternative sequences of atypical antipsychotic treatment. Treated patients were assumed to be in a current acute episode with at least a 10-year history of disease and to be naive to previous atypical treatments. Treatment strategies were based on either first-line olanzapine or risperidone with switching to the alternative drug as second-line treatment following an inadequate clinical response to first-line drug therapy. Clinical response data were derived from a pivotal published comparative study of both olanzapine and risperidone. Published data on the long-term use of antipsychotic drugs where used wherever possible to populate the model for relapse rates during the maintenance phase. Health care resource data were defined for Germany based on expert clinical opinion. A treatment strategy of first-line olanzapine was shown to be cost saving over a 1-year period, with additional clinical benefits in the form of avoided relapses. The model suggests that over the first year of treatment a strategy of first-line olanzapine is associated with lower risk of additional relapse (0.33 fewer acute relapses per 100 patients per year) and with cost savings (€35,306 per 100 patients per year). There is a need for longer term direct in-trial comparisons of atypical antipsychotics to confirm these indicative results.