The European Journal of Health Economics

In this paper, we analyze how a nationwide population-based skin cancer screening program (SCS) implemented in Germany in 2008 has impacted the number of hospital discharges following malignant skin neoplasm diagnosis and the malignant melanoma mortality rate per 100,000 inhabitants. Our panel data, drawn from the Eurostat database, cover subregions in 22 European countries, measured at the lowest nomenclature of territorial units for statistics (NUTS) level for 2000–2013. Applying fixed effects methods, we find a significantly positive and robust effect of the German SCS on the number of patients diagnosed with malignant skin neoplasm. However, the program does not significantly influence the melanoma mortality rate. This finding conflicts with the decreased melanoma mortality rate found for the pilot SCS program in northern Germany. Our results indicate that Germany’s nationwide SCS program is effective in terms of a higher diagnosis rate for malignant skin neoplasms and thus may contribute to an improvement in the early detection of skin cancer.

Acid sphingomyelinase deficiency (ASMD) type B is a rare genetic disorder leading to enlargement of the spleen and liver, pulmonary dysfunction, and other symptoms. Cost-utility analyses are often conducted to quantify the value of new treatments, and these analyses require health state utilities. Therefore, the purpose of this study was to estimate utilities associated with varying levels of severity of adult and pediatric ASMD type B. Seven adult and seven child health state vignettes describing ASMD were developed based on published literature, clinical trial results, and interviews with clinicians, patients with ASMD, and parents of children with ASMD. The health states were valued in time trade-off interviews with adult general population respondents in the UK. Interviews were completed with 202 participants (50.0% female; mean age = 41.3 years). The health state representing ASMD without impairment had the highest mean utility for both the adult and child health states (0.92/0.94), and severe ASMD had the lowest mean utility (0.33/0.45). Every child health state had a significantly greater utility than the corresponding adult health state. Differences between adult/child paired states ranged from 0.02 to 0.13. Subgroup analyses explored the impact of parenting status on valuation of child health states. Greater severity of ASMD was associated with lower mean utility. Results have implications for valuation of pediatric health states. The resulting utilities may be useful in cost-utility modeling estimating the value of treatment for ASMD.

International comparisons of health care systems and services have created increased interest in the comparability of cost results. This study compared top-down and bottom-up approaches to collecting unit cost data across centres in the context of examining the cost-effectiveness of dialysis therapy across Europe. The study tested whether health care technologies in different countries can be costed using consistent and transparent methods to increase the comparability of results. There was more agreement across the approaches for peritoneal dialysis than for than haemodialysis, with differences, respectively of €91–1,687 vs. 333–7,314 per patient per year. Haemodialysis results showed greatest differences where dialysis units were integrated as part of larger hospitals. Deciding which approach to adopt depends largely on the technology. However, bottom-up costing should be considered for technologies with a large component of staff input or overheads, significant sharing of staff or facilities between technologies or patient groups and health care costing systems which do not routinely allocate costs to the intervention level. In these circumstances this costing approach could increase consistency and transparency and hence comparability of cost results.

The choice of instrument (e.g. EQ-5D vs. SF-6D) can lead to different health-related utility scores, but it is unclear why these differences arise and whether they change cost utility analysis (CUA) results. This paper addresses these issues using a case study where using SF-6D rather EQ-5D led to greater utility gain and a lower cost per QALY for treatment. The paper examines reasons for this difference. This paper finds that an important factor was the inclusion in the SF-6D descriptive system of separate items for “vitality” and “social functioning”, not explicitly included in EQ-5D. Further studies are required that examine the impact of the choice of instrument on cost-utility.

This study developed Finnish preference weights for the seven-attribute Adult Social Care Outcomes Toolkit for carers (ASCOT-Carer) and investigated survey fatigue and learning in best-worst scaling (BWS) experiments. An online survey that included a BWS experiment using the ASCOT-Carer was completed by a sample from the general population in Finland. A block of eight BWS profiles describing different states from the ASCOT-Carer were randomly assigned to each respondent, who consecutively made four choices (best, worst, second best and second worst) per profile. The analysis panel data had 32,160 choices made by 1005 respondents. A scale multinomial logit (S-MNL) model was used to estimate preference weights for 28 ASCOT-Carer attribute levels. Fatigue and learning effects were examined as scale heterogeneity. Several specifications of the generalised MNL model were employed to ensure the stability of the preference estimates. The most and least-valued states were the top and bottom levels of the control over daily life attribute. The preference weights were not on a cardinal scale. We observed the position effect of the attributes on preferences associated with the best or second-best choices. A learning effect was found. The established preference weights can be used in evaluations of the effects of long-term care services and interventions on the quality of life of service users and caregivers. The learning effect implies a need to develop study designs that ensure equal consideration to all profiles (choice tasks) in a sequential choice experiment.

Hospital occupancy is a key metric in hospital-capacity planning in Germany, even though this metric neglects important drivers of economic efficiency, for example treatment costs and case mix. We suggest an alternative metric, which incorporates economic efficiency explicitly, and illustrate how this metric can be used in the hospital-capacity planning cycle. The practical setting of this study is the hospital capacity planning process in the German federal state of Rheinland-Pfalz. The planning process involves all 92 acute-care hospitals of this federal state. The study is based on standard hospital data, including annual costs, number of cases—disaggregated by medical departments and ICD codes, respectively—length-of-stay, certified beds, and occupancy rates. Using the developed metric, we identified 18 of the 92 hospitals as inefficient and targets for over-proportional capacity cuts. On the upside, we identified 15 efficient hospitals. The developed model and analysis has affected the federal state’s most recent medium term planning cycle.

We examine the personal health situation and how the complexities thereof affect the elderly Austrians’ willingness to accept electronic health records (EHR). Using data from the sixth wave of the SHARE survey in Austria, we find the complexity of individual health problems and the social integration of individuals influencing the acceptance of EHR. The higher the degree of multimorbidity, the more medication is prescribed, and the higher the number of hospital admissions, the higher is the acceptance of EHR. Having a chronical illness has a positive effect on EHR acceptance, whereas a pessimistic attitude and lack of joy in life, as indicators of depressive mood, have a negative impact. The results are mainly driven by women and younger patients aged between 50 and 70. People with poor social connection express lower acceptance of EHR.

In this paper, we examine the income gradient in child mental health using longitudinal data from a large, national cohort of Australian children. We contribute to the body of existing literature by: (i) investigating whether and to what extent a child’s mental health levels and their relationship to income vary when a child’s mental health is assessed by the child’s parent, the child’s teacher and the child her/himself; (ii) exploring whether the reporting differences in a child’s mental health is associated systematically with household income; and (iii) examining the child mental health gradient and the evolution of this gradient by the child’s age. We found that a child’s mental health and the income gradient vary depending on who assesses the child’s mental health (the gradient was the largest when assessed by parents and the smallest when assessed by the child). Furthermore, the magnitude of the effect of mental health and income gradient faded when we controlled for some important variables, such as maternal health.