Catia Nicodemo

Health-Related Quality of Life and Direct Costs in Patients With Anterior Cruciate Ligament Injury: Single-Bundle Versus Double-Bundle Reconstruction in a Low-Demand Cohort—A Randomized Trial With 2 Years of Follow-up

PURPOSE To evaluate health-related quality of life (HRQL) in patients undergoing anterior cruciate ligament (ACL) reconstructive surgery by use of 2 procedures and to estimate the direct costs of surgery. METHODS We performed a 2-year randomized, prospective intervention study of 2 surgical ACL reconstruction techniques (anatomic single bundle [SB] v double bundle [DB]). Fifty-five consecutive outpatients, with a mean age of 30.88 years, were randomized to SB or DB ACL reconstruction. The Medical Outcomes Study 36-item Short Form Health Survey (SF-36) was used to measure HRQL (primary outcome). ACL injuries were assessed by the International Knee Documentation Committee (IKDC) score (secondary outcome). The use of medical resources and their costs were evaluated. RESULTS We included 52 patients in the final analyses (23 in the SB group and 29 in the DB group). At baseline, there were no significant differences in study variables. At 2 years of follow-up, there were no significant differences in SF-36 and IKDC scores between groups. However, compared with baseline, the SF-36 physical function, physical role, bodily pain, social function, and emotional role scores were significantly better in the SB group (P < .05), whereas only the physical function dimension score was better in the DB group (P = .047). IKDC scores at 2 years improved significantly in the SB group (P < .001) and DB group (P = .004) compared with baseline. There was a significant correlation between the SF-36 physical function, physical role, and bodily pain dimensions and the IKDC score at 2 years (P < .05). The costs were € 3,251 for the SB group and € 4,172 for the DB group. CONCLUSIONS HRQL and medical outcomes were similar between SB and DB ACL reconstruction techniques, 2 years after surgery. However, the SB technique was more cost-effective.

WAGE DIFFERENTIALS BETWEEN NATIVE AND IMMIGRANT WOMEN IN SPAIN: ACCOUNTING FOR DIFFERENCES IN SUPPORT*

The objective of the study is to quantify the wage gap between native and immigrant women in Spain taking into account differences in their characteristics and the need to control for common support. Using the microdata from the Social Security Records (MCVL) and with a matching procedure of Nopo (2008) we analysed the decomposition of the wage gap. The advantage of this procedure is that we can simultaneously estimate the common support and the mean counterfactual wage for the women on the common support. In addition, we can describe not only differences at the mean, but along the entire wage distribution. The results obtained indicate that, on average, immigrants women earn less than native in the Spanish labour market. This wage gap is bigger when we analyse the developing countries, but our main finding is that part of this wage gap is related to difference in common supports, i.e. immigrant women have different characteristics than native women that make them less attractive in the labour market. If the need to control for common support is neglected, estimates of the wage gap will be biased.

The Gender Pay Gap in the Australian Private Sector: Is Selection Relevant Across the Earnings Distribution?

We use quantile regression and counterfactual decomposition methods to explore gender gaps across the earning distribution for a sample of full-time employees in the Australian private sector. Significant evidence of a self-selection effect for the women into full-time employment (or of components of self-selection related to observable or unobservable characteristics) is, interestingly, not found to be relevant in the Australian context. Substantial gender earnings gaps (and glass ceilings) are established, however, with these earnings gaps found to be predominantly related to the women receiving lower returns to their observable characteristics than the men.

Well-being and obesity of rheumatoid arthritis patients

We apply the potential outcomes framework in the analysis of an observational study of rheumatoid arthritis patients, in which we compare the mean functional-health and well-being scores (SF–36) of patients who are overweight and who are not. We combine propensity score matching with multiple imputation for nonresponse. We assess the sensitivity of the conclusions with respect to the details of the propensity model and the definition of being overweight.

The Transition from Vocational Education to Work: Evidence from Spain

© 2015 Universidad de Zaragoza. All rights reserved. This paper analyzes the transition from vocational education to the first job in Spain using a micro-dataset on labor histories. Among the determinants of this transition, we investigate, for the first time, the role of workplace training, a mandatory module in Spain that can be validated with previous job experience. Applying duration techniques, and accounting for unobserved heterogeneity, we find that being female, finishing education older or having high-educated parents reduce the exit rate to employment. We obtain that workplace training is an important factor to reduce unemployment duration.

Random or Referral Hiring: When Social Connections Matter

This study investigates the existence of hiring criteria associated with the degree of social connections between skill and low-skill workers. We provide evidence about to what extent managers rely on their social connections in recruiting low-skill workers rather than on random matching. As one unique feature we follow an approach for a posted wage setting that reflects the main features of the Spanish labor market. By working with sub-samples of high and low-skill workers we are able to assess that the recruitment of low-skill immigrants quite often follows a referral strategy and we identify interesting irregularities across the ethnic groups. As a common feature, referral hiring is usually influences by the ethnicity of the manager and the relative proportion of immigrants within the firm. Under these perspectives, our study outlines new insights to evaluate the future perspectives of the Spanish labor market.

Migration, Health, and Well-being: Models and Methods

Abstract In the public debate, immigration is often viewed as a threat to the access and the quality of health care services. The health needs of immigrants and refugees pose new challenges to health care systems. This chapter reviews the recent economic literature on immigration and health. We discuss the main methods used to study the health immigrant trajectories and the effects of immigration on demand and supply of health care in both destination and sending countries.

Transition and duration in disability: New evidence from administrative data

BACKGROUND In recent decades demographic changes (low fertility rates, increased life expectancy…) in most OECD countries, have brought profound changes in the population pyramid, with several effects in the welfare of society. One of them is the increase in the number of people with disabilities, since age is a determining factor in the emergence of this dependency. OBJECTIVE/HYPOTHESIS This paper studies the probability to enter and transit in and from a disability state, as well as its associated mortality, by attending to the distinction between the initial disability level and the process that leads on from it, and by addressing whether and how education, age and income affect this transition. METHODS Applying a Markov model and a survival analysis to new Spanish administrative data set (Muestra Continua de Vida Laboral (MCVL)) we estimate the probability that a person changes the state of disability and the duration of her progression in each case. RESULTS We find that people with an initial state of disability have a higher propensity to change status and take less time to transit amongst different stages than those who have no disability. Men do so more frequently than women and income have negative effects on the transition. CONCLUSIONS These results may help to incorporate into welfare programs some protection mechanisms for delaying transitions and target the most fragile population groups.

FRI0439 Beliefs, health status and outcomes in patients undergoing total knee arthroplasty. Prospective study with 12 months followup

Background Previous studies report that between 17-30% of patients are not satisfied with the outcome after undergoing total knee arthroplasty (TKA), believing that their pain or functional disability would improve more or that the recovery would be less difficult. Beliefs are motivators of behaviour, with the cognitive component, i.e. what the person knows or thinks they know, being one of the main factors. It has been reported that, in musculoskeletal diseases, the degree of behavior/adherence (recommendations agreed between the practitioner and patient) to therapeutic regimens is often low, thereby reducing efficacy. In TKA, where active patient participation in therapy is required, a high level of adhesion is necessary to obtain good results. Therefore, determining the extent to which patients believe that their behavior can influence TKA outcomes is of interest. Objectives To determine whether the belief that behavior influences the health status is associated with better outcomes in terms of quality of life in patients with knee osteoarthritis twelve months after TKA. Methods A prospective study with 12 months follow-up. Sociodemographic and clinical variables were collected. Patient’s opinions on the influence of their behavior on TKA outcomes were measured using the question “Do you think your behavior can affect your health status?” with 5 response categories (Likert scale): 1 totally agree; 2 agree somewhat; 3 do not know: 4 disagree somewhat: 5 strongly disagree. The health status was assessed using the SF-36 and WOMAC questionnaires. A multinomial logit model was constructed. Results 98 patients, mean age 70.3 years (SD 7.2), 82% female, 75% with low education, body mass index (BMI) 32.74 (SD 5.6), were included. 57% said they did not know and 15% strongly disagreed that they believed behaviour could influence the health status. The multinomial logit model showed that patients who disagreed that their behavior could affect their health had worse scores in the physical and mental SF-36 components and total WOMAC score (p<0.02) 12 months after TKA. Age, sex and BMI were not significantly associated with any of the behavioural categories considered. Conclusions The cognitive element of beliefs about the influence of behavior on health was very low. Patients who believed that their health depends on their behavior had better outcomes (SF-36 and WOMAC scores) 12 months after TKA than those who do not. This shows the importance of beliefs and the need for health professionals to design educational strategies to reinforce them in order to promote behaviours that improve therapeutic outcomes. This study was funded by Spanish Ministry of Health grant FIS PS09/01148 References Mason JB. The new demands by patients in the modern era of total joint arthroplasty: a point of view. Clin Orthop Relat Res 2008;466(1):146-52. Franklin PD, Li W, Ayers DC. The Chitranjan Ranawat Award: functional outcome after total knee replacement varies with patient attributes. Clin Orthop 2008;466:2597–2604. Disclosure of Interest None Declared

AB0780 Cost utility analysis of total knee replacement in obese patients with osteoarthritis. prospective study with 12 months follow up

Background Knee osteoarthritis is one of the most prevalent diseases in developed countries. When symptoms are severe and affect the quality of life, total knee replacement (TKR) is often recommended. Economic evaluation (EE)of treatments used in order to promote more efficient use of resources is advised. In processes such as TKR, where quality of life is the most important clinical outcome to assess, cost-utility analysis, which allows comparison of two treatment alternatives in terms of costs and benefits and which uses quality-adjusted life years (QALYs), is the preferred type of EE. In Spain, an incremental cost of between € 8,400 and € 44,200 per QALY gained is generally accepted (Abellan JM et al). Objectives To estimate the cost-utility of TKR in patientsdiagnosedwith knee osteoarthritis and obesity, compared with non-intervention. Methods Cost-utility evaluation from the social perspective, with all relative costs was taken into account, regardless of the financer. 71 patients undergoing TKR were prospectively studied for 12months. Variables: Sociodemographicand clinical. Health-related quality of life (HRQOL) was assessed using the WOMAC and SF-36 and QALYs by the Short Form6D (SF-6D) index. The baseline total cost of the economic resources used due to the knee process included direct medical and non-medical and indirect costs. The total post-TKR cost included the cost of surgery (operating room, hospital stay, technicalprocedures and physiotherapy). Resources used were collected during the six months before and 6-12 months after TKR. Results 71 patients, mean age 67.48 years (SD 8.6), 66 female, BMI 38.71 (SD 4.5) were included. Mean difference between scores at baseline and at 12 months was 33.14 points (95% CI 28.56 to 37.72, in the WOMAC total index (p <0.001) and 10.38 points (95% CI 7.97 to 12.80) in the physical component SF-36, (p <0.001) and 1.57 (95% CI -5.2 to 2.04) in the mental component SF-36 (p = 0.388). 12 months after TKR, patients gained a mean of 0.11 QALYS, compared with non-intervened patients. Mean direct non-medical costswere € 3,329 (SD 4,079) at baseline vs. € 2,901 (SD 4,885) at 12 months (p = 0.371), mean indirect costs were € 335 (SD 1,750) vs. € 90 (SD 322), p = 0.299, and mean direct medical costs were € 375 (SD 174) vs. € 173 (SD 78)without the cost of surgery, p <0.001. The mean incremental cost-utility was € 32,358 per QALY gained (P25: € -16,470; P50: €13,049: P75: € 44,706) when TKR was carried out. Conclusions Quality of life improved significantly after TKR. The costs, borne by patients and their families were similar at baseline and at 12 months after TKR. The analysis shows TKR has an acceptable cost-utility ratio from the accepted Spanish perspective in the first 12 months after surgery. References Abellán JM et al. La medición de la calidad de los estudios de evaluación económica. Propuesta de ‘checklist’ y guía de uso para la toma de decisiones. Rev Esp Salud Pública 2009;83:71-84 Acknowledgements This study was funded by Spanish Ministry of Health grant FIS PS09/01148 Disclosure of Interest None Declared