Gillian Currie

Special care facility compared with traditional environments for dementia care: a longitudinal study of quality of life.

Objectives: To compare the effect of a specialized care facility (SCF) on quality of life (QoL) for residents with middle‐ to late‐stage dementia over a 1‐year period with residence in traditional institutional facilities.

Randomized Trial of Brief Motivational Treatments for Pathological Gamblers: More Is Not Necessarily Better

The efficacy of brief treatments for media-recruited pathological gamblers was tested in a randomized clinical trial design (N = 314). Two self-directed motivational interventions were compared with a 6-week waiting list control and a workbook only control. Brief motivational treatment involved a telephone motivational interview and a mailed self-help workbook. Brief motivational booster treatment involved a telephone motivational interview, a workbook, and 6 booster telephone calls over a 9-month period. Primary outcomes were gambling frequency and dollar losses. As hypothesized, brief and brief booster treatment participants reported less gambling at 6 weeks than those assigned to the control groups. Brief and brief booster treatment participants gambled significantly less often over the first 6 months of the follow-up than workbook only participants. However, the workbook only participants were as likely to have significantly reduced their losses over the year and to have not met criteria for pathological gambling. Contrary to the hypothesis, participants in the brief booster treatment group showed no greater improvement than brief treatment participants. These results provide further support for the value of brief motivational treatments for pathological gambling.

Health economic evaluation

A glossary is presented on terms of health economic evaluation. Definitions are suggested for the more common concepts and terms.

Are cost of injury studies useful

Studies from the USA and Canada have attempted to estimate the economic costs associated with injury.1–3 The rationale for these studies is often to provide data for priority setting (both research and policy). In other words, the expression of the cost of injury in monetary terms is thought to illustrate the importance of the problem and, therefore, its high priority for research and health services resources. For example, some authors have suggested that policy makers identify “high cost” injuries (compared with other injuries) and make these injuries a priority for treatment and prevention programs.1,3 Cost of injury studies may be useful in the “political” sense, for example, by raising public and political awareness of the burden of injury. Our argument, however, is that such studies are not helpful in the context of setting priorities for resource allocation and research activities. Furthermore, concentration on cost of injury studies may divert policy makers from what they need to know in order to maximise societal benefits from resource allocation. In this paper, we briefly describe the cost of injury method, explain why cost of injury studies have limited usefulness, and explain how, in our view, health economics can better contribute to the field of injury prevention. Cost of injury studies usually include both direct and indirect costs. Direct costs are those resources used to prevent, detect, and treat injury and its complications. The resource use in each of these categories is measured, valued, and summed. The most common method involves combining data on health care utilisation and costs; for example, the length of hospital stay for a specific injury is multiplied by an estimate of the cost per day for that injury. Indirect costs relate to the loss of productive output in the economy because of …

Patient and health professional preferences for organ allocation and procurement, end-of-life care and organization of care for patients with chronic kidney disease using a discrete choice experiment

BACKGROUND Clinical practice, policy and research, and the ethical bases upon which they are founded, should be systematically and transparently informed by both patient and professional values. METHODS A discrete choice experiment was utilized to understand and quantify the preferences of 351 Canadian patients and healthcare providers in relation to ethically challenging aspects of the management of chronic kidney disease (CKD): procurement and allocation of organs for transplantation, end-of-life care discussions and decision making and the identities of those providing primary care. RESULTS Patients and health professionals had clear preferences for detailed prognostic information, early advance care planning, shared end-of-life decision making, coordinated models of care that enhance interaction and communication between primary and tertiary care and a more utilitarian approach of best match over first come, first served for allocating deceased donor kidneys. These data also suggest that the innovative strategies of non-directed anonymous donation and paired kidney exchange that are slowly being implemented internationally will be acceptable to both patients and healthcare providers. CONCLUSIONS Current models of CKD care do not consistently reflect the preferences or priorities of either health professionals or patients.

Measuring Preferences for Colorectal Cancer Screening: What are the Implications for Moving Forward?

There is a growing interest in the application of preferences to inform healthcare planning and delivery. Clinical practice guidelines are encouraging incorporation of preferences in patient management choices in recognition that often no single approach is best.The objective of this focused review is to provide an overview of the current state of preference measurement for colorectal cancer screening (CRCS) and highlight the implications for health policy, CRCS program implementation, and further research.MEDLINE and EMBASE electronic databases were searched (1990-May 2009) for English-language literature examining patient preferences for CRCS, using conjoint analysis methods. We systematically extracted information on the study population, whether the choice sets were framed around specific CRCS tests or the overall program, the attributes and levels included, and, where available, the ordering of importance of the attributes and key study findings.Qualitative data synthesis of key differences and commonalities in the approaches and findings are presented. Six conjoint analysis studies of CRCS were identified. While 66–88% of respondents in the general population indicated they would choose CRCS, this is greater than observed rates of uptake (40–50%). All studies were administered in a sample of the general population at average risk of CRC, except one that included a sample of physicians. The studies varied in the attributes and levels they included. However, accuracy, whether expressed in the context of a CRCS test or program, was consistently identified as a statistically significant and important attribute. Other attributes included in the conjoint analysis studies included level of discomfort during the test, preparation for the test, the testing process, frequency of testing, frequency of complications, the process of follow up, and cost.Our results suggested that (i) a majority of people would choose to be screened for CRC, although actual CRCS participation rates suggest otherwise; (ii) patients have distinct preferences for CRCS tests that can be linked to CRC test attributes; and consequently, (iii) there is no single CRCS test that is preferred by everyone. In addition, although the specific approach, attributes, and levels in the studies varied, they consistently found that multiple factors are important from the patient’s perspective and that preferences vary amongst subgroups. Consequently, careful consideration should be given to the design and implementation of a CRCS program based on a broader range of factors than the traditional outcomes such as mortality and incidence reduction. Attention should now be focused on how to use this information to inform health policy and develop CRCS programs that will increase screening uptake and adherence in the context of the health system in which the program will be provided. We propose a two-step process to designing and implementing a CRCS program based on evidence and preferences that informs patient choice.

Validation of an obstetric comorbidity index in an external population

An obstetric comorbidity index has been developed recently with superior performance characteristics relative to general comorbidity measures in an obstetric population. This study aimed to externally validate this index and to examine the impact of including hospitalisation/delivery records only when estimating comorbidity prevalence and discriminative performance of the obstetric comorbidity index.

Using Discrete Choice Experiments in Health Economics

Contents: Introduction Population Health and Health Care Systems Part I: Population Health Part II: Health Care Finance, Expenditure and Use Part III: Equity in Health and Health Care Part IV: Organization of Health Care Markets Part V: Provider Reimbursement, Incentives and Behaviour Part VI: Assessing the Performance of Health Care Organizations Evaluation of Health Care Part VII: Measuring Benefits Part VIII: Measuring Costs and Statistical Issues Part IX:Economic Evaluation and Decision Making Index Contributors: T. Adam, M.C. Auld, P.P. Barros, A. Basu, S. Birch, D. Bishai, H. Bleichrodt, W.D. Bradford, J. Brazier, F. Breyer, A. Briggs, J.F. Burgess Jr, L. Burgess, M. Chalkley, D. Chisholm, K. Claxton, P. Contoyannis, R. Cookson, G. Currie, D. Dawson, P. Deb, P. Dolan, C. Donaldson, B. Dowd, M. Drummond, T.T.-T. Edejer, T. Ensor, S.L. Ettner, D.B. Evans, D. Feeny, R. Feldman, E. Fenwick, A. Gafni, P.-Y. Geoffard, K. Gerard, J. Glazer, D.C. Grabowski, H. Gravelle, P. Grootendorst, T. Iversen, A.M. Jones, D. Kenkel, A.N. Kleit, D. Lakdawalla, M. Lindeboom, J. Louviere, H. Luras, A. McGuire, T.G. McGuire, W. Manning, X. Martinez-Giralt, H. Mason, D. Meltzer, A. Mills, S. Morris, J. Mullahy, E.C. Norton, J.A. Nyman, O. O’Donnell, T.A. Olmstead, N. Palmer, T.J. Philipson, J.L. Pinto, D. Polsky, C. Propper, M. Raikou, R. Rannan-Eliya, N. Rice, T. Rice, J. Roberts, C.J. Ruhm, M. Ryan, M. Schoenbaum, M.J. Sculpher, P. Shackley, J.L. Sindelar, P.C. Smith, R. Smith, A. Somanathan, A. Street, D.J. Street, M. Sutton, R. Thompson, P.K. Trivedi, A. Tsuchiya, E. van Doorslaer, D.J. Vanness, R. Viney, A. Wagstaff, M.C. Weinstein, D. Wilson, P. Zweifel

Willingness to Pay for What? A Note on Alternative Definitions of Health Care Program Benefits for Contingent Valuation Studies

The authors examine a number of ways in which willingness to pay (WTP) can be defined for measurement and use in a cost-benefit analysis (CBA) of a collectively funded health care program. They show how ambiguous specification of the program consequences that respondents should consider in their WTP responses can lead to problems of double counting or zero counting in a subsequent CBA. An example is whether the value of lost time from work because of poor health should be included by a CBA analyst (e.g., valued at the wage rate) as a separate cost item or whether this has already been monetized and included in respondents’ WTP data. The authors highlight how differences in assumed or actual institutional structures are often ignored in measures of WTP and the consequences of this for the interpretation of WTP data.

Specification of the Utility Function in Discrete Choice Experiments

BACKGROUND The specification of the utility function has received limited attention within the discrete choice experiment (DCE) literature. This lack of investigation is surprising given that evidence from the contingent valuation literature suggests that welfare estimates are sensitive to different specifications of the utility function. OBJECTIVE This study investigates the effect of different specifications of the utility function on results within a DCE. METHODS The DCE elicited the publics preferences for waiting time for hip and knee replacement and estimated willingness to wait (WTW). RESULTS The results showed that the WTW for the different patient profiles varied considerably across the three different specifications of the utility function. Assuming a linear utility function led to much higher estimates of marginal rates of substitution (WTWs) than with nonlinear specifications. The goodness-of-fit measures indicated that nonlinear specifications were superior.