John Cairns

The familial technique for linking maternal death with poverty

BACKGROUNDnRecognition of the synergy between health and poverty is now apparent in the development strategies of many low-income countries, and markers are needed to monitor progress towards poverty-relevant goals. Maternal mortality has been proposed as a possible candidate but evidence is lacking on the link with poverty at the level of individuals. We introduce a new approach to exploring the relation--the familial technique.nnnMETHODSnWe used data from 11 household surveys in ten developing countries to create percentage distributions of women according to their poverty-related characteristics and survival status (alive, non-maternal death, maternal death). These women were identified as the sisters of the adult female respondents in the surveys, and were assigned the same poverty status as their respondent sibling.nnnFINDINGSnThe analysis showed significant associations, across a diverse set of countries, between womens poverty status (proxied by educational level, source of water, and type of toilet and floor) and survival. These associations indicated a gradient within and across the survival categories. With increasing poverty, the proportion of women dying of non-maternal causes generally increased, and the proportion dying of maternal causes increased consistently. Further analysis reported here for one of the countries--Indonesia, revealed that about 32-34% of the maternal deaths occurred among women from the poorest quintile of the population. The risk of maternal death in this country was around 3-4 times greater in the poorest than the richest group.nnnINTERPRETATIONnThis new method makes efficient use of existing survey data to explore the relation between maternal mortality and poverty, and has wider potential for examining the poor-rich gap.

Prospective epidemiologic study of the outcome and cost‐effectiveness of antenatal screening to detect neonatal alloimmune thrombocytopenia due to anti‐HPA‐1a

BACKGROUND: To assess the value of antenatal screening to detect neonatal alloimmune thrombocytopenia (NAIT) due to anti‐HPA‐1a, a prospective study was carried out to quantify the potential clinical benefits and determine whether screening would be cost‐effective.

Evaluating changes in league structure: the reorganization of the Scottish Football League

This article investigates the relationship between league structure and the demand for professional team sport using data from the Scottish Football League (SFL) 1971 to 1980. The SFL was restructured in 1975 and thus provides an excellent opportunity for the empirical analysis of the influence of league structure. The general channels by which league structure affects demand are explored. Estimates are made of the impact on individual clubs by predicting what attendances would have been in the absence of the league reorganization. Finally, the distribution of attendances across clubs is examined for evidence of the influence of league structure.

Estimating time preferences for health using discrete choice experiments

This study is the first to use discrete choice experiments to elicit inter-temporal preferences for health. Inter-temporal preferences with respect to ones own future health are compared with inter-temporal preferences with respect to others future health. Discrete choice experiments are used to measure the relative importance of the duration of ill-health and how far in the future the ill-health occurs. Data were collected by postal questionnaire in the UK. The median implied rates of discount range from 0.055 to 0.091 for own health, depending on the period of delay, and from 0.078 to 0.147 for others health. The implied discount rate varies with respect to age, self-rated health, and version of the questionnaire. The implied discount rates are broadly comparable with other published estimates using closed-ended methods. One concern is the large percentage of respondents with dominant preferences. This issue needs to be explored before adopting the approach of discrete choice experiments to elicit inter-temporal preferences.

Health, wealth and time preference

It is conventional practice in economic evaluations to discount future health benefits at the same rate as future financial or resource flows. This paper reassesses the case for such a practice and emphasises the importance of the individuals rate of time preference over future health states. It reports an empirical study which set out to estimate and compare time preference states for future health and wealth states. The estimated rates were significantly lower for future health as compared to future wealth states.

Negative and zero time preference for health

The assumption of positive time preference is seldom challenged in analyses of intertemporal choices, despite considerable evidence of zero and negative discount rates. In this study, the majority of respondents have positive discount rates, but a substantial number have negative or zero discount rates. Using probit regression, the perception of the severity of the health-state, gender, education and perception of the questions in terms of difficulty are shown to influence whether individuals have positive discount rates.

Establishing patient preferences for blood transfusion support: an application of conjoint analysis.

Objective: To develop a method of determining the relative importance of waiting time and location of care for patients with haematological disorders requiring red cell transfusion. Such information is particularly relevant when evaluating interventions that affect patient well-being (e.g. by changing waiting time and location) but do not affect health outcomes. Methods: Conjoint analysis is used to assess the relative importance of waiting time and location with respect to pre-transfusion testing and red cell transfusion. Compensation is also included as an attribute in order to estimate the monetary value of changes in waiting time and location. Results: Waiting time and location are important attributes in the provision of pre-transfusion testing and red cell transfusion. Compensation is not an important attribute. On average patients are willing to wait an additional 45 minutes in order to have pre-transfusion testing in their own home and an additional 35 minutes in order to receive red cell transfusions in their preferred location. Conclusion: The relative importance of waiting time and location of care was established. However, it was not possible to assign monetary values since compensation was not an important attribute for these respondents. The paper highlights the scope for using conjoint analysis to analyse the non-health benefits that may result from changes in the delivery of care.

Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids.

Objectiveu2002 To estimate the cost‐effectiveness of a treatment strategy for symptomatic uterine fibroids, which starts with Magnetic Resonance‐guided Focused Ultrasound Surgery (MRgFUS) as compared with current practice comprising uterine artery embolisation, myomectomy and hysterectomy.

Saving future lives. A comparison of three discounting models

This paper compares three models of intertemporal choice concerning saving future lives: the constant discounting model, the proportional discounting model and the hyperbolic discounting model. The three models were investigated using data collected from the general public. Since these data have a multilevel structure, ordinary least-squares (OLS) estimates were supplemented by multilevel analysis. There is evidence in favour of the proportional (and to a lesser extent) the hyperbolic model over the constant discounting model. There is clear evidence for this data set that multilevel analysis is more appropriate than OLS.

Constant and decreasing timing aversion for saving lives

The traditional model of time preferences employed by economists is characterised by constant timing aversion. The available evidence suggests that this is not an appropriate assumption. This paper examines evidence for constant and decreasing timing aversion with respect to saving lives. Three discounting models are considered: the constant discounting model; the proportional discounting model; and the hyperbolic discounting model. Data collected from the general public are used to test the constant timing aversion model. Overall, the findings suggest that there is substantial evidence for decreasing timing aversion and against the constant timing aversion hypothesis.