Jørgen Trankjær Lauridsen

Generation of a Danish TTO value set for EQ-5D health states:

Aims: Health policy decisions should be based on national social preferences. In the absence of a set of Danish health preferences, patient outcome studies using the EQ-5D instrument have typically used UK health state valuations. This article describes the development of a Danish EQ-5D value set. Methods: Regression modelling was based on Time Trade-Off (TTO) data derived from computer-assisted interviews conducted with 1,332 respondents from the Danish general population. Using a split-sample technique, 46 health states were directly valued by the respondents. Five different model types were tested and compared on statistical and theoretical grounds. Eleven different specifications were then tested for the chosen model type to identify the most appropriate model that had high explanatory power and parameters that were both consistent (positively signed) and statistically significant. Results: An additive random effects model was found to be superior to ordinary least squares, fixed effects, random coefficient and censored Tobit modelling approaches. From the 11 model specifications tested, the TTO3 model (main effects model, without an N3 factor) performed best and was used to generate a Danish set of health state preferences. Conclusions: An additive random effects model appears to adequately generate a Danish set of EQ-5D health state preferences. The model has high explanatory power and produces consistent and significant parameters for EQ-5D dimensions and levels. It is recommended that this value set be used in Danish cost-utility studies using EQ-5D.

How failure to align organizational climate and leadership style affects performance

– The purpose of this paper is to investigate how misalignments between the organizational climate (measured as information‐processing demand) and the leadership style (measured as information‐processing capability) may result in negative performance consequences., – The empirical part of the paper is based on questionnaire data. Key informant is the CEO and thus there is a focus on the CEOs perception of climate and leadership style. Data are subjected to regression analysis., – The results indicate that misalignments between climate and leadership style are problematic for organizational performance. This is supported by the empirical findings that show partial support for three out of four hypotheses and full support for the fourth hypothesis., – Data cover information on Danish small‐ and medium‐sized firms. These cross‐sectional data and cannot study the effects of misalignments over time., – Because the findings show that misalignments between climate and leadership style are problematic to organizational level of performance, this implies that in case of misfits either the climate or the leadership style must be changed., – The main contribution of the paper is that the framework allows an explicit understanding of which managerial actions are needed to manage particular types of climate. Further, the framework enables an understanding of how misalignments may result in poor performance.

Cost of dementia: impact of disease progression estimated in longitudinal data.

Aims: Several studies have shown that health care costs are higher for demented than for non-demented persons and that health care costs are higher for more severe demented persons than less severe demented persons. However, most studies report on cross-sectional study designs, and thus fail to examine the influence of disease progression on changes in health care costs to individual persons. The objective of this study was, using longitudinal data, to examine changes in total health care costs with disease progression in demented persons. Methods: We assumed that disease progression could be characterised by transitions between different states of dementia which reflected the degree to which the disease progressed over time. Then, changes in health care costs were regressed on a set of explanatory variables including disease progression. A total of 465 demented and non-demented persons were interviewed twice. The time between interviews was about three years. Before each interview, the participant was examined for dementia and classified by type of dementia (Alzheimers disease, vascular or other types of dementia) and degree of dementia (very mild, mild, moderate, severe). Results: The results of this longitudinal study confirmed that health care costs increased over time for non-demented as well as for demented persons and that health care costs increased with disease progression. In particular, the health care costs increased when the disease had progressed into the severe state of the dementia. Also, decline in functional abilities was an important factor for explaining changes in health care costs.

Ageing and health care expenditure in EU-15

The purpose of this paper is to investigate the relationship between ageing and the evolution of health care expenditure per capita in the EU-15 countries. A secondary purpose is to produce estimates that can be used in projections of future health care costs. Explanatory variables include economic, social, demographic and institutional variables as well as variables related to capacity and production technology in the health care sector. The study applies a co-integrated panel data regression approach to derive short-run relationships and furthermore reports long-run relationships between health care expenditure and the explanatory variables. Our findings suggest that there is a positive short-run effect of ageing on health care expenditure, but that the long-run effect of ageing is approximately zero. We find life expectancy to be a more important driver. Although the short-run effect of life expectancy on expenditure is approximately zero, we find that the long-run effect is positive, so that increasing life expectancy leads to a more than proportional, i.e. exponential, increase in health care expenditure.

The influence of economic incentives and regulatory factors on the adoption of treatment technologies: a case study of technologies used to treat heart attacks.

The Technological Change in Health Care Research Network collected unique patient-level data on three procedures for treatment of heart attack patients (catheterization, coronary artery bypass grafts and percutaneous transluminal coronary angioplasty) for 17 countries over a 15-year period to examine the impact of economic and institutional factors on technology adoption. Specific institutional factors are shown to be important to the uptake of these technologies. Health-care systems characterized as public contract systems and reimbursement systems have higher adoption rates than public-integrated health-care systems. Central control of funding of investments is negatively associated with adoption rates and the impact is of the same magnitude as the overall health-care system classification. GDP per capita also has a strong role in initial adoption. The impact of income and institutional characteristics on the utilization rates of the three procedures diminishes over time.

Dynamic Spatial Modelling of Regional Convergence Processes

Econometric analysis of convergence processes across countries or regions usually refers to a transition period between an arbitrary chosen starting year and a fictitious steady state. Panel unit root tests and panel cointegration techniques have proved to belong to powerful econometric tools if the conditions are met. When referring to economically defined regions, though, it is rather an exception than the rule that coherent time series are available. For this case we introduce a dynamic spatial modelling approach which is suitable to trace regional adjustment processes in space instead of time. It is shown how the spatial error-correction mechanism (SEC model) can be estimated depending on the spatial stationarity properties of the variables under investigation. The dynamic spatial modelling approach presented in this paper is applied to the issue of conditional income and productivity convergence across labour market regions in unified Germany.

Income-related and educational inequality in small-for-gestational age and preterm birth in Denmark and Finland 1987-2003

Aims: In this paper, we examine income- and education-related inequality in small-for-gestational age (SGA) and preterm birth in Denmark and Finland from 1987 to 2003 using concentration indexes (CIXs). Methods: From the national medical birth registries we gathered information on all births from 1987 to 2003. Information on highest completed maternal education and household income in the year preceding birth of the offspring was obtained for 1,012,400 births in Denmark and 499,390 in Finland. We then calculated CIXs for income- and education-related inequality in SGA and preterm birth. Results: The mean household income-related inequality in SGA was −0.04 (95% confidence interval: −0.05, −0.04) in Denmark and −0.03 (−0.04, −0.02) in Finland. The maternal education-related inequality in SGA was −0.08 (−0.10, −0.06) in Denmark and −0.07 (−0.08, −0.06) in Finland. The income-related inequality in preterm birth was −0.03 (−0.03, −0.02) in Denmark and −0.03 (−0.04, −0.02) in Finland. The education-related inequality in preterm birth was −0.05 (−0.07, −0.04) in Denmark and −0.04 (−0.05, −0.03) in Finland. In Denmark, the income-related and education-related inequity in SGA increased over time. In Finland, the income-related inequality in SGA birth increased slightly, while education-related inequalities remained stable. Inequalities in preterm birth decreased over time in both countries. Conclusions: Denmark and Finland are examples of nations with free prenatal care and publicly financed obstetric care of high quality. During the period of study there were macroeconomic shocks affecting both countries. However, only small income- and education-related inequalities in SGA and preterm births during the period were observed.

Reliability of the Discrete Choice Experiment at the Input and Output Level in Patients with Rheumatoid Arthritis

OBJECTIVES To investigate the issue of conjoint reliability over time. METHODS A discrete choice experiment was applied using scenarios that describe the effect of treating rheumatoid arthritis patients with TNF-alpha inhibitors, a novel class of highly effective, but expensive antirheumatic agents. Respondents participated in three face-to-face interviews over a period of 4 months. Reliability was measured both at the input level, where the consistency of matches made by respondents to the Discrete Choice Experiment (DCE) question between replications was determined, and at the output level, where the parameters of the conjoint model were estimated and tested for joint significance and willingness to pay (WTP) confidence intervals were calculated. RESULTS Input level: Of the 1661 choices made in survey 1, 1316 were repeated in survey 2. Based on the observed number of consistently repeated choices and the expected number by chance, a fair agreement between the choices in the two surveys (chi2 = 324) was found. Of the 998 consistently repeated choices from survey 1 to survey 2, 818 were repeated in survey 3. There was again a high level of consistency between the choices in surveys 1 and 2 and the final choice in survey 3. Output level: The confidence intervals for WTP figures in surveys 1 and 2 and 1 and 3 were overlapping, implying that the DCE was reliable at the output level over time. CONCLUSION The proportion of consistent responses was higher than would be expected by chance. Conjoint reliability over time was found both at the input and output level.

Antibacterial properties of EMLA and lidocaine in wound tissue biopsies for culturing.

If a tissue biopsy from a chronic wound is sampled for culture, the antibacterial properties of local anesthetics may pose a problem in producing false‐negative results. The purpose of this study was to investigate the effects of EMLA® (AstraZeneca) and lidocaine on common wound pathogenic bacteria. An in vitro study of a total of 25 clinical isolates and ATCC reference strains of Staphylococcus aureus (including methicillin‐resistant S. aureus), Escherichia coli, Pseudomonas aeruginosa, and Streptococcus pyogenes was conducted. The isolates were exposed to the local anesthetic drugs (and some of their contents separately) at 35°C over a 24‐hour period and time–kill curves were recorded. No culture media were used and saline was used for controls. EMLA® was found to have a rapid acting and powerful antibacterial effect and should not be used before culturing tissue samples. Lidocaine 1% was found not to inhibit the bacterial strains when exposure time was held below 2 hours. We conclude that culturing tissue from a wound biopsy is safe within 2 hours when a pure, preservative‐free lidocaine 1% solution is used.

Socio-economic inequality of immunization coverage in India

AbstractTo our knowledge, the present study provides a first time assessment of the contributions of socioeconomic determinants of immunization coverage in India using the recent National Family Health Survey data. Measurement of socioeconomic inequalities in health and health care, and understanding the determinants of such inequalities in terms of their contributions, are critical for health intervention strategies and for achieving equity in health care. A decomposition approach is applied to quantify the contributions from socio-demographic factors to inequality in immunization coverage. The results reveal that poor household economic status, mothers illiteracy, per capita state domestic product and proportion of illiterate at the state level is systematically related to 97% of predictable socioeconomic inequalities in full immunization coverage at the national level. These patterns of evidence suggest the need for immunization strategies targeted at different states and towards certain socioeconomic determinants as pointed out above in order to reduce socioeconomic inequalities in immunization coverage. JEL Classification: I10, I12