Krister Hjalte

Scope and Scale Insensitivities in a Contingent Valuation Study of Risk Reductions

A contingent valuation study asking willingness to pay (WTP) for reducing the overall death risk as well as the risk for fatal and non-fatal injuries in road traffic accidents was performed in Sweden 1998. Different sub-samples were used to test for scale (different risk reductions) and scope (different outcomes) effects, existence of which implies that a respondent is capable of differentiating a WTP-answer accordingly. The results indicated that respondents needed some reference point for their valuation. For instance, dependent samples showed, contrary to independent ones, a significant difference between WTP of dying from any cause and in a traffic accident for the same relative but different absolute risk reduction. Regarding non-fatal traffic accidents, tests were performed comparing valuation of risk reductions for injuries with different outcomes but identical baseline risks and relative risk reductions. Similar to the case above, dependent samples differentiated their WTP and were willing to pay significantly more for a severe injury than for a slight one, which was not the case for independent samples.

Cost-Effectiveness of Simvastatin Versus Cholestyramine

SummaryCost-effectiveness ratios were estimated for each of 2 plasma cholesterol-lowering drug therapies, the HMG-CoA reductase inhibitor simvastatin and the well established cholestyramine, in comparison with a nonpreventive drug treatment alternative. The study was confined to Swedish men (aged 37 to 64 years at start of therapy) with total serum cholesterol levels above 6.2 mmol/L who were free of coronary artery disease (CAD). Costs included expected direct costs of plasma cholesterol-lowering treatment less expected savings resulting from preventing CAD. Effects were defined as changes in life expectancy. A discount rate of 5% and Swedish kronor (SEK) 1988 prices were used.The impact on CAD risks was calculated using multivariate logistic risk estimates from the Framingham Heart Study; Swedish estimates were used to calculate intervention costs and changes in healthcare costs. Over the range of cholesterol levels examined (6.2 to 9.8 mmol/L), simvastatin was consistently more cost-effective than cholestyramine.

Maxillary sinus augmentation with iliac autograft : a health-economic analysis

PURPOSE To estimate and compare the costs of maxillary sinus augmentation performed with autologous bone graft either from the iliac crest or from local bone harvested from the mandibula. To evaluate post-operative health-related quality-of-life parameters for patients subjected to sinus augmentation and iliac bone surgery. MATERIAL AND METHODS The hospital records of 14 patients subjected to sinus augmentation with iliac autograft, and 14 patients treated with local autograft, were analysed with regard to costs related to surgery, hospitalization and sick leave. Post-operative health parameters were assessed with a questionnaire. RESULTS Mean hospital costs, administration excluded, for sinus augmentation with iliac autograft was €3447. Policlinic treatment alternatives e.g. local bone autograft with or without bone substitutes, rendered costs of approximately 42% thereof. The loss of production for a worker was 41% of the total cost (€9285). With regard to health-related quality-of-life and post-operative morbidity, most of the patients had recovered 14 days after the iliac graft surgery. CONCLUSION The cost for a sinus augmentation with iliac surgery exceeds that of a policlinic procedure manifold. Provided that a policlinic operation with local bone, with or without bone substitute, renders an adequate end result, the economic gain would be substantial and post-operative morbidity would be greatly reduced.

Health–health analysis—an alternative method for economic appraisal of health policy and safety regulation: Some empirical Swedish estimates

Health-health analysis (HHA) focuses on statistical lives themselves as a numeraire. The underlying principle is that the expected gains in health and safety of reduced risks in one area may result in increasing risks somewhere else in society. By reducing one risk other risks may increase due to changed individual behaviour. In addition to this direct effect, another indirect effect will also be present. Expenditure on a particular health policy or safety regulation must be financed in one way or another, which will result in an opportunity cost or income effect leaving less resources for other health and safety promoting activities in society. Thus, we will have an effect that reduces safety and health benefits induced by that income loss. Whether the total net health effect from a specific safety regulation or health policy is positive or negative must be empirically analysed. One way of estimating the income loss that induces one death, which we call the value of an induced death (VOID), is to estimate it as a multiple of the traditional value to avert a statistical death, also named the value of a statistical life (VOSL).A contingent valuation (CV) study eliciting the willingness-to-pay (WTP) for reducing the overall risk of dying was performed as a postal questionnaire in Sweden in 1998. By use of data from this study, it was possible to estimate the VOID and the VOSL in Sweden amounting to SEK116 and SEK20.8 million respectively, indicating that the net health result confined to mortality effects, will be negative (more lives will be lost than saved) if a health policy or safety regulation will cost more than SEK116 million per life saved.