Health Equity: 11/12/09

Thursday, November 12, 2009

[EQ] Severity of illness and priority setting in healthcare

Severity of illness and priority setting in healthcare:
A review of the literature

Koonal K. Shah

Office of Health Economics, London, United Kingdom
Health Policy 93 (2009) 77–84

Journal Homepage: http://www.elsevier.com/locate/healthpol

Background:
It is widely assumed that the principal objective of healthcare is to maximize health. However, people may be willing to sacrifice aggregate health gain in order to direct resources towards those who are worst off in terms of the severity of their pre-treatment health state.

Objectives:
This paper reviews the literature on severity in the context of economic evaluation, with the aim of establishing the extent to which popular preferences concerning severity imply a departure from the health maximisation objective.

Methods:
Data were obtained using a keyword search of major databases and a hand search of articles written by leading researchers in the subject area.

Results:
The empirical evidence suggests that people are, on the whole, willing to sacrifice aggregate health in order to give priority to the severely ill. However, there remain unresolved issues regarding the elicitation and interpretation of severity preferences (and indeed popular preferences generally).

Conclusions:
The use of severity as a priority setting criterion is supported by a large number of empirical studies of popular preferences. Further work is needed, however, to accurately estimate the strength of this support.

Contents

1. Introduction

2. Materials and methods
3. Results

3.1. How severity is defined in the literature?

3.2. Empirical evidence on popular preferences

4. Discussion .

4.1. Question framing and study design

4.2. Interval scale properties

4.3. Pre-treatment severity vs. other concerns

4.4. Whose preferences should be used?

5. Conclusion

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[EQ] Methods for assessing the cost-effectiveness of public health interventions

Methods for assessing the cost-effectiveness of public health interventions:
Key challenges and recommendations

Helen Weatherly a, Michael Drummond a, Karl Claxton a,b, Richard Cookson c, Brian Ferguson d, Christine Godfrey e, Nigel Rice a, Mark Sculpher a, Amanda Sowden f

a Centre for Health Economics, University of York, United Kingdom

b Department of Economics and Related Studies, University of York, United Kingdom

c Department of Social Policy and Social Work, University of York, United Kingdom

d Yorkshire and Humber Public Health Observatory, United Kingdom

e Department of Health Sciences, University of York, United Kingdom

f Centre for Reviews and Dissemination, University of York, United Kingdom

Health Policy 93 (2009) 85–92

Website: http://www.sciencedirect.com/science/journal/01688510

Journal homepage: www.elsevier.com/locate/healthpol

Rationale:
Increasing attention is being given to the evaluation of public health interventions. Methods for the economic evaluation of clinical interventions are well established. In contrast, the economic evaluation of public health interventions raises additional methodological challenges. The paper identifies these challenges and provides suggestions for overcoming them.

Methods:
To identify the methodological challenges, five reviews that explored the economics of public health were consulted. From these, four main methodological challenges for the economic evaluation of public health interventions were identified. A review of empirical studies was conducted to explore how the methodological challenges had been approached in practice and an expert workshop convened to discuss how they could be tackled in the future.

Results: The empirical review confirmed that the four methodological challenges were important. In all, 154 empirical studies were identified, covering areas as diverse as alcohol, drug use, obesity and physical activity, and smoking. However, the four methodological challenges were handled badly, or ignored in most of the studies reviewed.

Discussion:
The empirical review offered few insights into ways of addressing the methodological challenges. The expert workshop suggested a number of ways forward for

overcoming the methodological challenges.

Conclusion:
Although the existing empirical literature offers few insights on how to respond to these challenges, expert opinion suggests a number of ways forward. Much of what is suggested here has not yet been applied in practice, and there is an urgent need both for pilot studies and more methodological research

Contents

1. Introduction

2. Methods

2.1. Key methodological challenges

2.1.1. Attribution of effects .

2.1.2. Measuring and valuing outcomes
2.1.3. Identifying intersectoral costs and consequences.

2.1.4. Incorporating equity considerations .
2.2. Review of empirical studies

2.3. Inclusion criteria

2.4. Data extraction
2.5. Review of findings

3.Results

3.1. Attribution of effects.
3.2. Measuring and valuing outcomes
3.3. Intersectoral costs and consequences . .
3.4. Equity considerations.

4. Discussion

4.1. Attribution of effects

4.2. Measuring and valuing outcomes

4.3. Intersectoral costs and consequences .

4.4. Equity considerations

5. Conclusions

References

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[EQ] Pandemic Influenza as 21st Century Urban Public Health Crisis

Pandemic Influenza as 21st Century Urban Public Health Crisis

David M. Bell, Isaac B. Weisfuse, Mauricio Hernandez-Avila, Carlos del Rio, Xinia Bustamante, and Guenael Rodier

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (D.M. Bell); New York City Department of Health and Mental Hygiene, New York, New York, USA (I.B. Weisfuse); Ministry of Health of Mexico, Mexico City, Mexico (M. Hernandez-Avila); Emory University Rollins School of Public Health, Atlanta (C. del Rio); Pan American Health Organization, San Jose, Costa Rica (X. Bustamante); and World Health Organization, Geneva, Switzerland (G. Rodier)

Emerg Infect Dis. 2009 December

Available online PDF [14p.] at: http://www.cdc.gov/eid/content/15/12/pdfs/09-1232.pdf

“…….The percentage of the world’s population living in urban areas will increase from 50% in 2008 to 70% (4.9 billion) in 2025. Crowded urban areas in developing and industrialized countries are uniquely vulnerable to public health crises and face daunting challenges in surveillance, response, and public communication.

The revised International Health Regulations require all countries to have core surveillance and response capacity by 2012. Innovative approaches are needed because traditional local-level strategies may not be easily scalable upward to meet the needs of huge, densely populated cities, especially in developing countries.

The responses of Mexico City and New York City to the initial appearance of influenza A pandemic (H1N1) 2009 virus during spring 2009 illustrate some of the new challenges and creative response strategies that will increasingly be needed in cities worldwide……”

“….According to United Nations estimates, the percentage of the world’s population living in urban areas will increase from 50% in 2008 to 70% (4.9 billion persons) in 2025. During 2007–2025, the number of cities with population 1–5 million will increase from 382 to 524, and the number of megacities (>10 million population, comprising the core city, suburbs, and continuously settled commuter areas) will increase from 19 to 27. Of the 27 megacities, 16 will be in Asia, 4 in Latin America, 3 in Africa, 2 in Europe, and 2 in North America…”

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