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"Normand, Charles E. M"
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Health Economics
Health Economics: An International Perspective is the only textbook to provide a truly international, comparative treatment of health economics. Offering an analysis of health systems across borders, the fourth edition of this key text has been updated and revised to take account of changes in a host of countries.
This edition features an expanded introduction, providing better grounding for many of the examples that come in subsequent chapters and making it easier for non-health care experts to see the links between the theory, the examples and the health care system components. It also boasts a restructured format, dividing the book into two broad sections: the first focuses on ideas and principles, along with evidence on their applications in the health sector, whereas the second focuses on introducing core tools and techniques used in applied health economics research.
Further updates to this edition include:
two new chapters on applied econometrics;
a new chapter on equity, focusing on equity in access to health care, paying particular attention to how access and need for health care are defined and measured in applied research;
a new chapter on emerging issues for health systems that are emanating from a series of global transitions both within (e.g. demographic change, epidemiological change, the global resolution on universal health coverage) and without the health sector (e.g. economic transitions).
Throughout the text, examples and illustrations are taken from a wide range of settings and world regions, providing a unique overview of the performance of different health systems.
eBook
Nitric oxide is not licensed for preterm neonates
INNOVO (neonatal ventilation with inhaled nitric oxide versus ventilatory support without inhaled nitric oxide for severe respiratory failure) is an international randomised controlled trial funded by the Medical Research Council to investigate the clinical effectiveness and cost effectiveness of inhaled nitric oxide compared with conventional ventilatory care for preterm and for \"mature\" neonates with severe respiratory failure.
Journal Article
Using predicted length of stay to define treatment and model costs in hospitalized adults with serious illness: an evaluation of palliative care
BackgroundEconomic research on hospital palliative care faces major challenges. Observational studies using routine data encounter difficulties because treatment timing is not under investigator control and unobserved patient complexity is endemic. An individual’s predicted LOS at admission offers potential advantages in this context.MethodsWe conducted a retrospective cohort study on adults admitted to a large cancer center in the United States between 2009 and 2015. We defined a derivation sample to estimate predicted LOS using baseline factors (N = 16,425) and an analytic sample for our primary analyses (N = 2674) based on diagnosis of a terminal illness and high risk of hospital mortality. We modelled our treatment variable according to the timing of first palliative care interaction as a function of predicted LOS, and we employed predicted LOS as an additional covariate in regression as a proxy for complexity alongside diagnosis and comorbidity index. We evaluated models based on predictive accuracy in and out of sample, on Akaike and Bayesian Information Criteria, and precision of treatment effect estimate.ResultsOur approach using an additional covariate yielded major improvement in model accuracy: R2 increased from 0.14 to 0.23, and model performance also improved on predictive accuracy and information criteria. Treatment effect estimates and conclusions were unaffected. Our approach with respect to treatment variable yielded no substantial improvements in model performance, but post hoc analyses show an association between treatment effect estimate and estimated LOS at baseline.ConclusionAllocation of scarce palliative care capacity and value-based reimbursement models should take into consideration when and for whom the intervention has the largest impact on treatment choices. An individual’s predicted LOS at baseline is useful in this context for accurately predicting costs, and potentially has further benefits in modelling treatment effects.
Journal Article
Health, Health Care, and Health Economics: Perspectives on Distribution
Health, Health Care, and Health Economics: Perspectives on Distribution, edited by M. L. Barer, T. E. Getzen and G. L. Stoddart, is reviewed.
Book Review
Variation in carbon and nitrogen concentrations among peatland categories at the global scale
Peatlands account for 15 to 30% of the world’s soil carbon (C) stock and are important controls over global nitrogen (N) cycles. However, C and N concentrations are known to vary among peatlands contributing to the uncertainty of global C inventories, but there are few global studies that relate peatland classification to peat chemistry. We analyzed 436 peat cores sampled in 24 countries across six continents and measured C, N, and organic matter (OM) content at three depths down to 70 cm. Sites were distinguished between northern (387) and tropical (49) peatlands and assigned to one of six distinct broadly recognized peatland categories that vary primarily along a pH gradient. Peat C and N concentrations, OM content, and C:N ratios differed significantly among peatland categories, but few differences in chemistry with depth were found within each category. Across all peatlands C and N concentrations in the 10–20 cm layer, were 440 ± 85.1 g kg -1 and 13.9 ± 7.4 g kg -1 , with an average C:N ratio of 30.1 ± 20.8. Among peatland categories, median C concentrations were highest in bogs, poor fens and tropical swamps (446–532 g kg -1 ) and lowest in intermediate and extremely rich fens (375–414 g kg -1 ). The C:OM ratio in peat was similar across most peatland categories, except in deeper samples from ombrotrophic tropical peat swamps that were higher than other peatlands categories. Peat N concentrations and C:N ratios varied approximately two-fold among peatland categories and N concentrations tended to be higher (and C:N lower) in intermediate fens compared with other peatland types. This study reports on a unique data set and demonstrates that differences in peat C and OM concentrations among broadly classified peatland categories are predictable, which can aid future studies that use land cover assessments to refine global peatland C and N stocks.
Journal Article
Motivations and experiences of patients with respiratory disease and their caregivers in a multinational trial of mirtazapine for severe breathlessness: a qualitative study (BETTER-B)
Background
Drug repurposing offers advantages over traditional drug development, such as shorter time and reduced costs. Understanding patient and caregiver perspectives on repurposed medicines is crucial to improving clinical trial design and conduct, especially in advanced disease. We carried out this study in the UK and Italy to explore the experiences and motivations of patients with respiratory diseases and their caregivers who participated in a trial investigating the repurposing of the antidepressant mirtazapine to alleviate severe breathlessness.
Methods
Qualitative study nested within a double-blind, placebo-controlled, randomised trial (BETTER-B: BETter TreatmEnts for Refractory Breathlessness). Purposive sampling ensured diversity in age and gender. Framework analysis was applied. Interviewed participants had Chronic Obstructive Pulmonary Disease (COPD) or Interstitial Lung Disease (ILD), experienced limiting breathlessness (grade 3 or 4 of the modified Medical Research Council breathlessness scale) and had participated in the trial.
Results
Twenty-three patients (13 men and 10 women) and eight caregivers (4 men and 4 women) were interviewed. Of patients (15 COPD, 8 ILD), 22 had completed the trial and one had withdrawn due to adverse effects. Interviews were conducted at home or via the telephone. Two main themes were derived: (1) 'knowledge and views about antidepressants and its use’ and (2) ‘experience and views on joining the trial’. The patients’ perceived need for relief from severe breathlessness and its impact outweighed any concerns about taking an antidepressant. Motivations for trial participation included the potential for benefit, altruism, trust in the healthcare system, and the strength of relationships between patients and healthcare professionals.
Conclusions
Participants willing to accept mirtazapine repurposed for another indication joined this trial regardless of their existing concerns about antidepressants. A clear explanation of trials and possible benefits, plus trust in professionals and the healthcare system, are instrumental in increasing trial participation for repurposed medicines.
Trial registration
ISRCTN Registry, ISRCTN10487976. Prospectively Registered on 19 November 2019.
Journal Article