| 11. |
- Johannesson, Magnus, et al.
(författare)
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On the decision rules of cost-effectiveness analysis
- 1993
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Ingår i: Journal of health economics. - : Elsevier B.V. - 1879-1646 .- 0167-6296. ; 12:4, s. 459-467
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Tidskriftsartikel (refereegranskat)abstract
- Birch and Gafni (1992) claim in a recent article that the decision rules of cost-effectiveness/utility analysis (CEA) fail to achieve their stated objectives, namely the maximization of health gains for a given amount of resources. This critique includes the following objections to CEA: First, they argue that CEA does not guarantee improvements in social welfare in situations where multiple health objectives exist (e.g., survival and functional status). Second, they argue that CEA does not consider the health gains forgone by reallocating resources from existing programs to fund new programs. Third, they argue that incremental CEA can lead to inefficient resource allocation when there are alternative levels of programs which compete for budgetary resources. Finally, they argue that the decision rules of CEA are incorrect in the presence of program indivisibilities, and that integer programming techniques are needed. These arguments are illustrated by using hypothetical examples. The analysis by Birch and Gafni is critically examined in this paper. First, we review the optimal decision rules in cost-effectiveness analysis. Second, we show that most of the objections to CEA raised by Birch and Gafni in their examples have no basis if CEA is used in an appropriate way. In fact, they are led to misleading conclusions because they fail to interpret the incremental cost-effectiveness ratios in their examples properly. The inconsistent results in their analysis arise due to (1) their failure to recognize the basis of QALYs as a measure of social welfare; (2) their failure to distinguish between optimal decision rules for independent programs versus mutually exclusive programs; and (3) their failure to exclude dominated alternatives from consideration in analysis of competing programs. Third, we address the valid but well-known point about program indivisibilities. We end with some concluding remarks.
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| 12. |
- Johannesson, Magnus
(författare)
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On the Discounting of Gained life-Years in Cost-Effectiveness Analysis
- 1992
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Ingår i: International journal of technology assessment in health care. - : Cambridge University Press. - 1471-6348 .- 0266-4623. ; 8:2, s. 359-364
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Tidskriftsartikel (refereegranskat)abstract
- A controversial issue in cost-effectiveness analysis is the discounting of gained life-years. What has not been realized, however, is that the different methods used for discounting this measurement provide fundamentally different results. The method used is seldom explicitly stated. In the present article the four main methods for the discounting of gained life-years are reviewed and compared. The conclusion is that if we wish to continue comparing results, researchers must employ the same methodology.
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| 13. |
- Johannesson, Magnus
(författare)
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QALYs, HYEs and individual preferences— A graphical illustration
- 1994
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Ingår i: Social science & medicine (1982). - : Elsevier Ltd. - 1873-5347 .- 0277-9536. ; 39:12, s. 1623-1632
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Tidskriftsartikel (refereegranskat)abstract
- The choice of outcome measure in cost-utility analysis has been a matter of concern. In particular the theoretical properties of quality-adjusted life-years (QALYs) and healthy-years equivalents (HYEs) have been debated. In this paper the underlying preference assumptions of QALYs and HYEs are illustrated graphically. For QALYs the assumptions of mutual utility independence, constant proportional trade-off, and risk neutrality are explained and illustrated. Mutual utility independence is shown to guarantee that the quality weight with the standard gamble method is independent of the number of years in the health state and constant proportional trade-off is shown to guarantee that the quality weight with the time-trade-off method is independent of the number of years in the health state. Together these two assumptions leads to a utility function over life-years that exhibits constant proportional risk posture, which is the basis for the risk-adjusted QALY model. The more commonly used risk-neutral QALY model is shown to be a valid cardinal utility function if risk neutrality over life-years holds for all health states. For HYEs to be a valid cardinal utility function the somewhat less restrictive assumption of risk neutrality over life-years in full health has to be made. It is also shown graphically that the proposed two-stage procedure to measure HYEs in theory gives the same result as directly using the time-trade-off method. Finally, it is shown that by estimating the certainty-equivalent number of HYEs it is possible in theory to obtain a measure that will always rank risky health profiles according to individual preferences. It is concluded that further empirical work should be undertaken to test the ranking properties of the different measures.
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| 14. |
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| 15. |
- Johannesson, Magnus
(författare)
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The Concept of Cost in the Economic Evaluation of Health Care: A Theoretical Inquiry
- 1994
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Ingår i: International journal of technology assessment in health care. - : Cambridge University Press. - 1471-6348 .- 0266-4623. ; 10:4, s. 675-682
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Tidskriftsartikel (refereegranskat)abstract
- The costs included in economic evaluations of health care vary from study to study. Based on the theory of cost-benefit analysis, the costs that should be included in an economic evaluation are those not already included in the measurement of willingness to pay (net willingness to pay above any treatment costs paid by the individual) in a cost-benefit analysis or in the easurement of effectiveness in a cost-effectiveness analysis. These costs can be defined as the onsumption externality of the treatment (the change in production minus consumption for those included in the treatment program). For a full economic evaluation, the consequences for those included in the treatment program and a caring externality (altruism) should also be added.
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| 16. |
- Johannesson, Magnus
(författare)
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The contingent valuation method-appraising the appraisers
- 1993
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Ingår i: Health economics. - : Wiley Subscription Services, Inc., A Wiley Company. - 1099-1050 .- 1057-9230. ; 2:4, s. 357-359
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Tidskriftsartikel (refereegranskat)abstract
- Morrison & Gyldmark (MG)1 in a recent issue of health economics reviewed the use of the contingent valuation (CV) method of measuring willingness to pay in the health area. Although it is useful to examine the appropriate role of the CV method in the health care field, the appraisal by MG has a number of limitations which are pointed out in this paper. These relate to some inaccuracies in the review of the literature, the limited nature of the criteria proposed by MG to evaluate CV studies, and finally I argue that the comparison between CV, QALYs, and HYEs is premature and confuses rather than clarifies the debate.
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| 17. |
- Johannesson, Magnus
(författare)
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The cost-effectiveness of the switch towards more expensive antihypertensive drugs
- 1994
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 28:1, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- A switch from treatment with diuretics and beta-blockers to treatment with the more expensive ACE-inhibitors and calcium-antagonists has been noted in the hypertension field. The aim of this paper was to analyse the cost-effectiveness of this switch towards more expensive antihypertensive drugs in Sweden. The upper limit of the cost-effectiveness of ACE-inhibitors and calcium-antagonists compared with diuretics and beta-blockers was estimated by assuming that ACE-inhibitors and calcium-antagonists achieve the epidemiologically expected risk reduction for coronary heart disease. The incremental cost per life-year gained varies between ∼ SEK 50 000 and ∼ SEK 6 000 000 ($1 = SEK 6) in the different patient groups analysed. It is concluded that ACE-inhibitors and calcium-antagonists may be potentially cost-effective in some patient groups at a high risk of coronary heart disease. Since an improved risk reduction has not been demonstrated in clinical trials, however, ACE-inhibitors and calcium-antagonists cannot at present be recommended for hypertension treatment in any patient groups unless treatment with diuretics and beta-blockers is contraindicated.
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| 18. |
- Johannesson, Magnus
(författare)
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The Impact of Age on the Cost - Effectiveness of Hypertension Treatment : An Analysis of Randomized Drug Trials
- 1994
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Ingår i: Medical decision making. - 1552-681X .- 0272-989X. ; 14:3, s. 236-244
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate whether any consistent pattern exists with respect to the cost-effectiveness of hypertension treatment and age, based on the results of ran domized drug trials. Data about age, entry diastolic blood pressure, and relative risks of coronary heart disease (CHD) and stroke from 19 randomized trials were used to derive point estimates of the cost-effectiveness of each trial. The relationship between age and cost per life-year gained was then estimated by regression analysis, controlling for entry diastolic blood pressure. The regression analysis shows a statistically significant average decrease in the cost per life-year gained of about SEK 15,000 per year of older age for both men and women ($1 = SEK 6). Sensitivity analysis showed that the improvement in cost- effectiveness with age was stable towards various assumptions, but that the magnitude of the improvement varied greatly with the discount rate. Based on the results of randomized drug trials, it is concluded that the cost-effectiveness of hypertension treatment improves with patient age for both men and women. Key words: hypertension; drug treatment; cost- effectiveness; age; economic evaluation. (Med Decis Making 1994;14:236-244)
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| 19. |
- Johannesson, Magnus, et al.
(författare)
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Willingness to pay for antihypertensive therapy - further results
- 1993
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Ingår i: Journal of health economics. - 1879-1646 .- 0167-6296. ; 12:1, s. 95-108
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Tidskriftsartikel (refereegranskat)abstract
- A measurement experiment regarding willingness to pay for antihypertensive therapy is reported. A new type of binary willingness to pay question is used, that allows for different degrees of certainty with respect to the responses. Mean willingness to pay is derived from a simple expected utility model and estimated using maximum likelihood methods. The estimated parameters are highly significant, with predicted signs, and imply a mean willingness to pay of about SEK 800 ($130) per month. The explanatory power of the equation that only includes 'certain' yes/no responses is, as expected, much higher than that of the equation where only 'uncertain' responses are included.
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| 20. |
- Johannesson, Magnus, et al.
(författare)
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Willingness to pay for lipid lowering: a health production function approach
- 1993
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Ingår i: Applied economics. - : Chapman & Hall Ltd. - 1466-4283 .- 0003-6846. ; 25:8, s. 1023-1031
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Tidskriftsartikel (refereegranskat)abstract
- This Paper reports the results of an experiment of measuring willingness to pay (WTP) for lipid lowering. WTP is derived from a theoretical model of health risk reductions, using a health production function approach. A survey of about 700 persons randomized into a lipid lowering trial in Sweden is used to estimate WTP. The willingness to give up time (WTGT) to take part in a lipid lowering programme is also measured in the survey, to assess its relationship to WTP. The response rates on the WTP and WTGT qusetions are 94% and 96%, respectively, and the patients are on average perpared to pay about Skr 350 per month or devote about 5 h of leisure time per week to get normal lipid levels. The Correlation of WTP and WTGT is 0.45 and highly significant. The results of regression of WTP and WTGT are in accordance with the theoretical predictions with a higher valuation for a greater perceived difference in health status with and without treatment. The income elasticity is also positive as expected.
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