nep-hea New Economics Papers
on Health Economics
Issue of 2018‒07‒23
twenty-one papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Incidence of Soft-Drink Taxes on Consumer Prices and Welfare: Evidence from the French " Soda Tax" By Fabrice Etilé; Sebastien Lecocq; Christine Boizot-Szantai
  2. Nutrition in Interwar Britain: A Possible Resolution of the Healthy or Hungry 1930s Debate? By Gazeley, Ian; Newell, Andrew T.; Reynolds, Kevin; Rufrancos, Hector Gutierrez
  3. Time Trends Matter: The Case of Medical Cannabis Laws and Opioid Overdose Mortality By Pohl, R. Vincent
  4. Medical marijuana laws and mental health in the United States By Kalbfuß, Jörg; Odermatt, Reto; Stutzer, Alois
  5. The value of extending life at its end: Health care allocation in the presence of learning spillovers By Hintermann, Beat; Minke, Matthias
  6. Education, Intelligence and Diseases in Old Age By Niccodemi, Gianmaria; Bijwaard, Govert
  7. Estimating Survival Times Using Swiss Hospital Data By Kuhlmey, Florian; Minke, Matthias
  8. Retirement and Unexpected Health Shocks By Bénédicte H. Apouey; Cahit Guven; Claudia Senik
  9. Closing Down the Shop: Optimal Health and Wealth Dynamics Near the End of Life By Julien Hugonnier; Florian Pelgrin; Pascal St-Amour
  10. A Theory of Reverse Retirement By Grégory Ponthière
  11. Uncertain altruism and non-linear long-term care policies By Canta, Chiara; Cremer, Helmuth
  12. Nursing Homes'Competition and Distributional Implications when the Market is Two-Sided By Bardey, David; Siciliani, Luigi
  13. Health Shocks, Human Capital, and Labor Market Outcomes By Parro, Francisco; Pohl, R. Vincent
  14. On the Design of Optimal Health Insurance Contracts under Ex Post Moral Hazard By Pierre Martinon; Pierre Picard; Anasuya Raj
  15. Does Sick Pay Affect Workplace Absence? By Alex Bryson; Harald Dale-Olsen
  16. The Impact of Universal Child Benefits on Family Health and Behaviours By LEBIHAN, Laetitia; MAO TAKONGMO, Charles Olivier
  17. Ownership and Hospital Behaviour: Employment and Local Unemployment By Andrew E. Clark; Carine Milcent
  18. Impact of Diagnosis Related Group Refinement on the Choice Between Scheduled Caesarean Section and Normal Delivery: Recent Evidence from France By Aleksandr Proshin; Alexandre Cazenave-Lacroutz; Zeynep Or; Lise Rochaix
  19. Of Mice and Merchants: Trade and Growth in the Iron Age By Jan David Bakker; Stephan Maurer; Jörn-Steffen Pischke; Ferdinand Rauch
  20. Comprehensive economic evaluation of thermotherapy for the treatment of cutaneous leishmaniasis in Colombia By Mery Patricia Tamayo; Jaiberth Antonio Cardona-Arias; Liliana López Carvajal; Iván Darío Vélez
  21. Cost-effectiveness analysis of thermotherapy versus pentava-lent antimonials for the treatment of cutaneous leishmaniasis By Mery Patricia Tamayo; Jaiberth Antonio Cardona-Arias; Liliana López Carvajal; Iván Darío Vélez

  1. By: Fabrice Etilé (PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, PSE - Paris School of Economics, ALISS - Alimentation et sciences sociales - INRA - Institut National de la Recherche Agronomique); Sebastien Lecocq (ALISS - Alimentation et sciences sociales - INRA - Institut National de la Recherche Agronomique); Christine Boizot-Szantai (ALISS - Alimentation et sciences sociales - INRA - Institut National de la Recherche Agronomique)
    Abstract: The behavioural impact and acceptability of soft-drink taxes depend crucially on their incidence on consumer prices and welfare across socio-economic groups and markets. We use KantarWorldpanel homescan data to analyse the incidence of the 2012 French soda tax on Exact Price Indices (EPI) measuring consumer welfare from the availability and consumption of Sugar-Sweetened Beverages (SSB) and Non-Calorically Sweetened Beverages (NCSB) at a local geographical level. The soda tax has had significant, similar but small impacts on the EPI of SSB and NCSB (+4%), corresponding to an aggregate pass-through of about 40%. Tax incidence was slightly higher for low-income and high-consuming households. Retailers set higher pass-throughs in low-income, less-competitive and smaller markets. They did not change their product assortments. The lack of horizontal competition in low-income markets had a sizeable effect on tax regressivity. Finally, the negative income gradient in tax incidence was offset by a positive gradient in expected health benefits.
    Keywords: Market structure,Tax incidence,Soft drink,Exact price index,Regressivity
    Date: 2018–06
  2. By: Gazeley, Ian (University of Sussex); Newell, Andrew T. (University of Sussex); Reynolds, Kevin (University of Brighton); Rufrancos, Hector Gutierrez (University of Stirling)
    Abstract: This paper re-examines energy and nutritional available to British working-class households in the 1930s using the individual household expenditure and consumption data derived from the 1937/8 Ministry of Labour household expenditure survey and the 1938/9 individual dietary data collected by the Rowett Research Institute. We conclude that for working households, energy and nutritional availability improved significantly compared with current estimates of availability before the First World War. For unemployed headed households, and female headed households in employment, the situation was much worse with energy and nutritional availability at similar levels to households that would be described as destitute at the turn of the Twentieth Century. Finally, we examine the impact of state interventions to improve diet and nutrition and conclude that these made a difference, but other than the case of calcium, they did not represent a decisive intervention, as many households in receipt of free school meals and milk did not have sufficient nutrients available in their diets to meet modern dietary standards.
    Keywords: nutrition, Britain, 1930s, working class
    JEL: I30 N34
    Date: 2018–06
  3. By: Pohl, R. Vincent
    Abstract: Mortality due to opioid overdoses has been growing rapidly in the U.S., with some states experiencing much steeper increases than others. Legalizing medical cannabis could reduce opioid-related mortality if potential opioid users substitute towards cannabis as a safer alternative. I show, however, that a substantial reduction in opioid-related mortality associated with the implementation of medical cannabis laws can be explained by selection bias. States that legalized medical cannabis exhibit lower pre-existing mortality trends. Accordingly, the mitigating effect of medical cannabis laws on opioid-related mortality vanishes when I include state-specific time trends in state-year-level difference-in-differences regressions.
    Keywords: medical cannabis laws, opioid overdose mortality, difference-in-differences, group-specific time trends
    JEL: C23 I12 I18 K32
    Date: 2028–06–06
  4. By: Kalbfuß, Jörg; Odermatt, Reto; Stutzer, Alois
    Abstract: The consequences of legal access to medical marijuana for individual welfare are a matter of controversy. We contribute to the ongoing discussion by evaluating the impact of the staggered introduction and extension of medical marijuana laws across US states on self-reported mental health. Our main analysis is based on BRFSS survey data from more than six million respondents between 1993 and 2015. On average, we find that medical marijuana laws lead to a reduction in the self-reported number of days with mental health problems. Reductions are largest for individuals with high propensities to consume marijuana for medical purposes and people who are likely to suffer from chronic pain. Moreover, the introduction of prescription drug monitoring programs lead to a reduction in bad mental health days only in states that allow medical marijuana.
    Keywords: medical marijuana laws; cannabis regulation; mental health; chronic pain; prescription drug monitoring
    JEL: H75 I12 I18 I31 K42
    Date: 2018–05–01
  5. By: Hintermann, Beat (University of Basel); Minke, Matthias (University of Basel)
    Abstract: We investigate the social value of medical interventions at the end of life that tend to have a high cost-benefit ratio. We model the optimal allocation of health resources across a continuum of diseases that dier by severity and treatment options, and extend it to allow for learning spillovers between treatments. We calibrate our model to admissions to intensive care units in Switzerland. Cancer treatments associated with learning spillovers that decrease the mortality for non-cancer patients by 1 percentage point justify a costbenefit ratio per additional life-year of 1.78.
    Keywords: End of life; allocation of health resources; learning spillovers
    JEL: I10
    Date: 2018–06–05
  6. By: Niccodemi, Gianmaria (University of Groningen); Bijwaard, Govert (NIDI - Netherlands Interdisciplinary Demographic Institute)
    Abstract: Several studies have found a positive association between education and health. Confounding factors that a ect both education choices and health, such as (ob- served) parental background and (unobserved) intelligence, may play an important role in shaping this association. In this paper we estimate the impact of education on diseases in old age, accounting for this endogeneity. Our estimates are based on administrative data on men born in 1944–1947, who were examined for military service in the Netherlands between 1961–1965, linked to national death and medication use records. We assume medication use identifies diseases. We estimate a structural model, consisting of (i) an ordered probit model for the educational attainment, (ii) a Gompertz mortality model for survival up to old age, (iii) a probit model for medication use in old age and, (iv) a measurement system using IQ tests to identify latent intelligence. Educational choices, surviving up to old age and medication use all depend on observed individual factors and on latent intelligence. Based on the estimation results, we derive the impact of education on diseases in old age. Our empirical results reveal a strong effect of education on physical diseases, but low or no effect of education on depression and anxiety.
    Keywords: educational inequality, intelligence, medication use, structural equation model
    JEL: I14 I24 C35 C38
    Date: 2018–06
  7. By: Kuhlmey, Florian (University of Basel); Minke, Matthias (University of Basel)
    Abstract: We compare and evaluate two different approaches to estimate overall survival curvesfrom censored data of recurrent events: (1) standard survival time analysis, and (2) a multistate framework that explicitly estimates the mortality rate during censored periods. With both models, we estimate disease-specific survival curves with data from the Swiss Federal Statistical Office's medical statistics on hospitals (MedStat). Using cancer registry data as a benchmark for overall survival, we find that the accuracy of survival time estimates based on the multistate model are not superior to the simpler single-risk model. Although the computationally demanding multistate model is less accurate in predicting survival times, it may nevertheless be useful if intermediate transitions are the targeted issues.
    Keywords: Survival analysis; multistate-model; data simulation; hospital discharge data
    JEL: C41 C53 I12
    Date: 2018–06–08
  8. By: Bénédicte H. Apouey (PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, PSE - Paris School of Economics); Cahit Guven (Deakin University - Minister for Innovation, Industry, Science and Research); Claudia Senik (PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, UP4 - Université Paris-Sorbonne)
    Abstract: Is retirement good for your health? This article explores the impact of retirement on unexpected health evolutions. Using data from the annual Household, Income and Labour Dynamics in Australia survey (2001-2014), we construct measures of the mismatch between each person's expected and actual health evolution (hereafter, "health shocks"). We find that after retirement, the probability of negative shocks decreases and the likelihood of positive health shocks increases, for both genders. These shocks translate into variations of life satisfaction in the same direction (i.e. unexpected positive health shocks increase life satisfaction). Other indicators of mental and physical health taken from the SF-36 vary in the same way, i.e. improve unexpectedly after retirement. By definition, health shocks are immune to the problem of reverse causality that could run from health to retirement. Hence, our findings are consistent with a positive impact of retirement on health.
    Keywords: Australia,HILDA,Health,Retirement,Health Shocks,Life Satisfaction
    Date: 2018–05
  9. By: Julien Hugonnier (Ecole Polytechnique Fédérale de Lausanne and Swiss Finance Institute); Florian Pelgrin (EDHEC Business School); Pascal St-Amour (University of Lausanne and Swiss Finance Institute)
    Abstract: Near the end of life, health declines, mortality risk increases and curative is replaced by uninsured long-term care, accelerating the fall in wealth. Whereas standard explanations emphasize inevitable aging processes, we propose a com- plementary closing down the shop justification where agents’ decisions affect their health and the timing of death. Despite preferring to live, individuals optimally deplete their health and wealth towards levels associated with high death risk and indifference between life and death. Reinstating exogenous aging processes reinforces the relevance of closing down. Using HRS data for elders, a structural estimation of the closed-form decisions identifies and tests conditions for these strategies to be optimal and confirm their economic relevance. We also discuss why policy intervention to reduce the incidence of closing down, although feasible, is not warranted.
    Keywords: End of life; Life cycle; Dis-savings; Endogenous mortality risk; Unmet medical needs; Right to refuse treatment
    JEL: I12
    Date: 2017–03
  10. By: Grégory Ponthière (PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, ERUDITE - Equipe de Recherche sur l’Utilisation des Données Individuelles en lien avec la Théorie Economique - UPEM - Université Paris-Est Marne-la-Vallée - UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12)
    Abstract: The retirement system is usually regarded as giving a fair reward for a long life of labor. However, the fairness of that system can be questioned, on the grounds that only workers who have a su¢ ciently long life benefit from that reward, but not workers who die prematurely. In order to reexamine the fairness of retirement systems under unequal lifetime, this paper compares standard retirement (i.e. individuals work before being retired) with - purely hypothetical - reverse retirement (i.e. individuals are retired before working). We first show that, whereas reverse retirement cannot be a social optimum under the utilitarian criterion (unlike standard retirement), reverse retirement can be optimal under the ex post egalitarian criterion (giving priority to the worst-o¤ in realized terms). From an ex post egalitarian perspective, reverse retirement dominates standard retirement in economies with high life expectancy and a flat age-productivity profile, whereas the opposite holds in less developed economies.
    Keywords: mortality,fairness,retirement,life cycle
    Date: 2018–05
  11. By: Canta, Chiara; Cremer, Helmuth
    Abstract: We study the design of public long-term care (LTC) insurance when the altruism of informal caregivers is uncertain. We consider non-linear policies where the LTC benefit depends on the level of informal care, which is assumed to be observable while children's altruism is not. The traditional topping up and opting out policies are special cases of ours. Both total and informal care should increase with the children's level of altruism. This obtains under full and asymmetric information. Social LTC, on the other hand, may be non-monotonic. Under asymmetric information, social LTC is lower than its full information level for the lowest level of altruism, while it is distorted upward for the higher level of altruism. This is explained by the need to provide incentives to high-altruism children. The implementing contract is always such that social care increases with formal care.
    Keywords: long term care; opting out; private insurance; public insurance; topping up; uncertain altruism
    JEL: H2 H5
    Date: 2018–06
  12. By: Bardey, David; Siciliani, Luigi
    Abstract: We investigate the effect of competition in the nursing homes sector with a two-sided market approach. More precisely, we investigate the distributional implications across the three key actors involved (residents, nurses and nursing homes) that arise from the two- sidedness of the market. Within a Hotelling set up, nursing homes compete for residents and for nurses, who provide quality to residents, by setting residents price and nurses wage. Nurses are assumed altruistic and therefore motivated to provide quality. The market is two- sided because: i) a higher number of residents a¤ects nurses workload, which affects their willingness to provide labour supply; and ii) a higher number of nurses affects residents? quality through a better matching process and by relaxing nurses time constraints. Our key findings are that i) the two-sidedness of the market leads to higher wages for nurses, which makes the nurses better off; ii) this is then passed to residents in the form of higher prices, which makes residents worse off; iii) nursing homes profits are instead unaffected. In contrast, when nurses wages are regulated, the two-sidedness of the market implies a transfer between residents and nursing homes. When residents price are regulated, it implies a transfer between nurses and nursing homes. These results are robust to institutional settings which employ pay-for-performance schemes (that reward either nursing homes or nurses): the two-sidedness of the market is strengthened and residents are still worse off.
    Keywords: nursing homes; competition; two-sided markets; distribution
    JEL: I18
    Date: 2018–06
  13. By: Parro, Francisco; Pohl, R. Vincent
    Abstract: Health, human capital, and labor market outcomes are linked through complex connections that are not fully understood. We explore these links by estimating a flexible yet tractable dynamic model of human capital accumulation in the presence of health shocks using administrative data from Chile. We find that (i) human capital mitigates the negative labor market effects of health events, (ii) these alleviating effects operate through channels involving occupational choice, the frequency of exposure to health events, and access to health care, and (iii) the effect of health shocks on labor market outcomes is heterogeneous across industries and types of diagnoses.
    Keywords: health shocks, hospitalizations, labor market outcomes, earnings, human capital, education
    JEL: I10 J22 J24
    Date: 2018–06–01
  14. By: Pierre Martinon (Commands - Control, Optimization, Models, Methods and Applications for Nonlinear Dynamical Systems - CMAP - Centre de Mathématiques Appliquées - Ecole Polytechnique - X - École polytechnique - CNRS - Centre National de la Recherche Scientifique - Inria Saclay - Ile de France - Inria - Institut National de Recherche en Informatique et en Automatique - UMA - Unité de Mathématiques Appliquées - Univ. Paris-Saclay, ENSTA ParisTech - École Nationale Supérieure de Techniques Avancées - X - École polytechnique - CNRS - Centre National de la Recherche Scientifique); Pierre Picard (Département d'Économie de l'École Polytechnique - X - École polytechnique); Anasuya Raj (Département d'Économie de l'École Polytechnique - X - École polytechnique)
    Abstract: We analyze the design of optimal medical insurance under ex post moral haz- ard, i.e., when illness severity cannot be observed by insurers and policyholders decide for themselves on their health expenditures. The trade-o¤ between ex ante risk sharing and ex post incentive compatibility is analyzed in an optimal revelation mechanism under hidden information and risk aversion. The optimal contract provides partial insurance at the margin, with a deductible when in- surers' rates are affected by a positive loading, and it may also include an upper limit on coverage. The potential to audit the health state leads to an upper limit on out-of-pocket expenses.
    Keywords: optimal control,health insurance, ex post moral hazard, audit, background risk
    Date: 2018
  15. By: Alex Bryson (University College London, National Institute of Social and Economic Research and Institute for the Study of Labor); Harald Dale-Olsen (Institute for Social Research, Oslo)
    Abstract: Higher replacement rates often imply higher levels of absenteeism, yet even in generous welfare economies, private sick pay is provided in addition to the public sick pay. Why? Using comparative workplace data for the UK and Norway we show that the higher level of absenteeism in Norway compared to UK is related to the threshold in the Norwegian public sick pay legislation. This threshold's importance is confirmed in a Regression Kinked Design (RKD) analysis on the Norwegian micro-data. Private sick pay is provided as an employer-provided non-wage benefit and when training costs are high.
    Keywords: Absenteeism, Public sick pay, Private sick pay, Comparative
    JEL: H31 J22 J28 J32
    Date: 2017–11–15
  16. By: LEBIHAN, Laetitia; MAO TAKONGMO, Charles Olivier
    Abstract: In 2006, the Universal Child Care Benefit was introduced in Canada for all children aged less than 6 years. This program aims to help cover the cost of children and to provide financial assistance to families with young children in their choice of childcare. We exploit this policy change to estimate the effects of unconditional family cash transfers on the health and behaviours of two-parent families and their children. Using a difference-in-differences model, we find no evidence that the program improved child and parental outcomes in aggregate. A modest but fragile beneficial effect is found for low-education families and for girls.
    Keywords: Universal child benefits, health, well-being, behaviour.
    JEL: I10 J13 J18
    Date: 2018–06–01
  17. By: Andrew E. Clark (PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique); Carine Milcent (PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique)
    Abstract: In this paper, we address two issues: i) how hospital employment changes with local unemployment, according to the type of hospital ownership, and ii) whether this relationship changed after the implementation of a pro-competitive reform that made hospitals more similar. A 2006-2010 French panel of 1,695 hospitals over five waves allows us to consider within-hospital employment changes. We first find that higher local unemployment is associated with greater employment in State-owned hospitals, but not for any other hospital ownership type: French local authorities then seem to respond to depressed local labour markets by increasing employment in State-owned hospitals. After the full implementation of the pro-competitive reform hospital funding became based only on activity and no longer on some historical budget. Theoretically, the new reimbursement system should break the relationship between public-hospital employment and local unemployment. Our results reveal that the reform worked as expected in less-deprived areas: reducing employment and eliminating the correlation between local unemployment and State-owned hospital employment. However, in higher-unemployment areas, public-hospital employment remains 2 counter-cyclical. Poor local labour-market health then seems to trump financial incentives in determining employment in public hospitals.
    Keywords: France,Unemployment,Public Employment,Competition,Management,Hospitals
    Date: 2018–02
  18. By: Aleksandr Proshin; Alexandre Cazenave-Lacroutz; Zeynep Or (IRDES - Institut de Recherche et Documentation en Economie de la Santé - Institut de la Recherche et Documentation en Economie de la Santé); Lise Rochaix (PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, PSE - Paris School of Economics, Hospinomics - PSE - Paris School of Economics)
    Abstract: Studying quasi-experimental data from French hospitals from 2010 to 2013, we test the effects of a considerable diagnosis related group (DRG) refinement that occurred in 2012. As a result, the reform had a direct impact on hospital-level financial incentives but did not immediately concern individual providers. Using a difference-in-differences approach, controlling for multiple patient, hospital and regional characteristics and allowing for hospital and year effects, we show that introducing new severity levels and clinical factors into the reimbursement algorithm had no significant effect on the probability of a scheduled C-section being performed. The results are robust to multiple formulations of financial incentives, to restricting the sample to bigger (>15%) DRG tariff incentive changes and to analyzing policy effects for individual years following the reform. Our results suggest that the DRG refinement did not lead to a transmission of hospital-level stimuli to midwifes and obstetricians. Our paper is the first study that focuses on the consequences of DRG refinement in obstetrics and develops an approach suitable for measuring monetary incentives in this setting.
    Keywords: C-section,DRG,midwifes,obstetricians,refinement,tariffs,vaginal labor
    Date: 2018–06
  19. By: Jan David Bakker (University of Oxford and CEP); Stephan Maurer (University of Konstanz and CEP); Jörn-Steffen Pischke (LSE and CEP); Ferdinand Rauch (University of Oxford and CEP)
    Abstract: We study the causal connection between trade and development using one of the earliest massive trade expansions: the first systematic crossing of open seas in the Mediterranean during the time of the Phoenicians. We construct a measure of connectedness along the shores of the sea. This connectivity varies with the shape of the coast, the location of islands, and the distance to the opposing shore. We relate connectedness to local growth, which we measure using the presence of archaeological sites in an area. We find an association between better connected locations and archaeological sites during the Iron Age, at a time when sailors began to cross open water very routinely and on a big scale. We corroborate these findings at the level of the world.
    Keywords: Urbanization, locational fundamentals, trade
    JEL: F14 N7 O47
    Date: 2018–07–09
  20. By: Mery Patricia Tamayo; Jaiberth Antonio Cardona-Arias; Liliana López Carvajal; Iván Darío Vélez
    Abstract: Background: Cutaneous leishmaniasis causes a high disease burden in Colombia, and available treatments present systemic toxicity, low patient compliance, contraindications, and high costs. Objective: To estimate the cost-effectiveness of thermotherapy versus Glucantime in patients with cutaneous leishmaniasis in Colombia. Methods: Cost-effectiveness study from an institutional perspective in 8,133 incident cases. Data on therapeutic efficacy and safety were included, calculating standard costs; the outcomes were disability adjusted life years (DALYs) and the number of patients cured. The information sources were the Colombian Public Health Surveillance System, disease burden studies, and one meta-analysis of controlled clinical trials. Incremental cost-effectiveness was determined, and uncertainty was evaluated with tornado diagrams and Monte Carlo simulations. Results: Thermotherapy would generate costs of US$ 501,621; the handling of adverse effects, US$ 29,224; and therapeutic failures, US$ 300,053. For Glucantime, these costs would be US$ 2,731,276, US$ 58,254, and US$ 406,298, respectively. With thermotherapy, the cost would be US$ 2,062 per DALY averted and US$ 69 per patient cured; with Glucantime, the cost would be US$ 4,241 per DALY averted and US$ 85 per patient cured. In Monte Carlo simulations, thermotherapy was the dominant strategy for DALYs averted in 67.9% of cases and highly cost-effective for patients cured in 72%. Conclusion: In Colombia, thermotherapy can be included as a cost-effective strategy for the management of cutaneous leishmaniasis. Its incorporation into clinical practice guidelines could represent savings of approximately US$ 10,488 per DALY averted and costs of US$ 116 per additional patient cured, compared to the use of Glucantime. These findings show the relevance of the incorporation of this treatment in our country and others with similar parasitological, clinical, and epidemiological patterns.
    Keywords: Cost-effectiveness evaluationCutaneous leishmaniasisThermotherapySodium antimony gluconate Colombia.
    Date: 2018–01–15
  21. By: Mery Patricia Tamayo; Jaiberth Antonio Cardona-Arias; Liliana López Carvajal; Iván Darío Vélez
    Abstract: Introduction: The treatment of cutaneous leishmaniasis is toxic, has contraindications and a high cost. Objective: To estimate the cost-effectiveness of thermotherapy versus pentavalent antimonials for the treatment of cutaneous leishmaniasis. Methods: Effectiveness was the proportion of healing, and safety with the adverse effects; these parameters were estimated from a controlled clinical trial and a meta-analysis. A standard costing were conducted. Average and incremental cost-effectiveness ratios were estimated. The uncertainty regarding effectiveness, safety and costs was determined through sensitivity analyses. Results: The total costs were $66,807 with Glucantime and $14,079 with thermotherapy. The therapeutic effectiveness rates were 64.2% for thermotherapy and 85.1% for Glucantime. The average cost-effectiveness ratios ranged between $721 and $1,275 for Glucantime and between $187 and $390 for thermotherapy. Based on the meta-analysis thermotherapy may be a dominant strategy. Conclusion: The excellent cost-effectiveness ratio of thermotherapy shows the relevance of its inclusion in guidelines for the treatment.
    Keywords: Cost-Effectiveness AnalysisCutaneous LeishmaniasisThermotherapyAntimony Sodium GluconateColombia
    Date: 2018–02–01

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