Adjusted productivity costs of stroke by human capital and friction cost methods: a Northern Finland Birth Cohort 1966 study

Background Productivity costs result from loss of paid and unpaid work and replacements due to morbidity and mortality. They are usually assessed in health economic evaluations with human capital method (HCM) or friction cost method (FCM). The methodology for estimating lost productivity is an area of considerable debate. Objective To compare traditional and adjusted HCM and FCM productivity cost estimates among young stroke patients. Methods The Northern Finland Birth Cohort 1966 was followed until the age of 50 to identify all 339 stroke patients whose productivity costs were estimated with traditional, occupation-specific and adjusted HCM and FCM models by using detailed, national register-based data on care, disability, mortality, education, taxation and labour market. Results Compared to traditional HCM, taking into account occupational class, national unemployment rate, disability-free life expectancy and decline in work ability, the productivity cost estimate decreased by a third, from €255,960 to €166,050. When traditional FCM was adjusted for occupational class and national unemployment rate, the estimate more than doubled from €3,040 to €7,020. HCM was more sensitive to adjustments for discount rate and wage growth rate than FCM. Conclusions This study highlights the importance of adjustments of HCM and FCM. Routine register-based data can be used for accurate productivity cost estimates of health shocks.

Friction cost approach methodology in pharmacoeconomic analyses

he use of a societal perspective in pharmacoeconomic analyses is a widely discussed topic. One of the fundamental problems of using the social perspective is the inconsistency of indirect costs calculation. We searched published articles on the use and di

Health Economic Evaluation of the Psychiatric Emergency Response Team (PAM) in Stockholm County

Background: The Psychiatric Response Team (the PAM unit) started as a suicide prevention project during the spring of 2015 to handle acute psychiatric patients previously handled by the police. Since 2017, the PAM has been a permanent service within the health care organization of Stockholm County. Method: Health economic estimates, based on different scenarios, were designed to investigate the economic evaluation of the PAM unit from both a health-care and a societal perspective. Another aim was to present an economic model that can be applied and developed in future studies to evaluate suicide-prevention projects. Potential savings achieved by the PAM unit were examined by measuring direct and indirect costs based on three different scenarios: restrictive, likely and optimistic. Costs were compared to the potential savings from changes in processes using the PAM unit. Estimates of potential savings from production losses were made using the friction-cost and human-capital methods. An estimate of human value was made using figures from previous studies in traffic-injury prevention. Different theoretical health economic methods of calculation are presented. Results: Total cost for the PAM unit during its first two years of operation was 13.2 million Swedish kronor (SEK). Comparatively, direct savings from a health-care perspective were estimated at 2.8-5.1 million SEK, while direct savings from a societal perspective were estimated at 5.9-10.6 million SEK. The estimate of indirect savings differs depending on approach adopted: from 1.0-1.5 million SEK (friction-cost) to 52.0-103.9 million SEK (human-capital). Further, if estimates of human value are included, there are additional savings ranging from 52.3 to 82.1 million SEK. Conclusion: The direct cost saving of the PAM unit, estimated on different scenarios, does not make it viable from a purely economic perspective. However, there are large indirect cost savings from avoidance of future production losses and savings in human value. The rescuing of a single patient from suicide by the PAM unit during one year would, under most estimated scenarios, justify the total cost of the intervention.

Where Do You Want to Go for Dinner? A Preference Expression Asymmetry in Joint Consumption

This research introduces a framework wherein consumers take on “requestor” or “responder” roles in making joint consumption decisions. The authors document a robust preference expression asymmetry wherein “requestors” soliciting others’ consumption preferences (e.g., “Where do you want to go for dinner?”) desire preference expressions (e.g., “Let’s go to this restaurant”), whereas “responders” instead do not express preferences (e.g., “Anywhere is fine with me”). This asymmetry generalizes under a broad set of situations and occurs because the requestor and responder roles differ in their foci. Compared to responders, requestors are more focused on mitigating the difficulty of arriving at a decision, whereas compared to requestors, responders are more focused on conveying likability by appearing easygoing. Responders thus behave suboptimally, incurring a “preference cost” (when masking preferences) and a “social friction cost” (requestors favor responders who express preferences). Requestors can elicit preference expression by conveying their own dislike of decision making, which increases responders’ focus on mitigating decision difficulty. The authors conclude by discussing the framework’s contributions to looking “under the hood” of joint consumption decisions.

Absenteeism and indirect costs during the year following the diagnosis of an operable breast cancer

IntroductionThe consequences of disease on work for individual patients as well as the consequences of absenteeism from work are subjects of interest for decision-makers.MethodsWe analyzed duration of absenteeism and related indirect costs for patients with a paid job during the year following diagnosis of early-stage breast cancer in the prospective OPTISOINS01 cohort. A human capital and friction costs approaches were considered for evaluation of lost working days. For this analysis, the friction period was estimated from recent French data. Statistical analysis included simple and multiple linear regression to identify determinants of absenteeism and indirect costs.Results93% of patients had at least one period of sick leave, with an average of 2 periods of sick leave and a mean total duration of 186 days. 24% of patients returned to work part-time after an average sick leave of 114 days (i.e. 41 LWD). Estimated indirect costs were €22,722.00 and €7,724.00 per patient, for the human capital and friction cost approaches, respectively. In the multiple linear regression model, factors associated with absenteeism were: invasive tumor (p=.043), mastectomy (p=.038), redo surgery (p=.002), chemotherapy (p=.027), being a manager (p=.025) or a craftsman (p=.005).ConclusionBreast cancer is associated with long periods of absenteeism during the year following diagnosis, but almost all patients were able to return to work. Major differences in the results were observed between the friction cost and human capital approaches, highlighting the importance of considering both approaches in such studies.

Estimation of Socioeconomic Burden of Lung Cancer in the Russian Federation

The aim of this study was to estimate the socio-economic burden of lung cancer (LC) in the Russian Federation. Methodology: the social burden of LC is defined as the number of patients newly diagnosed with LC in 2016, those who are followed-up in oncology clinics, disabled and deceased persons. The economic burden consists of total direct and indirect costs associated with LC and estimated from a government perspective. Direct medical costs include costs for diagnosis, inpatient and outpatient treatment, palliative care, follow-up costs, and expenditures for the subsidized drug coverage. Direct non-medical costs include payments for sickness and disability caused by LC. Indirect costs were calculated as a loss of a gross domestic product due to LC morbidity and mortality. Calculations were based on the methods described in Ignatieva V. I. et al. (2014) and adapted by the authors of this study to new methods of inpatient medical care payment. Indirect costs were calculated by the friction cost method. The sensitivity analysis was conducted to estimate the impact of initial parameters` variations, as well as the impact of indirect costs estimation with the human capital methods, on the results. Results. In 2016, medical care was provided to 185,631 patients with LC, of whom 51,768 (27.9%) were newly diagnosed during the year. Direct medical costs were about 6.83 billion rubles. Most costs were incurred in inpatient care (4.09 billion rubles, 60.0%) and for the subsidized drug coverage (1.49 billion rubles, 21.8%). Direct non-medical expenses were about 5.76 billion rubles, 5.16 billion (89.7%) were disability-related payments. Indirect costs were about 14.77 billion rubles (friction cost method).