TY - JOUR AB - Surgical measures to combat obesity are very effective in terms of weight loss, recovery from diabetes, and improvement in cardiovascular risk factors. However, previous studies found both positive and negative results regarding the effect of bariatric surgery on health care utilization. Using claims data from the largest health insurance provider in Germany, we estimated the causal effect of bariatric surgery on health care costs in a time period ranging from 2 years before to 3 years after bariatric intervention. Owing to the absence of a control group, we employed a Bayesian structural forecasting model to construct a synthetic control. We observed a decrease in medication and physician expenditures after bariatric surgery, whereas hospital expenditures increased in the post-intervention period. Overall, we found a slight increase in total costs after bariatric surgery, but our estimates include a high degree of uncertainty. AU - Kurz, C.F. AU - Rehm, M. AU - Holle, R. AU - Teuner, C.M. AU - Laxy, M. AU - Schwarzkopf, L. C1 - 56855 C2 - 47369 SP - 1293-1307 TI - The effect of bariatric surgery on health care costs: A synthetic control approach using Bayesian structural time series. JO - Health Econ. VL - 28 IS - 11 PY - 2019 SN - 1057-9230 ER - TY - JOUR AB - This paper aims to explore potential associations between health inequalities related to socioeconomic deprivation at the individual and the small area level. We use German cross-sectional survey data for the years 2002 and 2006, and measure small area deprivation via the German Index of Multiple Deprivation. We test the differences between concentration indices of income-related and small area deprivation related inequalities in obesity, hypertension, and diabetes. Our results suggest that small area deprivation and individual income both yield inequalities in health favoring the better-off, where individual income-related inequalities are significantly more pronounced than those related to small area deprivation. We then apply a semiparametric extension of Wagstaff's corrected concentration index to explore how individual-level health inequalities vary with the degree of regional deprivation. We find that the concentration of obesity, hypertension, and diabetes among lower income groups also exists at the small area level. The degree of deprivation-specific income-related inequalities in the three health outcomes exhibits only little variations across different levels of multiple deprivation for both sexes. AU - Siegel, M.* AU - Mielck, A. AU - Maier, W. C1 - 32536 C2 - 35099 SP - 1523-1530 TI - Individual income, area deprivation, and health: Do income-related health equalities vary by small area deprivation? JO - Health Econ. VL - 24 IS - 11 PY - 2015 SN - 1057-9230 ER - TY - JOUR AB - In this paper, we propose a methodological approach to measure the relationship between hospital costs and health outcomes. We propose to investigate the relationship for each condition or disease area by using patient-level data. We examine health outcomes as a function of costs and other patient-level variables by using the following: (1) two-stage residual inclusion with Murphy-Topel adjustment to address costs being endogenous to health outcomes, (2) random-effects models in both stages to correct for correlation between observation, and (3) Cox proportional hazard models in the second stage to ensure that the available information is exploited. To demonstrate its application, data on mortality following hospital treatment for acute myocardial infarction (AMI) from a large German sickness fund were used. Provider reimbursement was used as a proxy for treatment costs. We relied on the Ontario Acute Myocardial Infarction Mortality Prediction Rules as a disease-specific risk-adjustment instrument. A total of 12,284 patients with treatment for AMI in 2004-2006 were included. The results showed a reduction in hospital costs by €100 to increase the hazard of dying, that is, mortality, by 0.43%. The negative association between costs and mortality confirms that decreased resource input leads to worse outcomes for treatment after AMI. AU - Stargardt, T.* AU - Schreyögg, J. AU - Kondofersky, I. C1 - 24943 C2 - 31728 CY - Hoboken SP - 653-669 TI - Measuring the relationship between costs and outcomes: The example of acute myocardinal infarction in German hospitals. JO - Health Econ. VL - 23 IS - 6 PB - Wiley-Blackwell PY - 2014 SN - 1057-9230 ER - TY - JOUR AB - The Institute for Quality and Efficiency in Health Care (IQWiG) developed-in a consultation process with an international expert panel-the efficiency frontier (EF) approach to satisfy a range of legal requirements for economic evaluation in Germany's statutory health insurance system. The EF approach is distinctly different from other health economic approaches. Here, we evaluate established tools for assessing and communicating parameter uncertainty in terms of their applicability to the EF approach. Among these are tools that perform the following: (i) graphically display overall uncertainty within the IQWiG EF (scatter plots, confidence bands, and contour plots) and (ii) communicate the uncertainty around the reimbursable price. We found that, within the EF approach, most established plots were not always easy to interpret. Hence, we propose the use of price reimbursement acceptability curves-a modification of the well-known cost-effectiveness acceptability curves. Furthermore, it emerges that the net monetary benefit allows an intuitive interpretation of parameter uncertainty within the EF approach. This research closes a gap for handling uncertainty in the economic evaluation approach of the IQWiG methods when using the EF. However, the precise consequences of uncertainty when determining prices are yet to be defined. AU - Stollenwerk, B. AU - Lhachimi, S.K.* AU - Briggs, A.* AU - Fenwick, E.* AU - Caro, J.J.* AU - Siebert, U.* AU - Danner, M.* AU - Gerber-Grote, A.* C1 - 30812 C2 - 33888 CY - Hoboken SP - 481-490 TI - Communicating the parameter uncertainty in the IQWIG efficiency frontier to decision-makers. JO - Health Econ. VL - 24 IS - 4 PB - Wiley-blackwell PY - 2014 SN - 1057-9230 ER - TY - JOUR AB - Third party payers' decision processes for financing health technologies ('fourth hurdle' processes) are subject to intensive descriptive empirical investigation. This paper addresses the need for a theoretical foundation of this research and develops a theoretical framework for analysing fourth hurdle processes from an economics perspective. On the basis of a decision-analytic framework and the theory of agents, fourth hurdle processes are described as sets of institutions to maximize the value derived from finite healthcare resources. Benefits are assumed to arise from the value of better information about and better implementation of the most cost-effective choice. Implementation is improved by decreased information asymmetries and better alignment of incentives. This decreases the effects of ex ante and ex post moral hazard on service provision. Potential indicators of high benefit include high costs associated with wrong decisions and large population sizes affected by the decision. The framework may serve as a basis both for further theoretical work, for example, on the appropriate degree of participation as well as further empirical work, for example, on comparative assessments of fourth hurdle processes. It needs to be complemented by frameworks for analysing fourth hurdle institutions developed by other disciplines such as bioethics or law. AU - Rogowski, W.H. C1 - 11194 C2 - 30545 SP - 600-610 TI - An economic theory of the fourth hurdle. JO - Health Econ. VL - 22 IS - 5 PB - Wiley-Blackwell PY - 2013 SN - 1057-9230 ER - TY - JOUR AB - Cross-country comparisons of costs and quality between hospitals are often made at the macro level. The goal of this study was to explore methods to compare micro-level data from hospitals in different health care systems. To do so, we developed a multi-level framework in combination with a propensity score matching technique using similarly structured data for patients receiving treatment for acute myocardial infarction in German and US Veterans Health Administration hospitals. Our case study shows important differences in results between multi-level regressions based on matched and unmatched samples. We conclude that propensity score matching techniques are an appropriate way to deal with the usual baseline imbalances across the samples from different countries. Multi-level models are recommendable to consider the clustered structure of the data when patient-level data from different hospitals and health care systems are compared. The results provide an important justification for exploring new ways in performing health system comparisons. AU - Schreyögg, J. AU - Stargardt, T. AU - Tiemann, O. C1 - 4870 C2 - 27447 SP - 85-100 TI - Costs and quality of hospitals in different health care systems: A multi-level approach with propensity score matching. JO - Health Econ. VL - 20 IS - 1 PB - Wiley-Blackwell PY - 2011 SN - 1057-9230 ER - TY - JOUR AB - We evaluate the effect of the size of deductibles in the basic health insurance in Switzerland on the probability of a doctor visit. We employ nonparametric bounding techniques to minimise statistical assumptions. In order to tighten the bounds we consider two further assumptions: mean independence of an instrument and monotone treatment response. Under these two assumption we are able to bound the causal effect of high deductibles compared to low deductibles below zero. We conclude that the difference in health care utilisation is partly due to a reduction of moral hazard effects. AU - Gerfin, M.* AU - Schellhorn, M. C1 - 3078 C2 - 24075 SP - 1011-1020 TI - Nonparametric bounds on the effect of deductibles in health care insurance on doctor visits - Swiss evidence. JO - Health Econ. VL - 15 PB - Wiley PY - 2006 SN - 1057-9230 ER - TY - JOUR AB - Background: The SF-12 is a widely used generic measure of subjective health. As the scoring algorithms of the SF-12 do not include preference values, different approaches to assign a preference-based index are available that should be tested regarding their feasibility and validity. Objectives: To develop a concept for a preference-based index for the SF-12 on the basis of multi-attribute decision analysis and to perform initial tests of its feasibility and validity in an empirical study. Methods: A multi-attribute preference function for the SF-12 was developed, estimated and tested for validity. Two mail surveys (n = 100, 200) and an interview (n = 72) were conducted with women who had an operation for breast cancer. Visual analogue scale (VAS) and standard gamble (SG) measures elicited preference-based valuations. Results: Eight attributes were identified in the SF-12. Validity tests showed an average difference of 8 VAS score points between directly measured and predicted values for given health states. Conclusion: The initial results show that this approach might allow the direct assignment of a preference-based valuation to the SF-12. The quality of the psychometric features of the multi-attribute value function is encouraging. Future studies should test this concept more extensively, especially by determining parameters for a representative sample of the general population and by comparing performance with other approaches to value the SF-12. AU - Stratmann-Schoene, D.* AU - Kuehn, T.* AU - Kreienberg, R.* AU - Leidl, R. C1 - 1924 C2 - 23599 SP - 553-564 TI - A preference-based index for the SF-12. JO - Health Econ. VL - 15 IS - 6 PB - Wiley PY - 2006 SN - 1057-9230 ER - TY - JOUR AU - Wing Han Au, D.* AU - Crossley, T.F.* AU - Schellhorn, M. C1 - 2275 C2 - 23233 SP - 999-1018 TI - The effect of health changes and long-term health on the work activity of older Canadians. JO - Health Econ. VL - 14 PB - Wiley PY - 2005 SN - 1057-9230 ER -