Partially different? The importance of general equilibrium in health economic evaluations: An application to nocturia.

Both the human capital approach and the friction cost approach are frequently used to quantify the productivity costs associated with illness, disability or death in health economic evaluations. In this paper we argue that these approaches have one major, but common shortcoming: they only capture partial equilibrium (PE) effects and therefore underestimate the true potential productivity costs associated with health conditions. They neglect the sizable, indirect, ripple effects in the economy captured by general equilibrium (GE) models. To demonstrate our point, we compare a traditional PE with a GE approach for the application to nocturia, a condition characterized by the need to frequently wake up at night to urinate. Nocturia is associated with substantial impairment of daytime functioning and work productivity. We employ large-scale United Kingdom (UK) employer-employee survey data to estimate the prevalence and productivity loss. These estimates are then used as shared inputs to drive both approaches. We find that the traditional PE approach underestimates the annual productivity cost of clinically relevant nocturia by around 16%. We propose a generalized GE/PE multiplier to approximate the GE effect for other health conditions. Our findings stress the importance of accounting for sizable GE effects when conducting health economic evaluations.

Estimating the global economic benefits of physically active populations over 30 years (2020-2050).

OBJECTIVES: We assess the potential benefits of increased physical activity for the global economy for 23 countries and the rest of the world from 2020 to 2050. The main factors taken into account in the economic assessment are excess mortality and lower productivity. METHODS: This study links three methodologies. First, we estimate the association between physical inactivity and workplace productivity using multivariable regression models with proprietary data on 120 143 individuals in the UK and six Asian countries (Australia, Malaysia, Hong Kong, Thailand, Singapore and Sri Lanka). Second, we analyse the association between physical activity and mortality risk through a meta-regression analysis with data from 74 prior studies with global coverage. Finally, the estimated effects are combined in a computable general equilibrium macroeconomic model to project the economic benefits of physical activity over time. RESULTS: Doing at least 150 min of moderate-intensity physical activity per week, as per lower limit of the range recommended by the 2020 WHO guidelines, would lead to an increase in global gross domestic product (GDP) of 0.15%-0.24% per year by 2050, worth up to US$314-446 billion per year and US$6.0-8.6 trillion cumulatively over the 30-year projection horizon (in 2019 prices). The results vary by country due to differences in baseline levels of physical activity and GDP per capita. CONCLUSIONS: Increasing physical activity in the population would lead to reduction in working-age mortality and morbidity and an increase in productivity, particularly through lower presenteeism, leading to substantial economic gains for the global economy.

Quantifying the economic impact of government and charity funding of medical research on private research and development funding in the United Kingdom.

BACKGROUND: Government- and charity-funded medical research and private sector research and development (R&D) are widely held to be complements. The only attempts to measure this complementarity so far have used data from the United States of America and are inevitably increasingly out of date. This study estimates the magnitude of the effect of government and charity biomedical and health research expenditure in the United Kingdom (UK), separately and in total, on subsequent private pharmaceutical sector R&D expenditure in the UK. METHODS: The results for this study are obtained by fitting an econometric vector error correction model (VECM) to time series for biomedical and health R&D expenditure in the UK for ten disease areas (including 'other') for the government, charity and private sectors. The VECM model describes the relationship between public (i.e. government and charities combined) sector expenditure, private sector expenditure and global pharmaceutical sales as a combination of a long-term equilibrium and short-term movements. RESULTS: There is a statistically significant complementary relationship between public biomedical and health research expenditure and private pharmaceutical R&D expenditure. A 1% increase in public sector expenditure is associated in the best-fit model with a 0.81% increase in private sector expenditure. Sensitivity analysis produces a similar and statistically significant result with a slightly smaller positive elasticity of 0.68. Overall, every additional £1 of public research expenditure is associated with an additional £0.83-£1.07 of private sector R&D spend in the UK; 44% of that additional private sector expenditure occurs within 1 year, with the remainder accumulating over decades. This spillover effect implies a real annual rate of return (in terms of economic impact) to public biomedical and health research in the UK of 15-18%. When combined with previous estimates of the health gain that results from public medical research in cancer and cardiovascular disease, the total rate of return would be around 24-28%. CONCLUSION: Overall, this suggests that government and charity funded research in the UK crowds in additional private sector R&D in the UK. The implied historical returns from UK government and charity funded investment in medical research in the UK compare favourably with the rates of return achieved on investments in the rest of the UK economy and are greatly in excess of the 3.5% real annual rate of return required by the UK government to public investments generally.

Translating the efficacy of dapagliflozin in chronic kidney disease to lower healthcare resource utilization and costs: a medical care cost offset analysis.

AIMS: Dapagliflozin was approved for use in patients with chronic kidney disease (CKD) based on results of the DAPA-CKD trial, demonstrating attenuation of CKD progression and reduced risk of cardio-renal outcomes and all-cause mortality (ACM) versus placebo, in addition to standard therapy. The study objective was to assess the potential medical care cost offsets associated with reduced rates of cardio-renal outcomes across 31 countries and regions. MATERIALS AND METHODS: A comparative cost-determination framework estimated outcome-related costs of dapagliflozin plus standard therapy versus standard therapy alone over a 3-year horizon based on the DAPA-CKD trial. Incidence rates of end-stage kidney disease (ESKD), hospitalizations for heart failure (HHF), acute kidney injury (AKI), and ACM were estimated for a treated population of 100,000 patients. Associated medical care costs for non-fatal events were calculated using sources from a review of publicly available data specific to each considered setting. RESULTS: Patients treated with dapagliflozin plus standard therapy experienced fewer incidents of ESKD (7,221 vs 10,767; number needed to treat, NNT: 28), HHF (2,370 vs 4,684; NNT: 43), AKI (4,110 vs. 5,819; NNT: 58), and ACM (6,383 vs 8,874; NNT: 40) per 100,000 treated patients versus those treated with standard therapy alone. Across 31 countries/regions, reductions in clinical events were associated with a 33% reduction in total costs, or a cumulative mean medical care cost offset of $264 million per 100,000 patients over 3 years. LIMITATIONS AND CONCLUSIONS: This analysis is limited by the quality of country/region-specific data available for medical care event costs. Based on the DAPA-CKD trial, we show that treatment with dapagliflozin may prevent cardio-renal event incidence at the population level, which could have positive effects upon healthcare service delivery worldwide. The analysis was restricted to outcome-associated costs and did not consider the cost of drug treatments and disease management.

Chronic kidney disease (CKD) has a high clinical, economic, and societal burden and it affects approximately 8-16% of the global population. The progressive nature of CKD may lead to complications, co-morbidities, and mortality, costing healthcare systems millions and consuming a large proportion of healthcare resources. Dapagliflozin, a sodium-glucose co-transporter-2 inhibitor, has been demonstrated to slow CKD progression and reduce cardio-renal complications, as demonstrated in the DAPA-CKD trial. With the emergence of dapagliflozin as a treatment for CKD, it is important for clinicians and healthcare providers to understand how effective treatment can positively affect short-term healthcare service delivery and associated costs. This medical care cost offset modelling analysis considers a scalable population of 100,000 patients in 31 countries/regions worldwide. The analysis estimates treatment with dapagliflozin plus standard therapy to be offset by a 33% reduction in costs associated with key cardio-renal outcomes, translating to an average $264 million in cost offsets per 100,000 treated patients. This modelling analysis of pivotal trial data shows dapagliflozin could have considerable benefits to healthcare systems worldwide that are under strain from the rising burden of CKD.

The potential socio-economic impact of telemedicine in Canada.

Telemedicine has been available in Canada for a while but its uptake before the COVID-19 pandemic has been slow. The pandemic has since changed how people in Canada access healthcare by hastening digital transformation in the sector. Pre-pandemic, Canada was behind its international peers in its use of telemedicine. Now, many patient consultations, both primary and specialist, are conducted virtually. RAND Europe researchers examined the potential impact in Canada of continued, long-term use of telemedicine, which can include the use of "smart" devices to conduct medical tests, the digital storage and sharing of medical records, and real-time tele-consultations between healthcare providers and patients. They looked at the quality, access and cost of telemedicine, the barriers that have led to its relatively slow adoption, and what the economic effect would be of an increase in uptake. The study found that, alongside the benefits from tools such as telemonitoring and digital health records, widespread use of teleconsultations could lead to significant benefits for Canadian patients, the Canadian economy, and wider Canadian society. The findings directly contribute to the evidence base in telemedicine and virtual healthcare more generally.

COVID-19 and the Cost of Vaccine Nationalism.

Experience shows that, in response to pandemics, national governments tend to follow their own interests instead of pursuing a more globally coordinated approach. This nationalistic behaviour could have negative consequences on how well the COVID-19 global pandemic is managed and contained. A situation in which countries push to get first access to a supply of vaccines, potentially hoarding key components for vaccine production, has been commonly referred to as "vaccine nationalism." This article examines how the management of the COVID-19 crisis may be affected by vaccine nationalism and what the associated economic cost would be of inequitable access to vaccines across countries.

Community-dwelling adults with functional limitations are at greater risk for sleep disturbances.

OBJECTIVE: To evaluate whether sleep disturbances vary along a continuum of functional limitations in a large nationally representative sample of US adults. METHODS: Using 2014-2015 National Health Interview Survey data (n = 33,424), we considered associations between each of 5 sleep disturbance measures (duration, trouble falling asleep, trouble staying asleep, use of sleep medications, waking rested) and Functional Limitations Index score, which distinguishes among adults with little-or-no (least-limited), moderate (somewhat-limited), and high functional limitations (most-limited). RESULTS: Somewhat-limited and most-limited respondents reported significantly worse sleep health for all sleep disturbance measures than people with little-or-no limitations, even controlling for body mass index, psychological distress, and 14 health indicators. CONCLUSIONS: People with significant self-reported limitations in physical functioning, independent of specific disabilities or disabling condition, report more sleep disturbances. Clinicians may want to evaluate the sleep health of patients with functional limitations.

Incentives and Physical Activity: An Assessment of the Association Between Vitality's Active Rewards with Apple Watch Benefit and Sustained Physical Activity Improvements.

The benefits of physical activity include a lowered risk of some major non-communicable diseases and improving wellbeing and mental health. However, roughly about one third of the global adult population is not meeting the minimum weekly level of physical activity recommended by the World Health Organisation. Discovery, a South African multi-national insurance group, offers two types of incentives to its members: Vitality Active Rewards and Vitality Active Rewards with Apple Watch. The Vitality Active Rewards scheme, a gain-framed incentive, rewards individuals for tracking and reaching different thresholds of physical activity, whereas the Vitality Active Rewards with Apple Watch benefit makes monthly repayments for an Apple Watch in amounts linked to different levels of physical activity thresholds that the individual reaches per month. Discovery commissioned RAND Europe to conduct an independent assessment on whether the Vitality Active Rewards with Apple Watch benefit is associated with increased physical activity levels for Vitality members that take up the benefit, compared to those individuals that only participate in the Vitality Active Rewards programme. The study also examined whether these associations persist over time. The findings of this study suggest that incentivising physical activity to tackle inactivity and a sedentary lifestyle can lead to better activity levels. When more unhealthy individuals take up an incentive of this kind, the results can lead on average to a more pronounced behaviour change than we see in already relatively more active and healthy individuals. This is important when designing health promotion programmes.

Employee Engagement in the NHS: A Secondary Data Analysis of the NHS Healthy Workforce and Britain's Healthiest Workplace Surveys.

Staff health and wellbeing is an important area for employers. Leading a healthy life, both physically and mentally, helps the individual health of employees, but also benefits employers through boosting productivity in the workplace. The Five Year Forward View strategy, published by NHS England in 2014, underscores the importance of staff health and wellbeing as a crucial factor in improving the performance of the NHS and chief executive Simon Stevens announced a number of new initiatives and policy developments aimed at improving health and wellbeing within the workforce in 2015. RAND Europe conducted an independent study to examine the factors associated with engagement among NHS employees as part of a project with the Health Foundation, a charity committed to bringing about better health and healthcare in the UK. RAND Europe analysed data from the NHS Healthy Workforce Survey, conducted in 2016 across 35 UK NHS organisations, as well as VitalityHealth's Britain's Healthiest Workplace (BHW) survey in 2016, which involved RAND Europe's analysis of the survey results. The views expressed in the study are the authors' own and do not necessarily represent the views of the Health Foundation.

Assessing the burden of nocturia in the workplace: the associations between nocturnal voiding, subjective well-being, work engagement and productivity.

Aims: Nocturia (getting up at night to urinate, where each urination being followed by sleep or intention to sleep) is a bothersome symptom with potentially negative consequences for individual health and daytime functioning. This study assessed the burden of nocturia in the workplace by investigating associations between nocturia and subjective well-being (SWB), work engagement and productivity.Methods: Using large-scale international workplace survey data, the associations between nocturia, SWB, work engagement (Utrecht Work Engagement Scale, UWES-9) and productivity (Work Productivity and Activity Impairment, WPAI) were assessed. Bivariate and multivariate regression analysis was used with adjustment for a large set of confounding factors, including sleep duration and sleep quality.Results: Across a study sample of 92,129 observations, aged 18-70, an average of 10% of the survey population reported ≥2 nocturnal voids (generally considered clinically significant nocturia), with prevalence of nocturia increasing with age. Individuals with nocturia reported a 35.7% (p < .001) higher relative sleep disturbance score and were 10.5 percentage points (pp) (p < .001) more likely to report short sleep. Adjusted for covariates, nocturia was associated with a 3.5% (p < .001) lower relative SWB score and a 2% (p < .001) lower relative UWES-9 work engagement score. Nocturia was associated with a 3.9 pp (p < .001) higher work impairment due to absenteeism and presenteeism (WPAI). Adjusting additionally for sleep disturbance and sleep duration reduced the magnitude of the estimated effects, suggesting a key role for poor sleep in explaining the relationship between nocturia and the outcomes (SWB, UWES-9, WPAI) assessed.Conclusions: A key contribution of this study is the assessment of the association between nocturia and a range of work performance outcomes in a sizeable study using validated instruments to measure work engagement and productivity. The study highlights the importance of taking sleep into account when assessing the relationship between nocturia and associated outcomes.

The economic implications of later school start times in the United States.

Numerous studies have shown that later school start times (SST) are associated with positive student outcomes, including improvements in academic performance, mental and physical health, and public safety. While the benefits of later SST are very well documented in the literature, in practice there is opposition against delaying SST. A major argument against later SST is the claim that delaying SST will result in significant additional costs for schools due to changes in bussing strategies. However, to date, there has only been one published study that has quantified the potential economic benefits of later SST in relation to potential costs. The current study investigates the economic implications of later school start times by examining a policy experiment and its subsequent state-wide economic effects of a state-wide universal shift in school start times to 8.30AM. Using a novel macroeconomic modeling approach, the study estimates changes in the economic performance of 47 US states following a delayed school start time, which includes the benefits of higher academic performance of students and reduced car crash rates. The benefit-cost projections of this study suggest that delaying school start times is a cost-effective, population-level strategy, which could have a significant impact on public health and the US economy. From a policy perspective, these findings are crucial as they demonstrate that significant economic gains resulting from the delay in SST accrue over a relatively short period of time following the adoption of the policy shift.

Why Sleep Matters-The Economic Costs of Insufficient Sleep: A Cross-Country Comparative Analysis.

The Centers for Disease Control and Prevention (CDC) in the United States has declared insufficient sleep a "public health problem." Indeed, according to a recent CDC study, more than a third of American adults are not getting enough sleep on a regular basis. However, insufficient sleep is not exclusively a US problem, and equally concerns other industrialised countries such as the United Kingdom, Japan, Germany, or Canada. According to some evidence, the proportion of people sleeping less than the recommended hours of sleep is rising and associated with lifestyle factors related to a modern 24/7 society, such as psychosocial stress, alcohol consumption, smoking, lack of physical activity and excessive electronic media use, among others. This is alarming as insufficient sleep has been found to be associated with a range of negative health and social outcomes, including success at school and in the labour market. Over the last few decades, for example, there has been growing evidence suggesting a strong association between short sleep duration and elevated mortality risks. Given the potential adverse effects of insufficient sleep on health, well-being and productivity, the consequences of sleep-deprivation have far-reaching economic consequences. Hence, in order to raise awareness of the scale of insufficient sleep as a public-health issue, comparative quantitative figures need to be provided for policy- and decision-makers, as well as recommendations and potential solutions that can help tackling the problem.

Returns on Research Funded Under the NIHR Health Technology Assessment (HTA) Programme: Economic Analysis and Case Studies.

The Department of Health (England) requested that RAND Europe conduct an economic analysis of the impact of the HTA Programme. This article describes the results of that work, which consisted of analysis of the potential economic benefits of a sample of HTA funded studies and comparison to programme costs, supplemented by a set of short case studies exploring the impacts of the HTA Programme on policy and practice. Based on our analysis, if 12 per cent of the potential net benefit of implementing the findings of this sample of 10 studies for one year was realised, it would cover the cost of the HTA Programme from 1993 to 2012. Drawing on the case studies and the economic analysis, we have also made a number of observations that could help ensure that the HTA Programme maximises the likelihood of findings being adopted.

Psychological Wellbeing and Work: Improving Service Provision and Outcomes.

This study explores proposals to improve employment and health outcomes for people with common mental health problems and makes a number of recommendations. These include: using evidence-based models to provide services that combine employment and mental health support; increasing integration between existing treatment and employment services to improve outcomes in both areas; applying evidence-based models in new ways or a using combination of approaches; and providing timely access to coordinated treatment and employment support for a greater number of people with common mental health problems.