Addressing the distributional consequences of spillovers in health economic evaluation: A prioritarian approach.

Health spillovers arise when an individual's serious illness affects those close to them emotionally, psychologically, and/or physically. As a result, healthcare interventions that improve the lives of patients may also confer wider health benefits. However, contrary to widespread calls for health spillovers to be included in health economic evaluation, others have argued this could have adverse distributional consequences and equity implications. This paper presents a novel approach to spillover inclusion in health economic evaluation using a 'prioritarian transformation' of health gains that allows these equity concerns to be addressed. Affording greater weight to the incremental change in patient outcomes when incorporating carer/family health spillovers into resource allocation decisions, the method provides a feasible means of moderating the distributional impact of spillover inclusion. It also introduces a normative, theoretical perspective to a largely empirical extant literature and, as such, its axiomatic basis is examined. Finally, an illustrative example of the approach is presented to demonstrate its application.

Recommendations for Emerging Good Practice and Future Research in Relation to Family and Caregiver Health Spillovers in Health Economic Evaluations: A Report of the SHEER Task Force.

BACKGROUND: Omission of family and caregiver health spillovers from the economic evaluation of healthcare interventions remains common practice. When reported, a high degree of methodological inconsistency in incorporating spillovers has been observed. AIM: To promote emerging good practice, this paper from the Spillovers in Health Economic Evaluation and Research (SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda and future practice. METHODS: A modified nominal group technique was used to reach consensus on a set of recommendations, representative of the views of participating subject-matter experts. Through the structured discussions of the group, as well as on the basis of evidence identified during a review process, recommendations were proposed and voted upon, with voting being held over two rounds. RESULTS: This report describes 11 consensus recommendations for emerging good practice. SHEER advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. Where possible, spillovers related to displaced/foregone activities should be considered, as should the distributional consequences of inclusion. Time horizons ought to be sufficient to capture all relevant impacts. Currently, the collection of primary spillover data is preferred and clear justification should be provided when using secondary data. Transparency and consistency when reporting on the incorporation of health spillovers are crucial. In addition, given that the evidence base relating to health spillovers remains limited and requires much development, 12 avenues for future research are proposed. CONCLUSIONS: Consideration of health spillovers in economic evaluations has been called for by researchers and policymakers alike. Accordingly, it is hoped that the consensus recommendations of SHEER will motivate more widespread incorporation of health spillovers into analyses. The developing nature of spillover research necessitates that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for balance between consistency in approach, where valuable in a decision making context, and variation in application, to reflect differing decision maker perspectives and to support innovation.

Projected private hospital expenditure in Ireland, 2018-2035: What role for demographics, cost, and Sláintecare?

Despite private hospitals occupying an important role in the delivery of acute hospital care in Ireland, an understanding of future spending pressures on these services is limited. Particularly, a key dimension of Ireland's ambitious roadmap for healthcare reform (Sláintecare) seeks to remove private practice from public hospitals. However, to date, there has been no examination of how this reform could impact private hospital demand and expenditure, and ultimately, the capacity to treat public patients. Using previously unavailable administrative health insurer data and a healthcare macro-simulation projection model, we project real (volume-based) and nominal expenditure on private hospital services over the medium-term (2018-2035). We develop a number of projection scenarios that vary assumptions in relation to population growth and ageing, healthy ageing, and the future cost of care delivery. Additionally, by developing profiles of private activity in public hospitals, we examine how the removal of private practice from public hospitals could impact on demand and expenditure in private hospitals over time. Findings from this analysis have implications for capital investment and workforce planning in private hospitals, and failure to meet future demand could have implications for access to care in public hospitals. Moreover, should private practice be ended in public hospitals, most complex private in-patient and emergency care is likely to remain within the public hospitals with limited capacity benefits for the public system.

Application of High-Resolution Remote-Sensing Data for Land Use Land Cover Mapping of University Campus.

The study of Land Use Land Cover (LULC) is essential to understanding how land has been altered in recent years and what has caused the processes behind the change. This is significant for the future development of the area, particularly on the campus of the Universitas Padjadjaran Jatinangor. The purpose of this study was to apply remote-sensing techniques to map a university campus and vicinity by comparing the area of urban green space (UGS) and floor area ratios (FARs) of the campus in 2015 and 2017. Additionally, surface runoff analysis was also conducted. For our research, we used WorldView-2's high-resolution satellite imagery with a resolution of 0.46 m in the Universitas Padjadjaran (Padjadjaran University, or Unpad) Jatinangor campus, Jawa Barat, Indonesia. Our approach was to interpret the imagery by running the normalized difference vegetation index (NDVI) to distinguish UGS and FAR and using digital elevation model (DEM) interferometric synthetic aperture radar (SAR) data with hydrologic analysis to identify the direction of surface runoff. The results obtained are as follows: the UGS remained more extensive compared with FAR, but the difference decreased over time owing to infrastructure development. Surface runoff has tended to flow toward the southeast in direct relation to the slope configuration.

Mental health spillovers from serious family illness: Doubly robust estimation using EQ-5D-5L population normative data.

People are interconnected and ill-health is rarely experienced in isolation. However, while there has been extensive research on health spillovers related to informal caregiving, there is comparatively little evidence on how ill-health may impact upon non-caregiving family members. This paper analyses EQ-5D-5L normative data from a nationally representative sample of adult residents of Ireland to estimate the independent relationship between serious family illness and five distinct dimensions of health. The empirical strategy combines inverse probability weighting and multivariate ordered probit regression in a doubly robust estimation. We find that experience of serious family illness is associated with large mental health decrements that are independent of caring responsibilities, while similar results are not evident for the four other health dimensions. Furthermore, stratified sub-sample analyses indicate considerable heterogeneity by sex and by income. In particular, we find evidence consistent with larger mental health spillovers for females than for males, as well as for low- and medium-income households relative to high-income households. The latter suggests that such spillovers may be substantially worse for those with fewer resources. Overall, the findings have a range of potential implications, including for the provision of mental health supports and services, for equity of health outcomes, as well as for health economic evaluation. For example, we calculate that our estimates of health spillovers are consistent with a 1.3% reduction in health utility for non-caregiving family members.

Estimation of an Instrument-Defined Minimally Important Difference in EQ-5D-5L Index Scores Based on Scoring Algorithms Derived Using the EQ-VT Version 2 Valuation Protocols.

OBJECTIVES: To estimate and compare the minimally important difference (MID) in index score of country-specific EQ-5D-5L scoring algorithms developed using EuroQol Valuation Technology protocol version 2, including algorithms from Germany, Indonesia, Ireland, Malaysia, Poland, Portugal, Taiwan, and the United States. METHODS: A simulation-based approach contingent on all single-level transitions defined by the EQ-5D-5L descriptive system was used to estimate the MID for each algorithm. RESULTS: The resulting mean (and standard deviation) instrument-defined MID estimates were Germany, 0.083 (0.022); Indonesia, 0.093 (0.012); Ireland, 0.098 (0.023); Malaysia, 0.072 (0.010); Poland, 0.080 (0.030); Portugal, 0.080 (0.018); Taiwan, 0.101 (0.010); and the United States, 0.078 (0.014). CONCLUSIONS: These population preference-based MID estimates and accompanying evidence of how such values vary as a function of baseline index score can be used to aid interpretation of index score change. The marked consistency in the relationship between the calculated MID estimate and the range of the EQ-5D-5L index score, represented by a ratio of 1:20, might substantiate a rule of thumb allowing for MID approximation in EQ-5D-5L index score warranting further investigation.

Differences between ecological niches in northern and southern populations of Angolan black and white colobus monkeys (Colobus angolensis palliatus and Colobus angolensis sharpei) throughout Kenya and Tanzania.

Ecological niche models can be useful for clarifying relationships between environmental factors and a species' geographic distribution. In this study, we use presence-only data and environmental layers to create an ecological niche model to better understand the distribution of the East African Angolan black and white colobus monkey, Colobus angolensis palliatus, and to assess whether the model supports considering the population as two separate subspecies, Colobus angolensis sharpei and C. a. palliatus. We found the range of the predicted distribution for suitable habitat of C. a. palliatus as currently classified to be only 12.4% of that shown in the International Union for Conservation of Nature Red List range map and to be fragmented. As C. angolensis is considered a "Least Concern" species, this difference suggests that generalized maps may lead to understating the species' extinction risk. When presence points were divided into two previously proposed subspecies -C. a. palliatus (Kenya and Northern Tanzania) and C. a. sharpei (Southern Tanzania)-we found significant environmental differences between the distributions. The most important ecological variable for C. a. palliatus was predominantly precipitation of the driest month (69.1%) whereas for C. a. sharpei annual precipitation (44.8%) and land cover (normalized difference vegetation index, 16.4%) were the most important. When comparing suitable ranges for the separate distributions, we found only a 1.2% geographical overlap. These differences are consistent with previous subspecies delineations of C. a. palliatus and C. a. sharpei based upon morphology, pelage, and genetics. Our study suggests that extirpation of C. a. palliatus in suitable habitat areas and occurrence of this subspecies in anthropogenic environments, warrant further consideration for conservation actions.