28 d’agost 2015

Healthy life expectancy: the key indicator

Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition

In former posts I have advocated that healthy life expectancy should be used as an aggregated indicator of outcomes of health determinants. Unfortunately although it is imperfect, it is the best we have, and today you can check the latest estimates in a salient article in The Lancet.

Countries with highest healthy life expectancy, both sexes, 2013
1 Japan
2 Singapore
3 Andorra
4 Iceland
5 Cyprus
6 Israel
7 France
8 Italy
9 South Korea
10 Canada

Spain has disappeared from the former top 10. I have always said that ordinal rankings have flaws, however, comparisons across time are worth taking into account.
Internally in Spain it is difficult to reverse this trend. If you consider geographic variations of the indicator you can see a range from 55 years up to 65 (p.25) .Therefore there is too much noise when you focus on the state as the unit of analysis. Forget the results and the ranking.
The only situation that is unique in the ranking is Andorra, it always appear at the top and it is a small state. That's remarkable and merits close analysis.

26 d’agost 2015

Beware of healthcare providers consolidation

The Potential Hazards of Hospital Consolidation Implications for Quality, Access, and Price

The key message:
  With the current most substantial consolidation of health care in US history, the concerning implications of the trend of hospital consolidation on quality, access, and price must be carefully considered. However, unlike banks that became too big to fail, 85% of US hospitals pay no taxes because they are designated as nonprofit organizations serving a public good. Hospitals can set prices that are ultimately passed on to others in the form of escalating insurance deductibles and taxes.
The alternative:
 The good work of integrated hospitals should continue to create networks of coordinated care, while at the same time, physicians and patients should insist that hospitals compete on transparent prices and quality outcomes. Achieving this goal is an important prerequisite to a functional health care system.

25 d’agost 2015

Tackling obesity: the toolbox

Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking

World Cancer Research Fund International NOURISHING framework 
Food policy framework for healthy diets and the prevention of obesity and diet-related non-communicable diseases. 

 Key message:
The problem of obesity must be reframed to acknowledge on one hand that individuals bear some personal responsibility for their health, but that, on the other hand, environmental factors exploit biological, psychological, social, and economic vulnerabilities that promote overconsumption of unhealthy foods. A vicious cycle is created in which the preference and demand for unhealthy products are not only shaped by the environment, but lead to environmental changes that further encourage consumption of unhealthy foods. This cycle makes it difficult for people to act in their own long-term self-interest, but it can be broken with regulatory actions from governments and joint efforts from industry and civil society to create healthier food systems.

07 d’agost 2015

European health regulation on lab tests, the final round?

Medical devices: Council getting ready for talks with EP

Last June 15th, there was a small but significant step towards the final agreement on Medical devices and in vitro diagnostics regulation in Europe. The need for reform has been widely requested but the lack of political consensus and the low priority given to the issue has delayed its approval in many ocasions. It seems that now is the right opportunity, however if finally passes, it will be applied on 2020!!!. It really sounds weird that it would take 5 years to be fully developed.
Anyway, if you want to have a look at the details check here and here. Right now, the lobbies are not on vacation, they are fighting against some provisions that limit their current freedom of market access. Pay attention to final result, just to check who wins and who loses, and the current state of power balance between society and the lobbies.


NESBITT, Lowell. Dos ponts a Nova York, 1975

06 d’agost 2015

The size of income inequality

Income declared to tax authorities, not actual income. Selected statements:
  • 3% of citizens account for 30% of tax collection!
  • In 5 years, plutocrats have decreased by 50%!
  • In 5 years, average work income has plummeted 3,6% and taxes jumped to 9,5%!
My congratulations, tax authorities!

05 d’agost 2015

The price of cancer drugs, where is the limit?

04 d’agost 2015

Stratified medicine: defining the size of the market

Trusheim and Berndt provide an excellent overview of the economics of stratified medicine. I have reviewed the topic before and specifically in this post. An ideal companion diagnostic perfectly identifies and distinguishes treatment responders from those who will not.Unfortunately, in practice no diagnostic performs ideally. All diagnostics experience some level of error. In the case of a companion diagnostic, some patients will receive false positive results, scores indicating they will respond, but will not when treated. Other patients will receive false negative results, scores indicating they will not respond, but if treated they would.
So what? The key issue is about the setting of the cut-off that will define the size of the market:
Under competition, three essentially identical drugs may receive dramatically different labels, incremental cost-effectiveness ratio (ICER) justified pricing, and market positioning depending on their stratification approach. It appears superior to use an imperfect biomarker to none at all. It is less obvious whether patients, payers and firms prefer the same cut-off values for the companion diagnostic, or even whether each stakeholder a priori prefers the high, low or perhaps some other CDx cut-off value.
The competing development teams may face a version of the game theory ‘prisoner’s dilemma’ in which the optimal result for patients and all firms would be to select a low or mid companion diagnostic cut-off value but the advantages of a potentially differentiating high efficacy claim may drive developers to select a high cut-off value. If all choose this approach, overall value may be reduced with many patients excluded from treatment. But the potential advantage of a higher cut-off value may prove too alluring, or the fear of a competitor selecting one, may drive all to do so. Each situation will depend on the specific facts of the indication, therapeutic, companion diagnostic and competitors
The implications for regulating and financing of companion diagnostics are immediate. In Europe current legislation is as old as of 1998, the year that Herceptin entered into the market and the begining of stratified medicine. New regulation is still pending and there are  no perspectives about a unified approach to lab tests assessment. European regulator is still on vacation.

03 d’agost 2015

Lab on a chip concept, the future of diagnostics?

Future vision: next generation lab on chip concept from imec on Vimeo.
Imec develops the next generation of “lab on a chip” concepts. The idea is that such a disposable chip could be loaded with a sample of blood, saliva or urine and then quickly analyzed using a smartphone, tablet or computer, making diagnostic testing faster and easier for applications such as disease monitoring and management, disease surveillance, rural health care and clinical trials.