Boards

 The Black Box of Governance. Boards of Directors Revealed by Those Who Inhabit Them

The profits of opioid epidemic (3)

 The Hard Sell. Crime and Punishment at an Opioid Startup

An absolute public health crisis, a crime without punishment. The outrageous behavior of an obscure drug company, Insys Therapeutics.

Option value of healthcare technologies

 Broadening the Concept of Value: A Scoping Review on the Option Value of Medical Technologies

Key messages, 

Traditionally, cost-effectiveness analyses have been conducted from the payer perspective, although the question of whether they should be expanded to take a broader perspective continues to animate a lively debate. Lately, the attention has focused on wider components of benefits, including the so-called  option value. Our scoping review provides a comprehensive synthesis of conceptual and empirical aspects related to this topic recently introduced in the value assessment framework debate.

From a conceptual standpoint, the coexistence of 3 distinct definitions of option value in the literature emerging from our scoping review urges us to advocate for greater clarity of language in future research. We recommend using “insurance value” when referring to the utility of knowing that one may have access to a healthcare service should one need it in the future, as in definition A. Definition B mainly relates to decision making under uncertainty and specifically to the value of deferring uncertain unrecoverable decisions to a later time. In the evaluation of healthcare technologies and programs, this dimension of value originates from the possibility of delaying a reimbursement/adoption decision, if there is an expectation that better information on a technology’s (cost-) effectiveness will become  available in the future—for example, because a new clinical trial reports its results. Because this definition is rooted in financial options theory and its application to capital investment decisions, we recommend using the term “real option value,” consistently with the terminology used outside the healthcare sector 

According to the third definition, the claimed value does not originate from the uncertainty around a decision and the flexibility of deferring it, as in definition B, but rather it stems from the consideration that the value of a life-extending technology should also include the benefits of future treatments that otherwise would be precluded to patients if they did not benefit from improved survival. This definition of value pertains to the broader discussion on whether future costs and benefits not directly linked to the intervention being assessed should be accounted for when evaluating a technology.Therefore, we recommend that research related to this definition adopt the term “option value of survival.”

To date, no consensus has been reached yet

Les escaliers de la rue Chappe  à Montmartre.

The value of life (4)

 How Much Is a Human Life Worth? A Systematic Review

The distinction between a statistical life and a human life is crucial. Generally, economic research and policy evaluation aims at eliciting the VSL. A common misconception is that the VSL expresses the value for which an individual would trade their life. It does not. The VSL identifies how people value a smallreduction in mortality risk. For instance, if each individual is willing to pay $1 to reduce the risk of dying by 1 in 1000 000, then a population of 1 million individuals would be willing to pay $1 million to save 1 statistical life – the VSL is $1 million. Even though valuation tasks in surveys/experiments are generally framed as a change in the participant’s own mortality risk, the objective is to elicit the VSL because it is unlikely that the participant’s life will be saved owing to the intervention considered. 

Closely related to the concept of a VSL, the value of a statistical life-year (VSLY) represents the value of one additional year of life. One of the benefits of using VSLY estimates instead of VSL estimates is that the age of individuals benefiting from an intervention is taken into account when performing an  economic evaluation. As such, a higher value would be placed on the life of a child than the life of an elderly person owing to the difference in remaining life expectancy.

Unfortunately, VSLY are currently not available, you'll find VSL in this table:

 

Table 3. Median of the midpoint of reported value of a statistical life (VSL) estimates in included studies.

Sector	Overall (no. studies)	Developed countries (∗no. studies)	Developing countries (∗no. studies)	Stated-preference studies (∗no. studies)	Revealed-preference studies (∗no. studies)	Human capital approach (∗no. studies)
Environment	$1 062 630 (6)	$5 146 850 (2)	$680 489 (4)	$1 381 201 (5)	NA (0)	$744 058 (1)
Health	$6 770 534 (33)	$8 989 328 (21)	$580 663 (12)	$6 770 534 (33)	NA (0)	NA (0)
Labor market	$8 740 231 (35)	$11 784 289 (22)	$1 430 105 (13)	NA (0)	$8 740 231 (35)	NA (0)
Safety	$3 010 740 (9)	$7 075 108 (5)	$409 110 (4)	$3 010 740 (7)	$2 942 773 (2)	NA (0)
Transportation safety	$5 335 248 (41)	$7 075 108 (28)	$403 798 (13)	$5 335 248 (37)	$5 383 706 (4)	NA (0)
All sectors	$5 716 830 (116)	$8 342 027 (73)	$858 599 (42)	$5 185 402 (74)	$7 940 006 (41)	$744 058 (1)

NA indicates not available.

∗

No. studies indicates the number of studies on which the calculations for the median of the midpoint estimates are based. The number of studies considering all sectors is not necessarily equal to the sum of studies across the single sectors owing to some studies reporting VSL estimates for multiple sectors.

Rewardable pharmaceutical innovation

A Review of Current Approaches to Defining and Valuing Innovation in Health Technology Assessment

Key messages, 

Although, formerly, denoting a new drug as innovative was based on the drug having received patent protection or being a new molecular entity, this criterion is no longer sufficient from the perspective of many stakeholders. Rather, it became widely accepted that the central criterion to identify a drug as truly innovative should be the drug’s benefit or usefulness. With usefulness being a relative quality though, innovation is often defined by the particular view of what is deemed important or valuable. 

On the one hand, there is the notion that the value of innovation derives exclusively from the effect that the innovative drug has on the therapeutic benefit. What matters most for patients is whether a drug is the best choice to achieve treatment goals. It is this basic principle that guides most of the work on how to define rewardable innovation in the context of drug value assessments. The main argument is that, assuming a limited budget for healthcare expenditures, valuing anything beyond this therapeutic benefit in pricing and reimbursement decisions would reduce population health by displacing more cost-effective therapies. Furthermore, as a consequence, pharmaceutical companies might be incentivized to increasingly invest in R&D of slightly modified but basically similar products as opposed to drugs with a potentially larger positive therapeutic impact on patients.

On the other hand, it is argued that there might also be other, less obvious benefits from innovation in a wider sense. First, there may be benefits related to health or well-being that are not captured in measures of health outcomes typically used in clinical trials. A novel drug with less side effects or one that allows a more convenient treatment, for example, oral versus intravenous administration, may have the same effect on the therapeutic outcome but still improve the subjective well-being of the patients.

 

Tuscany, man made landscape

Health expenditure before COVID

 Spending on health in Europe: entering a new era

This report analyses health spending in 53 countries in the WHO European Region from 2000 to 2018 (the latest year for which internationally comparable data are available). It reviews key patterns and trends in health spending over time and across countries

 

Pharmaceutical utilization research

Methods to analyse medicine utilization and expenditure to support pharmaceutical policy implementation 

Reproductive genomics paradigm

The End of Genetics. Designing Humanity's DNA

Although human genetics has already advanced far enough to provide parents with information on which they may choose to act, key gaps in our knowledge make it very difficult to anticipate the consequences of the actions likely to become possible. These gaps mean that any reproductive engineering that is performed beyond the most straightforward elimination of strongly acting disease-causing mutations will be performed without a complete understanding of the likely consequences of those changes. This is a prospect that I find deeply troubling, and this book above all represents my best effort to empower non-specialists to develop their own opinions about this most central question for the future of humanity.

In response to this deep uncertainty, I have developed a thought experiment in reproductive genomics to help illustrate the kind of genome engineering that could be entertained in the not too distant future. Throughout the book I will refer back to this thought experiment to help make clear that we will have the technological ability of making some kinds of adjustments to the genomes of children, without having a matching ability to accurately predict the consequences of those adjustments. You will be in a position to understand this thought experiment more fully later in the book, but as a motivation in the reading that follows, consider the following possibility.

A very controversial book, glups!

This is the outline, 

Introduction

Chapter 1. The Future of Reproduction

Chapter 2. Learning to Read the Human Genome

Chapter 3. The Nature of Human Genetic Variation

Chapter 4. DNA and Human Disease

Chapter 5. Writing the Genomes of Our Children

The financial crash of 2008 never really ended

 The Lords of Easy Money. How the Federal Reserve Broke the American Economy

Ten years on, the gap between the rich and poor has grown dramatically, stock prices are trading far above what’s justified by actual corporate profits, corporate debt in America is at an all-time high, and this debt is being traded by big banks on Wall Street, leaving them vulnerable—just as they were during the mortgage boom. Middle-class wages have barely budged in a decade, and consumers are buried under credit card debt, car loan debt, and student debt.

Finding network effects desperately

 The Cold Start Problem. How to start and scale network effects.

Precision medicine (2)

Discovering Precision Health: Predict, Prevent, and Cure to Advance Health and Well-Being

Introduction The Power of Precision Health 1

Chapter 1 The State of U.S. Health and Health Care Delivery 15

Chapter 2 There’s More to “Health” Than Health Care 33

Chapter 3 The Innovation and Disruption Powering Progress in Health 43

Chapter 4 Fundamental, Discovery‐Focused Research: The Foundation of Biomedical Breakthroughs 111

Chapter 5 Peering into the Future: Leveraging The Powers of Prediction to Help Prevent Illness 147

Chapter 6 Prevention as a Pathway to Health and Wellness 177

Chapter 7 Curing Disease with More Precise Medical Therapies 207

Conclusion Achieving Precision Health: The Opportunities—and Challenges—Ahead 237

Paying for healthcare

Better Ways to Pay for Health Care

Public health budget evolution

 Last September I posted the data on per capita health expenditure. In 2020 we spent 1786€ per capita. The total budget for 2021 was 13.162m€, 1700€ per capita. Now the budget for 2022 says that we are going to spend 1.446€. This is an absolute nonsense. The budget approval has no relationship with former incurred expenditures...

Somebody should explain it clearly to the population and take measures. Forget this figure, it has no relationship with reality.

Bundled payments update (2)

 Year 1 of the Bundled Payments for Care Improvement–Advanced Model

A NEJM article shows a negligible effect of bundled payments. Unfortunately, I haven't seen any comment about the flaws in the design. A design mistake for not taking into account a holistic view.

If you reduce 78$ out of 27,315 $ per episode, this is an absolute FAILURE! (it is not a small reduction!!!)

However, the conclusion is:

In this study, we found that the BPCI-A program was associated with small reductions in Medicare payments among participating hospitals. Longer-term evaluation is needed to determine the full effect of the program.

Jean Pierre Capron