02 de novembre 2020

Health reform, a lost chance (once again) (2)

 Consenso por un sistema sanitario del siglo XXI

A new report and new proposals for health reform. The authors start saying that Informe Abril (released 29 years ago. Yes! I was there) was not finally considered as a source for any reform, as we all know. After that, there are 40 reports available, and nothing happened. After three decades, the probability of a health reform, in the wake of current pandemic and political weakness, is still lower in my opinion. Authors highlight the current difficulties of the health system and generic approaches to be considered.

However, health reform requires a consensus on values, and such consensus will not arise from experts, it is a social and political consensus. Expert consensus is a way to reflect concerns about a topic and ways to tackle it, but on policy terms its relevance and impact is minor.

Anyway, it's up to you your final assessment. 





01 de novembre 2020

Covid and the Value of Statistical Life

 COVID-19 and Uncertainties in the Value Per Statistical Life

Do the Benefits of COVID‐19 Policies Exceed the Costs? Exploring Uncertainties in the Age–VSL Relationship

For an individual, VSL can be derived by dividing WTP by the risk reduction. A population-average VSL of $10 million indicates that the typical individual is willing to pay $1,000 to decrease the chance of dying in a given year by 1 in 10,000. Individual WTP also can be summed across individuals expected to accrue the risk reduction. If 10,000 people will experience a 1 in 10,000 risk reduction and are each willing to pay $1,000 for the risk change, the total value is $10 million (10,000 times $1,000), and one less person would be expected to die that year as calculated by 10,000 times 1/10,000.

But

Individual WTP, then, is the fundamental measure—the $1,000 in this case. The conversion to a $10 million VSL is simply for convenience. 

 In a recent study with Ryan Sullivan and Jason F. Shogren, I compare the effects of three approaches often used to adjust for age: an invariant population-average VSL; a constant value per statistical life-year (VSLY); and a VSL that follows an inverse-U pattern, peaking in middle age. We find that when applied to the U.S. age distribution of COVID-19 deaths, these approaches result in average VSL estimates of $10.6 million, $4.5 million, and $8.5 million. The differences in these values is substantial enough to alter the conclusions of frequently cited analyses of social distancing.

 Table II. VSL by Age Group (in 2019 millions of dollars)

Age GroupInvariant VSLConstant VSLYInverse‐U Relationship
Under 1 year$10.63$13.88$5.38
1–4 years$10.63$13.74$5.38
5–14 years$10.63$13.37$5.38
15–24 years$10.63$12.64$5.38
25–34 years$10.63$11.76$8.50
35–44 years$10.63$10.63$10.63
45–54 years$10.63$9.19$10.72
55–64 years$10.63$7.54$8.15
65–74 years$10.63$5.68$8.15
75–84 years$10.63$3.72$8.15
85 years and over$10.63$2.03$8.15

 Table III. COVID‐19 Age‐Weighted Value (in 2019 millions of dollars)

Invariant VSLConstant VSLYInverse‐U Relationship
Total value, all COVID‐19 deaths$937.6 billion$394.8 billion$773.4 billion
Average VSL, weighted by COVID‐19 deaths by age$10.63 million$4.47 million$8.31 million
Table IV. Effect of Alternative Approaches on Analytic Results
————————————————‐Benefits————————————‐————
 LivesOriginalInvariantConstantInverse‐U
 CostsSavedApproachVSLVSLYRelationship
Thunström et al. (2020)$7.2 trillion1.24 million$12.4 trillion$13.16 trillion$5.54 trillion$10.30 trillion
Greenstone and Nigam (2020)N/A1.76 million$7.94 trillion$18.72 trillion$7.88 trillion$14.64 trillion
Acemoglu et al. (2020)$2.15 trillion8.7 millionN/A$92.44 trillion$38.93 trillion$72.31 trillion

Does this make sense? It seems quite high. If we value identified life more than a statistical life, can you imagine the final figure?

Whether the social distancing policy considered by Thunström et al. (2020) yields net benefits varies depending on the valuation approach. The authors use an invariant VSL but apply a somewhat lower value than we use in our analysis ($10 million rather than $10.63 million). However, both our invariant VSL and inverse‐U approaches lead to positive net benefits. Under our invariant approach, the benefits increase by almost $800 billion due to differences between the VSL estimates. Benefits decrease when using the inverse‐U approach, but not by a large enough amount to drop below estimated costs. Under the constant VSLY approach, benefits decrease by a substantial amount and the policy no longer appears cost‐beneficial.

While Greenstone and Nigam (2020) do not include a cost estimate in their calculations, the effects of our three approaches on their featured benefit estimates are significant. The benefit estimates more than double when applying the invariant VSL approach rather than their age‐adjusted approach. Interestingly, their estimates are very similar ($7.94 vs. $7.88 trillion) to the results using our constant VSLY method, while applying our inverse‐U estimates almost doubles the value in comparison to their inverse‐U approach. This result reflects the relative steepness of their curve at older ages as well as our assumption that values level off at older ages under the inverse‐U approach. As noted earlier, the additional sensitivity analyses reported by the authors also show siginificant variation in the results.

Acemoglu et al. (2020) have by far the largest estimates of lives saved across the three social distancing studies, which naturally increases the benefit values. Under all three approaches, we find that benefits exceed costs by an order of magnitude. However, Acemoglu et al. (2020) find that approaches other than the scenario reflected in Table IV are more cost‐effective, particularly if they target higher risk, older age groups.

Anyway, let's search a little bit more on that. Let's take the press. I don't think that this helps to take policy decisions in the current pandemic. It's just recreational research.


PS. The price of freedom is 103€ per day in my country (cost of non being free by mistake). Explained here.


Hockney



31 d’octubre 2020

Covid Costs, who knows?

 The COVID-19 Pandemic and the $16 Trillion Virus

Summary of the estimates by Cutler and Summers:



And a video:



30 d’octubre 2020

Covid vaccine landscape

 Evolution of the COVID-19 vaccine development landscape

Currently there are 321 vaccine candidates for COVID, however only 33 have entered clinical trials.

Although the leading COVID-19 vaccine candidates have progressed to advanced stages of clinical development at exceptional speed, many uncertainties remain given the lack of robust clinical data so far. Moreover, given the highly unusual circumstances associated with developing a vaccine during the evolution of a novel global pandemic, probability of success benchmarks for traditional vaccine development are likely to underrepresent the risks associated with delivering a licensed vaccine for COVID-19. The most advanced candidates are expected to begin reporting data from pivotal studies over the coming months, which if positive will be used to support accelerated licensure of the first COVID-19 vaccines. 

 

29 d’octubre 2020

Population Health amidst pandemic

 Fitting Community-Centered Population Health (CCPH) Into the Existing Health Care Delivery  Patchwork. The Politics of CCPH

COVID-19 Crisis Creates Opportunities for Community-Centered Population Health Community Health Workers at the Center


Norbert Goldfield et al provides a useful reflection on the current moment in US. And says:

The virus has exposed glaring weaknesses that cannot be unseen. The US health care system’s embrace of patient-centered care is being tested.

We need a new paradigm, one that moves from a patient-centered care system to a community-centered health and social care ecosystem. Unlike much of the current US medical care system, the community sector has lacked funding and development. Strong and consistent sources of support are needed to make this sector viable and keep it flourishing.

Politics will ultimately determine how our current patient-centered acute care–focused health care system will change. The wealthy undoubtedly will continue to have an outsize influence on any legislation promoting CCPH. Despite this fact, we will at least think about becoming better in improving our response before the next pandemic hits.

Both articles deserve being read. 


Hockney

 


28 d’octubre 2020

Primary care: measuring performance

 Taking Stock of the Global Primary Health Care Measurement Landscape

Better measurement for performance improvement in Low- and Middle-Income Countries: The Primary Health Care Performance Initiative (PHCPI) Experience of Conceptual Framework Development and Indicator Selection

During the pandemic everybody agree about the need for a strong primary care. What does this mean?

Check this framework:


And its Core indicators. Unfortunately they have forgotten the Central de Resultats indicators and data.
That's it.

Hockney

Primary care is the house in the center of the painting.