Using Cost-Effectiveness Analysis to Address Health Equity Concerns

This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health—the objective underpinning conventional CEA—and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and—crucially—who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs.     

Reassessing the two-year rodent carcinogenicity bioassay: A review of the applicability to human risk and current perspectives

The 2-year rodent carcinogenicity test has been the regulatory standard for the prediction of human outcomes for exposure to industrial and agro-chemicals, food additives, pharmaceuticals and environmental pollutants for over 50 years. The extensive experience and data accumulated over that time has spurred a vigorous debate and assessment, particularly over the last 10 years, of the usefulness of this test in terms of cost and time for the information obtained. With renewed interest in the United States and globally, plus new regulations in the European Union, to reduce, refine and replace sentinel animals, this review offers the recommendation that reliance on information obtained from detailed shorter-term, 6 months rodent studies, combined with genotoxicity and chemical mode of action can realize effective prediction of human carcinogenicity instead of the classical two year rodent bioassay. The aim of carcinogenicity studies should not be on the length of time, and by obligation, number of animals expended but on the combined systemic pathophysiologic influence of a suspected chemical in determining disease. This perspective is in coordination with progressive regulatory standards and goals globally to utilize effectively resources of animal usage, time and cost for the goal of human disease predictability.     

Die Messung von Burnout-Symptomen und Risikofaktoren mit COPSOQ

Measuring burnout symptoms with COPSOQ, a standardized and validated questionnaire, is an important contribution to risk assessment of work. Comparison between the results found in a certain company and datasets in the COPSOQ database allows to estimate the severity of burnout occurance and to develop suitable measures of prevention. It is essential to have reliable knowledge about the factors which influence burnout symptoms positively as well as negatively. This knowledge can be analyzed due to a large number of assessments carried out with the aim of improving occupational health.     

Risks,benefits and the role of stakeholders in pathogen reduction technology

While Canada’s blood supply is currently very safe, risks remain, prompting blood suppliers to develop a more effective strategy to minimise the risk of transmitting infectious agents through blood transfusion. Pathogen reduction technology provides an additional way to protect the blood supply from new threats. However, the uptake of this new technology has been slow, reflecting the safety of the current system, the success of surveillance and screening methods, the lack of knowledge regarding pathogen reduction technology and the impact of pathogen reduction on blood quality and recipient safety. In the absence of public debate, the legacy of previous adverse events and the challenges of negotiating perceptions of risk, our objective in this article is to explore stakeholder perceptions of the challenges of introducing pathogen reduction technology in Canada. In this article, we provide a debate about risk communication and assessment drawing on data from a study of 2010 that used focus groups and interviews with key stakeholders, including media, blood suppliers, blood or blood product recipients and implementers of pathogen reduction technologies to examine stakeholders’ perceptions of risk assessment and communication. We found that there was a broad understanding among stakeholders of the need to effectively communicate the risks and benefits of pathogen reduction technology and to provide accurate information. Consequently, we predict that public acceptance of the new technology will be largely based on its perception of the risk of pathogen reduction technology.     

A qualitative study to develop an instrument for initial nurse assessment

Complex health care needs focus on accountability and necessity of inclusion of nurses in documenting and monitoring clinical care plans have brought in the concept of initial nurse assessment and nursing process. However, no standardized form exists in the Armed Forces Medical Services to document initial nursing observations while a patient is being admitted in service hospitals.A focus group design was utilized to explore and conceptualize an initial nurse assessment form that may be utilized by service hospitals.