Can telehealth reduce health care expenditure? A lesson from German health insurance data

This study analyzes a telemedical program for chronic heart failure in Germany with respect to economic and treatment indicators. The program entails a routine data‐based preselection of the insured and specific treatment intensities for low‐ and high‐risk patients. This study complements previous research by considering differentiated end points such as mortality and rehospitalization as well as ambulatory, outpatient, and medication costs to account for potential cost shifts. In addition, different time frames and regional characteristics are dealt with. A difference‐in‐differences approach accounts for potential self‐selection into the voluntary program. Our results challenge the current paradigm of program‐induced cost shifting between hospital and ambulatory care. Except for a short‐term effect in the lower‐risk group, the program is associated with raising hospital admission rates as well as higher costs in all categories, while mortality is significantly reduced. The findings are robust as to various sensitivity checks.     

Can BCG be useful to mitigate the COVID-19 pandemic? A Canadian perspective

There is ample evidence from in vitro, animal and human studies that the Bacillus Calmette-Guerin (BCG) vaccine epigenetically reprograms innate immunity to provide “off target” protection against pathogens other than mycobacteria. This process has been termed “trained immunity”. Although recent ecological studies suggested an association between BCG policies and the frequency or severity of COVID-19 in different countries, the interpretation of these results is challenging. For this reason, a case-control study aiming to test this hypothesis has been initiated in Quebec. Several phase III clinical trials are underway, including one in Canada, to assess the efficacy of BCG against SARS-CoV-2 infection (results expected in 2021). In the past, BCG has been widely used in Canada but current indications are restricted to high-risk individuals and communities experiencing TB outbreaks as well as for the treatment of bladder cancer. The potential implication of BCG as an interim measure to mitigate COVID-19 is the subject of widespread discussion in the scientific community and can be considered for the vulnerable population in Canada. To conclude, BCG vaccination should be placed on the agenda of research funding agencies, scientific advisory committees on immunization and federal/provincial/territorial public health authorities.     

How to make universal,voluntary testing for COVID-19 work? A behavioural economics perspective

Testing is widely seen as one core element of a successful strategy to curtail the COVID-19 pandemic and many countries have increased their efforts to provide testing at large scale. As most democratic governments refrain from enacting mandatory testing, a key emerging challenge is to increase voluntary participation. Using behavioural economics insights complemented with data from a novel survey in the US and a survey experiment in Luxembourg, we examine behavioural factors associated with the individual willingness to get tested (WTT). In our analysis, individual characteristics that correlate positively with WTT include age, altruism, conformism, the tendency to abide by government-imposed rules, concern about contracting COVID-19, and patience. Risk aversion, unemployment, and conservative political orientation correlate negatively with WTT. Building on and expanding these insights may prove fruitful for policy to effectively raise people's propensity to get tested.     

Is it cost-effective to use a mucosal or paracervical block to relieve the pain and cramping from cryosurgery? A decision model

BACKGROUND: Cryosurgery is an effective treatment for cervical intraepithelial neoplasia, but it often causes pain and cramping. Both paracervical and mucosal blocks have been shown to provide relief from the pain and cramping associated with cryosurgery. The purpose of this article is to recommend the use of mucosal block, paracervical block, or no block on the basis of which procedure minimizes the costs of averting the pain and cramping that a woman experiences during cryosurgery. METHODS: A decision model was constructed encompassing the options (mucosal block, paracervical block, or no block) that a physician has when performing cryosurgery. The 4 possible outcomes for a patient undergoing cryosurgery were diagrammed as: (1) no pain and no cramping; (2) only cramping; (3) only pain; and (4) both pain and cramping. Each of these outcomes was measured on a 200-mm horizontal visual analog scale. Costs were derived for cryosurgery from the office perspective. Sensitivity analyses were conducted to test the robustness of the analysis. RESULTS: The base case analysis showed that the lowest cost per pain and cramping averted was for women who had a mucosal block before cryosurgery ($153.87), compared with women with a paracervical block ($183.24) and women with no block ($218.83). CONCLUSIONS: A mucosal block is the most cost-effective method to avert the pain and cramping from cryosurgery in women who have taken a nonsteroidal anti-inflammatory drug before the procedure.     

Are children rational decision makers when they are asked to value their own health? A contingent valuation study conducted with children and their parents

Despite the importance of including children's preferences in the valuation of their own health benefits, no study has investigated the ability of children to understand willingness‐to‐pay (WTP) questions. Using a contingent valuation method, we elicit children's and parents' WTP to reduce children's risk of an asthma attack. Our results suggest that children are able to understand and value their own health risk reductions, and their ability to do so improves with age. Child age was found to be inversely related to parents' and children's WTP. The results also suggest that non‐paternalistic altruism is predictive of children's WTP. For parents, care for their own health was found to be inversely related with their WTP for children's risk reductions. Comparison of parents' and children's WTP suggests that parents are willing to sacrifice for their child's health risk reduction an amount that is approximately twice that of their children. The analysis of matched pairs of parents and children suggest that there are within‐household similarities as the child's WTP is positively related to parents' WTP.     

Bayesian inference of gene–environment interaction from incomplete data: What happens when information on environment is disjoint from data on gene and disease?

Inference in gene-environment studies can sometimes exploit the assumption of mendelian randomization that genotype and environmental exposure are independent in the population under study. Moreover, in some such problems it is reasonable to assume that the disease risk for subjects without environmental exposure will not vary with genotype. When both assumptions can be invoked, we consider the prospects for inferring the dependence of disease risk on genotype and environmental exposure (and particularly the extent of any gene-environment interaction), without detailed data on environmental exposure. The data structure envisioned involves data on disease and genotype jointly, but only external information about the distribution of the environmental exposure in the population. This is relevant as for many environmental exposures individual-level measurements are costly and/or highly error-prone. Working in the setting where all relevant variables are binary, we examine the extent to which such data are informative about the interaction, via determination of the large-sample limit of the posterior distribution. The ideas are illustrated using data from a case-control study for bladder cancer involving smoking behaviour and the NAT2 genotype.     

Can one puff really make an adolescent addicted to nicotine? A critical review of the literature

Rationale  

In the past decade, there have been various attempts to understand the initiation and progression of tobacco smoking among adolescents. One line of research on these issues has made strong claims regarding the speed in which adolescents can become physically and mentally addicted to smoking. According to these claims, and in contrast to other models of smoking progression, adolescents can lose autonomy over their smoking behavior after having smoked one puff in their lifetime and never having smoked again, and can become mentally and physically "hooked on nicotine" even if they have never smoked a puff.     

Can observations of workplace bullying really make you depressed? A response to Emdad et al.

Background

A recent study by Emdad and colleagues published in International Archives of Occupational and Environmental Health concluded that being a bystander to workplace bullying is related to future symptoms of depression. In this response to the authors, we argue, through the use of empirical evidence, that this relationship can be explained by the observers own exposure to bullying. Furthermore, by also investigating the reversed association between the variables, we show that observations of workplace bullying can be influenced by symptoms of psychological distress.

Method

A reanalysis of prospective questionnaire survey data with a two-year time lag based on a representative sample of Norwegian employees was used to determine long-term relationships between observed bullying, self-reported exposure to bullying, and psychological distress.

Results

Bivariate, baseline observations of others being bullied were significantly associated with subsequent symptoms of psychological distress. Yet, this association disappeared when controlling for the observers own exposure to bullying. Analyzing reversed relationship between the variables, baseline symptoms of distress predicted being a bystander at follow-up.

Conclusion

By showing that the relationship between being a bystander to bullying and distress can be fully explained by the observers own exposure to bullying, our results question the conclusion by Emdad et al. (Int Arch Occup Environ Health. doi:10.1007/s00420-012-0813-1, 2012) that observed bullying in itself is related to subsequent distress. Together with the finding that psychological distress predicts subsequent observations of bullying, it is concluded that future research on observers should always take the observers’ own exposure to bullying, as well as negative perceptions biases, into account.     

Can the school make a difference? A multilevel analysis of adolescent risk and health behaviour

The main aim of this article is to assess the relationship between the structural and (health) policy variables of the school and characteristics of the individual on the risk and health behaviour of adolescents. Individual and school level effects on seven health-related behaviours are simultaneously estimated, using multilevel modelling. The data are from the Flemish health behaviour in school-aged children study in Belgium. Data are used from 29 Flemish schools in which students (N=3225), school administrators (N=29) and teachers (N=1132) were surveyed with anonymous written questions. The analysis confirms previous findings concerning individual level effects. Although differences between schools in risk and health behaviour were found to originate mainly from differences in pupil characteristics, substantial variation between schools remained with regard to regular smoking, drinking habits and tooth brushing after controlling for individual effects. A wide range of school structure and policy variables were taken into account, but only few of them were found to influence the health and risk behaviour of young people. Moreover, the study could not detect an effect of health promotion policy at school. The analysis therefore only partially confirms the hypothesis that the school has an impact on the health behaviour of young people. The findings demonstrate the need for a more thorough examination of the paths by which schools can influence the health behaviour of their pupils.     

Can survey data facilitate local priority setting? Experience from the Igunga and Nzega districts in Tanzania

Quality of Life Research - This study aimed to investigate whether a local survey applying EQ-5D and SAGE could provide data valuable in setting priorities. A cross-sectional household survey was...