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Economic analysis based on multinational studies: methods for adapting findings to national contexts
(2010)
Background: Health economic parameters are increasingly considered as variables in health care decisions, but decision makers are interested in country-specific evaluations. However, a large number of studies are performed in foreign countries or in a multinational setting, which limits the transferability to a single nation’s context.
Objective: The present analysis summarises several of the most common international methods for generating health economic analyses based on clinical studies from different settings.
Methods: A narrative literature review was performed to identify potential reasons for limited transferability of health economic evaluation results from one country to another. Based on these results, we searched the methodological literature for analytic approaches to handle the restrictions. Additionally we describe the possibility of transferring foreign economic study results to the country of interest by matching trial data with routine data of national databases.
Results: The main factors for limited transferability of health economic findings were found in country-specific differences in resource consumption and the resulting costs. These differences are affected by a number of influencing cofactors (demography, epidemiology and individual patient’s factors) and the overall health care system structures (e.g. payment systems, health provider incentives). However, despite the limitations country-specific health economic assessments could be realised using the pooled/split analyses approach, some statistical approaches and modelling approaches.
Conclusion: A variety of methods for identifying and adjusting country-specific differences in costs, effects and cost-effectiveness was established during the past decades. Multinational studies will continue to play a crucial role in the evaluation of cost-effectiveness at national levels. It seems likely that the growing interest in multinational studies will lead to continued developments in adaptation methods.
For patients with an acute exacerbation of chronic liver failure (ACLF), the molecular adsorbent recirculating system (MARS) can result in a prolongation of life, but data on costs and cost-effectiveness are lacking. A health economic evaluation of a prospective controlled cohort trial in patients with ACLF not eligible for liver transplantation with 3 years follow-up and consecutive modelling of long-term costs, outcomes and cost-effectiveness was conducted. Costs were calculated from the perspective of the German health-care system. One hundred and forty-nine patients with ACLF were included of which 67 (44.9%) were treated with MARS and 82 (55.1%) assigned to the control group. Mean survival was 692 days in MARS-treated patients (33% survival after 3 years) and 453 days in control patients (15% after 3 years, logrank P = 0.022). MARS patients gained 0.66 [95% confidence interval (CI): -0.12 to 1.46] life years (LYs), determined by the bootstrap method. The mean cost difference was 19.835 euro (95% CI: 13.308-25.429) with 35639 euro for MARS-treated patients and 15804 euro for controls. Incremental costs per LY gained were 29.985 euro (95% CI: 9.441-321.761) and 43.040 euro (95% CI: 13.551-461.856) per quality-adjusted LY gained. There is an acceptable cost-effectiveness of MARS, compared with other medical technologies presently reimbursed. Randomized controlled trials with sufficient sample size are necessary before a final recommendation for MARS can be given.
Objectives: To develop and psychometrically evaluate a domain-specific questionnaire to assess subtle but clinically relevant differences in treatment experiences and satisfaction over a wide range of currently available insulin therapy regimens. The study focussed on patients with type 2 diabetes mellitus and placed particular attention on the impact of different forms of insulin therapy on diabetes self-management. Methods: The development of the Insulin Treatment Experience Questionnaire (ITEQ) was conducted in three steps: (i) a qualitative phase to generate relevant items and identify relevant domains; (ii) a pilot study to reduce the number of generated items; and (iii) a validation study to assess major psychometric properties of the final ITEQ version. Results: The final version of the questionnaire comprised 28 items with the subscales ‘leisure activities’ (four items), ‘psychological barriers’ (two items), ‘handling’ (five items), ‘diabetes control’ (six items), ‘dependence’ (five items), ‘weight control’ (three items), ‘sleep’ (two items), and one further item assessing general treatment satisfaction. The subscales’ internal consistencies (Cronbach’s alpha) ranged from 0.52 to 0.83. Motivated by the homogenous structure of inter-scale-correlations (range 0.10–0.46), a summary composite score was calculated (alpha = 0.86). Construct validity showed statistically significant correlations with other scales (ITEQ vs the Problem Areas in Diabetes [PAID] questionnaire total score −0.60, ITEQ vs the Diabetes Treatment Satisfaction Questionnaire [DTSQ] total score 0.52). Conclusion: The newly developed ITEQ displayed satisfactory to good psychometric properties, thereby allowing the assessment of everyday life experience and treatment satisfaction in patients with insulin-treated type 2 diabetes. Additional research is needed to assess test-retest reliability and sensitivity to change.
We present a new approach for classifying MPEG-2 video sequences as dasiacartoonpsila, dasiacommercialpsila, dasiamusicpsila, dasianewspsila or dasiasportpsila by analyzing specific, high-level audio-visual features of consecutive frames in real-time. This is part of the well-known video-genre-classification problem, where popular TV-broadcast genres are studied. Such applications have also been discussed in the context of MPEG-7 [1]. In our method the extracted features are logically combined using a set of classifiers to produce a reliable recognition. The results demonstrate a high identification rate based on a large representative collection of 100 video sequences (20 sequences per genre) gathered from free digital TV-broadcasting in Europe.
In this paper we describe in detail the recent publications related to video-genre-classification and present our improved new approaches for classifying video sequences in real-time as 'cartoon', 'commercial', 'music', 'news' or 'sport' by analyzing the content with new high-level audio-visual descriptors and classification methods. Such applications have also been discussed in the context of MPEG-7. The results demonstrate identification rates of more than 90% based on a large representative collection of 100 videos gathered from free digital TV and Internet.
Wo genau liegt der technische Unterschied zwischen Fernsehern mit HD-ready und Full-HD? Welche Übertragungswege und Empfangsmöglichkeiten gibt es, und welche Zusatzgeräte brauchen die Verbraucher, um die verbesserte Bildqualität ihrer hochauflösenden TV-Geräte voll nutzen zu können? Und ist es wichtig, ob sich das Fernsehbild „progressiv“ oder „interlaced“ aufbaut? Antworten auf diese und weitere Fragen gibt die neue Publikation „HD-TV – Technologische Einblicke in das hochauflösende Fernsehen der Zukunft“.
Dr. Ronald Glasberg (Technische Universität Berlin) hat im Auftrag des BITKOM einen Leitfaden zu grundlegenden, technologischen Einblicken in das hochauflösende Fernsehen der Zukunft erstellt. Die Publikation weist die optionalen Übertragungswege via Terrestrik, Kabel, Satellit, Mobilfunk oder Internet auf. Vor allem die digitalen Übertragungswege ermöglichen dem Konsumenten viele Annehmlichkeiten wie zeitversetztes Fernsehen, Video-on-Demand, das Auffinden von Schlüsselbegriffen im laufenden Programm sowie zukünftig mehr Interaktivität.
It is often claimed that work opportunities decline with age, that hiring chances of older persons are poor. We investigate this by collecting questionnaire responses from personnel managers of German manufacturing firms, eliciting a hypothetical hiring decision based on three fictitious candidates. We rely on an age-neutral job and a small age-gap of 14 years between the youngest and the oldest candidate. The quasi-experimental design of the questionnaire allows us to control for possible productivity differences and other economic explanations for declining hiring chances. The data show a 60 percentage point difference in hiring probabilities between the youngest and oldest candidate.
Using a questionnaire and a sample of students and personnel managers we establish the existence of age discrimination in the hiring process in Germany and Norway. As expected, age discrimination is more prominent in Germany where the hiring probability of equally qualified applicants is reduced by about 22 percentage points due to an age differential of 14 years as opposed to only 12 percentage points in Norway. Within both countries the tendency to discriminate does not differ between students and personnel managers and does not depend on the age of the decision maker.