Open Access
El EQ-5D como medida de resultados en salud
(Elsevier España, S.L.U., 2015) Cabasés Hita, Juan Manuel; Economía; Ekonomia
El EQ-5D ha mostrado su validez y fiabilidad como medida de salud, pero su versión original presentaba algunas limitaciones, como efecto techo y escaso poder discriminatorio, especialmente en los cambios pequeños en los estados de salud más leves. Con objeto de superar estos problemas, el Grupo EuroQol lanzó la versión EQ-5D-5L en 2009, con la adición de dos niveles en cada una de las dimensiones (sin problemas, problemas leves, problemas moderados, problemas graves y problemas extremos/imposibilidad), lo que define un total de 3125 (5) estados de salud. El EQ-5D-5L ha mostrado ser una extensión válida del EQ-5D-3L que mejora las propiedades de medición, y ya se encuentra disponible en más de 120 idiomas. Existe también una versión juvenil, el EQ-5D-Y.
Open Access
Comparing the psychometric properties of the EQ-5D-5L between mental and somatic chronic patients populations
(2013) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Hernández Arenaz, Íñigo; Economía; Ekonomia
The validity and reliability of the EQ-5D-5L in comparison with the standard 3L has been tested through the analysis of psychometric properties making use of different samples of patients. However, it is likely that the condition of the illness may affect the power of the 5L version with respect to the 3L one. Here we report on parallel testing of EQ-5D-5L and 3L administered to a sample of chronic patients of both somatic and mental illness. The aim of this study is to check some psychometric properties in both subsamples. Methods: We check for the usual psychometric properties: feasibility, (in)consistency, ordinality (and transitivity), informativity, face validity and convergent validity. Also, we perform new analysis for checking transitivity and the Cronbach-? for convergent validity. Finally, we proposed a complementary way for looking at the property of informativity through three different indexes (effective, absolute and overall) based on the statistical discriminatory power. Data: We have a total of 1002 questionnaires finally collected. 444 (46.25%) chronic mental patients, 516 (53.75%) have somatic chronic illnesses; 42 observations of unknown origin of the illness have been dropped to perform this analysis. Results: The mean value reported in the VAS for the full sample is 60.93. Somatic patients report a mean of 64.42 points in this scale and mental patients report 56.83 points in the VAS. Analyzing the distribution of the responses to problems on each dimension we found, for all cases, a highly skewed distribution. Moreover, the distribution of responses changes significantly between subsamples, as expected. In all dimensions, it seems that somatic patients take more advantage of the extra levels introduced by the EQ-5D-5L. This group reduces to a greater extent the missing response rate, commit less (and of lower importance) inconsistencies, get a higher correlation of the 5L scale and the VAS within the 3L levels, complements better the dimensions to get an overall score (measured through the Cronbach’s alpha), reduces in a more significant way the “no problem” response and the Informativity gain is also superior (for both the Shannon Evenness Index and our Absolute Index). This higher performance of the EQ-5D-5L on somatic patients is endorsed by a higher preference of somatic patients toward the 5L version of the questionnaire than to the 3L one. Conclusion: Results show the suitability of the 5L version in both subsamples, but it is much more effective for somatic patients. These subsamples’ differences may be of concern when aggregating and comparing different data.
Open Access
Self perceived health status of schizophrenic patients in Spain: an analysis of geog raphical differences using bayesian approach
(2005) Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Vázquez Polo, Francisco J.; Negrín, Miguel A.; Domínguez Irastorza, Emilio José; Economía; Ekonomia
Objectives. This paper explores the use of regression models for estimating health status of schizophrenic patients, from a Bayesian perspective. Our aims are: 1- To obtain a set of values of health states of the EQ-5D based on self-assessed health from a sample of schizophrenic patients. 2- To analyse the differences in the health status and in patients’ perceptions of their health status between four mental-health districts in Spain. Methods. We develop two linear models with dummy variables. The first model seeks to obtain an index of the health status of the patients using a VAS as a dependent variable and the different dimensions of EQ-5D as regressors. The second model allows to analyse the differences between the self-assessed health status in the different geographic areas and also the differences between the patients’ self-assessed health states, irrespective of their actual health state, in the different geographic areas. The analysis is done using Bayesian approach with Gibbs sampling (computer program WinBUGS 1.4). Data concerning self-assessed EQ-5D with VAS from four geographic areas of schizophrenic patients were obtained for the purposes of this analysis. Results. We obtained the health status index for this sample and analysed the differences for this index between the four geographic areas. Our study reveals variables that explain the differences in patients’ health status and differences in their health states assessment. We consider four possible scenarios.
Open Access
Societal perspective on the eliciting of health states preferences
(2000) Cabasés Hita, Juan Manuel; Ugalde, José M.; Gaminde, Idoia; Economía; Ekonomia
With the concept of 'societal perspective' in mind, a study using the PTO and 8 EQ-5D defined health states, (using two selection criteria: states self assessed by people in a real context -women with breast cancer-, and similar distance in the TTO-York tariff), with a sample of 51 individuals selected from the general population of Navarra (Spain), was carried out. The main objectives were: 1) To elicit some EQ-5D health states values using a societal technique (PTO); 2) to check people concern about severity of illness when valuing equal gains from different starting points in the scale; and 3) to asses the effect on values of limited potential health improvements. The results shown very high values for the health states selected (0.90 to 0.99), due to the effect of anchoring on immediate death. Severity does not seem to be considered by the majority of people interviewed, although some 25% of them showed preference for similar health gains in those individuals in worse initial health. The same can be said for the concern for the limited potential health improvement, where most people seem to show an utilitarian perception.
Open Access
Motivational capital and incentives in health care organizations
(2014) Berdud García-López, Mikel; Cabasés Hita, Juan Manuel; Nieto Vázquez, Jorge; Economía; Ekonomia
This paper explores optimal incentive schemes in public health institutions when agents (doctors) are intrinsically motivated. We develop a principal-agent dynamic model with moral hazard in which agents’ intrinsic motivation could be promoted (crowding-in) by combining monetary and non-monetary rewards, but could also be discouraged (crowding-out) when the health manager uses only monetary incentives. We discuss the conditions under which investing in doctors’ motivational capital by the use of well designed nonmonetary rewards is optimal for the health organizations manager. Our results show that such investments will be more efficient than pure monetary incentives in the long run. We will also prove that when doctors are riskaverse, it is profitable for the health manager to invest in motivational capital.
Open Access
Cost efectiveness analysis of therapeutic strategies for patients with chronic hepatitis C previously non responders to interferon
(2003) San Miguel Elcano, Ramón; Mar, Javier; Cabasés Hita, Juan Manuel; Guillén Grima, Francisco; Butí, María; Economía; Ekonomia
Background: The efficacy of combination therapy in previous non responders to interferon (IFN) monotherapy with chronic hepatitis C is lower than in naïve patients, and there has been no economic evaluation in this population. Aim: To develop a cost-effectiveness analysis of therapeutic regimens with IFN alpha and ribavirin in previous interferon non-responders. Methods: A Markov simulation model was used to project the clinical and economic outcomes of five different therapeutic strategies including a “no treatment” alternative using the health care system perspective. The effectiveness data for the different doses and durations was obtained from a previously performed meta-analysis. A sensitivity analysis was performed to test robustness of the model, analysing changes in different variables. Results: Applying a 3% discount rate, the standard patient on combination therapy for 12 months showed an increase of 0.80 years and 1.55 quality adjusted life years (QALYs), when comparing combination therapy for 12 months vs. “no treatment” strategy. This option led to an incremental cost-effectiveness ratio of 11,767 euros per year of life gained and 6,073 euros per QALY. Conclusions: Combination therapy with interferon plus ribavirin in previous interferon non-responders shows an incremental cost-effectiveness ratio within the range of some well accepted medical interventions in our health care system.
Open Access
La financiación sanitaria autonómica. Bases para una propuesta
(1998) Cabasés Hita, Juan Manuel; Economía; Ekonomia
Se analizan las novedades recientes en el debate sobre financiación territorial sanitaria: el nuevo modelo de financiación autonómica para el quinquenio 1997-2001, y la nueva RAWP, fórmula inglesa de reparto financiero sanitario y el acuerdo del Consejo de Polí’tica Fiscal y Financiera de 27 de Noviembre de 1997 estableciendo un mecanismo de financiación de la sanidad de la Seguridad Social para el cuatrienio 1998-2001. La discusión sobre financiación auton—çomica de la sanidad es un asunto donde el consenso deviene crucial, y éste ha de empezar por un acuerdo de principio ético. Consideramos que el principio es la igualdad de oportunidades. Nuestra propuesta consiste en profundizar en la corresponsabilidad fiscal incorporando la sanidad a la financiación autonómica general. En este nuevo marco, habrá que diseñar los mecanismos de garantí’a que permitan el logro de los objetivos de la Ley General de Sanidad. Quedan, así’, establecidas, las bases para una agenda de trabajo para elaborar el acuerdo del año 2001.
Open Access
An economic model of behaviour: attitudes towards altruistic blood and organ donations
(2009) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Economía; Ekonomia
The aim of this research is to model altruistic blood and organ donors behaviour. First, we make an analysis of the decision of to be or not to be a donor for any individual. We propose a model where individuals compare the expected utility of deciding to become a donor, with the utility of the alternative decision (not to become a donor). Second, we continue with the identification of the variables having influence over this decision, the expected effects of such a donation (positive and negative) and the importance of the expectations over individuals well-being and the subsequent decision. We work with rational individuals that behave altruistically when making a decision. The model is specific because the goods we consider can only cover vital needs. We posed hypothesis about some variables for each kind of the donations considered (blood and organ donations). This hypothesis can be useful to identify which are the variables having influence actually over this decision. We propose a pilot survey to test our model. First results from a university students survey show the relevant variables influencing blood an organ donations, and seem to confirm the model.
Open Access
Attitudes towards blood and living organ donations
(2010) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Economía; Ekonomia
We model the decision of whether or not to become a blood/living organ donor. The expected utility for becoming a donor is a function of the degree of altruism, the consumption of goods, the costs of donation, the very pleasure of giving, and the recipient’s utility associated to donation. Empirically, we observe differences in the expected costs and benefits from donation between blood and non-blood donors, and between individuals with different willingness to donate living organs. Looking at benefits/costs of donation through reasons for donating/not donating, we conclude policies to encourage donation should focus on raising awareness and provide information.
Open Access
Contracting arrangements in the health strategy contex. A regional approach for Spain
(2000) Cabasés Hita, Juan Manuel; Gaminde, Idoia; Gabilondo, Luis; Economía; Ekonomia
Background. Several different proposals have been made recently to reform the organisation, financing and management of the health care system in Spain. The aim is to obtain improved efficiency, without prejudicing the equity level already achieved, by creating a more competitive framework. However, current health strategies seem not to be in accord with these proposals. This paper approaches the issue of matching these two main components of the health systems, health strategy and contracts, and emphasises the need to develop contracting arrangements within the general health policy framework. Design: Case studies, analysis of published and unpublished documents, and semi-structured interviews with key informants. Results and discussion. A review of regional health strategies and regional contracts developed in the 1990s is presented, followed by an analysis of the degree of incoherence between them. Then we discuss whether the programme contract can be an instrument guided by the health plan, commenting on its potential and limitations. Conclusion. The relationship between health strategy and health care management is practically non-existent in Spain. The need to insert the contract cycle within the broader framework of the planning cycle has led to proposals to adapt contracts and health plans to guarantee their coherence. This will require changes in the structure of both of these instruments and, probably, deeper structural modifications of the context within which both have been developed. To this aim, we make some recommendations for policy making.