Open Access
Valuation and modeling of EQ-5D-5L health states using a hybrid approach
(Wolters Kluwer Health, 2017) Ramos Goñi, Juan Manuel; Pinto Prades, José Luis; Oppe, Mark; Cabasés Hita, Juan Manuel; Serrano Aguilar, Pedro; Economía; Ekonomia
Background: The EQ-5D instrument is the most widely used preference-based health-related quality of life questionnaire in cost-effectiveness analysis of health care technologies. Recently, a version called EQ-5D-5L with 5 levels on each dimension was developed. This manuscript explores the performance of a hybrid approach for the modeling of EQ-5D-5L valuation data. Methods: Two elicitation techniques, the composite time trade-off, and discrete choice experiments, were applied to a sample of the Spanish population (n=1000) using a computer-based questionnaire. The sampling process consisted of 2 stages: stratified sampling of geographic area, followed by systematic sampling in each area. A hybrid regression model combining composite time trade-off and discrete choice data was used to estimate the potential value sets using main effects as starting point. The comparison between the models was performed using the criteria of logical consistency, goodness of fit, and parsimony. Results: Twenty-seven participants from the 1000 were removed following the exclusion criteria. The best-fitted model included 2 significant interaction terms but resulted in marginal improvements in model fit compared to the main effects model. We therefore selected the model results with main effects as a potential value set for this methodological study, based on the parsimony criteria. The results showed that the main effects hybrid model was consistent, with a range of utility values between 1 and −0.224. Conclusion: This paper shows the feasibility of using a hybrid approach to estimate a value set for EQ-5D-5L valuation data.
Open Access
Socio-demographic indicators of self-reported health based on EQ-5D-3L: a cross-country analysis of population surveys from 18 countries
(Frontiers Media, 2023) Szende, Agota; Janssen, Mathieu F.; Cabasés Hita, Juan Manuel; Ramos Goñi, Juan Manuel; Burström, Kristina; Economía; Ekonomia
Background: Generic health-related quality of life instruments, such as the EQ-5D, are increasingly used by countries to monitor population health via general population health surveys. Our aim was to demonstrate analytic options to measure socio-demographic dierences in self-reported health using the EuroQol Group’s archive of EQ-5D-3L population surveys that accumulated over the past two decades. Methods: Analyses captured self-reported EQ-5D-3L data on over 100,000 individuals from 18 countries with nationally representative population surveys. Socio-demographic indicators employed were age, sex, educational level and income. Logistic regression odds ratios and the health concentration index methodology were used in the socio-demographic analysis of EQ-5D-3L data. Results: Statistically significant socio-demographic dierences existed in all countries (p < 0.01) with the EQ VAS based health concentration index varying from 0.090 to 0.157 across countries. Age had generally the largest contributing share, while educational level also had a consistent role in explaining lower levels of self-reported health. Further analysis in a subset of 7 countries with income data showed that, beyond educational level, income itself had an additional significant impact on self-reported health. Among the 5 dimensions of the EQ-5D-3L descriptive system, problems with usual activities and pain/discomfort had the largest contribution to the concentration of overall self-assessed health measured on the EQ VAS in most countries. Conclusion: The EQ-5D-3L was shown to be a powerful multi-dimensional instrument in the analyses of socio-demographic dierences in self-reported health using various analytic methods. It oered a unique insight of inequalities by health dimensions
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
A pilot inquiry on incentives and intrinsic motivation in health care: the motivational capital explained by doctors
(2014) Berdud García-López, Mikel; Cabasés Hita, Juan Manuel; Nieto Vázquez, Jorge; Economía; Ekonomia
Where the contracts are incomplete, the resulting co-ordination problems may be attenuated if workers are intrinsically motivated to do the work. It is established by theoretical and empirical literature that workers within public organizations are intrinsically motivated to exert effort doing the job and have a strong sense of social agents with the mission of providing collective goods to citizens and tax payers. This paper is an empirical pilot study in the health care sector using methods of Qualitative Analysis research. We run semistructured interviews á-la-Bewley to sixteen physicians of Navarre’s health Care Servicio Navarro de Salud-Osasunbidea (SNS-O). The objective of the work is twofold: first, to find empirical evidence about doctors’ non-monetary motives and second, to find evidence about how these non-monetary motives shape doctors’ behavior. We formulate several testable hypotheses: (1) Doctors are intrinsically motivated agents, (2) Economic incentives and control policies may crowd-out intrinsic motivation and (3) Well designed incentives may crowd-in agents intrinsic motivation. Results confirm the hypotheses formulated above and coming from our theoretical findings [11], [12]. Finally, we also found empirical evidence of conflict between political advisors or health managers (principals) and physicians (agents). Results are a step forward in the optimal design of incentive schemes and policies which crowd in doctors’ intrinsic motivation.
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
Population norms for the EQ-5D-3L: a cross-country analysis of population surveys for 20 countries
(Springer, 2019) Janssen, Mathieu F.; Szende, Agota; Cabasés Hita, Juan Manuel; Ramos Goñi, Juan Manuel; Vilagut, G.; König, H. H.; Economía; Ekonomia
This study provides EQ-5D population norms for 20 countries (N = 163,838), which can be used to compare profiles for patients with specific conditions with data for the average person in the general population in a similar age and/or gender group. Descriptive EQ-5D data are provided for the total population, by gender and by seven age groups. Provided index values are based on European VAS for all countries, based on TTO for 11 countries and based on VAS for 10 countries. Important differences exist in EQ-5D reported health status across countries after standardizing for population structure. Self-reported health according to all five dimensions and EQ VAS generally decreased with increasing age and was lower for females. Mean self-rated EQ VAS scores varied from 70.4 to 83.3 in the total population by country. The prior living standards (GDP per capita) in the countries studied are correlated most with the EQ VAS scores (0.58), while unemployment appeared to be significantly correlated in people over the age of 45 only. A country's expenditure on health care correlated moderately with higher ratings on the EQ VAS (0.55). EQ-5D norms can be used as reference data to assess the burden of disease of patients with specific conditions. Such information, in turn, can inform policy-making and assist in setting priorities in health care.
Open Access
Identity, incentives and motivational capital in public organizations
(2014) Berdud García-López, Mikel; Cabasés Hita, Juan Manuel; Nieto Vázquez, Jorge; Economía; Ekonomia
This paper explores optimality of contracts and incentives when the principal (public organization) can undertake investments to change agents’ (public workers) identity. In the model, workers within the organization can have different identities. We develop a principal-agent dynamical model with moral hazard, which captures the possibility of affecting this workers’ identity through contracts offered by the firm. In the model, identity is a motivation source which reduces agents’ disutility from effort. We use the term identity to refer to a situation in which the worker shares the organizational objectives and views herself as a part of the organization. Contrary, we use the term conflict to refer to a situation in which workers behave self-interested and frequently in the opposite way of the organisation. We assume that the principal can include investments to foster identity in contracts. Think for instance in developing a single culture that is shared by all the members of an organization. We discuss the conditions under which spending resources in changing workers’ identity and invest in this kind of motivational capital is optimal for organizations. Our results may help to inform public firms’ managers about the optimal design of incentive schemes and policies. For instance, we conclude that investing in motivational capital is the best option in the long run whereas pure monetary incentives works better in the short run.
Open Access
Reflexiones sobre la sanidad pública en España en el horizonte de 2020
(2013) Cabasés Hita, Juan Manuel; Economía; Ekonomia; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa: OTRI 2012005009
Este trabajo pretende desarrollar una visión para el Sistema Nacional de Salud (SNS) en la perspectiva del año 2020. Partiendo de una evaluación de la situación actual del sistema sanitario y a la luz de los principios que definen un buen sistema sanitario, describe un escenario factible para la sanidad en España basado en cambios estructurales que afectan a la financiación, la equidad en el acceso a la asistencia sanitaria, la coordinación sanitaria, la colaboración público-privada, la detección y corrección de holguras de ineficiencia en la oferta y la demanda sanitarias, el cambio en el modelo de cuidados orientado a la cronicidad, el nuevo papel de la Atención Primaria y de la Especializada, la motivación e incentivos de los profesionales sanitarios, el papel creciente de los ciudadanos, destinatarios de la asistencia sanitaria y responsables de su salud, y la determinación de prioridades mediante la evaluación económica sistemática de las decisiones en materia sanitaria
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
Impact of successful treatment with directacting antiviral agents on health-related quality of life in chronic hepatitis C patients
(Public Library of Science, 2018) Juanbeltz Zurbano, Regina; Martínez Baz, Iván; San Miguel Elcano, Ramón; Goñi Esarte, Silvia; Cabasés Hita, Juan Manuel; Castilla Catalán, Jesús; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Economía; Ekonomia
Background. Direct-acting antivirals (DAA) have demonstrated high efficacy to achieve sustained virological response (SVR) in chronic hepatitis C patients. We aim to assess the change in healthrelated quality of life (HRQoL) among patients successfully treated, and to identify predictors of this variation. Methods. In a prospective observational study, patients with chronic hepatitis C who started DAA therapy between May 2016 and April 2017 completed the EQ-5D-5L questionnaire at baseline and 12 weeks after the end of therapy before knowing the virological result. Analysis included all patients with SVR. Results. Median baseline EQ-5D-5L scores of the 206 enrolled patients were 0.857 utility and 70.0 visual analogue scale (VAS). Following SVR, a reduction occurred in the proportion of patients with mobility problems (35% vs 24%, p = 0.012), pain/discomfort (60% vs 42%, p<0.001) and anxiety/depression (57% vs 44%, p = 0.012), with an increase in utility (+0.053, p<0.001) and VAS (+10, p<0.001). Score improvements were also observed in cirrhotic (+0.048 utility, p = 0.027; +15 VAS, p<0.001) and HIV co-infected patients (+0.039 utility, p = 0.036; +5 VAS, p = 0.002). In multivariate analyses, middle age (45±64 years) and baseline anxiety/depression were associated to greater improvement in utility after SVR, and moderate-advanced liver fibrosis and cirrhosis to greater increase in VAS score. Low baseline values were associated to greater improvements in utility value and VAS score. Conclusions The cure of chronic hepatitis C infection with DAA has a short term positive impact on HRQoL with improvement in mobility, pain/discomfort, anxiety/depression, utility value and VAS score. Patients with poor baseline HRQoL were the most beneficed.