Biomedical subjects

Emily Lancsar

Publications and source records attributed to Emily Lancsar.

6 recordsLinked to original sources

PubMed2006

Deleting 'irrational' responses from discrete choice experiments: a case of investigating or imposing preferences?

Investigation of the 'rationality' of responses to discrete choice experiments (DCEs) has been a theme of research in health economics. Responses have been deleted from DCEs where they have been deemed by researchers to (a) be 'irrational', defined by such studies as failing tests for non-satiation, or (b) represent lexicographic preferences. This paper outlines a number of reasons why deleting responses from DCEs may be inappropriate after first reviewing the theory underpinning rationality, highlighting that the importance placed on rationality depends on the approach to consumer theory to which one ascribes. The aim of this paper is not to suggest that all preferences elicited via DCEs are rational. Instead, it is to suggest a number of reasons why it may not be the case that all preferences labelled as 'irrational' are indeed so. Hence, deleting responses may result in the removal of valid preferences; induce sample selection bias; and reduce the statistical efficiency and power of the estimated choice models. Further, evidence suggests random utility theory may be able to cope with such preferences. Finally, we discuss a number of implications for the design, implementation and interpretation of DCEs and recommend caution regarding the deletion of preferences from stated preference experiments.

Choice Behavior↗

PubMed2005

Discrete choice experiments in health economics: distinguishing between the method and its application.

Bryan and Dolan have offered a critique of the use of discrete choice experiments in health economics. Their call for more open debate on "the relative strengths and limitations of the DCE method, particularly when applied in health settings" is warranted. However, their paper has only added to part of this debate in that it focuses on the application of choice experiments in the health sector but says little on the strengths and limitations of the DCE method in general. We argue that while the criticisms posed by Bryan and Dolan rightly challenge the manner in which DCEs have been applied in health economics, such criticism does not challenge the theoretical/methodological basis of DCEs per se.

Attitude to Health↗

PubMed2005

The individual and health sector costs of asthma: the first year of a longitudinal study in New South Wales.

OBJECTIVE: To identify the resources used and the costs incurred by people with asthma for health care and non-health care products and services to manage asthma. METHODS: A prospective, longitudinal study, using self-reported and administrative data, commenced in 2001 in New South Wales (NSW). Data sources included two six-monthly surveys, hospital admission data from NSW Health, and pharmaceutical benefits and Medicare data. A cohort of 245 people with asthma, aged between 5-75 years, was recruited from the general population and from hospital emergency departments. The study measured the use and cost of health care services and products, including alternative therapies and home modifications. Costs to both the health care system and individuals were measured. RESULTS: General practitioner visits and asthma medications were the items of health care most commonly used. Medications were also the largest component of individual costs for health care in terms of the average payment and the number of people facing an out-of-pocket cost, although home equipment and modifications were the most expensive individual items. The distribution of individual costs was highly skewed, ranging from dollar 0 to dollar 4,882 per person per annum (median dollar 89). Admitted hospital care was the largest component of the cost to the health care system. CONCLUSION: While individual costs were not large for the majority, some people faced substantial costs, with the highest of these being for non-health care items. IMPLICATIONS: Asthma management policies may need to incorporate schemes to alleviate the impact of costs for the minority experiencing significant out-of-pocket expenses.

Adolescent↗

PubMed2004

Deriving welfare measures from discrete choice experiments: inconsistency between current methods and random utility and welfare theory.

Discrete choice experiments (DCEs) are being used increasingly in health economics to elicit preferences for products and programs. The results of such experiments have been used to calculate measures of welfare or more specifically, respondents' 'willingness to pay' (WTP) for products and programs and their 'marginal willingness to pay' (MWTP) for the attributes that make up such products and programs. In this note we show that the methods currently used to derive measures of welfare from DCEs in the health economics literature are not consistent with random utility theory (RUT), or with microeconomic welfare theory more generally. The inconsistency with welfare theory is an important limitation on the use of such WTP estimates in cost-benefit analyses. We describe an alternative method of deriving measures of welfare (compensating variation) from DCEs that is consistent with RUT and is derived using welfare theory. We demonstrate its use in an empirical application to derive the WTP for asthma medication and compare it to the results elicited from the method currently used in the health economics literature.

Activities of Daily Living↗

PubMed2004

Cost-effectiveness analysis of the New South Wales adult drug court program.

In New South Wales, Australia, a cost-effectiveness evaluation was conducted of an adult drug court (ADC) program as an alternative to jail for criminal offenders addicted to illicit drugs. This article describes the program, the cost-effectiveness analysis, and the results. The results of this study reveal that, for the 23-month period of the evaluation, the ADC was as cost-effective as were conventional sanctions in delaying the time to the first offense and more cost-effective in reducing the frequency of offending for those outcome measures selected. Although the evaluation was conducted using the traditional steps of a cost-effectiveness analysis, because of the complexity of the program and data limitations it was not always possible to adhere to textbook procedures. As such, each step involved in undertaking the cost-effectiveness analysis is discussed, highlighting the key issues faced in the evaluation.

Cost-Benefit Analysis↗

PubMed2002

Diagnosis and prognosis of Australia's health information for evidence-based policy.

Without adequate information it is difficult to determine the success or failure of health policies. This paper assesses the adequacy of Australia's health information for evidence-based policy. Three policy areas are analysed: the impact of changing the public and private health financing mix; waiting lists and waiting times; and pooling of funds. In each, the issue is analysed to identify the key policy questions, the available data and existing analyses are examined, and gaps in data availability and analysis are assessed. There is variability in the extent and usefulness of current health information. In terms of the impact of changing the financing mix, there is good information on the distribution of finance, but much less available on comparative use or efficiency of public and private hospitals. There is comprehensive information available on waiting lists and waiting times but little analysis of the implications of this for equity of access or the costs and benefits of reducing waiting times. There is insufficient information for the development of the capitation based formulae required for the introduction of the pooling of funds, nor enough information to assess the extent and impact of current cost-shifting which might be addressed by pooling funds. While the concept of evidence-based medicine has been embraced with regard to specific treatment decisions, there has not been a parallel investment in the use of evidence to drive policy decisions.

Australia↗