New working paper – ‘The relationship between individual risk and cost-effectiveness in screening interventions’

I’ve just released a new working paper, along with my co-authors Profs Marilyn James and David Whynes. You can access it through RePEc here. The paper discusses the (somewhat obvious) relationship between a person’s risk of developing a disease and the cost-effectiveness of screening them. This is important because publicly-funded screening interventions will, in the future, I suspect, have to discriminate based on risk.

Here’s the abstract:

Advancements in our understanding of the causes and correlates of disease mean that we are now able to estimate an individual’s level of risk. This, and the ever-increasing need for healthcare interventions to be cost-effective, has led to calls for the introduction of risk-based screening. Risk-based screening would involve the use of information about an individual’s risk factors to decide whether or not they should be eligible for screening, or the frequency with which they should be invited to attend screening. Evidence is emerging that targeted screening, towards those at higher risk, can increase the cost-effectiveness of a screening programme. The relationship between individual risk and the cost-effectiveness of screening an individual is implicitly recognised in current population screening programmes in the UK. However, the nature of this relationship, and its implications for cost-effectiveness analysis, has not been presented in the academic literature. In this study we propose that an individual’s risk of developing a disease has a consistent and quantifiable relationship with the cost-effectiveness of screening them. We suggest a simple modification to standard methods of cost-effectiveness analysis that enables the incorporation of individual risk. Using numerical examples we demonstrate the nature of the relationship between risk and cost-effectiveness and suggest means of optimising a screening intervention. This can be done either by defining a minimum level of risk for eligibility or by defining the optimal recall period for screening. We suggest that methods of decision modelling could enable such an analysis to be carried out, and that information on individual risk could be used to optimise the cost-effectiveness of population screening programmes.

I’d really appreciate any comments you might have on this paper. Feel free to post below or alternatively please send me an email.

Advertisements

New working paper – ‘Happy and healthy: a joint model of health and life satisfaction’

Mónica Hernández-Alava, Allan Wailoo and I have just released a new working paper. You can access it through RePEc here. The paper builds on previous work (mainly by Paul Dolan) looking at subjective well-being as a potential means of valuing health benefits. Our study, however, identifies a number of limitations of these existing studies and offers a solution to some of their problems. Furthermore, our findings contradict some of those reported in previous studies.

Here’s the abstract:

Subjective well-being has been proposed as an alternative to preference based values of health benefit for use in economic evaluation. We develop a latent factor model of health and well-being in order to compare reported satisfaction with life, satisfaction with health and SF-6D responses. This approach provides a coherent, integrated statistical framework for assessing differences between these outcomes on the same scale. Using panel data from the British Household Panel Survey we find that SF-6D and satisfaction with health are influenced to a similar degree by changes in latent health and satisfaction with life is less responsive. For the average individual, there are no substantial differences in the relative impacts of physical versus mental health conditions between the three measures. These findings suggest that the differences between experienced and hypothetical values of health and life satisfaction may not lead to substantial differences in the assessment of value from health technologies.

This paper has been a long-time coming, and is barely recognisable from its earlier incarnations. It started out as my MSc dissertation, which was completed in 2010. Since then a slightly improved version appeared at HESG in Exeter earlier this year, after which the study got something of an econometric makeover. Please do have a read of the paper if you’re interested in this area of research and we’d welcome any comments you might have.