Economic evaluations of seasonal influenza vaccination for the elderly

The Council of the European Union (EU) has recommended that action should be taken to increase influenza vaccination in the elderly population | BMJ Open


Image source: Joe The Goat Farmer – Flickr // CC BY 2.0

Objectives: The aims were to systematically review and critically appraise economic evaluations for influenza vaccination in the elderly population in the EU.

Results: Of the 326 search results, screening identified eight relevant studies. Results varied widely, with the incremental cost-effectiveness ratio ranging from being both more effective and cheaper than no intervention to costing €4 59 350 per life-year gained. Cost-effectiveness was most sensitive to variations in influenza strain, vaccination type and strategy, population and modelling characteristics.

Conclusions: Most studies suggest that vaccination is cost-effective (seven of eight studies identified at least one cost-effective scenario). All but one study used economic models to synthesise data from different sources. The results are uncertain due to the methods used and the relevance and robustness of the data used. Sensitivity analysis to explore these aspects was limited. Integrated, controlled prospective clinical and economic evaluations and surveillance data are needed to improve the evidence base. This would allow more advanced modelling techniques to characterise the epidemiology of influenza more accurately and improve the robustness of cost-effectiveness estimates.

Full reference: Shields. G.E. et al. (2017) Systematic review of economic evaluations of seasonal influenza vaccination for the elderly population in the European Union. BMJ Open. 7:e014847


Global health financing

Two studies have been published in the Lancet on global health financing.

‘Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries’.

Global Burden of Disease Health Financing Collaborator Network, The Lancet Volume 389, No. 10083, p1981-2004, 20 May 2017

An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, the researchers further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. They also identify countries that deviate from the trends.

The Authors conclude that the availability of prepaid resources for health, such as government spending, is one of many determinants of access to health care, and can lead to population health gains. Economic development is associated with an increase in spending and specifically an increase in prepaid resources. This is at the core of the pursuit for universal health coverage.

This research also points to countries that deviate from the trends, spending more or less than expected, based on their level of economic development. This information is valuable to planners assessing funding gaps and financing opportunities, and can be used to provide insight into what future health financing challenges are likely. Tracking changes in health financing patterns across time and benchmarking against global trends is vital to addressing missed opportunities, ensuring access to medicines and high quality services, and the pursuit of universal health coverage.

Read the full text here

‘Future and potential spending on health 2015–40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries’.

Global Burden of Disease Health Financing Collaborator Network, The Lancet Volume 389, No. 10083, p2005-2030, 20 May 2017

Variation in GDP and health spending is expected to persist through 2040. Past trends and relationships suggest that health spending levels will continue to diverge globally and even within income groups. Increases in spending to reflect potential levels, as determined by GDP per capita and peer nations, would lead to more resources for health. However, the pathways to ensure these increases vary from country to country.

This analysis can inform decision makers about possible methods to mobilise funds for health, given their country’s level of development and financing environment. Despite expected increases in spending, this spending in some places will probably be insufficient to meet complex health needs, underlining the ongoing role of development assistance for health in some countries. Insights into spending trajectories and financing gaps are crucial as health stakeholders face the ambitious Sustainable Development Goals agenda and the push towards universal health coverage.

Read the full text here

Inclusive Growth Monitor 2017

The Joseph Rowntree Foundation has published ‘ Inclusive Growth Monitor 2017’.

In 2016 the Joseph Rowntree Foundation commissioned Sheffield Hallam University to develop an ‘inclusive growth monitor’ : a set of measures of prosperity and inclusion for Local Enterprise Partnership (LEPs).  The monitor is designed to help LEPs monitor indicators of poverty alongside indicators of growth, and to enable a broader understanding how different aspects of growth and poverty differ between LEPs and over time.

This second annual report published by the Inclusive Growth Analysis Unit – a partnership between the University of Manchester and JRF – gives each LEP a score on 18 different indicators based on prosperity (skills, jobs, and economic output) and inclusion (improvements in incomes at the bottom of the distribution, unemployment and the cost of living).

The Authors conclude that for national government the findings from the monitor raise a number of issues. There is a need for policy to seek to address the regional imbalance both in economic opportunities and skills. Without further policy intervention there is no reason to believe the current picture will improve on its own, risking further economic polarisation between regions. Coming out of the economic crisis into recovery between 2010-15, these enduring patterns of regional inequality remain largely unchanged, with London and the surrounding region if anything pulling further away from the rest of the country in its prosperity during this period.

For local government and broader Local Enterprise Partnership members the Inclusive Growth Monitor lays down the considerable challenge of reflecting on how innovation at the local level may improve performance in terms of both economic inclusion and prosperity through helping deliver a more equitable and inclusive form of economic growth.

Read the report here

Health care costs in the English NHS

The Centre for Health Economics in York has published ‘Health care costs in the English NHS: reference tables for average annual NHS spend by age, sex and deprivation group’.

This paper describes how to calculate average health care costs broken down by age, sex and neighbourhood deprivation quintile group using the distribution of health care spending by the English NHS in the financial year 2011/12.

The results can be used by cost-effectiveness analysts to populate their extrapolation models when estimating future health care costs. The results will also be of interest to the broader community of health researchers as they illustrate how NHS spending is distributed across different subgroups within the population.

The analysis presented in this report indicates that health care costs at any given age are higher for those living in more deprived neighbourhoods than those living in more affluent neighbourhoods. Research looking at the social distribution of health has found that quality of life is also lower at any given age for those living in more deprived neighbourhoods than for those living in more affluent neighbourhoods.

Read the full report here

Productivity of the English NHS: 2014/15 Update

The Centre for Health Economics in York has published ‘Productivity of the English
NHS: 2014/15 Update’.

This report updates the Centre for Health Economics’ time-series of National Health Service (NHS) productivity growth. The full productivity series runs from 1998/99, but this report updates the series to account for growth between 2013/14 and 2014/15, as well as looking at 10 year growth trends since 2004/05.

NHS productivity is measured by comparing growth in the outputs produced by the NHS to growth in the inputs used to produce them. NHS outputs include the amount and quality of care provided to patients. Inputs include the number of doctors, nurses and support staff providing care, the equipment and clinical supplies used, and the hospitals and other premises where care is provided.

The measure of NHS output captures all the activities undertaken for all NHS patients wherever they are treated in England. NHS output has increased between 2004/05 and 2014/15 primarily because ever more patients are receiving treatment. Compared to 2004/05, hospitals are treating 4.6 million (27%) more patients, while the number of outpatient attendances has increased by 19%.

The output measure also accounts for changes in quality. On the upside, there have been year-on-year improvements in hospital survival rates. On the downside, waiting times have been getting longer since 2009/10, although they remain shorter than they were in 2004/05. Taking account of the amount and quality of care, overall NHS output increased by 51% between 2004/05 and 2014/15. Output growth between 2013/14 and 2014/15 was 2.67%.

Productivity growth is calculated by comparing output growth with input growth. Over the last decade NHS productivity has increased by 13.83% in total. Productivity growth has been especially strong since 2009/10, year-on-year growth averaging 1.75%. Growth between 2013/14 and 2014/15, as these latest figures show, amounted to 0.87%.

This rate of NHS productivity growth since 2004/5 compares favourably with that achieved by the economy as a whole. Annual NHS productivity growth kept pace with that of the economy up to the recession in 2008/09. Since then NHS productivity growth has consistently outpaced that of the economy, which has stagnated.

Read the full report here

Understanding NHS financial pressures. How are they affecting patient care?

The Kings Fund has published ‘Understanding NHS financial pressures. How are they affecting patient care?’

Understnading NHS financial pressures

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Financial pressures on the NHS are severe and show no sign of easing. However, we know relatively little about their impact on patient care.

This study sought to investigate the impact of financial pressures in four very different areas of the health service: genito-urinary medicine (GUM), district nursing, elective hip replacement and neonatal services. The research used data analysis and interviews to explore different experiences across the system.

The researchers found that GUM and district nursing services were under particular strain. Both access to services and quality of patient care have been affected in ways that are difficult to detect with currently available metrics.

Within elective hip replacement services, activity has increased in recent years and patients remain happy with the outcome of their operations, but the latest data shows that average waiting times for treatment are starting to rise. Neonatal services appear to have largely maintained quality and access despite a number of longstanding pressures, although there is variation between units.

The findings create a challenge to the direction of travel set out in the NHS five year forward view of strengthening community-based services and focusing on prevention.

Read more here

First do no harm – The impact of financial incentives on dental x-rays

The Centre for Health Economics in York has published ‘First do no harm – The impact of financial incentives on dental x-rays’.

This paper assesses the impact of dentist remuneration on the incidence of potentially harmful dental x-rays. Unique panel data was used which provided details of 1.3 million treatment claims by Scottish NHS dentists made between 1998 and 2007. Controlling for unobserved heterogeneity of both patients and dentists the researchers estimated a series of fixed-effects models that are informed by a theoretical model of x-ray delivery and identify the effects on dental x-raying of dentists moving from a fixed salary to fee-for-service and patients moving from co-payment to exemption.

The study established that there are significant increases in x-rays when dentists receive fee for service rather than salary payments and patients are made exempt from payment. There are further increases in x-rays when a patient switches to a fee for service dentist relative to them switching to a salaried one.

Read more here