The Challenge of Conditional Reimbursement: Stopping Reimbursement Can Be More Difficult Than Not Starting in the First Place!

Background: Conditional reimbursement of new health technologies is increasingly considered as a useful policy instrument. It allows gathering more robust evidence regarding effectiveness and cost-effectiveness of new technologies without delaying market access. Nevertheless, the literature suggests that ending reimbursement and provision of a technology when it proves not to be effective or cost-effective in practice may be difficult.

An elicitation of utility for quality of life under prospect theory.

This paper performs several tests of decision analysis applied to the health domain. First, we conduct a test of the normative expected utility theory. Second, we investigate the possibility to elicit the more general prospect theory.

A short note on measuring subjective life expectancy: survival probabilities versus point estimates.

Understanding subjective longevity expectations is important, but measurement is not straightforward. Two common elicitation formats are the direct measurement of a subjective point estimate of life expectancy and the assessment of survival probabilities to a range of target ages. This study presents one of the few direct comparisons of these two methods.

Estimating sign-dependent societal preferences for quality of life.

This paper is the first to apply prospect theory to societal health-related decision making. In particular, we allow for utility curvature, equity weighting, sign-dependence, and loss aversion in choices concerning quality of life of other people. We find substantial inequity aversion, both for gains and losses, which can be attributed to both diminishing marginal utility and differential weighting of better-off and worse-off.

Valuing QALYs in Relation to Equity Considerations Using a Discrete Choice Experiment.

Background: To judge whether an intervention offers value for money, the incremental costs per gained quality-adjusted life-year (QALY) need to be compared with some relevant threshold, which ideally reflects the monetary value of health gains. Literature suggests that this value may depend on the equity context in which health gains are produced, but the value of a QALY in relation to equity considerations has remained largely unexplored.

Objective: The objective of this study was to estimate the social marginal willingness to pay (MWTP) for QALY gains in different equity subgroups, using a discrete choice experiment (DCE).

Treatment for Sleep Problems in Children with Autism and Caregiver Spillover Effects.

Sleep problems in children with autism spectrum disorders (ASD) are under-recognized and under-treated. Identifying treatment value accounting for health effects on family members (spillovers) could improve the perceived cost-effectiveness of interventions to improve child sleep habits. A prospective cohort study (N = 224) was conducted with registry and postal survey data completed by the primary caregiver.

A long life in good health: subjective expectations regarding length and future health-related quality of life.

Background: Subjective life expectancy is considered relevant in predicting mortality and future demand for health services as well as for explaining peoples' decisions in several life domains, such as the perceived impact of health behaviour changes on future health outcomes. Such expectations and in particular subjective expectations regarding future health-related quality of life remain understudied. The purpose of this study was to investigate individuals' subjective quality adjusted life years (QALYs) expectation from age 65 onwards in a representative sample of the Dutch generic public.

Rational expectations? An explorative study of subjective survival probabilities and lifestyle across Europe.

Background: Subjective survival probabilities (SSPs) are considered relevant in relation to lifestyle as lifestyle improvements may improve health and lower mortality risk.

Objective: To study individuals' SSP in a population of elderly (i.e.

Quality of life and time to death: have the health gains of preventive interventions been underestimated?

This article explores the implications of the relation between quality of life (QoL) and time to death (TTD) for economic evaluations of preventive interventions. By using health survey data on QoL for the general Dutch population linked to the mortality registry, we quantify the magnitude of this relationship. For addressing specific features of the nonstandard QoL distribution such as boundness, skewness, and heteroscedasticity, we modeled QoL using a generalized additive model for location, scale, and shape (GAMLSS) with a β inflated outcome distribution.

Predicting health utilities for children with autism spectrum disorders.

Comparative effectiveness of interventions for children with autism spectrum disorders (ASDs) that incorporates costs is lacking due to the scarcity of information on health utility scores or preference-weighted outcomes typically used for calculating quality-adjusted life years (QALYs). This study created algorithms for mapping clinical and behavioral measures for children with ASDs to health utility scores. The algorithms could be useful for estimating the value of different interventions and treatments used in the care of children with ASDs.

Did the health of the Dutch population improve between 2001 and 2008? Investigating age- and gender-specific trends in quality of life.

Although many countries' populations have experienced increasing life expectancy in recent decades, quality of life (QoL) trends in the general population have yet to be investigated. This paper investigates whether QoL changed for the general Dutch population over the period 2001-2008. A beta regression model was employed to address specific features of the QoL distribution (i.

Subjective health expectations at biological therapy initiation: a survey of rheumatoid arthritis patients and rheumatologists.

Subjective health expectations of patients with rheumatoid arthritis (RA) and rheumatologists remain understudied. We measured subjective expectations regarding treatment effects of biologicals as well as future length and quality of life. Moreover, we compared expectations regarding treatment effects to actual treatment effects.

Quality of life of nursing home residents with dementia: validation of the German version of the ICECAP-O.

Objectives: To validate the ICECAP-O capability wellbeing measure's German translation in older people with dementia living in a nursing home, and to investigate the influence of proxy characteristics on responses.

Method: Cross-sectional study. For 95 residents living in a German nursing home, questionnaires were completed by nursing professionals serving as proxy respondents.

Quality of life instruments for economic evaluations in health and social care for older people: a systematic review.

Gaining health may not be the main goal of healthcare services aimed at older people, which may (also) seek to improve wellbeing. This emphasizes the need of finding appropriate outcome measures for economic evaluation of such services, particularly in long-term care, capturing more than only health-related quality of life (HrQol). This review assesses the usefulness of HrQol and wellbeing instruments for economic evaluations specifically aimed at older people, focusing on generic and preference-based questionnaires measuring wellbeing in particular.

The value of a QALY: individual willingness to pay for health gains under risk.

Background: There is an increased interest in the monetary value of a quality-adjusted life-year (QALY). Past studies commonly derived willingness to pay (WTP) for certain future QALY gains. However, obtaining valid WTP per QALY estimates proved to be difficult.

Measuring the impact of caregiving on informal carers: a construct validation study of the CarerQol instrument.

Background: Informal caregivers provide a significant part of the total care needed by ill or disabled persons. Although informal care is often the preferred option of those who provide and those who receive informal care, caring can nevertheless be very straining. This study investigates construct validation of an instrument of the impact of caregiving, the CarerQol.

Prospect theory in the health domain: a quantitative assessment.

It is well-known that expected utility (EU) has empirical deficiencies. Cumulative prospect theory (CPT) has developed as an alternative with more descriptive validity. However, CPT's full function had not yet been quantified in the health domain.

The impact of informal care for patients with Pompe disease: an application of the CarerQol instrument.

Background: Patients with Pompe disease, a rare progressive neuromuscular disorder, receive a considerable amount of informal care. In this study, we examined the impact of providing informal care to patients with Pompe disease.

Methods: Caregivers were administered various instruments, which measured the (impact of) informal care in the context of Pompe disease.

A discrete choice experiment to obtain a tariff for valuing informal care situations measured with the CarerQol instrument.

Background / Objective: Economic evaluations adopting a societal perspective need to include informal care whenever relevant. However, in practice, informal care is often neglected, because there are few validated instruments to measure and value informal care for inclusion in economic evaluations. The CarerQol, which is such an instrument, measures the impact of informal care on 7 important burden dimensions (CarerQol-7D) and values this in terms of general quality of life (CarerQol-VAS).

A validation of the ICECAP-O in a population of post-hospitalized older people in the Netherlands.

Background: Various healthcare and social services may impact not only health, but wellbeing as well. Such effects may be more fully captured by capability-wellbeing instruments than with Health-related Quality of Life (HrQol) instruments. The aim of this study is to validate the ICEpop (Investigating Choice Experiments for the Preferences of Older People) CAPability measure for Older people (ICECAP-O) capability wellbeing instrument in a population of post-hospitalized older people admitted to a hospital 3 months earlier.

Deriving time discounting correction factors for TTO tariffs.

The Time Trade-off (TTO) method is a popular method for valuing health state utilities and is frequently used in economic evaluations. However, this method produces utilities that are distorted by several biases. One important bias entails the failure to incorporate time discounting.

Inquiry into the relationship between equity weights and the value of the QALY.

Background: A commonly held view of the decision rule in economic evaluations in health care is that the final incremental cost-effectiveness ratio needs to be judged against some threshold, which is equal for all quality-adjusted life-year (QALY) gains. This reflects the assumption that "a QALY is a QALY" no matter who receives it, or the equity notion that all QALY gains are equally valuable, regardless of the context in which they are realized. If such an assumption does not adequately reflect the distributional concerns in society, however, different thresholds could be used for different QALY gains, whose relative values can be seen as "equity weights.

A new prevention paradox: the trade-off between reducing incentives for risk selection and increasing the incentives for prevention for health insurers.

The Dutch risk equalization scheme has been improved over the years by including health related risk adjusters. The purpose of the Dutch risk equalization scheme is to prevent risk selection and to correct for predictable losses and gains for insurers. The objective of this paper is to explore the financial incentives for risk selection under the Dutch risk equalization scheme.