Categoría: Publicaciones

Value in Health, 27(9), pp. 1243-1250. (2024)

Autores: José María Abellán Perpiñán, Jorge E. Martínez Pérez, Fernando I. Sánchez Martínez y José Luis Pinto Prades.

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Objectives: To demonstrate the feasibility of estimating a social tariff free of utility curvature and probability weighting biases and to test transferability between riskless and risky contexts. Methods: Valuations for a selection of EQ-5D health states were collected from a large and representative sample (N =1,676) of the Spanish general population through computer-assisted personal interviewing. Two elicitation methods were used: the traditional time trade-off (TTO), and a novel risky-TTO (rTTO) procedure. Both methods are equivalent for better than death states, which allowed us to test transferability of utilities across riskless and risky contexts. Corrective procedures applied are based on rank-dependent utility theory, identifying parameter estimates at the individual level. All corrections are health-state specific, which is a unique feature of our corrective approach. Results: Two corrected value sets for the EQ-5D-3L system are estimated, highlighting the feasibility of developing national tariffs under non-expected utility theories, sucha as rank-dependent utility. Furthermore, transferability was not supported for at least half of the health states valued by our sample. Conclusions: It is feasible to estimate a social tariff by using interviewing techniques, sample size, and sample representativeness equivalent to prior studies designed to generate national value sets for the EQ-5D. Utilities obtained in distinct contexts may not be interchangeable. Our findings caution against routinely taking transferability of utility for granted.

International Journal of Technology Assessment in Health Care, 40(1), e21, pp. 1-9. (2024)

Autores: Fernando I. Sánchez Martínez, José María Abellán Perpiñán, Jorge E. Martínez Pérez y Jorge Luis Gómez Torres

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Objectives: This study aims to develop a framework for establishing priorities in the regional health service of Murcia, Spain, to facilitate the creation of a comprehensive multiple criteria decision analysis (MCDA) framework. This framework will aid in decision-making processes related to the assessment, reimbursement, and utilization of high-impact health technologies. Method: Based on the results of a review of existing frameworks for MCDA of health technologies, a set of criteria was proposed to be used in the context of evaluating high-impact health technologies. Key stakeholders within regional healthcare services, including clinical leaders and management personnel, participated in a focus group (n = 11) to discuss the proposed criteria and select the final fifteen. To elicit the weights of the criteria, two surveys were administered, one to a small sample of healthcare professionals (n = 35) and another to a larger representative sample of the general population (n = 494). Results: The responses obtained from health professionals in the weighting procedure exhibited greater consistency compared to those provided by the general public. The criteria more highly weighted were “Need for intervention” and “Intervention outcomes.” The weights finally assigned to each item in the multicriteria framework were derived as the equal-weighted sum of the mean weights from the two samples. Conclusions: A multi-attribute function capable of generating a composite measure (multicriteria) to assess the value of high-impact health interventions has been developed. Furthermore, it is recommended topilot this procedure in a specific decision context to evaluate the efficacy, feasibility, usefulness, and reliability of the proposed tool.

The European Journal of Health Economics, 25(8), pp. 1333-1343. (2024)

Autores: Jorge E. Martínez Pérez,José María Abellán Perpiñán, Fernando I. Sánchez Martínez y Juan José Ruiz López.

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Aim. This paper reports the first estimation of an SF-6D value set based on the SF-12 for Spain. Methods. A representative sample (n = 1020) of the Spanish general population valued a selection of 56 hypothetical SF-6D health states by means of a probability lottery equivalent (PLE) method. The value set was derived using both random effects and mean models estimated by ordinary least squares (OLS). The best model was chosen on the basis of its predictive ability assessed in terms of mean absolute error (MAE). Results. The model yielding the lowest MAE (0.075) was that based on main effects using OLS. Pain was the most significant dimension in predicting health state severity. Comparison with the previous SF-6D (SF-36) model estimated for Spain revealed no significant differences, with a similar MAE (0.081). Nevertheless, the new SF-6D (SF-12) model predicted higher utilities than those generated by the SF-6D (SF-36) scoring algorithm (minimum value − 0.071 vs − 0.357). Conclusion. A value set for the SF-6D (SF-12) based on Spanish general population preferences elicited by means of a PLE technique is successfully estimated. The new estimated SF-6D (SF-12) preference-based measure provides a valuable tool for researchers and policymakers to assess the cost-effectiveness of new health technologies in Spain.

Hacienda Pública Española/ Review of Public Economics, 249(2/2024), pp. 83-107. (2024)

Autores: José María Abellán Perpiñán, Jorge E. Martínez Pérez, Fernando I. Sánchez Martínez y Jorge Luis Gómez Torres

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This paper applies contingent valuation methodology to estimate the monetary value of the information contained in medicine leaflets. By surveying a sample of the general population, we obtain willingness-to-pay estimates of the value of providing additional quantitative information on potential benefits and side effects of a hypothetical medicine, according to the best evidence available about risk communication. The willingness-to-pay estimates found in our study ranged from 60 cents to 1 euro per month. In addition, some consistency tests of the robustness of our estimates are also presented, as well as evidence on their feasibility, reliability and validity.

Medical Decision Making, vol. 44(1), pp. 42-52. (2024)

Autores: José María Abellán Perpiñán, Jorge E. Martínez Pérez, José Luis Pinto Prades y Fernando I. Sánchez Martínez.

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Objective. The main aim of this article is to test monotonicity in life duration. Previous findings suggest that, for poor health states, longer durations are preferred to shorter durations up to some threshold or maximum endurable time (MET), and shorter durations are preferred to longer ones after that threshold. Methods. Monotonicity in duration is tested through 2 ordinal tasks: choices and rankings. A convenience sample (n = 90) was recruited in a series of experimental sessions in which participants had to rank-order health episodes and to choose between them, presented in pairs. Health episodes result from the combination of 7 EQ-5D-3L health states and 5 durations. Monotonicity is tested comparing the percentage rate of participants whose preferences were monotonic with the percentage of participants with nonmonotonic preferences for each health state. In addition, to test the existence of preference reversals, we analyze the fraction of people who switch their preference from rankings to choices. Results. Monotonicity is frequently violated across the 7 EQ-5D health states. Preference patterns for individuals describe violations ranging from almost 49% with choices to about 71% with rankings. Analysis performed by separate states shows that the mean rates of violations with choices and ranking are about 22% and 34%, respectively. We also find new evidence of preference reversals and some evidence—though scarce—of transitivity violations in choices. Conclusions. Our results show that there is a medium range of health states for which preferences are nonmonotonic. These findings support previous evidence on MET preferences and introduce a new ‘‘choice-ranking’’ preference reversal. It seems that the use of 2 tasks with a similar response scale may make preference reversals less substantial, although it remains important and systematic.

European Addiction Research, pp. 1-9. (2024)

Autores: Eduardo Martínez Gabaldón y Jorge E. Martínez Pérez

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Introduction: Drug use is a significant health, economic and social concern globally. Research indicates that personality traits are crucial in explaining drug use. This paper contributes to the expanding literature by exploring how personality traits at age 10 affect the likelihood of having used any drug at age 30. Methods: Data were extracted from the British Cohort Study 1970. The Big Five dimensions were derived by aggregating items related to distinct traits. Furthermore, probit regression analysis was conducted to ascertain the relationship between personality traits at age 10 and drug use by age 30. Results: Children with low levels of conscientiousness, or agreeableness; or high levels of extraversion, or internal locus of control at the age of 10 are more likely to use any drug in adulthood. In addition, significant differences were observed across gender and types of drugs. Conclusions: These findings suggest that early personality traits play a pivotal role in predicting the likelihood of drug use in adulthood. The results interest policymakers, as they could guide the implementation of personality-targeted interventions to mitigate the adverse effects of specific personality traits. For instance, emotional regulation training could benefit children with low conscientiousness; while stimulating activities such as sports, creative arts, or music could engage children with high extraversion.

Health Economics Review, 14(33) pp. 1-13. (2024)

Autores: Jorge E. Martínez Pérez, Juan A. Quesada Torres y Eduardo Martínez Gabaldón

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Background Due to population aging, healthcare expenditure is projected to increase substantially in developed countries like Spain. However, prior research indicates that health status, not merely age, is a key driver of healthcare costs. This study analyzed data from over 1.25 million residents of Spain’s Murcia region to develop a capitation-based healthcare financing model incorporating health status via Adjusted Morbidity Groups (AMGs). The goal was to simulate an equitable area-based healthcare budget allocation reflecting population needs. Methods Using 2017 data on residents’ age, sex, AMG designation, and individual healthcare costs, generalized linear models were built to predict healthcare expenditure based on health status indicators. Multiple link functions and distribution families were tested, with model selection guided by information criteria, residual analysis, and goodness of fit statistics. The selected model was used to estimate adjusted populations and simulate capitated budgets for the 9 healthcare districts in Murcia. Results The gamma distribution with logarithmic link function provided the best model ft. Comparisons of predicted and actual average costs revealed underfunded and overfunded areas within Murcia. If implemented, the capitation model would decrease funding for most districts (up to 15.5%) while increasing it for two high-need areas, emphasizing allocation based on health status and standardized utilization rather than historical spending alone. Conclusions AMG-based capitated budgeting could improve equity in healthcare financing across regions in Spain. By explicitly incorporating multimorbidity burden into allocation formulas, resources can be reallocated towards areas with poorer overall population health. Further policy analysis and adjustment is needed before full-scale implementation of such need-based global budgets.

BMC Health Services Research, 23, 1220, pp. 1-9. (2023)

Autores: Mariano Matilla-García, Paloma Úbeda Molla, Fernando I. Sánchez Martínez, Albert Ariza-Solé, Rocío Gómez-López, Esteban López de Sa y Ricard Ferrer

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Background: Cardiac arrest is a major public health issue in Europe. Cardiac arrest seems to be associated with a large socioeconomic burden in terms of resource utilization and health care costs. The aim of this study is the analysis of the economic burden of cardiac arrest in Spain and a cost-effectiveness analysis of the key intervention identified, especially in relation to neurological outcome at discharge. Methods: The data comes from the information provided by 115 intensive care and cardiology units from Spain, including information on the care of patients with out-of-hospital cardiac arrest who had a return of spontaneous circulation. The information reported by theses 115 units was collected by a nationwide survey conducted between March and September 2020. Along with number of patients (2631), we also collect information about the structure of the units, temperature management, and prognostication assessments. In this study we analyze the potential association of several factors with neurological outcome at discharge, and the cost associated with the different factors. The cost-effectiveness of using servo-control for temperature management is analyzed by means of a decision model, based on the results of the survey and data collected in the literature, for a one-year and a lifetime time horizon. Results: A total of 109 cardiology units provided results on neurological outcome at discharge as evaluated with the cerebral performance category (CPC). The most relevant factor associated with neurological outcome at discharge was ‘servo-control use’, showing a 12.8% decrease in patients with unfavorable neurological outcomes (i.e., CPC3-4 vs. CPC1-2). The total cost per patient (2020 Euros) was €73,502. Only “servo-control use” was associated with an increased mean total cost per hospital. Patients treated with servo-control for temperature management gained in the short term (1 year) an average of 0.039 QALYs over those who were treated with other methods at an increased cost of €70.8, leading to an incremental cost-effectiveness ratio of 1,808 euros. For a lifetime time horizon, the use of servocontrol is both more effective and less costly than the alternative. Conclusions: Our results suggest the implementation of servo-control techniques in all the units that are involved in managing the cardiac arrest patient from admission until discharge from hospital to minimize the neurological damage to patients and to reduce costs to the health and social security system.

Gaceta Sanitaria , 37, 102285, pp. 1-5. (2023)

Autores: Alberto Montero-Soler y Fernando I. Sánchez Martínez

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Objetivo: Realizar una aproximación a una estimación de la repercusión que tendría sobre el gasto público sanitario una ampliación de la cartera de prestaciones en salud bucodental que cubriera la mayor parte de los tratamientos terapéuticos que sufragan actualmente las personas de forma privada. Método: La estimación parte del nivel de gasto en servicios odontológicos del Sistema de Cuentas de Salud del a˜ no 2020 y se asume el dato de incremento de la demanda ante la universalización de los servicios extraído de un estudio de RAND para realizar, seguidamente, diversas proyecciones lineales de incremento del gasto introduciendo varios supuestos de copagos lineales para explorar el impacto de distintos mecanismos mixtos de financiación. Resultados: El incremento de la demanda sería de un 47,54% con respecto al gasto actual, y bajo los supuestos de partida el incremento en el gasto público alcanzaría unos 5345 millones de euros. Los diversos escenarios de copago minoran su impacto presupuestario. Conclusiones: A pesar de la mejora de la salud bucodental de la población espa˜ nola, persisten problemas derivados de la existencia de un gradiente socioeconómico que concentra la presencia y la prevalencia de enfermedades en los niveles socioeconómicos más bajos. Ampliar los servicios de la cartera bucodental para cubrir las necesidades de toda la población elevaría el gasto sanitario público en 0,48 puntos sobre el producto interior bruto, y aun así el gasto sanitario público espa˜ nol seguiría por debajo de la media de la Unión Europea.