A noticeable difference? Productivity costs related to paid and unpaid work in economic evaluations on expensive drugs.
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ABSTRACT:
SUBMITTER: Krol M
PROVIDER: S-EPMC4837201 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveThis study examines the relationship between telecommuting and gender inequalities in parents' time use at home and on the job before and during the COVID-19 pandemic.BackgroundTelecommuting is a potential strategy for addressing the competing demands of work and home and the gendered ways in which they play out. Limited evidence is mixed, however, on the implications of telecommuting for mothers' and fathers' time in paid and unpaid work. The massive increase in telecommuting due to COVID-19 underscores the critical need to address this gap in the literature.MethodData from the 2003-2018 American Time Use Survey (N = 12,519) and the 2020 Current Population Survey (N = 83,676) were used to estimate the relationship between telecommuting and gender gaps in parents' time in paid and unpaid work before and during the pandemic. Matching and quasi-experimental methods better approximate causal relationships than prior studies.ResultsBefore the pandemic, telecommuting was associated with larger gender gaps in housework and work disruptions but smaller gender gaps in childcare, particularly among couples with two full-time earners. During the pandemic, telecommuting mothers maintained paid work to a greater extent than mothers working on-site, whereas fathers' work hours did not differ by work location.ConclusionIn the context of weak institutional support for parenting, telecommuting may offer mothers a mechanism for maintaining work hours and reducing gender gaps in childcare, while exacerbating inequalities in housework and disruptions to paid work.
| S-EPMC8661776 | biostudies-literature
Project description:Medical interventions that increase life expectancy of patients result in additional consumption of non-medical goods and services in 'added life years'. This paper focuses on the distributional consequences across socio-economic groups of including these costs in cost effectiveness analysis. In that context, it also highlights the role of remaining quality of life and household economies of scale. Data from a Dutch household spending survey was used to estimate non-medical consumption and household size by age and educational attainment. Estimates of non-medical consumption and household size were combined with life tables to estimate what the impact of including non-medical survivor costs would be on the incremental cost effectiveness ratio (ICER) of preventing a death at a certain age. Results show that including non-medical survivor costs increases estimated ICERs most strongly when interventions are targeted at the higher educated. Adjusting for household size (lower educated people less often live additional life years in multi-person households) and quality of life (lower educated people on average spend added life years in poorer health) mitigates this difference. Ignoring costs of non-medical consumption in economic evaluations implicitly favors interventions targeted at the higher educated and thus potentially amplifies socio-economic inequalities in health.
| S-EPMC9292358 | biostudies-literature
Project description:Evidence-informed healthcare decision-making relies on high quality data inputs, including robust unit costs, which in many countries are not readily available. The objective of the Department of Health Economics' Unit Cost Online Database, developed based on systematic reviews of Austrian costing studies, is to make conducting economic evaluations from healthcare and societal perspectives more feasible with publicly available unit cost information in Austria. This article aims to describe trends in unit cost data sources and reporting using this comprehensive database as a case study to encourage relevant national and international methodological discussions. Database analysis and synthesis included publication/study characteristics and costing reporting details in line with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) with the year of the database launch as the cut-off point to assess how the methods have developed over time. Forty-two full economic evaluations and 278 unit costs were analyzed (2004-2016: 34 studies/232 unit costs, 2017-2022: 8 studies/46 unit costs). Although the reporting quality of costing details including the study perspective, unit cost sources and years has improved since 2017, the unit cost estimates and sources remained heterogeneous in Austria. While methodologically standardized national-level unit costs would be the gold standard, a systematically collated list of unit costs is a first step towards supporting health economic evaluations nationally.
| S-EPMC9819362 | biostudies-literature
Project description:BACKGROUND:Youth mental health interventions aimed at reducing substance use and delinquency in adolescents compete with other types of interventions for reimbursement from public funding. Within the youth mental health domain, delinquent acts impose high costs on society. These costs should be included in economic evaluations conducted from a societal perspective. Although the relevance of these costs is recognized, they are often left out because the unit costs of delinquent acts are unknown. AIMS OF THE STUDY:This study aims to provide a method for estimating the unit costs per perpetrator of 14 delinquent acts common in the Netherlands and included in self reported delinquency questionnaires: robbery/theft with violence, simple theft/pickpocketing, receiving stolen goods, destruction/vandalism of private or public property, disorderly conduct/discrimination, arson, cybercrime, simple and aggravated assault, threat, forced sexual contact, unauthorised driving, driving under the influence, dealing in soft drugs, and dealing in hard drugs. METHODS:Information on government expenditures and the incidence of crimes, number of perpetrators, and the percentage of solved and reported crimes was obtained from the national database on crime and justice of the Research and Documentation Centre of the Ministry of Justice and Security, Statistics Netherlands, and the Council for the Judiciary in the Netherlands. We applied a top-down micro costing approach to calculate the point estimate of the unit costs for each of the delinquent acts and, subsequently, estimated the mean (SD) unit costs for each of the delinquent acts by taking random draws from a triangular distribution while taking into account a 10% uncertainty associated with the associated point estimate. RESULTS:The mean (SD) unit costs per delinquent act per perpetrator ranged between EUR495 (EUR1.30) for "Driving under the influence" and EUR33,813 (EUR78.30) for a "Cybercrime". These unit costs may be considered as outliers as most unit costs ranged between EUR 2,600 and EUR 13,500 per delinquent act per perpetrator. DISCUSSION:This study is the first to estimate the unit costs per delinquent act per perpetrator in the Netherlands. The results of this study enable the inclusion of government expenditures associated with crime and justice in economic evaluations conducted from a societal perspective. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE:Youth mental health interventions aimed at reducing substance use and delinquency in adolescents are increasingly subjected to economic evaluations. These evaluations are used to inform decisions concerning the allocation of scarce healthcare resources and should cover all the costs and benefits for society, including those associated with delinquent acts. IMPLICATIONS FOR HEALTH POLICIES:The results of this study facilitate economic evaluations of youth mental health interventions aimed at reducing substance use and delinquency in adolescents, conducted from a societal perspective. IMPLICATIONS FOR FURTHER RESEARCH:Based on health-economic evaluations conducted in the field of youth mental health and the results of the current study, we recommend including the estimated unit costs in guidelines for health-economic evaluations conducted from a societal perspective. Future research could aim at examining whether these unit costs require regular updating. The methodology applied in this study allows for this.
| S-EPMC6839943 | biostudies-literature
Project description:This study examined differences between paid and unpaid family/friend caregivers to better understand the consumer-driven caregiving workforce. We compared economic vulnerability, unhealthy behavior, and serious emotional distress for 475 paid and 10,500 unpaid family/friend informal caregivers from the 2009 California Health Interview Survey. We then estimated whether caregiver status moderated the relationship between economic vulnerability and health outcomes. Compared to unpaid family/friend caregivers, paid family/friend caregivers had a 27% greater risk ( p = .002) of economic vulnerability. Among all family/friend caregivers, the probabilities of serious emotional distress and unhealthy behaviors increased by >100% and 28% for those with the greatest compared to the least economic vulnerability, and caregiver type did not moderate these relationships. To address economic and health vulnerabilities of paid informal caregivers, policy makers might increase wages in consumer-driven programs. These changes could prove beneficial to both paid informal caregivers and their care recipients, while reducing long-term inefficiencies in consumer-driven programs.
| S-EPMC6778838 | biostudies-literature
Project description:ObjectivesAmid growing concerns about the economic implications of population aging and the sustainability of older adults' working life, unpaid family care work receives less attention despite its direct relevance to population aging. This article systematically compares the paid and unpaid working life expectancy at age 50 to understand the overlap and trade-off between paid and unpaid work among older European adults.MethodUsing data from the Survey of Health and Retirement in Europe with the Sullivan method, the article presents gender differences across 17 countries in life expectancy at age 50 at various paid (employment) and unpaid (caregiving) role configurations.ResultsWhen work is defined to include unpaid family caregiving, women and men have similar working life expectancies at age 50, in contrast to prior research. However, its paid and unpaid components are gendered. The results also show that at age 50, women are expected to spend a similar number of years providing grandchild care and activities of daily living/instrumental activities of daily living care and that most of these years take place after retirement.DiscussionThe results highlight that the gendered tension between paid and unpaid work persists into older adulthood and needs to be accounted for in working life expectancy measures. The results also underscore the gendered implications of population aging and unpaid work in older adulthood for retirement age policies and strategies for promoting gender equality in later life.
| S-EPMC9122755 | biostudies-literature
Project description:The just noticeable difference (JND) model reflects the visibility limitations of the human visual system (HVS), which plays an important role in perceptual image/video processing and is commonly applied to perceptual redundancy removal. However, existing JND models are usually constructed by treating the color components of three channels equally, and their estimation of the masking effect is inadequate. In this paper, we introduce visual saliency and color sensitivity modulation to improve the JND model. Firstly, we comprehensively combined contrast masking, pattern masking, and edge protection to estimate the masking effect. Then, the visual saliency of HVS was taken into account to adaptively modulate the masking effect. Finally, we built color sensitivity modulation according to the perceptual sensitivities of HVS, to adjust the sub-JND thresholds of Y, Cb, and Cr components. Thus, the color-sensitivity-based JND model (CSJND) was constructed. Extensive experiments and subjective tests were conducted to verify the effectiveness of the CSJND model. We found that consistency between the CSJND model and HVS was better than existing state-of-the-art JND models.
| S-EPMC10007073 | biostudies-literature
Project description:Unpaid work in the sciences is advocated as an entry route into scientific careers. We compared the success of UK science graduates who took paid or unpaid work six-months after graduation in obtaining a high salary or working in a STEM (Science, Technology Engineering and Mathematics) field 3.5 years later. Initially taking unpaid work was associated with lower earnings and lower persistence in STEM compared with paid work, but those using personal connections to obtain unpaid positions were as likely to persist in STEM as paid workers. Obtaining a position in STEM six months after graduation was associated with higher rates of persistence in STEM compared with a position outside STEM for both paid and unpaid workers, but the difference is considerably smaller for unpaid workers. Socio-economic inequality in the likelihood of obtaining entry in STEM by taking an unpaid position is a well-founded concern for scientific workforce diversity.
| S-EPMC6583997 | biostudies-literature
Project description:BACKGROUND:In increasingly constrained healthcare budgets worldwide, efforts to improve quality and reduce costs are vital. Quality Improvement Collaboratives (QICs) are often used in healthcare settings to implement proven clinical interventions within local and national programs. The cost of this method of implementation, however, is cited as a barrier to use. This systematic review aims to identify and describe studies reporting on costs and cost-effectiveness of QICs when used to implement clinical guidelines in healthcare. METHODS:Multiple databases (CINAHL, MEDLINE, PsycINFO, EMBASE, EconLit and ProQuest) were searched for economic evaluations or cost studies of QICs in healthcare. Studies were included if they reported on economic evaluations or costs of QICs. Two authors independently reviewed citations and full text papers. Key characteristics of eligible studies were extracted, and their quality assessed against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Evers CHEC-List was used for full economic evaluations. Cost-effectiveness findings were interpreted through the Johanna Briggs Institute 'three by three dominance matrix tool' to guide conclusions. Currencies were converted to United States dollars for 2018 using OECD and World Bank databases. RESULTS:Few studies reported on costs or economic evaluations of QICs despite their use in healthcare. Eight studies across multiple healthcare settings in acute and long-term care, community addiction treatment and chronic disease management were included. Five were considered good quality and favoured the establishment of QICs as cost-effective implementation methods. The cost savings to the healthcare setting identified in these studies outweighed the cost of the collaborative itself. CONCLUSIONS:Potential cost savings to the health care system in both acute and chronic conditions may be possible by applying QICs at scale. However, variations in effectiveness, costs and elements of the method within studies, indicated that caution is needed. Consistent identification of costs and description of the elements applied in QICs would better inform decisions for their use and may reduce perceived barriers. Lack of studies with negative findings may have been due to publication bias. Future research should include economic evaluations with societal perspectives of costs and savings and the cost-effectiveness of elements of QICs. TRIAL REGISTRATION:PROSPERO registration number: CRD42018107417.
| S-EPMC7053095 | biostudies-literature
Project description:AimThe aim of this study was to determine prognostic factors for medical and productivity costs, and return to work (RTW) during the first two years after trauma in a clinical trauma population.MethodsThis prospective multicentre observational study followed all adult trauma patients (≥18 years) admitted to a hospital in Noord-Brabant, the Netherlands from August 2015 through November 2016. Health care consumption, productivity loss and return to work were measured in questionnaires at 1 week, 1, 3, 6, 12 and 24 months after injury. Data was linked with hospital registries. Prognostic factors for medical costs and productivity costs were analysed with log-linked gamma generalized linear models. Prognostic factors for RTW were assessed with Cox proportional hazards model. The predictive ability of the models was assessed with McFadden R2 (explained variance) and c-statistics (discrimination).ResultsA total of 3785 trauma patients (39% of total study population) responded to at least one follow-up questionnaire. Mean medical costs per patient (€9,710) and mean productivity costs per patient (€9,000) varied widely. Prognostic factors for high medical costs were higher age, female gender, spine injury, lower extremity injury, severe head injury, high injury severity, comorbidities, and pre-injury health status. Productivity costs were highest in males, and in patients with spinal cord injury, high injury severity, longer length of stay at the hospital and patients admitted to the ICU. Prognostic factors for RTW were high educational level, male gender, low injury severity, shorter length of stay at the hospital and absence of comorbidity.ConclusionsProductivity costs and RTW should be considered when assessing the economic impact of injury in addition to medical costs. Prognostic factors may assist in identifying high cost groups with potentially modifiable factors for targeted preventive interventions, hence reducing costs and increasing RTW rates.
| S-EPMC7094860 | biostudies-literature