7 results found
Barrenho E, Miraldo M, Propper C, et al., 2021, The importance of surgeons and their peers in adoption and diffusion of innovation: an observational study of laparoscopic colectomy adoption and diffusion in England, Social Science and Medicine, Vol: 272, ISSN: 0277-9536
Little is known about the role of clinicians in accounting for adoption and diffusion of medical innovations, especially within the English National Health System. This study examines the importance of surgical consultants and their work-based networks on the diffusion of an important innovation, minimally invasive elective laparoscopic colectomy for colorectal cancer. The study used linked patient-level and workforce data on 260,110 elective colectomies and 1288 consultants between 2000 and 2014, to examine adoption of laparoscopic colectomy pre- and post-introduction of clinical guidelines and total share of colectomies performed laparoscopically by adopters. Laparoscopy as a share of elective colectomy increased from 0% in 2000 to 53% in 2014. Surgeons, rather than hospitals, were the principal agents accounting for the increase and explain 46.6% of the variance in laparoscopic colectomy use. Female surgeons, surgeons trained outside the United Kingdom, and recent graduates had higher rates of laparoscopy adoption. More experienced surgeons and surgeons with more peers who perform laparoscopy were more likely to adopt, adopt early and have greater use of laparoscopy. Targeting clinicians, rather than hospitals, is central to increasing adoption and diffusion of new medical technologies.
Pires Barrenho EA, Miraldo M, Shaikh M, et al., 2017, Vertical and horizontal equity of funding for malaria control: a global multi source funding analysis for 2006-2010, BMJ Global Health, Vol: 2, ISSN: 2059-7908
Background International and domestic funding for malaria is critically important to achieve the Sustainable Development Goals. Its equitable distribution is key in ensuring that the available, scarce, resources are deployed efficiently for improved progress and a sustained response that enables eradication.Methods We used concentration curves and concentration indices to assess inequalities in malaria funding by different donors across countries, measuring both horizontal and vertical equity. Horizontal equity assesses whether funding is distributed in proportion to health needs, whereas vertical equity examines whether unequal economic needs are addressed by appropriately unequal funding. We computed the Health Inequity Index and the Kakwani Index to assess the former and the latter, respectively. We used data from the World Bank, Global Fund, Unicef, President’s Malaria Initiative and the Malaria Atlas Project to assess the distribution of funding against need for 94 countries. National gross domestic product per capita was used as a proxy for economic need and ‘population-at-risk’ for health need.Findings The level and direction of inequity varies across funding sources. Unicef and the President’s Malaria Initiative were the most horizontally inequitable (pro-poor). Inequity as shown by the Health Inequity Index for Unicef decreased from −0.40 (P<0.05) in 2006 to −0.25 (P<0.10) in 2008, and increased again to −0.58 (P<0.01) in 2009. For President’s Malaria Initiative, it increased from −0.19 (P>0.10) in 2006 to −0.38 (P<0.05) in 2008, and decreased to −0.36 (P<0.10) in 2010. Domestic funding was inequitable (pro-rich) with inequity increasing from 0.28 (P<0.01) in 2006 to 0.39 (P<0.01) in 2009, and then decreasing to 0.22 (P<0.10) in 2010. Funding from the World Bank and the Global Fund was distributed proportionally according to need. In terms of vertical inequity, all
Pires Barrenho EA, Miraldo M, Smith PC, 2017, Does global drug innovation correspond to burden of disease? The neglected diseases in developed and developing countries., ISSN: 1744-6783
While commonly argued that there is a mismatch between drug innovation and disease burden, there is little evidence on the magnitude and direction of such disparities. In this paper we measure inequality in innovation, by comparing R&D activity with population health and GDP data across 493 therapeutic indications to globally measure: (i) drug innovation, (ii) disease burden, and (iii) market size.We use concentration curves and indices to assess inequality at two levels: (i) broad disease groups; and (ii) disease subcategories for both 1990 and 2010.For some of top burden disease subcategories (i.e. cardiovascular and circulatory diseases, neoplasms, and musculoskeletal disorders) innovation is disproportionately concentrated in diseases with high burden and larger market size, whereas for others (i.e. mental and behavioural disorders, neonatal disorders, and neglected tropical diseases) innovation is disproportionately concentrated in low burden diseases.These inequalities persisted over time, suggesting inertia in pharmaceutical R&D in tackling the global health challenges.Our results highlight the priority disease areas for R&D investment in both developed and developing countries.
Barrenho E, Smith PC, Miraldo M, 2013, The determinants of attrition in drug development: a duration analysis, Publisher: Imperial College Business School
Jacobs R, Barrenho E, 2011, How to interpret different results for CRHTT data reply, BRITISH JOURNAL OF PSYCHIATRY, Vol: 199, Pages: 249-249, ISSN: 0007-1250
Jacobs R, Barrenho E, 2011, Impact of crisis resolution and home treatment teams on psychiatric admissions in England, BRITISH JOURNAL OF PSYCHIATRY, Vol: 199, Pages: 71-76, ISSN: 0007-1250
Jacobs R, Barrenho E, 2011, The Impact of Crisis Resolution and Home Treatment Teams on Psychiatric Admissions in England, JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS, Vol: 14, Pages: S13-S13, ISSN: 1091-4358
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