18 results found
Bloom C, de Preux L, sheikh A, et al., 2020, Health and cost impact of stepping down asthma medication for UK patients, 2001–2017: a population-based observational study, PLoS Medicine, Vol: 17, ISSN: 1549-1277
BackgroundGuidelines recommend stepping down asthma treatment to the minimum effective dose to achieve symptom control, prevent adverse side effects, and reduce costs. Limited data exist on asthma prescription patterns in a real-world setting. We aimed to evaluate the appropriateness of doses prescribed to a UK general asthma population and assess whether stepping down medication increased exacerbations or reliever use, as well as its impact on costs.Methods and findingsWe used nationwide UK primary care medical records, 2001–2017, to identify 508,459 adult asthma patients managed with preventer medication. Prescriptions of higher-level medication: medium/high-dose inhaled corticosteroids (ICSs) or ICSs + add-on medication (long-acting β2-agonist [LABA], leukotriene receptor antagonist [LTRA], theophylline, or long-acting muscarinic antagonist [LAMA]) steadily increased over time (2001 = 49.8%, 2017 = 68.3%). Of those prescribed their first preventer, one-third were prescribed a higher-level medication, of whom half had no reliever prescription or exacerbation in the year prior. Of patients first prescribed ICSs + 1 add-on, 70.4% remained on the same medication during a mean follow-up of 6.6 years. Of those prescribed medium/high-dose ICSs as their first preventer, 13.0% already had documented diabetes, cataracts, glaucoma, or osteopenia/osteoporosis. A cohort of 125,341 patients were drawn to assess the impact of stepping down medication: mean age 50.4 years, 39.4% males, 39,881 stepped down. Exposed patients were stepped down by dropping their LABAs or another add-on or by halving their ICS dose (halving their mean-daily dose or their inhaler dose). The primary and secondary outcomes were, respectively, exacerbations and an increase in reliever prescriptions. Multivariable regression was used to assess outcomes and determine the prognostic factors for initiating stepdown. There was no increased exacerbation risk for each possible medication stepdown (ad
Adomako-Mensah V, Belloni A, Blawat A, et al., 2020, The health and social care costs of a selection of health conditions and multi-morbidities
BackgroundMultimorbidity (MM) is the presence of 2 or more long-term health conditions in a singleindividual. It impacts an individual’s quality of life, mental health and wellbeing, dailyfunction, and often results in greater healthcare utilisation the more co-existingconditions they have (1-4). MM is a big challenge facing the NHS, especially givenEngland’s ageing population, with an estimated two-thirds of individuals aged 65 andover having 2 or more long-term conditions (5-6). Yet, little is known about the resourceuse of these patients despite being the group with the largest impact on the NHS andwith the worst health outcomes (7). Existing evidence focuses on specific healthconditions and their interactions with other conditions using different methodologies,making comparisons across different conditions difficult.This work has empirically assessed the impact of multi-morbidity on NHS and socialcare costs. With the aim of answering the question: is the impact of developing acondition on health and social care costs greater for someone with no prior conditions,or for someone with an existing condition. If patients have multiple conditions, theremay be some economies of scale involved with treatment, for example they may beable to discuss multiple queries during a single GP appointment, or in some cases thetreatment provided will address multiple conditions. However, treating patients withmulti-morbidities could theoretically also be more expensive than treating 2 conditionsseparately, as patients may be more likely to experience complications.MethodologyThis work considered the individual cost of 11 health conditions with high prevalence inthe English population and their most common interactions. These were: chronicobstructive pulmonary disease (COPD), diabetes (types 1 and 2), lung cancer, breastcancer, coronary heart disease (CHD), stroke, hypertension, dementia, liver disease,depression and colorectal cancer.This project had 2 components: a lite
Rizmie D, Miraldo M, Atun R, et al., 2019, The effect of extreme temperature on emergency admissions across vulnerable populations in England: an observational study, Lancet Public Health Science 2019 Conference, Publisher: Elsevier, Pages: S7-S7
BackgroundClimate change poses an unfamiliar challenge to population health and health-systems resilience. Although previous studies have estimated morbidity attributable to heat or cold across cities, we provide, to our knowledge, the first large-scale, population-wide assessment of the effect of extreme temperatures on excess emergency admissions in England and among vulnerable populations, who could be disproportionately affected.MethodsIn this observational study, we combined all daily inpatient admissions during 2001–12 in England with meteorological data using inverse distance weighting. We exploited random daily variation in temperature experienced by hospitals and a 30-day lag period, using a distributed lag model with multiple fixed-effects controlling for seasonal factors, to examine interaction effects across diseases with age and the indices of multiple deprivation.FindingsWe analysed 29 371 084 emergency admissions. A day with temperature above 30°C was associated with 3·5 more admissions per hospital (SE 0·45), relative to a 10–15°C day. This increased to 14·1 excess admissions per hospital (SE 5·56) over the following 30 days, generating 786 excess admissions across England per heatwave day. A day under –5°C generated 3·8 more admissions per hospital (SE 0·33), or 966 excess admissions across England. This increased to 62·3 admissions per hospital (SE 4·83) over the following 30 days. These effects were heterogeneous across age and deprivation level. Populations older than 74 years were up to 8 times more affected by extreme temperatures. Individuals living in low-employment and low-income areas were 2–10 times more likely to be admitted during a temperature shock. These results were statistically significant (p<0·0001) and passed several robustness and falsification tests.InterpretationTo our knowledge, this is the first study to determine heterogene
Fecht D, Sheridan CE, Roscoe CJ, et al., 2019, Inequalities in exposure to nitrogen dioxide in parks and playgrounds in Greater London, International Journal of Environmental Research and Public Health, Vol: 16, Pages: 1-11, ISSN: 1660-4601
Elevated levels of nitrogen dioxide (NO2) have been associated with adverse health outcomes in children including reduced lung function and increased rates of asthma. Many parts ofLondon continue to exceed the annual average NO2 concentration of 40µg/m3 set by the EU directive. Using high-resolution maps of annual average NO2 for 2016 from the London Atmospheric Emissions Inventory and detailed maps of open spaces from Britain’s national mapping agency, Ordnance Survey, we estimated average NO2 concentrations for every open space in Greater London and analysed geospatial patterns comparing Inner verses Outer London and the 32 London Boroughs. Across Greater London, 24% of play spaces, 67% of private parks and 27% of public parks had average levels of NO2 that exceeded the EU limit for NO2. Rates of exceedance were higher in Inner London; open spaces in the City of London had the highest average NO2 values among all the London Boroughs. The closest play space for more than 250,000 children (14%) under 16 years old in Greater London had NO2 concentrations above recommended levels. Of these children, 66% (~165,000 children) live in the most deprived areas of London as measured by the Index of Multiple Deprivations where average NO2 concentrations in play spaces where on average 6 µg/m3 higher than for play spaces in the least deprived quintile. More action is needed to reduce NO2 in open spaces to safe levels through pollution reduction and mitigation efforts as currently open spaces in Greater London including play spaces, parks and gardens still have dangerously high levels of NO2 according to the most recent NO2 map.
Pimpin L, Retat L, Fecht D, et al., 2018, Estimating the costs of air pollution to the National Health Service and social care: An assessment and forecast up to 2035, PLoS Medicine, Vol: 15, ISSN: 1549-1277
BACKGROUND: Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England. METHOD AND FINDINGS: Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline 'no change' scenario; (2) individuals' pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 μg/m3; and (4) NO2 annual European Union limit values reached (40 μg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data. CONCLUSIONS: Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure-response functions, as well as to disaggregate results by socioeconomic status.
de Preux LB, Rizmie D, 2018, Beyond financial efficiency to support environmental sustainability in economic evaluations, Future Healthcare Journal, Vol: 5, Pages: 103-107, ISSN: 2055-3323
The healthcare sector is one of the largest pollutersin the United Kingdom, accounting for 25% of total emissions of carbon dioxideof the public sector.Ironically,it is the healthcare sector itself that is primarily affected by any deterioration in the environmentaffectingindividuals’ health and their demand for healthcare.Therefore thehealthcare sector is a direct beneficiary of its own steps towards sustainabilityand is more and more viewed as the one who should lead the change. In this article, we first review the concepts of financial and environmental sustainability.Second,we discuss the existing evidence of sustainablechanges withinthis sector. Third, we propose a simple adaptation of the classic cost-effectivenessanalysis to incorporate carbon footprinting to account for these external costs. We illustrate our method using the case of in-centre versushome haemodialysis. We conclude that home dialysis is always a preferable alternative to in-centre treatment. Finally, we discuss the limitations of our approach, and the future research agenda.
Pimpin L, Retat L, Fecht D, et al., 2018, Estimation of costs to the NHS and social care due to the health impacts of air pollution
de Preux Gallone LB, Sassi F, 2018, Chapter 5 Economics of Pollution Interventions, Chief Medical Officer annual report 2017: health impacts of all pollution – what do we know?, Publisher: Department of Health and Social Care, 5
Interventions to reduce pollution have the potential toincrease social welfare through improvements in health,social and economic outcomes. This potential has beenshown in a range of economic analyses focusing on specificinterventions. In this chapter we present evidence fromstudies focusing on the health impacts of environmentalinterventions that have been evaluated from an economicperspective. Overall, this body of evidence is stronglysuggestive of beneficial welfare impacts from mostinterventions. However, there remains significant scope forexpanding and strengthening the current evidence base inorder to provide clearer guidance to policy makers in policydesign and investment decisions. Salient points made in thischapter include:1) England has successfully managed to “decouple” trendsof economic growth and polluting emissions, achievingreductions in emissions of a large range of pollutants withan expanding economy. However, the detrimental healthimpacts of current levels of pollution are still large, asare the potential benefits of taking more incisive actionsagainst pollution.2) Economic analysis approaches typically applied in theappraisal of environmental interventions are at oddswith those prevailing in the health care domain. A goldstandardeconomic evaluation approach in the area ofenvironmental health interventions should take a societalperspective and aim at assessing overall impacts onsocial welfare. Available evidence neglecting these keycomponents likely underestimates the net benefit ofpollution reduction measures.3) Research priorities should now include the evaluation ofthe societal benefits of measures to address pollutionin order to justify economically beneficial interventionsthat reduce individuals’ pollution exposure or remove thesource of emissions.
Martin R, Muûls M, de Preux LB, et al., 2014, On the Empirical Content of Carbon Leakage Criteria in the EU Emissions Trading Scheme., Ecological economics
Martin R, Muûls M, de Preux LB, et al., 2014, Industry Compensation Under Relocation Risk: A Firm-Level Analysis of the EU Emissions Trading Scheme, American Economic Review, Vol: forthcoming
When regulated firms are offered compensation to prevent them from relocating, efficiency requires that payments be distributed across firms so as to equalize marginal relocation probabilities, weighted by the damage caused by relocation. We formalize this fundamental economic logic and apply it to analyzing compensation rules proposed under the EU Emissions Trading Scheme, where emission permits are allocated free of charge to carbon intensive and trade exposed industries. We show that this practice results in substantial overcompensation for given carbon leakage risk. Efficient permit allocation reduces the aggregate risk of job loss by more than half without increasing aggregate compensation.
Muuls M, Martin R, Wagner UJ, et al., 2014, Problematic Permitting - Editor's choice
Martin R, de Preux L, Wagner U, 2012, The polluter-doesn't-pay principle, Publisher: CEP CP 369
Martin R, Muuls M, de Preux L, et al., 2012, Industry Compensation Under Relocation Risk: A Firm-Level Analysis of the EU Emissions Trading Scheme, Publisher: CEP, DP 1150
de Preux LB, 2011, ANTICIPATORY EX ANTE MORAL HAZARD AND THE EFFECT OF MEDICARE ON PREVENTION, HEALTH ECONOMICS, Vol: 20, Pages: 1056-1072, ISSN: 1057-9230
Anderson B, Leib J, Martin R, et al., 2011, Climate change policy and business in Europe: evidence from interviewing managers
Martin R, Muûls M, Preux LBD, et al., 2011, Anatomy of a paradox: Management practices, organizational structure and energy efficiency, Journal of Environmental Economics and Management, Pages: ---, ISSN: 0095-0696
Martin R, Muuls M, de Preux L, et al., 2010, Anatomy of a Paradox: Management Practices, Organisational Structure and Energy Efficiency, Publisher: CEPDP1039
Martin M, de Preux L, 2009, The Impacts of the Climate Change Levy on business: Evidence from Microdata, Publisher: NBER Working Paper, CEP Working Paper
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