Publications
30 results found
Laudicella M, Li Donni P, Olsen KR, et al., 2022, Age, morbidity, or something else? A residual approach using microdata to measure the impact of technological progress on health care expenditure, HEALTH ECONOMICS, Vol: 31, Pages: 1184-1201, ISSN: 1057-9230
Kruse M, Laudicella M, Olsen KR, et al., 2022, Effects of screening for anxiety and depression in patients with ischaemic heart disease - a nationwide Danish register study, SCANDINAVIAN JOURNAL OF PUBLIC HEALTH, ISSN: 1403-4948
Laudicella M, Li Donni P, 2021, The dynamic interdependence in the demand of primary and emergency secondary care: A hidden Markov approach, JOURNAL OF APPLIED ECONOMETRICS, Vol: 37, Pages: 521-536, ISSN: 0883-7252
Pulleyblank R, Laudicella M, Olsen KR, 2021, Cost and quality impacts of treatment setting for type 2 diabetes patients with moderate disease severity: Hospital- vs. GP-based monitoring, HEALTH POLICY, Vol: 125, Pages: 760-767, ISSN: 0168-8510
Olsen KR, Laudicella M, 2019, Health care inequality in free access health systems: The impact of non pecuniary incentives on diabetic patients in Danish general practices, SOCIAL SCIENCE & MEDICINE, Vol: 230, Pages: 174-183, ISSN: 0277-9536
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- Citations: 5
Laudicella M, Martin S, Donni PL, et al., 2018, Do Reduced Hospital Mortality Rates Lead to Increased Utilization of Inpatient Emergency Care? A Population-Based Cohort Study, HEALTH SERVICES RESEARCH, Vol: 53, Pages: 2324-2345, ISSN: 0017-9124
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- Citations: 6
Laudicella M, Walsh B, Burns E, et al., 2018, What is the impact of rerouting a cancer diagnosis from emergency presentation to GP referral on resource use and survival? Evidence from a population-based study, BMC CANCER, Vol: 18, ISSN: 1471-2407
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- Citations: 5
Walsh B, Laudicella M, 2017, Disparities In Cancer Care And Costs At The End Of Life: Evidence From England's National Health Service, HEALTH AFFAIRS, Vol: 36, Pages: 1218-1226, ISSN: 0278-2715
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- Citations: 15
Laudicella M, Walsh B, Munasinghe A, et al., 2016, Impact of laparoscopic versus open surgery on hospital costs for colon cancer: a population-based retrospective cohort study, BMJ Open, Vol: 6, ISSN: 2044-6055
Objective Laparoscopy is increasingly being used as an alternative to open surgery in the treatment of patients with colon cancer. The study objective is to estimate the difference in hospital costs between laparoscopic and open colon cancer surgery.Design Population-based retrospective cohort study.Settings All acute hospitals of the National Health System in England.Population A total of 55 358 patients aged 30 and over with a primary diagnosis of colon cancer admitted for planned (elective) open or laparoscopic major resection between April 2006 and March 2013.Primary outcomes Inpatient hospital costs during index admission and after 30 and 90 days following the index admission.Results Propensity score matching was used to create comparable exposed and control groups. The hospital cost of an index admission was estimated to be £1933 (95% CI 1834 to 2027; p<0.01) lower among patients who underwent laparoscopic resection. After including the first unplanned readmission following index admission, laparoscopy was £2107 (95% CI 2000 to 2215; p<0.01) less expensive at 30 days and £2202 (95% CI 2092 to 2316; p<0.01) less expensive at 90 days. The difference in cost was explained by shorter hospital stay and lower readmission rates in patients undergoing minimal access surgery. The use of laparoscopic colon cancer surgery increased 4-fold between 2006 and 2012 resulting in a total cost saving in excess of £29.3 million for the National Health Service (NHS).Conclusions Laparoscopy is associated with lower hospital costs than open surgery in elective patients with colon cancer suitable for both interventions.
Cookson R, Asaria M, Ali S, et al., 2016, Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level
<h4>Background</h4>Inequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them.<h4>Objectives</h4>The objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format.<h4>Design</h4>Longitudinal whole-population study at the small-area level.<h4>Setting</h4>England from 2001/2 to 2011/12.<h4>Participants</h4>A total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people.<h4>Main outcome measures</h4>Slope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality.<h4>Data sources</h4>Practice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8).<h4>Results</h4>Between 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying
Asaria M, Ali S, Doran T, et al., 2016, How a universal health system reduces inequalities: lessons from England, JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, Vol: 70, Pages: 637-643, ISSN: 0143-005X
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- Citations: 55
Laudicella M, Walsh B, Burns E, et al., 2016, Cost of care for cancer patients in England: evidence from population-based patient-level data, British Journal of Cancer, Vol: 114, Pages: 1286-1292, ISSN: 1532-1827
background: Health systems are facing the challenge of providing care to an increasing population of patients with cancer. However, evidence on costs is limited due to the lack of large longitudinal databases.methods: We matched cost of care data to population-based, patient-level data on cancer patients in England. We conducted a retrospective cohort study including all patients age 18 and over with a diagnosis of colorectal (275 985 patients), breast (359 771), prostate (286 426) and lung cancer (283 940) in England between 2001 and 2010. Incidence costs, prevalence costs, and phase of care costs were estimated separately for patients age 18–64 and greater than or equal to65. Costs of care were compared by patients staging, before and after diagnosis, and with a comparison population without cancer.results: Incidence costs in the first year of diagnosis are noticeably higher in patients age 18–64 than age greater than or equal to65 across all examined cancers. A lower stage diagnosis is associated with larger cost savings for colorectal and breast cancer in both age groups. The additional costs of care because of the main four cancers amounts to £1.5 billion in 2010, namely 3.0% of the total cost of hospital care.conclusions: Population-based, patient-level data can be used to provide new evidence on the cost of cancer in England. Early diagnosis and cancer prevention have scope for achieving large cost savings for the health system.
Munasinghe A, Laudicella M, Faiz O, 2015, Financial Benefits of Laparoscopic Colectomy: Could They Be Even Greater?, JAMA SURGERY, Vol: 150, Pages: 1202-1202, ISSN: 2168-6254
Laudicella M, Walsh B, Burns E, et al., 2015, The economic burden of cancer in England: evidence from patient-level data analysis, EUROPEAN JOURNAL OF CANCER CARE, Vol: 24, Pages: 12-12, ISSN: 0961-5423
Laverty AA, Laudicell M, Smith PC, et al., 2015, Impact of ‘high-profile’ public reporting on utilization and quality of maternity care in England: a difference-in-difference analysis, Journal of Health Services Research & Policy, ISSN: 1355-8196
Carrera PM, Laudicella M, 2014, Competitive healthcare and the elderly: Handle with care, MATURITAS, Vol: 78, Pages: 151-152, ISSN: 0378-5122
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- Citations: 1
Smith PC, Laudicella M, Li Donni P, 2013, Hospital quality and costs: evidence from England, Publisher: Imperial College Business School
Cookson R, Laudicella M, Li Donni P, 2013, Does hospital competition harm equity? Evidence from the English National Health Service, Journal of Health Economics, Vol: 32, Pages: 410-422
Increasing evidence shows that hospital competition under fixed prices can improve quality and reduce cost. Concerns remain, however, that competition may undermine socio-economic equity in the utilisation of care. We test this hypothesis in the context of the pro-competition reforms of the English National Health Service progressively introduced from 2004 to 2006. We use a panel of 32,482 English small areas followed from 2003 to 2008 and a difference in differences approach. The effect of competition on equity is identified by the interaction between market structure, small area income deprivation and year. We find a negative association between market competition and elective admissions in deprived areas. The effect of pro-competition reform was to reduce this negative association slightly, suggesting that competition did not undermine equity.
Cookson R, Laudicella M, Li Donni P, 2012, Measuring change in health care equity using smallarea administrative data - evidence from the English NHS 2001-8, Social Science & Medicine, Vol: 75, Pages: 1514-1522
This study developed a method for measuring change in socio-economic equity in health care utilisation using small area level administrative data. Our method provides more detailed information on utilisation than survey data but only examines socio-economic differences between neighbourhoods rather than individuals. The context was the English NHS from 2001 to 2008, a period of accelerated expenditure growth and pro-competition reform. Hospital records for all adults receiving nonemergency hospital care in the English NHS from 2001 to 2008 were aggregated to 32,482 English small areas with mean population about 1,500 and combined with other small area administrative data. Regression models of utilisation were used to examine year-on-year change in the small area association between deprivation and utilisation, allowing for population size, age-sex composition and disease prevalence including (from 2003-8) cancer, chronic kidney disease, coronary heart disease, diabetes, epilepsy, hypertension, hypothyroidism, stroke, transient ischaemic attack and (from 2006-8) atrial fibrillation, chronic obstructive pulmonary disease, obesity and heart failure. There was no substantial change in small area associations between deprivation and utilisation for outpatient visits, hip replacement, senile cataract, gastroscopy or coronary revascularisation, though overall nonemergency inpatient admissions rose slightly faster in more deprived areas than elsewhere. Associations between deprivation and disease prevalence changed little during the period, indicating that observed need did not grow faster in more deprived areas than elsewhere. We conclude that there was no substantial deterioration in socio-economic equity in health care utilisation in the English NHS from 2001 to 2008, and if anything, there may have been a slight improvement.
Gaynor M, Laudicella M, Propper C, 2012, Can governments do it better? Merger mania and hospital outcomes in the English NHS, Journal of Health Economics, Vol: 31, Pages: 528-543
The literature on mergers between private hospitals suggests that such mergers often produce little benefit. Despite this, the UK government has pursued an active policy of hospital mergers, arguing that such consolidations will bring improvements for patients. We examine whether this promise is met. We exploit the fact that between 1997 and 2006 in England around half the short term general hospitals were involved in a merger, but that politics means that selection for a merger may be random with respect to future performance. We examine the impact of mergers on a large set of outcomes including financial performance, productivity, waiting times and clinical quality and find little evidence that mergers achieved gains other than a reduction in activity. Given that mergers reduce the scope for competition between hospitals the findings suggest that further merger activity may not be the appropriate way of dealing with poorly performing hospitals.
Cookson R, Laudicella M, Li Donni P, et al., 2012, Effects of the Blair/Brown health reforms onsocioeconomic equity in health care, Journal of Health Services Research and Policy; Forthcoming
Laudicella M, Siciliani L, Cookson R, 2012, Waiting times and socioeconomic status: evidence from England, Social Science and Medicine; Forthcoming
Bojke C, Castelli A, Laudicella M, et al., 2012, Regional variation in the productivity of the English National Health Service, Health Economics; Forthcoming
Castelli A, Laudicella M, Street A, et al., 2011, Getting out what we put in: productivity of the English National Health Service, HEALTH ECONOMICS POLICY AND LAW, Vol: 6, Pages: 313-335, ISSN: 1744-1331
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- Citations: 9
Cookson R, Laudicella M, Li Donni P, 2011, Measuring change in health care equity using small area administrative data - evidence from the English NHS 2001-8, Publisher: Research Paper 67, Centre for Health Economics (University of York)
This study developed a method for measuring change in socio-economic equity in health care utilisation using small area level administrative data. Our method provides more detailed information on utilisation than survey data but only examines socio-economic differences between neighbourhoods rather than individuals. The context was the English NHS from 2001 to 2008, a period of accelerated expenditure growth and pro-competition reform. Hospital records for all adults receiving non-emergency hospital care in the English NHS from 2001 to 2008 were aggregated to 32,482 English small areas with mean population about 1,500 and combined with other small area administrative data. Regression models of utilisation were used to examine year-on-year change in the small area association between deprivation and utilisation, allowing for population size, age-sex composition and disease prevalence including (from 2003-8) cancer, chronic kidney disease, coronary heart disease, diabetes, epilepsy, hypertension, hypothyroidism, stroke, transient ischaemic attack and (from 2006-8) atrial fibrillation, chronic obstructive pulmonary disease, obesity and heart failure. There was no substantial change in small area associations between deprivation and utilisation for outpatient visits, hip replacement, senile cataract, gastroscopy or coronary revascularisation, though overall non-emergency inpatient admissions rose slightly faster in more deprived areas than elsewhere. Associations between deprivation and disease prevalence changed little during the period, indicating that observed need did not grow faster in more deprived areas than elsewhere. We conclude that there was no substantial deterioration in socio-economic equity in health care utilisation in the English NHS from 2001 to 2008, and if anything, there may have been a slight improvement.
Laudicella M, Olsen KR, Street A, 2010, Examining cost variation across hospital departments-a two-stage multi-level approach using patient-level data, SOCIAL SCIENCE & MEDICINE, Vol: 71, Pages: 1872-1881, ISSN: 0277-9536
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- Citations: 33
Cookson R, Laudicella M, 2010, Do the poor cost much more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001 to 2008., Soc Sci Med (Forthcoming)
The Blair/Brown reforms of the English NHS in the early to mid 2000s gave hospitals strong new incentives to reduce waiting times and length of stay for elective surgery. One concern was that these efficiency-oriented reforms might harm equity, by giving hospitals new incentives to select against socio-economically disadvantaged patients who stay longer and cost more to treat. This paper aims to assess the magnitude of these new selection incentives in the test case of hip replacement. Anonymous hospital records are extracted on 274,679 patients admitted to English NHS Hospital Trusts for elective total hip replacement from 2001/2 through 2007/8. The relationship between length of stay and small area income deprivation is modelled allowing for other patient characteristics (age, sex, number and type of diagnoses, procedure type) and hospital effects. After adjusting for these factors, we find that patients from the most deprived tenth of areas stayed just 6% longer than others in 2001/2, falling to 2% by 2007/8. By comparison, patients aged 85 or over stayed 57% longer than others in 2001/2, rising to 71% by 2007/8, and patients with seven or more diagnoses stayed 58% longer than others in 2001/2, rising to 73% by 2007/8. We conclude that the Blair/Brown reforms did not give NHS hospitals strong new incentives to select against socio-economically deprived hip replacement patients.
Kristensen T, Laudicella M, Ejersted C, et al., 2010, Cost variation in diabetes care delivered in English hospitals, DIABETIC MEDICINE, Vol: 27, Pages: 949-957, ISSN: 0742-3071
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- Citations: 16
Laudicella M, Cookson R, Jones AM, et al., 2009, Health care deprivation profiles in the measurement of inequality and inequity: An application to GP fundholding in the English NHS, JOURNAL OF HEALTH ECONOMICS, Vol: 28, Pages: 1048-1061, ISSN: 0167-6296
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- Citations: 6
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