We estimate the first monetary value of a health gain in Croatia to inform the debate about the appropriate "demand-side" cost-effectiveness thresholds in Croatia but also Central and Eastern Europe, ...where such debates are still uncommon. We test the empirical support for two equity considerations: age and severity operationalized as proportional shortfall (PS), and propose a pragmatic framework for combining equity considerations with the monetary value of health into a single threshold.
We used the contingent valuation method to elicit the willingness to pay per Quality-Adjusted Life Year (QALY) in Croatia, using a representative sample of the population (N = 1,500, online survey). 29 EQ-5D health states were valued using payment scales and open-ended question as payment vehicles. To test the hypotheses, we used both parametric tests and non-parametric tests. Multilinear regression was employed to test the theoretical validity of the results.
The monetary value of a health gain in Croatia is equivalent to 1.15 of GDP per capita (equaling €17,000). Age of patients seems to be an important equity-related characteristic. The WTP per QALY in the age-neutral risk group (€11,900) was nearly equivalent to the WTP per QALY in the adult (neutral) risk group (€11,700) but lower by 16% compared to the WTP per QALY estimated in children (€14,200; p = 0.00). WTP estimates are theoretically valid and to, a small degree, scale sensitive. There is a positive association between the level of proportional shortfall and willingness to pay. To increase the usefulness of our results for the policy-makers, we combine the elicited preferences into a single decision-making framework and construct several cost-effectiveness thresholds based on willingness to pay and equity-related preferences. Based on empirical results, cost-effectiveness thresholds could range up to €20,308 for the most severe health conditions in children or could be lowered to €16,777 for less severe health conditions.
In Central and Eastern Europe, in spite of a growing understanding of the importance of further developing value-based assessment frameworks there has been very little empirical research to guide, inform and promote this development. Countries in this region use mainly GDP-based thresholds without empirical evidence to support such important decisions. This may lead to thresholds that are too high, with detrimental consequence for the pricing and reimbursement systems.
We explored the monetary value of the end-of-life (EoL) health gains, that is, the value of a life-year (VOLY) gained at the end of a patient's life in Croatia. We tested whether the nature of the ...illness under valuation (cancer and/or rare disease) is a factor in the valuation of EoL-VOLYs. The aim was for our results to contribute to the health and longevity valuation literature and more particularly to the debate on the appropriate cost-effectiveness threshold for EoL treatments as well as to provide input into the debate on the justifiability of a cancer and/or a rare disease premium when evaluating therapies.
A contingent valuation was conducted in an online survey using a representative sample of the Croatian population (n = 1500) to calculate the willingness to pay for gains in the remaining life expectancy at the EoL, from the social-inclusive-individual perspective, using payment scales and an open-ended payment vehicle. Our approach mimics the actual decision-making problem of deciding whether to reimburse therapies targeting EoL conditions such as metastatic cancer whose main purpose is to extend life (and not add quality to life).
Average EoL-VOLY across all scenarios was estimated at €67,000 (median €40,000). In scenarios that offered respondents 1 full year of life extension, EoL-VOLY was estimated at €33,000 (median €22,000). Our results show that the type of illness is irrelevant for EoL-VOLY evaluations.
The pressure to reimburse expensive therapies targeting EoL conditions will continue to increase. Delivering "value for money" in healthcare, both in countries with relatively higher and lower budget restrictions, requires the valuation of different types of health gains, which should, in turn, affect our ability to evaluate their cost effectiveness.
The paper aims to identify and measure the costs and savings associated with the delivery of Comprehensive Medication Management (CMM) services in Croatia in patients diagnosed with hypertension ...accompanied by at least one additional established cardiovascular disease (CVD) and/or type 2 diabetes mellitus (DMT2) who use five or more medicines daily. The budget impact analysis (BIA) employed in this study compares the total costs of CMM to the cost reductions expected from CMM. The cost reductions (or savings) are based on the reduced incidence of unwanted clinical events and healthcare service utilisation rates due to CMM. The BIA model is populated by data on medication therapy costs, labour, and training from the pilot CMM intervention introduced in Zagreb's main Health Centre, while relevant international published sources were used to estimate the utilisation, incidence, and unwanted clinical events rates. Total direct costs, including pharmacists' labour and training (EUR 2,667,098) and the increase in the cost of prescribed medication (EUR 5,182,864) amounted to EUR 7,849,962 for 3 years, rendering the cost per treated patient per year EUR 57. CMM is expected to reduce the utilisation rates of healthcare services and the incidence of unwanted clinical events, leading to a total 3-year reduction in healthcare costs of EUR 7,787,765. Given the total CMM costs of EUR 7,849,962, CMM's 3-year budget impact equals EUR 92,869, rendering per treated patient an incremental cost of CMM EUR 0.67. Hence, CMM appears to be an affordable intervention for addressing medication mismanagement and irrational drug use.
Zdravstvena pismenost u Republici Hrvatskoj Bobinac, Ana; Dukić Samaržija, Nikolina; Ribarić, Elizabeta
Revija za socijalnu politiku,
01/2023, Letnik:
29, Številka:
3
Journal Article, Paper
Recenzirano
Odprti dostop
Research shows that low levels of health literacy have negative consequences for the health of the individual and the community. The aim of the research is to establish the average level of health ...literacy in Croatia on a nationally representative sample and to identify characteristics that can be linked to particularly low levels of health literacy. The results show that the level of health literacy in Croatia, on average, is at the very border between problematic and adequate. Within the population, however, there are significant differences in the level of health literacy associated with the class, economic and social characteristics of individuals. Lower health literacy reflects in an individual‘s reluctance to respond to preventive screenings, keep weight below obesity levels, or exercise regularly. Our results suggest that raising the level of health literacy in Croatia should not rely primarily on media campaigns, because health information from the media is difficult for citizens to understand and use for the purpose of protection against diseases. Key words: health literacy, HLS-EU-16, public health.
This paper provides an overview of the modern technologies used in selected global seaports, and their possible impact on future development of seaports. The research problem stems from inefficience ...of customs procedures, dispute information flow, unneeded container manipulation in port area, and time lost due to bureucracy procedures. Methods used in this paper are the descriptive method, method of analysis, classification method, and compilation method. Since the majority of leading global seaports are placed in China, the authors decided to analyze the most successful seaport from each country, in order to achieve heterogeneity and global insight into used modern technologies. In total, eleven seaports placed on Lloyd’s list Top 100 Ports have been analyzed. Key findings in this paper are: (1) different level of development of a particular country affects different levels of implementation of new technical and technological achievements, resulting in different levels of development of each seaport; (2) future development of modern technologies in seaports leans towards autonomous technologies such as autonomous drones, and self-driving trucks. Modern technologies may improve the safety and efficiency of operations in and outside seaports.
Istrazivanja pokazuju da niska razina zdravstvene pismenosti ima negativne posljedice za zdravlje pojedinca i zajednice. Cilj istrazivanja je utvrditi prosjecnu razinu zdravstvene pismenosti u ...Republici Hrvatskoj na nacionalno reprezentativnom uzorku te identificirati obiljezja koja se mogu dovesti u vezu s posebno niskom razinom pismenosti. Rezultati pokazuju da se razina zdravstvene pismenosti u Hrvatskoj, u prosjeku, nalazi na samoj granici izmedu problematicne i adekvatne. Unutar populacije, medutim, postoje znacajne razlike u razini zdravstvene pismenosti povezane s klasnim, ekonomskim i socijalnim obiljezjima pojedinaca. Niza zdravstvena pismenost odrazava se u nevoljkosti pojedinca da se odazove na preventivne preglede, da zadrzi tezinu ispod razine pretilosti ili da redovito vjezba. Nasi rezultati sugeriraju da se podizanje razine zdravstvene pismenosti u Hrvatskoj ne bi smjelo oslanjati primarno na medijske kampanje jer je informacije o zdravlju iz medija gradanima tesko razumjeti i upotrijebiti u svrhu zastitite od bolesti. Kljucne rijeci: zdravstvena pismenost, HLS-EU-16, javno zdravstvo. Research shows that low levels of health literacy have negative consequences for the health of the individual and the community. The aim of the research is to establish the average level of health literacy in Croatia on a nationally representative sample and to identify characteristics that can be linked to particularly low levels of health literacy. The results show that the level of health literacy in Croatia, on average, is at the very border between problematic and adequate. Within the population, however, there are significant differences in the level of health literacy associated with the class, economic and social characteristics of individuals. Lower health literacy reflects in an individual's reluctance to respond to preventive screenings, keep weight below obesity levels, or exercise regularly. Our results suggest that raising the level of health literacy in Croatia should not rely primarily on media campaigns, because health information from the media is difficult for citizens to understand and use for the purpose of protection against diseases. Key words: health literacy, HLS-EU-16, public health.
Izhodišča: Presaditev pljuč je zahtevna metoda zdravljenja za izbrane bolnike z napredovalo pljučno boleznijo. Naraščanje števila primernih kandidatov in standarizacija posega sta v letu 2018 ...omogočila vzpostavitev transplantacijskega centra v UKC Ljubljana. Prispevek poroča o prvih rezultatih.
Metode: Opravili smo analizo lastnega registra bolnikov. Rezultate smo primerjali s skupino bolnikov, ki so jim pred tem opravili presaditev v AKH Dunaj.
Rezultati: Med 15. 9. 2018 in 15. 9. 2021 smo opravili 37 presaditev pljuč (od tega pri 13 ženskah). Indikacije so bile KOPB (n = 13, 35 %), pljučne fibroze (n = 7, 19 %), cistična fibroza (n = 5, 14 %), kovidna pljučnica (n = 4, 11 %), bronhiektazije (n = 3, 8 %), pljučna hipertenzija (n = 2, 5 %), limfangioleiomiomatoza (n = 1, 3 %), pomanjkanje alfa-1-antitripsina (n = 1, 3 %) in bronhiolitis (n = 1, 3 %). V primerjavi s prejšnjo skupino bolnikov, napotenih v AKH Dunaj (71 bolnikov, od tega 35 žensk), je bil delež bolnikov s KOPB višji (35 % in 16 %, p = 0,019), bolniki pa so bili starejši (mediana razpon, 59 14–68 in 43 4–58 let, p = 0,001). 76 % darovanih pljuč ni ustrezalo standardnim merilom (30 % darovalcev je bilo starejših od 55 let, 22 % jih je imelo infiltrate na rentgenogramu pljuč, 24 % pa ni izpolnjevalo enega od ostalih meril), v 43 % pa je bila potrebna redukcija velikosti, kar pa ni vplivalo na primarno odpoved presadka. Kratkoročno preživetje je bili podobno v obeh skupinah (1-letno preživetje v UKC Ljubljana 89 % 95 % CI 78–99 % in v AKH Dunaj 83 % 95 % CI 74–92 %).
Zaključek: Prvi rezultati kažejo, da so zgodnji izidi po presaditvi pljuč primerljivi pri bolnikih, ki so imeli presaditev v UKC Ljubljana ali v AKH Dunaj.
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