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Can the municipalities prevent medication of mental diseases?

https://arctichealth.org/en/permalink/ahliterature122456
Source
J Ment Health Policy Econ. 2012 Jun;15(2):53-60
Publication Type
Article
Date
Jun-2012
Author
Mickael Bech
Maja Hansen
Jørgen Lauridsen
Christian Kronborg
Author Affiliation
COHERE, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.
Source
J Ment Health Policy Econ. 2012 Jun;15(2):53-60
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Child
Denmark
Female
Health Expenditures
Health Policy - economics - legislation & jurisprudence
Humans
Male
Mental Disorders - drug therapy - economics
Middle Aged
Registries
Regression Analysis
Young Adult
Abstract
In extension of a large municipality reform in 2007, which reduced the number of Danish municipalities from 275 to 98, it was the intention that the municipalities should assume responsibility for a part of the expenditure connected to secondary sector health care treatment. Furthermore, the municipalities were assigned the responsibility for--and equipped with a number of opportunities for--exerting primary preventive initiatives.
To investigate, whether the municipalities by applying these opportunities have been able to prevent medication of mental diseases. Specifically, this is resolved by analysing whether there are significant relationships between measures of municipal policy opportunities and the proportion of population medicated for mental diseases.
We apply a variety of statistical regression models. Initially, simple linear regression is applied. Next, a Seemingly Unrelated Regression approach, which accounts for intra-municipal behavioural correlation, is brought in play. Finally, this approach is extended to regressions which are adjusted for spatial spillover effects.
The initial simple linear specification indicates a potential significant relationship between municipal policy opportunities and medication. However, when applying a specification which is adjusted for intra-municipal correlation, this relationship vanishes. Finally, there seem to be indications of spatial spillover effects. Thus, the relationship between municipal preventive initiatives and medication seems to be a structural, intra-municipal relationship, rather than a cause-response effect.
Our results show that potential linkages between municipal preventive initiatives and medication for mental diseases are not of a simple nature. Specifically, sophisticated and targeted interventions are needed rather than broad and general public health initiatives.
Though the approach is promising, the data underlying the study is at present relatively weak. Future studies should involve more variables as well as longer times series in order to obtain proper understandings of the potential linkages between municipal policy efforts and medication.
PubMed ID
22813938 View in PubMed
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Characteristics of patients receiving allergy vaccination: to which extent do socio-economic factors play a role?

https://arctichealth.org/en/permalink/ahliterature143453
Source
Eur J Public Health. 2011 Jun;21(3):323-8
Publication Type
Article
Date
Jun-2011
Author
Karin Dam Petersen
Christian Kronborg
Dorte Gyrd-Hansen
Ronald Dahl
Jørgen Nedergaard Larsen
Allan Linneberg
Author Affiliation
Institute of Public Health-Health Economics, University of Southern Denmark, Odense C, Denmark. karin.petersen@stab.rm.dk
Source
Eur J Public Health. 2011 Jun;21(3):323-8
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Administration, Cutaneous
Adolescent
Adult
Age Factors
Aged
Asthma - prevention & control
Case-Control Studies
Cohort Studies
Denmark
Desensitization, Immunologic - utilization
Educational Status
Female
Health services needs and demand
Humans
Male
Middle Aged
Pain Measurement
Quality of Life
Questionnaires
Rhinitis, Allergic, Seasonal - prevention & control
Severity of Illness Index
Socioeconomic Factors
Vaccination
Abstract
Little is known about characteristics of patients receiving allergen-specific immunotherapy. Identifying obstacles to appropriate treatment according to guidelines may facilitate the development of strategies aiming at improved treatment of patients with allergic respiratory diseases. The objective of this study was to investigate differences in disease severity, demographic and socioeconomic status between allergic rhinitis patients receiving allergen-specific immunotherapy and allergic rhinitis patients not receiving allergen-specific immunotherapy.
A total of 366 patients were studied of whom 210 were going to receive subcutaneously administrated immunotherapy (SIT) against grass pollen and/or house dust mite allergy. The severity of rhino-conjunctivitis (hay fever) and/or asthma was classified according to international guidelines. The questionnaires included an EQ-5D visual analogue scale instrument and some socio-economic questions.
Severity of disease, young age, high level of education as well as greater perceived impairment of health-related quality of life due to allergic symptoms were significantly associated with use of SIT. Somewhat unexpectedly, household income was not associated with use of SIT.
Use of SIT was associated with both disease severity measures and educational level, but not income level. These results suggest social inequality as reflected by lower use of SIT among patients with lower educational level may represent an obstacle to treatment with SIT.
Notes
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PubMed ID
20484343 View in PubMed
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Cost analysis of establishing dialysis facilities for the treatment of chronic renal failure in Greenland.

https://arctichealth.org/en/permalink/ahliterature138966
Source
Int J Circumpolar Health. 2010 Dec;69(5):470-9
Publication Type
Article
Date
Dec-2010
Author
Christian Kronborg
Trine Kjær
Mickael Bech
Author Affiliation
University of Southern Denmark, Institute of Public Health, Health Economics Research Unit, J.B. Winsløws Vej 9, Odense, Denmark. cka@sam.sdu.dk
Source
Int J Circumpolar Health. 2010 Dec;69(5):470-9
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Costs and Cost Analysis - methods
Greenland
Health Services - economics
Humans
Kidney Failure, Chronic - therapy
Medical Tourism
Renal Dialysis
Abstract
At present there are no facilities offering treatment for chronic renal failure with dialysis in Greenland. Patients in need of treatment must go to Denmark. It has been proposed that treatment facilities should be established at Dronning Ingrids Hospital in Nuuk, Greenland. The objective of this study is to explore the costs of such an alternative compared with the situation today.
The costs of establishing dialysis facilities in Nuuk, Greenland, and providing dialysis for Greenlandic patients were compared with the costs of the current way of managing dialysis for Greenlandic patients in need of treatment. Data for the study were collected from publicly available statistics, from Dronning Ingrids Hospital in Nuuk and from Rigshospitalet in Copenhagen.
The actual number of patients in dialysis was found to be lower than expected. Based on Danish prevalence statistics, it was expected that about 27 persons in Greenland would be in dialysis each year. Over a time horizon of 10 years, the additional costs of establishing and offering dialysis treatment in Nuuk were expected to amount to an average of 1.4 million Danish kroner (€190,000) per year compared with the current treatment costs. Results were sensitive to the demand for dialysis treatment among people in need of treatment. If all patients in need of dialysis were treated, the additional costs of establishing dialysis facilities and providing treatment in Nuuk were estimated to about 7 million Danish Kroner (€930,000) per year compared with the status quo.
Changes in the demand for dialysis treatment may influence the cost of establishing treatment facilities in Nuuk.
PubMed ID
21118637 View in PubMed
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Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study).

https://arctichealth.org/en/permalink/ahliterature118731
Source
Br J Psychiatry. 2013 Jan;202(1):35-41
Publication Type
Article
Date
Jan-2013
Author
Lene Halling Hastrup
Christian Kronborg
Mette Bertelsen
Pia Jeppesen
Per Jorgensen
Lone Petersen
Anne Thorup
Erik Simonsen
Merete Nordentoft
Author Affiliation
Region Zealand, Psychiatric Research Unit, Roskilde, Denmark. lhhs@regionsjaelland.dk
Source
Br J Psychiatry. 2013 Jan;202(1):35-41
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antipsychotic Agents - therapeutic use
Community Mental Health Services - economics - organization & administration
Cost-Benefit Analysis
Denmark
Diagnosis-Related Groups - economics
Early Medical Intervention - economics
Family Therapy - economics
Health Care Costs - statistics & numerical data
Health Services - utilization
Humans
Intention to Treat Analysis
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Care Team - economics
Patient Education as Topic - economics
Psychotic Disorders - economics - therapy
Schizophrenia - economics - therapy
Single-Blind Method
Socialization
Young Adult
Abstract
Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited.
To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment.
An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken.
The mean total costs of OPUS over 5 years (€123,683, s.e. = 8970) were not significantly different from that of standard treatment (€148,751, s.e. = 13073). At 2-year follow-up the mean Global Assessment of Functioning (GAF) score in the OPUS group (55.16, s.d. = 15.15) was significantly higher than in standard treatment group (51.13, s.d. = 15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d. = 18.28) and 54.16 (s.d. = 18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective in 70% of the replications. For a willingness-to-pay up to €50,000 the probability that OPUS was cost-effective was more than 80%.
The incremental cost-effectiveness analysis showed that there was a high probability of OPUS being cost-effective compared with standard treatment.
PubMed ID
23174515 View in PubMed
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Cost of dementia: impact of disease progression estimated in longitudinal data.

https://arctichealth.org/en/permalink/ahliterature71352
Source
Scand J Public Health. 2003;31(2):119-25
Publication Type
Article
Date
2003
Author
Christian Kronborg Andersen
Jørgen Lauridsen
Kjeld Andersen
Per Kragh-Sørensen
Author Affiliation
Institute of Public Health, Health Economics, University of Southern Denmark, Winsløparken 19, 5000 Odense C, Denmark cka@sam.sdu.dk
Source
Scand J Public Health. 2003;31(2):119-25
Date
2003
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Comorbidity
Dementia - economics - pathology
Denmark
Disease Progression
Female
Health Care Costs
Home Care Services - economics - utilization
Humans
Interviews
Linear Models
Longitudinal Studies
Male
Nursing Homes - economics - utilization
Prescriptions, Drug
Research Support, Non-U.S. Gov't
Abstract
AIMS: Several studies have shown that health care costs are higher for demented than for non-demented persons and that health care costs are higher for more severe demented persons than less severe demented persons. However, most studies report on cross-sectional study designs, and thus fail to examine the influence of disease progression on changes in health care costs to individual persons. The objective of this study was, using longitudinal data, to examine changes in total health care costs with disease progression in demented persons. METHODS: We assumed that disease progression could be characterised by transitions between different states of dementia which reflected the degree to which the disease progressed over time. Then, changes in health care costs were regressed on a set of explanatory variables including disease progression. A total of 465 demented and non-demented persons were interviewed twice. The time between interviews was about three years. Before each interview, the participant was examined for dementia and classified by type of dementia (Alzheimer's disease, vascular or other types of dementia) and degree of dementia (very mild, mild, moderate, severe). RESULTS: The results of this longitudinal study confirmed that health care costs increased over time for non-demented as well as for demented persons and that health care costs increased with disease progression. In particular, the health care costs increased when the disease had progressed into the severe state of the dementia. Also, decline in functional abilities was an important factor for explaining changes in health care costs.
PubMed ID
12745762 View in PubMed
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Evaluation of a controlled, national collaboration study on a clinical pharmacy service of screening for risk medications.

https://arctichealth.org/en/permalink/ahliterature259519
Source
Int J Clin Pharm. 2014 Apr;36(2):368-76
Publication Type
Article
Date
Apr-2014
Author
Lene Juel Kjeldsen
Marianne Hald Clemmensen
Christian Kronborg
Ulla Hedegaard
Line Hedegaard Larsen
Inger Olsen Yderstræde
Jette Lyngholm Nielsen
Trine Rune Høgh Nielsen
Source
Int J Clin Pharm. 2014 Apr;36(2):368-76
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cooperative Behavior
Denmark
Drug-Related Side Effects and Adverse Reactions
Female
Humans
Male
Middle Aged
Personal Satisfaction
Pharmacists
Pharmacy Service, Hospital
Abstract
Risk medications are frequently associated with adverse events and hospitalisations.
To evaluate a risk medication screening service for in-patients at Danish hospitals.
Danish hospitals.
The study was designed as a controlled, prospective intervention study. Inpatients were screened for the use of five risk medications; anticoagulants, digoxin, methotrexate, NSAIDs and opioids, and during the intervention period recommendations were made by clinical pharmacists according to a standardized intervention scheme. The recommendations were discussed with the physician face-to-face.
Readmissions within 6 months after discharge.
In total, 1,007 control and 775 intervention patients were included in the study. The study found that half of the patients (50 % during the control and 48 % during the intervention period) admitted to Danish hospitals were treated with at least one of the five selected risk medications, significantly more drug related problems (DRPs) were identified during the control period (1.7/patient during the control and 1.4/patient during the intervention period (p
PubMed ID
24346818 View in PubMed
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Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature283298
Source
Lancet Oncol. 2016 Jun;17(6):836-44
Publication Type
Article
Date
Jun-2016
Author
Morten Bendixen
Ole Dan Jørgensen
Christian Kronborg
Claus Andersen
Peter Bjørn Licht
Source
Lancet Oncol. 2016 Jun;17(6):836-44
Date
Jun-2016
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - pathology - surgery
Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung - pathology - surgery
Carcinoma, Squamous Cell - pathology - surgery
Denmark
Female
Follow-Up Studies
Humans
Length of Stay
Lung Neoplasms - pathology - surgery
Male
Middle Aged
Neoplasm Staging
Pain, Postoperative - diagnosis - etiology
Pneumonectomy - adverse effects
Prognosis
Quality of Life
Thoracic Surgery, Video-Assisted - adverse effects
Thoracotomy - adverse effects
Abstract
Video-assisted thoracoscopic surgery (VATS) is used increasingly as an alternative to thoracotomy for lobectomy in the treatment of early-stage non-small-cell lung cancer, but remains controversial and worldwide adoption rates are low. Non-randomised studies have suggested that VATS reduces postoperative morbidity, but there is little high-quality evidence to show its superiority over open surgery. We aimed to investigate postoperative pain and quality of life in a randomised trial of patients with early-stage non-small-cell lung cancer undergoing VATS versus open surgery.
We did a randomised controlled patient and observer blinded trial at a public university-based cardiothoracic surgery department in Denmark. We enrolled patients who were scheduled for lobectomy for stage I non-small-cell lung cancer. By use of a web-based randomisation system, we assigned patients (1:1) to lobectomy via four-port VATS or anterolateral thoracotomy. After surgery, we applied identical surgical dressings to ensure masking of patients and staff. Postoperative pain was measured with a numeric rating scale (NRS) six times per day during hospital stay and once at 2, 4, 8, 12, 26, and 52 weeks, and self-reported quality of life was assessed with the EuroQol 5 Dimensions (EQ5D) and the European Organisation for Research and Treatment of Cancer (EORTC) 30 item Quality of Life Questionnaire (QLQ-C30) during hospital stay and 2, 4, 8, 12, 26, and 52 weeks after discharge. The primary outcomes were the proportion of patients with clinically relevant moderate-to-severe pain (NRS =3) and mean quality of life scores. These outcomes were assessed longitudinally by logistic regression across all timepoints. Data for the primary analysis were analysed by modified intention to treat (ie, all randomised patients with pathologically confirmed non-small-cell lung cancer). This trial is registered with ClinicalTrials.gov, number NCT01278888.
Between Oct 1, 2008, and Aug 20, 2014, we screened 772 patients, of whom 361 were eligible for inclusion and 206 were enrolled. We randomly assigned 103 patients to VATS and 103 to anterolateral thoracotomy. 102 patients in the VATS group and 99 in the thoracotomy group were included in the final analysis. The proportion of patients with clinically relevant pain (NRS =3) was significantly lower during the first 24 h after VATS than after anterolateral thoracotomy (VATS 38%, 95% CI 0·28-0·48 vs thoracotomy 63%, 95% CI 0·52-0·72, p=0·0012). During 52 weeks of follow-up, episodes of moderate-to-severe pain were significantly less frequent after VATS than after anterolateral thoracotomy (p
Notes
Comment In: J Thorac Dis. 2016 Sep;8(9):E1017-E101827747050
Comment In: Ann Transl Med. 2016 Oct;4(19):38327826585
Comment In: J Thorac Dis. 2016 Dec;8(12 ):E1746-E174728149630
PubMed ID
27160473 View in PubMed
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Public preferences for establishing nephrology facilities in Greenland: estimating willingness-to-pay using a discrete choice experiment.

https://arctichealth.org/en/permalink/ahliterature120724
Source
Eur J Health Econ. 2013 Oct;14(5):739-48
Publication Type
Article
Date
Oct-2013
Author
Trine Kjær
Mickael Bech
Christian Kronborg
Morten Raun Mørkbak
Author Affiliation
COHERE, University of Southern Denmark, Winsløwsvej 9B, 1., 5000, Odense, Denmark. tkj@sam.sdu.dk
Source
Eur J Health Econ. 2013 Oct;14(5):739-48
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Ambulatory Care Facilities - supply & distribution
Confidence Intervals
Consumer Satisfaction
Female
Financing, Personal
Greenland
Health services needs and demand
Humans
Kidney Failure, Chronic - therapy
Logistic Models
Male
Medical Tourism
Middle Aged
Models, Econometric
Nephrology
Public Opinion
Questionnaires
Renal Dialysis - economics
Abstract
At present there are no nephrology facilities in Greenland. Greenlandic patients with renal failure needing dialysis thus have to travel to Denmark to obtain treatment. For patients in haemodialysis this necessitates a permanent residence in Denmark. Our study was aimed at examining Greenlanders' preferences for establishing nephrology facilities in Greenland at Queen Ingrid's Hospital in Nuuk, and to estimate the associated change in welfare. Preferences were elicited using a discrete choice experiment (DCE). A random sample of 500 individuals of the general population was sent a postal questionnaire in which they were asked to consider the trade-offs of establishing nephrology facilities in Greenland as opposed to the current situation. This involved trading off the benefits of having such facilities in their home country against the costs of the intervention. Besides including a payment attribute described in terms of incremental tax payment, the DCE included two interventions attributes related to (1) the organisation of labour, and (2) the physical settings of the patients. Respondents succeeded in answering the DCE despite cultural and linguistic disparity. We found that all the included attributes had a significant effect on respondents' choices, and that respondents' answers to the DCE were in keeping with their values as stated in the questionnaire. DCE data was analyzed using a random parameter logit model reparametrized in willingness-to-pay space. The results showed that establishing facilities in Greenland were preferred to the current treatment in Denmark. The welfare estimate from the DCE, at DKK 18.74 million, exceeds the estimated annual costs of establishing treatment facilities for patients with chronic renal failure. Given the estimated confidence interval this result seems robust. Establishing facilities in Greenland therefore would appear to be welfare-improving, deriving positive net benefits. Despite the relatively narrow policy focus, we believe that our findings provide some insight into individuals' preferences for decentralization of public services and on citizens' views of 'self-governance' that go beyond the case of Greenland. More generally, this paper illustrates how DCE can be applied successfully to developing countries with culturally, demographically, and geographically distinct features.
PubMed ID
22975793 View in PubMed
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[The future economic burden of dementia on health and social services]

https://arctichealth.org/en/permalink/ahliterature80264
Source
Ugeskr Laeger. 2006 Oct 2;168(40):3432-6
Publication Type
Article
Date
Oct-2-2006
Author
Sørensen Jan
Gudex Claire M
Andersen Christian Kronborg
Author Affiliation
Syddansk Universitet, Center for Anvendt Sundhedstjenesteforskning, Odense C. jas@cast.sdu.dk
Source
Ugeskr Laeger. 2006 Oct 2;168(40):3432-6
Date
Oct-2-2006
Language
Danish
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Community Health Services - economics
Cost of Illness
Dementia - economics - epidemiology
Denmark - epidemiology
Efficiency, Organizational - economics
Health Care Costs - trends
Health Services - economics
Health Services Needs and Demand - economics - trends
Humans
Incidence
Models, Economic
Abstract
INTRODUCTION: Demographic changes in Denmark over the next 15 years will result in an increased number of elderly people and of individuals with dementia. As a result this will increase the demand for health care and social services. The aim of this study was to shed light on the likely economic consequences of this development. MATERIALS AND METHODS: A simple static, comparative model based on Danish incidence and cost data for different age groups and different levels of dementia severity was developed. The model projected the costs of the health and social services for treatment and care of people with dementia up to the year 2020. RESULTS: The future demographic changes and an increasing number of people with dementia will result in a 30% increase in health and social service costs due to dementia. This increase will be lower if individuals with dementia have a higher mortality rate than other individuals. If annual productivity gains of 1-3% can be achieved, the future cost (in real prices) could be reduced. CONCLUSION: The Danish health and social services will in the future be faced with increased costs for the treatment and care of people with dementia. This could be achieved through productivity gains, an increased level of financing or prioritisation of services that provide good value for money.
PubMed ID
17032611 View in PubMed
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Willingness to pay for allergy-vaccination among Danish patients with respiratory allergy.

https://arctichealth.org/en/permalink/ahliterature98420
Source
Int J Technol Assess Health Care. 2010 Jan;26(1):20-9
Publication Type
Article
Date
Jan-2010
Author
Karin Dam Petersen
Dorte Gyrd-Hansen
Allan Linneberg
Ronald Dahl
Jørgen Nedergaard Larsen
Henning Løwenstein
Christian Kronborg
Author Affiliation
University of Southern Denmark, Denmark. Karin.Petersen@stab.rm.dk
Source
Int J Technol Assess Health Care. 2010 Jan;26(1):20-9
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Asthma - economics - immunology - therapy
Cohort Studies
Denmark
Desensitization, Immunologic - economics
Female
Humans
Injections, Subcutaneous
Male
Middle Aged
Patient Acceptance of Health Care
Quality-Adjusted Life Years
Rhinitis, Allergic, Perennial - economics - immunology - therapy
Severity of Illness Index
Sex Factors
Socioeconomic Factors
Young Adult
Abstract
OBJECTIVE: The aim of this study was to elicit willingness to pay (WTP) for allergen-specific subcutaneous injection immunotherapy (SCIT) in a cohort of respondents suffering from allergic-rhinoconjunctivitis (a-RC)/asthma, and to investigate how patients self-select to SCIT according to need. METHODS: A random sample of the general population was screened for a-RC/asthma and asked if they were willing to consider SCIT. They were asked to state their WTP for SCIT by way of a discrete choice question (DC-q), an open-ended WTP question (o-WTP-q), and questions relating to their sociodemographic background and the severity of their a-RC/asthma. The characteristics of respondents demanding SCIT were compared with the characteristics of respondents who have actually received SCIT to establish possible barriers to demand. RESULTS: Our results suggest that respondents do well in self-selecting themselves to SCIT on the basis of need according to disease burden measured in terms of a-RC classification, number of contacts with a general practitioner, number of sick days, and potential quality-adjusted life-year loss. Mean WTP for SCIT was estimated at 655 euros (median, 267 euros) (o-WTP-q) and 903 euros (95 percent confidence limit, 348-1,459) (DC-q). CONCLUSION: Characteristics of respondents, who consider SCIT and are willing to pay for SCIT, suggest that allergy sufferers select themselves appropriately according to need and not according to other characteristics, such as income or education. There is a significant discrepancy between those who hypothetically consider SCIT and those demanding SCIT in real life. This study suggests that there are barriers to entry related to age and education, but not to income.
PubMed ID
20059777 View in PubMed
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10 records – page 1 of 1.