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Zwack CC, Haghani M, de Bekker-Grob EW. Research trends in contemporary health economics: a scientometric analysis on collective content of specialty journals. HEALTH ECONOMICS REVIEW 2024; 14:6. [PMID: 38270771 PMCID: PMC10809694 DOI: 10.1186/s13561-023-00471-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 11/28/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Health economics is a thriving sub-discipline of economics. Applied health economics research is considered essential in the health care sector and is used extensively by public policy makers. For scholars, it is important to understand the history and status of health economics-when it emerged, the rate of research output, trending topics, and its temporal evolution-to ensure clarity and direction when formulating research questions. METHODS Nearly 13,000 articles were analysed, which were found in the collective publications of the ten most specialised health economic journals. We explored this literature using patterns of term co-occurrence and document co-citation. RESULTS The research output in this field is growing exponentially. Five main research divisions were identified: (i) macroeconomic evaluation, (ii) microeconomic evaluation, (iii) measurement and valuation of outcomes, (iv) monitoring mechanisms (evaluation), and (v) guidance and appraisal. Document co-citation analysis revealed eighteen major research streams and identified variation in the magnitude of activities in each of the streams. A recent emergence of research activities in health economics was seen in the Medicaid Expansion stream. Established research streams that continue to show high levels of activity include Child Health, Health-related Quality of Life (HRQoL) and Cost-effectiveness. Conversely, Patient Preference, Health Care Expenditure and Economic Evaluation are now past their peak of activity in specialised health economic journals. Analysis also identified several streams that emerged in the past but are no longer active. CONCLUSIONS Health economics is a growing field, yet there is minimal evidence of creation of new research trends. Over the past 10 years, the average rate of annual increase in internationally collaborated publications is almost double that of domestic collaborations (8.4% vs 4.9%), but most of the top scholarly collaborations remain between six countries only.
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Affiliation(s)
- Clara C Zwack
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.
| | - Milad Haghani
- School of Civil and Environmental Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Lipman SA, Zhang L, Shah KK, Attema AE. Time and lexicographic preferences in the valuation of EQ-5D-Y with time trade-off methodology. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:293-305. [PMID: 35596831 PMCID: PMC9123877 DOI: 10.1007/s10198-022-01466-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/12/2022] [Indexed: 05/21/2023]
Abstract
In the valuation of EQ-5D-Y-3L, adult respondents are asked to complete composite time trade-off (cTTO) tasks for a 10-year-old child. Earlier work has shown that cTTO utilities elicited in such a child perspective are generally higher than when adults take their own perspective. We explore how differences in time preference in child and adult perspectives could explain this effect. Furthermore, as cTTO valuation in a child perspective involves explicit consideration of immediate death for a child, we also consider how cTTO utilities could be affected by decision-makers lexicographically avoiding death in children. We report the results of an experiment in which 219 respondents valued 5 health states in both adult and child perspectives with either a standard cTTO or a lead-time TTO only approach, in which immediate death is less focal. Time preferences were measured in both perspectives. Our results suggest that utilities were lower when lead-time TTO, rather than cTTO, was used. We find large heterogeneity in time preference in both perspectives, with predominantly negative time preference. The influence of time preferences on utilities, however, was small, and correcting for time preferences did not reduce differences between utilities elicited in both perspectives. Surprisingly, we found more evidence for differences in utilities between adult and child perspectives when lead-time TTO was used. Overall, these results suggest that time and lexicographic preferences affect time trade-off valuation in child and adult perspectives, but are not the explanation for differences between these perspectives. We discuss the implications of our findings for EQ-5D-Y-3L valuation.
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Affiliation(s)
- Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Liying Zhang
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Koonal K Shah
- National Institute for Health and Care Excellence, London, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- PHMR Ltd, London, UK
| | - Arthur E Attema
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Lipman SA, Zhang L, Shah KK, Attema AE. Time and lexicographic preferences in the valuation of EQ-5D-Y with time trade-off methodology. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:293-305. [PMID: 35596831 DOI: 10.1007/s10198-022-01466-6:1-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/12/2022] [Indexed: 05/24/2023]
Abstract
In the valuation of EQ-5D-Y-3L, adult respondents are asked to complete composite time trade-off (cTTO) tasks for a 10-year-old child. Earlier work has shown that cTTO utilities elicited in such a child perspective are generally higher than when adults take their own perspective. We explore how differences in time preference in child and adult perspectives could explain this effect. Furthermore, as cTTO valuation in a child perspective involves explicit consideration of immediate death for a child, we also consider how cTTO utilities could be affected by decision-makers lexicographically avoiding death in children. We report the results of an experiment in which 219 respondents valued 5 health states in both adult and child perspectives with either a standard cTTO or a lead-time TTO only approach, in which immediate death is less focal. Time preferences were measured in both perspectives. Our results suggest that utilities were lower when lead-time TTO, rather than cTTO, was used. We find large heterogeneity in time preference in both perspectives, with predominantly negative time preference. The influence of time preferences on utilities, however, was small, and correcting for time preferences did not reduce differences between utilities elicited in both perspectives. Surprisingly, we found more evidence for differences in utilities between adult and child perspectives when lead-time TTO was used. Overall, these results suggest that time and lexicographic preferences affect time trade-off valuation in child and adult perspectives, but are not the explanation for differences between these perspectives. We discuss the implications of our findings for EQ-5D-Y-3L valuation.
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Affiliation(s)
- Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Liying Zhang
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Koonal K Shah
- National Institute for Health and Care Excellence, London, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- PHMR Ltd, London, UK
| | - Arthur E Attema
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Lipman SA, Zhang L, Shah KK, Attema AE. Correction to: Time and lexicographic preferences in the valuation of EQ-5D-Y with time trade-off methodology. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1613-1615. [PMID: 36197576 PMCID: PMC9666327 DOI: 10.1007/s10198-022-01530-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 05/21/2023]
Affiliation(s)
- Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Liying Zhang
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Koonal K Shah
- National Institute for Health and Care Excellence, London, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- PHMR Ltd, London, UK
| | - Arthur E Attema
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Lipman SA, Attema AE, Versteegh MM. Correcting for discounting and loss aversion in composite time trade-off. HEALTH ECONOMICS 2022; 31:1633-1648. [PMID: 35474364 PMCID: PMC9541376 DOI: 10.1002/hec.4529] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 05/14/2023]
Abstract
Time trade-off utilities have been suggested to be biased upwards. This bias is a result of the method being applied assuming linear utility of life duration, which is violated when individuals discount future life years or are loss averse for health. Applying a "corrective approach", that is, measuring individuals' discount function and loss aversion and correcting time trade-off utilities for these individual characteristics, may reduce this bias in utilities. Earlier work has developed this approach for time trade-off in a student sample. In this study, the corrective approach was extended to composite time trade-off (cTTO) methodology, which enabled correcting utilities for health states worse than dead. In digital interviews a sample of 150 members of the general public completed cTTO tasks for six health states, and afterward they completed measurements of loss aversion and discounting. cTTO utilities were corrected using these measurements under multiple specifications. Respondents were also asked to reflect on and adjust their cTTO utilities directly. Our results show considerable loss aversion and both positive and negative discounting were prevalent. As predicted, correction generally resulted in lower utilities. This was in accordance with the direction of adjustments made by respondents themselves.
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Affiliation(s)
- Stefan A. Lipman
- Erasmus Centre for Health Economics RotterdamErasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamNetherlands
| | - Arthur E. Attema
- Erasmus Centre for Health Economics RotterdamErasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamNetherlands
| | - Matthijs M. Versteegh
- Institute for Medical Technology AssessmentErasmus University RotterdamRotterdamNetherlands
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Stolk-Vos AC, Attema AE, Manzulli M, van de Klundert JJ. Do patients and other stakeholders value health service quality equally? A prospect theory based choice experiment in cataract care. Soc Sci Med 2022; 294:114730. [DOI: 10.1016/j.socscimed.2022.114730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/23/2021] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
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Lipman SA, Brouwer WBF, Attema AE. What is it going to be, TTO or SG? A direct test of the validity of health state valuation. HEALTH ECONOMICS 2020; 29:1475-1481. [PMID: 32744408 PMCID: PMC7689723 DOI: 10.1002/hec.4131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 06/08/2020] [Accepted: 06/22/2020] [Indexed: 05/15/2023]
Abstract
Standard gamble (SG) typically yields higher health state valuations than time trade-off (TTO), which may be caused by biases affecting both methods. It has been suggested that TTO yields more accurate health state valuations, because TTO is subject to both upward and downward biases that may cancel out. Verifying this claim, however, would require a golden standard to test validity against. In this study, we attempted to provide a first direct test of the validity of health state valuation. A total of 119 students completed five TTO and SG tasks. Afterwards, their health state valuations elicited with TTO and SG were shown to them in an interactive graph. Respondents were asked to indicate which of the methods represented their valuation of a health state best. They could also adjust their valuation. Overall, we found that respondents indicated that TTO valuations better reflected health state valuations, a result that was more pronounced for more severe health states. When offered the opportunity, on average, respondents adjusted health state valuations downwards. These findings may have implications for future work on (bias correction in) health state valuations.
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Affiliation(s)
- Stefan A. Lipman
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Werner B. F. Brouwer
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Arthur E. Attema
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
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Lugnér AK, Krabbe PFM. An overview of the time trade-off method: concept, foundation, and the evaluation of distorting factors in putting a value on health. Expert Rev Pharmacoecon Outcomes Res 2020; 20:331-342. [PMID: 32552002 DOI: 10.1080/14737167.2020.1779062] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Preference-based instruments measuring health status express the value of specific health states in a single number. One method used is time trade-off (TTO). Health-status values are key elements in calculating quality-adjusted life years (QALYs) and are pertinent for resource allocation. Since they are used in economic evaluations of healthcare, searching for a theoretical foundation of TTO in economics is justified. AREA COVERED This paper provides an overview of TTO, including its relation to economic theory, and discusses biases and distortions, compiled from recent and older research. Inconsistencies between TTO and random utility theory were detected; The TTO is confounded by time preferences and by respondents' life expectancies. TTO is cognitively challenging, therefore guidance during the interviews is needed, producing interview effects. TTO does not measure one thing at a time, nor are the values independent of other states that are being valued in the same task. That is, TTO does not exhibit theoretical measurement properties such as unidimensionality and the invariance principle. EXPERT OPINION We conclude that the TTO may be a pragmatic method of eliciting health state values, but the limitations in regard to measurement theory and practical elicitation problems makes it prone to inconsistencies and arbitrariness.
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Affiliation(s)
| | - Paul F M Krabbe
- Department of Epidemiology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
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Lipman SA, Brouwer WBF, Attema AE. Living up to expectations: Experimental tests of subjective life expectancy as reference point in time trade-off and standard gamble. JOURNAL OF HEALTH ECONOMICS 2020; 71:102318. [PMID: 32229049 DOI: 10.1016/j.jhealeco.2020.102318] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 05/05/2023]
Abstract
Earlier work suggested that subjective life expectancy (SLE) functions as reference point in time trade-off (TTO), but has not tested or modelled this explicitly. In this paper we construct a model based on prospect theory to investigate these predictions more thoroughly. We report the first experimental test of reference-dependence with respect to SLE for TTO and extend this approach to standard gamble (SG). In two experiments, subjects' SLEs were used to construct different versions of 10-year TTO and SG tasks, with the gauge duration either described as occurring above or below life expectation. Our analyses suggest that both TTO and SG weights were affected by SLE as predicted by prospect theory with SLE as reference point. Subjects gave up fewer years in TTO and were less risk-tolerant in SG below SLE, implying that weights derived from these health state valuation methods for durations below SLE will be biased upwards.
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Affiliation(s)
- Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands.
| | - Werner B F Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Arthur E Attema
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands
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Attema AE, Bleichrodt H, l'Haridon O, Lipman SA. A comparison of individual and collective decision making for standard gamble and time trade-off. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:465-473. [PMID: 31902024 PMCID: PMC7188732 DOI: 10.1007/s10198-019-01155-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
Quality-Adjusted Life-Years (QALYs) are typically derived from individual preferences over health episodes. This paper reports the first experimental investigation into the effects of collective decision making on health valuations, using both time trade-off (TTO) and standard gamble (SG) tasks. We investigated collective decision making in dyads, by means of a mixed-subjects design where we control for learning effects. Our data suggest that collective decision making has little effect on decision quality, as no effects were observed on decision consistency and monotonicity for both methods. Furthermore, QALY weights remained similar between individual and collective decisions, and the typical difference in elicited weights between TTO and SG was not affected. These findings suggest that consulting with others has little effect on health state valuation, although learning may have. Additionally, our findings add to the literature of the effect of collective decision making, suggesting that no such effect occurs for TTO and SG.
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Affiliation(s)
- Arthur E Attema
- Erasmus School of Health Policy and Management, Erasmus University, P. O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Han Bleichrodt
- Erasmus School of Economics, Erasmus University, Rotterdam, The Netherlands
- Research School of Economics, Australian National University, Canberra, Australia
| | | | - Stefan A Lipman
- Erasmus School of Health Policy and Management, Erasmus University, P. O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
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Vásquez J, Botero S. Hybrid Methodology to Improve Health Status Utility Values Derivation Using EQ-5D-5L and Advanced Multi-Criteria Techniques. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1423. [PMID: 32098423 PMCID: PMC7068428 DOI: 10.3390/ijerph17041423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/26/2022]
Abstract
This paper presented a new approach to the calculation of quality-adjusted life years (QALY) based on multi-criteria decision-making (MCDM) methods and using the EQ-5D-5L questionnaire. The health status utility values were calculated through a hybrid methodology. We combined the analytic hierarchy process (AHP), the AHP with a D-number extended fuzzy preference relation (D-AHP), the fuzzy analytic hierarchy process (F-AHP), and the technique for order preference by similarity to the ideal solution (TOPSIS) to obtain individual and aggregated utility values. The preference data were elicited using a sample of individuals from a Colombian university. In all tested methods, the ordinal preferences were consistent, and the weights were compared using the Euclidean distance criterion (EDC). We identified F-AHP-TOPSIS as the optimal method; its benefits were associated with modeling the response options of the EQ-5D in linguistic terms, it gave the best approximation to the initial preferences according to EDC, and it could be used as an alternative to the known prioritization method. This hybrid methodology was particularly useful in certain medical decisions concerned with understanding how a specific person values his or her current health or possible health outcomes from different interventions in small population samples and studies carried out in low- and middle-low-income countries.
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Affiliation(s)
- Johanna Vásquez
- Departamento de Economía, Facultad de Ciencias Humanas y Económicas, Universidad Nacional de Colombia Sede Medellín, Medellín 050034, Colombia
| | - Sergio Botero
- Departamento de Ingeniería de la Organización, Facultad de Minas, Universidad Nacional de Colombia Sede Medellín, Medellín 050034, Colombia;
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Lipman SA, Attema AE. Rabin's paradox for health outcomes. HEALTH ECONOMICS 2019; 28:1064-1071. [PMID: 31218778 PMCID: PMC6771755 DOI: 10.1002/hec.3918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 05/16/2019] [Accepted: 05/19/2019] [Indexed: 06/09/2023]
Abstract
Many health economic studies assume expected utility maximisation, with typically a concave utility function to capture risk aversion. Given these assumptions, Rabin's paradox (RP) involves preferences over mixed gambles yielding moderate outcomes, where turning down such gambles imply absurd levels of risk aversion. Although RP is considered a classic critique of expected utility, no paper has as of yet fully tested its preferences within individuals. In an experiment we report a direct test of RP in the health domain, which was previously only considered in the economic literature, showing it may have pervasive implications here too. Our paper supports the shift towards alternative, empirically valid models, such as prospect theory, also in the health domain. These alternative models are able to accommodate Rabin's paradox by allowing reference-dependence and loss aversion.
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Affiliation(s)
- Stefan A. Lipman
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Arthur E. Attema
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
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