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Giang NH, Vinh NT, Phuong HT, Thang NT, Oanh TTM. Household financial burden associated with healthcare for older people in Viet Nam: a cross-sectional survey. Health Res Policy Syst 2022; 20:112. [PMID: 36443746 PMCID: PMC9706832 DOI: 10.1186/s12961-022-00913-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Population ageing and the associated increase in the healthcare needs of older people are putting pressure on the healthcare system in Viet Nam. The country prioritizes healthcare for older people and has developed financial protection policies to mitigate financial hardship due to out-of-pocket health expenditures (OOPHEs) borne by their households. This study examines the level and determinants of the financial burden of OOPHE among households with people aged ≥ 60 years in Viet Nam. METHODS A cross-sectional household survey was conducted among a sample of 1536 older people living in 1477 households in three provinces representing the North, Central and South regions of Viet Nam during 2019-2020. The financial outcomes were catastrophic health expenditure (CHE), using WHO's definition, and financial distress due to OOPHE. Multivariate binary logistic regression analysis was employed to determine the factors associated with these outcomes. RESULTS OOPHE for older household members accounted for 86.3% of total household health expenditure. Of households with older people, 8.6% (127) faced CHE, and 12.2% (181) experienced financial distress due to OOPHE. Households were at a higher risk of incurring financial burdens related to health expenditures if they had fewer household members; included only older people; were in rural or remote, mountainous areas; and had older members with noncommunicable diseases. There was no significant association between health insurance coverage and financial burden. However, when older people sought tertiary care or private care, the possibility of a household facing CHE increased. Regardless of the type and level of care, health service utilization by older people results in a higher likelihood of a household encountering financial distress. CONCLUSIONS This study reveals that OOPHE for older people can impose substantial financial burdens on households, leading them to face CHE and financial distress. This study provides evidence to justify reforming financial protection policies and introducing policy interventions targeted at better protecting older people and their households from the financial consequences of OOPHE. There is also the need to strengthen the grassroots health facilities to provide primary care closer to home at lower costs, particularly for the management of noncommunicable diseases.
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Affiliation(s)
- Nguyen Hoang Giang
- grid.492361.b0000 0004 0642 7152Health Strategy and Policy Institute, Lane 196, Ho Tung Mau Street, Mai Dich Ward, Cau Giay District, Hanoi, Viet Nam
| | - Nguyen The Vinh
- grid.492361.b0000 0004 0642 7152Health Strategy and Policy Institute, Lane 196, Ho Tung Mau Street, Mai Dich Ward, Cau Giay District, Hanoi, Viet Nam
| | - Hoang Thi Phuong
- grid.492361.b0000 0004 0642 7152Health Strategy and Policy Institute, Lane 196, Ho Tung Mau Street, Mai Dich Ward, Cau Giay District, Hanoi, Viet Nam
| | - Nguyen Thi Thang
- grid.492361.b0000 0004 0642 7152Health Strategy and Policy Institute, Lane 196, Ho Tung Mau Street, Mai Dich Ward, Cau Giay District, Hanoi, Viet Nam
| | - Tran Thi Mai Oanh
- grid.492361.b0000 0004 0642 7152Health Strategy and Policy Institute, Lane 196, Ho Tung Mau Street, Mai Dich Ward, Cau Giay District, Hanoi, Viet Nam
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Del Pozo-Rubio R, Moya-Martínez P, Ortega-Ortega M, Oliva-Moreno J. Shadow and extended shadow cost sharing associated to informal long-term care: the case of Spain. HEALTH ECONOMICS REVIEW 2020; 10:12. [PMID: 32430791 PMCID: PMC7236927 DOI: 10.1186/s13561-020-00272-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND A large part of the long-term care is provided by non-professional caregivers, generally without any monetary payment but a value economic of time invested. The economic relevance of informal caregivers has been recognized in Spain; however, public provision may still be scarce. The objective of this paper is to estimate the economic burden associated with informal long-term care that should assume the families through a new concept of cost sharing that consider opportunity costs of time provided by informal caregivers. METHODS The study sample includes all dependent adults in Spain. Socioeconomic information and the number of hours of informal care was collected through the Spanish Disability and Dependency Survey. The terms of shadow and extended shadow cost sharing were defined as the difference between the maximum potential amount of money that families could receive for the provision of informal care and the amount that actually they received and the value of informal care time with respect to the amount received, respectively. RESULTS 53.87% of dependent persons received an economic benefit associated to informal care. The average weekly hours of care were 71.59 (92.62 without time restrictions). Shadow cost sharing amounted to, on average, two thirds, whereas the State financed the remaining third. In terms of extended shadow cost sharing, the State financed between 3% and 10% of informal care provided by caregivers. CONCLUSIONS This study reveals the deficient support received for the provision of informal care in Spain. More than 90% of informal care time is not covered by the economic benefits that families receive from the State.
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Affiliation(s)
- Raúl Del Pozo-Rubio
- Department of Economics and Finance, University of Castilla-La Mancha, Avda, Los Alfares, 44 16.071, Cuenca, Spain
| | - Pablo Moya-Martínez
- Department of Economics and Finance, University of Castilla-La Mancha, Avda, Los Alfares, 44 16.071, Cuenca, Spain
| | - Marta Ortega-Ortega
- Department of Applied Economics, Public Economics and Political Economy, Complutense University of Madrid, Campus de Somosaguas s/n. 28.223 Pozuelo de Alarcón, Madrid, Spain
| | - Juan Oliva-Moreno
- Department of Economics and Finance, University of Castilla-La Mancha, Calle San Pedro Mártir, 7, 45002 Toledo, Spain
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Dong H, Li Z, Failler P. The Impact of Business Cycle on Health Financing: Subsidized, Voluntary and Out-of-Pocket Health Spending. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061928. [PMID: 32188003 PMCID: PMC7143791 DOI: 10.3390/ijerph17061928] [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: 01/14/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 11/23/2022]
Abstract
Diverse types of healthcare systems in countries offer opportunities to explore the heterogeneous sources of health financing. This paper widely explores the effect of the business cycle on subsidized, voluntary and out-of-pocket health spending in 34 countries with different types of healthcare systems, by the methodology of hierarchical linear modeling (HLM). We use a panel of annual data during the years from 2000 to 2016. It further examines the business cycle-health financing mechanism by inquiring into the mediating effect of external conditions and innovative health financing, based on the structural equation modeling (SEM). The empirical results reveal that the business cycle harms subsidized spending, whereas its effect on voluntary and protective health spending is positive. Results related to the SEM indicate that the mediating effect of external conditions on the relationship between the business cycle and health financing is negative. However, we find that the business cycle plays a positive effect on health financing through innovative health financing channels. Thus, designing and implementing efforts to shift innovative health financing have substantial effects on the sustainability of healthcare systems.
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Affiliation(s)
- Hao Dong
- School of Economics and Statistics, Guangzhou University, Guangzhou 510006, China;
| | - Zhenghui Li
- Guangzhou International Institute of Finance and Guangzhou University, Guangzhou 510006, China
- Correspondence: ; Tel.: 86-1335-285-7358
| | - Pierre Failler
- Economics and Finance Group, Portsmouth Business School, University of Portsmouth, Portsmouth PO1 3DE, UK;
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Financial Catastrophism Inherent with Out-of-Pocket Payments in Long Term Care for Households: A Latent Impoverishment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010295. [PMID: 31906289 PMCID: PMC6981754 DOI: 10.3390/ijerph17010295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/21/2019] [Accepted: 12/29/2019] [Indexed: 11/17/2022]
Abstract
Background: Out-of-pocket (OOP) payments are configured as an important source of financing long-term care (LTC). However, very few studies have analyzed the risk of impoverishment and catastrophic effects of OOP in LTC. To estimate the contribution of users to the financing of LTC and to analyze the economic consequences for households in terms of impoverishment and catastrophism after financial crisis in Spain. METHODS The database that was used is the 2008 Spanish Disability and Dependency Survey, projected to 2012. We analyze the OOP payments effect associated to the impoverishment of households comparing volume and financial situation before and after OOP payment. At the same time, the extent to which OOP payment had led to catastrophism was analyzed using different thresholds. RESULTS The results show that contribution of dependent people to the financing of the services they receive exceeds by 50% the costs of these services. This expenditure entails an increase in the number of households that live below the poverty. In terms of catastrophism, more than 80% of households dedicate more than 10% of their income to dependency OOP payments. In annual terms, the catastrophe gap generated by devoting more than 10% of the household income to dependent care OOP payment reached €3955, 1 million (0.38% of GDP). CONCLUSION This article informs about consequences of OOP in LCT and supplements previous research that focus on health. Our results should serve to develop strategic for protection against the financial risk resulting from facing the costs of a situation of dependence.
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Ambade PN, Katragadda C, Sun D, Bootman JL, Abraham I. Why health policies should be transnational: A case for East Asia Pacific countries. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2019; 30:101-125. [PMID: 31282430 DOI: 10.3233/jrs-199001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper argues that health policies should transcend national boundaries yet should not reach the supranational level. Along with multinational global health efforts, such cross-national health policies are essential to leverage joint efforts by countries learning from their peers that experience similar health system challenges. In our analysis, we used World Bank Health, Nutrition, and Population (HNP) data from 1995 to 2014 for East Asia Pacific (EAP) countries to explore health system comparability across member nations. We applied a hierarchical cluster analysis using Ward's method and a squared Euclidean distance approach to classify 24 EAP countries into four relatively stable clusters based on their (dis)similarities over nine selected health expenditure and health system performance related indicators. One-way analysis of variance (ANOVA) was used to assess the discreteness of the formed clusters. Each cluster had unique characteristics based on the included indicators and health system performance of the member countries. We present transnational health policy recommendations for the EAP region based on both our use of robust methodology and the resulting comparative clusters.
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Affiliation(s)
- Preshit Nemdas Ambade
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Chinmayee Katragadda
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| | - Diana Sun
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| | - J Lyle Bootman
- Department of Pharmacy Practice & Science, Center for Health Outcomes & Pharmacoeconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Ivo Abraham
- Department of Pharmacy Practice & Science, Center for Health Outcomes & Pharmacoeconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA.,Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
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Del Pozo-Rubio R, Mínguez-Salido R, Pardo-García I, Escribano-Sotos F. Catastrophic long-term care expenditure: associated socio-demographic and economic factors. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:691-701. [PMID: 30656482 DOI: 10.1007/s10198-019-01031-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE An increasing number of persons across the world require long-term care (LTC). In Spain, access to LTC involves individuals incurring out-of-pocket (OOP) expenditure. There is a large body of literature on the incidence of catastrophic OOP payments in access and participation in health systems, but not in the field of LTC nor the determinants of these expenses. Our aim was to analyse the socio-demographic and economic factors associated with different levels of catastrophic LTC expenditure in the form of private out-of-pocket payments among dependent persons in Spain. MATERIALS AND METHODS The study used the Spanish Disability and Dependency Survey (SDDS) conducted by the Spanish National Statistics Institute to obtain the socioeconomic, demographic and health profiles. The households were classified into those below the poverty threshold and those above the threshold of catastrophe, using measures of impoverishment and catastrophe. We estimated two logistic regression models, one binary (impoverishment) and one ordinal (catastrophe). RESULTS The results show that OOP expenditure on LTC increases the probability of impoverishment by 18.90%. The factors associated with higher probability of experiencing catastrophe were age, being single, widowed or separated, lower levels of household income and education, higher level of dependence and living in an autonomous community with lower per capita income. CONCLUSIONS These findings highlight the need to include exemptions or insurance in the design of LTC policies to protect dependent persons from the risk of financial burden.
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Affiliation(s)
- Raúl Del Pozo-Rubio
- Department of Economics and Finance, University of Castilla-La Mancha, Avda, Los Alfares, 44, 16071, Cuenca, Spain
- Research Group Economy, Food and Society, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Román Mínguez-Salido
- Department of Public Economy, Statistics and Economic Policy, University of Castilla-La Mancha, Avda, Los Alfares, 44, 16071, Cuenca, Spain
| | - Isabel Pardo-García
- Department of Public Economy, Statistics and Economic Policy, University of Castilla-La Mancha, Plaza de la Universidad, s/n, 02071, Albacete, Spain.
- Research Group Economy, Food and Society, University of Castilla-La Mancha, Ciudad Real, Spain.
| | - Francisco Escribano-Sotos
- Department of Economics and Finance, University of Castilla-La Mancha, Plaza de la Universidad, s/n, 02071, Albacete, Spain
- Research Group Economy, Food and Society, University of Castilla-La Mancha, Ciudad Real, Spain
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Myint CY, Pavlova M, Groot W. Patterns of health care use and out-of-pocket payments among general population and social security beneficiaries in Myanmar. BMC Health Serv Res 2019; 19:258. [PMID: 31029112 PMCID: PMC6486983 DOI: 10.1186/s12913-019-4071-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/08/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND As a consequence of the low government expenditure and limited access to health insurance offered by the Social Security Scheme (SSS), out-of-pocket payments (OOPPs) have become the main source of payment for health care in Myanmar. This study aims to provide evidence on the patterns of health care use and OOPPs by the general population and SSS beneficiaries in Myanmar. METHOD Face-to-face interviews were conducted among two samples drawn independently of each other. The first sample, the general population sample of persons not insured by SSS, was drawn from the general population in the Yangon Region. The second sample, the SSS sample, was drawn from those possessing SSS insurance. The data were analyzed per sample. Mann-Whitney U tests were applied to compare ordinal variables and independent sample t-tests were applied to compare continuous variables between the two samples. Two-step cluster analysis was applied to identify clusters of respondents with similar patterns of health care use and OOPPs. After the clustering procedure, we used regression analysis to examine the association between socio-demographic characteristics and cluster membership (patterns of health care use and OOPPs) for the two samples separately. RESULTS Only 23% of those who belonged to the SSS sample and sought health care during the past 12 months, report receiving health care from a SSS clinic during the last episode of illness. Close distance is the main reason for choosing a specific health facility in both samples. OOPPs for health care and pharmaceuticals, used during the last episode of illness are significantly higher in the general population sample. The regression analysis shows that the pattern of health care use is significantly associated with household income. In addition, respondents in the general population sample with a higher income pay higher amounts for their last health care used and were significantly more likely to have to borrow money or sell assets as a coping strategy to cover the payments. CONCLUSION Significantly higher OOPPs in the general population sample highlight the need of financial protection among this group. Myanmar needs to extend social protection for both coverage breadths and coverage depth.
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Affiliation(s)
- Chaw-Yin Myint
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Water, Research and Training Center (WRTC), Yangon, Myanmar
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Wim Groot
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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Dutta A, Bandyopadhyay S. Policy intervention for access to medicine: Does it work similarly for poor and non‐poor? Int J Health Plann Manage 2019; 34:e557-e568. [DOI: 10.1002/hpm.2671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Arijita Dutta
- Department of EconomicsUniversity of Calcutta Kolkata India
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Shil A, Puri P, Prakash R. A geospatial analysis of noncommunicable disease (NCD) burden in Indian agro-climatic and political regions. J Public Health (Oxf) 2017. [DOI: 10.1007/s10389-017-0876-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Pariyo GW, Wosu AC, Gibson DG, Labrique AB, Ali J, Hyder AA. Moving the Agenda on Noncommunicable Diseases: Policy Implications of Mobile Phone Surveys in Low and Middle-Income Countries. J Med Internet Res 2017; 19:e115. [PMID: 28476720 PMCID: PMC5438456 DOI: 10.2196/jmir.7302] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/02/2017] [Accepted: 03/05/2017] [Indexed: 11/16/2022] Open
Abstract
The growing burden of noncommunicable diseases (NCDs), for example, cardiovascular diseases and chronic respiratory diseases, in low- and middle-income countries (LMICs) presents special challenges for policy makers, due to resource constraints and lack of timely data for decision-making. Concurrently, the increasing ubiquity of mobile phones in LMICs presents possibilities for rapid collection of population-based data to inform the policy process. The objective of this paper is to highlight potential benefits of mobile phone surveys (MPS) for developing, implementing, and evaluating NCD prevention and control policies. To achieve this aim, we first provide a brief overview of major global commitments to NCD prevention and control, and subsequently explore how countries can translate these commitments into policy action at the national level. Using the policy cycle as our frame of reference, we highlight potential benefits of MPS which include (1) potential cost-effectiveness of using MPS to inform NCD policy actions compared with using traditional household surveys; (2) timeliness of assessments to feed into policy and planning cycles; (3) tracking progress of interventions, hence assessment of reach, coverage, and distribution; (4) better targeting of interventions, for example, to high-risk groups; (5) timely course correction for suboptimal or non-effective interventions; (6) assessing fairness in financial contribution and financial risk protection for those affected by NCDs in the spirit of universal health coverage (UHC); and (7) monitoring progress in reducing catastrophic medical expenditure due to chronic health conditions in general, and NCDs in particular. We conclude that MPS have potential to become a powerful data collection tool to inform policies that address public health challenges such as NCDs. Additional forthcoming assessments of MPS in LMICs will inform opportunities to maximize this technology.
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Affiliation(s)
- George W Pariyo
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States
| | - Adaeze C Wosu
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | - Dustin G Gibson
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States
| | - Alain B Labrique
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States
| | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States
| | - Adnan A Hyder
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States
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Burden A, Roche N, Miglio C, Hillyer EV, Postma DS, Herings RM, Overbeek JA, Khalid JM, van Eickels D, Price DB. An evaluation of exact matching and propensity score methods as applied in a comparative effectiveness study of inhaled corticosteroids in asthma. Pragmat Obs Res 2017; 8:15-30. [PMID: 28356782 PMCID: PMC5367458 DOI: 10.2147/por.s122563] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Cohort matching and regression modeling are used in observational studies to control for confounding factors when estimating treatment effects. Our objective was to evaluate exact matching and propensity score methods by applying them in a 1-year pre–post historical database study to investigate asthma-related outcomes by treatment. Methods We drew on longitudinal medical record data in the PHARMO database for asthma patients prescribed the treatments to be compared (ciclesonide and fine-particle inhaled corticosteroid [ICS]). Propensity score methods that we evaluated were propensity score matching (PSM) using two different algorithms, the inverse probability of treatment weighting (IPTW), covariate adjustment using the propensity score, and propensity score stratification. We defined balance, using standardized differences, as differences of <10% between cohorts. Results Of 4064 eligible patients, 1382 (34%) were prescribed ciclesonide and 2682 (66%) fine-particle ICS. The IPTW and propensity score-based methods retained more patients (96%–100%) than exact matching (90%); exact matching selected less severe patients. Standardized differences were >10% for four variables in the exact-matched dataset and <10% for both PSM algorithms and the weighted pseudo-dataset used in the IPTW method. With all methods, ciclesonide was associated with better 1-year asthma-related outcomes, at one-third the prescribed dose, than fine-particle ICS; results varied slightly by method, but direction and statistical significance remained the same. Conclusion We found that each method has its particular strengths, and we recommend at least two methods be applied for each matched cohort study to evaluate the robustness of the findings. Balance diagnostics should be applied with all methods to check the balance of confounders between treatment cohorts. If exact matching is used, the calculation of a propensity score could be useful to identify variables that require balancing, thereby informing the choice of matching criteria together with clinical considerations.
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Affiliation(s)
- Anne Burden
- Observational and Pragmatic Research Institute Pte Ltd, Singapore
| | - Nicolas Roche
- University Paris Descartes (EA2511), Cochin Hospital Group (AP-HP), Paris, France
| | - Cristiana Miglio
- Observational and Pragmatic Research Institute Pte Ltd, Singapore
| | | | - Dirkje S Postma
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen
| | - Ron Mc Herings
- PHARMO Institute for Drug Outcomes Research, Utrech, the Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrech, the Netherlands
| | | | | | - David B Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore; Academic Primary Care, University of Aberdeen, Aberdeen, UK
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