European Conference on Health Economics

Abstract

The biennial European Conference on Health Economics was held in Finland this year, at the Finlandia Hall in the centre of Helsinki. The European conferences rotate among European countries and fall between the biennial world congresses organized by the International Health Economics Association (iHEA). A record attendance of approximately 800 delegates from 50 countries around the world were present at the Helsinki conference. The theme of the conference was ‘Connecting Health and Economics’. All major topics of health economics were covered in the sessions. For the first time, social care economics was included in the agenda of the European Conference as a session of its own.

The wide coverage of themes at the European Conference on Health Economics (Helsinki, Finland) included healthcare financing, expenditure, purchasing, health system reforms, econometric methods, prevention, technology evaluation, performance assessment and equity. There were sessions covering public versus private insurance, utility measures, cost methodology, drug development, pharmaceutical pricing, informal care, cost–effectiveness, prioritization, health policies, health system performance, hospital performance and equity. In terms of patient groups sessions, these included themes on elderly people, retirement and long-term care, chronic conditions, maternal and child health, migrant groups and obesity. The abstracts can be accessed at the conference website [101].

The aim of this article is to focus on three major issues that will have general implications on the present and future within health economics: real-life cost–effectiveness of hospital care, research on quality of life instruments and social care economics.

Cost–effectiveness of hospital care

In a plenary presentation on register-based health economics, Unto Häkkinen (Institute for Health and Welfare, Finland) highlighted the problems encountered when macro-level modeling of the production of health is employed [1]. The difficulty with the ensuing broad framework is that many of its dimensions are not amenable to health policy interventions. A microeconomic disease-based strategy offers an approach more suitable to an analysis of healthcare system performance. This approach is based on modeling the natural progress of a disease, with specific interest in the role of health services and healthcare policy interventions as determinants in the disease’s progress. The value of a disease-based approach is promoted by the availability of comprehensive register data and the possibility of linking different registers and combining information from different sources.

This approach has been employed in the Finnish project, Performance, Effectiveness and Cost of Treatment (PERFECT) episodes, where nationwide benchmarking at hospitals and hospital district levels has been feasible for seven health problems (acute myocardial infarction, breast cancer, hip and knee join replacements, very low- birth weight infants, schizophrenia and stroke). The results indicate a positive trend over time in the development of outcomes in all disease groups. However, regional- and hospital-level variations in outcomes and costs of treating the seven diseases are much higher than the overall annual variation and have been rather stable since the late 1990s. The risk-adjusted results indicate that among the acute myocardial infarct and stroke patients, annually, approximately 20–30% of costs could be be contained if all hospital districts had the same cost as the cheapest region. In Finland, with a population of approximately 5 million people, a total of approximately 500 deaths (amounting to 7000 additional life years) would have been saved annually if all regions had had the same outcome as the best region in treatment in these two disease groups. Thus, there is potential to improve efficiency by reducing costs and improving outcomes.

In a study in which the PERFECT projects’ material was combined with a 4-year clinical follow-up, Emmi Korvenranta (University of Turku, Finland) et al. found that 67% of the very preterm infants (gestational age less than 32 weeks or birth weight less than 1501 g) survived without prematurity-related morbidities diagnosed during the first years of life and required relatively little hospital care [2]. The healthcare-related costs during the fifth year of life in children born very preterm without prematurity-related morbidities were close to the costs of infants born healthy at term (mean: €1023 vs €749, respectively), whereas the respective costs in those with prematurity-related morbidities had a mean of €3265. The average cost per quality-adjusted life year (QALY) at 4 years of age was €19,245 in the very preterm population as a whole. Prematurity-related later morbidities and decreasing gestational age increased the costs per QALY. As the initial hospital stay accounted for a great majority of the total 4-year costs, and the costs of hospitalization decreased with each follow-up year, the cost per QALY would most certainly decrease with age.

Quality of life instruments

In an analysis of a randomized control trial of alternative therapies for nonspecific neck pain, David Whitehurst (University of Birmingham, UK) et al. found that the interchangeability of the European Quality of Life 5 Dimensions (EQ-5D) and the Short- Form 6 Dimensions (SF-6D) was poor [3]. The finding was not surprising given the differences in their descriptive content and previous studies with similar findings across a number of clinical conditions. Current research on the five-level version of the EQ-5D probably addresses the shortcomings in the EQ-5D instrument.

Nick Kontodimopoulos (Hellenic Open University, Patras, Greece) et al. found, in a study on the ability of 15D, EQ-5D and SF-6D to discriminate coronary heart disease (CHD) among Type 2 diabetes patients, that only the 15D produced statistically significant utility differences between the two groups after correcting for the confounding effect of common diabetes variables [4]. Many of the 15D dimensions were sensitive enough to capture health-related quality of life (HRQoL) differences attributed only to CHD.

In a study by Tarja Vainiola (Helsinki University Central Hospital, Finland) et al., the impact of use of the 15D or EQ-5D instruments on the number of HRQoL years gained and cost per QALY gained in intensive care or high-dependency unit patients within the year following admission to the intensive care unit showed a maximum fivefold difference between the instruments [5]. As the instrument used has a major impact on the results of cost–utility analyses, there is an obvious need for standardization of methodology.

Risto Roine (Helsinki University Hospital, Finland) described a routine evaluation system of cost–utility data of hospital care in the Helsinki and Uusimaa hospital group [6]. For 8 years, HRQoL data using the 15D has been gathered on more than 15,000 patients in approximately 20 medical specialties and 40 disease entities. The utilities from highest to lowest at entry to hospital in five clinical categories of hysterectomy, cataract surgery, hip replacement surgery, eating disorders and depression were 0.91, 0.84, 0.81, 0.80 and 0.73, respectively. The effect of treatment on HRQoL was biggest for arthroplasty and depression. Of all of the treatment categories, the lowest cost per QALY was gained by lumbar disc surgery. The results show that valuable information for decision making regarding cost–effectiveness of a large range of care can be obtained by a routine evaluation system.

Social care economics

For the first time, economics of social care was devoted a special session in the agenda of the ‘European Conference of Health Economics’. The plenary presentation was given by Martin Knapp (London School of Economics and Political Science, UK) [7]. The presentation aimed to determine: which are the policy questions in social care that would benefit from economics research, and what is the current evidence base? Social care was defined based on the common aims that countries with different systems have, as well as on the main groups of people supported and on the main service types provided by the social care. Social care policy issues that were highlighted included financing, commissioning, prevention, technology of social care and outcome assessment. Increasing challenges were demonstrated by analyzing financing options for long-term care in relation to the increasing pressures on cost. Minimum safety net systems such as those in the UK and USA were compared with one system for all as in the Nordic countries and with progressive universalism employed in France. Challenges in commissioning (i.e., converting funds into services) in social care were illustrated by the variety of purchasers and providers with several transaction types. These raise questions about contract specification, incentives and market structure. Results of a randomized trial on the effectiveness of individual budgets in relation to that of conventional methods of resource allocation and service delivery demonstrated some evidence in favor of cost–effectiveness of individual budgets, especially for people with physical disabilities and people with mental health needs, but no evidence of effectiveness was found among older people.

The outcome assessment for social care interventions needs to be measured in terms of the extent to which the needs are met, for example, what changes are achieved in the lives of individuals and their families. Health outcome measures are not sufficient, and today’s QALY instruments cannot adequately measure social care outcomes. In an outcome assessment approach led by Ann Netten (University of Kent, UK), the fundamental aim is utility or well-being. These are influenced by functioning states, such as being clean, fed, safe and socially engaged. The emphasis is on capability to achieve improved functioning. In addition, the adult social care outcomes toolkit (ASCOT) instrument was presented. The toolkit includes eight domains: personal cleanliness and comfort; food and drink; control over daily living; clean and comfortable accommodation; safety; social participation and involvement; occupation; and dignity.

Although there are huge policy challenges ahead because of the increasing need and costs of social care services, few good economics studies are currently available to provide an evidence base for rational policy decisions. The allocation of resources within social care in the UK will be more important as public resources will be cut in the coming years. The economic research questions include: can families be relied upon to take responsibility; is the workforce sufficiently skilled to deliver best quality care (unlike that of healthcare, many social care jobs are low skilled, low status and low paid); how well are different systems including coordinated social care and healthcare; can state agencies understand and respond to the needs of individuals; and can markets be left to allocate social services? The need for more interest and funding for social care economics is obvious.

The conference included several high-class research papers and new innovative approaches. The organizers as well as researchers providing the content can be congratulated for a professionally and socially succesful congress. The delegates enjoyed the warmest and sunniest summer in Finland for 165 years. Most of them did not consider it too hot.

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.