Do We Really Value Identified Lives More Highly Than Statistical Lives?

Russell, Louise B.

doi:10.1177/0272989x13512183

Cited by 12 publications

(12 citation statements)

References 12 publications

(36 reference statements)

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“…28, 29 Currently there is a wide range of lifetime horizon ICERs for commonly performed procedures in acute neurology. For example, tissue-plasminogen activator (t-PA) for acute ischemic stroke in the 0–3 hour window is cost-saving, while the cost-effectiveness for decompressive craniectomy following severe traumatic brain injury is reported to be >$670,000/QALY.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Transfers to Centers With Neurological Intensive Care Units After Intracerebral Hemorrhage

Fletcher

Kotagal

Mammoser

et al. 2015

Stroke

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Background and Purpose Our aim was to estimate the cost-effectiveness of transferring patients with intracerebral hemorrhage (ICH) from centers without specialized neurological intensive care units (Neuro-ICUs) to centers with Neuro-ICUs. Methods Decision analytic models were developed for the lifetime horizons. Model inputs were derived from the best available data, informed by a variety of prior cost-effectiveness models of stroke. The effect of Neuro-ICU care on functional outcomes was modeled in 3 scenarios. A favorable outcomes scenario was modeled based on the best observational data and compared to moderately favorable and least-favorable outcomes scenarios. Health benefits were measured in quality adjusted life years (QALYs) and costs were estimated from a societal perspective. Costs were combined with QALYs gained to generate incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis and Monte Carlo simulations were performed to test robustness of the model assumptions. Results Transferring patients to centers with Neuro-ICUs yielded an ICER for the lifetime horizon of $47,431/QALY, $91,674/QALY and $380,358/QALY for favorable, moderately favorable, and least-favorable scenarios, respectively. Models were robust at a willingness-to-pay threshold of $100,000/QALY, with 95.5%, 75.0%, and 2.1% of simulations below the threshold for favorable, moderately favorable, and least-favorable scenarios, respectively. Conclusions Transferring ICH patients to centers with specialized Neuro-ICUs is cost-effective if observational estimates of the Neuro-ICU based functional outcome distribution are accurate. If future work confirms these functional outcome distributions, then a strong societal rationale exists to build systems of care designed to transfer ICH patients to specialized Neuro-ICUs.

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Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Transfers to Centers With Neurological Intensive Care Units After Intracerebral Hemorrhage

Fletcher

Kotagal

Mammoser

et al. 2015

Stroke

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“…Statistical lives involve aggregate numbers, such as 29,000 people die from liver cancer each year. As can be expected, the concepts of statistical life and identified life are very controversial [ 55 ]. In the United States, the value of a statistical life has been identified by government agencies to be in the US $7 million range [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

Good News and Bad News About Incentives to Violate the Health Insurance Portability and Accountability Act (HIPAA): Scenario-Based Questionnaire Study

et al. 2020

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Background The health care industry has more insider breaches than any other industry. Soon-to-be graduates are the trusted insiders of tomorrow, and their knowledge can be used to compromise organizational security systems. Objective The objective of this paper was to identify the role that monetary incentives play in violating the Health Insurance Portability and Accountability Act’s (HIPAA) regulations and privacy laws by the next generation of employees. The research model was developed using the economics of crime literature and rational choice theory. The primary research question was whether higher perceptions of being apprehended for violating HIPAA regulations were related to higher requirements for monetary incentives. Methods Five scenarios were developed to determine if monetary incentives could be used to influence subjects to illegally obtain health care information and to release that information to individuals and media outlets. The subjects were also asked about the probability of getting caught for violating HIPAA laws. Correlation analysis was used to determine whether higher perceptions of being apprehended for violating HIPAA regulations were related to higher requirements for monetary incentives. Results Many of the subjects believed there was a high probability of being caught. Nevertheless, many of them could be incentivized to violate HIPAA laws. In the nursing scenario, 45.9% (240/523) of the participants indicated that there is a price, ranging from US $1000 to over US $10 million, that is acceptable for violating HIPAA laws. In the doctors’ scenario, 35.4% (185/523) of the participants indicated that there is a price, ranging from US $1000 to over US $10 million, for violating HIPAA laws. In the insurance agent scenario, 45.1% (236/523) of the participants indicated that there is a price, ranging from US $1000 to over US $10 million, for violating HIPAA laws. When a personal context is involved, the percentages substantially increase. In the scenario where an experimental treatment for the subject’s mother is needed, which is not covered by insurance, 78.4% (410/523) of the participants would accept US $100,000 from a media outlet for the medical records of a politician. In the scenario where US $50,000 is needed to obtain medical records about a famous reality star to help a friend in need of emergency medical transportation, 64.6% (338/523) of the participants would accept the money. Conclusions A key finding of this study is that individuals perceiving a high probability of being caught are less likely to release private information. However, when the personal context involves a friend or family member, such as a mother, they will probably succumb to the incentive, regardless of the probability of being caught. The key to reducing noncompliance will be to implement organizational procedures and constantly monitor and develop educational and training programs to encourage HIPAA compliance.

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“…Whereas in some cases the mortality reduction is clinically inconsequential for individual patients, applications to populations of patients may introduce meaningful reductions in “statistical lives” [14]. For instance, approximately 1 million revascularization procedures occur annually in the United States [15].…”

Section: Modeling Methodologymentioning

confidence: 99%

Empirical Treatment Effectiveness Models for Binary Outcomes

et al. 2015

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Randomized trials provide strong evidence regarding efficacy of interventions but are limited in their capacity to address potential heterogeneity in effectiveness within broad clinical populations. For example, a treatment that on average is superior may be distinctly worse in certain patients. We propose a technique for using large electronic health registries to develop and validate decision models which measure – for distinct combinations of covariate values – the difference in predicted outcomes among two alternative treatments. We demonstrate the methodology in a prototype analysis of in-hospital mortality under alternative revascularization treatments. First, we developed prediction models for a binary outcome of interest for each treatment. Decision criteria were then defined based on the treatment-specific model predictions. Patients were then classified as receiving concordant or discordant care (in relation to the model recommendation) and the association between discordance and outcomes was evaluated. We then present alternative decision criteria and validation methodologies, as well as sensitivity analyses which investigate a) imbalance between treatments on observed covariates and b) the aggregate impact of unobserved covariates. Our methodology supplements population-average clinical trial results by modeling heterogeneity in outcomes according to specific covariate values. It thus allows for assessment of current practice, from which cogent hypotheses for improved care can be derived. Newly emerging large population registries will allow for accurate predictions of outcome risk under competing treatments, as complex functions of predictor variables. Whether or not the models might be used to inform decision making depends on the extent to which important predictors are available. Further work is needed to understand the strengths and limitations of this approach, particularly in relation to those based on randomized trials.

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Do We Really Value Identified Lives More Highly Than Statistical Lives?

Cited by 12 publications

References 12 publications

Cost-Effectiveness of Transfers to Centers With Neurological Intensive Care Units After Intracerebral Hemorrhage

Cost-Effectiveness of Transfers to Centers With Neurological Intensive Care Units After Intracerebral Hemorrhage

Good News and Bad News About Incentives to Violate the Health Insurance Portability and Accountability Act (HIPAA): Scenario-Based Questionnaire Study

Empirical Treatment Effectiveness Models for Binary Outcomes

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