{"id":115165,"date":"2018-03-11T10:43:31","date_gmt":"2018-03-11T10:43:31","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/avances-metodologicos-en-el-analisis-de-costes-y-resultados-para-la-evaluacion-economica-de-intervenciones-sanitarias\/"},"modified":"2018-03-11T10:43:31","modified_gmt":"2018-03-11T10:43:31","slug":"avances-metodologicos-en-el-analisis-de-costes-y-resultados-para-la-evaluacion-economica-de-intervenciones-sanitarias","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/politica-social\/avances-metodologicos-en-el-analisis-de-costes-y-resultados-para-la-evaluacion-economica-de-intervenciones-sanitarias\/","title":{"rendered":"Avances metodol\u00f3gicos en el an\u00e1lisis de costes y resultados para la evaluaci\u00f3n econ\u00f3mica de intervenciones sanitarias."},"content":{"rendered":"<h2>Tesis doctoral de <strong> Silvia Garrido Garcia <\/strong><\/h2>\n<p>Resumen  el objetivo global de esta tesis es examinar nuevos enfoques metodol\u00f3gicos referentes al an\u00e1lisis de costes y resultados para la evaluaci\u00f3n econ\u00f3mica de intervenciones sanitarias. Estos nuevos enfoques se aplican en tres estudios emp\u00edricos independientes, los cuales se presentan en los cap\u00edtulos 2, 3 y 4.  en el cap\u00edtulo 2 se analiza si la calidad de vida relacionada con la salud (cvrs) y la satisfacci\u00f3n con la vida est\u00e1n relacionadas de forma simult\u00e1nea y se cuantifica el sesgo que se comete en caso de no tener en cuenta dicha simultaneidad. Los datos del estudio se obtuvieron de una encuesta con 870 individuos, representativos de la poblaci\u00f3n general espa\u00f1ola en t\u00e9rminos de edad y sexo. Los resultados obtenidos a partir de un sistema de ecuaciones simult\u00e1neas ponen de manifiesto que, efectivamente, la relaci\u00f3n entre la cvrs y la satisfacci\u00f3n con la vida es simult\u00e1nea, siendo el efecto de la cvrs sobre la satisfacci\u00f3n superior (casi un 20%) al efecto opuesto. M\u00e1s importante, el hecho de no tener en cuenta la interdependencia entre la cvrs y la satisfacci\u00f3n con la vida da lugar a estimaciones sesgadas, infravalorando de forma considerable el efecto de la satisfacci\u00f3n con la vida sobre la cvrs (en torno a un 18%) y, en menor medida, el efecto contrario (aproximadamente un 6%). La existencia de una influencia mutua entre la cvrs y la satisfacci\u00f3n con la vida supone que las ganancias en cvrs no solo se pueden obtener por medio de intervenciones y pol\u00edticas sanitarias, sino tambi\u00e9n gracias a otro tipo de acciones y pol\u00edticas p\u00fablicas (tales como educaci\u00f3n y empleo) que, a trav\u00e9s de su impacto directo sobre la satisfacci\u00f3n, pueden inducir efectos colaterales positivos sobre la cvrs. A su vez, las intervenciones y pol\u00edticas sanitarias tambi\u00e9n se configuran como potentes herramientas para la mejora del bienestar subjetivo. Asimismo, el hecho de que la relaci\u00f3n entre la cvrs y la satisfacci\u00f3n con la vida sea simult\u00e1nea resalta la conveniencia de valorar de forma m\u00e1s amplia los resultados de las intervenciones sanitarias, no solo teniendo en cuenta aspectos estrictamente relacionados con la salud, sino tambi\u00e9n con la satisfacci\u00f3n con la vida.  por su parte, el cap\u00edtulo 3 presenta un estudio de valoraci\u00f3n monetaria de los cuidados informales a personas en situaci\u00f3n de dependencia a partir de las preferencias de cuidadores informales y no cuidadores. El estudio se basa en una encuesta en la que participaron 402 sujetos (202 cuidadores y 200 no cuidadores). A todos ellos se les present\u00f3 un escenario referido a una determinada situaci\u00f3n hipot\u00e9tica de cuidados informales y se les plantearon tres preguntas en las que deb\u00edan indicar la m\u00ednima compensaci\u00f3n monetaria que demandar\u00edan -es decir, su disposici\u00f3n a aceptar (daa)- por una hora extra de cuidados al d\u00eda en t\u00e9rminos generales, por una hora adicional diaria realizando la tarea menos preferida, y por una hora extra al d\u00eda desempe\u00f1ando la tarea m\u00e1s preferida. Adem\u00e1s, a los cuidadores tambi\u00e9n se les pregunt\u00f3 por la compensaci\u00f3n que requerir\u00edan en caso de tener que dedicar una hora adicional de cuidados al d\u00eda a la persona bajo su cuidado. Los valores obtenidos en las tres preguntas de daa relativas al escenario hipot\u00e9tico presentaron distribuciones similares en las dos muestras, ascendiendo los valores medios\/medianos de la daa (en t\u00e9rminos generales) a 6,4 \u00c2\u00bf\/5,5 \u00c2\u00bf en la muestra de cuidadores y a 6,5 \u00c2\u00bf\/5,5 \u00c2\u00bf en la muestra de no cuidadores. En general, las valoraciones de los dos grupos fueron sensibles a y consistentes con las preferencias de los encuestados entre distintas tareas de cuidados, aunque una considerable proporci\u00f3n de sujetos (en torno a 25% en cada muestra) indicaron la misma cantidad en las tres preguntas de daa referidas a la situaci\u00f3n hipot\u00e9tica. A nivel agregado, los cuidadores exigieron una menor compensaci\u00f3n monetaria por cuidar a su propio ser querido durante una hora extra al d\u00eda (valores medio\/mediano: 5,2 \u00c2\u00bf\/4,5 \u00c2\u00bf) que si esa hora adicional la tuvieran que dedicar a cuidar a la persona descrita en el escenario hipot\u00e9tico. No obstante, m\u00e1s de la mitad de los cuidadores ofrecieron la misma cantidad bajo las dos situaciones (hipot\u00e9tica y real), lo cual sugiere que las valoraciones de este grupo se vieron influidas por su propia experiencia prestando cuidados informales. por \u00faltimo, en el cap\u00edtulo 4 se investiga si el fen\u00f3meno de la inversi\u00f3n de preferencias -o preference reversal (pr)&#8211; entre decisiones de elecci\u00f3n y valoraci\u00f3n se aten\u00faa conforme los individuos aprenden mediante la adquisici\u00f3n de experiencia con dichas tareas. Para ello, se realiz\u00f3 un experimento, dividido en dos sesiones independientes, con el fin de distinguir entre el efecto de la mera repetici\u00f3n de tareas (primera sesi\u00f3n) y el efecto combinado de la repetici\u00f3n junto con la retroalimentaci\u00f3n (segunda sesi\u00f3n). La muestra se compuso de 319 estudiantes de grado de la universidad de murcia y se dividi\u00f3 en tres grupos atendiendo a la naturaleza de los resultados ofrecidos en las loter\u00edas: &quot;dinero&quot;, &quot;a\u00f1os de vida&quot; y &quot;d\u00edas sin dolor de espalda&quot;. En ambas sesiones se obtuvo el t\u00edpico patr\u00f3n asim\u00e9trico de pr, siendo la inversi\u00f3n de preferencias est\u00e1ndar -o standard preference reversal (spr)- mucho m\u00e1s frecuente que la inversi\u00f3n de preferencias no est\u00e1ndar -o non-standard preference reversal (nspr). En concreto, en t\u00e9rmino medio, un 50% y 53% de encuestados mostraron spr en las sesiones 1 y 2, respectivamente, mientras que tan solo un 1,5% y un 2,9% de individuos incurrieron en nspr en las mismas sesiones. El efecto combinado de la repetici\u00f3n de tareas y de la retroalimentaci\u00f3n contribuy\u00f3 a reducir de forma significativa la frecuencia de spr, al contrario que la repetici\u00f3n de tareas por s\u00ed misma. Como consecuencia de ello, el n\u00famero de respuestas consistentes aument\u00f3 significativamente a lo largo de la segunda sesi\u00f3n, aunque dicha mejora se vio limitada debido a la tendencia creciente de nspr en la misma sesi\u00f3n. Adem\u00e1s, se obtuvo una mayor proporci\u00f3n de spr en los dos grupos que fueron expuestos a resultados en salud (especialmente en el grupo en el que los resultados de las loter\u00edas se expresaron en t\u00e9rminos de a\u00f1os de vida) que en el grupo en el que se emplearon resultados monetarios. A pesar de que pr es un fen\u00f3meno robusto y persistente, los resultados de este experimento reflejan que una posible v\u00eda para mitigar su aparici\u00f3n pasa por obtener preferencias en sesiones interactivas, donde los encuestados, adem\u00e1s de realizar varias veces las mismas tareas, tambi\u00e9n tengan la oportunidad de reflexionar sobre las consecuencias de las decisiones adoptadas en dichas tareas. No obstante, esta soluci\u00f3n puede dar origen a nuevos sesgos, tales como el aumento de nspr observado en la segunda sesi\u00f3n del experimento.   abstract  the overall aim of this thesis is to examine new methodological approaches pertaining to the assessment of costs and outcomes for the economic evaluation of health care interventions. These new approaches are applied in the context of three independent empirical studies, which are reported in chapters 2, 3 and 4. chapter 2 aims to examine whether health-related quality of life (hrqol) and life satisfaction are simultaneously related, as well as to quantify the bias that occurs if simultaneity is not accounted for. The study sample consisted of 870 respondents, representative of the spanish adult general population. The results derived from a simultaneous equations system reveal that the relationship between hrqol and life satisfaction is actually simultaneous, with the effect from hrqol to life satisfaction being higher (almost 20%) than the opposite effect. More important, the fact of estimating the relationship between life satisfaction and hrqol under a unidirectional approach yields biased estimates, substantially undervaluing the effect of life satisfaction on hrqol (by around 18%) and, to a lesser extent, the reverse effect (by approximately 6%). The presence of a mutual influence between hrqol and life satisfaction entails that hrqol gains can be achieved not only by means of health care interventions and health policies, but also thanks to other types of actions and policies (such as education and employment) which, through their direct impact on life satisfaction, can prompt positive side effects on hrqol. In turn, health care interventions and health policies can be effective tools for enhancing subjective well-being. Likewise, the fact that hrqol and life satisfaction are simultaneously associated stresses the appropriateness of assessing the outcomes of health care interventions more broadly, considering not only aspects strictly related to health, but also to life satisfaction.  on the other hand, chapter 3 reports the results of a study for the monetary valuation of informal care based on the preferences of both informal carers and non-carers. The study is based on a survey with a sample of 402 individuals (202 informal carers and 200 non-carers). All respondents faced a hypothetical caring scenario and were asked three questions in which they had to state the minimum monetary compensation they would demand -that is, their willingness to accept (wta)- for one extra hour of care per day in general terms, for one additional hour performing the most unpleasant task, and for one extra hour undertaking the least unpleasant task. Furthermore, informal carers were also asked for the compensation they would require if they had to be in charge of their actual care recipient for one extra hour per day. The values elicited in the three wta questions referred to the hypothetical situation followed similar distributions in the two samples, with carers&apos; and non-carers&apos; mean\/median wta values (in general terms) amounting to \u00c2\u00bf6.4\/\u00c2\u00bf5.5 and \u00c2\u00bf6.5\/\u00c2\u00bf5.5, respectively. Overall, respondents&apos; valuations were sensitive to and consistent with their preferences over the tasks to be carried out in the extra hour of informal care, although a considerable proportion of subjects (around 25% in each group) provided the same value in the three hypothetical wta questions. At the aggregate level, carers&apos; required a lower monetary compensation for one extra hour taking care of their loved one (mean\/median wta values \u00c2\u00bf5.2\/\u00c2\u00bf4.5) than if they had to devote that time to look after the hypothetical care recipient. However, more than half of carers stated the same value under both situations (hypothetical and actual), which suggests that carers&apos; valuations were influenced by their own experience providing informal care.  finally, chapter 4 tests whether the preference reversal (pr) phenomenon between choice and valuation decisions is attenuated as individuals learn through the acquisition of experience with those tasks. To that end, an experiment was conducted over two separate sessions, in order to distinguish the effect of the mere repetition of tasks (first session) from the joint effect of repetition and feedback (second session). Participants in the experiment were 319 undergraduate students at the university of murcia (spain). The sample was split into three groups, according to the nature of the lottery outcomes used: &apos;money&apos;, &apos;years of life&apos; and &apos;days without back pain&apos;. The typical asymmetric pattern of pr was found in both sessions, being standard preference reversal (spr) much more frequent than non-standard preference reversal (nspr). To be exact, on average, 50% and 53% of respondents incurred in spr in sessions 1 and 2, respectively, whereas the rate of nspr in the same sessions was only 1.5% and 2.9%. The repetition of tasks in combination with feedback contributed significantly to attenuate the frequency of spr, unlike the repetition of tasks on its own. This led to a significant rise in the number of consistent responses over the second session, although this improvement was limited due to the upward trend in nspr over the same session. On the other hand, the rate of spr was higher among those subjects who were exposed to health outcomes (especially in the group where the outcomes of the gambles were expressed in terms of years of life) than among those who faced monetary outcomes. Despite pr is a robust and persistent phenomenon, the results of this experiment reveal that a possible way to reduce its presence is to elicit preferences in interactive sessions, where respondents not only make the same tasks several times, but also have the opportunity to reflect on the consequences of the decisions made in those tasks. Nevertheless, this solution can lead to new biases, such as the rise in nspr observed in the second session of the experiment.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Avances metodol\u00f3gicos en el an\u00e1lisis de costes y resultados para la evaluaci\u00f3n econ\u00f3mica de intervenciones sanitarias.<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Avances metodol\u00f3gicos en el an\u00e1lisis de costes y resultados para la evaluaci\u00f3n econ\u00f3mica de intervenciones sanitarias. <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Silvia Garrido Garcia <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 24\/01\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Jos\u00e9 Mar\u00eda Abellan Perpi\u00f1an<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: carmen Herrero blanco <\/li>\n<li>angel Lopez nicolas (vocal)<\/li>\n<li>Juan Oliva moreno (vocal)<\/li>\n<li>eva Mar\u00eda Rodriguez  miguez (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Silvia Garrido Garcia Resumen el objetivo global de esta tesis es examinar nuevos enfoques metodol\u00f3gicos referentes al [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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