Health Economics Commons^™

Examining Mobile Health App Engagement In A North American Employee Population: A One-Year Longitudinal Observational Study, Nabil Ratanshi

Electronic Thesis and Dissertation Repository

BACKGROUND: Mobile health (mHealth) apps may help promote physical activity and other health behaviours among office-based workers. Low app engagement, however, leading to little or no effect is typical. OBJECTIVE: To examine engagement with a rewards-based mHealth app and identify factors influencing engagement. METHODS: A one-year observational study was conducted with Canadian and U.S. users of the Sprout at Work app (N=2253; Female: 35.7%; Age: 39.3 years). Kaplan-Meier survival curves were used to examine engagement patterns from a ‘multiple-lives’ perspective (i.e., time to first disengagement, re-engagement, second disengagement). Regression models were used to identify factors influencing engagement. RESULTS: After one …

Essays On Disability And The Labour Market, Robert Geoffrey Millard

Electronic Thesis and Dissertation Repository

My dissertation consists of three chapters about the effects of disability and disability policy.

The second chapter analyzes the variation in labour market outcomes across disabilities by representing disability as a bundle of characteristics. Rich with information on the characteristics of a disabling condition, I use the Participation and Activity Limitation Survey to compare the relative importance of each {characteristic} and their interactions on employment, wages, hours worked, and annual employment income. The disability {characteristics} include the type of activity limitation, number of limitations, timing of onset, severity, and persistence. I find substantial cross-sectional variation in labour supply, wages, and …

Essays On Industrial Organization And Health Economics, Cecilia S. Diaz Campo

Electronic Thesis and Dissertation Repository

My thesis consists of three chapters studying the impact of health insurance design and public health policy on consumers’ health and health care utilization, welfare, and costs.

Chapter 2 studies an overlooked dynamic incentive that encourages health care utilization, which I term \textit{dynamic moral hazard}. Typical health plans feature high deductibles and caps on consumers' out-of-pocket spending, which generate nonlinear pricing. These nonlinearities, coupled with the uncertainty intrinsic to future health care demand, encourage consumers to increase spending since current utilization lowers future expected prices. Standard models study health care utilization decisions through the lens of annual models, which abstract …

Cost-Effectiveness Analysis Of Tpmt Genotype-Guided Azathioprine Treatment Compared To Standard Treatment For Patients With Moderate/Severe Ulcerative Colitis, Ali Unsal

Electronic Thesis and Dissertation Repository

This study assessed cost-effectiveness of pharmacogenomics (PGx)-based azathioprine (AZA) compared to standard AZA therapy for ulcerative colitis (UC) patients in Canada. A patient-level Microsimulation model was developed to compare the lifetime costs and quality-adjusted life years (QALYs) gained by a hypothetical cohort of UC patients with age and sex characteristics. The parameters used in the model were derived from the published literature and costs from the Ontario Schedules of Payments and published sources. The results were summarized in terms of the incremental cost-effectiveness ratio (ICER). Compared to standard AZA, PGx-based AZA care was the dominant strategy with 0.17 incremental QALYs …

Catch Me If You Can: Questionable Modelling Assumptions And Parameter Choices And Their Impact On Drug Reimbursement Decisions, Lina Ghattas

Undergraduate Student Research Internships Conference

The Canadian Agency for Drugs and Technologies in Health (CADTH) is a health technology assessment (HTA) agency. CADTH conducts appraisals on health technologies and makes reimbursement recommendations to Canadian public drug plans to guide their reimbursement decisions. When being considered for reimbursement, drug companies submit pharmacoeconomic reports, which typically include long-term decision models. These models make assumptions and use parameters that may favour one intervention over the other. In this study, we comprehensively review the last year of drug submissions appraised by CADTH, with the aim of identifying, categorizing, and critically reviewing key methodological flaws made by drug companies in …

Analysis Of Health Care Costs Over A One-Year Period Following Anticoagulant Therapy Among Ontario Patients Diagnosed With Atrial Fibrillation, Michael Situ

Electronic Thesis and Dissertation Repository

Atrial fibrillation patients are at high risk of ischemic strokes, which can be drastically reduced using oral anticoagulants (OACs). Warfarin has been the standard OAC for this population but its effectiveness rests on consistent monitoring with the potential for severe bleeding events. Newer OACs, like rivaroxaban and apixaban, address these drawbacks but have a comparatively higher upfront cost. Uncertainty remains over which OAC is cost-saving from a health care system perspective. Using a retrospective cohort study design and inverse probability weighting regression adjustment estimators, one-year health care costs among patients treated with warfarin, rivaroxaban, and apixaban were compared. Compared to …

Essays On Criminal Behaviour, Human Capital Formation, And Mental Health, Diego F. Salazar

Electronic Thesis and Dissertation Repository

My thesis consists of three chapters that contribute to the study of some of the negative consequences of incarceration and their relation with the life-cycle choices of juvenile offenders.

Chapter 2 studies the causal relationship between incarceration and mental health problems. In this chapter, I use different matching estimators to identify the causal effects of incarceration over several dimensions of mental health using data from a survey of juvenile offenders, the Pathways to Desistance (PTD) survey. My findings show that being incarcerated for the first time, between 17 and 18 years old, increases depression by at least 0.18 standard deviations …

"Integrated Science 3002a: Big Bike Giveaway: Changing London's Environment, Health, And Economy One Bike At A Time", Jermiah Joseph, Katelyn Melo, Devanshi Shukla, Tony Nguyen, Katherine Teeter

Community Engaged Learning Final Projects

There are significant benefits that manifest when an individual chooses to ride a bicycle as their primary mode of transportation. To investigate these benefits, the environmental, health, economic, and social impacts of biking were evaluated through research and data analyses. This revealed that numerous advantages can be obtained at an individual and local scale through citizens choosing to adopt a biking lifestyle. However, it was found that many Londoners are deterred from biking due to poor biking infrastructure. This paper calls into question the current cycling framework in London and it’s limitations on achieving the numerous benefits that biking offers. …

Financial Costs Incurred By Living Kidney Donors: Findings From A Canadian Multi-Centre Prospective Cohort Study, Sebastian Przech

Electronic Thesis and Dissertation Repository

This prospective cohort study across 12 Canadian transplant centres evaluated the costs incurred by 912 living kidney donors. Expenses and resources were captured to 3-months post-donation, and micro-costing was used to appraise the costs incurred by donors. Living kidney donors incurred average total costs of $4790, and direct and indirect costs of $2110 and $2679, respectively. 13.3% of donors incurred total costs exceeding $10,000, and 8.6% of donors incurred costs >25% of their annual household income. Costs incurred by spousal donors were not significantly different from either unrelated or closely related donors. Similarly, costs incurred by kidney paired donors were …

Essays On Human Capital Complementarities, Hiroaki Mori

Electronic Thesis and Dissertation Repository

The thesis consists of three chapters that study the interplay between skills and health in shaping labour market outcomes. I focus on two distinct but related issues: i) the wage losses among older workers due to work-limiting health conditions, and ii) the long lasting effects of childhood health conditions on human capital formation. Chapter two studies how health conditions among older workers affect their wages depending on the characteristics of their occupations. The U.S. Social Security Act defines disability as the inability due to health conditions to perform physically or mentally demanding tasks. To examine the potentially task-specific nature of …

The Impact Of Prior Experience Employees’ Perceptions And Beliefs About Workplace Policies And Practices, Michael D. Saxton

Electronic Thesis and Dissertation Repository

Domestic violence (DV) is associated with negative consequences for victims, children, families, and even national economies. More recently, research has demonstrated that DV also has a serious impact on workers and workplaces. Less is known about Canadians’ beliefs toward the impact DV has on workers or the extent to which individuals are able to identify co-workers’ experiences of DV. Using data from a pan-Canadian sample of 7,834 men and women, the current study examined: 1) how prior experiences with DV relates to beliefs toward the impact DV has on workers, 2) how gender and age relates to beliefs toward DV’s …

Cost-Effectiveness Of Bevacizumab Concomitant With The Standard Of Therapy For Newly Diagnosed Glioblastoma, Aren Fischer

Electronic Thesis and Dissertation Repository

Glioblastoma Multiforme (GBM), a glioma – cancer of the brain’s glial cells – is the most common and deadly malignant primary central nervous system tumor in developed countries. Two recently completed clinical trials investigating the use of bevacizumab (BEV), a monoclonal antibody, to treat newly diagnosed GBM concomitant with the standard-of-care (SOC) showed mixed survival and quality of life outcomes. In this study, a cost utility study was conducted to investigate if BEV should be used to treat newly diagnosed GBM. A three stage time-dependent Markov model was built using survival estimates from the two clinical trials, costs from Ontario …

A Comparison Of Clinical Trial And Model-Based Cost Estimates In Glaucoma – The Case Of Repeat Laser Trabeculoplasty In Ontario, Omar Akhtar

Electronic Thesis and Dissertation Repository

Background and objective: For cost-effectiveness analyses (CEA) of glaucoma interventions to be of use they require valid and accurate cost and effectiveness data. Costs remain understudied relative to effectiveness. The impact of cost estimation methods on resultant estimates is unknown in glaucoma. Direct measurement of costs is labour-intensive and expensive. Decision-analytic modelling of costs using literature sources, expert opinion, institutional experience and assumptions provides a quicker, less laborious alternative to empirical costing. A lack of long-term effectiveness data in chronic diseases like glaucoma means that modelling is widespread and inevitable, both for CEAs and budget impact projections. The same problem …

Essays On Health Insurer And Provider Interactions, Daniel Montanera

Electronic Thesis and Dissertation Repository

This thesis consists of three chapters on insurer and provider interactions. Despite widespread reports of defensive medicine in surveys of physicians, empirical investigations have produced conflicting evidence that defensive medicine is practiced on a significant scale. Findings imply that the relationships between malpractice pressure and health care spending and quality are non-monotonic. These predictions provide an explanation for the apparent conflicts and inconsistencies in the existing empirical literature, as well as policy guidance for future empirical investigations in separating observations and populations in different equilibrium types.

The next chapter expands the model by making physicians mobile, and includes a location …

The Cost-Effectiveness Of Combination Treatment Consisting Of Either Cetuximab Or Panitumumab Plus Folfiri Versus Treatment With Bevacizumab Plus Folfiri As First-Line Treatment For Kras Wild-Type Metastatic Colorectal Cancer Patients In Ontario, Emmanuel M.G. Ewara

Electronic Thesis and Dissertation Repository

I conducted a cost-effectiveness analysis of combination cetuximbab or panitumumab plus FOLFIRI as first-line treatment for patients with metastatic colorectal cancer (MCRC) from the perspective of the Ontario healthcare payer. I developed a Markov decision analytical model to simulate the lifetime costs and benefits of each treatment option. The model was parameterized using data collected from administrative databases in the province of Ontario and from published clinical trials. In the base case scenario, treatment consisting of bevacizumab plus FOLFIRI was found to dominate other treatment options. The ICER values were found to be sensitive to the efficacy of first-line treatment, …

Preliminary Economic Evaluation Of Brentuximab Vedotin In Relapsed And Refractory Hodgkin Lymphoma: An "Early Look" Model Based On Phase Ii Results, Vusal Babashov

Electronic Thesis and Dissertation Repository

We conducted a cost-effectiveness analysis of brentuximab vedotin for the treatment of relapsed and refractory Hodgkin Lymphoma (HL) from health care system perspective in Canada. We developed a Markov decision analytical model to simulate lifetime costs and benefits and parameterized the model using brentuximab phase II clinical trial and cd-link data which is a linked datasets of cancer registry with administrative databases of Ontario, Canada. In the base case scenario, brentuximab treatment led to an increase of 0.352 Quality Adjusted Life Years (QALYs) per person and $108,500 per person, which resulted in incremental cost effectiveness ratio (ICER) of $308,532 per …