Browsing by Author "Lewis, Ian Storm"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Open Access
    Addressing Health Equity in Cost-Effectiveness Analysis: A Review of Distributional and Extended Cost-Effectiveness Analysis
    (2021) Lewis, Ian Storm; Sinanovic, Edina
    Background Equity is rarely included in health economic evaluations, partly because the techniques for addressing equity have been inadequate. Since 2013 health economists have developed two competing health economic technologies: distributional costeffectiveness analysis (DCEA) and extended cost-effectiveness analysis (ECEA). Both technologies represent a significant advance, and each provides a framework to address equity considerations in cost-effectiveness analysis. Methods A scoping literature review was used to identify and synthesise the relevant literature on incorporating equity concerns into economic evaluations. A second focused review identified literature which discussed or applied DCEA and ECEA. Key themes in the literature were identified using NVivo qualitative data analysis software. Results The review revealed three key areas of difference between DCEA and ECEA: First, the analysis of trade-offs between improving health and reducing inequity; second, the analysis of financial impacts of health policies; and third, the incorporation of opportunity costs. ECEA can analyse financial risk protection while DCEA can analyse opportunity costs and trade-offs between improving equity and reducing health. ECEA is designed for low- and middle-income countries, whereas DCEA is better suited to developed health systems such as the National Health Service in the United Kingdom. To date, there have been 27 studies using ECEA and five studies using DCEA. Future developments for DCEA and ECEA include incorporating alternative methods to simplify the data requirements for the techniques, providing methods to assist decision makers to clarify their equity concerns, and improving the presentation of outcomes to make them accessible to non-specialists. Conclusions DCEA and ECEA are both economic frameworks which address equity considerations in cost-effectiveness analysis. This study examines and compares these two techniques in order to assist policymakers and decision makers to determine which of the two methods is best able to address their specific needs for their particular circumstances.
  • Thumbnail Image
    Item
    Open Access
    Neuropsychiatric symptoms in thymoma-associated and non-thymoma myasthenia gravis
    (2012) Freeman, Carla Patricia; Heckmann, Jeannine; Lewis, Ian Storm
    Myasthenia gravis (MG) is an acetylcholine receptor antibody- mediated disease targeting the neuromuscular junction resulting in fatigable muscle weakness. A number of reports have suggested a high prevalence of psychiatric symptoms amongst MG patients. Approximately 10% of MG subjects are found to have an associated thymoma and despite thymomectomy, the MG persists. The presence of thymoma may lead to other antibody-mediated neuropsychiatric manifestations including limbic encephalitis. We hypothesized that the prevalence of neuropsychiatric symptoms may be higher in MG subjects with thymoma-associated MG when compared with those who have non-thymoma MG. This study aims to compare the prevalence of neuropsychiatric symptoms in a South African population of non-thymoma MG and thymoma-associated MG.