Many NBER-affiliated researchers publish some of their findings in medical and other journals that preclude pre-publication distribution. This makes it impossible to include these papers in the NBER working paper series. This is a partial listing of recent papers in this category by NBER affiliates.
Opioid Deaths and Local Healthcare Intensity: A Longitudinal Analysis of the US Population, 2003–2014
American Journal of Preventive Medicine 58(1), January 2020, pp. 50–58.
This study examines the association between county-level health care intensity and opioid death rates. Health care intensity is measured with an index, based on data from the Dartmouth Atlas of Health Care capturing regional variation in Medicare spending in the last two years of life. The study shows a positive correlation between health care intensity and opioid death rates. The relationship is non-linear, with the strongest relationship for counties in the highest quintile of health care intensity. The positive relationship could reflect several different mechanisms, such as differing patterns of opioid prescriptions or different rates of other interventions that affect opioid use. Controlling for the quantity of prescribed opioids attenuated, but did not fully eliminate, the positive association between HCI and opioid death rates. Non-opioid drug death rates were unrelated to health care intensity.
The Impact of Pharmaceutical Innovation on the Burden of Disease in Ireland, 2000–2015
Journal of Public Health, January 2020, fdz183.
This study performs an econometric assessment of the impact that pharmaceutical innovation had on the burden of disease in Ireland. Health is measured in terms of disability-adjusted life-years (DALYs) for 66 diseases, which captures the disease-related loss of "healthy life years" in the population due to disability from the health conditions as well as from premature mortality. The author uses a difference-in-differences (or two-way fixed effects) research design, investigating whether diseases for which more new drugs were launched had larger subsequent reductions in mortality. This design controls for the effects of general economic and societal factors (e.g. income, education, and behavioral risk factors), to the extent that those effects are similar across diseases. Appropriate lags (up to 18 years) are modeled for the effects of medications on subsequent health. New medications (chemical entities) launched during 1983–1997 are estimated to have reduced the total number of DALYs lost in 2015 by about 234,600. Pharmaceutical expenditure per DALY gained in 2015 from drugs launched during 1983–1997 was €1137, which indicates that the new drugs launched during 1983–1997 were very cost-effective, overall. (Interventions that avert one DALY for less than average per capita income for a given country or region are considered very cost–effective’, and Ireland’s per capita GDP was €55,756 in 2015).
Modeling Peer Effect Modification by Network Strength: The Diffusion of Implantable Cardioverter Defibrillators in the US Hospital Network
Statistics in Medicine 39(8), April 2020, pp. 1125–1144.
This paper develops a model of peer effects and applies it to the diffusion of implantable cardioverter defibrillators (ICDs) across hospitals for patients with congestive heart failure. It examines the influence of peer hospitals — those that share cardiovascular-disease patients — on a hospital's adoption and continuation of capability to implant ICDs. The researchers present evidence that exposure to ICD-capable peer hospitals is strongly associated with the likelihood that a hospital becomes ICD-capable, even after controlling for the effects of geography. The direction and magnitude of the peer effects depend on the degree of connection with peer hospitals. The results suggest that inter-hospital peer networks could help explain patterns of regional variations in health care utilization.