I was on vacation last week so this is gonna be more of a quick hits episode.  This is Healthcare Triage News.

(Intro)

First up, a study in Health Affairs from last month, premium-based financial incentives did not promote workplace weight loss in a 2013-15 study.  About 200 obese employees took part in a workplace wellness program to lose weight.  Some were randomized with financial incentive of $550 if they met their 5% weight loss reduction goal.  After a year, the incentive was shown not to make a difference.  This is important, because such programs are built on the idea that incentivizing employees to do things like lose weight with financial incentives like reduced premiums will work.  They won't.  Even direct financial incentives don't work.  We did a whole episode on the failure of workplace wellness programs.  You should go watch it.

When I was looking at this study, economist (?~0:55) reminded me of another obesity study you should also know about.  From the New England Journal of Medicine, a school-based intervention for diabetes risk reduction.  This was a school-based randomized controlled trial with more than 4,600 students participating.  The intervention focused on nutrition, physical activity, behavioral knowledge, and skills and communication and social marketing, and after all of middle school, they found that the intervention did not reduce the prevalence of overweight and obesity.  There were some sub-measures that changed but come on!  If after a couple years, you can't reduce overweight and obesity, then it's hard to keep justifying this type of intervention.

Health Affairs had a whole issue this month on vaccines.  First up, return on investment from childhood immunization in low and middle income countries 2011-20.  Researchers did an an analysis looking at the return on investment with achieving projected coverage levels from immunizations for 10 antigens in 94 low and middle income countries from 2011 to 2020.   They looked at the cost of vaccines, supply chains, and service delivery, and compared them to the economic benefits.  They determined that the economic benefits were about 16 times the costs over the decade.  If they used a full income approach, which also adds in the value that people place on longer and healthier lives, the returns were 44 times the cost.  Most things we talk about on Healthcare Triage are cost effective, meaning that they improve quality at some usually high cost.  Vaccines are one of the few things that not only improve quality, but save money overall.  They require upfront investment, though, so governments, get on that.  

Finally, from that same issue, "No Shot: US Vaccine Prices and Shortages".  In 2004, the Institute of Medicine warned us about the potential for vaccine shortages and they're occurring.  Researchers looked at data on vaccine sales and shortages reported to the FDA and the American Society of Health-System Pharmacists from 2004 through 2013.  They found that vaccine shortages peaked in 2007, when there were shortages of 7 vaccines.  For comparison, there were two in 2013.  When the mean price per dose was greater than $75, there were no shortages.  When it was less than that, shortages occurred.  They also found that a 10% increase in price was associated with a 1% decrease in the probability of a shortage.  The authors argue that policymakers should consider this when placing price caps on vaccines, financial incentives apparently do work when we're talking about vaccine makers.

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