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HEU, Centre for Health Economics

Making a Difference


Publications authored/co-authored by HEU staff members/associates

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Featured Publications


EQ-5D self-reported health in Barbados and Jamaica with EQ-5D-5L population norms for the English-speaking CaribbeanHealth Qual Life Outcomes 19, 97 

[ABSTRACT[ Background: The EQ-5D instrument is increasingly used in clinical and resource allocation decision making in developed and developing countries. EQ-5D valuation and population norms studies have been undertaken for Trinidad and Tobago, however no population norms or value sets have been generated for the other Caribbean countries. The aims of this study were to provide population norms for Barbados and Jamaica, and to develop a set of population norms that could be used by the other English-speaking Caribbean countries.  Methods: The EQ-5D-5L self-reported health questionnaire was included in surveys of representative samples of adults in Barbados and adults in Jamaica in 2013. EQ-5D health states, mean EQ VAS scores and mean EQ-5D-5L index values (using the Trinidad and Tobago value set) were calculated for demographic groups in both countries based on 2347 respondents from Barbados and 1423 from Jamaica. A set of ‘Caribbean’ norms were developed by combining the Barbados and Jamaica data with norms recently published for Trinidad and Tobago.  Results: Data were obtained for 2347 and 1423 respondents in Barbados and Jamaica respectively. The mean index and EQ VAS values were 0.943 and 81.9 for Barbados, and 0.948 and 87.8 for Jamaica. The health states most commonly observed in the two countries were similar. Generally the demographic patterns of self-reported health were consistent with those found in other studies. Some differences between the countries were observed in the patterns of rates of reporting problems on the EQ-5D dimensions among age-gender groups specifically for anxiety/depression and pain/discomfort.  Conclusion: This study has produced a set of EQ-5D population norms that can be used as base-line values in clinical and clinico-economic analyses for Barbados and Jamaica and for the English-Speaking Caribbean region...see more


The socio-economic determinants of multimorbidity among the elderly population in Trinidad and Tobago. PLoS ONE 15(9): e0237307.

[ABSTRACT] Objective: To estimate the prevalence of multimorbidity and investigate the socioeconomic factors that are associated with multimorbidity among persons 70 years and older in Trinidad and Tobago. Design and methods: The data were obtained from a nationally representative comprehensive cross-sectional survey conducted in 2014 among elderly persons in the targeted age group. The prevalence of multimorbidity among the elderly population was estimated. A logit model was utilized to determine the socioeconomic characteristics that are associated with multimorbidity in the elderly. ...see more.

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EQ-5D-5L Population Norms and Health Inequalities for Trinidad and Tobago.  PLoS ONE 14(4): e0214283.

[ABSTRACT] The EQ-5D instrument is now used in many health systems as a health outcomes measure. Recently an EQ-5D valuation study was conducted for Trinidad and Tobago, but thus far there have been no population norms published for Trinidad and Tobago or for any Caribbean country. The objective of this study is to provide a set of population norms, and to investigate inequalities in health in Trinidad and Tobago. The EQ-5D-5L questionnaire was included in the 2012/2013 Adult Population Survey of the Global Entrepreneurship Monitor for Trinidad and Tobago. This survey covered a representative sample of 2,036 adults aged 18 and over. Demographic data and self-reported health using EQ-5D-5L were collected. The Trinidad and Tobago value set was used to obtain EQ-5D index values...see more.


PRM 30 Results From A New Visual Analogue Scale Protocol For EQ-5D Valuations. Value in Health, Vol. 14(3): 151

[ABSTRACT] OBJECTIVES: The MVH protocol uses a valuation subset of 43 EQ-5D states. Smaller valuation subsets would allow smaller samples if all respondents can value one set of states. This study tests the performance of valuation subsets based on orthogonal experiment designs. VAS values obtained for EQ-5D states are affected by the identity of adjacent states in the elicitation. This study also tests a VAS protocol developed to minimize such effects. METHODS: 230 respondents were each randomly assigned to one of two orthogonal EQ-5D valuation subsets. EQ-5D states were printed on 9cm x 4cm cards with rhomboid edges. Respondents first ranked a shuffled deck of 23 cards. A1meter VAS was then placed next to the ranked cards. Respondents transferred the cards on to the VAS with the rhomboid edges pointing to the respective values. They could see all of the cards in place at the same time. Ties were permitted and respondents were free to change the order of states in moving the cards from the ranked order to the VAS…see more.


Results from an Exploratory Study to Test the Performance of EQ-5D-3L Valuation Subsets Based on Orthogonal Designs and An Investigation Into Some Modelling and Transformation Alternatives for the Utility Function.  Health Economics Review. Vol. 4 (29).

[ABSTRACT] Background:EQ-5D-3L valuation studies continue to employ the MVH protocol or variants of MVH. One issue that has received attention is the selection of the states for direct valuation by respondents. Changes in the valuation subset have been found to change the coefficients of the utility function. The purpose of this study was to test the performance of valuation subsets based on orthogonal experiment designs. The design of the study also allowed a comparison of models based on raw or untransformed VAS values with values transformed at the level of the respondent and at the aggregate level. Methods: Two different valuation subsets were developed based on orthogonal arrays. A VAS elicitation was undertaken with two groups of similar respondents and the resulting utility functions based on the valuations of the two different valuation subsets were compared using mean absolute errors between model and observed values, and by correlation with values in and out of sample. The impact of using untransformed versus VAS values transformed at the level of the individual and at aggregate level and the inclusion of a constant term in the utility functions were also investigated...see more


What is the Financial Incentive to Immigrate? An Analysis of Salary Disparities Between Health Workers Working in the Caribbean and Popular Destination Countries.  BMC Health Services Research 19:109.

[ABSTRACT] Background: The continuous migration of Human Resources for Health (HRH) compromises the quality of health services in the developing supplying countries. The ability to increase earnings potentially serves as a strong motivator for HRH to migrate abroad. This study adds to limited available literature on HRH salaries within the Caribbean region and establishes the wage gap between selected Caribbean and popular destination countries. Methods: Salaries are reported for registered nurses, medical doctors and specialists. Within these cadres, experience is incorporated at three different levels. Earnings are compared using purchasing power parity (PPP) exchange rates allowing for cost of living adjusted salary differentials, awarded to different levels of work experience for the chosen health cadres in the selected Caribbean countries (Jamaica, Dominica, St Lucia and Grenada) and the three destination countries (United States, United Kingdom and Canada)...see more


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Experiences of gender-based violence among FSWs, MSM, and transgender women in Latin America and the Caribbean: a mixed methods analysis to inform HIV programming.  BMC International Health and Human Rights 19:9. 

[ABSTRACT] Background: Female sex workers, MSM, and transgender women—collectively referred to as key populations (KPs)—are disproportionately affected by gender-based violence (GBV) and HIV, yet little is known about the violence they face, its gender-based origins, and responses to GBV. The purpose of this study was to understand the nature and consequences of GBV experienced, to inform HIV policies and programming and to help protect KPs’ human rights. Methods: Using a participatory approach, FSWs, MSM, and transgender women in Barbados, El Salvador, Trinidad and Tobago, and Haiti conducted 278 structured interviews with peers to understand their experiences of and responses to GBV. Responses to open-ended questions were coded in NVivo and analyzed using an applied thematic analysis... see more


Stigma in health facilities: why it matters and how we can change it. BMC Medicine 17:25.

[ABSTRACT] Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge—both approaches and methods—regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development’s Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years...see more


The Impact of HIV-AIDS on Children at Risk – The Case of Trinidad and TobagoIn, HIV-AIDS & Social Work Practice in the Caribbean - Theory, Issues and Innovation.  Ian Randle Publishers.  ISBN 978-967-637-356-6.


Mobile Populations, Vulnerability, and HIV/AIDS in a Globalized World: The Case of the English Speaking Caribbean. In, HIV/AIDS: Global Frontiers in Prevention/Intervention.  Eds. Cyntia Pope, Renee T. White and Robert Marlow. Routledge Publishers.  ISBN 10: 0-415-95382-0

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