An integrated national pharmaceutical policy for the United Kingdom?
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Drug Costs↗
Biomedical subjects
A Bagust
Publications and source records attributed to A Bagust.
An alternative to body mass index for standardizing body weight for stature.
Although body mass index (BMI) has been adopted by WHO as an international measure of obesity, it lacks a theoretical basis, and empirical evidence suggests it is not valid for all populations. We determined standard weight-for-height using a model calibrated by multivariate analysis of observational data on body dimensions and health status in the USA (NHANES III). A multiple linear regression model based on a simple mathematical formulation accurately described the observed weight variations in this normal adult population. A standardized reference model using just two measurements (upper arm length and sitting height), readily applied in both clinical and research settings using lookup tables, improved explanatory power substantially compared to the best BMI formulation (r(2) increased 16.3% for males, 21.1% for females). Physical dysfunction and self-reported poor health showed strong trends with excess body weight. These findings need confirmation from larger population samples.
Adult↗
Dynamics of bed use in accommodating emergency admissions: stochastic simulation model.
OBJECTIVE: To examine the daily bed requirements arising from the flow of emergency admissions to an acute hospital, to identify the implications of fluctuating and unpredictable demands for emergency admission for the management of hospital bed capacity, and to quantify the daily risk of insufficient capacity for patients requiring immediate admission. DESIGN: Modelling of the dynamics of the hospital system, using a discrete-event stochastic simulation model, which reflects the relation between demand and available bed capacity. SETTING: Hypothetical acute hospital in England. SUBJECTS: Simulated emergency admissions of all types except mental disorder. MAIN OUTCOME MEASURES: The risk of having no bed available for any patient requiring immediate admission; the daily risk that there is no bed available for at least one patient requiring immediate admission; the mean bed occupancy rate. RESULTS: Risks are discernible when average bed occupancy rates exceed about 85%, and an acute hospital can expect regular bed shortages and periodic bed crises if average bed occupancy rises to 90% or more. CONCLUSIONS: There are limits to the occupancy rates that can be achieved safely without considerable risk to patients and to the efficient delivery of emergency care. Spare bed capacity is therefore essential for the effective management of emergency admissions, and its cost should be borne by purchasers as an essential element of an acute hospital service.
Bed Occupancy↗
Importance of health economics must be recognised when trials are designed.
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Clinical Trials as Topic↗
Clinical guidelines-the hidden costs.
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Costs and Cost Analysis↗
Modelling and costing the consequences of using an ACE inhibitor to slow the progression of renal failure in type I diabetic patients.
Antihypertensive drugs slow the progressive decline in renal function seen in patients with insulin-dependent diabetes and nephropathy. In a recent study, the ACE inhibitor captopril protected against this deterioration in renal function. We developed an economic model to analyse the cost impact of ACE inhibitor treatment on progression to endstage renal failure (ESRF) in diabetic patients over 4 years. Two scenarios were compared: one describing the progression of a cohort of 1000 patients receiving 25 mg captopril three times daily, and the other for an equivalent cohort without such prophylactic treatment. Previously published data were used to estimate the transition rates for each stage from the onset of renal failure until death. All direct costs were discounted by an annual rate of 6%, and were subjected to sensitivity analysis. The discounted cost saving of ACE inhibitor treatment for a cohort of 1000 patients was estimated as 0.95 million pounds over 4 years. Under sensitivity analysis, these results were very robust to variations in the costs of ESRF treatment. Prophylactic treatment with ACE inhibitors was predicted to provide substantial increases in life expectancy and reduction in the incidence of ESRF, while also providing significant economic savings.
Adolescent↗
An economic analysis of the Survival and Ventricular Enlargement (SAVE) Study. Application to the United Kingdom.
Recent studies have shown that ACE inhibitors reduce morbidity and mortality after myocardial infarction (MI). While these trials have obvious clinical implications, the widespread introduction of a new treatment for a condition as common as MI also has clear cost implications. The results of the post-MI studies with ACE inhibitors suggest that restricted use of treatment-in high-risk patients-is likely to be most cost effective, whereas treatment of all MI survivors, many of whom are at low risk, will be least cost effective. An approach somewhere in between may maximise clinical benefit at an acceptable cost. Economic analysis may help in deciding how these drugs might be best used after MI. We have conducted a cost-effectiveness and cost-utility analysis of the Survival and Ventricular Enlargement (SAVE) study, which reported the benefit of ACE inhibitors in intermediate-risk patients. Assuming all MI survivors require measurement of left ventricular function before selection for treatment (the approach used in the SAVE study), the incremental cost per life-year gained (LYG), over 4 years, using prophylactic captopril is approximately 10000 pounds sterling (Pounds) [1994 to 1995 values]. The cost per quality-adjusted life-year (QALY) is similar. These incremental cost per LYG and cost per QALY ratios compare favourably with other commonly used symptomatic and prophylactic treatments, and argue for extending post-MI use of ACE inhibitors to intermediate-as well as high-risk patients.
Angiotensin-Converting Enzyme Inhibitors↗
Quality or quantity.
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Nursing Service, Hospital↗
The singers, not the song.
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Clinical Competence↗
Dispel that old myth.
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Activities of Daily Living↗
Modelling the implications for hospital services of cervical cytology screening: a case history.
A screening programme is being introduced throughout the UK to reduce deaths from cancer of the cervix by early detection of precancerous lesions. A stochastic mathematical model has been developed in order to estimate the resource implications of this programme for hospital services in NW region. The model was developed over a period of 1 year, undergoing many changes in the process. The model has suggested operational policies for smear management and demonstrated the importance of wide coverage of the population.
Female↗
Resource management or managing resources?
Claims made by Stilwell and Hamlyn to have recorded reductions of 25% in average cost per patient in an out-patient clinic where detailed patient costing data was collected and employed are examined critically. Their failure to allow for case-mix differences is shown to nullify the apparent gain in resource efficiency. This raises issues concerning the value of providing managers with detailed patient costings, and throws doubt on the wisdom of current initiatives in Clinical Budgeting and Resource Management.
Costs and Cost Analysis↗
Dissecting the patient stay in the UK.
A method of analysing the factors which contribute to the length of stay in England as an acute medical in-patient has been developed, and applied in both real-time and cross-sectional studies. The major factors delaying discharge were found to be the time taken to respond to treatment and the actions of agencies other than the acute medical unit of the hospital. Areas where improvement could be made have been identified and some changes implemented. The system can be applied to monitor the effect of such changes.
Bed Occupancy↗
League tables.
Each year a new set of hospital league tables features briefly in the press, and on TV and radio stations. Local newspapers carry articles praising or berating their local hospitals to a bemused and mystified public. How seriously should we take this annual ritual? Where do the figures come from and what do they mean?
Health Services↗