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Biomedical subjects

D K Whynes

Publications and source records attributed to D K Whynes.

68 records · Page 4Linked to original sources
PubMed1991

The hospital costs of diagnostic procedures for colorectal cancer.

Diagnosis for colorectal cancer is commonly made using either colonoscopy or double contrast barium enema techniques. To data, little attention has been paid to the comparative costs of these two procedures and the paper presents estimates of hospital costs for each, using data from the colorectal study being undertaken in Nottingham, U.K. Consideration is also given to procedure sensitivity and the frequency of referral to the alternative technique in cases of incomplete diagnosis. The paper presents the conditions under which a given technique may be considered cost-superior to its alternative but concludes that the absence of conclusive clinical trial data and other considerations precludes the identification of a definitively optimum technique from the economic point of view.

Barium Sulfate↗
PubMed1991

The cost of screening for colorectal cancer.

STUDY OBJECTIVE: The aim was to make projections of the likely costs and yield resulting from the implementation of a faecal occult blood screening programme for colorectal cancer. DESIGN: Cost and clinical data were derived from the MRC colorectal screening trial currently in progress in Nottingham, UK. SETTING: The above data were used as the basis for modelling the likely implications were the trial to be reproduced as a screening programme within a "typical" family practitioner committee area. MAIN RESULTS: For an average family practitioner committee area with a target population of 75,000 subjects aged 50-74 years, the initial screening round might be expected to detect 85 cancers at a total cost of approximately 250,000 pounds. This represents a cost per cancer detected of 2700 pounds and a cost per person screened of approximately 5 pounds. For subsequent screening rounds, total costs might be expected to fall although average costs are likely to remain approximately constant. CONCLUSIONS: The model is successful in generating "order of magnitude" estimates for the costs of implementation of a screening programme for colorectal cancer. As benefit estimates are not yet available, however, no cost-effectiveness analysis can be undertaken at this stage. In general, sensitivity analyses reveal that programme costs are more sensitive to changes in clinical variables, especially detection and compliance rates, than they are to variations in the costs of resource inputs. A screening programme with a more elaborate protocol than that currently employed in the Nottingham trial will entail considerable cost increases.

Colonic Neoplasms↗
PubMed1991

Rehydration of guaiac-based faecal occult blood tests in mass screening for colorectal cancer. An economic perspective.

Owing to dehydration during storage, faecal occult blood tests have been found to lose sensitivity; accordingly, test rehydration before development has been advocated, although this practice has yet to be subjected to an economic evaluation. In this paper, the results from two major screening trials in Sweden and England, one using rehydration and the other not, are so evaluated, based on a costing model developed within the English trial. The higher sensitivity resulting from rehydration was found to be accompanied by losses in specificity, such that, although more cancers are detected, the costs of screening and of cancer detection are actually considerably higher under the rehydration regimen than with non-hydration.

Colorectal Neoplasms↗
PubMed1990

The costing of nursing care: a study of 65 colorectal cancer patients.

Nursing care is a major factor in the cost of most medical treatments. This paper reports on two alternative techniques for estimating the costs of nursing care, in the context of colorectal cancer treatment on a surgical ward in the University Hospital, Nottingham. The simpler, but cruder, technique is based on average patient costs, whilst the other is patient-specific and incorporates the use of nursing dependency data. Results from the two estimation methods are compared and the implications for the proper costing of nursing care are discussed.

Activities of Daily Living↗
PubMed1989

Screening and the costs of treating colorectal cancer: some preliminary results.

This paper describes a hospital costing analysis of 85 colorectal cancer patients treated in the context of a randomised control trial at the Queen's Medical Centre, Nottingham. Estimates are presented for investigation, surgical and inpatients costs. Comparisons between study and control group patients reveal only a small difference in overall costs of treatment.

Aged↗
PubMed1989

Managing drug use.

This study of Class A drug users in Nottingham identifies a local drug economy with specific demand and supply characteristics. With reference to demand, data are presented on users' purchasing power and purchasing behaviour, including drug re-sales and the use of credit. Crude elasticity relationships are discussed. The analysis of the supply side includes an examination of the dealing system and pricing methods. Following the integration of these two themes by way of summary the paper concludes with a discussion of the implication of its findings for public policy aimed at managing drug use.

Adult↗
PubMedDate not supplied

Selection bias in GP fundholding.

This paper uses a logistic regression model based on 1993 data for general practices in a single Family Health Services Authority (Lincolnshire) to analyse the differences in characteristics between existing fundholding (up to and including wave three) and non-fundholding practices. A high degree of classification accuracy is obtained. Fundholders are revealed to be more likely than non-fundholders to meet a number of the various quality criteria laid down by central government following the 1990 National Health Services Act, for example, with respect to prescribing cost control, minor surgery and cervical screening uptake. The model is employed to forecast the fourth wave of fundholding and poor predictions suggest the existence of a structural break in the characteristics of fundholders between those in the first three waves and those of wave four. The evidence presented also supports the existence of selection bias in the first three waves of fundholding, although further logistic regression analysis reveals a form of such bias in the fourth wave also.

Cost-Benefit Analysis↗
PubMedDate not supplied

Prescribing cost savings by GP fundholders: long-term or short-term?

Fundholding general practices have been observed to be more successful than non-fundholders in controlling the growth of their prescribing costs. Debate persists over the likely duration of this fundholding effect. Regression analysis of changes in prescribing costs for a large sample of practices over 5 years supports the view that prescribing cost economies have been short-rather than long-term, and that practices entering fundholding did not engage in strategic, cost-raising behaviour prior to joining the scheme.

Aged↗
PubMedDate not supplied

On approximations in treatment costing.

As detailed costing may be a time-consuming and expensive exercise within an evaluation, economists will be conscious of the possibilities of taking short-cuts. To explore the viability of such approaches in the context of acute care (the surgical treatment for colorectal cancer), we compare the results of a detailed costing study with reduced list costing and econometric estimation. We conclude, first, that use of a reduced list is likely to generate substantial research economies only at the expense of inaccuracy. Second, crude costing, based upon average costs of the specialty, is acceptable when the frame of reference is the aggregate. Such crude costing, however, is vulnerable to bias when specific sub-samples of patients are to be considered. Finally, total costs are predictable from a restricted list of cost and event variables, and with a high degree of accuracy, although ex ante specification of the functional form is problematic.

Acute Disease↗
PubMedDate not supplied

The NHS internal market: economic aspects of its medium-term development.

With the re-election of the Conservative Party in the United Kingdom in April 1992, it is now likely that the major reforms of its National Health Service as outlined in the 1989 White Paper--Working for Patients--and embodied in the 1990 National Health Service and Community Care Act will be implemented to completion. This article examines the reforms as a re-structuring of incentives facing agencies within the internal market for health care, and forecasts how agency behaviour is likely to change as a result of such re-structuring. Medium-term implications of the reforms for hospitals, general practitioners and patients are derived. A number of problems in the continued development of the internal market are anticipated.

Contract Services↗
PubMedDate not supplied

Cost-effectiveness of screening for colorectal cancer: a simulation model.

Colorectal cancer is a major cause of mortality in Western countries, although early detection of the disease is known to improve survival. Recent developments in medical technology have made mass population screening a practicable proposition and a number of randomized controlled trials of screening are currently being conducted. This paper reports on the construction of a computer simulation model of the cost-effectiveness of colorectal cancer screening, being developed in conjunction with a major UK trial. Based on accumulated trial data and semi-Markov descriptions of the disease process, the model will facilitate the assessment of the cost-effectiveness of a variety of screening modalities, with a view to informing policy in the future.

Adult↗
PubMedDate not supplied

Knowledge of cervical cancer and screening among women in east-central England.

This study assesses the extent and accuracy of women's knowledge of cervical cancer, risk factors, and the efficacy of the national screening program. Data were obtained from a questionnaire survey of randomly selected women eligible for screening, drawn from a population in east-central England. The majority of women in the sample overestimated the current incidence of cervical cancer, both absolutely and relative to other cancers. Perceiving incidence to be high was associated with reporting worries about the disease. With respect to the screening process, 78.3% believe that the smear abnormality rate is higher than it actually is, and only 7.6% correctly appreciate that the abnormality rate is highest at younger ages. With respect to performance, 16.3% believed the smear test to be completely accurate, and more than half overestimated the likely number of cancer cases prevented by screening. While certain cervical cancer risk factors were correctly assigned by the majority of women, undue emphasis was placed on genetic influence, while the risks posed by human papillomavirus infection were unfamiliar to almost half of the sample. We conclude that women typically possess only a partial picture of risk factors and overestimate both the incidence of cervical cancer and the efficacy of screening.

Adult↗
PubMedDate not supplied

Filtering strategies in mass population screening for colorectal cancer: an economic evaluation.

On the basis of clinical trial data, 13 strategies for initial screening (filtering) for colorectal cancer are modeled for the purpose of economic evaluation. A wide range of detection cost estimates are generated, although ranking options by detection cost ignores the important consideration of undetected cancers. Formulating the problem as one of cost-effectiveness, however, allows the authors to demonstrate that members of a subset of strategies uniquely outperform all others and that the optimum strategy can be identified by the ex ante specification of the valuation of cancers missed on screening.

Colorectal Neoplasms↗