Cost-effectiveness of migraine treatment: a commentary.
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Cost of Illness↗
Biomedical subjects
Dean G Smith
Publications and source records attributed to Dean G Smith.
The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs.
BACKGROUND: Nurse staffing levels are an important working condition issue for nurses and believed to be a determinant of the quality of nursing care and patient outcomes. OBJECTIVES: To examine the effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. METHODS: Using two existing databases, the study sample included 232 acute care California hospitals and 124,204 patients in 20 surgical diagnosis-related groups. The adverse events included patient fall/injury, pressure ulcer, adverse drug event, pneumonia, urinary tract infection, wound infection, and sepsis. Multilevel analysis was employed to examine, simultaneously, the effects of nurse staffing and patient and hospital characteristics on patient outcomes. RESULTS: Three statistically significant relationships were found between nurse staffing and adverse events. An increase of 1 hour worked by registered nurses (RN) per patient day was associated with an 8.9% decrease in the odds of pneumonia. Similarly, a 10% increase in RN Proportion was associated with a 9.5% decrease in the odds of pneumonia. Providing a greater number of nursing hours per patient day was associated with a higher probability of pressure ulcers. The occurrence of each adverse event was associated with a significantly prolonged length of stay and increased medical costs. Patients who had pneumonia, wound infection or sepsis had a greater probability of death during hospitalization. CONCLUSION: Patients are experiencing adverse events during hospitalization. Care systems to reduce adverse events and their consequences are needed. Having appropriate nurse staffing is a significant consideration in some cases.
California↗
Approval times for new drugs: does the source of funding for FDA staff matter?
The Food and Drug Administration (FDA) has been criticized for injudicious and excessively rapid approval of new drugs as a result of pharmaceutical industry influence. Many critics focus on the Prescription Drug User Fee Act (PDUFA) of 1992, which augmented the FDA's budget through the charging of user fees. We assess the effect of FDA staffing patterns and attributes of submitting firms on approval times for 843 new drug applications (NDAs) submitted between 1977 and 2000. NDA review times shortened by 3.3 months for every 100 additional FDA staff. The amount of funding for FDA staff appears to be a much more important influence on NDA review time than the source of funding.
Drug Approval↗
Markov modeling analysis of health and economic outcomes of therapy with valsartan versus amlodipine in patients with type 2 diabetes and microalbuminuria.
OBJECTIVE: To estimate 8-year health and economic outcomes of the angiotensin II receptor blocker valsartan versus the calcium channel blocker amlodipine in therapy of patients with type 2 diabetes and microalbuminuria based on clinical endpoints from a 6-month randomized controlled clinical trial, the MicroAlbuminuria Reduction With VALsartan (MARVAL) study. METHODS: We developed a Markov model that utilized urinary albumin excretion rate data to project patient distributions to 7 possible health states over 8 years. For each health state, we identified quality-adjustment weights (health utilities) and medical care costs from public sources. The model then calculated mean quality-adjusted survival, medical care costs, and cost-effectiveness ratios for each treatment arm. Treatment arms were compared with the incremental cost-effectiveness ratio. RESULTS: Patients treated with valsartan gained 7 months (mean) per patient of quality-adjusted survival relative to patients treated with amlodipine (77 versus 70 months; P<0.01); valsartan patients also incurred 32,412 dollars (mean) per patient lower medical costs than amlodipine patients (92,058 dollars versus 124,470 dollars; P<0.01). Model results were consistent for each year of analysis and robust to changes in key model parameters. CONCLUSION: This research (1) extends 6-month clinical trial outcomes to an 8-year period, (2) translates health outcomes from technical clinical endpoints to quality-adjusted survival, and (3) estimates economic consequences of therapeutic outcomes. The results quantify the favorable long-term health (i.e., quality-adjusted survival) and economic benefits (i.e., lower total medical costs) of therapy with valsartan, an angiotensin II receptor blocker, versus amlodipine, a calcium channel blocker, in the treatment of patients with type 2 diabetes and microalbuminuria based on an extension of the results of a short-term clinical (MARVAL) trial. These research findings are important to the extent patients with type 2 diabetes and microalbuminuria do not receive the recommended antihypertensive agents that block the renin-angiotensin system (angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers).
Albuminuria↗
The effects of preferred provider organizations on costs and utilization of hysterectomy.
In this study, the costs and service utilization of preferred provider organizations (PPOs) were compared against traditional indemnity plans with similar benefits and utilization review for hysterectomy, a potentially overused procedure. PPOs were associated with significant cost savings, achieved primarily through lower utilization rates.
Adult↗