Economics of cancer screening: total costs and benefits in economic terms.
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Cost-Benefit Analysis↗
Biomedical subjects
K M Pedersen
Publications and source records attributed to K M Pedersen.
Iodine status in neonates in Denmark: regional variations and dependency on maternal iodine supplementation.
Iodine status of 147 neonates born in five different regions of Denmark was evaluated in relation to the iodine content of breast milk and iodine supplementation taken by the mother. Approximately two-thirds of the women had not received iodine supplementation. They had low iodine concentrations in breast milk and urinary iodine concentrations of the neonates at day 5 were low. The median values (milk/urine) were 33.6/31.7 micrograms/l (Randers 22/26, Ringkøbing 29/16, Aalborg 36/31. Arhus 54/41 and Copenhagen 55/59 micrograms/l). Higher values were found in the group where tablets containing iodine had been taken (milk/urine: 57.0/61.0 micrograms/l). In general, the values are low compared with internationally recommended levels. We suggest that mothers without autoimmune thyroid disease should receive iodine supplementation in the form of vitamin/mineral tablets containing iodine (150 micrograms per tablet).
Denmark↗
Amelioration of some pregnancy-associated variations in thyroid function by iodine supplementation.
Knowledge of the effect of differences in iodine intake levels on public health in areas with no endemic goiter is limited. Groups at risk when iodine intake is relatively low are pregnant and lactating women and their newborns. A prospective randomized study was performed to evaluate the effect of iodine supplementation in an area where the median daily iodine excretion in urine is around 50 micrograms. Fifty-four normal pregnant women were randomized to be controls or to receive 200 micrograms iodine/day from weeks 17-18 of pregnancy until 12 months after delivery. In the control group, serum TSH, serum thyroglobulin (Tg), and thyroid size showed significant increases during pregnancy. These variations were ameliorated by iodine supplementation. Iodine did not induce significant variations in serum T4, T3, or free T4. Cord blood Tg was much lower when the mother had received iodine, whereas TSH, T4, T3, and free T4 levels were unaltered. The results suggest that a relatively low iodine intake during pregnancy leads to thyroidal stress, with increases in Tg release and thyroid size. However, the thyroid gland is able to adapt and keep thyroid hormones in the mother and the child normal, at least under normal circumstances, as evaluated in the present study. It is not known whether this stress is sufficient to be of importance for late development of autonomous thyroid growth and function.
Adult↗
Iodine deficiency in pregnancy in Denmark. Regional variations and frequency of individual iodine supplementation.
Iodine requirements are increased during pregnancy and lactation and adequate iodine intake is important for normal brain development of the fetus/newborn child. The aim of the present study was to evaluate the extent to which this increase in iodine requirement is met in pregnant women living in various regions of Denmark. One hundred and fifty-two healthy pregnant women admitted to five different Danish departments of obstetrics participated in the study. Iodine status was evaluated by measurement of iodine in spot urine at day five after delivery and by careful history of the intake of iodine containing vitamin/mineral tablets. Approximately one third of the women had received tablets containing iodine. In women who had not received iodine supplementation urinary iodine was low with a median value of 39.7 micrograms/g creatinine (Aalborg 28, Randers 33, Ringkøbing 34, Arhus 43 and Copenhagen 62 micrograms/g creatinine). These values are far below internationally recommended levels. The consequences remain to be evaluated and no firm recommendations can be given. It seems reasonable, however, to recommend a high intake of food containing iodine (e.g. milk products) during pregnancy and lactation. Since nearly all the women took some kind of vitamin/mineral supplementation it could be considered to advocate intake of vitamin/mineral tablets containing iodine.
Adolescent↗
Sensitive enzyme-linked immunosorbent assay for measurement of autoantibodies to human thyroid peroxidase.
The development of a sensitive assay for detection of autoantibodies against one of the major thyroid antigens, thyroid peroxidase (TPO), is described. TPO was purified from human thyroid tissue by: (1) isolation of thyroid microsomes using homogenization and differential centrifugation, (2) solubilization of membrane proteins by Zwittergent 3-14, and (3) anion exchange liquid chromatography on a FPLC Mono Q column. Autoantibodies against TPO (TPO-Ab) were measured using an enzyme-linked immunosorbent assay (ELISA) with serum samples diluted 1:100. Standards containing 70, 7, 0.7, 0.02 and 0 U ml-1 TPO-Ab were employed (reference standard code 66/387 NIBSC, London, UK). The detection limit was 0.02 U ml-1 corresponding to 2 U ml-1 in undiluted serum. The inter- and intra-assay coefficients of variation were 8.6% and 5.3%. In 109 healthy control subjects TPO-Ab was found in 9 (8.3%), while 43 (97.7%) out of 44 patients with newly diagnosed untreated Graves' disease had detectable TPO-Ab in serum. All of 16 patients with newly diagnosed spontaneously developing primary hypothyroidism had circulating TPO-Ab (range 16-7000 U ml-1). The new assay is a valuable tool for evaluation of thyroid autoimmunity in individual patients and for studying the epidemiology of thyroid autoimmunity.
Adolescent↗
High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Denmark and Iceland.
Little is known about the optimum level of iodine intake for iodine supplementation programmes, or about the effects of the high levels of iodine intake that are found in some countries. We compared the incidence of different types of hyperthyroidism in East-Jutland Denmark with a low average iodine intake but no endemic goitre, and the incidence in Iceland with a relatively high iodine intake. Hyperthyroidism was more common in East-Jutland than in Iceland, due to a much higher incidence of multinodular toxic goitre and also of single toxic adenoma. Most of the patients with these diseases were over 50 years of age. By contrast, the incidence of Graves' disease was significantly higher in Iceland than in East-Jutland. This difference was most marked in the younger age groups, in which hyperthyroidism was more than twice as common in Iceland as in East-Jutland. These results demonstrate that even mild iodine deficiency has a significant effect on population health, since it leads to a high incidence of autonomous thyroid nodules with hyperthyroidism in the elderly population. However, population iodine intake probably should not exceed a level much higher than that necessary to avoid iodine deficiency, otherwise Graves' disease may be induced in the young population.
Adolescent↗
Hyperfunctioning thyroid nodules.
The authors describe the principal clinical and pathological aspects of the solitary hyperfunctioning adenoma or the multifocal hyperfunction of a multinodular goitre. Successively they report the incidence of these conditions in countries with different iodine intake as well as the age distribution of the examined patients. In the area with low iodine intake the incidence of hyperthyroidism caused by multinodular goitre is 10 times higher than in the high iodine intake area. Finally, the role of the laboratory in the diagnosis of hyperthyroidism and in identifying the type of hyperthyroidism is discussed; an up-todate flow-sheme is also reported.
Adenoma↗
[Costs and cost analysis].
The costs of an activity is frequently the most conspicuous part in decision making when changes in health care services are considered. It is thus essential to be aware of the principles and considerations underlying the composition of costs. The concept of cost is not restricted to expenditures that have to be paid. It involves the notion of opportunity cost i.e. the cost of a service is the satisfaction or benefit foregone in not being able to use the resources involved to obtain some other service which is also desirable and therefore also provides satisfaction. Strictly, this relates to the best alternative way of using the resources. In order to estimate the costs of an activity, all costs, whether direct or indirect, tangible or intangible, ought to be taken into account. The fact that they may be difficult to measure a value is no excuse for ignoring them. In a cost analysis the result has to be assessed in the light of the types of costs employed and the aim of the analysis. Average cost is very often used, but is seldom the relevant costs. What is normally of concern is the cost of some change. Only by using marginal costs i.e. those costs that actually do change is it possible to obtain a true picture of resource consequences of that change. Regardless of the type of cost it is necessary to consider on whom the costs fall and to whom the benefits accrue. These may not be the same.
Costs and Cost Analysis↗
[The value of life and limb].
Assessment of the value of life and limbs is a controversial subject, not only emotionally but also theoretically. The economic starting point is based on assessment of the value of reduction or increase of the probability for an event which leads to disability or death. No concern is expressed for the single individual but for the phenomenon of probability where the person or persons who are affected by an event cannot be identified. Assessment of the value is in monetary units. The obvious discrepancy between the expression "value of life and limbs" and the theoretical content of the analysis has involved many misunderstandings. Attempts are made to elucidate and explain these. There is e.g. another method of assessing the value of life and limbs, the human capital method. In this, the disability and the premature death (compared with the current time) by means of loss of occupational income are assessed. The method is criticized and is discarded on the basis of theoretical arguments and consequences, the calculations of which are employed. Unfortunately, it has proved tempting to employ the method because it is relatively easy to make the calculations. Finally, the parts played by some recent questionnaire methods for assessment of alterations of risks are discussed. Assessment of the value of alterations in risks is an important requirement in order to carry out relevant cost-benefit analyses in the health sector. In cases where this is not possible, these analyses are meaningless.
Cost-Benefit Analysis↗
[A review of the types of economic analyses of the health economy].
Great confusion is involved concerning health economics analyses. For example: What is the difference between cost-benefit and cost-effectiveness analyses? Is there a difference between the so-called cost-of-illness analyses? What is a financial analysis? These questions are discussed on the basis of the underlying economic theory and the use of the analyses. In order to avoid terminological confusion, the English terminology is retained. Cost-benefit and cost-effectiveness analyses are social economical analyses because they are all-embracing as regards what is understood by costs and profits based on the so-called welfare economy where cost-benefit analyses are concerned. The theoretical basis for cost-effectiveness analysis is slightly more obscure. Where both forms of analysis are concerned, no concern is shown for who obtains the profits or who pays the costs, i.e. a cross-sectional perspective. The financial analysis contrasts with this because attention is focussed directly on expenditures and revenues and the accounts responsible for the expenses and which obtain the revenues. The cost-of-illness analysis is a confusing but frequently employed and quoted form of analysis where an attempt is made to calculate the costs of a certain disease or injurious agent (alcohol, tobacco, accidents) for the various parties involved. These are subdivided into direct costs, roughly corresponding to the costs of treatment and indirect costs which include e.g. loss of income resulting from the illness, disability or death. This form of analysis is strongly warned against as the results of analysis may easily be misused frequently with absurd implications.
Cost-Benefit Analysis↗
[What is cost effectiveness analysis?].
Cost-effectiveness analysis (CEA) is an established economical form of analysis which, in public services, replaces the marketing mechanism. The questions which CEA attempts to answer are: Which form of medical technology is most economically effective where a given disease is concerned. Where and how must the medical technology be commenced. Which group of patients can benefit from a given form of medical technology? It is a prerequisite for employment of CEA that there is unanimity in advance about the object of an activity, eg. a given treatment or procedure in the diagnostic investigation. Several strategies may be employed to ensure that the aim is sufficiently wide: the limits may be explicit; goals may be established which compare years of life with quality of life, or several goals may be present in the goal. The predominant economical expression in CEA is alternative costs which must be sacrificed in order to carry out a certain activity. In order to estimate what is obtained by carrying out an activity, an expression of effect is essential. These are most frequently both of quantitative and also of qualitative character and may be subdivided into three categories: Alterations in the employment of resources. Alterations in production by society. Alterations in the conditions of health of the individual. Doctors are important decisions-makers and distributors of resources in the health services. The questions which a CEA can provide graduated answers to, are the questions that the doctor works with in clinical practice.(ABSTRACT TRUNCATED AT 250 WORDS)
Cost-Benefit Analysis↗
[What is cost benefit analysis?].
The practical and theoretical bases of cost-benefit analysis are reviewed systematically with particular emphasis on how an analysis can be carried out in practice. A Danish analysis about introduction of vaccination for mumps, measles and German measles is included as a common example. The great significance of elucidating the socio-economical questions to be answered before commencing an analysis is emphasized. It is therefore recommended that, among other things, as a side-effect of the actual cost-benefit analysis, a cash-analysis and a budget analysis should be carried out to identify the parties involved in the immediate expenses and incomes. This is particularly important in the cases where the same parties have a central position in the decision-making processes concerned in the project. In addition, costs and benefits are frequently distributed differently in time in different ways: Short-term expenses and long-term benefits. In connection with decision-making, this may also involve problems and should, therefore, be elucidated in detail. Similarly, the importance of including many alternatives in the analysis is emphasized and illustrated. In conclusion, it is demonstrated how well the theoretical principles have been followed, the employment and the process which led to the concrete analysis.
Child↗
Malignant intestinal schwannoma. Case report.
Malignant schwannoma of the small intestine is rare and diagnosis often late. Histologic distinction from fibrosarcoma and leiomyosarcoma may require electron microscopy. The primary treatment is surgical. Close postoperative observation is recommended because of the tendency to recurrence. Remission after chemotherapy has been reported, but without controlled studies. The 5-year survival rate is unknown. Two cases are presented.
Aged↗
[What is healthy economy?].
Health economics is the branch of economics which is concerned theoretically and practically with the health sector and related subjects such as e.g. the market for medicine and medico-technical equipment. In health economics, the universal basic problem is: Distribution of scarce resources to competing ends and establishment of rules for this. In this respect, (health) economics is knowledge about priorities based on the methodical an appreciative basis of economics. The essence is the absolute or relative scarcity and the existence of alternative uses for the limited resources. Many identify health economics with societal economic analyses: cost-benefit analyses or cost-effectiveness analyses. A great many analyses of this type have been published and these have been employed to an increasing extent in connection with decisions about introduction or alteration of the existing therapeutic or diagnostic methods. Health economics is, however, much more: theoretical and empirical analysis of the demand for health and health services, including the effect of payment-for-service; supplier and producer behaviour including questions about the existence and consequence of supplier-induced demand i.e. the professional health groups may, themselves, determine the extent of the demand and employment for their services to a considerable extent. Analyses of productivity and effectiveness and methods for measuring and assessing health status are two other typical subjects. Thus, in the course of the past 15-20 years, health economy has become established as an academic subject with its own professorships and scientific journals.
Cost-Benefit Analysis↗
An investigation of the effect of regional variation in the treatment of hypertension.
Over a period both a monetary and physical measure of antihypertensive drug consumption has increased in Denmark, but the consumption has varied considerably between counties in any given year. Concurrently, SMR for myocardial infarctions and cerebrovascular diseases due to hypertension has declined. The relation between intensity of treatment and outcome in terms of reduced loss of life time or healthy time is analyzed at an aggregate level within a health economic framework. The relation is analyzed by using a pooled time series cross section regression analysis. Two models, a covariance and an error component model are used. Within the range of observed drug consumption, loss of life years and loss of good health show a tendency towards negative regression on consumption of drugs when controlled for relevant variables such as occupational structure, degree of urbanization, and hardness of the drinking water.
Antihypertensive Agents↗
Self-care within a model for demand for medical care.
Self-care is interpreted from a health economic point of view. Various approaches are presented. It is stressed that the decision-oriented approach used by other health service researchers is an integral part of the economic approach to the topic as is the idea of a continuum of care, from self-care to professional care. A new approach is taken to the modeling of self-care, in that self-care becomes part of a four-part demand for care model. This makes it possible to model the demand for care for three different groups separately: 1--persons with zero episodes; 2--persons with pure illness episodes and illness episodes with self-care; 3--persons with episodes involving professional care or professional care combined with self-care. Another contribution is due to the so-called episodic approach to the demand for care. The natural counting units are illness and treatment episodes, i.e. instead of counting for instance number of times a general practitioner is consulted we ought to count the number of episodes involving professional care, self-care or both types of care. The episodic approach seems to be well suited for work with self-care. The empirical part is based on a unique Danish panel study using health diaries returned weekly. Data from 27 of the 52 reporting weeks are used, involving more than 14,000 episodes distributed across about 2800 persons belonging to about 1000 households. The use of health diaries seems to be very well suited to the study of self-care in that less salient events and activities than professional care are picked up far better in prospective health diary studies than in retrospective questionnaire based surveys. Descriptive and regression (logistic and ordinary) results are presented.
Choice Behavior↗
[The Danish health survey 1982-1983. I. Collection of data by means of diaries].
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Adult↗
[The Danish health survey 1982-1983. II. The validity of health diaries].
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Adult↗