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Biomedical subjects

M C Weinstein

Publications and source records attributed to M C Weinstein.

At least 127 records · Page 7Linked to original sources
PubMed1983

Cost-effective priorities for cancer prevention.

Faced with limited resources, the United States must set priorities for research to identify preventable causes of cancer. A quantitative approach to priority setting, based on principles of decision analysis and cost-effectiveness analysis, can offer guidance in this process. An illustrative application of such a model suggests that the National Institutes of Health-supported clinical trial of dietary beta-carotene offers a greater expected reduction in cancer mortality per research dollar than carcinogen bioassays of high-volume industrial chemicals such as p-dichlorobenzene. National research priorities should reflect the relative cost-effectiveness of such investments.

Animals↗
PubMed1983

Cost-effectiveness of hormone replacement therapy in the menopause.

Costs, risks, and benefits of estrogen-progestin therapy in the menopause were compared with those for estrogen alone, using techniques of cost-effectiveness analysis. With the progestin added, reduced costs of endometrial monitoring and treatment of endometrial lesions more than offset the increased cost of the drug regimen with a net saving of $230-$430 per patient, depending on the duration of treatment. An estimated gain in life expectancy with estrogen-progestin compared to estrogen alone may be partly offset by a perceived reduction in the quality of life owing to the prolongation of menstruation in women receiving progestin. Overall, based on currently available evidence, estrogen-progestin therapy appears to be cost-effective, except in women who consider the adverse effects of continued menstruation to offset the relief of menopausal symptoms. These conclusions must be viewed as tentative, pending further clarification of the roles of estrogens and progestins in cardiovascular disease and breast cancer.

Aged↗
PubMed1983

Optimal strategies for the diagnosis and treatment of coronary artery disease. Analysis using microcomputer.

A computer program has been developed to aid in diagnostic and therapeutic decisions concerning a patient with chest pain. It provides an analysis tailored to the individual patient, in that the data used in the analysis depend on specific patient characteristics. The user can elect to examine all stored data values (probabilities, quality-adjusted life expectancies, and monetary costs), and to alter any of them. Decisions at three stages in the patient workup are considered: prior to any diagnostic test, following an exercise tolerance test, and following coronary angiography. The results of the analysis can be displayed in several tabular and graphical formats. In addition, the program can carry out a Monte Carlo simulation (or probabilistic sensitivity analysis) to determine the effect of uncertainty in the data on the stability of the choice of optimal strategy.

Computers↗
PubMed1982

Cost-effectiveness of coronary artery bypass surgery.

Recent data from the medical literature and other sources were used in an analysis of the cost-effectiveness of coronary artery bypass graft surgery (CABG) in symptomatic patients. Health effectiveness was expressed as the gain in quality-adjusted life expectancy, allowing for a range of subjective weights attached to symptomatic benefits. Costs included those of surgery, medical management of angina, and treatment of future myocardial infarctions. CABG appears to increase unadjusted life expectancy by 0.6 years in patients with two-vessel disease and 6.9 years in patients with left main coronary disease. Even in one-vessel disease, a gain in quality-adjusted life expectancy is estimated, owing to symptomatic benefits. For patients with severe angina, the estimated net cost per quality-adjusted year of life gained from CABG ranges from $3800 in left main disease to $30,000 in one-vessel disease. These figures compare favorably with those for other accepted medical therapies, such as treatment of moderate diastolic hypertension.

Angina Pectoris↗
PubMed1981

When doctors meet numbers.

A Statistical Skills Self-Assessment Questionnaire (SAQ) was developed using hypothetical clinical questions to explore respondents' mastery of vocabulary and rules of inference that seem relevant to the use of quantitative information. The SAQ was administered to 281 subjects, including 36 medical students, 45 interns and residents, 49 physicians engaged in research and 151 physicians in full-time practice. All groups of subjects showed frequent lack of consensus on the meaning of terms in common use (e.g., "false-positive rate" and "p values") and unfamiliarity with some important principles in quantitative inference (e.g., the Central Limit Theorem and Regression to the Mean). Subjects often seemed willing to draw conclusions unsupported by available data. Performance on the SAQ was inversely correlated with length of time since graduation from medical school, and practicing physicians tended to err more frequently than the other three groups.

Education, Medical↗
PubMed1981

Coronary artery bypass graft surgery: clinical decision making and cost-effectiveness analysis.

Decision-analytic techniques were used to evaluate the choice between an aortocoronary bypass operation and medical management in a set of hypothetical patients with coronary artery disease. The decision framework incorporates variables believed to have an important bearing on the choice of treatment. Probability estimates were obtained from two cardiologists and one cardiac surgeon. Patient preferences for the trade-off between years of survival and the quality of life as reflected by the severity of angina pectoris were made explicit by assigning utility values to alternative health outcomes. The results are expressed in terms of quality-adjusted years of life expectancy. Decision analysis favored operation for 13 of the 14 hypothetical patients, including patients with one- and two-vessel disease. The one patient for whom medical treatment was preferred had mild angina pectoris, severe left ventricular dysfunction, and a poor prognosis regardless of therapeutic modality. The results are sensitive to changes in the probability of long-term survival, but not to changes in operative mortality rates. In five patients, the physicians' clinical judgments favored medical treatment, whereas their decision-analysis-derived estimates of survival favored operation. Possible explanations for these discrepancies are discussed. A simplified cost-effectiveness analysis for patients in whom surgery was the optimal treatment indicated costs ranging from $1,500 to $250,000 per year of life gained and from $1,500 to $32,000 per quality-adjusted year of life gained.

Adult↗
PubMed1981

Economic assessments of medical practices and technologies.

Cost-effectiveness analysis can be useful as an aid to decision makers concerned with the allocation of health care resources. The approach requires an explicit, quantitative measure of the health effectiveness of the intervention under analysis, as well as a measure of its net resource cost. Cost-effectiveness analyses are less useful if the measure of effectiveness is expressed in units that are unique to the intervention or class of interventions being considered than if the measure is comparable across interventions. The life year as a unit offers the advantage of comparability across programs, but its use in cost-effectiveness analysis can be misleading if the effects of the program in question include changes in the quality of life. Cost-effectiveness analyses of estrogen therapy in the menopause, high blood pressure control, and coronary artery bypass surgery are used to illustrate the method of analysis and the sensitivity of conclusions to the manner in which quality-of-life impacts are included explicitly (or excluded entirely). Cost-effectiveness analyses, therefore, should always include sensitivity analyses in which preference weights and parameters are varied over the plausible range. Inability to measure the quality of life and preferences regarding such effects should not be an excuse for failing to include them in a cost-effectiveness analysis.

Coronary Artery Bypass↗
PubMed1980

Estrogen use in postmenopausal women--costs, risks, and benefits.

The cost effectiveness of estrogen use in postmenopausal women was analyzed with use of data from the medical and epidemiologic literature. Risks of endometrial cancer, uterine bleeding, and gallbladder disease were weighed against benefits associated with relief of menopausal symptoms and with prevention of osteoporosis and consequent fractures. Net effects on life expectancy are probably small in either direction, although they are likely to be positive in women with existing osteoporosis or prior hysterectomy. Treatment appears to be relatively cost effective in menopausal women with prior hysterectomy or osteoporosis but does not appear to be cost effective as a prophylactiv measure in asymptomatic women with intact uteri. For women with menopausal symptoms and intact uteri, the decision to prescribe estrogens for the individual patient and the cost effectiveness of estrogen use at the societal level depend critically on the subjective values assigned to symptomatic relief.

Aged↗
PubMed1980

Cost-effectiveness analysis for clinical procedures in oncology.

The provision of medical care consumes resources, and the resources available for the provision of medical care are limited. Decisions are being made at many levels of the Health Care System, including providers and fiscal intermediaries, to allocate these resources. Such decisions, however, are often inconsistent with the objective of deriving the maximum health benefits from the resources spent. Many cost-effectiveness and benefit-cost studies have been conducted in order to guide present and future resource allocation decisions. Many analyses have not been accepted by health care decision makers because a critical factor or issue has been omitted. In the attempt to be objective, the analyst may avoid uncertainties or subjective value judgments that often dominate the thinking of the decision maker. The role of the analyst in cost-effectiveness analysis, as in decision analysis for the individual patient, is to clarify and highlight such factors not to obfuscate them.

Cost-Benefit Analysis↗
PubMed1979

Pertussis vaccine--an analysis of benefits, risks and costs.

Using decision analysis, we estimated the benefits, risks and costs of routine childhood immunization against pertussis. Without an immunization program, we predict that there would be a 71-fold increase in cases and an almost fourfold increase in deaths (2.0 to 7.6) per cohort of one million children. With a vaccination program, we predict 0.1 case of encephalitis associated with pertussis and five cases of post-vaccination encephalitis; without a program, there would be only 2.3 cases of encephalitis associated with pertussis. Community vaccination would reduce by 61 per cent the costs related to pertussis. Our analysis supports continuation of vaccination in routine childhood immunization programs, but suggests the need for more reliable data on complications from the vaccine, further study of the epidemiology of pertussis and development of a less toxic vaccine.

Child↗
PubMed1979

Sample-size estimation: a sensitivity analysis in the context of a clinical trial for treatment of mild hypertension.

The effectiveness of treatment for mild hypertension (diastolic pressures of 85 to 105 mm Hg) has not been conclusively demonstrated. Both the costs of a carefully designed clinical trial and the likelihood that it will produce definitive answers will depend importantly on the sample size. This paper presents sample-size estimates under a variety of assumptions regarding the characteristics of the population to be studied, the degree of blood pressure control to be achieved, and the health benefits to be expected. Under a central set of assumptions, the estimated sample size per group is 22,700 with death as an endpoint and 14,000 with morbid events (CHD and stroke) as endpoints. As individual assumptions are varied one at a time, required sample sizes range from 10,900 to 101,100 and from 6,800 to 63,100 for the respective endpoints. Results are most sensitive to the degree of blood pressure control actually achieved to the expected health benefits from blood pressure control. They are also highly sensitive to the sex composition of the population and to expected dropout rates. The choice of sample size will depend on the decision maker's assessment of the likelihood that each assumption will be fulfilled and on the degree of willingness to risk an inconclusive study result. By making explicit the effect of variation in each assumption, decision making is rendered more susceptible to critical examination by outside reviewers.

Adult↗
PubMed1978

Screening for hypertension: a rational approach.

A strategy for the control of hypertension in communities is presented as a staged program. Stage I consists of the evaluation and improvement of hypertension management in health care facilities. Stage II entails case-finding in health care facilities. Finally, Stage III involves targeted screening in the community. While isolated screening programs have been justly labeled "irrational", such a sequential strategy represents a highly rational approach to the community control of hypertension.

Community Health Services↗
PubMed1977

Foundations of cost-effectiveness analysis for health and medical practices.

Limits on health-care resources mandate that resource-allocation decisions be guided by considerations of cost in relation to expected benefits. In cost-effectiveness analysis, the ratio of net health-care costs to net health benefits provides an index by which priorities may be set. Quality-of-life concerns, including both adverse and beneficial effects of therapy, may be incorporated in the calculation of health benefits as adjustments to life expectancy. The timing of future benefits and costs may be accounted for by the appropriate use of discounting. Current decisions must inevitably be based on imperfect information, but sensitivity analysis can increase the level of confidence in some decisions while suggesting areas where further research may be valuable in guiding others. Analyses should be adaptable to the needs of various health-care decision makers, including planners, administrators and providers.

Cost-Benefit Analysis↗