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P J Neumann

Publications and source records attributed to P J Neumann.

At least 37 records · Page 2Linked to original sources
PubMed1999

Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease.

OBJECTIVE: To demonstrate the use of cost-effectiveness analysis to assess the economic impact of donepezil in the treatment of mild or moderate AD. BACKGROUND: Cost-effectiveness analyses show the relationship between resources used (costs) and health benefits achieved (effects) for an intervention compared with an alternative strategy. METHODS: We developed a model to estimate the incremental cost-effectiveness of donepezil compared with no treatment. We determined costs per quality-adjusted life-years gained, a measurement that enhances the comparability of diverse studies. The model projects the progression of AD patients into more severe disease stages and into nursing homes. Data from a randomized clinical trial of donepezil were used to assess the drug's impact on the 6-week probabilities of progression. Data on the costs and health-related quality of life associated with different disease stages and settings were taken from published estimates and our companion cross-sectional study, respectively. RESULTS: Donepezil costs are partially offset by a reduction in the costs of care due to enhancement in cognitive functioning and the delay to more costly disease stages and settings. The magnitude of this cost offset and of the effect of donepezil on health-related quality of life depends on the model's assumptions about the duration of the drug effect, where controlled data are lacking. If the drug effect exceeds 2 years, the model predicts that for mild AD the drug would pay for itself in terms of cost offsets. CONCLUSIONS: The results of the cost-effectiveness model presented here suggest that donepezil may be cost-effective but additional controlled data on long-term drug efficacy are needed.

Alzheimer Disease↗
PubMed1999

Health utilities in Alzheimer's disease: a cross-sectional study of patients and caregivers.

OBJECTIVES: Although the broad impacts of Alzheimer's disease (AD) are increasingly recognized, little work has focused on the overall health-related quality of life experienced by Alzheimer's disease patients and their caregivers. The study had two main objectives: (1) to test the feasibility of measuring health utilities in Alzheimer's disease with a generic preference-weighted instrument using proxy respondents and (2) to assess the utility scores of Alzheimer's disease patients (and their caregivers) in different disease stages and care setting. METHODS: A cross-sectional study of 679 Alzheimer's disease patient/caregiver pairs was conducted at 13 sites in the United States: four academic medical centers, four managed care plans, two assisted living facilities, and three nursing homes. The Health Utilities Index Mark II (HUI:2) questionnaire was administered to caregivers of patients who responded both as proxies for patients and for themselves. Responses to the questionnaire were converted into a global utility score, between 0 and 1, using the HUI:2 multi-attribute utility function. RESULTS: Global utility scores varied considerably across patients' Alzheimer's disease stage: for the six stages assessed (questionable, mild, moderate, severe, profound, and terminal), mean utility scores were 0.73, 0.69, 0.53, 0.38, 0.27, and 0.14, respectively. In multiple regression analyses, Alzheimer's disease stage was a negative and significant predictor of utility scores for patients; setting did not exert an independent effect. Utility scores for the caregivers were insensitive to patients' Alzheimer's disease stage and setting. CONCLUSIONS: Patients' Alzheimer's disease stage had a substantial influence on health utilities, as measured by the HUI:2. More research is needed to assess the validity of using proxy respondents.

Activities of Daily Living↗
PubMed1999

Methods of cost-effectiveness analysis in the evaluation of new antipsychotics: implications for schizophrenia treatment.

Because health care payers are increasingly interested in learning whether new treatments offer value for money, there has been an abundance of research into the cost-effectiveness of pharmacologic therapies in the United States. In the past few years, a number of studies comparing the cost-effectiveness of the conventional neuroleptics with that of the atypical antipsychotics have been published. Cost-effectiveness analyses show the relationship between the resources used (costs) and the health benefits achieved (effects) for a health or medical intervention compared with an alternative strategy. Ideally, the analyses can help decision makers improve the health of the population by better allocating society's limited health care resources. However, the extent to which cost-effectiveness data are actually used in decision making is unclear. The analyses are sometimes viewed with skepticism, in part because studies differ in their methodological approaches. Recently, the U.S. Panel on Cost-Effectiveness in Health and Medicine offered recommendations for standard methodological practices, which may help improve the quality of studies and the acceptability of the approach in the future. The issue is particularly important in light of new legislation governing how the Food and Drug Administration will regulate promotional claims made by drug companies regarding health economic information.

Advertising↗
PubMed1999

The cost of Alzheimer's disease in managed care: a cross-sectional study.

BACKGROUND: The number of people with Alzheimer's disease (AD) is expected to grow as the US population ages. Given the increasing enrollment in managed care organizations, growth in the number of managed care patients with AD is a certainty. To our knowledge, no study to date has focused on the cost of care of community-dwelling AD patients receiving care through a health maintenance organization (HMO) system. METHODS: One hundred and fifty patients were recruited from 4 managed care sites from July through December 1996. Staff at each site clinically confirmed patients' AD diagnosis, AD severity, and ascertained patients' comorbidities. Demographic, quality of life, and service utilization data were collected from proxy respondents. Costs of hospitalization, medications, doctor visits (formal costs), and caregiver assistance (informal costs) were analyzed separately. RESULTS: The average total (formal and informal) per-patient costs in the 4 settings in 1996 were $18,804. Costs increased with cognitive impairment. For patients with mild, moderate, and severe AD, annual total costs were $14,904, $19,272, and $25,860, respectively. Annual direct costs were $5520, $7044 and $10,992, respectively. CONCLUSION: Across all severity levels, we calculated a total annual cost of $8.8 billion for managed care enrollees older than 65 years in the United States. We did not estimate these costs for the population younger than 65 years because of the variability in AD prevalence estimates. Due to the increased costs for patients with more severe AD, interventions that would reverse or delay progression may result in significant cost savings.

Aged↗
PubMed1998

The impact of risk information on patients' willingness to pay for autologous blood donation.

OBJECTIVES: For contingent valuation to provide valid values for policy making, it is important that respondents be well informed about the goods they are asked to value. Few studies, however, have tested the impact of providing this information This study assessed the impact of risk information on patients' willingness to pay for autologous blood donation and derived the willingness to pay in a sample of informed patients. METHODS: Patients were randomized either to receive information about the risks of complications from allogeneic (volunteer) blood transfusions or to base their willingness to pay responses on their own prior knowledge. Four hundred twelve autologous blood donors were recruited from three study sites. Self-administered questionnaires collected information on willingness to pay, risk perceptions, and socioeconomic information. RESULTS: As predicted by our theoretical model, providing risk information reduced the variance in the willingness to pay for autologous blood donation. A tendency for information to reduce the willingness to pay was also found, suggesting that uninformed patients, on average, overestimate the risks of allogeneic blood transfusions. The median willingness to pay in the informed sample was approximately $750 to $1,100, depending on the estimation method, compared with $800 to $1,900 in the uninformed group. Willingness to pay was significantly related to perceived transfusion risk, personal income, and dread of transfusions. CONCLUSIONS: Our results are consistent with an economic model where individuals update their prior risk perceptions with new information. The willingness to pay in the informed sample was far higher than the costs of autologous blood donation, suggesting that total benefits outweigh the costs of the procedure.

Adult↗
PubMed1997

Patients' willingness to pay for autologous blood donation.

Most cost-effectiveness analyses of autologous blood donation show very small health benefits for a substantial increase in resource utilization. However, these analyses do not consider the psychological benefits of peace of mind to patients participating in the program. In order to quantitate these benefits, we employed contingent valuation methodology to measure the willingness of patients undergoing elective surgery, to pay for autologous blood donation. The internal consistency of patient responses was investigated through correlations of willingness-to-pay values with risk perceptions and patient characteristics. Two hundred and thirty-five patients completed the self-administered questionnaire which included demographic, willingness-to-pay and risk perception questions. Median population willingness to pay for autologous blood donation was approximately $900 per patient. In multivariate analysis, willingness to pay varied significantly with dread of allogenic transfusion, perceived risk of requiring a blood transfusion and income. Patients who participate in autologous blood donation programs value the procedure highly and state they are willing to pay significant amounts out of pocket to assure themselves of available autologous blood. Willingness to pay correlated significantly with factors expected to influence value decisions.

Attitude to Health↗
PubMed1997

Methods of cost-effectiveness analysis in the assessment of new drugs for Alzheimer's disease.

New treatments for Alzheimer's disease highlight the complex clinical and financial issues at stake with new pharmacotherapies. This paper describes cost-effectiveness analysis as a method for assessing these issues. Cost-effectiveness analyses show the relationship between resources used and health benefits achieved for a medical intervention compared with an alternative strategy. In analyses of treatments of Alzheimer's disease, costs include health care resources, such as diagnostic tests, medications and efforts to monitor or treat side effects, acute hospital care, physicians' services, home health care, and nursing home care; non-health-care resources, such as support services provided by paid caregivers; and time spent by family members in unpaid provision of care and by patients in seeking care or undergoing an intervention. Effectiveness of interventions can be assessed by measuring changes in patients' cognitive functioning or by measuring years of life gained and the quality of life during those years. Cost-effectiveness studies often make use of disparate data sources, including data collected as part of randomized controlled clinical trials, and they often use mathematical models to support estimates. Because economic evaluations of new interventions for Alzheimer's disease will likely play an increasingly influential role in clinical and resource allocation in the coming years, physicians and other health system stakeholders should familiarize themselves with the techniques of cost-effectiveness analysis and become critical consumers of the literature describing these analyses.

Aged↗
PubMed1997

Should health insurance cover IVF? Issues and options.

An emotional debate has attended the question of whether health insurance should cover the cost of in vitro fertilization (IVF) for infertile couples. Some private health plans have opted to cover IVF, although most have not. Ten states have mandated that it be included or offered as a standard benefit for private health insurance plans. This article analyzes several key issues in the debate: the impact of insurance coverage; the cost-effectiveness of IVF; valuing the benefit of IVF; and adoption as an alternative. It recommends policy action in several areas: more efficiently allocating resources for IVF (by giving priority to couples with better chances of success, and by making more extensive use of facilities with higher success rates); ensuring that clear and reliable information about the effectiveness of IVF is available; and leveling the playing field between IVF and adoption.

Adoption↗
PubMed1997

Why training is the key to successful guideline implementation.

The market for pharmacoeconomic analysis is rapidly expanding. Demand for experienced investigators seems to have outpaced the capacity of both the academic community and industry to train qualified practitioners. The result is that many professionals charged with producing and using cost-effectiveness and other drug-related economic evaluation studies may lack the basic skills required to carry out their duties. This, in turn, raises concerns regarding the credibility and integrity of the field as a whole. In our opinion, the adoption of self-imposed practice guidelines is a necessary first step in confronting these issues. However, the power of guidelines to promote responsible practice will be limited by the technical preparation of the analysts charged with adhering to them. A long term solution requires a collaborative commitment, on the part of both the academic community and the private sector, to targeted graduate training in pharmacoeconomic methods, and to the provision of ample opportunities for continuing professional education.

Economics, Pharmaceutical↗
PubMed1996

The FDA and regulation of cost-effectiveness claims.

The Food and Drug Administration (FDA) has issued draft guidelines that would require more rigorous standards for making pharmacoeconomic claims. This paper critiques the guidelines and explores the objectives of market regulation for health-related cost and effectiveness information on pharmaceutical products. It argues that the FDA should proceed with caution and flexibility. In particular, regulations should recognize the potential usefulness of pharmacoeconomic information in helping health care decisionmakers make better-informed choices. They also should acknowledge the enhanced ability of those using the information to evaluate pharmacoeconomic studies and the degree to which the various players in the market can impose their own regulatory discipline.

Cost-Benefit Analysis↗
PubMed1996

Potential savings from using information technology applications in health care in the United States.

We reviewed economic evaluations of information technology (IT) applications in health care in the United States. National estimates suggest that fully automating administrative functions would save the system $5 to $8 billion per year. Hospital-specific estimates suggest that individual facilities could save $0.5 to $3 million annually from various clinical IT applications.

Cost Savings↗
PubMed1995

Participation in the Qualified Medical Beneficiary Program.

This article has three objectives: to estimate how many eligible elderly beneficiaries are participating in the Qualified Medicare Beneficiary (QMB) program; to determine the characteristics of participating and non participating eligibles; and to identify the most significant barriers to program participation. We used data from the Medicare Current Beneficiary Survey (MCBS) and the Medicare Buy-In file. We found that 41 percent of QMB eligibles are enrolled in the program; participation is higher for poor and less educated beneficiaries, those in poorer health, rural residents, African Americans, and Hispanics. Finally, we found that, in general, eligible beneficiaries are ill informed about the program.

Aged↗
PubMed1994

The cost of a successful delivery with in vitro fertilization.

BACKGROUND: The use of in vitro fertilization has engendered considerable debate about who should have the procedure, whether health insurance should cover the cost, and if so, to what extent. We investigated the cost of a successful delivery with in vitro fertilization. METHODS: We calculated the cost per successful delivery with in vitro fertilization (defined as at least one live birth) for a general population of couples undergoing in vitro fertilization and for two subgroups: couples with a diagnosis of tubal disease (who have a better chance of success), and couples in which the woman is over the age of 40 years and the man has a low sperm count (who have a lower chance of success). Information on charges per cycle of in vitro fertilization was obtained from six facilities across the country; delivery rates with this procedure were estimated from the literature. RESULTS: On average, the cost incurred per successful delivery with in vitro fertilization increases from $66,667 for the first cycle of in vitro fertilization to $114,286 by the sixth cycle. The cost increases because with each cycle in which fertilization fails, the probability that a subsequent effort will be successful declines. Sensitivity analyses indicated that the cost per delivery ranges from $44,000 to $211,940. For couples with a better chance of successful in vitro fertilization (i.e., those with a diagnosis of tubal disease), it costs $50,000 per delivery for the first cycle and $72,727 for the sixth. For couples in which the woman is older and there is a diagnosis of male-factor infertility, the cost rises from $160,000 for the first cycle to $800,000 for the sixth. CONCLUSIONS: The debate about insurance coverage for in vitro fertilization must take into account ethical judgments and social values. But analyses of costs and cost effectiveness help elucidate the economic implications of using in vitro fertilization and thus inform the policy discussion.

Adult↗
PubMed1994

The willingness to pay for in vitro fertilization: a pilot study using contingent valuation.

The use of in vitro fertilization (IVF) has increased rapidly in recent years and debate has focused on whether health insurance should cover the procedure. We developed and disseminated a contingent valuation survey to investigate how individuals value IVF treatment. Couples pursuing in vitro fertilization can be viewed as purchasing an increased probability of conceiving and bearing a child. In our survey, respondents were asked if they would pay stated amounts for IVF, under various assumptions about the probability of success. The survey explores the ex post perspective, (respondents' willingness to pay (WTP) for IVF in the event that they are infertile), the ex ante perspective, (WTP for IVF insurance, assuming respondents do not know their infertility status), WTP for a public IVF program, and how respondents value IVF relative to mortality risk reduction. Among 150 respondents who were potential childbearers, average WTP was $17,730 for a 10% chance at having a child through IVF in the event of infertility. Average WTP was $865 for a lifetime insurance benefit providing access to a 10% chance. Among 231 respondents of all ages, average WTP was $32 per year in taxes for a public program giving 1,200 couples per year in Massachusetts a 10% chance. The estimated implied ex post WTP per statistical baby was $177,730, while ex ante WTP per statistical baby was $1.8 million. The results of regression analyses were consistent with theoretical predictions, (e.g., increasing WTP with household income). The contingent valuation method is a potentially useful tool in understanding how people value the benefits of IVF. Further research is needed to test the validity of this methodology.

Adult↗
PubMedDate not supplied

Modeling for health care and other policy decisions: uses, roles, and validity.

The role of models to support recommendations on the cost-effective use of medical technologies and pharmaceuticals is controversial. At the heart of the controversy is the degree to which experimental or other empirical evidence should be required prior to model use. The controversy stems in part from a misconception that the role of models is to establish truth rather than to guide clinical and policy decisions. In other domains of public policy that involve human life and health, such as environmental protection and defense strategy, models are generally accepted as decision aids, and many models have been formally incorporated into regulatory processes and governmental decision making. We formulate an analytical framework for evaluating the role of models as aids to decision making. Implications for the implementation of Section 114 of the Food and Drug Administration Modernization Act (FDAMA) are derived from this framework.

Chlorofluorocarbons↗
PubMedDate not supplied

The association between caregiver burden and caregiver health-related quality of life in Alzheimer disease.

The burden experienced by family caregivers of individuals with Alzheimer disease (AD) affects the caregivers' overall health-related quality of life (HRQOL). Assessing the influence on HRQOL is an integral part of determining the efficacy and economic attractiveness of interventions for AD. Generic preference-weighted instruments such as the Health Utilities Index Mark 2 (HUI2) are recommended for measuring HRQOL for cost-effectiveness studies. However, these instruments focus on physical attributes and have not been tested in an AD caregiver population. We administered the HUI2 to a population of 679 caregivers to people with AD at 13 community and institutional sites in the United States. We also administered the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), a caregiver time questionnaire, and a caregiver burden instrument. The mean global HUI2 utility score for caregivers was 0.87 and varied little by the affected person's setting of care and AD stage (range, 0.86-0.89; p > 0.2). The caregiver burden scales all varied by the affected person's setting of care, and some also varied by disease severity. The mental health component summary score of the SF-36 for caregivers varied across both disease stage and setting. Caregiver time increased for caregivers of AD-affected persons with more severe cognitive impairment. Generic preference-weighted instruments may not adequately capture differences in the burden of caregivers of those with AD. The development of condition-specific preference-weighted instruments may provide the means to better estimate HRQOL in AD caregivers.

Aged↗