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Biomedical subjects

W B Stason

Publications and source records attributed to W B Stason.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1982

Implications of alternative strategies to diagnose coronary artery disease.

Strategies to diagnose coronary artery disease were examined for cost-effectiveness in a hypothetical population of 55-year-old men who, alternatively, are asymptomatic, have atypical angina or have definite angina. Strategies considered include various combinations of noninvasive tests (resting ECG, exercise stress test [ETT]. radionuclide scanning [RNS] and coronary angiography). Benefits are estimated in terms of the detection of multivessel disease and years of life gained from coronary artery bypass graft surgery (CABG). Only the direct costs (charges) for diagnostic or treatment procedures are considered. In asymptomatic persons, the average cost-effectiveness for different strategies ranges from $22,600 per year of life gained (ETT followed in positives by RNS) to $60,000 (angiography as primary screening test). Hence, screening is relatively cost-ineffective and would be extremely expensive if implemented widely. For patients with atypical angina, the cost-effectiveness ratio is about $9300 per year of life gained. Strategies involving use of ETT alone or in combination with the ECG or RNS appear to be preferable. For definite angina, the cost-effectiveness ratio is about $8800. Little difference is noted among various strategies for diagnosing definite angina, and the option to proceed directly to angiography appears reasonable.

Angina Pectoris↗
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↗
PubMed1979

Determinants of dropout rate among hypertensive patients in an urban clinic.

Noncompliance with follow-up is a serious problem in the management of hypertension. A retrospective cohort study examined dropout rates and their determinants among 249 randomly selected outpatients with essential hypertension from the medical clinic of an urban teaching hospital. Data were abstracted from hospital records and a subset of dropouts was interviewed. A lifetable analysis revealed that patients who were initiating therapy or who had been under therapy for less than six months had a 50% chance of remaining in care two years later, while 70% of patients who had been under therapy for more than six months at entry were still in care after this period. Patients who were less severely ill by several indicators were the most likely to drop out. It is hypothesized that the low perceived severity of illness, coupled with the costs and inconvenience of care and the lack of physician enthusiasm for the treatment of mild hypertension leads to non-compliance with follow-up.

Adult↗
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↗
PubMed1979

Toward developing a relative value scale for medical and surgical services.

A methodology has been developed to determine the relative values of surgical procedures and medical office visits on the basis of resource costs. The time taken to perform the service and the complexity of that service are the most critical variables. Inter-specialty differences in the opportunity costs of training and overhead expenses are also considered. Results indicate some important differences between the relative values based on resource costs and existing standards, prevailing Medicare charges, and California Relative Value Study values. Most dramatic are discrepancies between existing reimbursement levels and resource cost values for office visits compared to surgical procedures. These vary from procedure to procedure and specialty to specialty but indicate that, on the average, office visits are undervalued (or surgical procedures overvalued) four- to five-fold. After standardizing the variations in the complexity of different procedures, the hourly reimbursement rate in 1978 ranged from $40 for a general practitioner to $200 for surgical specialists.

Fee Schedules↗
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↗
PubMed1978

Impact of patient perceptions on compliance with treatment for hypertension.

Patient noncompliance with medical regimens is a major obstacle in achieving hypertension control. In this study the relationships between patients' perceptions of health, disease and medical treatment and compliance were examined in personal interviews with 142 patients under treatment for hypertension. Compliance was measured in terms of blood pressure control, self-reported medication-taking, and appointment keeping. A multivariate log linear technique was used to control confounding. Blood pressure control was found to be associated with the perceived effficacy of the antihypertensive regimen, having medications prescribed for other chronic conditions, a high level of anxiety when hypertension was first diagnosed, the impact of hypertension and its treatment on lifestyle, and a higher educational level. For self-reported medication-taking, the perceived severity of hypertension, having medications prescribed for other chronic conditions and older age were predictive. Blood pressure control and self-reported medication-taking were highly correlated with each other(p = .02). Older age and being employed were the only variables that contributed independently to improved appointment keeping behavior. From these findings, it might be expected that emphasis on the effectiveness of treatment and on the potential threat posed by hypertension would motivate improved blood pressure control.

Aged↗
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↗
PubMed1976

Alcohol consumption and nonfatal myocardial infarction.

A study of the relathonship between alcohol consumption and nonfatal myocardial infarction, involving 399 cases and 2486 reference subjects, indicated absence of any major overall association (rate ratio point estimate of 0.9 with 95% confidence limits of 0.6 and 1.2), but there was some evidence of a lower rate in subjects consuming six or more drinks per day (rate ratio point estimate of 0.6 with 95% confidence limits of 0.3 and 1.1). Confounding by several potential confounders was controlled by stratification according to a confounder-summarizing score.

Adult↗