PubMed · 9887858
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K R Jones. 1998. Operating indicators.. https://pubmed.ncbi.nlm.nih.gov/9887858/
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We assessed the direct and indirect economic costs and benefits of the current policy of revaccinating tuberculin-negative schoolchildren in the Czech Republic. The analysis is conducted from the perspective of the payer for health care. In considering whether revaccination should be discontinued, we consistently made assumptions which tend to favor revaccination. The direct costs of revaccination are estimated at Czech Koruna (KCR) 15.0 million (US$0.46 million) annually. The direct benefits are the treatment costs saved for future cases averted by revaccination. These range from KCR 0.5 million (US$0.015 million, ambulatory care, excluding transmission benefits) to KCR 13.7 million (US$0.4 million, hospitalization, including transmission benefits). Costs exceed benefits even if children are revaccinated without prior tuberculin testing. The major indirect cost is the loss of work output attributable to tuberculosis morbidity. Counting the averted loss in output as a benefit does not change the results qualitatively, although there is a 50% chance that the benefits will be greater than costs if treatment continues to be hospital-based. Thus, the costs of revaccination in the Czech Republic are found to exceed benefits over most, plausible variations in parameter values. The cost-benefit ratio is especially large if patients are given ambulatory treatment, as recommended by the World Health Organization.
Many patients with terminal cancer would prefer to receive care at home. Frequently, however, socio-economic or familial constraints make this impossible, although from the medical point of view there might be no objections, even when the late stage of the disease is associated with certain complications. However, the preconditions must first be defined and agreed when the patient and relatives are making the necessary preparations--as far as possible jointly with a team comprising family doctor, oncologist and nursing service. Binding agreements among all those involved are required to ensure that in difficult situations the patient and his family receive the support they need. A number of common medical problems met with during palliative treatment, such as diarrhea, constipation, pleural effusion, etc. are described.