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PubMed1994

Measuring the cost of children.

"The purpose of this paper is to present a survey and synthesis of those economic models that have been used to derive estimates of marginal child costs from cross-sectional data on household expenditure patterns [in Australia].... In the next section the argument that the 'costs of children' should not be a concern of social policy is considered (and rejected). Section III then summarises the models.... In Section IV an Engel curve system estimated from the 1988-89 Household Expenditure Survey is used to compare [the models].... In the concluding section some directions for further research and data collection strategies are discussed."

Adolescent↗
PubMed1985

Economic-demographic models for forecasting interregional migration.

"A class of spatial economic-demographic forecasting models is proposed. The models combine elements of traditional Markov and economic gravity models. A base-period probability structure is modified by the changing relative distribution of economic opportunity. Estimation issues are addressed, and an empirical application to US interstate migration during the late 1970s is described. It is contended that the framework represents a merger of past demographic and economic modeling traditions in a spatial interaction framework."

Americas↗
PubMedDate not supplied

A model for economic analysis.

The production process model is proposed as a way to guide economic evaluation of health care projects, programs, technology, or research. The model is illustrated with data from the development of a home care computer intervention.

Cost-Benefit Analysis↗
PubMed2002

Economic-environmental modeling of point source pollution in Jefferson County, Alabama, USA.

This paper uses an integrated economic-environmental model to assess the point source pollution from major industries in Jefferson County, Northern Alabama. Industrial expansion generates employment, income, and tax revenue for the public sector; however, it is also often associated with the discharge of chemical pollutants. Jefferson County is one of the largest industrial counties in Alabama that experienced smog warnings and ambient ozone concentration, 1996-1999. Past studies of chemical discharge from industries have used models to assess the pollution impact of individual plants. This study, however, uses an extended Input-Output (I-O) economic model with pollution emission coefficients to assess direct and indirect pollutant emission for several major industries in Jefferson County. The major findings of the study are: (a) the principal emission by the selected industries are volatile organic compounds (VOC) and these contribute to the ambient ozone concentration; (b) the direct and indirect emissions are significantly higher than the direct emission by some industries, indicating that an isolated analysis will underestimate the emission by an industry; (c) while low emission coefficient industries may suggest industry choice they may also emit the most hazardous chemicals. This study is limited by the assumptions made, and the data availability, however it provides a useful analytical tool for direct and cumulative emission estimation and generates insights on the complexity in choice of industries.

Alabama↗
PubMed1987

[Models of economic theory of population growth].

"The economic theory of population growth applies the opportunity cost approach to the fertility decision. Variations and differentials in fertility are caused by the available resources and relative prices or by the relative production costs of child services. Pure changes in real income raise the demand for children or the total amount spent on children. If relative prices or production costs and real income are affected together the effect on fertility requires separate consideration." (SUMMARY IN ENG)

Adolescent↗
PubMed1982

Determinants of child mortality, health, and nutrition in a developing country.

The authors investigate the determinants of child mortality and health and nutrition status in Nicaragua using economic models of household behavior. In particular, they examine regional differences by degree of urbanization. Various factors affecting child mortality are considered. The results indicate that "income is not an important factor, there is an inverse relation with number of siblings, and there are positive associations with calorie intake, schooling (except in the relatively low-income areas), the availability of refrigeration, and the quality of sewage systems."

Americas↗
PubMed2003

Self, friends, and lovers: structural relations among Beck Depression Inventory scores and perceived mate values.

BACKGROUND: We used an economic model based on evolutionary theory to guide an examination of relations among self-reported depressive symptoms and ratings of mate values of self, social, and sexual partners. This model treats assortative mating as a form of social exchange between partners of socially and sexually desirable traits. METHODS: Two studies used variants of the Mate Value Inventory (MVI), a multivariate assessment of attributes desired in social or sexual partners. For study 1, 115 male and 124 female undergraduates provided self reports on four forms of the MVI-11 and on the Beck Depression Inventory (BDI); for study 2, 208 male and 277 female undergraduates provided self reports on seven forms of the MVI-7 and on the BDI-II. RESULTS: Both multisample structural equations models indicated that the parameters were statistically equivalent between female and male subsamples and provided an adequate fit to the data. The models revealed significant relations between the mate values ascribed to the self and those ascribed to short- and long-term partners as well as best friends. Furthermore, greater BDI scores significantly predicted lesser ratings of mate value for the self, and hence indirectly predicted lesser ratings of mate value for all types of partners evaluated. LIMITATIONS: Although the data obtained from the MVI demonstrated good psychometric validity, external validity has not yet been established. CONCLUSIONS: The results are consistent with models predicting: (1) assortative mating by mate value, (2) differential exchange rates of mate value for different types of partners, (3) a negative relation between depressive symptoms and assessment of one's own mate value, and (4) a possibly consequential mismatch of mate values when one partner exhibits or recovers from significant depressive symptoms. The results are inconsistent with models predicting (5) a generalized negativity bias due to depression.

Adolescent↗
PubMed2002

Incremental cost-effectiveness of laser therapy for visual loss secondary to branch retinal vein occlusion.

PURPOSE: To ascertain the incremental cost-effectiveness of therapeutic interventions for improving visual loss associated with branch retinal vein occlusion. METHODS: A cost-utility analysis incorporating data from the Branch Vein Occlusion Study Group was performed using patient-based preferences obtained from time tradeoff utility analysis, decision analysis with Markov modeling, and economic modeling with future value analysis. The cost-effectiveness results are expressed in dollars/QALY (dollars expended per quality-adjusted life-year) gained. This unique model takes into account the visual acuity in the better seeing eye and the recurrent risk for visual loss in the contralateral eye. RESULTS: Laser therapy for macular edema secondary to branch retinal vein occlusion was associated with an incremental dollars/QALY gained of 6118 dollars (in year 2000 U.S. dollars). Two-way sensitivity analysis, varying the discount rate and the proportion of patients developing a vascular occlusion in the contralateral eye, revealed a range of dollars/QALY gained from 3370 dollars to 19,299 dollars. CONCLUSIONS: Laser therapy appears to be a cost-effective intervention for improving visual loss associated with macular edema secondary to branch retinal vein occlusion. Variants of the methodology employed to calculate the incremental cost-effectiveness of this intervention can be widely applied across all specialties in medicine.

Aged↗
PubMed2006

Retrospective cost-effectiveness analyses for polio vaccination in the United States.

The history of polio vaccination in the United States spans 50 years and includes different phases of the disease, multiple vaccines, and a sustained significant commitment of resources. We estimated cost-effectiveness ratios and assessed the net benefits of polio vaccination applicable at various points in time from the societal perspective and we discounted these back to appropriate points in time. We reconstructed vaccine price data from available sources and used these to retrospectively estimate the total costs of the U.S. historical polio vaccination strategies (all costs reported in year 2002 dollars). We estimate that the United States invested approximately US dollars 35 billion (1955 net present value, discount rate of 3%) in polio vaccines between 1955 and 2005 and will invest approximately US dollars 1.4 billion (1955 net present value, or US dollars 6.3 billion in 2006 net present value) between 2006 and 2015 assuming a policy of continued use of inactivated poliovirus vaccine (IPV) for routine vaccination. The historical and future investments translate into over 1.7 billion vaccinations that prevent approximately 1.1 million cases of paralytic polio and over 160,000 deaths (1955 net present values of approximately 480,000 cases and 73,000 deaths). Due to treatment cost savings, the investment implies net benefits of approximately US dollars 180 billion (1955 net present value), even without incorporating the intangible costs of suffering and death and of averted fear. Retrospectively, the U.S. investment in polio vaccination represents a highly valuable, cost-saving public health program. Observed changes in the cost-effectiveness ratio estimates over time suggest the need for living economic models for interventions that appropriately change with time. This article also demonstrates that estimates of cost-effectiveness ratios at any single time point may fail to adequately consider the context of the investment made to date and the importance of population and other dynamics, and shows the importance of dynamic modeling.

Adult↗
PubMed2003

Skills or skilled? Children's nursing in the context of the current debate around nursing skills.

This article seeks to demonstrate how the current debate around nursing skills is derived from an economic model of care and competency that has been based on the needs of the adult population. The professional perspective of children's nursing has been unheard in policy and decision-making circles concerning the skills agenda debate within educational and clinical practice. As a consequence, the need of children's nurses has been assumed to be the same as those of general/adult nursing. This article argues that children's nursing has followed a different historical and professional pathway on its progression to maturity. These differences call for alternative educational and clinical solutions for children's nurses in the issue of skills acquisition. In the children's nursing context, this is the difference between having a skill and being skilled. Recognition of this could ensure that children's nursing has a valuable contribution to make to the debate from its unique perspective.

Clinical Competence↗
PubMed2003

A model to assess the cost effectiveness of statins in achieving the UK National Service Framework target cholesterol levels.

BACKGROUND: Coronary heart disease (CHD) is a public health priority in the UK. The National Service Framework (NSF) has set standards for the prevention, diagnosis and treatment of CHD, which include the use of cholesterol-lowering agents aimed at achieving targets of blood total cholesterol (TC) < 5.0 mmol/L and low density lipoprotein-cholesterol (LDL-C) < 3.0 mmol/L. In order to achieve these targets cost effectively, prescribers need to make an informed choice from the range of statins available. AIM: To estimate the average and relative cost effectiveness of atorvastatin, fluvastatin, pravastatin and simvastatin in achieving the NSF LDL-C and TC targets. DESIGN: Model-based economic evaluation. METHODS: An economic model was constructed to estimate the number of patients achieving the NSF targets for LDL-C and TC at each dose of statin, and to calculate the average drug cost and incremental drug cost per patient achieving the target levels. The population baseline LDL-C and TC, and drug efficacy and drug costs were taken from previously published data. Estimates of the distribution of patients receiving each dose of statin were derived from the UK national DIN-LINK database. RESULTS: The estimated annual drug cost per 1000 patients treated with atorvastatin was pound 289000, with simvastatin pound 315000, with pravastatin pound 333000 and with fluvastatin pound 167000. The percentages of patients achieving target are 74.4%, 46.4%, 28.4% and 13.2% for atorvastatin, simvastatin, pravastatin and fluvastatin, respectively. Incremental drug cost per extra patient treated to LDL-C and TC targets compared with fluvastatin were pound 198 and pound 226 for atorvastatin, pound 443 and pound 567 for simvastatin and pound 1089 and pound 2298 for pravastatin, using 2002 drug costs. CONCLUSIONS: As a result of its superior efficacy, atorvastatin generates a favourable cost-effectiveness profile as measured by drug cost per patient treated to LDL-C and TC targets. For a given drug budget, more patients would achieve NSF LDL-C and TC targets with atorvastatin than with any of the other statins examined.

Atorvastatin↗
PubMed1997

Economic analyses of phase III cooperative cancer group clinical trials: are they feasible?

Both economic and clinical evaluations of new pharmaceutical agents are important to physicians who practice in the current health care environment. While cooperative cancer groups carry out large-scale phase III clinical evaluations of these agents, few cooperative group studies incorporate economic analyses because of concerns over overburdening of data management, investigators, and statistical center personnel. In this study, we describe the results and operational considerations of one of the first completed economic analyses of a phase III cooperative group trial of the Eastern Cooperative Oncology Group (ECOG). We developed an economic model estimating economic benefits of yeast-derived granulocyte-macrophage colony-stimulating factor (GM-CSF) as adjunct therapy for adult patients (56-70 years) with acute myelogenous leukemia. Clinical data were based on prospectively collected information from a recently reported double-blind phase III multi-institutional study carried out by ECOG. Retrospective economic data were obtained from financial information systems at our hospital, one of the study sites. The cost-minimization analyses were based on the perspective of a third-party payer. Indirect costs related to loss of earnings by patients and caregivers as well as quality-of-life adjustments were not incorporated into the model. Clinical trial results indicated that patients treated with GM-CSF had shorter times to recovery of absolute neutrophil count of 500 cells/mm3 and 1000 cells/mm3 and fewer serious infections than patients who received placebo following induction chemotherapy, while no significant differences were noted in red blood cell and platelet transfusion dependency, toxicities, and duration of hospitalization. The economic model estimated that the group treated with GM-CSF was estimated to have lower costs of care, associated with lower frequencies of serious infections and lower overall infection-related costs. Sensitivity analyses indicated that these results held true over a wide range of estimates of costs and infection rates. Prospective economic analyses of phase III cooperative cancer group clinical trials have not been completed to date. Strategies that are not likely to overburden data managers and statistical center personnel are possible to devise. However, these studies require careful planning and coordination between clinical trialists, economists, and health services researchers.

Adult↗
PubMed2003

A 3-stage model for assessing the probable economic effects of direct-to-consumer advertising of pharmaceuticals.

BACKGROUND: The pharmaceutical industry employs a variety of marketing strategies that have previously been directed primarily toward physicians. However, mass media direct-to-consumer (DTC) advertising of prescription drugs has emerged as a ubiquitous promotional strategy. OBJECTIVE: This article explores the economics of DTC advertising in greater depth than has been done in the past by using a 3-stage economic model to assess the pertinent literature and to show the probable effects of DTC advertising in the United States. METHODS: Economics literature on the subject was searched using the Journal of Economic Literature. Health services literature was searched using computer callback devices. RESULTS: Spending on DTC advertising in the United States increased from $17 million in 1985 to $2.5 billion in 2000. Proponents of DTC advertising claim that it provides valuable product-related information to health care professionals and patients, may contribute to better use of medications, and helps patients take charge of their own health care. Opponents argue that DTC advertising provides misleading messages rather than well-balanced, evidence-based information. The literature is replete with opinions about the effects of prescription drug advertising on pharmaceutical drug prices and physician-prescribing patterns, but few studies have addressed the issues beyond opinion surveys. The economic literature on advertising effects in other markets, however, may provide insight. CONCLUSION: DTC advertising indirectly affects the price and the quantity of production of pharmaceuticals via its effect on changes in consumer demand.

Advertising↗
PubMed1988

A non-linear goal programming approach to modeling intraregional economic development.

"This paper provides a one-period normative model that may be used as a guide or benchmark by which the economic planner may develop policies and plans for regional economic development. The model can accomodate a region that could be as large as a small country or as small as a city, provided sufficient relevant data are available." The authors outline "a procedure for modeling and solving economic planning and analysis problems with 'intergoal trade-offs' while retaining the deviational variable as a measure of satisfaction....[They present] a generalized regional polynomial goal programming model with some suggested objectives and constraints [and illustrate] the approach with a hypothetical example."

Economics↗
PubMedDate not supplied

Development and use of an economic evaluation model to assess establishment of local centralized rural biogas plants in Greece.

An economic evaluation model was developed in the Laboratory of Agricultural Structures (LAS) of the Agricultural University of Athens-the Modified Basic Economic Evaluation Model (MBEEM). This model is an improved version of the original Basic Economic Evaluation Model, available in LAS, and it is used to assess the cost-effectiveness of biogas production systems. Because of the parameters involved, a computer model was developed to facilitate the application of the MBEEM. The model was used in this work to determine the cost-effective size of a local centralized biogas production system fed with pig wastes.

Animals↗
PubMedDate not supplied

Modelling in economic evaluation: an unavoidable fact of life.

The role of modelling in economic evaluation is explored by discussing, with examples, the uses of models. The expanded use of pragmatic clinical trials as an alternative to models is discussed. Some suggestions for good modelling practice are made.

Clinical Trials as Topic↗
PubMed2002

Almotriptan versus sumatriptan in migraine treatment: direct medical costs of managing adverse chest symptoms.

OBJECTIVE: Triptans, a popular class of drugs for treatment of migraine headaches, can cause adverse events including chest symptoms. This study estimated the direct medical costs of managing chest symptoms in patients treated for acute migraine with almotriptan or sumatriptan using an economic model. METHODS: The economic model of this study combined data from a randomized clinical trial that compared almotriptan with sumatriptan and data from a practice pattern survey of physicians. The pertinent clinical evaluation period was the time immediately after administration of the first medication dose. The model was developed from the perspective of a managed care payer. RESULTS: The average direct medical cost of managing chest symptoms that appeared after the first dose of an oral triptan was $0.22 for patients treated with almotriptan and $1.64 for patients treated with sumatriptan, a difference of $1.42 per patient. CONCLUSION: Relative to sumatriptan, treatment with almotriptan is likely to reduce patient care costs associated with chest symptom adverse events.

Chest Pain↗