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PubMed1993

[Control strategies against salmonella infections in poultry raising at the European Economic Community level--translation of the so-called Economic Community Zoonoses Guideline].

Since at the end of the eighties there were reports on an increased occurrence in Great Britain of salmonella enteritidis infections in human beings which were predominantly caused by raw egg dishes, the Commission of the EEC also started activities designed as a protection against such an obvious new dimension of salmonella infections. Mainly prompted by British activities, the Commission of the EEC elaborated a proposal for a Zoonosis Directive of the EEC. This proposal was intended to provide for the recording of data on specific zoonoses and their pathogenic agents--i.e. a monitoring--as well as for the measures to be introduced at Community level or in the member states. The Directive was adopted in the Council of Ministers of Agriculture on 17 December 1992 (Directive 92/117/EEC), it is to be translated by a poultry salmonella regulation of the Federal Ministry of Food, Agriculture and Forestry. It will provide for controls by the farm manager, for official controls as well as for official measures including f.i. a quarantine of the poultry stock and a killing of the fowl. Beginning in 1995, there will probably be reports on EEC measures in the feeding stuffs sector (microbiological controls) as well as on national hygiene measures in the fields of egg marketing, raw egg consumption in canteens and voluntary control in laying hen farms--in anticipation of an EEC regulation on these stocks.

Animals↗
PubMed1999

Economic evaluation and mental health: sparse past. fertile future?

BACKGROUND: Demands for economic inputs to mental health policy-making, practice decisions and research evaluations have grown considerably in recent years, but the overall supply response has been modest and uneven. AIMS: This paper examines the key historical phases in the development of mental health economics research, and what they imply for the way economics is received and employed. Focusing on the quest for cost-effectiveness, the paper considers challenges for mental health economics. METHODS: An informal review of the growing demand for mental health economics (and how that demand has been expressed), and how economists have responded. RESULTS: Five historical development phases characterize this growth. Initially, the dominant feature is innocence or neglect of scarcity. Cost measures are rarely calculated, cost-effectiveness is not part of the decision-making lexicon and the potential for inefficiency is huge. In the second phase, innocence turns to criticism of attempts to introduce resource rationality, and many clinicians actively reject economics. Health is seen as priceless, and not to be compromised by the pursuit of efficiency. After a period of reluctance there follows impetuosity as the need for economic insights is recognized, but the search for data is desperate and undiscriminating. Poor quality research is conducted, with the risk that decisions are misinformed and perhaps damaging. Once again, resources are inappropriately used. Next follows the constructive development phase: previous mistakes are appreciated and the standards of evaluation improve markedly. Studies are better designed, more likely to be integrated into clinical or policy evaluations, carefully conducted and sensibly interpreted. Inefficiency should be reduced, along with inequity. Finally, there is perhaps a nirvana-like fifth phase in which sophisticated economic studies are widely undertaken, where systematic reviews and meta-analyses help to reveal the wider picture and where findings are readily available to clinicians, managers and providers. Whether such a stage is attainable is open to question. DISCUSSION: Although the number and sophistication of economic evaluations have both increased noticeably over recent years, there remain imbalances. There is little economics evidence on care arrangements or treatments for dementia, most of the neuroses and the disorders of childhood and adolescence. There are many fewer good evaluations of psychological interventions than of drug treatments. Geographically, few economic evaluations are conducted outside Western Europe, North America or Australasia. IMPLICATIONS FOR DECISION-MAKERS AND RESEARCH: Many challenges consequently face the next generation of mental health economics evaluations, both for research economists and for those health care decision-makers who find themselves increasingly having to draw on economics evidence. One challenge is to be fully aware that the information that economists can currently offer may fall short of what decision-makers need. The gap between the two must be fully appreciated. Building more comprehensive pictures of the cost and outcome consequences of different care policies and treatment interventions is one way to bridge this gap. At the same time a sense of perspective must be maintained and promoted. For example, there is growing concern across the world about the high prices of new drugs, yet drug acquisition costs usually represent only a small proportion of total costs. Decisions sometimes appear to be disproportionately focused on small parts of the overall mental health care picture. A similar tendency prompts another challenge, which is to undertake and interpret research so as to overcome, or at least not to exacerbate, the boundary problems that characterize the multi-service, multi-agency reality of many mental health care systems. The adequacy of short-term evaluations - which dominate our field - must be questioned in light of the chronicity of many mental health problems, and of their externality effects (including inter-generational transmission of problems). Although funding will always be a problem, longer-term evidence is needed. So, too, is research that looks at the reasons for inter-individual cost and outcome variations. Economic evaluations should also pay more attention to equity as well as efficiency as a criterion of improved resource allocation. Finally, more economic data should be gathered alongside and not after clinical data, particularly as economic assumptions often appear to drive key practice and policy changes.

Journal Article↗
PubMed2006

Economics methods in Cochrane systematic reviews of health promotion and public health related interventions.

BACKGROUND: Provision of evidence on costs alongside evidence on the effects of interventions can enhance the relevance of systematic reviews to decision-making. However, patterns of use of economics methods alongside systematic review remain unclear. Reviews of evidence on the effects of interventions are published by both the Cochrane and Campbell Collaborations. Although it is not a requirement that Cochrane or Campbell Reviews should consider economic aspects of interventions, many do. This study aims to explore and describe approaches to incorporating economics methods in a selection of Cochrane systematic reviews in the area of health promotion and public health, to help inform development of methodological guidance on economics for reviewers. METHODS: The Cochrane Database of Systematic Reviews was searched using a search strategy for potential economic evaluation studies. We included current Cochrane reviews and review protocols retrieved using the search that are also identified as relevant to health promotion or public health topics. A reviewer extracted data which describe the economics components of included reviews. Extracted data were summarised in tables and analysed qualitatively. RESULTS: Twenty-one completed Cochrane reviews and seven review protocols met inclusion criteria. None incorporate formal economic evaluation methods. Ten completed reviews explicitly aim to incorporate economics studies and data. There is a lack of transparent reporting of methods underpinning the incorporation of economics studies and data. Some reviews are likely to exclude useful economics studies and data due to a failure to incorporate search strategies tailored to the retrieval of such data or use of key specialist databases, and application of inclusion criteria designed for effectiveness studies. CONCLUSION: There is a need for consistency and transparency in the reporting and conduct of the economics components of Cochrane reviews, as well as regular dialogue between Cochrane reviewers and economists to develop increased capacity for economic analyses alongside such reviews. Use of applicable economics methods in Cochrane reviews can help provide the international context within which economics data can be interpreted and assessed as a preliminary to full economic evaluation.

Clinical Protocols↗
PubMed2002

The limited incorporation of economic analyses in clinical practice guidelines.

BACKGROUND: Because there is increasing concern that economic data are not used in the clinical guideline development process, our objective was to evaluate the extent to which economic analyses are incorporated in guideline development. METHODS: We searched medline and HealthSTAR databases to identify English-language clinical practice guidelines (1996-1999) and economic analyses (1990-1998). Additional guidelines were obtained from The National Guidelines Clearinghouse Internet site available at http://www.guideline.gov. Eligible guidelines met the Institute of Medicine definition and addressed a topic included in an economic analysis. Eligible economic analyses assessed interventions addressed in a guideline and predated the guideline by 1 or more years. Economic analyses were defined as incorporated in guideline development if 1) the economic analysis or the results were mentioned in the text or 2) listed as a reference. The quality of economic analyses was assessed using a structured scoring system. RESULTS: Using guidelines as the unit of analysis, 9 of 35 (26%) incorporated at least 1 economic analysis of above-average quality in the text and 11 of 35 (31%) incorporated at least 1 in the references. Using economic analyses as the unit of analysis, 63 economic analyses of above-average quality had opportunities for incorporation in 198 instances across the 35 guidelines. Economic analyses were incorporated in the text in 13 of 198 instances (7%) and in the references in 18 of 198 instances (9%). CONCLUSIONS: Rigorous economic analyses may be infrequently incorporated in the development of clinical practice guidelines. A systematic approach to guideline development should be used to ensure the consideration of economic analyses so that recommendations from guidelines may impact both the quality of care and the efficient allocation of resources.

Cost-Benefit Analysis↗
PubMed2004

Linking economic activities to the distribution of exotic plants.

The human enterprise is flooding Earth's ecosystems with exotic species. Human population size is often correlated with species introductions, whereas more proximate mechanisms, such as economic activities, are frequently overlooked. Here we present a hypothesis that links ecology and economics to provide a causal framework for the distribution of exotic plants in the United States. We test two competing hypotheses (the population-only and population-economic models) using a national data set of exotic plants, employing a statistical framework to simultaneously model direct and indirect effects of human population and ecological and economic variables. The population-only model included direct effects of human population and ecological factors as predictors of exotics. In contrast, the population-economic model included the direct effects of economic and ecological factors and the indirect effects of human population as predictors of exotics. The explicit addition of economic activity in the population-economic model provided a better explanation for the distribution of exotics than did the population-only model. The population-economic model explained 75% of the variation in the number of exotic plants in the 50 states and provided a good description of the observed number of exotic plants in the Canadian provinces and in other nations in 85% of the cases. A specific economic activity, real estate gross state product, had the strongest positive effect on the number of exotics. The strong influence of economics on exotics demonstrates that economics matter for resolving the exotic-species problem because the underlying causes, and some of the solutions, may lie in human-economic behaviors.

Ecosystem↗
PubMedDate not supplied

Partnership economics: nursing's challenge in a quantum age.

While the task of ascribing economic value to human caring is incredibly complex, Eisler (1998) reminds us that economic systems can and do change--and all our economic institutions are human creations. Humans can create new economic rules that recognize caring as the most foundational economically productive work (Eisler, 1998). In selected situations, the work of nursing has enormous economic value and new research continues to emerge which support our intuitive beliefs about the economic value of nursing's work (Levinson, Roter, & Frankel, 1997; Revans, 1964; Salmond, 1972). The future of health care requires that this work continues. The value of developing conscious economic inventions for nursing has the potential to assist nursing in its cost-effectiveness analysis, document the economic value of caring behaviors, inspire recruitment, and decrease the number of nurses leaving the profession. Nursing is challenged to shift its consciousness to one that is based on the value equation of quality, cost, and service. We are challenged to recognize the need to build a more equitable and humane economic system that gives real value to the work of caring, and to partner with other health care leaders, policy analysts, and economists in the process. Ultimately, developing economic measurements for the redefined work in nursing will require significant changes in economic measurements, institutions, rules as well as social norms, customs, and laws to quantify those goods not traditionally valued. The focus and energy of the nursing profession must move beyond overwhelming notions of loss and change; to challenging leadership to actively write and produce a better script for health in America beyond what we have developed over the past century. Indeed, this work is the requisite for the profession if what our children receive is the next level of enhancement from that which this generation obtained. It is no longer an option in creating a preferred future, it is nursing's mandate.

Economics, Nursing↗
PubMed2004

The RTOG Outcomes Model: economic end points and measures.

Recognising the value added by economic evaluations of clinical trials and the interaction of clinical, humanistic and economic end points, the Radiation Therapy Oncology Group (RTOG) has developed an Outcomes Model that guides the comprehensive assessment of this triad of end points. This paper will focus on the economic component of the model. The Economic Impact Committee was founded in 1994 to study the economic impact of clinical trials of cancer care. A steep learning curve ensued with considerable time initially spent understanding the methodology of economic analysis. Since then, economic analyses have been performed on RTOG clinical trials involving treatments for patients with non-small cell lung cancer, locally-advanced head and neck cancer and prostate cancer. As the care of cancer patients evolves with time, so has the economic analyses performed by the Economic Impact Committee. This paper documents the evolution of the cost-effectiveness analyses of RTOG from performing average cost-utility analysis to more technically sophisticated Monte Carlo simulation of Markov models, to incorporating prospective economic analyses as an initial end point. Briefly, results indicated that, accounting for quality-adjusted survival, concurrent chemotherapy and radiation for the treatment of non-small cell lung cancer, more aggressive radiation fractionation schedules for head and neck cancer and the addition of hormone therapy to radiation for prostate cancer are within the range of economically acceptable recommendations. The RTOG economic analyses have provided information that can further inform clinicians and policy makers of the value added of new or improved treatments.

Clinical Trials as Topic↗
PubMed1996

The nature of animal health economics in relation to veterinary epidemiology.

Animal health economics is being formally integrated into such institutions as sub-Saharan African universities and Veterinary Services. Unfortunately, the nature of the relationship between economics and epidemiology is not clearly understood. Economics has an extensive theoretical apparatus and an array of methods and techniques. Animal health economics has two interrelated branches: economics for the planning and management of animal health services and economic analysis of diseases and interventions. Epidemiology and economics, although separate scientific areas, are complementary when the goal is efficient management of animal health and associated delivery systems. In performing economic analyses, an "economic model' should determine data requirements (epidemiological and socioeconomic), as such analyses invariably require epidemiological inputs. The core concepts in economic analysis are as follows: conceptual models, opportunity cost of resources, marginal analysis and partial analysis. Important methods include statistical models, mathematical programming, budgets, cost minimisation, decision analysis, variants of cost-benefit analysis and simulation. Given the nature of animal health economics, veterinarians who want to practise as economists need a thorough training in economic principles and methods, in addition to training in basic epidemiology.

Africa South of the Sahara↗
PubMedDate not supplied

[30 years' development of economic theories in confrontation with facts].

In 1969, R. Frish and J. Tinbergen received the first Nobel Price in Economics. 200 years after Quesnay's "economic tables", economics were at last considered as a science. During the last thirty years, economics haven't lost their scientific reputation, but, confronted with different situations in the world and in France, economics have been unable to bring appropriate solutions to every problem. Nowadays, economics are quite far from the promises born after the Second World War: indeed, until the 1974 world crisis, Keynes' theory (from a macro-economic point of view) and Walras' formalisation of the markets (from a micro-economic point of view) were sufficient to give satisfying representations of any economic reality and mechanism. Nevertheless, these theories were unable to deal with both growing unemployment and raising inflation in the late 70's and early 80's. Today, economics present a wide variety of efficient analysis of society. Game theory, behaviour theory or econometrics are new means used to found new kinds of reality representation. Therefore, if economics can no longer be considered as an exact science, it remains nevertheless scientific.

Economics↗
PubMed2003

Influence of social support on health among gender and socio-economic groups of adolescents.

BACKGROUND: The influence of social support on health was explored among gender and socio-economic groups with the aim of contributing to the explanation of socio-economic health differences among Slovak adolescents. METHODS: The sample consisted of 2616 Slovak adolescents (52.4% male, 47.6% female, mean age 15 years). The data were assessed by a self-reported questionnaire including measures of social support, socio-economic status and health. RESULTS: There are significant gender differences in social support, which are unfavourable for males. On the other hand, there are significant gender differences in health, unfavourable for females. Low social support is significantly related to worse health. There are significant socio-economic differences in both health and social support, which are unfavourable for lower socio-economic groups. Three groups, females, adolescents from lower socio-economic groups, and also adolescents reporting low social support, less frequently consider their health as excellent or very good. Females suffer from more health complaints, report worse psychological health, vitality and mental health in comparison to males, to adolescents from higher socio-economic groups, and to adolescents reporting high social support. Males and adolescents from lower socio-economic groups more frequently reported low social support in comparison to females and adolescents from higher socio-economic groups. No significant differences in the influence of social support on health among gender and socio-economic groups of adolescents were confirmed. CONCLUSION: Social support is related to health and it is unequally distributed among gender and socio-economic groups. Social support had a positive impact on health, but this effect was independent of gender and socio-economic groups.

Adolescent↗
PubMed2002

Economic messages in prescription drug advertisements in medical journals.

BACKGROUND: The extent to which pharmaceutical companies promote the economic advantages of their products in advertisements in medical journals, and whether such claims are supported by evidence, has not been quantified. Our objectives were to examine how often prescription drug advertisements in leading medical journals contain economic messages, and to determine the types of promotional claims made and whether supporting evidence is provided. METHODS: All prescription drug advertisements appearing in six leading general medical and specialty journals in 3 selected months annually from 1990 to 1999 were reviewed. Using a standard data collection form, two reviewers examined each ad for economic content-including mention of the drug's price, value, cost saving, or cost-effectiveness. RESULTS: Economic messages appeared in 237 (11.1%) of the 2144 advertisements examined. Proportion of ads with economic content has increased over time (P = 0.003). Most frequently, economic ads contained statements that drugs were "less expensive" or "cost less" than alternative treatments (50.6% of economic ads). Supporting evidence for economic claims was clearly reported in 63.7% of cases, and typically referred to published drug prices rather than more detailed economic analysis. Ads for calcium channel blocking agents and ACE inhibitors frequently contained economic messages. CONCLUSIONS: Economic messages about prescription drugs are used in advertisements in leading medical journals and their frequency may be rising. Physicians should be aware of this phenomenon, and its potential impact on their prescribing decisions. More scrutiny of the supporting evidence underlying economic claims by the medical community and regulators may be needed.

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