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PubMed2001

Challenges for model-based economic evaluations of postmenopausal osteoporosis interventions.

Assessing the cost-effectiveness of long-term treatment for osteoporosis requires use of mathematical models to estimate health effects and costs for competing interventions. The primary motivations for model-based analyses include the lack of long-term clinical trial outcome data and the lack of data comparing all relevant treatments within randomized clinical trials. We report on specific modeling challenges that arose in the development of a model of the natural history of postmenopausal osteoporosis that is suitable for assessing the cost-effectiveness of osteoporosis interventions among various population subgroups in diverse countries. These include choice of modeling changes in bone mineral density (BMD) or in fracture rate, definition of health states, modeling mortality and costs of long-term care following fracture, incorporation of health utility, and model validation. This report should facilitate future postmenopausal osteoporosis model development and provide insight for decision-makers who must evaluate model-based economic analyses of postmenopausal osteoporosis interventions.

Aged↗
PubMed2005

An alternative cost effectiveness analysis of ThinPrep in the Australian setting.

OBJECTIVE: To assess the clinical and economic impacts of the use of liquid based cytology (LBC) in the Australian average risk population from the perspective of the public health care budget. BACKGROUND: Concerns over the evaluation of medical technologies in Australia, which are assessed by the Medicare Services Advisory Committee (MSAC), have been raised recently. We report on the evaluation of LBC, which although being widely adopted in other parts of the world, has, despite substantial uptake in the private sector in Australia, been rejected for public funding by MSAC. METHODS: We used the health economic model developed by MSAC, but populated the model with the best available international data, sourced from a published review article. The economic model considered the clinical benefits and the costs arising from a biennial cervical screening programme. Net costs divided by life years saved is the cost per life year saved and this is reported as the incremental cost effectiveness. RESULTS: Populating the MSAC model with data on test performance showed that one type of LBC (ThinPrep) 'dominates' the conventional Pap smear in the screening of average risk women in the Australian setting. CONCLUSION: The health economic model created by MSAC predicts that ThinPrep dominates the conventional Pap as a screening test for cervical cancer. An additional 2240 high-grade lesions could be detected, resulting in 480 life years gained and delivering an expected saving to the health care system of $5,536,000 per annum if liquid based cytology replaced the conventional Pap.

Australia↗
PubMed2005

Process model and economic analysis of itaconic acid production from dimethyl succinate and formaldehyde.

A complete process model and economic analysis has been developed for itaconic acid production via catalytic condensation of dimethyl succinate and formaldehyde. The process model is based on experimental yields and selectivities obtained for the condensation reaction and on recovery schemes for itaconic acid developed in our laboratory. For an 18 million kg/yr (40 million lb/yr) itaconic acid production facility with a 10-year lifetime, the model predicts a capital investment of $40 million and an itaconic acid selling price of $2.34/kg ($1.06/lb) to achieve 30% annual return on investment. Feedstock cost is the largest contributor to the price of itaconic acid; succinate conversion and selectivity to the intermediate citraconic acid therefore most strongly influence process economics. Results of these analyses indicate that itaconic acid can be produced catalytically from succinic acid and formaldehyde at lower cost than via the current fungal fermentation route.

Costs and Cost Analysis↗
PubMed2005

[Models of economic evaluation of health and safety interventions at workplace].

Economic analyses and evaluation of the effect of workers' health on the national economy have begun to play a significant role in decision-making processes in terms of relations between health and safety in the work environment and the financial policy of enterprises. The economic dimension of consequences of occupational diseases and accidents at work is more frequently associated with the financial policy of enterprises understood as an element of costs involved. This gains particular significance when enterprises must maintain and improve economic effectiveness especially in the case of limited resources and permanent competition on the market. Therefore, the evaluation of economic interventions in the area of health and safety at workplace and its results are so important in the enterprise decision-making process. Several models of economic evaluation are used in assessing effectiveness of actions aimed at improving health and safety at workplace against a background of the overall economic situation of enterprises. The author presents the principles of six models, which have been used in the evaluation process. These models are based on information about costs of interventions/programs designed to reduce harmful effects of working conditions on workers' health and information concerning the results of individual ventures. They also take account of the influence of changes in working conditions on reduced sick absence, increased effectiveness of enterprises, production costs, and changes in productivity. The relationship between costs of intervention and its effects in financial terms based on cost-benefit analysis is the measure of effectiveness of health investments. The models presented show in practice a number of limitations, resulting mostly from the way the data are recorded in individual enterprises. Therefore, it is recommended that evaluation should be preceded by a precise definition of its aims, the range of the intervention and effects to be attained, which should provide the basis for defining the means and resources necessary for its implementation. This mainly applies to availability of data on costs and effects as well as to calculation methods, which can be used in view of collected numerical data.

Health Promotion↗
PubMed2001

Modeling the economic benefits of better TB vaccines.

OBJECTIVE: To describe the economic benefits of a better tuberculosis (TB) vaccine by modeling prevented TB medical spending and lost productivity throughout the world. DESIGN: One model is based on benefits obtained from reducing the impact of TB on health spending. An alternative model is based on minimizing the impact of TB on health spending and lost productivity due to death and disability. Both models are applied to various world populations based on secondary data. RESULTS: In terms of avoided medical spending, preventing 100% of the TB risk in a single individual is estimated to be worth from $38 for males in formerly socialist countries to S0.23 for children in Asia. More than 1 billion people would reckon their expected medical savings to exceed $25.00 if they received a 75% effective vaccine of 10 years' duration. Preventing lost productivity is worth substantially more throughout the world. CONCLUSIONS: Improved TB vaccines would be of substantial immediate financial value to most of the populations of the world, including the poorest. The scientific uncertainties surrounding the development of a better vaccine could be a larger obstacle than investor uncertainty over whether a vaccine would be profitable.

Adolescent↗
PubMed2005

[Drug-eluting stents: from the results of clinical studies to economic simulation models in the Italian reality].

Several studies with drug-eluting stents (DES) have demonstrated dramatic reductions in restenosis rates compared with bare metal stents (BMS). Although the clinical benefits of DES are increasingly evident, important concerns about their costs have been raised. Most data regarding the impact of restenosis on long-term costs after percutaneous coronary intervention (PCI) are derived from clinical trials. These studies demonstrate that there is no single cost or economic burden of restenosis; these values vary substantially according to the specific patient population under investigation and to the healthcare system reality where they are applied. In the present study we propose an economic interactive decision model which was applied to the Italian healthcare system, considering the different reimbursement rates of the Italian regions for DES and for both PCI and coronary artery bypass surgical interventions (CABG). The aim of this model was to simulate the impact of DES introduction after potential complete reimbursement by the national healthcare system, hypothesizing the usage of 1.4 stent per patient in case of single vessel disease and 2.4 stents in case of multivessel disease, and utilizing the TAXUS IV rate of revascularization for reintervention costs calculation and the ARTS-I study for CABG costs. For a low risk patients' population, the mean cost of a procedure with DES was 6% greater than utilizing BMS (xi 8125 for DES vs xi 7651 for BMS). However, this percentage was reduced in case of diabetic patients (+4%), long lesions (+2%) and was favourable for small vessels (-3%). In addition, in case of multivessel disease with conversion from CABG to DES, the 12 months cost per patients was reduced of around 30% (xi 10 170 for PCI vs xi 14 584 for CABG). This model suggests that national healthcare system may save 2.1% of the total costs (xi 18.60 millions) if 60% of revascularization procedures converts to total DES utilization and 15% from CABG to PCI with DES.

Clinical Trials as Topic↗
PubMed1998

Customising an international disease management model to the needs of individual countries. Application to upper gastrointestinal disease.

The baseline economic model for upper gastrointestinal (UGI) disease was developed in the context of patterns of care and resource use within the UK. It provided the opportunity to evaluate the extent to which an economic model developed in one country could be applied to meet the pharmacoeconomic information needs of decision makers in another. The choice of countries for analysis was restricted to countries within the International Gastro Primary Care Group (IGPCG) who had previously agreed on the appropriateness of the basic clinical algorithm to their domestic healthcare environment. This provided a potential sample of 9 countries (Australia, Austria, Germany, Italy, The Netherlands, Sweden, Switzerland, the UK and the USA) of which the UK, Germany, Sweden and Switzerland were chosen as providing a broad spectrum of strategic and operating environments in which to test the international transferability of the economic model. The process and results obtained provide valuable evidence of the extent to which economic analyses can be transferred across national borders.

Disease Management↗
PubMed2002

A systematic review of health state utility values for osteoporosis-related conditions.

An important weakness of economic models in the field of osteoporosis has been the dependence on assumptions or expert judgements rather than empirical estimates for the utility values of key health events associated with osteoporosis such as hip, vertebral, wrist fracture and established osteoporosis. This paper seeks to identify the best available utility estimates for health states associated with osteoporosis and make recommendations about their use. It is based on a systematic search of the main literature databases. Studies meeting inclusion criteria have been reviewed in terms of the appropriateness of the valuation technique, the validity of the descriptive system (if one was used), the number and type of respondents, and overall quality of the study. Twenty three estimates of health state values (HSVs) were found across the four conditions from five studies. These empirical estimates were found to differ significantly from the commonly used assumptions in economic evaluation, but with a wide variation between estimates for the same state (0.32 to 0.80 for vertebral fracture states). This variation can be partly explained by the valuation technique, health state description and the background and perspective of respondent, and leaves scope for considerable discretion that could be abused. There are also problems in using values obtained from the study populations to those in economic models and the difficulty of predicting health state values in those who avoid a fracture. The review recommends a set of health state values as part of a "reference case" for use in economic models. Due to the paucity of good quality of estimates in this area, further recommendations are made regarding the design of future studies to collect HSVs relevant to economic models.

Aged↗
PubMed1985

A recursive model of economic well-being in retirement.

Although investigators have identified some of the social and economic forces that influence levels of economic resources among elderly adults, little has been done to organize these factors into predictive lifespan models of economic well-being. Applying path analysis to data on retiring workers from the Panel Study of Income Dynamics, the present research offers a beginning recursive model. It traces the influences of demographic/family background, human capital, and work-related characteristics on economic position in retirement. Controlling for differences in labor force participation and other human capital measures, race and family background lose their direct significance, whereas sex remains directly significant in predicting economic resource levels for recently retired workers. In addition, the model estimates the direct and indirect effects played by industrial sector location and social class position. In total the structurally based capital attainment model explains 65% of the variance in a measure of economic well-being that includes retirement income and wealth.

Aged↗
PubMed1992

Econometric critique of the economic change model of mortality.

The application of time-series data and analysis to study the effects of changes in unemployment rates on mortality rates has been a controversial issue in health-unemployment research for many years. This article presents new criticism against previous aggregate time-series regression models and concludes that these models are misspecified in functional form, and the t-ratios used in significance tests are grossly overstated. Future empirical analysis of the Economic Change Model of Mortality, i.e. the aggregate, time-series relationship between mortality rates and economic variables must pay more attention to the salient characteristics of time-series data and implications for regression results.

Bias↗
PubMedDate not supplied

Healthcare professional's demand for knowledge in informatics.

OBJECTIVE: To develop an economic model of health care professional demand for knowledge capital in health informatics. DESIGN: Case study with application of the contingent valuation method to develop a small-scale model. SETTING: Specialized clinic at a university Hospital in Sweden. RESULTS: The model displays the economic rationale behind an individual choice to spend leisure time for obtaining knowledge in health informatics. This decision reduces the total leisure time, but does not increase salary. Instead, it may increase the personal well-being by higher satisfaction gained from using information systems and by being recognized as a computer expert. CONCLUSIONS: Individuals have preferences over all uses of time and for activities they can choose to engage in. Support of health care staff's investment in health informatics knowledge capital may benefit both the individuals and indirectly the health care organization.

Health Personnel↗
PubMed1998

The economic implications of users willingness to increase knowledge capital in health informatics.

OBJECTIVE: To develop an economic model of health care professionals demand for knowledge capital in health informatics. DESIGN: Case study with application of the Contingent Valuation Method to develop a small-scale model. SETTING: Specialized clinic at a university Hospital in Sweden. RESULTS: The model displays the economic rationale behind an individual's choice to spend leisure time for obtaining knowledge in health informatics. This decision reduces the total leisure time, but does not increase salary. Instead, it may increase the personal well being by higher satisfaction gained from using information systems and by being recognized as a computer expert. CONCLUSIONS: Individuals have preferences over all uses of time and for activities they can choose to engage in Support of health care staff's investment in health informatics knowledge capital may benefit both the individuals and indirectly the health care organization.

Attitude of Health Personnel↗
PubMed1998

Selecting a decision model for economic evaluation: a case study and review.

The increased use of modelling techniques as a methodological tool in the economic evaluation of health care technologies has, in the main, been limited to two approaches--decision trees and Markov chain models. The former are suited to modelling simple scenarios that occur over a short time period, whilst Markov chain models allow longer time periods to be modelled, in continuous time, where the timing of an event is uncertain. In the context of economic evaluation, a less well developed technique is discrete event simulation, which may allow even greater flexibility. Taking the economic evaluation of adjuvant therapies for breast cancer as an illustrative example, the process of building a decision tree, a Markov chain model, and a discrete event simulation model are described. The potential benefits and problems of each approach are discussed. The suitability of the modelling techniques to economic evaluations of health care programmes in general is then discussed. This section aims to illustrate the areas in which the alternative modelling methods may be most appropriately employed.

Adult↗
PubMed2006

Public funding of bosentan for the treatment of pulmonary artery hypertension in Australia: cost effectiveness and risk sharing.

OBJECTIVES: In Australia, no therapeutic agents were subsidised for the treatment of idiopathic pulmonary artery hypertension (iPAH), a rare progressive and severe disease with short life expectancy, until 1 March 2004, when bosentan (a dual endothelin receptor antagonist of high cost) was listed on the Pharmaceutical Benefits Scheme (PBS). Bosentan, in addition to conventional therapy, has been shown to slow iPAH progression and improve clinical and haemodynamic status and symptomatology, compared with placebo and conventional therapy. The objective of this paper is to describe the process of the Australian Pharmaceutical Benefits Scheme listing for bosentan (Tracleer), which included a health economic model assessing the cost effectiveness of bosentan from a healthcare payer perspective, and a risk-sharing arrangement based on the establishment of a patient registry. METHODS: The health economic model predicted the cost, hospitalisation and mortality rates of a population of iPAH patients treated with either the conventional therapy regimen used in Australia or bosentan plus the conventional therapy regimen. The model was implemented as a first-order Monte Carlo simulation with mortality modelled directly as the main clinical outcome. The impacts of proposed continuation criteria, restricting the ongoing use of the drug, were evaluated. Costs and outcomes were discounted at 5% and a sensitivity analysis examined the robustness of the key assumptions. RESULTS: The model predicted that after 5, 10 and 15 years, the difference in average cumulative costs between bosentan plus conventional therapy and conventional therapy alone would be 116,929 Australian dollars (A dollars), A181,808 dollars and A216,331 dollars for each patient, respectively. There would be an associated increase in average life expectancy of 1.39, 2.93 and 3.87 years at 5, 10 and 15 years, respectively, with an incremental cost-effectiveness ratio at 15 years of A55,927 dollars for each life-year gained. Removing the continuation criteria from the model increased the incremental cost-effectiveness ratio to A62,267 dollars (1996-2002 values). CONCLUSIONS: Economic modelling based on improved survival suggests bosentan to be a potentially cost-effective treatment for iPAH. However, the structure of the model and its inputs should be reviewed and updated as more data become available.

Antihypertensive Agents↗
PubMed1991

Nursing care classification: a conceptual model.

Economic constraints, the information explosion, and advancement of scientific theories have resulted in the need for nurses to document their unique contribution to health care through validation of nursing resources consumed by patients. However, various classification systems have not predicted nursing resources well. This study reviews the theoretical frameworks, reliability, validity, and utility of nursing acuity and severity systems. It proposes a conceptual model for a new nursing classification system to be used for the validation of nursing resources, as the basis of a reimbursement system for nursing services, and for multiple practical and theoretical applications.

Humans↗
PubMed2007

Monte Carlo probabilistic sensitivity analysis for patient level simulation models: efficient estimation of mean and variance using ANOVA.

Probabilistic sensitivity analysis (PSA) is required to account for uncertainty in cost-effectiveness calculations arising from health economic models. The simplest way to perform PSA in practice is by Monte Carlo methods, which involves running the model many times using randomly sampled values of the model inputs. However, this can be impractical when the economic model takes appreciable amounts of time to run. This situation arises, in particular, for patient-level simulation models (also known as micro-simulation or individual-level simulation models), where a single run of the model simulates the health care of many thousands of individual patients. The large number of patients required in each run to achieve accurate estimation of cost-effectiveness means that only a relatively small number of runs is possible. For this reason, it is often said that PSA is not practical for patient-level models. We develop a way to reduce the computational burden of Monte Carlo PSA for patient-level models, based on the algebra of analysis of variance. Methods are presented to estimate the mean and variance of the model output, with formulae for determining optimal sample sizes. The methods are simple to apply and will typically reduce the computational demand very substantially.

Analysis of Variance↗