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PubMedDate not supplied

Do health-care decision makers find economic evaluations useful? The findings of focus group research in UK health authorities.

OBJECTIVES: The impact of economic evaluation studies on health-care decision makers has been shown to be rather limited. However, there is an increasing requirement for the cost-effectiveness of health-care interventions to be considered in formulating and implementing guidelines for clinical practice. This paper reports the findings of recent focus group research among UK health authorities, which examined the usefulness of published economic evaluations within the decision-making processes. The findings are presented and discussed in light of other studies that have addressed this issue. METHODS: Focus group research was conducted with decision makers from a sample of two UK health authorities using the National Health Service Economic Evaluation Database (NHS EED) as a research vehicle to locate and report the findings of relevant economic studies. The study sample was initially invited to respond to questionnaires exploring the usefulness of published economic evaluations in the decision-making process and to outline particular topics that it felt would benefit from similar economic evidence. Following this, a detailed search was undertaken to retrieve structured NHS EED abstracts on these topics such that the usefulness and limitations of economic evaluations to decision making could be determined. RESULTS: Decision makers generally recognized the usefulness and necessity of published economic evaluations in informing their decision-making processes. However, the value of studies was often limited because of the poor generalizability of results, the narrowness of research questions, and the lack of methodological rigor common to many published studies. A total of 237 NHS EED full abstracts were retrieved in the specified areas of interest, which, within specified caveats, were generally found to be useful as decision-making tools. There was a general consensus among decision makers in favor of developing a quality-scoring system for studies, thereby going beyond the critical summaries given in NHS EED. CONCLUSIONS: Decision makers value information on cost-effectiveness as well as effectiveness alone, but methodological improvements are necessary to increase the reliability of economic studies. A quality-scoring system for published studies would be a useful development as a filtering mechanism for decision makers but would raise a number of challenges for health economists.

Attitude of Health Personnel↗
PubMed1999

Principles of economic evaluation for interventions of chronic musculoskeletal pain.

Economic evaluation is attracting increasing attention to inform policy makers, insurers and other payers of the value of existing and new treatment modalities. Hence, it is desirable to assess not only the medical but also the economic consequences the new treatments produce. The available literature on economic evaluation revealed an urgent need for sound economic evaluation studies in the field of chronic musculoskeletal pain. Due to the generally weak methodology, the intended purpose of economic evaluation to help set funding priorities has often been bypassed. Although in general therapists have no direct responsibility for allocating scarce resources in the field of musculoskeletal pain, they are confronted with the results of these decisions in their everyday work. A clear understanding of the main principles of economic evaluation studies might therefore be advantageous. This paper addresses important methodological issues in economic evaluation research, such as the techniques for economic evaluation studies and the analytic perspective. In addition, the paper pays attention to the inclusion of costs and outcomes in economic evaluation research, sensitivity analysis, discounting, incremental analysis and ratios, and collecting of data.Further emphasis is placed on the transparent reporting of methods and study results. A clear reporting may help therapists and other researchers interpret the results of published studies and apply them to their own studies, and it may help decision makers generalize results from one setting to another. Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain.

Journal Article↗
PubMed2004

Investigating explanations of socio-economic inequalities in health: the Dutch GLOBE study.

BACKGROUND: The GLOBE study is a prospective cohort study specifically aimed at the explanation of socio-economic inequalities in health in the Netherlands. The returns of the study are reviewed after ten years of follow-up, and the studies' contribution to the development of policy measures to reduce inequalities in health in the Netherlands are described. METHODS: The study started in 1991 with a baseline postal survey (response rate 70.1% or n=18973, 15-74 years of age). Two sub-samples of respondents to this survey were subsequently interviewed in 1991 (response 79.4% and 72.3%, n=5667). Baseline data collection included measures of socio-economic position, health and possible explanatory factors. Follow-up involved repeated postal surveys and interviews, and routinely collected data on hospital admissions, cancer incidence and mortality by cause of death. RESULTS: Compared with higher socio-economic groups, lower socio-economic groups showed higher prevalence rates of poor self-reported health (perceived general health, health complaints, chronic conditions, disabilities), higher incidence rates of specific conditions (myocardial infarction) and higher rates of all-cause mortality. The higher prevalence of adverse material circumstances, unhealthy behaviour, adverse psychosocial characteristics, and adverse childhood circumstances in the lower socio-economic groups was important in the explanation of socio-economic inequalities in health. Socio-economic differences in health care utilization did not contribute to the explanation. CONCLUSIONS: The GLOBE study contributed significantly to the understanding of the explanation of socio-economic inequalities in health in the Netherlands. Study results were a main source of information in the development of policy measures aimed at the reduction of socio-economic inequalities in health in the Netherlands.

Adolescent↗
PubMed2002

Economic evidence for evidence-based practice.

PURPOSE: To explicate (a) the types of economic analyses available to nurses, (b) the measurement of costs in different types of economic evaluations, (c) recommendations for standardization, and (d) the assessment of economic evaluations for evidence-based practice. METHODS: Five types of economic analyses are reviewed. Recommendations for standardization of cost-effectiveness analyses are included as well as a worksheet for use in critiquing economic evaluations for validity and applicability to clinical settings. FINDINGS: Limited knowledge and a lack of consistent approaches to economic analyses are evident in the nursing and health care literature. However, nurses have not contributed to the conduct of rigorous economic evaluations or research to the extent found in other health care disciplines. CONCLUSIONS: Basing nursing practice on the best available evidence is now the expected standard of care. Applying economic evidence to practice requires understanding the methods used to conduct economic evaluations and to analyze the rigor of such evaluations.

Cost-Benefit Analysis↗
PubMed1998

Effect of a transient, geographically localised economic recovery on community health and income studied with longitudinal household cohort interview method.

STUDY OBJECTIVE: The main purpose of the study was to determine whether the health or economic status of a cohort of residents in an economically troubled geographical area changed between 1990 and 1993. DESIGN: Longitudinal, single cohort, interview survey method with the key variables of health status and economic status. Quasi-experimental pre-post design with economic rebound as the intervention. SETTING: A relatively low income geographical area in a rural, mountainous region before and after an economic rebound. In 1990, the local economy and health care system collapsed because of the closure of a series of manufacturing plants; outward migration from the area peaked. Between 1990 and 1993, new industries opened, and state and private community assistance programmes intervened, resulting in an economic rebound, migration into the area, and marked growth of the health service sector. PARTICIPANTS: A 2% sample of residents of households, using a combination of random, stratified, and clustered sampling. Residents included in the study had lived within the area throughout the 1990-1993 period of the study. MAIN RESULTS: Stable, non-migrating residents had a statistically significant 7% reduction in health status between 1990 and 1993, as measured by a composite of subjective and objective measures. The non-migrating residents also had a significant decrease in average household income ($14,700 in 1990 and $12,400 in 1993 in constant 1990 dollars) during the strong economic expansion, and therefore did not participate in or receive direct economic benefit from the expansion. There was a rapid population increase during the expansion, attributable to inward migrants who were younger and healthier than existing residents. The decline in health for the non-migrating residents was tentatively attributed to either direct or indirect effects of the decline in family income. CONCLUSIONS: Local economic development accompanied by expanded health care services availability can leave existing area residents poorer and less healthy, and this problem may be masked by an abundance of healthier, wealthier inward migrants.

Adolescent↗
PubMed2005

[The economic impact of tobacco consumption in Africa].

The economic contributions from tobacco cultivation and sales of products are often noted - jobs and incomes for farmers and employees, tax revenues for governments and enormous profits for cigarette companies, and for some countries, foreign exchange from net exports and foreign investment These are of course important. But set against these economic gains, there are also large economic losses that are less visible and less talked about, but also need to be counted. Many of these economic losses arise from the adverse health effects of tobacco use, but there are others too that affect a much wider group of citizens, and in particular, may exacerbate poverty among smokers and their families. This paper looks at the economic impact of tobacco use from the perspective of families, and at national level, for developing countries, providing a framework for considering the specific situations in Francophone African countries. Set against the economic benefits from tobacco, there are substantial economic costs. Annual health care costs are higher for smokers, and the burden of these costs falls on families, the public purse and employers/insurers. Earnings and productivity losses because of tobacco-related illness and premature death can be huge, and are borne by employers and employees. Illness is a major precipitating cause of poverty. Lit cigarettes cause thousands of fires and lost lives. Environmental damage to the soil from tobacco growing, pesticides and fertilizer, and deforestation resulting from firewood use to cure tobacco, can impose high economic losses. And there is the insidious, often overlooked cost of harm to the well-being of poor families whose scarce resources are used for cigarettes and other tobacco products instead of food and other necessities. We conclude that reducing tobacco use is good for health, good economics, and good for development

Africa↗
PubMed1997

Effect of live weight and differing economic values on responses to selection for milk fat, protein, volume, and live weight.

Five traits of major economic importance in the New Zealand dairy industry are milk volume, milk fat, milk protein, live weight, and survival. This study evaluated the impact of live weight as a trait in the selection objectives for the New Zealand dairy industry. Live weight of the lactating cow is an important measure because it reflects feeding costs via maintenance feed and salvage values of cows to be culled. In addition, selection responses were evaluated for differing relative economic values for milk protein and milk fat, and selection indexes that included or excluded phenotypic and genotypic correlations between traits were compared. Inclusion of live weight, with a negative economic value in a four-trait selection index with milk, milk fat, and protein resulted in higher economic response. Protein response to selection was not more than 2% when the relative economic value for the ratio of protein to milk fat exceeded 5:1 in a two-trait model; however, milk fat response decreased by over 10%. When a negative relative economic value was assigned to milk fat, economic returns were lower because of lower milk fat responses and the lack of higher protein responses compared with the same ratio for relative economic value but a positive weight for milk fat. Accounting for phenotypic and genetic correlations in deriving selection index weight improved economic response 5%.

Animals↗
PubMed2004

Generalisability in economic evaluation studies in healthcare: a review and case studies.

OBJECTIVES: To review, and to develop further, the methods used to assess and to increase the generalisability of economic evaluation studies. DATA SOURCES: Electronic databases. REVIEW METHODS: Methodological studies relating to economic evaluation in healthcare were searched. This included electronic searches of a range of databases, including PREMEDLINE, MEDLINE, EMBASE and EconLit, and manual searches of key journals. The case studies of a decision analytic model involved highlighting specific features of previously published economic studies related to generalisability and location-related variability. The case-study involving the secondary analysis of cost-effectiveness analyses was based on the secondary analysis of three economic studies using data from randomised trials. RESULTS: The factor most frequently cited as generating variability in economic results between locations was the unit costs associated with particular resources. In the context of studies based on the analysis of patient-level data, regression analysis has been advocated as a means of looking at variability in economic results across locations. These methods have generally accepted that some components of resource use and outcomes are exchangeable across locations. Recent studies have also explored, in cost-effectiveness analysis, the use of tests of heterogeneity similar to those used in clinical evaluation in trials. The decision analytic model has been the main means by which cost-effectiveness has been adapted from trial to non-trial locations. Most models have focused on changes to the cost side of the analysis, but it is clear that the effectiveness side may also need to be adapted between locations. There have been weaknesses in some aspects of the reporting in applied cost-effectiveness studies. These may limit decision-makers' ability to judge the relevance of a study to their specific situations. The case study demonstrated the potential value of multilevel modelling (MLM). Where clustering exists by location (e.g. centre or country), MLM can facilitate correct estimates of the uncertainty in cost-effectiveness results, and also a means of estimating location-specific cost-effectiveness. The review of applied economic studies based on decision analytic models showed that few studies were explicit about their target decision-maker(s)/jurisdictions. The studies in the review generally made more effort to ensure that their cost inputs were specific to their target jurisdiction than their effectiveness parameters. Standard sensitivity analysis was the main way of dealing with uncertainty in the models, although few studies looked explicitly at variability between locations. The modelling case study illustrated how effectiveness and cost data can be made location-specific. In particular, on the effectiveness side, the example showed the separation of location-specific baseline events and pooled estimates of relative treatment effect, where the latter are assumed exchangeable across locations. CONCLUSIONS: A large number of factors are mentioned in the literature that might be expected to generate variation in the cost-effectiveness of healthcare interventions across locations. Several papers have demonstrated differences in the volume and cost of resource use between locations, but few studies have looked at variability in outcomes. In applied trial-based cost-effectiveness studies, few studies provide sufficient evidence for decision-makers to establish the relevance or to adjust the results of the study to their location of interest. Very few studies utilised statistical methods formally to assess the variability in results between locations. In applied economic studies based on decision models, most studies either stated their target decision-maker/jurisdiction or provided sufficient information from which this could be inferred. There was a greater tendency to ensure that cost inputs were specific to the target jurisdiction than clinical parameters. Methods to assess generalisability and variability in economic evaluation studies have been discussed extensively in the literature relating to both trial-based and modelling studies. Regression-based methods are likely to offer a systematic approach to quantifying variability in patient-level data. In particular, MLM has the potential to facilitate estimates of cost-effectiveness, which both reflect the variation in costs and outcomes between locations and also enable the consistency of cost-effectiveness estimates between locations to be assessed directly. Decision analytic models will retain an important role in adapting the results of cost-effectiveness studies between locations. Recommendations for further research include: the development of methods of evidence synthesis which model the exchangeability of data across locations and allow for the additional uncertainty in this process; assessment of alternative approaches to specifying multilevel models to the analysis of cost-effectiveness data alongside multilocation randomised trials; identification of a range of appropriate covariates relating to locations (e.g. hospitals) in multilevel models; and further assessment of the role of econometric methods (e.g. selection models) for cost-effectiveness analysis alongside observational datasets, and to increase the generalisability of randomised trials.

Coronary Disease↗
PubMed1983

Teaching health economics: some guidelines arising from a WHO workshop.

This paper provides some guidelines for the teaching of health economics particularly but not exclusively to non-economist personnel in the health care sector. It arose from a workshop, sponsored by WHO (Regional Office for Europe) in Copenhagen in 1982, for training a few health service personnel from various European countries in the economics of health care. The material in the guidelines is organised under eight topic headings, each followed by the main themes of each topic and some possible teaching/learning problems. Organised in this way, it would be possible to use the outline as an eight-day course on health economics or eight weekly sessions in a traditional university undergraduate or postgraduate course. The eight topics covered include: (i) What is economics? (ii) Health measurement and valuation; (iii) The patient as demander; (iv) Supply and financing of health care; (v) Setting health priorities; (vi) Assessing the costs and benefits of alternatives; (vii) Strategies for efficiency in health care; and (viii) Equity in health and health care. At a time when there is an increasing demand for economic skills and trained economists with a knowledge of the health care sector, the article emphasises that it would be unfortunate if the view were to become widespread that economics is something that only economists do. Many decision-makers in health care make decisions every day to which the principles of economics can, and should be, applied. It is with a view to introducing more of these decision-makers to the principles of economic analysis that the authors have written this article. However, while some may gain directly, the article aims to stimulate and assist those who might contribute to this process by providing ideas on how economics of health care might be taught.

Cost-Benefit Analysis↗
PubMed2003

Influence of health risk behavior and socio-economic status on health of Slovak adolescents.

AIM: To investigate the role of health risk behavior, such as smoking and alcohol consumption, in the explanation of socio-economic health differences among adolescents. The hypothesis of different exposure and the hypothesis of different vulnerability were explored. METHOD: In the study carried out in 1998, the prevalence of health complaints of smokers vs non-smokers, alcohol consumers vs abstainers, and among different socio-economic groups of 2,616 Slovak adolescents (mean age, 14.9-/+0.62 years) were investigated by means of self-reported questionnaires. The adolescents were stratified according to sex and type of secondary school. RESULTS: Socio-economic disadvantage and the presence of health risk behavior were associated with greater frequency of health complaints by adolescents. Prevalence of smokers was higher in lower socio-economic groups, but no such trend was found for the prevalence of alcohol consumers. Socio-economic status and health risk behavior interactively influenced health, when socio-economic status was assessed according to the mother's characteristics. Socio-economic health differences between non-smokers and abstainers were not significant, unlike the differences between the smokers and alcohol consumers. The influence of health risk behavior was weaker in higher socio-economic groups. CONCLUSION: Both hypotheses, of different exposure and different vulnerability, could explain socio-economic health differences among Slovak adolescents, with different exposure playing a more important role.

Adolescent↗
PubMed2005

[Analysis on direct economic burden of stroke in the rural population of Hanzhong, Shaanxi Province].

OBJECTIVE: To analyze the direct economic burden of stroke in rural areas of Hanzhong. METHODS: Plan on primary interview was made after the purpose of the study had been informed to the managers of the 'surveillance field base', heads and members of the monitor assistants and detailed information was collected in the fields. Every single patient of stroke was then interviewed by the above said interviewers,using a self-designed questionnaire. 164 patients with stroke were interviewed in 53 villages with 75,000 persons lived there. The main items involved in the questionnaire would include: costs for inpatient or outpatient, reaching-out fees, fee for accommodation during treatment as outpatient, costs for treatment at home, long term medicine, caregivers and funerals as well as average income. RESULTS: The median of annual direct economic burden was 3100 Yuan for each patient in Hanzhong rural area. There were no significant differences seen between males and females or among age groups (P > 0.05). The proportion of patients with medians of annual direct economic burden of: 1000 Yuan and below, 1001-5000 Yuan, 5001-10,000 Yuan, 10,001-20,000 Yuan and over 20,001 Yuan, were 29.2%, 36.0%, 18.3%, 9.8% and 6.0% respectively. The median of annual direct economic burden of first episode stroke was 5500 Yuan for each patient, and that of stroke was 1700 Yuan for each chronic patient. The direct economic burden of first episode was significantly higher than that of stroke (P < 0.01). The costs of hospitalization, accommodation of hospitalization and treatment at home of middle-aged patients were significant higher than that of old age patients (P < 0.05). CONCLUSION: In this study, the direct economic burden of stroke was 2.9 times of the annual personal average income, which was contrary to the reports from other countries. However, the State Health Bureau bore 87.1% of the direct economic burden for urban patients, but patients in the rural areas had to pay from their own pockets. The direct economic burden of stroke was heavy in Hanzhong rural region, which called for measures to be made to decrease the direct economic burden of stroke in the region.

Age Distribution↗
PubMed2005

Economics of dementia and pharmacoeconomics of dementia therapy.

BACKGROUND: The economic impact of dementia is not well appreciated, even though Alzheimer's disease and related dementias were the third most expensive health condition in the United States in 2000. In 1997, the cost of managing patients with Alzheimer's disease and other dementias was estimated at US dollar 100 billion. Direct medical costs are compounded by indirect costs of care, including unpaid care and loss of earnings. OBJECTIVE: The aim of this review was to examine studies of the economic impact of approved treatments for dementia therapy. METHODS: Searches of the MEDLINE database were conducted to identify prospective, randomized trials and retrospective or modeling studies of the economic impact of dementia medications, as well as analyses of managed care data (years 1996-2004; English language; search terms: dementia or Alzheimer's cross-referenced with economic or costs). RESULTS: Only 3 studies directly examined the economic effects of dementia therapy. Two of these demonstrated economic benefits of treatment, whereas the third study concluded that there were no benefits; however, the conclusions of the latter study may have been weakened by such factors as the high rate of attrition and biased selection of study participants. Modeling studies and analyses of managed care data also indicate economic benefits from approved treatments. CONCLUSIONS: Therapies that are efficacious early in the disease can postpone the progression of dementia to more severe stages and may offer economic benefit to patients' families, caregivers, and society.

Aged↗
PubMed2005

A hermeneutic science: health economics and Habermas.

PURPOSE: Mainstream health economics labours under a misleading understanding of the nature of the topic area and suffers from a concomitant poverty of thinking about theory and method. The purpose here is to explore this critical position and argue that health economics should aspire to being more than a technical discipline. It can, and should, engage with transformative discourse. DESIGN/METHODOLOGY/APPROACH: It is argued that the hermeneutic sciences, emphasising interpretation not instrumentality or domination, offer a route into the change to which one seeks to contribute. The article specifically focuses on the way Habermas provides insights in his approach to knowledge, reason and political economy. How he emphasises complexity and interaction within cultural milieu is explored and primacy is given to preserving the life-world against the encroachments of a narrow rationalization. FINDINGS: The argument for a critical re-imagining of health economics is presented in three stages. First, the antecedents, current assumptions and critical voices from contemporary economics and health economics are reviewed. Second, the way in which health is best understood via engaging with the complexity of both the subject itself and the society and culture within which it is embedded is explored. Third, the contribution that hermeneutics, and Habermas' critical theory, could make to a new health economics is examined. ORIGINALITY/VALUE: The paper offers a radical alternative to health economics. It explores the shortcomings of current thinking and argues an optimistic position. Progress via reason is possible if one reframes both in the direction of communication and in the appreciation of reflexivity and communality. This is a position that resonates with many who challenge prevailing paradigms, in economics and elsewhere.

Economics, Medical↗
PubMed2005

Alternative futures for health economics: implications for nursing management.

As nursing has been subject to successive waves of 'managerialism' there has been a drive on the part of government and elements within the profession to enhance the science base and promote cost-effective health care interventions. This has generated new interest in the 'economics of nursing' as efficiency and 'value for money' are viewed as necessary precondition for the provision of a high quality nursing service. As an academic subject health economics has brought an elegant set of theories to bear on the topic of health and health care. However, mainstream health economics is premised on a series of simplifying assumptions that, if applied uncritically, can induce a range of unintended and adverse consequences. This paper asks how ideas developed in one sphere (health economics) can be become influential in another (nursing management and practice) and it seeks explanations in the theories of Michel Foucault, specifically in his exploration of the reciprocal relationship between power and knowledge. How are our assumptions about what is possible and desirable shaped, how far do mechanisms of surveillance and self-subjugation extend? A range of alternative economic approaches have been developed which challenge many mainstream health economics assumptions. Some of these are better suited to the complex social environment present within health care. Nurses, nurse managers and researchers should question the assumptions of dominant economic models and explore a range of economic frameworks when planning services and evaluating their practice.

Attitude to Health↗
PubMed1999

Real world designs in economic evaluation. Bridging the gap between clinical research and policy-making.

This paper identifies the information that economic evaluation should provide to adequately inform policy-makers. First, policy-makers need cost-effectiveness information that is both internally and externally valid. The latter aspect is often ignored and refers to the relevance of the results of economic trials to the specific decision-making context of the policy-maker. Second, policy-makers, like purchasers of care, may want assessments of the overall budget and health impacts of adopting an intervention in a disease or treatment area. This requires more of an aggregate analysis than the current approaches to economic evaluation (which are typically individual-orientated). There are 3 main conceptual approaches to economic evaluation: the use of randomised controlled trials (RCTs), observational studies and modelling. The RCT can be considered as the gold standard in economic evaluation because of its high internal validity, but results should be interpreted with caution because of its low external validity. There a number of options to enhance external validity; of these, additional modelling and observational data seem to be the most promising. To address issues at the system level, disease modelling or public health modelling is suggested. A 3-step approach, comprising successive assessment of internal validity, external validity (real world relevance) and net impact at the system level, can enhance the informative value of economic analyses. For example, this approach has been used to assess the informative value to decision-makers of an RCT in benign prostatic hyperplasia. The analysis emphasised the feasibility and importance of additional modelling beyond the results from an RCT-based economic analysis and provided important information of relevance for policy-making. Because of the need to increase the real world relevance of pharmacoeconomic analyses, there is potentially a large role for modelling in economic evaluation; however, in order to enhance its credibility, more attention should be paid to validity aspects.

Cost-Benefit Analysis↗
PubMed1988

Sociological explanations of economic growth.

Even if questions of how resources are distributed within and between societies are the main concern, it is necessary to continue to grapple with the issue of the causes of economic growth since economic growth and level of development continue to be among the most important causes of inequality, poverty, unemployment, and the quality of life. This paper's dependent variable is the economic growth rate of 55 less developed countries (LDCs) over 2 time periods. 1970-78 and 1965-84. The causal model consists of control variables--level of development and domestic investment in 1965--and a variety of independent variables drawn from major sociological theories of economic growth published during the last 3 decades. Multiple regression analysis shows that, net of the effects of the 2 control variables, the variables which have the strongest effect on economic growth are: 1) direct foreign investment, which has a negative effect, 2) the proportion of the population in military service, and 3) the primary school enrollment ratio, both of which have positive effects on economic growth. On the other hand, variables drawn from some theories receive no empirical support. The mass media of communications, ethnolinguistic heterogeneity, democracy and human rights, income inequality, and state-centric theory's key variable, state strength, all fail to show any significant impact on economic growth rates when the control variables and the significant independent variables are held constant. The theoretical implications of these findings are discussed.

Africa↗
PubMed1996

The economic evaluation of the FIRST study: design of a prospective analysis alongside a multinational phase III clinical trial. Flolan International Randomized Survival Trial.

Prospective economic assessments of new pharmaceutical therapies are increasingly being incorporated into phase III clinical trials. We report on the design of an economic evaluation integrated into the Flolan International Randomized Survival Trial (FIRST). Economic evaluation was considered a critical component of the assessment of this therapy given the resources required to administer epoprostenol (Flolan), a therapy that would require lifelong continuous intravenous infusion. Economic secondary endpoints were incorporated in the clinical trial. The economic evaluation of the treatment was integrated into all aspects of study development, including study design, implementation, and monitoring. Since this was a multinational trial, special care was required to ensure that the protocol design was appropriate for all study countries. The economic assessment required the development of several methodologic components: a set of background economic concepts to guide protocol development, a set of resource items to be recorded when required for study participants; a set of data collection instruments for assessment of health-related quality of life for study patients; and a protocol for a resource costing exercise for the study. We report the data elements included in the study design, as well as a discussion of some of the issues faced in developing the economic evaluation for this trial.

Antihypertensive Agents↗
PubMed2005

Synthesis and recommendations of the economic evaluation of OHS interventions at the company level conference.

PROBLEM: In today's economic environment, enterprises may not be able to fund every new project aimed at promoting health and safety in the workplace. Company level economic evaluation of interventions can provide guidance in sound business decision-making. The Economic Evaluation of Occupational Health and Safety Interventions at the Company Level Meeting brought together members of the global occupational safety and health community interested in encouraging the use of economic knowledge and tools to evaluate economic gains from occupational health and safety interventions. DISCUSSION: Discussions of the six models presented explored similarities, reliability, and potential use by corporate enterprises, small and medium enterprises, developing and transitioning nations, and economic theorists. Each group provided specific projects that could be pursued to advance knowledge in the area of economic evaluation at the company level. CONCLUSION: This conference established pathway to incorporate economic evaluation of health and safety interventions or programs at the workplace.

Cost-Benefit Analysis↗