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At least 325 records · Page 18Linked to original sources
PubMed2003

Modelling the economic impact of environmental flows for regulated rivers in New South Wales, Australia.

The management of water resources across Australia is undergoing fundamental reform in line with the priorities identified by the Council of Australian Governments (COAG) in 1994. This includes reforms to the specification of property rights, the way the resource is shared between the environment, irrigators and other users, charges for water use and the operational management of the river systems. In New South Wales (NSW), a series of water sharing plans (WSPs) is being developed for each water source in the State including regulated rivers, unregulated rivers and groundwater aquifers. These plans, which are the mechanisms by which COAG reforms are being implemented, are being developed by community-based water management committees (WMCs). The role of the WMCs is to develop a plan that achieves a balance between environmental, economic and social outcomes. NSW Agriculture has assisted a number of WMCs by quantifying the economic impact of proposed WSP options on the irrigation community. This paper outlines the approach taken by NSW Agriculture to quantifying economic impacts on irrigators in regulated catchments and provides results of case studies in the Lachlan River Catchment which is heavily developed for irrigation.

Agriculture↗
PubMed2005

Modeling the economic burden of diseases imputable to stress at work.

This study evaluated the costs of work-related stress in France. Three illnesses--cardiovascular diseases, depression, musculoskeletal diseases and back pain--that may result from exposure to stress are identified and the proportions of cases attributable to the risk factor are calculated from epidemiological studies. Two methodological hypotheses allow us to provide complementary evaluations of the social cost of occupational stress and raise the ethical questions inherent in the choice of methodology. For the year 2000 our model shows that of a working population of 23.53 million in France some 310,000-393,400 persons (1.3-1.7%) were affected by illnesses attributable to work-related stress, and that 2,300-3,600 persons died as a result of their illness. Work-related stress costs society between Euro 1,167 million and Euro 1,975 million in France, or 14.4-24.2% of the total spending of social security occupational illnesses and work injuries branch.

Adult↗
PubMed2002

Modelling the economic impact of managing a chronic anal fissure with a proprietary formulation of nitroglycerin (Rectogesic) compared to lateral internal sphincterotomy in the United Kingdom.

BACKGROUND AND AIMS: This study estimated the economic impact of using a proprietary formulation of 0.2% nitroglycerin (GTN) ointment (Rectogesic) compared with lateral internal sphincterotomy in the treatment of a chronic anal fissure in the United Kingdom (UK), from the perspective of the National Health Service (NHS). PATIENTS AND METHODS: Clinical and surgical outcomes attributable to managing a chronic anal fissure were obtained from published literature, supplemented with information about resource utilisation derived from interviews with a panel of colorectal surgeons and general practitioners. Using this information, a decision tree modelling the management of a chronic anal fissure by a colorectal surgeon was constructed. Unit resource costs at 1999/2000 prices were applied to the resource utilisation estimates in the model to estimate the expected NHS cost of managing a chronic anal fissure. Consensus on the information contained within the model was reached at a meeting with an expert panel comprising five of the interviewees and one other colorectal surgeon. RESULTS: The expected NHS cost of a colorectal surgeon initially managing a chronic anal fissure with GTN was estimated to be pound616, compared to pound840 when a lateral internal sphincterotomy is the first-line treatment. Moreover, the expected probability of successful healing following initial treatment with either intervention is 99-100%, taking into account all subsequent treatments. CONCLUSION: The initial use of GTN compared to lateral internal sphincterotomy to treat a chronic anal fissure affords a potential cost reduction to the NHS of pound224 per patient without any loss in effectiveness. Hence, GTN is potentially a cost-effective first-line treatment strategy for the management of a chronic anal fissure.

Anal Canal↗
PubMed2004

Self-Administration of cocaine-opioid combinations by rhesus monkeys: evaluation of the role of mu receptor efficacy using labor supply analysis.

Cocaine and heroin often are abused by self-administering the drugs in combination as a "speedball". We evaluated the extent to which intrinsic efficacy at the mu-opioid receptor influences combined cocaine-opioid self-administration and used the behavioral economic model termed "labor supply" to quantitatively evaluate the reinforcing effects of cocaine-opioid combinations. Rhesus monkeys (n = 8) were trained under a progressive-ratio schedule of i.v. cocaine injection in which the response requirement increased during the experimental session and the initial response requirement was varied. Combination of cocaine with heroin enhanced self-administration compared with the drugs individually, with ineffective doses of both drugs maintaining self-administration when combined. These effects also were observed with the high-efficacy mu agonist alfentanil and low-efficacy agonist nalbuphine. Using the labor supply economic model, combinations of heroin, alfentanil, or nalbuphine with relatively low doses of cocaine were found to increase the number of injections per session ("income") and total responses per session ("labor"). Combination of a relatively high dose of cocaine with either heroin or alfentanil, but not nalbuphine, also resulted in only a small reduction in income concomitant with increased labor, suggesting that heroin and alfentanil made cocaine consumption more resistant to increasing response costs, or more "inelastic." Collectively, these findings suggest that speedball self-administration may occur even with relatively low levels of intrinsic efficacy at mu-opioid receptors and that an inelastic relationship between drug consumption and labor may contribute to the persistence of speedball abuse.

Alfentanil↗
PubMedDate not supplied

Modeling the economic losses from pressure ulcers among hospitalized patients in Australia.

The objective of this study was to predict the number of cases of pressure ulcer, the bed days lost, and the economic value of these losses at Australian public hospitals. All adults (>or= 18 years of age) with a minimum stay of 1 night and discharged from selected clinical units from all Australian public hospitals in 2001-02 were included in the study. The main outcome measures were the number of cases of pressure ulcer, bed days lost to pressure ulcer, and economic value of these losses. We predict a median of 95,695 cases of pressure ulcer with a median of 398,432 bed days lost, incurring median opportunity costs of AU$285 M. The number of cases, and so costs, were greatest in New South Wales and lowest in Australian Capitol Territory. We conclude that pressure ulcers represent a serious clinical and economic problem for a resource-constrained public hospital system. The most cost-effective, risk-reducing interventions should be pursued up to a point where the marginal benefit of prevention is equalized with marginal cost. By preventing pressure ulcers, public hospitals can improve efficiency and the quality of the patient's experience and health outcome.

Adult↗
PubMed2006

Modelling the economic and health consequences of cardiac resynchronization therapy in the UK.

OBJECTIVE: Clinical evidence supports the use of cardiac resynchronization therapy (CRT) in advanced heart failure, but its cost-effectiveness is still unclear. This analysis assessed the economic and health consequences in the UK of implanting a CRT in patients with NYHA class III-IV heart failure. METHODS: A discrete event simulation of heart failure was used to compare the course over 5 years of 1000 identical pairs of patients -- one receiving both CRT and optimum pharmacologic treatment (OPT), the other OPT alone. All inputs were obtained from the data collected in the CArdiac REsynchronization in Heart Failure (CARE-HF) trial and a hospital in the UK. Direct medical costs (in 2004 pound) from the perspective of the National Health Service were considered. Both costs and benefits were discounted at 3.5%. Sensitivity analyses addressed all model inputs and multivariate analyses were performed by varying key parameters simultaneously. RESULTS: The model predicted 471 deaths and 2263 hospitalizations over 5 years with OPT alone and 348 deaths and 1764 hospitalizations with CRT, equivalent to a 26% reduction in mortality and 22% in hospitalizations, at a discounted cost of pound 11,423 per patient with CRT vs. pound 4,900 with OPT alone. CRT was predicted to increase quality-adjusted survival by 0.43 QALYs per patient, resulting in an incremental cost-effectiveness ratio of pound 15,247 per QALY gained (range: pound 12,531- pound 23,184). Sensitivity analyses revealed that this outcome was most sensitive to time horizon and cost of implantation. CONCLUSION: Based on these 5-year analyses, CRT is expected to yield substantial health benefits at a reasonable cost.

Cardiac Pacing, Artificial↗
PubMedDate not supplied

Local treatment pattern versus trial-based data: a cost-effectiveness analysis of drotrecogin alfa (activated) in the treatment of severe sepsis in Sweden.

Three methodological approaches were applied to analyze whether the cost-effectiveness of drotrecogin alfa (activated) (Xigris) as an adjunct to standard care compared with standard care alone is a cost-effective alternative for the treatment of Swedish patients with severe sepsis and organ dysfunction. Health-economic model simulations were applied to (1) Swedish treatment pattern data, (2) international trial data and local unit prices, and (3) Swedish local patient data combined with trial age structure to adjust for differences in the age structure between the trial and the Swedish patient sample. The methodological approach had no effect on the overall conclusion that the intervention was cost-effective in the treatment of Swedish patients with severe sepsis and organ dysfunction. However, the cost-effectiveness ratios were sensitive to the approach applied. The results indicate the importance of collecting not only information on local prices but also information about treatment pattern and patient characteristics when conducting country-specific health-economic model applications.

Adolescent↗
PubMed2002

External cost internalisation of urban transport: a case study of Dublin.

Transport users do not currently pay all costs associated with their transport activities and in particular do not pay the costs they impose on the environment. Case studies on Dublin, Amsterdam, Brussels and London have been conducted to evaluate how best to meet the requirement of the European Commission in its fair and efficient pricing aims in the transport sector, i.e. where transport users are made to pay all costs they impose. The paper presents the results of Do Nothing (DN) and Do Something (DS) scenarios for 2005 where in the latter case each transport user pays for all costs they impose including pollution, noise, accidents etc. The Dublin results, from an economics model used in the study, are examined in detail; the findings are compared with those of parallel studies conducted in the other cities to demonstrate the international relevance of this work. The comparison between the DN and DS scenarios indicates that taxes on all transport modes should be increased substantially, particularly in the morning and evening peak periods. As a result of the price increases, travel demand is reduced. A practical example where transport users could be made to pay for all their costs is road use pricing, i.e. charging individuals for the use of road space. The taxation levels suggested in the DS scenario have been used in a road use pricing trial in Dublin, the results of which were published in O'Mahony, Geraghty and Humphreys (Transportation 27, 269-283, 2000), to see if the reductions in the travel requirements of individuals proposed by the economics model are in fact true. The principles of the work presented in this paper are not only relevant to environmental impact management in the transport sector but can also be applied to other sectors.

Cities↗
PubMed2001

The discount rate in the economic evaluation of prevention: a thought experiment.

OBJECTIVES: In the standard economic model of evaluation, constant discount rates devalue the long term health benefits of prevention strongly. This study shows that it is unlikely that this reflects societal preference. DESIGN: A thought experiment in a cause elimination life table calculates savings of eliminating cardiovascular disease from the Dutch population. A cost effectiveness analysis calculates the acceptable costs of such an intervention at a threshold of 18 000 Euro per saved life year. METHODS: Cause specific mortality (all cardiovascular causes of death and all other causes) and health care costs (all costs of cardiovascular disease and all other causes of costs) by age and male sex of 1994. RESULTS: At a 0% discount rate, an intervention eliminating cardiovascular disease may cost 71 100 Euro. At the same threshold but at discount rates of 3% or 6%, the same intervention may cost 8100 Euro (8.8 times less) or 1100 Euro (65 times less). CONCLUSIONS: The standard economic model needs more realistic duration dependent models of time preference, which reflect societal preference.

Adult↗
PubMed1997

Economics of prostate cancer: a computer model.

The economic impact of health care for prostate cancer represents a substantial and growing burden to Canadian society. To better allocate increasingly scarce health care resources will require a comprehensive understanding of the costs and benefits of specific diagnostic and therapeutic interventions to manage this disease. A detailed health economic model of prostate cancer care, currently under development, will be described in this article. Using a decision analytic approach we will integrate current clinical trial data, epidemiologic data of disease progression, and Canadian health care cost data to build a Markov model of prostate cancer care. The final model will support cost-effectiveness analyses to compare competing strategies for screening and treating patients with this disease.

Journal Article↗
PubMed2006

Economics on trial: the use and abuse of economic methods in third party tobacco litigation.

OBJECTIVE: To analyse how the tobacco industry responded to economic models and methods used in third party payer tobacco litigation that has occurred since 1994. METHODS: Identified 12 third party payer cases and reviewed the transcripts using WinMax qualitative software. Focused on defendant's opening and closing statements, followed by trial testimony, depositions, and plaintiff's transcripts. RESULTS: Tobacco industry defendants tried to create doubt and confusion about whether or not smoking caused disease and by extension led to health care costs; argued that the economic models used were not legitimate and were not appropriate for estimating the costs incurred by plaintiffs; and criticised the data sources used because they did not consist of the individuals whose health care costs were being sought. CONCLUSIONS: Faced with a new and unprecedented wave of anti-tobacco litigation from third party payers, the tobacco industry tried to adapt strategies that had been used successfully in the past-creation of unfounded doubt and confusion, and manipulation of the discovery process to force plaintiffs to withdraw or concede defeat. The strategies failed because credible economic models of the health care costs of smoking had been developed that were able to quantify the damages to a large group of health care recipients, because plaintiff's attorneys were able to commit significant resources and willing to undertake substantial financial risk to defend their new legal approaches, and because previous arguments related to individual responsibility were deemed irrelevant in third party litigation.

Cost of Illness↗
PubMed2026

An Application of Iterative Health Economic Evaluation: An Update on the Early Cost Effectiveness of Whole-Genome Sequencing in Advanced Non-small-Cell Lung Cancer.

OBJECTIVE: Whole genome sequencing (WGS) can identify more druggable targets than the standard of care (SoC) panels, however, its health effects and costs are highly uncertain. Given the rapidly evolving treatment landscape and pricing, an iterative approach is crucial to continuously reassess evidence and adapt economic models. Our objective was to update a previously developed economic model for WGS. METHODS: We used a structured approach to identify and report model elements requiring updates, based on established tools and methodological guidance, and applied it to the probabilistic decision model by Simons et al.(2021), which compared SoC, WGS, and SoC followed by WGS in patients with inoperable stage IIIB, C/IV NSCLC in the Dutch setting. RESULTS: Updates included a new treatment (sotorasib), revised drug and diagnostic costs, and adherence to the latest guidelines. Drug and WGS diagnostics costs fell by 8% and 26%, respectively. SoC diagnostic prices increased by 17%. We explored the impact of the prevalence of druggable targets, effectiveness of off-label treatments, (academic-specific) diagnostic costs, and price negotiations. The ICER of WGS versus SoC decreased from €737,197 to €419,053/QALY. WGS would become cost-effective if diagnostic costs descended from €2,180 to €1,246 or if additional druggable targets were identified in ≥3.3% of patients. CONCLUSION: Our structured approach effectively identified items in the original analysis requiring updates and provides a foundation for further developing a checklist to guide iterative HTA. Continued monitoring and assessment of new treatment options, the dynamic diagnostics and costs throughout the life-cycle remain necessary to determine when WGS can be considered cost-effective.

NSCLC↗
PubMed2005

Enhancing profitability of dry mill ethanol plants: process modeling and economics of conversion of degermed defibered corn to ethanol.

An Aspen Plus modeling platform was developed to evaluate the performance of the conversion process of degermed defibered corn (DDC) to ethanol in 15- and 40-million gallons per year (MGPY) dry mill ethanol plants. Upstream corn milling equipment in conventional dry mill ethanol plants was replaced with germ and fiber separation equipment. DDC with higher starch content was fed to the existing saccharification and fermentation units, resulting in higher ethanol productivity than with regular corn. The results of the DDC models were compared with those of conventional dry mill ethanol process models. A simple financial analysis that included capital and operating costs, revenues, earnings, and return on investment was created to evaluate each model comparatively. Case studies were performed on 15- and 40-MGPY base case models with two DDC process designs and DDC with a mechanical oil extraction process.

Biotechnology↗
PubMed1997

[A new model for economic studies of therapies exemplified by postoperative parenteral nutrition].

In this economic evaluation we compared the costs of a new therapeutic system (two-chamber bag) in total parenteral nutrition (TPN) with the comparative standard therapeutic systems (multiple-bottle system in intensive care patients followed by a combination solution (glass bottles) on the ward). In the model, standard treatment algorithms of a 10-day course TPN for patients after major gastric surgery were specified for both application systems, the two-chamber bag and the comparative system. Based on the standard treatment pattern, the resource utilisation (manpower services, medical needs, material) was assessed. In a base case analysis the types and amounts of resources were valued using salaries, prices and tariffs to assess the costs. The costs per day and per case of the therapeutic systems were compared. Sensitivity analyses were carried out to validate the cost-estimates. The total costs per patient of the two-chamber bag amounted to DM 2324.41, which was substantially less than the DM 2728.99 cost of the comparative system. The average daily costs for the two-chamber bag system were 12% to 23% lower than for the comparative system. The results were shown to be valid for the whole range of tested parameters. This model makes it possible to obtain an economic evaluation of various therapeutic modalities without undertaking a prospective randomized study with the attendant high time and cost requirements.

Cost-Benefit Analysis↗
PubMed2000

Eradication of helicobacter pylori for non-ulcer dyspepsia.

BACKGROUND: Helicobacter pylori (H pylori) is the main cause of peptic ulcer disease. The role of H pylori in non-ulcer dyspepsia is less clear. OBJECTIVES: To determine the effect of H pylori eradication on dyspepsia symptoms and quality of life scores in patients with non-ulcer dyspepsia. SEARCH STRATEGY: Trials were identified through electronic searches of the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, CINAHL and SIGLE, using appropriate subject headings and keywords, searching bibliographies of retrieved articles, and through contacts with experts in the fields of dyspepsia and with pharmaceutical companies. SELECTION CRITERIA: All parallel group randomised controlled trials (RCTs) comparing drugs to eradicate H pylori with placebo or other drugs known not to eradicate H pylori for patients with non-ulcer dyspepsia. DATA COLLECTION AND ANALYSIS: Data were collected on individual and global dyspeptic symptom scores, quality of life measures and adverse effects. Dyspepsia outcomes were dichotomised into minimal/resolved versus same/worse symptoms. MAIN RESULTS: Seven randomised controlled trials were included in the systematic review. Five trials compared proton pump inhibitor dual or triple therapy with a proton pump inhibitor + placebo antibiotics, and evaluated dyspepsia at 6-12 months in 1,385 patients. H pylori eradication was significantly superior to placebo in treating non ulcer dyspepsia (relative risk reduction = 7%; 95% CI = 1% to 12%; p=0.02) and there was no significant heterogeneity between the studies. The number needed to treat to cure one case of dyspepsia = 19 (95% CI = 11 to 132). A further two trials compared Bismuth based H pylori eradication with an alternative pharmacological agent. These trials were smaller and had a shorter follow-up but suggested H pylori eradication was more effective than either H2 receptor antagonists or sucralfate in treating non-ulcer dyspepsia. REVIEWER'S CONCLUSIONS: H pylori eradication may be an effective therapy for H pylori positive non-ulcer dyspepsia. This result is not robust and further evidence on the efficacy of H pylori eradication in non ulcer dyspepsia would be helpful. The effect is modest and economic models would help establish whether this approach is cost-effective. This review will be updated as results from other ongoing trials (Malfertheiner 2000) are made available.

Anti-Bacterial Agents↗
PubMed1988

[A prospective analysis of fertility based on the Willis model].

"In this article, Willis' micro-economic model of fertility is tested with data obtained from the 1982 Netherlands Fertility Survey of the Netherlands Central Bureau of Statistics." This model enables a prospective as well as a retrospective analysis of fertility and helps analyze the impact of husband's and wife's educational status on fertility. The probability of couples having three or more children is shown to be higher when both partners have had only a primary education or when both have had a university-level education. (SUMMARY IN ENG)

Birth Rate↗