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PubMed2003

The relative contribution of outcome domains in the total economic benefit of addiction interventions: a review of first findings.

AIMS: This paper provides a focused summary of the relative contribution of addiction intervention outcomes to total economic benefit, based upon a compilation of published economic studies from the United States. DESIGN: The relevant literature was searched extensively, and 11 economic studies were selected for review. SETTING: The selected addiction interventions address both alcohol use/abuse and illicit drug use/abuse and represent various treatment modalities, including a brief physician intervention and long-term residential programs. PARTICIPANTS: Study participants included community-based drug users, pregnant and/or parenting women, problem drinkers, and criminal offenders. MEASUREMENTS: These studies estimated the economic benefits of an addiction intervention(s) in terms of one or more of the following outcome domains: criminal activity, health services utilization, employment earnings, and expenditures on illicit drugs and alcohol. FINDINGS: The primary finding of this review was that avoided criminal activity was the greatest economic benefit of addiction interventions and contributed more, as a separate outcome domain, to the total economic benefit of addiction interventions than any other outcome domain. Reduced utilization of health care services was also a noteworthy economic benefit of addiction interventions. CONCLUSIONS: This study provides a detailed exposition of economic benefits estimation and highlights the potential impact of individual outcomes, thus providing a useful resource for substance abuse researchers and administrators as they design and evaluate future interventions.

Alcoholism↗
PubMed2005

Alcohol and the economic crisis in Argentina: recent findings.

AIMS: In 2002 Argentina participated in the GENACIS project (Gender, Alcohol, and Culture: An International Study) as one of the countries funded by the World Health Organization. Four questions about the current economic crisis in Argentina were added to the original GENACIS questionnaire in order to find out the opinions of the general population in relation to alcohol and the economic crisis. METHODS: Gender differences in the answers to these questions were examined. Logistic regression was used to identify demographic, drinking pattern and drinking problems variables related significantly to responses to the economic crisis questions. FINDINGS: During the economic crisis people stopped or reduced going to bars and instead drank at home or at friends' homes. A large number of respondents also reported that people had changed to cheaper or lower-quality alcoholic drinks. Women were more likely to agree with statements that the economic crisis had increased 'escape' drinking and required reductions in money spent on alcohol; men were more likely to agree that the crisis had led to less drinking in bars and to the purchase of cheaper or lower-quality alcoholic beverages. Respondents who reported having significant others with drinking-related problems were more likely to endorse all four statements about effects of the economic crisis on drinking behaviour. A qualitative approach was used to discuss themes in the general comments that were recorded by the interviewers while collecting data. A strongly moralistic attitude towards alcohol was present in these comments, especially among women. CONCLUSION: The findings suggest that the economic crisis in Argentina led to major changes in patterns of drinking that differed according to gender roles and other demographic variables. The long-term effects of these changes remain to be determined as economic circumstances improve.

Adolescent↗
PubMed1996

Clinical economics review: gastroenterology.

In the prevailing climate of cost containment, doctors are increasingly expected to consider the economic consequences of treatment choices. Clinical (or medical) economics attempts to apply economic principles to the description and analysis of the costs of medical interventions, so as to identify how best to spend scarce health care resources. Such economic evaluations may assess the overall financial burden of a disease to society as a whole (macro-economics), or attempt to compare alternative treatment strategies for a specific clinical situation (micro-economics). In addition to expenditure on drugs and investigations (direct medical costs), economic studies may consider a variety of other costs. These include direct costs borne by patients (e.g. prescription charges, travel, food), indirect costs to society owing to lost productivity (resulting from morbidity or premature mortality) and even intangible costs which assign a monetary value to outcomes of disease such as pain, distress and anxiety. Four main types of economic analysis are in current use. Cost-minimization analysis attempts to identify the least expensive option in situations where there are a range of equally effective treatments for a given clinical condition, whereas cost-effectiveness analysis allows management strategies differing both in cost and efficacy to be compared. The cost-effectiveness of health care programmes targeting different disease states may also be compared using cost-utility analysis, in which health benefits are translated into a common utility-based unit of outcome, such as the Quality Adjusted Life Year (QALY). Cost-benefit analysis attempts to quantify health outcomes in monetary terms, so that the net result provides an assessment of value-for-money of health interventions. Gastrointestinal disorders are amongst the commonest of complaints, and considerable health care resources are consumed in treatment. Issues of cost-effectiveness are likely to assume increasing importance in gastroenterology because of the ever expanding range of drug choice, the increasing number of high cost treatments and the development of new therapeutic interventions.

Cost of Illness↗
PubMed2006

Economic values for production and functional traits and assessment of their influence on genetic improvement in the Boran cattle in Kenya.

Economic values for production (sale weight in steers, SWs, kg and heifers, SWh, kg; dressing percentage, DP; consumable meat percentage, CMP and milk yield, MY, kg) and functional (cow weight, CoWT, kg; cow survival rate, CoSR, %; postweaning survival rate, PSR, %; feed intake of cows, FIc, heifers, FIh and steers, FIs, kg DM) traits were estimated for six production systems utilizing the Boran breed in Kenya. The influence of the estimated economic values on genetic improvement was also assessed using different selection indices. The six production systems were described according to their sale age, levels of input and final goal, namely, short-fed medium input beef (SMB); long-fed medium input beef (LMB); short-fed high input beef (SHB); long-fed high input beef (LHB); long-fed low input dual purpose (LLD); and long-fed medium input dual purpose (LMD). Two evaluation bases were considered: fixed herd size and fixed pasture input. In the fixed herd-size situation, the economic values for production (except MY in beef systems) and functional traits (except FI in all systems) were positive meaning a unit increase in genetic merit of these traits had greater influence on revenues than costs. As expected, the economic value for MY was negative in the pure beef systems (SMB, LMB, SHB and LHB) and positive in the dual-purpose systems (LLD and LMD). When compared with the economic values estimated in the fixed herd-size situation, in the fixed pasture input situation they were lower for feed intake in the three classes of livestock and other traits related to it in all systems. These traits were CoSR, CoWR, PSR, CoWT, SWh and MY. The economic values for CoWT in LLD and LMD were negative (KSh -11.14 and -15.33 respectively). The economic values did not influence much the direction of the genetic response in each trait in the different production systems. However, the magnitude of the actual gain was dependent on the index applied. The magnitude of the economic values for production and functional traits estimated in this study suggest that genetic improvement of these traits will have a positive effect on profitability of Boran cows kept in dual-purpose systems and when herd size is restricted. In beef systems, genetic improvement of MY will have a negative effect on profitability, especially when restrictions on herd size and feed exists.

Animal Husbandry↗
PubMed2005

Socio-economic inequalities in the prevalence of Type 2 diabetes, cardiovascular risk factors and chronic diabetic complications in the Basque Country, Spain.

AIMS: To establish the relationship between socio-economic status and the prevalence of known Type 2 diabetes, cardiovascular risk factors and chronic diabetic complications. METHODS: In 2000, a cross-sectional survey was conducted among 61 general practitioners (GPs) who studied 65 651 people older than 24 years. Of those, 2985 known Type 2 diabetic patients were registered. The main outcome measures were: diabetes prevalence, major cardiovascular risk factors, chronic diabetic complications and primary care services utilization in Type 2 diabetic patients. Socio-economic status was based on area-based socio-economic measures. RESULTS: The prevalence of known Type 2 diabetes was higher in patients of lower socio-economic status (OR: 2.17, 95% CI: 1.77-2.28), especially among women (OR: 2.28, 95% CI: 1.91-2.73). In Type 2 diabetes patients, obesity, sedentary lifestyle, and abnormal levels of low-density lipoprotein (LDL) cholesterol and HbA(1c) were more prevalent among those from lower socio-economic status. Macroangiopathy was inversely associated with socio-economic status after adjustment for clinical and demographic variables. Patients of lower socio-economic status more frequently visited primary care services than those of higher status. CONCLUSIONS: This study shows an association between deprivation and Type 2 diabetes prevalence, cardiovascular risk factors and chronic diabetic complications in Type 2 diabetes patients. Despite a greater use of health services by less wealthy patients, they showed worse glycaemic control and more chronic complications. Besides clinical variables, socio-economic status and environmental information need to be considered in the assessment of risk profile of diabetic patients by health professionals and by health service planners.

Aged↗
PubMed2006

Public timber supply, market adjustments, and local economies: economic assumptions of the Northwest Forest Plan.

The Northwest Forest Plan in the Pacific Northwest sought to stabilize local economies, including local employment and income, by stabilizing the flow of wood fiber from public forests. This is also a common forest management objective in other regions and countries. Because this economic strategy ignores basic market adjustments, it is likely to fail and to unnecessarily damage forest ecosystems. Application of basic economic principles on how markets operate significantly changes the apparent efficacy of efforts to manage local economies by managing timber supply. The emphasis on timber supply tends to ignore the dominant role that the demand for wood fiber and wood products, rather than wood-fiber supply, plays in determining levels of harvest and production. Contemporary economics indicates that markets tend to operate to offset reductions in wood-fiber supply. This significantly moderates the economic cost of reducing commercial timber harvest in the pursuit of environmental objectives. In addition, contemporary economic analysis indicates that the economic links between natural forests and local communities are much broader than simply the flow of commercially valuable logs to manufacturing facilities. At least in the United States, the flow of environmental services from natural forests has increasingly become an amenity that has drawn people and economic activity to forested areas. Attractive site-specific qualities, including those supported by natural forests, can potentially support local economic development even in the face of reduced timber harvests. These market-related adjustments partially explain the Northwest Forest Plan's overestimation of the expected regional impacts associated with reduced federal timber supply and the ineffectiveness of the plan's efforts to protect communities by stabilizing federal timber supply

Conservation of Natural Resources↗
PubMed1994

Using economics to assess the place of screening.

To an economist the place of screening is, in principle, no different from that of any other medical intervention. Any screening activity should be evaluated in terms of the costs it incurs and the benefits it produces. The reasoning for this is based on one fundamental principle of economics: that of opportunity cost. Resources are scarce, requiring choices to be made about what health care to provide and what not to provide. Sacrifices will be made through not taking up some opportunities, and the benefits of these sacrifices are known as opportunity costs. The place of economics is to assist decision making to promote efficiency and equity in the health care sector. To do this it is necessary to relate the benefits of any screening activity to its costs. Of course, the practicalities of applying economics to assessment of screening activities may be different than for other areas of health care. For instance, screening has a broader range of outcomes than most types of health care, including investment in knowledge as well as health gain. This does have implications for the way in which these outcomes are valued in an economic analysis. This means that economics can be applied to a wide range of policy questions about screening. In this paper examples from applications of economics are used to consider the following issues: How should we set out and estimate costs and benefits (using the example of cholesterol screening)? What is benefit and how should it be measured (using an example from cystic fibrosis carrier screening)? How can economics be used to examine equity issues in screening (using an example from bone mineral density screening)? Together, these case studies highlight the range of screening issues to which economics can be usefully applied.

Adult↗
PubMed2006

Optimal search strategies for detecting cost and economic studies in EMBASE.

BACKGROUND: Economic evaluations in the medical literature compare competing diagnosis or treatment methods for their use of resources and their expected outcomes. The best evidence currently available from research regarding both cost and economic comparisons will continue to expand as this type of information becomes more important in today's clinical practice. Researchers and clinicians need quick, reliable ways to access this information. A key source of this type of information is large bibliographic databases such as EMBASE. The objective of this study was to develop search strategies that optimize the retrieval of health costs and economics studies from EMBASE. METHODS: We conducted an analytic survey, comparing hand searches of journals with retrievals from EMBASE for candidate search terms and combinations. 6 research assistants read all issues of 55 journals indexed by EMBASE for the publishing year 2000. We rated all articles using purpose and quality indicators and categorized them into clinically relevant original studies, review articles, general papers, or case reports. The original and review articles were then categorized for purpose (i.e., cost and economics and other clinical topics) and depending on the purpose as 'pass' or 'fail' for methodologic rigor. Candidate search strategies were developed for economic and cost studies, then run in the 55 EMBASE journals, the retrievals being compared with the hand search data. The sensitivity, specificity, precision, and accuracy of the search strategies were calculated. RESULTS: Combinations of search terms for detecting both cost and economic studies attained levels of 100% sensitivity with specificity levels of 92.9% and 92.3% respectively. When maximizing for both sensitivity and specificity, the combination of terms for detecting cost studies (sensitivity) increased 2.2% over the single term but at a slight decrease in specificity of 0.9%. The maximized combination of terms for economic studies saw no change in sensitivity from the single term and only a 0.1% increase in specificity. CONCLUSION: Selected terms have excellent performance in the retrieval of studies of health costs and economics from EMBASE.

Data Collection↗
PubMed2002

Economic value of thrombolysis with adjunctive abciximab in patients with subacute peripheral arterial occlusion.

BACKGROUND AND OBJECTIVE: Glycoprotein (GP) IIb/IIIa receptor inhibitors enhance thrombolysis in patients with acute coronary syndromes. This analysis evaluates the economic impact of abciximab, a GP IIb/IIIa inhibitor, as an adjunct to urokinase in peripheral artery occlusions of less than 6 weeks duration. STUDY DESIGN: A post-hoc economic analysis was performed using clinical data and inpatient resource utilisation derived from the prospective comparative phase II Platelet Receptor Antibodies in Order to Manage Peripheral Artery Thrombosis (PROMPT) pilot study. Study endpoints were amputation-free survival and survival without open surgery or major amputation after 90 days, and the rate of major complications at 30 days. PERSPECTIVE: Third-party payer and the societal perspective. PATIENTS AND METHODS: Seventy patients with lower extremity thrombi were randomised (2 : 5 ratio) to urokinase plus placebo or to urokinase plus abciximab. Economically relevant data were retrospectively derived from the clinical study database from a specific evaluation of patient records and from expert opinion. RESULTS: From the viewpoint of the society, average total per-patient direct and indirect costs accruing over 3 months were more favourable for treatment with abciximab plus urokinase than for urokinase alone [9723 euros (EUR) vs EUR10 322; 2000 values], despite higher initial hospitalisation costs of the combination therapy. Abciximab plus urokinase was the dominant strategy at 3 months due to a clinically higher rate of survival without amputation or bypass surgery coupled with a lower average per-patient cost. From the perspective of the third-party payer, treatment with abciximab plus urokinase was economically also superior to urokinase alone (EUR8773 vs EUR9663). CONCLUSIONS: Based on the preliminary findings of the PROMPT trial, the use of abciximab as an adjunct to urokinase in patients with subacute peripheral artery occlusions may be the favourable strategy compared with urokinase alone, in terms of clinical and economic outcomes. Further trials are needed to confirm these clinical and economic findings. The preliminary clinical benefits experienced by patients treated with abciximab plus urokinase in the PROMPT trial translated into cost savings in terms of reduced direct medical costs at 3 months. These cost savings more than offset the cost of abciximab. The use of abciximab as an adjunct to urokinase in patients with subacute peripheral artery occlusions may be the favourable strategy compared with urokinase-alone in terms of clinical and economic outcomes, but further trials are needed to confirm the these clinical and economic findings.

Abciximab↗
PubMed2005

The role of economic evaluation in vaccine decision making: focus on meningococcal group C conjugate vaccine.

In recent years, several countries have experienced increases in the incidence of serogroup C meningococcal disease. It can be controlled with older polysaccharide vaccines and particularly the recently developed conjugate vaccines. For 21 developed countries, we investigated the role that economic evaluation played in the decision to introduce the conjugate vaccine into either the routine childhood vaccination schedule, as a mass vaccination 'catch-up' campaign or not at all. A literature review was performed and experts from these countries were contacted. For six countries, we identified published economic evaluations for meningococcal C conjugate vaccination. In four of them (Australia, Canada [Quebec], The Netherlands and the UK) the analyses were performed before a decision about the use of the conjugate vaccine was made. In all of these countries, the economic evaluation offered guidance as to the most efficient way to add the conjugate vaccine to the routine infant immunisation schedule and, in three countries, this advice was adopted by decision makers. In Portugal and Switzerland, initial vaccination decisions were made without the economic evaluations that are influencing current decision making. Of the countries without economic evaluations, six implemented vaccination programmes. Overall, there was a positive correlation between the reported incidence of meningococcal C disease and (a) the decision to vaccinate and (b) performing an economic evaluation. All economic evaluations were modelling studies. The reported cost-effectiveness ratios were sensitive to the age of vaccination, the future meningococcal incidence, vaccine price and some methodological characteristics that varied widely between studies making direct comparisons difficult. In conclusion, in almost all countries where economic evaluations for meningococcal C conjugate vaccinations have been conducted, their results had an important role in the decision-making process. However, in most countries with strongly increasing meningococcal incidence, public health considerations took precedence. In order to improve the international comparability of such studies, firmer national and international modelling guidelines and better adherence to such guidelines seem necessary.

Cost-Benefit Analysis↗
PubMed2006

Economics of atypical antipsychotics in bipolar disorder: a review of the literature.

Economic evaluations are increasingly being used by policy makers to evaluate the relative costs and benefits of healthcare interventions. These analyses provide economic and clinical evidence to decision makers seeking to make recommendations on treatment alternatives for patients. This article describes the economic evidence on the atypical antipsychotics currently approved for the treatment of bipolar disorder. This area remains under-researched. A literature search identified only six relevant studies of atypical antipsychotics in bipolar disorder: two retrospective database analyses, three economic analyses alongside clinical trials and one cost-effectiveness analysis. Based on the limited available studies, there appears to be no significant difference in healthcare resource use between olanzapine, quetiapine, risperidone and valproate semisodium (divalproex sodium; an antiepileptic drug and a standard treatment for mania associated with bipolar disorder). While a cost-effectiveness study for the UK found haloperidol (a conventional antipsychotic) to be more cost effective than atypical antipsychotics, these results must be considered with caution because of the non-inclusion of adverse effects in the model. No economic data are available for aripiprazole, clozapine or ziprasidone in bipolar disorder. Until more economic evidence becomes available, the economic implications of atypical antipsychotic treatment in patients with bipolar disorder are unlikely to significantly impact on prescribing and treatment patterns. Future economic studies evaluating atypical antipsychotics in bipolar disorder should address the issue of long-term costs and effectiveness to reflect the chronic nature of the disease, the variety of health states that patients may experience and the range of treatments they may receive. A better understanding of the complex interplay between effectiveness, safety, quality of life, adherence and resource use should ultimately contribute to improving the treatment of bipolar disorder.

Antipsychotic Agents↗
PubMed2000

Evaluating the economic and noneconomic impacts of the veterinary medical profession in Michigan.

This study reaffirms the diversity and breadth of the veterinary profession. As it turns out, some of the furthest-reaching impacts of the veterinary medical profession were largely non-quantifiable. The veterinary medical profession had a substantial direct economic impact in Michigan during 1995. The total economic contribution of the veterinary medical profession to Michigan during 1995 that was attributable to expenditures on salaries, supplies, services, and their multiplier effect was approximately $500 million. In addition, the profession was associated with nearly 8,500 jobs (combined professional and lay positions). The veterinary medical profession was also considered to have an impact on the prosperity of the live-stock, equine, and pet food industries in Michigan, even though the economic contribution in these areas could not be directly quantified. Economic well-being of the individual businesses in these industries is directly related to the health and productivity of the associated animals, and improvements in output or productivity that accompany improved animal health likely carry substantial economic benefits in these sectors. In addition, progressive animal health management provides a crucial method of managing risk in the animal industries. Similarly, although the economic contribution could not be quantified, the veterinary medical profession enhances the safety and quality of human food through research, regulation, and quality assurance programs in livestock production, minimizing the risk of drug residues and microbial contamination. During 1995, approximately 5.3 million Michigan residents benefitted from the physical, psychological, and emotional well-being that accompanies companion animal ownership. By preserving the health and longevity of companion animals, veterinarians sustain and enhance these aspects of the human-animal bond. As Michigan enters a new century, it is likely that the state's veterinary medical profession will continue to make a highly valued societal contribution. Pets, equines, and food animals will continue to have prominent roles in Michigan for the foreseeable future, as will the human-animal bond, food safety, and medical research. Clearly, for economic and noneconomic reasons, it will be in the interest of the people of Michigan to seek opportunities to maintain and enhance the vitality of the state's veterinary medical profession. It was our hope that results of this study would provide university administrators, legislators, MVMA executives, and others with information needed to justify the ongoing provision of public support for the veterinary medical profession. In addition, we expect that the results will supply useful material for public relations and marketing campaigns by the MVMA and the Michigan State University College of Veterinary Medicine and will provide the media with public interest stories to promote the veterinary profession. Although this study considered the economic and noneconomic impacts of the veterinary medical profession only in Michigan, the results can provide an important reference point for educators, policy markers, and legislators in other states. In addition, this study could serve as a methodologic model for veterinary organizations in other states, or at the national level, to emulate.

Animals↗
PubMed1997

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

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

Adult↗
PubMed2004

An economic analysis of communal goat production.

The economic impact of different extension messages used was calculated using enterprise budgeting (gross margin analysis). Input data were gleaned from the literature, from participatory appraisals, as well as a field study, spanning 12 months, of small-scale communal goat farming systems in Jericho in the Odi District of North West Province. The number of offspring weaned per annum, as a proportion of does owned, was selected as the desired output for analysis. This study has shown that small-scale communal goat farmers are not adopting or implementing extension messages to improve production capacity. In South Africa the majority of goats are slaughtered in the informal sector. If the informal sector is to be persuaded to market goats commercially through formal channels, then knowledge of the economics of goat farming on communal lands should be provided. The economic aspects of extension messages are probably an important factor in determining acceptance and sustainability yet appear to be seldom investigated. The probable reason for lack of adoption of standard extension messages, which promote improved nutrition, parasite control, vaccination and treatment of goats, was economic. In other words, the so-called 'poor management practices' used by communal farmers appeared to be economically more profitable than the 'good management practices' suggested to increase production. The price of communal goats was not related to their mass. A higher level of inputs would probably have resulted in a heavier kid, however it was established that this would not have influenced the price received as a majority of the goats were slaughtered for ritual purposes where age, colour and sex were more important to the purchaser than body mass. It is standard practice in commercial farming systems to evaluate the economic benefits of all management practices before they are implemented. Production animal veterinarians use veterinary economics to compare different scenarios to control diseases or select management practices in commercial herds. It is suggested that the inputs and outputs of small-scale farming systems should be carefully analysed and that veterinary economics should also be used to evaluate the probable impact of extension messages formulated by veterinarians and animal health technicians.

Animal Husbandry↗
PubMed2000

Sleep apnoea syndrome: the health economics point of view.

This review analyses the available literature on the economic aspects of obstructive sleep apnoea, including the indirect medical costs, the indirect nonmedical costs, the direct costs of diagnosing and treating the disease, and the utilities as perceived by patients. The philosophical context of health economics is also considered. The literature available on the economic aspects of obstructive sleep apnoea is scarce, and frequently incomplete, so that only tentative conclusions can be reached. Obstructive sleep apnoea seems to lead to measurable (about two-fold) increases in indirect medical costs. Moreover, this excess cost seems to be reduced in the first years following the institution of treatment with nasal continuous positive airway pressure (nCPAP). There are also indirect nonmedical costs linked to the disease, for example traffic, domestic and workplace accidents. The exact extent of these costs is, however, impossible to ascertion from the available literature. Cost/utility analysis has shown full-night polysomnography to be the diagnostic approach with the higher cost/utility ratio, because diagnostic errors (greater with other approaches) carry a disproportionate weight. The cost of treating the disease has not been thoroughly assessed but appears as quite reasonable, and certainly not excessive. Finally, one study has shown in patients with severe sleep apnoea that treatment with nCPAP has a favourable effect when measured as quality adjusted life years. It is concluded that obstructive sleep apnoea leads to an excess in health-related expenditure, that treatment with nasal continuous positive airway pressure reduces this excess cost and thus makes sense in economic terms, and that patients believe nasal continuous positive airway pressure treatment to be worth considering for economic reasons. It is further concluded that medical decisions should be guided by medical (not economic) considerations, even if it is acknowledged that, for the time being, economic analysis is necessary to to convince health managers that obstructive sleep apnoea is also worth considering from the economic point of view.

Canada↗
PubMed2002

Socio-economic factors and mortality among 25-64 year olds followed from 1991 to 1994: the New Zealand Census-Mortality Study.

AIM: To measure the association of income, education, occupational class, small area socio-economic deprivation, car access and labour force status with mortality among 25-64 year old males and females using the 1991 census-cohort of the New Zealand Census-Mortality Study. METHODS: Mortality records for 1991-94 were anonymously and probabilistically linked to 1991 census records, thereby creating a cohort study of all New Zealand census respondents. Odds ratios of mortality comparing categories of each socio-economic factor were calculated using logistic regression. For income, education and deprivation (NZDep91) a modified relative index of inequality (RII(10:90)) was calculated. The RII(10:90) estimates the relative risk of mortality for low socio-economic people (10th percentile rank) compared to high socio-economic people (90 percentile rank) allowing direct comparisons across socio-economic factors. RESULTS: The relative risk of all-cause mortality for 25-64 year old males with an equivalised household income less than $20,000, compared to greater than $50,000, was 2.16 (95% confidence interval 1.99 to 2.34). For females, this relative risk was 1.68 (1.52 to 1.86). Using the RII(10:90) all-cause mortality was 2.22, 1.94 and 1.58 times greater among low compared to high socio-economic males for income, NZDep91 and education, respectively. For females, these RII(10:90) estimates were 1.77, 1.69 and 1.57, respectively. By cause of death, the strongest gradients were observed for respiratory diseases, followed by lung cancer, cardiovascular disease and unintentional injury. For suicide deaths, unemployed males and females had 2.70 (1.84 to 3.95) and 2.86 (1.19 to 6.85) greater rates than the employed. CONCLUSIONS: There are strong socio-economic gradients for all-cause mortality and most specific causes of mortality among both males and female adults in New Zealand, regardless of the choice of socio-economic factor. The gradients were strongest for income, followed by small area deprivation and education, and strongest for 'preventable' causes of death.

Adult↗
PubMed2003

The association of socio-economic position across the life course and age at menopause: the British Women's Heart and Health Study.

OBJECTIVE: To assess the association of indicators of adverse socio-economic position from across the life course with age at menopause. DESIGN: Cross sectional study as part of the British Women's Heart and Health Study. SETTING: 23 British towns. POPULATION: Three thousand and five hundred and thirteen women aged 60-79 years from a total cohort of 4286. Women who underwent a hysterectomy or oophorectomy prior to their 'natural' menopause or who were taking hormone replacement therapy around the perimenopausal period and for whom a biological age at menopause could not be calculated were excluded from this study. MAIN OUTCOME MEASURES: Age at menopause. RESULTS: Most of the 10 indicators of adverse socio-economic position from childhood through to adulthood were linearly associated with a younger age at menopause. In age adjusted analyses, women from manual social classes in childhood began their menopause on average 0.68 years (95% confidence interval [CI] 0.11, 1.3) earlier than those from non-manual social classes. Those who lived in a house as a child without a bathroom began their menopause 0.47 years (95% CI 0.12, 0.82) earlier than those with a bathroom. Those who shared a bedroom began 0.36 years (95% CI 0.03, 0.70) earlier than those who had their own bedroom and finally those who lived in a household with no access to a car as a child began their menopause 0.47 years (95% CI 0.02, 0.95) earlier than those with access to a car. Adult indicators of adverse socio-economic position were similarly associated with earlier age at menopause. Age at completing full time education was not substantively associated with age at menopause. The inverse associations between each of the indicators of both childhood and adult socio-economic position and age at menopause were not importantly affected by adjustment for other reproductive factors but they attenuated by between 6% and 21% with adjustment for adult smoking and body mass index. The inverse associations between each of the childhood indicators of socio-economic position only and age at menopause attenuated markedly (between 12% and 70%) with adjustment for adult leg length. There was a cumulative effect of disadvantage across the life course demonstrated by a strong linear trend between a composite score of the 10 socio-economic indicators and young age at menopause. The age at onset of menopause for women who had 9 or 10 adverse socio-economic indicators was on average 1.70 years (95% CI 0.36, 3.0) younger than that of women with none or only one indicator. CONCLUSIONS: Adverse socio-economic circumstances in childhood, as well as in adulthood, are associated with an earlier age at menopause. The association between childhood deprivation and early menopause may at least in part be mediated via exposures, such as childhood diet, which affect both linear growth and age at menopause.

Aged↗
PubMed2005

Economic valuation for sustainable development in the Swedish coastal zone.

The Swedish coastal zone is a scene of conflicting interests about various goods and services provided by nature. Open-access conditions and the public nature of many services increase the difficulty in resolving these conflicts. "Sustainability" is a vague but widely accepted guideline for finding reasonable trade-offs between different interests. The UN view of sustainable development suggests that coastal zone management should aim at a sustainable ecological, economic, and social-cultural development. Looking closer at economic sustainability, it is observed that economic analyses about whether changes in society imply a gain or a loss should take into account the economic value of the environment. Methods used for making such economic valuation in the context of the Swedish coastal zone are briefly reviewed. It is noted that the property rights context matters for the results of a valuation study. This general background is followed by a concise presentation of the design and results of four valuation studies on Swedish coastal zone issues. One study is on the economic value of an improved bathing water quality in the Stockholm archipelago. The other studies are a travel cost study about the economic value of improved recreational fisheries in the Stockholm archipelago, a replacement cost study on the value of restoring habitats for sea trout, and a choice experiment study on the economic value of improved water quality along the Swedish westcoast.

Animals↗