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PubMed1997

Health economics of gastroesophageal reflux disease.

The present study provides an overview of the current state of health economics studies of gastroesophageal reflux disease (GERD). It indicates the strengths and weaknesses of individual studies, and the state of health economics analysis in general as they apply to GERD. Specifically, this study adopts a pharmacoeconomic perspective, which is a subsection of health economics analytical methods, to provide a comparative analysis of alternative courses of action based on cost and consequence. The pharmacoeconomic outlook is most effective when it considers a comprehensive societal perspective, with special consideration given to other relevant viewpoints, such as the payer, the primary provider and, most important, the patient. Pharmacoeconomics provides several specific analytical techniques for GERD-related health economics analysis. The Canadian Association of Gastroenterology consensus conference on GERD in 1996 thought that a cost effective analysis was the most appropriate technique to assess the pharmacoeconomics of GERD. Six previous studies on GERD health economics have been performed comparing omeprazole with H2 receptor antagonists. These studies vary in cost data collected and in analytical techniques. In general, the existing outcome measurements of these previous health economics studies are not ideal. Namely, they combine various GERD grades, use randomized controls, are endoscopically based, assess pharmaceutical therapy only and are short term. More appropriate health economic trials in GERD, which focus on GERD management strategies and therapeutic treatment of GERD, need to be designed and conducted. These economic assessments, however, should not replace detailed thinking, careful observation, good judgement and common sense.

Canada↗
PubMed1997

[Economic considerations of patient education].

BACKGROUND: The aim of this review is to analyse the economic impact of patient education programmes for asthma management and to compare methodologically the published economic evaluations for asthma programmes. METHODS: An extended MEDLINE research identified 15 economic evaluations of asthma patient education programmes for the period 1981 to 1996. These studies were analysed regarding their overall results and their methodological quality using the criteria of Drummond et al. (1987). RESULTS: The economic and methodological results of the analysed asthma programmes show a wide variation. Some programmes result in higher costs (3 out of 15), but most of the published studies show a positive benefit-cost ratio for the implementation of an asthma patient education programme (10/15). Only 1/3 (5 out of 15) of the published studies fulfil at least 2/3 of the criteria of Drummond et al. (1987). One potential reason for the varying results are the different inclusion criteria for patients and cost categories. CONCLUSIONS: Patient education in chronic diseases such as asthma is a well recognised, effective and efficient component of a modern approach to disease management. The economic impact is nonetheless related to the design of the programme, the patient selection criteria, and the perspective of the analyses. Only some of the economic evaluations analysed in this review fulfil at least 2/3 of the methodological criteria for good economic practice. Future economic evaluations of patient education programmes should follow the published methodological standards more strictly.

Adult↗
PubMed1998

Health economic evaluations of antidepressants: a review.

In an era of constrained health care financing, clinicians are increasingly faced with considering the economic consequences in addition to the clinical outcomes associated with initiating a patient on antidepressant therapy. This has increased the demand for health economic studies comparing antidepressant use and associated health care expenditures in clinical practice. These health economics studies have used methods ranging from clinical trials to other types of analyses including prospective naturalistic trials or retrospective studies which may be less familiar to clinicians. Prospective and retrospective health economics studies performed in clinical practice complement the experience gained from clinical trials in assessing antidepressant use and economic outcomes in light of patient and provider behavior within the usual care environment of a complex health care system. Broadly considered, health economic studies of antidepressants have consistently found differences in clinical practice between the tricyclic antidepressants (TCAs) and the selective serotonin reuptake inhibitors (SSRIs) as well as among the SSRIs. These differences relate to the pattern and duration of antidepressant use as well as total direct health care expenditures. Future health economic research studies in clinical practice should focus on the economic consequences of long-term antidepressant use as well as the impact of antidepressant use on indirect costs such as productivity and absenteeism.

Antidepressive Agents↗
PubMed2026

Cost-Effectiveness of Electronic Patient-Reported Outcome Measure Interventions in Cancer: Systematic Review and Parameter Extraction for Economic Modeling.

BACKGROUND: Complex digital interventions that integrate electronic patient-reported outcome measures (ePROM) into clinical practice in cancer have the potential to improve quality of life, increase survival, and reduce health resource use and costs. Such systems can help patients with cancer self-manage chemotherapy symptoms, reduce clinicians' workloads through automated decision support, and resolve problems earlier. However, more research on the cost-effectiveness of ePROM monitoring is needed. OBJECTIVE: This paper comprises two complementary components: (1) a systematic literature review summarizing and evaluating the quantitative and qualitative evidence related to the cost-effectiveness of ePROM monitoring and (2) a health economic model parameter extraction. We also conducted supplementary targeted searches and scoping to provide context to our findings. METHODS: We searched Ovid (including MEDLINE and Embase), Scopus, and the International Health Technology Assessment Database for original English-language papers published on or before March 2025 using search strings that combined terms related to ePROMs, health economics, and cancer/oncology. We included papers reporting health economic-related outcomes for ePROM interventions designed for adult cancer populations and excluded screening tools and conference abstracts. RESULTS: We included 34 publications from 27 unique studies and identified and analyzed 26 ePROM-integrated interventions within these. Most (23/26) of the included interventions explicitly described some form of alert handling and automated decision support based on remote ePROM monitoring. Of the 34 publications, 5 presented full cost-effectiveness analysis results, of which 3 were highly uncertain and lacked clear differences in costs and health outcomes between ePROMs and standard care; conversely, 2 presented strong evidence of cost-effectiveness due to quality-of-life improvements, reduced hospitalizations, and potentially more autonomy in health-related travel (eg, ePROM-monitored patients can drive or walk to the hospital instead of using taxis or ambulances). A further 5 publications reported partial health economic results (eg, cost-consequence and budget impact), of which 1 detected no difference in strategies; in contrast, 4 reported lower health resource use and costs of ePROMs, mainly due to hospitalization reductions. Overall, 12 of the 27 studies included a qualitative component but mostly focused on user experience and design-related themes; only 2 of these addressed economic-specific themes (eg, changes in workflow and resource use due to ePROM implementation and integration), indicating some potential for time saving due to ePROM monitoring. CONCLUSIONS: Some ePROM-integrated interventions demonstrated cost-effectiveness in cancer care, but the evidence base remains limited. Where evidence does exist, cost-effectiveness appears driven by reduced hospitalization and improved quality of life. Qualitative research within the included studies rarely addressed economic questions. We provide a detailed parameter extraction for use in future economic modeling and recommend research priorities, including quantitative mapping of ePROM symptom data onto health resource use patterns, and qualitative work exploring how ePROM implementation affects clinical workloads and patient-perspective costs.

Humans↗
PubMed1992

Nutrition and socio-economic development in Southeast Asia.

While most Third World countries, particularly in Africa and Latin America, have experienced a deterioration in child welfare as a result of the severe economic downturn in the 1980s, Southeast Asia in general managed to sustain improvements in the situation of its children because it has maintained satisfactory rates of economic growth. However, there were exceptions within Southeast Asia. The Philippines, Vietnam, Dem. Kampuchea and Laos had unsatisfactory growth rates and, consequently, unsustained nutritional gains from the 1970s through the 1980s. Economic factors exerted a big impact on the Philippine nutrition situation, particularly on the dietary status of the households and the nutritional status of children. As a result of the economic dislocation occurring in the country, the nutritional gains of 1978-82 were not maintained in succeeding years. Unlike the case of Thailand, it has been estimated that the solution to nutritional problems in the Philippines is far from being achieved in the immediate future (Villavieja et al. 1989). On the other hand, the nutrition improvements in Thailand have been as remarkable as the economic growth over the last decade. Long-term investments in health, nutrition and other social services in Thailand (as well as in Indonesia) have paid off according to the assessment by the United Nations (1990). It appears, therefore, that the nutrition situation in developing countries is highly dependent on the economic situation, globally and nationally (Cornia et al. 1987), as well as on investment in social services. Adjustment policies should, therefore, consider their implications on distribution and poverty in order that they could positively contribute to the improvement of the nutrition of the people.

Asia, Southeastern↗
PubMed2006

Economic transition and household food consumption: a study of Bulgaria from 1985 to 2002.

Major economic transitions typically entail changes in the availability of and purchasing power for different types of foods leading to long-term changes in the composition of the diet. Bulgaria, a former Eastern Bloc country, underwent a difficult and protracted transition from a centralized to market economy with acute economic crises and a much slower recovery of income levels than in Poland, the Czech Republic, and Hungary. Using annual data from the Bulgarian National Household Survey, we study changes in the reported consumption of major foods (excluding alcoholic drinks) and their constituent macronutrients from 1985 to 2002, examining also the differences in dietary patterns between the period prior to and following the transition. The consumption of most major food items decreased, resulting in a fall in per capita energy consumption of 429 kcal/day (1.80 MJ/d), following the economic transition of 1991. As expected, the consumption of foods that were more expensive per unit of energy decreased greater than cheaper foods, -34% for animal products and -19% for visible fats, but only -10% for carbohydrates. These changes are related to the changes in income and market prices as well as the general negative trend in economic growth and hyperinflation in the mid-1990s. Thus, Bulgaria experienced a decrease in food consumption without significant changes in the dietary pattern following the economic transition of 1991. The fact that part of this decline may be attributed to continued economic challenges suggests that future transitions in the diet may be expected as economic development proceeds.

Agriculture↗
PubMed2005

The contribution of lone parenthood and economic difficulties to smoking.

Smoking is more prevalent among lower socioeconomic status groups, among those who perceive economic difficulties and among lone mothers. Less is known of how these factors contribute to smoking independently. The aim of this study was first to examine the association between smoking and both economic difficulties and lone parenthood. We then also studied to what extent smoking among people experiencing economic difficulties and lone parenthood is due to other factors such as socioeconomic status and social relations. The data derive from surveys conducted among the employees of the City of Helsinki, Finland, in 2000 and 2001 including 6243 respondents aged 40-60 yr (response rate 68%). The measures were daily smoking, economic difficulties and family type, as well as socioeconomic status (education, occupational social class, household income, housing tenure) and social relations. The more had respondents experienced economic difficulties, the more prevalent was their smoking. Smoking among lone parents was more common than among parents living together; this was true for both men and women. After controlling for socioeconomic status and housing tenure, the association between smoking and economic difficulties, as well as that between smoking and lone parenthood, attenuated but remained statistically significant. However, after controlling for social relations the associations became stronger. Both economic difficulties and lone parenthood were associated with smoking independent of education, occupational social class, household disposable income, housing tenure or social relations for both men and women.

Adult↗
PubMed2002

Economic evaluations of screening programs: a review of methods and results.

BACKGROUND: The economics of screening is part of the broader area of the economics of prevention, and is concerned with the allocation of resources to screening activities when confronted with the problem of scarcity. ISSUES: One important aspect of the economics of screening is the economic evaluation of screening programs. Economic evaluation involves a systematic assessment of the costs and benefits of screening. RESULTS: A review of methods and results of economic evaluations of screening produces no generalizable conclusion about the economic desirability or otherwise, of screening programs. Each particular screening program must be evaluated on its merits. There is no evidence of any systematic tendency for screening programs to be more or less cost-effective than other prevention or treatment programs. Across all programs, substantial disparities have been found in cost-effectiveness. CONCLUSIONS: The challenge in the future will be to secure the re-allocations of resources necessary to maximize health gains from limited health care resources, rather than to undertake the analyses on which such re-allocations would be based.

Australia↗
PubMed2005

Flow of natural versus economic capital in industrial supply networks and its implications to sustainability.

Appreciating the reliance of industrial networks on natural capital is a necessary step toward their sustainable design and operation. However, most contemporary accounting techniques, including engineering economics, life cycle assessment, and full cost accounting, fail in this regard, as they take natural capital for granted and concentrate mainly on the economic aspects and emissions. The recently developed "thermodynamic input-output analysis" (TIOA) includes the contribution of ecological goods, ecosystem services, human resources, and impact of emissions in an economic input-output model. This paper uses TIOA to determine the throughputs of natural and economic capitals along industrial supply networks. The ratios of natural to economic capitals of economic sectors reveals a hierarchical organization of the U.S. economy wherein basic infrastructure industries are at the bottom and specialized value-added industries constitute the top. These results provide novel insight into the reliance of specific industrial sectors and supply chains on natural capital and the corresponding economic throughput. Such insight is useful for understanding the implications of corporate restructuring on industrial sustainability metrics and of outsourcing of business activities on outsourcer, outsourcee, and global sustainability. These implications are discussed from the standpoints of weak and strong sustainability paradigms. The calculated ratios can also be used for hybrid thermodynamic life cycle assessment.

Costs and Cost Analysis↗
PubMed2003

A qualitative approach to the use of economic data in the selection of medicines for hospital formularies: a French survey.

OBJECTIVE: Qualitative interviews were conducted with pharmacists in hospitals and clinics in the Rhône-Alpes region of France to determine the role of economic data when selecting medicines for formularies, to identify barriers to the use of this information and to study to what degree a healthcare establishment's financing system influences the use of this data. METHOD: A stratified sample of healthcare establishments with over 100 short-stay beds were included: (1) thirteen public and semi-private hospitals financed through annual global budgets and (2) six private clinics financed on a fee-for-service basis. Interviews were carried out between October 1999 and January 2000, and coded independently by two researchers. MAIN OUTCOME MEASURE: A multiple correspondence analysis was performed to compare the two groups of healthcare establishments. RESULTS: The influence of economic data in the decision-making process is limited, for other factors appear to have greater weight: (1) efficacy and safety of medicines (2) relations between decision-makers and the pharmaceutical industry and (3) patient quality of life. Economic data used was mainly related to medication prices and quantities consumed. This data was used in a large number of decisions and seemed to have more importance in hospitals than in clinics. Information related to resources that could be saved by the inclusion of a new medicine on formularies was seldom used and apparently considered less important in hospitals than in clinics. Pharmacoeconomic evaluations were very rarely used. Six barriers to the use of economic data were raised by the pharmacists, including: lack of time, which limits the collection and analysis of such information; insufficient health economics training, an obstacle to decision-makers' analytical capacity; and closed budgets within hospitals. CONCLUSION: Economic data concerning 'medication budgets' appears to have a greater impact in public and semi-private hospitals than in private clinics. Obstacles linked to the decision-making context itself were particularly highlighted, and it can be concluded that in order to increase the use of economic data, it is first necessary to create an environment that is more favourable to its application.

Cost-Benefit Analysis↗
PubMed2003

Measurement of the economic impact of visual impairment from age-related macular degeneration in Australia.

The purpose of this report was to: (i) outline the potential value of health economic studies into age-related macular degeneration (AMD); (ii) provide an overview of health economic studies pertinent to AMD; and (iii) outline the basic frame work of cost-of-illness studies (a useful first step in applying economic methods). The detection and management of sensory loss in the elderly plays a key role in the Australian Government's Healthy Ageing Strategy. Age-related macular degeneration is currently the leading cause of blindness in elderly Australians. Although a large proportion of AMD cases remain untreatable, the introduction of photo-dynamic therapy provides a relatively expensive and possibly cost-effective innovation for others. Antioxidant therapy has also been proven effective in reducing progression of early to late disease. The discipline of economics can contribute to an understanding of AMD prevention and treatment through: (i) describing the current burden of disease; (ii) predicting the changes in the burden of disease over time, and (iii) evaluating the efficiency of different interventions. Cost-of-illness studies have been performed in many fields of medicine. Little work, however, has been done on describing the economic impact from AMD. A number of different economic evaluation methods can be used in judging the efficiency of possible interventions to reduce the disease burden of AMD. Although complementary in nature, each has specific uses and limitations. Studies of the economic impact of eye diseases are both feasible and necessary for informed health care decision-making.

Australia↗
PubMed2005

[Health economic evaluation of rehabilitation programmes in the "rehabilitation sciences" research funding programme in Germany].

A main problem of the German rehabilitation sector is to meet the increasing demand for rehabilitation treatment while available resources are scarce. Thus, health economic evaluation is gaining more importance for decision making in the rehab system. In the "Rehabilitation Sciences" research funding programme the relevance of health economic analyses was recognised from the outset. In nearly all regional networks health economic analyses were conducted - though with different scope. In the first funding period the main focus of health economic evaluation was on (1) patient education programmes and (2) the comparison of inpatient versus outpatient rehabilitation. The projects of the research funding programme have initialised health economic evaluation of rehabilitation in Germany. It was shown that health economics can contribute relevant results for designing rehabilitation concepts. The article concludes with an outlook on the main future questions of rehab economic evaluation.

Biomedical Research↗
PubMed2000

Mortality and economic development over the course of modernization: an analysis of short-run fluctuations in Spain, 1850-1990.

Distributed lag models are used to explore the issue of the importance of economic factors for demographic performance over the course of the demographic and economic modernization of Spain. Mortality indicators are generated by age, sex, and cause and are assessed in terms of shifts in Gross Domestic Product. During the pre-transitional period, links between mortality and economic performance were simultaneous and rather weak but in the expected direction, declining to near 0 by the beginning of the twentieth century. Afterwards the importance of economic shifts for mortality fluctuations increased dramatically and delayed effects began to predominate, only disappearing after 1950. The paper explains the increase in the importance of economic factors and the change in the lag structure in terms of the greater economic volatility of the 1915-1950 period, the progressive implantation of more efficient public health systems and their sensitivity to economic fluctuations, and improving levels of nutrition and general health.

Economics↗
PubMed2004

Measuring economic outcomes of cancer.

Economic outcomes are increasingly important in cancer research. This article provides an introduction to the nature and measurement of economic outcomes in cancer and gives the reader entry points to a considerable literature on measuring economic endpoints in health and medicine. Economic outcomes data are defined here as measures of resources consumed in prevention, detection, and treatment of cancer and its sequellae. Part I of this essay discusses the questions addressed by economic outcomes. Part II presents a typology of and introduction to measurement of economic outcomes. Part III discusses important measurement issues and calls for development and validation of standardized protocols and questionnaires to measure economic outcomes, especially at the patient level.

Health Care Costs↗
PubMed2002

An update on the health economics of asthma and allergy.

Health economics is receiving more attention as decision-makers--whether purchaser, physician, or patient--are looking for a more comprehensive understanding of the impact of adopting new healthcare strategies. In this article we review the recent advances in the health economics of asthma and allergy. In burden of illness studies, estimates of the economic burden of asthma and allergy were reported from countries and regions not previously detailing these costs. There were economic evaluations comparing medications and those that evaluated disease management programs. The recent studies of pharmaceuticals have focused on evaluating the cost-effectiveness of various controller medications for the treatment of asthma. Although mostly observational, such studies increase the evidence that these medications are relatively cost-effective. A few recent economic evaluations have been published examining disease management and education programs. These studies are generally long-term evaluations and have not shown consistent health economic impact. The field of health economics in asthma and allergy continues to evolve and aims to provide information to aid in decision making.

Asthma↗
PubMed2006

Economic growth and biodiversity loss in an age of tradable permits.

Tradable permits are increasingly becoming part of environmental policy and conservation programs. The efficacy of tradable permit schemes in addressing the root cause of environmental decline-economic growth--will not be achieved unless the schemes cap economic activity based on ecological thresholds. Lessons can be learned from the largest tradable permit scheme to date, emissions trading now being implemented with the Kyoto Protocol. The Kyoto Protocol caps neither greenhouse gas emissions at a level that will achieve climate stability nor economic growth. If patterned after the Kyoto Protocol, cap-and-trade schemes for conservation will not ameliorate biodiversity loss either because they will not address economic growth. In response to these failures to cap economic growth, professional organizations concerned about biodiversity conservation should release position statements on economic growth and ecological thresholds. The statements can then be used by policy makers to infuse these positions into the local, national, and international environmental science-policy process when these schemes are being developed. Infusing language into the science-policy process that calls for capping economic activity based on ecological thresholds represents sound conservation science. Most importantly, position statements have a greater potential to ameliorate biodiversity loss if they are created and released than if this information remains within professional organizations because there is the potential for these ideas to be enacted into law and policy.

Air Pollution↗
PubMed1996

Economic effects of the outmigration of obstetric services in a rural county.

Obstetrical health care resources have been declining in rural areas since 1980, resulting in reduced prenatal care that can result in higher medical costs. Loss of health care services is known to have negative economic consequences for rural communities. This article illustrates how hospitals and other providers of medical services can be used as vehicles for local economic development. Provision of medical services is an important component of the economic base of all communities and especially of small rural communities with hospitals. When a community loses medical services to another community, it loses both direct and indirect economic benefits. The research presented here analyzes the economic effects of outmigration of obstetric services from a rural "perimeter" community in Wyoming. The combined direct and indirect economic losses are shown to be significant. Annual revenue losses to the local hospital were estimated as high as 12 percent. It is important to make explicit the economic losses that result from reductions in health care. Such research, combined with knowledge of negative health and social factors can provide community leaders with additional motivation to find solutions to declining health care in rural areas.

Birth Rate↗
PubMed1994

Economic development and tropical disease.

Development stands for an improved quality of life through gains in health, education, living standards, and higher income. Development is based on economic growth. Although all indicators of development: GDP per capita, average life expectancy at birth, and per capita income have been rising in almost all countries, including the "developing" countries over the past decades, economic growth did not lead to the expected disappearance of infectious diseases. Economic growth is associated with severe degradation of the natural world. Though economic growth is essential for development, it is a highly imperfect proxy for it. The people who suffer from the adverse effects of economic growth are often different from those who benefit from it. Economic development shows two faces with regard to tropical diseases: it is essential for their prevention and cure and it contributes to their transmission and severity through its impact on the environment. The pivotal point is poverty. If economic growth leads to improved education and social organization, even adverse effects can be mastered by the community.

Economics↗