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PubMed1992

Lactation curve estimation for use in economic optimization models in the dairy industry.

Monthly data on completed lactations were employed to estimate a three-stage least squares lactation curve model for milk production, milk fat content, milk protein content, and body weight change in lactating Holstein cattle. In comparison with previous work on the lactation curve, our study employed an augmented incomplete gamma model of the lactation curve, a simultaneous rather than single equation estimation technique, monthly rather than daily or weekly observations, and a pragmatic treatment of the genetic background of individual cows using sire proof data. In addition to considering genetic and dietary effects on the lactation curve, the model isolates the seasonal effect of calving date and current production month as well as the age of the cow. By allowing for the simultaneous explanation of various measures of cow performance, the model accommodates formulation of diets tailored for individual cows or groups of cows and can be used in profit-maximizing mathematical programming models. Diet, production, and body weight changes are determined simultaneously and are not independent of one another.

Aging↗
PubMedDate not supplied

Technical-economic management models in dialytic treatment: an evolving reality. The Italian experience.

Health care organisations and financial factors (particularly treatment reimbursement rates) may influence the management of ESRD. We analysed the organisation of renal replacement therapy (RRT) in Italy, focusing on RRT population trends, patient distribution by treatment modality and provision, reimbursement rates, accreditation and quality control. Data from the Italian Dialysis and Transplant Registry and market research studies indicate that Italy has one of the highest dialysis and treatment acceptance rates in Europe. There is a high rate of hemodialysis (HD) and good use of peritoneal dialysis (PD), whereas the prevalence of transplanted patients is lower than the European mean. Dialytic treatment in private centers is limited by law to HD (mainly in Central-Southern Italy) and covers nearly 25-30% of the demand for RRT which means that, although Italy has a public national health care system, the provision of RRT is based on a "mixed" model. Regions with a higher prevalence of "private" dialysis have more dialysis centers, but a lower prevalence of PD since it is not permitted in private facilities, and fewer transplanted patients. The "public" system is not an automatic guarantee of quality and efficacy, and the "private" system is not necessarily a synonym of poor quality treatment due to its need to make a profit. The coexistence of private and public facilities (if well balanced and integrated) may in fact help overcoming bureaucracy in the public administration in relation to the demand for innovation and improving performances by means of fair competition.

Accreditation↗
PubMed2003

A clinical decision and economic analysis model of cancer pain management.

OBJECTIVE: To design a model that educates clinical decision makers and healthcare professionals about the burden of cancer pain in their individual populations, and that assists them in weighing the effectiveness and cost of different cancer pain management strategies. STUDY DESIGN: Tailored cost-effectiveness analysis using an evidence-based decision analytic model. METHODS: The spreadsheet-based model compares 3 strategies: (1) guideline-based care (GBC), (2) oncology-based care (OBC), and (3) usual care (UC). The model calculates the likelihood of cancer pain in a healthcare population, how effectively that pain is managed, and the average monthly cost of medications plus procedural interventions. Model inputs were derived from published US population demographics, cancer registry data, high-quality studies of cancer pain management, standard reimbursement schedules, and expert opinion. The model permits users to tailor population demographics, strategy effectiveness, and resource costs. RESULTS: Of 100 000 patients with typical US demographics, approximately 508 (0.51%) will have cancer and 205 (0.20%) will suffer from cancer pain. After 1 month, the percentage of cancer pain patients with effective pain management and the cost of each strategy were estimated as follows: (1) GBC, 80% and dollar 579; (2) OBC, 55% and dollar 466; and (3) UC, 30% and dollar 315. Compared with OBC, GBC had an incremental cost-effectiveness ratio of dollar 452 per additional patient relieved of cancer pain. Compared with UC, OBC had an incremental cost-effectiveness ratio of dollar 601 per additional patient relieved of cancer pain. CONCLUSION: Guideline-based cancer pain management leads to improved pain control with modest increases in resource use.

Algorithms↗
PubMed1995

Health system re-engineering: a CPRS economic decision model.

The fundamental problem with the health care delivery system remains too little health delivered for too great a cost. Information essential to sound clinical and administrative decision making is too frequently missing at the time and place of decision. Automated systems offer opportunities both to improve health and to reduce cost through effective and efficient information management. Information systems are the enabling technology for those business practice changes which improve the benefit-cost profile of a re-engineered delivery system. The Computer-based Patient Record (CPR) is the organizing framework of an enterprise-wide health information system. Since information management is a core function of the health care enterprise, evaluation of the CPR should include its impact on the value of health outcomes and contribution to the organizational mission, rather than solely by benefits which accrue within the delivery system. This paper proposes a model to measure the impact of information technology and specifically a CPR on a re-engineered health care delivery system.

Decision Support Techniques↗
PubMed1977

[Productive life-span of dairy cows and its economic significance. I. Disposal of dairy cows: the current situation (author's transl)].

The current situation regarding the replacement of dairy cows is discussed. Attention is successively paid to the duration of herd life and the replacement rate, the reasons for disposal and the relationship between age and the probability of disposal. Little research including all the required elements at the same time has been done in this field. Therefore, the literature can offer only a rough idea of the current situation regarding the replacement of dairy cows (Tables 1 and 2). Further research along a few lines presented in this paper is advocated. However, the findings derived from the literature may be used in an economic model to quantify the economic significance of differences in the herd life of dairy cows. This subject will be elaborated in two subsequent papers.

Animals↗
PubMed2001

A cost-effectiveness model of alternative statins to achieve target LDL-cholesterol levels.

An economic model was developed to estimate the relative cost-effectiveness of alternative HMG-CoA reductase inhibitors (statins)--atorvastatin, cerivastatin, fluvastatin, pravastatin and simvastatin--to achieve target low-density lipoprotein cholesterol (LDL-C) levels in a population of secondary CHD prevention patients. By using a cholesterol target as the endpoint of interest and a dose titration approach, the model assumes that the statins demonstrate a class effect through cholesterol lowering. The model was used to estimate the proportion of patients achieving target LDL-C levels (< 3 mmol/l) under each scenario tested. Total costs and incremental cost-effectiveness relative to no treatment and to the lowest cost option were estimated for each scenario. Total costs were highest for pravastatin and lowest for cerivastatin. Compared with no treatment, the incremental cost per patient treated to target LDL-C varied between 383 Pounds (atorvastatin) and 1213 Pounds (pravastatin). Incremental cost-effectiveness ratios in comparison with the lowest cost treatment (cerivastatin) were 141 Pounds per additional patient achieving target LDL-C with atorvastatin, and 275 Pounds with simvastatin. Fluvastatin and pravastatin were both less effective and more expensive than the lowest cost therapy. Although cerivastatin was associated with lowest expected costs, therapy with atorvastatin achieved the lowest cost-effectiveness ratios. Hence atorvastatin would allow the largest number of patients to be treated to target LDL-C within a fixed drug budget. Choosing between drug therapies on the basis of price alone may be misleading if the effectiveness of therapies varies.

Atorvastatin↗
PubMed1994

Endogenous population growth and the exploitation of renewable resources.

The authors consider a demo-economic model where the economy consists of two sectors ("hunting and farming" and "industry"), and both sectors depend directly or indirectly on the explanation of a renewable resource. The primary sector harvests a renewable resource (fish, corn, or wood) which is used as the input into industrial production, the secondary sector of our economy. Labor is divided up between these two sectors under the assumption of competitive labor markets. A system of two nonlinear differential equations for the resources and the population is studied by phase space analysis. Using the Hopf bifurcation theorem, the authors obtain two different routes to limit cycles and prove numerically the existence of a stable Malthusian limit cycle.

Conservation of Natural Resources↗
PubMed1998

The economics of breastfeeding in Singapore.

A study of 340 mothers was conducted in Kandang Kerbau Hospital on September 1992 to determine if it were more economical for households to breastfeed or bottle-feed an infant for the first three months. Two economic models, a low cost model and a high cost model, were adopted incorporating a mathematical expression from Almroth's work in 1979. The savings in a mother's gross income for the period ranged from 3% to 9% for the low cost model and from 8% to 21% for the high cost model. From the household perspective, two components contributed to the economic savings of breastfeeding over artificial feeding: the cost of goods consumed and the time taken to feed the baby. It was noted that the time taken to artificially feed is longer than the time taken to breastfeed an infant. The results of this study provided more concrete basis for policy makers and advocates of breastfeeding to promote breastfeeding in Singapore. The amount of savings from breastfeeding could be considered for the health care system from the public perspective.

Breast Feeding↗
PubMed2006

Economic evaluation for ophthalmologists.

PURPOSE: This review will describe the basic concepts of economic evaluation, using examples from the ophthalmic literature. The aim is to provide readers with knowledge about the fundamentals of economic evaluation to enable them to read papers critically, make healthcare funding and planning decisions, and understand the economic evaluation of interventions. REVIEW: Ophthalmic services are often constrained by a lack of funding, and this is true in both high- and low-income countries. Ophthalmology also competes with other healthcare specialities for funding. Economic evaluation is used to identify the most efficient way of allocating and planning the use of these scarce resources among alternative activities. An economic evaluation is typically conducted by comparing two or more interventions in terms of their effectiveness and their cost. Cost is the value of all resources used in the intervention. Effects, or consequences of the intervention, can be measured in monetary terms, through disease-specific outcomes or using health-related quality of life measures. The four most commonly used types of economic evaluations are cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis and cost-utility analysis. There are a variety of intended and unintended consequences of a health intervention, and so the consequences of the intervention may be positive or negative. Economic models, such as decision trees and Markov models, calculate effectiveness and costs, taking into account all the consequences of the intervention, including complications. Uncertainties in the parameters of the models can be expressed through sensitivity analyses and confidence intervals. CONCLUSIONS: Economic evaluation may be used to identify the most efficient way of allocating scarce resources among alternative activities. Its use, if standardized in all areas, can improve the quality of care while enhancing efficiency and thereby enabling more programs to be funded.

Cost-Benefit Analysis↗
PubMed2006

Cost-effectiveness of rosiglitazone combination therapy for the treatment of type 2 diabetes mellitus in the UK.

INTRODUCTION: Recent clinical trial results have demonstrated that, in patients with type 2 diabetes, second-line treatment of rosiglitazone in combination with metformin can lead to significant improvements in the control of fasting plasma glucose/ glycosylated haemoglobin A1c (HbA1c) after the failure of metformin monotherapy. Our objective was to assess the cost-effectiveness of the use of rosiglitazone in combination with metformin in overweight and obese patients with type 2 diabetes in the UK, failing to maintain glycaemic control with metformin monotherapy compared with conventional care using metformin in combination with sulfonylurea. METHODS: The Diabetes Decision Analysis of Cost--type 2 (DiDACT) model, an established long-term economic model of type 2 diabetes, which projects the relationship between treatment and HbA1c over extended periods, was used to determine the health outcomes and economic impact for matched age and sex cohorts of 1000 patients with type 2 diabetes. The perspective was that of the UK National Health Service and all costs were in UK pounds sterling. RESULTS: Treatment with rosiglitazone in combination with metformin provides better glycaemic control over the remaining lifetime of patients than metformin and sulfonylurea combination therapy. Patients treated with rosiglitazone combination therapy were predicted to have a longer life expectancy, gaining 123 and 140 additional life years per 1000 patients in the obese and overweight cohorts, respectively. Improvements in morbidity and a delay in the start of insulin therapy resulted in a projected improvement in quality of life. These effects combine with projected improved survival to yield 131 and 209 additional quality-adjusted life-years (QALYs) per 1000 patients in the obese and overweight cohorts, respectively. Discounted incremental cost-effectiveness ratios were estimated at pounds 16,700 per QALY gained for the obese cohort and pounds 11,600 per QALY gained for the overweight cohort. CONCLUSION: The model predicts that rosiglitazone in combination with metformin is a cost-effective treatment in the UK for both obese and overweight patients failing on metformin monotherapy, compared with conventional therapy using metformin in combination with sulfonylurea.

Combined Modality Therapy↗
PubMed1998

Economic values in broiler breeding.

The objectives of this study were to derive economic values in broiler breeding and to determine their relationship with production circumstances. Economic values were derived using a deterministic economic model based on profit equations with a fixed amount of broiler meat output of the production system. Nonintegrated and the integrated broiler production systems were studied. The difference between these originates from different definitions of cost components and scaling aspects. For each stage of an nonintegrated system, the model calculated the profit margin; for an integrated system, (total) cost prices per unit of product at each stage were calculated. The Dutch broiler performance data and prices were input into the model as the representative situation. For all traits, in the nonintegrated system, economic values were derived, expressed as Dutch guilders (Dfl) per unit of product, where the unit of product depends on the stage of the production system and equals an egg for the multiplier breeder, a day-old chick for the hatchery, and a marketable broiler for the commercial grower and processor. Resulting levels of economic values were illustrated by showing underlying cost or profit changes in the production system. For the integrated system, economic values were expressed as Dfl x marketable broiler(-1) x unit(-1). Economic values of traits in the integrated system were also derived for situations where technical parameters or prices of productive factors were changed (20% increase or decrease). A general conclusion from these sensitivity analyses is that the economic values are sensitive to production levels, product prices and feed prices; there are both linear and nonlinear relationships between economic values and production circumstances.

Agriculture↗
PubMed2002

Ready-to-use injection preparations versus conventional reconstituted admixtures: economic evaluation in a real-life setting.

OBJECTIVE: To measure, in a real-life setting, the benefits of using ready-to-use (RTU) injection preparations compared with conventional reconstituted admixtures (Admix) in terms of cost savings. DESIGN AND PERSPECTIVE: An economic model was developed, based on a randomised study. The perspective of the economic evaluation was that of the hospital administration. A microcosting approach was used to determine costs. SETTING: Department of Cardiac Surgery at the Charleroi University Hospital in Belgium. STUDY PARTICIPANTS: Fifty-eight patients undergoing cardiac surgery under cardiopulmonary bypass were randomised to Admix dobutamine or to the RTU dobutamine group and were followed up during 24 hours after initiation of dobutamine therapy. MAIN OUTCOME MEASURES AND RESULTS: Nursing time was reduced by 32% in the RTU group compared with the Admix group. Material cost was also reduced and the overall cost savings in the RTU group amounted to a 60% reduction in the cost of the conventional Admix process (p<0.001). When drug cost was included in the equation, cost savings varied from 1.60 euros (EUR) to EUR21.40 per patient depending on dosage. There was no difference between the two groups in terms of safety and efficacy. A user satisfaction survey showed that medical staff especially welcomed improved ease of preparation and potential for prevention of errors and risks of handling. CONCLUSION: This study confirmed the potential for RTU forms to reduce nursing time associated with preparation and administration of intravenous admixtures and to enable overall cost savings.

Aged↗
PubMedDate not supplied

The economics of treatment for infants with respiratory distress syndrome.

OBJECTIVES: To define clinical outcomes and prevailing patterns of care for the initial hospitalization of infants at greatest risk for respiratory distress syndrome (RDS); to estimate direct medical care costs associated with the initial hospitalization; and to introduce and demonstrate a simulation technique for the economic evaluation of health care technologies. METHOD: Clinical outcomes and usual-care algorithms were determined for infants with RDS in three birthweight categories (500-1,000g; >1,000-1,500g; and >1,500g) using literature- and expert-panel-based data. The experts were practitioners from major U.S. hospitals who were directly involved in the clinical care of such infants. Using the framework derived from the usual care patterns and outcomes, the authors developed an itemized "micro-costing" economic model to simulate the costs associated with the initial hospitalization of a hypothetical RDS patient. The model is computerized and dynamic; unit costs, frequencies, number of days, probabilities and population multipliers are all variable and can be modified on the basis of new information or local conditions. Aggregated unit costs are used to estimate the expected medical costs of treatment per patient. RESULTS: Expected costs of initial hospitalization per uncomplicated surviving infant with RDS were estimated to be $101,867 for 500-1,000g infants; $64,524 for >1,000-1,500g infants; and $27,224 for >1,500g infants. Incremental costs of complications among survivors were estimated to be $22,155 (500-1,000g); $11,041 (>1,000-1,500g); and $2,448 (>1,500 g). Expected costs of initial hospitalization per case (including non-survivors) were $100,603; $72,353; and $28,756, respectively. CONCLUSIONS: An itemized model such as the one developed here serves as a benchmark for the economic assessment of treatment costs and utilization. Moreover, it offers a powerful tool for the prospective evaluation of new technologies or procedures designed to reduce the incidence of, severity of, and/or total hospital resource use ascribed to RDS.

Birth Weight↗
PubMed1994

The algebra of managed care. Creating physician and hospital partnerships.

As healthcare faces an economic reengineering, hospitals and physicians are faced with new challenges. It is the first time that they have had joint economic interests, and survival for both is dependent on designing new economic models. This article describes the economic interrelationship between hospitals and physicians and provides insight into opportunities to encourage new levels of collaboration between them.

Contract Services↗
PubMed2001

Toward a behavioral economic understanding of drug dependence: delay discounting processes.

Behavioral economics examines conditions that influence the consumption of commodities and provides several concepts that may be instrumental in understanding drug dependence. One such concept of significance is that of how delayed reinforcers are discounted by drug dependent individuals. Discounting of delayed reinforcers refers to the observation that the value of a delayed reinforcer is discounted (reduced in value or considered to be worth less) compared to the value of an immediate reinforcer. This paper examines how delay discounting may provide an explanation of both impulsivity and loss of control exhibited by the drug dependent. In so doing, the paper reviews economic models of delay discounting, the empirical literature on the discounting of delayed reinforcers by the drug dependent and the scientific literature on personality assessments of impulsivity among drug-dependent individuals. Finally, future directions for the study of discounting are discussed, including the study of loss of control and loss aversion among drug-dependent individuals, the relationship of discounting to both the behavioral economic measure of elasticity as well as to outcomes observed in clinical settings, and the relationship between impulsivity and psychological disorders other than drug dependence.

Humans↗
PubMed2001

Comparing apples and oranges--model-based assessment of different tsetse-transmitted trypanosomosis control strategies.

The current control strategies for tsetse-transmitted trypanosomosis in cattle (trypanocidal drugs, tsetse control and trypanotolerant cattle) are briefly reviewed and their adoption rates in different geographic regions of sub-Saharan Africa are presented. The impact of these control strategies and the potential use of vaccines, should they be developed, on trypanosomosis transmission were compared using a mathematical model. The relative trypanosomosis prevalence compared with no control was estimated across a range of control coverages (from none to complete control coverage) by varying the change in specific model parameters influenced by individual control measures. Based on this comparison, the relative rankings of the effect of control strategies on reducing disease prevalence were: vector control, vaccination, and drug use, in that order. In this model, trypanotolerance was assumed to decrease disease prevalence, but not to influence transmission. Differences in the predicted impact of control measures on the transmission of human sleeping sickness are discussed. Finally, the role of transmission model outputs as inputs for economic models to guide investment decisions for trypanosomosis control is emphasised.

Africa South of the Sahara↗
PubMed2005

Economically optimal dietary crude protein and lysine levels for starting broiler chicks.

An experiment was conducted to quantify the growth response of broiler chicks to cumulative dietary lysine and CP intakes. From d 7 to 17, chicks were fed one combination of dietary lysine and CP (17, 20, 23, and 26% CP and 3.5, 4.0, 4.5, and 5.0 g lysine per 100 g of CP) in a diet containing 3,200 kcal/kg ME. There were significant linear and quadratic effects of dietary CP intake and quadratic effects of dietary lysine intake on body weight gain (BWG), confirming that a diminishing response (marginal BWG decreased as intake of dietary lysine increased) existed (R2 = 0.92 and 0.95, respectively). A significant interaction between dietary CP and lysine for BWG complicates economic modeling because responses must be considered together. A quadratic growth response equation describing BWG as a function of dietary lysine and CP intake was used to develop and demonstrate a quadratic programming model. In general, increasing the price of soybean meal (SBM) decreased the dietary CP concentrations that gave maximum BWG and the concentration of dietary lysine decreased proportionally. In SBM-based diets, the concentration of dietary lysine that maximized BWG was less than or equal to the concentration reached by the proportions of corn and SBM needed to meet dietary CP constraints. Savings from using maximum-profit vs. least-cost formulation models could approach 637,000 dollars per year for a single model poultry complex under some economic situations for the starter diet alone.

Animal Feed↗