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PubMed1993

Behavioral economics: a novel experimental approach to the study of drug dependence.

Drug abuse and dependence are among the most important problems facing society today. Understanding the determinants of drug abuse has been advanced by a considerable quantity of research on environmental and pharmacological factors that control drug taking in a variety of settings and species. Behavioral economics, which is the application of economic principles to the behavior of the individual, may have the potential to integrate a number of these empirical observations in a novel quantitative framework. In this paper the utility of behavioral economics for the study of drug dependence is reviewed. Specifically, we reviewed (i) the parsimony behavioral economics affords via the integration of variables, (ii) a ubiquitous behavioral process it has identified, (iii) the precise quantification of that behavioral process and its predictive utility, (iv) a novel independent variable suggested by behavioral economics, and (v) the utility of behavioral economic notions for the process of medication development. We conclude that behavioral economics provides a novel conceptual framework that has utility for the study of drug dependence.

Animals↗
PubMed2006

Economic value of out-of-hospital emergency care: a structured literature review.

STUDY OBJECTIVE: The evaluation of the impact of out-of-hospital emergency care is a relatively new research focus. As such, there is a compelling need to determine how finite health care resources should be used in this setting. The objective of this study is to conduct a structured review of published economic evaluations of out-of-hospital emergency care to assess its economic value. METHODS: A structured literature search and structured review of articles pertaining to the economic value of out-of-hospital care was performed. The bibliographic database MEDLINE was searched for pertinent English-language articles published between 1966 and 2003. The search used the medical subject headings "emergency medical services" and "emergency medical technician" and was limited to the subheading "economics" and crossed with the medical subject heading "economics." The titles generated by this search were systematically reviewed and limited by topic. Abstracts from the identified titles were reviewed to select a final set of pertinent articles. These articles were further limited based on explicit inclusion and exclusion criteria. Authors used a previously published structured evaluation tool to review the final set of identified articles for quality and content. RESULTS: The initial MEDLINE search identified 3,533 citations. From this set, 535 potentially relevant abstracts were reviewed. From the abstract review, 46 articles were identified, along with an additional 14 from searching the secondary references. Of these 60 articles, 32 met the review inclusion criteria and were subjected to a full structured review. These studies predominantly addressed the cost of cardiac arrest (n=13, 41%), major trauma (n=8, 25%), and emergency medical services treatment in general (n=8, 25%). Only 14 studies considered the costs and consequences of competing alternatives. Of these, 2 were cost-benefit and 12 were cost-effectiveness evaluations. Two of the 14 studies met all 10 criteria for high-quality economic evaluation, whereas 2 others met none. CONCLUSION: There is a paucity of out-of-hospital care literature that addresses cost and economic value. The extant literature is limited in scope, poor in quality, and evaluates small subsets of out-of-hospital emergency care costs. Favorable cost-effectiveness has not been firmly established for most aspects of out-of-hospital emergency care.

Adult↗
PubMedDate not supplied

Critical appraisal of published economic evaluations of home care for the elderly.

The goal of the study was to appraise the economic evaluations published between 1980 and 2004 of "home care" for the elderly, focusing on the methodological aspects. MEDLINE was searched to identify and assess economic evaluations (defined as an analysis comparing two or more strategies, involving the assessment of both costs and consequences) related to "home care" exclusively for the elderly (65 years or more) and to critically appraise the methodology using five accepted principles used worldwide for conducting economic evaluations. Twenty-four economic evaluations of "home care" for the elderly were identified and the articles were assessed. All five principles were satisfactorily addressed in two studies (8.3%), four principles in four studies (16.7%), three principles in five studies (20.8%), two principles in eight studies (33.3%) and only one principle in five studies (20.8%). A disparity in the methodology of writing economic evaluations compromises the comparisons among outcomes and lately jeopardizes decisions on the choice of the most appropriate healthcare interventions. The methodological principles represent important guidelines but the discussion of the context of the economic evaluation and the special characteristics of some services and populations should be considered for the appropriate use of economic evaluations.

Aged↗
PubMed2006

Patient-reported economic burden and the health status of heart failure patients.

BACKGROUND: Heart failure (HF) guidelines recommend treatment with multiple medications to improve survival, functioning, and quality of life. Yet, HF treatments can be costly, resulting in significant economic burden for some patients. To date, there are few data on the impact of patients' perceived difficulties in affording medical care on their health outcomes. METHODS AND RESULTS: Comprehensive clinical data, health status, and the perceived economic burden of 539 HF outpatients from 13 centers were assessed at baseline and 1 year later. Health status was quantified with the Kansas City Cardiomyopathy Questionnaire overall summary score. Cross-sectional and longitudinal (1-year) analyses were conducted comparing the health status of patients with and without self-reported economic burden. Patients with economic burden had significantly lower health status scores at both baseline and 1 year later. Although baseline perceptions of economic burden were associated with poorer health status, patients' perceived difficulty affording medical care at 1 year was a more important determinant of lower 1-year health status. CONCLUSION: HF patients reporting difficulty affording their medical care had lower perceived health status than those reporting little to no economic burden. More research is needed to further evaluate this association and to determine whether addressing perceived economic difficulties affording health care can improve HF patients' health status.

Aged↗
PubMed2006

Economic strain and self-rated health among lone and couple mothers in Sweden during the 1990s compared to the 1980s.

OBJECTIVES: Changes on the labour market and in Swedish welfare policy during the 1990s may have affected lone mothers. This study analysed economic strain and self-rated health (SRH) among lone and couple mothers in Sweden in the 1980s and the 1990s. PARTICIPANTS: 22,308, mothers, 19,122 couple and 3186 lone mothers, who responded to the Swedish Survey of Living Conditions in the years 1979-1998. METHODS: Exposure for economic strain was defined as having had difficulties to make ends meet in the last year, the outcome measure was less than good SRH. Prevalence rates were calculated and logistic regression analysis was used in the analysis. Adjustments were made for type of mother, age, time period, socio-economic group, income, born in Sweden/foreign born and employment. RESULTS: Prevalence rates of economic strain and less than good SRH increased during the 1990s compared to the 1980s among lone and couple mothers. A polarisation in SRH was noted among lone mothers, with worsening health in poorer groups and improved health among better off groups. Economic strain had a substantial explanatory value for the excess risk of less than good SRH throughout the period studied. The association between economic strain and SRH did not change between lone and couple mothers between the 1980s and the 1990s or in different income groups. CONCLUSIONS: The increased prevalence of less than good SRH among sub-groups of lone mothers may in part be due to an increase of financial problems among these groups in Sweden. Economic strain was an important explanatory factor.

Adolescent↗
PubMed2005

Economic and financial analysis of harvesting and utilization of river reed in the Okavango Delta, Botswana.

The Okavango Delta, the largest Ramsar wetland site, is one of the most resource-rich ecosystems in Botswana. A range of resources, including reeds, contribute in various ways to the well-being of many of the communities through subsistence and income generation. The economic value of reeds and other resources found in wetlands has been poorly understood, leading to the perception that wetlands are wastelands, and have little or no economic values. Such resources are therefore likely to receive lower priority in conservation when evaluated against other alternative activities. The aim of this research was to determine the benefit and financial and economic viability of harvesting river reed in the Okavango Delta. Primary data were collected through a structured questionnaire administered at three villages in the Okavango Delta. Secondary data were collected from existing literature. Financial and economic analysis was undertaken using static and financial models. Market prices were used to calculate the net income generated from the sale of harvested reed. The measurement criteria for static models were the annual net cash income, net annual economic benefit, and return on investment (ROI), while those under the dynamic models were the net present value (NPV), benefit cost ratio (BCR), and the net benefit investment (N/K) ratio. It was more financially profitable and economically viable to harvest and sell reeds at Shorobe village (a village relatively close to the District economic centre, Maun), than Shakawe or Etsha-13.

Agriculture↗
PubMed2006

Economic analysis in hand surgery.

Economic analysis is a method for allocating resources among competing alternatives. Four techniques commonly used in an economic analysis are cost-minimization analysis, cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis. These analyses provide information to guide medical decisions and to set funding priorities. Understanding the differences between the techniques allows for better decision making. Although economic analysis is used widely in other fields of medicine, its use in studies of disorders of the hand has been sparse. Only recently has economic analysis been included in studies focused on the care of the upper-extremity patient. As such, to interpret the results of these studies better, hand surgeons need to understand the similarities and differences and the strengths and weaknesses of the different techniques. Such an understanding will allow hand surgeons to know when economic analyses are comparable. Furthermore it will aid them in providing their patients not only medically sound care, but also economically efficient care. This article provides a synopsis of the most widely used and accepted techniques for performing an economic analysis. The key concepts of each of the 4 techniques are shown by using the small number of studies that are available in the upper-extremity literature.

Costs and Cost Analysis↗
PubMed2006

Economic aspects of antimicrobial therapy of acute exacerbations of COPD.

This article synthesizes and appraises the methodological quality of the international literature on costs of chronic obstructive pulmonary disease (COPD) exacerbations, economic value of antimicrobial therapy of exacerbations, and factors affecting the economic value of antibiotics. Included studies had carried out a cost-of-illness, cost-effectiveness, cost-utility or cost-benefit analysis. Exacerbation costs varied between countries and increased with the severity of the exacerbation. Hospitalization costs accounted for more than 45% of healthcare costs of exacerbations. Drug costs made up 6-21% of healthcare costs in the majority of studies. Cost estimates were biased due to difficulties involved in diagnosing and treating exacerbations, and because the patient sample studied may not be representative of the population of patients suffering from exacerbations. Although this needs to be corroborated by future research, evidence is emerging that second-generation antibiotics such as fluoroquinolones may have a favourable economic profile as compared with first-generation antibiotics. The higher acquisition costs of fluoroquinolones appear to be balanced by less treatment failure, more time between exacerbation episodes, and lower hospitalization costs. There is a need for prospective economic evaluations alongside clinical trials with a sufficient number of patients and length of follow-up period. The economic value of antibiotics is influenced by difficulties involved in diagnosing the condition, effectiveness, resistance, patient compliance with treatment, and treatment failure associated with antibiotics. The small number of economic evaluations and their methodological limitations precludes the recommendation of a specific antibiotic for use in the management of COPD exacerbations on economic grounds.

Acute Disease↗
PubMed2005

Determinants of child morbidity in Latin America: a pooled analysis of interactions between parental education and economic status.

Diarrhea and respiratory infections account for more than two-fifths of all deaths among children under five. Parental education and economic status are well-known risk factors for child morbidity, but little is known about whether education and economic status operate synergistically or independently to influence children's health. Confirming the presence and direction of such interactions is important to better target education and development policies. Our objective is to test for interactions between parental education and economic status in predicting the risk of diarrhea and respiratory illness among children under five, before and after adjusting for key proximate risk factors. We pool 12 Demographic and Health Surveys (DHS) and nine Living Standards Measurement Surveys (LSMS) from Latin America, creating two large databases. Quintiles of economic status are constructed from principal components asset indices. We use logistic regression to analyze episodes of diarrhea and respiratory illness, and interactions between economic quintile and maternal and paternal education are evaluated via likelihood ratio tests. We find that mother's education and quintile interact synergistically in the DHS data, while results are inconclusive in the LSMS data. The effect of increasing maternal education appears to be more protective for children in wealthy families than for children in poor families. Conversely, improvements in economic status reduce health risks more for children whose mothers are better educated. Father's education is protective and operates independently of economic status. Our findings imply that poverty alleviation efforts occurring in concert with programs to educate women and girls will be more effective for improving children's health than either approach alone.

Adult↗
PubMed2005

Does socio-economic advantage lead to a longer, healthier old age?

The effect of socio-economic disadvantage on mortality is well documented and differences exist even at older ages. However, whether this translates into differences in the quality of life lived at older ages is less well studied, and in particular in the proportion of remaining life spent without ill health (healthy life expectancy), a key UK Government target. Although there have been studies exploring socio-economic differences in disability-free life expectancy (DFLE) worldwide, these have tended to focus on a single measure of socio-economic advantage, for example, education, race, social class or income, with the majority based on cross-sectional data from younger populations. In this prospective study we examine differences in DFLE and total life expectancy (TLE) at older ages using a range of measures of socio-economic advantage. We use a longitudinal study of 1480 participants aged 75 years or over in 1988 registered with a UK primary care practice, who were followed up until 2003 with measurements at up to seven time points. Disability was defined as difficulty with any one of five activities of daily living. The largest differences in DFLE for both men and women were found for housing tenure. Women aged 75 years living in owned or mortgaged property could expect to live 1 year extra without disability compared with those living in rented accommodation, while for men the difference was almost 1.5 years. The effect of socio-economic advantage on disability-free and total life expectancies appeared to be larger for men than women. In women, socio-economic advantage had more effect on DFLE than total life expectancy for all indicators considered, thus the socio-economically advantaged experienced a compression of disability.

Aged↗
PubMed2000

The influence of economic evaluation studies on decision making. A European survey. The EUROMET group.

Despite the growing activity in the field of health economics very little is known about the influence of economic evaluation studies on health care decision making in the EU member states. Several investigations about the impact of health economic studies on decision making have been performed, but most of them did not involve decision makers themselves. In this paper the results of the EUROMET survey are reported and discussed. Different types of decision makers in nine European countries were surveyed by postal questionnaires, semi-structured interviews and focus group discussions. Questions include issues about the extent of knowledge about economic evaluation, the actual and potential use of study results as well as barriers and incentives in the use of studies. It is concluded that despite the general positive attitude knowledge about the formal methodology is rather limited. Accordingly, results of economic evaluation studies are not widely used in decision making. The results show that institutional dimensions, such as difficulties in transferring budgets, are viewed as important barriers. Also, the lack of credibility of studies is assigned a high relevance. Moreover, decision makers wish for a better explanation of the practical relevance of studies and feel that there is a need for more training in health economics. Considering these requirements a number of recommendations for enhancing the value of health economic studies are given.

Attitude of Health Personnel↗
PubMed1995

The clinical-economic trial: promise, problems, and challenges.

The clinical-economic trial is a study design that is appearing with greater frequency in medical and public health literature. Some experienced investigators view these trials with skepticism; to policy makers they represent a promising step in the control of rising health care costs. The success of clinical-economic trials in meeting the important goal of more rational and efficient use of health care resources will depend on the strengths and limitations of the research method. As part of a report to the Office of Technology Assessment of the U.S. Congress on new health care assessment techniques, we describe the reasons why economic data collection and analysis are being considered in clinical trials, identify and discuss various designs and methods for gathering economic trial data, and evaluate the strengths and limitations of different methods for providing sound data for decision making on appropriate use of health care interventions. Because of the potential significance and increasing visibility of such research, experts in research methods should give more attention to methodological research for clinical-economic trials. Future efforts should be directed at comparing different techniques for collecting data, examining the incremental value of precision in economic measurements and ensuring appropriate interpretation of data from clinical-economic trials.

Clinical Trials as Topic↗
PubMed1997

Economic evaluation of medical technologies in Sweden.

This paper reviews the use of economic evaluations in the Swedish health care system. The most important actors are defined and examples are given how economic evaluations have played a role in the decision making process. The introduction of extracorporal shock-wave lithotripsy (ESWL) is used as an example on how economic evaluation was used for recommendations to the county councils to adopt this technology. Mammography is used as an example of how the evaluation is used in the political process following an initiative in the parliament. A study of the cost-effectiveness of hypertension treatment illustrates how economic evaluations are included as part of a medical technology assessment by SBU, the Swedish Council on Technology Assessment in Health Care. The role of economic evaluations for drug reimbursement and pricing is also reviewed. The main conclusions are that economic evaluations are one of several factors influencing a decision making process that have a strong strive for consensus. It is thus difficult to make a definitive statement of the contribution of such study to the outcome of the decision making process, and there is no evidence that the evaluation was the decisive factor. However, a number of changes in the way resources are allocated in the Swedish health care system speaks for an increasing role for such studies in the future. The county councils are identified as the main target for economic evaluations, and SBU has a key role in supplying the county councils with high quality assessment of new and old technologies.

Cost-Benefit Analysis↗
PubMed2000

Methods for systematic reviews of economic evaluations for the Guide to Community Preventive Services. Task Force on Community Preventive Services.

OBJECTIVES: This paper describes the methods used in the Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide) for conducting systematic reviews of economic evaluations across community health-promotion and disease-prevention interventions. The lack of standardized methods to improve the comparability of results from economic evaluations has hampered the use of data on costs and financial benefits in evidence-based reviews of effectiveness. The methods and instruments developed for the Guide provide an explicit and systematic approach for abstracting economic evaluation data and increase the usefulness of economic information for policy making in health care and public health. METHODS: The following steps were taken for systematic reviews of economic evaluations: (1) systematic searches were conducted; (2) studies using economic analytic methods, such as cost analysis or cost-effectiveness, cost-benefit or cost-utility analysis, were selected according to explicit inclusion criteria; (3) economic data were abstracted and adjusted using a standardized abstraction form; and (4) adjusted summary measures were listed in summary tables. RESULTS: These methods were used in a review of 10 interventions designed to improve vaccination coverage in children, adolescents and adults. Ten average costs and 14 cost-effectiveness ratios were abstracted or calculated from data reported in 24 studies and expressed in 1997 USD. The types of costs included in the analysis and intervention definitions varied extensively. Gaps in data were found for many interventions.

Abstracting and Indexing↗
PubMed2004

Economic evaluation in total hip arthroplasty: analysis and review of the literature.

We performed a bibliographic search of MEDLINE databases from January 1966 to July 2002 to identify English language articles that contained either "cost" or "economic" in combination with "total hip arthroplasty" (THA) in the abstract or title. Each study was then critically reviewed for content, technique, and adherence to established healthcare economic principles. Only 81 of the 153 studies retrieved contained actual economic data. Only 6% of studies adhered to established criteria for a comprehensive health care economic analysis. Although the number of publications regarding economic evaluation of THA is on the rise, the methodologic quality of many of these studies remains inadequate. Future studies should employ sound healthcare economic techniques to properly evaluate and assess the true social and economic value of THA.

Arthroplasty, Replacement, Hip↗
PubMed1999

Economic evaluations in the hip arthroplasty literature: lessons to be learned.

Readers are increasingly encountering articles dealing with health economic evaluations that compare various surgical strategies, leaving orthopaedists with the challenge of determining which program is cost-efficient and truly pertains to their setting. This study carries out a systematic review of the literature to appraise the quality, quantity, and type of economic evaluation as it pertains to the hip arthroplasty literature. To identify all relevant articles, we conducted a comprehensive computerized bibliographic search of Medline from 1966 to 1996. This search produced 1,611 abstracts that were screened. Studies that were incorporated met the following inclusion criteria: i) formal economic analysis, ii) an intervention specific to hip arthroplasty, and iii) the perspective of the study was evident (ie, patient, provider, society). These studies were appraised with regards to methodologic soundness based on 8 established economic principles. Only 68 articles from the 138 retrieved met the study criteria. Only 2 of the 68 articles met all 8 criteria of a comprehensive economic evaluation. The hip arthroplasty literature is deficient in methodologically sound economic evaluations. Several guidelines are introduced to aid orthopaedists in appraising the various economic studies, and recommendations are made to improve the quality of these studies in the orthopaedic literature. We suggest that the generation of such information should rank high on the priority list of the orthopaedic profession, granting agencies, and governments.

Arthroplasty, Replacement, Hip↗
PubMed2002

Socio-economic status and serum lipids: a cross-sectional study in a Chinese urban population.

Socio-economic status and serum lipids are important factors in the progression of cardiovascular disease. We studied the association between socio-economic status and serum lipids in a Chinese urban population. In all, 4,541 respondents (2,231 men and 2,310 women) between 25-64 years of age participated in a cross-sectional population survey carried out in Tianjin, China, and provided blood samples. Three socio-economic indicators (education, occupation, and income), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were determined. People in higher socio-economic groups had a more unfavorable serum lipid profile compared with those in lower socio-economic groups. This significant association was especially apparent in men. Education seemed to be the most important predictor of serum lipids in the three socio-economic indicators. The direction of the association between high socio-economic status and poor serum lipid profiles appears to be opposite to those observed in the developed countries.

Adult↗
PubMed2006

Economic impacts of reduced milk production associated with papillomatous digital dermatitis in dairy cows in the USA.

The goal of this study was to measure the economic impacts of reduced milk production associated with papillomatous digital dermatitis (PDD) in dairy cows in the USA, and of specific risk factors for PDD, in 1996. The method applied was an economic-welfare analysis of producer and consumer surplus, with the GUM Workbench used to analyse uncertainties in the measurements. Reduced milk production associated with PDD was found to reduce consumer surplus by Dollars 750 million +/- Dollars 580 million, and to increase the economic surplus of producers by Dollars 560 million +/- Dollars 470 million, with a net economic loss of Dollars 190 million +/- Dollars 130 million. An examination of the economic effects of specific epidemiologic risk factors for PDD showed that having dairy cows that were not born on the operation had important economic consequences associated with the disease, as did the type of land to which dairy cows had access during the winter months and the type of flooring on which cows walked. Washing hoof-trimming equipment between cows was an important biosecurity measure that was associated with reduced PDD. The epidemiologic model used also implicated hoof trimmers who trimmed cattle hooves on other operations as having an important economic impact associated with this disease, although this finding may have been erroneous.

Animal Welfare↗