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PubMed2000

Health care savings from microbiological caries risk screening of toddlers: a cost estimation model.

OBJECTIVES: Modeling new biomedical technologies and determining their expected cost is necessary before initiating formal clinical trials. This paper estimates an economic model for the potential cost impact of microbiological screening of toddlers for caries risk compared to the traditional method of managing pediatric caries. METHODS: Potential cost savings were calculated based on screening test properties (sensitivity and specificity) derived from a population of 1,180 children aged 1 to 3 years with a caries prevalence of 15 percent. An algorithm was then developed to allocate prevalent and anticipate incident caries, treatment effectiveness assumptions, and existing regional treatment costs. RESULTS: The cost analysis model conservatively predicts savings of 7.3 percent from screening and early intervention. Cumulative dental treatment costs for a child at age 4 years are $367.90 if the child has been screened and $396.70 otherwise. The model further predicts that cost savings increase significantly as caries prevalence increases. CONCLUSIONS: Microbiologic risk assessment for pediatric caries may be an example of a preventive public health screening technique that results in both clinical benefits and cost savings. If the model is validated by randomized clinical trials, microbiologic screening could be used by pediatric primary care providers to identify toddlers who require early referral to dentists for further risk assessment and early caries management.

Algorithms↗
PubMed2005

Toward efficient riparian restoration: integrating economic, physical, and biological models.

This paper integrates economic, biological, and physical models to explore the efficient combination and spatial allocation of conservation efforts to protect water quality and increase salmonid populations in the Grande Ronde basin, Oregon. We focus on the effects of shade on water temperatures and the subsequent impacts on endangered juvenile salmonid populations. The integrated modeling system consists of a physical model that links riparian conditions and hydrological characteristics to water temperature; a biological model that links water temperature and riparian conditions to salmonid abundance, and an economic model that incorporates both physical and biological models to estimate minimum cost allocations of conservation efforts. Our findings indicate that conservation alternatives such as passive and active riparian restoration, the width of riparian restoration zones, and the types of vegetation used in restoration activities should be selected based on the spatial distribution of riparian characteristics in the basin. The relative effectiveness of passive and active restoration plays an important role in determining the efficient allocations of conservation efforts. The time frame considered in the restoration efforts and the magnitude of desired temperature reductions also affect the efficient combinations of restoration activities. If the objective of conservation efforts is to maximize fish populations, then fishery benefits should be directly targeted. Targeting other criterion such as water temperatures would result in different allocations of conservation efforts, and therefore are not generally efficient.

Animals↗
PubMed1981

Factors affecting food selection: the role of economics.

This article attempts to identify the scope and contributions of food demand research developed by microeconomists to facilitate incorporation of findings into food behavior research undertaken by nutrition professionals. It explores the ways economists have traditionally analyzed determinants of food selection, reviews the "New Home Economics" approach, which is being used to expand the traditional conceptual and empirical economics models, and discusses ways in which economics can contribute to a better understanding of the individual and household food selection process.

Commerce↗
PubMed2004

Productivity cost benefit to employers of treating migraine with rizatriptan: a specific worksite analysis and model.

Employers in the United States might not be aware of the productivity costs of migraine or the extent to which those costs can be reduced by optimal treatment. An economic model was developed to enable employers to estimate the productivity costs of migraine to their company and the savings that will accrue if those patients who suffer from migraine are treated with rizatriptan. Analyses were run for both a major financial services corporation and a representative U.S. company. The major financial services corporation, with 87,821 employees, is projected to lose 538 person-years annually, at an estimated cost of 23.8 million dollars. A representative U.S. company with 10,000 employees is projected to lose 46.0 person-years of productive effort annually as a result of migraine, valued at approximately 1.94 million dollars. The value of the annual work loss avoided if migraine is treated with rizatriptan is projected at 10.3 million dollars for the financial services corporation and 841,000 dollars for the representative U.S. company. There is a substantial productivity cost burden of migraine from a U.S. employer perspective. These productivity costs can be reduced significantly by treating migraine headaches with rizatriptan.

Absenteeism↗
PubMed2000

Applied pharmacoeconomics: modeling data from internal and external sources.

The use and application of techniques for modeling data obtained from various data sources are discussed. Modeling with internal and external data has become a popular way for health care organizations to apply pharmacoeconomics to pharmacy practice. Modeling studies use existing clinical and epidemiologic data to project the effect of a clinical, policy, or medication decision on a patient, population, or organization. Although several modeling techniques have been used in health care, the most common approaches are to modify and adapt existing models or to develop a unique model to answer questions of interest in a specific practice setting. Typically, an economic model developed by adapting an existing one will use either the clinical decision-analysis or Markov modeling technique. Regardless of the technique used, external data must be carefully evaluated to ensure that the data are appropriate for use in making decisions at a specific organization. For example, cost data must be analyzed to ensure that the calculations are reproducible. Also, it must be acknowledged that this strategy may not always be appropriate. The use of modeling techniques can assist decision-makers in making more informed clinical, policy, and medication decisions in real-world settings. Caution is required when adapting and interpreting existing models to ensure appropriate application in a specific organization.

Algorithms↗
PubMed2006

A physical analogue of the Schelling model.

We present a mathematical link between Schelling's socio-economic model of segregation and the physics of clustering. We replace the economic concept of "utility" by the physics concept of a particle's internal energy. As a result cluster dynamics is driven by the "surface tension" force. The resultant segregated areas can be very large and can behave like spherical "liquid" droplets or as a collection of static clusters in "frozen" form. This model will hopefully provide a useful framework for studying many spatial economic phenomena that involve individuals making location choices as a function of the characteristics and choices of their neighbors.

Happiness↗
PubMed1996

The November 1995 revised Australian guidelines for the economic evaluation of pharmaceuticals.

In November 1995, the revised Australian Guidelines for the Economic Evaluation of Pharmaceuticals ('the Guidelines') were published. The new document is to be seen as a measured bureaucratic response to the perceived shortcomings of the August 1992 document. The new document sets substantially more demanding and more rigorous evidentiary standards in the reporting of randomised clinical trials and in the justification of the selected evaluation methodology. It also introduces the requirement for a trial- or efficacy-based preliminary economic evaluation, and it recognises the need, under certain circumstances, to model economic evaluations. Although this document has an immediate appeal to those coming to pharmacoeconomic evaluations from a clinical perspective, the approach taken is unlikely to appeal either to economists (the Guidelines continue to discourage cost-benefit analysis) or to health system evaluators working in a competitive delivery environment (such as the US). The Guidelines, in a US environment, would be seen as not only unreasonable in their evidentiary demands and in the task imposed on evaluators, but limited in their failure to take an explicit modeling or system approach to therapy intervention evaluations.

Australia↗
PubMed2002

Cost effectiveness of tinzaparin sodium versus unfractionated heparin in the treatment of proximal deep vein thrombosis.

OBJECTIVE: To evaluate economic and health implications of tinzaparin sodium, a once a day low-molecular-weight heparin (LMWH), versus unfractionated heparin (UFH) in the treatment of acute deep vein thrombosis (DVT) from a US healthcare payer perspective. STUDY DESIGN: An economic model, composed of two submodules, was created: A short-term module based on clinical trial data covering the first 3 months and a long-term module that projects trial results based on published data for up to 50 years. METHODS: Clinical trial results were combined with data from long-term follow-up studies of DVT in a model that estimates the health and economic consequences of treatment. Both short- and long-term costs with tinzaparin sodium were compared with UFH, as were health outcomes and quality-adjusted life-years (QALYs). RESULTS: Patients treated with tinzaparin sodium are estimated to live a mean of 0.9 years longer on average (0.6 discounted), resulting in an increase of 0.8 QALYs (0.5 discounted). At the same time, lifetime savings are US dollars 621 per patient (1999 values), even when all patients receiving tinzapirin sodium are treated as inpatients. Early discharge of patients receiving tinzaparin sodium, or outpatient treatment, would save between US dollars 3000 and US dollars 5000 per patient. CONCLUSION: Tinzaparin sodium leads to better health outcomes and substantial economic savings compared with UFH treatment when all management costs are considered.

Ambulatory Care↗
PubMed1990

[Modeling labor resources using demoeconomic models of the BACHUE (DEMB) type in Poland].

The author analyzes demographic and economic models developed by Poland's Institute of Statistics and Demography. "The economic submodel describes the Polish national economy as divided into 11 sectors and branches of the production sphere and 7 sectors of the non-production sphere. The demographic submodel covers 5 blocks of equations." The author notes an interdependence among the variables studied and relates this to socioeconomic and demographic development factors. (SUMMARY IN ENG AND RUS)

Demography↗
PubMed2001

Iatrogenic cost factors incorporating mild and moderate adverse events in the economic comparison of aceclofenac and other NSAIDs.

OBJECTIVE: To perform a modelled economic analysis of the efficacy and tolerability of aceclofenac in comparison with those of other nonsteroidal antiinflammatory drugs (NSAIDs) used in the treatment of common arthritic disorders including osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. DESIGN: A decision analytical model was constructed to represent the clinical and economic consequences of NSAID treatment. Probabilities of noncompliance, lack of efficacy and incidence of adverse events were obtained from comparative randomised double-blind clinical trials. Local unit treatment costs were used and an expert panel was convened to estimate resource use. Both classical foldback analysis and bootstrap methods were used to compute point estimates and 95% confidence limits of costs for NSAID treatment. PATIENTS AND INTERVENTIONS: Data were obtained from 12 randomised double-blind clinical trials included in an earlier meta-analysis. MAIN OUTCOME MEASURES: Total costs to the healthcare provider, including NSAID treatment costs (drug acquisition costs and physician visits for prescription) and iatrogenic costs (substitution treatment costs for patients not achieving clinical efficacy and costs of medical visits, treatment, diagnostic tests and hospital stays associated with adverse events) and the iatrogenic cost factor (ICF) were used as the primary outcome measures. RESULTS: Means and 95% confidence intervals revealed no statistically significant differences in total costs between aceclofenac and other NSAIDs, with the exception of piroxicam, despite substantial differences in drug acquisition costs. The ICF for aceclofenac was lower than that for all other comparators, and differences in ICF between aceclofenac 200 mg/day and diclofenac 150 mg/day, indomethacin 100 mg/day, naproxen 1000 mg/day, tenoxicam 20 mg/day or ketoprofen 150 mg/day were statistically significant. CONCLUSION: These results show that the comparative overall costs of NSAIDs bears little relation to drug acquisition cost, and that the ICF is one of the most important determinants of overall costs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Caspofungin versus amphotericin B for candidemia: a pharmacoeconomic analysis.

BACKGROUND: In a randomized, comparative, clinical trial, caspofungin was found to be as effective as amphotericin B deoxycholate (ampho B) for treating candidemia (favorable outcomes in 71.7% and 62.8% of patients, respectively) and exhibited a generally better safety profile, particularly with respect to impaired renal function (IRF) (P = 0.02). OBJECTIVE: The goal of this study was to examine whether cost savings generated from the reduced rates of IRF observed in the clinical trial would be enough to offset the higher acquisition cost of caspofungin relative to ampho B. METHODS: We developed an economic model in which 100 hypothetical patients with candidemia were treated with caspofungin or ampho B. Rates of IRF and duration of drug therapy were taken from the clinical trial. Information on the cost of treating IRF was obtained through a search of MEDLINE using the terms amphotericin and cost, amphotericin and resource, amphotericin and hospital, and amphotericin and toxicity; and the medical subject headings kidney failure, acute/drug therapy; kidney failure, acute/epidemiology; kidney failure, acute/etiology; kidney/drug effects; cost of illness; costs and cost analysis; kidney failure, acute, and economics; and kidney failure, acute/economics. In addition, the Web site was searched for relevant references, and the Merck publication alert system was used. Antifungal drug costs were estimated using data from IMS Health. Costs were reported in year-2003 US dollars. RESULTS: In the base case, the model projected that using caspofungin instead of ampho B would result in substantially lower treatment costs for IRF, which would more than offset the higher drug acquisition cost (cost-offset percentage, 122%), leading to a net mean savings of 758.60 US dollars per patient. These results were not very sensitive to the difference in daily drug cost, but were sensitive to the mean cost attributable to treating IRF. As that varied, the cost-offset percentage varied from 61% (substantial cost offset) to 183% (cost savings). CONCLUSIONS: The results of this economic model suggest that, based only on differences in drug acquisition cost and renal toxicity, the use of caspofungin instead of ampho B in patients with candidemia may be a cost-saving strategy from the perspective of a hospital.

Amphotericin B↗
PubMed2003

[On the necessary risk of trusting in the future].

As the result of its centralized, exclusive economic model, Brazil has undergone a serious economic, political, and social crisis. The crisis is getting worse because the country is simultaneously undergoing extensive demographic, epidemiological, and technological changes. There is an urgent need to articulate various social groups to challenge and change the ongoing situation. A new historical future has to be established so that a different and less unequal society can emerge and guarantee better living conditions for coming generations.

English Abstract↗
PubMed2000

Coronary artery stents in the treatment of ischaemic heart disease: a rapid and systematic review.

BACKGROUND: Coronary artery stents are prosthetic linings inserted into coronary arteries via a catheter to widen the artery and increase blood flow to ischaemic heart muscle. They are used in the treatment of ischaemic heart disease (IHD). IHD is a major cause of morbidity and mortality (123,000 deaths per annum) in the UK and a major cost to the NHS. Clinical effects of IHD include subacute manifestations (stable and unstable angina) and acute manifestations (particularly myocardial infarction [MI]). Treatment includes attention to risk factors, drug therapy, percutaneous invasive interventions (PCIs) (including percutaneous transluminal coronary angioplasty [PTCA] and stents) and coronary artery bypass graft surgery (CABG). In the last decade there has been a steady and significant increase in the rate of PCIs for IHD. In the UK, rates per million population increased from 174 in 1991 to 437 in 1998. Stents are now used in about 70% of PCIs. Data from the rest of Europe suggest there is potential for PCI and stent rates to increase considerably. In the UK there is evidence of under-provision and inequity of access to revascularisation procedures. OBJECTIVES: The following questions were addressed. 1. What are the effects and effectiveness of elective stent insertion versus PTCA in subacute IHD, particularly stable angina and unstable angina? 2. What are the effects and effectiveness of elective stent insertion versus CABG in subacute IHD, particularly stable angina and unstable angina? 3. What are the effects and effectiveness of elective stent insertion versus PTCA in acute MI (AMI)? 4. What are best estimates of UK cost for elective stent insertion, PTCA and CABG in the circumstances of review questions 1 to 3? 5. What are best estimates of cost-effectiveness and cost-utility for elective stent insertion relative to PTCA or CABG in the circumstances of review questions 1 to 3? METHODS: A systematic review addressing the objectives was undertaken. DATA SOURCES: A search was made for RCTs comparing stents (inserted during a PTCA procedure) with PTCA alone or with CABG in any manifestation of IHD. The search strategy covered the period from 1990 to November 1999 and included searches of electronic databases (MEDLINE, EMBASE, BIDS ISI, The Cochrane Library), Internet sites, and hand-searches of cardiology conference abstracts and 1999 issues of cardiology journals. Lead researchers and local clinical experts were contacted. Manufacturers' submissions to the National Institute for Clinical Excellence were searched. The search strategy was expanded to look for relevant economic analyses and information to inform the economic model (including searching MEDLINE, the NHS Economic Evaluation Database and the Database of Abstracts of Reviews of Effectiveness). Searches focused on research that reported costs and quality of life data associated with IHD and interventional cardiology. STUDY SELECTION: For the review of clinical effectiveness, inclusion criteria were: (i) RCT design; (ii) study population comprising adults with IHD in native or graft vessels (including patients with subacute IHD or AMI); (iii) procedure involving elective insertion of coronary artery stents; (iv) elective PTCA (including PTCA with provisional stenting) or CABG as comparator; (v) outcomes defined as one or more of: combined event rate (or event-free survival), death, MI, angina, target vessel revascularisation, CABG, repeat PTCA, angiographic outcomes; (vi) trials that had closed and reported results for all or almost all recruited patients. For the economic evaluation, studies of adults with IHD were included if they were of the following types: studies reporting UK costs; comparative economic evaluation combining both costs and outcomes; economic evaluations reporting costs and outcomes separately for the years 1998 and 1999 (to ensure current practice was included).(ABSTRACT TRUNCATED)

Adult↗
PubMed1996

A priority queuing model to reduce waiting times in emergency care.

Investigates the increased waiting time costs imposed on society due to inappropriate use of the emergency department by patients, seeking non-emergency or primary care. Proposes a simple economic model to illustrate the effect of this misuse at a public or not-for-profit hospital. Provides evidence that non-emergency patients contribute to lengthy delays in the ER for all classes of patients. Proposes a priority queuing model to reduce average waiting times.

Appointments and Schedules↗
PubMed2004

Modelling in the economic evaluation of health care: selecting the appropriate approach.

OBJECTIVES: To provide an overview of alternative approaches to modelling in economic evaluation, and to highlight situations where each of the alternative modelling techniques should be employed. METHODS: A review of the available approaches to modelling in the economic evaluation of health care interventions with a leading discussion of examples of published studies leading to guidance in the selection of an appropriate approach in different circumstances. RESULTS: The main approaches to modelling used in economic evaluations in health care are decision trees, Markov models and individual sampling models. These methods assume independence of individuals within the model. Where interaction between individuals is important, other methods such as discrete-event simulation or system dynamics are preferable. CONCLUSIONS: The paper highlights the crucial question to be answered when selecting the approach to modelling: can the individuals being simulated in the model be regarded as independent? This issue is very commonly not recognised by analysts but is fundamental to the appropriate application of modelling in economic evaluation.

Cost-Benefit Analysis↗
PubMed1996

The nature of animal health economics in relation to veterinary epidemiology.

Animal health economics is being formally integrated into such institutions as sub-Saharan African universities and Veterinary Services. Unfortunately, the nature of the relationship between economics and epidemiology is not clearly understood. Economics has an extensive theoretical apparatus and an array of methods and techniques. Animal health economics has two interrelated branches: economics for the planning and management of animal health services and economic analysis of diseases and interventions. Epidemiology and economics, although separate scientific areas, are complementary when the goal is efficient management of animal health and associated delivery systems. In performing economic analyses, an "economic model' should determine data requirements (epidemiological and socioeconomic), as such analyses invariably require epidemiological inputs. The core concepts in economic analysis are as follows: conceptual models, opportunity cost of resources, marginal analysis and partial analysis. Important methods include statistical models, mathematical programming, budgets, cost minimisation, decision analysis, variants of cost-benefit analysis and simulation. Given the nature of animal health economics, veterinarians who want to practise as economists need a thorough training in economic principles and methods, in addition to training in basic epidemiology.

Africa South of the Sahara↗
PubMed2000

An economic evaluation of a publicly funded dental prevention programme in regional and rural Victoria: an extrapolated analysis.

OBJECTIVE: To determine the long-term cost-benefit of a community-wide, publicly-funded dental prevention programme. DESIGN: A modelled economic analysis which extrapolated the effectiveness and cost-effectiveness results of a three-year comprehensive preventive dental programme conducted in a single cohort of adolescents in the non-fluoridated towns of Geelong and Ballarat, Victoria, Australia. Assumptions were made for both benefits and costs. Sensitivity analysis was undertaken to report a range of estimates of potential programme benefits. SETTING: All secondary colleges in two non-fluoridated regional centres and their surrounding rural areas. SUBJECTS: All Year 7 to 9 students; mean age range of 12.5 to 15.5 years. RESULTS: The incremental benefit-to-cost ratios under all assumptions improved with each successive year of the community-wide programme and, even with the most conservative of assumptions, the overall ten-year benefit-to-cost ratio was above unity. CONCLUSION: While the analysis has inherent limitations as a result of its reliance on a range of assumptions, the findings do suggest that there are benefits to be gained from the implementation of a comprehensive dental preventive programme throughout the secondary school system in non-fluoridated centres comparable to Geelong and Ballarat.

Adolescent↗
PubMed2003

Cost-effectiveness of a targeted disinfection program in household kitchens to prevent foodborne illnesses in the United States, Canada, and the United Kingdom.

Foodborne illnesses impose a substantial economic and quality-of-life burden on society by way of acute morbidity and chronic sequelae. We developed an economic model to evaluate the potential cost-effectiveness of a disinfection program that targets high-risk food preparation activities in household kitchens. For the United States, Canada, and the United Kingdom, we used published literature and expert opinion to estimate the cost of the program (excluding the educational component); the number of cases of Salmonella, Campylobacter, and Escherichia coli O157:H7 infections prevented; and the economic and quality-of-life outcomes. In our primary analysis, the model estimated that approximately 80,000 infections could be prevented annually in U.S. households, resulting in 138 million dollars in direct medical cost savings (e.g., physician office visits and hospitalizations avoided), 15,845 quality-adjusted life-years (QALYs) gained, 788 million dollars in program costs, and a favorable cost-effectiveness ratio of 41,021 dollars/QALY gained. Results were similar for households in Canada and the United Kingdom (21,950 dollars Can/QALY gained and 86,341 pounds sterling/QALY gained, respectively). When we evaluated implementing the program only in U.S. households with high-risk members (those less than 5 years of age, greater than 65 years of age, or immunocompromised), the cost-effectiveness ratio was more favorable (10,163 dollars/QALY gained). Results were similar for high-risk households in Canada and the United Kingdom (1,915 dollars Can/QALY gained and 28,158 pounds sterling/QALY gained, respectively). Implementing a targeted disinfection program in household kitchens in the United States, Canada, and the United Kingdom appears to be a cost-effective strategy, falling within the range generally considered to warrant adoption and diffusion (<100,000 dollars/QALY gained).

Age Distribution↗