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Influence of production circumstances and economic evaluation criteria on economic comparison of breeds and breed crosses.

The ranking of genotypes (i.e., breeds and breed crosses) for economic performance depends on the production circumstances of the herd and the criteria for economic evaluation. In this study, the effects of evaluation criteria and production circumstance are quantified using data from the literature on six genotypes. The economic evaluation criteria measured at herd level included lifetime profit and lifetime profit expressed per day of calving interval, per day of productive lifetime, per day of total herd life, per unit of milk, and per unit of feed energy. Four production circumstances were studied; these circumstances included constraints on the output of milk and on herd use of concentrates, roughages, and both concentrates and roughages. Profit was determined based on the sale of milk, calves, cull cows, and heifers and the expenses incurred for concentrates and roughages, animal deaths, milking time, interest, and other inputs. Results indicate that production circumstances and evaluation criteria largely influence the ranking of genotypes and, therefore, the outcome of economic comparisons. The genotype that ranks the best under a certain criteria and circumstance ranks differently when these situations are altered. In economic comparisons of genotypes aimed at offering recommendations for implementation in smallholder dairy production systems in the tropics, the choice of the evaluation criteria should be determined by the limitation or constraint that characterizes the area where the genotypes are to produce or are currently producing. For example, for situations in which feed availability is limiting, genotypes should be ranked on total profit per unit of feed energy.

Animal Feed↗

Amended economic impact analysis of final rule requiring use of labeling on natural rubber containing devices--FDA. Final rule; amended economic analysis statement.

The Food and Drug Administration (FDA) is issuing an amended economic analysis statement relating to a final rule that published in the Federal Register of September 30, 1997 (62 FR 51021), requiring labeling statements concerning the presence of natural rubber latex in medical devices. This rule was issued in response to numerous reports of severe allergic reactions and deaths related to a wide range of medical devices containing natural rubber. The final rule becomes effective on September 30, 1998. In order to allow further comment on the economic impact of the September 30, 1997 final rule, FDA is publishing an amended economic impact statement, including an amended initial regulatory flexibility analysis (IRFA) that it has prepared under the Regulatory Flexibility Act (RFA), as amended by the Small Business Regulatory Enforcement and Fairness Act (SBREFA). FDA will respond to comments to this amended economic analysis statement, and publish in the Federal Register an amended final economic impact statement prior to the effective date of the September 30, 1997 rule.

Consumer Product Safety↗

Amended economic impact analysis of final rule requiring use of labeling on natural rubber containing devices--FDA. Final rule; amended economic analysis statement.

The Food and Drug Administration (FDA) is issuing an amended economic analysis statement relating to a final rule that published in the Federal Register of September 30, 1997 (62 FR 51021), requiring labeling statements concerning the presence of natural rubber latex in medical devices. This rule was issued in response to numerous reports of severe allergic reactions and deaths related to a wide range of medical devices containing natural rubber. The final rule becomes effective on September 30, 1998. In order to allow further comment on the economic impact of the September 30, 1997, final rule, FDA published in the Federal Register of June 1, 1998, an amended economic impact statement, including an amended initial regulatory flexibility analysis (IRFA) that it prepared under the Regulatory Flexibility Act (RFA), as amended by the small Business Regulatory Enforcement and Fairness Act (SBREFA). After considering comments submitted in response to the June 1, 1998, amended economic analysis statement, FDA is issuing the amended final economic impact statement, including an amended final regulatory flexibility analysis.

Dermatitis, Contact↗

Amended economic impact analysis of final rule requiring use of labeling on natural rubber containing devices--FDA. Final rule; amended economic analysis statement.

The Food and Drug Administration (FDA) is issuing an amended economic analysis statement relating to a final rule that published in the Federal Register of September 30, 1997 (62 FR 51021), requiring labeling statements concerning the presence of natural rubber latex in medical devices. This rule was issued in response to numerous reports of severe allergic reactions and deaths related to a wide range of medical devices containing natural rubber. The final rule becomes effective on September 30, 1998. In order to allow further comment on the economic impact of the September 30, 1997, final rule, FDA published in the Federal Register of June 1, 1998, an amended economic impact statement, including an amended initial regulatory flexibility analysis (IRFA) that it prepared under the Regulatory Flexibility Act (RFA), as amended by the Small Business Regulatory Enforcement and Fairness Act (SBREFA). After considering comments submitted in response to the June 1, 1998, amended economic analysis statement, FDA is issuing the amended final economic impact statement, including an amended final regulatory flexibility analysis.

Costs and Cost Analysis↗

Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria.

OBJECTIVES: The aim of the Consensus on Health Economic Criteria (CHEC) project is to develop a criteria list for assessment of the methodological quality of economic evaluations in systematic reviews. The criteria list resulting from this CHEC project should be regarded as a minimum standard. METHODS: The criteria list has been developed using a Delphi method. Three Delphi rounds were needed to reach consensus. Twenty-three international experts participated in the Delphi panel. RESULTS: The Delphi panel achieved consensus over a generic core set of items for the quality assessment of economic evaluations. Each item of the CHEC-list was formulated as a question that can be answered by yes or no. To standardize the interpretation of the list and facilitate its use, the project team also provided an operationalization of the criteria list items. CONCLUSIONS: There was consensus among a group of international experts regarding a core set of items that can be used to assess the quality of economic evaluations in systematic reviews. Using this checklist will make future systematic reviews of economic evaluations more transparent, informative, and comparable. Consequently, researchers and policy-makers might use these systematic reviews more easily. The CHEC-list can be downloaded freely from http://www.beoz.unimaas.nl/chec/.

Cost-Benefit Analysis↗

Economic considerations in comparing whole abdominal radiotherapy with combination doxorubicin-cisplatin chemotherapy in advanced endometrial carcinoma: how much economic data should be collected?

The key features of this study from the perspective of designing an economic analysis are that the resources consumed and the expected toxic effects are likely to be quite different in the two study arms, median survival will be measured in years, and the initial treatment assignment may affect the clinical course and resource consumption of the terminal phases of illness. Collecting complete data on all the costs associated with treatment, short-term toxic effects, long-term toxic effects, and treatment of recurrent disease as well as tracking the complex clinical course of patients over many years of follow-up would be an enormous undertaking. However, "phase II" or historical data on the costs and outcomes of care associated with each of these two treatment regimens would allow for a more tailored approach. But perhaps the first question that should be answered in designing an economic analysis to accompany a clinical trial is whether the resulting data are likely to be important. This study does not fulfill one of the main criteria for judging the appropriateness of including an economic analysis--large resource consequences. Fewer than 6000 cases of stage III or IV endometrial cancer occur annually in the United States, of which only a portion would be appropriate for the alternative treatment strategies evaluated in this protocol. Therefore, although the clinical question posed by this protocol is appropriate and important, the aggregate economic consequences of choosing one treatment approach over the other may not be of sufficient magnitude to justify the investment in a prospective economic analysis conducted alongside the clinical trial.

Abdomen↗

Is body mass index sensitively related to socio-economic status and to economic adjustment? A case study from the Congo.

Several nutritional surveys based on representative samples from various urban and rural situations show that the Congo presents a situation of nutritional transition. There is a large prevalence of low body mass index (BMI) in adults from rural zones and this increases with age. There is, however, a large prevalence of high BMI in urban populations despite the persistence of some degree of chronic energy deficiency (CED), particularly at younger ages. Correspondence analysis and logistic regression were used to construct a socio-economic index and measure adjusted risk factors for CED. In rural areas, the major risk factors were old age, sex (women) and the absence of schooling; low economic status, a commonly shared factor, did not differentiate between households for CED. In Brazzaville, CED was linked to a young age (< 30 years) and, clearly, to poverty. The change in the prevalence of CED in mothers from the capital city during a period of economic adjustment showed an increased incidence in young mothers, and also showed that the disparity between low and high economic levels regarding CED had grown. Finally, there was a high level of correspondence between the mean values for the weight-for-height of children and the BMI categories of the mothers. There is a parallel evolution during the period of economic adjustment between the increase of wasting in infants and the increase of CED in mothers. Therefore BMI appears to be a potential core indicator for use in nutritional surveillance in the Congo.

Adolescent↗

[Economic analysis and public health. Why does one need economic evaluation applied to diabetes? What methods does one choose: cost effectiveness, cost utility, cost benefit? Are such studies useful in terms of public health?].

The application of economic methods to public health is relatively recent and linked to the context of economic crisis: cooperation between medical doctors is to day in process. The main objective of health economics is the optimization of health care by improving resources allocation to take care of the patients. So, in France, the health system budget, 573 billions, represents 8.3% of the GNP; this percentage is one of the highest of Europe. Can such a growing rate decrease or are we going towards rationing of health system resources? In this context, economic analysis applied to diabetes uses mainly evaluation methods: cost-effectiveness, cost-utility, cost-benefit. Evaluation always supposes a comparison between medical alternative actions in terms of costs and results. Economic crisis made easier the acceptance of evaluation studies but their development supposes great scientific caution.

Budgets↗

Linking medicine and economics: health economics and quality of life in haemophilia care.

Scarce resources in healthcare are a fact of life everywhere. Providing optimal healthcare for haemophilia means delivering the best possible clinical outcomes at an acceptable total cost, however that is defined by individual societies. Health economics helps us to do this. So far, economic evaluation has enhanced our understanding of some of the economic implications of haemophilia and has provided some guidance on the way forward to optimize efficient allocation of resources for this condition. Further advances and consensus on evaluation methods and standards for the economics of haemophilia are required, however. This need will continue in the face of new, more sophisticated and therefore more costly haemophilia therapies.

Economics, Medical↗

Behavioral economics: reunifying psychology and economics.

"Behavioral economics" improves the realism of the psychological assumptions underlying economic theory, promising to reunify psychology and economics in the process. Reunification should lead to better predictions about economic behavior and better policy prescriptions.

Behavior↗

Economic development, political-economic system, and the physical quality of life.

This study compared capitalist and socialist countries in measures of the physical quality of life (PQL), taking into account the level of economic development. The World Bank was the principal source of statistical data for 123 countries (97 per cent of the world's population). PQL variables included: indicators of health, health services, and nutrition (infant mortality rate, child death rate, life expectancy, population per physician, population per nursing person, and daily per capita calorie supply); measures of education (adult literacy rate, enrollment in secondary education, and enrollment in higher education); and a composite PQL index. Capitalist countries fell across the entire range of economic development (measured by gross national product per capita), while the socialist countries appeared at the low-income, lower-middle-income, and upper-middle-income levels. All PQL measures improved as economic development increased. In 28 of 30 comparisons between countries at similar levels of economic development, socialist countries showed more favorable PQL outcomes.

Adult↗

Economic evaluation of influenza vaccination and economic modelling. Can results be pooled?

Scientific reviewing methods were applied to economic studies of influenza vaccination, and an economic model of influenza vaccination was developed from these primary sources. Issues arising from the secondary literature review include the quality of evidence on the effectiveness of the vaccines, the absence of a traditional population-based approach to reviewing economic data, confusion in terminology, and how to generalise from resource data contained in primary evaluations. Data from the literature review were summarised in terms of resource units used in the prevention and treatment of influenza. An economic model was constructed using local unit costs (from the Emilia region of Italy) and applying the data to a notional population. The model was sensitive to length of stay in hospital but not to variation in incidence of influenza, days off work or number of medical consultations. The model was predicated on and is sensitive to an estimate of 80% vaccine effectiveness. The approach is constrained by the available data, but could be more generally useful in that it allows variations in the quantity of inputs to be considered separately from variations in their values. The model may be used locally as a decision-making tool, although the method needs further development.

Humans↗

Economic growth, inequality, and the economic position of the poor in 1985-1995: an international perspective.

The "trickle-down" theory argues that wider income differences are good for economic growth, that growth is good for the poor, and therefore that widening income disparities benefit the poor. The theory thus fulfills Rawlsian principles of justice. The purpose of this article is to present a preliminary evaluation of the correctness of this theory. Income data for 21 countries were obtained from the Luxembourg Income Study, for the period 1985-95. The results of the analysis show no clear connections between inequality and economic prosperity. The wider the inequality, the worse is the absolute income of the poor. In this respect the theory is falsified. However, the trickle-down theory is partly correct in arguing for the beneficial effects of economic growth for the poor: the absolute income level of the poor is dependent on what is happening in the national economy, while the incidence and depth of poverty in advanced countries are not so much associated with economic factors as a result of national social policy programs.

Cross-Sectional Studies↗

Health economics, economic evaluation, and glaucoma.

Glaucoma has not received a great deal of attention from health economists in the past, partly due to the fact that no new treatments have been introduced for some time. Economic evaluation is generally performed for new technologies, to assess their cost-effectiveness compared with current treatments, to estimate the potential changes in the use of health care resources that their introduction may produce, and to make decisions about their reimbursement status and formulary inclusion. Economic studies in glaucoma have been largely limited to studies about cost, because a useful outcome measure has been lacking. Therapy aims at reducing intraocular pressure, but the data to estimate the absolute risk of vision loss due to high pressure have been lacking. Hence, it has been impossible to assess the benefit of treatments in terms of their ability to reduce blindness. However, as new out knowledge about these issues increases and more data become available, such studies become possible. This review illustrates the issues encountered when performing economic evaluation in glaucoma and reviews the current economic literature in the field.

Cost-Benefit Analysis↗

Socio-economic rehabilitation programmes of LEPRA India--methodology, results and application of needs-based socio-economic evaluation.

There is now a better understanding of the scope and process of rehabilitation. The approach recognizes the impact of leprosy on the individual, aims to understand the needs and concerns of those affected, their families and community in the rehabilitation process, and that aims to restore the person to normal social life. LEPRA India has undertaken socio-economic rehabilitation (SER) activities in its projects in Andrah Pradesh and Orissa States in India with a holistic approach that has been evolutionary, developmental and participatory. A SER Officer (SERO) was posted to each project. A plan was formulated by the SERO with participation of all project staff. The main emphasis of the programme was on active participation of the affected person in the rehabilitation process. A needs-assessment study was conducted in the target population using a semi-structured questionnaire. Information was elicited about social and economic status, before and after the disease, and the current rehabilitation needs of the persons affected. The next step was meeting the needs through interventions by the SER staff. The impact of the programme on restoration of social and economic status of the affected persons was analysed. The paper stresses the importance of assessing the needs of persons affected by leprosy, structuring a rehabilitation programme with the active participation of the affected person and evaluating the impact of the interventions in restoring normal social and economic life.

Adult↗

Health and safety economics: limitations of economic appraisal of occupational health services activities in Poland.

Methods of economic appraisal developed for evaluating activities in health care system may as well be successfully used for evaluating occupational health service activities. This involves the problem of resources management and cost containment not only at the company level, but also at different managerial and institutional levels. The decision makers have to know what resources are spent on occupational health, what is the effectiveness and efficiency of investing in employees health. The key issue of good understanding of the theory and practice of economic appraisal is a precise definition of costs, effectiveness and benefits. Another important area is the identification of information sources and barriers of economic appraisal. The results of the project carried out by the Nofer Institute of Occupational Medicine have provided evidence that defining costs, effectiveness and benefits of preventive activities need to be developed. It becomes even more clear after an analysis of existing limitations of economic appraisal in Polish enterprises.

Cost Control↗

The link between 'green' and economic success: environmental management as the crucial trigger between environmental and economic performance.

The link between environmental and economic performance has been widely debated in the literature for the last ten to fifteen years. One view is that improved environmental performance mainly causes extra costs for the firm and thus reduces profitability. However, also the opposite has been argued for: improved environmental performance would induce cost savings and increase sales and thus improve economic performance. Theoretical and empirical research have provided arguments for both positions and have not been conclusive so far. This article discusses reasons for the different views and the differences in empirical research and presents a theoretical framework to explain the coexistence of the conflicting views. It is argued that not merely the level of environmental performance, but mainly the kind of environmental management with which a certain level is achieved, influences the economic outcome. The model presented provides implications for both empirical research and company management in practice. Research and business practice should focus less on general correlations and more on causal relationships of eco-efficiency, i.e. the effect of different environmental management approaches on economic performance.

Commerce↗

Diet, health and the nutrition transition: some impacts of economic and socio-economic factors on food consumption patterns in the Kingdom of Tonga.

An essential element of the "health transition" is the emergence of disease patterns associated with changes in dietary regimes. The consumption of nutritionally poor (imported) foods in the Pacific is associated with increasing rates of diet related non-communicable diseases (NCDs). An oft-made assumption is that changes in consumption patterns are related to food preference (specifically preferences for high fat and/or dense carbohydrate foods). Recent work in the Kingdom of Tonga suggests that the "common-sense" association between food preference and food consumption is incorrect. The results of a large survey (n=430) indicate availability is the key factor in consumption, and that food preference, knowledge of the nutritional values of foods, and frequency of consumption are not correlated. Further analysis shows there are significant differences in consumption patterns between persons of higher and lower socio-economic status; perception of availability and frequency of consumption are a function of economic and social position--specifically access to cash. These results underline the salience of economic factors; the rise in NCDs is correlated with the increasing importance of the cash economy (not cultural values or ignorance of nutritional issues). In the absence of economic solutions, current consumption patterns will continue.

Adolescent↗