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PubMedDate not supplied

An economic model for comparing alternative policies for cervical cytologic smear screening.

In this paper a mathematical model is developed to determine the probability that a truly negative cervical cytologic smear will be correctly identified by a system of screening policies that uses one or more cytotechnologists to independently and sequentially prescreen such smears for the detection of cervical cancer. This is an extension of previous work that modeled the probability of detecting a truly positive smear under the same set of policies. In this system any positive reading by a cytotechnologist causes a slide to be rescreened by a pathologist, and if all cytotechnologists declare a slide to be negative, the slide is placed in a pool for random selection of slides to be rescreened by the pathologist. The policy of single screening by a cytotechnologist, with subsequent 10% rescreening of the negative slides, as suggested by the Clinical Laboratory Improvement Amendments of 1988, is thus embedded in the policies that are modeled. In addition, a cost model is developed that takes into account the cost of screening a slide by a cytotechnologist, of rescreening a slide by a pathologist, of a false-positive reading and of a false-negative reading. This cost model can be used to determine which policy is optimal for the parameters that pertain to a specific situation. Examples are presented to illustrate the use of the cost model. The results of a computer simulation model are also presented to validate the mathematical results and to display the variability of total cost.

Costs and Cost Analysis↗
PubMed2005

Enhancing economic models for the analysis of animal disease.

This paper discusses how economic tools can be targeted and combined to enhance their usefulness in analyses of animal disease problems. It briefly reviews the most commonly used economic modelling techniques to clarify the applicability of specific economic methods to different problems in animal health analysis. The paper then reviews applications of these methods in the literature and suggests how further research could integrate and improve different economic approaches and link epidemiological and economic methods to address a wider range of issues at different scales of analysis.

Animal Diseases↗
PubMed2007

A systematic review and economic model of the clinical effectiveness and cost-effectiveness of docetaxel in combination with prednisone or prednisolone for the treatment of hormone-refractory metastatic prostate cancer.

OBJECTIVES: A systematic review was undertaken and an economic model constructed to evaluate the clinical effectiveness and cost-effectiveness of docetaxel (Taxotere, Sanofi-Aventis) in combination with prednisone/prednisolone for the treatment of metastatic hormone-refractory prostate cancer (mHRPC). The main comparators considered were other established chemotherapy regimens and best supportive care. DATA SOURCES: Twenty-one resources (including MEDLINE, EMBASE and the Cochrane Library) were searched to April 2005. REVIEW METHODS: Two reviewers independently assessed studies for inclusion. Data from included studies were extracted and quality assessed. Where appropriate, outcomes were synthesised using formal analytic approaches. A new economic model was developed in order to establish the cost-effectiveness of docetaxel compared with a range of potential comparators. A separate review was undertaken to identify sources of utility data required to estimate quality-adjusted life-years (QALYs). Sensitivity analyses were also undertaken to explore the robustness of the main analysis to alternative assumptions related to quality of life. Monte Carlo simulation was used to propagate uncertainty in input parameters through the model in such a way that the results of the analysis could be presented with their uncertainty. The impact of uncertainty surrounding the decision was established using value of information and implementation approaches. RESULTS: Seven randomised controlled trials were identified that met the inclusion criteria. A direct comparison of docetaxel plus prednisone versus mitoxantrone plus prednisone in an open-label randomised trial showed improved outcomes for docetaxel plus prednisone in terms of overall survival, quality of life, pain and prostate-specific antigen decline. Two other chemotherapy regimens that included docetaxel: docetaxel plus estramustine and docetaxel plus prednisone plus estramustine, also showed improved outcomes in comparison with mitoxantrone plus prednisone. Indirect comparison suggested that docetaxel plus prednisone seems to be superior to corticosteroids alone in terms of overall survival. Conclusions on cost-effectiveness were primarily informed by the results of the in-house model. This indicated that mitoxantrone plus a corticosteroid is probably cheaper and more effective than corticosteroid alone. Compared with mitoxantrone plus prednisone/prednisolone, the use of docetaxel plus prednisone/prednisolone (3-weekly) appears cost-effective only if the NHS is prepared to pay 33,000 pounds per QALY. The incremental cost-effectiveness ratio associated with docetaxel plus prednisone (3-weekly) remained fairly robust to these variations with estimates ranging from 28,000 pounds to 33,000 pounds per QALY. Value of information analysis revealed that further research is potentially valuable. Given a maximum acceptable ratio of 30,000 pounds per QALY, the expected value of information was estimated to be approximately 13 million pounds. CONCLUSIONS: This systematic review of the research suggests that docetaxel plus prednisone seems to be the most effective treatment for men with mHRPC. The economic model suggests that treatment with docetaxel plus prednisone/prednisolone is cost-effective in patients with mHRPC provided the NHS is prepared to pay 33,000 pounds per additional QALY. Future research should include the direct assessment of quality of life and utility gain associated with different treatments, including the effect of adverse events of treatment, using generic instruments, which are suitable for the purposes of cost-effectiveness analyses.

Antineoplastic Agents↗
PubMed2004

Integrated epidemiology and economics modelling for the management of animal health.

This paper discusses the role of integrated epidemiology and economics modelling in animal health planning, with particular reference to the evaluation of national level interventions that involve the vaccination of livestock. Well-integrated epidemiology and economics is considered essential if model outputs are to be of value in national animal disease control planning. The different approaches to the use of modelling in priority setting and resource allocation in animal health are reviewed and discussed. The authors conclude that this particular application of modelling is poorly developed, due in part to the complexities involved. Much more has been done to develop models that evaluate the merits of different intervention scenarios for a given single disease, and examples of these are presented. However, the authors conclude that despite the widespread use of such models, there is still considerable scope for the development of a more standardised approach, incorporating consideration of both direct and indirect implications of intervention options. In discussing the changing demands on animal health economics modelling, the authors propose that increased attention should be given to the valuation of "externalities", the calculation and interpretation of the distribution of costs and benefits, the evaluation of the impact of disease control on poverty reduction, and the development of real-time economics modelling techniques, to assist particularly in the effective management of disease outbreaks.

Animal Welfare↗
PubMed1995

Conceptualizing race in economic models of medical utilization: a case study of community-based elders and the emergency room.

There is no consensus on the appropriate conceptualization of race in economic models of health care. This is because race is rarely the primary focus for analysis of the market. This article presents an alternative framework for conceptualizing race in health economic models. A case study is analyzed to illustrate the value of the alternative conceptualization. The case study findings clearly document the importance of model stratification according to race. Moreover, the findings indicate that empirical results are improved when medical utilization models are refined in a way that reflects the unique experiences of the population that is studied.

Black or African American↗
PubMed2006

Economic modeling in chronic obstructive pulmonary disease.

Calculating the cost-effectiveness of interventions is an important step in accurately assessing the health and financial burdens of a disease. Although clinical trials that include cost data can be used to compare the cost-effectiveness of specific interventions, they only deal with outcomes within the time frame of the trial. Health economic models can synthesize epidemiologic, clinical, economic, and quality-of-life data from many different sources and extrapolate results to a point many years in the future. The models generally compare interventions with respect to the costs per life-year gained or per quality-adjusted life-year gained. The use of health economic models to assess the economic burden of chronic obstructive pulmonary disease (COPD) and the value of interventions is growing, and will continue to do so as the burden of the disease is better appreciated. Several COPD disease-state models have been described; each uses a consistent definition of COPD severity that is based on FEV(1)% predicted, but the models differ in the allowed transitions, disease progression estimates, utility weights, and costs. This article reviews COPD health economic models and discusses the importance of survival benefits and utilities (health state valuations) for COPD in economic models.

Cost of Illness↗
PubMed1988

Economic models of fertility behaviour in Australia.

The author analyses individual fertility patterns in Australia from the perspective of recent economic models of the family. The emphasis is on the relationship between fertility and economic variables such as human capital, market wages, and wealth. "Several dimensions of fertility are considered, including 'quality' of children, completed family size, and the decision whether to have children or not." Data are from the 1973 Social Mobility in Australia Survey.

Adolescent↗
PubMed2006

Cost-effectiveness of cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion: a systematic review and economic model.

OBJECTIVES: To compare patient outcomes, resource use and costs to the NHS and NHS Blood Transfusion Authority (BTA) associated with cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion. DATA SOURCES: Electronic databases covering the period 1996-2004 for systematic reviews and 1994-2004 for economic evidence. REVIEW METHODS: Existing systematic reviews were updated with data from selected randomised controlled trials (RCTs) that involved adults scheduled for elective non-urgent surgery. Any resource use or cost data were extracted for potential use in populating an economic model. Relative risks or weighted mean difference of each outcome for each intervention were assessed, taking into account the number of RCTs included in each outcome and intervention and the presence of any heterogeneity. This allowed indirect comparison of the relative effectiveness of each intervention when the intervention is compared with allogeneic blood transfusion. A decision analytic model synthesised clinical and economic data from several sources, to estimate the relative cost-effectiveness of cell salvage for people undergoing elective surgery with moderate to major expected blood loss. The perspective of the NHS and patients and a time horizon of 1 month were used. The economic model was developed from reviews of effectiveness and cost-effectiveness and clinical experts. Secondary analysis explored the robustness of the results to changes in the timing and costs of cell salvage equipment, surgical procedure, use of transfusion protocols and time horizon of analysis. RESULTS: Overall, 668 studies were identified electronically for the update of the two systematic reviews. This included five RCTs, of which two were cell salvage and three preoperative autologous donation (PAD). Five published systematic reviews were identified for antifibrinolytics, fibrin sealants and restrictive transfusion triggers, PAD plus erythropoietin, erythropoietin alone and acute normovolaemic haemodilution (ANH). Twelve published studies reported full economic evaluations. All but two of the transfusion strategies significantly reduced exposure to allogeneic blood. The relative risk of exposure to allogeneic blood was 0.59 for the pooled trials of cell salvage (95% confidence interval: 0.48 to 0.73). This varied by the type and timing of cell salvage and type of surgical procedure. For cell salvage, the relative risk of allogeneic blood transfusion was higher in cardiac surgery than in orthopaedic surgery. Cell salvage had lower costs and slightly higher quality-adjusted life years compared with all of the alternative transfusion strategies except ANH. The likelihood that cell salvage is cost-effective compared with strategies other than ANH is over 50%. Most of the secondary analyses indicated similar results to the primary analysis. However, the primary and secondary analyses indicated that ANH may be more cost-effective than cell salvage. CONCLUSIONS: The available evidence indicates that cell salvage may be a cost-effective method to reduce exposure to allogeneic blood transfusion. However, ANH may be more cost-effective than cell salvage. The results of this analysis are subject to the low quality and reliability of the data used and the use of indirect comparisons. This may affect the reliability and robustness of the clinical and economic results. There is a need for further research that includes adequately powered high-quality RCTs to compare directly various blood transfusion strategies. These should include measures of health status, health-related quality of life and patient preferences for alternative transfusion strategies. Observational and tracking studies are needed to estimate reliably the incidence of adverse events and infections transmitted during blood transfusion and to identify the lifetime consequences of the serious hazards of transfusion on mortality, health status and health-related quality of life.

Aminocaproates↗
PubMed1996

An economic model to assess the savings from a clinical application of haematopoietic growth factors.

Patients receiving chemotherapy frequently develop fever and neutropenia. Haematopoietic growth factors (HGFs) may decrease the duration of such episodes or may prevent a febrile neutropenic episode. In this study we introduce a Markov type economic model for the hospital which calculates all relevant direct costs and savings of HGF therapy and may support decisions on HGF administration. A distinction is made between patients receiving intensive and standard chemotherapy schedules. Our results indicate that HGFs can induce savings in intensive chemotherapy and standard chemotherapy following neutropenic fever. Prophylactic administration of HGF is cost-effective if the risk of infection is considerable. The risk of infection depends on underlying malignancy, corresponding treatment modalities and the health condition of the patient. The model is meant as an analytical framework and should be used carefully, as not all benefits (e.g. benefits to the patients) are considered. These benefits may be balanced against the additional costs or savings resulting from the economic model.

Antineoplastic Agents↗