SEARCH · Search PubMed

Results for “ECONOMICS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 559 records · Page 31Linked to original sources

PubMed1994

The role of economic appraisal in Denmark.

The numbers of economic appraisals conducted have been increasing during the last ten years in Denmark. This article involves 17 economic appraisals on specific health issues. Most of the studies use the cost-effectiveness approach. Cost appraising has only been conducted in five of the studies, three use the cost-benefit approach, and only one uses the cost-utility approach. Most of the studies have been directed at the policy level and only five have been directed at the clinical decision making level. The success of the individual economic appraisals is being assessed by looking at their ability to change behaviour among the decision makers according to the results obtained and by looking at their ability to enter the decision making process. However, as this article stresses, economic appraisals have also been used to introduce the economic appraisal approach as a way of thinking, as a road to efficiency, within the health services. This has led to the incorporation of economic appraisals into committee work at the National decision making level, the issuing of guidelines to local health authorities including efficiency, and to some acceptance of the efficiency term among health professionals.

Clinical Competence↗

PubMed1994

The importance of childhood socio-economic group for adult health.

Socio-economic conditions in childhood and their effect on morbidity and mortality in adult life have been discussed frequently during the last 10 years or so. At least two hypotheses have been discussed. The hypothesis that perinatal and childhood conditions are directly and causally related to morbidity and mortality has been met by a critique, the essence of which is that the relationship could be an indirect one. Those experiencing poor conditions early in life are more likely to experience poor conditions later in life and the association between perinatal and childhood factors and adult health is mediated by adult social factors. Here, this alternative hypothesis is tested on a sample drawn from the Swedish population. The sample was interviewed in 1980-81 and the register of those who consented to the interview included 6298 men and 6397 women aged 16-74 years. This register was linked to the Cause of Death Register for the period 1980-88. 461 men and 289 women died during the follow up. Firstly it is concluded that childhood socio-economic group is significantly linked to male mortality, when age is taken into account. This could not be demonstrated for women. The variation in general health between childhood socio-economic groups, on the other hand, is significant for women but not for men. When a number of mediating variables are added, the effect of childhood socio-economic group remains significant for men. It is thus not possible to exclude the possibility that childhood socio-economic conditions have a direct effect on adult health. At the same time, it is suggested here that at least a part of that effect is mediated by social factors in adulthood. That childhood socio-economic conditions may be independently related to adult health does not support the hypothesis of 'biological programming'.

Adolescent↗

PubMed1994

A prospective cohort study investigating the explanation of socio-economic inequalities in health in The Netherlands.

In this paper, the objectives, design, data-collection procedures and enrollment rates of the Longitudinal Study on Socio-Economic Health Differences (LS-SEHD) are described. This study started in 1991, and is the first large-scale longitudinal study of the explanation of socio-economic inequalities in health in the Netherlands. The LS-SEHD aims at making a quantitative assessment of the contribution of different mechanisms and factors to the explanation of socio-economic inequalities in health. It is based on a research model incorporating both 'selection' and 'causation' mechanisms, and a wide range of specific factors possibly involved in these mechanisms: health-related life-style factors, structural/environmental factors, psychosocial stress-related factors, childhood environment, cultural factors, psychological factors, and health in childhood. The design of the LS-SEHD is that of a prospective cohort study. An aselect sample, stratified by age, degree of urbanization and socio-economic status, for approx. 27,000 persons was drawn from the population registers in a region in the Southeastern part of The Netherlands. The persons in this sample received a postal questionnaire. An aselect subsample of approx. 3500 persons from the respondents to the postal questionnaire was, in addition, approached for an oral interview. The follow-up of these samples will use routinely collected data (mortality by cause of death, hospital admissions by diagnosis, cancer incidence), as well as repeated postal questionnaires and oral interviews. The response rate to the base-line postal questionnaire was 70.1% (n = 18,973), and that to the base-line oral interview was 79.4% (n = 2802). If the LS-SEHD is compared to a number of frequently cited longitudinal studies of socio-economic inequalities in health from the United Kingdom, it appears that the differences with the OPCS Longitudinal Study and the birth cohort studies (such as the National Survey of Health and Development) are huge. The LS-SEHD is more akin to the Whitehall(I)-study and the West of Scotland 20-07 study. For example it has the sample size of the former but the open population and emphasis on social factors of the latter. A comparison of the results of various longitudinal studies of socio-economic inequalities in health is recommended.

Adolescent↗

PubMed2005

Associations of socio-economic position and disability among older women in Britain and Jyväskylä, Finland.

The aim was to compare the pattern of associations in measures of socio-economic position and disability among British and Finnish older women. In Britain data from the British Women's Heart and Health Study was used. Women from 23 towns took part in a nurse-assessed medical examination and postal questionnaire (n = 4286). In Finland, data from the Evergreen study was used. Eight hundred and four women from the city of Jyväskylä were interviewed at home. Socio-economic position was measured according to social class in childhood, education, use of a car, home ownership and previous occupation. Disability measures included questions on difficulties in washing/dressing and climbing stairs. Logistic regression analyses were conducted to examine the relationship between disability and socio-economic position. In the age-adjusted analysis of both samples increasing disability in washing/dressing and climbing stairs was associated with at least one of the measures of deprivation. The relationship between socio-economic position and disability was more distinct in the British than Finnish women. Despite adjustment for a range of confounders, the relationship between socio-economic position and disability was not much attenuated, particularly in the British women. The associations in the measures of socio-economic position and disability showed a slightly different pattern between the British and Finnish women.

Age Factors↗

PubMed2006

Evidence-based anaesthesia and health economics.

The aim of this chapter is to focus on evidence-based health economics in anaesthesia. More and more, requests for additional facilities will have to be based on detailed arguments supported by 'hard evidence' as to the gain to be expected from the patient's angle and the cost. Evidence-based clinical practice in anaesthesia isolated from economic issues is not an optimal goal. As clinicians we have to demonstrate not only the need for the use of evidence-based principles in economic evaluation, but also that such principles should themselves be based on health economics. This chapter shows how to bring economic evaluation and systematic review together, and how to use such evaluations in the clinical setting. It shows how economics can be used to broaden the evidence base for a more efficient and equitable health policy, and sets a future research agenda for this challenging area of work in Cochrane reviews dealing with anaesthesia topics.

Anesthesia↗

PubMed2006

Understanding the limited impact of economic evaluation in health care resource allocation: a conceptual framework.

Concern has increasingly been expressed at the low level of impact that economic evaluations have on the priority setting decisions they are designed to inform. The concern to maximise the impact of economic evaluation in health care is reminiscent of research utilisation debates rehearsed in the various policy studies disciplines. This paper draws on selected themes and frameworks from this literature in order to explore issues and map out an agenda relating to the uptake and use of cost effectiveness analysis in health policy decisions. The authors consider the implications for health economics, and other policy-related research and evaluation, of adopting either a rational or interactive model of research utilisation. Economic evaluations can be normative or descriptive decision tools. The choice of approach will reflect the assumed model of research utilisation and has implications for overcoming barriers to impact on policy. There is an underlying conceptual link between the rational model of research utilisation, the normative approach to economic evaluation and a focus on barriers to the accessibility of published analyses. In contrast, acknowledgement of an interactive and incremental policy process predisposes the analyst to a more descriptive approach and suggests the importance of broader systems, process and ethical barriers to the use of economic evaluation. We address the crucial issue of the importance of establishing objectives and discuss how this issue effects how those seeking to influence policy should proceed. Finally, we discuss indirect or 'enlightenment' models of research utilisation and the implications of these for the community of health economists.

Health Care Rationing↗

PubMed2006

Process economics of industrial monoclonal antibody manufacture.

Pressures for cost-effective manufacture of antibodies are growing given their high doses and increasing market potential that have resulted in significant increases in total site capacities of up to 200,000 L. This paper focuses on the process economic issues associated with manufacturing antibodies and reviews the cost studies published in the literature; many of the issues highlighted are not only specific to antibodies but also apply to recombinant proteins. Data collated at UCL suggest current benchmark investment costs of $660-$1580/ft2 ($7130-$17,000/m2) and $1765-$4220/L for antibody manufacturing facilities with total site capacities in the range of 20,000-200,000 L; the limitations of the data are highlighted. The complications with deriving benchmark cost of goods per gram (COG/g) values are discussed, stressing the importance of stating the annual production rate and either titre or fermentation capacity with the cost so as to allow comparisons. The uses and limitations of the methods for cost analysis and the available software tools for process economics are presented. Specific examples found in the literature of process economic studies related to antibody manufacture for different expression systems are reviewed. The key economic drivers are identified; factors such as fermentation titre and overall yield are critical determinants of economic success. Future trends in antibody manufacture that are driven by economic pressures are discussed, such as the use of alternative expression systems (e.g. transgenics, E. coli and yeast), disposables, and improvements to downstream technology. The hidden costs and the challenges in each case are highlighted.

Animals↗

PubMed2006

Economic evaluation in critical care medicine.

Scarce resources are a reality in all health care systems. There is a constant challenge to maximize health benefits within the resources available. This is particularly relevant when caring for critically ill patients, given the resource-intensive technologies and medicines used and the highly specialized professionals required. Moreover, given the high acuity of illness, decision makers and health care providers in critical care units must constantly assess the value derived from therapies and resources used. Economic evaluation is the comparative analysis of alternative health care interventions in their relative costs (resource use) and effectiveness (health effects). Economic evaluations have been increasingly published in critical care journals and read by clinicians. This article illustrates how the basic principles of health economics can be applied to health care decision making through the use of economic evaluation. We demonstrate how economic evaluation can link medical outcomes, quality of life, and costs in a common index, even for therapies for different medical conditions and with different health outcomes. This article highlights the need for randomized clinical trials and economic evaluations of therapies in critical care medicine for which the effect of the therapy on health outcomes and/or costs are unknown.

Canada↗

PubMed2005

Linking socio-economic factors, environment and land cover in the German Highlands, 1945-1999.

Land-cover changes are caused by human activities and natural ecological processes. Thus, our study uses an interdisciplinary approach to research land-cover changes. We present a method to (i) link socio-economic/environmental factors and land-cover changes, (ii) identify indicators of land-cover changes, and (iii) distinguish between socio-economic and environmental indicators associated with local types of overall land-cover changes. The study was conducted in the Lahn-Dill Highlands, Germany, a typical marginal rural landscape. In this region, we investigated land-cover changes occurring over the period 1945-1999. Land-cover data were derived from multi-temporal aerial photographs. Types of overall land-cover changes characterising the districts within the study area were differentiated. With the help of redundancy analysis (RDA), we analysed the relationships between land-cover changes and widely available socio-economic/environmental factors. The results reveal that both individual land-cover changes at patch level and types of overall land-cover changes characterising districts are correlated with socio-economic and environmental factors. Whereas the stable environmental factors are drivers of land-cover changes in our rural study area, socio-economic factors introduced into the analysis mostly result from land-cover changes. We identified correlative socio-economic indicators that cannot explain land-cover changes, but that in combination with the environmental factors can be used to greatly facilitate the reconstruction of past land-cover changes and thus lead to a better knowledge of land-cover history. Based on the types of overall land-cover changes, the results of the study can be adopted for the study of land-cover changes in other regions.

Agriculture↗

PubMed2004

Arsenicosis in Bangladesh: prevalence and socio-economic correlates.

The potential effects of arsenic-contaminated drinking water on health are of concern, but our understanding of the risk factors of arsenicosis remains limited. This study assessed the prevalence of and socio-economic differentials in arsenic-associated skin lesions in a rural community in Bangladesh. Data were collected from a village where the Bangladesh Rural Advancement Committee has operated a health surveillance system and a community-based arsenic mitigation project since 1999. In total, 1654 residents in the study village were examined in May 2000 for arsenic-associated lesions on their skin. Socio-economic information was extracted from the surveillance system database covering the village. Nearly 2.9% of the study population had clinical manifestations of arsenic poisoning. The prevalence of arsenicosis was associated with age, sex, education and the economic status of the household. Multivariate analysis identified age and economic status as significant predictors of arsenicosis controlling for education and gender. In conclusion, a clear understanding of the socio-economic distribution of arsenicosis in different demographic and socio-economic groups will be useful in identifying the high-risk groups from arsenic-affected communities. More studies are needed to design effective interventions to mitigate the effects of arsenic in Bangladesh.

Adolescent↗

PubMed2005

Assessment of sociodemographic factors and socio-economic status affecting the coverage of compulsory and private immunization services in Istanbul, Turkey.

OBJECTIVES: The primary objective of this study was to determine the coverage of the Expanded Programme of Immunization (EPI) of the Ministry of Health and the coverage of private vaccines in the Umraniye Health District in order to establish approaches for improving vaccination services. Other objectives were to define the areas that present higher risks for non-vaccination and to determine the factors that influence vaccination coverage. METHODS: A '30 x 7' cluster sampling design was adopted as the sampling method. Thirty streets were selected at random from each health care region. Sociodemographic and socio-economic characteristics of the population, utilization of vaccination services and vaccination status of children under the age of 5 years were determined by face-to-face interviews. Odds ratios for the sociodemographic and socio-economic characteristics, health centre region and inner country immigration were assessed as possible related factors with the vaccination coverage rates for children under 5 years and under 1 year using the backward elimination method in logistic regression. RESULTS: Vaccination coverage was as follows: hepatitis B third dose, 84.6%; Bacille Calmette-Guérin, 94.8%; diphtheria, tetanus, pertussis (DPT) third dose, 90.1%; oral polio virus (OPV) third dose, 90.0%; measles, 88.7%; DPT booster dose, 79.1%; OPV booster dose, 79.0%; measles, mumps, rubella (MMR), 13.3%; haemophilus influenza type b (Hib), 9.3%; and Varicella vaccine, 3.3%. The full vaccination rates for children under 5 years and under 1 year were 68.3 and 79.5%, respectively. Higher socio-economic status was associated with a higher rate of full vaccination and private vaccination for children under 5 years of age. CONCLUSIONS: Full vaccination rates for children aged less than 1 year and less than 5 years were higher in our district than in Istanbul. However, we did not meet the EPI aims for any of the vaccines, and differences were observed in vaccination coverage rates between different socio-economic groups in the district. Therefore, an intervention programme should be considered to achieve the EPI's goals, particularly in socio-economically disadvantaged groups. Also, the coverage of private vaccination (MMR, Hib, Varicella) is low and more children from higher socio-economic groups receive these vaccines.

Adolescent↗

PubMed2006

Using economic valuation techniques to inform water resources management: a survey and critical appraisal of available techniques and an application.

The need for economic analysis for the design and implementation of efficient water resources management policies is well documented in the economics literature. This need is also emphasised in the European Union's recent Water Framework Directive (2000/60/EC), and is relevant to the objectives of Euro-limpacs, an EU funded project which inter alia, aims to provide a decision-support system for valuing the effects of future global change on Europe's freshwater ecosystems. The purpose of this paper is to define the role of economic valuation techniques in assisting in the design of efficient, equitable and sustainable policies for water resources management in the face of environmental problems such as pollution, intensive land use in agriculture and climate change. The paper begins with a discussion of the conceptual economic framework that can be used to inform water policy-making. An inventory of the available economic valuation methods is presented and the scope and suitability of each for studying various aspects of water resources are critically discussed. Recent studies that apply these methods to water resources are reviewed. Finally, an application of one of the economic valuation methods, namely the contingent valuation method, is presented using a case study of the Cheimaditida wetland in Greece.

Agriculture↗

PubMed2005

Some mechanisms linking economic inequality and infant mortality.

We use data from the 1985, 1987 and 1991 United States Vital Statistics Linked Infant Birth and Death Records to assess the relationship between state-level economic inequality and an infant's probability of death. We find that economic inequality is associated with higher neonatal mortality even after we control mother's age and race and state characteristics that are likely to be associated with both inequality and infant death. Inequality is not associated with post-neonatal mortality. We assess three mechanisms that could link income inequality and infant deaths: non-linearity in the relationship between parental income and infant death, economic segregation, and state health care spending. Our evidence suggests that non-linearity in the relationship between family income and infant health accounts for little of the relationship between inequality and infant death. However inequality is associated with greater economic segregation, which in turn is associated with a higher probability of infant death. This effect is partially offset by the fact that inequality is also associated with state spending on health care, which is in turn associated with lower death rates. The increase in economic segregation increased infant deaths more than the increase in health care spending reduces them, so the net effect of economic inequality is to increase infant deaths especially in the first month after birth.

Humans↗

PubMed2006

Places, people and mental health: a multilevel analysis of economic inactivity.

This paper investigates multilevel associations between the common mental disorders of anxiety, depression and economic inactivity measured at the level of the individual and the UK 2001 census ward. The data set comes from the Caerphilly Health & Social Needs study, in which a representative survey of adults aged 18-74 years was carried out to collect a wide range of information which included mental health status (using the Mental Health Inventory (MHI-5) scale of the Short Form-36 health status questionnaire), and socio-economic status (including employment status, social class, household income, housing tenure and property value). Ward level economic inactivity was measured using non-means tested benefits data from the Department of Work and Pensions (DWP) on long-term Incapacity Benefit and Severe Disablement Allowance. Estimates from multilevel linear regression models of 10,653 individuals nested within 36 census wards showed that individual mental health status was significantly associated with ward-level economic inactivity, after adjusting for individual-level variables, with a moderate effect size of -0.668 (standard error=0.258). There was a significant cross-level interaction between ward-level and individual economic inactivity from permanent sickness or disability, such that the effect of permanent sickness or disability on mental health was significantly greater for people living in wards with high levels of economic inactivity. This supports the hypothesis that living in a deprived neighbourhood has the most negative health effects on poorer individuals and is further evidence for a substantive effect of the place where you live on mental health.

Adolescent↗

PubMed2002

A review of the literature on the economics of noncompliance. Room for methodological improvement.

Therapeutic noncompliance is a major issue in health care, having important negative consequences for clinical outcome as well as for health-care costs. This paper reviews the literature on the economics of therapeutic noncompliance, identifies methodological shortcomings and formulates recommendations for future economic research in this area. Medication noncompliance was explored more extensively, as the majority of articles dealt exclusively with this aspect of therapy. Eighteen studies were assessed according to their definition and measurement of medication noncompliance, study design, and identification and valuation of costs and outcomes. Very diverse designs and often invalid methods for calculating costs were found. Medication noncompliance is often ill-defined and measured in an inaccurate way. The economic consequences of therapeutic noncompliance have rarely been investigated according to the standard principles of good economic evaluation. Six studies examined both costs and consequences of noncompliance in a cost-outcome description or a cost-benefits, cost-effectiveness or cost-utility analysis. Eight studies dealt with the economic value of compliance-enhancing interventions. In general, studies on the economic consequences of noncompliance lack methodological rigour and fail to meet qualitative standards. There is a clear need for more and better research on the impact of noncompliance, on the cost-effectiveness of interventions and the potential of compliance-enhancing interventions to improve patient outcomes and/or reduce health-care costs.

Cost of Illness↗

PubMed2003

Regulating the economic evaluation of pharmaceuticals and medical devices: a European perspective.

Throughout the developed world, economic evaluation of costly new pharmaceuticals and medical devices became increasingly widespread and systematic during the 1990s. However, serious concerns remain about the validity and relevance of this economic evidence, and about the transparency and accountability of its use in public sector reimbursement decisions. In this article, we summarise current concerns in Europe, based on interviews with European health economists from industry, universities, research institutes and consulting firms. We identify five challenges for European policy-makers, and conclude that there is considerable scope for improving decision-making without damaging incentives to innovate. The challenges are: (1). full publication of the economic evidence used in reimbursement decisions; (2). the redesign of licensing laws to improve the relevance of economic data available at product launch; (3). harmonisation of economic evaluation methodologies; (4). development of methodologies for evaluation of health inequality impacts; and (5). negotiation of price-performance deals to facilitate the use of economic evidence in post-launch pricing review decisions, as information is gathered from studies of product performance in routine use.

Clinical Trials as Topic↗

PubMed1999

Limits to rationality: economics, economists and priority setting.

This paper investigates why economic approaches to priority setting have had only limited impact in practice. It argues that obstacles to the take-up of the economic approach centre on (1) limitations in the theory and practice of economic evaluations, and (2) the nature of the wider context within which decisions on priority setting take place. On the first point, it argues that, despite advances in research methods, there is still debate about the theoretical basis of measures typically used in economic evaluations, such as QALYs, and that much of the extant empirical data is of questionable quality. On the second point, it maintains that politicians, health care professionals and local people attach importance to other factors besides allocative efficiency. If economic approaches are to have more impact in the future, it argues that health economists need to adopt a wider research agenda, focusing on public sector decision-making and, in particular, the incentives and constraints governing the use of economic data in different types of health care organisation.

Cost-Benefit Analysis↗

PubMed1997

Socio-economic differences in general practitioner and outpatient specialist care in The Netherlands: a matter of health insurance?

Equal treatment for equal needs, irrespective of socio-economic position, is a major issue in many countries. Although in the Netherlands differences in utilization of health care between population groups are less pronounced than in most other countries, some differences by socio-economic position do exist. Controlling for health status, individuals with a high socio-economic status have a higher probability of outpatient contacts with a specialist, but a lower probability of general practitioner contacts, compared with those with a low socioeconomic status. In this cross-sectional study, we studied whether socio-economic differences in GP and outpatient specialist care utilization that exist after health status is taken into account could be explained by different aspects of health insurance. The study population, in which people with asthma and chronic obstructive pulmonary disease (COPD), diabetes mellitus, severe back complaints, and heart diseases are overrepresented, consists of 2867 respondents. Multivariate analyses show that the socio-economic differences in outpatient specialist contacts cannot be explained by differences in health insurance, whereas differences in general practitioner contacts can partially be explained by the fact that individuals with higher socio-economic status more often have a private (instead of public) insurance. This is not owing to differences in deductible or insurance coverage between public and private insurance, but is more likely to be caused by differences in regulatory aspects between these two insurance schemes (such as the stronger gate-keeper role of the general practitioner in the public insurance scheme.

Adult↗