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PubMed2005

Cost-of-illness analysis. What room in health economics?

Cost-of-illness (COI) was the first economic evaluation technique used in the health field. The principal aim was to measure the economic burden of illness to society. Its usefulness as a decision-making tool has however been questioned since its inception. The main criticism came from welfare economists who rejected COIs because they were not grounded in welfare economics theory. Other attacks related to the use of the human capital approach (HCA) to evaluate morbidity and mortality costs since it was said that the HCA had nothing to do with the value people attach to their lives. Finally, objections were made that COI could not be of any help to decision makers and that other forms of economic evaluation (e.g. cost-effectiveness, cost-benefit analysis) would be much more useful to those taking decisions and ranking priorities. Conversely, it is here suggested that COI can be a good economic tool to inform decision makers if it is considered from another perspective. COI is a descriptive study that can provide information to support the political process as well as the management functions at different levels of the healthcare organisations. To do that, the design of the study must be innovative, capable of measuring the true cost to society; to estimate the main cost components and their incidence over total costs; to envisage the different subjects who bear the costs; to identify the actual clinical management of illness; and to explain cost variability. In order to reach these goals, COI need to be designed as observational bottom-up studies.

Cost of Illness↗
PubMed2006

Conducting an economic analysis to assess the electrocardiogram's value.

BACKGROUND AND PURPOSE: Health economic analyses seek to assess the relative value (cost vs health benefit trade-offs) of medical technologies. However, these methods have been underused in studies of the electrocardiogram (ECG). METHODS: We develop a framework for the economic evaluation of the ECG as a decision support tool within broader treatment strategies. We then apply this framework to the development of an economic study protocol for the Prehospital Wireless Transmission of Electrocardiograms to a Cardiologist via a Hand-held Device Multicenter study. RESULTS: Our framework defines key cost-effectiveness concepts and describes alternative methods for estimating medical costs and health benefits. We demonstrate how this framework has been applied to develop the Prehospital Wireless Transmission of Electrocardiograms to a Cardiologist via a Hand-held Device Multicenter economic protocol. CONCLUSIONS: The conduct of health economic studies alongside ECG clinical studies could provide important information for those seeking to promote newer ECG applications that require significant financial investments.

Cost-Benefit Analysis↗
PubMed2004

An approach for integrating economic impact analysis into the evaluation of potential marine protected area sites.

Marine protected areas (MPAs) are one tool that can be used in the comprehensive management of human activities in areas of the ocean. Although researchers have supported using MPAs as an ecosystem management tool, scientific research on MPAs in areas other than fisheries and fisheries management is limited. This paper presents a model for designing marine protected areas that protect important components of the ecosystem while minimizing economic impacts on local communities. This model combines conservation principles derived specifically for the marine environment with economic impact assessment. This integrated model allows for consideration of both fishery and non-fishery resources and activities such as shipping and recreational boating. An illustration of the model is presented that estimates the total economic impacts on Massachusetts' coastal counties of restricting fishing and shipping at certain sites in an area in the southern Gulf of Maine. The results suggest that the economic impacts on the region would differ according to the site in which shipping and fishing were restricted. Restricting activities in certain sites may have considerable impacts on local communities. The use of the model for evaluating and comparing potential MPA sites is illustrated through an evaluation of three different policy scenarios. The scenarios demonstrate how the model could be used to achieve different goals for managing resources in the region: protecting important components of the ecosystem, minimizing economic impacts on the local region, or a combination of the two.

Animals↗
PubMed1997

Economic evaluation of bovine brucellosis and tuberculosis eradication programmes in a mountain area of Spain.

We applied social cost-benefit analysis to the economic evaluation of the bovine brucellosis and bovine tuberculosis eradication programmes carried out by the public eradication authority for mountain areas in the Spanish Central Pyrenees. We considered only the effects on animal health and production. We also evaluated several hypotheses corresponding to the different sanitary situations of two valleys studied. The results were different for the two disease programmes. The brucellosis programme was economically efficient over a sufficiently long time frame, but the bovine tuberculosis programme was not. A factor having the greatest influence on the economic efficiency of the programmes was the initial prevalence of the disease in the two valleys studied. The greater this was, the more difficult it was to obtain positive net benefits; this was due the initially high compensation paid for the slaughter of animals testing positive for the disease. The relatively small animal health and production returns derived from the tuberculosis programme explained it's failure to generate positive economic results. The fact that the economic evaluation resulted in unfavourable outcomes is not in itself justification for project termination, because the benefits to the wider community through the prevention of zoonosis were not considered in this analysis.

Animals↗
PubMed1997

Economic evaluation of national identification and recording systems for pigs in Belgium.

Four national identification and recording (I&R) systems for the Belgian pig industry were evaluated economically, using a computer simulation model. These systems were: (1) the previous system; (2) a revised system (based on the previous one); (3) a system based on electronic identification; (4) a system similar to (3) but which also allows electronic monitoring of individual pigs. The evaluation of the systems particularly concerned their use in the control of classical swine fever (CSF). Four factors have shown to be very influential in economic decision making with respect to I&R systems: (1) the economic losses per CSF epidemic; (2) the frequency of CSF epidemics; (3) the operational costs of the I&R system; (4) the possibility of additional use of the system besides CSF control. It was concluded that for the Belgian situation, replacement of the previous I&R system by the revised one is economically justifiable. Because of high operational costs, electronic identification systems are only economically feasible in very specific situations, e.g. when a higher degree of additional use is possible or with a relatively high frequency of CSF epidemics.

Animal Husbandry↗
PubMedDate not supplied

Natural capital in ecology and economics: an overview.

The Brundtland Commission report, Our Common Future, defined sustainable development as development that meets the needs of the present without compromising the ability of future generations to meet their own needs. Although the idea of sustainable development has been widely accepted, it has proved difficult to identify and implement policies and practices that promote sustainable economic growth. Some economists, environmental scientists and policy analysts believe that they can transform the consensus about sustainability into manageable practices. They propose to accomplish this feat with a set of new ideas about the relationships between the economy and the environment offered under the banner of 'natural capital'. An ideal account of natural capital would be one or more standard measures or models that would allow the direct comparison of environmental goods, like forests, fresh water and clean air, with economic goods, like money, capital and productivity. By bringing economic science and environmental science to an objective common ground, a natural capital model has the potential to provide a concrete means of comparing the economic and ecological costs and benefits of particular policies and programmes. This paper offers a survey and analysis of several new contributions to the formation of the natural capital concept from economists, ecologists, policy analysts, biometricians, foresters and a philosopher. The paper concludes that existing microeconomic theory may be 'ungreenable', if it is not reformulated. While macroeconomic approaches to natural capital have beenmore successful, they share the limitation that ecosystems and species are valued solely in monetary terms. These problems are taken to suggest that the development of a successful natural capital model may require economic theory to be recast to include non-monetary social preferences and values.

Conservation of Natural Resources↗
PubMed2002

Hindsight bias in economic expectations: I knew all along what I want to hear.

Hindsight bias in economic expectations was investigated with particular focus on the moderating effects of attitudes. Stronger hindsight bias was expected for subjectively favorable economic developments. Six months before and after the introduction of the euro as the official book currency of the European Monetary Union, participants rated the probabilities of several economic developments. Results show that hindsight bias occurs with economic expectations and that it is moderated by attitudes. Euro supporters showed stronger hindsight bias for positive economic developments than for negative ones, whereas euro opponents showed the opposite pattern. The results support the notion that hindsight bias is a reconstruction bias in which self-serving tendencies can influence the reconstruction selectively for favorable and unfavorable outcomes.

Adult↗
PubMed2002

Pharmaco-economics of blood transfusion safety: review of the available evidence.

BACKGROUND AND OBJECTIVES: Pharmaco-economics provides a standardized methodology for valid comparisons of interventions in different fields of health care. The role of pharmaco-economics in the safety of blood and blood products has, however, been very limited to date. This review discusses the pharmaco-economic evaluations of strategies to enhance blood product safety that have been published in the scientific literature. MATERIALS AND METHODS: We reviewed pharmaco-economic methodology with special reference to cost-effectiveness analysis. We searched the literature for cost-effectiveness in blood product safety. RESULT: Net costs per quality adjusted life-year (QALY) gained varied from cost-saving for human immunodeficiency virus (HIV)- and hepatitis C virus (HCV) antibody screening and leucoreduction to several million US dollars per QALY gained for solvent-detergent treatment of plasma, nucleic acid amplification testing and HIV p24 antigen testing. CONCLUSIONS: To date the safety of blood transfusion has been largely determined by available technology, irrespective of pharmaco-economics. Net costs up to several million US dollars per QALY gained were found for interventions implemented.

Blood Transfusion↗
PubMedDate not supplied

[Impact of universal varicella vaccination in Germany: an epidemiological and economic analysis].

Varicella is a highly contagious viral disease which mainly affects young children and usually is perceived as infection with a mild disease course. However, there is increasing evidence indicating that the morbidity and mortality as well as the economic impact associated with varicella are significant. While universal childhood vaccination against varicella is currently not recommended in Germany, the availability of safe and efficacious vaccines offers the opportunity for preventive intervention. Detailed and reliable data on the consequences of varicella and the possible impact of a universal vaccination program are missing to date for Germany. In order to generate this information, we conducted a comprehensive evaluation. The objective was to quantify the medical consequences and the economic impact of varicella on third-party payers and the society by means of a model analysis, and particularly to assess the effects of various universal vaccination strategies. The study confirms that varicella represents a significant health and economic burden in Germany. Following mathematical modelling, universal varicella vaccination for children at the age of 12-18 months could prevent more than 82 % of cases and complications on average per year. Economically, universal vaccination would lead to net cost savings not only for the society but also for the third-party payers. From these findings it can be concluded that universal varicella vaccination is a strategy which should be encouraged, from a medical, epidemiological, but also economic viewpoint.

Chickenpox↗
PubMed2005

[Teleradiology: economic research analysis of CT investigations in a small hospital].

PURPOSE: To evaluate, discuss and compare economic aspects of teleradiological applications in CT examinations in a small hospital. Scenario (1): CT examination by an extern institution including transport of a patient. Szenario (2): External consultation of an internal CT examination (teleradiology according to ROV). Scenario (3): Complete in-house radiology department. To evaluate economic aspects of teleradiology service providers. MATERIALS AND METHODS: Costs have been separated into fixed and variable costs in a model. Total costs of 500 CT examinations per year have been calculated for the three scenarios. A break-even analysis has been performed to determine the necessary/minimal number of CTs per year for economical advantages. The number of CT consultations for teleradiology service providers to make profit has been calculated. RESULTS: Scenario (1): This is the most cost-effective scenario for 500 CTs per year, but most time-consuming. Beyond 548 CTs per year using a single slice CT and 965 CTs per year using a multislice CT the teleradiology scenario [scenario (2)] is most cost-effective. Beyond 1065 CTs per year an in-house radiology department [scenario (3)] is economically reasonable. On the basis of 30 Euros per CT consultation a teleradiology service providing system will be profitable starting from 322 CT consultations per year. CONCLUSION: Teleradiology applications are economically reasonable in a wide range in small hospitals. CT teleradiology services can also be provided on a cost-effective basis at a reachable number of consultations.

Cost-Benefit Analysis↗
PubMedDate not supplied

Economic regulation of ambulance services in California.

OBJECTIVE: This study was intended to identify economic regulatory programs used by California counties (including ambulance franchising and rate setting), to inventory their foci and application, and to identify differences around the state. By studying the variety of programs used in one state, this study establishes a framework for evaluation of state and local regulatory programs elsewhere. METHODS: This study surveyed all California local EMS agencies (LEMSAs); these are California's equivalent of regional EMS organizations. The survey achieved a 100% response rate, and all data involve population parameters obviating the need for inferential statistics. RESULTS: Seventy-three percent of California counties use economic regulations. Large-population counties and those that operate their own LEMSAs are more likely to use economic regulations than are small counties and those that participate in multicounty EMS agencies. Despite a preference for competition in the authorizing statute, most franchises were granted without competition to existing providers. The majority of franchises in the state were granted to public services. Most ambulance rate setting occurs outside of a competitive process. CONCLUSIONS: Economic regulations that were intended to provide a structured marketplace are often being used to protect existing providers, particularly public services, from competition. The growing interest by fire departments in entering the market for emergency ambulance service, along with the existing bias toward them in granting of franchises, does not bode well for use of the competitive process. The growth of managed care may change or eliminate the need for economic regulations but, if they are to continue, more state oversight should be considered.

Ambulances↗
PubMed1991

Patterns of economic change surrounding the death of a spouse.

The timing of economic changes near the death of a spouse is not well understood. Using multiple regression analysis and longitudinal data from the Panel Study of Income Dynamics, the economic situations of middle-aged and older widows and widowers were compared to those of otherwise similar intact couples over an 11-year period. The analysis shows that all four widowed groups had fewer economic resources 5 years after the death than did their married counterparts. Yet, each group took very different economic paths to get to this point. For example, older widows and widowers begin the analysis with significantly lower income-to-needs ratios 5 years prior to the death, while middle-aged widows experience more economic change near the time of the death. These findings suggest that both middle-aged and older cohorts of widowed individuals may have made consumption choices over the life cycle that differ from those made by their intact counterparts.

Age Factors↗
PubMed1995

Health economics as an aspect of health outcome: basic principles and application in rheumatoid arthritis.

Health economic evaluation comprises the systematic appraisal of the costs, the benefits and the relative economic efficiency of different medical interventions. The first section of this paper outlines the techniques of economic analysis and how they relate to the efficient use of health resources. This is followed by a review of the health economics of rheumatoid arthritis as a model for the wider application of health economics in the field of rheumatology.

Ambulatory Care↗
PubMed2000

Aesthetic surgery economics: lessons from corporate boardrooms to plastic surgery practices.

Healthcare traditionally has been described as not conforming to the laws of economics. Consumers pay for aesthetic surgery directly, thus freeing it from the usual confounding factors and making it more likely to comply with the market forces explained by economics. Recent studies have demonstrated the ability of classic economics to analyze, predict, and optimize the financial environment of aesthetic surgery. This article describes economic principles and how they can be applied to aesthetic surgery. Some of the basic instruments of economics include the study of supply and demand, prices, and price elasticity; capital investments; communication and cooperation; and consumer cognitive limitations. Each of these tools offers plastic surgeons the opportunity to gain improved control of their financial environment.

Capital Expenditures↗
PubMed2006

Economics of rotavirus gastroenteritis and vaccination in Europe: what makes sense?

Rotavirus is a major cause of gastroenteritis in children throughout Europe and the world. In addition to causing morbidity and mortality in children, rotavirus gastroenteritis (RVGE) creates a major economic burden on health care systems and families in Europe. The costs of hospital admissions for RVGE and nosocomial infections generate significant medical treatment costs throughout the region. Less information is available on the costs associated with less severe episodes and the costs borne by families, including lost time from work. The availability of rotavirus vaccines presents an effective opportunity to prevent RVGE and these associated economic costs, as well as providing protection to each child and hence benefiting the child's family. The adoption of rotavirus vaccine by health authorities in Europe will require a comparison of the costs and benefits. Economic evaluations that compare the costs of vaccination to the economic benefits of rotavirus vaccination will provide an estimate of its financial impact on health care systems and society. However, to provide a complete picture, economic evaluations of rotavirus vaccines will need to account for both the reduced costs and the reduced morbidity from prevented RVGE. Cost-effectiveness analyses based on quality-adjusted life years (QALYs) provide a systematic approach for assessing vaccination as a health investment, comparing the incremental costs associated with rotavirus vaccination and the reduced morbidity and mortality. QALYs provide a standardized approach for quantifying and comparing reductions in health-related quality of life and premature mortality. Although methodologic limitations exist in applying the QALY approach to childhood vaccines, their use in cost effectiveness analyses allows decision makers to consider the full health benefits of rotavirus and other vaccines.

Aged↗
PubMed2003

Length of stay data as a guide to hospital economic performance for ICU patients.

CONTEXT: Length of stay data are increasingly used to monitor ICU economic performance. How such material is presented greatly affects its utility. OBJECTIVE: To develop a weighted length of stay index and to estimate expected length of stay. To assess alternative ways to summarize weighted length of stay to evaluate ICU economic performance. DESIGN: Retrospective database study. SUBJECTS: Data for 751 ICU patients in 1998 at two hospitals used to develop weighted length of stay index. Data on 42,237 patients from 72 ICUs used as the basis of economic performance evaluation. MAIN OUTCOME MEASURES: Difference between actual and expected weighted length of stay, where expected weighted length of stay is based on patient clinical characteristics. RESULTS: Length of stay statistically explains approximately 85 to 90% of interpatient variation in hospital costs. The first ICU day is approximately four times as expensive, and other ICU days approximately 2.5 times as expensive, as non-ICU hospital days. In a regression model for weighted length of stay, patient clinical characteristics explain 26% of variation. ICU economic performance can be measured by excess weighted length of stay of a "typical" patient or by occurrence of long excess weighted lengths of stay. Although different summary measures of performance are highly correlated, choice of measure affects relative ranking of some ICUs' performance. CONCLUSION: Providers of statistical data on ICU economic performance should adjust length of stay for patient characteristics and provide multiple summary measures of the statistical distribution, including measures that address both the typical patient and outliers.

Accounting↗
PubMed1995

Work motivation among high school students before and during the economic recession in the Swedish labour market.

In 1990, 2349 high school pupils from 21 high schools in the Stockholm, Uppsala and Södertälje regions answered a questionnaire concerning how important different characteristics of work were in their future job. The questionnaire also included an open question, "How would you describe an ideal job?" In 1993 the same questionnaire was answered by 1171 high school students. The two measurement occasions were separated by economic changes leading, from a condition of economic security and full employment, to a condition characterised by economic insecurity and high unemployment especially among young people. Results showed that the economic insecurity of 1993 lowered the students' ratings of the importance of all characteristics of work with the exception of the security of work. A strong gender factor influenced the ratings. Thus, the female students rated the importance of the characteristics of work higher than the male students did. The only exception concerned "good pay", which was rated higher by the male. In 1993 these effects were less pronounced, although still evident. The motivational structure seemed to be unaffected by the economic insecurity. The same four motivational factors, i.e. (1) the expressive work goals, (2) the working conditions, (3) the benefits of work and (4) the social aspects of work, appeared in the analyses of both measurement occasions.

Adolescent↗
PubMedDate not supplied

Economic evaluations and usefulness of standardized nursing terminologies.

PURPOSE: To review different types of economic analyses commonly found in healthcare literature, discuss methodologic considerations in framing economic analyses, identify useful resources for economic evaluations, and describe the current and potential roles of standardized nursing terminologies in providing cost and outcome data for economic analysis. DATA SOURCES: The Advanced Billing Concepts Code Resource-based Relative Value Scale and Nursing Outcomes Classification. DATA SYNTHESIS: Using case studies, the applicability of standardized nursing terminologies in cost-effectiveness analysis is demonstrated. While there is potential to inform specific questions, comparisons across analyses are limited because of the many outcome measures. CONCLUSIONS: Including a standardized quality-of-life measure in nursing terminologies would allow for the calculation of accepted outcome measures and dollars per quality adjusted life years gained. IMPLICATIONS FOR PRACTICE: The nurse's ability to assess and contribute to all aspects of rigorous economic evidence is an essential competency for responsible practice.

Cost-Benefit Analysis↗