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At least 73 records · Page 4Linked to original sources
PubMed2000

Incremental cost-effectiveness of laser therapy for choroidal neovascularization associated with histoplasmosis.

PURPOSE: Laser photocoagulation has been shown in a large clinical trial to be efficacious in reducing the degree of vision loss occurring secondary to choroidal neovascularization (CNV) associated with ocular histoplasmosis. Nevertheless, data are lacking concerning the impact of the therapy on quality of life and its value to stakeholders in health care. Recently, information concerning the utility value of visual states has become available. Accordingly, the authors undertook to ascertain the cost-effectiveness of laser photocoagulation for the treatment of extrafoveal CNV occurring in eyes with ocular histoplasmosis. METHODS: Design--A computer simulation, econometric model is presented to evaluate the incremental cost-effectiveness of laser photocoagulation therapy, as compared with the natural course of the disease, for the treatment of patients with extrafoveal CNV associated with ocular histoplasmosis. The model applies long-term visual data from previous clinical trials, utility analysis (which reflects patient perceptions of quality of life), decision analysis with Markov modeling, and present value analysis with discounting to account for the time value of money. Outcome measure--Cost per quality-adjusted life-year gained from treatment. RESULTS: Laser photocoagulation therapy for extrafoveal CNV associated with ocular histoplasmosis costs $4167 1999 US dollars (at a 3% discount rate) for each quality-adjusted life-year gained from treatment. Sensitivity analysis shows that changing the discount rate substantially alters the cost-effectiveness, with a value of $1339 at a 0% discount rate and $56,250 at a 10% discount rate. CONCLUSIONS: Compared with therapeutic modalities for other disease entities, laser therapy for the treatment of extrafoveal CNV associated with ocular histoplasmosis appears to be a cost-effective treatment from the patient preference-based point of view.

Adult↗
PubMed2005

Availability of new drugs and Americans' ability to work.

OBJECTIVE: The objective of this work was the investigation of the extent to which the introduction of new drugs has increased society's ability to produce goods and services by increasing the number of hours worked per member of the working-age population. METHODS: Econometric models of ability-to-work measures from data on approximately 200,000 individuals with 47 major chronic conditions observed throughout a 15-year period (1982-1996) were estimated. RESULTS: Under very conservative assumptions, the estimates indicate that the value of the increase in ability to work attributable to new drugs is 2.5 times as great as expenditure on new drugs. CONCLUSIONS: The potential of drugs to increase employee productivity should be considered in the design of drug-reimbursement policies. Conversely, policies that broadly reduce the development and utilization of new drugs may ultimately reduce our ability to produce other goods and services.

Adult↗
PubMed2001

Provider choice and utility loss due to selective contracting in rural and urban areas.

An econometric model estimated the disutility of traveling long distances for depression treatment, and simulations calculated the utility loss associated with selective contracting in rural and urban areas. A representative sample of depression patients (n = 106) and all practicing providers (n = 3,710) in Arkansas were identified and the distances between them were calculated. Using discrete choice analysis, patient preferences for provider type and travel distance were estimated. Simulations calculated the utility loss associated with alternative scenarios of selective contracting. Provider type and distance were significant predictors of provider choice. To equate the utility loss associated with selective contracting in rural and urban areas, a slightly higher proportion of rural physicians and a substantially higher proportion of rural mental health specialists must be contracted. To avoid further reductions in geographic access, managed care organizations should contract with a higher proportion of rural providers than urban providers.

Arkansas↗
PubMed2006

Forecasting fluid milk and cheese demands for the next decade.

Predictions of future market demands and farm prices for dairy products are important determinants in developing marketing strategies and farm-production planning decisions. The objective of this report was to use current aggregate forecast data, combined with existing econometric models of demand and supply, to forecast retail demands for fluid milk and cheese and the supply and price of farm milk over the next decade. In doing so, we can investigate whether projections of population and consumer food-spending patterns will extend or alter current consumption trends and examine the implications of future generic advertising strategies for dairy products. To conduct the forecast simulations and appropriately allocate the farm milk supply to various uses, we used a partial equilibrium model of the US domestic dairy sector that segmented the industry into retail, wholesale, and farm markets. Model simulation results indicated that declines in retail per capita demand would persist but at a reduced rate from years past and that retail per capita demand for cheese would continue to grow and strengthen over the next decade. These predictions rely on expected changes in the size of populations of various ages, races, and ethnicities and on existing patterns of spending on food at home and away from home. The combined effect of these forecasted changes in demand levels was reflected in annualized growth in the total farm-milk supply that was similar to growth realized during the past few years. Although we expect nominal farm milk prices to increase over the next decade, we expect real prices (relative to assumed growth in feed costs) to remain relatively stable and show no increase until the end of the forecast period. Supplemental industry model simulations also suggested that net losses in producer revenues would result if only nominal levels of generic advertising spending were maintained in forthcoming years. In fact, if real generic advertising expenditures are increased relative to 2005 levels, returns to the investment in generic advertising can be improved. Specifically, each additional real dollar invested in generic advertising for fluid milk and cheese products over the forecast period would result in an additional 5.61 dollars in producer revenues.

Animals↗
PubMed1988

Understanding economic modeling aids in decision making.

With the problems some hospitals are facing in raising capital, the importance of careful economic analyses increases. Four economic models, the demand model, economic feasibility model, economic impact model, and econometric model, can all be used by the healthcare industry to perform a thorough analysis. By doing economic analyses, hospitals will be able to more effectively allocate scarce financial resources and identify potential returns and risks associated with investments.

Decision Making, Organizational↗
PubMed2000

Health care in the 21st century: evidence-based medicine, patient preference-based quality, and cost effectiveness.

The combination of evidence-based medicine, patient-based preferences using utility analysis, and econometric modeling yields a model to evaluate the incremental cost effectiveness of health care interventions. This methodology allows a comparison of the cost effectiveness of virtually all health care interventions and incorporates the patient voice to provide an information system that can improve the quality of health care and simultaneously reduce costs. It has been estimated that such an information system could save more than $90 billion per year of the annual $1.3 trillion health care bill in the United States.

Cost-Benefit Analysis↗
PubMed2001

Clinical and economic outcomes of an ambulatory urinary tract infection disease management program.

OBJECTIVE: To evaluate the effectiveness of a urinary tract infection disease management program. STUDY DESIGN: A pre-post design was used. One year of data before and after promoting the treatment guideline were compared. PARTICIPANTS AND METHODS: A 300,000-member managed care organization introduced an antibiotic treatment guideline designed to change the antibiotic prescribing practices of community physicians. The study intervention was the promotion of a treatment guideline through mailings and face-to-face interventions by 2 disease management specialists. A relational database was created to measure changes in healthcare resources, use of antibiotics, and health event profiles. RESULTS: The study demonstrated that prescribing patterns could be modified through treatment guideline distribution and face-to-face discussions. The study also found similar success rates across a range of antibiotics. Average health event costs decreased by 36% for kidney infections (P = .696) and by 7% for bladder infections (P < .05) after the treatment guideline was implemented; however, when controlling for patient age, sex, and comorbidities, the econometric model did not find a reduction in health event costs for either kidney or bladder infections. Fluoroquinolones were a cost driver compared with other antibiotics used to treat kidney and bladder infections. CONCLUSIONS: Consideration should be given to expanding the number of well-established antibiotics on the treatment guideline. Also, fluoroquinolones should be reserved for patients with sulfa allergies or failures with initial antibiotic treatment. In addition, it is recommended that future costs and outcomes be assessed after changes are made to the treatment guideline.

Ambulatory Care↗
PubMedDate not supplied

[The health gap in Mexico, measured through child mortality].

OBJECTIVE: To estimate the health gap in Mexico, as evidenced by the difference between the observed 1998 mortality rate and the estimated rate and the estimated rate for the same year according to social and economic indicators, with rates from other countries. MATERIAL AND METHODS: An econometric model was developed, using the 1998 child mortality rate (CMR) as the dependent variable, and macro-social and economic indicators as independent variables. The model included 70 countries for which complete data were available. RESULTS: The proposed model explained over 90% of the variability in CMR among countries. The expected CMR for Mexico was 22% lower that the observed rate, which represented nearly 20,000 excess deaths. CONCLUSIONS: After adjusting for differences in productivity, distribution of wealth, and investment in human capital, the excess child mortality rate suggested efficiency problems in the Mexican health system, at least in relation to services intended to reduce child mortality. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Delivery of Health Care↗
PubMed2003

Nurse staffing, quality, and financial performance.

In examining the relationship among nurse staffing, quality of care, and financial performance, prior empirical studies used competing measures and applied different levels of analysis. Using longitudinal data from 1990 through 1995, our study applied a dynamic econometric model to evaluate whether hospitals that changed their nurse staffing and quality of care affected their financial performance. Sampling 422 hospitals over this study period, we found a statistically significant increase in operating costs when registered nurse levels increase, but no statistically significant decrease in profit. Higher levels of non-nurse staffing caused higher operating expenses, as well as lower profits.

Financial Management, Hospital↗
PubMed1994

A study of factors affecting dental expenditures in Quebec: 1962-1991.

The issue of dental manpower planning has received considerable attention in Quebec in recent years. Quebec dentists agree that there is a need for detailed information regarding the impact of economic factors on the supply of and demand for dental care in the province. This study examines the impact of economic factors on dental care expenditures in Quebec between 1962 and 1991. The functional form of the econometric model used by the authors is similar to the one used in a study of the growth of the U.S. dental sector between 1950 and 1989. The dependent variable is per capita dental expenditure, and the three independent variables are: dentist/population ratio, per capita personal disposable income; and percentage of the population with dental insurance coverage. All data come from secondary sources. The findings indicate that per capita dental expenditure has grown substantially in Quebec over the past three decades, with the rate of growth slowing dramatically during the 1980s. Dental insurance coverage, the number of dentists in the community and the disposable income of the population all have a positive impact on dental expenditure in Quebec. However, it is clear that the incomes of Quebec dentists may decrease in the future if: no restrictions are placed on the number of new dental graduates entering the profession; dental insurance programs are curtailed; or dental disease levels continue to fall.

Dentistry↗
PubMed1998

Financial incentives and primary care provision in Britain: do general practitioners maximise their income?

The system of remunerating general practitioners (GPs) in Britain underwent significant changes in April 1990 with the implementation of a new contract between individual GPs and health authorities. The changes were a precursor to a wide-ranging programme of reforms of the British National Health Service. This paper investigates the relationship between financial incentives and the provision of primary health care services in Britain. A comprehensive anonymized data set was used, comprising information on 208 general practices in Scotland which serve just under one million people. An econometric model was tested to identify the determinants of cross-practice variation in the magnitude of the changes in GPs' remuneration levels between the two contracts. A linear programming model was used to examine the GPs' response to the financial incentives built into the new contract. The results of the econometric model indicated that the main beneficiaries of the 1990 contract were the practices which had expanded over the 1989-92 period, re-structured the GPs' partnership and made use of managerial skills by employing a practice manager; those practices also had larger lists in 1992 and relatively more patients attracting deprivation payments. The linear programming model showed that only a small minority of the practices (4.8%) maximised the remuneration from the new contract. Optimal solutions concerning income maximization strategies identified financial disincentives in the fee structure of the remuneration system associated with the provision of selected services and the care of particular groups of patients. The successful adoption of these strategies would involve cream skimming and selective service provision. However, there is no conclusive evidence of British GPs engaging in such activities.

Age Factors↗
PubMed1992

International health spending forecasts: concepts and evaluation.

Health care depends on the organizational and financial decisions which constituted each national system. Since those decisions were made at various times over the preceding years under different macroeconomic conditions, current expenditures are a distributed lag function of GDP growth and inflation rates. The accuracy of forecasts from such causal econometric models are compared to exponential smoothing, moving average, and ARIMA methods. Data fro 19 OECD countries 1965-79 are used for calibration, and then ex ante forecasts are generated for 1980-87 so that actual forecast accuracy can be tested. The greatest reduction in mean absolute error was obtained with the econometric model estimated in aggregate across all 19 countries, although single-country models, exponential smoothing and international averaging were also effective. A combination of all four forecasts was more accurate than any one alone, reducing MAE by 25% relative to a constant growth projection.

Delivery of Health Care↗
PubMed2002

Incremental cost-effectiveness of initial cataract surgery.

PURPOSE: The purpose of this study was to perform a reference case, cost-utility analysis of initial cataract surgery using the current literature on cataract outcomes and complications. DESIGN: Computer-based econometric modeling. METHODS: Visual acuity data of patients treated and observed over a 4-month postoperative period was obtained from the US National Cataract Patient Outcomes Research Team (PORT). The results from this prospective study were combined with other studies that investigated the complication rates of cataract surgery to complete the cohort of patients and outcomes. These synthesized data were incorporated with time-tradeoff utility values, decision analysis, and econometric modeling to account for the time value of money. MAIN OUTCOME MEASURES: The number of quality-adjusted life-years (QALYs) gained was calculated for the study group undergoing cataract extraction in the first eye when the vision was the same in both eyes. This was divided into the cost of the procedure to find the year 2000 nominal US dollars spent per quality-adjusted life-year ($/QALY) gained. RESULTS: Initial cataract surgery, compared with observation, resulted in a mean gain of 1.776 QALYs per patient treated. A 3% annual discount rate was used to account for the benefit over time, yielding 1.25 QALYs gained. The mean cost of treatment (also discounted at a 3% annual rate) of each patient totaled 2525 US dollars. The cost divided by the discounted benefit resulted in $2020/QALY gained for this procedure. CONCLUSIONS: Initial cataract surgery seems to be highly cost-effective compared with procedures across multiple medical specialties. This information, incorporating patient preferences into evidenced-based medicine, will play an increasingly important role in the evaluation of health care in the future.

Aged↗
PubMed2005

Economic evaluation for conservation of farm animal genetic resources.

The decline in biodiversity of farm animal genetic resources (AnGR) has come to the forefront of concern in the discussion of animal conservation and breeding programmes. To improve decision-making regarding conservation and breeding programmes, a number of evaluation techniques of farm AnGR are available. This paper presents an overview of the different values associated to AnGR and of the techniques for their measurement being employed in the economic literature. Those include linear programming and farm simulation models, dynamic models estimating the value of research and development and econometric models estimating the demand for breed characteristics. While farm programming and simulation models are fairly well developed, they do have large data requirements. Alternatively, contingent valuation methods are available, in particular when the goal is to capture non-market values embedded in breeds.

Animal Husbandry↗
PubMed1979

A time series approach to forecasting Australian total live-births.

The relationship between classical demographic deterministic forecasting models, stochastic structural econometric models and time series models is discussed. Final equation autoregressive moving average (ARMA) models for Australian total live-births are constructed. Particular attention is given to the problem of transforming the time series to stationarity (and Gaussianity) and the properties of the forecasts are analyzed. Final form transfer function models linking births to females in the reproductive age groups are also constructed and a comparison of actual forecast performance using the various models is made. Long-run future forecasts are generated and compared with available projections based on the deterministic cohort model after which some policy implications of the analysis are considered.

Australia↗
PubMed1992

Model for predicting egg output and metabolisable energy intake of laying pullets.

1. The data compiled by Marsden and Morris (1987) to examine the relationships between environmental temperature and the long-term, adapted responses of laying pullets were divided at random into two subsets of 99 and 113 observations. The first subset was used to estimate regression coefficients for an econometric model, and the second subset to validate the model. 2. Equations to predict inputs (costs) and outputs (returns) were estimated with a three-stage least-squares regression model. Three stage least-squares estimation is a technique which corrects for the simultaneity of variables within the model and correlation across equations of the model. This results in more efficient estimates of the regression coefficients. 3. The final output and output equations were: MEI = 253.86-190.31EM+5.766EM2-0.546EM3 + 0.7034T-0.004388T3 + 695.08BW-120.23BW2 + 397.37ME-13.132ME2-1.06MEXT; R2 = 0.86; EO = 119 + 0.025MEI -0.0000045MEI2-1.462T-0.0791T2-135.3BW + 38.31BW2-1.483T X BW + 0.0288T2 X BW + 0.673 delta BW; R2 = 0.59 where MEI = daily metabolisable energy intake (kJ/bird d), T = environmental temperature (degree C), EO = egg output (g/bird d), BW = body weight, and ME = metabolisable energy concentration (kJ/g). The values for R2 indicate very good fits considering that the data were recorded over a 26-year period in 14 different laboratories. 4. This statistical model can serve as the basis for an econometric model of egg production to determine the environmental temperature that maximises profits from laying pullets of different body weights.

Animals↗
PubMed1985

Pricing and location of physician services in mental health.

Puzzling results of a positive association between the number of physicians per capita and the level of fees for physician services have been reported in the literature. These results may be due to misspecification of econometric models and use of data aggregated across medical specialties. It is hypothesized that the unusual results would not persist with a carefully specified econometric model for a single medical specialty. A general model of pricing and location of physician's services is applied to the market for psychiatrist's services. The results imply that the market for psychiatrist's services operates in a manner consistent with the predictions of the competitive model.

Fees, Medical↗
PubMed2005

US valuation of the EQ-5D health states: development and testing of the D1 valuation model.

PURPOSE: The EQ-5D is a brief, multiattribute, preference-based health status measure. This article describes the development of a statistical model for generating US population-based EQ-5D preference weights. METHODS: A multistage probability sample was selected from the US adult civilian noninstitutional population. Respondents valued 13 of 243 EQ-5D health states using the time trade-off (TTO) method. Data for 12 states were used in econometric modeling. The TTO valuations were linearly transformed to lie on the interval [-1, 1]. Methods were investigated to account for interaction effects caused by having problems in multiple EQ-5D dimensions. Several alternative model specifications (eg, pooled least squares, random effects) also were considered. A modified split-sample approach was used to evaluate the predictive accuracy of the models. All statistical analyses took into account the clustering and disproportionate selection probabilities inherent in our sampling design. RESULTS: Our D1 model for the EQ-5D included ordinal terms to capture the effect of departures from perfect health as well as interaction effects. A random effects specification of the D1 model yielded a good fit for the observed TTO data, with an overall R of 0.38, a mean absolute error of 0.025, and 7 prediction errors exceeding 0.05 in absolute magnitude. CONCLUSIONS: The D1 model best predicts the values for observed health states. The resulting preference weight estimates represent a significant enhancement of the EQ-5D's utility for health status assessment and economic analysis in the US.

Adult↗