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PubMed1999

Dental caries, socio-economic development and national oral health policies.

A relationship between a population's level of socio-economic development and dental caries has often been assumed. Proxy measures such as sugar consumption have been used to reflect this. This study tests the hypothesis that there is a relationship between dental caries and the level of socio-economic development, using recent international data. It goes on to explore the implications of this relationship for the development of national oral health policies. Dental caries data was obtained from the WHO, Global Oral Epidemiology Data Bank for the period 1981-1996. Socio-economic data was obtained from the United Nations Development Programme (UNDP). Countries were ranked according to the Human Development Index (HDI) and their GNP. The study confirms the existence of a relationship between dental caries and development. Caries is a good proxy measure for socio-economic development. Countries in the throes of socio-economic transition have the highest DMFT scores.

Child↗

PubMed2003

Economic crime: does personality matter?

Since the publication of Edwin Sutherland's classical study, White Collar Crime, personality has been treated as completely irrelevant as a cause or as a correlating variable in studies of economic crime. This article questions that thesis. In an ongoing Swedish project studying economic crime in the areas of construction, engineering, and the music industry, 128 informants were interviewed regarding the personal character of the economic criminal compared to that of the law-abiding businessperson. Data were collected from five different regions in Sweden using the Big Five model, the personality model most often used within the field of personality research today. This article compares the results from the interviews with the few international studies that exist regarding economic crimes in these areas and common results are emphasized. It also presents nuanced analyses of the significance of personality in economic crime.

Crime↗

PubMed2005

Socio-economic inequalities in suicide: a European comparative study.

BACKGROUND: Social factors have been shown to be predictors of suicide. It is not known whether these factors vary between countries. AIMS: To present a first European overview of socio-economic inequalities in suicide mortality among men and women. METHOD: We used a prospective follow-up of censuses matched with vital statistics in ten European populations. Directly standardised rates of suicide were computed for each country. RESULTS: In men, a low level of educational attainment was a risk factor for suicide in eight out of ten countries. Suicide inequalities were smaller and less consistent in women. In most countries, the greater the socio-economic disadvantage, the higher is the risk of suicide. The population of Turin evidenced no socio-economic inequalities. CONCLUSIONS: Socio-economic inequalities in suicide are a generalised phenomenon in western Europe, but the pattern and magnitude of these inequalities vary between countries. These inequalities call for improved access to psychiatric care for lower socio-economic groups.

Adult↗

PubMed2004

The economic impact of dentistry.

BACKGROUND: The goal of the authors' research was to determine the national economic impact of expenditures arising from the provision of dental services. METHODS: The authors used a well-known and accepted methodology in economics known as input-output analysis to measure the economic impact. These models describe--among other things--the interrelationships between businesses, government, households and the foreign sector with regard to where inputs come from and where outputs go. RESULTS: For 2000, national expenditures attributable to the provision of dental services were calculated at dollar 203.6 billion. Dentistry accounted for more than two million jobs nationwide. Taxes generated directly or indirectly from dental activity totaled more than dollar 33 billion. The annual impact of one additional dentist on the economy was estimated at dollar 1,278,253. CONCLUSIONS: Dentistry provides substantial local and national economic benefits, including increased economic activity, employment and tax revenues. For small counties, an additional dentist provides a significant boost to the local economy.

Dental Care↗

PubMed1986

An analysis of divergent trends in alcohol consumption and economic development.

Alcohol consumption has increased significantly since World War II--a trend that is frequently explained by the economic growth during this period. During the second half of the 19th century, the overall trend in alcohol consumption decreased despite strong economic growth. In this study, the reasons for this apparent anomaly are discussed. It is argued that economic factors played an important role in the decrease during the late 19th century as well as in ensuing years, and that the difference in consumption trends is due to factors other than economics. This argument is corroborated by a time-series analysis of Norwegian data 1865-1982, showing that the effects of economic development were at least as strong during the first part of this period as they were during the latter.

Alcohol Drinking↗

PubMedDate not supplied

Examining the value and quality of health economic analyses: implications of utilizing the QHES.

OBJECTIVE: To examine the increasing use of health economic studies and practical implications of evaluating their quality utilizing the Quality of Health Economic Studies (QHES) instrument. METHODS: We first reviewed secondary references to examine ways in which health economic analyses are used in different health care settings, the manner in which these data are appraised and evaluated, and their relevance and value in decision making. The QHES, a new instrument designed to support fast, accurate initial assessments of study quality, was then introduced and validated. A case study was performed using the QHES to score the quality of 30 cost-effectiveness studies in gastroesophageal reflux disease (GERD) published since 1985. Areas where additional research could guide efforts to identify and enhance the use of higher-quality cost-effectiveness studies were suggested. RESULTS: Results from the published validation study of the QHES demonstrated the validity of this new instrument. The resulting QHES scores in the case study of GERD papers ranged from 43 to 91 with a mean of 63.6 (SD=14.7). Approximately 27% of the studies rated had scores less than 50, and 27% had scores above or equal to 75. All 30 studies made conclusions and recommendations and justified them based on their study results. Most studies used appropriate cost and health outcome measures. Very few studies stated the perspective of their analysis and reasons for its selection. The majority of the studies did not perform incremental analysis. CONCLUSION: An examination of the QHES validation study and the case study in GERD suggests that there is a rationale and potential utility to use a quality scoring system for cost-effectiveness studies. The QHES may play an important role in discriminating higher-quality cost-effectiveness information to enhance decision making. The QHES can also serve as a guideline for conducting and reporting future cost-effectiveness studies, as an aid in the editorial process, and for stratification in systematic reviews. Complex decisions regarding resource allocation rarely rely solely on economic considerations but do increasingly use health economic analyses. To the extent that such analyses are used, the QHES may help ensure that higher-quality analyses receive more analytic attention and greater weight in the decision-making process.

Cost-Benefit Analysis↗

PubMed2001

Economics of antihypertensive therapy in the elderly.

Because of the high incidence of morbidity and mortality associated with hypertension in the elderly, the treatment of hypertension in this patient group must involve consideration of clinical, humanistic and economic outcomes. The most frequently used method of pharmacoeconomic analysis for antihypertensive therapy involves cost-effectiveness analysis, although several other methods are available. Current evidence reveals a trend toward cost effectiveness of antihypertensive treatment in elderly patients. However, these formal analyses are limited by the need for extrapolation of data regarding efficacy and level of risk from epidemiological and randomised trials, information which is often lacking. To incorporate economic factors into clinical decision making, other measures of economic impact should be explored. The economic impact of antihypertensive therapy is affected by the level of risk for the patient and the efficacy of the treatment. Data indicate that the risk of morbidity and mortality related to hypertension increases with age and that current antihypertensive drugs reduce this risk. When choosing an antihypertensive agent, the following parameters should be considered: acquisition cost, likelihood of adverse effects and other determinants of treatment adherence, and individual predictors of response. The economic outcomes will be maximised if prudent drug selection is supplemented by appropriate diagnostic and classification procedures and reduction of cardiovascular risk factors other than hypertension. The accumulation of data addressing the risks and benefits of therapy for the very old and the comparative efficacy of newer antihypertensive therapies will further clarify the decision-making process.

Aged↗

PubMed1994

Methodological issues in economic assessments of new therapies. The case of colony-stimulating factors.

Pharmacoeconomic evaluations estimate the value of medical interventions by comparing their clinical consequences and costs. Economic analyses, based on resource use data collected during 3 clinical trials of lenograstim, were performed as part of a lenograstim economic evaluation programme. Undertaking economic evaluations alongside clinical trials presents a number of methodological challenges, since the trials may be performed in atypical settings, have inappropriate follow-up, or use end-points that are not useful for economic evaluation. This paper reports on how these challenges were met in the lenograstim economic evaluation programme. In particular, it was decided that the evaluations would be based on an intent-to-treat perspective, with the same period of follow-up (for costs) for both lenograstim and vehicle groups.

Adjuvants, Immunologic↗

PubMed1998

Development of an economic model for the management of upper gastrointestinal disease in primary care. Preliminary findings.

Health economic models for identifying therapeutic options that maximise health benefits from limited healthcare resources are being developed in a number of therapeutic areas. The development of such a model for upper gastrointestinal (UGI) symptoms to support decision-making by primary care clinicians is of particular importance, given the prevalence of this symptomatology. This economic model was based upon the clinical guidelines aimed at improving the management of UGI disorders at the primary care level that were developed by the International Gastro Primary Care Group. This paper discusses the derivation, methodology and results of the economic model developed to assess the resource implications arising from these clinical guidelines. In order to construct the economic model, it was necessary to identify the following: every therapeutic pathway followed by patients resource use along each pathway the probabilities of following alternative pathways. One crucial factor underlying the interpretation of results obtained from any economic model is the time period covered by the model. The model presented here analysed the initial 12-month treatment period of 'new' patients presenting with UGI symptoms. In order to test the implications of a longer term perspective, the model is currently being developed to analyse resource use over a 24-month period. The model demonstrates that utilising the predominant symptom approach to the diagnosis and treatment of patients with UGI disorders appears to provide significant benefits in terms of patient management and effective resource use. This factor, together with the more intensive use of Helicobacter pylori eradication therapy, provides the potential to reduce the cost of drugs for the treatment of UGI disorders by approximately 15% in the UK. A major strength of the model is its adaptability to a wide range of clinical and cost scenarios. Such adaptability enables the model to effectively reflect the potential resource implications in countries exhibiting significantly different levels of cost and patient management. In this manner, the model provides one valuable method by which clinicians can be supported in optimising the management of UGI disorders within current resource constraints.

Cost-Benefit Analysis↗

PubMed1998

Methodological quality of economic modelling studies. A case study with hepatitis B vaccines.

The notable increase in the quantity of economic evaluations in the last 2 decades has not been matched by good methodological standards. This problem is particularly evident in the field of economic evaluations of hepatitis B vaccines. The results of 2 systematic reviews conducted by us in 1993 and 1996 showed three problem areas. A sizeable minority of study reports failed to provide a clear study aim, showing a basic ignorance of the first rule of conducting scientific research. The basic epidemiological assumptions upon which the economic models were based showed variability which persisted even after stratification, raising the question of the accuracy of the epidemiological knowledge base of hepatitis B infection and its progression. Lastly, many of the studies showed weaknesses in basic methods of conducting and reporting economic evaluations. Examination of these problem areas led us to conclude that no conclusions about the efficiency of hepatitis B vaccines could be drawn from the available evidence. Addressing the problem of poor methodological standards concerns the whole research community. However, as a proportion of economic evaluations are published, one obvious means of exerting pressure to increase and maintain methodological standards is the editorial and peer review process. Editors of specialist and general medical journals should agree on and enforce common explicit guidelines for study conduct and reporting, following the example of the British Medical Journal.

Hepatitis B↗

PubMed2002

Why has the use of health economic evaluation in Japan lagged behind that in other developed countries?

The aging population and the increasing availability of new medical technologies, particularly pharmaceuticals, have led to growing pressure on governments worldwide to contain healthcare costs. Increasingly, economic evaluation is used to aid decisions on the reimbursement and formulary access of drugs, and pharmaceutical companies are often required to demonstrate the cost effectiveness of their products. Canada and the UK are examples of countries that have successfully incorporated mandatory requirements for economic evaluations into the decision-making process in healthcare. Japan faces cost-containment issues for its health and welfare system similar to those seen elsewhere in the world. Despite this, economic assessments are not currently used in the allocation of drug budgets. Reasons why economic evaluations for healthcare have not yet been used routinely in Japan include governmental approaches to healthcare cost containment, the pricing of pharmaceuticals, the organisation of the healthcare system, attitudes of the medical profession, and limited knowledge and expertise. However, small but encouraging steps are now being taken towards the introduction of economic evaluations in Japanese medicine.

Canada↗

PubMed2004

Review of health economics modelling in rheumatoid arthritis.

As the cost of drug treatment for rheumatoid arthritis (RA) constitutes only a small proportion of total costs of the disease to individuals and society, therapeutic interventions have the potential for significant economic benefit. To take advantage of this potential, clinicians need to gain a global, long-term perspective on patient care. Economic evaluations of RA therapies are critically important in influencing decisions regarding the role of costly, but highly effective new therapies, particularly in settings where there are financial constraints on healthcare provisions. Such evaluations, therefore, need to be methodologically similar with valid results to enhance their value to clinicians and policy decision-makers. This requires the use of appropriate elements in the numerator (i.e. total number of dollars spent on healthcare as a result of the intervention) and the denominator (net health effectiveness) components of the cost-effectiveness equation. Other important design factors also need to be managed properly to ensure validity of the evaluation. In this regard, the guidelines proposed by the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) Task Force represent a useful approach to help create common standards for economic evaluations in RA. Recently, the development of a number of decision analysis models in RA has helped predict the likely cost-effectiveness of new interventions such as the anti-tumour necrosis factor (TNF)-alpha agents, etanercept and infliximab, both of which have been found to be cost-effective relative to other disease-modifying anti-rheumatic drugs (DMARDs) using short-term efficacy endpoints. In comparisons of these two agents in patients with DMARD-resistant RA, etanercept has been shown to be more cost-effective than the combination of methotrexate and infliximab, administered in various dosages, over a period of 1 year using American College of Rheumatology (ACR) response rates as the primary efficacy measure. However, the criteria for determining clinical efficacy is paramount and other studies that use radiographic progression as a measure of clinical effectiveness show no difference between etanercept and infliximab in clinical efficacy. Important issues that need to be considered in developing economic models in RA include consideration of the connection between the prevention of radiographic progression and downstream economic consequences, and the need to employ lifetime models wherever possible because a long time period is necessary to determine the true cost-effectiveness of agents that modify radiographic progression of RA, such as etanercept, infliximab, and adalimumab. In doing so, it is hoped that such studies will provide optimal information to facilitate important decisions on resource allocation.

Antirheumatic Agents↗

PubMed2005

Pharmacological management of overactive bladder : a systematic and critical review of published economic evaluations.

Overactive bladder is a common condition, with recent findings estimating the prevalence in adults at about 15%. Symptoms, including urinary urgency, high voiding frequency and urge incontinence, have been shown to decrease patients' quality of life. Given its high prevalence, the economic burden of overactive bladder is also substantial, with a recent estimate placing the annual cost in the US at 9.1 billion US dollars (year 2000 values). The objective of this review is to provide a critical appraisal of published economic evaluations of pharmacological and non-pharmacological treatments for overactive bladder. Published economic evaluations of treatments for overactive bladder have focused entirely on pharmacological treatments -- mainly on the two most commonly used drugs, oxybutynin and tolterodine, each of which is available in immediate- and extended-release formulations. Ten economic evaluations (more than half are cost-effectiveness studies) have been published. Modelling with decision trees or Markov models has been the predominant method. Evaluations comparing drug therapy with no treatment have concluded that drug therapy is cost effective. Analyses comparing the formulations of oxybutynin and tolterodine have produced highly inconsistent results, largely due to the sources of data employed for effectiveness and treatment discontinuation rates. There are no evaluations of drugs relative to non-pharmacological treatment, and there are other significant gaps in the economic evaluations of treatment to date. These include gaps resulting from a lack of reliable data on the performance of these drugs in real-world settings, particularly data on long-term persistence with treatment. A more definitive pharmacoeconomic comparison of oxybutynin and tolterodine formulations, incorporating all available clinical data, and other treatment options would help direct treatment.

Benzhydryl Compounds↗

PubMedDate not supplied

[Economic crime].

Economic crime, often also referred to as white collar crime, is one of the most incidious and predatory of offenses. Unlike street crime, for which there may well be some protection, the average citizen is completely at the mercy of the perpetrators of economic crimes. The concept of white collar crime was first identified by Edwin H. Sutherland. He dealt with the problem as a violation of trust involving either or both misrepresentation and duplicity. He argued for the use of criminal sanctions rather than civil remedies as a means of dealing with white collar offenses. Sutherland's views were attacked by the legal profession, by sociologists and criminologists and by public opinion specialists. They contended that an act treated in civil court is not a crime; that criminals are those persons who are defined as such and white collar criminals are neither so defined nor do they define themselves as criminals and, finally, that economic crime is universal. Can anyone be criminal, then, ask the critics? A number of studies by Clinard, Quinney, Black, Ball, Cressey, Newman and others have translated the interest in white collar crime into empirical terms. The last thirty-five years have also witnessed the elaboration and alteration of the theory itself. Geis' work has been particularly important in this respect. His "street" versus "suite" crime is a useful dichotomy. Most important, however, have been the monograph and papers by Herbert Edelhertz who has conceptualized the issues on various levels - from consumer fraud to the illegal activities of the multinational corporation. This article is concerned with the exposition of the theory and research in the field. Most significant, the paper raises serious doubts whether the problem of economic crime can be researched and studied; it raises even more difficult issues concerning the legal and sociological implications of economic crime and of its prevention, management and control.

Attitude↗

PubMed1999

Incorporating clinical outcomes and economic consequences into drug formulary decisions: a practical approach.

BACKGROUND: In 1994, Regence BlueShield (Regence), a large non-staff model health plan, adopted guidelines governing the review of new and existing drug products. However, certain limitations were apparent: adequate data were not available in a timely fashion; unpublished studies and information on unapproved indications were difficult to obtain; data addressing humanistic and economic outcomes were not routinely supplied by manufacturers; and the time required by Regence staff clinical pharmacists to assemble and summarize published clinical studies for the pharmacy and therapeutics (P&T) committee was excessive. OBJECTIVE: To describe the process used by Regence to collect and review clinical, economic, and other health outcomes data as part of the plan's drug formulary adoption process. PROCESS DESCRIPTION: To address these limitations, Regence revised its process to require pharmaceutical manufacturers to submit a detailed dossier with clinical and economic data from published and unpublished studies, along with a disease-based economic model projecting the potential impact that introducing the product would have on health outcomes and economic consequences occurring across the entire Regence system. After performing independent literature reviews to ensure the accuracy and comprehensiveness of the information obtained, clinical pharmacists at Regence complete a detailed summary of each drug for the P&T committee. CONCLUSION: The new process has addressed the limitations of the previous system and, by improving the timeliness and relevance of available information, it supports Regence's goal of maintaining an evidence-based formulary.

Blue Cross Blue Shield Insurance Plans↗

PubMedDate not supplied

Socio-economic implication of multi-drug resistant malaria in the community; how prepared is Nigeria for this emerging problem?

The control of faciparum malaria is becoming increasingly challenging in many endemic areas of the world, including Nigeria, due to the development of resistance to chloroquine and other anti-malarial drugs. Current rising health care costs demands that any preventive medicine and/or disease control program be judged according to its economic viability. As has been previously noted, any successful control of malaria will depend on socio-economic factors that influence its prevalence and management in the community. Cost-benefit or cost-effectiveness analysis of proposed and current intervention strategic are thus justified. This paper presents a review of studies involving socio-economic evaluation of the morbidity and mortality consequences of malaria. Studies involving health facility utilization profile for malaria in Nigeria and elsewhere are also reviewed. The review finds no studies evaluating or determining an appropriate economic model/framework for malaria control in Nigeria and concludes that as enormous and challenging the problem of multi-drug resistant malaria is, it can still be contained if control and management strategies are adopted based on sound and practical socio-economic judgement.

Antitubercular Agents↗

PubMed2003

The new economic credentialing: protecting hospitals from competition by medical staff members.

This Article addresses hospitals' use of economic criteria to determine an individual's qualifications for staff privileges. Hospitals are resorting to economic conflict-of-interest credentialing policies in an attempt to ensure physician's loyalty and maintain their own economic viability. Physicians, however, argue that entrepreneurial activities are necessary for them to meet the economic challenges posed by declining reimbursements and rising insurance costs. The Article surveys the numerous legal theories that physicians (and, in some cases, the federal government) could employ in attacking these new types of credentialing policies and concludes that, on balance, hospitals should be able to implement their policies in ways that minimize liability in most jurisdictions. The Article concludes by discussing other issues that economic credentialing policies raise, including those implicating tax-exempt status and nonlegal considerations.

Antitrust Laws↗

PubMed2003

[Shifting of emphasis in the world health sector strategy; from political concerns to economic ones].

Primary Health Care, proclaimed by WHO in 1978, is a health strategy that aims to achieve the ultimate objective "Health For All", with underlying political concerns for ideals such as social justice, equity and human rights. Meanwhile, "globalization", urged by the U.S.A., other developed countries and multinational corporations, has since promoted liberalization of trade, capital and finance, which has in the past few decades been sweeping all over the world. With this "new economic liberalism", values that put much emphasis on economic efficiency are now at the forefront. The World Bank, which supports the tendency along with the International Monetary Fund and the World Trade Organization, has become an influential actor in helping developing countries to prosper economically. The World Bank, whose basic idea is that investment in health is basic for economic growth, has in the 1990s also exerted considerable influence on the international health sector with its overwhelming provision of financial assistance. Instead of political concerns like equity and human rights, 'economic concerns' such as fairer budget allocation, cost-effectiveness, cost reduction and efficiency have now become main points for discussion in the international health field. This shift in emphasis poses fundamental questions for the core goal of the World Health Organization; "Health For All".

Economics↗