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PubMed1989

Economic predictors of mental health service utilization: a time-series analysis.

This research was designed to understand the relationships between economic indicators and mental health service utilization. Six monthly and three quarterly time-series analyses were done to assess the time-dependent association between three state-level economic indices and two measures of mental health service utilization. Consistent with the existing literature, increases in manufacturing employment were inversely related to both first admissions in state hospitals and case openings in community outpatient facilities. Labor force participation was also inversely related to first admissions to state hospitals. No relationship was found between service employment and either of the mental health service use indices. The specific findings suggest that two processes may be operating in the relationship of labor force participation and manufacturing employment with mental health service utilization. Some of the findings suggest a "crisis" process, in which service use increases rapidly following an economic stressor, whereas other findings suggest a more insidious process, in which economic stressors slowly weaken the mental health of the community and eventually lead to increased mental health service use. These results can be used to better inform social policy and preventive interventions by highlighting the human costs of changes in economic well-being. The need for more ecological research is discussed.

Adaptation, Psychological↗
PubMed1991

Differences in postural hypotension and ankle jerks in the elderly from two contrasting socio-economic levels.

Subjects in low socio-economic strata in underdeveloped countries are subjected to considerable adverse influences which may enhance age-related changes in the nervous system. We therefore assessed the presence of ankle jerks and the degree of postural hypotension in two groups, one from the upper socio-economic level (58 subjects) and the other from the lower socio-economic level (56 subjects). All subjects were over 65 years of age. Only 6% had bilateral loss of ankle jerks, with no difference between the groups. Postural hypotension of 30 mmHg or greater was more frequent in the upper socio-economic group, nine out of 58 versus two out of 56 in the lower group. We conclude that there is no relationship in the elderly between social deprivation and certain markers of neurological dysfunction, such as the absence of ankle jerks and postural hypotension. The reasons for a greater frequency of postural hypotension in the higher socio-economic group are unclear.

Aged↗
PubMed1999

[Economic aspects of psychotherapy management in psychosomatics and psychiatry. A systematic survey of the literature].

Economic evaluations have become more and more important in the somatotherapeutic field. This survey's objective was to examine if the current economic evaluation techniques can be applied to psychotherapy. 8 data banks, 17 key words from the psychotherapeutic field and 14 economic key words were used, the identified original studies were classified in accordance with Drummond, the methodical quality of each study was assessed at a score between 0 and 10 points. 21 studies were found: 16 cost-benefit analyses, 4 cost-effectiveness analyses and one cost-utility analysis. The quality of the representation of the clinical results (mean value 8.6) was better than that of the economic results (mean value 6.1). It was perfectly possible to evaluate psychotherapeutic interventions with regard to economic aspects by means of the current techniques but in most cases there was a considerable lack of quality in both representation and calculation. Furthermore the evaluation type of cost-utility analysis, which is the only one that takes quality of life aspects into consideration and therewith seems to be the most appropriate approach regarding the psychotherapeutic field, has been greatly ignored.

Cost-Benefit Analysis↗
PubMed2004

Parental socio-economic status and risk of first admission with schizophrenia- a Danish national register based study.

BACKGROUND: We examined the relationships between measures of parental and personal socio-economic status and risk of first admission with schizophrenia in order to identify whether low socio-economic status in cases is a consequence of the illness process or is a familial risk factor. METHODS: A national population-based nested case-control study based on Danish longitudinal registers was conducted. The sample included 7704 first admissions with ICD-8 or ICD-10 schizophrenia admitted to a psychiatric facility in Denmark between 1981 and 1998 and 192590 individually time-, age- and gender-matched population controls identified through national registers, and their parents and siblings. Socio-economic indicators measured in the year prior to admission and background factors for cases, controls, and parents were included. RESULTS: Risk of schizophrenia was associated with unemployment, low educational attainment, being single, lower wealth status, low income, and being childless. Increased risk was associated with a family history of psychiatric disorders, birth in urban areas, birth outside of Denmark, and having three of more siblings. Increased risk of schizophrenia was associated with parental unemployment and parental lower income, but was not associated with parental wealth. Risk for schizophrenia was associated with higher education in parents. CONCLUSIONS: Increased risk of first admission was associated with socio-economic disadvantage in cases. Although we found some associations between parental unemployment and parental higher education and risk of schizophrenia, there was little evidence that low parental socio-economic status increases the risk of schizophrenia.

Adolescent↗
PubMed2004

Socio-economic inequalities in first-time use of antidepressants: a population-based study.

OBJECTIVE: To analyse whether first-time use of antidepressants (incidence) and selection of TCAs (tricyclic antidepressants) versus new-generation drugs are associated with socio-economic status and psychiatric history. METHOD: We conducted a population-based cohort study using registry data covering Funen County, Denmark. A total of 305,953 adult residents without antidepressant prescriptions 5 years prior to the study period (1998) were included. RESULTS: The 1-year incidence rate of antidepressant prescription (1.7%) increased with age. It was higher in people who were female, less educated, unemployed, those receiving old-age or disability pension, low-income groups, and singles. The proportion prescribed new-generation antidepressants (82%) showed no difference according to socio-economic variables (education, annual income and socio-economic group), but was higher among the young and single. Admission to psychiatric hospital within 4 years prior to the study period was associated with high-incidence rate of antidepressant prescription and overall a preference for the new-generation antidepressants. CONCLUSION: Socio-economic status did not seem to influence the selection of TCAs versus new-generation antidepressants. Compatible with the general epidemiology of depression, low socio-economic status was associated with a high number of first-time users of antidepressants in the population, and the incidence rate increased with age.

Adolescent↗
PubMed2002

[Are the "elderly" living at the expense of the "young"? Remarks on the burden distribution between "generations" in an aging population from the economic perspective].

Public and scientific discussion on the effects of an aging population is often biased: aging is primarily seen as an economic burden. Increasing contribution rates in pension schemes, health and long-term care insurance are highlighted. This paper tries to provide a more balanced view. The distinction between a cross-sectional and a longitudinal view already gives different information on distributional effects. Labeling older people as "economically inactive" is a much too narrow perspective focused on the activity on the labor market only. Other types of work are neglected such as caring for children or frail elderly as well as economic activities from wealth, consumption as well as paying taxes to finance public expenditure. The approach of "generational accounting" is also narrow, focusing on public expenditure, social insurance contributions and only some types of taxes, but not dealing with private, especially intrafamily transfers. In economic terms, a comprehensive approach is needed regarding the effect of institutions and measures on the economic situation of cohorts. The role of investment in human capital is mentioned as a decisive factor for productivity in a country. Further education and retraining of older workers is one important element. An integrative approach dealing with the different fields of activities is needed when analyzing the intergenerational as well as the intragenerational distribution. This requires an elaborated and differentiated reporting of distributional effects. This important precondition, however, does not exist in Germany.

Aged↗
PubMed2006

The economics of inclusion body processing.

Many recombinant proteins are often over-expressed in host cells, such as Escherichia coli, and are found as insoluble and inactive protein aggregates known as inclusion bodies (IBs). Recently, a novel process for IB extraction and solubilisation, based on chemical extraction, has been reported. While this method has the potential to radically intensify traditional IB processing, the process economics of the new technique have yet to be reported. This study focuses on the evaluation of process economics for several IB processing schemes based on chemical extraction and/or traditional techniques. Simulations and economic analysis were conducted at various processing conditions using granulocyte macrophage-colony stimulating factor, expressed as IBs in E. coli, as a model protein. In most cases, IB processing schemes based on chemical extraction having a shorter downstream cascade demonstrated a competitive economic edge over the conventional route, validating the new process as an economically more viable alternative for IB processing.

Bioreactors↗
PubMed1998

Health economics of care for patients with cancer and intractable disease in Japan.

Concern about the economic aspect of cancer care is increasing. However, economic evaluations for cancer care are deficient in a number of areas, despite recent important contributions. To generate better evidence for economic evaluation of care for patients with cancer and intractable disease, the recent trends and problems with economic evaluations in these areas in Japan are examined. Several examples of economic evaluations, such as those concerned with bone marrow transplantation for leukemias, breast-conserving treatment for early breast cancer, and antiemetic treatment for patients receiving cancer chemotherapy, showed substantial possibilities for evaluating value for money in health care with a view to establishing an effective and efficient health care system.

Cost-Benefit Analysis↗
PubMed2005

Health economic evaluation in lumbar spinal fusion: a systematic literature review anno 2005.

The goal of this systematic literature review was to assess the evidence for cost-effectiveness of various surgical techniques in lumbar spinal fusion in conformity with the guidelines provided by the Cochrane Back Review Group. As new technology continuously emerges and divergent directions in clinical practice are present, economic evaluation is needed in order to facilitate the decision-makers' budget allocations. NHS Economic Evaluation Database, MEDLINE, EMBASE and Cochrane Library were searched. Two independent reviewers (one clinical content expert and one economic content expert) applied the eligibility criteria. A list of criteria for methodological quality assessment was established by merging the criteria recommended by leading health economists with the criteria recommended by the Cochrane Back Review Group. The two reviewers independently scored the selected literature and the disagreement was resolved by means of consensus following discussion. Key data were extracted and the level of evidence concluded. Seven studies were eligible; these studies reflected the diversified choices of economic methodology, study populations (diagnosis), outcome measures and comparators. At the conclusion of quality assessment, the methodological quality of three studies was judged credible. Two studies investigated posteolateral fusion (PLF) +/- instrumentation in different populations: one investigated non-specific low back pain and one investigated degenerative stenosis + spondylolisthesis. Both studies reflected that cost-effectiveness of instrumentation in PLF is not convincing. The third study concerned the question of circumferential vs anterior lumbar interbody fusion and found a non-significant difference between the techniques. In conclusion, the literature is limited and, in view of the fact that the clinical effects are statistically synonymous, it does not support the use of high-cost techniques. There is a great potential for improvement of methodological quality in economic evaluations of lumbar spinal fusion and further research is imperative.

Cost-Benefit Analysis↗
PubMed2005

Economic evaluations: a new avenue of outcome assessment in spinal disorders.

The number of economic evaluations in the field of spinal disorders and methodological studies have increased in the last decade. The objective of this paper is to provide an overview of current views on economic evaluations in the field of spinal disorders and to facilitate clinicians to interpret and use results from these studies. A full economic evaluation compares both costs and effects of two or more interventions. Key elements of economic evaluations such as identifying adequate alternatives, analytical perspective, cost methodology, missing values and sensitivity analyses are addressed. Further emphasis is placed on the interpretation of results of economic evaluations conducted alongside randomised clinical trials. Incremental cost-effectiveness ratios, cost-effectiveness planes, acceptability curves and cost-effectiveness thresholds are discussed. The contents may aid in taking the efficacy 'hurdle' in the field of spinal disorders.

Back Pain↗
PubMed2002

Priority setting for decision makers: using health economics in practice.

Based on the premise of resource scarcity in health care,numerous approaches to priority setting have been proposed. However, limited comparative analysis is found in the literature, and decision makers lack knowledge of available tools. Several approaches to priority setting are critiqued here from both practical and theoretical perspectives, including needs assessment, cost-of-illness studies, core services, economic evaluation and quality-adjusted life-year league tables, and program budgeting and marginal analysis (PBMA). Most explicit priority setting approaches fail to recognize the underlying economic principles of opportunity cost and the margin, leading in part to their lack of widespread use in practice and to the perpetuation of historical allocation patterns. PBMA is based on underlying economic principles and has been widely used in practice. While there are many approaches to priority setting, even so-called "economic" techniques often fail to recognize fundamental economic principles, leaving decision makers unable to meet key objectives. Greater focus on these principles will aid in priority setting in practice.

Journal Article↗
PubMed2003

Theory verses empiricism in health economics. An analysis of the past 20 years.

We report the results of a study analyzing the proportion of theoretical and empirical articles in two core health economics journals. The Journal of Health Economics published 30% theory during the period 1982-1986, but by 1997-2001 the proportion had risen to 40% theory. Health Economics published 38% theory during 1992-1996, but the proportion fell to 32% theory during 1997-2001. In both journals articles were more likely to be published by men (78%), and published women were 50% less likely to publish theory than were men. Articles were more likely to be published by United States authors (54%), but United States authors were less likely to publish theory than authors from other countries. Compared to other disciplines, health economics published a higher proportion of theory than sociology, chemistry, and physics but less than economics and political science.

Journal Article↗
PubMed2004

Economic burden of head and neck cancer. A literature review.

This literature review presents the economics of head and neck cancer (HNC), the world's sixth most common neoplasm. HNC economics is complicated by the involvement of multiple body sites, multiple medical specialties, and multiple treatment modalities. Economic analyses of HNC published in English between 1990 and 2002 were identified from electronic data sources. Additional studies were identified manually from bibliographies of retrieved articles. Study characteristics and findings were analyzed. We identified 51 studies that reported original cost data. Most were cost-identification or cost-comparison studies; only one evaluated cost-effectiveness. Few assessed the overall economic burden of HNC or cost effectiveness of current treatments, thus making appropriate comparisons impossible. Systematic measurement of the cost of HNC and its treatment in existing practice settings would be valuable. Inclusion of economic components in clinical trials and the conduct of retrospective or prospective observational studies, such as patient registries, would yield important new information.

Absenteeism↗
PubMed2006

[Guidelines for health-economic evaluations in Austria].

BACKGROUND: The evaluative health economics is a recent field of research in health economics. Cost-effectiveness decisions play an increasing role, particularly for policy-makers to find systematic decisions under uncertainty. The task is all the more important as the use of innovative health technologies for diagnosis, prevention and treatment is rapidly expanding and thus leads to financial restrictions in health care. Hence, decision making has to be supported by systematically implementing analytical tools. METHODS: When it comes to interpret the results of health-economic evaluations in a valid way it is necessary that state-of-the-art methodology is carried out in a transparent way. It is in this vein that guidelines were developed for Austria. On the one hand, they should set standards but, on the other hand, they should not restrict methodical progress guided by freedom of scientific research in health economics. CONCLUSIONS: Setting guidelines of health-economic evaluations is an important breakthrough in Austria.

Administrative Personnel↗
PubMed1982

Race and socio-economic status in survival from breast cancer.

The survival data on 515 white and 388 black female breast cancer patients seen at the Medial College of Virginia between 1968 and 1977 were analyzed to study the effect of age, stage and race on survival prognosis. For a subset of the data representing patients from the city of Richmond (117 white and 206 black), socio-economic status (SES) information was generated on the basis of six predictors of SES and, in addition, the role of social class was studied. Each of these factors has a significant association with survival time. In particular, the probability of surviving a given length of time after diagnosis is ordered according to the socio-economic level and the statistical test for dose response show a highly significant directional relationship. Age and stage do not explain the difference in survival between the two races. Race and SES are highly associated; a higher proportion of blacks than whites come from the lower end of the socio-economic scale. Moreover, the racial difference in survival becomes insignificant when it is adjusted for the distribution of socio-economic levels. This suggests that the observed difference in breast cancer survival between blacks and whites is, to a large extent, due to the difference between the two races with respect to the distribution of socio-economic status.

Adult↗
PubMed1986

Economic aspects of risk assessment in chemical safety.

This paper considers how the economic aspects of risk assessment in chemical safety can be strengthened. Its main focus is on how economic appraisal techniques, such as cost-benefit and cost-effectiveness analysis, can be adapted to the requirements of the risk-assessment process. Following a discussion of the main methodological issues raised by the use of economic appraisal, illustrated by examples from the health and safety field, a number of practical issues are discussed. These include the consideration of the distribution of costs, effects and benefits, taking account of uncertainty, risk probabilities and public perception, making the appraisal techniques useful to the early stages of the risk-assessment process and structuring the appraisal to permit continuous feedback to the participants in the risk-assessment process. It is concluded that while the way of thinking embodied in economic appraisal is highly relevant to the consideration of choices in chemical safety, the application of these principles in formal analysis of risk reduction procedures presents a more mixed picture. The main suggestions for improvement in the analyses performed are the undertaking of sensitivity analyses of study results to changes in the key assumptions, the presentation of the distribution of costs and benefits by viewpoint, the comparison of health and safety measures in terms of their incremental cost per life-year (or quality-adjusted life-year) gained and the more frequent retrospective review and revision of the economic analyses that are undertaken.

Environmental Exposure↗
PubMed1984

The economic costs of smoking and benefits of quitting for individual smokers.

The results of a study that estimated the expected lifetime economic consequences of cigarette smoking for individual smokers are reported herein. The estimates were obtained by combining age- and sex-specific estimates of the incidence-based costs of three smoking-related diseases (lung cancer, coronary heart disease, and emphysema) with estimates of smokers' increased likelihood of developing these illnesses in each remaining year of life relative to nonsmokers. Estimates of the economic consequences of quitting based on these disease cost estimates and on estimates of exsmokers' probability of future disease relative to continuing smokers are also reported. Both the estimates of the economic costs of smoking and the benefits of quitting were calculated separately for men and women between the ages of 35 and 79 who were light, moderate, or heavy cigarette smokers. While the economic costs of smoking varied considerably by sex, age, and amount smoked, they were significant for all groups of smokers. Costs for a 40-year-old man, for example, ranged from $20,000 for a smoker of less than one pack of cigarettes per day to over $56,000 for a smoker of more than two packs of cigarettes per day. The economic benefits of quitting also were found to be sizable for all groups of smokers.

Adult↗
PubMed1987

Economic evaluation and the rational diffusion and use of health technology.

In principle, economic evaluation provides a suitable framework for the assessment of the costs and benefits of health technologies. However, despite a rapid growth in the publication of cost-effectiveness and cost-benefit analysis in health care, there is little evidence that economic evaluation has yet become part of an integrated approach to technology assessment. This paper, based on the findings of a European Community project on economic appraisal of health technology, discusses how the design and conduct of economic evaluations can be improved so as to increase their relevance to health care decision making, and how policies on the diffusion and use of health technology can be devised so as to make fuller use of the economic evaluations that are carried out.

Communication↗