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PubMed1991

Economic evaluation in health care: is there a role for cost-benefit analysis?

This paper is devoted to the contingent valuation (CV) method and its possible area of application in health economics. With the CV method willingness to pay or willingness to accept is measured with survey methods. The CV method has been developed in environmental economics and is now the most commonly used method of measuring environmental benefits. The method has, however, seldom been used in economic evaluations of health care. The development of economic evaluation in the health care area is reviewed, and the existing methods (the human capital approach, cost-effectiveness analysis and cost-utility analysis) are compared with cost-benefit analysis using the CV method. It is shown that existing methods have several weak points, this makes the CV method an appealing alternative and/or complement to existing methods. From the empirical applications of the CV method in economic evaluations of health care it is evident that it is possible to achieve acceptable response rates. The methodological problems encountered when measuring willingness to pay with survey methods are shown to be similar to the problems encountered when measuring utility and quality of life in cost-utility analysis. Further studies with the CV method are necessary to further explore questions concerning the reliability and validity of the method.

Consumer Behavior↗
PubMed1996

Economic evaluation and health care decision-making.

The current role of economic appraisal in health policy and medical practice is outlined, emphasizing the pharmaceutical sector where developments are most marked. General health policy in the Netherlands and pharmaceutical policy in Australia are presented as examples of how economic appraisal may diffuse further as a decision-support tool for health authorities. This can be promoted by studying how policy-makers interpret and use results of economic evaluation studies and how the international transferability of information on the cost-effectiveness profiles of health technologies can be enhanced. To be relevant for health policy, results from economic appraisal studies must be valid and reliable, relevant to the policy context and communicated to the proper decision-makers. A number of recommendations are provided for economic appraisals to meet such requirements.

Australia↗
PubMed1983

The feasibility of economic evaluation of diagnostic procedures.

This paper reviews the principles of cost-benefit and cost-effectiveness analysis as they are applied to diagnostic procedures. These medical procedures present particularly thorny problems to those who would subject them to economic evaluation. Five specific problem areas encountered in attempting to apply economic evaluation to diagnostic procedures are discussed in detail. They are: defining homogeneous patient groups for analysis; specifying the relevant diagnostic alternatives; measuring diagnostic accuracy; measuring diagnostic costs; and specifying the measured outcomes of the diagnostic process. The economic evaluation literature on two diagnostic procedures--the skull X-ray and computed tomographic (CT) scanning is reviewed within the context of a model of economic evaluation. Two studies were found to successfully apply the principles of economic evaluation to CT scanning; none were found for skull X-rays. The most common approaches to evaluating the usefulness of these procedures, and the limitations of these approaches, are summarized.

Cost-Benefit Analysis↗
PubMed1985

Child mortality and economic variation among rural Mexican households.

In two rural Mexican communities, rates of child mortality are significantly related to economic situations of households. Measured over the childbearing years of post-reproductive women, the rate of child mortality (ages 0-5 years) per mother is 163 per 1000 children in one village and 338 in the other. Significant economic correlates, which are defined ethnographically in each community, are housing quality, quality of farm land and marital status. Correlations of child mortality rates with economic variables range from -0.25 to -0.54, showing that poorer mothers lose significantly more children in the first 5 years of life. These results parallel those of urban, regional, national and international studies, but economic correlates of child mortality have not previously been found in rural Latin America. The methodological contributions of this study include a meld of ethnographic and survey techniques of data collection, the development of culturally appropriate variables to measure economic status, the use of child rather than infant mortality rates, and a household-related demographic measure, the rate of child mortality per mother.

Child, Preschool↗
PubMed1992

Child developmental delay and socio-economic disadvantage in Australia: a longitudinal study.

Socio-economic inequalities in adult and child health in Australia have been an issue of national concern. While a large body of data has discussed adult health, there have been relatively few Australian reports of socio-economic inequalities in child health. This occurs in a context where there have been increases in the proportion of Australian children living in poverty and where there has been an increased interest in child developmental delay as an indicator of child health status. This paper reports the result of a longitudinal study of pregnancy outcomes and one indicator of child health, namely child developmental delay. Three indicators of socio-economic status (chronic socio-economic disadvantage, mother's education, family income) were used to predict child developmental delays observed some 5 1/2 years after the study commenced. Mothers who had the lowest socio-economic status (using any of the indicators) had substantially higher rates of children manifesting developmental delays.

Australia↗
PubMed1994

Researcher-driven versus policy-driven economic appraisal of health technologies: the case of France.

From the failure of early voluntarist attempts of the 1970's to introduce formal economic assessment in administrative decision-making for public health policies, to the recent introduction of new regulatory mechanisms to control the diffusion and use of health care technologies, the French experience deeply questions the mechanistic idea that reinforcement of cost-containment policies necessarily means successful opportunities for economic appraisal. The article presents various examples from the French health care system showing how ambiguities between the management goals of cost-containment and the promotion of economic appraisal can create barriers for acceptance of any form of economic analysis. But, it also draws some positive lessons about the ways to surpass the traditional opposition between 'researcher-driven' vs 'policy-driven' research in the field of health economic assessment through institutional innovations and methodological advances.

Cost Control↗
PubMed1981

Climacteric symptoms according to body weight in women of different socio-economic groups.

The people influence of body weight on the climacteric symptoms of 618 selected women in spontaneous post-menopause has been studied bases on data collected at a Geriatric Centre and subsequently incorporated into a postal questionnaire. These cases were divided into 3 groups according to the "obesity degree": (I) less than 5 kg (53.1% of the cases);(II) between 5 and 15 kg (31.7%); and (III) greater than 15 kg (15.2%). The data were also analysed according to the socio-economic groups to which the women belonged. Overweight women, compared with thin women, seemed to suffer less "somatic" symptoms such as hot flushes and perspiration, independently of their socio-economic level. This might well be a consequence of the higher endogenous oestrogen activity. On the contrary, "psychic" symptoms (anxiety, depression, irritability, crying spells) seemed to be more frequent and severe (a) in the "obesity degree" sub-group III, compared with sub-groups I and II, in the women belonging to the higher socio-economic group, and (b) in the sub-groups I and III, compared with sub-group II, in the women belonging to the lower socio-economic group. Such a difference between the socio-economic groups is possibility due to cultural factors. The effects of endogenous oestrogens in the overweight women seem to be easily overruled by the influence of psychological factors.

Aged↗
PubMed1994

Socio-economic status and risk factors for cardiovascular disease: a multicentre collaborative study in the International Clinical Epidemiology Network (INCLEN). The INCLEN Multicentre Collaborative Group.

As part of a multicentre collaborative study of risk factors for cardiovascular disease (CVD) in the International Clinical Epidemiology Network (INCLEN), each of 12 Centres in 7 countries examined the relationship between CVD risk factors and socio-economic variables. Each Centre (three in Thailand, two each in China, Chile and Brazil and one each in the Philippines, Indonesia and Colombia) examined approx. 200 men aged 35-65 drawn at random from a population within their locality (not designed to be necessarily representative of the general population). Standardized measures of CVD risk factors included body mass index (BMI), blood pressure, blood cholesterol and cigarette smoking habits. Education, occupation and current income were grouped into ordinal categories of socio-economic status according to standard protocol guidelines, and comparisons were made between risk factor levels within each of these categories. Many of these populations had higher levels of education (as a marker of socio-economic status) than would the general population of their country. For both BMI and blood cholesterol there were a number of centres which showed positive associations with socio-economic status. These were predominately in China or urban or rural South East Asia. For blood pressure and cigarette smoking the associations with socio-economic status tended to be negative, more in line with the direction of association seen in the "Developed" World. The high risk factor levels found in these populations, particularly the alarming prevalence of cigarette smoking in Asia and the high cholesterol levels in Latin America and Urban S.E. Asia suggest that CVD will emerge as a major public health problem in the Developing World.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Economic evaluation alongside cancer trials: methodological and practical aspects.

A recent extension of clinical evaluation is "economic evaluation", which seeks to characterise each relevant alternative health care strategy in terms of a summary measure incorporating the costs and benefits of such strategies. In an economic evaluation, separate measurements of resource volumina and resource prices on the cost side, and separate measurements of survival and quality of life effects and valuation of these outcome effects on the benefit side are required. From these effect parameters, which should be calculated for all competing strategies considered in the analysis, the relative cost-effectiveness of one strategy as against the other can be derived. The degree of generalisability of the study results determines the validity of economic evaluation in decision-making. This depends on the generalisability of the clinical findings, and in this respect the so-called "piggyback" economic evaluation, which is added to a clinical trial, has its limitations. In the field of cancer, specific attention should be given to costs and effects occurring after non-mortality endpoints, to patient and family costs and to variations in treatments between settings of care. It is argued that conventional clinical trials and economic evaluations will integrate further in the future.

Clinical Trials as Topic↗
PubMed2005

Conducting economic evaluations alongside multinational clinical trials: toward a research consensus.

Demand for economic evaluations in multinational clinical trials is increasing, but there is little consensus about how such studies should be conducted and reported. At a workshop in Durham, North Carolina, we sought to identify areas of agreement about how the primary findings of economic evaluations in multinational clinical trials should be generated and presented. In this paper, we propose a framework for classifying multinational economic evaluations according to (a) the sources of an analyst's estimates of resource use and clinical effectiveness and (b) the analyst's method of estimating costs. We review existing studies in the cardiology literature in the context of the proposed framework. We then describe important methodological and practical considerations in conducting multinational economic evaluations and summarize the advantages and disadvantages of each approach. Finally, we describe opportunities for future research. Delineation of the various approaches to multinational economic evaluation may assist researchers, peer reviewers, journal editors, and decision makers in evaluating the strengths and limitations of particular studies.

Clinical Trials as Topic↗
PubMed2004

An economic framework for understanding physical activity and eating behaviors.

This paper offers an economic framework of human behavior with respect to physical activity and nutrition. Economics offers useful insights into these behaviors because it is the study of how people allocate their scarce resources of time and money to maximize their lifetime happiness. This paper outlines the criteria for policy interventions from an economic perspective and also considers arguments for policy intervention that are not based on economic considerations. The implications of the economic framework are summarized and its limitations are described.

Algorithms↗
PubMed2004

Economic determinants of urban form: resulting trade-offs between active and sedentary forms of travel.

Economic factors have an impact on how the built environment is shaped, which in turn affects how we choose to travel. Regional transportation investment decisions are firmly rooted in economic "cost-benefit" trade-off considerations. The placement (central or outlying) and mode of transportation in which investments are made (transit, highway, sidewalks, or bikeways) influence where homes, businesses, schools, and other types of uses are located. Transportation investments create or limit access and establish a set of economic trade-offs that help determine if an area will be compact or dispersed, and mixed use or single use. Developers consider cost trade-offs between constructing connected street grids versus disconnected cul-de-sac networks, which determines if residents can walk to services and transit. Taken collectively, transportation investments and resulting land-use patterns determine if destinations are far apart or close together and linked with direct and safe sidewalks or bikeways. The end result is a built environment that determines whether walking and biking is feasible or perceived as more beneficial than driving or taking transit. This paper assesses (1) the economic forces that shape transportation investment decisions, (2) the economic impact of these investments on land use, and (3) how we as consumers choose to travel as a result of these transportation investment and land-use decisions.

Cost-Benefit Analysis↗
PubMed2004

An economic approach to health care.

Economic analyses have the potential to put all of the positive and negative outcomes of an intervention into perspective to aid decision making. The quality of the data upon which the analysis is based has an impact on the resulting quality of the analysis itself. Analysis of cost-effectiveness requires the input of many types of data, and where data are not available, assumptions must be made. There are many instances where the analysis may go wrong, and it is important to remain cognizant of these. The critical parts of the analysis, which have also been identified in quality assessment tools, include the following: design of the study question, sources of probability estimates and cost data, sensitivity analysis, and the interpretation of results. If the readers are able to identify the assumptions of the analysis they are better equipped to judge the validity. We have reviewed economic analyses relating to two hot economic topics in rheumatology. These are the cost-effectiveness of cyclooxygenase-2 (COX-2) inhibitors for 'arthritis' and cost-effectiveness of anti-tumor necrosis factor alpha (anti-TNF) agents for rheumatoid arthritis (RA). The results of the COX-2 analyses vary by review. Some show cost savings, while others calculate a significant cost in order to achieve any change in quality of life. Given the unanswered questions that still exist, it seems reasonable to conclude that COX-2 inhibitors may be cost effective when used in patients at a high risk of GI complications. Unanswered questions remain regarding the concomitant use of low-dose ASA and proton pump inhibitors and how they may affect the results of these economic analyses. The cost-effectiveness of anti-TNF agents has not been explored in as much detail as that of the COX-2 agents. Two studies have presented cost-effectiveness models that include a hypothetical biologic agent. Two economic analyses report on the cost-effectiveness of etanercept compared with traditional disease-modifying anti-rheumatic drugs (DMARDs) in methotrexate-resistant and methotrexate-naïve patients with RA. Both the analyses show that etanercept has a cost-effectiveness ratio of around 40,000 US dollars for every patient who achieves an American College of Rheumatology 20% improvement score (ACR 20) within a 6-month period. A cost-utility analysis was published regarding the use of infliximab in methotrexate resistant RA. It showed a cost-utility ratio of 3400:34,000 Euro per quality adjusted life year (QALY) gained, depending on the country evaluated (Sweden and the UK, respectively). An important finding in all three studies was that indirect costs dominate costs in RA; therefore, they should be included in all future analyses of this disease.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

The economics of hepatitis C virus.

Hepatitis C virus is a disease of major public health significance throughout the world in terms of overall morbidity and mortality and in its economic consequences and demands on medical resources. The global economic burden of this disease has yet to be fully realized. In this article the authors discuss the economic burden of hepatitis C, the economics of therapy, and the economics of its prevention and screening.

Antiviral Agents↗
PubMed2005

Socio-economic factors and health care system characteristics related to cancer survival in the elderly. A population-based analysis in 16 European countries (ELDCARE project).

The ELDCARE study aims to investigate, at the ecological level, the relationships between socio-economic variables and cancer survival in patients aged 65 years and over. Survival data for patients diagnosed during the period 1985-1989 and followed up to 1994 were provided by 43 European Cancer Registries in 16 countries participating in the EUROCARE 2 project. Relative survival was computed by Hakulinen's methods. Data on socio-economic factors were collected by national statistics offices for the years around 1991. Pearson's correlation was used to study the relationships between cancer survival and socio-economic factors. We selected four groups of variables. The first group included macro-economic variables (such as Gross Domestic Product, GDP; Total Health Expenditure, THE); the second, the main characteristics of national health care systems; the third, demographic factors; and the fourth, variables on labour market organisation. The countries with the largest proportions of elderly populations, in Northern and Western Europe, spent more on health than the less affluent countries of Eastern Europe. GDP was strongly related to THE but a very high variability in Computed Tomography Scanners (CTS) among countries with similar THE was observed. Indeed, those countries with THE around US 1500 dollars per capita had survival rates for breast cancer ranging from 67 to 82%. Cancer survival in elderly patients in Europe was most strongly related to GDP and THE, especially for good prognosis cancers. Survival was strongly correlated with health care technologies, particularly CTS, but not with health employment. Survival was positively correlated with proportion of married elderly people (and negatively with widowed elderly), suggesting a role played by social support in influencing the prognosis of elderly patients. These results highlight how health outcomes in the elderly are a complex phenomenon, not determined only by GDP and THE, but affected by social organisation and life habits as well as economic development conditions.

Age Factors↗
PubMed2004

Economic burden of acute myeloid leukemia: a literature review.

OBJECTIVE: The primary objective was to examine the economic burden associated with acute myeloid leukemia (AML), a deadly hematological malignancy. AML is the most common form of acute leukemia in adults, particularly in individuals over 60 years of age; AML also accounts for 15-20% of childhood leukemia. MATERIALS AND METHODS: A systematic review was conducted of relevant studies published in the English language. Economic analyses of AML published between 1990 and 2002 were identified from electronic data sources using broad search criteria. Additional studies were obtained by manual searches of bibliographies of articles identified in the electronic searches. Articles were screened for relevance and included if the main theme included some element of AML cost of treatment, cost drivers, or cost-effectiveness. Studies reporting only drug prices without a formal comparison or analysis were not included. RESULTS: Twenty-nine studies were included in the review. Although information was limited on the comprehensive economic burden of AML from a societal perspective, the costs appear to be split equally between direct and indirect costs. Direct costs of AML from a public payer perspective were available for a few countries such as the Netherlands, Sweden, US (Medicare), and Italy. These studies found that the key cost drivers appear to be hospitalization length of stay related to initial chemotherapy, relapse of disease, and bone marrow transplant (BMT) and peripheral blood stem cell transplant (PBSCT). Several cost analyses have been published comparing the different treatment strategies; however, most of them were published in the early 1990s, and their analysis revolved around cost-comparison rather than comprehensive cost-effectiveness. The published studies investigated pharmacological agents (e.g., idarubicin, daunorubicin, mitoxantrone, fludarabine and combination therapies), as well as BMT, PBSCT, and the treatment of complications. CONCLUSION: Studies addressing the economic costs and burden of AML are relatively sparse in the international literature. Possible reasons for such a lack of information appear to include the low incidence rate of AML (e.g., about 260,000 new cases were reported in 2002 in the world) and the fact that it primarily afflicts older adults >60 years of age, making broad, well-designed economic analyses a challenge for most researchers. However, due to the high cost associated with the medical procedures (e.g., BMT, PBSCT) and the aging of the world population, further research is warranted.

Adolescent↗
PubMed2005

Pain among women: associations with socio-economic and work conditions.

We examined pain prevalence (general/body sites) and its characteristics/consequences among a randomised sample of women from the general population between 18 and 64 years (n=3,616). We also scrutinised associations between pain and various factors (e.g. socio-economic) by means of multivariate logistic/linear regression analyses. The women completed a questionnaire assessing various areas (e.g. pain). The design was cross-sectional and data were collected during 8 consecutive weeks. Sixty-three per cent of women reported pain during the last 3 months, of which 65% during more than 3 months. The multivariate analyses revealed associations between various socio-economic factors (e.g. financial strain) and pain in general/all studied body sites. In addition, psychosocial work conditions (i.e. work strain and social support) were significantly related to pain. Moreover, the multivariate analyses conducted among women with pain indicated relationships between socio-economic/psychosocial work conditions, and pain characteristics (e.g. intensity) and consequences (i.e. disability). A large number of women from the general population suffer from pain, in particularly prolonged pain. Women in a deprived socio-economic situation not only run a higher pain risk, but also experience their pain as more severe/disabling than their more privileged counterparts. Improvements of, for example, the socio-economic status among women living in deprived social and material circumstances, along with improved working environment may be crucial to reduce women's pain problems.

Adolescent↗
PubMed2006

Current impact of gene technology on healthcare. A map of economic assessments.

OBJECTIVES: It has been claimed that gene technology will induce revolutionary changes in healthcare. This paper investigates how and to what extent these changes have been economically assessed. METHODS: A generic framework was developed to distinguish between methodologically similar evaluations of healthcare technology. Methodological issues and the current state of economic evidence concerning human DNA technology were extracted from publications within these groups of evaluations. RESULTS: Economic evaluations of "healthcare consisting of gene technology" were identified primarily for in vitro diagnostics for hereditary disease and others for pharmacogenetics and molecular pathology. "Healthcare enabled by gene technology" is far more encompassing and includes, e.g., biotechnology drugs for which various health economic evaluations can be found. Yet here, the impact of gene technology intertwines with the impact of other technologies and is therefore hardly susceptible to evaluation. The fields of evaluation may be classified best according to the two dimensions "purpose" and "stage of development". Current evaluations cover screening, diagnostic and treatment technologies in investigational, new and established stages. Apart from prenatal screening, healthcare consisting of gene technology was cost saving only for genotype tests replacing continuous phenotype tests and for one pharmacogenetic test. Conclusive evidence of favourable cost-effectiveness ratios is available only for few conditions. CONCLUSION: Hypotheses about the impact of gene technology on healthcare must be explicit about the definition of "genetic" medicine. A general statement regarding healthcare enabled by gene technology is not possible. Based on current evidence, an era of healthcare consisting of gene technology built on widespread predictive testing is not desirable from a health economic viewpoint.

Delivery of Health Care↗