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At least 793 records · Page 44Linked to original sources
PubMed2004

Out of touch or on the money: Do the clinical objectives of addiction treatment coincide with economic evaluation results?

Previous economic studies have examined the association between substance abuse treatment and reduced costs to society, but it remains uncertain whether the economic measures used in cost and benefit-cost analyses of treatment programs correspond in direction and magnitude with clinical outcomes. In response to this uncertainty, the present study analyzed a longitudinal data set of addiction treatment clients to determine the statistical agreement between clinical and economic outcomes over time. Data were collected from 1,326 clients in the Chicago cohort of the Persistent Effects of Treatment Study. These individuals were interviewed at baseline as well as at 6-, 24-, 36-, and 48-month followup periods (91.6% followup). Correlations between clinical and economic measures were generally small (rho of 0.1 to 0.3) and often became non-significant once we controlled for baseline severity. The results demonstrate that although some associations exist, outcomes should be evaluated along both clinical and economic dimensions.

Adult↗
PubMed2005

Socio-economic position and its relationship to physical capacity among elderly people living in Jyväskylä, Finland: five- and ten-year follow-up studies.

Socio-economic differences in self-reported disability are well described but much less is known about their associations with more objective measures of physical capacity. The aim was to study socio-economic differences in performance-based physical capacity in 75-year-old persons, examining changes in performance at five- and ten-year follow-up intervals. At the baseline 350 residents of the city of Jyväskylä, Finland, aged 75 were interviewed and 295 of them took part in clinical examinations. The corresponding figures at the five-year follow-up were 234 and 191 and at the ten-year follow-up 139 and 103. The statistical significance of differences in physical capacity between the socio-economic groups and genders were tested using ANOVA in univariate and repeated measures models and ANCOVA, with confounders added to the models. Generally, higher education and income were separately related to better maximal walking speed and vital capacity at every measurement point. In addition, higher income was related to better maximal isometric hand grip strength at both follow-ups. When education and income were in the same model, only income was related to physical capacity, almost without exception. Similarly, in the five- and ten-year follow-up periods, both education and income groups showed a parallel decline in physical capacity. The association between income and physical capacity remained even after adjusting for smoking, physical activity and number of chronic diseases. The results indicate that elderly people in disadvantaged socio-economic groups show lower levels of performance in almost all domains of physical capacity, but change in capacity over time does not differ significantly between either markers of socio-economic position.

Activities of Daily Living↗
PubMed2006

If control of Neospora caninum infection is technically feasible does it make economic sense?

Recent work on Neospora caninum, a protozoan parasite that causes abortions in dairy cattle has focused on a number of different control options. Modelling has suggested the most effective options for control but the present paper argues that the most effective option might not necessarily be optimal from an economic point of view. Decision trees, using published quantitative data, were constructed to choose between four different control strategies. The costs of these interventions, such as 'test and cull', therapeutic treatment with a pharmaceutical, vaccination or "doing nothing" were compared, and modelled, in the first instance, on the New Zealand and Australian dairy situation. It is argued however, that the relative costs in other countries might be similar and that only the availability of a registered vaccine will change the decision tree outcomes, as does the within-herd prevalence of N. caninum infection. To "do nothing" emerged as the optimal economic choice for N. caninum infections/abortions up to a within-herd prevalence of 18%, when viewed over a 1-year horizon, or 21% when costs were calculated over a 5 years horizon. For a higher (>or=21%) within-herd prevalence of N. caninum infection vaccination provided the best (i.e. most economic) strategy. Despite being the most efficacious solutions, 'test and cull' or therapeutic treatment never provided a viable economic alternative to vaccination or "doing nothing". Decision tree analysis thus provided clear outcomes in terms of economically optimal strategies. The same approach is likely to be applicable to other countries and the beef industry, with only minor changes expected in the relationships of decisions versus within-herd prevalence of N. caninum infection.

Abortion, Veterinary↗
PubMed2004

Medical economics in the field of influenza--past, present and future.

Influenza represents a major challenge for public health worldwide. The burden of suffering is not only reflected by the extent of hospitalisations and deaths arising from this devastating disease, but also by the attributed economic toll. The economics of this disease can, however, be changed favourably due to the availability of efficacious vaccines. Recent studies have demonstrated the economic benefits of vaccinating not only persons at risk, but also healthy working adults. There seems to be an economic advantage even in immunising certain pediatric subpopulations. Only with a clear and transparent body of economic evidence will it be possible to advise health authorities and payors on the utility of influenza vaccination vaccination policies.

Adult↗
PubMed1999

Towards evaluating the economic impact of bovine neosporosis.

In spite of the global importance of neosporosis as a cause of bovine abortion, there is very little information about its economic consequences. The economic costs are a product of estimations of the quantity of the effects attributable to Neospora infection, and the particular unit costs of those effects. In this brief review, which arose from a workshop on the economics of coccidiosis held at the COST 820 meeting, Toledo 1998, we discuss the possible effects of neosporosis which are of economic significance and summarise the available estimates of their magnitude to provide a basis for further economic analysis. Neospora infection has been associated with abortion, increased culling and reduced milk yield. In addition, it has been diagnosed in cases of stillbirth and neonatal mortality, it is likely to contribute to early foetal death and resorption and it is responsible for a reduction in the value of female breeding cattle. In quantifying the role of Neospora, it is important that epidemiologically based, case-controlled studies are conducted because, given the extreme efficiency with which bovine Neospora infection is vertically transmitted, demonstration of prevalence of infection in affected animals (including foetuses) is not a true indicator of the significance of this disease. Relatively few epidemiological studies have been conducted, but in investigations in the USA, Holland and Britain, infected cows have been shown to be about three times more likely to abort than non-infected cattle. In the UK this approach has been used to estimate the proportion of abortions in the national dairy population which may be attributable to Neospora caninum.

Abortion, Veterinary↗
PubMed2001

Economics of surgery.

The time has come to subject surgery to the same rigours of economic assessment that other health-care sectors are already receiving--namely, the comparative assessment of costs and benefits. The surgical management of gallstones provides a good example of the role of economics in surgery. Gallstone disease is common and patients are usually referred to a surgeon, but the threshold for intervention is not agreed and varies widely, with considerable implications for resources. Gallstone removal has been subject to much innovation over the past 10 years, yet economic assessment of laparoscopic and "mini" cholecystectomy and of gallstone lithotripsy is rare, despite the fact that operation rates have increased by up to 50% in some countries. For surgery to compete with other interventions, economic assessment of new surgical techniques will be increasingly important. This assessment should be based on well-conducted clinical trials in which interventions are provided in a routine service setting, and in which benefits are assessed among other things on the basis of the patient's perceived quality of life. Economic assessment often needs data beyond those collected in a clinical trial, however pragmatic the trial design, so modelling will often be required, incorporating a range of sources of evidence. Finally, evidence alone will not be enough to promote cost-effective practices. The take-up of surgical techniques will always be affected by the way hospitals and surgeons are remunerated. Affecting practice requires a realistic system of reimbursement that reflects evidence on cost effectiveness.

Cholecystectomy, Laparoscopic↗
PubMed2004

Accounting- versus economic-based rates of return: implications for profitability measures in the pharmaceutical industry.

BACKGROUND: Accounting-based profits have indicated that pharmaceutical firms have achieved greater returns relative to other sectors. However, partially due to the theoretically inappropriate reporting of research and development (R&D) expenditures according to generally accepted accounting principles, evidence suggests that a substantial and upward bias is present in accounting-based rates of return for corporations with high levels of intangible assets. Given the intensity of R&D in pharmaceutical firms, accounting-based profit metrics in the drug sector may be affected to a greater extent than other industries. OBJECTIVE: The aim of this work was to address measurement issues associated with corporate performance and factors that contribute to the bias within accounting-based rates of return. METHODS: Seminal and broadly cited works on the subject of accounting- versus economic-based rates of return were reviewed from the economic and finance literature, with an emphasis placed on issues and scientific evidence directly related to the drug development process and pharmaceutical industry. RESULTS: With international convergence and harmonization of accounting standards being imminent, stricter adherence to theoretically sound economic principles is advocated, particularly those based on discounted cash-flow methods. Researchers, financial analysts, and policy makers must be cognizant of the biases and limitations present within numerous corporate performance measures. Furthermore, the development of more robust and valid economic models of the pharmaceutical industry is required to capture the unique dimensions of risk and return of the drug development process. CONCLUSIONS: Empiric work has illustrated that estimates of economic-based rates of return range from approximately 2 to approximately 11 percentage points below various accounting-based rates of return for drug companies. Because differences in the nature of risk and uncertainty borne by drug manufacturers versus other sectors make comparative assessments of performance challenging and often inappropriate, continued work in this area is warranted.

Accounting↗
PubMedDate not supplied

The economics of benign prostatic hyperplasia treatment: a literature review.

Benign prostatic hyperplasia (BPH) is one of the most common benign neoplasms in elderly men in the United States; it has been estimated that the annual costs of caring for these men exceed $4 billion. This condition is rarely life threatening, but often affects the individual's quality of life in varying degrees. There are several treatments for this condition, including surgery, with the most common procedure being transurethral resection of the prostate. Other treatment options include medication (such as finasteride and terazosin), balloon dilation, and watchful waiting. The cost associated with BPH depends on the severity of the disease and the appropriate course of treatment. The objective of this paper is to identify and evaluate the economic research papers that have considered either the economic burden or costs associated with alternative BPH therapy options and to identify key areas for future economic research. This review indicates that the economic studies of BPH are diverse in nature and greater attention needs to be placed on the societal appraisal of competing BPH therapies. Other research areas include the economic analysis of both short- and long-run BPH treatment options, increased cost-utility analysis, and the use of retrospective claims database analysis using regression techniques.

Aged↗
PubMed2001

Can epidemiology and economics make a meaningful contribution to national animal-disease control?

The general role of veterinary epidemiology and economics to national animal-disease control throughout the world is considered for the four main groupings of animal diseases: zoonotic, food-borne, endemic and epidemic diseases. This is done by considering how veterinary epidemiology and economics has contributed to priority setting (which diseases come first?), decision-making (for a given disease, which strategy is best?), and disease control implementation (how can optimal delivery and adoption of selected interventions best be achieved?). Within each of these categories, progress made and future opportunities are discussed. In addition, a review is made of how veterinary epidemiology and economics has been institutionalised. We conclude that veterinary epidemiology and economics holds a unique role in the development of national policies and strategies for improved animal health world-wide. However, we consider that we must capitalise more on the unique comparative advantage of the partnership between veterinarians and agricultural economists. We believe that much remains to be done to improve the "institutionalisation" of veterinary epidemiology and economics, and the adoption and impact of the products of our unique partnership, particularly in countries of the developing world.

Agriculture↗
PubMed2000

Incorporating option values into the economic evaluation of health care technologies.

Despite uncertainty being intrinsic to economic evaluation of health care, existing techniques for handling uncertainty remain underdeveloped compared to the formal techniques commonly applied in the business sector. This paper develops an alternative approach to handling uncertainty in economic evaluation based on 'option-pricing' techniques. The presence of uncertainty and the degree of irreversibility of a decision make it clear that some flexibility in the timing of a decision is often a desirable characteristic with an economic value. We demonstrate how option-pricing techniques can be applied to the decision rules for economic evaluation in health care. The key determinants of an option value are the presence and type of uncertainty; the ability to defer a decision; and the irreversibility of the decision. The relative significance of each of these for a particular economic evaluation will depend on the particular characteristics of the technology under consideration.

Cost-Benefit Analysis↗
PubMed2001

Health-related quality of life by disease and socio-economic group in the general population in Sweden.

Measuring health-related quality of life (HRQoL) on population level, is becoming increasingly important for priority setting in health policy. In the health economics field, it is common to measure HRQoL in terms of health-state utilities or QoL weights. This study investigates the feasibility of obtaining mean QoL weights by mapping survey data to the generic HRQoL measure EQ-5D and to describe the HRQoL in terms of mean QoL weights in certain disease and socio-economic groups. Data from the 1996-1997 Survey of Living Conditions, interviews with a representative sample (16-84 years) of the Swedish population (n=11 698) were used. The mean QoL weight decreased from 0.91 among the youngest to 0.61 among the oldest, and was lower for women than for men. The QoL weight was 0.88 in the highest socio-economic group and 0.78 in the lowest socio-economic group. The QoL weight was lowest (0.38) among persons with depression and highest among persons with hypertension (0.71). The QoL weight decreased from 0.95 for persons with very good global self-rated health to 0.20 for persons with very poor global self-rated health. The results support the feasibility and validity of the mapping approach. HRQoL varies greatly between socio-economic groups and different disease groups.

Activities of Daily Living↗
PubMed2002

A review of the application of health economics to health and safety in healthcare.

A literature review is described which aimed to evaluate economic evaluations of health and safety interventions in healthcare. Severe limitations in the methodological rigor of nearly all the published work were identified. Most effort had been invested in costing studies, which are not economic evaluations in their own right. Problems were identified with valuing benefits in health and safety because they frequently take many years to emerge and are difficult to measure. Understanding of economic techniques within the health and safety professions was limited, resulting in wide-ranging assumptions being made as to the positive economic impact of health and safety interventions. Reasons for this are explored and include the subjective benefits of intervention programmes being so impressive and the likelihood of economic savings so great that there have been few demands for objective data. Healthcare managers, health economists, and health and safety professionals have not traditionally worked together and have inherent misunderstandings of each other roles. The review concludes that the aim of future research should be to assist the National Health Service (NHS) to make valid decisions about health and safety investment and risk control methods. This should be done with the aim of improving the health of those affected by or working within the healthcare sector.

Costs and Cost Analysis↗
PubMed2003

Health economic evaluation in Japan: a case study of one aspect of health technology assessment.

There is a burgeoning literature in health economic evaluation, with this form of analysis becoming increasingly influential at the health policy making level in a number of countries. However, a search of the literature reveals that in Japan, the world's second largest health care market, very little health economic evaluation has been undertaken. The main reason for the lack of interest in economic evaluation is that the fee-for-service and strict price regulation that characterises the system of health care financing in Japan is not conducive to this form of analysis. Moreover, the government and many researchers are satisfied that the current organisation of health care has given long life and low infant mortality at low cost. Even if it is accepted that low health care costs and good health prevail in Japan, slower economic growth rates, an ageing population and the development of new medical technologies will place increasing pressure on health care resources and will necessitate a more rational use of these resources. Good economic evaluation, by weighing benefits against costs, has an important role to play.

Budgets↗
PubMed2001

An invitation to ecological economics.

The emerging interdisciplinary field of ecological economics should be a recognized research priority. Only through a combination of sound ecology and good economics can we hope to manage our exploitation of the biosphere in a manner that is both sustainable and efficient. This article is an invitation to ecologists to use economic tools and to participate in ecological economic debate. To this end, we review basic ecological economic concepts and discuss how the field has arisen, what benefits it offers, and what challenges it must overcome.

Journal Article↗
PubMed2000

Health and rapid economic change in the late twentieth century.

Rapidly expanding economies, such as the post-war Tiger Economies, are associated with increasing health and rapidly contracting economies, such as Central and Eastern Europe in the early 1990s, are associated with declining health. In Central and Eastern Europe health decline in association with economic contraction has been mediated by changes in income distribution and, also, by health-determining aspects of civil society. The nations of Central and Eastern Europe are an example of swift economic and political transformation occurring concurrently with economic decline; with increasing disparity in income distributions; and with high levels of distrust in civil institutions. Concurrent with these declines was a marked reduction in health status, described here in terms of life expectancy. Conversely, the nations of Southeast Asia experienced rapid economic growth and increasing life expectancies. Though data are scarce, the experience of the Tiger Economies appears to be one of economic growth; a virtuous cycle of increased investment in education and housing; and increasing parity in income distribution based upon a relatively equitable distribution of returns on education.

Cross-Cultural Comparison↗
PubMed2002

Investigating socio-economic explanations for gender and ethnic inequalities in health.

This paper examines inequalities in the self-reported health of men and women from white and minority ethnic groups in the UK using representative data from the Health Survey for England, 1993-1996. The results show substantially poorer health among all minority ethnic groups compared to whites of working-age. The absence of gender inequality in health among white adults contrasts with higher morbidity for many minority ethnic women compared to men in the same ethnic group. The analysis addresses whether socio-economic inequality is a potential explanation for this pattern of health inequality using measures of educational level, employment status, occupational social class and material deprivation. There are marked socio-economic differences according to gender and ethnic group: high morbidity is concentrated among adults who are most socio-economically disadvantaged, notably Pakistanis and Bangladeshis. Logistic regression analyses show that socio-economic inequality can account for a sizeable proportion of the health disadvantage experienced by minority ethnic men and women, but gender inequality in minority ethnic health remains after adjusting for socio-economic characteristics.

Adult↗
PubMed2003

Children's health-related quality of life, neighbourhood socio-economic deprivation and social capital. A contextual analysis.

Neighbourhood objective socio-economic indicators and community-reported subjective measures of social capital were examined in relation to children's health-related quality of life in the Netherlands. Three different data-sources were used: (1) objective neighbourhood socio-economic indicators, (2) subjective neighbourhood data on social capital, and (3) individual data of a family cohort study, including questions on children's health-related quality of life, and family socio-economic status. Multilevel analyses were conducted using both neighbourhood level and individual level data. Neighbourhood socio-economic status and social capital were associated. Measures of socio-economic deprivation and social capital were both non-specifically associated with children's general health and satisfaction, independent of possible individual-level confounders. However, children's mental health and behaviour were specifically associated with one aspect of social capital, the degree of informal social control in the neighbourhood.

Child↗
PubMed2003

Ethnicity, socio-economic position and gender--do they affect reported health-care seeking behaviour?

While the pursuit of equity of access to health care is a central objective of many health care systems, there is evidence that patients of ethnic minority descent, in lower socio-economic position (SEP) or of female gender are less likely than Whites, more affluent groups or men, respectively, to access secondary and tertiary medical care. However, it is unclear at which point in the chain of events leading from perception of need through attendance at primary/emergency care, to referral and receipt of secondary care, this inequality occurs. This study examined the influence of ethnicity, socio-economic position and gender on an individual's perception of the need and urgency for seeking health care. A random sample was selected from two large city General Practices in the UK who were sent postal questionnaires which included two clinical vignettes describing characters experiencing chest pain and discovering a lump in the armpit. The main outcome measure was response to the 'chest pain' and 'lump' vignettes in terms of immediate health care utilisation. The questionnaire survey (n=1350, response rate 66%) indicated that Black respondents, respondents from lower socio-economic groups and women were at least as likely to report immediate health care seeking in response to the clinical vignettes than White respondents, those from higher socio-economic groups or men. This finding was consistent across all scenarios after adjustment for interpretation of the vignette, access to health services and attitudes to health and health care. For example, those in the lowest SEP group were almost 60% more likely to report immediate care seeking in response to the lump vignette (OR 1.59, 95% CI 1.08-2.33) compared to those in the highest SEP group; and Black respondents 40% more likely (OR 1.41, 95% CI 0.92-2.17). This study suggests inequalities in access to health care by ethnicity, socio-economic position and gender are not related to patients in these groups failing to self-refer to primary or accident and emergency care, barriers must therefore occur at the level of health care provision.

Adolescent↗