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At least 793 records · Page 44Linked to original sources
PubMed2002

QALYs versus WTP.

Quality adjusted life years (QALYs) and willingness to pay (WTP) are alternative measures of the value of reductions in health risk that are often used in evaluating environmental, health, and safety practices. Although both methods are based on individual preferences, the underlying assumptions differ. The different bases yield systematically different conclusions about the relative value of reducing health and mortality risks to individuals that differ in age, preexisting health conditions, income, and other factors. The choice of which method to use depends on judgments about what constraints should be placed on individual preferences and what factors should be considered in aggregating preferences across people.

Environment↗
PubMed2004

A cost-utility analysis of microwave and thermal balloon endometrial ablation techniques for the treatment of heavy menstrual bleeding.

OBJECTIVE: To assess the cost effectiveness of the second-generation surgical treatments for heavy menstrual bleeding (microwave and thermal balloon endometrial ablation) compared with existing endometrial ablation techniques (transcervical resection and rollerball, alone or in combination) and hysterectomy. DESIGN: A state transition (Markov) cost-utility economic model. POPULATION: Women with heavy menstrual bleeding. METHODS: A Markov model was developed using spreadsheet software. Transition probabilities, costs and quality of life data were obtained from a systematic review of effectiveness undertaken by the authors, from published sources, and expert opinion. Cost data were obtained from the literature and from a NHS trust hospital. Indirect comparison of thermal balloon endometrial ablation versus microwave endometrial ablation or either second-generation endometrial ablation method versus hysterectomy, and comparison of second-generation versus first-generation techniques were carried out from the perspective of health service payers. The effects of uncertainty were explored through extensive one-way sensitivity analyses and Monte Carlo simulation. MAIN OUTCOME MEASURES: Incremental cost effectiveness ratios based on cost per quality adjusted life year (QALY) gained, and cost effectiveness acceptability curves. RESULTS: Compared with first-generation techniques, both microwave and thermal balloon endometrial ablation cost less and accrued more QALYs. Hysterectomy was more expensive, but accrued more QALYs than all endometrial ablation methods. Baseline results showed that differences between microwave endometrial ablation and thermal balloon endometrial ablation were slight. Sensitivity analyses showed that small changes in values may have a marked effect on cost effectiveness. Probabilistic simulation highlighted the uncertainty in comparisons between different endometrial ablation options, particularly between second-generation techniques. CONCLUSIONS: Despite limitations in available data, the analysis suggests that second-generation techniques are likely to be more cost effective than first-generation techniques in most cases. Hysterectomy, where a woman finds this option acceptable, continues to be a very cost effective procedure compared with all endometrial ablation methods.

Catheter Ablation↗
PubMed2006

Cost-effectiveness of anastrozole compared to tamoxifen in hormone receptor-positive early breast cancer. Analysis based on the ATAC trial.

The 5-year completed treatment analysis of the Anastrozole and Tamoxifen-Alone or in Combination (ATAC) trial showed the superiority of anastrozole over tamoxifen for reduction of disease progression in patients with hormone receptor-positive (HR+) early breast cancer (EBC). The objective was to evaluate the cost-effectiveness of anastrozole versus tamoxifen in this setting. A health economic model was developed comparing the natural history of EBC patients treated with anastrozole or tamoxifen. The perspective of the Belgian health care system was taken. Disease progression from EBC was obtained from the ATAC trial and further progression beyond the clinical trial from published literature. Resource use data were obtained from the ATAC study and from published local retrospective data. Anastrozole was cost-effective versus tamoxifen, provided that a time horizon of at least 9 years is taken. This sensitivity to time horizon is inherently associated with the adjuvant setting due to the different evolution of costs and outcomes over time. Costs are incurred solely during the first 5 years, whereas outcomes are cumulated beyond adjuvant treatment. In conclusion, provided that a sufficient time horizon is taken and that long-term model predictions are confirmed from further follow-up from the ATAC study, anastrozole is a highly cost-effective adjuvant therapy compared to tamoxifen.

Anastrozole↗
PubMed2002

Mission-based budgeting hours model: an accurate way to understand physician costs.

Financial resources to manage academic emergency departments are becoming more scarce. The Association of American Medical Colleges (AAMC) has embraced mission-based management (MBM) as one viable option to allocate financial and personnel resources based on medical school goals. The key features of this style are integrating financial statements, measuring faculty activity, holding service line leaders accountable, and building a trust through information sharing. The authors describe how they integrated their service line cost through an hours model. From this they describe a formula for calculating the cost of protected time. The authors use mission-based budgeting to more accurately understand their physician costs and use the formula to effectively negotiate internal and external contracts.

Academic Medical Centers↗
PubMed2005

Dyspepsia and GERD: breaking the rules.

Dyspepsia is a common condition in clinical practice. Economic models have suggested that empirical PPI therapy may be cost-effective in uninvestigated dyspepsia. Empirical PPI therapy is an attractive alternative to endoscopic investigation in young dyspeptic patients who are not infected with Helicobacter pylori.

Dyspepsia↗
PubMed2005

Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives.

Our objective was to review and assess the treatment of low-tension wounds and evaluate the cost-effectiveness of wound closure methods. We used a health economic model to estimate cost/closure of adhesive wound closure strips, tissue adhesives and sutures. The model incorporated cost-driving variables: application time, costs and the likelihood and costs of dehiscence and infection. The model was populated with variable estimates derived from the literature. Cost estimates and cosmetic results were compared. Parameter values were estimated using national healthcare and labour statistics. Sensitivity analyses were used to verify the results. Our analysis suggests that adhesive wound closure strips had the lowest average cost per laceration ($7.54), the lowest cost per infected laceration ($53.40) and the lowest cost per laceration with dehiscence ($25.40). The costs for sutures were $24.11, $69.91 and $41.91, respectively; the costs for tissue adhesives were $28.77, $74.68 and $46.68, respectively. The cosmetic outcome for all three treatments was equivalent. We conclude adhesive wound closure strips were both a cost-saving and a cost-effective alternative to sutures and tissue adhesives in the closure of low-tension lacerations.

Bandages↗
PubMed2005

Pattern-oriented modeling of agent-based complex systems: lessons from ecology.

Agent-based complex systems are dynamic networks of many interacting agents; examples include ecosystems, financial markets, and cities. The search for general principles underlying the internal organization of such systems often uses bottom-up simulation models such as cellular automata and agent-based models. No general framework for designing, testing, and analyzing bottom-up models has yet been established, but recent advances in ecological modeling have come together in a general strategy we call pattern-oriented modeling. This strategy provides a unifying framework for decoding the internal organization of agent-based complex systems and may lead toward unifying algorithmic theories of the relation between adaptive behavior and system complexity.

Animals↗
PubMed2005

Trading water for carbon with biological carbon sequestration.

Carbon sequestration strategies highlight tree plantations without considering their full environmental consequences. We combined field research, synthesis of more than 600 observations, and climate and economic modeling to document substantial losses in stream flow, and increased soil salinization and acidification, with afforestation. Plantations decreased stream flow by 227 millimeters per year globally (52%), with 13% of streams drying completely for at least 1 year. Regional modeling of U.S. plantation scenarios suggests that climate feedbacks are unlikely to offset such water losses and could exacerbate them. Plantations can help control groundwater recharge and upwelling but reduce stream flow and salinize and acidify some soils.

Carbon↗
PubMed1996

Intimin from enteropathogenic Escherichia coli restores murine virulence to a Citrobacter rodentium eaeA mutant: induction of an immunoglobulin A response to intimin and EspB.

The formation of attaching and effacing (A/E) lesions is central to the pathogenesis of enteropathogenic Escherichia coli (EPEC)-mediated disease in humans and Citrobacter rodentium (formerly C. freundii biotype 4280)-mediated transmissible colonic hyperplasia in mice. Closely related outer membrane proteins, known as intimins, are required for formation of the A/E lesion by both EPEC (Int(EPEC)) and C. rodentium (Int(CR)). A secreted protein, EspB (formally EaeB), is also necessary for A/E-lesion formation. Here we report that expression of a cloned Int(EPEC), encoded by plasmid pCVD438, restores murine virulence to an intimin-deficient mutant of C. rodentium DBS255. Replacement of Cys937 with Ala abolished the ability of the cloned EPEC intimin to complement the deletion mutation in DBS255. Ultrastructural examination of tissues from wild-type C. rodentium and DBS255(pCVD438)-infected mice revealed multiple A/E lesion on infected cells and loss of contact between enterocytes and basement membrane. Histological investigation showed that although both wild-type C. rodentium and DBS255(pCVD438) colonized the descending colon and induced colonic hyperplasia in orally infected 21-day-old mice, the latter strain adhered to epithelial cells located deeper within crypts. Nonetheless, infection with the wild-type strain was consistently more virulent, as indicated by a higher mortality rate. All the surviving mice, challenged with either wild-type C. rodentium or DBS255(pCVD438), developed a mucosal immunoglobulin A response to intimin and EspB. These results show that C. rodentium infection provides a relevant, simple, and economic model to investigate the role of EPEC proteins in the formation of A/E lesions in vivo and in intestinal disease.

Adhesins, Bacterial↗
PubMed1994

Silk gland-specific tRNA(Ala) genes interact more weakly than constitutive tRNA(Ala) genes with silkworm TFIIIB and polymerase III fractions.

Constitutive and silk gland-specific tRNA(Ala) genes from silkworms have very different transcriptional properties in vitro. Typically, the constitutive type, which encodes tRNA(AlaC), directs transcription much more efficiently than does the silk gland-specific type, which encodes tRNA(AlaSG). We think that the inefficiency of the tRNA(AlaCG) gene underlies its capacity to be turned off in non-silk gland cells. An economical model is that the tRNA(AlaSG) promoter interacts poorly, relative to the tRNA(AlaC) promoter, with one or more components of the basal transcription machinery. As a consequence, the tRNA(AlaSG) gene directs the formation of fewer transcription complexes or of complexes with reduced cycling ability. Here we show that the difference in the number of active transcription complexes accounts for the difference in tRNA(AlaC) and tRNA(AlaSG) transcription rates. To determine whether a particular component of the silkworm transcription machinery is responsible for reduced complex formation on the tRNA(AlaSG) gene, we measured competition by templates for defined fractions of this machinery. We find that the tRNA(AlaSG) gene is greatly impaired, in comparison with the tRNA(AlaC) gene, in competition for either TFIIIB or RNA polymerase III. Competition for each of these fractions is also strongly influenced by the nature of the 5' flanking sequence, the promoter element responsible for the distinctive transcriptional properties of tRNA(AlaSG) and tRNA(AlaC) genes. These results suggest that differential interaction with TFIIIB or RNA polymerase III is a critical functional distinction between these genes.

Animals↗
PubMed1996

Health services market testing--the experience of the community services review team in British Forces Germany.

During 1993-1995 the health services in British Forces Germany were subjected to a market testing process by which the primary, community and acute health services for the British Servicemen and women, their families and attached civilian staff, a population of 70,000, were put out to competitive tender with the then current provider, the Defence Medical Services, as one tenderer for the contract. This paper outlines the methodology developed by the Health Alliance Community Services Review team in formulating a successful bid. It is considered that the process outlined could be of value to those involved in future market tests, commissioning projects or performance improvement programmes.

Community Health Nursing↗
PubMed1991

Economic analysis of vaccination applied to ovine listeriosis.

An economic model for determining whether vaccination against a disease would be beneficial financially on individual farms is proposed; it is based on four pieces of information: the costs of a disease case including its treatment, the cost of vaccinating each animal including veterinary fees, the expected incidence of the disease, and the efficacy of the vaccine. The model was applied to ovine listeriosis, which is a serious disease problem in Norway. Vaccination appeared to be beneficial for the average sheep flock of 100 ewes which might expect two or more cases of listeriosis per year. Furthermore, the model suggests the ratio of the price of a single vaccination to the cost of a disease case can be used to plan more efficient vaccine field trials.

Animals↗
PubMed2019

Recombinant Adeno-Associated Virus Gene Therapy in Light of Luxturna (and Zolgensma and Glybera): Where Are We, and How Did We Get Here?

The recent market approvals of recombinant adeno-associated virus (rAAV) gene therapies in Europe and the United States are landmark achievements in the history of modern science. These approvals are also anticipated to herald the emergence of a new class of therapies for monogenic disorders, which had hitherto been considered untreatable. These events can be viewed as stemming from the convergence of several important historical trends: the study of basic virology, the development of genomic technologies, the imperative for translational impact of National Institutes of Health-funded research, and the development of economic models for commercialization of rare disease therapies. In this review, these historical trends are described and the key developments that have enabled clinical rAAV gene therapies are discussed, along with an overview of the current state of the field and future directions.

Animals↗
PubMed2003

Cost-effectiveness of adjuvant treatment with acamprosate in maintaining abstinence in alcohol dependent patients.

An open prospective cohort study was performed in Germany in order to evaluate the costs of treating alcohol dependence under real-world conditions. Eight hundred and fourteen recently detoxified alcohol-dependent patients were provided with psychosocial rehabilitation support. In addition, 540 alcohol-dependent patients treated with adjuvant acamprosate therapy were compared with 274 patients without pharmacotherapy. Real costs were assessed over a period of one year. Of the patients who were treated with acamprosate, 33.6% remained abstinent compared to only 21.1% in the standard cohort. The mean total costs per patient treated with acamprosate were EUR 1,631.49 per year. In the standard cohort, total costs were EUR 2,068.83. This difference is highly significant (p = 0.012). Direct costs amounted to 76.9% of the total costs, with a 27% difference between the cohorts (p < 0.001). There was no difference in indirect costs between the two groups (p = 0.324). This real-cost study confirms the favourable cost-effectiveness of acamprosate previously suggested by pharmaco-economic modelling studies.

Acamprosate↗
PubMed2000

Economic outcomes of implantable cardioverter-defibrillators.

BACKGROUND: We reviewed the literature pertaining to the cost-effectiveness of implantable cardioverter-defibrillator (ICD) therapy in the management of ventricular fibrillation and tachycardia. Discussed are the methodology, advantages, and limitations of economic-outcomes analyses as related to ICD therapy; the impact of new technology and physician practice patterns; and methodological recommendations for future studies. METHODS AND RESULTS: Articles published between 1990 and 1997 were screened for cost-effectiveness analyses of ICD versus antiarrhythmic drug therapy. Randomized clinical trials, prospective and retrospective studies, and economic models were included. These studies report incremental cost-effectiveness ratios ranging from cost savings of $13 975 per life-year saved (LYS) to an incremental cost of $114 917 per LYS for ICD therapy. Differences were due to study type, cost-reporting methodology, ICD technology used, and length of follow-up. Assuming current technology and physician practice patterns, we find that ICD total therapy costs may break even in 1 to 3 years. CONCLUSIONS: Recent literature suggests that ICDs are a cost-effective therapy for management of life-threatening ventricular tachyarrhythmias. The advent of new technology and patient management practices should further improve the cost-effectiveness of ICD therapy. Future studies of ICD cost-effectiveness should address the implications of truncated follow-up periods and quality of life.

Cardiology↗
PubMed2003

Recent advances in telepsychiatry: an updated review.

OBJECTIVE: In response to new developments and interest in the area of telepsychiatry, literature on this topic has greatly increased over the past three years. Because of this increase, the authors conducted a literature review of telepsychiatry to update a previously published review that covered the years 1970 to 2000. METHODS: A search was conducted on the MEDLINE, PsycINFO, and Telemedicine Information Exchange (TIE) databases for literature published from March 2000 to March 2003 on telepsychiatry applications, using the following terms: telepsychiatry, telepsychology, telemental health, videoconferencing, and video conferencing. RESULTS: Sixty-eight publications were identified over this three-year period, exceeding the 63 publications identified in the previous literature review. The authors summarize the results of findings in six areas: novel clinical demonstrations and current program descriptions; the reliability of clinical assessments; clinical outcomes; satisfaction of patients and clinicians; cost and cost-effectiveness; and legal, regulatory, and ethical issues. Studies describing existing programs and novel clinical applications support the belief that the use of telepsychiatry is expanding. Overall, studies continued to support the notion that telepsychiatry assessments can produce reliable results, telepsychiatric services can lead to improved clinical status, and patients and clinicians are satisfied with treatment delivered via telepsychiatry. Evidence supported the notion that telepsychiatry is a cost-effective means of delivering mental health services; however, this conclusion was based on limited studies of economic models of telepsychiatry programs. Also limited were papers on the topics of legal, regulatory, and ethical issues. CONCLUSIONS: Despite the rapid increase in information on telepsychiatry, methodologically sound studies in the area of telepsychiatry are still infrequent.

Consumer Behavior↗
PubMed1997

The pattern-of-care model: a tool for planning community mental health services.

In periods of change, psychiatric services must project outcomes of decisions about service innovations and reductions, including budgetary implications. To support such decision making, a public-sector psychiatric service in Melbourne, Victoria, Australia, developed a modeling tool that combines data from its service activity database and budgetary information with modeling techniques based on use of a spreadsheet. The model is based on clients' use of three major service components: the inpatient unit, continuing clinical care and consultancy services, and crisis assessment and treatment services. It classifies clients according to patterns of care-that is, whether they used one, two, or three of the components, in various combinations. The authors report service use and financial data derived from the model for the financial year 1992-1993. They describe two scenarios for using the model to project changes in patterns of care and costs when new services are implemented. Such a model can clarify costs, including opportunity costs, of management decisions and facilitate participation of senior clinicians in active service planning within the realities of budgetary constraints.

Budgets↗
PubMed1982

Economic costs of attrition in clinical trials.

Conventional analyses of the cost-effectiveness of preventive regimens fail to account for the impact of attrition on reported costs. Using an economic model in which costs are allocated to fixed and variable components, and data from a recently completed clinical field trial, costs per participant are shown to vary with the rate of attrition. That this variation is usually obscured in reported studies results from methods conventionally used to measure the participants in calculating average costs. This paper proposes a method for resolving this dilemma by allocating costs among the number of beneficiaries in terms of resource utilization.

Adolescent↗