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PubMed2003

Posttraumatic stress disorder (PTSD) in the Armed Forces: health economic considerations.

This paper addresses the use of health economics in relation to posttraumatic stress disorder (PTSD) in the Armed Forces, with a view to assessing the feasibility of carrying out future evaluative studies. Although psychological and pharmacological interventions can be used to treat PTSD, no economic evaluations are known to exist. There is an economic burden associated with PTSD, and treatments require the use of scarce resources. Health economics provides tools (including cost-effectiveness, cost-benefit, and cost-utility analyses) to ascertain the relative efficiency of different treatment options. The paper concludes that the quality of life and resource consequences of PTSD require a better understanding of the economics of the disorder and the alternative ways to treat it.

Cost of Illness↗
PubMed2003

Industry-sponsored economic studies in oncology vs studies sponsored by nonprofit organisations.

The purpose of this analysis of health economic studies in the field of oncology was to investigate among sponsored studies whether any relationship could be established between the type of sponsorship and (1) type of economic analysis, (2) health technology assessed, (3) sensitivity analysis performed, (4) publication status, and (5) qualitative conclusions about costs. The Health Economic Evaluations Database (HEED, version 1995-2000) was searched on the basis of oncological ICD-9 codes, sponsorship, and comparative studies. This search yielded a total of 150 eligible articles. Their evaluations were prepared independently by two investigators, on the basis of specific criteria. When evaluators disagreed, a third investigator provided a deciding evaluation. There was no statistically significant relationship between the type of sponsorship and sensitivity analysis performed (P=0.29) or publication status (P=0.08). However, we found a significant relationship between the types of sponsorship and of economic analysis (P=0.004), the health technology assessed (P<0.0001), and qualitative cost assessment (P=0.002). Studies with industrial sponsorship were 2.56 (99% lower confidence interval (CI)=1.28) times more likely to involve cost-minimisation analyses, were 0.04 (99% higher CI=0.39) times less likely to investigate diagnostic screening methods, and were 1.86 (99% lower CI=1.21) times more likely to reach positive qualitative conclusions about costs than studies supported by nonprofit organisations. In conclusion, our results suggest that there is a greater probability that industry-sponsored economic studies in the field of oncology tend to be cost-minimisation analyses, to investigate less likely diagnostic screening methods, and to draw positive qualitative conclusions about costs, as compared to studies supported by nonprofit organisations.

Conflict of Interest↗
PubMed2001

Fat intake is more strongly associated with lifestyle factors than with socio-economic characteristics, regardless of energy adjustment approach.

OBJECTIVE: To compare how three different energy adjustment approaches influence the ranking of individuals on fat intake, and to examine the relation between fat intake and socio-economic, demographic and lifestyle characteristics for each energy adjustment approach. DESIGN: A cross-sectional analysis project, using a sub-sample (7055 women and 3240 men) from the Malmö Diet and Cancer Study. Dietary habits were assessed with an interview based diet history method. Fat intake was, depending on energy-adjustment method, defined as absolute intake (FATg), percentage energy from fat (FAT%), and residuals from total fat regressed on total energy (FATres). Cross-classification compared categorisation into fat intake quintiles. Logistic regression estimated, separately for each of the three approaches, the associations between high fat intake and socio-economic, demographic and lifestyle characteristics. RESULTS: Agreement in individuals' ranking was high between FAT% and FATres, but FATg differed substantially from the others. Current smoking, low level of leisure time physical activity and low alcohol intakes were, in multivariate analysis, consistently associated with risk of high fat consumption regardless of energy adjustment method. However, the associations with socio-economic characteristics varied with energy adjustment method and gender groups. CONCLUSIONS: The similarities between FAT% and FATres, in the ranking of individuals and in the association with lifestyle factors and socio-economic characteristics implies that it is possible to translate results obtained with FATres to recommendations using FAT%. The consistent lifestyle pattern across fat intake definitions (in energy adjusted models) may indicate that fat consumption is more strongly related to lifestyle factors than to socio-economic characteristics.

Aged↗
PubMed2006

Socio-economic status and abdominal obesity among Finnish adults from 1992 to 2002.

OBJECTIVE: To examine 10-year changes in waist circumference (WC) and identify socio-economic groups having higher WC than expected by their body mass index (BMI). DESIGN: Population based cross-sectional surveys carried out in four regions of Finland in 1992, 1997 and 2002. SUBJECTS: A total of 9026 women and 8173 men, aged 25-64 years. MEASUREMENTS: Waist circumference, BMI, socio-economic indicators (education, household income, employment status, marital status) and health behaviors (smoking, alcohol use, physical activity). RESULTS: In 2002, women had about 2.7 cm and men about 1.0 cm higher WC than subjects 10 years previously. Waist circumference increased more than BMI among women, especially among unemployed women. Higher WC among non-employed women was not explained by socio-economic indicators or health behaviors. Among men, smaller WC was associated with lower socio-economic status. However, associations partly disappeared after adjustment for health behaviors including physical activity at work. CONCLUSION: Socio-economic patterning of WC is divergent and gender-specific. More attention should be paid to increasing waistlines among women.

Alcohol Drinking↗
PubMed2003

A country-by-country comparison of FVIII concentrate consumption and economic capacity for the global haemophilia community.

The article presents a method to estimate the level of factor VIII (FVIII) concentrate consumption and economic capacity for each of the 110 countries considered in the study. A number of health-economic indicators were examined and purchasing power parity (PPP) gross national income (GNI) per capita had the strongest correlation with amount of FVIII concentrates sold in a country. Available data on FVIII concentrate consumption and health-economic indicators were used to calculate index values for FVIII use and economic capacity so each country can assess and compare its level of FVIII concentrate consumption with the economic resources of other countries in the global haemophilia A community. This article is of importance to policy makers, care givers and patient organizations in planning health-care resources for the treatment of haemophilia.

Developing Countries↗
PubMed1997

Anti-malarial drug resistance, malnutrition and socio-economic status.

To investigate the relationship between nutritional status and resistance to chloroquine treatment, we designed a nested case-control study prospective with respective to the outcome of Plasmodium falciparum-infected school children aged 5-14 years from Honiara, Solomon Islands. 38 chloroquine-resistant cases were compared with treatment-susceptible controls with respect to current nutritional status, behavioural characteristics, medical and demographic data. The overall prevalence of moderate malnutrition was 28%. The incidence rate of chloroquine resistance was 23%. Malnourished children were generally at higher risk for treatment failure than well-nourished ones (OR: 3.6; 95% CI: 1.6-8.4; P = 0.001). This effect was modified by socio-economic status. Stratified analysis by logistic regression resulted in an eightfold risk of resistance for malnourished children in the higher socio-economic category (OR: 8.1; 95% CI: 2.4-27.9; P = -.0001). In children from the lower socio-economic group, the effect of malnutrition was not significant (OR: 1.5; 95% CI: 0.4-5.6). Socio-economic differences may affect the immune status. The treatment response in children of lower socio-economic status, which are more exposed to malaria, may therefore be less affected by malnutrition.

Adolescent↗
PubMed2002

The economic payoffs of integrated malaria control in the Zambian copperbelt between 1930 and 1950.

It has long been suggested that malaria is delaying the economic development of countries that are most severely affected by the disease. Several studies have documented the economic consequences of malaria at the household level, primarily in communities engaged in subsistence farming. A missing element is the appraisal of the economic impact of malaria on the industrial and service sectors that will probably become the backbone of many developing economies. We estimate the economic effects of integrated malaria control implemented during the colonial period and sustained for 20 years in four copper mining communities of the former Northern Rhodesia (now Zambia). Integrated malaria control was characterized by strong emphasis on environmental management, while part of the mining communities also benefited from rapid diagnosis and treatment and the use of bednets. The programmes were highly successful as an estimated 14,122 deaths, 517,284 malaria attacks and 942,347 work shift losses were averted. Overall, 127,226 disability adjusted life years (DALYs) were averted per 3-year incremental period. The cumulative costs of malaria control interventions were 11,169,472 US dollars (in 1995 US dollars). Because the control programmes were so effective, the mining companies attracted a large reservoir of migrant labourers and sustained healthy work forces. The programmes averted an estimated 796,622 US dollars in direct treatment costs and 5,678,745 US dollars in indirect costs as a result of reduced work absenteeism. Within a few years of programme initiation, Northern Rhodesia became the leading copper producer in Africa, and mining generated the dominant share of national income. Copper production and revenues, which increased dramatically during malaria control interventions, amounted to the equivalent of 7.1 billion US dollars (in 1995 US dollars). Integrated malaria control in copper mining communities was a sound investment. It had payoff for public and occupational health, generally, and without it copper extraction and social and economic development would have been impossible.

Absenteeism↗
PubMed2001

The role of economic evaluation in mental health care.

OBJECTIVE: A consequence of the integration of psychiatry into acute and public health medicine is that psychiatrists are being asked to evaluate their services. There is pressure on mental health-care systems because it is recognized that funds should be directed where they can provide the best health outcomes, and also because there are resource constraints which limit our capacity to meet all demands for health care. This pressure can be responded to by evaluation which demonstrates the effectiveness and efficiency of psychiatric treatment. This paper seeks to remind psychiatrists of the fundamental principles of economic evaluation in the hope that these will enable psychiatrists to understand the methods used in evaluation and to work comfortably with evaluators. METHOD: The paper reviews the basic principles behind economic evaluation, illustrating these with reference to case studies. It describes: (i) the cost of the burden of illness and treatment, and how these costs are measured; (ii) the measurement of treatment outcomes, both as changes in health status and as resources saved; and (iii) the various types of economic evaluation, including cost-minimization, cost-effectiveness, cost-utility and cost-benefit analysis. RESULTS: The advice in the paper provides psychiatrists with the necessary background to work closely with evaluators. A checklist of the critical questions to be addressed is provided as a guide for those undertaking economic evaluations. CONCLUSIONS: If psychiatrists are willing to learn the basic principles of economic evaluation and to apply these, they can respond to the challenges of evaluation.

Australia↗
PubMedDate not supplied

Indirect economic effects of long-term breast cancer survival.

PURPOSE: The indirect morbidity/disability costs of breast cancer may be rising as a consequence of the growth in the population of long-term survivors. This study was conducted to test whether women who have survived breast cancer for at least 5 years experience long-lasting or continuing economic consequences that are attributable to their disease. DESCRIPTION OF STUDY: A group of 105 women who initially had been treated for breast cancer approximately 5 years before were interviewed to obtain data on economic, demographic, and health changes in the period since diagnosis. An age-matched and work-matched group of 105 women without cancer also was interviewed to obtain the same data for the same time period. Key changes in the economic position of subjects and their families were measured, including changes in work effort, pay rates, and annual earnings of working women and changes in household earnings, income, and assets of all women. RESULTS: These preliminary empirical findings suggest that breast cancer exacts an economic toll from long-term survivors. In particular, survivors who were working at the time of their diagnosis experienced significantly larger reductions in annual market earnings over the 5-year study period than did working control subjects. These losses appear to arise mostly from reduced work effort, not changes in pay rates. Also, changes in total household earnings were lower for survivors, suggesting the presence of family adjustments to the disease. However, no significant differences were detected between the groups in changes in total income or assets over the study period. CLINICAL IMPLICATIONS: Clinicians and policy makers must seek ways to minimize the indirect economic losses that are attributable to breast cancer.

Breast Neoplasms↗
PubMedDate not supplied

Towards a European consensus on conducting and reporting health economic evaluations--a report from the ISPOR Inaugural European Conference.

This report is a summary of key issues in consensus development regarding the conduct and reporting of health economic research in the European context, presented and discussed at the ISPOR Inaugural European Conference in Cologne, Germany, December 1998. Recommendations of the Harmonization by Consensus of the Methodology for Economic Evaluation of Health Care Technologies in the European Union (HARMET) project were presented, as well as two instruments under development: software for Reporting Economic Evaluation Results (REER) and software for collecting and managing cost data called the Health Cost Database Software (HCDS). Working independently, but interrelated with the objectives of the HARMET initiative, preliminary results from the ongoing European Network on Methodology and Application of Economic Evaluation Techniques (EUROMET) project were presented. Each presentation was followed by an expert discussion panel with audience participation. Issues raised included the development of standards and related topics such as usefulness to European decision-makers, and education and training in health economics in Europe.

Journal Article↗
PubMed2003

Measuring costs and consequences in economic evaluation in asthma.

Formal economic evaluation is playing an increasingly important role in health-care decision-making. This is shown by the requirement to present economic data to support applications for public reimbursement for new pharmaceuticals in Australia and the provinces of Canada, and by the appraisal process initiated by the National Institute for Clinical Excellence in the U.K. This growing role of economic analysis applies as much to the field of asthma as anywhere. This paper provides a detailed review of applied economic studies in asthma. The review is used to explore a range of methodological issues in the field including the choice of perspective and maximand, whether to use disease-specific or generic measures of outcome and whether decision-makers should receive disaggregated cost and consequence data or results that focus on an incremental cost-effectiveness ratio. It is concluded that, given the heterogeneity in decision-makers' objectives and constraints, economic studies should be planned and executed in such a way as to maximize flexibility in how results are presented.

Anti-Asthmatic Agents↗
PubMed2002

[Socio-economic differences in the utilisation of screening programmes and health promotion measures in North Rhine-Westphalia, Germany].

This paper examines the effect of socio-economic status on the utilisation of screening programmes and health promotion measures, based on data of a representative health survey in North Rhine-Westphalia (Germany), with a sample of 1,920 respondents. The analysis focuses especially on the utilisation of the cancer screening programme and the 'Health Check-Up' programme, which both have a high rank in German secondary prevention strategies. During the study year and the year before 29.2 % of the relevant male and 56.5 % of the female population took part in cancer screening programmes. At the same time 29.6 % of the males and 30.1 % of the females took part in the 'Health Check-Up' programme. In respect of socio-economic differences, the data confirmed the results of former studies in which non-participation of cancer screening programmes increased with decreasing social class. The social gradient was more pronounced with women than with men. While for the 'Health Check-Up' no socio-economic differences could be found, the participation rates in health promotion measures for women varied significantly with socio-economic status. For both screening programmes generally weaker statistical associations were found if the socio-economic status index was substituted by the educational level of the respondents. The findings suggest that strategies designed to increase participation of such programmes should concentrate more on lower social status persons to prevent the development of inequalities in health.

Adolescent↗
PubMed1997

Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning.

BACKGROUND: Although the relation between low income and poor health is well established, most previous research has measured income at only one time. METHODS: We used income information collected in 1965, 1974, and 1983 from a representative sample of adults in Alameda County, California, to examine the cumulative effect of economic hardship (defined as a total household income of less than 200 percent of the federal poverty level) on participants who were alive in 1994. RESULTS: Because of missing information, analyses were based on between 1081 and 1124 participants (median age, 65 years in 1994). After adjustment for age and sex, there were significant graded associations between the number of times income was less than 200 percent of the poverty level (range, 0 to 3) and all measures of functioning examined except social isolation. As compared with subjects without economic hardship, those with economic hardship in 1965, 1974, and 1983 were much more likely to have difficulties with independent activities of daily living (such as cooking, shopping, and managing money) (odds ratio, 3.38; 95 percent confidence interval, 1.49 to 7.64), activities of daily living (such as walking, eating, dressing, and using the toilet) (odds ratio, 3.79; 95 percent confidence interval, 1.32 to 9.81), and clinical depression (odds ratio, 3.24; 95 percent confidence interval, 1.32 to 7.89) in 1994. We found little evidence of reverse causation -- that is, that episodes of illness might have caused subsequent economic hardship. CONCLUSIONS: Sustained economic hardship leads to poorer physical, psychological, and cognitive functioning.

Activities of Daily Living↗
PubMed1996

National policies for technical change: where are the increasing returns to economic research?

Improvements over the past 30 years in statistical data, analysis, and related theory have strengthened the basis for science and technology policy by confirming the importance of technical change in national economic performance. But two important features of scientific and technological activities in the Organization for Economic Cooperation and Development countries are still not addressed adequately in mainstream economics: (i) the justification of public funding for basic research and (ii) persistent international differences in investment in research and development and related activities. In addition, one major gap is now emerging in our systems of empirical measurement-the development of software technology, especially in the service sector. There are therefore dangers of diminishing returns to the usefulness of economic research, which continues to rely completely on established theory and established statistical sources. Alternative propositions that deserve serious consideration are: (i) the economic usefulness of basic research is in the provision of (mainly tacit) skills rather than codified and applicable information; (ii) in developing and exploiting technological opportunities, institutional competencies are just as important as the incentive structures that they face; and (iii) software technology developed in traditional service sectors may now be a more important locus of technical change than software technology developed in "high-tech" manufacturing.

Employment↗
PubMed2005

Interactions between traditional regional determinants and socio-economic status on dietary patterns in a sample of French men.

The aim of the present study was to assess the respective contributions of regional and socio-economic factors to dietary pattern. We used the data from the final MONICA (MONItoring of trends and determinants in Cardiovascular disease) population survey conducted in the three French centres in 1995-7 among a representative sample of 976 men aged 45-64 years. Dietary intake was assessed using a 3-d record method. Dietary patterns were identified by a factor analysis, based on fifteen food items. An analysis of variance was then used to study their relationship with regional and socio-economic determinants. Two major dietary patterns were identified: a 'Western diet', characterized by high intakes of sugar and sweets, grains, butter, added fats, eggs, potatoes and cheese; a 'prudent diet', mainly distinguished by high intakes of fruit, vegetables, olive oil and fish and low intakes of alcohol, high-fat meat and potatoes. Strong associations were mostly observed with the 'prudent diet' pattern, with a significant relationship with region, educational and income-tax levels, leisure-time physical activity and smoking status. There was also a statistically significant interaction between region and educational level (P=0.05), and between region and income-tax level (P=0.03), indicating that the influence of socio-economic factors is different among regions. In conclusion, these results indicate large regional and socio-economic differences in the dietary patterns of this French male population. When considering the 'prudent diet' pattern, they also suggest that traditional regional influences may now be overcome by socio-economic determinants.

Aged↗
PubMed1998

Operational research on the economics of insecticide-treated mosquito nets: lessons of experience.

Over the last 10 years or so, awareness has grown of the importance of including an economic component in studies evaluating the potential of new interventions against the main tropical diseases such as malaria. There has been a tendency to regard this as a simple addition to carry out, not requiring specialised knowledge or skills, or substantial time and resources. One consequence has been the rather slow development of knowledge on economic aspects, with a literature that is both small and of uneven quality. This review draws on the experience of supporting the addition of an economic component to the large African trials of the impact of insecticide-treated mosquito nets, as well as on a broader knowledge of the literature on the economics of malaria, to discuss what type of economic information can be useful and what questions it can be used to answer, how the information can be obtained, what pitfalls are likely to be encountered in interpretation, and what needs to be done to improve the quantity and quality of studies.

Bedding and Linens↗
PubMed2006

The global economic burden of alcohol: a review and some suggestions.

Economic arguments for acting for health are increasingly important for policymakers, yet to date there has been no consideration of the likely economic burden of alcohol on the global level. A review of existing cost estimates was conducted, with each study disaggregated into different cost areas and the methodology of each element evaluated. The range of figures produced from more robust studies was then applied tentatively on the global level. The reviewed studies suggested a range of estimates of 1.3-3.3% of total health costs, 6.4-14.4% of total public order and safety costs, 0.3 - 1.4 per thousand of GDP for criminal damage costs, 1.0-1.7 per thousand of GDP for drink-driving costs, and 2.7-10.9 per thousand of GDP for work-place costs (absenteeism, unemployment and premature mortality). On a global level, this suggests costs in the range of US dollars 210-665 billion in 2002. These figures cannot be understood without considering simultaneously six key problems: (i) the methods used by each study; (ii) who pays these costs; (iii) the 'economic benefits' of premature deaths; (iv) establishing causality; (v) omitted costs; and (vi) the applicability of developed country estimates to developing countries. Alcohol exerts a considerable economic burden worldwide, although the exact level of this burden is a matter of debate and further research. Policymakers should consider economic issues alongside evidence of the cost-effectiveness of particular policy options in improving health, such as in the WHO's CHOICE project.

Alcohol Drinking↗
PubMed1996

Outcomes measurement: health state preferences and economic evaluation.

A major health care policy issue in this era of accountability is controlling the introduction and utilization of increasingly sophisticated and expensive health care technologies. Data are needed about both the effectiveness and the costs of assistive technologies before making decisions without relying on "that's what we did last time," "gut feelings," or even "educated guesses." Services, such as assistive technology, fall in the category where rigorous scientific evidence about cost-effectiveness is virtually nonexistent. The field of medical technology assessment has been studying cost-effectiveness for decades and offers many methodological ideas to related fields such as assistive technology. Based on the experiences of medical technology assessment, the measurement of health state preferences and its use to estimate quality-adjusted life years is discussed in this paper. Economic evaluation can be defined as the comparative analysis of alternative courses of action in terms of both costs and consequences. Information from economic evaluation studies, including the use of quality-adjusted life years as an outcome measure, helps us to determine which health care services we can afford to incorporate into routine clinical practice. The major forms of economic evaluation for health care described in this paper are cost-benefit, cost-effectiveness, and a special form of cost-effectiveness, cost-utility. Important national and state health care policies are being considered and implemented on the basis of economic evaluation data and these are bound to have major implications for assistive technology. The assistive technology field needs to be aware of these methods both to understand how large scale health-related policy decisions are impacted by economic evaluations and to become participants in and contributors to this process.

Cost-Benefit Analysis↗