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PubMed2002

Searching literature databases for health care economic evaluations: how systematic can we afford to be?

BACKGROUND: As the health care economic-evaluation literature continues to grow, a need for sound methods to conduct systematic reviews of the existing evidence is emerging. So far, reviews of economic evaluations have relied upon noncomprehensive sources and have adopted simplistic search methods, both likely to lead to biased results. OBJECTIVE: To provide evidence of the performance of alternative approaches for identifying published health care economic evaluations and to illustrate what forms of bias may affect systematic reviews of such studies. METHODS: The sensitivity and specificity of alternative search strategies were tested for the period January to March 1997, using seven major medical and social science literature databases, one economic evaluation database and a published bibliography. Studies were selected blindly by pairs of reviewers (agreement 94.1%-96.5%), using a two-stage procedure. RESULTS: By limiting the scope of a review to Medline and by using appropriate search strategies, researchers may significantly reduce the number of nonrelevant references retrieved by their electronic searches (sensitivity 72%, specificity 75%, compared with more extensive strategies), which require exclusion by manual screening. The yield of searches based on specialized bibliographies and databases may be different because of variations in selection criteria, coverage and time lag for inclusion of references. CONCLUSIONS: Medline is the key source for reviews of economic evaluations. Researchers may select from the search strategies proposed in this paper the one that offers an optimal balance between sensitivity and specificity in relation to the aims of their review. Manual searches and searches of databases other than Medline have a limited incremental yield. The sensitivity of all search strategies increases when tighter methodological standards are set, but more research is needed on methods for identifying methodologically sound studies.

Bias↗
PubMed1999

The effect of increased consumer demand on fees for aesthetic surgery: an economic analysis.

Economic theory dictates that changes in consumer demand have predictable effects on prices. Demographics represents an important component of demand for aesthetic surgery. Between the years of 1997 and 2010, the U.S. population is projected to increase by 12 percent. The population increase will be skewed such that those groups undergoing the most aesthetic surgery will see the largest increase. Accounting for the age-specific frequencies of aesthetic surgery and the population increase yields an estimate that the overall market for aesthetic surgery will increase by 19 percent. Barring unforeseen changes in general economic conditions or consumer tastes, demand should increase by an analogous amount. An economic demonstration shows the effects of increasing demand for aesthetic surgery on its fees. Between the years of 1992 and 1997, there was an increase in demand for breast augmentation as fears of associated autoimmune disorders subsided. Similarly, there was increased male acceptance of aesthetic surgery. The number of breast augmentations and procedures to treat male pattern baldness, plastic surgeons, and fees for the procedures were tracked. During the study period, the supply of surgeons and consumer demand increased for both of these procedures. Volume of breast augmentation increased by 275 percent, whereas real fees remained stable. Volume of treatment for male pattern baldness increased by 107 percent, and the fees increased by 29 percent. Ordinarily, an increase in supply leads to a decrease in prices. This did not occur during the study period. Economic analysis demonstrates that the increased supply of surgeons performing breast augmentation was offset by increased consumer demand for the procedure. For this reason, fees were not lowered. Similarly, increased demand for treatment of male pattern baldness more than offset the increased supply of surgeons performing it. The result was higher fees. Emphasis should be placed on using these economic relationships to expand the demand for aesthetic surgery.

Fees, Medical↗
PubMed2001

Economic analysis of basiliximab in renal transplantation.

BACKGROUND: Basiliximab is a chimeric monoclonal directed against the alpha-chain of the interleukin-2 receptor. International studies have shown that it is highly effective in preventing acute rejection in patients receiving Neoral, and causes no measurable incremental toxicity, but its economic value remains unknown. METHODS: This study employed an economic model to examine the potential economic benefit of basiliximab. Parameter estimates were derived from a randomized, prospective, double-blind study conducted in 21 renal transplant centers in seven countries in which 380 adult primary allograft recipients were randomized within center to receive basiliximab (20 mg i.v.) on days 0 and 4 or placebo in addition to dual immunosuppression with Neoral and steroids. Key clinical events included primary hospitalization, immunosuppressive drug use, patient and graft survival, graft rejection, treatment of rejection, dialysis, and repeat hospitalization. Health resources were valued via a comprehensive electronic cost dictionary, based upon a detailed economic evaluation of renal transplantation in Canada. Medication costs were calculated from hospital pharmacy acquisition costs; basiliximab was assessed a zero cost. RESULTS: The average estimated cost per patient for the first year after transplant was $55,393 (Canadian dollars) for placebo and $50,839 for basiliximab, rising to $141,690 and $130,592, respectively, after 5 years. A principal component of the cost in both groups was accrued during the initial transplant hospitalization ($14,663 for standard therapy and $14,099 for basiliximab). An additional $15,852 and $14,130 was attributable to continued care, graft loss, and dialysis in the two groups, whereas follow-up hospitalization consumed an additional $15,538 for placebo and $13,916 for basiliximab. The mean incremental cost of dialysis was $5,397 for placebo compared with $3,821 for basiliximab, whereas incremental costs of graft loss were $2,548 compared with $2,295 in the two treatment groups. The principal costs associated with repeat admission to the transplant ward and the general ward were marginally higher for placebo ($7,395 vs. $6,300 and $5,986 vs. $4,625). Treatment of acute rejection and maintenance immunosuppressive drug use were associated with only limited savings as a result of basiliximab (savings <$200 each). Sensitivity analysis indicated that the most influential parameters affecting the savings as a result of using basiliximab were a reduction in the duration of initial and repeat hospitalization followed by the reduced risks of acute rejection and graft loss. CONCLUSIONS: Before accounting for the cost of the therapy itself, basiliximab produces an estimated economic saving of $4,554 during the first year after transplant, of which $3,344 is attributable to the reduced costs of graft dysfunction, including graft loss and dialysis ($1,722) and follow-up hospitalizations ($1,622). When marketed, basiliximab is expected to cost approximately $3,000 per course (two doses of 20 mg), resulting in a net first-year saving of $1,554. Under these circumstances, basiliximab can be considered a dominant therapy in renal transplantation.

Antibodies, Monoclonal↗
PubMed2006

Socio-economic and occupational risk factors for gastric cancer: a cohort study in Sweden.

The effects of socio-economic/occupational factors on gastric cancer at various subsites (including corpus, cardia and unspecified cancers) are not well known. To investigate this issue, we carried out a follow-up study on the economically active Swedish population, based on the Swedish Family-Cancer Database. We calculated standardized incidence ratios and 95% confidence intervals for different occupational groups, adjusted for age, period, region and socio-economic status. The reference group was all the economically active population. Manual workers and farmers were at an increased risk of stomach cancer. An increased risk of corpus cancer was observed for male miners and quarry workers, fishermen, construction workers, packers, loaders and warehouse workers, clerical workers and female assistant nurses and postal workers. For cardia cancer, significantly increased standardized incidence ratios were observed for gardeners, transport workers, bricklayers and chemical process workers among men. Only male miner and quarry workers showed significantly increased risk of unspecified cancer. In conclusion, the present study indicates that socio-economic groups differ in risk by almost a factor of two for corpus and unspecified cancers, and less for cardia cancers. Cement and mineral dusts appear as major occupational risk factors.

Cohort Studies↗
PubMedDate not supplied

Economics of prevention: the public health research agenda.

Public health policy makers often focus their attention on the economic evaluation methods (eg, cost-benefit and cost-effectiveness analyses) because of their interest in the economic returns from investment in prevention programs. This article presents a case for the broader applicability of economic theories and methods in development of public health prevention research issues. Public financing, delivery, and regulatory policies are often advocated and used to correct the imperfections in the market for preventive health services. A proper understanding of the incentives and constraints faced by individual agents in the market, however, can improve the effectiveness of these policies in achieving the prevention targets. In developing a research agenda, economics can play a more substantial role beyond the traditional economic evaluation research.

Health Services Needs and Demand↗
PubMed2004

The economic burden of dry eye: a conceptual framework and preliminary assessment.

PURPOSE: To develop a conceptual framework for analyzing the economic burden of dry eye and a preliminary assessment of key factors that contribute to that burden. METHODS: The MEDLINE database was searched from 1966 to May 2003 combining the term "dry eye" with various economic terms. In addition, individual interviews with a panel of clinicians were conducted to provide additional insight on resource use. RESULTS: Direct resource utilization among dry eye sufferers includes healthcare professional visits, nonpharmacological therapies, pharmacological treatments, and surgical procedures, with the latter 2 categories being the major cost drivers. Complementary and alternative medicine (CAM) therapies are a newly recognized component of the dry eye economic burden. There is wide variation in patterns of diagnosis and treatment, but current therapies are not universally effective. Given the prevalence of the condition, indirect costs may be large. Utilization of pharmacological therapies, especially those other than tear replacements, the extent of CAM use, cost of complications of surgical procedures, and indirect costs are unknown. The natural history and probability that patients will transition between therapies, based on underlying disease severity, need to be elucidated. CONCLUSIONS: Dry eye is a prevalent condition with the potential for a high economic burden; additional studies are needed to further characterize the economic impact.

Cost of Illness↗
PubMed2005

Economic considerations for pertussis booster vaccination in adolescents.

BACKGROUND: Despite good acellular pertussis vaccine safety and protective efficacy, as well as high vaccination rates among young children, the incidence of pertussis in the United States has steadily increased since the 1980s. This is especially true for adolescents and adults who are susceptible because of waning immunity, which is not long lived. Other populations are at increased risk for morbidity of infection, although infants younger than 6 months of age who have not completed the primary immunization series have the greatest morbidity and mortality. Other groups who might benefit from booster immunizations include hospital workers, family contacts, and individuals with compromised health. Although older individuals generally have milder illnesses, they are often the source of infection for younger children. An adolescent/adult formulation of acellular pertussis vaccine requires a lower dose of pertussis antigens and can be combined with currently recommended diphtheria and tetanus toxoids (Tdap). These new vaccines for adolescents and adults are safe, immunogenic, and protective. METHODS: Through an extensive review of the literature, the direct and indirect costs associated with pertussis and its complications are examined, cost-benefit analyses of pertussis booster vaccination are evaluated for different groups, and the economic considerations involved in implementing a pertussis booster vaccination program in adolescents are discussed. RESULTS: Pertussis infections cause outbreaks in schools, families, and workplaces, resulting in prolonged morbidity and significant costs for medical care, lost time, and wages. Physician visits, chest radiographs, and antibiotics comprise the majority of direct costs, and costs associated with work loss often comprise the majority of indirect costs related to pertussis illness. Adolescents and adults also transmit their infections to nonimmune children. A cost-benefit analysis evaluated the health and economic benefits of seven strategies for administering a pertussis booster. The most economical strategy is to immunize all adolescents 10-19 years of age, which may prevent 0.4-1.8 million cases of pertussis and save US 0.3-1.6 billion dollars in a decade. A tetanus and diphtheria booster (Td) is currently recommended for children 11-12 years of age. The Tdap vaccine offers an enhancement for the Td booster by providing protection against pertussis, and it will not require an additional injection or office visit. CONCLUSIONS: Immunizing adolescents with a pertussis booster in the form of Tdap is the most economical and easiest-to-implement strategy and should provide significant health and economic benefits.

Adolescent↗
PubMed2026

Childhood Economic Mobility and Systemic Inflammation Among Men Who Experienced Low Income in Toddlerhood: The Moderating Role of Trait Hostility.

OBJECTIVE: Childhood economic upward mobility (ie, increases in family income across childhood) may attenuate links between childhood poverty and systemic inflammation in adulthood, the extent of which may vary depending on inter-individual differences in personality characteristics, including hostility. METHODS: Men who experienced low income in toddlerhood (N=171) were followed prospectively into adulthood. Annual family income was collected 12 times when men were 1.5 to 17 years old. Men completed the Cook-Medley Hostility Scale and had their fasting blood drawn to measure circulating levels of C-reactive protein (CRP) at age 32. Multiple linear regression analyses examined main and moderation effects of childhood economic upward mobility and adult hostility on CRP levels adjusting for income at 1.5 years, race, parent educational attainment, and adult income, education, waist circumference, and smoking status. RESULTS: Main effects were nonsignificant, but an interaction effect emerged. Counter to expectations, childhood economic upward mobility related to greater adult CRP as trait hostility decreased ( &#x3b2; =-0.203, P =.018). Simple slope analyses further revealed that childhood economic upward mobility was positively associated with CRP among men lower in hostility ( &#x3b2; =0.23, SE=0.09, P =.020) but was unrelated to CRP among men higher in hostility. Results of post hoc sensitivity analyses are also discussed. CONCLUSIONS: Counterintuitive findings suggest that for men who experience poverty in toddlerhood, the association between childhood economic upward mobility and adult CRP may be nuanced and even in the positive direction for men low in hostility, which aligns with work on unintended health consequences of upward mobility.

Humans↗
PubMed2003

Clinical and economic impact of Apligraf for the treatment of nonhealing venous leg ulcers.

BACKGROUND: Controlled studies have shown that Apligraf(R) (Organogenesis Inc., Canton, USA) is more economical and more effective at healing venous leg ulcers (VLUs) than compression therapy alone. However, the clinical and economic impact of Apligraf on healing VLUs in clinical practice has not been fully examined. METHODS: A medical chart review was conducted of patients who were treated with Apligraf for one or more nonhealing VLUs over a 2-year period at the Henry Ford Hospital. Following Apligraf treatment, patients were followed for up to 9 months. Primary clinical outcome measures were mean change in baseline ulcer size (cm2) per week and percent reduction in baseline ulcer size at final study visit. Economic evaluation of Apligraf treatment was based on VLU-related medical care costs (US$) in relation to ulcer size (cm2) changes before and after Apligraf therapy. RESULTS: Thirteen patients with 21 chronic VLUs were treated with Apligraf. All had at least one comorbidity, most commonly hypertension (38%). Twelve patients were known to have had a prior history of VLU. At baseline, mean ulcer duration was 23.9 months and median ulcer size was 13.5 cm2; for the 6 months preceding Apligraf treatment, in which patients received conventional compression therapy, mean ulcer size increased +0.72 cm2 per week. During the Apligraf post-treatment study period, mean ulcer size decreased by -2.37 cm2 per week. At final clinic visit, ulcers exhibited an average 60.5% reduction in baseline size; 21 ulcers (n = 13) showed 75% or greater reduction in size, compared with baseline. Economic data were available for five patients; among these individuals ulcer-related medical costs per unit change in ulcer size were lower following Apligraf treatment relative to such costs with conventional compression therapy applied during the Apligraf pretreatment period. CONCLUSIONS: In a clinical practice setting, Apligraf is more effective and more economical at healing VLUs than conventional therapy alone.

Aged↗
PubMed2005

Economic values for resistance to gastrointestinal helminths in meat sheep in Kenya.

Economic values for resistance to gastrointestinal (GI) helminths in meat sheep were estimated based on previously published genetic and phenotypic parameters in a selection index objectively optimizing gains on yearling weight (YW). A two-trait index of YW and faecal egg count (FEC) were considered when accounting only for tangible roles of sheep production using individual records for index calculation (scheme 1) or including individual, sire, dam and male paternal half-sib information (scheme 2). Schemes 3 and 4 were similar to schemes 1 and 2, respectively, but accounted for both tangible and intangible roles of sheep production. Economic values within each scheme were estimated for five breeding objectives as follows: (i) index response in YW equals response from single trait selection, (ii) index response in YW is maximum, (iii) the level of FEC was held constant, (iv) A predetermined response of -0.22 (x1000) eggs per gram was assumed and (v) Monetary value of response in FEC is minimum. All estimated economic values were negative, and were Kenya Shillings (KSh) -34.90 (US dollar -0.50), 0.00, -92.20 (US dollar -1.32), -153.31 (US dollar -2.19) and -47.90 (US dollar -0.68), respectively, for options 1-5 in scheme 1. In all schemes the breeding options ranked 4, 3, 5 and 1 in descending order; however, options 1 and 5 exchanged positions in schemes 2 and 4. Economic values were responsive to changes in heritability of FEC and genetic correlation between the two traits. The magnitude of the economic values reflects the importance of including resistance to GI helminths in the breeding objectives for meat sheep in different production systems.

Animals↗
PubMed2002

Suicide differentials in Australian males and females by various measures of socio-economic status, 1994-98.

OBJECTIVES: To investigate Australian suicide differentials in males and females by three area-based measures of socio-economic status (SES). METHODS: Suicide data for 1994-98 were used to investigate area-based gradients of SES for the Index of Relative Socio-Economic Disadvantage (IRSED) (an overall measure of SES), the Index of Economic Resources (IER), and the Index of Education and Occupation (IEO), using Poisson regression models adjusting for age, country-of-birth and urban-rural residence. RESULTS: After adjusting for age, country-of-birth and urban-rural residence, significant increasing linear trends in suicide risk from high to low quintiles of SES were evident in males for the IRSED (an average multiplicative increase in suicide risk of 8% per quintile), IER (9% increase) and IEO (5% increase). For females, there was no evident SES gradient for the IRSED after adjusting for age, country-of-birth and urban-rural residence, but a significant positive linear trend from high to low quintiles of SES was found for the IER (6% increase per quintile). A significant decreasing linear trend (increasing suicide risk with increasing SES) was evident for the IEO (30% per quintle). CONCLUSION: Male suicide is positively associated with all three measures of SES examined. Female suicide is significantly associated with the IER (positive association) and IEO (negative), and because of this is not associated with the overall measure of SES. These findings partly explain why female suicide has been found to be poorly correlated with area-based measures of SES. IMPLICATIONS: Specific components of area-based socio-economic status provide a clearer picture of socio-economic suicide differentials in Australian females, with implications for population-based preventive strategies.

Adolescent↗
PubMed2004

Utilisation of general practitioner services by socio-economic disadvantage and geographic remoteness.

OBJECTIVE: To examine the association between socio-economic status (SES) and GP utilisation across Statistical Local Areas (SLAs) that differed in their geographic remoteness, and to assess whether Indigenous status and GP availability modified the association. DESIGN: Retrospective analysis of Medicare data for all unreferred GP consultations (1996/97) for 952 SLAs comprising the six Australian States. Geographic remoteness was ascertained using the Area Remoteness Index of Australia (ARIA), and SES was measured by grouping SLAs into tertiles based on their Index of Relative Socioeconomic Disadvantage score. MAIN OUTCOME MEASURE: Age/sex standardised rates of GP utilisation for each SLA. MAIN RESULTS: In SLAs classified as 'highly accessible', rates of GP use were 10.8% higher (95% CI 5.7-16.0) in the most socio-economically disadvantaged tertile after adjustment for Indigenous status and GP availability. A very different pattern of GP utilsation was found in 'remote/very remote' SLAs. After adjustment, rates of GP use in the most socio-economically disadvantaged tertile were 25.3% lower (95% CI 5.9-40.7) than in the most advantaged tertile. CONCLUSIONS: People in socio-economically disadvantaged metropolitan SLAs have higher rates of GP utilisation, as would be expected due to their poorer health. This is not true for people living in disadvantaged remote/very remote SLAs: in these areas, those most in need of GP services are least likely to receive them. Australia may lay claim to having a primary health care system that provides universal coverage, but we are still some way from having a system that is economically and geographically accessible to all.

Ambulatory Care↗
PubMed2006

The effect of rural hospital closures on community economic health.

OBJECTIVE: To examine the effect of rural hospital closures on the local economy. DATA SOURCES: U.S. Census Bureau, OSCAR, Medicare Cost Reports, and surveys of individuals knowledgeable about local hospital closures. STUDY DESIGN: Economic data at the county level for 1990-2000 were combined with information on hospital closures. The study sample was restricted to rural counties experiencing a closure during the sample period. Longitudinal regression methods were used to estimate the effect of hospital closure on per-capita income, unemployment rate, and other community economic measures. Models included both leading and lagged closure terms allowing a preclosure economic downturn as well as time for the closure to be fully realized by the community. DATA COLLECTION: Information on closures was collected by contacting every state hospital association, reconciling information gathered with that contained in the American Hospital Association file and OIG reports. PRINCIPAL FINDINGS: Results indicate that the closure of the sole hospital in the community reduces per-capita income by 703 dollars (p<0.05) or 4 percent (p<0.05) and increases the unemployment rate by 1.6 percentage points (p<0.01). Closures in communities with alternative sources of hospital care had no long-term economic impact, although income decreased for 2 years following the closure. CONCLUSIONS: The local economic effects of a hospital closure should be considered when regulations that affect hospitals' financial well-being are designed or changed.

Health Facility Closure↗
PubMedDate not supplied

Cardiac resynchronization therapy (CRT) in heart failure--a model to assess the economic value of this new medical technology.

OBJECTIVES: This article describes the framework of a comprehensive European model developed to assess clinical and economic outcomes of cardiac resynchronization therapy (CRT) versus optimal pharmacological therapy (OPT) alone in patients with heart failure. METHODS: The model structure is based on information obtained from the literature, expert opinion, and a European CRT Steering Committee. The decision-analysis tool allows a consideration of direct medical and indirect costs, and computes outcomes for distinctive periods of time up to 5 years. Qualitative data can also be entered for cost-utility analysis. Model input data for a preliminary economic appraisal of the economic value of CRT in Germany were obtained from clinical trials, experts, health statistics, and medical tariff lists. RESULTS: The model offers comprehensive analysis capabilities and high flexibility so that it can easily be adapted to any European country or special setting. The illustrative analysis for Germany indicates that CRT is a cost-effective intervention. Although CRT is associated with average direct medical net costs of Euro 5880 per patient, this finding means that 22% of its upfront implantation cost is recouped already within 1 year because of significantly decreased hospitalizations. With 36,600 Euros the incremental cost per quality-adjusted life-year (QALY) gained is below the euro equivalent (41,300 Euros, 1 Euro = US1.21 dollars) of the commonly used threshold level of US50,000 dollars considered to represent cost-effectiveness. The sensitivity analysis showed these preliminary results to be fairly robust towards changes in key assumptions. CONCLUSIONS: The European CRT model is an important tool to assess the economic value of CRT in patients with moderate to severe heart failure. In the light of the planned introduction of Diagnosis Related Group (DRG) based reimbursement in various European countries, the economic data generated by the model can play an important role in the decision-making process.

Cardiac Pacing, Artificial↗
PubMedDate not supplied

Analyses of cost data in economic evaluations conducted alongside randomized controlled trials.

OBJECTIVE: The adoption and diffusion of new medical treatments depend increasingly on evidence of costs and cost-effectiveness. This evidence is increasingly being generated from economic data collected in randomized clinical trials. The objective of this article is to evaluate the statistical methods used for analysis of cost data in economic evaluations conducted alongside randomized controlled trials. METHODS: Systematic review of economic evaluations based on patient-level cost or resource-use data collected in randomized trials was published in 2003. One hundred fifteen articles were identified from the MEDLINE database. The use of statistical methods for 1) joint comparison of costs and effects and assessment of stochastic uncertainty, 2) incremental cost estimation, and 3) handling of incomplete or censored cost data was evaluated. RESULTS: Only 42 (37%) of the 115 economic evaluations presented a cost-effectiveness ratio or estimated net benefits and 24 (57%) of these reported the uncertainty of this statistic. A comparison of costs alone was more common with 92 (80%) of the 115 studies statistically comparing costs between treatment groups. Of these, about two-thirds (62; 68%) used at least one statistical test appropriate for drawing inferences for arithmetic means. Incomplete cost data were reported in 67 (58%) studies with only two using a published statistical approach for handling censored cost data. CONCLUSION: The quality of statistical methods used in economic evaluations conducted alongside randomized controlled trials was poor in the majority of studies published in 2003. Adoption of appropriate statistical methods is required before the results from such studies can consistently provide valid information to decision-makers.

Cost-Benefit Analysis↗
PubMed2005

A socio-economic perspective on periodontal diseases: a systematic review.

OBJECTIVE: The aim of this systematic review was to ascertain whether socio-economic conditions increase the risk of periodontal diseases. METHODS: A MEDLINE search was conducted for the period 1965-April 2004. Only original articles were included; 47 studies remained for the final assessment. The studies were analysed regarding the outcome of the association between socio-economic variables and periodontal disease, depending on the study design (cross-sectional survey or longitudinal case-control) and whether smoking was included or not. RESULTS: Twenty-nine out of 36 studies with a cross-sectional design were in favour of the association between socio-economic factors and periodontal diseases. In the studies with a longitudinal or case-control design, there were five in favour of the association, and also six against. When smoking was included in the analysis of cross-sectional studies, a significant association between socio-economic variables and periodontal disease was found in 11 studies and no significance in another five studies. The corresponding figures for case-control studies showed four studies being significant, but also four studies showing no significance. CONCLUSION: Based on relevant study designs and including smoking in the analysis, the socio-economic variables associated with periodontal diseases appear to be of less importance than smoking.

Body Weight↗
PubMed1991

The economic impact of hospitals in rural communities.

This article presents how to assess the economic impact of a hospital on a rural community. The economic impact is identified by assessing the direct, induced, and indirect impacts that result because of the presence of a hospital in a rural community. The methodology utilizes survey data and estimation procedures for four rural hospitals. The economic impact estimates are based on microdata. Income multipliers are estimated for each of the rural communities. The research demonstrates that rural hospitals do make significant economic contributions to the communities they serve. Community leaders can use the model presented to evaluate the economic impact of their local hospital.

Community-Institutional Relations↗
PubMed1979

Techniques of economic analysis in psychiatric practice.

Since there is a limit to the amount of money that society can and will spend on health care, economic analysis is becoming increasingly important. This article attempts to review the use that has been made of economic analysis in psychiatric practice. It has been shown that treatment costs are a small part of the total cost of mental ill health, although 'expensive treatments' may reduce the cost of illness to society. In the USA the treatment of schizophrenia has been studied from the economic viewpoint. The economics of the alternatives of hospital and community care have been investigated. Cost-benefit analysis has been modified for application to the monitoring and assessment of psychiatric treatment. Economic analysis can and should be used, in conjunction with clinical analysis, to determine policies for better mental health care.

Community Mental Health Services↗