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At least 865 records · Page 48Linked to original sources
PubMed1994

Potential effect of tacrine on expenditures for Alzheimer's disease.

Tacrine is the first drug approved for the treatment of mild or moderate Alzheimer's disease (AD). The present study evaluates the potential ramifications of tacrine on AD costs. An economic model was specified to link cognitive changes observed in a 30-week clinical trial of tacrine with estimates of the cost of AD, drug therapy, monitoring, time in a nursing home, and survival from diagnosis. Two groups were evaluated: (1) 367 patients receiving varying doses of tacrine, including treatment failures, and (2) 67 patients able to tolerate the high dose of 160 mg/day. Based on a literature review, a patient with AD survives a mean 4.4 years from diagnosis and incurs lifetime treatment costs of $57,169 (1993 dollars). Patients taking doses of 80-160 mg/day, showed an improvement in Mini-Mental State Exam (MMSE) of 1.0 point, which resulted in 9.5 months of predicted community and institutional care avoided, for annual savings of $2,243/patient (range, $-109 to $3,342). Patients able to tolerate the 160-mg dose improved 2.0 points on the MMSE, resulting in a prediction of 12.1 months of reduced community and nursing home care, for annual savings of $4,052/patient. Tacrine therapy could generate savings up to 17% of the current costs of AD, or a total of $3.6 billion annually for the estimated 1.6 million persons with mild-to-moderate AD.

Aged↗
PubMed1978

The determination of average hospital length of stay: an economic approach.

The observed variation in length of hospital stay across the regions of the country has long been of interest to regulators, providers, and third party payors in the hospital industry. The purpose of this article is to provide an economic model of hospital and industry behavior within which these variations can be explained. The model is tested using state data for the year 1973. The model performs well, although the theoretical role of the occupancy rate suggests that additional testing is warranted.

Bed Occupancy↗
PubMed1984

Proposals for a prevention policy: an analysis of the French report.

We present here and criticize the "Proposals for a Prevention Policy" drawn up by a multidisciplinary commission in France during 1982. The Report provides original elements at three conceptual levels: (i) a socio-economic model of causality of disease with a temporal, a probabilistic and a polyfactorial dimension; (ii) a social point of view brought to the concepts of health, prevention and health promotion; (iii) general principles for preventive intervention at a population level, including a breaking with the "victim-blaming" ideology. In this Report, work is always at the very center of the analysis developed by the commission. Practically, proposals are concerning work and environment on the one hand and structures and functional of public health services on the other hand. They may appear somewhat unrealistic or not clearly detailed. But one should understand that the commission essentially proposes an attitude of active involvement on the part of social actors rather than a list of concrete proposals. Undoubtedly, this French Report poses and discusses questions which are of interest even outside of the French context.

France↗
PubMed1998

Comparative health systems: a conceptual framework.

This article presents a review of the conceptual frameworks utilized in comparing health care systems among countries. While much of the available literature remains descriptive, several structural features are becoming widely recognized and offer a basis for empirical study. The structural variables involving financing and reimbursement mechanisms are emphasized and the research centers on these structural arrangements as methods of cost containment. There are, however, more global or comprehensive approaches which offer a broader range of issues to be considered. Finally, the authors note the barriers and hindrances in attempting to develop and conduct comparative approaches to health care systems.

Delivery of Health Care↗
PubMedDate not supplied

The costs of cardiorespiratory disease episodes in a study of emergency department use.

OBJECTIVE: The average per person direct cost of illness of cardiorespiratory disease episodes was estimated based on a prospective study of emergency department visits. METHODS: Economic modelling of health care costs using prospectively collected resource utilization data (9/1/94 to 8/31/95) from hospital emergency department visitors assigned a diagnosis of asthma, chronic obstructive pulmonary disease (COPD), respiratory infections or cardiac conditions. RESULTS: The total direct costs (1997 CDN$) [95% C.I.] per patient were $1,043.55 [$922.65, $1,164.47] for asthma, $1,690.11 [$1,276.92, $2,103.30] for COPD, $676.50 [$574.46, $778.54] for respiratory infections, and $3,318.74 [$2,937.72, $3,699.76] for cardiac conditions. CONCLUSIONS: This study showed that on average, patients diagnosed with a cardiac condition had the highest total direct cost. Hospitalization cost was the largest component of costs for all diagnoses except asthma, for which medications were the single largest component of direct costs.

Adult↗
PubMed2000

Settlement has many faces: physicians, attorneys and medical malpractice.

We conduct an analysis of the jurisdictional dispute over the management of medical malpractice lawsuits, focusing on the process through which liability is defined. We utilize a North Carolina sample of physicians who have been sued, their defense counsel, and counsel for the plaintiff in the case. A comparison of the perspectives of these three parties reveals that over half of the physicians who settle perceive themselves as not liable. Defense counsel are more adept at predicting both negotiated resolutions and whether or not money will be paid than either plaintiffs' counsel or physicians. Almost two-thirds of physicians who thought they were not liable expressed a desire for vindication. Almost half the time when the physicians denied liability money was nonetheless paid to resolve the claim. Physician responses to the outcome of their cases focus on the need for reform, especially in terms of a call for peer or expert review. We identify and discuss culture conflict between law and medicine. For lawyers "settlement" is not a negative thing, but for physicians it implies fault. We challenge existing literature which analyzes the settlement of medical malpractice claims solely in terms of rational economic models, and we argue that social psychological variables are equally important.

Adult↗
PubMed2001

Is there a sound basis for deciding how many dentists should be trained to meet the dental needs of the Canadian population? Systematic review of literature (1968-1999).

A systematic review was conducted of the literature on human resources planning (HRP) in dentistry in Canada, critically assessing the scientific strength of 1968-1999 publications. Inclusion and exclusion criteria were applied to 176 peer-reviewed publications and "grey literature" reports. Thirty papers were subsequently assessed for strength of design and relevance of evidence to objectively address HRP. Twelve papers were position statements or experts' reports not amenable for inclusion in the system. Of the remaining 18 papers, 4 were classified as projections from manpower-to-population ratios, 4 as dental practitioner opinion surveys, 8 as estimates of requisite demand to absorb current capacity and 2 as need-based, demand-weighted studies. Within the 30.5 years reviewed, 53.4% of papers were published between 1982 and 1987. Overall, many papers called for a reduction in human resources, a message that dominated HRP during the 1980s, or noted an increase in the demand for services. HRP publications often had questionable strength or analytic frameworks. The paradigm of busyness-scarcity evolved from a belief around an economic model for the profession into a fundamental tenet of HRP. A formal analysis to establish its existence beyond arbitrary dentist:population ratios has usually been lacking.

Canada↗
PubMedDate not supplied

[Sociocultural aspects of the genesis of personality disorders].

The prevalence of personality disorders seems to be increasing in the last decades. Many sociologists and historians believe that since the end of World War II, we have seen important changes, social, cultural and economic, which could indicate that we are entering a new age. The Postmodern Age, after nearly 500 years of Modern Age. Postmodernits is characterized by an increase of the speed in all realms of life, permanent changes, materialism, dominance of capitalism as economic model, changes of roles, etc. We speculate about the posibility that the characteristics of postmodern society may be contributing to the increase of prevalence of personality disorders in general and some of them in particular.

Altruism↗
PubMed2001

Pilot scale nanofiltration membrane separation for waste management in textile industry.

This paper presents the pilot scale membrane separation studies on dyehouse effluents of textile industry. Nanofiltration (NF) membranes which have 2 m2 of surface area were evaluated for membrane fouling on permeate flux and their suitability in separating COD, color and conductivity in relation to operating pressure and feed concentration from textile industry dyehouse effluents. Successive batch runs demonstrated that any serious membrane fouling was not experienced for NF membrane tested in treating this type of wastewater. The permeate flux was found to increase significantly with operating pressure. Flux decreased with increasing recovery rate. The overall removal efficiencies of COD, color and conductivity were found as greater than 97%. COD was lower than 10 mg/l at 12 bar pressures. Permeate COD was also increased with increasing recovery and COD was 30 mg/l with recovery of 80%. Almost complete color removal was achieved with nanofiltration membrane. Color value was also decreased from 500 Pt-Co to 10 Pt-Co unit. This significant reduction in color and COD makes possible the recycle of the permeate in the dyehouse. Permeate conductivity was decreasing with increasing pressure and retention of conductivity increases with increasing pressures. This phenomenon is expected from the analysis of conductivity mass transport model. Economical analysis have been done and the total estimated cost will be 0.81$/m3 based on 1000 m3/day of and this value is very economical for Istanbul City due to increasing industrial water supply tariffs.

Coloring Agents↗
PubMed2000

A South African pharmaco-economic analysis of the Acute lnfarction Ramipril Efficacy (AIRE) Study.

OBJECTIVES: Heart failure (HF) is a serious, prevalent health condition in industrialised countries where the incidence has been on the increase. The economic repercussions are costly, and therefore cost-effective medication is important in the overall management of the condition. It has been shown that angiotensin-converting enzyme (ACE) inhibitors are clinically effective in the management of HF. Ramipril has been shown to reduce mortality and the probability of hospitalisation in post-myocardial infarction (MI) patients. Internationally, the use of this drug has proved to be cost-effective. The objective of this study was to investigate the economic implications of using ramipril in South Africa for post-MI patients with HF. METHODOLOGY: An incremental cost-effectiveness analysis was performed comparing the use of ramipril and placebo in post-MI patients with HF who were receiving standard therapy. The economic impacts included drug acquisition costs and savings on hospitalisation; these were evaluated based on the clinical benefits of using ramipril in terms of life-years gained (LYG). The cost-utility of the use of ramipril was determined to provide an incremental cost per quality-adjusted life-year (QALY). Sensitivity analyses were performed on the major economic variables; discounting of future costs and savings was performed at rates of 0%, 5 % and 10 %. RESULTS: The use of ramipril results in an incremental cost/LYG of R16 808 and a total incremental cost per patient per month of R107 over 3.8 years. When the quality of life of the patients is taken into account, the cost-utility analysis shows an incremental cost/QALY of R21 382 for those younger than 65 years of age and R18 029 for those older than 65 years. The pharmaco-economic model was robust and consistent when tested at the extremes of the major variables, including costs, savings and discount rates. CONCLUSION: The results indicate that it is cost-effective to administer ramipril in addition to standard therapy for post-MI patients with HF in South Africa.

Journal Article↗
PubMed2001

[Epidemiology and costs of lung cancer in France].

There were 21,850 cases of newly diagnosed lung cancers in France in 1995. This figure corresponds to an incidence rate (standardized to the population of Europe) of 66.5 per 100,000 men and 8.9 per 100,000 women. The incidence is age-related and reaches a peak between 70 and 74 years of age for men and between 75 and 79 years of age for women. The incidence also varies by region and the highest rates were observed in east of France. Non-small-cell lung cancers represent 80% of all lung cancers. Between 1985 and 1995, as a result of changes in tobacco consumption, the incidence rates increased by 56% in women and by 5% in men under the age of 65. The incidence rates in France are close to the average rates observed in Europe. In 1995, lung cancers led to 23,900 deaths in France (mortality rate standardized to Europe: 36.6 per 100,000). 85% of deaths due to lung cancer occurred among men. Prognosis of lung cancer remains poor and has not improved appreciably over the last two decades. 58% of all patients died during the first year and 82% during the three years following lung cancer diagnosis. Survival rates appear to be better for patients with non small cell lung cancer than for patients with small cell lung cancer. Few studies have addressed the economics of lung cancer in France. Cost-of-illness studies of lung cancer were published mainly in Canada, the Netherlands and Australia. These analyses have included descriptive works as well as economic models based on theoretical diagnostic and treatment algorithms.

Age Factors↗
PubMed2001

Towards efficient pollution control in the Baltic Sea: an anatomy of current failure with suggestions for change.

We study the Baltic Sea countries' declaration to reduce nutrient loads by 50% in each country in an ecological-economic model. The model consists of country-based abatement-cost functions, and transfer coefficients describing how phosphorus and nitrogen flow from one country to another, as estimated in a hydrological model of the Baltic Sea. We show that for nitrogen in particular the overall abatement costs of the current policy are much higher and that the benefits are more uneven than under a cost-efficient policy. Consequently, one can expect that countries with high marginal abatement costs have the least incentives to follow the agreement and to invest in nitrogen abatement. This is also confirmed by our data. Therefore, we suggest and outline a joint implementation policy to promote cost efficiency and to increase incentives for investments.

Baltic States↗
PubMed2002

[Screening and intervention. A strategy in type 2 diabetes?].

Before the introduction of screening for type 2 diabetes, it is necessary to evaluate not only the technology, but also the patient perspective, the economical consequences, and the organising aspects. A review of the relevant literature shows that type 2 diabetes is a rapidly increasing, serious disease. However, there is no documentation that systematic screening will have a positive effect on morbidity and mortality, owing to the lack of randomised clinical trials. The methods for screening could be optimised, and there is a lack of literature on patient perspective. Economical models indicate that opportunistic screening is more cost-effective than is systematic screening, but the lack of randomised trials makes the conclusion dubious. A decision to introduce systematic screening for type 2 diabetes should await the results of ongoing randomised clinical trials. In the meantime, efforts should be spent on improving the level of care for those already diagnosed with diabetes.

Cost of Illness↗
PubMed2002

Health assessments of an 'at risk' population in general practice. Resource implications of identifying unmet health care needs--a case study.

OBJECTIVE: To estimate the resource implications associated with health care assessments for patients with chronic disease and those aged 75-years and over. SETTING: A four doctor general practice on the NSW Central Coast. METHOD: Examination of eligible patients according to health assessment guidelines, and development of health care plans where appropriate. Economic modelling of time and monetary resource requirements for these activities and the follow up management of identified health care issues. RESULTS: Eighty-four patients (80.8%) had a total of 181 additional health care issues identified--73 were geriatric specific, 32 preventive, 63 general medical and 13 of a support services nature. The assessments required a total of 61.5 hours (mean: 36 mins)--GP: 42 hours (mean: 24 mins); nurse: 20 hours (mean: 11 mins)--at a total cost to Medicare of $15,075 (mean: $145). Modelling of the resource requirements estimate a time requirement of 117.5 hours for the GP (mean: 1.1 hours), 57 hours for specialists (mean: 33 mins) and 140 hours for allied health providers (mean: 1.3 hours). The costs to the community are $11,511 for the GP (mean: $111), $18,791 for specialists (mean: $181) and $6688 for allied health care professionals (mean: $64). CONCLUSION: Health assessments of an 'at risk' population in general practice may be worthwhile. However, the resource requirements of all members of the health care system may be so high as to make it unsustainable.

Age Factors↗
PubMed1993

Long-term demographic interactions in precensus England.

"Modern time series methods are applied to the analysis of annual demographic data for England, 1541-1800. Evidence is found of non-stationarity in the series and of co-integration among the series. Building on economic models of historical demography, optimal inferential procedures are implemented to estimate the structural parameters of long-term equilibria among the variables. Evidence is found for a small, but significant, Malthusian 'preventive check' as well as interactions between fertility, mortality and nuptiality that are consistent with the predictions often made in demographic studies. Tentative experiments to detect the influence of environmental factors fail to reveal any significant impact on the estimates obtained."

Demography↗
PubMed2002

Cost effectiveness of beta blocker therapy for patients with chronic severe heart failure in Ireland.

Management of heart failure is estimated to consume 1% to 2% of total healthcare resources and recent data from the UK suggests this may be as high as 4% with hospital admissions accounting for approximately 70% of this expenditure. The safety and efficacy of b-blockers when added to standard therapy i.e. ACE inhibitors in chronic heart failure has recently been demonstrated in large placebo controlled trials. The ability of b-blockers to reduce hospital admission rates would be expected to prove cost effective. In this study the cost effectiveness of the b-blocker carvedilol when added to standard therapy in patients with severe heart failure was determined. Using economic modelling techniques and Irish cost data the incremental cost effectiveness ratio (ICER) for carvedilol therapy was 1,560 Euro per life year gained (LYG). Sensitivity analysis demonstrated an ICER range of 1,560 Euro/LYG to 7,322 Euro/LYG under a variety of assumptions. This suggests that carvedilol therapy for patients with severe chronic heart failure is not only safe and effective but is highly cost effective in the Irish healthcare setting.

Adrenergic beta-Antagonists↗
PubMed2002

HER2 testing and correlation with efficacy of trastuzumab therapy.

The need for accurate detection of HER2 status is becoming more apparent, as therapeutic decisions are influenced by this information in both the adjuvant and advanced-stage setting. Since the US Food and Drug Administration approved trastuzumab (Herceptin) for the treatment of metastatic breast cancer, the urgency of accurately evaluating HER2 status of breast cancer specimens, in order to identify patients who might benefit from this therapy, has increased. A wide range of assay methods are available for determining HER2 status, but immunohistochemistry followed by fluorescence in situ hybridization (FISH) is the recommended approach for ambiguous cases. FISH is not as widely available and is more costly than immunohistochemistry, but economic modeling shows that it is the most effective (and cost-effective) option.

Animals↗