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At least 865 records · Page 48Linked to original sources
PubMed2006

The health hazards of unemployment and poor education: the socioeconomic determinants of health duration in the European Union.

The effect of socioeconomic status on the likelihood that an individual enters a period of poor health is examined using an Accelerated Failure Time methodology. This study employs data from the European Community Household Panel for the years 1994-2002 across 13 European countries, using the Physical and Mental Health Problems, Illnesses and Disabilities measure of physical health. Some socioeconomic status indicators do impact on the length of time an individual remains in good health - these being unemployment, which has a negative effect, and education, which has a positive effect - but others, such as income, have far less of an impact. Age and gender effects are also found.

Adult↗
PubMed2006

Cost analysis in interventional radiology--A tool to optimize management costs.

OBJECTIVE: The objective of the study was to analyze the methods to reduce cost in interventional radiology departments by reorganizing procurement. MATERIALS AND METHODS: All products used in the Department of Interventional Radiology were inventoried. An ABC-analysis was completed and A-products (high-value and high turnover products) underwent a XYZ-analysis which predicted demand on the basis of ordering frequency. Then criteria for a procurement strategy for the different material categories were fixed. The net working capital (NWC) was calculated using an interest rate of 8%/year. RESULTS: Total annual material turnover was 353,000 euro. The value of all A-products determined by the inventory was 260,000 euro. Changes in the A-product procurement strategy tapped a cost reduction potential of 14,500/year euro. The resulting total saving was 17,200 euro. Improved stores management added another 37,500 euro. The total cost cut of 52,000 euro is equivalent to 14.7% of annual expenses. CONCLUSION: A flexible procurement strategy helps to reduce the storage and capital tie-up costs of A-products in interventional radiology without affecting the quality of service provided to patients.

Cost Control↗
PubMed2005

Cost-effectiveness of presumptively medically treating women at risk for ectopic pregnancy compared with first performing a dilatation and curettage.

OBJECTIVE: To compare the cost and complication rate of two alternative strategies for the diagnosis and medical management of ectopic pregnancy when ultrasound is nondiagnostic. DESIGN: A decision tree was constructed to compare [1] dilatation and curettage (D&C) followed by treatment of all ectopic pregnancies with methotrexate versus [2] empiric treatment of all patients with possible ectopic pregnancies with methotrexate without D&C. SETTING: University setting. PATIENT(S): Ten thousand hypothetical women with nonviable pregnancies and a known incidence of ectopic pregnancy were entered into a computer model. MAIN OUTCOME MEASURE(S): The two approaches were compared with respect to the number of missed ectopic pregnancies, complications, procedures performed, admissions to the hospital, and cost. RESULT(S): The D&C group had 1% more failed managements of ectopic pregnancies and 13.4% fewer patients with a miscarriage undergo a second treatment for resolution. The D&C group had 13.7% fewer complications including 6.3% fewer hospitalizations. D&C costs $173 to $223 more than empiric use of methotrexate per patient. CONCLUSION(S): Empirically treating women at risk for ectopic pregnancy with methotrexate does not reduce complications or save money. In the absence of such savings, the desire to make an accurate and definitive diagnosis, allowing objective prognosis on future fertility and risk of repeat ectopic pregnancy, supports the need to distinguish a miscarriage from ectopic pregnancy before treatment with methotrexate.

Abortifacient Agents, Nonsteroidal↗
PubMed2005

A Markov model of the cost-effectiveness of human-derived follicle-stimulating hormone (FSH) versus recombinant FSH using comparative clinical trial data.

This study compared the cost and effectiveness of highly purified, human-derived follicle-stimulating hormone (FSH) (Bravelle) to recombinant FSH (Follistim) using Markov modeling and Monte Carlo simulation. One IVF treatment cycle resulted in costs of 11,584 dollars +/- 211 dollars for human-derived FSH and 12,762 dollars +/- 170 dollars for recombinant FSH, while three treatment cycles, holding the transition probabilities of the first cycle constant for the next two cycles, resulted in costs of 22,712 dollars +/- 1,107 dollars for human-derived FSH and 24,935 dollars +/- 1,205 dollars for recombinant FSH.

Clinical Trials as Topic↗
PubMed2005

Whose health is affected by income inequality? A multilevel interaction analysis of contemporaneous and lagged effects of state income inequality on individual self-rated health in the United States.

The empirical relationship between income inequality and health has been much debated and discussed. Recent reviews suggest that the current evidence is mixed, with the relationship between state income inequality and health in the United States (US) being perhaps the most robust. In this paper, we examine the multilevel interactions between state income inequality, individual poor self-rated health, and a range of individual demographic and socioeconomic markers in the US. We use the pooled data from the 1995 and 1997 Current Population Surveys, and the data on state income inequality (represented using Gini coefficient) from the 1990, 1980, and 1970 US Censuses. Utilizing a cross-sectional multilevel design of 201,221 adults nested within 50 US states we calibrated two-level binomial hierarchical mixed models (with states specified as a random effect). Our analyses suggest that for a 0.05 change in the state income inequality, the odds ratio (OR) of reporting poor health was 1.30 (95% CI: 1.17-1.45) in a conditional model that included individual age, sex, race, marital status, education, income, and health insurance coverage as well as state median income. With few exceptions, we did not find strong statistical support for differential effects of state income inequality across different population groups. For instance, the relationship between state income inequality and poor health was steeper for whites compared to blacks (OR=1.34; 95% CI: 1.20-1.48) and for individuals with incomes greater than $75,000 compared to less affluent individuals (OR=1.65; 95% CI: 1.26-2.15). Our findings, however, primarily suggests an overall (as opposed to differential) contextual effect of state income inequality on individual self-rated poor health. To the extent that contemporaneous state income inequality differentially affects population sub-groups, our analyses suggest that the adverse impact of inequality is somewhat stronger for the relatively advantaged socioeconomic groups. This pattern was found to be consistent regardless of whether we consider contemporaneous or lagged effects of state income inequality on health. At the same time, the contemporaneous main effect of state income inequality remained statistically significant even when conditioned for past levels of income inequality and median income of states.

Adult↗
PubMed2006

Neighbourhood inequalities in health and health-related behaviour: results of selective migration?

We hypothesised that neighbourhood inequalities in health and health-related behaviour are due to selective migration between neighbourhoods. Ten-year follow-up data of 25-74-year-old participants in a Dutch city (Eindhoven) showed an increased probability of both upward and downward migration in 25-34-year-old participants, and in single and divorced participants. Women and those highly educated showed an increased probability of upward migration from the most deprived neighbourhoods; lower educated showed an increased probability of moving downwards. Adjusted for these factors, health and health-related behaviour were weakly associated with migration. Over 10 years of follow-up, selective migration will hardly contribute to neighbourhood inequalities in health and health-related behaviour.

Adult↗
PubMed2004

The Pharmacy-based Cost Group model: validating and adjusting the classification of medications for chronic conditions to the Dutch situation.

In 2002, the Dutch government implemented a Pharmacy-based Cost Group (PCG) model in the social health insurance sector. This model uses specific types of medication prescribed to individuals in a base year as markers for chronic conditions, which are then employed to adjust capitation payments to their sickness fund in the subsequent year. In this study, a classification of prescribed medication is derived for 22 chronic conditions, based on an assessment of the relation between prescribed medication and diagnoses indicated by physicians on their prescriptions. Of the 22 chronic conditions in this classification, 13 were included in the PCG model that is currently used in the Netherlands.

Capitation Fee↗
PubMed2004

Technical efficiency in the use of health care resources: a comparison of OECD countries.

Our paper analyzes technical efficiency in the production of aggregate health outcomes of reduced infant mortality and increased life expectancy, using Organization for Economic Cooperation and Development (OECD) health data. Application of data envelopment analysis (DEA) reveals that some countries achieve relative efficiency advantages, including those with good health outcomes (Japan, Sweden, Norway, and Canada) and those with modest health outcomes (Mexico and Turkey). We conclude the USA may learn from countries more economical in their allocation of healthcare resources that more is not necessarily better. Specifically, we find that the USA can substantially reduce inputs while maintaining the current level of life expectancy.

Cross-Cultural Comparison↗
PubMed2004

Medical savings accounts in a universal system: wishful thinking meets evidence.

Medical savings accounts (MSAs) and similar approaches based on flowing reimbursements through individuals/consumers rather than providers are unsuited for systems with universal coverage. Data from Manitoba, Canada reveal that, because expenditures for physician and hospital services are highly skewed in all age groups, MSAs would substantially increase both public expenditures and out-of-pocket costs for the most ill. The empirical distribution of health expenditures limits the potential impact of many current 'demand-based' approaches to cost control. Because most of the population is relatively healthy and uses few hospital and physician services, inducing the general population to spend less will not yield substantial savings.

Cost Control↗
PubMed2005

What happened to the care of older persons in Sweden? A retrospective analysis based upon simulation model calculations, 1985-2000.

There is in Sweden a lack of national data connecting public care services to needs in various sub-groups. As result of these statistical deficiencies there has been a severe lack of solid facts to guide the public debate in Sweden concerning the developments of the old age care system. Also connected to this are the similar problems of predicting future needs development in order to estimate future burdens on the systems of care. A computer model has been developed that, by combining different national and local data sources, describes the development of the Swedish public system of care for older persons in terms of service provision and costs per needs group according to age, gender, marital status and degree of disability or ill-health. The model works in 5-year steps and has a retrospective part covering the period 1985-2000 and a prospective part for the period 2005-2030. In this article is described the structure of the model, assumptions, data sources and results for the retrospective part of the model. The model calculations show that despite of a large increase in the number of older persons there has not been a very substantial increase of needs. The number of persons with severe ill-health is basically unchanged, even if there appears to have been some shift in the composition of the group towards more heavy disability. The reductions in provided services, that the municipalities have been forced to do depending on the harsher economic conditions in Sweden since the beginning of the 1990s, have almost exclusively been targeted on persons with lesser needs. Those most in need have largely been shielded.

Aged↗
PubMed2005

Closing the youth access gap: the projected health benefits and cost savings of a national policy to raise the legal smoking age to 21 in the United States.

Current youth access laws, even if strictly enforced, do not prevent teenagers from obtaining cigarettes through social sources. To reduce the number of legal buyers a typical teenager routinely encounters, and to lessen ambiguity for vendors determining if a teen is of legal purchasing age, legislation raising the minimum legal purchase age (MLPA) for cigarettes to 21 has been discussed in several states. To estimate how a national law raising the smoking age to 21 would impact smoking prevalence, net costs (in terms of compliance enforcement, ID checking, and medical care) and health benefits (in terms of life years and QALYs) to the population over time, a dynamic computer simulation model was developed using publicly available secondary data. The model simulations were carried out for several scenarios assuming varying impacts of the policy change on smoking initiation probability over a 50-year period. One scenario assumes that smoking initiation probabilities for individuals under 21 shift by 3 years so a 18-year old in the simulation, for example, is as likely to initiate smoking as an 15-year old in the status quo. Under this assumption, raising the smoking age would reduce smoking prevalence for adults (age 18+) from the status quo level of 22.1-15.4% after 50 years. Prevalence would drop from 20 to 6.6% for 14-17-year olds, from 26.9 to 12.2% for 18-20-year olds, and from 21.8 to 15.5% for the 21+ group. The policy would produce a net cumulative savings to society of 212 billion US dollars (driven by reduced medical costs), and the accumulation of nearly 13 million additional QALYs over the period.

Adolescent↗
PubMed2006

Understanding the limited impact of economic evaluation in health care resource allocation: a conceptual framework.

Concern has increasingly been expressed at the low level of impact that economic evaluations have on the priority setting decisions they are designed to inform. The concern to maximise the impact of economic evaluation in health care is reminiscent of research utilisation debates rehearsed in the various policy studies disciplines. This paper draws on selected themes and frameworks from this literature in order to explore issues and map out an agenda relating to the uptake and use of cost effectiveness analysis in health policy decisions. The authors consider the implications for health economics, and other policy-related research and evaluation, of adopting either a rational or interactive model of research utilisation. Economic evaluations can be normative or descriptive decision tools. The choice of approach will reflect the assumed model of research utilisation and has implications for overcoming barriers to impact on policy. There is an underlying conceptual link between the rational model of research utilisation, the normative approach to economic evaluation and a focus on barriers to the accessibility of published analyses. In contrast, acknowledgement of an interactive and incremental policy process predisposes the analyst to a more descriptive approach and suggests the importance of broader systems, process and ethical barriers to the use of economic evaluation. We address the crucial issue of the importance of establishing objectives and discuss how this issue effects how those seeking to influence policy should proceed. Finally, we discuss indirect or 'enlightenment' models of research utilisation and the implications of these for the community of health economists.

Health Care Rationing↗
PubMed2005

Management of non-ST-elevation acute coronary syndromes: how cost-effective are glycoprotein IIb/IIIA antagonists in the UK National Health Service?

BACKGROUND: The glycoprotein IIb/IIIa antagonists (GPAs) represent a new class of drugs to prevent platelet aggregation in the acute treatment of non-ST-elevation acute coronary syndromes (NSTE-ACS). Systematic reviews have identified serious limitations in published cost-effectiveness analyses, including a lack of UK-specific studies and an absence of studies comparing different protocols for the use of GPAs. METHODS: A model was developed to assess the cost effectiveness of a variety of protocols employing GPAs for patients presenting with NSTE-ACS in the UK. The perspective of the UK National Health Service was adopted, with outcomes in terms of quality-adjusted life-years (QALYs). Four treatment strategies were evaluated: GPAs as part of initial medical management (Strategy 1); GPAs in patients with planned percutaneous coronary interventions (PCIs; Strategy 2); GPAs as an adjunct to the PCI procedure (Strategy 3); and no GPAs (Strategy 4). Baseline event rates and costs were taken from a UK observational study of ACS patients and relative risk reductions from GPAs were taken from a meta analysis of trials. Long-term costs and QALYs were estimated using data from a UK longitudinal study. RESULTS: The most cost-effective use of GPAs is likely to be Strategy 1, with an incremental cost per QALY gained of between pound4605 to pound10,343. Focusing this use of GPAs only on the subgroup of patients at high risk appears to represent the most cost-effective use of NHS resources. CONCLUSIONS: Medical management of patients with NSTE-ACS using GPAs is the most cost-effective use of resources, particularly if targeted to higher risk subgroups.

Coronary Disease↗
PubMed2005

The economic effect of a tertiary hospital-based heart failure program.

OBJECTIVES: This study was designed to determine the economic effect of a tertiary heart failure (HF) program at an academic medical center. BACKGROUND: Most hospitals use cross-sectional financial models to analyze the economic contribution of clinical programs for a budget period. We estimated the incremental value of a tertiary hospital HF program on the basis of the longitudinal utilization of a sample of HF patients. METHODS: The primary data source was a sample of 82 HF patients referred for cardiac transplant evaluation at an academic medical center during calendar years 2000 to 2001. Cumulative recurrent rates of utilization, cost, and reimbursement for hospital services were computed as functions of time using reliability models. The economic contribution of patients transplanted was contrasted with those not transplanted. RESULTS: Mean hospitalizations and outpatient encounters per patient at the end of the first year of follow-up for those transplanted were 2.1 (95% confidence interval [CI] 1.6 to 2.7) and 11.9 (95% CI 9.2 to 15.4), compared with 1.1 (95% CI 0.8 to 1.6) and 6.0 (95% CI 4.8 to 7.6), respectively, for those not transplanted. Mean revenue and direct cost per patient were 194,470 dollars (95% CI 136,683 dollars to 276,689 dollars) and 146,623 dollars (95% CI 96,377 dollars to 233,065 dollars), respectively, for transplanted patients and 43,587 dollars (95% CI 28,149 dollars to 67,503 dollars) and 33,424 dollars (95% CI 21,584 dollars to 51,760 dollars), respectively, for non-transplanted patients. The point estimates of first-year contribution margins per patient for transplanted and non-transplanted patients were 47,847 dollars and 10,163 dollars, respectively. CONCLUSIONS: Newly evaluated patients for cardiac transplantation at an academic medical center generated substantial incident demands for inpatient and outpatient services over a two-year follow-up period. The estimated contribution margin associated with these services was positive. Hospitals without cardiac transplantation that serve high-acuity HF patients may generate favorable long-term contribution margins, on the basis of the results for the non-transplant group.

Academic Medical Centers↗
PubMed2004

Instrumental variables technique: cigarette price provided better estimate of effects of smoking on SF-12.

OBJECTIVE: Debate surrounds the usefulness of the instrumental variables (IV) technique for medical research. The choice of an instrument for the technique has been contentious. This study estimated the effects of smoking on physical functional status. We chose an especially valid and strong instrument: cigarette price. STUDY DESIGN AND SETTING: The data were a nationally representative cross-sectional sample of 34,288 persons aged 30 to 91 in 1996-1997. The sample was drawn from the Community Tracking Study. Number of cigarettes smoked per day was predicted by the average cigarette price for the state in which the subject resided. The outcome measure was physical functional status and was measured by the SF-12 physical functional index. RESULTS: In multivariable models we found the following: cigarettes per day was strongly and negatively associated with the SF-12 index (P<.001); cigarette price was strongly and negatively associated with cigarettes per day (P=.002); the predicted cigarettes per day (the IV) was strongly and negatively associated with the SF-12 index in linear regression and tobit regression (P=.047 and P=.021). CONCLUSION: Estimated coefficients from the IV method suggested that the effect of smoking on physical functional status was substantially larger than estimates that relied on conventional methods.

Adult↗
PubMed2004

Tissue plasminogen activator was cost-effective compared to streptokinase in only selected patients with acute myocardial infarction.

OBJECTIVE: We sought to explore the patient-specific cost-effectiveness in a community-based sample for a therapy for which the average cost-effectiveness in a clinical trial has been well-described. STUDY DESIGN AND SETTING: Based on a validated multivariate model, we generated predictions of the effectiveness and cost-effectiveness of t-PA compared to streptokinase on 921 consecutive patients who received thrombolytic therapy for acute myocardial infarction. RESULTS: The average cost-effectiveness of t-PA was US dollar 40,140 per life-year saved. For the quartile of patients most likely to benefit, the incremental cost-effectiveness of t-PA was US dollar 15,396. However, only 44% of patients who received thrombolytic therapy had an estimated cost-effectiveness ratio below US dollar 50,000 per year of life saved; the ratio was greater than US dollar 100,000 in 37% of treated patients. Patients in the lowest quartile of expected benefit are, overall, more likely to be harmed than to benefit from t-PA. CONCLUSION: Compared to the pattern of thrombolytic agent choice observed, targeting t-PA to the half of patients most likely to benefit could save 247 lives and US dollar 174 million nationally per year.

Aged↗
PubMed2003

Wildfire effects on hiking and biking demand in New Mexico: a travel cost study.

We use a travel cost model to test the effects of wild and prescribed fire on visitation by hikers and mountain bikers in New Mexico. Our results indicate that net benefits for mountain bikers is $150 per trip and that they take an average of 6.2 trips per year. Hikers take 2.8 trips per year with individual net benefits per trip of $130. Both hikers' and mountain bikers' demand functions react adversely to prescribed burning. Net benefits for both groups fall as areas recover from prescribed burns. Because both visitation and annual recreation benefits decrease to these two types of visitors, this gives rise to multiple use costs associated with prescribed burning. With respect to wildfire, hikers and mountain bikers both exhibit decreased visitation as areas recover from wildfires, however, only hikers indicate an increase in per trip net benefits. Bikers' demand effectively drops to zero. These results differ from previous findings in the literature and have implications for efficient implementation of the National Fire Plan and whether prescribed burning is a cost effective tool for multiple use management of National Forests. Specifically, that fire and recreation managers cannot expect recreation users to react similarly to fire across recreation activities, or different geographic regions. What is cost effective in one region may not be so in another.

Bicycling↗
PubMed2004

Trade-off analysis in the Northern Andes to study the dynamics in agricultural land use.

In this paper we hypothesize that land use change can be induced by non-linearities and thresholds in production systems that impact farmers' decision making. Tradeoffs between environmental and economic indicators is a useful way to represent dynamic properties of agricultural systems. The Tradeoff Analysis (TOA) System is software designed to implement the integrated analysis of tradeoffs in agricultural systems. The TOA methodology is based on spatially explicit econometric simulation models linked to spatially referenced bio-physical simulation models to simulate land use and input decisions. The methodology has been applied for the potato-pasture production system in the Ecuadorian Andes. The land use change literature often describes non-linearity in land use change as a result of sudden changes in the political (e.g. new agricultural policies) or environmental setting (e.g. earthquakes). However, less attention has been paid to the non-linearities in production systems and their consequences for land use change. In this paper, we use the TOA system to study agricultural land use dynamics and to find the underlying processes for non-linearities. Results show that the sources of non-linearities are in the properties of bio-physical processes and in the decision making-process of farmers.

Agriculture↗