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PubMed2006

Economic stability and health status: evidence from East Asia before and after the 1990s economic crisis.

The East Asian economies of Indonesia, Malaysia and Thailand suffered declines in their economic growth rates in 1997. The Indonesian and Thai government followed the World Bank prescription for adjustment, which included a cut-back in government spending at a time when there were significant job losses. Malaysia chose its own path to adjustment. Evidence presented in this paper shows that although the declines were short-lived that there was an impact on the health status measured by mortality rates for the populations of Indonesia and Thailand. There was little apparent impact on the health status of Malaysians. The lessons for other developing economies include the importance of social safety nets and the maintenance of government expenditure in minimising the impact of economic shocks on health.

Delivery of Health Care↗
PubMed1993

Economic implications of smoking cessation therapies: a review of economic appraisals.

There is a paucity of studies on the economics of smoking cessation. Those undertaken have investigated only a narrow range of available interventions, using variable methodologies which make interstudy comparisons problematical. There is a need for more economic appraisal in this area and for greater consistency in the methodologies employed. Growing evidence on the effectiveness of pharmacotherapies has not been matched by evidence of their cost effectiveness, and studies in this area, particularly on transdermal nicotine, are urgently required. Cost-benefit analyses (CBAs) have focused on programmes targeted at pregnant women and indicate that resource savings, mainly from reductions in the number of low birthweight neonates, can exceed the costs of the measures. Efforts to persuade pregnant women to quit thus appear to be highly cost beneficial, but further evidence on the efficiency of measures targeted at other groups or to the general population of smokers is required. Cost-effectiveness analyses (CEAs) suggest that measures targeted at specific groups are more cost effective than those targeted at the general population of smokers, and that the cost effectiveness of such programmes is further improved by providing educational materials that are specific to the targeted groups. Advice on how to maintain abstinence appears to improve the cost effectiveness of help with quitting, and routine advice from physicians to their smoking patients is a cost-effective way of reducing smoking prevalence.

Cost-Benefit Analysis↗
PubMed2004

Methods for expected value of information analysis in complex health economic models: developments on the health economics of interferon-beta and glatiramer acetate for multiple sclerosis.

OBJECTIVES: To develop methods for performing expected value of perfect information (EVPI) analysis in computationally expensive models and to report on the developments on the health economics of interferon-beta and glatiramer acetate in the management of multiple sclerosis (MS) using this methodological framework. DATA SOURCES: Electronic databases and Internet resources, reference lists of relevant articles. REVIEW METHODS: A methodological framework was developed for undertaking EVPI analysis for complex models. The framework identifies conditions whereby EVPI may be calculated numerically, where the one-level algorithm sufficiently approximates the two-level algorithm, and whereby metamodelling techniques may accurately approximate the original simulation model. Metamodelling techniques, including linear regression, neural networks and Gaussian processes (GP), were systematically reviewed and critically appraised. Linear regression metamodelling, GP metamodelling and the one-level EVPI approximation were used to estimate partial EVPIs using the ScHARR MS cost-effectiveness model. RESULTS: The review of metamodelling approaches suggested that in general the simpler techniques such as linear regression may be easier to implement, as they require little specialist expertise although may provide only limited predictive accuracy. More complex methods such as Gaussian process metamodelling and neural networks tend to use less-restrictive assumptions concerning the relationship between the model inputs and net benefits, and therefore may permit greater accuracy in estimating EVPIs. Assuming independent treatment efficacy, the 'per patient' EVPI for all uncertainty parameters within the ScHARR MS model is 8855 British pounds. This leads to a population EVPI of 86,208,936 British pounds, which represents the upper estimate for the overall EVPI over 10 years. Assuming all treatment efficacies are perfectly correlated, the overall per patient EVPI is 4271 British pounds. This leads to a population EVPI of 41,581,273 British pounds, which represents the lower estimate for the overall EVPI over 10 years. The partial EVPI analysis, undertaken using both the linear regression metamodel and Gaussian process metamodel clearly, suggests that further research is indicated on the long-term impact of these therapies on disease progression, the proportion of patients dropping off therapy and the relationship between the EDSS, quality of life and costs of care. CONCLUSIONS: The applied methodology points towards using more sophisticated metamodelling approaches in order to obtain greater accuracy in EVPI estimation. Programming requirements, software availability and statistical accuracy should be considered when choosing between metamodelling techniques. Simpler, more accessible techniques are open to greater predictive error, whilst sophisticated methodologies may enhance accuracy within non-linear models, but are considerably more difficult to implement and may require specialist expertise. These techniques have been applied in only a limited number of cases hence their suitability for use in EVPI analysis has not yet been demonstrated. A number of areas requiring further research have been highlighted. Further clinical research is required concerning the relationship between the EDSS, costs of care and health outcomes, the rates at which patients drop off therapy and in particular the impact of disease-modifying therapies on the progression of MS. Further methodological research is indicated concerning the inclusion of epidemiological population parameters within the sensitivity analysis; the development of criteria for selecting a metamodelling approach; the application of metamodelling techniques within health economic models and in the specific application to EVI analyses; and the use of metamodelling for EVSI and ENBS analysis.

Adjuvants, Immunologic↗
PubMed1977

[Productive life-span of dairy cows and its economic significance. II. The replacement of dairy cows: an economic model (author's transl)].

A model, initially based on the work of Zeddies (10), is presented , by which the economic aspects of the replacement problem may be studied. First, the principle underlying the replacement decision is discussed. Then, the data to be included in the model are determined. This mainly concerns the elements associated with age, such as milk production, the value of newborn calves, the slaughter of the cows, the feed cost and the cost of a pregnant heifer just before calving. The age-associated probability of culling is also included in the model. A number of questions regarding the economic importance of the duration of herd life have been studied using this model. In the third paper, the results of this application of the model will be presented.

Animal Feed↗
PubMed1987

[Economic approaches to fertility: a comparative analysis of the New Home Economics and Easterlin theories].

"The purpose of this paper is to provide a comparative analysis of the New Home Economics and Easterlin theories of fertility, within a critical context. It is emphasized that in spite of similarities between the two theories, each makes distinct contributions: while one stresses the cost of children as a determinant of fertility, the other stresses the importance of material aspirations through the relative income concept." (SUMMARY IN ENG AND SPA)

Adolescent↗
PubMed2003

A bibliometric analysis of health economics articles in the economics literature: 1991-2000.

This paper describes and analyzes trends in health economics articles indexed in the economics literature from 1991 to 2000, demonstrating the robust state of publication in the field during the past decade. While articles, pages, and the number of journals increased, single authorship declined dramatically from almost half of articles published to only one-third, and papers with four or more authors increased three-fold. Over three-fourths of articles were analyses of healthcare markets or health production, while policy oriented articles constituted the third largest share. Author concentration ratios decreased almost by half and the Herfindhal-Hirschman index of author concentration declined from 14 in 1991 to only 4 in 1999.

Authorship↗
PubMed1995

The economic advancement of the mentally ill in the community: 2. Economic choices and disincentives.

In order to evaluate the extent to which economic factors influence the life choices of people with mental illness, we interviewed 50 mentally ill people living in Boulder, Colorado. Subjects experience significant financial disincentives to work. The average total cash and noncash income of part-time employed subjects ($1,028 a month) is only modestly higher than that of unemployed subjects ($929 a month). Most clients calculate that $5 is the minimum hourly wage which makes work economically practical. Work disincentives could be improved by a more appropriately graduated scheme for reducing disability benefits for beginning workers. A wage subsidy would provide a work incentive to underproductive clients. Psychiatric treatment costs for unemployed subjects in this sample are twice those for the part-time employed. We suggest that research is needed to determine if treatment costs can be reduced by paying clients a wage subsidy.

Adult↗
PubMed2005

[Health economic aspects of psoriasis therapy. Is inpatient topical treatment of plaque-type psoriasis in this age of biologics still appropriate from both medical and economic viewpoints?].

BACKGROUND: We tried to clarify whether the treatment of plaque psoriasis as an inpatient with dithranol and narrow band UV-B 311 nm is still appropriate and economical when compared to biologics such as efalizumab. PATIENTS AND METHODS: In a 15 month period, all patients admitted to the hospital after unsuccessful outpatient treatment of psoriasis were evaluated prospectively according to medical and economical criteria. RESULTS: PASI-score was reduced by 89% in 74 patients. The direct cost to improve one in-patient by 75% in PASI score (PASI-75) was 4342.27 EUR; the total costs for employed patients were 7441.81 EUR. Direct costs of treatment with efalizumab would come to 15048.89 EUR per patient with PASI-75 in a 12 weeks period. CONCLUSION: Topical inpatient therapy for plaque psoriasis is well tolerated and a less expensive option than biologics in those who fail ambulatory treatment.

Adult↗
PubMed2003

How did Finland's economic recession in the early 1990s affect socio-economic equity in the use of hospital care?

The study evaluates the changes in socio-economic equity in the use of general hospital care in Finland from the late 1980s to the mid 1990s. In the early 1990s the Finnish economy plunged into a deep recession which slashed over 10% of GDP and resulted in a 12% decrease in national health expenditure. At the same time, the administration and financing of specialised health services were reformed. The impact on general hospital care was controversial: budgets were reduced but better productivity increased the supply of many services. According to the study, data, based on individual linkage of nationwide hospital registers to disposable family income data in population censuses, overall acute general hospital admission rates among Finns aged 25-74 increased by over 10% from 1988 to 1996. For some surgical procedures, such as cataract, coronary revascularisation and some orthopaedic operations, rates more than doubled. In both years, lower-income groups generally used hospital care more than the better-off. However, there was a slight shift towards a pro-rich distribution, mainly due to a larger increase in surgical care among the high-income groups. In 1988 the lowest income quintile used 8% and in 1996 15% fewer operations than the highest. For individual procedures and surgical diagnostic categories, the general trends of increasing disparities were similar. Despite cuts in expenditures in the early 1990s, the Finnish general hospital system based on public funding and provision managed to increase the supply of services. However, this increase coincided with widening socio-economic discrepancies in the use of surgical services. The paper proposes that these increasing inequities were due to certain features of the Finnish health care system which create social discrepancies in access to hospital care. These include the high profile of the private sector in specialised ambulatory care and in the supply of some elective procedures, and semi-private public hospital services requiring supplementary payments from patients.

Adult↗
PubMed1997

Clinical realities and economic considerations: economics of intrathecal therapy.

The estimated annual cost of medical management of chronic back pain is $25 billion. Such management is often ineffective and overly costly. Most physicians who have employed intrathecal pain therapy attest to its efficacy in the management of intractable chronic pain. However, few economic analyses are available to evaluate the cost effectiveness of different modalities and to aid in clinical decision making and third-party reimbursement policies. Current analyses tend to focus on short-term cost-benefit measurements and to ignore variables such as quality of life and patient functioning. This bias has impaired the ability of payers to make appropriate decisions regarding the safety, cost effectiveness, and efficacy of intrathecal pain therapy in noncancer patients. Clinical data demonstrate that for cancer patients whose expectancies exceed 3 months, the overall costs of intrathecal pain therapy may be less than those of tunneled epidural catheters or external infusion devices. In nonmalignant pain, intrathecal therapy appears to be cost effective compared to conventional medical management at 22 months. Further debate and fine tuning of these economic models from all perspectives are required.

Analgesics, Opioid↗
PubMed1996

Results of the economic evaluation of the first study. A multinational prospective economic evaluation. FIRST Investigators. Flolan International Randomized Survival Trial.

We present the prospective economic evaluation that served as a secondary endpoint for the FIRST study, a randomized international multicenter trial of patients with severe congestive heart failure. Although the clinical results of this study were disappointing, we demonstrated the feasibility of incorporating prospective economic evaluation in phase III clinical trials.

Aged↗
PubMed1995

Economic analysis and pharmaceutical policy: a consideration of the economics of the use of desflurane.

Several factors have to be considered in determining the cost of applying a new inhalational anaesthetic such as desflurane into clinical practice. Factors beyond the immediate control of the anaesthetic practitioner include the price set by the manufacturer (although this may be influenced by economic and political pressures), and the physical-pharmacological properties of the anaesthetic (e.g. vaporization, potency, solubility). The anaesthetic practitioner can minimise cost by applying lower inflow rates. Lower solubility (and hence lower uptake) provides a greater economy at lower inflow rates than does higher solubility. Furthermore, lower solubility permits the use of lower inflow rates with greater precision to the control of anaesthesia, and greater ease of application. At present unit prices, the cost of desflurane approximately equals that of isoflurane when a 1 l.min-1 inflow rate is used. The use of lower inflow rates presupposes that such rates do not allow the production of toxic compounds in recirculating gases. Modern equipment makes low-flow anaesthesia reliable and easy to control, and as desflurane is not degraded by the standard carbon dioxide absorbents, its use in low-flow systems is effective and economical. These cost considerations do not take into account the savings that may result from a more rapid recovery from anaesthesia, nor do they take into account the increased expense of capital equipment needed to apply a new anaesthetic.

Anesthesia, Closed-Circuit↗
PubMed1998

A 1-year community-based health economic study of ciprofloxacin vs usual antibiotic treatment in acute exacerbations of chronic bronchitis: the Canadian Ciprofloxacin Health Economic Study Group.

OBJECTIVE: To evaluate the costs, consequences, effectiveness, and safety of ciprofloxacin vs standard antibiotic care in patients with an initial acute exacerbation of chronic bronchitis (AECB) as well as recurrent AECBs over a 1-year period. DESIGN: Randomized, multicenter, parallel-group, open-label study. SETTING: Outpatient general practice. PATIENTS: A total of 240 patients, 18 years or older with chronic bronchitis, with a history of frequent exacerbations (three or more in the past year) presenting with a type 1 or 2 AECB (two or more of increased dyspnea, increased sputum volume, or sputum purulence). MAIN OUTCOME MEASURES: The assessment included AECB symptoms, antibiotics prescribed, concomitant medications, adverse events, hospitalizations, emergency department visits, outpatient resources such as diagnostic tests, procedures, and patient and caregiver out-of-pocket expenses. Patients completed the Nottingham Health Profile, St. George's Respiratory Questionnaire, and the Health Utilities Index. The parameters were recorded with each AECB and at regular quarterly intervals for 1 year. These variables were compared between the ciprofloxacin-treated group and the usual-care-treated group. RESULTS: Patients receiving ciprofloxacin experienced a median of two AECBs per patient compared to a median of three AECBs per patient receiving usual care. The mean annualized total number of AECB-symptom days was 42.9+/-2.8 in the ciprofloxacin arm compared to 45.6+/-3.0 days in the usual-care arm (p=0.50). The overall duration of the average AECB was 15.2+/-0.6 days for the ciprofloxacin arm compared to 16.3+/-0.6 days for the usual-care arm. Treatment with ciprofloxacin tended to accelerate the resolution of all AECBs compared to usual care (relative risk=1.20; 95% confidence interval [CI], 0.91 to 1.58; p=0.19). Treatment assignment did not affect the interexacerbation period but a history of severe bronchitis, prolonged chronic bronchitis, and an increased number of AECBs in the past year were associated with shorter exacerbations-free periods. There was a slight, but not statistically significant, improvement in all quality of life measures with ciprofloxacin over usual care. The only factors predictive of hospitalization were duration of chronic bronchitis (odds ratio=4.6; 95% CI, 1.6, 13.0) and severity of chronic bronchitis (odds ratio=4.3; 95% CI, 0.8, 24.6). The incremental cost difference of $578 Canadian in favor of usual care was not significant (95% CI, -$778, $1,932). The cost for the ciprofloxacin arm over the usual care arm was $18,588 Canadian per quality-adjusted life year gained. When the simple base case analysis was expanded to examine the effect of risk stratification, the presence of moderate or severe bronchitis and at least four AECBs in the previous year changed the economic and clinical analysis to one favorable to ciprofloxacin with the ciprofloxacin-treated group having a better clinical outcome at lower cost ("win-win" scenario). CONCLUSIONS: Treatment with ciprofloxacin tended to accelerate the resolution of all AECBs compared to usual care; however, the difference was not statistically significant. Further, usual care was found to be more reflective of best available care rather than usual first-line agents such as amoxicillin, tetracycline, or trimethoprim-sulfamethoxazole as originally expected. Despite the similar antimicrobial activities and broad-spectrum coverage of both ciprofloxacin and usual care, the trends in clinical outcomes and all quality of life measurements favor ciprofloxacin. In patients suffering from an AECB with a history of moderate to severe chronic bronchitis and at least four AECBs in the previous year, ciprofloxacin treatment offered substantial clinical and economic benefits. In these patients, ciprofloxacin may be the preferred first antimicrobial choice.

Adolescent↗
PubMed1972

Behavioral economics: areas of cooperative research between economics and applied behavioral analysis.

The current research methods of behavioral economics are characterized by inadequate empirical foundations. Psychologists involved in the experimental analysis of behavior with their research strategies and their experimental technology, particularly that of the Token Economy, can assist in providing empirical foundations for behavioral economics. Cooperative research between economists and psychologists to this end should be immediately fruitful and mutually beneficial.

Journal Article↗
PubMed2000

[Social-economic inequality in mortality among older mem amd women. Research on the role of health, life style, parental socio-economic status and psychosocial conditions].

This article describes to what degree socio-economic differences exist among community living older men and women, and to what degree these differences are to be explained by health, behaviour, childhood and psychosocial conditions. The data are available from 1427 men and 1503 women (aged 55-85), participating in the Longitudinal Aging Study Amsterdam (LASA) in 1992/1993. As indicators of socio-economic status (ses) we used the highest level of education and net monthly income. Age-adjusted mortality risks for men and women with low income and for men with a low level of education are about 1.5 times as high as for to the persons with high income and educational level. Among men, but not among women, the difference in mortality risk between low and high status persons remains after adjustment for age, health status, and several risk factors. Differences in lifestyle, parental ses and psychosocial characteristics explain little to nothing of the age-adjusted ses-differentiation in mortality. It is concluded that ses-inequalities in mortality are present among Dutch men and, to a lesser extent among women, until high age, and are partly explained by the relatively large health problems of the lower status group.

Age Distribution↗
PubMed2001

Sumatriptan: economic evidence for its use in the treatment of migraine, the Canadian comparative economic analysis.

The objective of this study was to evaluate economic and health effects of sumatriptan relative to customary therapy in Canada. The relationship between treatment and functionality was established based on analysis of existing data from a multinational study. A Monte Carlo model was developed to simulate 1 year for each of customary therapy and six sumatriptan formulations. Costs are expressed in 1998 Canadian dollars. Sumatriptan is expected to reduce the time spent with migraine symptoms and resulting time lost. Under customary therapy, the annual cost of lost time is estimated at pound908 ($1973). With sumatriptan, these costs ranged from pound406 ($882) with subcutaneous sumatriptan to pound577 ($1254) with nasal sumatriptan 10 mg, saving pound331-502 ($719-1091) in the annual cost of time lost. All these benefits are expected to be obtained at an additional drug cost ranging from pound869 ($1889) for subcutaneous sumatriptan to pound278 ($605) for sumatriptan suppository. The cost of sumatriptan treatment is significantly offset by a substantial reduction of costs associated with time lost due to migraine symptoms.

Canada↗
PubMed2002

The economic impact of dementia in Belgium: results of the National Dementia Economic Study (NADES).

OBJECTIVES: To estimate costs associated with dementia and its severity and to identify main cost determinants. DESIGN: One-year prospective cohort study. SETTING: 231 general practitioners (GPs) and 15 specialist clinics throughout Belgium. SUBJECTS: 605 patients aged > or = 65 years (219 referent patients, 218 demented patients at home and 168 demented patients in institution). OUTCOME MEASURES: Medical costs (visits to GPs/specialists, physiotherapy, hospitalisation, nursing, incontinence, medication) and non-medical costs (special equipment, services, professional help and caregiving). RESULTS: Total monthly costs amounted to 368.50 Euro dollar for referent patients, 445.56 Euro dollar for demented patients at home and 2301.7 Euro dollar for demented patients in institutions. Highest costs were measured in patients with severe dementia (556.88 Euro dollar at home, 2465.28 Euro dollar in institutions). In demented patients at home, 60% of costs were accounted for by the health system, with hospitalisation and medication being the main cost components (36% and 20%). In demented patients in institution, 46% of the costs were accounted for by the health system, with residential costs and nursing being the main cost components (42% and 32%). In multivariate covariance analysis, the main determinants of costs for demented patients at home were physical dependence and co-morbidity (neoplasm, cardiovascular disease). The adjusted difference between demented and referent patients was 25 Euro dollar per month. CONCLUSIONS: A large fraction of the costs observed in dementia is explained by the association of dementia with physical dependence, co-morbidity and need for caregiving. From an economic point of view, the results support the caring for patients at home.

Aged↗