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PubMed2001

Perceived stress and coronary heart disease risk factors: the contribution of socio-economic position.

OBJECTIVES: The aim of this study was to explore the relationship between risk factors for coronary heart disease (CHD) and perceived stress, adjusted for socio-economic position. DESIGN: Cross-sectional analysis of CHD risk factors, perceived stress and socio-economic position. METHOD: A cohort of employed Scottish men (N = 5848) and women (N = 984) completed a questionnaire and attended a physical examination. RESULTS: Higher socio-economic groups registered higher perceived stress scores. Perceived stress was associated with the following CHD risk factors in the expected direction: high plasma cholesterol, little recreational exercise, cigarette smoking, and high alcohol consumption. Contrary to expectations, stress was related negatively to high diastolic blood pressure, body mass index (BMI) and low forced expiratory volume. Correction for socio-economic position tended to abolish the associations between stress and physiological risk factors; the associations between stress and behavioural risk factors withstood such correction. The residual patterns of associations between perceived stress and CHD risk were broadly similar for men and women. A lower BMI, a greater number of cigarettes smoked, and greater alcohol consumption were associated with higher levels of perceived stress for both sexes. Lower levels of recreational exercise were associated with higher levels of stress for men only. CONCLUSIONS: Self-reported stress is related to health-related behaviours and to physiological CHD risk factors. The direction of the association with physiological risk was often contrary to expectation and appeared to be largely due to confounding by socio-economic position. In contrast, the association with health-related behaviours was in the expected direction and was largely independent of such confounding.

Journal Article↗
PubMed2004

Economic assessment in the management of non-Hodgkin's lymphoma.

An increasing need for economic evaluations of non-Hodgkin's lymphoma (NHL) treatments exists. We performed a literature review on the currently available NHL economic evaluations, using PubMed and the Cochrane database. English and Dutch language papers on treatment in adults were selected. A total of 88 publications were found, 44 of which were included. Of these, 6 economic evaluation-specific methodological items are evaluated (study perspective, overhead costs, data sources, charges or prices, sensitivity analysis, presentations of resource use and unit costs), enabling readers to judge the value of these studies. The 11 subjects covered by the economic evaluations are discussed. Many NHL treatments remain to be studied in economic evaluations. Future publications should report on the six methodological items in more detail, and preferably tackle them in the recommended way.

Adult↗
PubMed2005

The economic burden of depression in the US: societal and patient perspectives.

Depression imposes significant costs on sufferers, their families and care-givers, employers and insurance payers. This article summarises medical and health economics literature regarding the societal economic burden of depression and the incremental economic burden of depression sufferers in comparison with non-depressed counterparts. This substantial knowledge base probably underestimates the true economic burden of the disease because the available data and analysis techniques do not capture all of the subtle costs of this condition. Future investigation is likely to focus on the relationship between depression and comorbid conditions, the role of caregiver burdens, and the economic differences in life outcomes.

Cost of Illness↗
PubMed2005

Economic evaluation of the effects of planting date and application rate of imidacloprid for management of cereal aphids and barley yellow dwarf in winter wheat.

The effects of planting date and application rate of imidacloprid for control of Schizaphis graminum Rondani, Rhopalosiphum padi L. (Homoptera: Aphididae), and barley yellow dwarf virus (BYDV) in hard red winter wheat were studied. The first experiment was conducted from 1997 to 1999 at two locations and consisted of three planting dates and four rates of imidacloprid-treated seed. The second experiment was conducted from 2001 to 2002 in Stillwater, OK, and consisted of two varieties of hard red winter wheat seed and four rates of imidacloprid. Aphid densities, occurrence of BYDV, yield components, and final grain yield were measured, and yield differences were used to estimate the economic return obtained from using imidacloprid. In the first study, aphid populations responded to insecticide rate in the early and middle plantings, but the response was reduced in the late planting. Yields increased as insecticide rate increased but did not always result in a positive economic return. In the second study, imidacloprid seed treatments reduced aphid numbers and BYD occurrence, protected yield, and resulted in a positive economic return. The presence of aphids and BYDV lowered yield by reducing fertile head density, total kernel weight, and test weight. Whereas the application of imidacloprid seed treatments often provided positive yield protection, it did not did not consistently provide a positive economic return. A positive economic return was consistently obtained if the cereal aphid was carrying and transmitting BYDV and was more likely to occur if wheat was treated with a low rate if imidacloprid and planted in a "dual purpose" planting date window.

Agriculture↗
PubMed1999

Economic impact assessment of rinderpest control in Africa.

The authors assess the economic impact of the Pan-African Rinderpest Campaign (PARC). The PARC programme commenced in 1986 with the objective to control and ultimately eradicate rinderpest from Africa. From among the thirty-five countries that participated in PARC, ten countries were selected for the analysis, based on data availability. The three following key socio-economic issues were addressed: cost-effectiveness, returns to investment and the welfare gains of the intervention. The standard cost-benefit approach based on a computer spreadsheet model was used to assess the economic impact of rinderpest control. Benefits of the intervention consisted of increased revenue due to avoided production losses. Estimates of the value of production losses were obtained under both 'with PARC' and 'without PARC' scenarios and the incremental benefits were derived as the difference between the two scenarios. In addition, an economic surplus model was used to assess the distribution of welfare effects generated by the intervention. Analysis of funding for the national campaigns showed roughly equal commitment to the programme by national governments and the principal donor, the European Union. Examination of the implementation costs in the ten countries indicated that with the exception of one country, PARC was implemented in a cost-effective manner with average costs appearing within a relatively narrow range. The figures obtained in ECU (European currency units) were between ECU0.27 and ECU0.60 per head of cattle vaccinated. The estimated average return from the ten countries (ECU1.8 for each ECU invested in the campaign) demonstrates that based on the sample of countries, rinderpest control in Africa has been economically profitable. In each of the ten countries, estimated benefits at least covered the value of the investment in PARC. The programme has provided a total net present value of ECU29 million for the ten countries, suggesting that the implementation of PARC has been a wise public investment decision. Analysis of the distribution of the welfare gains from PARC revealed that producers derived the greater share of the ECU58 million in net value of production losses avoided due to rinderpest control in the ten countries. Consumer gains accounted for approximately one-fifth of the total, due to lower prices from increased supplies.

Africa↗
PubMed1999

The economics of optimal health and productivity in the commercial dairy.

Dairy production practices are changing; in order to remain viable, producers must optimise the health and productivity of dairy herds in economic terms. Health care is important in economic terms because disease can substantially reduce the productivity of individual animals. Preventive disease control programmes can thus result in economic gains for the dairy producer. The author describes new approaches to preventing postpartum diseases and dealing with fertility problems which can result from these diseases. Other aspects of dairy production are also changing, employing new technologies where these are judged to be profitable. Innovations include: the use of bovine somatotropin; systematic breeding/culling programmes; new mathematical modelling techniques to determine optimum feed composition and to define optimal growth levels for accelerated heifer-rearing programmes; the use of computers to collect, store and analyse data on animal production and health; and semen selection programmes. Increasing awareness of bio-security is also vital, not least because of the large investment present in dairy herds. Whatever practices are employed, they must offer economic returns to producers that compete with alternative uses of capital. Optimal levels of disease control must be determined for a particular production situation, taking into account not only the economic health of the producer, but also the well-being of the animals.

Animals↗
PubMed2000

Economic deprivation and AIDS incidence in Massachusetts.

OBJECTIVES: This study quantified AIDS incidence in Massachusetts in relation to economic deprivation. METHODS: Using 1990 census block-group data, 1990 census population counts, and AIDS surveillance registry data for the years 1988 through 1994, we generated yearly and cumulative AIDS incidence data for the state of Massachusetts stratified by sex and by neighborhood measures of economic position for the total, Black, Hispanic, and White populations. RESULTS: Incidence of AIDS increased with economic deprivation, with the magnitude of these trends varying by both race/ethnicity and sex. The cumulative incidence of AIDS in the total population was nearly 7 times higher among persons in block-groups where 40% or more of the population was below the poverty line (362 per 100,000) than among persons in block-groups where less than 2% of the population was below poverty (53 per 100,000). CONCLUSIONS: Observing patterns of disease burden in relation to neighborhood levels of economic well-being elucidates further the role of poverty as a population-level determinant of disease burden. Public health agencies and researchers can use readily available census data to describe neighborhood-level socioeconomic conditions. Such knowledge expands options for disease prevention and increases the visibility of economic inequality as an underlying cause of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Differences in attitudes, knowledge and use of economic evaluations in decision-making in The Netherlands. The Dutch results from the EUROMET Project.

OBJECTIVE: To investigate differences in attitudes, knowledge and actual use of economic evaluations in different groups of decision-makers, and to compare the results from the Netherlands with the overall European results of the European Network on Methodology and Application of Economic Evaluation Techniques (EUROMET) project. DESIGN AND SETTING: Members of the EUROMET group conducted interviews and surveys with politicians, regulators, hospital pharmacists and physicians in The Netherlands. Three approaches of investigation could be adopted: (i) a postal questionnaire survey, (ii) semi-structured interviews, and (iii) a focus-group approach. MAIN OUTCOME MEASURES AND RESULTS: In the Netherlands, decision-makers generally have a positive attitude towards economic evaluations. Nevertheless, their actual use and knowledge of economic evaluations are still limited. Hospital pharmacists and regulators are more objective than physicians and politicians, who also base their judgements on other societal values. Hospital pharmacists and regulators have a greater knowledge of economic evaluations, and they use them more often than the other groups. Most decision-makers do not want to base their decisions strictly on a cost-effectiveness ranking alone. Our findings were similar to the findings in other European countries. CONCLUSIONS: Decision-makers prefer to make their own broad comparisons of advantages and disadvantages, and do not base their decisions solely on a single summary measure.

Attitude↗
PubMed2002

Antihypertensive treatment with and without benazepril in patients with chronic renal insufficiency: a US economic evaluation.

OBJECTIVE: To conduct an economic analysis in the US of antihypertensive treatment with and without benazepril in patients with chronic renal insufficiency. DESIGN: A four-state Markov model, using clinical data obtained from a 3-year randomised clinical trial [the Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency (AIPRI) study] plus its extension study (median 3.6 years), and cost data obtained from published US sources. The period of analysis was 7 years following randomisation. PERSPECTIVE: Healthcare payer. SETTING: Clinical data were obtained from multiple medical centres in three European countries as described in the published studies. Key economic data were obtained from the US Healthcare Financing Administration's End Stage Renal Disease programme. PATIENTS AND INTERVENTIONS: In the clinical studies on which this economic analysis was based, patients with chronic renal insufficiency of various aetiologies were randomised to antihypertensive therapy with or without concomitant benazepril. MAIN OUTCOME MEASURES AND RESULTS: Over 7 years of analysis, patients randomised to antihypertensive treatment with concomitant benazepril therapy incurred on average USD12991 (1999 values) lower medical costs than patients prescribed antihypertensive treatment without benazepril, and obtained an additional 0.091 quality-adjusted life years (QALYs). Costs and QALYs were greater for the benazepril arm than the placebo arm for all years of analysis after the first. Rank order stability of results favouring the benazepril therapy arm was found in sensitivity analyses of changes in key model parameters. Additional economic and health benefits favouring patients receiving benazepril would be seen if underlying model rates of dialysis and transplantation were increased, as may be appropriate to reflect treatment practice differences in the US relative to European countries. CONCLUSIONS: Benazepril therapy as a component of antihypertensive treatment of persons with chronic renal insufficiency initially costs money, but investment costs are recouped quickly and return on investment continues to grow. The impact of end-stage renal disease on patient health and healthcare costs is great. Thus, the quality-adjusted survival benefits and overall cost savings seen in benazepril recipients over a prolonged period (2 to 7 years) indicate that the strategy of prescribing benazepril to reduce progression of renal disease in patients with renal insufficiency is both clinically and economically beneficial compared with current antihypertensive regimens without ACE inhibition.

Adult↗
PubMed2003

Pharmaceutical care programmes for the elderly: economic issues.

Pharmaceutical care is defined as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life. It describes the process through which a pharmacist collaborates with a patient and with healthcare professionals in designing, implementing and monitoring a therapeutic plan that will produce specific, desirable therapeutic outcomes for the patient. The elderly are a patient population who could particularly benefit from pharmaceutical care provision as they are at greater risk of experiencing significant drug-related problems such as inappropriate prescribing, noncompliance with prescribed medication and adverse drug reactions/interactions leading to a decrease in health-related quality of life. The extent of economic benefit of pharmaceutical care reported in the literature is variable and its generalisability is suspect due to the lack of trials which have utilised a robust research design. The few studies which have undertaken a rigourous economic evaluation have used a range of data collection methods that is reflective of the difficulty of capturing essential data. Furthermore, even in well-designed studies, the generalisability of economic evaluations to other countries is questionable because of unique national data collection systems and an inability to pool international data because of disparities between different healthcare systems. The use of a suitable measure for health-related quality of life is also problematic in a very diverse and heterogeneous population such as the elderly and, therefore, adds to the difficulties of inclusion of such measures in economic analyses of pharmaceutical care programmes. A more standardised approach to data collection is required to facilitate economic analyses as an essential element in the evaluation of any pharmaceutical care programme for the elderly. Suggestions on such approaches, together with a critical appraisal of studies performed to date, are the focus of this review.

Aged↗
PubMed2004

Reconciliation of economic concerns and health policy: illustration of an equity adjustment procedure using proportional shortfall.

Economic evaluations have become an important and much used tool in aiding decision makers in deciding on reimbursement or implementation of new healthcare technologies. Nevertheless, the impact of economic evaluations on reimbursement decisions has been modest; results of economic evaluations do not have a good record in predicting funding decisions. This is usually explained in terms of fairness; there is increasing awareness that valuations of QALYs may differ when the QALYs accrue to different patients. The problem, however, is that these equity concerns often remain implicit, and therefore frustrate explicitness and transparency in evidence-based decision making. It has been suggested that a so-called equity adjustment procedure may (partially) solve this problem. Typically this would involve the application of so-called equity weights, which can be used to recalculate the value of QALY gains for different patients. This paper explores such an equity adjustment procedure, using the equity concept of proportional shortfall. Proportional shortfall assumes that measurement of inequalities in health should concentrate on the fraction of QALYs that people lose relative to their remaining life expectancy, and not on the absolute number of QALYs lost or gained. It is the ratio of QALYs lost over the QALYs remaining. This equity concept combines elements of two popular but conflicting notions of equity: fair innings and severity-of-illness. We applied the concept of proportional shortfall to ten conditions and tentatively explored how an equity adjustment procedure using proportional shortfall might affect priority setting. Our equity adjustment procedure lowered the cost-effectiveness threshold when a condition was relatively mild. Because the proportional shortfall caused by the ten conditions differed considerably, the equity-adjustment procedure discriminated strongly between the ten conditions, and this experiment provided a good opportunity to explore the impact of equity adjustment for healthcare reimbursement decisions. In conclusion, our results suggest that equity can be measured and that integration of equity concerns into an economic evaluation improves the fit between economic models and reimbursement decisions. It is recommended that cost-effectiveness driven health policy systems consider equity adjustments.

Cost-Benefit Analysis↗
PubMed2004

Economic costs to business of the HIV/AIDS epidemic.

HIV infection is a devastating disease for individuals and society. The economic burden of employees with HIV infection is a matter of increasing concern for employers. The purpose of this paper was to conduct a comprehensive review of published studies which measured/estimated economic costs incurred by HIV-infected employees, and evaluate the potential economic impact of the HIV/AIDS epidemic on business in different countries. This review finds a conceptual consensus in the literature that suggests that the HIV/AIDS epidemic has a potentially sizable economic cost to business, primarily due to increased costs for employment-based insurance premiums, welfare benefits, lost productivity, new hiring and training, and a downsized economy and labour market. Based on published data in the US, accounting for the first three major cost items, in 2002 an HIV-infected worker would cost an employer in the US an estimated 37,320 US dollars for asymptomatic individuals and 50,374 US dollars for symptomatic individuals per person-year. However, this review found little consistent empirical data in the literature regarding the scale of disease costs specific to businesses in different settings. In addition, the current literature offers little guidance in terms of well designed, validated, and easily replicated analytical frameworks for conducting a comprehensive cost analysis from a business perspective. Future research is needed to improve both the theoretical modelling and empirical work in assessing the full economic impact of the HIV/ADIS epidemic on patients, businesses and society at large.

Commerce↗
PubMed2005

The economic impact of neuropsychiatric symptoms in Alzheimer's disease: can drugs ease the burden?

The majority of patients with Alzheimer's disease (AD) will have clinically significant neuropsychiatric symptoms during the course of their disease. There is growing evidence that neuropsychiatric symptoms increase direct costs of care in patients with AD, especially the costs associated with formal long-term care and unpaid caregiving. For example, we have estimated that a 1-point worsening of the neuropsychiatric inventory score is associated with an incremental increase of between USD 247 and USD 409 per year in total direct costs of care based upon year 2001 US dollars, depending on the value of unpaid caregiving. Although data are still limited, there have been a series of well designed, controlled clinical trials that have established the efficacy of several drugs used in the treatment of neuropsychiatric symptoms in patients with AD. The economic impact of using efficacious drugs to treat neuropsychiatric symptoms in patients with AD has not been evaluated formally. To successfully complete formal economic evaluations of these drugs there is a need for more research to refine methods for determining the economic value of unpaid caregiving and to collect more data concerning the incremental effects of neuropsychiatric symptoms on QOL, costs of care and survival. The current ongoing treatment trials that are collecting economic and QOL data as a part of the trial will be able to perform cost-effectiveness and cost-utility analyses of these new efficacious drugs. These economic evaluations will provide important information for decision makers who are formulating healthcare policy for the treatment of patients with AD.

Alzheimer Disease↗
PubMed2005

Future challenges for the economic evaluation of healthcare: patient preferences, risk attitudes and beyond.

The continued growth in the economic evaluation of healthcare over the past 25 years has led to a shortage of trained health economists globally, leading to a number of universities and/or national governments developing specialised health economics programmes to train more health economists. One of the common problems with many of these training programmes is that they only educate new health economists to the Masters level, and as such they are unable to cover the many skills needed by a successful health economist. Furthermore, government and industry interests have ensured that economic evaluation is a heavily regulated environment that gives little incentive to seek further education. These two related factors (under-education and over-regulation) have lead to a situation where economic evaluation methods may adversely limit innovation of therapeutics and devices in clinical areas that perform badly when evaluated on the cost per QALY scale. The good news, however, is that the tide is turning and theoretically sound adjustments (such as risk adjustments and stated preferences) to the current paradigm are now being considered. This, of cause, is just the tip of the iceberg with other important issues such as time preference and the endogeneity of preference remaining very much under-researched areas in health. This paper concludes that many of these real-world issues, such as patient preferences, can be avoided by using artificial objective functions such as cost per QALY, but this comes at the cost of irrelevance and the misallocation of resources. If we are to meet all of the future challenges in economic evaluation in healthcare then we must focus more on advanced education and far less on the regulation of health economists.

Attitude↗
PubMed2006

Prostaglandin analogues for the treatment of glaucoma and ocular hypertension: a systematic review of economic evidence.

We conducted a systematic review of economic studies of prostaglandin analogues for the treatment of glaucoma to assess the scope of current cost-effectiveness evidence and its relevance to decision-makers. The literature search retrieved 102 studies published before July 2005; after additional hand searching of conference proceedings, 13 full-text articles and 13 abstracts met the inclusion criteria. The reviewers extracted the key characteristics of each of the economic evaluations, and all studies received a grade in five categories to summarise the quality of the study: methodology, transparency, sensitivity, relevance and overall score. The current economic literature is predominantly focused on identifying the short-term direct cost of glaucoma treatment, particularly the precise quantification of glaucoma drug costs. Using the European and US treatment guidelines as a benchmark, it is evident that the current body of literature does not satisfy the needs of decision-makers, although certain studies provide some valuable information, which is a step towards reaching this goal. The main methodological issue in the economic models is an absence of a clinically relevant long-term effectiveness measure, or where this measure is produced, there is a lack of transparency and validation of the methods used. More attention needs to be given to modelling the consequences of treatment, and those consequences should include patient compliance, control of intraocular pressure and progression of visual field deficit, since these drive both the costs and the overall outcomes. We recognise that constructing the 'ideal' clinical outcome measure represents a major challenge to researchers. As such, we have outlined a modelling framework that could be used to produce the required level of economic evidence, and ongoing clinical research (such as the Early Manifest Glaucoma Trial) could provide the validated link between intraocular pressure and disease progression, which forms an essential part of such models.

Cost-Benefit Analysis↗
PubMed2005

Perceived health as related to income, socio-economic status, lifestyle, and social support factors in a middle-aged Japanese.

BACKGROUND: Few studies have examined the association of perceived health with socio-economic status, especially income, and social isolation and support in Japan. The purpose of this study is to clarify the associations among perceived health, lifestyle, and socio-economic status, as well as social isolation and support factors, in middle-aged and elderly Japanese. METHODS: Subjects were 9,650 participants aged 47-77 years who completed a self-administered questionnaire in 2000 in the second survey of a population-based cohort (the Komo-Ise study). The questionnaire included items on sociodemographic and socio-economic factors, social isolation and support, lifestyle, past history of chronic disease and perceived health. Perceived health was dichotomized into excellent or good health and fair or poor health. A logistic regression analysis was used to determine the odds ratios of socio-economic status, social characteristics and lifestyle in relation to self-reported fair or poor health. RESULTS: We found that household income, physical activity, sleeping, smoking habit, and BMI had a strong association with self-reported fair or poor health in middle-aged and elderly Japanese men and women. Male subjects tended to report fair or poor health as household income decreased. The results for women differed in that social isolation and low social support had a stronger association for self-reported fair or poor health than low household income. CONCLUSIONS: The results indicated that perceived health was associated with socio-economic and social characteristics among middle-aged and elderly residents in Japan.

Aged↗
PubMed2001

The relationship of social support and economic self-sufficiency to substance abuse outcomes in a long-term recovery program for women.

A growing literature suggests that women experience chemical dependency in a very different manner than men. Their needs in treatment may also vary. In particular, women with low incomes face greater economic hardship, and may be more subject to the influence of social support in maintaining recovery. Despite evidence for the relationship of both employment and social support in substance abuse treatment outcomes, many programs are reducing services and lengths of stay. The authors explored outcomes for fifty-nine women who attended long-term substance abuse treatment in a womens' facility that emphasized employment and economic self-sufficiency. Reductions in substance use were associated with an increase in economic autonomy. Improvement in other life domains was positively associated with measures of economic self-sufficiency. Women living in drug-free social environments had higher rates of abstinence and better overall functioning. At least among women who participated in our study, economic outcomes, substance use, and general functioning went hand-in-hand. Eliminating services such as employment assistance may, while reducing cost, also negatively impact outcomes among the most vulnerable clientele.

Adult↗
PubMed1978

The economic and political determinants of human (including health) rights.

This paper presents an analysis and critique of the U.S. government's current emphasis on human rights; and (a) its limited focus on only some civil and political components of the original U.N. Declaration of Human Rights, and (b) its disregard for economic and social rights such as the rights to work, fair wages, health, education, and social security. The paper discusses the reasons for that limited focus and argues that, contrary to what is widely presented in the media and academe: (1) civil and political rights are highly restricted in the U.S.; (2) those rights are further restricted in the U.S. when analyzed in their social and economic dimensions; (3) civil and political rights are not independent of but rather intrinsically related to and dependent on the existence of socioeconomic rights; (4) the definition of the nature and extension of human rights in their civil, political, social, and economic dimensions is not universal, but rather depends on the pattern of economic and political power relations particular to each society; and (5) the pattern of power relations in the U.S. society and the western system of power, based on the right to individual property and its concomitant class structure and relations, is incompatible with the full realization of human rights in their economic, social, political, and civil dimensions. This paper further indicates that U.S. financial and corporate capital, through its overwhelming influence over the organs of political power in the U.S. and over international bodies and agencies, is primarily responsible for the denial of the human rights of the U.S. population and many populations throughout the world as well.

Civil Rights↗