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PubMed2005

The need for online information on the economic consequences of cancer diagnosis, treatment, and survivorship.

The Internet is commonly used to provide treatment information to patients diagnosed with cancer. Notably missing from the existing websites is information on the cost of cancer care in terms of medical costs to the patient and work-related consequences. The purpose of this paper is to describe what is known about the economic cost of cancer and to describe how this information can be structured so that it is of more benefit to patients. This paper first provides an overview of the information available regarding medical expenses and productivity costs associated with cancer survivorship, particularly with respect to cancer and employment. Second, it draws attention to the sparse economic information available online to cancer survivors. Patients can find information on sources of financial assistance, but they cannot estimate from the available information the cost of their care or anticipate the impact that cancer and its treatment may have on their jobs. Finally, a strategy for filling the void in online economic cancer information is described. Substantial opportunity exists to provide economic information to cancer patients and their families. The Internet is a natural forum for gathering and disseminating economic information. A unique advantage of the Internet is its ability to put information immediately in the hands of cancer patients and their families--assisting them to become informed consumers and skilled negotiators.

Charities↗
PubMed2005

Economic impacts of reduced milk production associated with an increase in bulk-tank somatic cell count on US dairies.

OBJECTIVE: To measure the economic impacts attributable to an increase in bulk-tank somatic cell count (BTSCC) on US dairies. DESIGN: Meta-analysis of data from various sources. PROCEDURE: Economic impacts attributable to reduced milk production associated with an increase in BTSCC (> or = 200,000 cells/mL) in dairy cows during 1996 were estimated from supply-and-demand curves for milk and from an estimate of the effect of increased BTSCC on milk production. RESULTS: Reduced milk production associated with an increase in BTSCC in dairy cows during 1996 caused an economic loss (mean +/- 2SE) of 3.1 +/- 2.1 billion dollars to consumers, an economic gain of 2.2 +/- 1.7 billion dollars to dairy producers, and a total loss of 810 +/- 480 million dollars to the US economy as a whole. CONCLUSIONS AND CLINICAL RELEVANCE: Consumers would stand to benefit from increased milk production associated with reducing the BTSCC to < 200,000 cells/mL on all dairy operations, whereas the US dairy industry would experience an economic loss. Individual dairy producers need to compare the costs of measures intended to reduce BTSCC with the anticipated benefits from a decrease in BTSCC.

Animals↗
PubMed1995

Economic factors and the rates of suicide in Germany between 1881 and 1989.

The potential consequence of economic stress most frequently cited in the literature of medical sociology is the increase in the rate of suicide, it probably being the most valid and reliable indicator of collective mental health. To assess the probability of such being the consequence of current economic realignment in the Federal Republic of Germany, we deemed it promising to evaluate the extent to and manner in which economic factors have to date affected the frequency of suicide in Germany. The current study analyzed the effects of four economic variables (growth of the economy, average real income, unemployment and frequency of bankruptcy) on the rates of suicide in Germany from 1881 to 1989. We set the commencement date of the period analyzed as early as possible to include long-term developments as well as the effects of different moderator variables. The annual fluctuations of all four variables, in conformity with our hypothesis, correlated both in the period preceding World War II as well as in the postwar period with those in the rates of suicide. The strongest correlations held for the rate of unemployment and for the frequency of bankruptcy in times of obvious social disintegration coupled with diminished state safeguards against unemployment. Our hypothesis that the effects of economic factors would more strongly influence the rates of suicide by men as opposed to women could not be corroborated.

Cross-Sectional Studies↗
PubMed2004

Economic value of female fertility and its relationship with profit in Spanish dairy cattle.

A data file of 225,085 inseminations and 120,713 lactations from 63,160 Holstein cows was analyzed to obtain female fertility economic value according to number of inseminations per service period (INS). Fertility cost (FCOST) was included in a bioeconomic model, taking into account number of doses of semen, hormonal treatments, fertility culling cost, and delayed milk and calf sales. A profit equation was elaborated to estimate fertility cost and profit according to INS. Fertility in Spanish dairy cattle has worsened >10% over the last 14 yr. Days open have increased by about 15 d, and INS has increased from 1.7 to 2.0. A quadratic relationship was found between FCOST and INS. Similar profitability was estimated for cows who needed one or 2 INS, but when >3 INS were needed, profit decreased by >205 (US dollars)/yr per cow. Cows that needed more INS had higher milk yield per lactation, but also had a higher culling risk and lower productive life and lifetime production, therefore, lower profit. Calving interval (CI) and INS economic values were, respectively, -4.90 and -67.32 (US dollars)/yr per cow and per one unit of change. The economic values of productive traits were 4.04, 1.02, and 1.19 (US dollars)/yr per cow and per one unit of change for kg protein, kg fat, and days in milk, respectively. A mature body weight economic value of -0.67 (US dollars)/yr per cow and per kg was estimated. The relative importance of fertility traits with respect to protein was 64% for CI and 24% for INS, although the CI economic value is highly influenced by phenotypic standard deviation considered.

Animals↗
PubMed2005

Economic and environmental feasibility of a perennial cow dairy farm.

More efficient and economical production systems are needed to improve the sustainability of dairy farms. One concept to consider is using perennial cows. Perennial cows are those that maintain a relatively high milk production for >or=2 yr without going through the typical dry period followed by calving. Farm records show that some cows have produced over 20 kg/d after 4 yr of continuous lactation. A farm simulation model was used to evaluate the long-term performance, environmental impact, and economics of a conceptual perennial cow production system on a typical dairy farm in Pennsylvania. Compared with a traditional 100-cow farm with replacement heifers produced on the farm, a perennial herd of 100 cows and purchased replacements provided environmental benefit but sustained a substantial economic loss. However, increasing the perennial herd to 128 cows better utilized the feed produced on the farm. Compared with the traditional 100-cow farm, use of the perennial 128-cow herd reduced supplemental protein and mineral feed purchases by 38%, increased annual milk sales by 21%, reduced nitrogen losses by 17%, maintained a phosphorus balance, and increased annual net return to farm management by 3200 dollars. A traditional 120-cow dairy farm with purchased replacements also used a similar amount of farm-produced feed. Compared with this option, the farm with 128 perennial cows reduced protein and mineral feed purchases by 36%, maintained similar annual milk sales, increased manure production by 7%, reduced N losses by 10%, and increased annual net return by 12,700 dollars. The economic feasibility of the perennial-cow dairy farm was very sensitive to the milk production maintained by the perennial herd and market prices for milk and perennial replacement animals. The analysis was relatively insensitive to the assumed useful life of perennial cows as long as they could be maintained in the herd for at least 3 yr. Thus, a perennial cow production system can improve the economic and environmental sustainability of a traditional dairy farm if a similar level in annual milk production per cow can be maintained.

Agriculture↗
PubMed2005

Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation.

OBJECTIVES: To determine whether laparoscopic methods are more effective and cost-effective than open mesh methods of inguinal hernia repair, and then whether laparoscopic transabdominal preperitoneal (TAPP) repair is more effective and cost-effective than laparoscopic totally extraperitoneal (TEP). DATA SOURCES: Electronic databases. Conference proceedings. Manufacturers' submissions to the National Institute for Clinical Excellence (NICE) were reviewed. REVIEW METHODS: Selected studies were rigorously assessed. Dichotomous outcome data were combined using the relative risk method and continuous outcomes were combined using the Mantel-Haenszel weighted mean difference method. Time to return to usual activities was described using hazard ratios derived from individual patient data reanalysis. A review of economic evaluations undertaken by NICE in 2001 was updated and an economic evaluation was performed. The estimation of cost-effectiveness focused on the comparison of laparoscopic repair with open flat mesh. A Markov model incorporating the data from the systematic review was used to estimate cost-effectiveness for a time horizon up to 25 years. RESULTS: Thirty-seven randomised control trials (RCTs) and quasi-RCTs met the inclusion criteria on effectiveness. Fourteen studies were included in the review of economic evaluations. Laparoscopic repair was associated with a faster return to usual activities and less persisting pain and numbness. There also appeared to be fewer cases of wound/superficial infection and haematoma. However, operation times are longer and there appears to be a higher rate of serious complications in respect of visceral (especially bladder) injuries. Mesh infection is very uncommon with similar rates noted between the surgical approaches. There is no apparent difference in the rate of hernia recurrence. Laparoscopic repair was more costly to the health service than open repair, with an estimated extra cost from studies conducted in the UK of about 300-350 pounds per patient. The point estimates of cost provided by the economic model also suggest that the laparoscopic techniques are more costly (approximately 100-200 pounds more per patient after 5 years). From the review of economic evaluations, the estimates of incremental cost per additional day at usual activities were between 86 pounds and 130 pounds. Where productivity costs were included, they eliminated the cost differential between laparoscopic and open repair. Additional analysis incorporating new trial evidence suggested that TEP was associated with significantly more recurrences than open mesh but these data did not greatly influence cost-effectiveness. CONCLUSIONS: For the management of unilateral hernias, the base-case analysis and most of the sensitivity analysis suggest that open flat mesh is the least costly option but provides less quality adjusted life years (QALYs) than TEP or TAPP. TEP is likely to dominate TAPP (on average TEP is estimated to be less costly and more effective). It is likely that, for management of symptomatic bilateral hernias, laparoscopic repair would be more cost-effective as differences in operation time (a key cost driver) may be reduced and differences in convalescence time are more marked (hence QALYs will increase) for laparoscopic compared with open mesh repair. When possible repair of contralateral occult hernias is taken into account, TEP repair is most likely to be considered cost-effective at threshold values for the cost per additional QALY above 20,000 pounds. The increased adoption of laparoscopic techniques may allow patients to return to usual activities faster. This may, for some people, reduce any loss of income. For the NHS, increased use of laparoscopic repair would lead to an increased requirement for training and the risk of serious complications may be higher. Chronic pain should now be addressed prospectively using standard definitions and allowing assessment of the degree of pain. More evidence is required on the loss of utility caused by persisting pain and numbness, as well as serious complications resulting from minor surgery. Prospective population-based registries of new surgical procedures may be the best way to address this, as a complement to randomised trials assessing effectiveness. Further research relating to whether the balance of advantages and disadvantages changes when hernias are recurrent or bilateral is also required as current data are limited. Methodologically sound RCTs are needed to consider the relative merits and risks of TAPP and TEP. Further methodological research is required into the complexity of laparoscopic groin hernia repair and the improvement of performance that accompanies experience.

Cost-Benefit Analysis↗
PubMed1997

Measuring the economic cost of malaria to households in Sri Lanka.

The economic cost at the household level of labor days lost due to malaria and other illnesses was estimated in a rural community in Sri Lanka. Over a one-year period, 223 episodes of malaria were recorded from the 298 inhabitants of the village. Based on daily activity records, the economically active age group was defined as 14-60 years. In this age group, 1.8% of working days were lost due to malaria and 5.2% due to all other illnesses. The value of a labor day lost was based on the actual rural wage rate for children, women, and men, with weeks during periods of high labor demand weighting more than weeks during lean agricultural periods. In this way the annual economic loss per household amounted to US $15.56 for malaria and US $47.46 for all other illnesses. This corresponded to a loss of 6% and 18% of annual household net income, respectively. Although the overall economic impact was limited, malaria cases were concentrated in an important agricultural season. During this season, 5.6% of working days were lost due to malaria. In addition, children, who were not part of the economically active population, lost 10% of school days due to malaria during the high transmission season. In estimating the socioeconomic impact of malaria and in measuring cost-benefits of malaria control interventions, these costs have to be considered together with direct expenditures incurred by households such as on treatment and travel and with costs for the service providers.

Absenteeism↗
PubMed2000

Understanding economic and other burdens of terminal illness: the experience of patients and their caregivers.

BACKGROUND: Terminal illness imposes substantial burdens--economic and otherwise--on patients and caregivers. The cause of these burdens is not understood. OBJECTIVE: To determine the mechanism for economic and noneconomic burdens of terminal illness and to identify potential ameliorating interventions. DESIGN: In-person interviews of terminally ill patients and their caregivers. SETTING: Six randomly selected U.S. sites: Worcester, Massachusetts; St. Louis, Missouri; Tucson, Arizona; Birmingham, Alabama; Brooklyn, New York; and Mesa County, Colorado. PARTICIPANTS: 988 terminally ill patients and 893 caregivers. MEASUREMENTS: Needs for transportation, nursing care, homemaking, and personal care; subjective perception of economic burden; expenditure of more than 10% of household income on health care costs; caregiver depression and sense of interference with his or her life; and patient consideration of euthanasia or physician-assisted suicide. RESULTS: Of all patients, 34.7% had substantial care needs. Patients who had substantial care needs were more likely to report that they had a subjective sense of economic burden (44.9% compared with 35.3%; difference, 9.6 percentage points [95% CI, 3.1 to 16.1]; P = 0.005); that 10% of their household income was spent on health care (28.0% compared with 17.0%; difference, 11.0 percentage points [CI, 4.8 to 17.1]; P < or = 0.001); and that they or their families had to take out a loan or mortgage, spend their savings, or obtain an additional job (16.3% compared with 10.2%; difference, 6.1 percentage points [CI, 1.4 to 10.6]; P = 0.004). Patients with substantial care needs were more likely to consider euthanasia or physician-assisted suicide (P = 0.001). Caregivers of these patients were more likely to have depressive symptoms (31.4% compared with 24.8%; difference, 6.6 percentage points [CI, 0.4 to 12.8]; P = 0.01) and to report that caring for the patients interfered with their lives (35.6% compared with 24.3%; difference, 11.3 percentage points [CI, 5.0 to 17.7]; P = 0.001). Caregivers of patients whose physicians listened to patients' and caregivers' needs had fewer burdens. CONCLUSIONS: Substantial care needs are an important cause of the economic and other burdens imposed by terminal illness. Through empathy, physicians may be able to ameliorate some of these burdens.

Adult↗
PubMed1991

Physician economic efficiency--a new factor in credentialing.

"Economic credentialing"--the use of economic indicators in evaluating physicians for the purposes of staff appointment and reappointment--is a controversial new development in the ongoing struggle to control hospital costs while maintaining quality patient care. This article describes the concept of economic credentialing, discusses some of the legal considerations raised by the use of economic criteria in the credentialing process, and presents the findings of a recent study of the utilization of economic credentialing in hospitals today.

Antitrust Laws↗
PubMed1998

Prevention of nonsteroidal anti-inflammatory drug-induced gastropathy: clinical and economic implications of a single-tablet formulation of diclofenac/misoprostol.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage arthritis. While controlling symptoms and improving quality of life, NSAID use is associated with gastroduodenal injury and a 2%-4% annual risk for symptomatic gastroduodenal ulceration, hemorrhage, and perforation. This requires clinicians to balance the efficacy of NSAIDs against the potential risk of serious gastrointestinal events. Identification and stratification of risk can help guide the optimal approach for arthritis management of individual patients or large populations such as managed care organizations. NSAID-induced gastroenteropathy carries considerable economic consequences; 46% of arthritis costs are related to managing serious adverse events. It is reasonable to assume that these costs may not be incurred if high-risk patients are recognized and optimally managed. Newer therapies with proven safety margins present an attractive option, especially for patients at higher risk. The single-tablet formulations of diclofenac and misoprostol (Arthrotec) offer an alternative in managing NSAID patients because of their inherent safety profile. Studies with diclofenac/misoprostol indicate its effectiveness in treating signs and symptoms of arthritis and in reducing the incidence of NSAID-induced gastroenteropathy. As such, this agent may provide improved medical and economic outcomes. This review discusses the clinical aspects of NSAID-induced gastroenteropathy, including available preventive therapies. Approaches to assessing patients' risk for developing complications, and the relationship of medical risk and economic outcomes, are also examined. Although not all patients require preventive therapy, patients with heightened risk may benefit clinically and economically from gastroprotective NSAIDs. Additional research or modeling may provide further insight into the economic implications of managing and preventing NSAID-induced gastroenteropathy.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1988

Understanding economic modeling aids in decision making.

With the problems some hospitals are facing in raising capital, the importance of careful economic analyses increases. Four economic models, the demand model, economic feasibility model, economic impact model, and econometric model, can all be used by the healthcare industry to perform a thorough analysis. By doing economic analyses, hospitals will be able to more effectively allocate scarce financial resources and identify potential returns and risks associated with investments.

Decision Making, Organizational↗
PubMed1999

[Home and outside home food complementarity in Bamako (Mali): nutritional and economic aspects. What is the rationality behind consumers' choices?].

BACKGROUND: Great modifications in social and family relationships and life style come from rapid urbanisation in developing countries. Various types of malnutrition coexist in these towns. Food consumption outside the home is more and more common. This in turn encourages rapid growth in the food informal economic sector which must be taken into account in food and nutrition policy and planning. The aim of this study was to analyse the characteristics and complementarities between home and outside the home food consumption of different kinds of individuals coming from different kinds of families in Bamako, in terms of expenditures and aspects of food and nutritional intakes. METHODS: 366 individuals from 74 families were interviewed. They were chosen according to defined criteria in three districts of Bamako of high, middle and poor socio-economic level. RESULTS: At home the daily food expenditure is 2.27 and 3.79 times greater per individual in rich than in middle income and poor families respectively. Animal proteins are respectively 41%, 19% and 9% of daily protein intake. Energy from lipids is 20 to 30% in rich and middle families. In poor ones it is only 15% which is the lower limit of nutritional recommendations. Moreover, contrary to proteins and carbohydrates, the cost of lipids seems, almost incompressible. Almost everybody eats out of home food, particularly children. Its cost, on an energy basis, is higher than home food. The expense is 19 to 27% of the family food budget. It appears necessary to the satisfaction of nutritional requirements in middle income and poor families. Despite various costs, whatever be the socio-economic level, energy intakes coming from that food are equivalent in absolute terms among various kinds of individuals: children, men and women. CONCLUSION: Families had to adapt their food strategies after the 1994 Franc CFA devaluation. Various hypotheses are presented, linked to intra-family relationships and, within poor families, to insertion in the street food economic sector, in order to understand, the logic of food choices. Such an analysis, where health, nutritional, economic, social and cultural aspects of food are taken into account, allows some concrete orientations for urban food and nutrition policy.

Adolescent↗
PubMedDate not supplied

Economic evaluations of gastric and pancreatic cancer.

The total cost of cancer care in the US is about $146 billion, of which pancreatic cancer comprises $2.6 billion (1.8% of the total) and gastric cancer comprises $1.8 billion (1.3%). We have reviewed published studies presenting economic analysis of treatment or follow-up for patients with pancreatic or gastric cancer. Relatively few studies report on economic evaluations of pancreatic cancer care. There are also few economic studies for gastric cancer, although we identified three cost-effectiveness analyses. In general, economic analyses in these areas are relatively unsophisticated, relying on charge data or simple multipliers (e.g., average cost per day in the hospital multiplied by days in the hospital), and are often limited to in-hospital costs (particularly studies for pancreatic cancer). A wide range of costs is included in these studies and a variety of methodologies for assigning costs are used, making comparisons between studies difficult. Future health economics research in this area should evaluate the costs and effectiveness of alternative practice patterns for gastric and pancreatic cancer; conduct additional cost-effectiveness analyses of chemotherapeutic interventions; consider quality of life, survival, stage at diagnosis, patient-borne costs, and complications of therapy; and, take advantage of administrative data from large populations.

Cost of Illness↗
PubMedDate not supplied

Economic credentialing: the propriety of managing physician costs through privileging.

Hospital executives face the unique task of managing the costs of an institution in which they have no direct managerial authority over the primary cost drivers, namely, the physicians who practice in the hospital. Perhaps the most controversial method of controlling physician costs consists of the application of economic factors to the credentialing process. Using the credentialing process as a technique to exert fiscal control over physicians affords hospital executives and their governing boards a tremendous cost-management opportunity. The legal propriety of economic credentialing remains unsettled. Many commentators, relying on limited case law, conclude that hospitals can engage in economic credentialing. Nevertheless, hospitals should exercise care when employing an economic rationale to restrict privileges lest they stir up legal challenges. Moreover, if hospitals use economic credentialing to limit medicaid patients' access to hospitals by excluding these patients' physicians from the hospital, the federal government may have the last word on the propriety of the practice.

American Medical Association↗
PubMed1999

Economic development and health status among the poor in squatter settlements of Karachi.

OBJECTIVE: Socioeconomic status is an important determinant of health outcome measures. This study examines and presents some of the important health outcomes amongst the higher and lower socioeconomic groups within the urban poor. SETTING: Data analysis is based on a Health and Demographic Survey conducted in urban squatter settlements of Karachi in 1996. METHODS: A structured questionnaire was administered to all households in the catchment area. The indicator used to assess economic status is ownership of assets. RESULTS: Comparison between the two economic levels shows that the lower socio-economic group was more likely to experience child mortality, (CI; 1.02-1.29, p = 0.02) have lower contraceptive usage (CI; 2.11-2.64; p < 0.001) and childhood immunization rates (CI; 2.08-2.40, p < 0.001). No significant association was observed between economic levels and prevalence of diarrhea. The housing, literacy and employment status was consistently better in the higher economic stratum who were more likely to be Pushto-Punjabi speaking as compared to the Sindhi speaking population. CONCLUSION: To have sustainable improvement in the health status of the poor, those who are most vulnerable need to be identified and programs aiming to improve health should also undertake broader development initiatives like raising family income.

Child↗
PubMed2000

[German recommendations for health care economic evaluation studies. Revised version of the Hannover consensus. Hannover Consensus Group].

Financial restrictions and stronger orientation towards outcomes increasingly demand rational decisions to be made about the use of resources in the health care system. Such decisions are the subject of medical, ethical and economic considerations. Management of the health care system requires medical and economic orientation both at the general level and with regard to the selection of suitable forms of care in hospital and medical practices. In this context, evaluative health economics can be a valuable decision-making aid. In order for the results of health economic evaluation studies to be validly interpreted, a minimum of standard methodology and sufficient transparency is required. To this end, recommendations were developed. They are intended to convey standard approaches, without unnecessarily constraining methodologic progress and scientific freedom. Ongoing refinement of the guidelines and adaptation of the current state of health economic research are desirable.

Cost-Benefit Analysis↗
PubMed2000

[Recent developments in the economic evaluation of health].

BACKGROUND: The economic evaluation of health programmes and technologies is a booming discipline. A recent review estimated the volume of published studies in 1,800 per year, more than half of them being applied studies. MATERIAL AND METHODS: This article reviews the most relevant recent trends in the development of the discipline, which can be summarized as follows: a) cost-utility analysis has become a well established approach and cost-benefit analysis is growing very fast, although in absolute terms it still plays a minor role (many studies are presented as cost-consequence analyses, which means that health benefits are measured in different ways); b) there is an increasing relationship between economic evaluation and clinical research, which often forms the core of applied studies; c) there is an increasing concern for the issues related to the application of economic evaluation to decision-making; d) a related issue is the manifold proposal on methodological standards issued by different organizations and academic groups, with the aim of improving the comparability and transferability of the results, and e) finally, increasing attention is being paid to the knowledge, attitudes and actual use, of economic evaluation by decision-makers. CONCLUSIONS: To sum up, economic evaluation appears to be very dynamic in its theoretical aspects, but it is also concerned with its ultimate justification of being a useful tool for decision-makers.

Cost-Benefit Analysis↗
PubMed2000

[Medico-economic assessment of the therapeutic management of patients with hepatitis C].

OBJECTIVES: To present a review of the literature on the economic assessment of health care for hepatitis C virus infected patients. METHODS: The identification of articles was based on Medline. A scale was used to compare the methodology and results of the economic evaluations. RESULTS: The results emphasize the shortage of studies in the field of hepatitis C, and the inadequacy of epidemiological, clinical and economic data on hepatitis C virus infection, as well as of clinical research from an economic perspective. CONCLUSION: To implement an efficient screening and health care policy, health care decision makers need criteria to evaluate the efficiency of treatment strategies for hepatitis C. Economic analyses could provide important information for the social debate on hepatitis treatment.

Antiviral Agents↗