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PubMed1993

Decision analysis of hematopoietic growth factor use in patients receiving cancer chemotherapy.

BACKGROUND: Hematopoietic growth factors (HGFs) have been shown to reduce the incidence of neutropenia and fever in patients receiving cancer chemotherapy. PURPOSE: This cost analysis was designed to determine the conditions in which use of HGFs in patients receiving cancer chemotherapy is cost-effective. METHODS: We used a standard model based on decision theory; the model assumes that all patients experiencing neutropenia and fever will be hospitalized and treated with intravenous antibiotics. Data from a prospective, randomized clinical trial of granulocyte colony-stimulating factor in small-cell lung cancer treated with combination chemotherapy were used to determine baseline probabilities for control hospitalization risk and survival; proportional hospitalization risk with prophylactic HGF; and median durations of hospitalization and prophylactic HGF use. The model was analyzed by one-way and multivariate sensitivity analyses, with estimation of threshold values at which the expected cost is the same for either of two treatment options. One or more of the specific costs and durations and the probability for each group of threshold curves were varied in a sensitivity analysis that generated variable thresholds. Use of Monte Carlo analysis based on the available distributions of the main variables provided 90% confidence limits and an inference method for comparing decision options. RESULTS: The expected excess cost per treatment cycle, based on hospitalization for neutropenic fever and/or HGF administration, was $5500 for no HGF, $4750 for prophylactic HGF, and $6875 for therapeutic HGF. Sensitivity analysis provided the following thresholds for no HGF versus prophylactic HGF: control risk of hospitalization, 0.40; risk of hospitalization with HGF as a proportion of control, 0.64; total daily cost of hospitalization, $727; total daily cost of HGF, $344; duration of hospitalization, 7.3 days; and duration of HGF use, 11.0 days. Multivariate analysis revealed that conditions favoring the use of HGF on a cost basis become greater (a) as risk of hospitalization, total daily hospital cost, and duration of hospitalization increase and (b) as the proportional risk of hospitalization with HGF, daily cost of HGF, and duration of HGF treatment decrease. CONCLUSIONS: The major determinants of total excess cost were the control risk of hospitalization, the proportional reduction in risk with HGF, and the average daily hospital cost. IMPLICATIONS: Use of HGFs should be based on the risk of hospitalization for neutropenic fever and consideration of the patient population and institutional costs.

Colony-Stimulating Factors↗
PubMed2004

Cost aspects of transurethral resection of the prostate, contact laser prostatectomy, and electrovaporization.

OBJECTIVES: To compare the costs of transurethral resection of the prostate (TURP), contact laser prostatectomy (CLP), and electrovaporization in men with lower urinary tract symptoms associated with benign prostatic hyperplasia. METHODS: We conducted a randomized controlled trial that included men with lower urinary tract symptoms who met the criteria of the International Scientific Committee on benign prostatic hyperplasia. Subjective changes were quantified using questionnaires validated by the American Urological Association. The maximal free urinary flow rate was estimated. Morbidity and mortality were registered. These parameters were measured at regular intervals for up to 1 year and once during long-term follow-up. A cost analysis together with a sensitivity analysis was performed on the basis of a follow-up of 12 months. RESULTS: A total of 50 men were randomized to TURP, 45 to laser treatment, and 46 to electrovaporization. The subjective and objective changes were very similar during the 12 months of follow-up. The costs were highest for CLP (1885 dollars), followed by TURP (1707 dollars), and were lowest for electrovaporization (1489 dollars). However, the length of hospital stay decreased during the trial more for CLP and electrovaporization than for TURP. Recalculations demonstrated almost equal costs for CLP and TURP (1697 dollars and 1643 dollars, respectively) and the lowest costs for electrovaporization (1386 dollars). CONCLUSIONS: Electrovaporization has a better cost-effectiveness than CLP and TURP in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia. CLP and TURP showed very similar cost-effectiveness ratios.

Cost-Benefit Analysis↗
PubMed2002

Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery.

PURPOSE: To determine preoperative risk factors predictive of adverse outcomes after gastric bypass surgery. SUMMARY BACKGROUND DATA: Gastric bypass results in sustained weight loss for seriously obese patients, but perioperative complications can be formidable. Preoperative risk assessment is important to establish the risk-benefit ratio for patients undergoing these operations. METHODS: Data for 10 risk factors predictive of adverse outcomes were collected on 1,067 consecutive patients undergoing gastric bypass surgery at the UCLA Medical Center from December 1993 until June 2000. Univariate analyses were performed for individual risk factors to determine their potential significance as predictors for complications. All 10 risk factors were entered into a logistic regression model to determine their significance as predictors for complications. Sensitivity analysis was performed. RESULTS: Univariate analysis revealed that male gender and weight were predictive of severe life-threatening adverse outcomes. Multistep logistic regression yielded only male gender as a risk factor. Male patients were heavier than female patients on entry to the study, accounting for weight as a potential risk factor. Patients older than 55 years had a threefold higher mortality from surgery than younger patients, although the complication rate, 5.8%, was the same in both groups. Sensitivity analysis demonstrated that the risk for severe life-threatening adverse outcomes in women increased from 4% for a 200-lb female patient to 7.5% for a 600-lb patient. The risk increased from 7% for a 200-lb male patient to 13% for a 600-lb patient. CONCLUSIONS: Large male patients are at greater risk for severe life-threatening complications than smaller and/or female patients. Risk factors thought to be predictive of adverse outcomes, such as a history of smoking or diabetes, proved not to be significant in this analysis. Older patients had the same complication rate but a threefold higher mortality, suggesting that they lack the reserve to recover from complications when they occur.

Adult↗
PubMed2004

Cost-effectiveness of positron emission tomography for non-small cell lung carcinoma in Canada.

BACKGROUND: Several studies over the past decade have demonstrated that 2-fluoro-2-D-[18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) is more accurate than computed tomography (CT) for the staging of non-small cell lung carcinoma (NSCLC). This study uses quantitative decision tree modeling and sensitivity analysis to assess the cost-effectiveness of both a CT- and a CT+PET-based management strategy for staging NSCLC in Canada. Both management costs and life expectancy are determined. MATERIAL/METHODS: Two patient management scenarios were compared--one using CT alone and one using both CT and PET. A survey of recent literature was used to construct a meta-analysis of available studies for the accuracies of CT and PET in staging NSCLC. Life expectancies were determined from recent Canadian statistics, and expected life expectancies with disease were calculated from knowledge of published survival rates. Management costs were determined from: estimates of the installation cost of PET facilities in Canada; management costs from our institutions; and recently published Canadian cost estimates of various procedures. RESULTS: A cost savings of 1455 Canadian dollars per person is expected for the CT+PET strategy, along with an increase in life expectancy (3.1 days), when compared with the CT alone strategy. This cost savings remained in favour of the CT+PET strategy when subjected to a rigorous sensitivity analysis. CONCLUSIONS: PET may be a cost effective means of staging NSCLC in Canada.

Carcinoma, Non-Small-Cell Lung↗
PubMedDate not supplied

Does enhancing partner support and interaction improve smoking cessation? A meta-analysis.

BACKGROUND: We wanted to determine whether an intervention to enhance partner support helps as an adjunct to a smoking cessation program. METHODS: We undertook a meta-analysis of English-language, randomized controlled trials of smoking cessation interventions through July 2002 using the following data sources: Cochrane Tobacco Addiction Group specialized register, Cochrane controlled trials register, CDC Tobacco Information and Prevention Database, MEDLINE, Cancer Lit, EMBASE, CINAHL, PsycINFO, ERIC, PsycLIT, Dissertation Abstracts, SSCI and HealthSTAR, with reviews of bibliographies of included articles. Included were trials that assessed a partner support component with a minimum follow-up of 6 months. The outcomes measured were abstinence and biochemical assessment at 6 to 9 months and more than 12 months after treatment. Partner Interaction Questionnaire scores were primary and secondary outcomes. RESULTS: Nine studies (31 articles) met inclusion criteria. Partner definition varied among studies. All studies included self-reported smoking cessation rates, but there was limited biochemical validation of abstinence. For self-reported abstinence at 6 to 9 months after treatment, the Peto odds ratio (OR) = 1.08 (95% confidence interval [CI], 0.81-1.44) and at 12 months Peto OR = 1.0 (95% CI, 0.75-1.34). Sensitivity analysis of studies using live-in, married, and equivalent-to-married partners found a higher odds ratio at 6 to 9 months after treatment, Peto OR = 1.64 (95% CI, 0.5-4.64). Sensitivity analysis of studies reporting significant increases in partner support found at 6 to 9 months after treatment Peto OR = 1.83 (95% CI, 0.9-3.47); and at 12 months Peto OR = 1.22 (95% CI, 0.67-2.23). CONCLUSIONS: Interventions to enhance partner support showed the most promise for clinical practice when implemented with live-in, married, and equivalent-to-married partners. Such interventions should focus on enhancing supportive behaviors, while minimizing behaviors critical of smoking.

Humans↗
PubMed2004

What is the cost-effectiveness of hepatitis C treatment for injecting drug users on methadone maintenance in New Zealand?

The cost-effectiveness of hepatitis C virus (HCV) anti-viral therapy for injecting drug users (IDUs) on methadone maintenance is important because the majority have chronic infections that remain untreated. Cost-effectiveness analysis examines the costs of treatment compared with the benefits, which in this study are defined as savings in life. The cost-effectiveness of treatment for HCV infection is investigated for Mäori and non-Mäori IDUs on methadone maintenance therapy (MMT) in New Zealand. Markov models are used to model cohorts of IDUs, changes in their health states and the effects of MMT and anti-viral therapy on morbidity and mortality. Comparisons were made between conventional combination therapy (COT) and combination therapy with pegylated interferon. Sensitivity analysis is used to model cost-effectiveness of treatment under varying assumptions of progression of liver disease and compliance with treatment. The cost-effectiveness of MMT alone was estimated at 25397 dollars per life year saved (LYS) for non-Mäori men and 25035 dollars for non-Mäori women IDUs (costs and benefits discounted at 3%). The incremental effects of providing COT to all eligible patients were to save extra years of life, as well as to involve additional costs of anti-viral therapy. Analysis of both the incremental costs and benefits showed that a policy of providing COT to all patients meeting treatment criteria would have similar cost-effectiveness to MMT alone. Costs per LYS were estimated to be lower for Mäori for both men and women, reflecting ethnic differences in mortality. Cost-effectiveness was found to improve if the average age of stabilizing on MMT could be lowered by 5 years from the current average age of 31 years to age 26. Cost-effectiveness of the new treatment with pegylated interferon and ribavirin was found to be similar to that of COT because the increased LYS were offset by expected higher costs of the new pharmaceuticals. Sensitivity analysis showed that anti-viral treatment remained cost-effective under varying assumptions of the rate of disease progression and compliance with treatment.

Adult↗
PubMed2006

Assessment of the impact of cattle testing strategies on human exposure to BSE agents in Japan.

In Japan, cattle screening tests for BSE are conducted at slaughterhouses for surveillance purposes and as a meat safety measure, but the public health impacts of such testing and the subsequent removal of positive animals from the food chain have not been quantitatively assessed. We evaluated the influence of removing specified risk materials and the alternation of age limits for testing cattle at the slaughterhouse on human exposure to the BSE agent in Japan by constructing a probabilistic risk model. A stochastic model using Monte Carlo simulation was constructed in order to estimate the BSE infectivity destined for the food chain from a single BSE-infected animal at slaughter. The impact of different testing strategies and risk material removal were then compared. Murine intra-cerebral ID50 (m.i.c. ID50) units were used as units for BSE infectivity. Sensitivity analysis was conducted for key input variables by changing values within plausible ranges. The expected fraction of BSE-infected cattle presented for slaughter that would be detected by screening tests was 20%, even if all slaughtered cattle were tested. The removal of risk materials reduced the median value estimate of infectivity destined for human consumption by 95%. Cattle screening tests reduced the infectivity further, but reduction efficacy did not differ among the various testing strategies. Sensitivity analysis indicated that the characteristics of BSE infectivity accumulation during the incubation period, extension of the incubation period, and lowering the detection limit of screening tests had no significant impact on relative infectivity reduction, which remained stable irrespective of testing strategy or changes in these parameters. This study suggests that the impact of changing the age limit for testing cattle on beef safety is small, provided that the removal of risk materials is conducted properly.

Abattoirs↗
PubMed1997

[Cost-effectiveness analysis of the screening strategies for primary angle closure glaucoma].

PURPOSE: To evaluate varlous primary angle clouse glaucoma(PACG)screening strategies by cost effectiveness analysis for choosing the best screening strategy. METHODS: We designed a model of the process of PACG screening, diagnosis, treatment, and estimated variable parameters of this model through literatures reviewed and the results of our study. Then four screening strategiers which are oblique flashlight test, measurement of axial anterior chamber depth (AACD), examination of peripheral anterior chamber depth (PACD), and combination of oblique flashlight test with examination of PACD in series were calculated by computer to obtain the costs for various screening strategies and the quality ajusted life years (QALYs) saved. We performed sensitivity analysis to determine how the variation in the parameter assumptions would affect the calculated cost effectiveness of the various screening strategies. Based on the principle of cost effectiveness, the screening strategy of more cost effective would be chosen. RESULTS: The results showed that no matter what age group, the screening strategy of oblique flashlight test and measuring PACD combined in series is the lowest cost per QALY gained than other strategies. This screening strategy is optimum, next is oblique flashlight test Screening method. We found that screening strategies not only gains QALY, but also is cost saving as well in the range 40-< 70 years old. sensitivity analysis result showed that optimum strategy is still the combined serial strategy, in addition to the capable closure angle ratio of a population with a 10% up and down, the oblique flashlight test became an optimum strategy and the combined serial method became next in > or = 70 years old group. CONCLUSION: The results showed that the oblique flashlight test and measurement of PACD combined in series is an optimum screening strategy. This research suggests that using adequate screening strategy should not only increase the QALYs, but also save the cost for the government and the patients themselves.

Anterior Chamber↗
PubMed1999

Secondary analysis of economic data: a review of cost-benefit studies of neonatal screening for phenylketonuria.

STUDY OBJECTIVE: To estimate the net financial benefit of neonatal screening for phenylketonuria (PKU): by a simple pooling of cost data from the literature; and by a more complex modelling approach. DESIGN: A systematic literature review was conducted to identify papers containing data on the monetary costs and benefits of neonatal screening for PKU. The methodological quality of the studies was appraised, and data were extracted on resource use and expenditure. Monetary data were converted to common currency units, and standardised to UK incidence rates. Net benefits were calculated for median, best case and worst case scenarios, and the effect of excluding poor quality studies and data was tested. The net benefit was also estimated from a model based on data from the literature and assumptions appropriate for the current UK situation. Extensive sensitivity analysis was conducted. MAIN RESULTS: The direct net benefit of screening based on the median costs and benefits from the 13 studies identified was 143,400 Pounds per case detected and treated (39,000 Pounds and 241,800 Pounds for worst case and best case scenarios respectively). The direct net benefit obtained by the modelling approach was lower at 93,400 Pounds per case detected and treated. Screening remained cost saving under sensitivity analysis, except with low residential care costs (less than 12,300 Pounds per annum), or very low incidence rates (less than 1 in 27,000). CONCLUSIONS: The economic literature on PKU screening is of variable quality. The two methods of secondary analysis lead to the same conclusion: that neonatal PKU screening is worthwhile in financial terms alone in the UK, and that it justifies the infrastructure for collecting and testing neonatal blood samples. This result cannot necessarily be extrapolated to other countries.

Cost-Benefit Analysis↗
PubMed2005

Thyroid hormone withdrawal in patients with differentiated thyroid carcinoma: a one hundred thirty-patient pilot survey on consequences of hypothyroidism and a pharmacoeconomic comparison to recombinant thyrotropin administration.

The study objective was to elucidate clinical, quality-of-life, and pharmacoeconomic effects of hypothyroidism secondary to thyroid hormone withdrawal (withdrawal) in athyroid patients with differentiated thyroid cancer (DTC). We also intended to compare societal costs of withdrawal and recombinant human thyroid-stimulating hormone administration (rhTSH) in this population. We mailed a 13-item pilot survey to patients with DTC who had undergone withdrawal before diagnostic whole-body scan (dxWBS). Using survey results and actual and estimated cost data, we retrospectively constructed a societal cost model comparing withdrawal versus rhTSH and performed a sensitivity analysis by increasing the conservatism of 8 assumptions about withdrawal costs. One hundred thirty (55%) of 236 patients answered the questionnaire. Among respondents, 92% had symptomatic and 85% multisymptomatic hypothyroidism. Almost half sought medical attention for hypothyroid complaints. Approximately one third drove motor vehicles while hypothyroid. Median absence from salaried work was 11 days per withdrawal. In the pharmacoeconomic model, societal costs per dxWBS were approximately 326 euro (25%) greater for withdrawal than for rhTSH. In the sensitivity analysis, societal costs of rhTSH exceeded those of withdrawal by approximately 307 euro (30%). In conclusion, hypothyroidism secondary to withdrawal causes important morbidity, safety risks, and productivity impairment. rhTSH avoids these drawbacks at roughly equivalent societal cost to that of withdrawal.

Adult↗
PubMed2024

Uric Acid Levels and Cardiovascular and Cerebrovascular Diseases: A Mendelian Randomization Study.

INTRODUCTION: The relationship between uric acid (UA) levels and cardiovascular and cerebrovascular diseases (CCVD) is controversial. A two-sample Mendelian randomization (MR) study was conducted to explore the causal effects of UA levels on CCVD. METHODS: Genetic variants strongly associated with UA levels were selected as instrumental variables from the Genome-Wide Association Study (GWAS) dataset. The GWAS data, sourced from the Global Urate Genetics Consortium (GUGC), comprised a sample size of 110,347 individuals. The selected CCVD outcomes included stroke, coronary artery disease (CAD), as well as atrial fibrillation and flutter. The primary analytical approach employed the inverse-variance weighted (IVW) method, supplemented by MR-Egger and weighted median as complementary methods. Sensitivity analysis was performed to test heterogeneity and pleiotropy. RESULTS: The MR analysis results indicated a causal association between UA levels and stroke (odds ratio [OR]: 1.002; 95% confidence interval [CI]: 1.000-1.003; p = 0.036), CAD (OR: 1.118; 95% CI: 1.044-1.197; p = 0.001), as well as atrial fibrillation and flutter (OR: 1.141; 95% CI: 1.037-1.256; p = 0.007). The results of MR-Egger and weighted median methods confirmed the direction of the IVW results, enhancing the robustness of the findings. No significant anomalies were detected in the sensitivity analysis. CONCLUSION: The MR study suggests that UA levels exert causal effects on stroke, CAD, as well as atrial fibrillation and flutter.

Humans↗
PubMed2003

Economic analyses of feeding systems combining pasture and total mixed ration.

Partial budgeting was used to compare net incomes of high-yielding Holstein cows fed either a total mixed ration (TMR), a pasture-based diet, or a combination of both. Variables included in the analysis were milk income, feed, feeding, manure handling, fencing, and water system expenses (revenues and costs based on 2000 values). Base data were from 45 Holstein cows (109 days in milk), assigned to one of three dietary treatments: TMR (nongrazing with TMR ad libitum), pasture plus TMR (pTMR, with pasture in the day and TMR at night), or pasture plus concentrate (PC, pasture twice daily plus 1 kg of concentrate/4 kg milk). Data from those groups were projected to a case-study herd of 70 cows and subjected to sensitivity analysis at varying milk prices and feed and pasture costs. Although costs per kilogram of milk produced were lowest for PC cows, cows on TMR had the highest net income per cow per day (5.61 dollars) because of higher yields of milk (38.1 kg/d) and milk components (1.24 kg/d of fat, 1.13 kg/d of true protein), although expenses were highest among all systems (4.12 dollars). Cows on the PC had lower daily net income (5.31 dollars) due to lower yields of milk (28.5 kg/d) and milk components (0.89 kg/d of fat, 0.79 kg/d of true protein) even though expenses were also lowest (2.57 dollars). Cows fed the pTMR were intermediate in production (32.0 kg/d of milk, 1.06 kg/d of fat, 0.93 kg/d of true protein) but had similar daily net income per cow (5.28 dollars) to the PC cows but were lower than the TMR cows. Sensitivity analysis showed that the TMR system was more profitable than the pTMR and PC systems, with expenses considered, except at combinations of lower milk prices and higher feed costs. Differences between the pTMR and PC systems were less, with PC being more profitable in half of the scenarios, particularly at lower milk prices and higher feed costs.

Animal Feed↗
PubMed2001

Computational analysis of PKA-balanol interactions.

Protein kinases are important targets for designing therapeutic drugs. This paper illustrates a computational approach to extend the usefulness of a single protein-inhibitor structure in aiding the design of protein kinase inhibitors. Using the complex structure of the catalytic subunit of PKA (cPKA) and balanol as a guide, we have analyzed and compared the distribution of amino acid types near the protein-ligand interface for nearly 400 kinases. This analysis has identified a number of sites that are more variable in amino acid types among the kinases analyzed, and these are useful sites to consider in designing specific protein kinase inhibitors. On the other hand, we have found kinases whose protein-ligand interfaces are similar to that of the cPKA-balanol complex and balanol can be a useful lead compound for developing effective inhibitors for these kinases. Generally, this approach can help us discover new drug targets for an existing class of compounds that have already been well characterized pharmacologically. The relative significance of the charge/polarity of residues at the protein-ligand interface has been quantified by carrying out computational sensitivity analysis in which the charge/polarity of an atom or functional group was turned off/on, and the resulting effects on binding affinity have been examined. The binding affinity was estimated by using an implicit-solvent model in which the electrostatic contributions were obtained by solving the Poisson equation and the hydrophobic effects were accounted for by using surface-area dependent terms. The same sensitivity analysis approach was applied to the ligand balanol to develop a pharmacophoric model for searching new drug leads from small-molecule libraries. To help evaluate the binding affinity of designed inhibitors before they are made, we have developed a semiempirical approach to improve the predictive reliability of the implicit-solvent binding model.

Azepines↗
PubMed2002

Cost-effectiveness of preoperative positron emission tomography in ischemic heart disease.

BACKGROUND: Revascularization of patients with ischemic heart disease and poor left ventricular function for surgical procedures is expensive and carries considerable risks, but may improve survival for patients with hibernating myocardium. Positron emission tomography can detect hibernating myocardium, and may be cost-effective if used to select patients for operation. METHODS: An economic model was developed to compare the cost-effectiveness of three management strategies: (1) coronary artery bypass grafting for all patients; (2) using positron emission tomography to select candidates for coronary artery bypass grafting, those without hibernation remaining on medical therapy; and (3) medical therapy for all patients. The model used data from our hospital and the published literature. A sensitivity analysis was also undertaken. RESULTS: Positron emission tomography was cost-effective in selecting patients for operation. In a hypothetical population of 1,000 patients, using positron emission tomography saved marginally more life-years and cost approximately Pound Sterling 3 million less. Using positron emission tomography before coronary artery bypass grafting instead of all patients receiving medical treatment saved lives but was more expensive. The incremental cost per life-year saved was Pound Sterling 77,000. The sensitivity analysis showed that the prevalence of hibernation and the survival rate of patients refused revascularization on the basis of the positron emission tomography scan were the areas most likely to influence cost-effectiveness. CONCLUSIONS: Positron emission tomography may be cost-effective to select patients with poor left ventricular function for coronary artery bypass grafting.

Coronary Artery Bypass↗
PubMed2001

Cost analysis of a hospital-at-home initiative using discrete event simulation.

OBJECTIVES: To examine whether, from a National Health Service (NHS) and local authority social services' viewpoint, a hospital-at-home service was cost saving compared with conventional inpatient care. METHODS: The subjects of this part-retrospective and part-prospective cost analysis were 51 elderly medical and orthopaedic surgical patients assessed at Hillingdon Hospital, West London, as being suitable for hospital-at-home care. Thirty patients received hospital-at-home care, provided for up to 14 days, while 21 patients remained in hospital and received standard inpatient care. All direct costs to the NHS hospital, community health services' provider and social services' department during the initial episode of care and the three months after discharge were collected for each group of patients. Costs and clinical event data were entered in a discrete event simulation model which generated baseline results. Uncertainty surrounding the model's parameters was explored using sensitivity analysis. RESULTS: The baseline simulation performed with 1000 patients in each group showed the mean cost per patient for hospital-at-home care and three-month follow-up to be around three-fifths the mean cost per patient of inpatient care and follow-up. Most of the excess cost in the inpatient group was attributable to the initial period of hospitalisation. Under all assumptions used in the sensitivity analysis, the hospital-at-home service was less costly. CONCLUSIONS: For elderly patients assessed as needing no more than 14 days of hospital care, hospital-at-home care is cost saving to health and social care agencies when compared with conventional inpatient care.

Aged↗
PubMed2005

A cost-utility analysis of low-dose hormone replacement therapy in postmenopausal women with an intact uterus.

OBJECTIVE: The objective of this study was to evaluate the cost utility of one year's treatment with a low-dose conjugated estrogen/medroxyprogesterone acetate (CE/MPA low dose) preparation (Premique Low Dose [Wyeth Pharmaceuticals, Maidenhead, UK]), compared with a higher-dose preparation (Premique; CE/MPA [Wyeth Pharmaceuticals, Maidenhead, UK]), in postmenopausal women with an intact uterus. The evaluation captured the resource implications associated with the difference in treatment discontinuation and adverse event driven consultations in patients receiving either the low- or higher-dose preparation. This economic evaluation was conducted from the perspective of the NHS. RESEARCH DESIGN AND METHODS: A health economic model was developed to calculate the incremental cost per quality-adjusted life year (QALY) gained from treatment with a lower-dose CE/MPA combination, compared with a higher-dose CE/MPA preparation. Cohorts of 100 patients were assumed to receive either CE/MPA low dose or CE/MPA for one year. A probabilistic sensitivity analysis was used to explore whether the base case model was robust to the assumptions employed. Neither costs nor consequences were discounted because of the one year timeframe. RESULTS: In the base case, CE/MPA low dose dominates, i.e. it showed a greater health gain at a reduced cost, in both mild and severe symptom populations. These results were repeated in the sensitivity analysis, with the cost-effectiveness planes for both mild and severe symptom populations showing a greater utility at a reduced cost. CONCLUSIONS: CE/MPA low dose has been demonstrated to be a cost-effective treatment of estrogen-deficiency symptoms in postmenopausal women with an intact uterus. It has great potential for increasing the number of patients benefiting from relief of menopausal symptoms while also reducing the resource utilisation associated with managing the adverse effects associated with higher-dose HRT.

Cost-Benefit Analysis↗
PubMed2006

Controls on atrazine leaching through a soil-unsaturated fractured limestone sequence at Brévilles, France.

The objective of this study was to identify the main controls on atrazine leaching through luvisols and calcisols overlying fissured limestone using the dual-permeability model MACRO. The model parameterisation was based on a combination of direct measurements (e.g. hydraulic properties, adsorption and degradation), literature data and calibration against bromide leaching experiments in field plots. A Monte Carlo sensitivity analysis was carried out for a typical application pattern, considering two different depths of unsaturated limestone (15 and 30 m). MACRO calibrations to the field experiments demonstrated the occurrence of strong macropore flow in the luvisol, while transport in the calcisol could be described by the advection-dispersion equation. MACRO simulations of tritium and atrazine leaching qualitatively matched tritium concentration profiles measured in the limestone and atrazine concentrations measured in piezometers and in aquifer discharge via a spring. The sensitivity analysis suggested that the thickness of the limestone, as well as the transport properties and processes occurring in the unsaturated rock (e.g. matrix vs. fissure flow) will have little significant long-term effect on atrazine leaching, mainly because degradation is very slow in the limestone. No mineralization of atrazine was detected in one-year incubations and a mean half-life of 10 years was assumed in the simulations. Instead, processes occurring in the soil exerted the main control on predicted atrazine leaching, especially variations in the degradation rate and the strength of sorption and macropore flow. However, fissure flow in unsaturated rock is expected to exert a much more significant control on groundwater contamination for compounds that degrade more readily in the deep vadose zone.

Atrazine↗
PubMed2003

Transitioning the second-generation antihistamines to over-the-counter status: a cost-effectiveness analysis.

BACKGROUND: A U.S. Food and Drug Administration advisory committee deemed the second-generation antihistamines (SGA) safe for over-the-counter use against the preliminary opposition of the manufacturers. As a result, loratadine is now available over-the-counter. First-generation antihistamines (FGA) are associated with an increased risk of unintentional injuries, fatalities, and reduced productivity. Access to SGA over-the-counter could result in decreased use of FGA, thereby reducing deleterious outcomes. The societal impact of transitioning this class of medications from prescription to over-the-counter status has important policy implications. OBJECTIVE: To examine the cost-effectiveness of transitioning SGA to over-the-counter status from a societal perspective. RESEARCH DESIGN: A simulation model of the decision to transition SGA to over-the-counter status was compared with retaining prescription-only status for a hypothetical cohort of individuals with allergic rhinitis in the United States. Estimates of costs and effectiveness were obtained from the medical literature and national surveys. Sensitivity analysis was performed using a second-order Monte Carlo simulation. MAIN OUTCOME MEASURES: Discounted, quality-adjusted life-years saved as a result of amelioration of allergic rhinitis symptoms and avoidance of motor vehicle, occupational, public and home injuries and fatalities; discounted direct and indirect costs. RESULTS: Availability of SGA over-the-counter was associated with annual savings of 4 billion dollars (2.4-5.3 billion dollars) or 100 dollars (64-137 dollars) per allergic rhinitis sufferer and 135,061 time-discounted quality-adjusted life years (84,913-191,802). The sensitivity analysis provides evidence in support of these results. CONCLUSION: Making SGA available over-the-counter is both cost-saving and more effective for society, largely as a result of reduced adverse outcomes associated with FGA-induced sedation. Further study is needed to determine the differential impact on specific vulnerable populations.

Accidents↗