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At least 973 records · Page 54Linked to original sources
PubMed2003

Health-health analysis-an alternative method for economic appraisal of health policy and safety regulation. Some empirical Swedish estimates.

Health-health analysis (HHA) focuses on statistical lives themselves as a numeraire. The underlying principle is that the expected gains in health and safety of reduced risks in one area may result in increasing risks somewhere else in society. By reducing one risk other risks may increase due to changed individual behaviour. In addition to this direct effect, another indirect effect will also be present. Expenditure on a particular health policy or safety regulation must be financed in one way or another, which will result in an opportunity cost or income effect leaving less resources for other health and safety promoting activities in society. Thus, we will have an effect that reduces safety and health benefits induced by that income loss. Whether the total net health effect from a specific safety regulation or health policy is positive or negative must be empirically analysed. One way of estimating the income loss that induces one death, which we call the value of an induced death (VOID), is to estimate it as a multiple of the traditional value to avert a statistical death, also named the value of a statistical life (VOSL).A contingent valuation (CV) study eliciting the willingness-to-pay (WTP) for reducing the overall risk of dying was performed as a postal questionnaire in Sweden in 1998. By use of data from this study, it was possible to estimate the VOID and the VOSL in Sweden amounting to SEK116 and SEK20.8 million respectively, indicating that the net health result confined to mortality effects, will be negative (more lives will be lost than saved) if a health policy or safety regulation will cost more than SEK116 million per life saved.

Accidents, Traffic↗
PubMed2004

Willingness-to-pay for reducing fatal accident risk in urban areas: an Internet-based Web page stated preference survey.

Contemporary transport project evaluation requires the ability to value reductions in the number of estimated fatal and non-fatal accidents after project implementation. In this quest, we designed a stated preference (SP) experiment to estimate willingness-to-pay (WTP) for reducing fatal accident risk in urban areas. The survey was implemented in a Web page allowing rapid turnover and a complete customisation of the interview. The sample was presented with a series of route choice situations based on travel time, cost and number of car fatal accidents per year. With this data we estimated Multinomial Logit (MNL) and Mixed Logit (ML) models based on a consistent microeconomic framework; the former with linear and non-linear utility specifications and allowing for various stratifications of the data. The more flexible ML models also allow to treat the repeated observations problem common to SP data and, as expected, gave a better fit to the data in all cases. Based on these models, we estimated subjective values of time, that were consistent with previous values obtained in the country, and also sensible values for the WTP for reductions in fatal accident risk. Thus, the Internet appears as a potentially very interesting medium to carry out complex stated choice surveys.

Accidents, Traffic↗
PubMed2000

Which are the relevant costs and benefits of road safety measures designed for pedestrians and cyclists?

This paper discusses the current state-of-the-art with respect to impact assessment and cost-benefit analysis of measures designed to improve safety or mobility for pedestrians and cyclists. The study concludes that a number of impacts that are likely to regarded as important for pedestrians and cyclists are not included in current impact assessments and cost-benefit analyses as these are made in Norway. Impacts that are not currently included in impact assessments and cost-benefit analyses are: (a) changes in the amount of walking and cycling; (b) changes in travel time for pedestrians and cyclists; (c) changes in road user insecurity (feeling of safety); and (d) changes in road user health state. In order to include these effects in impact assessments and cost-benefit analyses, more needs to be known about their occurrence and monetary value. Hypothetical examples of ideally designed cost-benefit analyses are given, based on highly preliminary monetary values for travel time, insecurity and generalised costs of travel for pedestrians and cyclists. These analyses indicate that inclusion of these effects in cost-benefit analyses could make a major difference for the results of those analyses.

Accidents, Traffic↗
PubMed2003

How cost-effective are new preventive strategies for cardiovascular disease?

Costs of providing a particular medical service can be measured, but it is more difficult to assess whether the service provides good value for the money spent. Rigorous trials have demonstrated the health benefits connected with interventions for treatment and prevention of cardiovascular disease (CVD), and in-depth analyses of the costs associated with many of those interventions have been performed. Careful use of terminology clearly differentiating among cost-minimization (relative costs of proved equivalent therapeutics), cost-effectiveness (lives saved or years of life added), and cost-benefit (total net effect in monetary terms) analyses is warranted. Although trials commonly assess clinical effectiveness as reductions in mortality or CVD-specific outcomes, improvement in quality of life may be equally important and is expressed in quality-adjusted life-years. Comparisons between therapies can be assessed as a cost-effectiveness ratio. Extensive cost-effectiveness studies have been conducted on many important cardiovascular therapies: (1) beta-blockers and diuretics for multiple CVD outcomes, mortality, and prevention of recurrent myocardial infarction (MI); (2) statins for both primary and secondary prevention of CVD; (3) enalapril for prevention and treatment of congestive heart failure; (4) tissue plasminogen activator treatment of acute MI; (5) coronary artery bypass graft for left main, single-, and 2-vessel coronary artery disease, or severe angina; (6) physician counseling for smoking; and (7) radiofrequency ablation therapy for Wolff-Parkinson-White syndrome. Therapies considered economically attractive include (1) secondary prevention with statins in hyperlipidemia, (2) smoking cessation programs, (3) primary prevention in treatment of high blood pressure with diuretics and beta-blockers, (4) primary prevention with regular exercise programs, (5) secondary prevention with cardiac rehabilitation, and (6) postinfarction treatment with beta-blockers and angiotensin-converting enzyme (ACE) inhibitors. A recent cost-minimization analysis has been performed showing aspirin to be a "best buy" therapy for secondary prevention of CVD. The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized Assessment Study in ACE-I Intolerant Patients with Cardiovascular Disease (TRANSCEND) program provide potential opportunities for both cost-minimization and cost-effectiveness analyses.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2001

Cost effectiveness of human papillomavirus testing to augment cervical cancer screening in women infected with the human immunodeficiency virus.

PURPOSE: To determine the cost effectiveness of incorporating molecular testing for high-risk types of human papillomavirus into a cervical cancer screening program for women infected with the human immunodeficiency virus (HIV). SUBJECTS AND METHODS: We developed a Markov model to simulate the natural history of cervical cancer precursor lesions in HIV-infected women. Probabilities of progression and regression of cervical lesions were conditional on transient or persistent infection with human papillomavirus, as well as stage of HIV and effectiveness of antiretroviral therapy. Incorporating data from prospective cohort studies, national databases, and published literature, the model was used to calculate quality-adjusted life expectancy, life expectancy, lifetime costs, and incremental cost-effectiveness ratios for two main strategies: targeted screening-human papillomavirus testing is added to the initial two cervical cytology smears obtained after an HIV diagnosis and subsequent screening intervals are modified based on the test results; and universal screening-no testing for human papillomavirus is performed, and a single cytology screening interval is applied to all women. RESULTS: In HIV-infected women on anti-retroviral therapy, a targeted screening strategy in which cervical cytology screening was conducted every 6 months for women with detected human papillomavirus DNA, and annually for all others, cost $10,000 to $14,000 per quality-adjusted life year gained compared with no screening. A universal screening strategy consisting of annual cervical cytology for all women was 15% less effective and had a less attractive cost-effectiveness ratio. Targeted screening remained economically attractive in multiple sensitivity analyses, although when the overall incidence of cervical cancer precursor lesions was lowered by 75%, the screening interval for women with detected human papillomavirus DNA could be widened to 1 year. CONCLUSIONS: Adding human papillomavirus testing to the two cervical cytology smears obtained in the year after an HIV diagnosis, and modifying subsequent cytology screening intervals based on the results, appears to be an effective and cost-effective modification to current recommendations for annual cytology screening in HIV-infected women.

AIDS-Related Opportunistic Infections↗
PubMed1999

The cost-effectiveness of voluntary intrapartum rapid human immunodeficiency virus testing for women without adequate prenatal care.

OBJECTIVES: We sought to determine the health and economic consequences of voluntary rapid human immunodeficiency testing during labor for women who have not received adequate prenatal care. STUDY DESIGN: A decision-tree model was used to assess the number of pediatric human immunodeficiency virus cases that would be averted if women who were unable to determine their human immunodeficiency virus serostatus antenatally were offered an intrapartum rapid human immunodeficiency virus test. Medical costs associated with the introduction of this policy were also determined. Probability and cost estimates entered into the model are based on data in the published literature. RESULTS: Under the base-case assumptions, a policy of intrapartum voluntary rapid human immunodeficiency virus testing decreases the number of cases of perinatal human immunodeficiency virus from 407 to 339 per 100,000 women without adequate prenatal care per year, with a corresponding cost savings of $6 million. Sensitivity analysis demonstrates that these cost savings are maintained across a wide range of assumptions and that even conservative scenarios still result in a cost-effective policy. CONCLUSIONS: In the absence of adequate prenatal care, a voluntary rapid human immunodeficiency virus test not only allows patients to fully explore their options with regard to testing and treatment but also has the potential to provide significant health benefits to women and children and economic benefits to the medical system.

Analysis of Variance↗
PubMedDate not supplied

Antidepressant pharmacotherapy: economic outcomes in a health maintenance organization.

Recent pharmacotherapeutic advances in the treatment of depression have included the development of selective serotonin re-uptake inhibitors (SSRIs). The present study was designed to contrast direct health service expenditures for the treatment of depression among patients enrolled in a health maintenance organization (HMO) and prescribed either the SSRI fluoxetine or one of three tricyclic antidepressants (TCAs) (amitriptyline, nortriptyline, or desipramine). Information regarding health service utilization was derived from the computer archive of a network-model HMO system serving 400,000 beneficiaries. A total of 701 HMO beneficiaries were found to satisfy the study selection criteria. Multivariate regression analysis was used to discern the incremental influence of selected demographic, clinical, financial, and provider characteristics on 1 year post-period expenditures (PPE) for health care. Analysis-of-variance procedures with Duncan's multiple-range test, or chi-square analyses, revealed no significant difference across antidepressant pharmacotherapy for age, sex, 6-month prior-period expenditures for physician visits, psychiatric visits, laboratory tests, hospitalizations, or psychiatric hospital services related to the treatment of depression, or number of prescribed therapeutic agents for disease state processes other than depression. Receipt of fluoxetine was associated with a significantly (P < or = 0.05) higher rate of initial prescribing by psychiatrists, an increase in the number of prescriptions for antidepressant pharmacotherapy obtained (30-day supplies), and a reduction in the number of monthly intervals during which time antidepressant pharmacotherapy was not procured. Receipt of fluoxetine as antidepressant pharmacotherapy was associated with a significantly (P < or = 0.05) higher mean medication possession ratio (MPR) relative to amitriptyline, nortriptyline, or desipramine. Multivariate findings for patient-level data reflecting a definitive diagnosis of depression (n = 555) indicate that receipt of a TCA resulted in a significant (P < or = 0.05) increase in the use of physician visits ($36.07), psychiatric visits ($41.38), laboratory tests ($1.71), hospitalizations ($208.77), and psychiatric hospital services ($187.27), and a significant (P < or = 0.05) reduction in expenditures for antidepressant pharmacotherapy (-$162.21), for a total increase in health service utilization of $312.99 (P < or = 0.05) 1 year post-initiation of antidepressant pharmacotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

The cost utility analysis of riluzole for the treatment of amyotrophic lateral sclerosis in the UK.

This study reports the results of a long-term economic evaluation of riluzole in the treatment of amyotrophic lateral sclerosis (ALS) versus best supportive care in the United Kingdom. The aim was to assess the cost implications of the life extension offered by riluzole through cost utility analysis based on patient assessed utilities of different health states.A Markov model was used to assess the cost-effectiveness of Rilutek with best supportive care. Transition possibilities and the distribution of patients by health states were taken from a cohort of 954 patients drawn from a large randomised, double blind, placebo-controlled, multicentre trial between 1992 and 1994 in the first 18 months and used to extrapolate the model to assess the long-term prolongation of life. Four distinct health states were used corresponding to mild, moderate, severe and terminal states. Costs associated with Rilutek included the acquisition cost and bi-monthly monitoring for raised ALT levels. Patient assessed utilities were collected by use of the standard gamble technique. 77 patients were entered into the study from two centres (King's, London and Preston) in the UK. Mean utilities for each of the health states was generated and, given that the data were skewed, a sensitivity analysis was undertaken with the median utility values. The implications of life extension offered by riluzole versus best supportive care were assessed both in terms of life extension projected and quality adjusted survival using patient based utilities. Using the Markov model and the transitional probabilities the base case cost per life year gained was estimated at pound sterlings 14,370 and applying Standard Gamble utility scores, the base case cost per QALY was assessed as pound sterlings 20,904. The effect of discounting costs and benefits altered the cost effectiveness analysis to pound sterlings 17,760 per life year gained while a sensitivity analysis around median or mean scores for the utility weight resulted in a range of pound sterlings 19,020 to pound sterlings 25,794 per QALY gained.

Amyotrophic Lateral Sclerosis↗
PubMed2001

Cost-effectiveness of a trial of labor after previous cesarean.

OBJECTIVE: To determine the cost-effective method of delivery, from society's perspective, in patients who have had a previous cesarean. METHODS: We completed an incremental cost-effectiveness analysis of a trial of labor relative to cesarean using a computerized model for a hypothetical 30-year old parturient. The model incorporated data from peer-reviewed studies, actual hospital costs, and utilities to quantify health-related quality of life. A threshold of $50,000 per quality-adjusted life-years was used to define cost-effective. RESULTS: The model was most sensitive to the probability of successful vaginal delivery. If the probability of successful vaginal birth after cesarean (VBAC) was less than 0.65, elective repeat cesarean was both less costly and more effective than a trial of labor. Between 0.65 and 0.74, elective repeat cesarean was cost-effective (the cost-effectiveness ratio was less than $50,000 per quality-adjusted life-years), because, although it cost more than VBAC, it was offset by improved outcomes. Between 0.74 and 0.76, trial of labor was cost-effective. If the probability of successful vaginal delivery exceeded 0.76, trial of labor became less costly and more effective. Costs associated with a moderately morbid neonatal outcome, as well as the probabilities of infant morbidity occurring, heavily impacted our results. CONCLUSION: The cost-effectiveness of VBAC depends on the likelihood of successful trial of labor. Our modeling suggests that a trial of labor is cost-effective if the probability of successful vaginal delivery is greater than 0.74. Improved algorithms are needed to more precisely estimate the likelihood that a patient with a previous cesarean will have a successful vaginal delivery.

Adult↗
PubMed2003

Economics of reducing menstruation with trimonthly-cycle oral contraceptive therapy: comparison with standard-cycle regimens.

OBJECTIVE: To evaluate whether, and under what circumstances, trimonthly-cycle oral contraceptive pill (OCP) therapy is cost saving over standard-cycle OCP therapy for reducing the severity of menstrual-related symptoms. METHODS: We created three economic models, with each model representing a unique cost perspective (societal, private third party, and patient), to estimate the incremental annual costs associated with women taking trimonthly-cycle rather than standard-cycle OCP. Direct costs considered were costs for OCP prescriptions, female hygiene products, generic over-the-counter pain relievers and iron tablets, home pregnancy tests, and physician visits for menstrual-related concerns. Indirect costs considered were lost wages due to menstruation-related disability and opportunity costs of physician visits. We derived base-case and sensitivity range estimates from prior literature, public use data, expert opinion, and cross-sectional survey data that we collected from 59 adult women taking standard-cycle OCP visiting a large, community-based gynecology office. All costs were adjusted to 2002 US dollars. RESULTS: Under base-case assumptions that both regimens were equivalently priced (1.16 US dollars/pill) and trimonthly OCP reduces hygiene product use by 50%, annual societal costs per person were 460 US dollars for trimonthly OCP and 501 US dollars for standard OCP (incremental cost savings = 41 US dollars). Assuming no difference in monthly drug copayment costs between the two regimens (5.00 US dollars), annual private third-party costs were nearly identical at 365 US dollars per regimen. Annual patient costs were 95 US dollars for trimonthly OCP and 136 US dollars for standard OCP. Trimonthly OCP remained cost saving to society as long its price remained below a 9% premium to standard OCP prices. The degree to which trimonthly OCP reduces hygiene product use also significantly influenced the cost difference between the two regimens. CONCLUSION: Compared with standard-cycle OCP, trimonthly-cycle OCP appears to be associated with significant societal and patient cost savings. These savings are highly conditional upon trimonthly OCP being priced similarly to standard OCP.

Adolescent↗
PubMedDate not supplied

Providing cost-effective therapy using pharmacoeconomic evaluations: the public sector approach.

Four years ago it became obvious within the US Department of Defense (DOD) that expenditures for pharmaceuticals and health care were escalating beyond control. Realizing this upward pressure on costs was one of the major trends jeopardizing the military health care system, which cares for 8 million-plus beneficiaries, the DOD began using pharmacoeconomics to manage pharmacy expenditures. The DOD has several competing goals: to reduce pharmaceutical expenditures within the context of an open formulary while maintaining optimum patient care; provide practitioners, pharmacists, and administrators with the information they need to make cost-effective choices in pharmacotherapy; and provide for a consistent and equitable pharmacy benefit throughout the DOD based on cost-effective recommendations. Currently used methods for pharmacoeconomics did not meet the DOD's needs, so it turned to applied pharmacoeconomics. This paper discusses the use of applied pharmacoeconomics as it pertains to the DOD.

Cost Control↗
PubMed2001

The cost-effectiveness of photodynamic therapy for fellow eyes with subfoveal choroidal neovascularization secondary to age-related macular degeneration.

PURPOSE: Photodynamic therapy (PDT) has recently been demonstrated to be beneficial for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD). Herein, we determine the cost-effectiveness of PDT for the treatment of subfoveal choroidal neovascularization (CNV) in patients with disciform degeneration in one eye and whose second and better-seeing eye develops visual loss secondary to predominantly classic subfoveal CNV. The analysis was performed from the perspective of a for-profit third-party insurer. DESIGN: Cost-utility Markov models were created to determine the cost-effectiveness of PDT under two different scenarios, by using efficacy data derived from the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study and patient-based utilities. METHODS: Decision analyses were performed by incorporating data from the TAP Study, expected longevity data, and patient-based utilities. Cost-effective models were then created by incorporating incremental medical costs. Various sensitivity analyses were carried out to determine the robustness of our models. A Monte Carlo simulation was also used to determine whether there was a significant difference in quality-of-life adjusted years (QALYs) gained between PDT therapy and the placebo. RESULTS: For the hypothetical patient whose second and better-seeing eye becomes affected and who has 20/40 vision at baseline in this affected eye (base case 1), PDT was associated with a 10.7% relative increase in their quality-of-life (treatment conferred an additional undiscounted 0.1342 QALYs over a 2-year period). For the hypothetical patient whose second and better-seeing eye becomes affected and who has 20/200 vision at baseline in this affected eye (base case 2), PDT was associated with a 7.8% relative increase in their quality-of-life (treatment conferred an additional undiscounted 0.0669 QALYs over a 2-year period). Sensitivity analysis showed our models were robust and that PDT was usually the dominant treatment choice. Our cost-effective model demonstrated that the cost for a QALY was $86,721 (US dollars discounted at 3%) for base case 1, assuming 5.5 treatments; and $173,984 (USD discounted at 3%) for base case 2. CONCLUSIONS: PDT will cost a third-party insurer $86,721 for an AMD patient with 20/40 vision in the better-seeing eye to obtain one QALY and $173,984 for an AMD patient with 20/200 vision in the better-seeing eye to obtain one QALY. PDT can be considered to be a treatment that is of only minimal cost-effectiveness for AMD patients who have subfoveal CNV in their second and better-seeing eyes and who have good presenting visual acuity at baseline. It is a cost-ineffective treatment for AMD patients who have poor visual acuities in their affected better-seeing eyes.

Aged↗
PubMed1999

A model to estimate the financial consequences of classical swine fever outbreaks: principles and outcomes.

A model is presented aimed at a financial analysis of a Classical Swine Fever outbreak. Financial consequences are calculated for affected parties, including governments (EU and national), farms, and related industries in the production chain. The model can be used to calculate the losses of a real outbreak as well as of a simulated one. In this article, the model is applied to the 1997/1998 outbreak of Classical Swine Fever in the Netherlands. Results show that total financial consequences of the outbreak are US $2.3 billion. Consequential losses for farmers and related industries are US $423 million and US $596 million respectively. Budgetary consequences for governments include less than 50% of the total losses calculated by the model. The model can be adapted easily to suit other diseases and countries.

Animal Husbandry↗